Models of adaptation
Spinal cord injury is associated with extensive social,
occupational, and psychological challenges. Previously
these adaptations have been viewed in a stage theory
framework.10,11 Stage theories postulate that time since
injury is a crucial factor in adaptation and that the
goal of rehabilitation is to move an individual through
a series of predetermined stages towards acceptance of
disability.12 These presumptions have been seriously
challenged in the past two decades.13 A lack of
empirical evidence for stage model theories, signi®cant
variability in rehabilitation outcomes, and an increased
awareness of the heterogeneity of this population has
promoted a diering emphasis for rehabilitation
research. This contemporary emphasis considers reha-
bilitation to be a multi-factorial process and places
emphasis on the roles that coping and appraisal play in
adjustment.