Quality of life after Spinal Cord Injury
美国留学医学代写 Spinal Cord Injury (SCI) is a condition that has a variety of long term physiological, psychological and economical consequences for individuals
Abstract
Spinal Cord Injury (SCI) is a condition that has a variety of long term physiological, psychological and economical consequences for individuals and their family. Employment is an essential public health issue affecting post SCI and it is influenced by critical physical, social, psychological and environmental factors. As a result of these factors the rate of employability after SCI is declining over the years. Due to the variety of the factors that affect this issue, it has been imperative to conduct literature review and research in this field. 美国留学医学代写
The Literature Review of for the sake of this study has involved forty one recent studies (2007-2010) that were recognised after searching on Medline, Embase and CINAHL databases, to provide nurses involved in rehabilitation of such patients about the latest information regarding rates, benefits and factors that impact the employment after SCI. This is in addition to the role of vocational rehabilitation (VR) to facilitate for those people on how to achieve it. Further information has been obtained after conducting research on the same.
Key words *Spinal Cord Injury *Employment *Factors *Vocational Rehabilitation
译文：
摘要 美国留学医学代写
脊髓损伤 (SCI) 是一种对个人及其家庭具有多种长期生理、心理和经济后果的疾病。就业是影响 SCI 后的重要公共卫生问题，它受到关键的身体、社会、心理和环境因素的影响。由于这些因素，SCI 后的就业率多年来一直在下降。由于影响这一问题的因素多种多样，开展该领域的文献综述和研究已成为当务之急。
为了这项研究，文献综述涉及 41 项最近的研究（2007-2010），这些研究在搜索 Medline、Embase 和 CINAHL 数据库后得到认可，为参与此类患者康复的护士提供有关费率的最新信息， SCI后影响就业的福利和因素。此外，职业康复 (VR) 还可以帮助这些人了解如何实现这一目标。在对其进行研究后获得了进一步的信息。
关键词 *脊髓损伤 *就业 *因素 *职业康复
Introduction
Spinal Cord Injury (SCI) is a shocking experience that causes multiple body organ sequelae that leave the person with different degrees of physical disability that limits autonomy of daily living self care, psychological, social and economic consequences. SCI may affect young people under the age of thirty which is a vital period, the turning point in one’s life time to establish their career after their education. Incidentally these complications impact their liability to seek employment or return to work (RTW). (Isaksson et al, 2007; Jongbloed et al, 2007; Wu and Chan, 2007; Blanes et al, 2009; Kurtaran et al, 2009; Lidal et al, 2009; Rowell and Connelly, 2010).
译文：
介绍 美国留学医学代写
脊髓损伤 (SCI) 是一种令人震惊的经历，它会导致多种身体器官后遗症，使人具有不同程度的身体残疾，从而限制了日常生活的自主权、心理、社会和经济后果。 SCI可能会影响30岁以下的年轻人，这是一个至关重要的时期，是一个人接受教育后建立职业生涯的转折点。 顺便说一句，这些并发症会影响他们寻求就业或重返工作岗位 (RTW) 的责任。 （Isaksson 等，2007；Jongbloed 等，2007；Wu 和 Chan，2007；Blanes 等，2009；Kurtaran 等，2009；Lidal 等，2009；Rowell 和 Connelly，2010）。
Benefits of Employment
Employment and income for SCI patient is crucial as it provides multiple benefits including social, psychological, emotional and physical outcomes. Employment after SCI provide a chance for disabled people to be a productive member and financially independent which contributes to improve their confidence and self identity. Moreover, it maintains them to be more sociable within the community that improve their life’s satisfactions, QOL and well being (Jongbloed et al, 2007; Kelly, 2007; Wu and Chan, 2007; Gontkovsky et al, 2009; Lidal et al, 2009; Lin et al, 2009; Kurtaran et al, 2009). 美国留学医学代写
Young and Murphy (2007) cited that the employment serves to reduce medical complications and the treatment among SCI patients. Another recent study Goosens et al (2008) discussed that the severity of the neuropathic pain among unemployed SCI patients is higher than those who are employed. Also many studies reported that employed individuals demonstrated significantly fewer depressive symptoms than those who were unemployed (Crisp, 2007; Burns, 2010). It is evident that employment is fundamental for SCI patients which lead us to give more attention for this issue as it positively impacts them.
