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Patient: 16 year old Female

MOI: SCI after falling off a four-wheeler at her parent's ranch 3 weeks ago

Pt Height and Weight: 5'6 and 110 lbs

Hobbies: drawing, sketching, and working at ranch

Environmental Factors: Pt lives with parents and 1 sibling in a 2 story house with a bed and bath on second floor and no steps to enter the home. Both parents live and work at ranch daily.

Neurological & Motor Levels:

Right Sensory- C4

Left Sensory- C4

Right Motor- C6

Left Motor- C6

NLI- C4

ASIA- A Complete Injury

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Rigid High backrest with mild contour and full trunk support (solid backrest with adjustable straps) 

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Rigid High backrest with mild contour and full trunk support (solid backrest with adjustable straps) 

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Height: 17-18 inches

Shape: Mildly contoured with lateral trunk supports

Material: Lightweight carbon fiber shell with lateral trunk supports

Seat-to-back angle: 100 degrees

Rationale: A rigid adjustable tension backrest provides the firm postural support that our patient needs given the absence of trunk control. Our patients' NLI is C4, and therefore the patient still has neck control, but requires assistance at the trunk. The patient has no motor or sensory function below the C8 level, which is why this patient would benefit from lateral trunk support.

The solid structure of the carbon fiber shell provides a way to keep the pelvic alignment in neutral, as well as keeping the patient from sliding forward in the seat. The height of the backrest offers sufficient thoracic support to compensate for the absence of trunk musculature, and the addition of lateral supports helps keep the patient in midline and prevents lateral leaning/shifts during mobility tasks. The lightweight material maximizes comfort, and makes it easier to use for a younger patient, especially giving that the patient helps her father tend to their ranch.

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Pneumatic Tires (air filled tires): Filled with air providing cushioning and shock absorption

Pros:

-Most comfortable ride with shock absorption

-Best for uneven or outdoor terrain

-Provides good traction

Cons:

-Require regular maintenance (checking air pressure)

-Heavier

-May go flat

-The pneumatic tires allow the patient to travel across the ranch over various types of terrain while providing efficient propulsion to support her ranch activities.

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Hybrid Wheelchair Cushion - Gel, Air, and Foam 

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Hybrid Wheelchair Cushion - Gel, Air, and Foam 

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Our patient has an ASIA A SCI and a neurological level of injury at C4, with no motor or sensory function below C8, an appropriate wheelchair cushion would be a hybrid cushion that combines gel, foam, and air. This type of cushion will provide the patient with both pressure redistribution and postural stability. Since the patient lacks postural control due to their high cervical SCI, the additional stability is essential to maintain upright posture and reduce shear forces.

A high cervical spinal injury, with decreased postural instability and prolonged sitting time puts the patient at a high risk for pressure injuries. In order to redistribute the pressure the foam and gel component offer pressure relief properties.

Another method to decrease the risk of pressure injuries is to educate the patient and family members on preforming a weight shifting technique that involves throwing either the left or right arm backward and over the wheelchair handle. Once the arm is positioned over the handle, the patient will then preform a bicep curl and lifting the opposite leg. During this motion, the patient will also utilize the head to hips relationship to generate momentum for both the arm swing and lifting of the opposite hip.

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Ultra-Lightweight: Despite its weight, it still has a robust build and retains the essential characteristics of an ultra-lightweight chair: efficiency, responsiveness, and customizable configuration. These are critical for an active teenager to maintain an independent and healthy lifestyle. This design gives her the durability for the farm and the performance for everything else.

Having this ultra-lightweight allows for easy handling in most cases as she lives in a 2 story home, but allows her to enjoy her hobbies working on the ranch by reducing risk of shoulder injury and maximize power efficiency.

Features:

-Reinforced dual-tube frame that increases stability and supports a higher weight capacity of up to 140 kg (309 lbs)

-Enhanced transportability due to the weight being <30lbs.

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A rigid frame is a superior option than others due to the pt's demanding lifestyle working at the ranch.

Efficiency: Transfers more energy from each propulsion forward instead of dispersing throughout loose parts for a non-rigid frame, making it less tiring to use over long distances on the ranch.

Durability: With fewer moving parts, it is less likely to break, resist wear-and-tear, and does not fold to unpredictable terrain.

Responsiveness: It provides more direct contact sensation with the ground, offering better control and stability which will increase safety on unpredictable terrain.

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Reasoning: Since the patient is a 16-year-old with a complete spinal cord injury (ASIA A) who lives on a farm, our team recommended the use of wheelchair traction gloves. These gloves will assist with more efficient wheelchair propulsion, particularly on outdoor or uneven terrain commonly found on a farm. In addition, they will help reduce friction related skin breakdown and callus formation, promoting long term preservation of hand integrity and function. By improving propulsion efficiency and comfort, the gloves support greater independence and participation in both farm and community activities.

Pros: Gloves ranges from $25-$30, making them a cost effective tool for the patient to utilize. They provide efficient grip strength and propulsion efficiency during community mobility. They offer a protective barrier against callus formation and over use injuries.

Cons: Given the patients environment, these gloves may become worn down faster than expected. The typical duration of the gloves last around 6-12 month. Regular replacement of these gloves could become a financial burden over time, particularly with higher levels of activity.

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Rationale: Given the patients environment, push knobs could be a huge benefit in regards to improving propulsion efficiency. These knobs could help conserve energy and help the patient get through uneven and rough terrain. These knobs can be found on amazon and range from $8-$10. Usually these knobs come in a pack of 2-3.

Cons: While push knobs can enhance propulsion efficiency and reduce energy expenditure, they may also decrease the muscular effort required for self propulsion. Over time, this could lead to reduced upper extremity strength and endurance if not balanced with a regular exercise program.