The life changes and stresses that come with spinal cord injuries may contribute to increasing risks that patients may have problems with emotional well-being. Adapting and overcoming SCI-related challenges such as psycho-social and emotional problems is a time and energy-intensive process. Patients require varying degrees of time to develop sufficient coping strategies and resources that help to adequately confront these new and often times multiple stressors. During rehabilitation, health care providers need to be aware of signs and symptoms that might indicate anxiety and/or depression, as well as approaches, interventions and specific actions that could be undertaken to help mitigate these conditions.

From the earliest stages of rehabilitation to a patient’s discharge and beyond, such disorders can arise even two years after an SCI-related incident. Importantly, this case study emphasizes the fact that implementation of psycho-social and emotional interventions need to recognize the changing nature of stress and coping over time. Stressors, resources and coping strategies can all shift with a patient’s circumstances, requiring less, more or different interventions.

Ingrid had difficulties accepting both her disease and her circumstance as a patient and the dependency it entailed. These and other factors played a role in her not quite achieving the Cycle’s goals for rehabilitation and her continued emotional instability. In terms of the Stress Appraisal Model, her lack of expected progress reflected a low level of capacity for overcoming specific stressors and increasing her emotional stability.

There were two major stressors she needed to cope with: a complete, AIS A, C5 tetraplegia and all of the impairments in body functions, body structures and limitations in activities and participation, along with a high degree of future uncertainty that included both her prognosis and prospects for reintegration, both professionally and socially. She had a multitude of serious medical conditions that complicated both her recovery and making an accurate prognosis.

Uncertainty about the future

The break-up with her boyfriend further served to weaken one of her important resources, and underscored the uncertainty that the future held for her. At the same time, Ingrid possessed a range of resources to help her cope: a social network, a supportive family and a skilled and knowledgeable team of medical and psychosocial SCI professionals. Nevertheless, aspects that would support her coping abilities which she consciously or unconsciously employed should be improved in the future to contribute to greater emotional stability: to accept her situation, to further improve her knowledge of the disease as well as inherent aspects of her condition (e.g. pain, low blood pressure, poor sphincter control, motor and mobility limitations).

Each of these factors contributed to Ingrid’s appraisals – her perception that she would not (and perhaps could not) overcome her physical limitations, and additionally, an absence of an accurate prognosis - a threat to her livelihood. In terms of her life context as an independent woman with both social and professional resources available, the relational balance between her perceived stress and the existing coping strategies and resources she employed resulted in her poor emotional well-being.

The health team undertook their best efforts to tailor rehabilitative interventions to best promote Ingrid’s emotional well-being.Unfortunately, improvements remained less than what had been hoped for. Therapies worked not only at an individual-level, but also integrated social and educational aspects and even adapted to a new context when necessary – in this case following her break-up. Ingrid did leave the Rehab Cycle slightly better off than she entered it. The subsequent assessment and interventions would offer another chance at greater progress, further recovery and more steps towards independence and emotional well-being.