At the end of the Rehab Cycle, Mr. Wun’s gains were only modest. Some interventions resulted in slight improvements, while others only maintained Mr. Wun’s conditions without worsening them. The problem of the impaired healing of the tracheostomy incision, for example, remained and consequently impacted his related bodily functions; a follow-up surgery would be required. Urination and defecation functions remained completely impaired, but intervention targets were still achieved because no further complications arose (e.g. urinary tract infections, bowel impactions, etc.).

Mr. Wun left the Cycle with better self-care skills.

Nevertheless, the single Cycle Goal that was achieved was improving mobility, primarily as a result of increased hand and arm use, although unfortunately his ability to change his body position did not improve. In other areas, Mr.Wun’s spasticity was reduced and he left the Cycle with better self-care skills. However, Mr. Wun’s SCIM score only increased slightly, from 12 to 15 – mainly through improvements in respiratory function and, to a lesser extent, in his indoor mobility. Mr. Wun’s gains in the area of environmental accessibility were negligable.

The improvements to mobility – just one aspect of increasing access – did not make a significant difference to most of the accessibility issues that concerned him. He was still not be able to have access to the environment independently.

Figure 4: ICF evaluation display

Figure 4: ICF Evaluation Display: ICF Qualifiers 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. 1,2,3 show the relation to Cycle goals 1, 2, 3; SG is related to Service Program Goal, G is related to the Global Goal.

The interventions undertaken in this Rehab Cycle could only ever have limited effects in the face of the environmental barriers that still existed throughout Thailand, including the area in which he lived. Despite recent changes in laws and ratification of the UN Convention, for Mr. Wun’s access to the world beyond his home would unfortunately remain largely out of reach and would have to wait until these policy changes were translated into concrete infrastructural improvements.

Despite his improvements in mobility, Mr. Wun will continue to have problems with accessibility to his community because of the existing environmental barriers. These we can’t do much about – even an expensive electric wheelchair is not going to overcome them.

Mr. Wun’s physical therapist

Evaluation