-Improve jaw and chewing strength so patient can eat safely

-Provide activities that strengthens vision, smell, hearing, memory, and communication to keep those sensory nerves strong

-Ventilation necessary as diaphragm will not function properly

-Full dependent in all ADL's, bed mobility, and transfers

-30 degrees of active cervical motion

-Ability to direct care verbally

-Educate on transfers

-Educate on pressure relief

-Cervical posture and ROM exercises

-Cranial nerve testing if applicable

-Effective communication strategies

-Breathing exercises

-Ability to perform pressure relief in wheelchair with power recline feature

-Use of environmental control units with set up

-Maximal assistance with bed mobility

-Independent pressure relief with power reclining wheelchair

-Flex and abduct shoulder to 90 degrees

-Flex elbows

-Adduct scapulae

-Raise arms to assist with rolling and bring hand to mouth]

-Driving is possible with a van and adaptive hand controls

Positioning would include:

-Supine to long sit education

-Using their elbows and hands to push up into a sitting position

Transfer training:

-sliding board transfer

-educated on using their shoulders and triceps to push up from their chair and onto the board

Ensure good posture during mobility and transfers

Positioning would include:

-Proper wheelchair posture

-Supine to-side lying transitions

-Educated on using their arms to push up their body weight and rotate to side-lying.

Mobility would include:

-Rolling to sitting-up drills

-Push-up transfers from their chair

-Slide board transfers

2. curb negotiation training

3. wheelchair fall safety training

• Hips/pelvis

• Trunk or chest

• Head

• Arms

Mobility interventions:

• PROM of LEs to prevent contractures

• Putty claw exercise (squeeze putty and then move hand into a claw position)

• Slide board transfers

• Pressure relief in wheelchair

• C-walking to go from supine to long sitting

-Pressure wounds would most likely be at the ischial tuberosity or scapulae area as that is where the patient will put the most pressure while in chair throughout the day

Pressure wound prevention:

-changing positions every 2 hours

-pressure relief ever 15-30 minutes for 60-90 seconds

-pressure cushion

-ensure skin is clean and dry after using the restroom or shower

-avoid harsh products that can compromise skin integrity

Pressure wound prevention:

-changing positions every 2 hours

-pressure relief ever 15-30 minutes for 60-90 seconds

-pressure cushion

-ensure skin is clean and dry after using the restroom or shower

-avoid harsh products that can compromise skin integrity

Treatment of skin injuries:

• good hygiene

• moisturizing lotion (completely rubbed into the skin and avoid elbows)

• leave areas open to air when possible

Skin checks:

• check morning and night; unless there is a known area that's injured, then you should check hourly

• check more often if sitting for longer periods of time

• use a mirror to do your own checks or have someone else check for you

• check skin immediately after a fall or other injury

• check areas with little-no sensation

-For feeding, everything must be set up and be close to patient as the patient can not extend their arms

-Educate about how to perform transfers

-Educate about pressure wounds

-Pressure sores and how serious they are

-How to prevent pressure sores and how vital pressure relief and position changes are

-Signs/symptoms of a pressure wound and infection

-Educate on the importance of staying active and following the HEP provided

-Signs/symptoms of a DVT

-Signs/symptoms of autonomic dysreflexia

-Proper transfer techniques

-Pressure sores and how serious they are

-How to prevent pressure sores and how vital pressure relief and position changes are

-Signs/symptoms of a pressure wound and infection

-Educate on the importance of staying active and following the HEP provided

-Signs/symptoms of a DVT

-Signs/symptoms of autonomic dysreflexia

-Proper transfer techniques

2. make sure the caregiver knows where to look for pressure injuries

3. make sure everyone is aware of autonomic dysreflexia and what to do in case that happens

• Signs and symptoms of emergency situations (DVT, autonomic dysreflexia)

• Signs and symptoms of pressure sores or ulcers

• Importance of movement and following HEP

• How they can help the patient with the HEP and other functional tasks

• Educate the family about the SCI and possible changes in their way of living

• Pressure relief and repositioning

-Bicep curls

-Grip strength

-Activities that strengthen cranial nerves

-Push / pull strengthening

Manual Therapy: PROM of upper and lower extremities and STM to neck

Interventions: wrist curls with lightweight, wrist rotations, bicep curls, modified triceps extensions, resisted external rotation of shoulders

Manual Therapy: PROM of UE and LE, STM to neck and upper back, PROM of the trunk

Interventions: triceps pushups in the wheelchair, scapular squeezes, shoulder retractions with resistance bands, bicep curls, wrist curls, overhead triceps pulls

2. picking up marches for precision grip training

• getting dressed (especially the LEs)

• preparing meals

• performing cares after using the restroom

• hygiene (showers/baths)

• transfers

2. car steering wheel adaptations for driving

-Wrist driven flexor hinge orthosis

-Intentional tenodesis grasp

-Transfer training of sliding board for independence in the restroom

-Fine tune motor function

-Feeding

-Brushing hair / teeth

-Power wheelchairs are preferred for energy conservation

-Adaptive equipment like splints or orthosis to help perform ADL's

-Minimal assistance with sliding board transfers

-Grab bars for further mobility and independence

-Sliding boards

-Wrist splints

-Adaptive clothing for independent dressing

-Vehicle modifications

-Vehicle adaptions

-Adaptive Clothing

-Wrist support to propel the wheelchair

2. Introduction to spinal cord injury. Introduction to Spinal Cord Injury | Types and Levels of SCI. Accessed February 9, 2025. https://www.myshepherdconnection.org/sci/introduction.

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• redness

• swelling

• bruises

• cuts

• burns

• scabs

• rashes

• blisters

• shiny or discolored spots

It is important to reposition every 2 hours and weight shift every 30 minutes for at least 60 seconds