Talking About Sexuality in the Context of Rehabilitation Following Traumatic Brain Injury: An Integrative Review of Operational Aspects

Deschênes, Pascale Marier; Lamontagne, Marie-Ève; Gagnon, Marie‐Pierre; Moreno, Jhon Alexander

doi:10.1007/s11195-019-09576-5

Cited by 10 publications

(8 citation statements)

References 37 publications

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“…In these instances, a psychological-based intervention characterised by eight sessions with a clinical psychologist may not be beneficial, rather a different discipline, such as physiotherapy or occupational therapy, may be better placed to address the issues. Indeed, there is a strong consensus that interdisciplinary sexuality service delivery is required to meet the needs of the TBI population [ 17 , 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several models and recommendations have been put forth for the management of sexuality problems after TBI. Extant literature advocates for the PLISSIT model [ 27 ] as one approach that may be used to address sexual health and wellbeing across TBI healthcare settings [ 14 , 28 , 29 , 30 ]. The acronym PLISSIT classifies four levels of intervention: permission to discuss sexuality, provision of limited information, specific suggestions regarding the individual’s sexual problem, and intensive therapy with a qualified healthcare professional.…”

Section: Introductionmentioning

confidence: 99%

“…As a result, there is little information on interventions for persistent and complex post-TBI sexuality problems at the Specific Suggestions and Intensive Therapy levels. Although previous research has offered broad and nonspecific recommendations for the use of counselling, individual and group psychotherapy, sex therapy, pharmacology, and cognitive and behavioural therapy to address sexuality problems after TBI [ 5 , 17 , 29 , 32 , 39 , 40 , 41 ], only a handful of descriptive case reports [ 41 , 42 , 43 ] and single case studies [ 44 , 45 ] have been completed. Studies have generally focused on treating male sexual dysfunction through the application of standard medical and sex therapy treatments [ 44 , 45 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluating a Novel Treatment Adapting a Cognitive Behaviour Therapy Approach for Sexuality Problems after Traumatic Brain Injury: A Single Case Design with Nonconcurrent Multiple Baselines

Fraser

Downing

Haines

et al. 2022

JCM

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There has been little progress in development of evidence-based interventions to improve sexuality outcomes for individuals with traumatic brain injury (TBI). This study aimed to evaluate the preliminary efficacy of an individualised intervention using a cognitive behaviour therapy (CBT) framework to treat sexuality problems after TBI. A nonconcurrent multiple baseline single-case design with 8-week follow-up and randomisation to multiple baseline lengths (3, 4, or 6 weeks) was repeated across nine participants (five female) with complicated mild–severe TBI (mean age = 46.44 years (SD = 12.67), mean post-traumatic amnesia = 29.14 days (SD = 29.76), mean time post-injury = 6.56 years (median = 2.50 years, SD = 10.11)). Treatment comprised eight weekly, individual sessions, combining behavioural, cognitive, and educational strategies to address diverse sexuality problems. Clinical psychologists adopted a flexible, patient-centred, and goal-orientated approach whilst following a treatment guide and accommodating TBI-related impairments. Target behaviour was subjective ratings of satisfaction with sexuality, measured three times weekly. Secondary outcomes included measures of sexuality, mood, self-esteem, and participation. Goal attainment scaling (GAS) was used to measure personally meaningful goals. Preliminary support was shown for intervention effectiveness, with most cases demonstrating sustained improvements in subjective sexuality satisfaction and GAS goal attainment. Based on the current findings, larger clinical trials are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluating a Novel Treatment Adapting a Cognitive Behaviour Therapy Approach for Sexuality Problems after Traumatic Brain Injury: A Single Case Design with Nonconcurrent Multiple Baselines

