Tetraplegia is a serious condition resulting from a spinal cord injury (SCI) that leads to complete or incomplete paralysis of all four limbs.1 2 Persons with tetraplegia face a range of physical and psychological challenges. Even an incomplete loss of arm and hand function has an immense impact on an individual's ability to carry out everyday activities.

Peter was a 20-year-old plasterer at the time of his car accident in 2001. He is diagnosed with tetraplegia (sub C6, as a consequence of vertebral fracture of C5) ASIA B.

The team decided to close the initial rehabilitation cycle (or Rehab-Cycle^®) that focused on hand recovery using a standardised treatment scheme (see table 2) and open a new Rehab-Cycle^® that intended to address both Peter’s current physical situation and behaviour.

Goal-setting

Based on the assessment of Peter’s functioning status, as documented on the ICF Assessment Sheet, a profile of Peter’s functioning, or ICF Categorical Profile, was created using the standardized language of the International Classification of Functioning, Disability and Health (ICF). The ICF Categorical Profile for Peter visually depicts his functioning status at the time of the assessment using ICF qualifiers, and shows long and short-term goals that the rehabilitation team, with consideration of Peter's perspective, has identified. It was believed that clear and meaningful common goals would help to increase Peter’s intrinsic motivation and foster his feeling of responsibility toward the program.

The information shown in the ICF Categorical Profile created for Peter was instrumental in completing the ICF Intervention Table, an ICF-based tool that provides a comprehensive overview of Peter's intervention targets, the interventions themselves and the corresponding rehabilitation team members who is (are) assigned to address each intervention target.

Just two weeks before completing the Rehab-Cycle^® Peter asked to be discharged, and he was released against the recommendations of his rehabilitation team. Unfortunately, he was unable to be dissuaded, and a final evaluation was performed just before he left the clinic  – significantly earlier than originally intended.

As illustrated in Peter’s case, the translation of the results of a surgical intervention such as upper extremity surgery into positive, meaningful outcomes for a patient can present a significant challenge.

Multi-faceted Factors Impacting Functioning

Real-life outcomes are dependent not only upon the success of medical intervention, but also on the subsequent rehabilitative interventions and the person himself. While it is well-documented that upper extremity surgery is effective for increasing functionality, 8 15 16 surgery and the treatment scheme alone may not guarantee positive results, as was evident three weeks into Peter’s medical management. Outcomes are also affected by the person's level of participation and acceptance of responsibility in the rehabilitation process, as well as the healthcare professional-patient interaction. Peter’s case illustrates this well.

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