Handbook of Psychology

CHAPTER 18

Spinal Cord Injury

TIMOTHY R. ELLIOTT AND PATRICIA RIVERA

415

NEUROLOGICAL CATEGORIES AND CLASSIFICATION OF
SPINAL CORD INJURY 415
Levels of Injury and Functional Goals 416
EPIDEMIOLOGY OF SPINAL CORD INJURY 417
Age 418
Gender 418
Ethnicity 418
Educational and Occupational Status 418
Marital Status 419
Etiology of Injury 419
Sexuality and Reproductive Health 419
Aging and Physiologic Changes 420
Mortality 420
SECONDARY COMPLICATIONS FOLLOWING SPINAL
CORD INJURY 421
Pain 421
Pressure Sores 421

Spasticity and Contractures 422

Urinary Tract Infections 422

Depression 422

Anxiety 423

ADJUSTMENT FOLLOWING SPINAL CORD INJURY 423

Enduring Characteristics and Individual Differences 424

Social and Interpersonal Environment 427

Phenomenological and Appraisal Processes 428

Dynamic and Developmental Processes 428

PSYCHOLOGICAL INTERVENTIONS 429

ADVANCEMENTS AND FUTURE DIRECTIONS 430

REFERENCES 430

Few injuries have as profound and long-lasting consequences
as spinal cord injury (SCI). Loss of sensation, impaired mo-
bility, and bladder, bowel, and sexual function are the pri-
mary areas of functioning affected by the occurrence of an
SCI, but the economic, social, and psychological rami“ca-
tions must also be considered. With advancements in medical
treatments, an increasing availability of assistive technolo-
gies, and removal of societal and environmental barriers,
many persons with SCI are healthy individuals who can par-
ticipate actively and productively in society.
In this chapter, we review the major aspects of spinal cord
injury and current information about the condition and its
concomitants. We then provide a model of adjustment

and present evidence concerning the major components of

the model. We conclude with an overview of intervention

strategies and issues in health and public policy that affect

persons with SCI.

NEUROLOGICAL CATEGORIES AND

CLASSIFICATION OF SPINAL CORD INJURY

The spine is made up of 33 vertebrae, or bones that are con-

nected by ligaments and separated by disk-shaped cartilage.

There are 7 cervical, 12 thoracic, 5 lumbar vertebra, and the

sacrum (or tail bone). The spinal cord runs through the hol-

low center of each vertebra, from the base of the brain to the

second lumbar vertebra and is the communication relay from

the brain to the peripheral nervous system. The nerves within

the spinal cord are known as upper motor neurons(UMN)

while the nerves that branch out of the spinal cord are known

aslower motor neurons(LMN). Lower motor neurons carry

information related to movement from the spinal cord to

the muscles and relay sensory information such as pressure

and temperature back to the brain via the spinal cord. As

This chapter was supported in part by the National Institute on Dis-
ability and Rehabilitation Research Grant #H133B980016A, and
the National Center for Medical Rehabilitation Research, National
Institute of Child Health and Human Development, National Insti-
tutes of Health, Grant #T32 HD07420. The contents of this article
are solely the authors• responsibility and do not necessarily repre-
sent the of“cial views of the funding agencies.