Despite the overall improvement in Simon’s functioning and some degree of improvement to most of the intervention targets, these gains were not sufficient to meet the Cycle Goals. Simon fell just short of achieving the aims set at the start of this Rehab Cycle. Nevertheless, his outlook remained positive:
I never expected to make so much progress so quickly. Now I can swim and ride a bike, but there are still some challenges. I’m nervous while swimming and can’t yet get onto a mountain bike, which I find really disappointing. But I know these will also improve with time and practice.
Some of Simon’s reflections, post-Rehab Cycle
I never expected to make so much progress so quickly.
Over the two-month course of this Rehab Cycle, Simon’s progress continued, and there were measurable improvements to his condition. First and foremost, the overall improvements to his condition were reflected in an upgrade to his ASIA score. At the end of this cycle, Simon’s impairments were designated an ASIA D, meaning his motor functions were preserved below the neurological level with at least half of the key muscles graded at three or better.
Simon could now walk independently for up to 15 minutes.
The results of Cycle Goal 1 interventions (Locomotion) were evident in Simon’s improved walking ability: muscle power functions increased in power from total paralysis to grade five for some muscles, and his gait pattern and control of voluntary movements were synchronized. These advances worked to improve his walking skill overall; Simon could now walk independently for up to 15 minutes.
However, due to his reduced muscle strength and endurance, his ability was still limited; beyond this limit he required the use of crutches. Furthermore, his risk of falling also increased, and uneven surfaces such as grass or sand continued to present difficulties. The latter was a result of his impaired proprioceptive functions. Simon’s exercise tolerance also remained limited. In terms of mobility, Simon’s spasticity and reduced leg strength limited him to driving a car with an automatic transmission.
Figure 4: ICF Evaluation Display: *ICF Qualifier range from 0 = no problem to 4 = complete problem in the components of body functions (b), body structures (s), activity and participation (d) and from -4 = complete barrier to +4 = complete facilitator in the environmental factors. °1,2,3 show the relation to Cycle goals 1,2,3; SPG is related to Service Program Goal, GG related to the Global goal
As for Simon’s own perspective on his gains towards CG2, he felt more secure walking without assistive devices due to improved balance and reaction functions. However, some limitations still existed: he was insecure maneuvering on stairs and too weak to run. To accommodate the remaining challenges to his walking ability, Simon used a wheelchair and crutches for moving outdoors and for longer distances.
"Simon improved his balance and reaction functions significantly over the past two months. His risk of falling has really decreased, especially on even surfaces and over short distances. He still needs to improve his walking on uneven ground."
Simon’s occupational therapist, at the conclusion of the Rehab Cycle
Based on a dynamometer analysis, Simon demonstrated increases of up to 50 percent of his pre-Rehab-Cycle® values in muscle power funtion in both hands.
The interventions that aimed to achieve Cycle Goal 2 (carrying, handling and moving objects) targeted sense and touch functions, lifting and carrying ability, hand and arm use and meal preparation.
Based on a dynamometer analysis, Simon demonstrated increases of up to 50% of his pre-Rehab Cycle values in muscle power function in both hands.
While this represented a significant gain, this was still less than half of the hand force produced by a male without SCI. The combination of weak muscle power and absence of sensitivity made it difficult to carry out some daily tasks such as typing, exchanging a printer cartridge or carrying heavy jars. Nevertheless, he felt confident in many other daily tasks – from using a cup to preparing simple meals.
"While Simon’s shoulder mobility, fine-hand functions and muscle power all improved considerably, his touch functions haven’t changed since the start of the Rehab Cycle. This will continue to limit his fine-hand functions."
Simon’s physical therapist, at the conclusion of the Rehab Cycle
One of Simon’s hopes was in the area of recreation and leisure. Here he was able to make some modest gains. Prior to the accident, he was an avid mountain-biker; at the conclusion of the Rehab Cycle, he was able to ride a woman’s bike, whose frame configuration makes it easier to mount. However, in recreation and leisure he didn’t entirely meet his specific goals.