Following discharge, the SCI patient may be scheduled for outpatient therapy for:

1. Strength training, which can continue to increase during the first 2 years after the injury and permit patients to become more independent

2. Intensive ADL training

3. Vocational retraining for both avocational, non-paid productive activities and gainful employment (Krause and Anson, 1996; 1997; Krause, 1997)
   • Although avocational, non-paid activities have a positive effect on the quality of life (Yuen, et al 2004), a return to education and gainful employment activities result in an even higher quality of life and superior adjustment and are therefore important rehabilitative objectives. Part-time employment provided significant advantages over unemployment status; however individuals who spent at least 30 hours a week in paid employment had the highest levels of resources (Meade, et al 2006).
   • The best predictors of gainful employment are years of education, age at time of injury, and level of injury (Krause, et al 1998), as well as race and years living with SCI (Krause, et al 1999) and early work experiences and work ethic (Crewe, 2000). More education usually offers more nonmanual, stationary jobs, and therefore less vocational adjustment and more motivation to enter gainful employment. Injury level is significantly associated with the ability to drive and the motivation to work (McShane and Karp, 1993). Social support for a person's motivation and ability to participate in occupation are also important (Isaksson, et al 2007). Participants with higher internality locus of control scores and activity scores (personality) reported more favorable employment outcomes. Higher scores on chance and powerful others (locus of control), neuroticism, and aggression/hostility (personality) were associated with diminished employment outcomes (Krause, et al 2006).
   • Males are more likely to be in paid employment than women, but women are more likely to be in a positive vocational mode (Young, et al 1994)
   • The most frequently cited reasons for not working are the physical inability to perform the same type of work as before the injury, the loss of benefits, the inaccessibility of the workplace, the need for a personal assistant and/or assistive technology (Inge, et al 1996) and health (Krause and Pickelsimer, 2008).
   • Improvements of workplace and transportation accessibility, increased vocational supports, and interventions to decrease pain and fatigue are needed to ensure participation for persons with spinal cord injury (Schopp, et al 2007; Sandsjo et al, 2008).
   • Employment for individuals 16 to 59 years of age living with SCI increases from 13% 2 years after injury to 38% 12 years after injury (Heinemann, 1995). A 1995-2005 review found aproximately 40% of working age people greater than 12 months postinjury are employed, with rate increasing to and peaking at 10-12 years post injury (Young and Murphy, 2009).
   • Job retention services by rehabilitation professionals improves job retention rates (Roessler, 2001) and vocational counseling, rehabilitation services, such as job placement and support services are important to return-to-work success (Marini, et al 2008).

4. Computer access technology evaluation and selection, based on the patient's physical capabilities with and without assistive devices, pacing skills, learning capacity, motivation level, financial support, effect on others, etc. The goal is to identify the technology that provides the most functional access for a patient and that is well tolerated by the patient's environment (Anson, 1994)

5. Reevaluation, to identify the return of muscle activity that can be strengthened and become functional, for example. This possibility is on the rise since improved acute care in recent years has led to an increase in incomplete injuries

6. New movement, new adaptive equipment, and/or orthotic training, particularly as more patients with SCI are now experiencing normal physiologic changes associated with aging in respiration, degenerative joint disease, bowel mobility, coping mechanisms, etc.

7. Tendon transfer surgery

   In a study of C1-C4 tetraplegics 14-24 years post injury, assistance in the areas of socialization, financial status, personal assistance services, transportation, and entry into competitive employment continued to be needed, but the quality of life was higher than expected, considering the substantial physical limitations of the group (Hall, et al 1999).