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van den Broek B, Rijnen S, Stiekema A, van Heugten C, Bus B. Factors related to the quality and stability of partner relationships after traumatic brain injury: A systematic literature review. Arch Phys Med Rehabil 2022; 103:2219-2231.e9. [PMID: 35395254 DOI: 10.1016/j.apmr.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/22/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The latest literature review on partner relationships following traumatic brain injury (TBI), conducted a decade ago, discussed solely quantitative work and noted significant knowledge gaps. The current review updates and expands on this work by providing an overview of the current state of knowledge on factors related to relationship quality and stability following TBI. DATA SOURCES CINAHL, Embase, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycINFO, and PubMed were searched on April 23, 2020, for literature on factors associated with 1)relationship quality and 2)relationship stability following TBI. STUDY SELECTION English quantitative and qualitative studies investigating factors associated with relationship quality and/or stability following TBI were included. Two reviewers independently assessed eligibility. If consensus was not reached, a third reviewer's conclusion was decisive. Forty-three studies were included. DATA EXTRACTION Information regarding study objectives and characteristics, participant demographics, (in)dependent variables, and main findings was extracted. Study quality was rated using the JBI Checklist for Analytical Cross Sectional Studies and/or the CASP Checklist for Qualitative Research. Both were performed by the lead reviewer and checked by the second reviewer. DATA SYNTHESIS Thirty-eight factors related to relationship quality and/or stability were identified, covering injury characteristics (e.g., severity), body functions (e.g., personality changes), activities (e.g., communication), participation (e.g., social dependence), environment (e.g., children), and personal factors (e.g., coping strategies). CONCLUSIONS Relationship quality and stability following TBI are found to be related to a multitude of factors, including newly identified factors such as personality changes and dependence. Future research may wish to quantitatively investigate factors thus far only identified in qualitative research, explore possible positive effects of TBI on relationships, study the experiences of same-sex couples, and include the perspectives of both partners with and without the injury.
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Affiliation(s)
- Brenda van den Broek
- Multidisciplinary Specialist Centre for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel, the Netherlands; School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands.
| | - Sophie Rijnen
- Multidisciplinary Specialist Centre for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands
| | - Annemarie Stiekema
- School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands
| | - Caroline van Heugten
- School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands; Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands
| | - Boudewijn Bus
- Multidisciplinary Specialist Centre for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands
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Marier-Deschênes P, Gagnon MP, Déry J, Lamontagne ME. Traumatic Brain Injury and Sexuality: User Experience Study of an Information Toolkit. J Particip Med 2020; 12:e14874. [PMID: 33064104 PMCID: PMC7434066 DOI: 10.2196/14874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/01/2019] [Accepted: 12/19/2019] [Indexed: 01/30/2023] Open
Abstract
Background After having sustained a traumatic brain injury (TBI), individuals are at risk of functional impairments in information processing, abstract reasoning, executive functioning, attention, and memory. This affects different aspects of communicative functioning. Specific strategies can be adopted to improve the provision of health information to individuals with TBI, including the development of written materials and nonwritten media. Objective A user-centered design was adopted to codevelop four audiovisual presentations, a double-sided information sheet, and a checklist aimed at informing individuals about post-TBI sexuality. The last phase of the project was the assessment of the user experience of the information toolkit, based on the User Experience Honeycomb model. Methods Overall, two small group discussions and one individual semistructured interview were conducted with individuals with moderate to severe TBI. Results The participants mentioned that the toolkit was easily usable and would have fulfilled a need for information on post-TBI sexuality during or after rehabilitation. They mostly agreed that the minimalist visual content was well-organized, attractive, and relevant. The information was easily located, the tools were accessible in terms of reading and visibility, and the content was also considered credible. Conclusions Aspects such as usability, usefulness, desirability, accessibility, credibility, and findability of information were viewed positively by the participants. Further piloting of the toolkit is recommended to explore its effects on the awareness of the potential sexual repercussions of TBI in individuals and partners.
