Marshalling a patient's resources

Sporting accidents are a frequent cause of traumatic spinal cord injuries (SCI) and a common subset of these are those resulting from skiing and snowboarding. ¹ The devastating injuries that are associated with such recreational sports often affect young men under thirty. ²

Snowboarders, for example, are at particular risk of SCI and have higher rates of such injuries when compared to skiers, especially intermediate and expert boarders involved in jumping. ^3,4  Additionally, the prevalence of SCI within this group has been increasing in accordance with the rising popularity of the sport.⁵ 

While sporting accidents are but one example of the sudden and unanticipated events that can result in SCI, they affect a largely young and healthy population.

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 spinal cord injury; 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 This dependency, in turn, involves all aspects of self-care and mobility that are fundamental to a person’s ability to become independent.

Box 1: Epidemiology of traumatic SCI

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 externalities 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 behavioral resources. 7,8  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.

Box 2: The Resource Oriented Approach

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 one young SCI patient’s intrinsic resources, along with his life goals for greater independence, combined with the support of goal-directed training, facilitated the success of the rehabilitation process.