Paraplegia: Educational History, Work History, Activities of Daily Living


Jessica is paraplegic and as a result, she is currently facing problems at work. The problem is due to substance she is currently abusing as a way of alleviating the situation she finds herself in. According to the case, Jessica is contemplating suicide smoking marijuana is the only way that helps her feel better. This is the reason her only source of livelihood might be at risk. The goal is to recommend an appropriate treatment plan that will not just help Jessica overcome the feeling of helplessness but also help her stay out of any form of substance abuse.

Treatment Plan

Personal Data



Date of Assessment: 5/29/2014


Date of Birth/Age: 34 years old

Referral Source:

Psychological History:

The case presented reveals that Jessica has ad psychological issues for over ten years. Since the basketball accident, Jessica has lost the feeling of self-worth, had multiple cases of suicidal attempts, and has been under constant depression. Jessica feels unable to cope with life’s pains and as a result, has turned to marijuana abuse.

Presenting Problem

Injuries which result into serious problems with physical ability can be extremely devastating not just to the affected party but also to the family members and close friends. Such an injury changes everything in life and for a moment, one feels like the world comes to a standstill. Paraplegic injuries are caused by spinal code damage which leads to impairment of one’s legs. The Catastrophic Injury Resource Center emphasizes that paraplegic patients need specialized care in order to assist in minimizing the physical impact as well as the level of depression (De Vivo, 2009).

Substance addiction and dependence is a critical discussion in the society where people are under peer pressure. Most people who experience health problems that restrict them to enjoy life not only harbor depression, but also fail to attain the freedom of choosing the path to follow and end up turning to substances in order to deal with their frustrations. These substances cause the problems at home, work, and school where personal relationships are affected severely (Mendonça, Hawkins, & Richards, 2008). In this regard, the substance abuse and addiction offer a short-term solution to the health issues that an individual possesses.

Substance abuse can result into depression and suicidal thoughts as is the case with Jessica that has definitely lost self-control. Additionally, use of marijuana affects intellectual capacity as well as an individual’s working capability. Addicted persons are likely to lose work vigor and get more and more careless, a situation that Jessica is already degenerating into. Additionally, with more exposure to substance abuse, Jessica is more likely to lose the effective ability to remember and likely to show such behavioral features as restlessness, craving to smoke, insomnia, and loss of appetite (Gutkin, 2012).

Moreover, this will further contribute to a feeling of depression, anxiety, and reduced self-esteem often referred to as personality disorder. High consumption of marijuana is likely to lead to absent mindedness, vulnerability to accidents, tardiness, and laziness. According to research, those who test positive for Marijuana usage checkups have 55% chances of being involved in industrial accidents, 85% in injuries, and 75% increase in absenteeism as compared to the non-smokers (Lyman, 2011).

Current Living Situation

The living situation largely defines the kind of treatment plan appropriate for any given condition. Suffering paraplegia changes one’s life. It calls for adjustments to their life as well as that of their family. Conventionally, people’s reaction to paraplegia is dependent on multiple factors including age of injury, sex, psychological factors, self-esteem, temperament, family support, financial ability, and accessibility to support services (Azevedo & Santos, 2011). Sadly, living conditions shape the way people feel. More often than not, feeling of uselessness, inferiority and lowered self-esteem are a result of inability to do simple tasks.

Additionally, when one suffers paraplegia at a young age as is the case with Jessica, a feeling of bitterness creeps in. This is mainly due to the reality that the dreams they had might not come true after all. According to Blanes (2007) most complications which make rehabilitation difficult are traceable to family and social support issues.

Young people aged 21 and 35 years affected by paraplegia actively face social problems associated paraplegia. Sadly, Jessica falls within this category and has been within the category for 10 years. Like in many cases, the condition has forced Jessica to shelve her professional ambitions and settle for a clerk job. This potentially impacts on his personal, family, as well as social life. One study revealed that marital status or ability to get married also dictates the life of people affected by paraplegia.

De Vivo (2010) noted that divorce rate amongst couples where one person if affected by paraplegia is higher as compared to the case with normal couples. Although Jessica is not married, from her conversation with Mary, it is evident she feels her condition as denied her opportunity to enjoyed a married life.

Family support is of great importance. Unfortunately, this is something that is lacking for Jessica’s case. As indicated in the case, her father is distant while her mother has lots of job commitments. On the other hand, her siblings are still in high school. The case study almost asserts that other than at work where she interacts with fellow workmates, she has no social life at home. There are literally no people she can interact with at home. Financially, Jessica is largely dependent on the earnings from her job as a clerk. Consequently, it is important that she understands the importance of the job and hence not do anything that might jeopardize it. It is highly likely that Jessica would feel neglected as a result of his condition.

Support System

As a result of the prevailing conditions, Jessica requires a support system, thanks to the fact that she accepts that she has a problem and needs help. She also acknowledges that she needs the job and as such should have doing things that might cost her the job.

Educational History/ Work History/Activities of Daily Living

Jessica enjoys college level education and hence should be made to understand that his physical condition does not limit his mental ability. In essence, Jessica should be helped understand that she can still attain her dreams through other means.


There are various services to which Jessica is entitled to as a result of her condition. It is important that she be assisted to access these services and hence eliminate the feeling of neglect.

