Getting on with life: positive experiences of living with a spinal cord injury

Currently, the dominant cultural beliefs toward disability are negative, and the existing literature is limited with respect to examining how people are using and/or viewing their disabilities positively. The purpose of this study was to identify how individuals living with a spinal cord injury (SCI) viewed and/or used their disability positively, and what contextual influences facilitated this positive approach. This study was a secondary analysis of qualitative data from a larger study. The findings revealed three levels at which disability was viewed and/or used positively by people with SCI: self, peers, and disability community. In addition, several aspects of the participants' situations were found to facilitate this positive view and/or use of disability: personality, spirituality, support systems, and acceptance of one's disability. The findings reveal that individuals with SCI are viewing and/or using their disabilities positively in many different ways. This study has significant implications for the direction of future research and for health care professionals who need to increase their advocacy and facilitating roles.     

Sexual response in women with complete spinal cord injury

Conclusions There is still much we do not know about sexuality and women with SCI. Nevertheless, positive steps are being taken to learn more about the physiological and interpersonal aspects of sexuality. Ultimately, these efforts will enhance the quality of life for women with SCI.     

Women living with a spinal cord injury: perceptions about their changed bodies

In this article we illuminate the narratives of women living with a spinal cord injury (SCI) with regard to (a) learning how to live with a changed body and (b) exploring the factors that influence how they feel toward their new bodies. An SCI produces immediate physical impairments resulting in a changed body, which can then have physical, emotional, and social consequences to these women. Through its focus on enhancing the body, physical therapy can help to promote a positive view of the self within the changed body. Our analysis of these women's experiences resulted in a fluid, three-phase framework of learning to live with a changed body that generally moves from (a) discomfort, to (b) moving toward comfort, to (c) comfort. Physical therapy can potentially influence the process of women's gaining comfort with their changed bodies following an SCI. The framework provides a basis for future research on adaptation following SCI.     

Sexual functioning of women with complete spinal cord injury: Nursing implications

The Human Sexual Response Cycle and the neurological alteration in physiological sexual functioning of women following complete spinal cord injury is discussed. Nursing implications regarding current theoretical knowledge, its foundation in research and practical considerations for patient education is reviewed. Specific suggestions are also provided for the sexual concerns of birth control, lubrication issues, elimination problems, loss of motor and sensory control and changes in orgasmic function.     

Neurophysiology of sexual response in spinal cord injury

Commonalities and differences in the neurophysiology of sexual response in persons with spinal cord injuries and the non-cord injured are described. Recognition of individual differences and other implications for sex education and counseling with the spinal cord injured are presented.Preparation of this article was supported, in part, by Grant MH 14346-03, NIMH.     

The experiences of foundation doctors with dyspraxia: a phenomenological study

Dyspraxia, otherwise known as Developmental Coordination Disorder (DCD), is a specific learning difficulty (SpLD). Its main difficulties manifest as problems with motor coordination, organisation, academic and social difficulties. There are now more students arriving at university with SpLDs, and, therefore, a similar rise may be expected within medical education. There has been no previous research focusing on dyspraxia in doctors. An interpretive phenomenological approach was used. Six UK foundation schools disseminated the announcements. Three participants took part in loosely structured telephone interviews regarding their experiences of undertaking medical school and foundation school with dyspraxia. These were transcribed verbatim and then thematically analysed. The themes could be split into two main categories: “Weakness and Coping Strategies” and “Perspectives of Dyspraxia”. “Weakness” included: clumsiness, organisation and needing extra time. The participants focused on their “Coping Strategies” that included: Ensuring safety, adapted learning preferences and external support. “Perspectives of Dyspraxia” included: diagnosis, career choice, stigma, “normalisation” and the “difference view” or “medical deficit” view of dyspraxia. Doctors with dyspraxia often mask their difficulties through sophisticated coping strategies. These were determined and hardworking individuals who believe that their dyspraxia was a positive aspect of their identity, adopting a “difference view”. They felt further education is needed about dyspraxia to change the perceived stigma. There is now a need for further research in this area.

     

Lifestyle physical activity for individuals with spinal cord injury: a pilot study

PURPOSE: To evaluate the acceptability and feasibility of a lifestyle physical activity program for people with spinal cord injury (SCI). METHODS: Sixteen nonexercising adult volunteers with SCI participated in a single group pre-post-test of the "Be Active in Life Program" comprising stage-matched educational materials, home visit by a nurse, construction of a personal plan to increase activity, and four follow-up phone calls. Program acceptability, stage of change, barriers to health-promoting activities, abilities for health practices, health, depression, and muscle strength were rated. Physical activity was monitored using actigraphy and a self-report record. RESULTS: Participants rated the program positively, although some preferred a structured exercise approach. Eighty-one percent of participants progressed in stage of change and 60% increased physical activity. There were significant changes in motivational barriers, exercise self-efficacy, self-rated health, and muscle strength. DISCUSSION: Lifestyle physical activity is feasible and acceptable and could be effective in promoting greater physical activity among people with SCI.     

