Reablement - Person Centred Approaches in Rehabilitation

What happens when a person suffers a catastrophic injury? Their life changes 100%. They transition from being fully independent in life to being fully dependent on services and natural supports if they are lucky enough to have them but heir side.

Reablement is a journey using person centred approaches to find independence after injuries like this. I have been blessed to have the opportunity to work with a couple of people in this type of situation.

My brother was the first. His injuries left him in a vegetative state for 7 months. He was 100% dependent on care workers, nurses, doctors and us as his family to do everything for him. He breathed through a Tracheotomy and ate through a feeding tube. He could not use the vocabulary that he always had, in fact he had no words; only mumbles at best.

When I saw him being treated like "just a patient" I was concerned. I knew he wouldn't live long like this but I wanted his last days to be as meaningful as they possibly could. I wanted him to have as much choice and control as possible. How is that possible you ask? Well it was and we made it so.

We had to make a lot of guesses based on what we knew about him before the accident. We made a lot of decisions for him based on what we thought he would want. We created a one page profile for him so that care workers got a sense of who he was as a person, not just a patient. We talked about what was important to him and for him. We talked about what as working and not working for him from all different perspectives. We listened to his body language and made decisions based on what we thought he was telling us. When he passed I believe we had given him a comfortable end of life, one that he would have chosen in that situation. Of course we will never know for sure but I think we did the best we could for him. He did have choice and control in the end as he should.

Currently I am working with a young girl who suffered a catastrophic injury in the last year or so. She was a vibrant 17 year old woman when she was in a car accident and left paraplegic. She remains a vibrant 18 year old today but as you can imagine her life has changed drastically. She spent many months in hospitals until she was able to come home. Her life is consumed by service workers provided by her insurance that have very specific goals to work on with her to keep the insurance company funding them. Of course they truly want to see her succeed as well but the bottom line is if they don't make progress the insurance company will deem the services unnecessary. This would be devastating to everyone involved. So all of these services spend many hours each week trying to encourage her to participate in her services. She has been resistant at best. She has said from day one "I will get there someday, I will find the motivation but right now I don't care and I won't do anything until I am ready!"

I was hired as her rehab coach, to keep her motivated in daily life activities. She has been resistant to that as well. She sees her life as a typical teenagers life and doesn't see why people see her as someone who needs help to clean, cook, or get up every day. Her services see her as a young girl who is not going to school and staying in bed all day; essentially not participating in her own life.

We created a One Page Profile together some time ago to share with her team. It was helpful in creating conversation and helping them to modify how they approach her. We have looked at what is important to her and for her, what is working and not working for her but haven't made a lot of progress.

I was very happy this past weekend when she finally found her motivation and called me to ask for support in some very specific areas. "I am ready now", she said! She found her motivation, she linked something that is important for her to something that is important to her - her new boyfriend; and now she is ready to move forward.

So now our focus is on some specific coping strategies as well as looking at her hopes and fears for the future, her history and how it dictates who she is today. We will look at what a perfect week looks like for her, some decision making tools and use a learning log to record our progress. We want to educate her service providers and ensure that she has control of her situation and a good balance of her important to's and for's so she has a meaningful life. Isn't that what we all want?

I am also very happy that she is allowing me to use her story as an example for an upcoming presentation I am doing for the Vocational Rehabilitation Associations Annual Conference in Ottawa. We are actually hoping that she can attend with me just to see what conferences are like, attend a session or two and if she feels comfortable help me share her story.



Person Centred Approaches are so very useful in all areas of life, no matter what you are dealing with. We all go through stages and phases, small and large, expected and unexpected; we learn so much about other people and ourselves through these approaches. I am looking forward to sharing them with the rehab world and seeing how far we can spread them.