Client Dx/ Pertinent Hx: Bob Joe

20-year-old male s/p posterior fusion and internal fixation of C5-C7. Diagnosed complete C7 tetraplegia
after diving headfirst into a shallow lake. Dive caused an initial fracture-dislocation of C6 on C7. Bone graft
for surgical procedure was taken from pt.’s iliac crests. Pt. presents with decreased bilateral shoulder flexion
and abduction ROM, and limited passive SLR ROM. Flaccidity present in bilateral LE. Absent hand
function. Decreased strength in bilateral UE. Absent sensation at C8 and below. Pt. presents w/ a hard
cervical collar and urinary catheter. Pt. appears alert and oriented; pt. is able to follow multistep commands.

Problems (functional issues and prioritize....at least 4 issues):

 Pt.’s cough is weak and non-functional.
 Pt. is unable to roll over in bed independently w/o maximal assist.
 Pt. has impaired bilateral UE ROM.
 Pt. has impaired bilateral UE strength.

Treatment Considerations (medical condition/family/ environment etc.):

 Pt. will need to be educated on weight shifting to prevent pressure sores/injuries.
 Pt. will need to improve bed mobility and sitting balance in order to gain all possible independence.
 Treatment team will need to address home environment and caregiver status with pt.’s family.
 Pt. and his family may need treatment from psychology/mental health service.
 Pt. may be at risk for autonomic dysreflexia – pt. and family education are needed.
 Pt. will need respiratory management/clearance of secretions due to non-functional cough – pt. will
need to be taught how to use a spirometer and how to utilize deep breathing techniques.
 Surgery precautions currently restrict pt. to 90 degrees shoulder flexion and abduction.

Potential Team Members (list at least 4):

 Surgeon/physician
 Nurse(s)
 Occupational Therapy
 Psychology
 Respiratory Therapy

Equipment Considerations:
 Manual wheelchair
 Slide board (transfers)
 Mat table
 OT adaptive equipment
 Spirometer

Three Long-Term Goals listed (functional/ objective/ SMART):

 Pt. will be independent with bed mobility and transfers.
 Pt. will be independent with feeding, grooming, and dressing w/ adaptive equipment.
 Pt. will be independent with manual wheelchair mobility.
 Pt. will be able to drive independently w/ an adapted automobile.

Home Exercise Program relating to short term goals with 5 home exercises. Use Medbridge
and upload code/exercises

Access Code: 3AW6KNQV

URL: https://www.medbridgego.com/
Date: 06/22/2022
Prepared by: Talisha Dawes

Exercises

 Supine Bilateral Punches - 1-2 x daily - 3 sets - 10 reps

 Supine Bicep Curl w/ Resistance Band - 1-2 x daily - 3 sets - 10 reps
 Supine Elbow Extension Stretch in Supination - 1 x daily - 7 x weekly - 3 sets - 10 reps
 Wrist Extension Self Stretch - 2 x daily - 3 sets - 10 reps
 Supine Chin Tuck - 1 x daily - 3 sets - 10 reps - 3 second hold

Patient Education

 Pressure Relief in a Manual Wheelchair

Short Term Goal #1:

Pt. will be able to roll independently or with minimal assist from supine to side-lying.
(Due to surgery precautions, pt. is not yet able to increase shoulder flexion or abduction above 90 degrees.
Do not progress pt. to “supine to prone rolling” until cleared for increased shoulder flexion.)

Treatment techniques for STG #1 (minimum of 3):

Once cleared by physician/surgeon, pt. will be assisted through rolling techniques in order to improve bed
mobility and future independence. Do not exceed 90 degrees shoulder flexion until cleared.
 Supine “Punch-Outs” (supine bilateral shoulder protraction exercise): 3x10, 1-2x daily
 Momentum supine rocking side to side: 2-minute increments, 1-2x daily
 Assisted roll from supine to side-lying w/ top leg crossed over bottom – pt. educated on chin
tuck/head movement and punch through motion during roll.

Short Term Goal #2:

Pt. will be able to perform an independent supine pull up onto elbows.

Treatment techniques for STG #2 (minimum of 3):

In order to be able to independently transition from supine to long-sit, the pt. must be able to perform an
independent pull up to supine on elbows.
 Mini pull ups (supine w/ arms under rear, have pt. perform mini bicep pull ups): 3x10, 1-2x daily
 Supine bicep curl w/ resistance band (pt. supine, hold end of resistance band down by pt.’s feet &
have pt. perform unilateral bicep curls): 3x10, 1-2x daily, repeat on other side.
 Assisted supine pull up to elbows – pt. is educated on utilizing the head/chin tuck to assist motion.

Short Term Goal #3:

Pt. will be able to independently manage sitting balance.

Treatment techniques for STG #3 (minimum of 3):

In order to be able to independently transfer, the pt. needs to first be able to navigate sitting balance.
 Practice stacked balance (position pt. shoulders over hips and adjust them until they can feel what
stacked balance feels like)
  Anterior tripod to posterior tripod exercise (have pt. practice transitioning between anterior and
posterior tripod)
 Hands on knees weight shifting in sitting (have pt. practice weight shifting on their hands so that they
can confidently balance with both hands on their knees).

Treatment Progression of one of your STG's and treatments listed above:

STG #1 progression:
 Once pt. is able to roll from supine to side-lying independently, we can begin to teach him how to
push up onto his elbow and move himself into short sitting.
 Once in short sitting, have pt. perform press ups to strengthen scapular muscles in preparation for
independent wheelchair mobility. (3x10, 1x daily).