The Sexuality Education Program of the Massachusetts Statewide Head Injury Program

Traumatic brain injury (TBI) can create changes in a person's thinking and emotional self-control that can lead to unwanted and unsuccessful social behaviors. In some instances a person with a severe TBI may lose certain social abilities he or she may have once possessed, and might now show a lack of discretion or empathy or tact in their social behavior. Many individuals who were injured in childhood or adolescence might not have had sufficient opportunity to develop and refine adult socialization skills. These undeveloped, or diminished, social abilities are likely to affect an individual's sense of lovability and capability in terms of social and sexual relationships. Many persons with a TBI report a loss of pre-injury friendships, and increased loneliness and social isolation after an injury. Many individuals also report changes in their sexual drive, or sexual functioning, which additionally affect their ability to pursue intimate relationships, or successfully renegotiate changes in an existing intimate relationship. And yet, a person with a TBI will still experience normal human needs for closeness and affection, as well as normal sexual interests. Therefore, education and skill training and guidance are needed to assist the person with a TBI in making his or her best adjustment to these various changes and challenges. Also, some of the emotional and social challenges faced by the person with a TBI will be exhibited in his or her interactions with clinicians. So education and training is needed for staff as well in order for staff members to understand and respond to these behavioral concerns in an effective and skillful manner. To meet these needs, the Massachusetts Statewide Head Injury Program implemented the Sexuality Education Program. This article describes the components of a comprehensive sexuality related staff training and client education program for a statewide network of residential and day treatment programs serving adults with TBI.     

The Experience of Military Sexual Trauma and Rehabilitation for Individuals with Spinal Cord Injury/Dysfunction

It has been well documented that spinal cord injury injury/dysfunction (SCI/D) can have a substantial impact upon psychological functioning. The complications that are produced by such an event include an array of physical issues (e.g., incontinence, impotence) to social difficulties (e.g., social resource access). Originally, the rehabilitation treatment focused on the physical impairment and psychological effects on the individual. For example, literature on sexuality after injury has examined the areas of the sexual response cycle, reproductive functioning, sexual behavior, and adjustment. Today, as the professional's awareness of the incidence of sexual trauma increases, assessing the impact of trauma history is an important healthcare consideration. Within the VA Healthcare System, military sexual trauma history is routinely screened. The complexities of working with individuals with SCI/D and sexual trauma can be challenging as some may lack effective verbal and social skills necessary for resolving interpersonal conflicts and advocacy. A pragmatic clinical model to utilize social skills deficit training is described in conjunction with specific sexual trauma treatment, as a way of increasing effective working relationships to maximize rehabilitation potential. Reprinted with permission from AASCIPSW, SCI Psychosocial Process.     

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.     

Sexual Pursuits of Pleasure Among Men and Women with Spinal Cord Injuries

Following a spinal cord injury, sexual relationships, intimacy, and pleasure remain important pursuits for individuals. This literature review examines the subjective experiences of sexual intimacy for men and women with spinal cord injuries, as well as their intimate partners. Several themes emerged that span gender differences and nationality differences. Specifically, studies indicate that despite individual struggles with neutering internal and external perspectives, they can lead satisfying sex lives that may be more creative and mutually pleasurable than their sex lives prior to the injury. This review also provides suggestions to improve sex education and therapy following a spinal cord injury.     

脊髓损伤致截瘫患者的心理变化及护理对策

目的从整体观念出发,对患者的心理问题做全面分析,重视其心理活动与心理、生物、社会因素之间的相互制约和影响,制定相应的护理对策。方法自行设计护理对策,实施心理护理。结果28例患者均获得了心理重建。结论由于脊髓损伤而导致躯体的疾病,在其发生、发展以及转归过程中都与心理社会因素密切相关。有效的心理护理能影响和改变患者的心理状态,让患者在最佳的心理状态下主动接受治疗,提高患者的适应能力。     

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.     

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.     

康复期颈髓损伤高位截瘫患者系统化护理的疗效评价研究

目的：研究并探讨康复期颈髓损伤高位截瘫患者系统化护理的疗效评价研究。方法：选取2012年10月-20／4年3月本院收治的60例高位截瘫患者进行临床回顾性分析,根据护理方式的不同将患者分为两组。对照组30例采用常规方式护理,试验组30例采用系统化护理的方式护理,比较两组的护理效果。结果：试验组康复期并发症低于对照组,且总体有效率高于对照组,差异均有统计学意义（P〈0．05）;试验组护理后较前SAS分明显降低,且低于对照组护理后（P〈0．05）。结论：采用系统化护理对康复期颈髓损伤高位截瘫患者的康复效果较好,对于患者的生活质量有一定的提高,值得临床上大力推广。     

Training the Interdisciplinary Team in Sexuality Rehabilitation Following Spinal Cord Injury: A Needs Assessment

Historically, the management of sexuality issues in spinal cord injury rehabilitation has received scant attention as a staff training issue. This has occurred despite evidence in the literature identifying significant barriers to the provision of sexuality rehabilitation. This paper reports on a needs assessment conducted within an Australian spinal cord injury rehabilitation service to identify the training needs of staff in relation to client sexuality. Using the Knowledge, Comfort, Approach and Attitudes Towards Sexuality Scale (KCAASS), a previously developed theoretical model and questionnaire, 90 multidisciplinary staff were surveyed. A combination of open and closed questioning techniques were used. While the findings suggest some differences between disciplines, the training needs of the interdisciplinary team were surprisingly similar. Knowledge is required in the areas of counselling, professional boundary setting, fertility and assistive devices while specific training is needed to promote staff comfort in dealing with personal approaches from clients.     

预防截瘫患者褥疮发生的护理对策

目的探讨预防截瘫患者褥疮发生的护理对策。方法对26例截瘫患者在临床护理上关键是做好"五勤":勤翻身、勤擦洗、勤按摩、勤整理、勤更换等护理工作。结果 26例截瘫患者通过我们精心护理,无一例褥疮发生。结论预防截瘫患者褥疮的发生,做好早期预防护理工作十分重要,精心而合理的临床护理是防止截瘫患者发生褥疮的有效措施。     

预防截瘫患者褥疮发生的护理对策

目的探讨预防截瘫患者褥疮发生的护理对策。方法对26例截瘫患者在临床护理上关键是做好“五勤”：勤翻身、勤擦洗、勤按摩、勤整理、勤更换等护理工作。结果26例截瘫患者通过我们精心护理。无一例褥疮发生。结论预防截瘫患者褥疮的发生,做好早期预防护理工作十分重要,精心而合理的临床护理是防止截瘫患者发生褥疮的有效措施。     

Diagnostic Value of Urine Strip Testing for White Blood Cells: an Implication for Screening in Individuals with Spinal Cord Injury

Urinary tract infection (UTI) is an important health problem affecting millions of people each year. A significant high incidence of UTI can be seen in individuals with disabilities, especially those with paralysis due to spinal cord injury. Dip stick screening tests may offer promise as an early warning system of UTI since they are easy to perform and can be self-administered. Here, we report our experience of the diagnostic value of the urine strip test for white blood cell count in medical laboratory practice. The sensitivity of urine strip test was 100%, the specificity 92.2%, the positive predictive value 33.8% and the negative predictive value 100%. False positive was 7.8% and false negative 0%. This can confirm the needs for further examination in cases with positive urine strip screening test. Hence, the usage of urine strip examination as a screening tool for pyuria, an early sign of UTI among people with disabilities is recommended.     

The Influence of Visceral Fat on the Postprandial Lipemic Response in Men with Paraplegia

Background: Postprandial lipemia (PPL) is associated with vascular dysfunction and may be an etiologic factor in the progression of atherogenic cardiovascular disease.

Objective: In 10 men with paraplegia and 10 able-bodied men, the magnitude of the PPL responses and the relationship of abdominal adiposity and the PPL responses were determined.

Methods: Anthropometrics, dual energy x-ray absorptiometry, and abdominal ultrasonography were performed to determine visceral fat and total body fat. A fasting lipid profile was performed. A high-fat milkshake (1.3 g fat/kg body mass) was administered with serum collected at baseline and at 2, 4, and 6 hours after the test meal for subsequent measurement of triglyceride. The triglyceride response was determined by the area under the triglyceride curve.

Results: No significant differences were noted between the groups in fasting lipid values or in measures of visceral fat. Total body fat tended to be higher in men with paraplegia than in able-bodied men (34.9 ± 10.0 vs. 27.3 ± 6.7%, p = 0.07). No significant difference between the groups was observed in triglyceride response. In men with paraplegia, visceral fat was strongly associated with the triglyceride (r = 0.8, p = 0.005), fasting low-density lipoprotein (r = 0.66, p = 0.04), and triglyceride responses (r = 0.80, p = 0.005); a significant relationship was not found between fasting high-density lipoprotein and any measure of adiposity. In men with paraplegia, triglyceride response was positively related to all measures of abdominal adiposity.

Conclusion: Visceral abdominal fat was related to delayed triglyceride clearance after a fat load, which may contribute to coronary heart disease (CHD) risk and progression of vascular disease in men with paraplegia.     

Semen Quality in Males with Spinal Cord Injury: Medical and Psychological Aspect

Lower paraplegia is an important medical condition that presents a significant life challenge. One important concern in male with lower paraplegia is the complications in reproductive function. Indeed, sexual function is confirmed for the interrelationship between sexual function and autonomic dysreflexia. Sexual and genital prognosis in adult paraplegics is a present focus and will be presented in this article.     

