INITIAL EVALUATION

General information
Pt.'s name: J.W
Age: 20 yrs. old
Sex: M
Address: Gatchalian, Las Pinas
Civil status: Single
Handedness: R
Occupation: College Student
Religion: Roman Catholic
Nationality: Filipino
Date of consultation: September 20, 2021
Referring M.D: Dr. Sam
Referring unit: Emergency Room
Date of referral: September 22, 2021
Rehab MD: Dr. Pangilinan
Date of IE: October 2, 2021
Informant/Reliability: Pt./Good
Type of Pt.: out-pt.
Dx: Paraplegia 2° complete SCI ASIA A (NL: T11, SL: T11, ML: T11) 2° grade 3 T12 traumatic
spondylolisthesis

S:>

c/c: Pt. complains of poor posture, balance, the need of maximum 2+ assist. in some aspects of
ADLs such as ambulation, bed mobility, transfers, bathing, dressing, and toileting.

Pt.’s goal: To achieve the functional level of independence and ambulate with or without
assistance. improve ROM and balance, strengthen B UE be able to perform transfers and daily
activities, as well as wheelchair training.

HPI
A 20 years old college student and his friends were involved in a high impact injury, a car
accident. September 20, 2021, the patient was in a passenger seat and was not aware that his
seatbelt was not properly worn and left his seatbelt off. The incident happened, when his friend
Ana (driver) approached an intersection with a green light, so she continued driving at the speed
limit without any need to slow down. However, a driver from the left failed to notice the red light
and collided with her car on the driver's side. The collision propelled the car onto the right
median, leading it to overturn and end up in an upside-down position. Ana was buckled in and is
not badly hurt, but the pt. was unconscious. Ambulance came and he was brought to the
hospital immediately. He was immediately treated, and given an x-ray, MRI, CT scan ordered by
 Dr. Sam ; a "Scotty dog decapitated" sign was seen on T12 and "Scotty dog with collar" sign on
L1. And no brain haemorrhage and cervical herniated disc was found.

September 21, 2021, the pt. woke up, and could not move his legs, he also notes that he can’t
feel his legs. The pt. has a complaint of intermittent dull aching pain on his low back c̅ 8/10 PS.
Pt. can move both his upper arms. The pt. was able to breathe on his own and could not control
his bowels or bladder. Dr. Sam performed Bulbocavernosus Reflex to test if there was spinal
shock d/t the accident and the test resulted negative. Pt was diagnosed with paraplegia 2°
complete SCI ASIA A (NL: T11, SL: T11, ML: T11) 2° grade 3 T12 traumatic spondylolisthesis;
and underwent a spinal fusion surgery. Pt. also uses a condom catheter for urinary
incontinence.

September 24, 2021, pt. was referred to Dr. Pangilinan for further A:. & eval., & finally r eferred
to PT for execution of rehab P: & mx. In the post-operative ward constant monitoring of the
patient for 72 hours was done to counter unwanted complications such as AD, DVT, edema,
and pneumonia and proceeded to early mobilization, and PT for rehab P & progression mx.
once cleared.

Ancillary Procedure:

Date Procedure Findings

September 20, 2021 Oblique view & Lateral view of (+) "Scotty dog with collar" sign
the Spine X-Ray on T12
(+) "Scotty dog decapitated" sign
on T1

September 20, 2021 CT Scan (-) skull & facial fractures

(-) other bone fractures

head and neck head and neck MRI (-) brain hemorrhage
(-) cervical herniated disc

Meds.:

Present Route Dosage Indication

Naproxen Oral 275 mg q 6 to 8 hours prn ↓ pain

Past Route Dosage Indication

Acetaminophen Oral 50 mg p.o 3x/d ↓ pain

Epidural Anaesthesia Inhalation 300 mg anesthetic

(Lidocaine)

PMHx:
(-) Previous hospitalisation
(-) Htn
(-) DM
(-) Cardiac problems
(-) CA
(-) Previous trauma
(-) Neurological ds
(-) Pulmonary problems
(-) Obesity
(-) Drugs

FMHx:
Maternal Paternal

Htn (+) (-)

CVA (-) (-)

Cardiac Dse (-) (-)

Pulmonary Dse (-) (-)

CA (-) (-)

Arthritis (-) (-)

DM (-) (-)

