Marshalling a Patient's Resources

General Introduction

Sporting accidents are a frequent cause of traumatic spinal cord injuries (SCI), and a common subset of these SCI are those resulting from skiing and snowboarding. The devastating injuries that are associated with such recreational sports often affect young men under thirty.

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Independence as a Goal

Michael's Story

When I think about my situation now, I have this very strong feeling that I simply have to look forward. I'm not the kind of person who has ever had any doubts about myself or what I do. I just accept my new situation and look forward. I won't fall into the trap of self-pity. I absolutely will gain my independence. It's a goal, it's my goal and I will continue to work towards it.

Michael 2007

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From Michael's perspective i.e. “the patient perspective”, many of his needs were activity-based and logically centred around his wish to become independent again. Michael felt there were numerous activities he would like to work on, such as being able to sit up alone, balancing himself, moving about in a wheelchair or washing and caring for himself.

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Goal-setting/Determination of Intervention Targets

These past weeks have not been easy for me, I need help to do almost everything. It’s hard to describe, but it’s like I’ve somehow lost my body and now I need to find it, to re-learn how to do simple things. What I really want is to be able to go through my day without help from others.


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Physical therapy as an intervention

Assignment and Intervention

Interventions corresponding to each of the targets were assigned to the appropriate members of Michael's rehabilitation team. In addition to the physician, nurse, physical therapist, occupational therapist, psychologist, social worker and architechtural expert who make up the standard rehabilitation team, a sports therapist was welcomed to the team to focus on Michael’s athletic activities. The roles and distribution of resources within the multidisciplinary team can be seen on Michael's ICF Intervention Table.

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At 16 weeks following the accident (i.e. one month after the interventions started), an evaluation of Michael’s progress was performed. The results are illustrated in the ICF Evaluation Display, an overview of the results of the first and of the final assessment of the intervention targets identified in the assessment phase of the Rehab-Cycle®. It also shows whether the goals as defined by a goal value or ICF qualifier were achieved. See table 4.

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Improvement in functioning is not only a result of reducing disease-specific problems and symptoms, but also of strengthening general resources. This is part of a salutogenic approach, focusing on the factors that contribute to an individual’s health. 12 13 14 15 These resources must be assessed, and when appropriate, taken into consideration in rehabilitation management. In most cases, the person engaged in rehabilitation possesses valuable resources that can help him or her overcome challenges associated with SCI. 10 11 16

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