After the rehabilitation I really made some big gains — independence with use of the wheelchair, better self-care and being able to position myself ... I also hope to get a car and be able to drive. Really the most important thing for me is to be able to work once I’m discharged. The support I’ve gotten [from the vocational counselor] has been a tremendous help. I’m now even thinking of asking my old boss at the moving company if there’s something I could do there.

Martin, reflecting on his progress and his future

For survivors of spinal cord injuries, both deciding on a profession and finding employment present a set of challenges that can seem especially daunting. Despite the high rate of those who do not return to work, a significant number of individuals with SCI are able to take up an occupation within an impressive variety of fields.

Those that are able and willing to work can benefit greatly from the guidance and support offered by a vocational trainer. The vocational trainer can assist a patient through his or her exploration, discovery, decision-making and, finally, reintegration into a desired career. This case study focused on the first phase of a model three-phased process of vocational counseling.

A significant number of individuals with SCI are able to take up an occupation within an impressive variety of fields.

This initial activation phase helps establish trust and encourages and supports the patient in his early steps towards reentering the work force. Counseling and continuing education helps him to develop ideas about interests and vocational possibilities that can be explored in the later phases of counseling.

Vocational training is one important component of rehabilitation management in SCI. Such management is supported by the Rehab Cycle, benefiting from its patient- and resource-focused assessment and phased approach that includes specific goal-setting, intervention targets and evaluations.

However, in Martin’s case the training began prior to the start of his presented Rehab Cycle. Almost immediately after Martin’s rehabilitation was initiated, he began considering his future and his prospects for working. He knew immediately that as a young man of 26, he needed and wanted to work at something he enjoyed. An occupation was more than simply a financial benefit for him, it was an important part of his reintegration into life and society, and elemental to how he felt he was perceived, to his so-called human functioning.

However, despite his intentions, his condition left him unsure about what options might be available to him, and even less sure about a choice he would be comfortable with. He realized that the physical work he had enjoyed as a mover would no longer be possible and a fundamental problem for him was where to turn next.

Given his assessment in the Rehab Cycle, the health care team clearly recognized the importance of employment and work in achieving independence. Thus, they included a specific Cycle Goal on establishing Martin’s vocational integration. This Cycle Goal was addressed through the continuation of the activation phase that concluded at the cycle’s evaluation.

An occupation was more than simply a financial benefit for him, it was an important part of his reintegration into life and society.

The introduction of a vocational trainer to Martin’s rehabilitation program sought to help him with these issues. Through the trainer’s encouragement, Martin successfully completed a typing course and subsequently a computer course, leading him to enroll in an English language class. Although he disliked working with computers and the corresponding lack of physical demands and social interaction, the intervention was in some ways a success in its primary aim: Martin’s own motivation had been supported through the coursework he was undertaking which was not only giving him new possibilities, but also clearly defining areas he where he had little interest, resulting in his desire to move forward with other courses.

Furthermore, at the end of the cycle, a relationship of trust had been established between the trainer and the patient, critical for moving into the next two phases. Additionally, the improvements in the other Cycle Goals of mobility and self-care would also contribute over the longer term to Martin’s chances of successfully finding and keeping a job.

At the end of the cycle, a relationship of trust had been established between the trainer and the patient, critical for moving into the next two phases.

Case Study 9 will focus on Martin’s process of community reintegration, including the final phases of vocational training (clarification/decision-making and integration), accompanying him on his journey towards successful employment and starting a new life.