Running head: SPINAL CORD INJURY CASE STUDY 1

SPINAL CORD INJURY CASE STUDY 2

Abstract
This spinal cord injury case is about my 50 year old brother named Kevin that fell off our mother’s roof and fractured his vertebra at the T5-T9 level. He is now a paraplegic that has come to live with my family. What is his functional level to this day? What are the capabilities and functional limitations for someone with this paralysis? These are some of questions that will be addressed in this study. A person with a spinal cord injury needs some assistive devices to enable them to be somewhat mobile. A wheelchair and a new device called a Tech RMD were purchased to make daily tasks less challenging. The rented home he will be living in needs some modifications made to the exterior and interior, to accommodate a person with this paralysis. We will be looking at every room that he will be living in and make changes to them based upon the observation and measurements taken at the on-site visit from a physical therapist. A wheel chair ramp and grab bars are examples of some adaptive devices that might be added to the home for Kevin as a result of the on-site visit. The funding for this and some other things will be covered from a few fund raisers and donations from the local community made on his behalf. The final result of this study shows the limitations that a paraplegic overcomes to live the most independent life they can. It also shows that some technology and modifications to a home can make this transition easier too.

SPINAL CORD INJURY CASE STUDY 3 Spinal Cord Injury Case Study The patient is my brother Kevin, a 50 year old male, whom was of normal health prior to the accident. Kevin lived with our mother and was on the roof doing some maintenance when he fell some 20 feet to the ground. He landed on his back and fractured his spine at T5-T9 level. The result was a complete paralysis of both lower extremities, otherwise known as paraplegia. This condition comes with many limitations that make everyday life challenging. He will need modifications to his living environment, which will be discussed in this case study.
Capabilities
The capabilities that accompany this spinal injury are full head, neck, and shoulder movement with normal muscle strength. He will also have full use of arms, wrists, and fingers (Kelen, Tintinalli & Stapczynski, 2004). He will have the ability to transfer independently from bed to chair, chair to furniture, chair to car, and vise versa. A manual wheelchair will be used for everyday living. The ability to drive a car adapted with hand controls will be possible for this type of injury. He has the ability to breathe normally and is independent in personal care. Communication skills are normal for this type of injury also (Kelen, Tintinalli & Stapczynski, 2004).
Functional Limitations The functional limitations that accompany this injury are complete loss of use of the lower extremities, therefore unable to walk. Depending on upper body strength, assistance may be needed in wheelchair transfers. Partial domestic assistance will be required, such as heavy household cleaning and some home maintenance. A paraplegic has the inability to maintain moderate duty employment which would require standing and walking. The limits a paraplegic face will stay the same as time goes on. The way they approach them will progress as they figure out how to live with them.
Present Functional Level Kevin’s functional level at this time is full use of head, neck, and shoulder movement with normal muscle strength. He has full use of hands and fingers. Transfers from the wheelchair to the bed, car, and some home furniture are completed independently. He is able to prepare complex meals and clean up after himself in the kitchen. He can perform general household duties independently such as clothing management (i.e., laundry, ironing, clothing repair) and light cleaning. He is independent in personal hygiene care including dressing, bathing with the help from an assistive device, shaving, combing hair, brushing teeth, etc. He is able to enter and exit the house independently with the use of a wheelchair. Kevin is able to drive his car now that

