Sexual education in spinal cord injury rehabilitation: Current trends and recommendations

Persons with spinal cord injuries (SCI) (N=458) representing a national sample were surveyed by mail to determine trends in the provision of sexual education and sexual counseling services in rehabilitation programs. Of the competed responses (N=251), 45% remembered receiving such services. When sexual education/counseling services were provided, the components of the services varied considerably, and; for the most part, the subject of sexuality was superficially treated. Only 48% of those who received such services reported the services they received met their needs (N=53). The odds of not receiving sexual education or sexual counseling services for female respondents were about two times greater than for male respondents. The study also reveals a gap between services provided during rehabilitation and services desired by consumers. Recommendations are then offered for the development of sexual education and sexual counseling programs that may better meet the needs of persons with SCI.A thesis presented to the Department of Epidemiology and Public Health, Yale University, New Haven, Connecticut, 1991.     

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.     

Rehabilitation professionals and sexual counseling for spinal cord injured adults

The Michigan Rehabilitation Association (M.R.A.) and the Program in Human Sexuality of the University of Minnesota collaborated to produce a 1-day seminar on sexual function in spinal cord injury. Evaluation of the participants and the seminar showed that the program was beneficial for most and harmful for few. Questionnaire responses indicated that few M.R.A. members are currently doing sexual counseling but many see an opportunity to do so. A relationship appeared between those who have received some form of training in sexual counseling and those who are doing counseling with clients. It is postulated that frank and sincere discussion of sexuality may improve rapport between client and counselor. However, before such an interaction can comfortably take place, the counselor may gain from an opportunity to examine his or her own attitudes toward human sexuality and gather more information about the sexuality of physically disabled adults.This study was supported in part by Rehabilitation Research and Training Center Grant No. RT-2, Social and Rehabilitation Services, Department of Health, Education, and Welfare, Washington, D.C., the Bush Foundation, The Commonwealth Fund, and the University of Minnesota Medical School.     

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.     

Female sexuality after spinal cord injury

A questionnaire investigating women's perception of sexuality and sexual behavior after spinal cord injury was mailed to all 74 women followed by the Central Pennsylvania Spinal Cord Injury Program. 37% responded. (After spinal cord injury, women rated sex as being 26% less important to them, but also felt 23% less satisfied with their sexual lives.) 52% were able to achieve an orgasm after their injury, but half of the women who experienced orgasm felt it was different after spinal cord injury. The biggest perceived change after spinal cord injury was perceived attractiveness of their bodies. Women rated their bodies as being only half as attractive after their injury as before. Female sexuality remains a vastly underresearched area in spinal cord injury, and much more data is needed to counsel women about sex after their injury. All members of the rehabilitation team need to be comfortable addressing issues of sexuality with their patients.Presented at the American Spinal Injury Association Annual Meeting, Orlando, FL, May 4, 1990.     

延伸护理在脊髓损伤患者中的应用效果

目的 探讨延伸护理联合膀胱自我管理指导在脊髓损伤患者中的应用情况.方法 选择2018年4月4日-2019年9月30日在本院接受治疗的脊髓损伤患者60例,按照随机数表法将其分为2组,各30例.其中对照组患者单纯接受自我管理指导,观察组患者在对照组的基础上联合延伸护理.对比两组患者的日常生活自理能力、生存质量、干预前后膀胱...     

Sexual response in spinal cord injured adults: A review of the literature

The literature on sexual response in spinal cord injured (SCI) adults is reviewed and criticized. Principal characteristics of spinal cord injury are reviewed, and variables usually taken into account in studying sexual behavior in the SCI population are specified. Target behaviors of erection, ejaculation, attempts at intercourse, and male and female orgasm are isolated, and relevant data are reported. Attention is given to conceptual and methodological shortcomings of past research. Literature relevant to remediation of sexual problems in the SCI population is reported, and outcomes are noted. Future directions for research are indicated with particular emphasis placed on the appropriate utilization of psychophysiological techniques.This article is a condensed version of a chapter published inHandbook of Sex Therapy, LoPiccolo, J., and LoPiccolo, L. (eds.), Plenum, New York, 1978.     

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.     

颈部脊髓损伤急性期肺部感染危险因素

 目的 探讨颈部脊髓损伤（CSCI）急性期肺部感染的危险因素。方法 回顾性分析108例CSCI患者（C1~C8脊髓损伤）的临床资料,根据发病后1个月内是否发生肺部感染,分为肺部感染组和非肺部感染组。分析两组患者的基本情况、受伤形式、相关实验室检查等相关资料。结果 108例患者中,55例发生肺部感染,肺部感染发生率为50.9%。单因素分析发现,低血红蛋白水平、ASIA分级、低钠血症、呼吸机辅助通气可能是CSCI患者发生肺部感染的影响因素（均P<0.05）。多因素logistic回归分析结果显示,ASIA分级（OR＝0.399,95%CI：0.227~0.702,P＝0.001）、呼吸机辅助通气（OR＝77.564,95%CI：8.587~700.595,P<0.001）、血清钠离子水平（OR＝0.839,95%CI：0.735~0.958,P=0.009）为CSCI患者肺部感染的危险因素。结论 对于CSCI患者,ASIA分级A或B级、使用呼吸机辅助通气,以及低钠血症是肺部感染的独立危险因素。     