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Affiliation(s)
- Pascale Marier-Deschênes
- Université Laval, Department of Rehabilitation, Québec, QC, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada.,Centre de recherche sur les soins et services de première ligne de l'Université Laval, Québec, QC, Canada
| | - Marie-Pierre Gagnon
- Centre de recherche sur les soins et services de première ligne de l'Université Laval, Québec, QC, Canada.,Université Laval, Faculty of Nursing, Québec, QC, Canada.,Centre de recherche du CHU de Québec, Québec, QC, Canada
| | - Julien Déry
- Université Laval, Department of Rehabilitation, Québec, QC, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada
| | - Marie-Eve Lamontagne
- Université Laval, Department of Rehabilitation, Québec, QC, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada
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Marier-Deschênes P, Gagnon MP, Lamontagne ME. Co-creation of a post-traumatic brain injury sexuality information toolkit: a patient-oriented project. Disabil Rehabil 2019; 43:2045-2054. [PMID: 31729237 DOI: 10.1080/09638288.2019.1686543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM Different studies and two clinical practice guidelines emphasize the necessity to provide patients undergoing rehabilitation with information about commonly occurring changes in sexuality following traumatic brain injury (TBI). The purpose of this study was to co-create information resources for individuals with moderate to severe TBI and their partners to consult during rehabilitation. METHODS An iterative user-centered design was used, combining focus group and individual interviews. A convenience sample of individuals with TBI and life partners was constituted. RESULTS The needs and expectations of these participants in terms of form and content of an information toolkit on post-TBI sexuality were explored. The subjects that matched the interests and needs of participants were numerous and supported by the literature. Contrasting with existing written resources, the participants' views oriented the creation process toward the development of a toolkit including five audiovisual presentations, a double-sided information sheet, and a checklist. CONCLUSIONS A similar approach of co-creation could be used to develop other information packs aimed at patients with other disabilities. The created material is expected to be a usable and useful tool for individuals with TBI, which can support clinicians in addressing the subject of sexuality.Implications for rehabilitationThe central role held by individuals with moderate to severe traumatic brain injury, in identifying the sexuality related topics to be addressed and the form of resources to be created, led to a better understanding of their needs.This patient-centered research brought solutions to difficulties related to the understanding of health information, prevalent among patients.This patient-oriented project highlights the necessity for adequacy between the health information provided by rehabilitation professionals and the capacity of their patients' to seek for, process, and understand its content.
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Affiliation(s)
- Pascale Marier-Deschênes
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Canada
| | - Marie-Pierre Gagnon
- Faculty of Nursing, Université Laval, Québec, Canada.,Centre de Recherche du CHU de Québec, Québec, Canada
| | - Marie-Eve Lamontagne
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Canada
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Robert H, Pichon B, Haddad R. [Sexual dysfunctions after traumatic brain injury: Systematic review of the literature]. Prog Urol 2019; 29:529-543. [PMID: 31477433 DOI: 10.1016/j.purol.2019.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/23/2019] [Accepted: 08/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Sexual dysfunction (SD) is common in the general population, up to 50% in women and with no clearly defined prevalence in men but up to 30% in erectile dysfunction. Sexual dysfunctions (SD) are common after a traumatic brain injury (TBI) but remain underrated in clinical practice, yet it is a crucial aspect of the person with consequences for the relationship with the other, psychological wellbeing and quality of life. OBJECTIVE To determine, through a systematic literature review, the epidemiology, assessment tools and treatment of SD in the TBI population. SOURCES (keywords, languages): Medline, COCHRANE and OVID databases were used with specific keywords (MeSH), combined with Boolean operators: "sexual dysfunction", "sexuality", "erectile dysfunction" and "traumatic brain injury". STUDY SELECTION Only studies published in French or English, and with full-text available, have been included. Articles have been independently reviewed and extracted. RESULTS Of the 199 articles reviewed after exclusion of duplicates, 86 articles were reviewed in their full text. A total of 40 studies were included in the final analysis. After TBI, 6% to 83% of patients report SD: decreased frequency of sexual intercourse (47-62%), desire and/or arousal (24-86%), erectile dysfunction (24,2-57%), difficulties with orgasm (29-40%), inappropriate sexual behaviour (8,9%). There is no consensus method for evaluating SD in this population, with 16 tools identified. Among them, only two questionnaires were validated in this population, the Brain Injury Questionnary of Sexuality - not validated in French - and the Overt Behavior Scale, the latter being intended for the evaluation of sexual behaviour disorders. Several factors are significantly and positively associated with SD: age (P≤0.01), severity of TBI (P≤0.002), depression (P<0.001), anxiety (P<0.001), and fatigue (P=0.042). Others are negatively associated: time since injury (P=0.01), perceived physical health status (P<0.001) and social participation (P<0.001). There is little data on the treatment of SD outside of case studies. LIMITS Quantitative analysis could not be performed due to differences in the studies included in their design, evaluation tools, choice of TBI severity criteria, and post-TBI timeframes. Four unavailable articles could not be consulted. CONCLUSION SD are common after TBI but remain poorly evaluated in clinical practice, despite their impact on patients and their partners. Their evaluation and treatment should be part of the overall management of patients after TBI. Nevertheless, there is currently no validated tool in French to evaluate these SD, nor are there any guidelines on their treatment.
