Box 1 | Epidemiology of Traumatic SCI
Spinal cord injuries can be the result of either non-traumatic or traumatic mechanisms. The most common causes of SCI involve trauma. A traumatic SCI results from a blow to the spine that fractures or compresses the vertebrae or other penetration of the spinal cord. Following the trauma, additional damage can occur due to hemorrhaging, swelling or inflammation.10
In the United States, 44.5% of all SCIs are a result of motor vehicle accidents; 18.1% are a result of falls (primarily in persons over 45 years); 16.6% are a result of violence, particularly in urban areas; and 12.7% of SCIs occur due to sporting injuries, with diving being the riskiest of sports in this regard.11 However, skiing and snowboarding also pose a risk of SCI. One Canadian study found an incidence of 0.01 and 0.04 per 1000 skier and snowboarder days, respectively.12 Another study places the rate of SCI amongst ski and snowboard injuries between 1% and 13%.13
When young athletes such as snowboarders are suddenly struck by traumatic SCI, they face a drastic change in their independent and autonomous experience: From a healthy individual, often able to function at the extremes of physical agility and endurance, to a person unable to perform basic physical activities and, in the initial phases of post-SCI rehabilitation, wholly dependent upon others. Thus, gaining full independence is often viewed as essential to reaching a self-directed and autonomous life, particularly in these cases.
Such an attainment of independence is a process that is clearly closely related to the level of the SCI; that is, different levels of injuries result in different limitations on functioning. This resulting range of functioning in each individual patient corresponds to different degrees of dependency.6
Rehabilitation management should not simply consider the limitations in functioning, but also take into accound each patient's specific resources...
This dependency, in turn, involves all aspects of self-care and mobility that are fundamental to a person’s ability to become independent.
The extent and degree to which functional independence may be gained by a patient, however, is not simply dependent upon the level of injury and its respective limitations. Each individual patient will bring with him or her a spectrum of resources. These include contextual factors such as education and social support or they may consist of a person’s intrinsic qualities such as health, age or other motivational, cognitive, emotional and behavioural resources. 78
Therefore, a patient’s resources (sometimes referred to as individual coping mechanisms), together with his or her intrinsic goals, provide a key link to functional independence that health care professionals should support and encourage. Rehabilitation management should not simply consider the limitations in functioning, but also take into account each patient’s specific resources, factoring in multiple bio-psycho-social variables when considering treatment and rehabilitative programs.
This salutogenic process (see text box 2) results in an individual, goal-directed rehabilitation plan based on and adapted from an interdisciplinary approach.9
This case study seeks to illustrate how the intrinsic resources of one young patient with SCI , along with his life goals for greater independence, combined with the support of goal-directed training, facilitated the success of the rehabilitation process.
Gaining full independence is often viewed as essential to reaching a self-directed and autonomous life...
Box 2 | The Resource-Oriented Approach
A resource-oriented approach can be found in the concept of salutogenesis (from the Latin salus, meaning health, and genesis, meaning origin) This concept focuses on health and well-being rather than on the factors that cause disease. The term was first used by Aaron Antonovsky and may be differentiated from a deficit-oriented or pathogenetic approach, which focuses on the factors of disease or disability.
A key factor in salutogenesis is a person’s sense of coherence, described by Antonovsky as “a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that one’s internal and external environments are predictable and that there is a high probability that things will work out as well as can reasonably be expected.” There are three common factors found among healthy individuals that also come into play under challenging circumstances:
Control an individual can influence and manage the course of events.
Commitment an individual finds a sense in, and curiosity for, meaningfulness in life and the world.
Challenge an individual’s understanding that it is normal and beneficial for life to change.
The salutogenic approach may, as seen in this case study, involve harnessing a patient’s resources and coping strategies. Our patient, Michael, his rehabilitation and how he reacted to the challenges he faced perfectly illustrate the three aforementioned factors.