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.
However, improvements to her peer relationships and community integration could only be evaluated in the context of the rehabilitation centre. Whether or not Gabi’s improved social skills resulted in increased emotional stability in her normal environment – particularly at school – would have to be assessed in the near future.
Gabi made improvements in both respiratory functions and reducing pain sensations, but there was no change in the areas of increasing muscle power in her arms and, accordingly, no improvments in the supportive functions of the arms, which would have been important for increasing her transferring skills.
Among the specific intervention targets, Gabi made gains in a number of areas, while in others there were few, if any, changes:
Body structures and functions – Gabi made improvements in both respiratory functions and reducing pain sensations, but there was no change in the areas of increasing muscle power in her arms and, accordingly, no improvements in the supportive functions of the arms, which would have been important for increasing her transferring skills.
Activities – Gabi was better able to carry out a daily routine and made gains in a number of self-care activities:
- She was now able to dress herself, putting on her pants independently;
- She developed some techniques for catheterizing herself independently. Both this skill and dressing allowed her to use the toilet without assistance, although she still required an extended amount of time.
- With respect to looking after her health she developed more personal responsibility in caring for herself.
- In terms of mobility, she improved her ability to transfer herself into a wheelchair from the ground. But due to her lack of arm power, knee pain and the wheelchair design, she still needed assistance.
- Her ability to change body positions and move around outside the home with a wheelchair remained unchanged.
She really enjoyed being one of the "stronger" persons in the group; this in contrast to her experience at school.
Participation – Gabi’s psychologist felt that she had made significant improvements in creating strategies to deal with complex interpersonal interactions and informal social relationships. She was also better able to deal with stress and other psychological demands.
It is important to note, however, that this was based upon observations within the context of the three-week program for adolescents with disabilities. Whether or not these skills (along with her demonstrated assertiveness and social competencies) would be maintained in her home and school environments with non-wheelchair bound peers remain to be seen.
Gabi was well-integrated into the group and motivated in anything she was involved with. She always arrived in a good mood and with ideas of her own. In this context, she really enjoyed being one of the “stronger” persons in the group; this in contrast to her experience at school. This experience will no doubt have made her more assertive.
Gabi learned to communicate her fears and her wishes. We discussed her interactions at school quite a bit. I suggested that since uncertainty and a sense of inferiority appear repeatedly, she should continue regular psychological counseling.
She had made significant improvements in creating strategies to deal with complex interpersonal interactions and informal social relationships. She was also better able to deal with stress and other psychological demands.