[ARTICLE] Effectiveness of a structured sexual rehabilitation programme following stroke: A randomized controlled trial – Full Text

Abstract

Background: Sexual activity is an integral part of life; it is important to address sexual health after stroke, but this is often poorly done.

Objective: To assess the effectiveness of a structured sexual rehabilitation programme compared with written information alone regarding sexual and psychological functioning (anxiety, depression, stress), functional independence and quality of life in an Australian stroke cohort.

Methods: A total of 68 participants were randomized to a structured sexual rehabilitation programme (treatment group; n = 35) or to written information alone (control group; n = 33). Outcome measures included: Sexual Functioning Questionnaire Short Form; Depression, Anxiety Stress Scale; Functional Independence Measure, and Stroke and Aphasia Quality of Life Scale-39 Generic. Assessments were performed at baseline, 6 weeks and 6 months after the intervention. Participant’s preferences regarding how they would like to receive information, who from, and how frequently, were collected at baseline.

Results: There was no difference between groups for any outcome measures. Half of the participants (51%) wished to receive information and were divided equally into preferring written information vs face-to-face counselling, with the majority (54%) preferring information after discharge from an inpatient setting.

Conclusion: Provision of written information alone appears to be as effective as a 30-min individualized sexual rehabilitation programme in an inpatient setting. Further research is needed regarding longer term outcomes and outpatient settings.

Stroke is a leading cause of death and disability (1). Sexual dysfunction is common after stroke, and has multifactorial causes: damage to the brain (causing decline in sexual desire/interest and coital frequency for both sexes, decline in vaginal lubrication and orgasm in females, and in erection and ejaculation in males, and physical changes, such as hemiplegia with resulting impairment of mobility) together with medical issues, such as medications and premorbid medical conditions (diabetes, hypertension, cardiac issues) and psychological factors (fear of new stroke, loss of self-esteem, role/relationship changes) are major contributors (2–5).

Sexuality is a broad concept and may be experienced and expressed in a variety of ways; including thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles, and relationships (6). Sexual activity is an integral part of life and the importance of addressing sexual health after stroke is well accepted (7). Despite this, it is common for sexuality to be poorly addressed, not just in stroke, but also in other neurological conditions, such as spina bifida (8) and spinal cord injury (9). The 2012 Australian National Stroke Audit Rehabilitation Services Report (10), which included 2,789 post-stroke patients across 111 Australian public and private hospitals, showed that only 17% of patients received information on sexuality. This is despite the opportunities provided through the staffing complement in rehabilitation settings. In practice, allied healthcare providers could have a primary or secondary role in sexual rehabilitation; they could be the sole providers of intervention or provide further intervention in their specific areas of expertise, such as physiotherapy training to optimize mobility in bed for sexual positioning, nursing education for catheter management, and dyspraxia training with speech therapy for sexual activities such as kissing. In addition, although current guidelines recommend the assessment and management of post-stroke sexual dysfunction (7), it is unclear what types of intervention (timing, content, intensity, setting) should be provided and how effective they are. The only intervention study currently available in the literature that addresses the impact of intervention on sexual activity following stroke suggests that a sexual rehabilitation intervention programme prior to hospital discharge increased sexual satisfaction and frequency of sexual activity one month post-discharge, but did not promote sexual knowledge (11). This study was conducted with culturally homogenous 40–49-year-old Korean couples and had significant methodological limitations (generalizability, pre-post design, and short follow-up). Patient’s preferences relating to sexual counselling, such as the timing of such counselling, also varied, creating further challenges for optimization of care (12, 13). Some studies show that most participants feel overwhelmed in the early adjustment period and that the best time to address sexual adjustment issues is towards the end of an acute rehabilitation hospitalization or shortly after discharge. In a pilot randomized controlled trial (RCT) conducted in 2014, the feasibility and importance of providing sexual rehabilitation following stroke was demonstrated; however, the “pilot” nature of the study did not allow for conclusive findings to be drawn (14).

The primary aim of this RCT was to assess the effectiveness of a comprehensive structured sexual rehabilitation programme compared with written information alone, on sexual and psychological (anxiety, depression, stress) function, and on functional independence and quality of life in an Australian stroke cohort. Building on the previous pilot RCT, to our knowledge this will be the first adequately powered RCT in this area. The findings will provide evidence that may lead to improved care.

