Objectives: This paper reviews the literature concerning psychological adjustment to spinal cord injury, focusing on the recent methodological developments and new directions in research. Method: Several literature reviews using the search terms Spinal Cord Injury, Paraplegia, Coping and Adjustment were undertaken using the databases in Pubmed, Medline and Embase. The papers that were published from 2001 onwards, written in English and used a sample of adults were included. Results: The literature reviewed lends further support to the importance of appraisals and coping strategies in the adjustment to spinal cord injury. Methodological issues highlighted in earlier reviews are addressed in conjunction with further theoretical explorations. Conclusions: Although many of the methodological criticisms have been addressed, there remains a need for longitudinal research into the process of adjustment to spinal cord injury and the contributory role of appraisals and coping strategies. Measurement tools designed specifically for use within the spinal cord injured population should be utilized in the prevention of maladaptive adjustment issues, whereas able-bodied comparison groups would allow identification of coping strategies unique to the spinal cord injured population.

Study design: Multi-centre, single cohort. Objectives: To assess the needs, perceived environmental barriers, level of participation and psychological function of spinal cord injured patients living in the community 3-18 months after discharge. Setting: The National Spinal Injuries Centre, Stoke Mandeville, UK.; Princess Royal Spinal Injuries Centre, Sheffield UK.; Midlands Centre for Spinal Injuries, Oswestry, UK. Method: Participants sustaining injury aged 18 or above were recruited from one of three spinal cord injuries units 3-18 months after discharge. Postal packs containing questionnaires, consent forms and information were distributed and a 2-week reminder was sent. Results: Main findings showed community needs to be generally well addressed however psychosocial needs were rated significantly lower than physical. Responses suggested no environmental impact on participation levels, however, qualitative data highlighted delays in accommodation, adaptations and availability of equipment to interfere with transition to community living. A substantial amount of respondents reported significant impact on independence and activity from secondary conditions and pain. Nearly all the sample reported dissatisfaction with their sexual life and these needs were not well addressed. Conclusions: Societal participation continues to be affected by secondary conditions and pain, whereas delays in equipment and structural adaptations impact on the transition to community living. Sexual needs and problems remain an issue for the spinal cord injured population and a need which is left unaddressed in the community.

All patients were involved in a multidisciplinary Goal Planning and Needs Assessment Rehabilitation Programme. Rehabilitation outcomes were measured using the Needs Assessment Checklist (NAC), which has been specifically designed for use with people with SCI. It is a reliable and valid clinical assessment tool, which provides a means to assess and facilitate the delivery of an individually tailored rehabilitation programme. Results: No significant difference was found between the MHD and non-MHD groups for rehabilitation outcomes. The MHD group showed higher achieved independence scores in psychology for the first needs assessment. Overall, both groups were found to make significant improvements in their level of independence for all nine areas of need between the first and second NAC administration. Conclusion: Results suggest that rehabilitation can be tailored to meet the individual needs of patients with SCI having MHD; however, further research comparing these outcomes with other rehabilitation approaches is required. The function of timely psychological support for MHD patients on admission to the NSIC has been suggested as a potential explanation for rehabilitation performance. Most importantly, rehabilitation outcomes of patients with MHD have not been found to differ significantly compared with those without MHD.