Vocational Decision-Making and Rehabilitation Following Paediatric Traumatic Spinal Cord Injury: An Illustrative Case Study Analysis

Within traumatic-injury populations, adjustment following the suffering of a permanent impairment such as a traumatic Spinal Cord Injury (tSCI) follows quite a different path (and has quite different longer term participation outcomes) when the individual involved is a child or adolescent, and not an adult. The most influential framework for understanding the factors influencing longer-term outcomes for those with an ill-health condition is a general model applicable to those of any age, and thus demographic factors such as "age at injury" or "age at disease onset" are not specifically depicted in the model of factors influencing injury sequelae, except that they are implicitly contained within one of the two sets of variables (one "Personal", one "Environmental") which are proposed to moderate the longer-term outcomes achieved following the suffering of an impairment of structure or function. While the ICF framework has been most useful to both health researchers and managers of health services, its influence on the particular set of services offered by health and human-service professionals has been weakened by the fact that, in its original publication of the model, both sets of moderating variables were just listed as blocks of variables with no detail about the major personal or environmental variables exerting most influence - and therefore, by implication, requiring focussed consideration by care planners and deliverers of health services. The case study below of an adolescent who suffered a paraplegia yet subsequently achieved a most successful rehabilitation outcome illustrates the key psychosocial factors (one "personal" and one "environmental") involved in adjusting successfully to major impairment and ultimately achieving a high post-injury quality of life.

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