As this Rehab Cycle ended, it concluded five complete months of rehabilitation since the accident. Ingrid showed little progress with regard to her emotional well-being. Besides coping with her injury, she had now needed to cope with the break-up of her relationship. Both of these stress factors led to increased difficulties with handling stress. This particularly affected her participation in the treatment sessions. As a consequence the health care team decided to reduce the intensity of her physical rehabilitation to support her emotional state during this Cycle.

As an overview of Ingrid’s functional improvement during this latest Cycle, her SCIM (Spinal Cord Independence Measure) score increased from 8 to 20. A modest improvement in a number or areas: self-care and indoor/outdoor mobility increased slightly; in-room mobility (including transferring) remained at 0, but wheelchair mobility increased to two; and respiration and sphincter management also increased from eight to ten.

Figure 4: SCIM (Spinal Cord Independence Measure)

Figure 4: SCIM (Spinal Cord Independence Measure) scores from beginning to five months following SCI.

These SCIM scores help to illustrate few gains Ingrid made in this cycle, but also highlight her shortcomings. In sum, Ingrid achieved her goals for moving and handling objects and for self-care. These improvements were based on the advances made to intervention targets such as muscle power functions in the upper extremities and improved movement related activities (such as fine hand use, hand and arm functions and techniques for activities in self-care). However, Ingrid made only limited gains in the use of her hands (including fine hand functions) and arms. At the Cycle’s end, she was still able to hold light objects such as adapted cutlery.

With better hand/arm functioning, Ingrid could undertake some self-care activities with greater skill. Slight progress was made in washing, dressing and caring for her body. Unfortunately, these gains did not greatly reduce her dependency and she continued to require assistance for these activities.

Ingrid also did not reach the goals set for her mobility. The goal value for mobility was set at one, which would have corresponded to major improvements. The maintenance of the blood pressure improved, but remained beyond normal values and continued to impede her mobility. Although she improved her skill at maneuvering a manual wheelchair, transferring herself from the wheelchair to the bed and vice versa remained a problem. Improvements here would likely have required more intensive training. Spasticity also impacted her mobility.

Although she improved her skill at maneuvering a manual wheelchair, transferring herself from the wheelchair to the bed and vice versa remained a problem.

At the beginning of the Rehab Cycle it increased, but improved during water therapy. Unfortunately, these gains remained only during the therapy interval and spasticity returned once the intervention stopped. Lastly, some improvement was made to Ingrid’s abilities at changing positions. However, undertaking these activities highlighted her loss of functioning and contributed to her feelings of stress.

It’s all quite hard to accept; all the interventions in the day just exhaust me. Add to that my impatience, my feeling sad much of the time, the uncertainty. Nothing is improving as I expected and I feel constantly as though I’m waiting for things to get better…and I know I take out much of my frustration on the staff. I have to be patient and I’m finding this very difficult to accept.

Ingrid, after the Rehab Cycle (5 months post-accident)

Figure 5: ICF Evaluation Display

Figure 5: 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. CG1,2,3 show the relation to Cycle goals 1,2,3; SPG is related to Service Program Goal, GG related to the Global goal