Spinal Cord Injury (SCI) is very costly as expenses have to be met lifelong. Major costs includes meeting initial hospitalization and rehabilitation, housing and vehicle modifications and recurring costs for long-lasting medical supplies, medications and care assistance. The loss of income after disability makes SCI persons financially dependent on others which is considered as a set back towards the wellbeing of the patient and the family (Priebe et al, 2007; Krause et al, 2008).
译文：
就业的好处 美国留学医学代写
SCI 患者的就业和收入至关重要，因为它提供了多种好处，包括社会、心理、情感和身体结果。 SCI 后的就业为残疾人提供了成为生产成员和经济独立的机会，这有助于提高他们的信心和自我认同。此外，它使他们在社区内更善于交际，从而提高他们的生活满意度、QOL 和幸福感（Jongbloed 等，2007；Kelly，2007；Wu 和 Chan，2007；Gontkovsky 等，2009；Lidal 等，2009 ；Lin 等人，2009 年；Kurtaran 等人，2009 年）。
Young 和 Murphy (2007) 指出，该工作有助于减少 SCI 患者的医疗并发症和治疗。最近的另一项研究 Goosens 等人 (2008) 讨论了失业 SCI 患者神经性疼痛的严重程度高于就业者。此外，许多研究报告称，与失业者相比，就业者表现出的抑郁症状明显更少（Crisp，2007 年；Burns，2010 年）。很明显，就业是 SCI 患者的基础，这使我们更加关注这个问题，因为它对他们产生了积极影响。
脊髓损伤 (SCI) 的费用非常昂贵，因为必须终生支付费用。主要费用包括初始住院和康复、住房和车辆改装以及长期医疗用品、药物和护理援助的经常性费用。残疾后的收入损失使 SCI 患者在经济上依赖他人，这被认为是对患者和家庭福祉的倒退（Priebe 等，2007；Krause 等，2008）。
Time since injury
As cited above, the opportunity of obtaining a job immediately on post discharge of rehabilitation program is low for SCI individuals (Lidal et al, 2009). Lidal et al, 2009 asserted that, percentage of employed SCI individuals after injury was 13% 1 year following the trauma, 22% 5 years, 28% 10 years, 35% 15 years, 37% 20 years and 41% 25 years respectively following the accident. Also another more recent studies showed that the percentage of SCI persons who were employed following injury was 28% 1 year after trauma (Murphy et al, 2009), 30% to 35% at about 10 to 15 years after trauma (Marini et al, 2008). These results denote that, the rate of employability progress significantly over the years post SCI onset (Lidal et al, 2009; Kraus et al, 2010, b).
译文：
受伤后的时间 美国留学医学代写
如上所述，SCI 个人在康复计划出院后立即获得工作的机会很低（Lidal 等，2009）。 Lidal 等人，2009 年断言，创伤后 1 年、22% 5 年、28% 10 年、35% 15 年、37% 20 年和 41% 25 年后受伤后就业的 SCI 个体的百分比 意外。 另一项最近的研究表明，受伤后就业的 SCI 人员百分比在创伤后 1 年为 28%（Murphy 等，2009），在创伤后约 10 至 15 年为 30% 至 35%（Marini 等， 2008）。 这些结果表明，在 SCI 发病后的几年里，就业能力显着提高（Lidal 等人，2009 年；Kraus 等人，2010 年，b）。
Factors for employment
Employment and income for SCI patient is crucial as it provides multiple benefits including social, psychological, emotional and physical outcomes. Employment after SCI provide a chance for disabled people to be a productive member and financially independent which contributes to improve their confidence and self identity. Moreover, it maintains them to be more sociable within the community that improve their life’s satisfactions, QOL and well being (Jongbloed et al, 2007; Kelly, 2007; Wu and Chan, 2007; Gontkovsky et al, 2009; Lidal et al, 2009; Lin et al, 2009; Kurtaran et al, 2009). 美国留学医学代写
Young and Murphy (2007) cited that the employment serves to reduce medical complications and the treatment among SCI patients. Another recent study Goosens et al (2008) discussed that the severity of the neuropathic pain among unemployed SCI patients is higher than those who are employed. Also many studies reported that employed individuals demonstrated significantly fewer depressive symptoms than those who were unemployed (Crisp, 2007; Burns, 2010). It is evident that employment is fundamental for SCI patients which lead us to give more attention for this issue as it positively impacts them.
