Skip to content
2025 BRAIN AND SPINAL CORD INJURY ADVISORY COUNCIL SPINAL CORD INJURY SURVEY
1.
Where do you live? (Please specify CITY and COUNTY)
2.
What is your housing situation?
With Family
In my own home
In an Apartment
In Subsidized housing
In a Group home
In an Assisted living facility
In Shared Housing
Other (please specify)
3.
Was it hard for you to find a place to live after leaving the hospital?
Yes
No
(If you said YES, please answer question 4; if you said NO, go to question 5.)
4.
I didn’t know where to look for assistance in finding new housing because: (Check all that fit)
I didn’t know where to look for assistance in finding new housing.
It was too expensive and/or no housing was available
I needed a special apartment for my mobility device
There weren’t enough wheelchair-accessible homes
Other (please specify)
5.
What year did your injury occur?
6.
How would you describe your injury? (Check one)
Quadriplegia (can't move arms or legs)
Paraplegia (can’t move legs)
Brain Injury
Incomplete (some movement)
Complete (no movement)
7.
How did your injury occur?
Abuse
Assault
Accident.
Fall
Substance Abuse
Other (please specify)
8.
How would you best describe your injury?
Severe (very serious)
Moderate (kind of serious)
Mild (not too serious)
9.
Rate how well a healthcare professional explained your injury.
Strongly Agree
Agree
Disagree
Strongly Disagree
10.
Who helped you understand your injury? (Check all that fit)
My Doctor
Nurse
Family member
I researched it myself
Peer/Mentor
Peer Support Group
Other (please specify)
11.
What kind of health insurance do you have?
Medicare
Medicaid
Private Insurance
Self Pay
Workers Compensation
Other (please specify)
12.
What services have you received in the community? (Check all that fit)
Assistive Technology
Day Program
Changes to home for accessibility
Mental Health Counseling
Occupational Therapy
Personal Care Attendants
Personal Care Provider
Physical Therapy
Respite
Speech Therapy
Support Groups
13.
What other services would help support you in your community?
14.
How do you get around?
I drive myself
Taxi/Uber
Public transport
Family/friends
Not applicable
It is hard for me to find transportation
Other (please specify)
15.
Are you currently working?
Yes
No
If No, answer question 15, otherwise go to question 16.
16.
Do you want a job?
Yes
No
17.
Please share any other important comments or how your brain and/or spinal cord injury has affected your life:
18.
Did someone help you fill out this survey?
Yes
No
If yes, what is their relationship to you?
19.
Caregiver and Family Member Section:
My relationship to the person is:
Spouse/partner
Nurse
Family/friend
Personal care assistant
Other (please specify)
20.
Caregiver and Family Member Section:
How has caring for them affected your own health?
Mentally
Physically
Both
Not Applicable
Other (please specify)
21.
Caregiver and Family Member Section:
What other services would help you support your loved one?
22.
Caregiver and Family Member Section:
Please share any other important information:
