Planning Grant for Establishing a Collaborative Team to Investigate: Health and Quality of Life Related Challenges for Individuals with Spinal Cord Injury, Living in Medically Underserved Areas of Kentucky, Receiving Rehabilitation Services

Spinal cord injury (SCI) often results in permanent damage to the spinal cord causing loss of motor and sensory function that significantly impacts the person's quality of life. Secondary complications following SC! (e.g. spasticity, autonomic dysreflexia, urinary tract infections, pressure sores, and osteoporosis) significantly impact the individual's quality of life by limiting functional abilities and participation in desired roles and activities. There continues to be a significant need for research to develop Sw strategies for the prevention of secondary complications following Sd. One assumption has been that standard rehabilitation practices provided in acute settings (usually located in larger urban settings) is sufficient to meet the needs of all individuals with SCI (those who return to live in urban settings as well as those living in rural communities). However, rehabilitation providers have noted that people with disabilities in rural areas are at greater risk of secondary complications. In addition, problems endemic to rural areas, such as higher rates of unemployment and decreased access to rehabilitation services also affect service delivery in rural rehabilitation, which can also influence the incidence of secondary complications. In order to provide the best care for individuals living in rural communities, research on the applicability of current standards of care and their implementation in rural communities is needed. However, in order to effectively conduct this research a better understanding of the needs and barriers of individuals with SC! and their families living in rural communities as well as the needs and barriers of health care professionals practicing in the rural communities is required. in the proposed study, two specific aims will be executed that will examine this problem. in specific aim 1 the health and quality of life related supports and challenges to individuals with SCI in medically underserved rural communities will be described. Multiple qualitative approaches will be used to examine this area from the perspective of both the individuals with SCI and their families and the health care providers that treat these individuals in the rural setting. In specific aim 2 a collaborative research team of researchers, rehabilitation specialists, community-based health care practitioners, individuals with Sd, and their families will be established that will identify, develop, and disseminate information and strategies to improve outcomes and quality of life of individuals with SCI living in medically underserved rural communities. Funding of this proposal will allow the collection of preliminary data and establishing the community~based research team that will be essential in directing future research questions and grant proposals.