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Affiliation(s)
- H Robert
- GRC n°18, service de rééducation neurologique, Sorbonne université, UPMC université Paris 06, handicap moteur, cognitif et réadaptation (HaMCRe), Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, AP-HP, 75013 Paris, France.
| | - B Pichon
- GRC n°18, service de rééducation neurologique, Sorbonne université, UPMC université Paris 06, handicap moteur, cognitif et réadaptation (HaMCRe), Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, AP-HP, 75013 Paris, France; GRC 001, GREEN groupe de recherche en neuro-urologie, Sorbonne université, hôpital Rothschild, AP-HP, 75012 Paris, France
| | - R Haddad
- GRC 001, GREEN groupe de recherche en neuro-urologie, Sorbonne université, hôpital Rothschild, AP-HP, 75012 Paris, France
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Anto-Ocrah M, Bazarian J, Lewis V, Jones CM, Jusko TA, Van Wijngaarden E. Risk of female sexual dysfunction following concussion in women of reproductive age. Brain Inj 2019; 33:1449-1459. [PMID: 31322004 DOI: 10.1080/02699052.2019.1644377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objectives: Traumatic Brain Injury (TBI) has frequently been associated with changes in sexual functioning. The TBI and sexuality literature, however, has limited generalizability to concussed females, who often use the emergency department (ED) as their first line of care after head injury. Primary Objective: The primary objective of this study was to evaluate the impact of concussions on female sexual functioning. Secondary Objective: Secondarily, we evaluated if concussed women with sexual dysfunction also report more post-concussion symptoms (PCS) and/or mood changes. Research Design: This was a prospective cohort, with outcomes assessed at 6-10 weeks after ED enrollment. Methods and Procedures: Sexual dysfunction was defined as ≤ 45 on the Brain Injury Questionnaire on Sexuality (BIQS). The Rivermead Post-concussion Symptoms Questionnaire (RPQ) and the Hospital Anxiety and Depression Scale (HADS) assessed PCS and post-injury mood, respectively. Main Outcomes & Results: Eighty-nine eumenorrheic females (8-14 menstrual cycles/year) completed the study; 31(36%) had concussions, and 55(64%) were extremity injured. Concussed women had 70% increased risk of sexual dysfunction (adj.RR:1.70, 95% CI: 1.04,2.76; p = .03) versus extremity injured. Of clinical relevance, concussed women with sexual dysfunction also reported more PCS symptoms (adj.β = 5.5, 95% CI: -6.7,18.2; p = .37) and mood scores (adj.β = 8.0; 95% CI: -0.4, 16.4; p = .06). Conclusions: This study highlights the need for more research and interventions for one of the fastest growing subgroups within the TBI population.
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Affiliation(s)
- Martina Anto-Ocrah
- a Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA.,b Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA.,c Department of Neurology, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Jeff Bazarian
- a Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA.,c Department of Neurology, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA.,d Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Vivian Lewis
- b Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Courtney Marie Jones
- a Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA.,d Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Todd A Jusko
- d Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Edwin Van Wijngaarden
- d Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
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Sexuality Re-education Program Logic Model for People with Traumatic Brain Injury (TBI): Synthesis via Scoping Literature Review. SEXUALITY AND DISABILITY 2018. [DOI: 10.1007/s11195-018-09556-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Arango-Lasprilla JC, Olabarrieta-Landa L, Ertl MM, Stevens LF, Morlett-Paredes A, Andelic N, Zasler N. Provider perceptions of the assessment and rehabilitation of sexual functioning after Traumatic Brain Injury. Brain Inj 2017; 31:1605-1611. [DOI: 10.1080/02699052.2017.1332784] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Juan Carlos Arango-Lasprilla
- BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | | | - Melissa M. Ertl
- Division of Counseling Psychology, University at Albany, SUNY, Albany, New York, USA
| | - Lillian Flores Stevens
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA
- Departments of Psychology, Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Alejandra Morlett-Paredes
- Departments of Psychology, Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nathan Zasler
- Concussion Care Centre of Virginia, Ltd., Richmond, Virginia, USA
- Tree of Life Services, Inc., Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
- Vice-Chairperson of the International Brain Injury Association, Alexandria, VA, USA
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Strizzi J, Olabarrieta-Landa L, Olivera SL, Valdivia Tangarife R, Andrés Soto Rodríguez I, Fernández Agis I, Arango-Lasprilla JC. Sexual Function in Men with Traumatic Brain Injury. SEXUALITY AND DISABILITY 2017. [DOI: 10.1007/s11195-017-9493-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Simpson GK, McCann B, Lowy M. Treating male sexual dysfunction after traumatic brain injury: Two case reports. NeuroRehabilitation 2017; 38:281-9. [PMID: 27030904 DOI: 10.3233/nre-161319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Sexual dysfunction is common after traumatic brain injury (TBI) but evaluation of treatment interventions have been sparse. OBJECTIVE To report on the treatment of sexual dysfunction for two males with severe TBI. METHODS AND RESULTS Case one was treated for erectile dysfunction (ED). After a medical examination which found no underlying physiological problems, Sildenafil was prescribed. Scores on the Golombok Rust Inventory of Sexual Satisfaction Impotence subscale found that scores had improved from the dysfunction range at baseline to the functional range at 6 weeks follow-up. There was some reduction in this improvement at 3 months follow-up, maybe associated with a co-morbid deterioration of emotional state. Case two was treated for idiopathic delayed ejaculation (DE). A standard sex therapy intervention was employed that resulted in the resolution of the problem, documented on the Sex Behavior sub-scale of the Derogatis Inventory for Sexual Functioning-Self Report (comparing baseline to post intervention and follow-up scores). CONCLUSIONS The case reports show promise for the treatment of sexual dysfunction after severe TBI using standard medical and sex therapy treatments. In the future, controlled evaluations are required to demonstrate the efficacy of such interventions.
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Affiliation(s)
- Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia.,Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, NSW, Australia
| | - Brett McCann
- Australasian Institute of Sexual Health Medicine, Sydney, NSW, Australia
| | - Michael Lowy
- Australasian Institute of Sexual Health Medicine, Sydney, NSW, Australia
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Moreno A, Gan C, Zasler N, McKerral M. Experiences, attitudes, and needs related to sexuality and service delivery in individuals with traumatic brain injury. NeuroRehabilitation 2016; 37:99-116. [PMID: 26409696 DOI: 10.3233/nre-151243] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To explore the experiences, attitudes, and needs related to service delivery regarding sexuality issues in individuals with traumatic brain injury (TBI). METHODS Community-dwelling individuals with TBI having completed a post-acute TBI rehabilitation program. The TBI sample consisted of 16 men (42.1%) and 22 women (57.9%), with an average age of 38.9 years (SD = 9.9) and 12.8 years of education (SD = 2.8). They were on average 2.6 years post-injury (SD = 1.4). Glasgow coma scale at admission was on average 12.6 (SD = 3.5). Participants completed a questionnaire adapted to individuals with TBI addressing experiences, attitudes, and needs regarding sexuality and service delivery. RESULTS Individuals with TBI reported a low frequency of specific discussions with their treating clinician(s) about sexual and reproductive health issues, as well as many unmet needs regarding sexuality. None of the participants considered discussion about these issues to be inappropriate. They reported more favourable attitudes towards discussing sexual health topics compared to actual service delivery with family physicians, general practitioners, psychologists, and other health care professionals (p's < 0.05). CONCLUSIONS Individuals with TBI desired more openness about discussing sexual concerns. Findings are discussed in terms of the clinical implications to meet the individuals' needs regarding sexual concerns after TBI.
