PATIENT'S PROFILE

These profiles will illustrate how the Matrix Rehabilitation Services assessment and treatment process is applied to people with chronic disabilities:

BARBARA

Barbara was a 48-year-old healthcare aid at a nursing home. She had a history of a work related injury to her left arm which had left her with localized pain and resulted in her being shifted to an alternative, less physically demanding job.

However, beginning about four years ago, Barbara developed much more widespread pain and aching that made her unable to perform even the lighter duties of her employment. She saw numerous specialists, was eventually given the diagnosis of fibromyalgia, and went on disability benefits.

Frustrated, Barbara's employer and disability insurer made it clear they suspected her difficulties were not legitimate. Barbara became angry that her honesty was being questioned.

At this point, Barbara was referred to Matrix. A detailed medical review confirmed some specific, well-defined pathology in Barbara's shoulder, which caused some of her restrictions but could not account for her overall discomfort and disability. No other definable disease or pathology was identified.

It was clear that Barbara held some very strong beliefs about the nature of chronic pain and fibromyalgia, as well as anger about the manner in which she had been treated by her employer and insurer. A history of previous abuse was also identified which clearly had affected Barbara's reaction to her perceived treatment within the workplace.

A treatment program was recommended which included independent and continuing counselling for Barbara's previous history of abuse. A carefully constructed activation and mobilization program was implemented. Changes were made in Barbara's medication, including a reduction in the use of analgesics, and establishing her on a therapeutic dose of an anti-depressant.

Matrix worked closely with Barbara's employer and insurer to ensure everyone's clear cooperation with a graduated return to employment. Barbara's employer agreed to make her previous position available to her, and participate in a graduated return to work. However, it was made clear to Barbara that she must be able to perform adequately without excessive absenteeism due to chronic pain, in order to continue to be employed with the nursing home.

Similarly, Barbara's insurer agreed to continue benefits for the duration of the treatment program, including the graduated return to work, but also made it clear that Barbara need not remain totally disabled with respect to any form of gainful employment.

Ongoing therapy included physical activation and mobilization, cognitive restructuring and anger management. Barbara successfully returned to full-time work in her incumbent position. Her absenteeism did not exceed acceptable levels. Follow up over the last three years has indicated that Barbara has been able to maintain this level of employment without interruption.

GARY

Gary was a 43-year-old commissioned salesman. When assessed, he had been suffering from chronic fatigue syndrome (CFS) for the previous five years and had made two unsuccessful attempts to return to work.

Gary had founded the local chapter of a CFS support group. He was then receiving long-term disability benefits and held the view, confirmed by his physicians (experts on CFS), that he would never return to employment.

Gary's assessment at Matrix included a very thorough medical review. There were no issues of outstanding disease or pathology. However, a thorough assessment of Gary's pre-disability activities uncovered that his lifestyle had been extremely demanding, professionally, socially and personally. His previous efforts to return to work were characterized by a resumption of this lifestyle followed by a significant relapse.

Following Gary's assessment, a treatment program was designed and subsequently implemented. Gary's employer was supportive and willing to participate in a very closely controlled graduated return to work, but made it clear to Gary that if this third attempt to return to work was not successful, it was unlikely that he would continue on as an employee of that company.

Similarly, Gary's disability carrier was very supportive of treatment and a graduated return to the workplace. However, they made it clear that if Gary was unable to return to the pressures and demands of commission sales, they would expect him to seek alternative, less demanding employment, and would not consider him to be totally disabled indefinitely.

Gary's treatment required restructuring of his work habits, his recreational habits, and his beliefs. Carefully pacing both recreational and vocational activities according to a predetermined schedule - rather than perceived demands or the previous structure of these tasks - was a difficult undertaking for Gary.

Nonetheless, Gary persisted. With the help of Matrix staff, he gradually returned to a more balanced lifestyle, carefully controlling the demands of his work and ensuring appropriate time for himself and his family.

Interestingly, Gary found that he could be almost as successful, in terms of the bottom line, by being much more selective in following up prospects and becoming more efficient in the workplace, yet still limit himself to a 35-40 hour work week. Appropriately balanced and controlled physical activity, stress management strategies, and other lifestyle changes were essential components of Gary's program.

Gary successfully returned to full-time commissioned sales. Matrix has followed his progress for the last four years, and he continues to function well and successfully.