The Rehab Cycle

Evaluation

At 16 weeks following the accident (or one month into the latest Rehab Cycle), an evaluation of Michael’s progress was performed. The results are illustrated in the evaluation display (see Figure 3).

Most of the interventions met their targets in the expected time given. In terms of body structure and function, Michael’s skin structure was doing well and his muscle stiffness had decreased. He had also made rapid progress in his activities: He was better able to maintain a sitting position and transfer himself, wash, dress and regulate his urination and defecation.

Michael was also able to begin exploring athletic options open to him and started making some progress playing basketball.

Psychologically, his acceptance and knowledge of his disease improved. Of his overall attitude and progress, his psychologist noted:

Michael is a very special young man who has quite a sophisticated attitude to his actual life situation. This is not common in persons of his age and it enables him to handle this difficult situation in a realistic and determined way.

He knows what he wants and is always seeking his physical limits to improve his functioning. At the moment he is retreating a little from his social environment. This is a typical behavior just before one’s discharge to home, when a patient realizes all challenges in the home environment to come.

But Michael has a very good prognosis for becoming an independent, integrated and self-determined individual with a positive life satisfaction.

However, a few intervention targets were not achieved (although, even with these, there was some progress made). These included back pain, joint mobility, moving around in the wheel chair and caring for his body. The following explanations offer some insight:

1. Back Pain Continued: the degree of pain changed with the amount of training and getting used to the wheel chair.

Figure 3: Evaluation display

2. Joint Mobility: the target for knee joint extension was not met, but did not result in any other functional problems and would continue to be worked on. 3. Moving Around with the Wheelchair: steps proved particularly difficult for Michael; though there was some improvement, more intensive practice was needed. Here Michael also benefited by his absence of fear in maneuvering the wheelchair — another resource not noted in the initial assessment. 4. Caring for his Body: Michael was able to perform this, but didn’t feel sure enough in his abilities and still wanted his nurses to check him.

The fact that these intervention targets were not met was not considered a threat by the health team to meeting the cycle goals. Given Michael’s overall achievements, the health care team fully expected improvements on these targets in the subsequent rehabilitation process, not least because of his the strengthened resources he brought with him.  more