SPINAL CORD INJURY CASE STUDY 4 he had it adapted with hand controls. He is predicted to live a functional life for a person with this injury.
Assistive Devices Kevin will need some assistive devices to complete his daily tasks. A manual wheelchair was purchased for him to be mobile. The wheelchair dimensions are 30 inches wide by 48 inches long by 30 inches high (The wheels are 24 inches in diameter. It will have desk style removal armrests, and removable foot plates. The wheelchair is made of titanium, which is lightweight, enabling him to load and unload easily from his car. Since a wheelchair limits what someone can do, a new piece of equipment was found to help him with this. The Tek Robotic Mobilization Device (Tek RMD) was purchased. This device enables the paraplegic to stand independently in a completely upright position with correct posture. The Tek RMD has the dimensions of 14.25 inches wide by 24.50 inches long, which is smaller than a wheelchair. The Tek RMD can be used anywhere a wheelchair can go, and it allows him to do some exercises on it from a stand position by himself. This is important for paraplegics because they need to stand for approximately one hour each day to preserve optimal health. This device has a joystick control panel for operation and a remote control.
Adaptive Devices We needed to get some adaptive devices to assist in his activities of daily living. Two ramps were installed for his entry and exit of the home and are 4 foot long x 36 inches wide and made of fiberglass with non-skid surfaces for safety (O’Sullivan & Schmitz, 2007). The two entry doors to the home had lever-type handles installed to make entry and exit easier. Kick plates (10 inches x 34 inches) were placed on both entry doors. Kevin’s bathroom needed a cushioned shower bench (16 inches wide x 13 inches deep) so he could shower safely and independently. Adhesive strips were placed on the surface of the tub and two stainless steel grab bars (42 inches long) were also installed to improve safety for bathing. A hand held sprayer was installed to aid in bathing. A long-handled reacher was purchased to allow for grabbing things that are too high or too low. The cabinets in the kitchen had glide-out-shelves installed to the lower cabinets in the kitchen (O’Sullivan & Schmitz, 2007). A small four wheeled cart was purchased to assist Kevin in the kitchen. Rubber suction cups were placed on the legs of furniture to ensure stability. A fitted wooden board was placed in the two sofas to make them a bit higher. Kevin’s bedroom had wire shelving added to his closet for storage and accessibility. A pillow-top mattress in his bedroom replaced the standard queen mattress that he originally used prior to his injury. The new mattress places him higher which makes his transfer easier. Six electrical outlets were also equipped with night lights to provide illumination at night.

SPINAL CORD INJURY CASE STUDY 5
Funding Source Kevin lived in a small town and the local public, friends and family decided to have a couple of fund raisers for Kevin. It was well known around town that he was going to need to have some things provided for. A concert series was planned with two well-known bands at a park. The events were advertised heavily on the radio for weeks. Between the concerts and donations, he was funded for the assisted devices and adaptive devices he needed.
Future Plans My mother is 83 years old, which makes it difficult for her to take care of a person with this condition. I insisted that Kevin come to live with me and my family for the present time. It is in his future plans to find work in Panama as a computer programmer, and be able to have a home built to accommodate his paralysis. He would likely need a roommate to be available for assistance when needed. We will take each day at a time and see what happens with those plans. Kevin will always live nearby me so I can assist him in any way, but for now he will live with me.
Route of Entry The on-site visit was made by a local physical therapist to the home we are renting. The suggestions made by the physical therapist starts at the route of entry. The driveway to the home is of a smooth, level concrete surface that has easy access to the home. The walking surface to the home is a level, smooth concrete sidewalk to the front door that is well-lighted. The home has no steps to the front door, but does have a 3 inch rise. We needed to install a wheelchair ramp to allow him easy and safe entry to the home. A fiberglass ramp (4 foot long x 36 inches wide) that has a non-skid surface was installed.
Entrances
The front door of the home is 36 inches wide and swings in to 5 foot x 5 foot area, which allows plenty of room for a wheelchair. The threshold plate was removed so that entry would be smoother for the chair. A kick plate (10 inches x 34 inches) was installed to the front door. The other entry accessible door to the home from the outside is in the garage. The entry from the garage has a 60 inch aisle and 2 inch rise to the door, so a fiberglass ramp (4 foot x 36 inches) with a non-skid surface was installed. The threshold plate was removed for smoother entry and a kick plate (10 inches x 34 inches) was installed on the 36 inch door that swings into a 5 foot x 5 foot area. A lever-type handle was installed on the 32 inch hall bath door that swings in, and another lever-type handle was installed on his 32 inch bedroom door, to allow for easier access.

