Psychosocial Considerations in Spinal Cord Injury: Difference between revisions
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[[File:Wheelchair 4.jpg|thumb|Psychosocial considerations in spinal cord injury]] | [[File:Wheelchair 4.jpg|thumb|Psychosocial considerations in spinal cord injury]] | ||
[[Spinal Cord Injury|Spinal cord injury]] (SCI) has the potential of resulting in devastating consequences after occurrence.<ref name=":0">Dezarnaulds A, Ilchef R. Psychological adjustment after spinal cord injury. Useful Strategies for Health Professionals. Agency for Clinical Innovation. 2014.</ref> Often, the management of SCI is centered on the motor, sensory, and autonomic dysfunctions, yet SCI can have tremendous psychosocial consequences on affected individuals.<ref name=":3">Dijkers MP. Quality of life of individuals with spinal cord injury: a review of conceptualization, measurement, and research findings. Journal of rehabilitation research and development. 2005 May 1;42(3):87.</ref><ref name=":1">Post MW, Van Leeuwen CM. Psychosocial issues in spinal cord injury: a review. Spinal cord. 2012 May;50(5):382-9.</ref><ref name=":2">North NT. The psychological effects of spinal cord injury: a review. Spinal cord. 1999 Oct;37(10):671-9.</ref> Research has shown that many with sudden onset of SCI will exhibit extreme negative emotions which can impair psychological as well as social integration after an injury.<ref name=":0" /> Also, mental health problems such as anxiety, depression, post traumatic stress disorder among others may be at an elevated level for people with SCI,<ref name=":1" /><ref name=":2" /> with psychological and social factors having a role to play in both the incidence and progression of these mental health problems.<ref name=":7">Chevalier Z, Kennedy P, Sherlock O. Spinal cord injury, coping and psychological adjustment: a literature review. Spinal Cord 2009; 47: 778–782.</ref> Thus, it is necessary to pay attention to these psychosocial factors which may have extreme consequences on achieving remarkable rehabilitation goals and improving the [[Quality of Life|quality of life]] (QoL) of people with SCIs,<ref name=":0" /> | [[Spinal Cord Injury|Spinal cord injury]] (SCI) has the potential of resulting in devastating consequences after the occurrence.<ref name=":0">Dezarnaulds A, Ilchef R. Psychological adjustment after spinal cord injury. Useful Strategies for Health Professionals. Agency for Clinical Innovation. 2014.</ref> Often, the management of SCI is centered on the motor, sensory, and autonomic dysfunctions, yet SCI can have tremendous psychosocial consequences on affected individuals.<ref name=":3">Dijkers MP. Quality of life of individuals with spinal cord injury: a review of conceptualization, measurement, and research findings. Journal of rehabilitation research and development. 2005 May 1;42(3):87.</ref><ref name=":1">Post MW, Van Leeuwen CM. Psychosocial issues in spinal cord injury: a review. Spinal cord. 2012 May;50(5):382-9.</ref><ref name=":2">North NT. The psychological effects of spinal cord injury: a review. Spinal cord. 1999 Oct;37(10):671-9.</ref> Research has shown that many with sudden onset of SCI will exhibit extreme negative emotions which can impair psychological as well as social integration after an injury.<ref name=":0" /> Also, mental health problems such as anxiety, depression, post-traumatic stress disorder among others may be at an elevated level for people with SCI,<ref name=":1" /><ref name=":2" /> with psychological and social factors having a role to play in both the incidence and progression of these mental health problems.<ref name=":7">Chevalier Z, Kennedy P, Sherlock O. Spinal cord injury, coping and psychological adjustment: a literature review. Spinal Cord 2009; 47: 778–782.</ref> Thus, it is necessary to pay attention to these psychosocial factors which may have extreme consequences on achieving remarkable rehabilitation goals and improving the [[Quality of Life|quality of life]] (QoL) of people with SCIs,<ref name=":0" /> | ||
== Incidence of Psychosocial Issues in Patients with Spinal Cord Injury == | == Incidence of Psychosocial Issues in Patients with Spinal Cord Injury == | ||