PSEHx:
● Type B personality
● Only child
● Caffeine beverage drinker (3 cups of coffee/day)
● Non-alcoholic beverage drinker
● Non-cigarette smoker
● Lives with parent
● Loves to travel
● Loves reading and playing table tennis (3x/week)
● Loves to eat fruits such as apple, mango and strawberries
● Lives in a bungalow house
● Has a solo room and 10 steps from the main door
● Distance of bedroom ↔ bathroom ~ 10 steps, bedroom ↔ kitchen ~ 10 steps, bedroom ↔
living room ~ 10 steps, bedroom ↔ entrance door ~ 15 steps, living room ↔ gate ~ 20 steps. No
stair steps on the front

O:>
VS

a p

BP 110/70 mmHg 120/80 mmHg

RR 16 cpm 18 cpm

PR 80 bpm 80 bpm

Temp Afebrile to touch Afebrile to touch

OI
● In wheelchair
● A/C/C
● Ectomorph
● (+) Diaper
● (+) Urinary Catheters
● (+) Bowel Catheters
● (+) orthotic device - taylor brace
● (+) atrophy on B LE
● (-) swelling on B UE and LE
● (-) erythema on B UE and LE
● (-) ecchymosis on B UE and LE
● (-) deformities on B UE and LE
● (-) wounds on B UE and LE
● (-) skin trophic on all exposed areas
● (-) skin discoloration on all exposed areas
PALPATION
● Normothermic on B UE and LE
● Normotonic on B UE, Hypertonic on B LE
● (+) LOM on B LE -> all planes
● (+) Grade 3 spasticity on B LE
● (+) Muscle spasm
● (+) Muscle weakness on B LE
● (-) Muscle guarding
● (-) Tenderness on B UE and LE
● (-) Edema on B UE and LE
● (-) Nodules on B UE and LE
● (-) Taut bands on B UE and LE
● (-) Crepitus on B UE and LE

ROM All major joints of B UE and neck are WNL actively and passively done c N end feel
except for the ff

Action N Value Activ Passive AD PD End Feel

e

Thoracolumbar Flexion 0-80 35 40 45 40 Late muscle spasm

Thoracolumbar 0-25 10 15 15 10 Late muscle spasm

Extension

Thoracolumbar Lateral 0-35 20 25 15 10 Late muscle spasm

Flexion

B Hip Flexion 0-120 0 0-90 0 30 Spastic

B Hip Extension 0-30 0 0-20 0 10 Spastic

B Hip Abduction 0-45 0 0-25 0 20 Spastic

B Hip Adduction 0-30 0 0-20 0 10 Spastic

B Hip IR 0-45 0 0-25 0 20 Spastic

B Hip ER 0-45 0 0-25 0 20 Spastic

B Knee Flexion 0-135 0 10-95 0 10-40 Spastic

B Ankle DF 0-20 0 0-10 0 10 Spastic

B Ankle PF 0-50 0 0-30 0 20 Spastic

 B Ankle Inversion 0-35 0 0-20 0 15 Spastic

B Ankle Eversion 0-15 0 0-10 0 5 Spastic

Sig. (+) LOM on B LE AROM -> all planes d/t paralysis 2 UMNL and B LE PROM d/t spasticity 2
UMNL, thoracolumbar -> all planes d/t pain and instability 2 spondylolisthesis

MMT All major muscles of B UE and neck are grossly assessed graded 5/5 except for the ff

Action Grade

B Hip Flexors 0/5

B Hip Extensors 0/5

B Hip Abductors 0/5

B Hip Adductors 0/5

B Hip IR 0/5

B Hip ER 0/5

B Knee Flexors 0/5

B Ankle DF 0/5

B Ankle PF 0/5

B Ankle Invertors 0/5

B Ankle Evertors 0/5

Sig. (+) paralysis on B LE d/t UMNL

Neuro Evaluation
DTR
Sig. (+) Hyperreflexia on B LE d/t UMNL

Sensory A
0% intact superficial sensation on B LE as to pain, light touch, and deep pressure sensation
0% intact deep sensation on B LE as to proprioception and kinesthesia
STDs used: pin, brush for light touch, and thumb for deep pressure
Sig.: Impaired superficial and deep sensation on B LE (See ASIA scale)

CN Testing:

CN Procedure Response Significance

CN 1: Olfactory Test each side by closing off Pt. was able to Intact CN I
Nerve the other nostril. The sense detect and determine
of smell is tested by using the smell
common, non-irritating
odours (coffee) and asking
the pt. to identify the odour.
CN II: Optic Nerve Using a snellen chart, the Pt. was able to see Intact CN II
visual acuity is tested with and read the letters
the pt. 20 ft. away from the on the chart
chart. Each eye is tested
separately while covering the
other eye.
CN III: Oculomotor Testing pupillary reactions Pt. present with Ⓝ Intact CN III
(constrictions) by shining a pupillary reactions
light on each eye
CN IV: Trochlear Observe the position of the Pt. was able to follow Intact CN IV
eye and ask the pt. to follow the PT’s finger
the PT’s finger towards
adduction (inward) and
downward movement of the
eye. Each eye is tested.
 CN V: Trigeminal Sensory: test light sensation Sensory: sensation Intact CN V
Nerve with cotton ball over forehead are intact and equal
(ophthalmic), cheeks bilaterally
(maxillary), chin
(mandibular). Motor: Jaw strength
equal bilaterally
Motor: palpate temporal &
masseter muscles as patient
clenches teeth. PT try to
separate jaw by pushing
down on chin
CN VI: Abducens The PT observes the position Pt. was able to follow Intact CN VI
Nerve of the eye and asks the pt. to the PT’s finger
follow the PT’s finger towards
abduction (outward) Each
eye is tested.
CN VII: Facial Nerve Test muscles of facial Pt. was able to Intact CN VII
expressions by showing perform facial
teeth, smiling, closing eyes expressions
tightly, and raising eyebrows
CN VIII: Test for lateralization: by Pt. was able to hear Intact CN VIII
Vestibulocochlear placing vibrating tuning fork sound equally on Ⓑ
Nerve on top of head, mid-position; ears
check if one sound heard in
one ear, or equally in both
CN IX: PT lightly stimulates the back Pt. presents gag Intact CN IX
Glossopharyngeal of the throat using cotton reflex
Nerve swab on each sides
CN X: Vagus Nerve Ask the pt. say “ah”, observe Pt.’s soft palate Intact CN X
motion of soft palate and remained elevated
position of uvula and uvula remained
in midline
CN XI: Spinal Ask the pt. to shrug Ⓑ Pt. was able to shrug Intact CN XI
Accessory Nerve shoulders upward against shoulders
resistance
CN XII: Hypoglossal Ask pt. to protrude tongue, Pt. was able to Intact CN XII
Nerve move side-to-side perform tongue
movements

Mental Status:
 Procedure Response Significance
Judgement Pt. was asked “What would you Pt. was able to answer Ⓝ
do if you found a stamped, with correct judgment
addressed envelope on the based on the situation
sidewalk?”
Orientation The examiner asked the pt. the Pt. was able to provide Ⓝ
following questions: the correct answers
● What is your name?
● Where are you right
now?
● What time is the date
today?
Memory Immediate recall: Pt. was asked Pt. was able to recall Ⓝ
to repeat the following words: immediate, short and
“Lemon, apple, banana” long term memories

Short-term memory: Pt. was

asked the following questions:
● What did you eat for
breakfast?
● What’s the date today?

Long-term memory: Pt. was

asked the following questions:
● When is your birthday?
● What’s the name of your
husband?
Abstract thinking Ask pt. to interpret the proverb Pt. was able to interpret Ⓝ
“Don’t judge a book by its the proverb correctly
cover”.
Attention Ask pt. to repeat a series of Pt. was able to perform Ⓝ
numbers, letters, and words the task correctly
such as the following:
● 6, 12, 18, 24, 30, 36
● A, E, I, O, U
Calculation Ask pt. to solve a few Pt. was able to provide Ⓝ
mathematical equations such as the correct answers
11+4, 15-7, and 7x6.
Sig: Mental Status of the pt. Is considered Ⓝ

Pathologic Reflex:
 Reflex Procedure Response Significance

Babinski Stroking the sole of foot The pt respond c flexion of (+) UMN lesion
Ⓑ big toe

Chaddock Stroking the dorsolateral Pt did not respond c (-) Pyramidal

aspect of the Ⓑ foot from extension of the big toe Tract Lesion
the posterior portion of and the fanning of four
the skin just beneath the small toes.
external malleolus
anteriorly and along the
external edge of the foot.

Oppenheim Stroking the Pt did not respond c (-) Pyramidal

anteromedial surface of extension of big toe and tract lesion
Ⓑ tibia fanning of four small toes.

