Contextualizing Disability: A Cross-sectional Analysis of the Association between the Built Environment and Functioning among People Living with Spinal Cord Injury in the United States

Spinal Cord, 2019 · DOI: 10.1038/s41393-018-0186-8 · Published: February 1, 2019

Spinal Cord Injury Participation Accessibility

Simple Explanation

This study investigates how the environment around people with spinal cord injuries (SCI) affects their physical abilities. It looks at factors like the mix of different types of buildings (residential, commercial), the number of destinations (stores, parks), and how these factors relate to their ability to move around, take care of themselves, and use their hands. The study found that for people with paraplegia (lower body paralysis), living in neighborhoods with more destinations and parks was linked to better self-care abilities. For those with tetraplegia (paralysis affecting all four limbs), more destinations in the community were associated with better wheelchair mobility and hand function. These findings suggest that the environment plays a role in the lives of people with SCI, and making communities more accessible and providing more opportunities for activity could improve their physical functioning and overall well-being.

Study Duration

Not specified

Participants

N=402 adults living with chronic spinal cord injury (SCI)

Evidence Level

Cross-sectional study

Key Findings

1
People with paraplegia living in neighborhoods with more destinations and a nearby park reported higher levels of self-care functioning.
2
For people with tetraplegia, living in a community with more destinations was associated with better wheelchair mobility and fine motor functioning.
3
living in a neighborhood with high land use mix was associated with higher fine motor functioning scores.

Research Summary

This study examined the association between the built environment and physical functioning in adults with spinal cord injury (SCI). It used a cross-sectional design and data from four SCI Model Systems centers in the United States. The study found that for individuals with paraplegia, living in neighborhoods with more destinations and a park was linked to better self-care. For individuals with tetraplegia, living in communities with more destinations was associated with improved wheelchair mobility and fine motor skills, while a high land use mix in the neighborhood was associated with better fine motor function. The authors conclude that the built environment is associated with functioning after SCI and warrants further investigation. Understanding this relationship can inform community-based interventions and public policy to promote accessibility and reduce limitations.

Practical Implications

Community-Based Interventions

Designing community-based interventions to improve accessibility and opportunities for activity may promote physical functioning and lessen limitations after SCI.

Effective Public Policy

Informing effective public policy to promote accessibility on a larger scale can improve the environmental context of disability.

Patient and Family Planning

Helping patients and their families plan for successful community living post-SCI by considering the opportunities for activity in different locations.

Study Limitations

1
The amount of variance explained by the built environment was relatively small.
2
The cross-sectional design of this study precludes the analysis of reverse causation.
3
The proxy built environment factors developed for this analysis were limited to available GIS data for a wide array of geographic locations.

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