I live with the things that I have and those that I can do, not with the things that I lost.
Martin, after his discharge
The path from an accident and spinal injury to a patient’s reintegration into his former community represents a dramatic transformative process. The rehabilitation involved presents SCI patients and healthcare providers with numerous challenges extending beyond those afflicting body structures and functions. Continuity of care in this process is critical and most often requires additional, non-medical interventions in order to achieve the best outcomes.
As each patient differs in their available resources, personality, barriers and injuries, these interventions need to be individually tailored, allowing for enough flexibility to be able to adapt to the process and changes that occur along the way. Furthermore, healthcare workers planning reintegration interventions need to consider a wide variety of factors that could promote or hinder progress in the transition.
The application of ICF-based tools allows for the consideration of multiple factors and perspectives in the patient’s comprehensive assessment; intervention planning and implementation; and final evaluation. The Rehab Cycle offers one good framework for structuring such a transitional rehabilitative program.
For Martin and the healthcare team, their efforts while applying the multidisciplinary approach of the Rehab Cycle and its interventions offered many successes, each providing a degree of independence necessary for his long-term reintegration to his community. Martin’s vocational counseling resulted in clear accomplishments and his prospects for the future looked promising.
While his next steps were already established, the vocational counselor would make himself available for any career-related needs Martin might have in the future. Martin’s housing situation had been settled, with a bold, new phase beginning as he moved into an apartment on his own. In the face of this development, he found himself apprehensive and uncertain, but gathered strength from the fact that he would remain in his community.
With an adapted car and driver’s license, Martin’s access to independent transportation was greatly increased. Through his pro-activeness and self-discipline, he discovered new possibilities for recreation that will do much to improve and maintain not only his physical health, but also his self-esteem. In the few areas where he fell short of the set goals, more work will be needed.
Lastly, regarding movement-related functions, pain management will rely on avoiding intensive stress on the spine over the next six months; it was determined that Martin will attempt to deal with the remaining spasticity on his own.
Upon completion of the final Rehab Cycle, the sum of the accomplishments can be seen as even greater than the achievement of the individual interventions. Despite Martin’s normal apprehension regarding independence, the overall improvements to his physical functions, activities and participation gave him the strength, courage and capacity to leave the rehab facility. Martin’s Global Goal of community reintegration was being realized.
Three weeks after his discharge, Martin’s own words best describe his situation:
I just arrived from a holiday in Austria! Everything is working out well. I’ve got so much to do, appointments about my insurance and with others who are supporting me… the rest of the time I meet my friends and family. It’s so much better than being bored with nothing to do.
About my fear of returning home, I now realize that things work out all right. And if not, I can accept it. I’ve found a calmness and patience in me that I never had before.
The new flat is great and I’m very much enjoying living on my own, although some things still have to be adapted to make life easier. For instance, the kitchen and bathroom need to be made a bit more accessible, like with cabinets I can reach and a washer and drier and other little things like that.
In a few weeks I’ll start working at my old employer. He’s arranged a new position for me… I don’t know the details, but he says I need to have a clear idea of my future. If I have that, then he’ll support me with a job. As soon as possible I want to start a vocational coach training. I can’t describe how excited I am about this, to be helping others who are in a similar situation as I was… I’m really looking forward to the future.
Community reintegration is the final aim for the lengthy rehabilitative path that a person with a severe spinal cord injury must take. In the continuum of rehabilitation, this reintegration preparation is no less critical than other the other stages of the process and presents patients and healthcare teams with a set of multi-faceted challenges.
Based on Martin’s assessment and disease progression, the desired outcomes focused on vocation, mobility, housing, recreation and movement. For other patients (or even for Martin at a later stage), a set of different issues may be relevant. Relationships and sexuality, education, substance abuse and other psychological issues are all examples of other areas where interventions might be necessary for arriving at the final goal of community reintegration.
While many aspects of reintegration lie with the patient himself or herself (think of Martin’s initiative), healthcare professionals play an equally important role in the outcome. Their efforts and the resources they bring are an integral part of the process. Flexible patient-centered and goal-focused approaches help healthcare professionals appropriately plan for and implement the difficult process of attaining community reintegration goals.
Given the challenges that community reintegration presents to the patient, support and guidance from healthcare providers is essential for a smooth transition.
While many aspects of reintegration lie with the patient himself or herself, healthcare professionals play an equally important role in the outcome.
Despite the life-altering accident, Martin was fortunate in the end to have had both the disposition and the professional assistance necessary to achieve a great deal over the course of his rehabilitation. At the conclusion of this case study, he is well on his way to rejoining his community, renewing his life and starting a new career in which he can find pleasure and take pride.