The advances in the medical management following spinal cord injury | The advances in the medical management following spinal cord injury have increased the life expectancy of patients in recent years.<ref name=":8">Strauss DJ, DeVivo MJ, Paculdo DR, Shavelle RM . Trends in life expectancy after spinal cord injury. ''Arch Phys Med Rehabil'' 2006; 87: 1079–1085.</ref> Yet SCI leads to considerable physical disability and also secondary medical complications<ref name=":3" />. Furthermore, there have been reports of abnormal incidence of substance abuse,<ref name=":4">North NT . The psychological effects of spinal cord injury: a review. ''Spinal Cord'' 1999; 37: 671–679.</ref> psychological morbidity,<ref name=":5">Craig A, Tran Y, Middleton J . Psychological morbidity and spinal cord injury. ''Spinal Cord'' 2009; 47: 108–114.</ref> and risk of suicide in patients with spinal cord injury.<ref name=":4" /> | ||
A research showed that psychological and social support factors are related to subjective | A research showed that psychological and social support factors are related to subjective wellbeing in patients with SCI.<ref name=":1" /> A systematic review on psychological morbidity revealed that up to 30% of people with SCI are at the risk of having a depressive disorder, with a higher relative risk of anxiety disorder, increased level of anxiety, poor quality of life (QoL), and feelings of helplessness.<ref name=":5" /> | ||
In a study<ref name=":6">Khazaeipour Z, Norouzi-Javidan A, Kaveh M, Khanzadeh Mehrabani F, Kazazi E, Emami-Razavi SH. Psychosocial outcomes following spinal cord injury in Iran. The journal of spinal cord medicine. 2014 May 1;37(3):338-45.</ref> in Iran on psychosocial outcomes following SCI, there were findings of psychosocial problems that were associated with financial hardship, basically due to unemployment, high cost of living, with other factors such as difficulty in transportation, inadequate home modifications, marriage, social communication, education, sports and entertainment. These issues were also found to vary with the gender of persons with SCI.<ref name=":6" /> | In a study<ref name=":6">Khazaeipour Z, Norouzi-Javidan A, Kaveh M, Khanzadeh Mehrabani F, Kazazi E, Emami-Razavi SH. Psychosocial outcomes following spinal cord injury in Iran. The journal of spinal cord medicine. 2014 May 1;37(3):338-45.</ref> in Iran on psychosocial outcomes following SCI, there were findings of psychosocial problems that were associated with financial hardship, basically due to unemployment, high cost of living, with other factors such as difficulty in transportation, inadequate home modifications, marriage, social communication, education, sports and entertainment. These issues were also found to vary with the gender of persons with SCI.<ref name=":6" /> | ||
== Psychosocial Factors in Spinal Cord Injury == | == Psychosocial Factors in Spinal Cord Injury == | ||
The occurrence of SCI is statistically determined to be around the second to the third decade of life. <ref>Chamberlain, J.D., Deriaz, O., Hund-Georgiadis, M. ''et al.'' Epidemiology and contemporary risk profile of traumatic spinal cord injury in Switzerland. ''Inj. Epidemiol.'' 2, 28 (2015). <nowiki>https://doi.org/10.1186/s40621-015-0061-4</nowiki></ref> This period corresponds to an important period of emotional and psychological development for many people.<ref name=":0" /> Therefore, the psychology of the patient with SCI is affected, and this is influenced by culture, conditions, and settings in a community. <ref name=":6" /> These psychosocial factors may feature early after a SCI, and continue into individual's life, requiring adjustments and adaptions in order to improve the quality of life of the patient, and overall outcome of care.<ref name=":0" /> There is a link described between psychological dimensions such as personalities, perceptions and adjustments to SCI, with younger individuals more accepting of SCI than older individuals.<ref name=":0" /> | The occurrence of SCI is statistically determined to be around the second to the third decade of life.<ref>Chamberlain, J.D., Deriaz, O., Hund-Georgiadis, M. ''et al.'' Epidemiology and contemporary risk profile of traumatic spinal cord injury in Switzerland. ''Inj. Epidemiol.'' 2, 28 (2015). <nowiki>https://doi.org/10.1186/s40621-015-0061-4</nowiki></ref> This period corresponds to an important period of emotional and psychological development for many people.<ref name=":0" /> Therefore, the psychology of the patient with SCI is affected, and this is influenced by culture, conditions, and settings in a community.<ref name=":6" /> | ||
