Review Paper: Aspects related to Resilience in People with Spinal Cord Injury

Abstract

Objective Rehabilitation of the spinal cord injury is a continuous process needing adaptation in all aspects of life. Successful adaptation to challenging situations is called "resilience". Occupational therapists can help the person reconstruct his/ her identity and adapt by improving their resilience. It is also extensive and diverse in concept and definition. It is extremely influenced by the culture and environment. This study aims to narratively review the evidences published on the aspects related to the resilience of people with spinal cord injury. Materials & Methods Comprehensive electronic search of keywords including “spinal cord injury”, “resilience” and “adaptation” was done via Google Scholar, PubMed, Scopus, ScienceDirect and Pro Quest and IranMedex to find related articles published within 2000-2015 according to inclusion criteria. From the initially obtained 1823 articles, 1756 articles were omitted due to failure to satisfy the inclusion criteria or being repetitions. After actors underlying resilience and 4 and 5 articles focused on social participation and psychosocial adaptation after spinal cord injury in respect. Results As seen from the included documents, there are various definitions of resilience. Resilience was defined as coping with the conditions after spinal cord injury such that the person takes in his/ her activities of daily living with improved mental health and appropriate community mobility. It is also defined as the process that involves a complex interaction of the person with his/ her environment. There are four trajectories in terms with resilience. Fifty percent of people involved are resilient, 25 percent of them showed recovery, 12.8 percent showed delayed distress, and 12.5 percent have chronic dysfunction. This adaptation is definitely influenced by the surrounding social context since any environmental complication can lead to a decline in resilience. The more the environmental relations are, the simpler adaptation occurs. So, it is necessary to notice the communicative and environmental simplifiers in the rehabilitation program. Family and economic status have a significant role in the resilience of people with spinal cord injury. Resilient people with spinal cord injury have better adaptation and lower levels of depression while entering rehabilitation as well as show more acceptance of the disability during discharge and more satisfaction of their lives. The resilience is extensively impacted by the individual characteristics and social circumstances. The resilience is a multidimensional concept that includes contextual factors, social participation, and mental adaptation. Being a male, having a mild-to-moderate physical job, having a high academic level before the injury, and obtaining appropriate education after injury can lead to resilience and paid employment later. In contrast, misunderstanding of physical complications, passive personality, pessimism, and lack of psychosocial support from the family are barriers for being employed after injury. The less the family and environmental barriers are, the better mental health and adaptation is anticipated. Factors such as job and suitable education before the injury as well as optimism and positive attitude provide effective resilience later. Spirituality and self-control have a good prognosis for resilience. The supportive role of the environment, particularly of that of family members, is also important. Conclusion Resilience in spinal cord injury needs psychologically more attempt than the physical aspects, because it needs more time to adapt after a sudden accident. Spirituality, stress management strategies, optimism, and social support from family members and friends facilitate resilience. As resilience is impacted by the culture and environment, more studies on the explanation of the aspects related to the resilience of Iranian population is recommended.

Keywords

• Spinal cord injury
• Resilience
• Adaptation