Gordon’s (LE) Squeezing Ⓑ calf Pt did not respond c (-)Pyramidal

muscles extension of big toe and tract lesion
fanning of four small toes.

Piotrowski’s Percussion of Ⓑ lower Pt did not respond c (-) Organic

limbs dorsiflexion and supination disease of
of foot central nervous
system

Hoffman Flicking of terminal Pt did not respond c flexion (-)Pyramidal

phalanx of Ⓑ index, of distal phalanx of the tract lesion
middle thumb and of distal
phalanx of index or middle
finger

Rossolimo’s Tapping of the plantar Pt did not respond c (-) Pyramidal

surface of Ⓑ toes plantar flexion of toes tract lesion

Schaeffer’s Pinching of achilles Pt did not respond c flexion (-) Organic

tendon in middle third on of foot and toe hemiplegia
Ⓑ foot

Postural Assessment: Pt. was assessed on sitting position both AP and lateral view outside //
bars.
 A/P View Lateral View

Midline Head forward

Levelled Shoulder Rounded

Levelled Scapula Protracted

Levelled Elbow Neutral

Levelled Hand Neutral

Levelled Trunk ↑ Kyphosis

Can’t Assess Pelvis Can’t Assess

Can’t Assess Hips Can’t Assess

Can’t Assess Knees Can’t Assess

Can’t Assess Ankle/Foot Can’t Assess

Sig: (+) Kyphotic Posture d/t upper spine falling off the lower 2° grade 3 spondylolisthesis

Special test:

Special test Procedure Response Indication

RULE IN:

Passive The pt is in a prone The pt complains of (+) Lumbar instability

Lumbar position and relaxed. strong pain in the
Extension Test The PT passively lifts lumbar region,
and extend Ⓑ LE at the very heavy feeling
same time to about 1 in the low back, or it
foot from the bed. While feels like the low
the pt’s LE are in back is “coming off”
extension, the PT gently and the pain
pulls the legs. disappears when
the legs are
lowered to the start
position.
 Babinski Test The pt is in supine The pt did not (+) Upper motor neuron
position and the PT runs extend his Ⓑ big lesion
a pointed object along toe.
the plantar aspect of the
pt’s Ⓑ foot

RULE OUT:

Foraminal The pt. is in sitting Pt did not respond (-) Cervical Nerve root
Compression position and the PT c̅ pain that radiates Compression
Test compress the head in to arm.
neutral position, then c̅
head extended and c̅
headed extended and
rotated to unaffected
side.

Jackson’s Pt. is positioned in a The pt did not (-) Cervical Nerve root
Compression sitting position and the responds c̅ pain Compression
test PT rotates the pt’s head that radiates into
to one side and appies a his arm.
downward pressure on
the head

Tone Assessment:

Modified Ashworth Scale

0 No ↑ in mm tone

1 Slight ↑ in mm tone; manifested by a catch and release; min resistance at the end
of ROM

1+ Slight ↑ in mm tone; manifested by a catch followed by min resistance at the

remainder of ROM

2 More marked ↑ in mm tone through most of ROM but affected part easily moved

3 Considerable ↑ in mm tone; passive movt difficult

4 Rigid in flexion and extension

LE Region
 Muscle/s Ⓛ Ⓡ

Hip Flexors 3 3

Hip Extensors 3 3

Hip Abductors 3 3

Hip adductors 3 3

Knee Flexors 3 3

Knee Extensors 3 3

Ankle Dorsiflexors 3 3

Ankle Plantarflexors 3 3

Ankle evertors 3 3

Ankle invertors 3 3

B/T Assessment:
Balance assessed in sitting position inside // bars c assist.

Normal can assume, maintain, weight shift and be challenged

Good can weight shift, limitations are evident
Fair assume, maintain, can’t weight shift, can’t be challenge
Poor requires support to maintain balance
Zero requires maximal assistance to maintain balance
Sig: pt. demonstrated fair balance

Tolerance
Poor: <15mins
Poor+: 15-30mins
Fair: 30-45mins
Fair+: 45mins-1hr
Good: 1hr
Sig: Pt. demonstrate fair+ tolerance
Functional Independence Measurement (FIM)

Score Definition

7 Complete Independence

6 Modified Independence

5 Supervision

4 Minimal Contact Assistance

3 Moderate Assistance

2 Maximal Assistance

1 Total Assistance

ADMISSION DISCHARGE GOAL

SELF-CARE

Eating 2 7 7
Grooming 3 7 7
Bathing 1 7 7
Dressing - Upper 4 7 7
Dressing - Lower 1 2 7
Toileting 1 6 7
SPHINCTER CONTROL

