Discussion

At the end of rehabilitation I really made some big gains – independence in using the wheelchair, better self-care and being able to position my body...I also hope to get a car and be able to drive. The most important thing for me is to be able to work once I’m discharged. The support I’ve received [from the vocational rehabilitation counsellor] has been a tremendous help. I’m now even thinking of asking my old boss at the moving company if there is work that I could do there.

Martin, reflecting on his progress and his future

For survivors of spinal cord injury (SCI), deciding on a vocational direction in light of the SCI and finding employment once a vocational decision has been made, present a set of challenges that can seem very daunting.

Persons with SCI who are able and willing to work can benefit greatly from the guidance and support offered by a vocational rehabilitation (VR) counsellor.67811131517 The VR counsellor can assist the person through his or her vocational exploration and decision-making, and ultimately reintegration into a desired profession.

This case study of Martin centred around the actions taken during the first phase of a three-phase model of VR – the activation phase. The activation phase aimed to establish trust between Martin and the VR counsellor (and others involved in the process), and provide the opportunity to encourage and support Martin in taking the first steps toward re-entering the work force. VR counselling and continuing education courses helped him to pinpoint his interests and to develop ideas that can be explored in the later phases of VR counselling.

As illustrated by this case study, VR (counselling and training) is one important component of rehabilitation management in SCI. Martin's case also showed that rehabilitation management and VR can benefit from the phase-by-phase Rehab-Cycle^® approach, specifically its person- and resource-oriented assessment, targeted goal-setting, coordinated allocation of resources and interventions, and evidence-based evaluation of progress.

In Martin’s case, VR counselling and training had already begun prior to the start of the present Rehab-Cycle^® and continued until the end of the Rehab-Cycle^®. Almost immediately after Martin's rehabilitation started, he began considering his future including the prospects of working. Martin recognised early on that as a young man of 26, he needed and wanted to work in something he enjoyed. For Martin, work participation was more than just earning money; it was an important part of his reintegration into life and society. This view of work is consistent with the findings indicating that the majority of the persons with SCI studied expressed the desire to work.15

""For Martin, work participation was more than just earning money; it was an important part of his reintegration into life and society.""

However, despite this view of work, Martin was unsure about the options available to him as a person living with SCI, and even less sure about the options with which he would feel comfortable. He acknowledged that it was no longer possible for him to do the physical work he previously enjoyed as a mover. Martin's acknowledgement that he will no longer be able to do such physical work can be seen as positive, considering that persons with SCI who had less physically-demanding occupations are more likely to find gainful employment.6710 However, Martin experienced difficulty deciding on the vocational direction and the next steps he should take.

VR counselling and training empowered Martin to explore different options and to get “hands-on” by acquiring basic training in using a computer. Participation in the computer course was only the means that the VR counsellor employed to help Martin build his self-confidence and strengthen his decision-making skills. It also inspired his initiative-taking; this was evident in Martin's decision to participate in an English language class. This VR approach seemed to have opened up the road to discovering new possibilities, and at the same time clarified areas of work that Martin did not want to pursue.

Besides the interventions to address Martin's specific goal of returning to work, other interventions were provided to tackle other important goals i.e. mobility and self-care – both also relevant to increasing vocational potential.278131720 Greater independence in mobility, especially in transportation and driving has shown to be a positive predictor of work participation following a SCI.2813 Achievements in improving mobility and self-care proved to be contributory to Martin’s later success in finding and keeping a job.