Independence

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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Assessment

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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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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Evaluation

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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Discussion

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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Literature

  1. Chissell HR, Feagin JA, Warme WJ, Lambert KL, King P, Johnson L. Trends in ski and snowboard Injuries. Sports Med. 1996; 22: 141-145.
  2. Tarazi F, Wing PC et al. Spinal injuries in skiers and snowboarders. Am J Sports Medicine. 1999; 27:177-180.
  3. Levy AS, Smith RH. Neurologic Injuries in skiers and snowboarders. Semin Neurol. 2000; 20:233 – 245.
  4. Yamakawa H et al. Spinal injuries in snowboarders: Risk of jumping as an integral part of snowboarding. J Trauma. 2001; 50: 1101-1105.
  5. Wakahara K, Matsumoto K, Sumi H, Sumi Y, Shimizu K. Traumatic spinal cord injuries from snowboarding. Am Journal Sports Med. 2006; 34(10): 1670-1674.
  6. Bickenbach J et al. A global picture of spinal cord injury. In: Bickenbach J, Officer A, Shakespeare T, von Groote P. Eds. International perspectives on spinal cord injury. Geneva, Switzerland: World Health Organization; 2013. p 13-22.
  7. Mayo Clinic. Diseases and conditions: Spinal cord injury. [Internet] October 2014. Available from : http://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/basics/definition/con-20023837. Accessed November 2014.
  8. 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
  9. Kirshblum SC, Priebe MM, Ho CH, Scelza WM, Chiodo AE, Wuermser L-A. Spinal cord injury medicine. 3. rehabilitation phase after acute spinal cord Injury. Arch Phys Med Rehabil. 2007; 88 (Suppl 1): S62-70.
  10. Galvin LR, Godfrey HPD. The impact of coping on emotional adjustment to spinal cord injury (SCI): Review of the literature and application of a stress appraisal and coping formulation. Spinal Cord. 2001; 39: 615-627.
  11. Stucki G, Cieza A, Melvin J. The international classification of functioning, disability and health: a unifying model for the conceptual description of the rehabilitation strategy. J Rehabil Med. 2007; 39: 279 – 285.
  12. Antonovsky A. Health, stress, and coping: New perspectives on mental and physical well-being. San Francisco: Jossey-Bass. 1979.
  13. Antonovsky A. The salutogenic model as theory to guide health promotion. Health Promotion International. 1996; 11(1): 11-18.
  14. Kobasa S, Hilker R, Maddi S. Who stays healthy under stress? J Occup Med. 1979; 21(9): 595-598.
  15. Kent C. Salutogenesis. Chiropractic Leadership Alliance (CLA) website. [Internet]. October 2002. Available from: http://www.subluxation.com/salutogenesis/. Access November 2014.
  16. Peter C, Rauch A, Cieza A, Geyh S. Stress, internal resources and functioning in a person with spinal cord disease. NeuroRehabilitation. 2012; 30(2):119-130.
  17. Post MW, de Witte LP, van Asbeck FW, van Dijk AJ, Schrijvers AP. Predictors of health status and life satisfaction in spinal cord injury. Arch Phys Med Rehabil. 1998; 79: 395-401.

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