Each of the intervention targets was assigned to a member of the healthcare team which included a physician, a nurse, both a physical and an occupational therapist, and a social worker. As a team they planned and implemented appropriate interventions intended to improve the specific targets.
Table 3 gives a detailed view of targets, interventions and their assignments. Each intervention would be evaluated at the end of the six-week cycle.
Interventions for both self-care and the prevention of complications were primarily undertaken by Mr. Dee’s physician and nurse. Regular urinalyses and occasional sterile catheterization (to empty the bladder) were conducted to help compensate for the lack of urination functions. Medication was given to influence the increased muscle tone in the lower extremity. Through one-on-one training, the nurse helped Mr. Dee improve activities related to self-care – washing, dressing, caring for his body – and instructed him on looking after his health and preventing complications. Mr. Dee’s wife would also be integrated into many of these instructional sessions to improve her ability to care for him.
Mr. Dee’s physical and occupational therapists primarily focused on interventions aimed at improving mobility. Stretching and active, assistive range of motion (ROM) exercise was implemented to improve muscle power, joint mobility and muscle tone. While the PT additionally focused on specific daily trainings to improve body balance, gait patterns, transferring skills and walking with a walker, the OT focused on the improvement of activities in the upper body like fine hand use and handling objects. The combination of therapeutic games and the fitting of adaptive devices for hand use were aimed to facilitate these improvements. Finally, each team member would help increase Mr. Dee’s (and his wife’s) knowledge about his disease. A social worker would also add to his counseling, particularly with regard to health services and policies that might be of relevance.
All of these interventions were performed in a rehabilitation setting with limited financial resources. For instance, expensive rehabilitation equipment such as a locomat, a therapeutic swimming pool, and gymnasium were not available.
However, a professional and well-trained staff that was both resourceful and knowledgeable applied other appropriate techniques for rehabilitation where such equipment was lacking. Simple devices were often utilized in physical therapy – a hand crank to improve muscle power; a stationary bed for exercise in changing basic body positions and simple, inexpensive devices to train fine hand function and hand and arm use are some examples.
After receiving instruction from the nurses, Mr. Dee’s wife could take over responsibility in caring for her husband in many self-care activities.
Figure 3: ICF Intervention Table; ICF codes, targets, interventions and assigment. PT: MD: Medical doctor, Physical Therapist, OT: Occupational Therapist, SE: Social worker. The values are rated within the ICF qualifier