The patient with paraplegia is at an increased risk for pressure injury on the ischial spines and other dependent areas due to decreased sensation and decreased movement. Therefore, the most important instruction to give the patient to protect skin integrity is to use the arms to shift the position in the wheelchair every 15-20 minutes. The patient may wear gloves to prevent blisters and calluses from forming on the hands, but this is less important than preventing pressure injuries on the buttocks. Shoes and socks will protect the feet from incidental injury, but this is less important than shifting position in the wheelchair. The patient should be instructed to assess for injuries each day to the lower extremities, but this does not necessarily prevent skin breakdown.