SPINAL CORD INJURY CASE STUDY 6
Furniture Arrangement A few changes to the furniture arrangement were going be made to make the living areas roomier. A coffee table in the family room was removed to allow easier access for his transfers. The leather sofa was fitted with a wooden board under the cushions to make them sit higher. Suction cups were placed under the sofa legs and two chairs in the family room to make it stabile on the tile floor. The living room area had a love seat that was replaced with a chair. The living room couch was moved and placed against the wall. A fitted board was placed under the cushions of the couch to make it sit higher. A table at the front entrance of the home was removed to give more room upon exit and entry with the wheelchair.
Electrical Controls The standard light switches in the house were suitable for Kevin’s paralysis. We did place some night-lights in the hallways, bedroom and bathroom and near both to provide illumination at night. Some longer pull cords were installed on ceiling fans in his bedroom and the family room to make them easier to reach. Ground fault circuit interrupters were already in the bathrooms and kitchen to prevent electrical shock, so we didn’t need to make a change there.
Floors
The floor surface of the home is 19 inch tile all around except for the carpeted bedrooms. The tile makes use of a wheelchair much easier than carpet because of the friction carpet creates. The carpet in his bedroom was taken out and replaced with 19 inch tile. The area rug in the family room was secured with some carpet tape. Scatter rugs in the hallways, kitchen and bathrooms were removed to make movement in his wheelchair easier.
Bedroom Area The bed that was in his bedroom was too low, so a queen size pillow-top mattress was purchased to raise the surface for his transfers. We also moved his bed against the wall and placed suction cups under the bed legs to provide stability. A bedside table with a lamp was added to his room to provide more assistance for him. The closet clothes bar was lowered to 52 inches to make removal of clothing more accessible to him. Shelving was installed 45 inches from the floor in the closet to provide some additional storage for clothing, grooming articles, and any other items he may need frequently. Kevin needed a low profile computer workstation area with free knee clearance, so a desk top was installed in a corner of his bedroom.

SPINAL CORD INJURY CASE STUDY 7
Alarms
There are seven smoke alarms and carbon monoxide detectors all throughout the home. The home is equipped with a security system that is monitored by a company 24 hours a day. A couple of control pads for the system are located 51 inches high on the inside wall at both inside entrances. The pads can be reached when in the wheelchair and Tech RMD.
Bathroom
The hall bath that Kevin will use needed some baskets added under the sink to make retrieval of items easier. The bath tub area needed a shower bench so he could bath safely. We installed a 16 inch wide x 13 inch deep cushioned bench that swivels 360 degrees to accommodate his bathing. A hand spray attachment was installed to the shower head to assist in bathing. The surface of the tub was smooth so adhesive strips were placed on the surface for added safety. A couple 24 inch stainless steel grab bars were needed in the bath area to assist in tub transfers. The vanity is next to the toilet so he can use the top of vanity to assist in transfers if needed.
Kitchen
The counter top in the kitchen is 34 inches high and 24 inches deep which is ideal for someone in a wheelchair (Fairchild & Pierson, 2008). The surface of the countertop is smooth to help with sliding of heavy objects. The refrigerator in the kitchen is a side by side model, which is the perfect type for the disabled. The stove is 34 inches from the floor and has front controls and a smooth top (Fairchild & Pierson, 2008). The floor plan for the kitchen is large and roomy to allow for maneuvering easily in his chair and Tech RMD. The lower cabinets needed glide-out shelves installed to allow ease of access from a wheelchair. A small cart with casters was needed to allow transporting of items from the refrigerator to the counter, and other such activities more efficient. The kitchen table we had was too low, so we removed it and found one a little higher at a consignment shop. The new table allows for more knee space while sitting in his chair or Tech RMD. Conclusion In order to gain a full understanding of what a person with a spinal cord injury goes through on a daily basis, it is important to conduct a study that looks at the limitations and capabilities. We then must also look at their present level of function and then try to find ways to make them as independent on a routine basis as possible in their home environment. The effects this injury might have on relationships are hard to grasp for a normal functioning person. The challenges they will face daily will impact them emotionally as well as physically for the duration of their lives. The strength a paraplegic might gain physically and mentally will greatly impact those around them and inspire all of us to make the most of every day we are given here on earth.
SPINAL CORD INJURY CASE STUDY 8 References
Fairchild, S. L., & Pierson, F. M. (2008). Principles & Techniques of Patient Care, St. Louis, Missouri: Saunders Elsevier Inc.
Kelen, G. D., Tintinalli , J. E., & Stapczynski:, J. S. (2004). Emergency Medicine, United States of America: The McGraw-Hill Companies, Inc.
O’Sullivan, S. B., & Schmitz, T. J. (2007). Physical Rehabilitation, Philadelphia, PA: F.A. Davis Company.