Each Cycle Goal was broken down into intervention targets that could be addressed by the individual members of the health care team. Corresponding health care personnel were assigned to each of the targets and took responsibility to chose appropriate and specific interventions (Table 2). For Martin’s hope for a job and the fulfillment of the Cycle Goal ‘Vocational Reintegration,’ the critical target was remunerative employment and its intervention, vocational training. As before, the vocational trainer focused exclusively on this target, seeking to complete the activation phase. Following the typing course, it was agreed that Martin could enroll in a computer course while he continued to receive vocational counseling to guide him. It began with a word processing course and ended one month later with a class teaching the basics of spreadsheets.

...it was agreed that Martin could enroll in a computer course while he continued to receive vocational counseling to guide him.

However, the vocational intervention was certainly not the only one related to successful employment. Interventions relating to mobility and self-care would also be highly relevant to Martin’s chances at attaining and maintaining a rewarding occupation. For instance, mobility would affect his ability both to get to and from work (e.g. by driving) as well as his mobility within the workplace (e.g. through the training and use of devices such as a wheelchair and a Swiss Track TM). To improve his mobility, Martin participated among others in daily circuit training to improve his muscle-power functions. While daily physical therapy focused on the improvement of his ability to transfer himself in different situations, occupational therapy aimed to increase his outdoor mobility using different equipment.

The nurses assisted and instructed Martin in terms of self-care activities with the aim of enabling him to gain independence in these areas of functioning. Self-care interventions would also be essential to leading an independent life, which would be necessary to work. Instruction in dressing and counseling for looking after his health are just two interventions that can easily be understood as essential to any future vocation. Also the psychologist met Martin weekly to support him in his coping strategies and self-competencies, both important aspects for his vocational situation.

Assignment and Intervention

During the implementation of this program the different rehabilitative interventions were adapted to the changes in Martin’s functioning all the time. For example, to influence the increasing spasticity, Martin was assigned to hippotherapy — a special treatment utilizing a horse and its movements for physiological effects — and sauna, and he was also instructed to take specific body positions which should reduce the spasticity. The evaluation of effectiveness of the program was planned for two months later.

Self-care interventions would also be essential to leading an independent life, which would be necessary to work.
Figure 3: ICF Intervention Table

Figure 3: ICF Intervention Table: Phys: Physician, PT: Physiotherapist, OT: Occuaptional Therapist