These psychosocial factors may feature early after a SCI, and continue into an individual's life, requiring adjustments and adaptions in order to improve the quality of life of the patient, and overall outcome of care.<ref name=":0" /> There is a link described between psychological dimensions such as personalities, perceptions, and adjustments to SCI, with younger individuals more accepting of SCI than older individuals.<ref name=":0" /> A prospective longitudinal study<ref name=":10">Scholten EW, Ketelaar M, Visser-Meily JM, Stolwijk-Swüste J, van Nes IJ, Gobets D, van Laake-Geelen CC, Stolwijk J, Dijkstra CA, Agterhof E, Gobets D. [https://www.archives-pmr.org/article/S0003-9993(20)30384-1/pdf Self-efficacy predicts personal and family adjustment among persons with spinal cord injury or acquired brain injury and their significant others: A dyadic approach]. Archives of physical medicine and rehabilitation. 2020 Nov 1;101(11):1937-45.</ref> shows that there is a combined effect of self-efficacy of the person (belief about one’s ability to cope with a variety of difficult situations in life) with SCI or person with Acute Brain Injury and that of their significant others (often family members or a close friend) on personal and family adjustment. The study suggests that low self-efficacy appearing to be a risk factor for adjustment problems, emphasizing the importance of screening for low self-efficacy of the patients and their care-givers that may help healthcare professionals to identify and support families that are more at risk at an early stage, which may help to prevent later adjustment problems and related costs<ref name=":10" />. | |||
=== Psychosocial Reactions to SCI === | === Psychosocial Reactions to SCI === | ||
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* Negative body image or shame | * Negative body image or shame | ||
* Feelings of worthlessness | * Feelings of worthlessness | ||
* Low self esteem | * Low self-esteem | ||
* Anger and aggression | * Anger and aggression | ||
* Shame and embarrassment | * Shame and embarrassment | ||
| Line 41: | Line 43: | ||
== Psychosocial Considerations in Spinal Cord Injury == | == Psychosocial Considerations in Spinal Cord Injury == | ||
With increasing evidence depicting elevated levels of depression in people with SCI,<ref name=":5" /> as well as negative psychosocial states such as anxiety and a reduction in the quality of life of people with spinal cord injuries<ref name=":0" />, it is important that appropriate considerations should be applied to psychosocial issues in SCI. According to Dezarnaulds and Ilchef,<ref name=":0" /> about 40% of patients recently diagnosed with SCI can have an accompanying psychiatric diagnosis, with common ones including substance abuse disorders, delirium, depressive disorders and adjustment disorders. | With increasing evidence depicting elevated levels of depression in people with SCI,<ref name=":5" /> as well as negative psychosocial states such as anxiety and a reduction in the quality of life of people with spinal cord injuries<ref name=":0" />, it is important that appropriate considerations should be applied to psychosocial issues in SCI. According to Dezarnaulds and Ilchef,<ref name=":0" /> about 40% of patients recently diagnosed with SCI can have an accompanying psychiatric diagnosis, with common ones including substance abuse disorders, delirium, depressive disorders, and adjustment disorders. | ||
Thus, individuals with SCI must receive psychosocial treatment in a bid to decrease psychosocial morbidity and improve general quality of life.<ref name=":5" /><ref name=":8" /> The aim of these treatments would primarily be to improve perceptions of control, improve mood, elevate the level of social engagement, increase level of self-management, improve employability, increase understanding and influence of injury on important aspects of life such as physical and mental health, and sexuality.<ref>Mehta, S., Aubut, J-A. L., Legassic, M., Orenczuk, | Thus, individuals with SCI must receive psychosocial treatment in a bid to decrease psychosocial morbidity and improve general quality of life.<ref name=":5" /><ref name=":8" /> The aim of these treatments would primarily be to improve perceptions of control, improve mood, elevate the level of social engagement, increase level of self-management, improve employability, increase understanding and influence of injury on important aspects of life such as physical and mental health, and sexuality.<ref>Mehta, S., Aubut, J-A. L., Legassic, M., Orenczuk, | ||
