Spinal Cord Injury (SCI)

There are an estimated 11,000 new cases of spinal cord injury (SCI) in the United States per year. Over the last several years, SCI has primarily affected persons aged 16 – 30, 78 percent of whom are males; and predominately Caucasian (78 percent).

Almost half of the spinal injuries occur as a result of motor vehicle injury, second are falls, and the remainder come from acts of violence such as gun shot wounds or knife injuries as well as war related injury.

SCI is defined as, damage or trauma to the spinal cord that results in loss of sensory and motor function. An SCI can result in either a “complete injury” (a loss of all voluntary movement) or an “incomplete injury” (a partial loss of voluntary movement).

An SCI is classified utilizing a scale developed by the American Spinal Injury Association (ASIA) that uses a system to describe the level of injury. For example, a person with an ASIA A complete injury describes a person who has no voluntary movement or sensation below the level of injury.

Dealing with the Diagnosis

Spinal cord injury (SCI) is a devastating event that not only has physical but social and psychological ramifications for both the individual and the family. In one moment, a person’s world is monumentally changed forever with reverberations throughout the whole family system. The person who sustains an SCI is at high risk for many factors including: dependency, depression, drug addiction and, if married, divorce. They can also struggle with debilitating secondary medical complications and other factors such as the effects of perceived social discrimination, declining help and lack of social, family, and emotional support.

Family Implications

When something traumatic happens to one family member, the whole family feels the effects. Roles and responsibilities change. Marital strain occurs when one partner has to take on unfamiliar roles such as providing assistance with activities of daily living, financial responsibility and intimacy changes. This can put the person without the disability at high risk for depression.

Parents who have a young adult child that has an SCI will often reestablish the role or responsibility of parenting. If the person has left home, this may mean moving back in. This can affect self-esteem of the person with SCI and cause conflict with parents.

Interpersonal relationships are affected as well. Friends who may have had previous interests or activities they enjoyed doing together are now different. The person with SCI may withdraw or may feel embarrassed being seen post-injury. While having a young child sustain a spinal cord injury, brings a new dynamic to the entire family system and numerous challenges to the child who must face an SCI during times of dynamic growth and development.

Phases of Adjustment

When a person, and by association, a family, experiences a traumatic event, they will experience a series of emotions or phases. These phases are used as a guideline to understanding this overwhelming emotional process. It is important to note that the person with SCI may be in one phase and the family in a different phase during the same period of time. It is critical to keep lines of communication open and to allow everyone to experience this process at their own pace.

Initial phase

The first stage is a general sense of denial or disbelief stage. This process is a built-in defense mechanism to help us cope with extremely stressful situations. It is a normal process and is usually helped by getting more information. This first step on the road to adjustment is characterized by absorbing information, learning new tasks for care, and understanding what is lost and what is left.

Middle phase

The next phase is usually characterized by more emotional responses such as guilt, anger, and depression. Someone may experience feelings of anger or may displace the anger they feel about the injury onto someone else. A person with an injury may feel guilty, especially if careless or reckless behavior was the cause of the injury. They may also now perceive themselves as a burden to the family. Depression is associated with the losses endured by everyone going through this experience. Whatever the emotion, a person with a SCI or family member should be supported and validated. If symptoms become severe, professional counseling is appropriate and recommended.

Adjustment Phase

This phase can be short or last a lifetime. Generally, during this phase the injured person becomes more familiar with living with an SCI. They may gain independence at a wheelchair level with regard to self-care or may adjust to having a caregiver. During this phase, one generally returns to activities they were doing before an injury such as: socializing, driving, employment/volunteering, and adaptive recreation.
[Full article available at www.helpstartshere.org]