The Rehab Cycle

Evaluation

I didn’t achieve as much as I wanted to. I still can’t walk!

- Mr. Meiers at the end of his Rehab Cycle

Despite the complications that arose, Mr. Meier was able to make progress in his final Rehab Cycle, reaching two of his three cycle goals: mobility and general health status.

Table 4: ICF Evaluation Display

The ICF Evaluation display (Table 4) gives a detailed overview of goals, intervention targets, as well as assessment and evaluation metrics for comparison. At the evaluation, we find that Mr. Meiers’ mobility improved overall with increased muscle power functions and mobility along with better assistive devices.  His general health status showed improvement based upon improved cardiovascular and excretory functioning. However, the cycle goal for self-care was not accomplished. This was primarily due to a lack of improvement to a number of specific intervention targets, namely caring for the skin, toileting and dressing.

For the improvements that did occur, the spinal cord independence measure (SCIM) score increased from 9 to 38 out of 100 possible points (see Table 3), with the largest gains in independent respiration and the ability to turn and sit up in bed.

On this scale, self-care also demonstrated some improvement — eating and holding a cup, soaping with adaptive devices and putting on and taking off these devices independently. Unfortunately these accomplishments fell short of what had been hoped for by the team and Mr. Meier himself.

Table 3: Spinal Cord Independence Measure

Those activities which could not be improved as was hoped all required coordination for performing multiple tasks. For Mr. Meier the execution of such tasks were likely difficult given his impaired memory functions. This in turn limited his self-care activities.  With respect to his age and his general health condition, Mr. Meiers showed some improvement in his functional outcomes. Still his heart disease, his reduced exercise tolerance and the limitations on physical activity all had an effect on his rehabilitative training. Additionally, his reduced memory functions will require future assistance in performing certain tasks.

For example, transferring himself into a car or from his bed to a wheelchair is a somewhat complex process, taking a number of steps that must be committed to memory to be successfully achieved.

At the evaluation, he was not able to recall and execute these steps. This will leave him very dependent on others for assistance.

Given his mental and physical health condition, I don’t anticipate an improvement in his functional outcome.

- Mr. Meiers’ physical therapist at the end of his final Rehab Cycle