The Patient and Health Professional Perspectives
While limitations in these areas were normal for his injury level, Michael understood that they undermined his ability to act and live on his own. Clearly, these limitations greatly contrasted to his previous state and athletic physical abilities.These problems were further compounded by his broken arm, a condition that led to a delay in the rehabilitation necessary to increase his independence. His body function problems were within the normal range of expectations for his condition.
Notable, however, was Michael’s perspective on participation, which again underscored his attitude and drive towards his new limitations, as well as a source of his available and potential resources. For instance, his desire to attend university, participate in sports and socialize were important underlying motivational factors.
From the health professional perspective, there were a number of elements in each of the groupings seen in table 1 that were considered by the team to be of particular importance for Michael to move forward in the Rehab Cycle. Of special relevance were his environmental and personal factors, many of which acted as resources and facilitators for his rehabilitation. These factors may not always be initially clear and can be elucidated through either the health professional or patient perspectives. In Michael’s case, it was obvious to the health care team that he possessed quite a number of facilitating factors from different components that could contribute to realistic goal-setting. These included, for instance, his living situation, coping strategies, motivation, athleticism, overall fitness and support of family and friends:
- From the personal factors, his desire for independence and learning and his orientation around goals and recognition of his limits all helped to inform and direct the goal-setting. Additionally, his age and athleticism were important factors.
- With respect to functioning, Michael had an above-average ability to acquire new skills and exceptional movement above the level of T3.
- Also aspects of his environment, both physical (a manual wheelchair, wheelchair accessible health center and health insurance coverage) and social (support from his parents, girlfriend, extended circle of friends and health professionals), facilitated the rehabilitation process.
It was understood that these resources and environmental factors could be harnessed by both Michael and his health care team, and would frame Michael's rehabilitation.
Figure 1: ICF Assessment Sheet
For the final part of the assessment, the results of the health professional’s tests and examinations were matched with the corresponding values of the International Classification of Functioning, Disability and Health (ICF) qualifiers in order to generate an ICF Functioning profile (see table 2).This profile could later be used as a reference for outcome evaluations. Michael’s functioning status was assessed 12 weeks following the accident and included all of those ICF categories 14 that were relevant for describing Michael's functioning and intervention planning.
Table 2: ICF Categorical Profile; ICF Qualifier: rate the extent of problems (0 = no problem to 4 = complete problem) in the components of body functions (b), body structures (s), activities and participation (d) and the extent of positive (+) or negative impact of environmental (e) and personal factors (pf); Goal Relation: 1, 2, 3 refers to Cycle goal 1, 2, 3; SP refers to Service-Programme Goal; G refers to the Global Goal; Goal value refers to the ICF qualifier to achieve after an intervention.