College of Science and Health Theses and Dissertations

Date of Award

Summer 8-22-2021

Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Susan McMahon, PhD

Second Advisor

Susan Tran, PhD

Third Advisor

Jocelyn Carter, PhD


Spinal cord injury (SCI) is a complex medical condition that refers to an acute spinal cord lesion that affects sensation, muscle control, and autonomic functioning. One fifth of injuries occur in youth, and adults with pediatric-onset SCI may have unique experiences and outcomes compared to those with adult-onset injuries due to the impacts of SCI on development. A socioecological disability framework can provide a critical perspective into how individual and environmental factors interact and impact the experiences of individuals with SCI. Individuals with SCI often have significant secondary health conditions with chronic pain and pressure injuries as two of the most common. SCI and related medical issues can significantly impact community participation including mobility (e.g., using transportation), occupational functioning (e.g., finding a job or going to school), and social integration (e.g., spending time with family and friends). Secondary medical conditions and participation can also influence psychosocial outcomes such as depression, anxiety, satisfaction with life (SWL), and posttraumatic growth (PTG). The current study utilizes a subset of 180 adults with pediatric-onset SCI from a continuous, longitudinal study with data from a 10-year period and up to nine time points. Data were collected through a hospital system in the U.S. and are part of a larger study that explores long-term medical and psychosocial outcomes. The study explores the relationships between medical complications (e.g., pain severity and pressure injuries), community participation (i.e., mobility, occupational functioning, and social integration), and psychosocial outcomes in the form of depression, anxiety, SWL, and PTG over time. Positive coping strategies (e.g., religion/spirituality, use of emotional support, acceptance) were studied as moderators for the relationship between medical complications and participation over time, with higher levels of coping strategies predicted to buffer against the negative impact of medical complications on participation. Descriptive statistics and correlations were examined for all relevant variables and hierarchical linear modeling (HLM) was utilized for main analyses. Over time, experiencing a pressure injury in the past year was associated with lower community participation, higher levels of pain severity were associated with higher levels of depression symptoms, and higher levels of community participation were associated with lower levels of depression symptoms and higher levels of SWL. Mobility was specifically related to depression symptoms and occupational functioning was related to SWL over time. Coping was not found to moderate relationships between secondary medical conditions and community participation. This study builds upon the SCI literature by focusing on longitudinal data and key relationships over time in adults with pediatric-onset SCI. While much of the literature focuses on immediate effects of SCI on functioning, this study examines individuals’ functioning years after their injuries. Results suggest that prevention of secondary medical conditions such as pressure injuries may be an avenue for facilitating community participation and that strategies focused on increasing participation may lead to positive psychosocial functioning over time. Implications for research, practice, and policy are discussed.

SLP Collection


Included in

Psychology Commons