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Chapter 4 presents information on psychosocial issues following spinal cord injury, as well as strategies for facilitating adaptation.
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Spinal cord injury often causes sudden and profound life changes. Imagine, if possible, what it would be like to be actively engaged in sports, driving, working, and other daily activities one minute and the next minute to be incapable of moving one's extremities or acting independently. In the initial days and weeks following spinal cord injury, an individual may require multiple surgeries and extensive hospitalization, which alone are distressing to them and to their family. During this time, and over the months that follow, the person may be adapting to paralysis, incontinence of bowel and bladder, and lack of independence for basic self-care and mobility, with uncertainty regarding improvement or long-term outcome. For any person, such sudden and significant changes in functioning would be jarring and overwhelming, understandably leading to feelings of grief and isolation. As the person continues recovery and ventures into the community, they are faced with the longer-term adaptation to the challenges posed by inaccessible physical environments, as well as changes in social contexts and status that may range from accepting and accommodating to hostile, dismissive, avoidant, or indifferent. Over time, individuals who have sustained spinal cord injury may need to learn new skills and adapt to many changes in their life, including physical, medical, psychological, and social changes resulting from injury. The goal of rehabilitation is to assist each individual in this process, which is ideally initiated within the environment of the hospital and inpatient rehabilitation center before continuing after discharge.
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“My world was constructed of obstacles and barriers that other people could not see, even though they stared at me all the time.”
John Hockenberry
journalist, author, advocate, T5 SCI survivor1
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CHANGES AND LOSSES ASSOCIATED WITH SPINAL CORD INJURY
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The scope and types of change following spinal cord injury are multifaceted. Some losses are obvious and immediate, whereas others are more subtle and can be determined only with the passage of time and evaluation of circumstances.
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Perhaps the most obvious and immediate losses engendered by spinal cord injury are those of physical functioning. Depending on the completeness and level of the injury, a person can lose control of some or all limb and trunk musculature. As muscles atrophy with time since the injury, the physique of the individual will change dramatically: Once strong and muscular limbs may become thin, whereas the weakening of trunk and abdominal muscles and lack of mobility may cause flaccidity and weight gain. Where sensation is affected, the individual loses the ability to perceive the presence, position, and motion of their limbs or to experience the myriad pleasant and unpleasant sensations from the environment. Often, bowel and bladder control are lost or impaired and sexual functioning will ...