Independence

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.

Michael

Generating an ICF functioning profile i.e. an ICF Categorical Profile enabled Michael and his rehabilitation team to visualize his functioning status at the time of assessment. Michael’s functioning status was assessed 12 weeks following the accident and included all of those ICF categoriesthat were relevant for describing his functioning and intervention planning. This profile could later be used as a reference for outcome evaluations.

Figure 2: ICF Categorical Profile

Table 2: ICF Categorical Profile; ICF Qualifier: rate the extent of problems (0 = no problem to 4 = complete problem) in the components of body functions (b), body structures (s), activities and participation (d) and the extent of positive (+) or negative impact of environmental (e) and personal factors (pf); Goal Relation: 1, 2, 3 refers to Cycle goal 1, 2, 3; SP refers to Service-Program Goal; G refers to the Global Goal; Goal value refers to the ICF qualifier to achieve after an intervention.

Independence as a Goal

In creating an individualized ICF Categorical Profile Michael and his rehabilitation team were able to set global as well as more specific, short-term goals that were informed to a large extent by the resources he brought with him. This is reflected in both Michael's statements as well as in the information indicated on table 1 ICF Assessment Sheet.

"What I really want is to be able to go through my day without help from others."

Constituting a subjective assessment of a person's perceived needs and derived from discussions and interactions with the person, the "patient perspective" generally plays a significant role in setting goals. This was also the case with Michael.

Given his personality, wishes and intrinsic life goals, the rehabilitation team decided that setting a global goal of full independence along with university entry was in Michael's case quite realistic. Consequently, the team and Michael defined a service-program goal as ‘Independence in activities of daily living (ADLs)’. To achieve the service-program goal, a series of shorter-term cycle goals were set; these focused on self-care and mobility and were to be addressed over a period of six months. Sport was defined as a cycle goal as well to reflect Michael’s wish to participate again in sports.

Determination of Intervention Targets

Once these cycle goals were defined by the team, the process moved on to the determination of the appropriate intervention targets for each cycle goal. Intervention targets are those ICF categories that correspond to specific goals and that will be addressed with interventions in the rehabilitation program.

In Michael's case, the cycle goal of ‘independence in self-care’ incorporated targets focusing on balance, washing, bladder and bowel management, muscle stiffness, and knee mobility. The cycle goal ‘independence in mobility’ consisted of targets relating to back pain, limitations in changing body position and transferring, balance, and overcoming barriers with a wheelchair. Furthermore, the cycle goal ‘sport’ corresponded directly with the target sport and also with involuntary movement reaction. These intervention targets were then addressed in the next phase of the Rehab-Cycle® i.e. the intervention phase.

"Independence in self-care incorporated targets focusing on balance, washing, bladder and bowel management, muscle stiffness, and knee mobility."

ICF Research Branch CoordinatorICF Research Branch in cooperation with the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI)

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