Return-to-Work of Persons with SCI

Rehabilitation following SCI recognizes the importance of returning to work (RTW) and the essential role employment plays in participation within a community. Remunerative employment is a vital aspect of human functioning — a concept that integrates the body functions, body structures and activities of an individual within a social context.1 Within the International Classification of Functioning, Disability and Health (ICF), work and employment make up an important element of the major life areas and include such endeavors as apprenticeships, acquiring, keeping and terminating a job, and both remunerative and non-remunerative employment.2

For persons living with the consequences of SCI, physical challenges are just one of many obstacles to be confronted as they work to rebuild their lives. Finding and securing employment presents a further challenge. Societal pressure to work is significant, and this is not diminished for those with SCI.3 Among adults, one of the most important factors (and, in turn, indicators) for reintegrating into a community is the participation in productive work.4

Read more: General Introduction

Introducing Martin, accident survivor and career seeker

It was mid-summer in Martin’s 26th year when he was involved in a collision on his motorcycle — a devastating accident that he was lucky to have lived through. Martin had been a motorcycle enthusiast for most of his young adulthood. Despite the risks, he had been both skillful and fortunate in avoiding accidents.

However, this single crash left him with a serious traumatic spinal cord injury, classified as an ASIA A at the 7th thoracic vertebra. On the same day of admission to the acute hospital, an emergency surgery was performed to support his spine and prevent further damage. Two days later, he was ready to be discharged to a rehabilitation center.

Read more: Martin's Story

As with every Rehab Cycle, an assessment was performed that took into account the perspectives of both Martin (the patient perspective) and his health care team (the health professional perspective). For a clearer picture, this included taking into consideration the events and interventions of the prior months of Martin’s vocational counseling.

With an assessment underway the patient and health professional perspectives were recorded into the ICF Assessment Sheet. These describe Martin’s perceived problems and needs regarding body structures/functions, activities and participation, which were nearly all confirmed by the results of the specific assessment performed by the health professionals.

Read more: Assessment

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.

Read more: Assignment and Intervention

Two months later, Martin had made significant progress in multiple areas within this Rehab Cycle. The individual evaluations of each of his intervention targets are illustrated in the ICF Evaluation display (Table 3). First and foremost, his vocational training was proving successful at both building initiative and trust. Although Martin found himself unenthusiastic about working on a computer he participated in all course sessions.

Read more: Evaluation

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

Read more: Discussion