Life on Wheels (12 page)

Women might have underlying issues of abuse. Their disability might even be the result of spousal abuse, which is sadly responsible for a share of brain injury and spinal cord injury from gunshot, for instance. A past history of sexual abuse will certainly be aggravated by becoming a woman with a disability. Women become more attractive targets for abuse by being in an increased position of vulnerability.

It is common for women’s menstrual cycles to be interrupted for up to six months to a year after a spinal cord injury.

This raises psychological issues about the desire to have children— the loss of a feature that is a matter of feminine identity for some women—and anxiety about whether the cycle will return, despite what rehab staff says.

A skilled psychologist can help women begin to address these and other issues in order to achieve success in their sexuality. Nosek again:

Sexuality is discussed in more detail in Chapter 5, Intimacy, Sex and Babies.

A primary goal of rehab is for you to be able to work, if at all possible. Rehab staff want to foster your opportunity to return to your previous or some other kind of job. The anticipation of returning to a productive role in the world can increase your appreciation for how the rehab process is a path to an integrated, fulfilled life with your disability.

You will work with a vocational rehabilitation counselor who might be employed by the rehab center, assigned by the insurer, or representing your state vocational rehabilitation agency. Vocational rehabilitation (Voc Rehab) is a government program that exists at both state and federal levels. Legislation dating as far back as 1917 has authorized money to help injured workers get back to work. Your insurer might also have vocational rehab services and funds to offer you. If you get back to work, they figure you will not require as much expensive continuing healthcare or longterm disability benefits.

Counselors you work with will have varying loyalties, depending on who employs them. Those loyalties can limit their effectiveness, as attorney, quadriplegic, and disability activist Deborah Kaplan, former Director of the World Institute on Disability notes:

The hard truth is that your state vocational rehab agency will generally work with you only when they consider you employable. How that gets defined might be up to the particular case worker you encounter. This man with advanced muscular dystrophy reports:

State vocational rehabilitation services are getting tighter these days. There has been greater demand on these programs, in part due to the increasing number of repetitive strain injuries resulting from computer use in offices. In some states, legislation limits the money that can be spent for a given case—this limited amount can be small if you need an education and adaptive tools such as a computer or a modified vehicle. Voc Rehab funding is also sensitive to the economy. State budget cutbacks following the burst of the “dot.com bubble” in the 1990s had a negative impact on Voc Rehab money.

You always have the chance to advocate for yourself. For instance, you don’t have to accept the first counselor who is assigned to you. If there is someone in the rehab facility to organize your vocational rehab, she might work harder on your behalf because she has no association with the funding source. When a counselor is doing her job well, she does the following:

Takes a history of your past job experience and skills

Learns about your medical status and prognosis

Considers how your disability affects your ability to return to previous work

Evaluates new career possibilities and makes suggestions to see what interests you, if your previous work is not possible

Surveys the job market to help identify realistic options

Explores sources and means of funding, if you require training or education

Coaches you on job-seeking and interview skills

Advises you and your employer on possible modifications and accommodations that make it possible for you to perform the job

Vocational counselors want to make the most of your physical and psychological rehabilitation, accomplished with hard work by you and the rehab team. They want to make a smooth transition to work or to education and take best advantages of your accomplishments in rehab.

Many of the major rehab centers—including but not limited to Craig Hospital near Denver, Colorado; Shepherd Center in Atlanta, Georgia; Rancho Los Amigos near Los Angeles, California; The Rehabilitation Institute of Michigan in Detroit; Jackson Memorial Hospital, which is closely associated with The Miami Project to Cure Paralysis in South Florida; the Kessler Institute for Rehabilitation in New Jersey; Drake Center in Indianapolis; and Mt. Sinai Rehab in New York City—have research programs. The types of projects in which these groups engage include data gathering or measuring such things as quality of life with a disability or public attitudes toward disability. Or they might be involved in basic science, such as spinal cord regeneration or pain management.