Figure 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).
Monica’s perspective was assessed by her health care team. Her own view of her condition focused heavily on activities and participation, and her issues with body functions and structures were limited.
For instance, she didn’t feel pain, could sense dull touch and felt her joints were very flexible. Her true level of activity, she felt, was quite limited by her dependence in toileting, caring for her skin, changing her body position and dressing (particularly as she feared disturbing her incision).
Before admission to the rehab center, she had also felt that she could no longer drive. Her ability to do housework was partially limited, however she was preparing meals for her son each day.
With regard to participation, Monica felt a general lack of freedom. Beyond the rehab center, it was important for her to socialize with friends and pursue her old hobby of fixing antiques and selling them at the flea market.
She also enjoyed gardening as much as possible and watching television. Additionally, from Monica’s perspective there were environmental and personal factors that impacted her functioning status. The former consisted of accessible accommodation, a supportive son, daily ambulant care and health insurance.
Simple geographical facts such as streets paved with cobblestones affected her mobility in a wheelchair. One of her important sources of strength was living in a house with a garden together with her son.
Beyond the rehab center, it was important for her to socialize with friends and pursue her old hobby...
Monica’s physician and health care team added their own perspectives, finding numerous impairments. With her bowel and bladder functioning, Monica had, due to her diagnosis, difficulties controlling both her urination and defecation which required routine catheterization and manual elimination.
She also had a reduced sense of touch and loss of muscle power below the level of the lesion. The reduced physical activity in the previous weeks led to weakened arms that could not support any significant weight.
There were issues surrounding the structure of her skin, relating directly to pressure sores. Although her surgical incision was healing quite nicely, the team thought there were serious shortcomings in many areas of activities. Monica was truly limited in looking after her health, caring for her skin, transferring herself and changing positions, and washing and using the toilet — all areas that could potentially be so much better.
Not surprisingly, the health team realized that Monica also had issues dealing with her body image and how she perceived herself. They also realized there were many environmental factors that could help facilitate Monica’s rehabilitation.
She obviously had access to appropriate medication, assistive devices as well as an adjustable air mattress. While standard care for, for a complete picture it is important to note they were accessible in support of her rehabilitation.
Many of Monica’s personal factors presented barriers to rehabilitation: addiction to smoking and feelings of emotional instability, low acceptance of her disease, little self-responsibility and low levels of health behaviour all offered challenges to the health care team.