Psychosocial, Community Reintegration, and Lifelong Care
Psychological adjustment
Depression and anxiety are common after SCI, and suicide risk is elevated. Screen systematically, but remember that somatic items such as fatigue, appetite change, and sleep disturbance overlap with SCI itself; use structured interviews and clinical judgment. Address substance misuse, grief, body image, and adjustment over time. Peer mentoring and family involvement improve engagement.
Sexuality and fertility
Men usually retain reflexogenic erections; phosphodiesterase-5 inhibitors and vacuum devices are first-line, with intracavernosal injection or prosthetics for refractory cases. Ejaculation is often impaired - penile vibratory stimulation and electroejaculation with sperm retrieval enable fatherhood. Women typically retain fertility; pregnancy is possible, and labor and delivery carry autonomic dysreflexia risk in injuries above T6. Provide contraception and preconception counseling.
Community reintegration
Plan for return to work, driving, accessible housing, and recreation. Vocational rehabilitation, assistive technology, and caregiver training are core services. Social isolation and transportation barriers are frequent and modifiable.
Lifelong care and aging
With aging, shoulder overuse and rotator cuff disease, carpal tunnel syndrome, osteoporosis, cardiovascular disease, and pressure injury recurrence accumulate. Leading causes of death include respiratory disease, cardiovascular disease, septicemia, and suicide. Schedule annual comprehensive reviews covering skin, bowel and bladder, spasticity, pain, mental health, vaccinations, and equipment fit.
Traps
Telling women with SCI they cannot conceive; dismissing depression as an expected reaction to disability; and failing to anticipate autonomic dysreflexia during pregnancy, labor, or procedures.
Rule of thumb
In cervical or high thoracic SCI, new fever, headache, or diaphoresis means think autonomic dysreflexia until excluded.