Employment/ RTW is considered as one of the most significant outcomes of rehabilitation that aims to reinstate the patient to its maximum level of functioning and imbibe well with the community following SCI. Overall, it serves to make SCI people financially independent to be more productive towards society and in improving life expectancy and Quality Of Life (QOL) (Hansen et al, 2007; Jongbloed et al, 2007; Marini et al, 2008; Blanes et al, 2009; Hammell, 2009; Murphy et al, 2009; van Velzen et al, 2009; Burns et al, 2010).
译文：
就业因素
SCI 患者的就业和收入至关重要，因为它提供了多种好处，包括社会、心理、情感和身体结果。 SCI 后的就业为残疾人提供了成为生产成员和经济独立的机会，这有助于提高他们的信心和自我认同。此外，它使他们在社区内更善于交际，从而提高他们的生活满意度、QOL 和幸福感（Jongbloed 等，2007；Kelly，2007；Wu 和 Chan，2007；Gontkovsky 等，2009；Lidal 等，2009 ；Lin 等人，2009 年；Kurtaran 等人，2009 年）。
Young 和 Murphy (2007) 指出，该工作有助于减少 SCI 患者的医疗并发症和治疗。最近的另一项研究 Goosens 等人 (2008) 讨论了失业 SCI 患者神经性疼痛的严重程度高于就业者。此外，许多研究报告称，与失业者相比，就业者表现出的抑郁症状明显更少（Crisp，2007 年；Burns，2010 年）。很明显，就业是 SCI 患者的基础，这使我们更加关注这个问题，因为它对他们产生了积极影响。
就业/RTW 被认为是最重要的康复成果之一，旨在使患者恢复其最大功能水平，并在 SCI 后与社区很好地融合。总体而言，它有助于使 SCI 人在经济上独立，以提高对社会的生产力，并提高预期寿命和生活质量 (QOL)（Hansen 等人，2007 年；Jongbloed 等人，2007 年；Marini 等人，2008 年；Blanes 等人，2009；Hammell，2009；Murphy 等，2009；van Velzen 等，2009；Burns 等，2010）。
Many studies have highlighted that the employment rates is highly variable and lessen more rapidly after SCI.
This is constantly associated with multi biopsychosocial factors such as age, race/ ethnicity, injury severity, family and society support, self esteem and educational level. Also, physical environment barriers including transportation, accessibility to building, accommodation and assistive devices remain the major obstacles for obtaining and resuming employment (Hansen et al, 2007; Holtslag et al, 2007; Jongbloed et al, 2007 Krause and Pickelsimer, 2008; Lidal et al, 2009; Lin et al, 2009; Krause and Reed, 2009; Krause et al, 2009; and Lind, 2009; Burns et al, 2010; Fadyl and McPherson, 2010). Thus, these factors imply the importance of vocational rehabilitation (VR) in care of SCI patients in curbing the barriers that are amenable to modify which enhance them to RTW (Hansen et al, 2007; Wu and Chan, 2007; Fadyl and McPherson, 2010).
It is worthwhile to mention that the level of injury influence the type of the work SCI patients undergo.
Quadriplegic persons resort to less manual jobs such as management and teaching positions whereas paraplegic sometimes can employ office and simple industrial works. From this discussion, we can understand the necessity of assessing SCI patient’s level of injury and physical ability to prepare the plans for adjusting their work place or in finding a suitable choice of equipments (e.g. emotional wheelchairs, manual wheelchairs etc) and employment that may improve their socioeconomic status. 美国留学医学代写
It is evident from the above debate that the employment is a complex issue associated with various physical, social, psychological and environmental factors. Pursuing employment is significant for a SCI persons well being. Consequently, this work will review recent literatures (2007- 2010) that discussed this subject including importance, rates, factors and barriers that influence decision of employment for SCI persons. It also provides insights on the role of the VR in facilitating to RTW. So as to provide rehabilitation professionals such as nurses the latest facts and in depth understanding to easily access sources of information that guide and advice SCI patients and their families on how to achieve that successfully according to their abilities.
