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Goal-setting/Determination of Intervention Targets

Based on the rehabilitation team's assessment results and Jason's own statements about his functioning and overall situation, intervention targets and concrete goals to achieve during Jason's Rehab-Cycle® were identified.

In addition to the results of the initial comprehensive assessment, the goal-setting in Jason's Rehab-Cycle® took into account his improvement in functioning since the onset of his spinal cord injury (SCI). Consequently, five goals were set. The three cycle goals of ‘re-gaining walking ability’, ‘participation in sports’, and ‘health maintenance’ were set as the most immediate goals to achieve. These specific cycle goals were the “stepping stones” toward achieving Jason's service-program goal of ‘increased independence in daily living’, i.e. the goal to achieve at the end of this Rehab-Cycle®, and ultimately Jason's global goal of ‘community reintegration’.

These five goals were documented on Jason's ICF Categorical Profile, a visual depiction (bar graph) of his functioning status at the time of the initial assessment. In addition to the goals, the ICF Categorical Profile lists the corresponding categories of the International Classification of Functioning, Disability and Health (ICF)16 that corresponded to the aspects of functioning identified during the initial assessment.

In order to compare Jason's functioning at the initial assessment with his functioning at the end of the Rehab-Cycle®, ICF qualifiers were used to indicate the goal value i.e. the rating that was intended to be reached at the end of the Rehab-Cycle®. The ICF categories (and personal factors) that corresponded to any of the goals set and were associated with a goal value were considered intervention targets. Intervention targets were those categories intended to be addressed with specific interventions. For example, for cycle goal 2 ‘participation in sports’ Jason and his rehabilitation team defined the following intervention targets:

  • b28013 Pain in back
  • b455 Exercise tolerance functions
  • b710 Mobility of joint functions
  • b715 Stability of joint functions
  • b7303 Power of muscles in the lower half of the body
  • b7304 Power of muscles of all limbs
  • b7305 Power of muscles of the trunk
  • b740 Muscle endurance functions
  • b755 Involuntary movement reaction functions
  • b7600 Control of simple voluntary movements
  • d410 Changing basic body positions
  • d420 Transferring oneself
  • d455 Moving around

The intervention targets for the other goals can be seen on table 2.

FIgure 2: ICF Category sheer

Table 2: ICF Categorical Profile; ICF Qualifier: rate of 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 the Service-Program Goal; G refers to the Global Goal; Goal value refers to the ICF qualifier to achieve after an intervention.

Many of the environmental factors that were assessed during the assessment phase of the Rehab-Cycle® may have served as a facilitator (e.g. e1201 Assistive products and technology for personal indoor and outdoor mobility and transportation; wheelchair) or as a barrrier (e.g. e155 Design, construction and building products and technology of buildings for private use; inaccessible home) for Jason's global goal of ‘community reintegration’. However, the rehabilitation team decided not to address these as intervention targets in that particular Rehab-Cycle®.

Although the body function category of b1301 Motivation was not defined as an intervention target, the personal factor that was labelled ‘personal motives’ was. A possible factor of intrinsic motivation, the intervention target of ‘personal motives’ was addressed by the psychologist during the intervention phase of the Rehab-Cycle®. Even though the other members of the rehabilitation team did not perform any interventions that directly addressed motivation, they still kept an eye on Jason's motivation and its influence on the interventions.