I really believe that things will change. And I’m continually hopeful that change is possible even after so little recovery over such a long period of time. If I didn’t believe this, nothing would happen.
Goal-Setting – Striking a Balance
Helen’s hope, and therefore her personal goals, centered on her hand function. Through the slow course of her initial rehabilitation following her release from the ICU, Helen found her dependency at the best of times difficult, and at the worst of times degrading.
For most of her 67 years, she had lived autonomously and did not particularly like to be washed and dressed by others. For Helen, the use of her hands was the key to again attaining the dignity and independence she desired. Accordingly, all of her psychological focus and efforts went into regaining that functionality and attaining a level of fine hand function that would again allow her the freedom to dress and clean herself and attend to her normal activities of daily living.
Given the uncertainty surrounding the prognosis for GBS, the health care team was conservative in setting goals. Moreover, her medical team felt that this was an unrealistic or, at most, a less realistic goal. It was also important to consider that Helen’s focus was based on an intrinsic inner strength, hope and optimism – denying this would have also been counterproductive.
I'm continually hopeful that change is possible even after so little recovery over such a long period of time.
At the end of the team discussion, the global goal was defined as optimal independence, which could be adapted based upon Helen’s progress. This goal was intentionally broad, to allow for adaptation as she progressed in her recovery. With Helen now in the recovery phase of the disease, this goal had been accomplished. For this Rehab Cycle, a new program goal was set: preparation for discharge to home.
From the assessment, three Cycle Goals were elaborated to meet this goal:
- Improving respiratory function
- Improving speaking and ingestion functions,
- Improving mobility through increased independence in transferring, changing body positions and wheelchair mobility.
Notably, there was a discrepancy in the two perspectives offered: Helen was hopeful about improving her hand function; her health professionals were, however, uncertain of the prognosis and left any specific references to hand use out in this phase of the goal-setting.
Identification of Intervention Targets
Intervention targets were defined and coded according to the International Classification of Functioning, Disability and Health (ICF) (see Table 1 for more detail). Lastly, two ongoing, parallel intervention targets had been and were included that were fundamental to the program goal: counseling for the purchase and adaptation of wheelchair-accessible accommodation and clarification for the payment of health services, assistive devices and the reconstruction.
Figure 2: ICF Intervention Table: Helen’s intervention targets, interventions, their assignments and goal and evaluation values. Note the last target on hope and inner strength; all team members are assigned to this target.