Bladder 1 6 7
Bowel 1 6 7
TRANSFER

Bed, 1 3 7
Chair,
Wheelchair
Toilet 1 3 7
Tub, Shower 1 5 7
LOCOMOTION

Walk - - 7
 Stairs - - 7
COMMUNICATION

Comprehension 7 7 7
Expression 7 7 7
SOCIAL COGNITION

Social Interaction 7 7 7
Problem Solving 7 7 7

Memory 7 7 7

ASIA SCALE:

Anthropometric Measurement:
Muscle Bulk Measurement (MBM)

Measurement for Atrophy: Using a tape measure

R L Difference
Muscle

14 cm 12 cm 2 cm
15 cm (6 inches) below the apex of the patella

15 cm 13 cm 2 cm
Apex of the patella or joint line

20 cm 19 cm 1 cm
5 cm (2 inches) above the base of the patella

20 cm 22 cm 2 cm
10 cm (4 inches) above the base of the patella

24 cm 20 cm 4 cm
15 cm (6 inches) above the base of the patella

25 cm 28 cm 3 cm
23 cm (9 inches) above the base of the patella
Sig: (+) muscle atrophy on B LE quadriceps and tibialis anterior 2° to disuse atrophy

Sensory Analysis:

0% intact superficial sensation on Ⓑ LE as to pain, light touch and deep pressure

0% intact deep sensation on Ⓑ LE as to proprioception and kinesthesia.
STDs used: pin for pain, brush for light touch and thumb for deep pressure

Sig: Impaired superficial and deep sensation on Ⓑ LE ( see ASIA scale)

Functional Analysis:

Pt. is dependent on some ADLs c̅ max +2 assist in ambulation, bed mobility, transfers. +1
moderate assist in undressing and dressing of lower garments and toileting. Pt. is unable to do
weight bearing activities such as standing and walking on B LE

A:>

PT Impression:
Pt. was diagnosed c̅ Paraplegia 2° complete SCI ASIA A (NL: T11, SL: T11, ML: T11) 2° grade 3
T12 traumatic spondylolisthesis, is cooperative and willing to undergo PT mx. Has a good rehab
potential d/t his optimistic nature & good motivation. PT mx will focus on strengthening of Ⓑ LE,
improving balance, education of proper transfers and prevention of 2° complications such as
DVT, pressure sores & soft tissue contractures.

Prognosis:

GOOD PROGNOSIS BAD PROGNOSIS

● No other comorbidities
● Cooperative ● Fracture
● Willing to undergo PT mx. ● Mental health effect ( anxiety,
● Good motivation depression -> suicide)
● Supportive family ● Complete paralysis on B LE
● Healthy lifestyle ● Long recovery period
● Active person
● Compliance
● Age
● No past medical hx.

Problem list:

1. Dependent c̅ maximum 2+ assist. In ambulation, bed mobility, transfers and +1

moderate assist in undressing and dressing of lower garments and toileting.
2. Intermittent dull aching pain on his low back c̅ 8/10 PS
3. Paralysis on B LE d/t UMNL
4. LOM on B LE AROM -> all planes and B LE PROM -> all planes
5. Grade 3 spasticity on B LE
6. Muscle spasm
7. Atrophy on B LE
8. Fair balance
9. Kyphotic Posture

STG: p 6 mos. Of PT mx, pt. Will achieve the ff.

1. ↓ dependence from max 2+ → max +1 assist., +1 moderate assist → +1 minimal assist.

in undressing and dressing and toileting
2. ↓ Intermittent dull aching pain on his low back c̅ PS 8/10 → 5/10
3. ↑ muscle strength on Ⓑ LE
 4. ↑ N AROM on B LE -> all planes and ↑ PROM on B LE -> all planes c̅ increments of 4°
5. ↓ Grade 3 spasticity -> Grade 2 on B LE
6. ↓ Muscle spasm
7. ↓ Atrophy on B LE
8. ↑ balance from fair -> good
9. Correct posture

LTG: p 1 year Of PT mx, pt. Will achieve the ff.

