Patients with incomplete spinal cord injuries experience quadriplegia and paraplegia. With therapy, some portion of the patients will recover the ability to walk, either aided or unaided. Yet some of the treatments date back to Hippocrates. (See this NIH page.)

Patients are asked to keep a positive mental attitude, in order to increase both the speed and degree of their recovery.

Is there research that demonstrates the effectiveness of positive patient attitude, or would patients recover the same regardless? Or, put another way, is the "Can Do" attitude of sports movies real, or is this the stuff of legend?

  • Correct. I did not say "incomplete spinal cord injury" in the title for brevity's sake, but did say it in the opening line. – rajah9 Aug 17 '11 at 19:02
  • sorry, I was reading on my iphone, I must have missed it. My apologies – Monkey Tuesday Aug 18 '11 at 1:32

The data presented in this paper confirmed the findings of the literature that suggest a significant proportion of people with SCI are at risk of developing negative psychological states (Elliott & Kennedy, 2004; Middleton et al., 2007; North, 1999). The SCI group had significantly raised levels of self-reported depressive mood relative to the able-bodied controls. While differences between the SCI group and the controls did not reach significance for the other seven measures, the SCI group had consistently higher levels of negative psychological states for all measures, compared to the able-bodied controls. Furthermore, people with SCI had seven times the risk of having increased levels of negative psychological states typical of people with a psychiatric disorder compared to the able-bodied controls (20% of the SCI people had elevated levels of negative psychological states). It is possible that some questionnaires (such as the Beck Depression Inventory) inflate negative mood scores because they contain items biased towards medical complications associated with SCI (eg. items that focus on sleep, weight and physical performance). However, inspection of the items in the POMS suggests this is not a problem, as items require subjects to respond to 60 adjectives about how they feel. Therefore, the elevated POMS scores associated with SCI more than likely reflect valid increases in self-reported negative psychological states. This finding is somewhat concerning given that the participants had been living in the community on average 11 years after their injury, and were people who were getting on with their lives. They were not psychologically upset people recruited from hospital wards due to complications or mental health problems. Clearly, the findings have implications for current psychosocial strategies being used during and after rehabilitation.

One limitation in this study was the use of only a self-report questionnaire to assess psychological states. Future research therefore needs to utlize a comprehensive range of assessment including diagnostic clinical interviews designed to detect psychopathology. However, as stated above, the findings of this paper have revealed possible challenges for current rehabilitation strategies designed to counter negative psychological states. Further research should assess and gather best evidence regarding treatments that can reduce psychological states in SCI people during rehabilitation, as this may then reduce the prevalence of negative states in the long-term by assisting the person with SCI to maintain a healthy mental health and adjustment (Craig et al., 1998). Potential treatments include pharmacological therapies to counter psychopathology such as depression, as well as non-pharmacotherapies such as cognitive behavioral therapy or other psychosocial therapies known to be beneficial for improving psychological status. It is crucial however, that psychosocial and mental health be seen as important outcomes for rehabilitation following SCI (Middleton et al., 2007).

It is also becoming clear that our knowledge about the association between negative psychological states and SCI needs clarification. Ten years ago rehabilitation researchers and clinicians were calling for comprehensive research that could clarify the nature of the psychological reaction of people to SCI (Elliott & Frank, 1996; Jacobs, Zachariah & Bhattacharji, 1995). Unfortunately, little has changed today. We need to determine the prevalence of people with SCI who develop despondency or mild depressive disorder (eg. elevated negative psychological states) as distinct to a major depressive disorder (MDD), dysthymia or possibly adjustment disorder. We also need to determine how many people with SCI develop depressive symptoms due to a primary anxiety disorder such as PTSD. The influence of pre-morbid psychopathological factors on psychopathology both during and after rehabilitation also needs clarification. Clearly, prospective research needs to be conducted to resolve the gaps in our knowledge about the association between SCI and negative psychological states. Such comprehensive data could well lead to an improvement in rehabilitation strategies that address the psychosocial needs of people with SCI. http://www.psychosocial.com/IJPR_12/Spinal_Cord_Injury_Craig.html

Mental health affects the physical body in many ways. A positive attitude is crucial to prevent stress and depression which again leads to more medical issues and hence complicates the recovery.

