title: Environmental factors and their role in community integration after spinal cord injury.
abstract: BACKGROUND
  The International Classification of Functioning, Disability and Health (ICF) model presents an opportunity to better understand previously neglected longterm social outcomes after traumatic spinal cord injury (SCI), especially the experience of participation.
  
  
  OBJECTIVE
  The study explored the relationship between perceived environmental barriers and perceived community integration (a participation proxy) in a sample of adults with traumatic SCI.
  
  
  METHODS
  The study interviewed African American and White women and men (n = 136) who had lived with SCI for an average of 11.5 years.
  
  
  RESULTS
  Participants reported environmental barriers at twice the level indicated by previous studies; the natural environment and the policies of government were the most problematic. Levels of community integration were also high. Data suggest a significant relationship (p < .01) between perceived environmental barriers and community integration for adults with SCI, providing support for the ICF model.
  
  
  CONCLUSIONS
  Improved measures and more sophisticated concepts and theories are needed to explicate the relationship between environmental factors and participation concepts in the ICE With respect to practice, occupational therapists need to be aware that removal of environmental barriers is only a first step in the more complex effort to facilitate optimal community integration after SCI.
authors.affiliation: Occupational Therapy and Gerontology, Wayne State University, Detroit, MI 48202, USA c.lysack@wayne.edu
authors.forename: Cathy
authors.initials: C
authors.lastname: Lysack
authors.forename: Marie
authors.initials: M
authors.lastname: Komanecky
authors.forename: Allison
authors.initials: A
authors.lastname: Kabel
authors.forename: Katherine
authors.initials: K
authors.lastname: Cross
authors.forename: Stewart
authors.initials: S
authors.lastname: Neufeld
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000145:classification / Q000523:psychology / Q000534:rehabilitation; D004779:Environment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012111:Residence Characteristics; D012649:Self Concept; D012737:Sex Factors; D018434:Sickness Impact Profile; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D014186:Transportation; D044465:White People