Life Satisfaction Among Persons with Spinal Cord Injuries

Journal of Rehabilitation, July-Sept, 2000 by Brent W. Chase, Thomas A. Cornille, R. William English

Every year, approximately 10,000 persons in the United States, typically young adults (New Mobility, 1996), seriously injure their spinal cords and become permanently paralyzed. Through advances in medical treatment, most persons survive a spinal cord injury and live two or more decades post-injury. However, researchers have only recently begun to study the long-term psychosocial implications of a spinal cord injury (Whiteneck, Charlifue, Frankel, et al., 1992). One such psychosocial implication is the person's perceived satisfaction with the quality of his or her life following such an injury. This study examined factors associated with the life satisfaction of persons with a spinal cord injury including biological, personal, and social factors.

Life satisfaction is described as a psychological state that may be broadly associated with psychological well-being (Neugarten, Havighurst, & Tobin, 1961) rather than some "objective" assessment of the person's quality of life. A person may have a high quality of life yet lack satisfaction, whereas another person may have a lower quality of life yet have satisfaction. For instance, a person may have wealth and access to the finer things of life, but without true friendship or a sense of purpose he or she may be dissatisfied; while a person whose life is rich in relationships and purpose but lack affluence may be satisfied with his or her life.

Numerous studies have shown that life satisfaction is usually compromised or lowered by spinal cord injury (Decker & Schulz, 1985; Nosek, Fuhrer, & Potter, 1995). Similarly, Neugarten et al. (1961) showed that the mean scores (10.76) for persons with spinal cord injuries were lower than the average scores (13.2) of general population group. Mehnert, Krauss, Nadler, and Boyd (1990) found in their study that 90% of the participants without disabilities were either very satisfied (50%) or somewhat satisfied (40%) with life, whereas 68% of the participants with disabilities were either very satisfied (37%) or somewhat satisfied (31%).

The social and emotional adjustments to a spinal cord injury vary considerably from person to person, with some making satisfactory adjustments whereas others remain chronically distressed (Mackelprang & Hepworth, 1987). Some of the factors found to be related to life satisfaction of persons with physical disabilities include satisfaction with family closeness (Warren, Wrigley, Yoels, & Fine, 1996), accepting responsibility for the injury (Bulman & Wortman, 1977; Warren et al, 1996), social support (Decker & Schulz, 1985; Rintala et al., 1992), leisure (Coyle et al., 1994), satisfaction with personal assistance (Nosek et al., 1995), employment (Crewe & Krause, 1990; Krause, 1990; Mehnert et al., 1990), and residential satisfaction and locus of control (Boschen, 1996).

Just as a spinal cord injury affects many areas of life, many areas of life affect the response to such an injury. Weinberg (1984) asked 22 persons with severe physical disabilities the following question: "If there were a surgery available that was guaranteed to completely cure your disability (with no risk) would you be willing to undergo the surgery?" That author found that only 50% would opt for the surgery. Reasons for rejecting the surgery were contentment with their lives and fear they would be a different person. Half of the people in this sample believed that the inclusion of disability in their life was a positive feature, and one they would not change.

Overall, however, it appears that life satisfaction is diminished after disability. This finding is understandable considering that a spinal cord injury affects most major life activities and necessitates profound changes to cope. Previous research is inconclusive on the impact of the degree of disablement or disability on life satisfaction. The view that severity of disablement lowers life satisfaction is supported by a study of 758 persons with traumatic brain injury (Heinemann & Whiteneck, 1995). They found that physical impairment was the strongest predictor of personal disability and that severity of disability was the strongest predictor of social functioning. Similarly, Nosek et al. (1995) reported that life satisfaction decreases as handicap or obstacles to social functioning increase.

The contrasting viewpoint is that the severity of disability is not a predictor of life satisfaction (Cushman & Hassert, 1992; Whiteneck et al., 1992; Woodrich & Patterson, 1983). These findings may reflect different uses of concepts about sequelae to spinal cord injuries and the relationships between those concepts (World Health Organization, 1980). The World Health Organization model distinguishes between three important concepts, impairment, disability, and handicap. Impairment occurs at the organ level and represents any loss or abnormality of psychological, physiological, or anatomical structure or function. The concept of impairment is limited to the physical level of change for "typical" functioning. For example, loss of strength and range of motion are factors inherent in the area of injury. Disability occurs at the individual level and represents any restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered typical for a human being. For example, loss of ability to walk is the impairment linked to the injury, while requiring a wheelchair for mobility refers to the disability of the individual. Finally, handicap occurs at the societal level and represents a disadvantage that limits or prevents fulfillment of a role that is typical (depending on age, sex, and social and cultural factors). For example, handicap reflects limitations that result from the lack of accessibility to buildings or sidewalk curbs. These concepts provide important distinctions which were utilized in this study and are used with these specific meanings for this report.