Goal-Setting

Tetraplegia is a serious condition resulting from a spinal cord injury (SCI) that leads to complete or incomplete paralysis of all four limbs.12 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,81516 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.

1. Paraforum. SCI as health condition. [Internet] December 2013. Available from: https://www.paraforum.ch/article/sci/?group=36. Accessed November 2014.
2. Chin LS, Mesfin FB, Dawodu ST. Spinal cord injuries: Practice essentials, background, anatomy, pathophysiology, etiology, epidemiology, prognosis, patient education. 7 [Internet] July 2014. Available from: http://www.emedicine.com/pmr/topic182.htm. Accessed November 2014.
3. Snoek GJ, Ijzerman MJ, Hermens HJ, Maxwell D, Biering-Sorensen F. Survey of the needs of patients with spinal cord injury: impact and priority for improvement of hand function in tetraplegics. Spinal Cord. 2004; 42: 526-532.
4. American Spinal Injury Association. Worksheet International standards for neurological classification of spinal cord injury (ISNCSCI); Revised version 02/13 http://www.asia-spinalinjury.org/elearning/ASIA_ISCOS_high.pdf. [Internet] Available from http://www.asia-spinalinjury.org/elearning/ISNCSCI.php. Accessed November 2014
5. Shepherd Center. Understanding spinal cord injury: What you should know about spinal cord injury and recovery. 2014. [Internet] Available from: http://www.spinalinjury101.org/details/levels-of-injury. Accessed November 2014.
6. Elfström ML, Rydén A, Kreuter M, Taft, C, Sullivan M. Relations between coping strategies and health-related quality of life in patients with spinal cord lesion. J Rehabil Med. 2005; 37: 9-16.
7. Moberg E. Surgical treatment for absent single-hand grip and elbow extension in quadriplegia. Journal of Bone and Joint Surgery. 1975; 57A(2): 196-206.
8. Wuolle KS, Bryden AM, Peckham PH, Murray PK, Keith M. Satisfaction with upper-extremity surgery in individuals with tetraplegia. Arch Phys Med Rehabil. 2003; 84: 1145-1149.
9. Vastamäki M. Short-term versus long-term comparative results after reconstructive upper-limb surgery in tetraplegic patients. Journal of Hand Surgery. 2006; 31A (9): 1491-1494.
10. Mohammed KD, Rothwell AG, Sinclair SW, Willems SM, Bean AR. Upper limb surgery for tetraplegia. Journal of Bone and Joint Surgery. 1992; 74(6): 873.879.
11. Holliday RC, Ballinger C, Playford ED. Goal setting in neurological rehabilitation: patients’ perspectives. Disability and Rehabilitation. 2007; 29(5): 389-394.
12. Schulman-Green DJ, Naik AD, Bradley EH, McCorkle R, Bogardus ST. Goal-setting as a shared decision making strategy among clinicians and their older patients. Patient Education and Counselling. 2006; 63: 145-151.
13. Donnelly C, Eng JJ, Hall J, Alford L, Giachino R, Norton K, Kerr DS. Client-centred assessment and the identification of meaningful treatment goals for individuals with a spinal cord injury. Spinal Cord. 2004; 42 (5): 302-307.
14. Department of Health (DH). Long-term Conditions National Service Framework (NSF) team. National service framework for long-term conditions. London, UK: Department of Health; 2005.
15. Meiners T, Abel R, Lindel K, Mesecke U. Improvements in activities of daily living following functional hand surgery for treatment of lesions to the cervical spinal cord: self-assessment by patients. Spinal Cord. 2002; 40: 574-580.
16. Bryden AM, Wuolle KS, Murray PK, Peckham PH. Perceived outcomes and utilization of upper extremity surgical reconstruction in individuals with tetraplegia at model spinal cord injury systems. Spinal Cord. 2004; 42: 169-176.
17. Wade DT. Goal-setting in rehabilitation: an overview of what, why and how. Clinical Rehabilitation. 2009; 23: 291-295.
18. Locke EA, Latham GP. Building a practically useful theory of goal-setting and task motivation. A 35-year odyssey. Am Psychol. 2002; 57: 705–717.
19. Mastos M, Miller K, Eliasson AC, Imms C. Goal-directed training: linking theories of treatment to clinical practice for improved functional activities in daily life. Clinical Rehabilitation. 2007; 21: 47-55.
20. Hurn J, Kneebone I, Cropley M. Goal-setting as an outcome measure: a systematic review. Clinical Rehabilitation. 2006; 20: 756-772.
21. Wahman K, Biguet G, Levi R. What promotes physical activity after spinal cord injury? An interview study from a patient perspective. Disability and Rehabilitation. 2006; 28(8): 481-488.

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