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1. Spinal cord injury Presented by` Diksha Tambe Aditi Tate Umang Khillare Mansi Shelar

2. DEMOGHRAPHICS NAME- WAMAN WAGHMARE AGE- 37 YR SEX- MALE OCCUPATION- LABOURER ADDRESS- KHOPOLI DATE OF ADMISSION- 23 rd march 2024

3. c/c - unable to do transfers since 1 month HOPI - pt. was apparently alright 1 month back until he met with an accident on 23 rd march 2024, when he was travelling to khopoli on his bike suddenly his bike slipped and he fell down from highway , after approx. 2.5 hrs he gained consciousness and himself called his family , at that moment he realised that he was not able to feel his legs, also had back and face injury. Later at 9pm his family reached at the spot of accident and took him by an auto to local hospital; stiches where made they send him to MGMhospital for further procedures. At 12 am he arrived in mgm hospital was taken to emergency ward for investigations and 3 am he was admitted to ICU, he was there in ICU for 7 days. On 28 th march he undergone spinal fusional surgery at D10 to L2 ; after 2 days he was shifted to male surgical ward and physiothersphy was started

4. OBSERVATION- pt is concious & well oriented to time place and person Pt position – side lying on left side peripheral IV line on the flexor aspect of left forearm Winging of scapula b/l Suture line [scar] –extended from T7 to L1 Pressure sore – over the sacral region grade 3 Over chest lateral to the left nipple in the 5 th ICS in line with the midaxillary line grade 1. Urine catheter present[ foleys]

5. Palpation Warmth and tenderness absent Scar length – 21cm

6. Assessment [positive findings] Impaired sensations- below T4level MMT- upper limb grade 3 lower limb grade 0 Tone – 0 flaccid in lower limbs B/L Reflexes [superficial ,deep] – 0 absent On auscultation – reduced air entry in lower and middle zones anteriorly , laterally and posteriorly.

7. ICF HEALTH STATUS- BODY STRUCTURES- Structural impairments Skin and related stuctures - bed sores Structure of the nervous system- spinal cord and related structures

8. Body functions Functional impairments Sensory function – impaired sensation below T4 Reduced muscle strength – upper limb 3 lower limb - 0 Tone 0 in lower limb Reflexes grade 0 of knee jerk achilles reflex Reduced air entry in lower and middle zones ant,lat and post. Reduced chest expansion in all zones

9. ACTIVITY & PARTICIPATION Activity limitation & Participation restriction source of information capacity performance Selfcare Washing one self Patient history Patient faces severe difficulty in washing himself Patient faces mild difficulty as he gets assistance from nursing staff and family members toileting Patient history Patient faces severe difficulty while toileting Patient faces moderate difficulty while toileting as he gets assistance from nursing staff . Mobility Changing & maintaining body positions Patient history Patient faces severe difficulty in changing maintaining body positions Patient faces moderate difficulty as he gets assistance from family members .

10. Contextual factors Environmental factors Source of information Facilitator / barrier description qualifier Product and technology Patient reported questionnaire facilitator Physiotherapy treatment and medications aids in the recovery process +3 Support and relationships Patient reported questionnaire facilitator Supportive and caring nature of the family members +3 attitude Patient reported questionnaire facilitator Cooperative family members +3 Services , systems, And policies Patient reported questionnaire facilitator Is aware and availing se +2

11. Personal factors Source of information Facilitator/ barrier description Q Co morbidity Patient history F No known co morbidity to hinder the recovery process +3 attitude observation F Positive and cooperative +3

12. management problem list unable to move both lower limbs formation of grade 3 pressure sores at the sacral region difficulty in transfers air entry reduced in the lower and middle zones ant lat and post reduced chest expansion in all zones

13. short term goals patient education 1.sensitizing the patient about the condition the recovery process and the role of physiotherapy. 2. giving factual information about the patients capacity and limitations to the family members 3. teaching the caregivers the home program exercises 4. educating about proper hygine methods about the pressure sores like not lying in the same position for longer hours , changing the dressing time to time, changing the bedsheets time to time educating about the use of proper matteress [foam/water/air] 5. foleys catheter care like keeping the catheter hanging on the railing of bed while sleeping, checking the quantity quality and colour of the fluid in the drain

14. 7. teaching the patient and also the caregiver about the in bed transfers and proper sidelying position for the patien lower limb: hips and knee flexed for stability with 2 pillows in between ankles dorsiflexed toes extended upper limb: lower arm flexed and lying through between the pillows suporting the head and the thorax elbow extended supinated and supported on pillows upper arm rested over the pillow on the thorax 8. educating the pt. about the correct use of reciprocating gait orthosis n informing him to wear them while ambulating

15. avoid secondary complications DVT, PULMONARY EMBOLISM - ATMs passive -heel slides passive to improve air entry in the lower n middle zones -segmental breathing lateral costal and posterior basal breathing exercises - incentive spitometer to improve chest expansion diaphragmatic and thoracic exapnsion exercises to prevent contractures - manual stretching of hamstrings, TA piriformis also of ul to maintain joint mobility and integrity arom exs of ul and prom exs of ll

16. to improve tone -tilt table - orientation to upright position start wit propping the bed at 30 if patient feels dizzy do atms to improve circulation and venous return increasing the degree wuth each day - heavy joint compression-at hip knee ankle -tapping -fast brusing to increase strength -ul exercises acc. ACSM guidlines F=2-3 days/week I=40% of 10 RM T=2-4 sets for 8-12 reps T= weights using Delormes regimen progression can be made 50%-10RM........75%-10RM........100%-10RM

17. to improve transfers -rolling -segmental- supine on elbow -supine to sit to improve sitting balance -pertubations - reach outs insitting guarded LONG TERM GOALS - progression and maintainece of the short term goals - transfer from bed to wheelchair 1. preparatory phase- trunk flexed forward and laterally away from the surface rtransfering to. 2. left phase- buttocks are lifted off the seating surface as trunk rotates 3. decent phase- when buttocks are on another surface

18. - sit to stand performed on parallel bars jack knifing reaction to initiate gait training -with the parallel bars support and guarded by the therapist -with assistive devices like cane walker crutches and orthosis