| Line 59: | Line 61: | ||
== Psychosocial Providers in Spinal Cord Injury == | == Psychosocial Providers in Spinal Cord Injury == | ||
Psychosocial providers are concerned with the emotional well-being of the person with spinal cord injury, as well as their families.<ref name=":9">The Asian Spinal Cord Network. Psychosocial Guidelines in Spinal Cord Injury Rehabilitation. Jagadamba Press; 2015. Available from: https://ascon.info/wp-content/uploads/2018/05/psychosocial-guidelines15.pdf [Accessed 10 December, 2020]</ref> The psychosocial provision comprises of a multidisciplinary team | Psychosocial providers are concerned with the emotional well-being of the person with spinal cord injury, as well as their families.<ref name=":9">The Asian Spinal Cord Network. Psychosocial Guidelines in Spinal Cord Injury Rehabilitation. Jagadamba Press; 2015. Available from: https://ascon.info/wp-content/uploads/2018/05/psychosocial-guidelines15.pdf [Accessed 10 December, 2020]</ref> | ||
The psychosocial provision comprises of a multidisciplinary team that plays highly dynamic roles.<ref name=":9" /> | |||
=== Psychiatrists === | === Psychiatrists === | ||
They evaluate need of | They evaluate the need of individuals with SCI for psychotropic medications, after an assessment of the symptoms and range of psychiatric symptoms. <ref name=":9" /> | ||
=== Clinical Psychologists === | === Clinical Psychologists === | ||
They create individual or group psychotherapy and evaluation for patients with spinal cord injuries, especially those with cognitive challenges following SCI. They also carry out | They create individual or group psychotherapy and evaluation for patients with spinal cord injuries, especially those with cognitive challenges following SCI. They also carry out psychosocial assessments after the admission of patient with spinal cord injury to recognize the risk factors. The psychologist helps to improve the perception of the individual to keep in place their feelings, goals and aspirations, and not to see themselves as a patient alone, helping to help patient make physical and psychological gains during rehabilitation. <ref name=":9" /> | ||
=== Social Workers === | === Social Workers === | ||
| Line 71: | Line 75: | ||
=== Occupational Therapists === | === Occupational Therapists === | ||
Occupational therapists assess | Occupational therapists assess and target the development of skills to enable the individual perform needed daily roles. They are trained to have a robust conceptualization of the integration of the person, environment and task.<ref name=":9" /> | ||
=== Peer Counsellors === | === Peer Counsellors === | ||
| Line 77: | Line 81: | ||
== Conclusion == | == Conclusion == | ||
Psychosocial concerns are common following spinal cord injuries. These concerns are usually influenced by a number of factors which are usually around the psychology and the social interaction of the patient. It is important for these psychosocial problems to be recognized and managed by the multidisciplinary team of psychosocial providers, especially from the acute phase of the injury where assessments and identification of risk factors can be made. Efficient management of these psychosocial problems can lead to better quality of life for patients with SCI and improve rehabilitation outcomes. | Psychosocial concerns are common following spinal cord injuries. These concerns are usually influenced by a number of factors which are usually around the psychology and the social interaction of the patient. It is important for these psychosocial problems to be recognized and managed by the multidisciplinary team of psychosocial providers, especially from the acute phase of the injury where assessments and identification of risk factors can be made. Efficient management of these psychosocial problems can lead to a better quality of life for patients with SCI and improve rehabilitation outcomes. | ||