译文：
许多研究强调，就业率变化很大，而且在 SCI 后下降得更快。
这始终与多种生物心理社会因素相关，例如年龄、种族/民族、伤害严重程度、家庭和社会支持、自尊和教育水平。此外，包括交通、建筑物的可达性、住宿和辅助设备在内的物理环境障碍仍然是获得和恢复就业的主要障碍（Hansen 等人，2007 年；Holtslag 等人，2007 年；Jongbloed 等人，2007 年 Krause 和 Pickelsimer，2008 年；Lidal等，2009；Lin 等，2009；Krause 和 Reed，2009；Krause 等，2009；和 Lind，2009；Burns 等，2010；Fadyl 和 McPherson，2010）。因此，这些因素意味着职业康复 (VR) 在 SCI 患者的护理中的重要性，以遏制可以改变的障碍，从而增强他们的 RTW（Hansen 等，2007；Wu 和 Chan，2007；Fadyl 和 McPherson，2010 ）。
值得一提的是，受伤程度会影响 SCI 患者所从事的工作类型。
四肢瘫痪的人求助于较少的体力工作，例如管理和教学职位，而截瘫患者有时可以从事办公室和简单的工业工作。从这次讨论中，我们可以理解评估 SCI 患者的受伤程度和身体能力的必要性，以准备调整他们的工作地点或寻找合适的设备选择（例如情感轮椅、手动轮椅等）和就业的必要性。他们的社会经济地位。
从上述辩论中可以明显看出，就业是一个与各种身体、社会、心理和环境因素相关的复杂问题。追求就业对 SCI 人的福祉很重要。因此，这项工作将回顾最近讨论该主题的文献（2007-2010），包括影响 SCI 人员就业决策的重要性、比率、因素和障碍。它还提供了有关 VR 在促进 RTW 中的作用的见解。以便为护士等康复专业人员提供最新的事实和深入的了解，以便轻松访问信息来源，指导和建议 SCI 患者及其家人如何根据他们的能力成功实现这一目标。
It was mentioned earlier that the employment is a corner stone for the patient who experience SCI and it is correlated with different factors.
Through reviewing included literature, differences between studies in terms of the methodology, assumed definitions of employment (Resumed work, Paid work, Fulltime employment, Remunerative employment etc.) and time to RTW post SCI, showed that the employment rates was 38% (Jongbloed et al, 2007), 13% to 69% (Krause and Pickelsimer, 2008), 11 to 71% (van Velzen et al, 2009) and 31% to 48% (Samuelkamaleshkumar, 2010) respectively. These outcomes demonstrated that employment rates for these individuals are varied and consistently declining after SCI (Schopp et al 2007; Chapin and Holbert, 2009; Krause and Reed, 2009; Lin et al, 2009; Arango-Lasprilla et al, 2009; Krause et al, 2010 a). These studies showed key factors associated with this issue, which includes education, types of employment, injury severity, age, time since injury, gender, marital status and social support, vocational counselling, medical problems related to SCI, employers role, environment and professional interests. 美国留学医学代写
(Figure.1) Example of job accommodation: adapted workstation for tetraplegic person includes small keyboard (A) with mouthstick for typing as the worker is without functional arms (B) supported adjustable table with a mounting arm (C) trackball mouse for easy and faster navigation between pages (D). The existing keyboard was left in place where it was before for other colleagues to use if required.
