The Rehab Cycle

Evaluation
Two months later, Martin had made significant progress in multiple areas within this Rehab Cycle. The individual evaluations of each of his intervention targets are illustrated in the ICF Evaluation display (Table 3). First and foremost, his vocational training was proving successful at both building initiative and trust. Although Martin found himself unenthusiastic about working on a computer he participated in all course sessions.

Box 3: Career fields — potential for growth29

Despite a relative lack of enthusiasm with the computer course, he continued to attend, demonstrating his ability to work independently and effectively. In the end, he not only completed both sections of the course successfully, but also was also able to make a decision of his own initiative to enroll in an English as a Foreign Language course. The vocational counselor found this to be a very positive development given Martin’s prior indecisiveness. It demonstrated that the process of Martin’s vocational clarification was under way. Taking this development into account, the vocational trainer decided to start with the next step of vocational training in the following Rehab Cycle, the phase of clarification and decision making. From his experience, several careers are options for persons with SCI (see Box 3).

Regarding his overall functioning, the health care team was pleased to find he had made excellent progress. After four months of rehabilitation, he was completely independent in both his daily living activities and his abilities of self-care, including bowel and bladder management. From the perspective of his health care team, he was quite ready to be discharged from the rehabilitation center.

Table 3: ICF Evaluation display

However, challenges for Martin remained. A number of impairments in body structures and body functions persisted. While Martin’s leg pain was under control, a pain at the base of his spine was increasing in intensity and is not yet under control. His muscle spasticity was also still a problem and was affected by neither sauna therapy nor hippotherapy. Another outstanding issue was a recurring urinary tract infection that was continually being treated medically.  At the end of this Rehab Cycle, Martin succeeded in achieving all of his Cycle Goals, leaving him and his health care team optimistic about the future.

 

During the course of rehabilitation (through his evaluation), Martin’s SCIM score steadily increased from 8/100 to 70/100 (see Table 4). Furthermore, his advances in the SCIM score occurred in multiple areas of self-care, mobility and body functions.

For his final evaluation in this Rehab Cycle, Martin’s psychologist offers a qualitative perspective on his progress as well as Martin’s own thoughts at the cycle’s completion:

Table 4: Martin’s spinal cord independence measure (SCIM)

Keep in mind Martin’s coping ability and the disease progress. He had difficulties initially with making decisions and commitments, and we really pushed him to participate in the computer course. He then did extremely well and thrived in the face of the challenge. Once we can move forward in arriving at some decision on Martin’s future, we’ll do everything we can to help realize it. For the next two months we need to continue to work on clarifying his vocational perspectives. —Martin’s vocational trainer Martin is dealing quite well with his situation and really shows interest in his well-being and his future. He is sensitive and very open about his emotions — a very positive trait. Taking Martin’s behavior into account, I think he’ll have no trouble achieving his goals. —Martin’s psychologist

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