This classification called for a shift in the way medicine views health and disability.
In 2001, at the 54th World Health Assembly, the 191 Member States of the World Health Organization approved the International Classification of Functioning, Disability, and Health. This model not only contributes to the theoretical understanding of the recovery process following injury, but also provides concrete testable hypotheses for future studies. Both stress-induced glucocorticoid resistance and stress-induced epigenetic changes to the glucocorticoid receptor can modulate the nuclear factor-kappa B regulated inflammatory pathways and the Bcl-2 regulated apoptosis pathways. The stress experienced in life prior to SCI and also as a result of the traumatic injury, could compromise glucocorticoid receptor sensitivity and function, and contribute to high levels of inflammation and apoptosis post-SCI, decreasing the tissue remaining at the injury site and undermining recovery of function. We propose a theoretical model to explain the negative impact of chronic psychological stress on physical and psychological recovery. We propose that individuals’ past and present life experiences (in the form of stress exposure) may significantly modulate patients’ outcome post-SCI. Despite the considerable advances in SCI research, we are still unable to identify the causes of variability in patients’ recovery following injury. Here, converging evidence for the modulatory role of chronic psychological stress in the recovery process following spinal cord injury (SCI) is presented.
Considerable literature links the subsequent changes in stress resiliency to physical health.
There is strong evidence indicating that the social environment triggers changes to the psychological stress response and glucocorticoid receptor function.
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