08 | Community Reintegration

General Introduction

Persons with spinal cord injury (SCI) face extraordinary challenges beyond adapting to the physical aspects of their injury. They may also be confronted with functional limitations, and most importantly restrictions in participation within his or her physical and psychosocial environment. Considering this, a key goal of rehabilitation of persons with SCI is the reintegration into the community.1 2 3

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Moving Toward the Future

Martin's Story

Martin is not only an accident survivor, but also a career-seeker. Martin and his rehabilitation team already took steps toward community reintegration at the beginning of his rehabilitation, and these initial steps centred around returning to work.

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Assessment

The assessment of Martin's functioning in his new Rehab-Cycle® highlighted a number of outstanding problems as well as strengths acquired during the first months of his rehabilitation that could impact his community reintegration.

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Goal-setting/Determination of Intervention Targets

At the end of Martin's first Rehab-Cycle® it was clear that the next phase of rehabilitation would need to intensify its focus on community reintegration. While his previous long-term global goal of independent living remained unchanged in Martin's new Rehab-Cycle®, his service-program goal was redefined as 'transition to community'.

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The Occupational Therapist Providing Wheelchair Training Outdoors

Assignment and Intervention

The intervention targets identified for Martin's second Rehab-Cycle® was assigned to specific members of the rehabilitation team  – physician, physical therapist, occupational therapist, psychologist, social worker, and vocational rehabilitation (VR) counsellor to provide appropriate interventions to address the targets.

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Evaluation

Shortly before discharge to the community, Martin’s functioning status was re-evaluated, a final rating of the intervention targets based on the evaluation was given and compared to the rating given in the first assessment to determine Martin's goal achievement.

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Returning Home and to the Community

Discussion

I live with the things that I have and those that I can do, not with the things that I have lost.

Martin, after his discharge

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Literature

  1. Forchheimer M and Tate DG. Enhancing community re-integration following spinal cord injury. NeuroRehabilitation. 2004; 19(2): 103-113.
  2. Scelza WM, Kirshblum SC, Wuermser LA, Ho CH, Priebe MM, Chiodo AE. Spinal cord injury medicine. 4. Community reintegration after spinal cord injury. Arch Phys Med Rehabil. 2007; 88(3)Suppl.1: S71-S75.
  3. Spinal Cord Injury Rehabilitation Evidence (SCIRE). Community Reintegration. [Internet] 17 May 2012. Available from: http://www.scireproject.com/om-toolkit/community-reintegration. Accessed April 2015.
  4. World Health Organization. International Classification of Functioning, Disability and Health, Geneva: World Health Organization; 2001.
  5. Meyer T, Gutenbrunner C, Bickenbach JE, Cieza A, Melvin J, Stucki G. Towards a conceptual description of rehabilitation as a health strategy. J Rehabil Med. 2011; 43(9): 765-769.
  6. Bickenbach J et al. Chapter 4: Health care and rehabilitation needs. In: Bickenbach J, Officer A, Shakespeare T, von Groote P. Eds. International perspectives on spinal cord injury. Geneva, Switzerland: World Health Organization; 2013. p. 67-91.
  7. Dijkers M. Community integration: Conceptual issues and measurement approaches in rehabilitation research. Top Spinal Cord Inj Rehabil. 1998; 4(1): 1-15.
  8. Boschen KA, Tonack M, Gargaro J. Long-term adjustment and community reintegration following spinal cord injury. Int J Rehab Res. 2003; 26(3): 157-164.
  9. Noreau L, Fougeyrollas P. Long-term consequences of spinal cord injury on social participation: The occurrence of handicap situations. Disabil and Rehab. 2000; 22(4): 170-180.
  10. Tate DG, Forchheimer M. Enhancing community reintegration after inpatient rehabilitation for persons with spinal cord injury. Top Spinal Cord Inj Rehabil. 1998; 4(1): 42-55.
  11. Nosek MA, Parker RM, Larsen S. Psychosocial independence and functional abilities: Their relationship in adults with severe musculoskeletal impairments. Arch Phys Med Rehabil. 1987; 68(12): 840-845.
  12. Kendall MB, Ungerer G, Dorsett P. Bridging the gap: Transitional rehabilitation services for people with spinal cord injury. Disabil and Rehab. 2003; 25(17): 1008-1015.