Biomedical Engineering Reference
In-Depth Information
made by the client must be supported to consolidate their postinjury sense of self and their
psychological growth. The vertical trunk of the Y represents this part of the path. During
the process, the client can discover aspects of continuity with the preinjury self and can
develop new adaptive and personal meanings arising as a result of the injury and related
experiences.
Gracey et al. (2009) suggest that at the very top of the Y, it is possible that many clients
will experience a discrepancy by trying to keep a sense of identity through the negation of
the difficulties. In the long run, this leads to the loss of relationships and social networks.
Customers often deny the presence of difficulty, even with rehabilitation professionals. In
the Y-shaped model, social and interpersonal factors can play a role in overcoming per-
sonal discrepancies, in reaching a new awareness, and in developing coping resources.
Nevertheless, findings from many studies suggest that the focus in rehabilitation may go
beyond compensation for deficits and perhaps should more explicitly incorporate a focus
on growth and personal meaning.
In the Y-shaped model, the key phases of the process of rehabilitation correspond to
(1) the development of safety; (2) the understanding of, engagement with, and reduc-
tion of social, interpersonal, and intrapersonal discrepancies; and (3) supporting psy-
chological growth. For each key phase the authors (Gracey et al. 2009) identify the social,
interpersonal, cognitive, and emotional variables involved and the corresponding reha-
bilitation activities and strategies. In conclusion, the authors believe that the meaning of
life experiences is key to well-being—psychosocial outcome measures that focus solely
on the amount or level of activity might not reflect meaningful personal change for the
individual.
Steiner and colleagues (2002) proposed the Rehab-CYCLE, a modified version of the
Rehabilitation Cycle developed by Stucki and Sangha (1998). It leads the health-care pro-
fessional with a logical sequence of activities to successful problem-solving or individual
goals achieved. The Rehab-CYCLE identifies the patient's problems and needs and relates
the problems to relevant factors of the person and the environment. It is useful to define
therapy goals, to plan and implement interventions, and to assess the effects.
To have a conceptual framework for ordering and understanding what disease means
to a patient, the authors (Steiner et al. 2002) developed an extension of the Rehab-CYCLE
(Stucki and Sangha 1998) that they called the “Rehabilitation Problem-Solving Form”
(RPS-Form). The RPS-Form consists of a single datasheet that is based on the ICF. It is
divided into three parts: (1) a header for basic information, (2) an upper part to describe the
patient's perspective, and (3) a lower part for the analysis of the health-care professionals.
The RPS-Form is designed to distinguish between the perspectives held by the patient and
those of the health-care professional. The patient's view is recorded in the upper part of
the form denoted with “Patient (or Relatives): Problems and Disabilities,” and the health-
care professional's views are noted in the lower part denoted with “Health Professionals:
Mediators Relevant to Target Problems.” The rehabilitation team attempted to identify
those characteristics of the patients or their environment that caused or contributed to
their problems.
The multiple interactions between patient and environment and between all com-
ponents of the patient's organism require thinking in terms of causal networks rather
than in straight lines where A causes B, which leads to C. When it is unclear whether
a variable is directly responsible for a disability or whether it is an element that con-
tributes to certain processes involved with the disability, the RPS-Form uses the term
“mediator” to describe such variables (Steiner et al. 2002). The main task of the rehabili-
tation team is to discern the target mediators (i.e., those mediators that are supposed
