Psychosocial Factors in Spinal Cord Injury



Not only does the physical self change, the psychological self changes after spinal cord injury.Body image, self-worth, loss and grief, suicidal ideation, life roles, family dynamics Ė these are but a few of the psychosocial factors that must be addressed after spinal cord injury.Intensive psychological support is a critical piece of the rehabilitation process.


The following shows that stages of adjustment in dealing with spinal cord injury.How an individual moves through these stages varies.Some get caught along the way.On-going support systems need to be identified or developed for psychosocial adjustment and success.


Stages in Adjustment to Injury


††††††††††††††††††††††† Stage ††††††††††††††††††††††††††††††††††††† Response______________________

††††††††††††††††††††††† Shock††††††††††††††††††††††††††††††††††††† - Disbelief at what happened

-   Denial that anything serious or bad

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† has actually happened

††††††††††††††††††††††† ______________________________________________________

††††††††††††††††††††††† Expectancy of Recovery†††††††††† - Hope that injury is only temporary

-   Bargaining as a means of ensuring

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† a fast and complete recovery

††††††††††††††††††††††† ______________________________________________________

††††††††††††††††††††††† Mourning††††††††††††††††††††††††††††††††† - Recognition that the injury is

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† permanent and that a self-image

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† based on previous abilities has been

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† lost

-   Constriction of interests

-   Focus on self-depreciating behavior,

†† such as self-pity and expressions of

†† hopelessness and worthlessness

-   Depressive behavior, including turning

†† away from the support system of

†† family and friends

††††††††††††††††††††††† ______________________________________________________

††††††††††††††††††††††† Defense††††††††††††††††††††††††††††††††††† - New self-image begins to form

-   New behavior is tested and tried out,

†† including angry, aggressive, or

†† acting-out behavior

-   Dependence-independence struggle of

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† adolescence is repeated

-   Emphasis is placed on the here and now

††††††††††††††††††††††† _______________________________________________________

††††††††††††††††††††††† Adjustment†††††††††††††††††††††††††††††† - New self-image is formed

-   Goals and plans can be made for the

†† future

-   Interest in exploring the quality of life for

†† him- or herself and significant others

-   Ability to make decisions and solve

†† problems

††††††††††††††††††††††† ________________________________________________________

††††††††††††††††††††††††††††††† Source:Seidel, A.C. (1982). Spinal Cord Injury. In Logigian, M.K. (Ed.), Adult Rehabilitation: A

††††††††††††††††††††††††††††††† Team Approach for Therapists (pp. 325-346). Little, Brown, & Co.



When attempting to help a person with a spinal cord injury, understanding where they are in the adjustment process is a key piece of information.Accepting help is a new skill to learn.For example, in developing a vocational plan, success will be dependent not only on the physical tasks that have been mastered, but also the psychosocial skills related to adjustment to disability.Adjustment is not just a task, however, but rather a process to be maintained.Optimal health is a combination of physical and mental health.


Now letís take a closer look at functional deficits related to SCI.