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Adjustment to spinal cord injury

What is Adjustment

Simply put, adjustment is the process of becoming used to a new situation. Life following a spinal injury is often very different to your life before your injury and involves a great deal of adjustment as you negotiate a number of new challenges.

For everyone adjustment involves a process of appraisal and re-appraisal. Appraisal refers to how you think about and evaluate yourself, your situation, challenges and solutions. Appraisals can be optimistic and realistic leading to good mental health through adopting positive coping strategies. Appraisals can also be pessimistic, leading to poor mental health through adopting poor coping strategies. The appraisal and coping process is called the “engine room” of adjustment and for maintaining good mental health because it is very important.

Good news!

The way you perceive the world is not fixed - different situations can be viewed from a variety of perspectives. Research has found that how we explain events in our lives impacts how well (or poorly) we deal with those events.

“Having a high quality of life following a spinal injury involves a sense of balance between your body, mind and your social context and environment. Understand your condition, take control and introduce order and predictability into your life. Learn what is possible, set goals, develop values that make sense of your disability, and search out resources to manage your life better.”

Person with C4 tetraplegia

The following figure shows the relationship between a challenging situation, a positive appraisal/re-appraisal and coping process, and positive adjustment outcomes. Many things can challenge your resilience (time since injury, level of injury, negative thinking, poor social support, pain), however, your engine room is very powerful, and can help you adjust well regardless of what life can throw at you.       

Diagram of mental health engine room

Adjustment case studies

man in wheelchair describing something to his therapist using hand gestures
Neuropathic pain and mindfulness / thought training


You are prescribed pain medication, which causes side effects, like confusion, fatigue and weight gain. You decide to try something different to cope.

Your doctor suggests reducing the dosage in combination with an online mindfulness App.

Positive adjustment

Learning the new mindfulness techniques gives you another strategy to manage pain.

Reducing medication improves your ability to think and you have more energy.

Reappraising your new situation you realise you have more positive resources than you realise


This new approach to managing your pain allows you to focus on other activities such as hobbies and socialising.

You also have improved self-esteem due to the way you dealt with this challenge

friends consoling man in a wheelchair
Onset of anxiety and relaxation techniques


You are beginning to experience serious anxiety and feelings of panic about dealing with your injury in the coming years. This has caused feelings of helplessness, sleep disturbance and a reluctance to mix socially. There is also an embarrassment and reluctance to talk to family and friends about it.

You try to cope, hoping it will go away however it gets worse to cause nausea, fatigue, and depression.

Positive adjustment

The risk of not doing anything about your situation is a serious threat to your mental and physical health. You get advice from a trusted friend who has a spinal cord injury too.

It is agreed that you must focus more on optimistic activities such as an online relaxation course, and regular exercise


You begin to develop positive coping strategies, that encourage further positive changes, such as changes to medications, diet and social activities.

Note to self...

Get a GP referral to a psychologist if these strategies are not working.


Transitioning from hospital back into the community can feel liberating. It will also be very challenging as you learn to be independent again. You will strengthen your adjustment if you set achievable goals, keep active, eat well, think optimistically and realistically, seek help when needed and maintain strong social ties.

Take home messages

man with head in hand crying

is a normal reaction to change

yellow toolbox

in this module to increase your overall wellbeing

asian woman with hand on chin thinking

and learn to manage your thinking

man in a wheelchair holding a folder looking straight ahead

of your symptoms

clipboard with pen and paper

a mental health management plan

doctor standing with arms crossed

with your GP to discuss medication options

Be proactive and take responsibility for managing your own health risks

This involves:

  • Educate yourself so that you understand how your spinal cord injury affects your mental health
  • Keep you up-to-date about the latest research findings.
  • Become a partner in decision-making and learning to problem solve with your family and health professionals.
  • Develop an individual mental health self-management program that works for you.
  • Engage in ongoing health and wellness activities. This includes:
    • Exercising regularly
    • Maintain a healthy weight to reduce load on your shoulders, arms and hands
    • Use medications only as instructed by your doctor(s)
    • Incorporate regular relaxation and mindfulness techniques into your daily life.