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Affiliation(s)
- Alexander Moreno
- Center for Interdisciplinary Research in Rehabilitation (CRIR) - Centre de Réadaptation Lucie-Bruneau (CRLB), Montréal, Québec, Canada.,Centre de Recherche en Neuropsychologie et Cognition (CERNEC), Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Caron Gan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Nathan Zasler
- Concussion Care Centre of Virginia, Ltd., and Tree of Life Services, Inc., Richmond, VA, USA.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Michelle McKerral
- Center for Interdisciplinary Research in Rehabilitation (CRIR) - Centre de Réadaptation Lucie-Bruneau (CRLB), Montréal, Québec, Canada.,Centre de Recherche en Neuropsychologie et Cognition (CERNEC), Department of Psychology, Université de Montréal, Montréal, Québec, Canada
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Bivona U, Antonucci G, Contrada M, Rizza F, Leoni F, Zasler ND, Formisano R. A biopsychosocial analysis of sexuality in adult males and their partners after severe traumatic brain injury. Brain Inj 2016; 30:1082-95. [PMID: 27260951 DOI: 10.3109/02699052.2016.1165867] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The primary aim of this study was to investigate changes in sexual function in males and their partners following severe TBI. Secondary aims of the study were to explore the relationship between selected sociodemographic, emotional/behavioural and sexual function variables. METHODS Twenty males with a history of severe TBI and 20 healthy controls (HC) and their respective partners were recruited. Sexual life was assessed with the Sexuality Evaluation Schedule Assessment Monitoring (SESAMO). Study participant level of self-awareness was evaluated by the Awareness Questionnaire, whereas their neuropsychiatric and psychopathological statuses were assessed by the NPI, the HAM-D and STAI. RESULTS A reduction in desire and frequency of sexual intercourse was found in all survivors and their partners. Moreover, higher levels of survivor depression correlated with lower partner harmony. Survivor feelings toward their partners gradually decreased over time, as did the ability to make decisions as a couple. The comparison with HC couples revealed that both survivors' and their partners' exaggerated the extent of disease. CONCLUSIONS After male severe TBI, men appear to have a reduced quality of their sexual life, which may be more a result of relationship dysfunction than a sexual performance deficit related to their brain injury history.
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Affiliation(s)
| | - Gabriella Antonucci
- a IRCCS Fondazione Santa Lucia , Rome , Italy.,b Department of Psychology , 'Sapienza' Università , Rome , Italy
| | - Marianna Contrada
- a IRCCS Fondazione Santa Lucia , Rome , Italy.,b Department of Psychology , 'Sapienza' Università , Rome , Italy
| | - Federica Rizza
- b Department of Psychology , 'Sapienza' Università , Rome , Italy
| | | | - Nathan D Zasler
- c Concussion Care Centre of Virginia, LTD.,d Tree of Life Services, Inc. , Richmond , VA , USA
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Abstract
OBJECTIVES The primary objective was to examine specific aspects of sexual functioning (frequency, desired frequency, importance, and satisfaction) and their relationship to fatigue in individuals with traumatic brain injury (TBI) compared with those without brain injury. The relationship of demographic variables, emotional well-being, and health-related quality of life to sexual functioning was also explored. PARTICIPANTS 200 community-dwelling adults with self-reported mild-to-severe TBI and 83 individuals without brain injury. MEASURES Participation Objective, Participation Subjective, Fatigue Assessment Instrument, Global Fatigue Index, Beck Depression Inventory, and SF-36 Health Survey. METHODS Data were collected through administration of self-report measures and interviews as part of a larger study of post-TBI fatigue. RESULTS Several aspects of sexual activity (frequency, desired frequency, and importance) were closely related to specific features of fatigue among individuals with TBI. Women with TBI reported lower frequency and lower importance of sex than men. In individuals without brain injury, the impact of fatigue was limited to the frequency of sexual activity with no sex differences observed. CONCLUSIONS Fatigue plays a different role in the subjective experience of sexual activity for men and women with TBI than for those without brain injuries. Fatigue and sex should be taken into account in future research and interventions focused on sexual function after TBI.
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Abstract
PURPOSE OF REVIEW Traumatic brain injury (TBI) is one of the leading causes of permanent disability in young adults and is frequently accompanied by changes in sexual behaviors. Satisfying sexuality is an important factor for overall quality of life in people with disabilities. The purpose of this article is to review the studies evaluating the assessment, correlates and management of sexuality following TBI. RECENT FINDINGS The Brain Injury Questionnaire of Sexuality is the first validated questionnaire specifically developed for adults with TBI. A considerable amount of individuals with TBI show inappropriate sexual behaviors and sexual dysfunctions. Whereas inappropriate sexual behaviors are related to younger age, less social participation and more severe injuries, sexual dysfunctions show an association with higher fatigue, higher depression scores, less self-esteem and female sex. Healthcare professionals have suggested that because of discomfort at the individual or institutional level, sexual problems are often not sufficiently addressed and have suggested that a specialist should treat sexual problems. SUMMARY Although some important correlates of sexual problems could be identified, methodological differences across studies limit their comparability. Furthermore, there is an absence of evidence-based treatment strategies for addressing sexual problems. Therapeutic efforts should take into account the identified correlates of sexual problems following TBI.
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Changes in sexual functioning from 6 to 12 months following traumatic brain injury: a prospective TBI model system multicenter study. J Head Trauma Rehabil 2014; 28:179-85. [PMID: 23661069 DOI: 10.1097/htr.0b013e31828b4fae] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate longitudinal changes in sexual functioning during the first year following moderate to severe traumatic brain injury (TBI). DESIGN Prospective cohort study. SETTING Community. PARTICIPANTS 182 persons (53 women and 129 men) with moderate to severe TBI who were admitted to 1 of 6 participating TBI Model System centers and followed in the community at 6 and 12 months after injury. MAIN MEASURES Derogatis Interview for Sexual Functioning-Self-Report (DISF-SR); Global Sexual Satisfaction Index (GSSI). RESULTS Mean T-scores on the DISF-SR Arousal subscale demonstrated marginal improvement over time, with a 2.59-point increase (P = .05) from 6 to 12 months after injury. There were no significant differences over this 6-month period on the remaining DISF-SR subscales, including sexual cognition/fantasy, sexual behavior/experience, and orgasm. There was no significant change in satisfaction with sexual functioning on the GSSI from 6 months (72% satisfied) to 12 months (71% satisfied). CONCLUSIONS AND IMPLICATIONS Sexual function and satisfaction appears to be stable in those with moderate to severe TBI from 6 to 12 months after injury, with the exception of minimal improvement in arousal. These findings, to our knowledge, reflect the first evidence regarding prospective changes in sexual functioning in this population. Future research can go far to assist clinicians in treatment planning and managing patient expectations of recovery of sexual functioning after TBI.
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Predictors of sexual functioning and satisfaction 1 year following traumatic brain injury: a TBI model systems multicenter study. J Head Trauma Rehabil 2014; 28:186-94. [PMID: 23661070 DOI: 10.1097/htr.0b013e31828b4f91] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate predictors of sexual functioning 1 year following traumatic brain injury (TBI). DESIGN Prospective cohort study. SETTING Community. PARTICIPANTS A total of 255 persons with TBI (187 males; 68 females) who had been treated at 1 of 6 TBI Model Systems inpatient rehabilitation units and were living in the community. MAIN MEASURES Derogatis Interview for Sexual Functioning-Self-Report (DISF-SR); Global Satisfaction With Sexual Functioning (Global Sexual Satisfaction Index); Participation Assessment With Recombined Tools-Objective; Patient Health Questionnaire-9. RESULTS Older age, female gender, and more severe injury were associated with greater sexual dysfunction 1 year following injury. As age increased from 24 to 49 years, the odds of sexual impairment increased more than 3-fold (95% confidence interval: 1.82-5.88). Females had a 2.5 increase in odds of sexual impairment compared with males (95% confidence interval: 1.23-5.26). Greater social participation was predictive of better sexual functioning. Dissatisfaction with sexual functioning was predicted by older age and depression. CONCLUSIONS AND IMPLICATIONS Older persons and females appear to be at greater risk for sexual dysfunction after TBI and may benefit from specialized assessment and treatment services. Relationships were identified between social participation and sexual function and between depression and sexual satisfaction that may serve as clinical indicators for further assessment and intervention. Further research is needed to elucidate these relationships and identify effective clinical approaches.
