While Global goals are broad and often common among SCI patients, based on community integration and independent living, the steps toward these goals can differ greatly from patient to patient. Simon noted specific hopes – to run and mountain-bike again, to be able to drive and to relearn to swim – with some perhaps more achievable than others.
Given Simon’s consistent improvements up until this point, along with his interests and hopes, a Service Program Goal of resuming leisure activities was established. Achieving this would be a big step towards reaching a Global Goal of community integration without limitations.
Informed by the assessment’s findings – particularly Simon’s perspectives on his activities – two Cycle Goals were defined that would help him resume optimal performance in leisure activities. The first Cycle Goal (CG1) was to improve Simon’s locomotion (based on Simon’s activities need to run, drive and mountain bike again); the second (CG2) was to improve his abilities of carrying, handling and moving objects (based on Simon’s activities need to “grab objects” better).
Determination of intervention targets
The overview provided in the ICF Assessment Sheet is useful for not only determining goals but also integral in the subsequent selection of intervention targets. In Simon’s case, most of these were clear. With respect to CG1, the selected targets would focus not only on increasing locomotion through devices and driving, but, based upon his progress and prognosis, also support and improve his walking ability.
Here, there were a set of specific body functions that needed to be addressed. These included Simon’s reduced muscle power and balance functions, the impairments in muscle tone functions (spasticity), gait patterns and coordination of voluntary movements. The improvement in respiratory and exercise tolerance functions also would contribute to increase Simon’s locomotion.
In terms of activities, a number of mobility-dependent targets were identified. Simon’s limited ability to walk extended distances or up stairs would need to be improved, along with his ability to drive. The availability and use of assistive devices (crutches and a wheelchair) would help with Simon’s mobility over longer distances.
The intervention target relationships to CG2 are shown in the ICF Assessment Sheet (Figure 1). Notably, there are a number of targets that overlap with the first Cycle Goal, illustrating how closely related the Cycle Goals are.
Figure 2: ICF Assessment Sheet