A patient with C4 ASIA A SCI is seated in a manual reclining wheelchair. What is this patient's expected level of independence with pressure relief using this type of wheelchair?

A patient with C4 ASIA A SCI is seated in a manual reclining wheelchair. What is this patient's expected level of independence with pressure relief using this type of wheelchair?

• A. Independent with setup
• B. Dependent
• C. Independent
• D. Requires minimal assistance

Answer: (B)

Pressure relief in a wheelchair depends on the ability to perform a weight shift, typically by pushing up with the arms or leaning forward to offload the sitting bones. In a complete spinal cord injury at C4, there is little to no voluntary movement below the level of injury and trunk control is severely impaired, with minimal usable upper-limb strength. Without adequate arm and trunk control, the person cannot reliably or safely perform a pressure-relieving push-up in a manual reclining chair, and a manual chair provides no automatic pressure-relief mechanism. Therefore, independence for pressure relief is not achievable, and the patient would require assistance from another person.

Pressure relief in a wheelchair depends on the ability to perform a weight shift, typically by pushing up with the arms or leaning forward to offload the sitting bones. In a complete spinal cord injury at C4, there is little to no voluntary movement below the level of injury and trunk control is severely impaired, with minimal usable upper-limb strength. Without adequate arm and trunk control, the person cannot reliably or safely perform a pressure-relieving push-up in a manual reclining chair, and a manual chair provides no automatic pressure-relief mechanism. Therefore, independence for pressure relief is not achievable, and the patient would require assistance from another person.