== Resources == | == Resources == | ||
Revision as of 11:51, 28 December 2020
Original Editor - Joseph Ayotunde Aderonmu
Top Contributors - Joseph Ayotunde Aderonmu, Admin, Naomi O'Reilly, Kim Jackson and Vidya Acharya
Introduction[edit | edit source]
Spinal cord injury (SCI) has the potential of resulting in devastating consequences after the occurrence.[1] Often, the management of SCI is centered on the motor, sensory, and autonomic dysfunctions, yet SCI can have tremendous psychosocial consequences on affected individuals.[2][3][4] Research has shown that many with sudden onset of SCI will exhibit extreme negative emotions which can impair psychological as well as social integration after an injury.[1] Also, mental health problems such as anxiety, depression, post-traumatic stress disorder among others may be at an elevated level for people with SCI,[3][4] with psychological and social factors having a role to play in both the incidence and progression of these mental health problems.[5] Thus, it is necessary to pay attention to these psychosocial factors which may have extreme consequences on achieving remarkable rehabilitation goals and improving the quality of life (QoL) of people with SCIs,[1]
Incidence of Psychosocial Issues in Patients with Spinal Cord Injury[edit | edit source]
The advances in the medical management following spinal cord injury have increased the life expectancy of patients in recent years.[6] Yet SCI leads to considerable physical disability and also secondary medical complications[2]. Furthermore, there have been reports of abnormal incidence of substance abuse,[7] psychological morbidity,[8] and risk of suicide in patients with spinal cord injury.[7]
A research showed that psychological and social support factors are related to subjective wellbeing in patients with SCI.[3] A systematic review on psychological morbidity revealed that up to 30% of people with SCI are at the risk of having a depressive disorder, with a higher relative risk of anxiety disorder, increased level of anxiety, poor quality of life (QoL), and feelings of helplessness.[8]
In a study[9] in Iran on psychosocial outcomes following SCI, there were findings of psychosocial problems that were associated with financial hardship, basically due to unemployment, high cost of living, with other factors such as difficulty in transportation, inadequate home modifications, marriage, social communication, education, sports and entertainment. These issues were also found to vary with the gender of persons with SCI.[9]
Psychosocial Factors in Spinal Cord Injury[edit | edit source]
The occurrence of SCI is statistically determined to be around the second to the third decade of life.[10] This period corresponds to an important period of emotional and psychological development for many people.[1] Therefore, the psychology of the patient with SCI is affected, and this is influenced by culture, conditions, and settings in a community.[9]
These psychosocial factors may feature early after a SCI, and continue into an individual's life, requiring adjustments and adaptions in order to improve the quality of life of the patient, and overall outcome of care.[1] There is a link described between psychological dimensions such as personalities, perceptions, and adjustments to SCI, with younger individuals more accepting of SCI than older individuals.[1] A prospective longitudinal study[11] shows that there is a combined effect of self-efficacy of the person (belief about one’s ability to cope with a variety of difficult situations in life) with SCI or person with Acute Brain Injury and that of their significant others (often family members or a close friend) on personal and family adjustment. The study suggests that low self-efficacy appearing to be a risk factor for adjustment problems, emphasizing the importance of screening for low self-efficacy of the patients and their care-givers that may help healthcare professionals to identify and support families that are more at risk at an early stage, which may help to prevent later adjustment problems and related costs[11].
