Jason, a 17-year-old, was on track to complete an apprenticeship as a technician when he suffered a spinal cord injury. At the time, he was living with his parents and a younger brother on a rural hillside. When not working, Jason was an enthusiastic and competitive handball player, training four times a week, playing matches each weekend, and competitively doing quite well. He also had a large circle of friends and socialized often.
To identify Jason’s experience of functioning three months following the accident he was asked in detail. His experiences were entered into the ICF Assessment Sheet (Figure 1, upper part of the sheet). As a consequence of the first months of limitations in mobilization Jason felt greatly limited among aspects of his activities and participation: his dependence on others to perform greater mobility activities, the absence of the regular exercise, and the lack of sports that he was accustomed are examples of limitations that left him frustrated.
With respect to body structures and functions, he felt much improved sensitivity in his legs, but they were still “out of balance” with the right leg being almost hypersensitive compared to the left. He was also not able to flex his right foot and toes – an important action for walking.
The intervention targets were assigned to health professionals and interventions and entered into the ICF Intervention Table (Figure 3). The focus of Jason’s Rehab Cycle interventions was on walking and sports, the majority being undertaken by either his physical or sports therapist. This included strength and endurance training, movement exercises and repetitive training. He also began playing a number of sports appropriate to his capabilities, including archery, swimming and table tennis in the beginning.
One problem initially arose as he began playing wheelchair basketball. The therapists felt he was at risk of further injury and recommended he not play in that particular sport. Nevertheless, he continued. His doctor focused on reducing pain through medication. A psychologist supported Jason’s emotional functioning through regular counseling sessions. For his health maintenance, Jason was supported by the whole team, in particular by the nurses in caring for his body, offering regular feedback, and helping improve this target.
Jason’s Rehab Cycle lasted three months and was completed seven months post-injury when an evaluation took place. The results of this evaluation were entered into the ICF Evaluation Display (Figure 4). By the end of the Cycle, Jason had achieved each of his Cycle Goals – and in turn, his Service Program Goal of increased independence. This was evident in his final SCIM score of 90 (increased from 65 at admission) (Figure 5).
Among those who work in a rehabilitative setting there is an understanding that motivation can impact a patient’s achievement of rehabilitation goals and his or her longer-term outcomes. Nevertheless, despite its relative importance, targeting interventions for (and evaluating) a patient’s motivation is an inexact science. In this case study - and as suggested by some studies9 - motivation appeared to be affected by both internal (individual) and external (social) factors.