Assessment – Helen’s Perspective
Helen’s tetraplegia left her with very little motor function. However, she could still feel sensations. As mentioned, her hope focused on increasing her ability to wash and dress herself and gaining use of her hands.
Additionally, Helen had a number of other needs. Due to weakened musculature around her mouth, she found chewing to be strenuous and could only speak very quietly, leading to difficulties with communication and conversation. This latter issue compelled her to limit her visitors to family only; talking with friends was just too exhausting.
She also lacked the ability to fully inflate her lungs and while she was able to breathe sufficiently, she required a ventilator at night to ensure her lungs were adequately ventilated. Lastly, Helen was having trouble both in transferring herself into and out of bed and also felt very insecure moving around in her wheelchair, which seemed at first to be a near impossibility.
Assessment – Health Professional Perspective
These impairments affected not only her range of motion but also her ability to fully respire, exercise, ingest food and water and talk. As before, while she could control her respiration, she was not fully able to inflate her lungs. Furthermore, while she could sense her need to urinate and defecate, her ability to do so could not be controlled.
Importantly, based upon their previous experience and Helen’s progression thus far, the health team did not feel that Helen’s hand function could be immediately improved. The prognosis here, they agreed, was simply uncertain. Many of her activities of daily living were severely limited. For example, her ability to perform self-care was impaired due to her loss of hand function.
Helen’s contextual factors were also of importance. Among her facilitating personal factors were not only her hopeful and optimistic personality but an extensive knowledge about the disease (her daughter, a nurse, did much to inform her about GBS) upon which she was able to base her beliefs and hopes for improvement.
Among her facilitating personal factors were not only her hopeful and optimistic personality but an extensice knowledge about the disease...
There were environmental factors that presented both facilitators and obstacles. She had a supportive family and health care team, as well as her two dogs. On the other hand, her previous home could not be adapted for her use and she would need to relocate to a flat conducive to her condition. She also lacked insurance that would pay for her wheelchair.
Table 1: ICF Categorical Profile; 1, 2, 3: Relation to Cycle Goals; SP: Relation to Service-Program Goal; G: Relation to Global Goal; ICF Qualifier* rates the extent of problems (0 = no problem to 4 = complete problem) in the components of body functions (b), body structures (s), activity and participation (d) and the extent of positive (+) or negative impact of environmental (e) and personal factors (pf).