The Rehab Cycle began in July 2007 with an assessment that included both a health professional perspective as well as Mr. Meiers’ own perceptions and experiences. This assessment was based on the description of ICF components (body structures and functions, activities and participation and environmental/personal factors).It helped identify what he and his health professionals saw to be outstanding needs and individual problems — some of which were age-related (see Figure 1).

At the moment, I don’t have any discomfort … I just can’t walk. The worst of it is that I still can’t go the bathroom on my own. To be in this condition makes you utterly helpless.

The health team keeps telling me that I’ve been a model student and patient, but I just don’t see this at all. – My mood is extremely fragile at the moment. It’s difficult for me even to talk about it. At times I’m simply crying! This is terrible as a grown man. I’ve never cried before in my life, never had this problem! I used to feel like a normal man.

Mr. Meier

For Mr. Meiers, there were a variety of age-dependent (or age-related) physical and psychological aspects and personal factors that had impacted his disease and recovery progression. It was important at the start of this Rehab Cycle to take stock of these issues.

His low tolerance for exercise and reduced muscle power functions in the upper extremity resulted in insufficient supportive functioning in his arms.

Being in this condition makes you utterly helpless.

Beyond just his age, these were consequences of the extended period in which his condition was serious and he was restricted to his bed.These impairments in body functions would all be critical factors in his rehabilitation and combined with the disease-dependent impairments placed significant limitations on his activities. Psychologically, he was having trouble with his memory where recalling certain words presented a challenge that he recognized by himself.

Assessment

Other issues were more or less independent of age. Personal factors included his assets (both financial and property) and the feeling that at his age he had accomplished much, led a good life and “had no intention of making lots of plans for the future”.

Among Mr. Meiers’ body functions and structures, he felt no pain but maintained some sensation in his legs. Urinary and defecation functions were completely impaired and led to complete dependence in bladder and bowel management. Particularly difficult for Mr. Meier was being dependent on others when using the toilet.

The loss of muscle power functions in the lower half of the body and increasing spasticity in the legs made it difficult for him to transfer from bed to wheelchair and back and to change his body position from lying to sitting. With respect to his age-dependent impairments he was not able to compensate for these disease-dependent problems in his body functions. Probably due to medication, he was suffering from itchy skin.

However, after his tracheostomy tube was removed, he was able to eat without significant limitation and his digestion functioned normally.

...the feeling that at his age he had accomplished much, led a good life and 'had no intention of making lots of plans for the future.

Among his activity limitations, he had many of the common complaints of an incomplete paraplegic patient — an inability to walk, wash and care for himself and a need for assistance getting dressed. Related to mobility, the health care team felt that Mr. Meiers’ wheelchair (an environmental factor) was less than optimal and additional assistive devices would be necessary to achieve optimal functioning.

Having to stay at the rehabilitation center restricted him from organizing life at home and his work managing his property.

The loss of muscle power functions in the lower half of the body and increasing spasticity in the legs made it difficult for him to transfer from bed to wheelchair and back and to change his body position from lying to sitting. With respect to his age-dependent impairments he was not able to compensate for these disease-dependent problems in his body functions. Probably due to medication, he was suffering from itchy skin.

However, after his tracheostomy tube was removed, he was able to eat without significant limitation and his digestion functioned normally. Among his activity limitations, he had many of the common complaints of an incomplete paraplegic patient — an inability to walk, wash and care for himself and a need for assistance getting dressed.

Related to mobility, the health care team felt that Mr. Meiers’ wheelchair (an environmental factor) was less than optimal and additional assistive devices would be necessary to achieve optimal functioning.

Based upon both the patient and health professional perspectives, mutually agreed upon goals were established by the health care team and Mr. Meier. The global goal was defined as sufficient general functioning in daily life with a new Programme Goal of optimal independence in daily living.

Based upon this program goal, three Cycle Goals were selected: first, the improvement of mobility (including independent transferring and changing of body positions); second, the improvement of self-care (including independent dressing) and third, health maintenance (describing the prevention of further secondary complications like pressure ulcers, respiratory infection or impairments in mobility of joint functions).

After the definition of the Cycle Goals, the relevant intervention targets were determined and marked in the ICF Categorical Profile.

Psychologically, he continued to have intense mood swings, often leading him to cry for what he perceived as 'no reason.
Figure 1: ICF Assessment Sheet

Figure 1: ICF Assessment Sheet

Figure 2: ICF Categorical Profile

Figure 2: ICF Categorical Profile: (extraction): Illustrates the aspects of the functioning status which are relevant for this patient (Spinal Cord Injury, ASIA A Th 3). *ICF Qualifiers range from 0 = no problem to 4 = complete problem in the components of body functions (b), body structure (s), activity and partisipation (d) and from -4 complete barrier to +4 = complete facilitator in the environmental factors. In personal factors, the sign + and - indicates to what extent a determined pf has a positive or negative influence on the individual ́s functioning. ºC1, 2, 3 mark the relation to Cycle Goals 1, 2, 3; SP is related to Service Programme Goal, G related to Global Goal.