428 Spinal Cord Injury
and negative social stereotypes restrict mobility, hinder social
integration, and impair independence (Targett, Wilson,
Wehman, & McKinley, 1998). Perceived independence, per-
sonal transportation, and individual living arrangements are
strong predictors of good self-concepts among community-
residing persons with SCI (Green, Pratt, & Grigsby, 1984).
Independent living and community residence has pronounced
bene“ts. After matching study participants on major demo-
graphic characteristics, Putzke and Richards (2001) found
that persons living in nursing homes reported lower life satis-
faction and greater handicap in terms of decreased mobility,
physical independence, and economic self-suf“ciency than
community-residing peers. Not surprisingly, greater social in-
tegration, employment, and increased mobility are associated
with greater life satisfaction (Crisp, 1992; Dijkers, 1999;
Richards et al., 1999).
Despite the obvious bene“ts, some persons with SCI may
become very uncomfortable in anticipation of increased
interactions with able-bodied persons and the resumption of
social roles (M. Dunn, 1977). And while contact with others
can augment coping in the “rst year of injury (Rogers &
Kennedy, 2000), professionals, peers, and individuals in gen-
eral may have negative reactions and make derogatory as-
sumptions about persons with SCI if they express pessimism
and distressed mood in social interactions (Elliott & Frank,
1990; Elliott, Yoder, & Umlauf, 1990).
Phenomenological and Appraisal Processes
In contemporary views of adjustment, an emphasis is placed
on the importance of appraisals in understanding individual
experiences. The appraisal component is the centerpiece of
our model because its processes have considerable in”uence
on subsequent adjustment. We believe that elements of posi-
tive growth are “rst evident in how people evaluate and in-
terpret their situation and circumstances. Following SCI,
people vary in their perception of life events and the degree
to which these events are stressful, and these perceptions are
directly associated with subsequent distress (Crisp, 1992;
Frank & Elliott, 1987). Individuals actively process aspects
of their situations to “nd positive meanings and side bene“ts
(D. Dunn, 2000). Many people try to accept, positively rein-
terpret, and seek personal growth soon after the onset of SCI
(Kennedy et al., 2000). Appraisal processes also may help to
explain why persons with SCI who are distressed exhibit
many different coping behaviors, whereas those who are less
distressed reported fewer coping efforts and a greater sense
of internal locus of control (Frank, Umlauf, et al., 1987). This
may also account for the bene“cial sequelae of acceptance
coping and cognitive restructuring on the adjustments of per-
sons with spinal cord injuries who return to their communi-
ties (Hanson, Buckelew, Hewett, & O•Neal, 1993; Kennedy,
Lowe, Grey, & Short, 1995).
Speci“c beliefs about the disability (e.g., •I will walk
againŽ) and attributions of responsibility and blame are un-
stable over time and are not consistently related to objective
and subjective indices of adjustment (Elliott & Richards,
1999; Hanson et al., 1993; Reidy & Caplan, 1994; Richards,
Elliott, Shewchuk, & Fine, 1997; Schulz & Decker, 1985).
People who ruminate about their perceived victimization,
however, may do so at the expense of “nding meaning and
direction in their circumstances (Davis, Lehman, Wortman,
Silver, & Thompson, 1995), and at the expense of thera-
peutic activities bene“cial to their adjustment (A. Moore,
Bombardier, Brown, & Patterson, 1994). Adaptive personal-
ity and interpersonal characteristics predispose some individ-
uals toward more functional cognitive appraisals, and people
lacking in these personal and social resources will be more
likely to exhibit dif“culties in accepting their condition and
their circumstances.
Thus, it is probable that individuals who are more goal
oriented, hopeful, effective in solving problems, and in sup-
portive relationships will focus on positive aspects of their
situation, report fewer problems with their environment,
come to terms with their condition, and evidence less distress
over time (Elliott, 1999; Elliott et al., 2000; Elliott, Godshall,
et al., 1991; Elliott, Witty, et al., 1991). Individuals with these
personal and social characteristics will be more likely to rec-
ognize, marshal, and use resources and support in their social
environment to maximize their adjustment.Dynamic and Developmental ProcessesChanges in a person•s belief system, interpersonal environ-
ment, and physical health may occur over time. Advances in
medical therapies, assistive technologies, and public and
health policy can facilitate adjustment. Social advocacy led
to the passage of the Rehabilitation Act of 1973 and the
Americans with Disabilities Act of 1990. More recently,
actor Christopher Reeve has advocated successfully for in-
creased public awareness about, and federal and private
funding for, curative and quality-of-life research. Today•s
advocacy movement demands consideration for the relation-
ship between individuals and their physical, social, and cul-
tural environments.
Physical disability does not occur or exist in a vacuum.
Changes in the interpersonal environment or in public and
health policy can have dramatic effects on quality of life fol-
lowing SCI. Many of these changes are essentially outside
the realm of personal volition, and opportunities may not be