The program lasted for three weeks; shortly before it ended an evaluation of goal achievements took place. Overall, Stefan made some significant steps towards independence. Despite the fact that he achieved only the mobility cycle goal, there were still some improvements in the area of self-care after three weeks of interventions (Figure 5).

Improved mobility was critical to overall independence and being able to attend his vocational course. Following this rehabilitation program, he could perform transfers from bed to wheelchair with supervision or, at most, minimal assistance. While other transfers required more support, he was certainly improving his skills. With training he was also better able to independently use the hand bike and, following a small technical adaptation, could dock the SwissTrack (pulling machine for the wheelchair) independently to his wheelchair on his own.

He could move his wheelchair independently on even ground, but still required assistance to overcome little steps and uneven surfaces. A new set of “faster” wheels allowed Stefan to maneuver more quickly. However, using the train remained a challenge: the elevators at the stations were unusable because the doors closed too quickly for him to move his SwissTrack inside; and on the train, he lacked enough time to undock and redock the SwissTrack, leaving his only option to block the train’s door.

Stefan’s arm power did not improve sufficiently despite the exercises. He also continued to have difficulties maintaining a sitting position and also had a fear of falling backwards. But his hand grip power had significantly improved compared to measurements taken in previous years.

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. °1,2,3 show the relation to Cycle goals 1,2,3; SG is related to Service Program Goal, G related to the Global goal

Regarding self-care, although the cycle goal set by the health care team was not met, he was now able to care for body parts in less time than before. And although washing and dressing took him on average 30 minutes, he could now perform both activities independently. Shaving remained a time-intensive task, but it was thought this too would become more efficient with practice. Unfortunately no significant improvements were made in Stefan’s abilities to care for body parts and look after his health; for these tasks, his mother or others would continue to play a critical role. Hence, his mother was involved in a session to optimize her support in these activities.

Stefan’s psychologist recognized the sophistication of Stefan’s coping strategies, noting that while he described himself to others as “dependent and lazy”, the description functioned as a useful defense of maintaining a status quo of dependency. On the other hand, Stefan had a side of his personality that was driven, in evidence by his intention of attending the year long vocational course and his mastery of the pan pipe. Efforts within this rehabilitation program resulted in some minor improvement in self-assurance (increasing from a negative to a “neutral” factor), though Stefan’s assertiveness could still be improved.