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.
The results were entered into the ICF Assessment Sheet (Figure 1) and the ICF Categorical Profile (Figure 2).
Gabi very much wished to decrease her dependence on her family. In her daily activities she required much assistance, particularly in dressing, which resulted in complete dependence when using the bathroom. This in turn meant she could not be left alone for any extended period.
She also felt limited in mobility due to her stiffened spine, but thought of her muscle power as normal (as it had never been different). As a result of the spinal fixation and the relatively short length of her arms, her mobility with a wheelchair was limited; she was not able transform the hand-bike to the wheelchair independently and needed constant assistance in transferring from the ground to the wheelchair.
In sum, Gabi felt mobility and self-care were critical factors for independence. In addition, emotional instability played a role that would need to be addressed.
Gabi’s experience of limitations in activities was not only related to movement, but also to mental acuity. She felt that she was “slow in understanding,” normally needing more time than others to complete homework – a fact that further reinforced her “difference” within the classroom.
Academically, her perceived learning difficulties were confirmed by receiving consistently poor grades.
Aspects of participation also played a major role at this time and related also to school: the subject of peer relationships was intimately bound with schooling and she described this in a number of her concerns. Socially she found her relations to fellow non-wheelchair using classmates, whom she referred to as “walkers,” to be “stressful.”
She was subject to regular teasing and being excluded by them. However, she also recognized a very real and qualitative difference in her relationships with other teenagers who were in wheelchairs. The difference was dramatic: her feelings were more open and she could better communicate, relate to and enjoy their company.
Lastly, it was not just peer relationships that were causing her stress in school – since she would soon begin her final school year, she was beginning to have concerns about future possible vocations.
The health professional described limitations in three main areas that were in close agreement with Gabi’s own assessment: mobility, self-care and peer relationships. Factors such as pain, limited joint mobility and limitations in activities such as changing body positions, transferring, moving outside of the home, use of a wheelchair and transportation all reduced her mobility.
Among those factors that lowered her ability to perform self-care were urinary system dysfunction and limitations in a number of activities including carrying out a daily routine, changing her body positions, transferring herself, caring for body parts, toileting and dressing and looking after her own health. Finally, the health-care team felt that peer relationships were closely related to her emotional functions, and that these influenced and impacted each other.
Accordingly, Gabi showed limitations in interpersonal interactions and informal social relationships, primarily with persons without disabilities. Also relevant to her social functioning, Gabi was thought to have low assertiveness and self-esteem, both of which tended to further restrict her participation at school.
She also recognized a very real and qualitative difference in her relationships with other teenagers who were in wheelchairs.
Figure 1: ICF Assessment Sheet. The aspects related to Global Goal ‘Peer relationships’ are highlighted with a circle. Related intervention targets are illustrated with the connecting lines.