Enhancing vocational outcomes of spinal cord-injured persons: the occupational therapist's role.

Because work is a core element of our physical, social, and psychological survival, the significance of work for spinal cord-injured persons is no less than it is for able-bodied persons. To develop expectations of a productive life-style, vocational planning must be initiated early in the rehabilitation process, with the occupational therapist contributing significantly to the initial and ongoing functional and prevocational assessment. Interaction between the therapist and the spinal cord-injured person can promote the experience of control over environment, a feeling of responsibility for success of the rehabilitation process, the ability to solve functional problems outside of the rehabilitation environment, an understanding of the range of behavioral and environmental options available to the individual, and successful performance of job-related tasks in a supportive setting. The interaction between the occupational therapist, the vocational rehabilitation specialist, and the employer should be characterized by clear, nontechnical communication, an understanding of what functional activities the patient actually does (rather than what the person can do), a willingness to try creative solutions to environmental and performance problems, and a recognition of the employer's need for quantity and quality of production. All these combined reduces the potential for failure on the job and enhances the likelihood of achieving the highest possible level of vocational potential.