Substance Use

Substance abuse is a way through which some people affected by traumatic events choose to bury their stress. Paraplegic people often fall to substance abuse as a way of doing away with their depression and consequently, en up facing more serious psychological challenges.

Leisure Activities

Other professionally designed treatment approach, leisure is an important area for people with paraplegia. Jessica should be encouraged to engage in leisure activities which will not only improve her physical well-being but will also help take her mind off any stressful thoughts which may lead to further depression.

Current Risk Assessment: (Suicidal/Homicidal Ideation, Safety, Ability to Care for Self)

Without immediate assistance, Jessica is exposed to multiple risks including risk of suicide, further substance abuse and loss of life. It is important that measures are taken to ensure such risks are minimized or possibly eliminating.

Mental Status: Single

Rationale for Diagnosis

Diagnosis is based the need to eliminate depression and suicidal thoughts while at the same time seeking to reduce physical effects resulting from paraplegia.

Current Medications

None recorded

Current Services

None at the moment


The proposed treatment approaches aim at ensuring that Jessica can think straight and constructively and hence is able to make reasonable judgments that are beneficial to himself and the people around her. Additionally, the measures are expected to help bridge the gap between Jessica and other family members.

Treatment goals

Dealing with Abuse/neglect

Aim: Explore and resolve issues relating to history of abuse/neglect victimization

  • Help Jessica to share details of abuse/neglect with professional
  • Help Jessica to learn about conventional long-term/residual effects associated with paraplegia
  • Come up with appropriate strategy to assist Jessica in coping with stressful memories/thoughts

Anger management

Jessica like any other person whose dreams have been cut short is likely to experience cases of anger. Consequently it is important to help her learn how to manage the anger.

Aim: Enhance and practice anger management ability

  • Teach Jessica how to move away from circumstances that trigger heavy emotions.
  • Avoiding tantrums/explosive circumstances.
  • Learn and understand positive anger management techniques.
  • Practice verbal communication whenever angry

Jessica should be able to manage anger even in situations where they are treated badly.

Controlling trauma

Aim: Exploration and resolution of issues related to paraplegia

  • Jessica should be able to share trauma details
  • Reframing of negative perceptions, whenever possible and drawing strength from the same
  • Understanding conventional long-term and residual effects associated with paraplegia s
  • Taking steps towards rebuilding life after suffering paraplegia

Dealing with Behavior Problems

Goal: Improve Jessica’s behavior as well as attitude/mood, and also maintain positive behavior

  • Be free of any unwarranted behaviors such as substance abuse and suicide attempts
  • Help Jessica create a self-rewarding system
  • Come up with ways through which frustration is managed
  • Help Jessica list positive personal experiences on a weekly basis for character motivation
  • Help Jessica keep free of substance use and abuse


Goal: Undertake actions to help in improving Jessica’s overall mood

  • Stay free from any instances of suicidal thoughts
  • Have someone to call in instances where suicidal thoughts creep in
  • Get adequate rest through sufficient sleep on a daily basis
  • Report feeling more positive about self and abilities
  • Avoid sleeping as a way of escaping others
  • Create short and reasonable task to accomplish each day as a way of building self-esteem
  • Come up with strategies that will keep oneself from getting distracted by unwanted thoughts

Safety plan

Jessica is exposed to multiple risks including the possibility of committing suicide and the possibility of slipping into full scale drug abuse. In order to alleviate these possibilities, it is important to engage Jessica into multiple activities she can engage in each time he is depressed on unpleasant thoughts creep in. Additionally, a possibility of seeking full scale rehabilitation should be considered.

  • Discharge Goals
  • Incorporating family members in helping Jessica fully recover
  • Having Jessica learn to interact more with other people, seek advice form colleague ant works and talk to her boss more openly about her problems
  • Eliminate depression
  • Make Jessica sent new and practice goals worth working for in life


Azevedo, G. R. & Santos, V. L. (2011). The social representations of family members about the caregiving process. Rev Latino Am Enfermagem, 14 (2), pp.770-780.

Blanes, L. (2007). Health-related quality of life of primary caregivers of persons with paraplegia. Spinal Cord, 45 (12), pp. 399-403.

De Vivo, M. J. (2009). Causes and costs of spinal cord injury in the United States. Spinal Cord, 35 (3), pp. 809-813

De Vivo, M. J. (2010). Spinal cord injury: its short-term impact on marital status. Arch Phys Med Rehabil, 66 (9), pp. 501-504.

Lyman, M. D. (2011). Drugs in society causes, concepts and control (6th ed.). Cincinnati, Ohio: Anderson.

Mendonça, M. J, Hawkins, L. N., & Richards, J. S. (2008). Outcomes of post-spinal cord injury marriages. Arch Phys Med Rehabil, 76 (2), pp. 130-138.

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PsychologyWriting. (2023, January 6). Paraplegia: Educational History, Work History, Activities of Daily Living. Retrieved from


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PsychologyWriting. (2023) 'Paraplegia: Educational History, Work History, Activities of Daily Living'. 6 January.


PsychologyWriting. 2023. "Paraplegia: Educational History, Work History, Activities of Daily Living." January 6, 2023.

1. PsychologyWriting. "Paraplegia: Educational History, Work History, Activities of Daily Living." January 6, 2023.


PsychologyWriting. "Paraplegia: Educational History, Work History, Activities of Daily Living." January 6, 2023.