The Effectiveness of a Sexuality Training Program for the Interdisciplinary Spinal Cord Injury Rehabilitation Team

While there is evidence to support consideration of client sexuality needs in the provision of rehabilitation services to people with spinal cord injury (SCI), the interdisciplinary team rarely receives training in this area. The current study aimed to examine the effectiveness of a consumer-driven sexuality training program in improving staff knowledge, comfort (general and personal) and attitudes. Using a local needs assessment to identify training needs and the Permission, Limited Information, Specific Suggestions and Intensive Therapy (PLISSIT) model as a training framework, a sexuality training program was developed in one Australian SCI service. A randomized controlled trial was conducted and significant improvement was found in all domains for the treatment group – Knowledge(χ²= 46.141, p< 0.001), Comfort (χ²= 23.338, p< 0.001), Approach(χ²= 23.925, p< 0.001) and Attitude (χ²= 15.235, p< 0.001) compared to the control group. Changes were found to be maintained at three month follow-up – Knowledge (Z=−5.116, p< 0.001), Comfort (Z=−3.953, p< 0.001), Approach (Z=−4.103, p< 0.001) and Attitudes (Z=−2.655, p< 0.001). These results support the use of an individualized needs-based sexuality training program in fostering staff knowledge, comfort and attitudinal change in an interdisciplinary SCI rehabilitation service.     

The Development of a Scale to Assess the Training Needs of Professionals in Providing Sexuality Rehabilitation Following Spinal Cord Injury

The training needs of rehabilitation professionals in the area of sexuality and sexual function, particularly following spinal cord injury (SCI) has received little attention in the literature. Specifically, there is negligible theoretical discussion related to staff training needs, as well as a paucity of standardised scales to measure these needs. A conceptual model was developed encompassing staff knowledge, comfort, and attitudes towards sexuality following SCI. Using this model, a scale was developed, evaluated, and refined. Factor analysis supported the construct validity of the scale in measuring the existing conceptual model outlined but highlighted the existence of a separate construct related to personal approaches from clients. The subsequently named Knowledge, Comfort, Approach and Attitudes towards Sexuality Scale (KCAASS) demonstrated high levels of internal consistency across the four conceptual domains. The KCAASS has utility for rehabilitation facilities interested in identifying and targeting training initiatives related to addressing client sexuality needs following SCI.     

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.     

Discussion Guide for the Sexually Explicit Educational Video Sexuality Reborn: Sexuality Following Spinal Cord Injury

The use of sexually explicit media in education is a sensitive teaching area because of the range of adverse reactions sexually graphic images may evoke. The person planning to use a sexually explicit video needs to create a safe environment with time for discussion and they must be prepared to facilitate discussion that will elicit reactions and help viewers deal with them. This paper provides clear goals, objectives, rationale, and guidelines for using Sexuality Reborn. It also provides recommended topics for discussion including references to the key scenes, discussion questions, and comments.     

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.     

Use of Sexually Explicit Films in Spinal Cord Injury Rehabilitation Programs

Sexual Attitude Reassessment (SAR) seminars, popular in the 1970s for use in progressive spinal cord injury (SCI) rehabilitation programs, have lost favor. The practice, however, of using only one sexually explicit film (SEF) as the primary method of providing sexuality education has taken its place. The use of SEFs is a sensitive teaching issue. Used properly, a SEF may facilitate a more receptive attitude toward sexuality and SCI. Used inappropriately, a SEF may result in adverse reactions. This paper reviews the theoretical rationale for using SEFs, the traditional use of SEFs in SARs that focus on attitudes and values, and empirical studies of the use of SEF. Recommendation is made for a paradigm shift from a general focus on changing attitudes and values to a more targeted focus on improving judgments of self-efficacy when using one SEF. Theoretical support is given based on observational learning and social cognitive theory.     

半横断模型与脊髓损伤修复

随着交通和建筑事故的增多，脊髓半切伤综合征的病人也越来越多见，以往大多数学者都集中于挤压伤或打击伤模型，但由于这些模型与临床上的半切伤受力及损伤机制明显不同。所以建立和研究半切模型中脊髓损伤的变化机制，对于临床有很重大的现实意义。本文对半横断模型与脊髓损伤修复之间关系的研究进展进行综述。     

Sexual Rehabilitation for Men with Spinal Cord Injury: Preliminary Report on a Behavioral Strategy

Training of the perineal muscles was attempted in our centers on the basis of our previous findings indicating that when the appropriate source of stimulation is used, subjects exhibit peaks of activity suggesting a rehabilitation potential. Muscular training was considered because pressure stimulation of the glans penis triggers contractions of perineal muscles which propel the blood throughout the penis to ensure optimal tumescence. The technique was combined with biofeedback and home exercises and was tested on 10 patients initially presenting erectile difficulty but maintaining perineal innervation. The results showed significant improvements in average and maximal tumescence and maintenance of these improvements. The results are discussed in terms of their clinical application to a cognitive-behavioral approach to sexual dysfunction in spinal cord-injured men.     

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.     

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.     

我国康复代步器在脊髓损伤康复中的现状与展望

恢复步行能力是脊髓损伤患者康复过程中的一大难题。按照现代康复修复、重建、代偿、适应的原则,通过康复代步器代偿脊髓损伤患者的步行能力是患者重返家庭、重返社会的有效措施。本文总结了当下康复代步器在脊髓损伤康复中的应用情况,并对康复代步器未来的发展方向做出了分析。     

A Longitudinal Study of Sexuality Training for the Interdisciplinary Rehabilitation Team

Discipline specific and multidisciplinary training programs have been developed to provide practitioners working in health and disability fields with various combinations of knowledge, skills, attitudes and practitioner comfort important for such discussions. There is little, however, which demonstrates the long term effectiveness of such training programs. The current study is a 2-year follow-up to a randomized controlled trial that examined the effectiveness of a sexuality training program for rehabilitation practitioners working within spinal cord injury rehabilitation. Using both questionnaire-based and qualitative data, findings suggest that training can have long-lasting effects on practitioner knowledge, comfort and attitudes in addressing sexuality issues with clients. Training that is developed around the individualized needs of practitioners and the settings within which they work may be particularly effective. Future research is needed to explore the applicability of this type of training to other rehabilitation and healthcare settings.     

Women with Complete Spinal Cord Injury: A Phenomenological Study of Sexuality and Relationship Experiences

The phenomenological study described in this paper examines the sexuality and relationship lived experiences of 15 adult women who sustained complete spinal cord injury between the levels of T6 and L2 verified by a physiatrist. Audiotaped, semi-structured interviews were conducted by an interdisciplinary team of investigators. A set of themes and sequentially consistent patterns emerged from post-injury data that were labelled: Cognitive-genital dissociation, sexual disenfranchisement, sexual exploration, and sexuality reintegration. Sexuality and relationship issues in women with complete SCI are discussed, and indications for future studies and educational implications are presented.     

气垫导轨脊髓撞击损伤试验模型的设计

目的：建立一种合理的脊髓损伤模型,以进行脊髓损伤基础研究。方法：采用气垫导轨固定撞锤轨道,改变撞击方向,改进精确定位方式。结果：改进后可有效避免撞击的二次损伤,方便了控制的改进。结论：气垫导轨式脊髓撞击损伤试验模型制作简单经济,容易实现,便于推广,具有一定的应用价值。     

脊髓损伤后运动神经末梢中TrkA和NGF表达的研究

[目的]探讨脊髓损伤(spinal cord injury，SCI)对下肢肌肉组织中高亲和性神经生长因子受体(transfection of high affinity nerve growth factory gene，TrkA)和神经生长因子(nerve growth factor，NGF)表达的影响以及内源性神经营养素(neurotrophins,NTs)的生物学作用模式。[方法]雄性成年SD大鼠15只随机分成正常对照组、假手术对照组和脊髓损伤组，麻醉后采用改良的Allen氏重物打击方法(50g/cm)损伤T12节段，应用免疫组织化学方法，观察正常、假手术和脊髓T12节段损伤48h后大鼠下肢肌肉组织中TrkA和NGF表达的情况。[结果]大鼠奇髓T12段损伤48h后，下肢肌肉中神经-肌肉接头处有TrkA明显表达，在肌细胞质中有较强NGF表达。正常和假手术组成年大鼠下肢肌肉中末见表达。[结论]脊髓损伤后神经生长因子和受体大量表达有利于受伤运动神经末梢摄取内源性神经营养素并上行转运至受伤神经元发挥其生物效应以促进损伤脊髓的修复。     