Continue —> Journal of Rehabilitation Medicine – Effectiveness of a structured sexual rehabilitation programme following stroke: A randomized controlled trial – HTML

[WEB SITE] Research Reports – Sexuality in individuals with traumatic brain injury and their partners – CNS

Neuropsychol Rehabil. 2016 Sep 28:1-10. [Epub ahead of print]

Downing M(1), Ponsford J(1).

Whilst previous research has detailed the impact of TBI on an individual’s
sexuality, few studies have investigated couples’ sexuality where one partner has sustained a TBI.

The study assessed sexual function in individuals with TBI and their partners. Fifty five individuals who had sustained TBI and their partners completed the Derogatis Interview for Sexual Function-Self Report (DISF-SR). All participants scored below the 50th percentile in relation to norms. Whilst participants with TBI obtained lower T-scores than partners on all subscales (except for sexual behaviour/experiences where scores were equivalent), as well as the total score, none of these differences was significant. Item analysis indicated that female participants with TBI reported significantly lower scores than female partners on frequency of having normal lubrication. Normative comparisons revealed that approximately one-third of individuals with TBI and one-fifth of their partners scored below the second percentile.

Given the high frequency of sexual problems in individuals with TBI, which also impact their partners, addressing sexual problems should be a priority in rehabilitation and beyond.

Source: Traumatic Brain Injury Resource Guide – Research Reports – Sexuality in individuals with traumatic brain injury and their partners

[WEB SITE] Sex and Sexuality | Stroke.org

 

Talking about sex is hard for many people in general. Surviving a stroke and experiencing sexual dysfunction can add to the uneasiness of the subject. Part of getting back into a normal routine and life involves resuming a healthy sex life. The need to love and be loved, and to have the physical and mental release sex provides, is important.

more —>  Sex and Sexuality | Stroke.org.

[WEB SITE] Sexuality and Traumatic Brain Injury

The connection between sexuality and traumatic brain injury (TBI) may not be immediately apparent, but decidedly, it exists.

When an individual sustains a traumatic brain injury and is in the acute and sub-acute stage of care, the primary goals are sustaining life and limiting the short and mid-term effects of the traumatic brain injury by appropriate care. Once that care has succeeded in achieving the immediate goals and the individual discharged for post-acute rehabilitation at a facility such as NeuLife Rehab in Mount Dora, Florida many other factors may surface and become relevant to the individual’s rehabilitation. Sexuality can be one of them.

When an injury involves the brain, it can be catastrophic or mild. Depending upon the part of the brain that is injured, comorbities and even the gender of the individual who sustained the injury, sexual issues may result. They can be of various types, including:

Decreased desire for sex

Increased desire for sex

Decreased arousal. This essentially means that while the individual has a desire for sex, his or her body does not respond in a way that allows sex to occur. Naturally, depending upon whether the traumatic brain injury occurred to a man or to a woman, the type of dysfunction will differ

Lack of or reduced ability to achieve ultimate satisfaction through sexual activity

Reproductive changes. In women, this can be caused by hormonal changes based upon the location of the traumatic brain injury and can result in the cessation of menstrual cycles for varying periods of time. Men can experience reduced sperm production. Either, or both, can result in difficulties in a woman becoming pregnant. In turn, this can result in psychological and relationship problems that may require specialized rehabilitation.

Continue –> Sexuality and Traumatic Brain Injury.

[VIDEO] How Can Brain Injury Affect a Person’s Sexuality? – YouTube

How can brain injury affect a person’s sexuality?

via How Can Brain Injury Affect a Person’s Sexuality?.

[REVIEW] Community Reintegration | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF

 

Abstract

While the majority of stroke survivors return to live in the community, re-integration may be an enormous challenge. The ability to return to an acceptable lifestyle, participating in both social and domestic activities is important for perceived quality of life. The present review examines issues arising following discharge from hospital care or rehabilitation into the community. These include social support, impact of caregiving on informal carers, family functioning, provision of information and education, leisure activities, driving, sexuality and return to work.

Get Full Text PDF

via Community Reintegration | EBRSR – Evidence-Based Review of Stroke Rehabilitation.