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Two months after starting the Rehab-Cycle®, Lisa had progressed, meeting the goals set for two of her three cycle goals – independence in self-care and increased participation in recreation and leisure.

I’ve improved so much – my muscle power, using my wheelchair, transferring myself, and especially in doing sports. Immediately after the accident, I knew that sports would continue to be a very big part of my life. It offers me an opportunity to move, to be happy, to meet other people, and to really experience how well I am improving in the course of my recovery...I feel like my fear of falling is almost gone; I think the Feldenkrais helped the most with this.

Lisa, at the end of the Rehab-Cycle®

Part of Lisa's improvement was reflected in the increase of her Spinal Cord Independence Measure (SCIM) score from 50 to 60. At the end of her rehabilitation program Lisa's SCIM score remained at 60 out of a total possible score of 100; this was likely due to the physical limitations resulting from her injury. See table 5.

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While Lisa's mobility had improved, it did not reach the level of improvement that her rehabilitation team had hoped for. A number of factors prevented further improvement. For example, fear, although greatly reduced, continued to work against her efforts to improve mobility. Likewise, ongoing pain, increasing spasticity and poor arm support functions all contributed to the difficulties Lisa had in transferring and changing body positions. In addition, Lisa's mobility in transportation was limited, since she still had not taken the examination to obtain a driver’s license at the end of the Rehab-Cycle®.

Lisa has improved in many areas of physical functioning, but her fear [of falling] continues to limit some activities – she still has difficulties transferring to her wheelchair; I think without the fear she could have made even more gains.

Lisa’s physical therapist

The art therapy class, spiritual guidance and Feldenkrais therapy that Lisa received were valuable for her recovery. Lisa felt that these interventions had an introspective and calming effect, helping her to adapt to her new life situation and even alleviate some fear of falling.

With regards to return-to-work, Lisa’s former employer readily agreed to take her back to teach geography and potentially other subjects. Given her love of sports, she hoped to someday be able to combine her enthusiasm for sports and her passion for teaching, possibly as a motivational sports instructor. Although Lisa still felt somewhat insecure and she still required some support from the occupational therapist, she planned on returning to work as soon as she was able.

In pursuit of the cycle goal of increasing participation in recreation and leisure, Lisa was highly motivated and pro-active in both sports and non-sports related interventions. She made gains in both exercise tolerance and muscle power, as well as in manoeuvring the wheelchair better – a prerequisite for participating in many sport interventions.

""I knew that sports would continue to be a very big part of my life.""

Although her muscle endurance fell short of the stated goal, she still made significant strides in all of the sport activities she undertook. Throughout this Rehab-Cycle®, Lisa’s love of sports and athletic history shined through in all the sport activities she tried. The sports therapist indicated that Lisa excelled in swimming, archery and tennis as well as in team sports, such as basketball.

Lisa's canoeing test went well, and she planned on pursuing this activity with her boyfriend, who had been extremely supportive. She even discovered a passion for handbiking. Lisa planned on purchasing her own handbike and intended to train for competitions.

Sports are extremely important to Lisa. Not only do they benefit her physically, but they also help to support her emotionally and socially – along with her boyfriend and other people.

Lisa’s sports therapist

The achievement of Lisa's stated goals was documented on Lisa's ICF Evaluation Display, an overview of the results of the first and last assessment of the intervention targets identified during the assessment phase of the Rehab-Cycle®. See table 6.

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Table 6: 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