Community integration of individuals with spinal cord injuries - Spinal Cord Injury, Part 3

American Rehabilitation,  Spring, 1997  by Wayne A. Gordon,  Margaret Brown

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In considering the ways and the extent to which individuals with spinal cord injury (SCI) have or have not achieved community integration, we would do well to pause to consider what the concept of community integration entails.

First, the definition adopted herein states that "community integration" refers exclusively to non-institutional living, i.e., the focus is solely on people with SCI who are living in nonmedical, noncustodial settings.

Second, community integration refers to a changing and long-term status of the individual. Because the effects of SCI and the individual's adaptations to injury are not static, short term or acute, but rather unfold over the lifetime, the individual's integration into the community must evolve over time. Further, this evolution is a function not only of changes in the structures and functions of the individual's body, but also of a variety of developmental processes; for example, changes in the person's skills at negotiating life as a person with a disability, as well as the abilities and strengths the individual brings to situations -- adaptability, intellectual skills, motivation level, and the like. The dynamics of community integration for an individual with SCI also vary with the ebb and flow of environmental resources, opportunities, and challenges; for example, vocational opportunities that change over time, social support provided within the individual's family and friend network, his or her access to economic resources, the community's willingness to provide opportunities and function inclusively with respect to individuals with disabilities, and the like (Brown, Gordon & Ragnarsson, 1987).

Third, community integration refers to an individual's status within a social-physical environment, i.e., how the individual "sits" within an environment defined by society and by natural law. In this view, four ways of relating to the social-physical environment are central to "community integration":

* characteristics of the individual's residence -- type of housing, presence of others in the residence, etc.;

* the individual's vocational and economic role activities;

* his or her integration into social networks; and

* his or her participation in community- and home-based activities.

In sum, community integration encompasses two basics of life: where one lives and what one does within the social-physical context of living.

In fact, as stated above, the "where one lives" component of community integration is a defining characteristic. Integration into the community, at the very least, requires living in a residence that supports and, hopefully, encourages an individual to interact fully with the community. Private homes, apartments, and some group homes are preferable to nursing homes or hospitals for an individual to live life to his/her full capabilities.

From this perspective, the "what one does" component of community integration is crucial in trying to measure the degree to which individuals with SCI living in the community are also integrated into the community. Higher levels of integration into the community require that an individual have a meaningful and culturally appropriate vocational/economic role to play. This may entail working as a student, a volunteer, a homemaker, or as a salaried worker. Community integration also has a social network component. Thus, as the individual is integrated into more complex social groups, including family, friends, community settings, self-help groups, and such, he or she optimizes contacts with others. Finally, the community-integrated individual engages in a variety of activities inside and outside the home that define daily life for active community members (e.g., travel to work/school, grocery shopping, going to movies, dining out, cleaning house). In sum, in this approach we must look at vocational/economic roles, social network involvement, and patterns of daily life activities to determine where individuals with SCI fit on the integration continuum -- from "only just there" to "fully active" in and interwoven into the fabric of the community.

Although one can measure (Willer, Rosenthal, Kreutzer, Gordon, & Rempel, 1993; Whiteneck, Charlifue, Gerhart, Overholser, & Richardson, 1994) the degree of integration of an individual with SCI into the community and the ways in which people with SCI participate in community living (or do not), this does not imply that one can say what is successful versus unsuccessful community integration. Success, we believe, is defined individually and is determined by a person's achieving a life consistent with his/her hopes and aspirations; success must be insider-driven rather than outsider-dictated.

In this article, recent literature on several aspects of community integration of individuals with SCI will be discussed, adhering to the four-part concept of community integration defined above: where one lives, vocational/ economic roles, engagement in social networks, and involvement in activities in the home and com-munity.