Spinal Cord Injury Adjustment Model
Original Editor - Dinalize Purcell
Top Contributors - Dinalize Purcell and Khloud Shreif
Introduction
Spinal cord injuries (SCIs) impact a person's life significantly and can lead to difficulty integrating back into society. The goal of adjustment post-injury is to reach an acceptable quality of life (QoL) and to return to the desired social roles, for example, to return to employment or the primary caregiving of one's family [1].
This adjustment process is complex and is influenced by many factors. For example, people with SCIs can experience elevated levels of psychological, such as depression, anxiety, [2]or lower functional independence resulting from the SCI.
Craig et al [3] have suggested the Spinal Cord Injury Adjustment Model (SCIAM) to understand the complex process of adjustment post-SCI. This model suggests that adjustment is a complex and dynamic process that follows a non-linear timeline. The model entails interactions between bio-psycho-social factors. [3]
SCIAM
SCIAM theorizes that adjustment consists of moderators, mediators, and outcome measures. The outcome measure is either a positive or negative adjustment to society after an SCI. This adjustment is not something that happens once off, but that changes throughout the different phases of rehabilitation. [3] Figure 2 below illustrates the interactions between these components of SCIAM. [4]An important addition that this model makes to other adjustment models is that mediating factors can change the adjustment outcome.
Craig et al[4] found that there is double mediation, however, other researchers have not yet found evidence for this double mediation. There have been studies that show the mediating effect of factors such as coping strategies, and appraisal on outcome measures such as depression, anxiety, and life satisfaction. [5][6][7]
Components
Moderators
Moderators are factors that have a direct influence on the adjustment outcome. For example, depression can lead to negative adjustment post-discharge. [4] According to Craig et al, [3] the following are the main moderators to consider when using this model:
- Biological: age, sex, level of SCI, co-morbidities, or secondary health conditions such as traumatic brain injury or urinary tract infection. The level of injury will have a big influence as this will determine the patient's functional independence and level of self-care, outcome measures such as the Spinal Cord Independence Measure can help to determine the limitations and the treatment goals of patients.
- Psychological: psychological status before the SCI, personality, resilience.
- Social: support networks such as family and friends, financial status.
- Environmental: Employment, health services available, physical environment such as housing and infrastructure.
Mediators
Mediators can influence the relationship between moderators and the adjustment outcome. Therefore, appraisals and coping strategies can improve adjustment even if the moderator negatively influences adjustment. If we continue with the example above, if a person has depression that leads to negative adjustment, then applying positive appraisal and coping strategies can improve adjustment.[3]
- Appraisal: This refers to how a person views the situation; they look at all the moderators, their resources, and their abilities to handle the situation (general self-efficacy) and weigh all the positives with the negatives. This appraisal then leads to the chosen coping strategies.[3] For example, if a person views the situation negatively then they might apply maladaptive coping strategies like withdrawal, self-neglect or alcohol abuse.
- Coping strategies: as mentioned above according to SCIAM this is determined by the appraisal of the situation. Coping can be adaptive or maladaptive and is generally divided into three categories, problem-focused, avoidance, and emotion-focused coping. [8]Positive or adaptive coping can include behaviour such as following exercise programs as seen inn figure 3, drinking medication, and seeking social support.
In SCIAM these two mediators interact with one another, this is referred to as double mediation. [3] There is also a re-appraisal process where if a person is not satisfied with the adjustment outcome, they will re-evaluate their situation and choose different coping strategies to achieve a different outcome.[4][3]
Adjustment
As mentioned above adjustment in SCIAM is seen as non-linear, therefore it can change over time and as the moderators and mediators change. Examples of adjustment outcomes are depression, anxiety, social engagement, and participation, quality of life, and life satisfaction. [3]
Clinical Significance
SCIAM attempts to understand the complex process of adjustment after an SCI. As seen in the model adjustment is dependent on various factors all influencing and interacting with one another. For the clinician, it is important to remember this concept and look at the holistic picture of a patient. It also emphasises the importance of working in a multidisciplinary team to meet all the needs of a patient. This model can be used to try to understand and influence the correct factors that might lead to negative adjustment of a person with an SCI. The end goal is the improvement of the rehabilitation and treatment of a person with an SCI.
References
- ↑ Craig A., Nicholson Perry K., Guest R., Tran Y., Middleton J. Adjustment following chronic spinal cord injury: Determining factors that contribute to social participation. Brit. J. Health Psychol. 2015;20:807–823
- ↑ Craig A., Perry K.N., Guest R., Tran Y., Dezarnaulds A., Hales A., Ephraums C., Middleton J. Prospective Study of the Occurrence of Psychological Disorders and Comorbidities After Spinal Cord Injury. Arch. Phys. Med. Rehabil. 2015;96:1426–1434
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Craig A., Tran Y., Middleton J. Theory of adjustment following severe neurological injury: Evidence supporting the Spinal Cord Injury Adjustment Model. In: Costa A., Villalba E., editors. Horizons in Neuroscience Research. Volume 29. Nova Science Publishers; New York, NY, USA: 2017. pp. 117–139.
- ↑ 4.0 4.1 4.2 4.3 4.4 Craig A, Tran Y, Arora M, Pozzato I, Middleton JW. Investigating Dynamics of the Spinal Cord Injury Adjustment Model: Mediation Model Analysis. J Clin Med. 2022 Aug 4;11(15):4557.
- ↑ Peter C, Müller R, Post MW, van Leeuwen CM, Werner CS, Geyh S; Swiss Spinal Cord Injury Cohort Study Group. Depression in spinal cord injury: assessing the role of psychological resources. Rehabil Psychol. 2015 Feb;60(1):67-80.
- ↑ Peter C, Müller R, Cieza A, Post MW, van Leeuwen CM, Werner CS, Geyh S. Modeling life satisfaction in spinal cord injury: the role of psychological resources. Qual Life Res. 2014 Dec;23(10):2693-705
- ↑ Galvis Aparicio M, Kunz S, Morselli D, Post MWM, Peter C, Carrard V. Adaptation during spinal cord injury rehabilitation: The role of appraisal and coping. Rehabil Psychol. 2021 Nov;66(4):507-519
- ↑ Buchanan B. Coping orientation to problems experienced inventory (Brief-Cope). NovoPsych. Retrieved December. 2021;9:2022. Available:[1] (accessed 19/09/2024)