译文：
前面已经提到，就业是经历 SCI 的患者的基石，它与不同的因素相关。
通过查阅文献，研究之间在方法论、就业的假设定义（恢复工作、带薪工作、全职工作、有偿工作等）和 SCI 后 RTW 时间方面的差异表明，就业率为 38%（Jongbloed等人，2007）、13% 到 69%（Krause 和 Pickelsimer，2008）、11% 到 71%（van Velzen 等人，2009）和 31% 到 48%（Samuelkamaleshkumar，2010）。这些结果表明，这些人的就业率在 SCI 后各不相同并且持续下降（Schopp 等人，2007 年；Chapin 和 Holbert，2009 年；Krause 和 Reed，2009 年；Lin 等人，2009 年；Arango-Lasprilla 等人，2009 年；Krause 等人al，2010 年 a)。这些研究显示了与此问题相关的关键因素，包括教育、就业类型、伤害严重程度、年龄、受伤后的时间、性别、婚姻状况和社会支持、职业咨询、与 SCI 相关的医疗问题、雇主角色、环境和专业利益。
（图 1）工作场所示例：适用于四肢瘫痪者的改装工作站包括小键盘 (A) 带有用于打字的口器，因为工人没有功能臂 (B) 支持可调节工作台，带有安装臂 (C) 轨迹球鼠标，以方便和页面之间更快的导航 (D)。现有的键盘留在原来的位置，供其他同事在需要时使用。
Vocational counselling
Thinking about physical disability, accessing and transportation, lack of information about occupation alternatives and modification or assistive devices are concerns that considerably impact decision of employment for SCI persons which make it intricate (Hansen et al, 2007; Lidal et al, 2007; Schopp et al 2007; Fadyl and McPherson, 2010). Rehabilitation interventions through vocational counselling provide a comprehensive assessment of these barriers that tend to establish services and strategies that minimize them and raise occupational integration (Hansen et al, 2007; Lidal et al, 2007; Martz, 2007; Marini et al, 2008; Fadyl and McPherson).
译文：
职业辅导
考虑身体残疾、通行和交通、缺乏有关替代职业和改造或辅助设备的信息，这些问题会极大地影响 SCI 人的就业决定，使其变得错综复杂（Hansen 等人，2007 年；Lidal 等人，2007 年；Schopp 等人 2007 年；法迪尔和麦克弗森，2010 年）。 通过职业咨询进行的康复干预对这些障碍进行了全面评估，这些障碍往往会建立服务和策略，将它们最小化并提高职业整合（Hansen 等人，2007 年；Lidal 等人，2007 年；Martz，2007 年；Marini 等人，2008 年；Fadyl 和麦克弗森）。
Marital status and social support
After the sudden changes that confront the SCI individuals, they need someone to provide support that motivates them to go forward with this new life. There were limited studies that discussed the relationship between marital status and obtaining employment. Marital status is co-related with RTW as married person is responsible about the family income that needs to continue this role after the injury (Fadyl and McPherson, 2010). 美国留学医学代写
The presence of a supportive partner can enhance job achievement although there was one study stated against that (Kurtaran et al, 2009). Positive attitude from persons in the social network and the availability of support from family/partner, friends and employer have been acknowledged as key facilitators of vocational participation for SCI persons (Isaksson et al, 2007; Jongbloed et al, 2007; Kelly, 2007; Lin et al, 2009; Burns et al, 2010). Thus rehabilitation interventions should include the family/partner in their programs since they are of focal aspect in social support (Kurtaran et al, 2009).
译文：
婚姻状况和社会支持
在 SCI 个体面临突然的变化之后，他们需要有人提供支持，激励他们继续新的生活。讨论婚姻状况与就业之间关系的研究非常有限。婚姻状况与 RTW 相关，因为已婚人士负责在受伤后需要继续担任此角色的家庭收入（Fadyl 和 McPherson，2010 年）。
尽管有一项研究反对，但支持性伴侣的存在可以提高工作成就（Kurtaran 等，2009）。社交网络中人员的积极态度以及家人/伴侣、朋友和雇主的支持被认为是 SCI 人员职业参与的关键促进因素（Isaksson 等，2007；Jongbloed 等，2007；Kelly，2007；林等人，2009 年；伯恩斯等人，2010 年）。因此，康复干预措施应将家庭/伴侣纳入其计划，因为它们是社会支持的重点（Kurtaran 等，2009）。
Due to the fact that spinal cord injury pose significant effects to virtually all the systems in the body of the human being, most people who have fallen victim are confronted by serious concerns about the potential consequences of participation in sexual relationships.
The victims are exposed to changing perceptions of the body accompanied by the absence of forums of meeting similar situations which is usually a devastating situation. There is a possibility of an increase in the burden of experience arising as a result of the feeling of a belonging to a discriminated group.
Majority of the couples are exposed to issues of sexuality without necessary consulting counselors or even sexual therapists. Most of the issues of great concern with regard to sexuality need an open communication between the two partners which is the most effective avenue of resolving the issue. However, if need arises for the intervention of a therapist to effect the transition issues after SCI, then the idea may be welcomed. 美国留学医学代写
According to the available data from research, there is a higher number of single people who have never married at all as well as divorced persons who have in the past been affected by SCI. this category of people also experience a higher rate of divorce as compared to the normal people and also there is the number of those who marry is limited.
