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To determine the risk factors associated with skin tear development while participating in activity-based restorative therapy (ABRT), describe the possible consequences of skin tears incurred during therapy, and provide risk reduction strategies.This was a retrospective review of electronic medical records from 2012 to 2015 in a spinal cord outpatient rehabilitation center; 21 of 54 patients who reported a wound at initial evaluation were diagnosed with skin tears. Nine of the 21 patients acquired skin tears during their course of ABRT. Of those 9, 7 were diagnosed with tetraplegia and 2 with paraplegia. All patients were treated by a wound care specialist 2 to 3 times per week while participating in therapy, with plan-of-care modifications to improve wound healing and maximize benefits of ABRT.Primary outcome measures were level of injury, International Standards for Neurological Classification of Spinal Cord Injury, age at initial evaluation, Spinal Cord Independence Measure, and International Skin Tear Advisory Panel skin tear classification.Six of 9 patients completed their full scheduled course of therapy with wounds closing within 30 days. Two patients’ treatments were discontinued, and 1 patient was discharged because of exacerbation of a preexisting pressure injury.Skin tears can affect therapy by altering patient outcomes. Patient and clinician education, policy modifications, and risk management plans improved skin protection and prevented skin tears in this patient population. Only 2 subsequent cases of therapy-related skin tears were recorded in 2016.