This stage is characterized by progressive weakness and deterioration of mobility and endurance. The patient In a uses a wheelchair when out of bed, and arm muscles may rator Transferring the cises exhibit moderate or severe weakness. patient to and from a wheelchair becomes a major effort, tech and a lift may be necessary. 6 Patients become unable to chro and skin care by the caregiver are necessary. Pain may of p move themselves in bed; thus, frequent repositioning become a major problem in immobilized joints and Arms needs to be addressed in the overall treatrnent plan.