Psychosocial Reactions to SCI[edit | edit source]
The psychological and social reaction following spinal cord injury in an individual may include the following:[1][3][4][5]
- Depression
- Post-traumatic stress disorder
- Suicidal thinking or lack of desire to live
- Apathy and not caring about life
- Inability to provide self-care and follow medical advice
- Marital and relationship conflict
- Lack of motivation for vocational or educational pursuits
- Feeling trapped in the family surroundings
- Unnecessary dependency on others
- Social Isolation
- Negative body image or shame
- Feelings of worthlessness
- Low self-esteem
- Anger and aggression
- Shame and embarrassment
- Feelings of helplessness and hopelessness
- High levels of stress
- Self-Blame
Psychosocial Considerations in Spinal Cord Injury[edit | edit source]
With increasing evidence depicting elevated levels of depression in people with SCI,[8] as well as negative psychosocial states such as anxiety and a reduction in the quality of life of people with spinal cord injuries[1], it is important that appropriate considerations should be applied to psychosocial issues in SCI. According to Dezarnaulds and Ilchef,[1] about 40% of patients recently diagnosed with SCI can have an accompanying psychiatric diagnosis, with common ones including substance abuse disorders, delirium, depressive disorders, and adjustment disorders.
Thus, individuals with SCI must receive psychosocial treatment in a bid to decrease psychosocial morbidity and improve general quality of life.[8][6] The aim of these treatments would primarily be to improve perceptions of control, improve mood, elevate the level of social engagement, increase level of self-management, improve employability, increase understanding and influence of injury on important aspects of life such as physical and mental health, and sexuality.[12][13][14]
Psychosocial Providers in Spinal Cord Injury[edit | edit source]
Psychosocial providers are concerned with the emotional well-being of the person with spinal cord injury, as well as their families.[15]
The psychosocial provision comprises of a multidisciplinary team that plays highly dynamic roles.[15]
Psychiatrists[edit | edit source]
They evaluate the need of individuals with SCI for psychotropic medications, after an assessment of the symptoms and range of psychiatric symptoms. [15]
Clinical Psychologists[edit | edit source]
They create individual or group psychotherapy and evaluation for patients with spinal cord injuries, especially those with cognitive challenges following SCI. They also carry out psychosocial assessments after the admission of patient with spinal cord injury to recognize the risk factors. The psychologist helps to improve the perception of the individual to keep in place their feelings, goals and aspirations, and not to see themselves as a patient alone, helping to help patient make physical and psychological gains during rehabilitation. [15]
Social Workers[edit | edit source]
They help patients and family arrange for funding to pay rehabilitation services, and also prepare patient for discharge. They also carry out counselling to the family of the individual with SCI, and prepare services that would be available in the community post discharge.[15]
Occupational Therapists[edit | edit source]
Occupational therapists assess and target the development of skills to enable the individual perform needed daily roles. They are trained to have a robust conceptualization of the integration of the person, environment and task.[15]
Peer Counsellors[edit | edit source]
They help the patient with their psychological adjustment after SCI. Usually, they are role models for patients with SCI through their participation in activities such as sports, social engagements, suggestions, education and counselling. Peer counsellors are usually previous patients with SCI that have been able to successfully re-entred the community.
Conclusion[edit | edit source]
Psychosocial concerns are common following spinal cord injuries. These concerns are usually influenced by a number of factors which are usually around the psychology and the social interaction of the patient. It is important for these psychosocial problems to be recognized and managed by the multidisciplinary team of psychosocial providers, especially from the acute phase of the injury where assessments and identification of risk factors can be made. Efficient management of these psychosocial problems can lead to a better quality of life for patients with SCI and improve rehabilitation outcomes.
Resources[edit | edit source]
- Psychosocial Guidelines in Spinal Cord Injury Rehabilitation
- Psychosocial Adjustments after Spinal Cord Injury
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Dezarnaulds A, Ilchef R. Psychological adjustment after spinal cord injury. Useful Strategies for Health Professionals. Agency for Clinical Innovation. 2014.
