Theory of adjustment following severe neurological injury: evidence supporting the spinal cord injury adjustment model

Adjustment to chronic injury, especially when experienced under traumatic circumstances, can be extremely challenging and distressing. Many individuals who sustain a physical injury will struggle to cope with subsequent impairment and secondary conditions that include chronic pain, infections, persistent fatigue, reduced social participation and autonomy, reduced cognitive performance, loss of employment, as well as elevated psychological distress. This chapter presents integrated psychological theory that endeavours to explain how adults with the severe neurological disorder of spinal cord injury (SCI), cope with the many challenges and stresses involved in adjustment to this catastrophic injury. Adjustment to SCI is best viewed as a complex process, multifactorial in nature involving non-linear adaptation over time. Based on integrated theory, the SCI Adjustment Model (SCIAM) is discussed as a means to clarify how multiple factors contribute in a dynamic way to adjustment over time, resulting in either adaptive or maladaptive outcomes. Research findings are then presented that support the SCIAM model. Support for this theory of adjustment involves the relationship between pre-injury, peri-traumatic (Bovin & Marx, 2011) and mediating factors (e.g., appraisal and re-appraisal) to adjustment outcomes. Relationships over time will also be presented that support the dynamic model. Implications arising from this model for an improved understanding of how people adjust following a severe neurological injury like SCI will be explored.