译文：
由于脊髓损伤几乎对人体的所有系统都产生了显着影响，因此大多数坠落受害者的人都对可能产生的后果产生严重担忧。
受害者面临着不断变化的身体观念，同时缺乏遇到类似情况的论坛，这通常是一种毁灭性的情况。由于归属于受歧视群体的感觉，可能会增加经验负担。
大多数夫妇在没有必要咨询顾问甚至性治疗师的情况下就面临性问题。大多数与性有关的重大问题都需要两个合作伙伴之间的公开沟通，这是解决问题的最有效途径。但是，如果需要治疗师的干预来影响 SCI 后的过渡问题，那么这个想法可能会受到欢迎。
根据现有的研究数据，从未结过婚的单身人士以及过去曾受 SCI 影响的离婚人士的数量更多。与正常人相比，这类人的离婚率也更高，而且结婚的人数有限。
Predictors_for_Return_to_Work
Basically, it’s clear that the rate of employability among the quadriplegic tend to be lower than the paraplegic persons (Jongbloed et al, 2007; Krause et al, 2008; Marini et al, 2008; Rowell and Connelly, 2008; Lidal et al, 2009). One study (van Velzen et al, 2009) examined correlation between physical capacity and wheelchair skill performance and RTW after one year discharge from rehabilitation program demonstrated that, tetraplegic subjects wheelchair capacity and employability is low, related to higher level of injury that impact their hands function. It also showed the same result for the subjects who had complete injury. 美国留学医学代写
It is worthwhile to mention that the level of injury influence the type of the work SCI patients undergo. Quadriplegic persons resort to less manual jobs such as management and teaching positions whereas paraplegic sometimes can employ office and simple industrial works From this discussion, we can understand the necessity of assessing SCI patient’s level of injury and physical ability to prepare the plans for adjusting their work place or in finding a suitable choice of equipments (e.g. emotional wheelchairs, manual wheelchairs etc) and employment that may improve their socioeconomic status.
译文：
Predictors_for_Return_to_Work
基本上，四肢瘫痪者的就业率明显低于截瘫者（Jongbloed 等，2007；Krause 等，2008；Marini 等，2008；Rowell 和 Connelly，2008；Lidal 等，2009 ）。一项研究（van Velzen 等人，2009 年）检查了身体能力和轮椅技能表现与康复计划出院一年后 RTW 之间的相关性表明，四肢瘫痪受试者的轮椅能力和就业能力较低，这与影响他们的手的损伤程度较高有关功能。对于完全受伤的受试者，它也显示了相同的结果。
值得一提的是，受伤程度会影响 SCI 患者所从事的工作类型。四肢瘫痪的人较少从事管理和教学等体力工作，而截瘫患者有时可以从事办公室和简单的工业工作从这次讨论中，我们可以理解评估SCI患者的受伤程度和身体能力以准备调整工作计划的必要性放置或寻找合适的设备选择（例如情感轮椅、手动轮椅等）和可以改善其社会经济地位的工作。
There are two paths or tracks to RTW post SCI.
Firstly, some SCI persons take fast track in the form of returning back to their existing or their professional jobs, whereas others opt for slow track having to undergo training and education in a rehabilitation centre taking an average of 4.6 years to get accustomed to (Krause et al, 2010, b). Generally, employability chance for SCI persons who have previous work or professional employment is higher than those who start new occupation (Holtslag et al, 2007; Krause et al, 2008, 2010, b). Thus, the role of VR is critical in providing advices such as benefits; relevant jobs and getting better level of education that reduce the gap between onset of injury and employment (Isaksson et al, 2007; Lidal et al, 2007; Fadyl and McPherson, 2010). 美国留学医学代写
When coming to social environmental barriers, one of the interesting findings is the correlation between RTW as well as in sustaining work and governmental incentives and disincentives like social security benefits and disability pensions. In some countries in US, Europe and Scandinavian countries, SCI persons are financially compensated by public insurance programs. Though the compensation is granted on a temporary basis, these benefits are provided on the ability of the SCI person to RTW. However, the claim for compensation does not entitle them to have professional reintegration (Jongbloed et al, 2007). It was mentioned that this relationship is negatively associated with high disability benefits/compensation that diminishes the odd of the employment for SCI patient and occupational rehabilitation outcomes (Holtslag et al, 2007; Schopp et al 2007; Krause and Pickelsimer, 2008; Lidal et al, 2009, and Lind, 2009).
