Design research has recently been exploring the application of design approaches and methods in new fields such as service design, and in healthcare. There is a small but growing body of robust literature on the application of design approaches used in these types of contexts. Healthcare service delivery is facing complex challenges in developing patient-centred 'social model' approaches which can complement or enhance prevailing clinical 'medical model' approaches and which allow patients to take more ownership of their recovery. The work described here opens up the discussion of potential opportunities to enhance the rehabilitation pathway and to improve self-management for Spinal Cord Injury (SCI) survivors, of how management is conceived, and of how this affects the relationships between and responsibilities of all concerned. It does so by asking if ‘design approaches’ can be used to help increase the resourcefulness and resilience of, and reduce dependency in SCI survivors during their rehabilitation and on their return to the community. Literature reviews were conducted of: 1) prior work; 2) patient-voiced issues; 3) SCI patient pathways and rehabilitation management models; 4) design literature discussing structured design thinking, skills, methods, and approaches. From these a framework for the analysis of tacit skills in SCI patients was derived for a workshop designed to observe and record tacit skills used by SCI survivors in addressing a daily living challenge. Although this research revealed that SCI survivors are able to demonstrate the use of innate ‘design’ skills, the question remains about the conditions required for these to be practiced, autonomously, in everyday situations.