Returning Home and to the Community

Individuals with spinal cord injuries face extraordinary challenges beyond adapting to the physical aspects of their injuries. The overarching goal of rehabilitation has been described as reintegration into the community.1From this perspective, disability can be understood in the context of a biopsychosocial model, which includes biological, individual and social elements.2 With such a comprehensive rehabilitation objective there are not only challenges to be met regarding physical and functional limitations, but also importantly, problems to be faced in a person’s participation within his or her physical and psychosocial environment.

Read more: General Introduction

In the beginning of Martin’s rehabilitation the initial steps with respect to community reintegration were traced towards the longer-term goal of reestablishing a profession. Originally trained as a home electronics salesman, but employed as a mover prior to the accident, Martin needed to begin considering job options and his future as he began planning his return home. Case Study 7 described his experiences at the start of vocational counseling.

At this point in the rehabilitative process the focus remained on promoting both trust and his decision-making capacity. This would later lead to a clarification of career perspectives and, finally, securing a job. This end was critical for a young person such as Martin. Employment meant more than simply financial security — having a job that he enjoyed was a central element to both his overall human functioning and his reintegration into the community. Stable employment would ultimately contribute not only to Martin’s financial security and independence, but to his self esteem and overall life satisfaction.

Read more: Martin's Story Revisited

The Team's Assessment

Patient and health professional perspectives
The assessment of this actual Rehab Cycle highlighted a number of outstanding problems, as well as strengths gained up to this point in Martin’s rehabilitation. Body functions and structures related to movement continued to present with spasticity, pain and irritated skin. Each of these contributed to making Martin’s motions difficult.

Read more: Assessment

From the previous cycle, it was clear that the next phase of rehabilitation would need to focus on community reintegration. Martin’s Global Goal remained unchanged: independent living. A new Program Goal was determined as transition to community. Note that the previous Service Program Goal was defined as independence in daily living (in the rehabilitation facility). Martin had achieved this in the last Rehab Cycle.

Read more: Goal setting/determination of intervention targets

Each target’s intervention was assigned to an appropriate member of the healthcare team. In this Rehab Cycle, the intervention was assigned to Martin’s physician, physical therapist, occupational therapist, psychologist, social worker and vocational counselor. Nursing staff would play a supportive role at this stage and would not be responsible for any specific interventions.

The physical therapist focused on most of the interventions related to body function/structure and the movement Cycle Goal. Regular manual therapy helped with back and upper extremity pain. Daily endurance and circuit resistance training built exercise tolerance and muscle power in the regions above the level of injury.

Read more: Assignment and Intervention

Evaluation

Shortly before discharge to the community, an evaluation of Martin’s functioning status was implemented. In a team meeting each health professional reported the results of those intervention targets for which he was responsible. A final rating of the problems in functioning was done by the team, the ICF Qualifiers were entered in the ICF Evaluation Display, and afterwards goal achievement was checked and discussed.

Read more: Evaluation

I live with the things that I have and those that I can do, not with the things that I lost.

Martin, after his discharge

The path from an accident and spinal injury to a patient’s reintegration into his former community represents a dramatic transformative process. The rehabilitation involved presents SCI patients and healthcare providers with numerous challenges extending beyond those afflicting body structures and functions. Continuity of care in this process is critical and most often requires additional, non-medical interventions in order to achieve the best outcomes.

Read more: Discussion