Goal-setting/Determination of Intervention Targets

Having a comprehensive overview of Lisa's functioning based on the rehabilitation team's assessment and her own statements about her situation helped the rehabilitation team to identify specific intervention targets and concrete goals to achieve during the Rehab-Cycle^®, including those related to reviving Lisa's active participation in sports.

Setting Goals Toward Community Integration

The intervention targets and goals identified for Lisa were documented on the ICF Categorical Profile. Lisa's ICF Categorical Profile is a visual display of ICF categories that reflect the relevant aspects of Lisa's functioning that were observed and evaluated during the assessment phase of the Rehab-Cycle^® and documented on her ICF Assessment Sheet.((BITTE ANCHOR AUF ICF ASSESSMENT SHEET VON DER SEKTION ASSESSMENT SETZEN)) It also shows the goals Lisa and her rehabilitation team mutually agreed to pursue during the Rehab-Cycle^®. See table 3.

Table 3: 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. *Below the lesion level

‘Independence in self-care’, ‘improvement in mobility’ and 'increased participation in recreation and leisure' were the three so-called cycle goals that were considered the most immediate goals to achieve. These specific cycle goals were the "stepping stones" toward achieving Lisa's service-program goal of 'independence in daily living' and ultimately her global goal of 'community integration'. The cycle goal of recreation and leisure was set in order to revitalise Lisa’s athletic abilities and love of sports. It also built upon the knowledge that intensified physical activity and participation in sports have a beneficial effect on rehabilitation outcomes, not only on physical functioning but also on the execution of daily activities and participation in major life areas.

"The cycle goal of recreation and leisure was set in order to revitalise Lisa’s athletic abilities and love of sports."

Determination of Intervention Targets

For each cycle goal, one or more intervention targets were defined. Intervention targets are ICF categories (and personal factors) that correspond to any of the cycle goals, the service-program goal and/or global goal and are intended to be addressed with specific interventions. In Lisa's case, the following are examples of intervention targets that were identified in order to achieve the cycle goal of ‘increased participation in recreation and leisure’: b455 Exercise tolerance functions, b7300 Power of isolated muscles and muscle groups, b7353 Tone of muscles of lower half of the body, b740 Muscle endurance functions, b755 Involuntary movement reaction functions, d4153 Maintaining a sitting position, e140 Products and technology for culture, recreation and sport, and the personal factor of body awareness.

Several intervention targets and the cycle goals identified for Lisa are intertwined. For example, the cycle goal of ‘increased participation in recreation and leisure’ and the personal factor of coping with spinal cord injury (SCI) are intrinsically linked. In Lisa's case, coping with SCI was associated with the broader service-program goal of ‘independence in daily living’ rather than isolating it to ‘increased participation in recreation and leisure’. Lisa's ability to cope with her SCI is also associated with another intervention target that is of special importance for the ‘increased participation in recreation and leisure’, that is, Lisa's fear of falling. This is reflected in b152 Emotional functions.

To achieve Lisa's three cycle goals, environmental and personal factors were also considered. For example maintaining Lisa's high level of body awareness and intrinsic motivation was seen as essential to achieving Lisa's cycle goals of ‘improvement in mobility’ and ‘increased participation in recreation and leisure’. An optimal wheelchair for various purposes was important for all the cycle goals as well as for Lisa's service-program goal of increased independence in daily living.

All of Lisa's intervention targets were documented on the ICF Intervention Table that was employed during the intervention phase of the Rehab-Cycle^®.