Sexuality After Injury: Interviews with Women After Traumatic Spinal Cord Injury

The aim of this study is to illuminate sexual experiences in women after traumatic spinal cord injury (SCI), including psychological, physical and social barriers that will have to be overcome to resume a sexually active life with a partner. Interviews with eight women were performed. The women were 20–43 years old, previously healthy, with experience of stable heterosexual relationships both before and after SCI. The interviews covered three main areas: 1. The first sexual contact after injury: expectations, concerns, outcome; 2. Communication with partner on sexual matters, before and after injury; and 3. Sexual activity after injury: limitations, compensatory strategies. In addition, advice from the women to newly injured and rehabilitation staff/counselors was requested. Results suggest a strong influence of pre-injury sexual behaviour on post-injury sexual adaptation. A positive attitude towards sexuality and good communicative skills seem to be of particular importance for a favourable outcome of sexual rehabilitation. Even under such circumstances, however, SCI as a rule leads to significant loss of sexual ability. A realistic approach is therefore recommended in counseling, taking the mourning of loss of function into consideration, and allowing the patients to express their grief. Thus, sexual rehabilitation programs need to address a dynamic process of mourning and coping, rather than merely teaching skills for having sexual intercourse after SCI.     

Contribution of travel participation to social integration and life satisfaction after spinal cord injury

BackgroundResearch has found that participation in travel declines for people after spinal cord injury (SCI) because the traumatic injury usually results in impaired physical mobility and sensation, and barriers in the environment make travel more challenging. While travel participation can offer numerous physical, psychological, and emotional benefits, empirical evidence on positive outcomes of travel for people after SCI is scarce in the literature.ObjectiveTo empirically examine the effects of travel participation on social integration and life satisfaction for people with SCI, along with other personal characteristics including income, self-perceived health status, levels of physical independence, occupational activities, and travel barriers.MethodsCross sectional data are collected from 250 patients enrolled in a SCI Model System. Hierarchical regression analyses, followed by mediation analyses, are conducted to assess the effects of travel participation on social integration and life satisfaction.ResultsTravel participation along with occupational activities is shown to significantly impact social integration, with participation in occupational activities partially mediating the relation from travel participation to social integration. The significant effect of travel participation on life satisfaction is fully mediated by social integration. Income and self-perceived health status both significantly contribute to social integration and life satisfaction.ConclusionsTravel participation should be considered as an independent domain that directly impacts the social integration of people with SCI, which in turn enhances their life satisfaction. Systematic interventions with standard protocols for travel-related skill training and assessments procedures are needed for people after SCI.     

Providing Comprehensive Sexual Health Care in Spinal Cord Injury Rehabilitation: Implementation and Evaluation of a New Curriculum for Health Care Professionals

A grant from the Paralyzed Veterans of America funded the development, implementation, and evaluation of a three-day interdisciplinary continuing education and training program in comprehensive sexual health care. The program was targeted toward health care professionals working in spinal cord injury (SCI) rehabilitation. The major goal of the program was to offer participants an opportunity to increase the knowledge, comfort, and skills necessary to understand and manage the sexual health care needs of people with SCI. The curriculum included clearly stated goals, behavioral objectives in operational terms, and multiple quantitative and qualitative program evaluations. In addition, the comprehensive curriculum incorporated extensive skills training including state-of-the-art standardized patient training techniques. Evaluation results indicated statistically significant and qualitatively important positive gains in knowledge, comfort, and skills. The five month follow-up study indicated that skills learned over the three-day workshop were successfully transferred to the work environment.     

Sexuality and Women with Spinal Cord Injury

Women with spinal cord injury (SCI) have unique concerns and problems related to their sexuality. The purpose of this study is to assess sexual issues in women with SCI, for better management and rehabilitation of such patients. Consequently, 40 such women were interviewed based on a standardized questionnaire. Evaluation of sexual activity, medical problems most significantly interfering with sexual activity, menstruation, pregnancy, child bearing and relationships was done. Interest in sex and importance of sex in lives did not change significantly after SCI. The key concerns after SCI were sexual, bladder and bowel dysfunctions, bed sores, pain, spasticity and satisfaction of partner and cultural taboos. Only, 30% women had received information on sexual matters, that too to isolated problems. There is a distinctive need for clinical attention, education, research and development around gynaecological/reproductive, sexual and urogenital issues unique to women with SCI in India.     

