Swiss Paraplegic Research

Goal Setting

From the previous cycle, it was clear that the next phase of rehabilitation would need to focus on community reintegration. Martin’s Global Goal remained unchanged: independent living. A new Program Goal was determined as transition to community. Note that the previous Service Program Goal was defined as independence in daily living (in the rehabilitation facility). Martin had achieved this in the last Rehab Cycle.

Box 2:

Organization of Transition to Community

Both the healthcare team and Martin himself then identified four areas that they felt needed to be addressed:

• Mobility — To be independent when using the wheelchair in any location, as well as in the use of means of transportation (car, public).
• Recreation — What options existed and what were Martin’s interests, especially to find opportunities for sporting activities?
• Employment — Building on the vocational counseling already begun, what were Martin’s prospects and potential avenues for work?
• Accommodation — What type of housing was possible and desirable?

Based on these areas of concern, the following Cycle Goals were defined:

1. Vocational reintegration
2. Independence in transportation and housing
3. Development of recreation and leisure activities
4. Movement-related functions

Determination of intervention targets

For each of the Cycle Goals, intervention targets were established:

Table 2:

ICF Categorical Profile

• To advance vocational reintegration, Martin’s decision-making competencies needed to be improved, suitable careers needed to be identified and employer support needed to be ensured in order to develop a concept of Martin’s future profession.

• Achieving independence in transportation and housing required further wheelchair training on a variety of terrain and the ability to drive an adapted car including securing an appropriate driver’s license. Assistive devices needed to be ordered, including a car adapted for disabled-access and a Swiss Track™, a motorized device for increasing wheelchair mobility. Lastly, Martin’s decision-making competencies and his stress regarding the future needed to be focused on finding a solution to his housing problem.

• The development of recreation and leisure activities, primarily sporting activities, were achieved through improving exercise tolerance, muscle and movement functions, the ability to maintain a sitting position, exploring specific athletic activities and initiating contact with a local sports club for the disabled.

• Intervention targets regarding movement related functions were focused on Martin’s insufficient immune response (manifested for example, in Martin’s recurring urinary tract infections which increased his muscle spasticity and stiffness). Pain management would increase Martin’s range of motion and allow for more intensive training. Also emphasized was improving Martin’s relationship with his body which, it was hoped, would contribute to increased movement functions.

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