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2025 BRAIN AND SPINAL CORD INJURY ADVISORY COUNCIL SPINAL CORD INJURY SURVEY
1.
I live in (city/county)
2.
I am currently living (check all that apply):
With Family
Own home
Apartment
Subsidized housing
Group home
Assisted living facility
Shared Housing
Living with a caregiver
3.
It was difficult for me to find a place to live after I left the hospital:
Yes
No
(If you answered YES to question 3, please answer question 4; if you answered NO, please proceed to question 5.)
4.
The reason it was so difficult for me to find a place to live after I left the hospital is:
I didn’t know how to find a place to live
There were no accessible housing opportunities
I needed a subsidized accessible apartment that will accommodate a mobility device
Accessibility challenges (e.g., not enough wheelchair-accessible homes)
Nothing available for me
Too expensive; didn’t have the money
No one would help me
Issues applying for services
Other (please specify)
5.
In what year was your Injury?
6.
My injury can be described as (check one):
Quadriplegia
Paraplegia
Brain Injury
7.
The cause of my brain or spinal cord injury was:
Abuse
Assault
ATV
Auto
Fall
Gun
Motorcycle
Bicycle
Pedestrian Accident
Sports related
Substance Abuse/Opioid Overdose
Other (please specify)
8.
The severity of my injury can be described:
Severe
Moderate
Mild
9.
Do you feel you fully understand your brain or spinal cord injury and how it affects your life?
Yes
No
10.
I feel that I was well informed of my injury by the healthcare professionals.
Strongly Agree
Agree
Disagree
Strongly Disagree
11.
How would you rate the clarity of the information provided by healthcare professionals?
Excellent
Good
Fair
Poor
12.
The person(s) who helped me understand what my injury means are (check all that apply):
My Doctor
Nurse
Family member
I researched it myself
Peer/Mentor
Peer Support Group
Other (please specify)
13.
I have healthcare through:
Medicare
Medicaid
Private Insurance
Personal Payment
Workers Compensation
Other (please specify)
14.
My insurance covers most of my healthcare costs/needs:
Yes
No
15.
Were you contacted or offered any help or support from any agency following your injury?
Yes
No
If yes, please provide the name of the agency.
16.
Would it have been helpful if somebody contacted you to help you to get back in the community?
Yes
No
17.
Since my injury I have been able to get what I need as a survivor:
Yes
No
If you answered no, please list what your unmet needs are:
18.
The services I am receiving/have received while living in the community are (check all that apply):
Assistive Technology
Day Program
Employment Services
Home Environmental Modifications
State Independent Living Center
Adaptive recreation
Mental Health Counseling
Occupational Therapy
Personal Care Attendants
Personal Care Provider
I am not/have not received services since my injury
Physical Therapy
Respite
Speech Therapy
Support Groups
19.
I am satisfied with my services.
Yes
No
If no, please describe what improvements you would suggest:
20.
Those who provide support to me/assist in everyday activities (check all that apply):
Spouse/partner
Family/friend
Nurse
Personal care assistant
Other (please specify)
21.
I can get from one place to another by:
Driving myself
Taxi/Uber
Public Transportation
Family/friend
Not applicable
Other (please specify)
22.
Finding transportation is a difficult thing for me to do:
Strongly Agree
Agree
Disagree
Strongly Disagree
23.
Would you benefit from better access to transportation services (e.g., accessible public transit,
ride-sharing services, or volunteer-based transport)?
Yes
No
24.
Before COVID-19 pandemic, did you experience any isolation?
Yes
No
25.
Do you currently experience social isolation due to your injury?
Yes
No
26.
I have received adequate mental health support since my injury?
Yes
No
If no, please explain:
27.
Mental health support services should be more integrated into spinal cord injury rehabilitation:
Yes
No
28.
Since my brain or spinal cord injury, I have been able to get resources to help me financially through (check all that apply):
Internet
Family/friend
Case Manager
Social Security Disability (SSD)
Social Security Income (SSI)
Doctor/Hospital
Granite State Independent Living (GSIL)
Supplemental Nutrition Assistance Program (SNAP)
Other (please specify)
29.
I am able to do the following activities by myself (check all that apply):
Dressing
Grooming
Bathing/Hygiene
Toileting/using the bathroom
Meal preparation/shopping
Managing medications
House cleaning/maintenance
Other (please specify)
30.
For those activities listed in question 29, do you receive any assistance to help you perform these activities?
Yes
No
31.
Do you feel that your injury has caused challenges in family communication or caregiving roles?
Yes
No
32.
My relationships have improved because I have (check all that apply):
A better understanding of my injury
Spouse/Partner/Family/Friends have been educated
Educated/informed from medical professionals
Support Staff
Network with Peers
Counseling or family therapy
Other (please specify)
33.
I am currently employed:
Yes
No
(If you answered No to question 31, answer question 30, otherwise skip to question 32.)
34.
Do you want to be employed?
Yes
No
If yes, what type of job would you be interested
in? (Full-time, Part-time, or Volunteer)
35.
Have you used any assistive technology to help with mobility, communication, or daily tasks?
Yes
No
If so, what have you used:
36.
Would you like more information or access to newer assistive technologies?
Yes
No
37.
Please share additional comments that you feel are important for us to know. In what other ways has your brain or spinal cord injury impacted your quality of life (e.g., personal well-being, career, relationships, daily activities)?
38.
In what other ways has your brain or spinal cord injury impacted your quality of life (e.g., personal well-being, career, relationships, daily activities)?
39.
Has anyone helped you to fill out this survey?
Yes
No
If so, what is their relationship to you?
40.
Have you used any assistive technology to help with mobility, communication, or daily tasks?
Yes
No
If so, what have you used:
41.
Would you like more information or access to newer assistive technologies?
Yes
No
42.
Additional Sections for Caregivers and Family Members (optional):
My relationship to the individual is:
Spouse/partner
Family/friend
Nurse
Personal care assistant
Other (please specify)
43.
Additional Sections for Caregivers and Family Members (optional):
How has caregiving impacted your own physical or mental health?
Physically
Mentally
Both
Not applicable
Other (please specify)
44.
Additional Sections for Caregivers and Family Members (optional):
What additional services would assist you in supporting your loved one?
45.
Additional Sections for Caregivers and Family Members (optional):
What challenges have you faced in accessing resources or support?
46.
Additional Sections for Caregivers and Family Members (optional):
Throughout your assistance of the individual have you experienced the following:
Anxiety
Depression
PTSD
None of the above
Other (please specify)
47.
Additional Sections for Caregivers and Family Members (optional):
Please share any other relative information:
