Coping and adaptation following acute spinal cord injury: a theoretical analysis

Abstract

Abstract. Coping and adaptation theory is used to synthesise existing data concerning psychological recovery from acute spinal cord injury. Psychological reactions to spinal cord trauma are similar to those of mourning and other situations of severe loss. Each reaction plays a specific role in fostering or hindering recovery depending upon when it occurs. Premorbid personality and the influence of significant others play a central role in coping with injury. These factors partly explain why some patients cope better than others to equally serious disability. A critique of research methodologies and sug gestions for new studies are provided.

Self-neglect of spinal injured patients

“…The necessary development of a modified identity (Steward 1977-78) is an arduous task involving the gradual integration of the reality of the losses within the person's cognitive, affective and behavioural functioning, and the mastering of physical and psychological dependency. The time for this trans formation to occur ranges from 8-12 weeks (Jochheim, 1983), to 2 years (Kerr and Thompson, 1972), to an indefinite period (Bracken and Shepard, 1980). There is, however, consensus in the literature that the disruption of psychological equilibrium caused by the injury, creates emotional distress and a process of mourning.…”

Adjustment to spinal cord injury: stage theory revisited

“…Historically, adjustment to SCI has been viewed as a sequential staging process involving three to five naturally occurring phases (Guttmann, 1976;Bracken and Shephard, 1980;Rigoni, 1977;Stewart, 1977;Tucker, 1980). For example, Stewart describes a three-stage model of coping and adaptation, including denial, depression, and a 'moratorium' or restitution stage (Stewart, 1977).…”

Family functioning and functional independence in spinal cord injury adjustment

“…During the initial period following injury the SCI person may experience severe emotional reactions such as anger, depression and alienation (Bracken and Shepard, 1980;Weller and Miller, 1977a). Family members must cope with these reactions while simultaneously addressing their own feelings of frustration and victimisation (Mailick, 1979).…”

“…The nature of the relationship between the disabled member and family can determine the SCI person's emotional reaction to his or her injury (Harris et al, 1973;Klein et al, 1967) and thereby influence the course of rehabilitation (Bracken and Shepard, 1980;Dinsdale et al, 1971). Unfortunately the family's ability to support rehabilitation efforts may be compromised by the abrupt and pervasive demands for change placed on the family system by permanent dis ability (Mailick, 1979;Steinglass et al, 1982).…”

“…Unfortunately the family's ability to support rehabilitation efforts may be compromised by the abrupt and pervasive demands for change placed on the family system by permanent dis ability (Mailick, 1979;Steinglass et al, 1982). In this regard clinical reports describe a shift in patterns of communication (Mailick, 1979;Rohrer et al, 1980;Weller and Miller, 1977b), emotional intimacy (Bracken and Shepard, 1980;Cleveland, 1979) and role identification (Klein et al, 1967;Shellhase and Shellhase, 1972) within SCI families. Failure to adequately address problems in family adaptation to SCI may be critical to understanding negative treatment outcome in SCI rehabilitation (Hohmann, 1979;Trieschman, 1980).…”