康复健康教育对脊髓损伤患者康复疗效的影响

目的：探讨康复健康教育对脊髓损伤患者康复疗效的影响。方法：57例脊髓损伤患者在人院后、康复全过程中、出院前进行康复健康教育指导；进行入院时、出院前疾病康复知识、预防并发症知识、ADL各项目评分比较。结果：患者出院前疾病康复知识、预防并发症知识均高于人院时；ADL各项目评分比较均高于人院时，差异均有统计学意义（P〈0．01）。结论：康复健康教育对提高脊髓损伤患者康复疗效有较大影响；对促进脊髓损伤患者的康复起着至关重要的作用。     

对脊髓损伤患者实施心理康复护理的临床效果观察

目的对脊髓损伤患者实施心理康复护理,观察和分析其护理的临床疗效。方法按照随机数字表法将120例脊髓损伤患者分为对照组和康复组。对照组实施常规护理,康复组在对照组基础上实施心理康复护理,比较2组护理前后FMA、Barthel、Sheikh评分以及SDS、SAS评分。结果经过护理后,两组患者的FMA、Barthel以及Sheikh评分比干预前明显提高,且康复组优于对照组（P〈0.05）;两组患者的SDS和SAS评分明显下降,且康复组比对照组下降更明显（P〈0.05）。结论对脊髓损伤患者实施心理康复护理,可有效改善患者运动功能和日常生活能力,同时改善患者的抑郁和焦虑状态,促进患者康复。     

Exploring the factors that influence the goal setting process for occupational therapy intervention with an individual with spinal cord injury

This paper investigates the factors that influence the process that occurs between an individual with a spinal injury and his/her occupational therapist when setting goals for therapy intervention. A single case study design was adopted using a combination of in-depth semistructured interviews with a therapist and patient, and observation of occupational therapy treatment sessions. After analysis of the results, the following four categories emerged as influencing the goal setting process: the context for setting goals; the concept of independence; the features of goals; and the process dimensions of goal setting. The study highlights that the patient and therapist's respective views of independence, and their understanding of the features of goals may influence the success of the goal setting process. Further investigation into these areas is indicated.     

Clinical observations in vibratory stimulation of the penis of men with spinal cord injury

Less than 10% of men with complete spinal cord injury experience ejaculation in intercourse. Vibratory stimulation of the penis triggers a predictable series of body reactions in most men with lessions above the thoracic 11th spinal cord level. These reactions are very similar to the physical manifestations of the sexual response in men with intact nervous systems. Between half and three quarters of men with lesions above the thoracic 11th spinal cord level ejaculate. The spermatozoa count is within the normal range. but the percentage of motile spermatozoa is low. The reactions leading to ejaculation take between 30 sec and 3 min and are characterized by rhythmic abdominal and leg spasms, lowered, then elevated pulse rates, elevation of blood pressure, and after the culmination of these experiences, relaxation, tiredness, and a general feeling of well-being. Autonomic dysreflexia (elevation of the blood pressure and severe headache) was avoided with preventive medication. The observations suggest that interrelated ejaculatory centers may be located in the thoracic 11th-and-below areas of the spinal cord. The vibratory stimulation technique has positive implications for both the reproductive and sexual needs of men with spinal cord injury and their partners.The authors acknowledge the generous grant of the Mr. & Mrs. P. A. Woodward Foundation toward the Fertility Project at the G. F. Strong Rehabilitation Centre and the University Hospital, Shaughnessy Site.     

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.     

Lifetime Active Care: A qualitative study of long‐term family carers of people with spinal cord injury in Australia

This study reports the findings of a qualitative, grounded theory study which explored the experiences of partners and other long‐term family carers living with and supporting loved ones with spinal cord injury. The study is exploratory in that little was previously known about the experience of long‐term care‐giving in this context in Australia. Most research in this area has focused on this experience during the first 5 years postinjury. This study focuses on the experiences of family carers beyond that 5‐year period. The study aimed to explore the experience of partners and other long‐term family carers of people with spinal cord injury, and illuminate their daily lives, interests, concerns and caring approaches in this context. Data collection included in‐depth interviews, a focus group and an on‐line, password‐protected research blog for participant narrative reflections. Findings revealed that the experience of long‐term caring is complex, all‐encompassing and lifelong. This experience is conceptualised here as lifetime active care which always involves what we describe as protective, negotiated, surreptitious and strategic caring. These dimensions of caring are interdependent and deeply embedded in the daily, active support provided by long‐term carers of people with spinal cord injury. We argue that carers in this context are involved in processes that have, in other contexts, been conceptualised as narrative reconstruction and also that the four dimensions of caring identified involve significant emotion work. The social processes of lifetime active care may shed light on the experiences of family carers in other long‐term care contexts.     

胸腰段脊柱骨折伴脊髓损伤治疗方法的对比研究

目的观察前路手术入路和后路手术入路治疗胸腰段脊柱骨折伴脊髓损伤的疗效。方法 2010年3月～2011年4月笔者所在医院治疗胸腰段脊柱骨折伴脊髓损伤患者44例,随机分为两组,前路手术组和后路手术组,各22例。对两组患者治疗的疗效进行分析。结果两组患者经治疗后,前路手术组术后运动评分、触觉评分、cobb角、伤椎高度恢复情况好于后路手术组,差异有统计学意义（P〈0.05）。结论前路手术入路可让患者的脊髓功能得到良好的恢复,其疗效优于后路手术入路。