Mr. Meiers’ health care team included his physician, a nurse, physical therapist, occupational therapist and social worker. Each team member was assigned to corresponding intervention targets.

His physician, for instance, was responsible for cardiovascular, elimination and muscle tone functions, providing interventions primarily through pharmaceutical management. The nurses supported Mr. Meier in nearly all activities of self-care.

The physical therapist aimed to support muscle power functions, mobility of joint functions and strengthen supportive functions of the arms. To improve these targets, she implemented interventions like muscle strength training of the upper extremity, specific “prop-up” trainings and passive movement of the lower extremity joints.

Each of the interventions, targets and assignments for Mr. Meier is listed in more detail in Table 2.

As the intervention phase proceeded, all did not go as planned. With the initial three weeks of interventions, the health care team were encouraged with some of the results and less pleased with others.

There had been a moderate turn for the better in Mr. Meiers’ condition, with slight but significant improvements in many of the intervention targets including respiration and circulatory functioning and mobility.

However, elements of self-care did not seem to be improving and time was running out.

Just before end of the Rehab Cycle, a critical change occurred that threatened the entire process.

The rehabilitation team discovered that Mr. Meiers’ consciousness had altered such that he was no longer oriented to time and place. This was a sudden and wholly unanticipated event with initially no explanation.

The team were confounded as they helplessly watched his physical condition deteriorate along with his mental state. Although it was suspected that his state had cardiovascular and/or neurological etiologies, ECGs and CT scans were inconclusive. After seven days, Mr. Meiers’ symptoms of dementia subsided. Nevertheless, no clear diagnosis was made that affirmed his temporary health condition.

Mr. Meier showed slow but steady improvements — he became more conscious to his surroundings and situation. He began to exercise again and his rehabilitation interventions were carefully resumed at a lower level of intensity than before.

table 1

Figure 3: ICF Intervention Table. Phys = Physician, PT = Physiotherapist, OT = Occupational Therapist, SW = Social Worker.