Geographic variation in participation for physically disabled adults: The contribution of area economic factors to employment after spinal cord injury

This study investigates the role of area economic characteristics in predicting employment-a key aspect of social participation for adults with physical disabilities-using data from a national registry of persons with spinal cord injury (SCI). SCI results in chronic impairment and most commonly occurs during young adulthood when working is a key aspect of the adult social role. Geocoded data were collected from two of the 14 SCI Model Systems (SCIMS) centers involved in the National SCIMS database and used to link individual-level data with area-level measures extracted from the 2000 US Census. The analysis included participants of working-age (18-64 years) and living in the community (N=1013). Hierarchical generalized linear modeling was used to estimate area-level variation in participation and the relative contribution of area-level economic indicators, adjusted for individual-level health, functioning, and background characteristics. The likelihood of employment for adults with SCI varied by area and was associated with area SES and urbanicity, but not area unemployment. These findings suggest that variation in area economic conditions may affect the feasibility of employment for persons who experience chronic physical disability during adulthood, thus limiting full participation in society.     

The Experience of Four Individuals with Paraplegia Enrolled in an Outpatient Interdisciplinary Sexuality Program

Spinal cord injury has a significant impact on an individual’s physical, emotional, as well as sexual functioning. Four consecutive males with spinal cord injury were referred to the outpatient spinal cord injury sexuality program at an urban Veterans Affairs Medical Center and seen by an interdisciplinary team comprised of a nurse, physician and psychologist. They felt that their questions had been answered and their emotional well-being had been appropriately addressed in a respectful environment and effective process. Results suggest that availability of continued access to counseling regarding sexually related issues is very important and that patients can benefit from an interdisciplinary approach in addressing functional and emotional needs.     

Spinal Cord Injury and Sexuality in Married or Partnered Men: Activities, Function, Needs, and Predictors of Sexual Adjustment

The sexual behaviors, functioning, needs, and sexual satisfaction levels of men with spinal cord injuries (SCI) were studied. A sample of 50 men with SCI (median age = 50; median age at injury = 25.0), either married or in a committed relationship, responded to an anonymous survey of a large southern California regional spinal injury rehabilitation center. Multiple regression analyses indicated that perceived partner satisfaction, relationship quality, and sexual desire were significant predictors of sexual satisfaction and behavior. Erectile function, level of genital sensation, and orgasmic capacity all varied widely in the sample, as well. However, none of these variables were significantly related to sexual satisfaction. A varied sexual repertoire was independently related to sexual satisfaction and behavior, but did not offer additional predictive power. Results suggest that for married or partnered men with SCI, relationship factors including partner satisfaction and relationship quality are significantly and positively related to sexual satisfaction. Married or partnered men with SCI who report low relationship satisfaction, have difficulty satisfying their partner, and/or report low sexual desire may benefit from assessments and interventions that address these issues.     

Sexual counseling and spinal cord injury

Spinal cord injury (SCI) may result in significant disruption of physical, social, vocational, psychological and sexual function. As an integral component of human behavior, it is a mistake to isolate and treat sexual activity as a separate entity, or to ignore it entirely in the rehabilitation setting. This article reviews the important variables that influence the ability of spinal cord injured individuals to perceive of self and act as a sexual being. Assessment issues are addressed, with a specific focus on those aspects of assessment that are unique to or need special consideration in treating spinal cord injured individuals. The PLISSIT mode of sex therapy is described to illustrate the interventions used with the spinal cord injured client. This model is utilized because it allows each staff member to participate according to their level of skill, knowledge, and comfort. This article demonstrates that through use of multiple therapeutic modalities it is possible for the spinal cord injured client to be rehabilitated to a satisfactory level of sexuality.     

Sexual Self-esteem and Body Image of South African Spinal Cord Injured Adolescents

Although adolescents sustain a large portion of spinal cord injuries, the area of spinal cord injured adolescents and the issues surrounding their sexuality are under-researched. This is the first South African study on the sexuality of spinal cord injured adolescents and attempts to address this paucity. It is generally postulated that the sexuality of adolescents who have sustained SCI will be detrimentally affected by the consequences of having a physical disability, resulting in developmental lags relative to non-disabled peers. The focus of this article is to explore the impact of spinal cord injury on adolescents sexual self-esteem and body image. A qualitative study was conducted, with data being collected via in-depth individual interviews, which were subsequently analyzed thematically. A disparity was found between dominant ableist discourses of the SCI adolescent as a sexually immature and passive spectator, and the lived experiences of the participants involved in the study. The study concluded that entrenched socially constructed attitudes appear to limit the opportunities for spinal cord injured adolescents to express their sexuality more than the limitations by their disabilities.     

