My Rights as a Person with Disability

Spinal Cord Injury (SCI) usually occurs suddenly and can happen to any person. Due to the bodily impairments, activity limitations and restrictions in participation related to SCI most of the affected persons face physical, emotional and socio-economic losses1. To achieve community integration the needs of persons with SCI, including medical and rehabilitative treatment have to be comprehensively addressed. To ensure that the costs of the interventions including loss of income are covered, legal claims such as applying for social benefits are required. Taking the Swiss example, social benefits are granted irrespective of income, unlike most other countries, by means of social security legislation.

Social Security Legislation

Social security legislation plays an important role in resolving the problems a person with SCI faces after the injury and it is a tool for the implementation of social policy. Disability policy, as a part of social policy, is implemented through laws that defines the entitlements of persons with disabilities and refers to the current understanding of disability (see Box 1). There are two different areas of laws, the social security legislation and the antidiscrimination legislation. Whereas the social security legislation directly addresses the needs of persons with disabilities in providing financial benefits, antidiscrimation legislation with the aim of ensuring fair opportunities and equality, indirectly addresses the needs of persons with disabilities in targeting the barriers (e.g. inaccessibility of public places) which deny equality.

Read more: General Introduction

18-year old Ben

Ben, an 18-year old young man, was living with his parents and his younger brother in a house near Berne, Switzerland. He has a huge circle of friends, a girlfriend, and loves outdoor activities especially sports activities. As an enthusiastic freestyle snowboarder participating in international competitions, he was in the second year of his apprenticeship as a carpenter, when he suffered a spinal cord injury (Th 12, AIS A) as a result of a snowboard accident which happened during the European championships. He received first treatment including a spinal surgery in the clinic of the Canton Lucerne and was transferred to the Swiss Paraplegic Centre one day later.

Read more: Ben´s story

Assessment (5 months following SCI)

Five months following the accident, the last Rehab Cycle began with an overall assessment including the patient and the health professional perspectives in all components of functioning and the environmental and personal factors which were recorded in the “ICF Assessment Sheet”. The ICF Core Set for SCI in the early post-acute situation was used as a basis for this assessment. The results of this Assessment were integrated into the “ICF Assessment Sheet” (Figure 1) and the “ICF Categorical Profile” (Figure 2).

Read more: Assessment

The ICF Assessment Sheet and the ICF Categorical Profile, which illustrate the extent of Ben`s problems in functioning and the impact of the environmental and personal factors, served as the basis for the identification of the intervention targets during the last phase of his inpatient rehabilitation program. These intervention targets ensure the achievement of the Cycle Goals. Individual members of the rehabilitation team were assigned to each of the intervention targets and took responsibility for selecting appropriate and specific interventions (Table 1).

Whenever necessary, the clarification of the legal aspects and the application of social benefits should be undertaken by different health professionals with Ben’s involvement. With regard to the first Cycle Goal vocational integration, it was necessary to clarify his claim for social security benefits for the period during the language course abroad with the invalidity insurance. To find an appropriate language school (wheelchair accessible) he received support from the vocational counselor. The language courses in English and French and the computer course continued as arranged at the beginning of the vocational counseling. To gain some work experience, an internship with the new employer was arranged. In addition, the duration and the working hours of the internship need to be clarify.

Read more: Assignment and Intervention

Shortly before Ben’s discharge, an evaluation of the improvement of the intervention targets and the achievement of the Cycle and Service Program Goals was performed involving all members of the rehabilitation team. With respect to the legal situation and the enforcement of Ben’s legal rights all essential claims had been initiated but the final decision from the insurances were still open at the time of discharge. However, beyond the financial queries, the interventions performed through the rehabilitation team had been successful.

Read more: Evaluation

The legal framework strongly influences the life of a person with a SCI. The case of Ben shows the importance to address legal issues during rehabilitation programs not only to receive all the social security benefits but also to empower persons with specific needs to take over the responsibility to ensure her or his rights as a person with disability.

Read more: Discussion