译文：
RTW POST SCI 有两种途径或途径。
首先，一些 SCI 人以返回现有或专业工作的形式走快车道，而其他人则选择慢跑道，必须在康复中心接受培训和教育，平均需要 4.6 年才能适应（克劳斯等人，2010 年，b)。一般来说，有过工作或专业工作的 SCI 人的就业机会高于开始新职业的人（Holtslag 等，2007；Krause 等，2008，2010，b）。因此，VR 在提供诸如福利等建议方面的作用至关重要；相关工作并获得更好的教育水平，从而缩小受伤和就业之间的差距（Isaksson 等人，2007 年；Lidal 等人，2007 年；Fadyl 和 McPherson，2010 年）。
在谈到社会环境障碍时，有趣的发现之一是 RTW 与维持工作与政府激励和抑制措施（如社会保障福利和残疾养老金）之间的相关性。在美国、欧洲和斯堪的纳维亚国家的一些国家，SCI 人通过公共保险计划获得经济补偿。虽然补偿是临时授予的，但这些福利是根据 SCI 人员的 RTW 能力提供的。然而，赔偿要求并不赋予他们重新融入职业生涯的权利（Jongbloed 等，2007）。有人提到，这种关系与高残疾福利/补偿呈负相关，这会降低 SCI 患者和职业康复结果的就业几率（Holtslag 等人，2007 年；Schopp 等人，2007 年；Krause 和 Pickelsimer，2008 年；Lidal 等人，2009 年和林德，2009 年）。
One study (Martz, 2007) examined that the environmental related barriers in seeking employment in Russia, stated that the most hurdle to get employment for SCI persons are not persuaded to RTW in fear of losing their disability benefits.
Marini et al (2008) stated that the new trends of legislative proposal sorted out this issue by customizing the disincentive outcomes as SCI persons who receive social security benefits are endorsed to work with minimum reduction of their pecuniary and medical benefits. Also, he suggested that it is essential to adopt benefits counselling in VR programme. The same statement was mentioned by Kruase and Reed (2009) as well. This review shows that the employability barriers after SCI varies from person to person and country to country based on their personal, physical disability and the governmental policies. These issues should be in consideration during the patient’s assessment and intervention to RTW. 美国留学医学代写
Clearly, comprehensive rehabilitation services that include vocational counselling critically assist SCI individual to resume work, which improve their community reintegration and impact governmental and political policies to change attitudes and raise employment opportunity for them (Hansen et al, 2007; Priebe et al, 2007; Marini et al, 2008; 2009; and Lind, 2009).
译文：
一项研究（Martz，2007 年）检查了在俄罗斯求职时与环境相关的障碍，指出 SCI 人就业的最大障碍是不会因为害怕失去残疾福利而被说服到 RTW。
Marini 等人（2008 年）指出，立法提案的新趋势通过定制不利结果来解决这个问题，因为获得社会保障福利的 SCI 人被认可在工作时减少他们的金钱和医疗福利。此外，他建议在 VR 计划中采用福利咨询是必不可少的。 Kruase 和 Reed (2009) 也提到了同样的说法。该审查表明，SCI 后的就业障碍因人而异，因国家而异，具体取决于个人、身体残疾和政府政策。在患者对 RTW 进行评估和干预时，应考虑到这些问题。
显然，包括职业咨询在内的综合康复服务可以帮助 SCI 患者恢复工作，从而改善他们重新融入社区的情况，并影响政府和政治政策以改变态度并为他们增加就业机会（Hansen 等人，2007 年；Priebe 等人，2007 年； Marini 等人，2008 年；2009 年；和 Lind，2009 年）。
Materials and methods
A search using three electronic databases namely Medline, Excerpta Medica Database (EMBASE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was made based on their individual features as follows. In all searching strategies that were executed, various terms were searched using both MeSH and freetext protocols. Expressly, the MeSH search was achieved via combining the following key terms, ‘Spinal Cord Injuries’ and ‘Employment’.
