Participation after spinal cord injury: the evolution of conceptualization and measurement.

The increasing life expectancy after spinal cord injury has given social participation a new recognition as one of the ultimate goals of a comprehensive rehabilitation process. Recent evolution of the concept suggests 2 different approaches to document participation after spinal cord injury and a careful appraisal of the related outcome measures is important as discrepancies of results between the 2 approaches can be significant. Literature on objective participation reports a large variability in several dimensions that are particularly influenced by intrinsic factors such as severity of injury and secondary impairments. The direct influence of the environmental factors remains to be demonstrated by empirical studies. There are fewer tools available to evaluate subjective impressions of participation but recent investigations support the importance of taking account of the person's perceived restrictions participation in order to get better understandings of an individual's specific needs and problems. The aim of this article is to present the evolution of the conceptualization and measurement of the two approaches and to describe the level of participation of individuals with SCI.