Walking as a Recovery Goal

The ability to walk is often one of the major long-term goals of spinal cord injury (SCI) patients. Studies have demonstrated that in terms of recovery in patients with some preserved walking functions, improving the quality of walking ability ranks higher than bladder, bowel and sexual functions.1 In addition, individuals with incomplete injuries more often than not are able to regain some capacity to walk; 86% of these patients ultimately will develop some degree of walking ability.2 Thus, exploring paths to a “walking recovery” is one critical aspect of rehabilitation in cases of incomplete paraplegia.

Read more: General Introduction

I don’t actually have any real problems; I’m independent, I can do anything. What we’re talking about here are problems of luxury.

Simon, five months following injury

Assessment of Simon's "problems"

Five months into Simon’s rehabilitation, a new Rehab Cycle began to focus general efforts on the recovery of walking ability. The assessment would be essential for integrating both the patient’s and the health professionals’ perspectives of the patient’s current status. These perspectives would help to define the Global, Service-Program and Cycle Goals to work towards and to establish relevant interventions along with their corresponding intervention targets.

Read more: Assessment

While Global goals are broad and often common among SCI patients, based on community integration and independent living, the steps toward these goals can differ greatly from patient to patient. Simon noted specific hopes – to run and mountain-bike again, to be able to drive and to relearn to swim – with some perhaps more achievable than others.

Given Simon’s consistent improvements up until this point, along with his interests and hopes, a Service Program Goal of resuming leisure activities was established. Achieving this would be a big step towards reaching a Global Goal of community integration without limitations.

Read more: Goal Setting / determination of intervention targets

For each intervention target, appropriate interventions were assigned to one or more of Simon’s healthcare team members (see Table 3 below). Simon’s independence had increased to such a degree that nursing assistance was largely unnecessary except for managing medications and some instruction when needed. Given the goal-focus on locomotion and object handling, the majority of the interventions in this Rehab Cycle were divided between the physical, sports and occupational therapists, with many overlapping responsibilities.

Read more: Assignment and Intervention

Despite the overall improvement in Simon’s functioning and some degree of improvement to most of the intervention targets, these gains were not sufficient to meet the Cycle Goals. Simon fell just short of achieving the aims set at the start of this Rehab Cycle. Nevertheless, his outlook remained positive:

I never expected to make so much progress so quickly. Now I can swim and ride a bike, but there are still some challenges. I’m nervous while swimming and can’t yet get onto a mountain bike, which I find really disappointing. But I know these will also improve with time and practice.

Some of Simon’s reflections, post-Rehab Cycle

Read more: Evaluation

Rehabilitation incorporating walking as a goal requires both the guidance and support of the rehabilitation team and the focus and determination of the patient.

As the severity of disease and the course of rehabilitation vary with each patient, the assessment of functioning and the selection of appropriate goals, targets and interventions present a critical point of decision in each patient’s rehabilitative management. This process involves clinical reasoning, integration of findings of high-quality research, health professionals’ knowledge and experience and the patient’s needs and context for achieving the best possible outcomes.

Read more: Discussion