Introducing Martin, accident survivor and career seeker

It was mid-summer in Martin’s 26th year when he was involved in a collision on his motorcycle — a devastating accident that he was lucky to have lived through. Martin had been a motorcycle enthusiast for most of his young adulthood. Despite the risks, he had been both skillful and fortunate in avoiding accidents.

However, this single crash left him with a serious traumatic spinal cord injury, classified as an ASIA A at the 7th thoracic vertebra. On the same day of admission to the acute hospital, an emergency surgery was performed to support his spine and prevent further damage. Two days later, he was ready to be discharged to a rehabilitation center.

Prior to the accident, Martin had been content with his livelihood and vocational path, having recently completed an apprenticeship training to become a salesperson for home electronics. However, he soon realized that working as a salesman was not his calling, and after finishing the program he sought out work that was more physical. He eventually settled into a job as a mover, an occupation requiring significant strength and endurance.

I finished an apprenticeship to become a salesperson in consumer electronics, but I got bored with it. I needed something different … and found work as a mover. I really enjoyed this … working with different people, the flexibility of the job.

Martin, giving a retrospective at the start of his rehabilitation

Outside of his work, leisure time was actively spent riding his motorcycle, playing golf and socializing with friends and family. Needless to say, reintegrating into a new life and livelihood after the injury would present some daunting challenges.

With the initial phase of Martin’s rehabilitation that preceded the Rehab Cycle, limitations regarding movement were imposed by his surgical team and could involve neither the rotation nor flexion of his spine for the three months following the surgery. These limitations constrained his activities and consequently his overall rehabilitative progress. Shortly after admission to the rehabilitation center his SCIM Score was evaluated at a low 8 out of 100 (see the 3rd column in Table 3). However, one area that could be approached was Martin’s vocational perspective.

Integration through motivation: A brief retrospective of Martin’s vocational counseling

Martin is young and energetic and will need to work at some point. But he’s going to have to find a new occupation. Before, he defined his job by its physical demands. Now we’ve got to look towards the possible, the realistic.

Martin’s vocational trainer

Now I’ve got to figure out a new profession for myself. I really see this as a great chance. Before the accident, I knew I wouldn’t be working as a mover when I was 65. So I’m going to jump at this opportunity and discover something new.

Martin on his vocational training

A three-phased approach to vocational counseling and rehabilitation. This case study focuses on the Activation Phase.

Box 2 | A three-phased model of vocational counseling

As an important element of the reintegration process, vocational counseling provides guidance and a supportive framework in an SCI patient’s search for employment. One effective model of such counseling utilizes a three-phased approach in achievingthis goal (see Figure 1 on the next page). The phases include:

The activation phase
The activation phase aims to establish a basis of self-trust and build a capacity for decision-making through both extrinsic and intrinsic motivation. Interventions in this phase often include classes based upon individual interests and regular counseling sessions with the vocational counselor.

The clarification/decision phase
As a patient opens to discussions of his or her future, the second phase can begin and is divided into three parts — an analysis of resources, the defining potential tracks and areas of work and, lastly, an evaluation of the patient’s knowledge of a specific area, capacity for learning and level of ability. The next steps for Phase 3 are also planned.

The integration phase
When either a potential position is found at an employer or a vacancy is available in a desired educational program, the integration phase can begin. Here the vocational counselor acts as a professional intermediary who is able to both consider the needs of the patient and understand the demands of the labor market. By establishing concrete plans and goals in this phase. the patient is able to further define his or her path among a variety of interests and possibilities.

This initial step of the reintegration process begins at about three weeks post-injury. Here, a patient begins vocational counseling with an exploration of interests and wishes. A motivational program supports him in initiating his own activities that will hopefully lead towards employment. This can include enrolling in available continuing education courses such as language or computer classes.

Table 1

Table 1: A three-phased approach to vocational counseling and rehabilitation. This case study focuses on the Activation Phase.

The primary goal in this phase is to promote self-motivation and self-trust in the patient, which will support or reinvigorate his capacity for decision-making, a critical building block for the second phase of the process.

Shortly after Martin’s admission to the rehabilitation center, a vocational trainer initiated his training based on this three-phased approach, slowly introducing him to the aims of vocational counseling. While in Martin’s case this phase began at one month post-injury, depending upon the patient and the time and resources available such an intervention may start even earlier.

For Martin, the activation phase involved the start of his vocational training as well as his enrollment and participation in a number of continuing education courses offered by the rehabilitation center. This initial vocational training aimed at building trust — both in himself and in the counselor. It was a critical first step in allowing Martin to partially delegate his relations to the employment sector to a competent third party without losing a sense of responsibility and independence. Enrollment in selected courses would also help to enhance Martin’s decision-making skills.

Initially unsure about what direction to take and certain only that he wanted to move forward with his rehabilitation, Martin was advised to take a general computer course. After some discussion with the trainer, they decided an additional approach might be to begin with a typing course given that he already had some limited typing skills.

The challenges Martin had in maintaining a sitting position for an extended length of time resulted in a slow start to this course. However, over the course of one month, he slowly and steadily improved. At the end, he was able to slowly type with ten fingers.

With the improved stability of Martin’s spine two months after injury, a new Rehab Cycle began and Martin’s next steps were planned regarding his vocational perspectives and other aspects of individual rehabilitation.