Marshalling a Patient's Resources

Sporting accidents are a frequent cause of traumatic spinal cord injuries (SCI) and a common subset of these are those resulting from skiing and snowboarding. 1 The devastating injuries that are associated with such recreational sports often affect young men under thirty. 2 Snowboarders, for example, are at particular risk of SCI and have higher rates of such injuries when compared to skiers, especially intermediate and expert boarders involved in jumping. 34 Additionally, the prevalence of SCI within this group has been increasing in accordance with the rising popularity of the sport.5 While sporting accidents are but one example of the sudden and unanticipated events that can result in SCI, they affect a largely young and healthy population.

Read more: General Introduction

Independence as a Goal

When I think about my situation now, I have this very strong feeling that I have to simply look forward. I'm not the kind of person who has ever had any doubts about myself or what I do. I just accept my new situation and look forward. I won't fall into the trap of self-pity. I absolutely will gain my independence. It's a goal, it's my goal and I will continue to work towards it.

Michael 2007

Read more: Michael's Story

From Michael's perspective (i.e. “the patient perspective”), many of his needs were activity-based and centered logically around his wish to be independent. Michael felt there were numerous activities he would like to work on, such as being able to sit up alone, balancing himself, moving about in a wheel chair or washing and caring for himself.

Read more: Assessment

These past weeks have not been easy for me, with all the help I need to do almost everything. It’s hard to describe, but it’s like I’ve somehow lost my body and now I need to find it, to re-learn how to do simple things. What I really want is to be able to go through my day without help from others.

Michael

Read more: Goal setting

Once these cycle goals were defined by the team, the process moved on to the identification of the intervention targets. Appropriate targets for each cycle goal were selected. The cycle goal of self-care incorporated targets focusing on balance, washing, bladder and bowel management, muscle stiffness, and knee mobility. The cycle goal for mobility consisted of targets relating to back pain, limitations in changing body position and transferring, balance, and overcoming barriers with a wheelchair. Furthermore, trials of different kinds of sports were planned as the intervention for the cycle goal of sports.

Self-care incorporated targets focusing on balance, washing, bladder and bowel management, muscle stiffness, and knee mobility.
Read more: Assignment and Intervention

At 16 weeks following the accident (i.e. one month after the interventions started), an evaluation of Michael’s progress was performed. The results are illustrated in the ICF evaluation display (see table 4).

Most of the interventions met their targets within the expected timeframe. In terms of body functions and structure, Michael’s muscle stiffness had decreased and the structure of areas of his skin continued to pose no problem. He also made rapid progress in his activities; he was better able to maintain a sitting position and transfer himself, wash, dress and regulate his urination and defecation.

Read more: Evaluation

Improvement in functioning is not only a result of reducing disease-specific problems and symptoms, but also of strengthening general resources. This is part of a salutogenic approach, focusing on the factors that contribute to an individual’s health. 151617 These resources must be assessed and, when appropriate, taken into consideration in rehabilitation management. In most cases, the patient possesses valuable resources that can help him or her overcome challenges associated with SCI. 1819

Read more: Discussion