1. ↓ dependence from max 1+ → modified independence c use of Scott-Craig Orthosis c

BAC in ambulation, +1 moderate assist → +1 minimal assist. in undressing and dressing
of lower garments and toileting.
2. Diminished intermittent dull aching pain from 5/10 -> 1/10
3. Regain N Muscle strength on B LE
4. Regain N AROM and PROM on B LE -> all planes
5. Eliminate spasticity on B LE
6. Eliminate muscle spasm on
7. Eliminate atrophy on B LE
8. Regain N balance
9. Demonstrate proper posture

P:> Pt. will be treated 3x/wk. for 6 mos. as an out-pt., and will receive the ff mx:
1. US on B LE x 1.5W/cm² x 1 MHz x 10’ to ↑ tissue extensibility
2. PROM on B LE x 10 reps x 3 sets → AP flexion, extension, abduction, adduction, ER,
IR, PF, and DF to ↑ ROM
3. FES on Ⓑ LE x 5Hz x 10’ to ↑ facilitate ROM
4. Rood’s inhibitory techniques to ↓ spasticity
a. Slow stroking along the vertebral musculature x 3’
b. Neutral warmth x 10-20’
c. Prolonged stretch on Ⓑ LE x 20 secs.
d. Light joint compression on Ⓑ LE musculatures
e. Tendon pressure on Ⓑ LE tendons
5. Transfer exercises x 10 reps x 1 set
a. Floor ↔ w/c
b. w/c ↔ floor
c. Bed ↔w/c
d. W/c ↔ Bed
e. Bed ↔ Chair
f. Chair ↔ Bed
6. Bed Mobility Exercises x 10 reps x 1 set
a. Supine ↔ side-lying
b. Side-lying ↔ supine
c. Side-lying ↔ Sitting
 d. Sitting ↔ side-lying
e. Supine ↔ Sitting
f. Sitting ↔ supine
g. Supine ↔ prone
h. Prone ↔ supine
i. Log rolling
7. Bicep curls using 10lb. DB x 10 reps x 2 sets to ↑ muscle strength, ↑ 2 lbs every 2 weeks
8. Dumbbell press using 15lbs DB x 10 reps x 2 sets ↑ muscle strength, ↑ 5lbs every 2
weeks
9. Assisted chest dips x 10 reps x 2 sets to ↑ muscle strength, ↑ 1 rep every 4 weeks
10. Assisted pull ups x 10 reps x 2 sets to ↑ muscle strength, ↑ 1 rep every 4 weeks
11. Seated balance training 10 reps x 2 sets to ↑ balance
a. Lateral seated weight shift exercise
12. Ambulation training c forearm crutches x 5m x 2 rounds to facilitate ambulation
13. Once patient is able to bear weight // bars walking c̅ use of Scott-Craig Orthosis x 20'

HEP:
1. W/c transfers x 3 sets
● Floor ↔ w/c
● w/c ↔ floor
Bed ↔w/c
● W/c ↔ Bed
● Bed ↔ Chair
● Chair ↔ Bed
2. Bed Mobility exercises +1 assist
● Supine ↔ side-lying
● Side-lying ↔ supine
● Side-lying ↔ Sitting
● Sitting ↔ side-lying
● Supine ↔ Sitting
● Sitting ↔ supine
● Supine ↔ prone
● Prone ↔ supine
● Log rolling
3. GPS on Ⓑ LE x 30SH x 5 reps x 1 to ↑ flexibility.
4. Seated balance training 10 reps x 1 set to ↑ balance
a. Lateral seated weight shift exercise
5. UE Ergometry x 20’ to ↑ endurance
6. Proper postural training c use of Taylor brace together c use of mirror as feedback

HI:
1. Follow the HEP provided.
2. Take prescribed meds. accordingly.
3. Encourage pt. to maintain monthly medical appointments.
4. Inform the pt. to limit coffee consumption.
5. Encourage pt. to observe proper energy conservation techniques for example
scheduling rest
periods between ADLs.
6. Educate pt. and family member/caregiver to change position q 2 hrs. to prevent
formation of pressure ulcer and contractures.
7. Educate pt. to use cushions on pressure sensitive areas to ↓ discomfort.
8. Tell the family member/caregiver to check skin change on the pressure sensitive areas.
9. Encourage pt. to observe proper skin hygiene and apply moisturiser on Ⓑ LE
10. Inform the pt. to get enough rest and do not over exercise.
11. Teach pt. on how to wear a Taylor brace at all times excluding sleeping, eating and
bathing.