As with every Rehab Cycle, an assessment was performed that took into account the perspectives of both Martin (the patient perspective) and his health care team (the health professional perspective). For a clearer picture, this included taking into consideration the events and interventions of the prior months of Martin’s vocational counseling.
With an assessment underway the patient and health professional perspectives were recorded into the ICF Assessment Sheet. These describe Martin’s perceived problems and needs regarding body structures/functions, activities and participation, which were nearly all confirmed by the results of the specific assessment performed by the health professionals.
Many of these were not uncommon to those suffering from complete paraplegia: Given his complete loss of motor and touch functions below the level of injury, challenges existed for Martin among several activities that included: bladder management within catheterization required the help of nurses, as well as washing and dressing himself.
Additionally, other specific medical issues needed to be addressed including a fungal skin infection, a urinary tract infection, poor peripheral circulation resulting in problems of blood pressure maintenance, pain in his back and problems with body balance, sitting without the use of arms was difficult due to his loss of muscle power functions in the trunk, mobility with a wheelchair in difficult locations needed assistance of others.
However on the topic of vocation, one of Martin’s key perspectives (under participation) was described as “wanting to work again, but not at a computer for the entire day.” Additionally, some of his personal factors relevant to vocation included his sales training and prior work experience as a mover. He also understood the need for clarification of his future vocational perspective.
The health care team also acknowledged the importance of remunerative employment in his case. A number of Martin’s body function and activity issues would have an impact on both future employment opportunities and functional independence, particularly those affecting mobility.
Figure 1: ICF Assessment Sheet
His requirements for support in several activities of daily living and in looking after his health would present some challenges to attaining both independence and employment. On the other hand, Martin’s positive outlook and enthusiastic attitude towards the challenges he faced would be greatly facilitating in his search for employment.
I feel like I have a very positive attitude towards all of this. Maybe because I see this as temporary, like a disease that will last a few years. I still believe that I’ll walk again … maybe it will take five years, but my will is strong — my family’s will as well. This really empowers me to reach for my limits and try to learn as fast as possible.
The assessment phase offered a foundation for goals to be determined by the health care team. The use of the ICF Categorical Profile (Table 1) supported this step of the Rehab Cycle. As a Global Goal, leading an independent life (which would include returning to work) was considered by both the team and the patient himself to be a realistic aim. Martin was engaged and enthusiastic. He wanted to return to work as soon as possible and believed he could again be autonomous given enough time. His health care team also agreed that in the long term, the goal was not beyond his physical limitations. Thus the Global Goal was defined. As an overall Service Program Goal, gaining independence in daily living was established as the next step in achieving an independent life. Attaining three separate but related Cycle Goals would help Martin converge on the Service Program Goal:
- Improved mobility
- Improved self-care
Initiating Martin’s intention of clarifying his vocational perspective
Each of the Cycle Goals was distilled directly from the perspectives as outlined by both the patient and the health care providers. The Cycle Goal on vocation was taken directly from one of Martin’s personal factors, his intention to clarify a new vocation, and built upon the vocational counseling that had been undertaken in the preceding weeks. The other Cycle Goals were also drawn from a spectrum of body functions/structures, activities and environmental or personal factors. It is worth mentioning that the vocational training undertaken to work towards the goal of a vocational perspective for Martin had begun some weeks prior to the start of this Rehab Cycle. Specifically, it was the activation phase of the process of vocational counseling that was underway. Based upon the assessment, this was nevertheless taken up as a critical Cycle Goal as an element of independence in daily living. The finalization of this activation phase was now intended to correspond with the final evaluation for this Rehab Cycle. The following two phases of the vocational training would be integrated into the next Rehab Cycle (see Case Study 9).
Figure 2: ICF Categorical Profile: *ICF qualifiers range from 0 = no problem to 4 = complete problem in the components of body functions (b), body structures (s), activity and participation (d) and from 4 = complete barrier to +4 = complete facilitator for environmental factors. Among personal factors (pf), the signs+ and - indicate to what extent a pf has a positive or negative influence on the individual’s functioning. °Specific cycle goals are indicated by CG 1,2 and/or 3; SG = Service Program Goal, G = Global Goal.