Abstract Information


Appraisals of Disability in Middle Adulthood Following Pediatric-Onset Spinal Cord Injury

1Chlan K, 2Zebracki K, 3Kennedy P, 2Vogel L
1Shriners Hospitals fo Children, Chicago, IL, United states; 2Shriners Hospitals for Children, Chicago, IL, United states; 3Deceased; The National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire, , UK

Objective: To describe cognitive appraisals in individuals with pediatric-onset spinal cord injury (SCI) during middle adulthood and examine the relationship between appraisals and demographic and injury-related factors.

Design/method: A cross-sectional survey of 112 individuals ages 35-51 (M=41.0, SD=5.1) who sustained an SCI prior to age 19 (M=14.1, SD=4.0; range=0-18) completed a structured telephone interviews. In addition to demographic and medical questionnaires, cognitive appraisals were assessed using Appraisal of DisAbility: Primary and Secondary Scale (ADAPSS). The ADAPSS is a 33-item SCI-specific appraisal scale that assesses individuals’ initial evaluations of an event and their evaluation of their own coping strategies for dealing with this event. The scale consists of 6-factors; three negative: fearful despondency, overwhelming disbelief, negative perceptions of disability and three positive: determined resolve, growth and resilience, and personal agency. Higher levels of negative appraisals and lower levels of positive appraisals represent likelihood to appraise injury in terms of loss and threat and as unmanageable. At-risk groups are identified by the highest category of the negative appraisals and the lowest category of the positive appraisals.

Results: Overall, participants fell in normal to very good ranges for all factors with the strongest factor being very high levels of determined resolve, followed by low levels of negative perceptions of disability, fearful despondency, and overwhelming disbelief, and high levels of growth and resilience. The weakest factor was personal agency but still fell within the normal range. Participants at-risk for maladaptive appraisals were minimal for each group: 2/112 (1.8%) for fearful despondency, overwhelming disbelief, and personal agency; 1/112 (0.9%) for determined resolve; 0/112 at risk for growth and resilience; and 5/112 (4.5%) for negative perceptions of disability. Differences were seen in appraisals and level of injury with those with tetraplegia having significantly higher growth and resilience levels (p=0.030) but also significantly higher levels of negative perceptions of disability and lower levels of personal agency (p=0.033 and 0.047, respectively) than those with paraplegia. Those with incomplete injuries had significantly higher levels of fearful despondency and overwhelming disbelief scores (p=0.018 and 0.016, respectively) than those with complete injuries. There were no differences in appraisals found for age at injury, duration of injury, current age, gender, or race.

Conclusion: Overall, individuals in middle adulthood appraise coping to injury as manageable. However, there are subgroups of individuals who are at-risk of maladaptive appraisals, including those with tetraplegia or incomplete injuries. Cognitive behavior therapy is recommended to address maladaptive appraisals and consequently, improving coping and reducing risk for symptoms of depression and anxiety.

Support: Shriners Hospitals for Children-Chicago and Craig H. Neilsen Foundation #324671


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