13 | SCI in Adolescence and Peer Relationships

Evaluation

At the end of the three-week Rehab-Cycle® a final assessment was completed, and Gabi’s progress in the intervention targets was evaluated to see whether the goals that she and her rehabilitation team set in the beginning of the Rehab-Cycle® were achieved.

"Gabi also achieved her service-program goal of increased overall level of independence..."

After three weeks of rehabilitation in individual sessions and in group activities, Gabi was successful in reaching her cycle goal of increased independence in self-care. She was now able to dress herself independently, including putting on her pants without the help of others. She also developed some techniques for managing catheterisation by herself. Both this self-management of catheterisation and independent dressing allowed her to use the toilet without assistance, even if she still required a lot of time to finish. Moreover, Gabi took more personal responsibility for looking after herself.

Gabi also achieved her service-program goal of increased overall level of independence, despite the fact that the cycle goal of increase independence in mobility was not achieved. Her mobility did improve a little but still remained a moderate problem. For example, in spite of improvements in her transferring skills i.e. transferring herself from the ground up to the wheelchair, Gabi still required assistance for transferring due to her lack of arm power, knee pain, and the ill-suited wheelchair design. In addition, her ability to change body positions and move around outside the home with her wheelchair remained unchanged.

Nevertheless, due to progress in reducing pain and in respiratory functions, as well as gains in carrying out her daily routine, the rehabilitation team felt that Gabi's overall level of independence did improve.

The psychologist also concluded that Gabi had made significant improvement, specifically in finding strategies to deal with complex interpersonal interactions and in being able to better deal with stress and other psychological demands related to informal social relationships. The psychologist also commented that Gabi learned to communicate her fears and wishes. They discussed her interactions with others at school quite a bit. The psychologist did suggest that Gabi continue regular psychological counselling after discharge from the rehabilitation centre, since feelings of uncertainty and inferiority may appear again after the programme.

Gabi was well-integrated in the group and was motivated in everything she was involved with. She always arrived in a good mood, and brought ideas of her own. In this context, she really enjoyed being one of the “stronger” persons in the group, in contrast to her experience at school. The experience here has no doubt made her more assertive.

Gabi’s physician

It is important to note that the comments made by the psychologist and the physician were based upon observations within the context of a three-week rehabilitation programme designed specifically for adolescents with disabilities. Whether the skills Gabi gained in the programme along with the assertiveness and social competencies she demonstrated at the end of the three weeks would be maintained at home and at school remained to be seen. Evaluation of real improvement in developing and maintaining peer relationships and better community integration was only possible outside the context of the rehabilitation centre.

This was also the case for Gabi’s emotional stability. Whether Gabi's enhanced social skills would result in increased emotional stability in her normal environment, particularly at school, could only be evaluated in that environment.

Gabi's progress in the intervention targets were documented on the ICF Evaluation Display, an extended version of Gabi's ICF Categorical Profile ((BITTE ANKER AUF TABELLE 2)) that visually shows (as a bar graph) the rating given to each of Gabi's intervention targets during the final assessment as well as the ratings from the initial assessment. Note that a comparison of the initial and final rating only shows that there was a change, but not whether the change was due to the interventions. The ICF Evaluation Display also indicates whether the goals set were achieved or not. See table 6.

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Table 5: ICF Evaluation Display; 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; Goal achievement: + means achieved, - means not achieved.

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