Environmental Factors and Their Role in Community Integration after Spinal Cord Injury

Abstract

Background. The International Classification of Functioning, Disability and Health (ICF) model presents an opportunity to better understand previously neglected longterm social outcomes after traumatic spinal cord injury (SCI), especially the experience of participation. Purpose. The study explored the relationship between perceived environmental barriers and perceived community integration (a participation proxy) in a sample of adults with traumatic SCI. Methods. The study interviewed African American and White women and men (n=136) who had lived with SCI for an average of 11.5 years. Results. Participants reported environmental barriers at twice the level indicated by previous studies; the natural environment and the policies of government were the most problematic. Levels of community integration were also high. Data suggest a significant relationship (p<.01) between perceived environmental barriers and community integration for adults with SCI, providing support for the ICF model. Implications. Improved measures and more sophisticated concepts and theories are needed to explicate the relationship between environmental factors and participation concepts in the ICF. With respect to practice, occupational therapists need to be aware that removal of environmental barriers is only a first step in the more complex effort to facilitate optimal community integration after SCI.