Psychophysiological assessment of male sexual arousal following spinal cord injury

Adult males with and without permanent damage to the spinal cord were contrasted in terms of their sexual responsiveness to erotic stimulation in film, spoken-text, and fantasy modes. Among the 16 spinal cord injured (SCI) men who were studied, several who had anticipated they would achieve erection failed to do so, whereas others demonstrated penile tumescence during erotic stimulation despite claiming they had lost the capacity for psychogenic erection. Self-report is thus not a valid index of sexual responsivity following spinal cord injury. Levels of tumescence varied across modalities of stimulation in the same manner for SCI and non-SCI men, and within each modality the two groups demonstrated similar rates of buildup of arousal over segments of stimulation. The SCI men without erections should not be considered asexual since their subjective arousal paralleled the subjective arousal of the non-SCI men and the SCI men with erections.     

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.     

Evaluation of sexual reproductive health needs of women with spinal cord injury in Tehran,Iran

Sexuality and Disability - Physical disability is one of the factors influencing the sexual and reproductive health (SRH) of people. Women with a severe disability receive fewer Pap smear tests,...     

Brain (PET) responses to vaginal-cervical self-stimulation in women with complete spinal cord injury: preliminary findings

Our recent research provides evidence that women with complete spinal cord injury (SCI) at the midthoracic level show perceptual responses to vaginal and/or cervical self-stimulation (for example, pain suppression and sexual response, including orgasm). On the basis of studies in laboratory rats, we hypothesized that the vagus nerves provide a sensory pathway from the vagina, cervix, and uterus directly to the brain in women. To test this hypothesis, we performed a PET-MRI study on two women with complete SCI and 1 woman with no injuries. Whereas control foot stimulation of the women with SCI did not activate the somatosensory thalamus, cervical self-stimulation increased activity in the region of the nucleus of the solitary tract, which is the brainstem nucleus to which the vagus nerves project. These preliminary findings suggest that the vagus nerves can convey genital sensory input directly to the brain in women, completely bypassing SCI at any level.     

Men's experiences of giving and taking social support after their wife's spinal cord injury

The aim of this study was to gain an understanding of how men living with women with spinal cord injury (SCI) experienced and acted when they were giving and taking social support to and from their wives and other persons in their social network. Another aim was to give some possible explanations of the complex process of change that they went through. Data were collected through in-depth interviews with four men and field notes. To describe the men's subjective experiences and the process of change, a narrative approach inspired by Polkinghorne was used. The analyses resulted in one story that included the four men's experiences and action. The story showed that when the men went through a process of change, they used and needed both emotional and practical support to handle their new life situation. Furthermore, the men's experiences and action against social support changed over time. This indicated that, through narratives from spouses, professionals within rehabilitation could understand the process of change they went through after their partner's sudden injury, and support them to find strategies to handle their changed life situation. To give some possible explanations for the men's experiences and action during the process of change, the findings are discussed in relation to theories concerning adaptation and coping.     

Men's experiences of giving and taking social support after their wife's spinal cord injury

The aim of this study was to gain an understanding of how men living with women with spinal cord injury (SCI) experienced and acted when they were giving and taking social support to and from their wives and other persons in their social network. Another aim was to give some possible explanations of the complex process of change that they went through. Data were collected through in-depth interviews with four men and field notes. To describe the men's subjective experiences and the process of change, a narrative approach inspired by Polkinghorne was used. The analyses resulted in one story that included the four men's experiences and action. The story showed that when the men went through a process of change, they used and needed both emotional and practical support to handle their new life situation. Furthermore, the men's experiences and action against social support changed over time. This indicated that, through narratives from spouses, professionals within rehabilitation could understand the process of change they went through after their partner's sudden injury, and support them to find strategies to handle their changed life situation. To give some possible explanations for the men's experiences and action during the process of change, the findings are discussed in relation to theories concerning adaptation and coping.     

Body composition of patients with spinal cord injury

Body composition of 10 control subjects and 37 spinal cord injured (SCI) patients was measured by dilution of 3H2O and Na2 35SO4. SCI patients were classified into four groups by ascending level of lesion, low and high paraplegics and low and high quadriplegics. The studies show diminishing total body water, intracellular water, lean body mass and body cell mass and increasing fat mass with higher spinal lesions. No differences in body weight or extracellular water were observed so that the ratio of extracellular water/total body water was increased as the level of injury increased.     

Marital status of persons with spinal cord injury

The proposition that persons are selected into and out of marriage on the basis of their health or disability status has often been advanced, but remains untested. This article presents a theoretical rationale for the proposition; provides an initial test of that proposition by comparing the marital status of a sample of persons with spinal cord injury with the marital status of the general public; and elaborates on the proposition by examining the extent to which other factors account for differences in marital status among members of this disabled group. The selected factors were sex, severity of disability (indicated by need for assistance, perceived health, and extent of paralysis), socio-economic status (indicated by adequacy of income and welfare status), current age, and age at onset of disability. A secondary analysis of existing survey data on 251 Oregon residents with spinal cord injury (182 males, 69 females) yielded the following results. The marital selection proposition was supported in that the marital status of this sample differed markedly from that of the general population. The disability exerted a greater effect on the marital status of females than of males. All the selected variables were significantly associated with marital status for one or for both sexes. Discriminant function analyses, employing these variables, identified correctly the marital status of 67.6% of the males, and 75.4% of the females. Profiles of married, formerly married, and single men and women with spinal cord injury are presented. Suggestions are offered for further testing of the marital selection proposition and for elaborating theory linking disability and health status to marital status.     

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.