Hope has motivational importance to individuals who have suffered a major physical loss. Theories of adjustment to a spinal cord injury take one of three approaches: (1) premorbid personality, which highlights the individual's past experiences, personal meanings, and body image; (2) typologies of injury reactions, which range from normal to psychotic; and (3) stage models of adjustment, characterized by movement from denial to depression to anger to acceptance. In rehabilitation a curvilinear relationship between hope and acceptance exists in that extremely high and extremely low levels of hope impede acceptance. Reality-oriented clients who possess moderate levels of hope report more positive rehabilitation outcomes. The role the professional should assume in balancing the client's hope and expectations remains an individual decision based on the client's emotional response and psychological needs. At the Pritzker Institute in Chicago, where studies in the use of functional electrical stimulation (FES) in aiding paraplegic persons to stand and ambulate are being conducted, careful candidate screening and interviewing assess the client's hope and expectations before treatment. To achieve a balance between hope and reality, each client should be assessed from a familial, economic, vocational, psychological, social, and intellectual perspective. (BL)