During the initial assessment phase, both patient and health professional perspectives were evaluated for each of the ICF components: body structures and functions, activity, participation, and environmental and personal factors.
Given her injuries and prior rehabilitation, Lisa felt that while she had made some progress, there was still much which could be improved. Medically, she had many of the typical impairments associated with a spinal cord injury at the Th8 level. Pain, reduced muscle power in the upper extremity, a lack of exercise tolerance, unstable blood pressure and a moderate degree of spasticity were impaired body functions that would need to be addressed in this Rehab Cycle.
Although she felt herself to be emotionally stable, her fear of falling, though improved, remained an issue. The healthcare team defined this as an “impaired emotional function” due to the accident. However, her neuro-psychological assessment was normal for her condition (recall the traumatic brain injury she suffered during the fall). From Lisa’s perspective regarding activities, she found it challenging that she continually toppled over when sitting and sometimes exhausted herself performing tasks such as dressing and transferring herself from bed to wheelchair. Her fear of falling also contributed to the limitations in physical activity. Still, there were things she realized she could do: transfer into a car, manage her bladder and care for her skin. Other activities that were still compromised included complete dependence in caring for her skin and emptying her bowels; partial dependence in dressing, washing and transferring; and limitations in her ability to maintain a sitting position.
Although she felt herself to be emotionally stable, her fear of falling remained an issue.
Lisa’s injuries altered the life she had led up until the injury in terms of participation and environment. As a teacher, particularly with her skill and enthusiasm in the area of sports, the conditions for her future work had to be clarified. However, returning to her profession was one of her aims.
Additionally, her living situation needed to be clarified. She lived with her boyfriend in an apartment that was not completely wheelchair accessible and would require some adaptations if they decided to remain there. Lisa had an active social and familial network. She felt that her relationship with her boyfriend had intensified as he sought to support her and meet her needs. She met often with her immediate family and received many visits from friends — which at times she felt were almost too frequent.
Her healthcare team noted that for a former athlete, Lisa’s involvement in sports was too restricted up to this time-point within her rehabilitation process and needed to be addressed now.
Among Lisa’s relevant personal factors, there was a high level of body awareness and intrinsic motivation, both important components for an SCI patient’s engagement in sports. Additionally, there were some environmental factors that would need to be addressed before Lisa’s discharge. These included selecting the best wheelchair and adapting her car and accommodation.