Ben, an 18-year old young man, was living with his parents and his younger brother in a house near Berne, Switzerland. He has a huge circle of friends, a girlfriend, and loves outdoor activities especially sports activities. As an enthusiastic freestyle snowboarder participating in international competitions, he was in the second year of his apprenticeship as a carpenter, when he suffered a spinal cord injury (Th 12, AIS A) as a result of a snowboard accident which happened during the European championships. He received first treatment including a spinal surgery in the clinic of the Canton Lucerne and was transferred to the Swiss Paraplegic Centre one day later.

In the acute phase of the SCI rehabilitation, Ben suffered from posttraumatic stress disorder, urinary tract infections and neuropathic pain. All of these symptoms could be treated successfully. Beside the provision of interventions focusing in impairments and activities of daily living, a number of additional issues, in particular the optimization of environmental factors had to be addressed to achieve Ben’s optimal participation and integration into community.

Ben’s vocational reintegration presented a challenge. Due to his accident he had to quit his apprenticeship as a carpenter and had to reorient himself toward a new occupational future. (See case 7 regarding vocation and employment in patients with SCI.) After receiving intensive vocational counseling, he eventually found a new apprenticeship as a merchant employee thanks to the network of his vocational counselor (VC). With the help of the VC he applied for financial support through the Swiss Paraplegic Foundation to take a language course in the United States of America. The VC also intervened with the Invalidity Insurance because they refused the application for financial benefits for the period of the language course at first and he initiated the process for the release from the mandatory military services because of Ben’s SCI.

Moving around independently was another crucial aim. To be able to use the public transport he received counseling on how to plan such an endeavor and to apply for a Disability Accompany Card from Swiss Federal Railways (SBB). With this card he would be able to travel accompanied by another person who have the status of a helping person and therefore travel for free. In order to enjoy more flexibility in terms of mobility, the need of an own car had been identified. The occupational therapist helped him to find out how to get the driving license. Orthopaedic technicians conducted a pre-driving assessment to clarify the functional capacity and the necessary mobility equipment and car adaptations.

A needs assessment conducted by the occupational therapist and the centre for independent living, identified the essential modifications to his home. The social worker in collaboration with his parents initiated the application for the financial benefits.

The legal framework played an essential role to organize all these interventions and ultimately, to achieve Ben’s community integration. It was essential for Ben to be aware of the legal context and his specific rights including practical advice as to not feel subject to the system. However, at this stage of rehabilitation he described his knowledge about his rights and claims with a “5 to 6 out of a scale from 0 to 10”, and more concretely, in one occasion, he said:

In theory, one learns about the social security system in school, but the need to really understand how it works becomes only important once you have to rely in the system. As a lay person it is almost impossible to have an overview about all laws and regulations and the related procedures.

Ben, five months following his SCI

After five months of rehabilitation without any major difficulty his discharge was planned for the following months. His SCIM Score was evaluated at 86 out of 100 approximately 3 months following SCI in comparison with 16 shortly after admission to the rehabilitation center. In general, his athleticism and his young age contributed to an extraordinary quick and unproblematic rehabilitation progress. However, there were still some open questions regarding the achievement of optimal community integration in the long-term. To ensure that Ben could exercise his rights and to increase his knowledge about them, every member of the rehabilitation team would have to support Ben in terms of practical advice in relation to social agencies. Ben’s social worker, his occupational therapist and the vocational counselor played an essential role in the rehabilitation process and another Rehab Cycle begun to address the unresolved issues.