Assessment

From Michael's perspective (i.e. "the patient perspective"), many of his needs were activity-based and centered logically around his wish to be independent (see Figure 1). Michael felt there were numerous activities he would like to work on, such as not being able to sit up alone, balance himself, move about in a wheel chair or wash and care for himself. While limitations in these areas were normal for his injury level, Michael understood that they undermined his ability to act and live on his own. Clearly, these limitations greatly contrasted to his previous state and athletic physical abilities.

These problems were further compounded by his broken arm, a condition that led to a delay in the rehabilitation necessary to begin decreasing his dependence. His body function problems were within the normal range of expectations for his condition. Notable, however, were Michael’s perspectives on participation, which again underscored his attitude and drive towards his new limitations, as well as a source of his available and potential resources. For instance, his desire to attend university, participate in sports and socialize were important underlying motivational factors. From the health professional perspective, there were a number of elements in each of the groupings seen in Figure 1 that were considered by the team to be of particular importance for Michael moving forward in the Rehab Cycle. Of special relevance were his environmental and personal factors, many of which acted as resources and facilitators for his rehabilitation.

These factors may not always be initially clear and can be elucidated through either the health professional or patient perspectives. In Michael’s case, it was obvious to the health care team that he possessed quite a number of facilitating factors from different components that could be contributing for a realistic goal-setting.

These included, for instance, his living situation, coping strategies, motivation, athleticism, overall fitness and support of family and friends:

• From the personal factors, his desire for independence and learning and his orientation around goals and recognition of his limits all helped to inform and direct the goal-setting. Additionally, his age and athleticism were important factors.

• With respect to functioning, Michael had an above-average ability to acquire new skills and an exceptional function for movement above the level of Th3.

• Also, aspects of his environment, both physical (a manual wheelchair, a lack of barriers in the health center and the payment of health insurance) and social (support from his parents, girlfriend, extended circle of friends and health professionals), facilitated the rehabilitation process.

Figure 1:  Assessment Sheet

It was understood that these resources and factors could and would underlie and be harnessed by both Michael and his health care team during his rehabilitation. For the final part of the assessment, the results of the health professional’s tests and examinations were matched to the corresponding values of the International Classification of Functioning, Disability and Health (ICF) qualifiers in order to generate an ICF Functioning profile (see figure 2). This profile could later be used as the basis for a reference for outcome evaluations. Michael’s functioning status was undertaken 12 weeks following the accident and included all of those categories of the ICF 14 that were relevant for description of his functioning and intervention planning.

Figure 2:  ICF Categorial Profile