Psychological or physiological: why are tetraplegic patients content?

To assess the effects of spinal cord injury (SCI) on perceived health-related quality of life (QOL).

SCI is physically disabling, socially handicapping, and romantically limiting. Nevertheless, little is known about post-SCI neurocognitive and psychosocial life. Better understanding of the cognitive and emotional worlds of SCI patients is essential to better address and meet their needs and expectations.

Twenty subjects with high-cord (T6 and above) complete (American Spinal Injury Association [ASIA] A) SCI (High SCI) were compared with 10 subjects with low-cord (T7 and below) ASIA A SCI (Low SCI) and with 11 Able-Bodied control subjects. Satisfaction with Life and Short Form-36 instruments were used to assess physical and emotional aspects of QOL. Analyses of variance were used to assess potential differences across groups.

Overall, satisfaction with life was the same among the groups. Expectedly, High SCI and Low SCI subjects reported lower physical functioning than Able-Bodied subjects (p < 0.0001). But, oddly, there were no differences in perceived physical role, physical health, or social functioning. Furthermore, High SCI subjects reported better perceived mental health than Able-Bodied control subjects (p = 0.004) and a trend over Low SCI subjects (p = 0.06), better perceived emotional role in society (p = 0.02), and greater vitality (p = 0.01) than Low SCI subjects and Able-Bodied subjects.

Despite severe physical impairment and disability and frequent medical complications, subjects with complete spinal cord injury at high anatomic levels report better than average quality of life, being overall content. Reasons for these findings are unclear. Psychological adaptive reactions are likely, but the possible role of physiologic and neurocognitive changes needs further exploration.