早期膀胱功能训练对脊髓损伤患者膀胱功能恢复的影响

目的探讨早期膀胱功能训练对脊髓损伤患者膀胱功能恢复影响。方法纳入临床确诊的脊髓损伤患者40例,按照随机数字表法将入组对象分成对照组与观察组,每组均20例,对照组采用常规综合治疗,观察组在对照组基础上采用叩击法排尿训练,对比两组治疗后临床疗效、24小时排尿次数、留置导尿时间、膀胱恢复情况(膀胱容量、残余尿量)、尿路感染发生率、住院天数、生活质量评分、感觉评分的差异。结果(1)对照组临床有效率为75.0%,而观察组临床有效率明显升高,其有效率为95.0%,差异有统计学意义(P=0.027)。(2)与对照组比较,观察组留置导尿时间、尿路感染发生率、膀胱残余尿量、24小时排尿次数均降低,而膀胱容量明显增加,差异有统计学意义(均P<0.05)。(3)与对照组比较,观察者住院天数明显下降,而生活质量评分、感觉评分明显升高,差异有统计学意义(均P<0.01)。结论早期膀胱功能训练可有效促进脊髓损伤患者膀胱功能恢复,显著改善生活质量,减少并发症的发生,提高临床治疗效果。     

槲皮素促进小鼠脊髓损伤后轴突生长及功能恢复研究

目的 评价槲皮素对小鼠脊髓损伤后轴突生长及功能恢复的影响。方法 C57BL/6雌性小鼠24只,随机分为2组,各12只。将2组小鼠T10节段施以完全性脊髓钳夹伤,治疗组分别于损伤前30 min、损伤后即刻、损伤后1-10 d每天1次腹腔注射槲皮素(50 mg/kg),对照组则腹腔注射等量0.9%氯化钠溶液。于损伤后14 d将BDA神经示踪剂注入小鼠皮层感觉运动区,示踪皮质脊髓束,组织切片复染GFAP标记损伤边界。通过荧光显微镜观察损伤区近段皮质脊髓束轴突退缩及再生情况。在术后当日及1、3、7、14、28 d,采用BMS(Basso mouse scale)量表评价小鼠后肢及躯干运动功能。结果 损伤后第28天,与对照组相比,槲皮素治疗组轴突出芽量化比值上升;神经轴缩球量化比值下降;传导束到损伤边缘距离下降,差异均有统计学意义(P0.01)。行为学评估表明槲皮素显著提高小鼠BMS评分(P0.01),第28天治疗组BMS显著高于对照组(P0.01)。结论 槲皮素可明显促进脊髓损伤后轴突出芽,减少回缩,促进运动功能恢复。     

Long Term Vocational Adjustment After Spinal Cord Injury: Implications for Occupational Therapists

Sixty persons with spinal cord injury were interviewed an average of 11 years after the onset of disability. They answered questions concerning their sense of identity, knowledge of self and social environment, and ability to cope with vocational decision making and other problems. These questions were part of a standardised scale of Vocational Identity. The results of this study indicate that persons experiencing high levels of well-being also reported high levels of Vocational Identity. Other variables, which were found to be important correlates of well-being in a previous study by Decker and Schulz (1985), were also associated with Vocational Identity. Implications for occupational therapists are discussed.     

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.     

中上胸椎骨折脱位合并脊髓不完全性损伤的手术治疗

目的探讨中上胸椎骨折脱位合并脊髓不完全性损伤的手术治疗方法及疗效。方法 2006年4月至2010年3月,采用后路减压植骨融合长节段椎弓根钉内固定治疗中上胸椎骨折脱位合并脊髓不完全性损伤患者15例,观察术前、术后随访的X线及CT片,比较伤椎的Cobb角、椎体高度和神经损伤的变化情况。结果 15例患者均获12～48个月(平均26.5个月)随访,切口均一期愈合,骨折愈合时间:6～14个月(平均9.5个月)。术后并发症:肺部感染1例,深静脉血栓l例,均经处理后痊愈,无内固定失效发生。术前和术后在伤椎的Cobb角、椎体高度丢失方面进行比较,差异有统计学意义(P<0.05)。术后神经损伤按照ASIA分级:B级2例改善为C级,1例改善为D级;C级5例改善为D级,2例改善为E级;D级3例均改善为E级,无加重患者。结论中上胸椎骨折脱位合并脊髓不完全性损伤采用后路减压植骨融合长节段椎弓根钉内固定治疗可获得满意疗效,把握手术时机以及术中仔细操作是成功的关键。