I’ve always been the person to help others - now I need the help, but I feel like a burden... I now have a goal to work in the kitchen of our restaurant. I believe the more motivation you have, the better the healing...so I have to move forward. Once I get home, I’ll just have to see how it goes...

Conrad at the time of evaluation

Conrad’s interventions proceeded slowly over the four months following his admission and assessment. To evaluate the changes in his level of functioning, a re-assessment was performed; the results were entered in the ICF Evaluation Display (Figure 6). Although he achieved only one of his cycle goals (mobility), steady gains were made in many of the interventions and there were improvements that moved him towards the other two cycle goals (self-care and vocation). His SCIM score increased from 20 to 44, showing slight gains in mobility and bowel management.

Cycle Goal 1 (Mobility)

Interventions supporting mobility showed varied results. Conrad’s pain remained (also as a result of the colostoma closure and reduced physical therapy), although slightly less and with improvements in the lower limbs. His exercise tolerance and supportive arm functioning both improved, as well as his abilities at transferring and changing body positions independently. Conrad was able to now transfer from bed, shower and toilet to wheelchair and back. This also clearly had a positive impact on self-care, with an independent ability to toilet and wash. As a result of Conrad’s challenging living environment, there was a focus on wheelchair mobility. By the end of the Cycle, Conrad was quite skilled at maneuvering his wheelchair. However, much of his joint mobility and muscle power lacked major gains and the protective functioning of the skin remained impaired.

With regard to environmental factors influencing his mobility, permits for home reconstruction were still in process, leaving him and his wife to temporarily cope with a non-wheelchair accessible house. This was eventually done by Conrad through ascending stairs in a sitting position by using his arms. However, this was beginning to cause increased pain and shoulder/arm complications. Funding for reconstruction was not covered by insurances and was being sought through a foundation.

Conrad fears not being independent, of having to turn to those he’s helped and supported in the past. He really loathes the thought of becoming a burden.

Conrad’s Physical Therapist at the time of evaluation

Cycle Goal 2 (Self-care and health maintenance)

Conrad had mixed results. He began the Cycle with significant limitations in washing, self-care, caring for body parts and looking after one’s health. Given his improvements to mobility by the end of the Cycle, he could perform a number of these activities independently: washing, showering and caring for body parts. There were some improvements to regulating urination and defecation, however, he was still not able to self-catheterize for urination. A fixed catheter was placed through his abdomen that would need to be maintained. His colostoma was closed surgically and was healing well, though he now needed to learn to purge his bowel contents. Difficulties remained in dressing independently and he continued to depend on his wife for this activity.

Cycle Goal 3 (Economic self-sufficiency)

Regarding Conrad’s remunerative employment perspectives, Conrad’s social worker held regular discussions with both him and his former employer, exploring potential solutions for his continued employment. Included here were part-time administrative positions and work-from-home options; unfortunately, none of these ideas could be agreed on during his stay at the rehabilitation center.

Conrad has worked with his employer for 30 years...His employer is a bit stuck in finding a solution, but I think they will find a place for him in the end.

Social Worker

Financial perspectives: At the time of evaluation, Conrad was receiving 80% of his former salary through his health insurance.
Design technology: Efforts were underway with support from the social worker for the feasible redesign and reconstruction of Conrad’s home to improve accessibility.
Assistive devices: A foundation had committed to provide financial aid for assistive devices. Again, no household assistance was available and Conrad’s wife and family members needed to take on much of this responsibility.

Conrad’s situation over the past months has been very difficult for him…the future seems just as challenging: the financial uncertainty, the building permits, the reconstruction of his home. Conrad has worked long and hard for his home, for his retirement. Moving somewhere else that’s more wheelchair accessible just isn’t an option for him at this point.; These things are moving forward only very slowly - it isn’t an easy process at all.

Social Worker at the time of evaluation