The findings suggest that psychological factors, such as depression, and aspects of coping strategies may contribute to premature mortality. Further research is needed to develop interventions that focus on protective psychological factors to reduce mortality risk following SCI. Coping strategies in the early stages of rehabilitation are an important predictor of both long-term psychological outcomes and appraisals, and this has clinical implications for psychological aspects of rehabilitation.

Pain and mood evidently interact following spinal cord injury, and the nature of this relationship is complex. The current study provides some support for the bidirectional causality hypothesis, suggesting that pain and mood exert an effect upon each other. It is important to address pain and psychological issues early and together in the post-injury phase to optimize rehabilitation outcomes.

Study design: Single-centre, retrospective cohort study. Objectives: To analyse the return-to-work intentions during spinal cord injury (SCI) rehabilitation. Setting: Tertiary care, spinal cord injury rehabilitation unit, National Spinal Injuries Centre, Stoke Mandeville Hospital, Ayelsbury, UK. Methods: Employment outcomes were obtained from the Needs Assessment Checklist (NAC), for all patients admitted to the unit between February 2008 and October 2014. NAC1 is completed within 4 weeks post-mobilisation and NAC2 upon the patient moving to the pre-discharge ward. Data from 362 participants were analysed for return-to-work intentions, by gender, age and injury severity. Results: Seventy-six percent of the sample population was employed at the time of their injury. At NAC1, 22.4% of individuals had made plans to return to work, whereas 44.2% had not; at NAC2, 34.3% had made plans to return to work and 31.2% had not. This difference was found to be statistically significant. There were significant differences in return-to-work intentions by injury severity at NAC1 but not NAC2, and by age group at NAC2 but not NAC1. Conclusion: Less than half of those employed at the time of their injury had made plans to return to work before their discharge from the unit. The low proportion of individuals with SCI returning to work-just one in three-is concerning in view of the lost health and psychosocial benefits, and requires greater prominence during rehabilitation. Future research into effective employment interventions to improve employment outcomes in this population is required.

Inclusive practices mean many children with autism spectrum disorders (ASD) attend mainstream education settings. To manage the stressors involved and access its benefits, support can be critical. Indeed, insufficient support can detrimentally impact wellbeing, longer-term development, and the inclusivity agenda. Expanding a limited evidence-base on educational support after diagnosis, focus groups and interviews were conducted for eight parent/carers of children with ASD, twelve special education needs (SEN) school staff, and four children with ASD attending mainstream school. An inductive thematic analysis on the data elicited three themes: a system overwhelmed by unmet needs, the impact on quality of life, and hope for the future. The overwhelming finding was a significant lack of education support for parent/carers and school staff, with the mainstream education system poorly designed and insufficiently resourced to facilitate the inclusion of children with ASD, particularly for those impacted by historic difficulties with access. The tireless work of parent/carers and frontline SEN educators fostered a sense of hope and engendered inclusivity for the children who participated, who felt supported. Given their buffering role, protecting and supporting parent/carer and SEN teacher wellbeing requires a policy shift supporting longer term inclusivity alongside improvements in funding streams and accessibility in provision.

The relationship between non-traumatic cause of injury and rehabilitation outcomes may be mediated by severity of injury. Individuals with infection-related NTSCI are more likely to be complete, therefore, present more significant rehab needs, and lower rehabilitation outcomes particularly in physical health, activities of daily living and bowel management domains. This supports previous findings of Kay et al. and provides a possible explanation for the differences. This further informs future interventions.