Spinal cord injury (SCI) is a devastating neurological disorder that can disrupt voluntary motor control, sensory function, and autonomic nervous system regulation, impacting multiple body systems and functions, such as cardiovascular, cognitive, bladder and bowel function. Beyond these physical consequences, SCI results in profound psychosocial life challenges creating significant barriers to adjustment. Individuals often struggle with problems related to sexuality, weight and sleep management, cognitive performance, and mental health, significantly affecting their overall quality of life and emotional wellbeing. Chronic pain, fatigue, substance abuse, relationship conflicts, social discrimination and reduced employment prospects are also commonly faced issues following SCI. This chapter will describe and discuss best evidence approaches on dealing with the life challenges after SCI, emphasizing the critical need for comprehensive, multidisciplinary rehabilitation integrated with psychosocial and person-centred care. A rehabilitation framework will be outlined, highlighting the importance of considering the close integration of medical, physical, social, cognitive, and psychological factors for effective treatment planning and rehabilitation. Moreover, a model will be presented that explains the complex dynamics involved in how people adjust to SCI. The chapter will conclude with a discussion on the value and use of latest guidelines that provide direction in the psychosocial management for persons with SCI when participating in SCI rehabilitation. By highlighting the importance of personalized, comprehensive care, this chapter aims to improve understanding and support for the complex multifaceted impacts and management of SCI with a focus on psychosocial and adjustment challenges.