Adolescence: A Time of Changes and Challenges

In understanding the challenges faced by adolescents with disabilities, it is important to recognize that for most adolescents, with or without disability, is a period of rapid and dramatic changes that present quite a number of challenges. This is a time of not only biological development, but also of significant cognitive, psychological and social change.1 It is a time of transition that prepares each young person for adult life. During these years, a number of developmental tasks are involved.

  • Developing a self-identity (including values, personality and sexual identity)
  • Reducing one’s physical, emotional and financial dependence on parents and caregivers
  • Developing social relationships (primarily with peers) through appropriate behaviour and communication skills

Starting to learn a vocation or other significant way of spending time2In the process of searching for, creating and defining identity, peer relationships become more important as familial connections recede to some degree. Among groups of peers, adolescents often “compare themselves to others, test and develop their roles, and interpret others’ impressions of their own identity.3” Identity helps to forge an understanding of the “complex relationship between individuals and society.”4

Read more: General Introduction

Gabi's Story

Gabi was born with spina bifida and has been living with the condition for 15 years. For her, this has meant living with paraplegia below the level of the third lumbar vertebra. Over the years, Gabi has grown and learned to cope with many of the functional limitations that resulted from this condition, achieving some degree of success in managing its associated impacts on her and her interactions with the environment.

Read more: Gabi's Story

Assessment and Goal Setting

The Rehab Cycle

At the beginning of the rehabilitation program an assessment was performed to identify Gabi’s and the health professional’s perspective of the current functioning status. These perspectives would help to define the individual Global, Service-Program and Cycle Goals and included an interview with Gabi as well as tests and examinations performed by the health professionals.

Read more: Assessment and Goal Setting

Figure 4: ICF Evaluation Display

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. In personal factors, the sign + and - indicates to what extent a determined pf has a positive or negative influence on the individual’s functioning. °CG1,2 mark the relation to Cycle goals 1,2,3; SPG is related to Service Program Goal, GG related to the Global goal

At the end of the three-week program, Gabi’s progress was evaluated (see Figure 5 for a complete overview). Based upon assessments of whether or not the specific goals for each intervention target were attained, the health team concluded that the Cycle Goal of improving self-care was achieved.

Gabi achieved the Service Program Goal of increased independence.

Her mobility improved a little but still remained a moderate problem. However, based upon her gains among these Cycle Goals, Gabi achieved the Service Program Goal of increased independence. Among the details, however, were some important qualifications that will be discussed below.

Read more: Evaluation


With both improved medical therapies and surgical interventions available for treating spina bifida, those born with the condition are living longer lives of improved quality. As life expectancy increases and more SB patients live into adulthood, new bio-psychosocial problems related to the transition from adolescence to adulthood arise.

Growing up with physical disabilities such as spina bifida presents adolescents with a range of challenges – not only for body structures and functions – but also for activities and participation.

Read more: Discussion