[Participation limitations following acquired brain damage: a pilot study on the relationship among functional...

The SGB IX, book 9 of the German social code (Sozialgesetzbuch, SGB), which is the legal basis of rehabilitation in Germany, states "participation and self-determined conduct of life" as the ultimate ambition of rehabilitation. This concept of participation and disability is based on the WHO model expressed in the International Classification of Functioning, Disability and Health (ICF). In this model, participation after the onset of a health problem may not only be infringed by disturbances in body functions and structures and the resulting activity limitations but also by contextual factors such as environmental and personal factors. In an outpatient neurological rehabilitation centre we prospectively rated for 49 patients the influence of these contextual factors as well as of objectively assessed functional/activity limitations on the overall disability. On average, functional/activity limitations were rated as contributing 58.4% (SD=17.2%), personal factors 26.4% (SD=12.7%) and environmental factors 15.1% (SD=11.2%) to the overall disability. The functional/activity limitations closely matched the expected limitations based on the underlying brain lesions. The degree of disability based on contextual factors was not related to activity limitations based on disturbances of body functions and structures. Also, demographic variables such as age, sex or chronicity were not significantly linked to contextual factors. Since contextual factors together contributed 41.6% (SD=17.2%) to the overall disability they have major relevance for the rehabilitation process, because they essentially decide on the extent to which abilities acquired by the rehabilitant during rehabilitation actually be transfered to his everyday life. Therefore, rehabilitation programmes need to include assessment and treatment of contextual factors. It hence is necessary to develop instruments to quantify contextual factors.