Low levels of dopamine affects (one of the symptoms of depression or lack of motivation) the basal ganglia which is crucial for motor skills and learning. http://www.ncbi.nlm.nih.gov/pubmed/20438237

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  • Thank you for this reference, @Nostrum. If I were to place the study results in symbolic logic, let p=SCI at risk; q=elevated POMS scores. Paper's hypothesis is p=>q. (Note, I am aware of the correlation=causation error and realize that the article is claiming correlation, not causation. My symbolic logic is a shorthand that may give rise to other fallacies.) If p => q then ~q => ~p, or non-elevated POMS scores imply lower SCI risk. Would you agree or disagree with my logic? – rajah9 Aug 23 '11 at 16:03
  • Thinking more about correlation, my other thought is that higher SCI risk might mean less recovery, leading to elevated POMS scores. In this case, a patient with a lower POMS score might be happier because of the progress he is making. It would have little to say to the patient who fabricated a lower POMS score (or has a chipper, determined physical therapist who encourages a lower POMS score). – rajah9 Aug 23 '11 at 16:10
  • Interesting about dopamine being crucial for motor skills, and learning. These are critical to rehabilitation and recovery. I wonder if drugs that affect dopamine, such as certain SSRI, could influence recovery. – rajah9 Aug 23 '11 at 16:12
  • Regarding SSRI I have seen several studies that support this, even the ones that does not affect dopamine levels; ric.org/aboutus/mediacenter/press/2010/spinalcordinjury.aspx reuters.com/article/2009/10/18/… – Nostrum Aug 23 '11 at 16:53
  • I agree with your logic. From what I can tell low value of q (both pre-existing and contemporary) generally lowers the risk stated in p, which in turn gives a better forecast when it comes to recovery. – Nostrum Aug 23 '11 at 17:00


Ryff has shown that individuals with higher levels of well-being have lower cardiovascular risk, lower levels of stress hormones and lower levels of inflammation

It stands to reason that this would improve the outcome in a person with a spinal cord injury since inflammation and swelling of tissue are the main reasons these injuries are so damaging.

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  • +1 Thank you for the article. Although there are experts quoted, my skeptic eye is seeing hopeful speech, not documented fact. For example, Ryff starts out a sentence "There is no doubt in my mind his positive attitude extended his life..." Well there is doubt in my mind. Christopher Reeves' life may have been extended by being able to buy more medical than the average person could afford. It could have been from experimental treatments. It could have been from an active lifestyle. I would like you to convince me with reason and studies, not with Ryff's imaginings. – rajah9 Aug 12 '11 at 15:35
  • Well you can find plenty of her work on Google Scholar scholar.google.com/scholar?hl=en&q=Carol+Ryff Whether you can read any of it without paying for the PDFs is another matter :) – dtanders Aug 12 '11 at 15:43
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    Please suggest a criteria for references that doesn't force me to buy journal subscriptions to post answers to SE – dtanders Aug 12 '11 at 17:40
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    The USAT is a highly visible, professionally made general media publication that's unlikely to publish counter-factual information and I quoted pretty much the only interesting part of the whole article. Yeah, it just barely clears my personal bar for respectability, but it's at all not likely to be false information. – dtanders Aug 12 '11 at 17:56
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    Use google scholar. Find the original paper and google it's title. Read the abstract, that's always available. You'd be amazed at how many times papers say very different things from newspapers, or to find that there are actually no papers but just press releases from a PR company. – Sklivvz Aug 14 '11 at 16:38

One article that I found was Spinal Cord, (21 June 2011), "Predicting the long-term impact of acquired severe injuries on functional health status: the role of optimism, emotional distress and pain," by O Vassend, A J Quale, O Røise, and A-K Schanke.

(I found this by searching Google Scholar for "patient attitude spinal cord injury," which led me to several articles on the journal Spinal Cord. There seemed to be quite a few articles dealing with medical staff attitude, so I just searched Spinal Cord archives for "patient psychology.")

The study used a hierarchical regression analysis and a sample size of n=101, with a follow-up 4 years later with n=75.

It doesn't say whether patients who adopt an optimistic attitude do better, but instead, that patients who have an optimistic attitude fare better. The article concludes: "high optimism should be regarded as a resilience characteristic, protecting the individual against long-term sequelae of severe physical injury." In contrast, "patients characterized by low optimism, combined with presence of pain and depression/anxiety, may constitute a high-risk group for disability and reduced quality of life."

So there may be something to be said for going in with a "can do" attitude.

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