An analysis of the changing demographics of individuals with spinal cord injury who received state vocational rehabilitation services between 2004 and 2008

Traumatic spinal cord injury (SCI) is a complex disability and considered a severe physical impairment (Basso, 2000; Inge, Wehman, Kregel, & Sherron-Target, 1996; Logan, Sloane, Lyles, Goldstein, & Hoenig, 2008; Middleton, Leong, & Mann, 2008) as it affects substantially more than an individual's mobility (Dijkers, 2005; Krause & Pickelsimer, 2008; North, 1999). Additive factors include physiological impairments, psychosocial adjustment, secondary conditions, a lack of direct services, and physical and attitudinal barriers (McKinley, Jackson, Cardenas & DeVivo, 1999; Meyers, Mitra, Walker, Wilber & Allen, 2000; Weaver, Guihan, Pape, Legro, LaVela & Collins, 2001; Wehman, Wilson, Parent, Sherron-Targett, & McKinley, 2000). It is estimated that 12,000 individuals acquire and survive spinal cord injuries each year and that 259,000 individuals with SCI currently live in the United States (National Spinal Cord Injury Statistical Center (NSCISC, 2009). Recent findings indicate the average age at injury is 40 with the majority being Caucasian (66.1%), male (80.9%), with motor vehicle accidents (42.1%) or falls (26.7%) being the most frequently reported reasons for injury (NSCISC, 2009). In comparison with findings from 1979, recent statistics suggest that the average age of onset has increased by 12 years and a shift of occurrence by race has also occurred; Caucasians decreased by 10%, while African Americans nearly doubled (27.1%), and Hispanics experienced a 2.0% increase to 8.1% (NSCISC, 2009). Employability for individuals with SCI is important as it can help to offset costs often associated with SCI, including attendant care, medical supplies and assistive technology (Krause & Terza, 2006) and that limits in these and other resources, including healthcare, increase the risk of morbidity and mortality (Aday, 1994; Flaskerud & Winslow, 1998; Krause, DeVivo & Jackson, 2004). Further research suggests individuals with tetraplegia or injury to the cervical section of the spine (e.g., neck) acquired at an early age (e.g., 20 years old) may die on average 20 years earlier than those without injury and seven years earlier than those with paraplegia (NSCISC, 2009); additionally, minorities, older individuals and rural residents are at higher odds for death (Saunders, Selassie, Hill, et. al., 2009). While these factors suggest employment is important for the well-being of consumers with SCI, several decades of research indicate an acquired SCI significantly impacts employability with level of education, age at injury, gender, and race serving as interactive factors. Almost sixty percent (57.5%) of those with SCI were employed at the time of injury; however, only 11.5% were employed one year post injury, and just over 35% were employed 20 years later (NSCISC, 2009). Individuals with SCI fall slightly below the national employment average for all individuals with any disability (reported at 36.0% for 2007; Meade, Armstrong, Barrett, Ellenbogen, & Jackson, 2006; U.S. Census Bureau, 2007) and those employed have lower rates of income (Basso, 2000; Wehman et al., 2000). Similar to findings of the aggregate disability population, level of education has been positively correlated with employability (Anderson, Dumont, Azzariaa, Le Bourdaisc, & Noreau, 2007; Berkowitz, O'Leary, & Kruse 1998; Hirsh, Molton, Johnson, Bombardier, & Jensen; 2009; Krause, 1992) with an increased level of education increasing employment options as well (Anderson, & Vogel 2002). Factors associated with age suggest that those injured later in life have poorer employment outcomes (Hirsh et. al., 2009; Yasuda, Wehman, Targett, Cifu & West, 2002). This may be associated with a longer period of adjustment with spinal cord injury as studies indicate employment rates increase as time since injury increases (Krause & Coker, 2006; Krause, et al., 1999; Meade, Lewis, Jackson & Hess, 2004). …