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After reading this chapter, the reader will be able to:

  • Explain key models of psychological adjustment to disability and the implications for clinical interventions for people with spinal cord injuries (SCIs)

  • Differentiate the concept of quality of life/life satisfaction from health-related quality of life and describe the relevance to SCI rehabilitation

  • Identify the key factors that contribute to quality of life during different times in the life course of people with SCIs

  • Define participation and discuss barriers to participation in employment, marriage and parenting, and access to health care experienced by people with spinal cord injuries and identify solutions to these barriers

  • Describe how barriers to participation affect emotional adjustment and quality of life


The person with a newly acquired spinal cord injury (SCI) is confronted not only with the loss of mobility and physical function but also with a tremendous amount of uncertainty about what the future holds. Most people do not have personal or immediate experience with disability and often have negative preconceptions about disability and its impact on quality of life and social participation. The media often portrays people with disabilities in stereotypical ways–as objects of pity, objects of terror, or, in rare cases, as inspirational overcomers. The lives of real people with SCI, however, defy these stereotypes. They hold jobs, go to school, fall in and out of love, raise families. In short they are capable of engaging in a broad array of social roles. Their lives ought not to be objects of pity, fear, or inspiration. Each of these portrayals is detrimental because it obscures the complexity of the lives of people with disabilities; yet, in the absence of complete information, stereotypes are what many people use when trying to understand what a newly acquired SCI means for them. Disability research and much of clinical practice perpetuates negative conceptualizations of SCI by approaching research from a deficits-based approach. While relying on empirical research that highlights the negative impact of SCIs, this chapter seeks to debunk some of the myths of life with a SCI by providing a realistic picture of psychosocial adaptation, quality of life, and community participation for people with SCIs.

This chapter will describe the dominant perspectives on psychosocial adjustment to SCIs and the implications for therapeutic interventions. Psychosocial adjustment is closely related to quality of life and community participation outcomes. Each of these topics will be discussed, concluding with a discussion of participation that is influenced by SCI. Practical suggestions that rehabilitation professionals may integrate into their clinical work with people who have SCIs are offered. This chapter strives to integrate a traditional psychological rehabilitation focus with a disability studies perspective, so as to provide a balanced and nuanced view of the lived experience of life following SCI.

The purpose of this chapter is to provide a comprehensive guide to the most current thinking regarding the psychological ...

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