Sexual Satisfaction in People with Spinal Cord Injury

The objective of this study is to extend knowledge regarding sexual satisfaction, comparing the findings among pre- and post-lesion periods and a control group. From Brazil, the participants were 90 men, of whom 40 had a spinal cord injury (SCI) and 50 had no physical disability. The instrument used was a structured open and closed–ended questionnaire. Of the 40 men with SCI, 29 had paraplegia and 11 had tetraplegia. The participants were asked about their level of sexual satisfaction: 72% of the control group declared themselves to be very satisfied; 80% of the men with SCI in the pre-lesion period also reported being very satisfied, while in the postlesion period this number fell to 47.5%. In the pre-lesion period and in the control group sexual satisfaction exhibited positive correlations with: sexual frequency; sexual stimulation; sexual desire and intensity of orgasm. Meanwhile, in the post-lesion period there were correlations between variables that are modified by the SCI: erection sufficient for penetration; reaching orgasm; achieving penetration and finding sex possible without penetration. Noteworthy, the study found that there are changes in the sexual satisfaction of men with SCI. In many cases this change results from the difficulty in maintaining a sex life similar to that experienced pre-lesion. Furthermore, new correlations with sexual satisfaction appear in the post-lesion period.     

康复护理对脊髓损伤患者生活质量的影响

目的：探讨康复护理对脊髓损伤（spinalcordinjury,SCI）患者生活质量的影响。方法：依据WHOQOL-100量表设计SCI患者生活质量调查表,对60例SCI住院患者采取有针对性的提高生活质量的系统康复护理,执行周期为16周,然后进行统计评分。结果：经过4周和16周的系统康复护理,发现60例SCI患者的生存质量评分由入院时的（4．95±0．75）好转到（2．35±0．42）,生活质量由很糟、苦恼提高到大致满意或还可以;其中改善生活质量最关键的护理措施是膀胱功能重建技术,使导尿管拔率由人院时的10％提高到康复护理16周时的90％。结论：康复护理对SCI患者生活质量提高效果明显;膀胱功能重建的康复护理是改善SCI患者生存质量的关键因素,也是SCI康复护理的临床突破之一。     

Physical activity and sedentary behavior in people with spinal cord injury: Mitigation strategies during COVID-19 on behalf of ACSM-EIM and HL-PIVOT

People with spinal cord injury (SCI) face unique challenges during the COVID-19 pandemic, including greater risk of poor COVID-19-related outcomes, increased social isolation, and restricted access to important services. Furthermore, COVID-19 related restrictions have decreased already low levels of physical activity (PA) in this population. Therefore, the purpose of this commentary is to: 1) address the impact of COVID-19 on PA and sedentary behavior (SB) in people with SCI; 2) provide potential SB reduction strategies to guide future research; and 3) provide recommendations to increase PA and reduce SB on behalf of the American College of Sports Medicine Exercise is Medicine (ACSM-EIM) and Healthy Living for Pandemic Event Protection (HL-PIVOT) using a social-ecological model targeting the individual-, social environment-, physical environment-, and policy-level determinants of behavior in people with SCI.     

功能独立性评定在脊髓损伤患者中的临床应用

目的探讨康复治疗对于不同程度脊髓损伤(spinal cord injury，SCI)患者功能恢复的意义。 方法选择2016年12月至2017年10月丽水市4家医院脊髓损伤住院患者共80例，设立一般治疗的对照组和康复治疗的实验组，通过功能独立性评定(function independent measure，FIM)及临床随访，评估康复治疗在脊髓损伤中的应用价值。 结果康复治疗对于提高脊髓损伤患者生活水平有高效性和实用性；患者的认知功能和运动功能恢复情况相似，73.33%患者优先恢复进餐能力；患者的配合程度影响恢复情况。 结论FIM评估能有效反映脊髓损伤患者的真实状况。康复治疗有助于SCI患者尽可能提高独立生活能力，将会成为攻克SCI这一常见棘手疾病的有力助手。     

The influence of social support on the rehabilitation of women with spinal cord injury: experiences recounted by occupational therapists