After MeSH searching other descriptors were searched as free-text terms. These terms included ‘spinal cord’, ‘spinal cord disorders’; ‘spinal cord diseases’; ‘spinal cord trauma’; ‘spinal cord lesion’; ‘occupation’; ‘return to work ’ and ‘vocational integration’. Then these MeSH and free text were pooled using Boolean operator ‘OR’/Boolean operator ‘AND’ in order to produce the final process searching more specific to the topic of interest. The search resulted in a total of 222 studies, 87 EMBASE, 50 on MEDLINE and 85 from CINAHL. After discarding doubles, reviewing the article title and abstract and full examination of the search result, a total of forty one studies were kept for this review.
译文：
材料和方法 美国留学医学代写
使用三个电子数据库进行搜索，即 Medline、医学摘录数据库 (EMBASE) 和护理和相关健康文献累积索引 (CINAHL)，基于它们各自的特征进行如下搜索。在执行的所有搜索策略中，使用 MeSH 和自由文本协议搜索各种术语。明确地说，MeSH 搜索是通过组合以下关键术语“脊髓损伤”和“就业”来实现的。
在 MeSH 搜索之后，其他描述符被作为自由文本项进行搜索。这些术语包括“脊髓”、“脊髓疾病”； “脊髓疾病”； “脊髓外伤”； “脊髓损伤”； ‘职业’; “重返工作岗位”和“职业融合”。然后，使用布尔运算符“OR”/布尔运算符“AND”将这些 MeSH 和自由文本合并，以生成更特定于感兴趣主题的最终过程。搜索结果共有 222 项研究，其中 87 项是 EMBASE，50 项来自 MEDLINE，85 项来自 CINAHL。剔除双打后，查阅文章标题和摘要，全面查阅检索结果，本次审查共保留41篇研究。
Inclusion/ Exclusion criteria
As the translation facilities were not available, the search results were limited to the English language studies that were available within the author’s college libraries. The search was not limited to specific study designs; it focused on all types of publications (in order to get the maximum number of studies that cover the subject) that discussed the employment for the SCI adult as a study population, rates, benefits, factors or barriers in attaining it.
To identify recent studies, search limitation was also conduced to the last three years of the publication (2007- 2010).
译文：
纳入/排除标准 美国留学医学代写
由于翻译设施不可用，搜索结果仅限于作者大学图书馆中可用的英语语言研究。 搜索不仅限于特定的研究设计； 它侧重于所有类型的出版物（以获得涵盖该主题的最大数量的研究），这些出版物讨论了 SCI 成人作为研究人群的就业、比率、收益、因素或障碍。
为了确定最近的研究，还对出版物的最后三年（2007-2010）进行了搜索限制。
Conclusion 美国留学医学代写
In addition to physical disability and psychological problems that confront SCI persons, more challenges are faced in obtaining employment following injury. This review identified that the employment rates after SCI is incessantly coming down over the years. Different factors influencing this issue includes education, type of employment, injury severity, age, time since injury, gender, marital status and social support, vocational counselling, medical problems related to SCI and employers role. However, the foremost barriers to obtain job for SCI people includes physical limitations, inadequate transportation, difficulty in accessing, housing, concerns about losing disability benefits, employer discrimination, access to healthcare and lack of knowledge about job choices and training.
Identifying these factors and barriers assist to set up a comprehensive rehabilitation program, that upholds counselling and teaching about community vocational services that support and enhance employment outcomes.
译文：
结论
除了SCI患者面临的身体残疾和心理问题外，受伤后就业面临更多挑战。该审查确定，SCI 后的就业率多年来不断下降。影响这个问题的不同因素包括教育、就业类型、伤害严重程度、年龄、受伤时间、性别、婚姻状况和社会支持、职业咨询、与 SCI 相关的医疗问题和雇主角色。然而，SCI 患者获得工作的最大障碍包括身体限制、交通不便、难以获得、住房、担心失去残疾福利、雇主歧视、获得医疗保健以及缺乏关于工作选择和培训的知识。
确定这些因素和障碍有助于制定全面的康复计划，支持有关支持和提高就业成果的社区职业服务的咨询和教学。
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