Jason’s Rehab Cycle lasted three months and was completed seven months post-injury when an evaluation took place. The results of this evaluation were entered into the ICF Evaluation Display (Figure 4). By the end of the Cycle, Jason had achieved each of his Cycle Goals – and in turn, his Service Program Goal of increased independence. This was evident in his final SCIM score of 90 (increased from 65 at admission) (Figure 5).
Figure 4: Changes in the Spinal Cord Independence Measure (SCIM) over the course of Jason’s rehabilitation program
Cycle Goal 1: Walking
At the completion of the Cycle, Jason was able to walk – and even jog – independently without the use of assistive devices on a range of surfaces and terrains. Due to decreased stability when he walked longer distances or more than 30 minutes, he would use crutches to reduce his risk of falling.
Among the intervention targets, he showed improvements all around: higher muscle power, better joint mobility and stability, improved gait patterns and overall mobility. Many affected muscle groups were now able to perform ‘active movement (against gravity and resistance) with a full range of motion’ – quite a contrast from the ‘total paralysis’ in these same groups that was measured at admission.
Cycle Goal 2: Sports
Jason’s enthusiasm for sports activities returned slowly as the Cycle progressed. From an initial lack of focus in some of the group activities (e.g. swimming), he began to fight for his right to engage in others (basketball), also accepting the potential negative consequences that were made clear by his therapists. Towards the end of this Rehab Cycle, Jason was able to pass a physical fitness test that resulted in a “sports pass”; this gave him the chance to use the facilities whenever he wished. His doctor has encouraged him to continue his athletic activities, but advised him not to compete as it may put him at risk of further injury, particularly to his spine.
Cycle Goal 3: Health Maintenance
Jason had achieved better health maintenance, gaining weight and improving his skills at body parts care, skin care and dressing. His emotional functioning was much improved and he was no longer taking the anti-depressant. His enthusiasm for sports also was clearly a direct benefit to this goal.
Regarding the Global Goal of successful community reintegration, the health care team felt that Jason had good prospects given his progress. The vocational rehabilitation team in the clinic had managed to negotiate a transitional solution for Jason with his old employer giving him the prospect of fully rejoining his apprenticeship program.
Jason’s motivation was presumed to be a likely facilitating factor in his achieving all Cycle Goals. His health care team believed that had he remained unmotivated and disinvested in the interventions, the outcomes would have been quite different. His physiotherapist shared some thoughts on the matter:
Initially, I tried to reason with him to motivate him; I explained I was on his side and there to support him, but could only do so if he let me. When that had no effect, I tried to leave him alone – if he didn’t want to do an exercise, then ‘Fine,’ I would tell him, ‘don’t do it, you can leave the clinic in a wheelchair.’ At some point the idea clicked that he was responsible for himself. I’m not certain what the real reasons were, but Jason changed his behaviour. I think he has just really grown up during this process. He’s an adult now.
Sometimes it was really hard to motivate myself. The routines every day were tiring…In the end, what I wanted was to walk again – by the end of this rehabilitation I just wanted to walk.
Jason on his change in attitude
ICF Evaluation Display