430 Spinal Cord Injury
Determining and appreciating these needs can be a tricky
enterprise, particularly when working with other colleagues
in multidisciplinary endeavors. In one example, a multidisci-
plinary panel working with a consumer group published clin-
ical guidelines for assessing and treating depression among
persons with SCI. This panel evaluated the scienti“c evi-
dence and rated antidepressant therapy more favorably (and
devoted more page space to these treatments) than behavioral
approaches, despite the absence of any clinical trial of anti-
depressant therapy among persons with SCI (Consortium for
Spinal Cord Medicine, 1998). Although other guidelines
have been more favorable to behavioral issues and ap-
proaches among persons with SCI (e.g., the pressure sore
guidelines, Consortium for Spinal Cord Medicine, 2000), this
situation illustrates the need for the judicious representation
of behavioral expertise in a sensitive, yet informed, manner at
the different levels of policy formation.
ADVANCEMENTS AND FUTURE DIRECTIONS
Increased federal and private funding for curative and cor-
rective research in SCI has resulted in several productive
research programs. Advancements in these areas may soon
have a substantial impact on persons living with SCI. Trans-
plant research examining the use of stem and glial cells has
demonstrated that nerve conduction and regeneration can
occur in animal models (Imaizumi, Lankford, & Kocsis,
2000; Kocsis, 1999). Other projects have demonstrated that
spinal nerve “ber regeneration may be facilitated with the im-
plantation of electronic circuits (Borgens et al., 1999). Stud-
ies of electronic circuit implants will soon be conducted on
individuals volunteering for clinical trials.
Similarly, there are considerable advancements in our
understanding of chronic pain following SCI. Most clinical
models of pain in this area have adopted an operant behav-
ioral perspective (e.g., Umlauf, 1992). Research relying on
animal models of pain following SCI has indicated that exi-
totoxic and ischemic damage to spinal gray and white matter
are implicated in the development of persistent pain, and
pharmacological approaches may be the best therapeutic
strategies for preventing and alleviating pain sensations
following SCI (Yezierski, 1996).
It is instructive to note that persons living with SCI have long
expressed a desire for curative research and for assistance in al-
leviating persistent pain. These concerns were not necessarily
ignored over the years, but many researchers and clinicians
have attended to other problems that were deemed mutually im-
portant by policymakers, professionals, and consumer groups.
A health care agenda that incorporates a greater consumer per-
spective, however, may ultimately be more cost-effective and
satisfying to all stakeholders. Persons with SCI and their family
members are interested in receiving continued rehabilitation
therapies in the home (Elliott & Shewchuk, 2000). Travel to
outpatient clinics may be dif“cult for some individuals, and re-
search has found that distance to the clinic and transportation
problems impede attendance in outpatient therapies (Canupp,
Waites, DeVivo, & Richards, 1997). Professionals can work to-
gether to develop neighborhood centers in rural, underserved
areas or use technology such as telecommunication devices to
deliver a variety of cost-effective services and therapies to par-
ticipants at home (Temkin & Jones, 1999).
Other technologies and assistive devices can have im-
mense effects on positive growth (Scherer, 2000). Virtual real-
ity technologies can be used to help individuals learn speci“c
coping skills (e.g., coping with persistent pain; Hoffman, Doc-
tor, Patterson, Carrougher, & Furness, 2000) and attain greater
mobility and independence (e.g., learning driving skills;
Schultheis & Rizzo, 2001). These technologies will eventu-
ally prove to be ef“cacious and, accordingly, should be subsi-
dized by health care programs.
Behavioral researchers are urged to use measures and
analyses that are less pathological in intent and more respect-
ful and sensitive to the unique phenomenological experi-
ences, interpretations, and concerns of people living with
SCI. Consumer advocates have long criticized the biased ap-
proaches many behavioral researchers have toward persons
with physical disabilities (Olkin, 1999). Many consumers
view behavioral research with skepticism. It is imperative
that tools are used that are at once reliable, valid, and theoret-
ically relevant, and yet are sensitive and respectful to persons
with SCI. Moreover, to achieve a truly consumer-driven ser-
vice delivery, behavioral scientists will need to use qualita-
tive measurement and research devices with greater precision
and sophistication. This will ensure a more accurate repre-
sentation of these individuals and their experience into re-
search projects and in program development, which will in
turn facilitate a greater partnership between these consumers
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