6.3 Exercise: Identifying goals, steps and actions

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Complete the case studies. For each case study, make assumptions about injury and other details as necessary to help you focus on identifying goals, steps and actions.

Case study example

The following case study is completed as an example.

Jacinda experienced a significant fracture to her skull which required a plate to be inserted.

Jacinda has played rugby since she was a teenager. She loves the sport and gained a strong sense of self-worth from her skills in rugby pre-injury. She has played some representative games. She thinks that continuing to play rugby will keep her life on an even keel.

Jacinda is a proud Wiradjuri woman, and a big part of the youth culture in her community is being involved with the local rugby team. She identifies that the camaraderie around the team makes her happy and helps her feel socially included.

Jacinda wants to play rugby again.

Jacinda has been told that she can’t play rugby because of her repaired skull. She has lost some of her physical proficiency following her accident. Partly because of her neurological injuries, but also because the prolonged period of bed rest means she has lost strength and fitness.

After talking with Jacinda, her family, her rehabilitation team and the manager of the rugby team, it was agreed that there are skills Jacinda can focus on developing while complying with the surgeon’s advice. She has agreed to the following steps:

  • Participate in ball skill practice with the aim of being able to:
    • catch a ball from still position at 10 metres 80% of the time
    • throw the ball on target at 10 metres for 80% of throws.
  • Run the length of the field in a certain time.
  • Study game strategies to share with her practice mates.
  • Attend matches in role of team assistant.
  • Attend social gatherings with the team.

Case study #1: Jo

Jo had to retire from their role as a librarian at 53 years old after suffering a stroke. They still enjoy the stimulation of academic discussion that they used to get from their work and the atmosphere of the library. They want to make sure their days are busy with meaningful activity and social interaction.

Jo will become involved with two local community groups.

Jo has not joined local community groups before and doesn’t really know where to start. They are anxious about meeting new people on their own. They have some physical mobility restrictions that mean environments and activities need to be accessible and safe.

Jo will investigate what is available in their local community with the help of a friend, family member or social support worker.

Help Jo learn to explain their access needs and talk to group organisers about whether they are able to accommodate those needs.

Take thorough baseline measures of muscle movement and strength as well as mapping sensation across dermatomes.

Daily physiotherapy in the gym and their own exercise program.

Regular re-assessment to track progress.

Encourage Jo to acknowledge improvement as well as areas that are not improving.

Script and trial appropriate mobility aids across Jo’s recovery – starting with a light weight manual wheelchair.

Jo to engage in transfer training and activity of daily living training to maximise independence and safety.

Jo to engage in a range of social and recreational activities using mobility aids.

Jo’s rehabilitation physician and therapy team to monitor progress and build Jo’s health literacy regarding their prognosis.

Case study #2: Jamil

Jamil has a spinal cord injury from a car accident that happened during the school holidays. He needed to undergo surgery to stabilise his spine. He retained full movement of his arms and laughed about patchy sensation in his legs. Before he was transferred to rehabilitation, he found that he could wriggle his big toe.

Jamil is determined to walk. It’s all he wants to talk about and all he wants to do. His inpatient rehabilitation team are prepared to work with him to see what might be possible.

Jamil wants to be able to walk.

Neurological recovery may stop.

Jamil may have difficulty accepting that his disability is permanent.

Maximise physical recovery of strength and sensation in his legs and trunk.

Provide Jamil the opportunity to practice alternate mobility skills and experience positive activity and participation with this alternate mobility.

Jamil to go on home and community outings using mobility aids as needed.

Take thorough baseline measures of muscle movement and strength as well as mapping sensation across dermatomes.

Daily physiotherapy in the gym and their own exercise program.

Regular re-assessment to track progress.

Encourage Jamil to acknowledge improvement as well as areas that are not improving.

Script and trial appropriate mobility aids across Jamil’s recovery – starting with a light weight manual wheelchair.

Jamil to engage in transfer training and activity of daily living training to maximise independence and safety.

Jamil to engage in a range of social and recreational activities using mobility aids.

Jamil’s rehabilitation physician and therapy team to monitor progress and build Jamil’s health literacy regarding his prognosis.

Case study #3: Jewel

Jewel is 13 years old. She was attending her local school on Yuin Country when she was diagnosed with a brain tumour. It was removed but left her with problems with activity tolerance and memory. Other people are having difficulty understanding her speech.

She has told some of her therapists that she is worried about not being able to catch up with her classroom peers and not being able to resume her love of dancing with the local Yuin Cultural Dance troupe.

Jewel is keen to get back to school and recreational activities to see her friends.

To resume school attendance by June.

To resume dance classes by August.

To maintain her friendships with school peers.

Fatigue.

The amount of rehabilitation sessions she needs to attend.

Jewel and her family’s understanding of the long term nature of her disabilities.

Her friends’ understanding that Jewel has changed in some ways, but is still the same in others – she just might need some understanding and support as she gets back to school and social interactions.

Gradual return to learning program to help manage fatigue.

Continued therapy to maximise recovery.

Resuming dance classes with support and education for the dance instructors.

Family encouraged and supported to invite Jewel’s friends over for short visits.

Therapists to attend school meetings and provide education to teaching staff.

Joint development of a gradual return to learning program.

Home work negotiated to ensure Jewel can complete some work at home when she is not able to attend school.

School to apply for learning support person in class to work one-on-one with Jewel.

Physiotherapy program with a home program supervised by parents to improve strength and endurance.

Speech therapy to continue work on articulation. Work with parents to ensure exercises and strategies are practiced at home.

Therapists to work with family so they can recognise the signs Jewel is becoming fatigued and use appropriate strategies to manage.

Family to invite one friend over at a time to hang out with her, for short periods initially. Gradual increase in time and activities as Jewel tolerates.

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