The Rehab Cycle - Functioning status
Mr. Dee and his healthcare team began the assessment by determining his functioning status, identifying his problems and needs through his own perspective as well as those of the health professionals. For the health professionals’ perspective, a list of ICF categories was used as a guide.
Two weeks following the accident, his healthcare team found decreased joint mobility in his ankles, muscle tone functions that showed severe spasticity in the lower extremities and severely reduced muscle power functions in Mr. Dee’s legs, arms and trunk. As a result of these limitations, he had generally reduced involuntary movement reactions.
Mr. Dee’s touch functions were impaired in the areas below his level of injury along with the skin’s protective function. Urination and defecation also proved to be problematic, as he could not control either.
Table 1: SCIM score two weeks following trauma
In aspects of activities and participation, his healthcare team found “severe” and “complete” problems in changing and maintaining body positions, transferring himself, fine hand use, and accordingly, many of the activities of daily living (e.g., self-care) where he would need a minimum of mobility capacity.
The spinal cord injury measure (SCIM) was used to measure his independence in daily activities. Overall, his score at admission to rehabilitation was low, with scores for self-care, in-room mobility, and outdoor mobility of 0, 1, and 2, respectively.
The team also recognized the importance of both remunerative employment and Mr. Dee’s overall reintegration into his community.
The patient's perspective
Mr. Dee’s symptoms were made evident in the patient perspective. He felt both the abnormal functioning and lack of control of his hands and legs, along with an overall lowering of sensation – sometimes even numbness – in his extremities. Added to this was the fact that he felt spasticity increase with activity.
Overall this was worrisome to him, particularly with regard to his ability to work. Mr. Dee had concerns about the “strength of his spine” and whether it might someday support the physical demands that farming required.
Activities that he felt limited in included grasping, walking, and washing. Mr. Dee found this was often a result of spasticity. Perspectives in participation centered on work. Mr. Dee foresaw the challenges that returning to his vocation would present and worried about earning an income.
Contextual factors – both environmental and personal – were also assessed. Mr. Dee had a number of barriers with regard to his former living situation, primarily related to issues of access: his house on stilts; the uneven ground surrounding his home; and a single pit toilet removed by 20m from his residence.
Other barriers included his limited financial resources, no assistive devices, and the physical demands of his vocation as a farmer. However, there were also facilitators that would help with his rehabilitation: a supportive wife and family; access to healthcare; an educated daughter; and, from his own perspective, an acceptance of his situation.
The results of the findings were entered into the ICF Assessment Sheet (Figure 1) and ICF Categorical Profile (Table 2).
Figure 1: ICF Assessment Sheet (Cycle goals are marked in the sheet)
Figure 2: ICF Categorical Profile *ICF Qualifiers range from 0 = no problem to 4 = complete problem in the components of body functions (b), body structures (s), activity and participation (d) and from -4 = complete barrier to +4 = complete facilitator in the environmental factors. In personal factors, the sign + and - indicates to what extent a determined pf has a positive or negative influence on the individual’s functioning. °C1,2,3 mark the relation to Cycle goals 1,2,3; SG is related to Service Program Goal, G related to the Global Goal ICF Assessment Sheet (Cycle goals are marked in the sheet)