外伤性截瘫患者医院感染相关因素分析

目的了解外伤性截瘫患者医院感染的发病率、感染部位及相关因素,为有针对性进行预防与控制医院感染的发生提供依据。方法对2004年1月~2008年12月出院的168例外伤性截瘫患者进行回顾性调查,通过查阅患者的病案资料,按照事先设计的项目逐一登记并进行统计汇总。结果发生医院感染55例、69例次,医院感染率32.74%、例次感染率41.07%;感染部位主要为泌尿道31例次(44.93%)、其次为呼吸道19例次(27.53%)、皮肤软组织13例次(18.84%);医院感染相关因素与住院时间、截瘫程度、年龄、手术及侵入性操作有关(P0.01);医院感染病原菌主要是条件致病菌,以G-菌为主。结论针对相关因素,尽量减少侵入性操作、缩短住院时间、加强基础护理、严格无菌观念,以减少医院感染的发生。     

Promoting psychological health in women with SCI: Development of an online self-esteem intervention

BackgroundThere are no known interventions addressing self-esteem in women following spinal cord injury (SCI).ObjectivesTo test the feasibility of an online self-esteem intervention for women with disabilities, as modified for women with SCI.MethodWe conducted a randomized, controlled feasibility test of a self-esteem intervention (N = 21). Participants were randomly assigned to the intervention or control group that received intervention materials at the end of the study. Intervention participants met as avatars for 7 weekly real-time group sessions in Second Life (SL), a free online virtual world. Feasibility indicators were study engagement, acceptability of SL and the intervention, and improvements on measures of psychological health promoting behaviors, social support, self-efficacy, self-esteem, and depression.ResultsIntervention participants (n = 10) were highly engaged, and most described the SL program as more enjoyable and more convenient than in-person programs. All rated the intervention as “good” (n = 4) or “very good” (n = 6), and all 10 rated themselves has having made positive life changes as a result of the program. Intervention participants experienced significantly greater change than controls on two measures of health-promoting behavior (Health Promoting Lifestyle Profile-II Spiritual Growth/Self-actualization; Interpersonal Relations). Examining change in the intervention group using regression analyses, we found medium-to-large effects of the intervention on these behaviors and measures of depression (CESD-10, PHQ-9). The intervention had small effects on remaining measures.ConclusionWe found preliminary support for the feasibility of this modified self-esteem intervention offered in SL. Such programming may help circumvent barriers to community-based psychological services and may improve psychological health.     

The Extended PLISSIT Model for Addressing the Sexual Wellbeing of Individuals with an Acquired Disability or Chronic Illness

This paper discusses the limitations in the way that healthcare practitioners may use Annon’s PLISSIT model in meeting the sexual wellbeing needs of individuals with an acquired disability and presents the merits of the extended model, Ex-PLISSIT. Key features of this model include explicit Permission-giving as a core feature of each of the other stages, the requirement to review all interactions with patients, and the incorporation of reflection as a means of increasing self-awareness by challenging assumptions.     

Development and evaluation of an educational curriculum for healthcare providers on overweight/obesity management in individuals with spinal cord injury based on diverse stakeholder engagement

BackgroundSpinal cord injury (SCI) healthcare providers are aware of the harmful consequences of overweight/obesity in persons with SCI, but many are unaware of available information and lack training to guide weight management care in the SCI population.ObjectiveDescribe the development and content of an educational curriculum for healthcare providers to help individuals with SCI prevent or manage overweight/obesity.MethodsThe biopsychoecological framework guided curriculum planning, data collection, and product development. Thematic analysis of interviews conducted with individuals with SCI, informal caregivers, and SCI healthcare providers pinpointed central educational curriculum topics. SCI healthcare providers evaluated the curriculum.ResultsSeven comprehensive topics were developed: 1. Scope and consequences of overweight/obesity in SCI; 2. Classifying and measuring overweight/obesity in SCI; 3. Guidelines related to weight management in SCI; 4. Identifying challenges (and solutions) to weight management in SCI; 5. Strategies for providers to facilitate weight management; 6. Understanding goals, motivators, and desired feedback for weight management; and 7. Knowing how informal caregivers are affected by weight and weight management of care recipients with SCI. High ratings (>80% strong agreement) were achieved on content, word choice, organization, relevance, and actionability. Modification needs were identified and subsequently made to layout, visual aids, and provision of tangible resources. Providers described the curriculum as a scientifically rigorous resource that addresses a knowledge gap, provides population-specific content, and is useful across interdisciplinary teams.ConclusionWe developed a self-directed learning educational curriculum addressing topics most salient to stakeholders involved in overweight/obesity management of persons with SCI.     

Starting a new conversation: Engaging Veterans with spinal cord injury in discussions of what function means to them,the barriers/facilitators they encounter,and the adaptations they use to optimize function

Background

Assessments of function in persons with spinal cord injury (SCI) often utilize pre-defined constructs and measures without consideration of patient context, including how patients define function and what matters to them.