As the recovery from neurological deficits depends upon the severity of injury, completeness and level of injury are important factors. Whether the injury is complete or incomplete contributes to future outcomes.
In other words those with ASIA B or D SCIs (incomplete) often show a more substantial recovery than those with ASIA A (complete) injuries.2
... the fewer the deficits at the acute stage regarding to initial level of injury, motor strength and whether the injury is complete or incomplete, the higher the rate of recovery.
Mr. Seiler had agreed to assist a local farmer, herding and feeding his sheep along the farmer’s mountain farm. As he dispersed feed one morning to the sheep along the shear mountainside, one of the wilder spirited animals ran at him and leapt upon him, immediately knocking him over and sending him down the sloping surface. He fell rapidly, plummeting about ten meters before coming to a stop.
As I was tumbling down the mountainside, I thought to myself, ‘My God, when am I going to stop!’ I was so conscious during the whole fall, as I came to a halt, I was freezing, shaking — I couldn’t move my arms and legs; I was so very afraid. Like the cliché, I really did see my life pass before me. Now I continue to relive this over and over!
The rehabilitative treatment at the Early Rehabilitation Unit began with the health care team’s assessment of both the patient’s perspective and the health professionals’ perspective and was defined to last for four weeks.
As with each Rehab Cycle, these perspectives were based on Mr. Seiler’s body functions and structures, activities, participation and environmental and personal factors. The information and data obtained here would inform the next phases of the cycle.
The functioning status of Mr. Seiler was illustrated in the team meeting within the presentation of the ICF Categorical Profile (Table 2). Based upon this initial assessment of Mr. Seiler, goals were defined by the health care team, taking both perspectives into account. The Global Goal, Service-Program Goal and Cycle Goals were established. The Global Goal was set as reintegration into participation considering Mr. Seiler’s hobbies but also the wish to work again.
Each intervention target was assigned to the appropriate health care team members who included Mr. Seiler’s physician, nurse, physical and occupational therapist. An assessment of each of the intervention targets was performed at the beginning of the Rehab Cycle using specific tests or examinations by the responsible health professional (see Table 3).
A number of interventions performed are worth highlighting. While the health care team hesitated in allowing Mr. Seiler to attempt walking, they finally agreed given his rapid recovery and enthusiasm. Walking was included as an intervention target to meet Cycle Goal 2. This intervention was carried out by either the nurse or physical therapist who accompanied and supported Mr. Seiler during brief walking activities.
One month after the accident, the initial, early post-acute care Rehab Cycle was completed with an evaluation of its progress. Encouragingly, Mr. Seiler’s recovery had surpassed expectations of both the health care team and the patient himself. The positive course of the recovery of the initially impaired body structures contributed to this result. Additionally, his engagement, motivation and self-discipline all contributed significantly, clearly paying off in his positive results. Each of the intervention target goals was achieved and remarkably six of the intervention targets exceeded their expected outcome values. Overall, this led to the achievement of all three cycle goals. The cycle goal for moving in different locations was also achieved beyond expectations. Taken together, these stepwise accomplishments resulted in reaching and surpassing the anticipated Service program goal of greater independence in daily living. Included here are a number of personal reflections on Mr. Seiler’s recovery:
The case study of Mr. Seiler sought to show that rehabilitation of traumatic SCI patients occurs not only within the early post-acute rehabilitation phase, but involves a continual process that begins at the time of the accident, extends through acute care and beyond to a patient’s optimal recovery. Such a recovery benefits from contributions of both health professionals and the patient. All of the rescue personnel and health care team members involved in this process, in addition to the patient him or herself, have a major impact on the functional outcome.