Abstract

Objective: Women with a spinal cord injury (SCI) often require support from others to perform their everyday activities. The aim was to describe OTs' experiences of how social support from the network influences or could influence the rehabilitation of women with SCIs. Methods: Four occupational therapists, specialized in rehabilitation of persons with SCIs, narrated 11 separate stories relating to women with an SCI. Five themes were identified: “Assisting the women to identify new ways to perform activities”, “Giving support to the women by re-establishing relationships on their behalf”, “Enabling the women to find solutions to problems that have an impact on everyday activities”, “Enabling the women to learn what it is like to live with an SCI from first-hand accounts”, and “Assisting the women to set goals in anticipation of life outside the clinic”. Results and conclusions: The results indicate that professionals within rehabilitation need to be aware of and actively create and strengthen natural social networks during the complex and demanding rehabilitation process. Furthermore, they ought to use their capacity as professionals to ensure that support is provided and to reduce negative interactions within the injured person's network, given that social support, social integration, and negative interactions have the potential to influence health and well-being.     

Impact of altered sexuality and sexual function in spinal cord injury: A review

The purpose of this article is to review the literature regarding the impact of altered sexuality and sexual function in individuals with spinal cord injuries. Dependent on both biological and psychological factors, sexual behavior and identity can be deleteriously affected by a spinal injury. The relationship of sexuality, sexual identity, and self-concept is discussed, and a distinction between sex and sexuality is drawn. Attitudes, emotions, and functional capabilities are explored, and readjustment and rehabilitation issues are considered. Sexual adjustment can be critical in the total rehabilitation of a person with a spinal cord injury.     

If not the Disability, then what? Barriers to Reclaiming Sexuality Following Spinal Cord Injury

Human sexuality has been medicalized and largely reduced to its physical components. This has led to a focus on the performative part of sexuality, and to a lack of interest in its social component. Men with spinal cord injury often report an unsatisfying sexual life, with limited chances to express their sexuality. This study shows that sociocultural barriers may be as disabling as physical impairment. The participants of this qualitative study felt that several barriers compromised their right to a satisfying sexual life, including certain social beliefs and attitudes (e.g. social disapproval and exclusive notion of sexuality), lack of employment, inappropriate personal assistance and inaccessibility among others. Impairment per se was not viewed as a barrier, since the new situation assumed status of normality. It is suggested that changes in education as well as the removal of physical barriers may positively influence societal attitudes and make sexuality more “accessible” to disabled people.     

Sexual Rehabilitation Services after Spinal Cord Injury: What Do Women Want?

Purpose: To explore and describe women’s experiences and concerns related to inpatient sexual rehabilitation.Participants: Twenty-four women who experienced traumatic SCI between 17 and 63 years of age. Methods: Semi-structured interviews with follow-ups were conducted on topics including amount and type of inpatient sexual education and counseling experiences, sexual concerns after injury, and suggestions regarding sexual rehabilitation approaches and activities.Results: Multiple themes emerged. Overarching themes included the importance of timing and honoring individual differences. Only two women reported receiving in-depth sexual rehabilitation services. Sexuality was not a priority soon after injury for a majority but assumed greater importance later. Participants believed sexuality should be broached during inpatient rehabilitation and introduced by the health professional. Reactions to healthcare professionals’ communication styles and behaviors were described.Conclusion: Participants’ feedback can help inform training and practice of rehabilitation professionals who w ork with women with SCI and other acquired disabilities. Concrete suggestions are offered.     

Sexuality, Identity and Women with Spinal Cord Injury

Sexuality is an integral component of every individual’s identity. The literature offers limited information about the sexuality and sexual identity of women with spinal cord injury (SCI), beyond the physiological and neurological aspects. The qualitative study described in this paper aimed to explore the experiences and perceptions of a small sample of adult women with SCI regarding their sexuality post-injury. Semi-structured interviews were conducted with four women, which were audio-taped and then transcribed. Thematic analysis was adopted for analyzing the narrative data. Themes that were identified include: factors facilitating positive sexual adjustment, barriers to sexuality post-injury and lack of sexual education in the rehabilitation process. Women with SCI echoed the need to be recognized as sexual beings, despite disability. Health professionals must be willing to discuss issues of a sexual nature and need an understanding of how illness or disability may impact on sexuality, in order to adequately assist individuals with physical disabilities address sexual and intimacy issues.