The health professionals described, among other problems, reduced functional mobility of joints, muscle endurance, and increased muscle spasms and therefore all members of Ida’s rehabilitation team were involved in the broad range of interdisciplinary interventions that focused on her two cycle goals. These included her physician, nurse, physical, occupational and sports therapists, as well as her psychologist. Pharmacological interventions were still included and should be adapted to the situation.
As the result of a discussion between the medical doctor and the psychologist, medical anti-depressant therapy was prescribed. While specific drugs were able to mitigate some pain, it was clear that these alone were insufficient to improve her overall participation. Hence, in addition to the pharmacological therapy, a majority of interventions were non-drug based. In order to improve pain management, many interventions centered on improving Ina’s ability to cope with stress. Therefore Ida’s psychologist undertook extensive counseling on pain, coping strategies and carrying out a daily routine.
Additionally, there was a focus by all of the team to provide counseling and support to improve her emotional state. Furthermore, counseling was also provided to Ina’s immediate family to enhance their ability to support her. In particular, Ina’s husband was considered an important facilitator in improving her quality of life and ensuring his capacity to care was a critical element of attaining the cycle goal. Additionally, for building coping strategies, interventions utilizing arts, music and sport therapy were integrated. These included exercises involving singing bowls and painting that promoted focus and relaxation. Sports therapies included table tennis and swimming.
Interventions that aimed concurrently to increase Ina’s level of mobility included:
- Body balance training including hippotherapy for maintaining a sitting position
- Transferring training to and from different heights, surfaces and paddings
- Training with assistive devices including wheelchair and SwissTrac
- Muscle endurance and body balance training (throwing balls, catching balls, lifting body on push bars etc.)
- Sports including swimming, archery and table tennis (although only irregularly)
All interventions were assigned to the different health professionals and entered into the ICF Intervention Table (Figure 3). This treatment program was in initially planned for four weeks but was extended to seven weeks due to problems of finding the right dose and choice of medication in the beginning of her pain management program. Furthermore, Ida wanted to `test` arts, music and hippotherapy for a longer time to be sure that this would provide her with the adequate tools to manage her pain.
Figure 3: ICF Intervention Table PT: Physical Therapist, Spo: Sport Therapist, Psych: Psychologist, MD, Medical Doctor