424 Spinal Cord Injury
These groups represent essential stakeholders in any program
of care and service, and the critical distinctions between these
areas of emphasis ultimately re”ect their opinions regarding
future service and intervention. Thus, medical professionals
are concerned about continued support for medical advance-
ments, treatments, and management of SCI; consumers and
advocates are invested in rectifying social barriers that im-
pede full access and integration, and support the availability
and provision of assistive technologies to enhance indepen-
dence and quality of life.
In our model, we recognize that different elements
in”uence adjustment at any time, and we ar gue that these
characteristics depend to a great extent on the unique, phe-
nomenological appraisals of the individual living with SCI.
As depicted in Figure 18.3, adjustment is conceptualized into
several broad-based domains, each of which has considerable
in”uence on two areas of adjustment. The primary compo-
nents involve individual characteristics and the immediate
social and interpersonal environment (see left side of Figure
18.3). These in”uence the phenomenological and appraisal
processes that constitute elements of positive growth and, in
turn, predict psychological and physical health outcomes (see
far right side of Figure 18.3). These components are framed
within the developmental continuum that ”ow left to right,
and is shown at the bottom of the “gure. The dynamic con-
tinuum encompasses changes in any of the aforementioned
“ve areas as people age, as technologies advance, as relation-
ships shift, and as health and public policies evolve. This
continuum re”ects the ongoing process of growth, adapta-
tion, and development in the person and the environment, and
in corresponding alterations in interactions between these en-
tities. Thus, in our model, we adopt a collectivistic approach
in which behavior results from the combined interactions of
individual, situational, and environmental factors that func-
tion in an integrated and ”uid manner.
Enduring Characteristics and Individual Differences
Enduring characteristicsare de“ned as demographic charac-
teristics, disability-related characteristics (e.g., level of injury
and pain), predisability behavioral patterns, and personality
characteristics.
Demographic Characteristics
Few researchers have taken a priori theoretical perspectives
in examining ethnic, gender, age, or socioeconomic status
(SES) differences as they relate to adjustment following dis-
ability (Elliott & Uswatte, 2000; Fine & Asch, 1988). Most
demographic characteristics are included in clinical studies
for descriptive purposes only, and their relation is usually
examined within the context of maladjustment. Demographic
variables have been inconsistently related to outcome vari-
ables, although more sophisticated statistical models have
provided more useful information in more recent years. In
particular, study of intraindividual changes using growth
curve analyses reveals intriguing differences in terms of gen-
der, age, and education among persons in initial inpatient SCI
rehabilitation that warrant further scrutiny (Warschausky,
Kay, & Kewman, 2001). It should be noted that the socially
de“ned constructs of ethnicity, gender, SES, and age share
considerable overlap with the social/environment component
of our model.
Older individuals who incur SCI may have a more dif“-
cult time adjusting in the “rst year of SCI and may engage in
fewer activities than younger persons (Elliott & Richards,
1999). Life satisfaction seems to have a curvilinear relation-
ship with age among young adults: Those in late adolescence
and in their late twenties seem to have lower life satisfaction,
particularly if they are not working (Putzke, Richards, &
Dowler, 2000a). Stressful life events may have different
effects on persons with SCI as a function of their age, which
in turn may re”ect dif ferent developmental tasks across the
lifespan (Frank, Elliott, Buckelew, & Haut, 1988). Surveys
indicate that younger persons with SCI are more interested in
topics that concern sexuality, fertility, family planning, mus-
cle function test, and nerve conductance, and are less inter-
ested in information concerning pain, bowel and bladder
management, and pressure sore prevention than older per-
sons with SCI (Hart, Rintala, & Fuhrer, 1996).
Several trends have been observed in regard to gender dif-
ferences. Women report an overall higher life satisfaction
than men (Dijkers, 1999). Men evidence more problems with
pneumonia and other pulmonary/respiratory complications
than women (Burns, Putzke, Richards, & Jackson, 2000).
Postmenapausal women may experience signi“cant deterio-
ration in bone mineral density, contributing to problems with
osteoporosis (Weeks, 2001).
Descriptive studies imply that persons from ethnic minor-
ity groups may face more dif“culties in their adjustment.
Some studies indicate that these persons may have higher
levels of distress and lower life satisfaction than Caucasians,
and certain secondary complications may be more frequent as
well (Elliott & Uswatte, 2000). However, these data are tenu-
ous for several reasons. The relations between ethnicity and
any outcome variable may be mediated in part by a host of
variables including education, access to health care, socio-
economic status, sponsorship, transportation, living arrange-
ments, and trust between consumer and health care provider.
Without appreciating the sociocultural and community