关键词：脊髓;创伤和损伤;康复技术;脊柱
摘 要：Spinal cord injuries now occur in nearly one quarter of the casualties from the conflicts in Afghanistan and Iraq. We know our military treatment facilities are seriously challenged by these casualties for several reasons including co-morbidities associated with blast injuries and the lengthy rehabilitation required. We also now know medical treatments that promise to return the fractured bodies to approximate pre-injury function. Yet, we lack basic knowledge of the long-term outcomes defined as personally and socially meaningful by survivors and families who are seeking to heal the fractured relationships with valued communities. This gap limits our ability to deliver on the promise given by advances in battlefield trauma care and rehabilitation which is to enable a return to full lives in the community (Messinger 2010; Luborsky 1993, 1994a). Today s problem is that acute care treatments for the physical break are not matched by knowledge of how survivors continue life, conceptualize SCI and return to a full life. The US Surgeon General (DHHS 2004) faults the literatures narrow incident-based focus on acute medical events and neglect of ongoing processes after events; this narrowness neglects how people return to a valued life with disability(Verbrugge & Jette 1994). Yet, consensus is emerging that long-term outcomes are the next frontier (IOM 2005, WHO 2001) requiring us to ask new questions and use methods suited to cultural meanings and roles (Lysack et al 2007; Messinger 2010). An ample literature documents negative outcomes from inadequately treating the social and personal afflictions after SCI and other mobility loss. Thus, the hard earned knowledge of physical skills for living with altered bodies remains unmatched by societal practices to equip people with a culturally meaningful sense of community needed to thrive.