Assessment (5 months following SCI)
Five months following the accident, the last Rehab Cycle began with an overall assessment including the patient and the health professional perspectives in all components of functioning and the environmental and personal factors which were recorded in the “ICF Assessment Sheet”. The ICF Core Set for SCI in the early post-acute situation was used as a basis for this assessment. The results of this Assessment were integrated into the “ICF Assessment Sheet” (Figure 1) and the “ICF Categorical Profile” (Figure 2).
The next step in the assessment was the definition of rehabilitation goals: The Global Goal was defined as ‘Community Integration’. As one important step to achieve the Global Goal, the rehabilitation team agreed on the Service Program Goal ‘Independence in daily living’. To meet the Service Program Goal of ‘Independence in daily living’, the Cycle goals focused on the solution of problems related to Ben’s vocational integration, mobility and housing situation. The legal framework especially legal claims would play an important role in this regard.
1. Vocational integration
Having to face problems related to the SCI, Ben was unable to complete his apprenticeship as a carpenter. Vocational counseling had already been initiated shortly after admission to the rehabilitation center. In the first phase, interests and wishes had been explored (see case study 7: Vocation and Employment in SCI patients). However, at this point in time there were still some open questions:
- Is everything organized for the transitional period until the start of the new apprenticeship?
- Who is going to pay for the language course which is planned in the United States of America?
- Is everything clarified in connection with daily allowance until the start of the new education?
- Is everything organized in relation to the internship with the new employer?
The fact that Ben’s capacity regarding his mobility and using transportation has been evaluated as limited and hence, would restrict his work reintegration, the health professionals planned to focus on his ability to drive a car. To buy his own modified car was also a central aim that needed to be addressed. Regarding this issue, there were some open questions too:
- What needs to be done to be allowed to take the exam for the driving license?
- What car modifications are needed?
- Are all the financial issues clarified?
3. Housing situation
Being suddenly dependent on a wheelchair required not just a modified car but also an accessible home. The previously conducted needs assessment resulted in a list of necessary modifications. However, there were still some open questions:
- Have all the modifications to the home been made realized and is it therefore now accessible?
- Who is going to pay for all the modifications to the home?
- What does , living independently in an apartment mean?
Box 2 provides some general considerations to the problems relevant to a person with SCI and why these issues are important to be incorporated in legislation.
Box 2 | Spinal Cord and the impact of Legislation
The determined Cycle Goals were the basis to plan the rehabilitation program until his discharge from the rehabilitation centre one month later.