Ingrid lived a highly independent life. At 37 she had managed a career as a businesswoman, was involved in a relationship with her boyfriend and maintained an active social life. She belonged to a dancing group and took time out of her schedule to participate in the local volunteer fire department. Additionally, she enjoyed some athletic activities; one sport she recently began was mountain biking along trails outside the city.

During one of her first mountain biking tours alone, she suffered a severe accident. The accident resulted in a serious luxation-fracture at her 6th and 7th cervical vertebrae and another stable fracture of her 2nd and 3rd vertebrae (commonly known as a “Hangman’s fracture”). Upon arrival at the spinal trauma center, these serious fractures required two immediate surgeries in order to properly stabilize her cervical spine. Both procedures were successful and she was transferred two days after the last operation to the rehabilitation center. For safety reasons Ingrid had to wear a neck brace to immobilize the affected areas – a stiff neck for six weeks, followed by another six weeks in a soft one. As a consequence of the fractures, Ingrid suffered from an AIS (Asia Impairment Scale) A, C5 tetraplegia – a complete injury leaving no motor or sensory functions below the level of the fracture.

Ingrid repeatedly suffered from severe circulation problems resulting in difficulties maintaining her blood pressure.

From the start of Ingrid’s rehabilitation, her recovery was accompanied by emotional issues and challenges for her coping strategies. One of the given’s of most spinal cord injuries is a relative degree of uncertainty surrounding a given patient’s long-term prognosis (see also Case Study 7). This uncertainty meant an experience of perceived stress to Ingrid and was at the core of Ingrid’s difficulties.

No one can tell me what I will be able to do and where I will be in twelve months.

Ingrid, two months after the accident

During the first two months of rehabilitation, Ingrid was confronted with the wide range of SCI-related impairments, limitations and restrictions. This daily experience of her functional limitations took a heavy emotional toll. In addition to the limitations related to the severity of the disease, Ingrid contracted pneumonia and a persistent dry cough. While trying to improve her mobility (including changing body positions), Ingrid repeatedly suffered from severe circulation problems resulting in difficulties maintaining her blood pressure. Again, this significantly limited her activities. As rehabilitation continued, head, neck and shoulder pain reduced her overall mobility and added to her declining condition. During this period of rehabilitation hand braces were required to improve her hand functionality over her long-term recovery. Finally, a pressure sore developed that required limiting her time spent in a wheelchair, greatly decreasing her ability to get around in the wheelchair.

Six or twelve months out, no one could predict what her physical condition would be.

The range of problems affecting Ingrid’s rehabilitation complicated her prognosis. At this early point in her rehabilitation process with the health issues she faced, Ingrid’s health care team could not determine with any accuracy where she would be in her recovery at a given time in the future. Six or twelve months out, no one could predict what her physical condition would be.

Ingrid did not easily accept this degree of uncertainty and, not surprisingly, this unknown in her life led to increasing stress. By her own measure, she felt ever more emotionally instable. This reached a point where she requested psychological counseling. It was to her advantage that Ingrid realized the benefit a psychological intervention might offer. Two months after the accident, a new Rehab Cycle was begun to focus on some of these and other outstanding issues.