Analysis of and Intervention for Behavioral and Psychological Adjustment and Coping After Pediatric Spinal Cord Injury

Principal Investigator: Keith Slifer

Sustaining a spinal cord injury (SCI) is a life-altering event, both for youth and their families. Recent innovations in the treatment of pediatric SCI offer the potential for greater restoration of sensory and motor functioning (McDonald & Sadowsky, 2002), but intensive inpatient or outpatient spinal cord rehabilitation therapy is typically required.

In addition to increased therapy demands, youth who have sustained SCI are faced with numerous stressors including hospitalization, medical complications, physical limitations, and overall loss of independence. Previous research has found increased anxiety, depression, and posttraumatic stress disorder in those with SCI (Boyer et al., 2000; Chevalier et al., 2009; Craig et al., 2009). Additionally, adolescents with SCI tend to endorse negative views of themselves and feelings of shame regarding loss of bowel and bladder control, (Mulcahey, 1992), and youth report decreased health-related quality of life (HRQOL; Garma et al., 2011). Poor coping may affect overall compliance with necessary rehabilitation goals (Gorski et al., 2005), and given the associated effect of mood on HRQOL, it has been recommended that psychological intervention be conducted with youth and their families (Garma et al., 2011).

Physical and emotional effects of pediatric SCI create unique medical and psychosocial stressors for children participating in intensive spinal cord rehabilitation. Early identification of these concerns may optimize both physical and mental health functioning during rehabilitation. The purpose of this investigation is to conduct a retrospective record review for a group of youth (ages 2-21), who received psychological services while undergoing inpatient rehabilitation for SCI who were admitted to the Kennedy Krieger Institute’s Spinal Cord Injury Rehabilitation program between January 1, 2007 and June 1, 2012. Existing demographic (within the limits of HIPAA regulations), medical, behavioral and psychological data collected as part of routine clinical care during inpatient stays and follow-up visits at Johns Hopkins Hospital and Kennedy Krieger Institute will be extracted. Once these data are collected, we will create a database that is de-identified of all protected health information. This de-identified data set will be used to assess the range and most common types of behavioral and psychological problems occurring in this population, the individual, environmental and psychosocial predictors of these difficulties, the range of clinical interventions that we have employed clinically and the differential effectiveness of our intervention techniques.