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Case Studies
The following case studies of patients with spinal cord injuries show the manifold strengths of the Rehab Cycle in clincial practice. The individuals portrayed in these cases differ in regard to the nature and cause of their injuries and the height of the lesion.
1Goal Setting
2Independence
3Hope
4Health Behavior
5SCI in the Elderly
6Recovery after traumatic SCI
7Vocations
8Community Reintegration
9Sports in Rehabilitation
10Walking Recovery
11Care in Developing Countries
12SCI and Environmental Accessibility
13SCI in Adolescence and Peer Relationships
14Bowel and bladder management
15Psychological issues and SCI
16When more time is less
17Motivation and rehabilitation
 
Case Study 8:
Interventions in Community Integration: Vocation through Recreation
Martin's Story Revisited

In the beginning of Martin’s rehabilitation the initial steps with respect to community reintegration were traced towards the longer-term goal of reestablishing a profession. Originally trained as a home electronics salesman, but employed as a mover prior to the accident, Martin needed to begin considering job options and his future as he began planning his return home. Case Study 7 described his experiences at the start of vocational counseling.

At this point in the rehabilitative process the focus remained on promoting both trust and his decision-making capacity. This would later lead to a clarification of career perspectives and, finally, securing a job. This end was critical for a young person such as Martin.

Employment meant more than simply financial security — having a job that he enjoyed was a central element to both his overall human functioning and his reintegration into the community. Stable employment would ultimately contribute not only to Martin’s financial security and independence, but to his self esteem and overall life satisfaction.

At the conclusion of Martin’s first phase of rehabilitation (and of Case Study 7) with its focus on independence in daily living and the start of vocational counseling, Martin had made some significant steps towards his goals (increasing his trust, decision-making capacity and beginning vocational counseling).

Fundamentally, he had established a relationship of trust with his vocational counselor that would do much for the phases of counseling to come. He had also successfully completed a typing course and a computer class — and done extremely well in both. While the latter course had made clear his disinterest in working strictly with computers, it nevertheless increased his motivation to move forward in exploring other possible career paths. This was well illustrated by his initiative in enrolling in an English as a Foreign Language course and beginning to think about possible career alternatives (e.g. inquiring at his former employer if employment possibilities existed).

Still, this remained only one aspect of community reintegration. There were challenges in other areas of his life that he and his healthcare team needed to address as well.

It had been four months since the accident. The past two months of rehabilitation had concluded without any complications and Martin had gained independence physically as well as in activities of daily living within the rehab center. He was given a discharge date of 2 months from this time-point, and his reintegration into his community needed to be addressed. This raised issues regarding participation that needed to be attended to and the future that lay beyond the rehabilitation center continued to worry Martin.

The insecurity of my future situation is my biggest problem right now; it also defines my most important goals. When I think about my leaving the rehab center, there is so much that is unclear — my work, my living situation. It’s a real stress for me.
- Martin, 2 months prior to his discharge

Over the course of his first Rehab Cycle, vocation played an important role. Now two months before his discharge, Martin and his healthcare team would turn their attention to additional preparations for his reintegration. A new Rehab Cycle would support his critical first steps in transitioning back to his community.

 

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