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Simpson G. Addressing the Sexual Concerns of Persons With Traumatic Brain Injury in Rehabilitation Settings: A Framework for Action. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.2.2.97] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractTraumatic brain injury (TBI) impacts upon people's sexuality with 50% to 60% of persons reporting some level of disruption post-injury. However, only small proportions of patients/family members report that rehabilitation health professionals made inquiries about whether they had any sexual concerns. Rehabilitation programs have a responsibility to meet the challenge of addressing this important area of human functioning. An agency framework is described that provides a non-threatening, structured way for services to conceptualise, introduce or upgrade sexuality services in a manner that can be maintained over the long term. The framework contains an underlying philosophy of sexuality, five proposed modalities of service provision and detail of the underlying organisational structures that are required to provide sexuality services with consistency and effectiveness over the long term. Finally, organisational strategies that can be employed to implement the framework are discussed as well as suggestions about the sequencing of such strategies. By using the framework, rehabilitation services can put sexuality back onto their treatment agenda, as they seek to restore patients/clients with TBI to the “highest level of adaptation attainable” (World Health Organisation, 1996, p. 1) in all areas of their lives.
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Exploring Experiences of Intimacy From the Viewpoint of Individuals With Traumatic Brain Injury and Their Partners. J Head Trauma Rehabil 2011; 26:56-68. [DOI: 10.1097/htr.0b013e3182048ee9] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The purpose of this study was to investigate body image concerns and psycho-emotional health in males with acquired brain injury (ABI). Using a between subjects study of 25 males with ABI and 25 matched controls, variables were analysed using correlations and 2 x 2 analyses of variance (ANOVAs) with head injury and injury type as independent variables. Body image and psycho-emotional health were evaluated using self-report questionnaires. Disability and cognitive impairment were measured using a mixture of self-report, cognitive testing and clinical notes. Results indicated that males with ABI had significantly lower self-esteem and body dissatisfaction on a number of items relating to physical and sexual functioning. There were significant differences in body image between stroke and TBI, but there was no corresponding relationship with psycho-emotional health. These body image differences might be explained by age. The finding that ABI has a negative effect on body image and that this relates to psycho-emotional health should be investigated further, perhaps being included in future rehabilitation strategies.
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Affiliation(s)
- Hannah Howes
- Department of Psychology, University of Wales, Swansea, Wales, UK.
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Simpson G, Long E. An Evaluation of Sex Education and Information Resources and Their Provision to Adults With Traumatic Brain Injury. J Head Trauma Rehabil 2004; 19:413-28. [PMID: 15597032 DOI: 10.1097/00001199-200409000-00006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate sex education and information resources developed to address the sexual health concerns of persons with traumatic brain injury (TBI) and the means by which agencies have introduced this clinically sensitive program initiative. DESIGN A process evaluation methodology was used to assess program reach, participant satisfaction, program component usage, and quality of materials. SUBJECTS Two samples comprising multidisciplinary rehabilitation and disability staff (n = 37) from 36 brain injury agencies that had been utilizing the resources and 12 people with brain injury, respectively. SETTINGS A diverse range of rehabilitation and community brain injury agencies. OUTCOME MEASURES Two purpose-designed evaluation protocols for staff and consumers, respectively, and a readability analysis to assess the comprehensibility of program materials (eg, information sheets) for people with TBI. RESULTS Agencies strongly endorsed their role in addressing consumer sexual health concerns. Agencies generally used a selective rather than a universal approach to sex education, with an average of 10% of consumers within agency caseloads receiving some intervention within the previous 12 months. The 4 issues most frequently addressed in education programs were sexual dysfunction, how to meet people, what is sexuality, and sexual adjustment in the context of established preinjury relationships. Finally, the average reading age needed to comprehend the resources was higher than the recommended levels for communicating health information. CONCLUSION The sex education program resources have been positively evaluated by both rehabilitation and community agencies as a means of providing education and information to address the sexual health concerns of people with TBI.
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Affiliation(s)
- Grahame Simpson
- Brain Injury Rehabilitation Unit, Liverpool Hospital, Liverpool BC, New South Wales 1871, Australia.
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