- ↑ 2.0 2.1 Dijkers MP. Quality of life of individuals with spinal cord injury: a review of conceptualization, measurement, and research findings. Journal of rehabilitation research and development. 2005 May 1;42(3):87.
- ↑ 3.0 3.1 3.2 3.3 Post MW, Van Leeuwen CM. Psychosocial issues in spinal cord injury: a review. Spinal cord. 2012 May;50(5):382-9.
- ↑ 4.0 4.1 4.2 North NT. The psychological effects of spinal cord injury: a review. Spinal cord. 1999 Oct;37(10):671-9.
- ↑ 5.0 5.1 Chevalier Z, Kennedy P, Sherlock O. Spinal cord injury, coping and psychological adjustment: a literature review. Spinal Cord 2009; 47: 778–782.
- ↑ 6.0 6.1 Strauss DJ, DeVivo MJ, Paculdo DR, Shavelle RM . Trends in life expectancy after spinal cord injury. Arch Phys Med Rehabil 2006; 87: 1079–1085.
- ↑ 7.0 7.1 North NT . The psychological effects of spinal cord injury: a review. Spinal Cord 1999; 37: 671–679.
- ↑ 8.0 8.1 8.2 8.3 Craig A, Tran Y, Middleton J . Psychological morbidity and spinal cord injury. Spinal Cord 2009; 47: 108–114.
- ↑ 9.0 9.1 9.2 Khazaeipour Z, Norouzi-Javidan A, Kaveh M, Khanzadeh Mehrabani F, Kazazi E, Emami-Razavi SH. Psychosocial outcomes following spinal cord injury in Iran. The journal of spinal cord medicine. 2014 May 1;37(3):338-45.
- ↑ Chamberlain, J.D., Deriaz, O., Hund-Georgiadis, M. et al. Epidemiology and contemporary risk profile of traumatic spinal cord injury in Switzerland. Inj. Epidemiol. 2, 28 (2015). https://doi.org/10.1186/s40621-015-0061-4
- ↑ 11.0 11.1 Scholten EW, Ketelaar M, Visser-Meily JM, Stolwijk-Swüste J, van Nes IJ, Gobets D, van Laake-Geelen CC, Stolwijk J, Dijkstra CA, Agterhof E, Gobets D. Self-efficacy predicts personal and family adjustment among persons with spinal cord injury or acquired brain injury and their significant others: A dyadic approach. Archives of physical medicine and rehabilitation. 2020 Nov 1;101(11):1937-45.
- ↑ Mehta, S., Aubut, J-A. L., Legassic, M., Orenczuk, S., Hansen, K. T., Hitzig, S. L., & Teasell, R. W. An evidence-based review of the effectiveness of cognitive behavioral therapy for psychosocial issues post-spinal cord injury. Rehabilitation Psychology 2011; 56 :15 -25.
- ↑ Middleton J., Craig A. Psychological challenges in treating persons with spinal cord injury. In A. Craig and y. Tran (Eds.). Psychological dynamics associated with spinal cord injury rehabilitation: New directions and best evidence. New york: Nova Science Publishers, 2008.
- ↑ Middleton J., Tran y., Craig A. Relationship between quality of life and self-efficacy in persons with spinal cord injuries. Archives of Physical Medicine and Rehabilitation 2007; 88:1643-1648.
- ↑ 15.0 15.1 15.2 15.3 15.4 15.5 The Asian Spinal Cord Network. Psychosocial Guidelines in Spinal Cord Injury Rehabilitation. Jagadamba Press; 2015. Available from: https://ascon.info/wp-content/uploads/2018/05/psychosocial-guidelines15.pdf [Accessed 10 December, 2020]
- ↑ Facing Disability. Psychological Impact of a Spinal Injury. Available from:https://www.youtube.com/watch?v=oEKls35mvjI [Last accessed 11 December, 2020]
