The aim of psychosocial rehabilitation is to reduce handicaps as far as possible. One handicap in chronically ill adolescents is the impairment of quality of life. The quality of life of chronically ill or handicapped adolescents can be defined with a bio-psycho-social model. The connections between adaptivity level, severity of the physical disability and experienced helplessness of young wheelchair users with paraplegia or tetraplegia are demonstrated. Advantages of inpatient and outpatient rehabilitation with regard to quality of life are reported.

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With the Functional Independence measure, which is a reliable and valid instrument, data can be collected for large groups of persons with different disabilities. For the first time the FIM has been used for outcome assessment in medical rehabilitation of a cohort of neurologically ill adolescents. The instrument is appropriate for this purpose. The severity of disability, which changes during rehabilitation of adolescents, is adequately estimated with FIM. The motor FIM and the cognitive FIM can be summed up separately for evaluation. In our investigation the construct validity of the cognitive FIM was demonstrated: the cognitive FIM showed a high correlation with the degree of neuropsychological impairment following brain damage. Psychiatric disorder does not correlate with the motor FIM and the severity of disability.

In order to avoid threatening social disintegration, it is important for children and adolescents with chronic mental disorders and also for physically disabled children to diagnose disturbances of social participation in an early stage and to commence rehabilitation measures. The need for rehabilitation, the ability to rehabilitate and the rehabilitation prognosis are important for identifying the individual rehabilitation goals. A multi-axial diagnosis according to the ICF with a determination of adaptability, a behavioural analysis, skills, activity and participation is required. For disabled children, there are only a few ICF check lists for diagnosing social participation. Because of this, the ICF check list CASP (Child & Adolescent Scale of Participation) for measuring social participation according to Bedell was translated, which is shown in the appendix.

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