Fraser

Downing

Haines

et al. 2022

JCM

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“…Because concussed patients are often discharged from the ED and not admitted, rigorous follow-up may be needed to ensure that these patients, females in particular, get adequate follow-up care to abate some of the long term consequences of the injury-sexual changes included. Providers should be trained to address sexual health after concussions with their patients in the outpatient setting, and prescribe the necessary behavioral and/or pharmacological therapies required to address the concerns raised by their head injured patients (Parish et al 2019;Deschênes et al 2019;Deschenes et al 2017). This is especially crucial given the higher prevalence of pituitary dysfunctions in concussed (16.8%) compared to moderately injured TBI (10.9%) patients.…”

Section: Discussionmentioning

confidence: 99%

Mild traumatic brain injury/concussion and female sexuality, a scoping review of the literature

et al. 2020

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Background: The American Congress of Rehabilitation Medicine (ACRM) in 2010 called for more head injury research on gender disparities to bridge the gender gap for the short-and long-term effects of TBI, including sexual and reproductive outcomes. In this paper, we review the state of the literature before and after the ACRM announcement, and evaluate how research teams have considered females and mildly injured TBI(mTBI)/concussion groups in post-TBI-related changes in sexual functioning. Methods: The research question for this scoping review was "what is the state of the literature in the evaluation of post-TBI sexual changes for women, and individuals with mTBI?" Using the 2010 ACRM call for action as a line of demarcation, we compared our findings before and after the 2010 announcement. Results: We identified 9 research studies that addressed sexual functioning changes in females and mTBI/ concussion groups. Four of the nine were published before the 2010 ACRM announcement, and five were published after. The representation of female research participants increased steadily over the 28-year timespan. The proportion of individuals with mTBI included in the post-2010 era was higher than the earlier time period. Consistently, women with mTBI reported more adverse sexual outcomes compared to male cohorts, orthopaedic, and non-injured comparison groups. This observation persisted regardless of recruitment site (rehabilitation center/ Emergency Department (ED)/Community) or time of outcome assessment (acute versus chronic). The findings also remained despite the heterogeneity of survey questionnaires used to evaluate sexual functioning outcomes.Excluding the most recent 2019 study, none of the research groups compared the findings by TBI severity, making it difficult to fully understand how concussion-related sexual changes compare to more severe forms of the head injury. The long term impacts of the sexual changes, such as infertility and relationship discord were also absent across all studies; even though most evaluated outcomes chronically (some as far out as 20 years post injury). Conclusion: The number of publications in the era before the ACRM call for action and afterwards were almost identical. In order to tailor interventions for the appropriate groups of TBI patients, more neurosexuality research is needed to increase awareness of the importance of sexuality as a health outcome for individuals with neurodisabilities.

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“…Accordingly, in a Canadian study conducted in a stroke rehabilitation setting, Auger et al [35] showed that individuals poststroke considered sexuality issues as important but still secondary to activities of daily living (ADL) [35]. In a review of articles, books, and essays concerning sexuality issues in TBI rehabilitation, many sources highlighted the importance of written materials, and suggested that sexuality rehabilitation should be initiated early in brain injury rehabilitation [36]. Many of these sources referred to the PLISSIT model [37] to assess sexuality in brain injury rehabilitation.…”

Section: Assessing Sexuality At Rehabilitationmentioning

confidence: 99%

Unmet Need for Sexual Rehabilitation after Acquired Brain Injury (ABI): A Cross-Sectional Study Concerning Sexual Activity, Sexual Relationships, and Sexual Rehabilitation after ABI

Holmström

Elmerstig

2023

Sex Disabil

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In relation to brain injury rehabilitation, research has stressed the importance of including sexuality issues due to increased risk for sexual dysfunctions after Acquired Brain Injury (ABI). This study aims to explore experiences after non-stroke ABI concerning individual and relational aspects of sexuality, received information about sexuality at rehabilitation, and gender differences. A postal nationwide survey was conducted in Sweden, 2018–2019. The sample included individuals who had participated in brain injury rehabilitation 2014–2016, response rate 40% (250/624). Among all participants 78% had resumed sexual activity, and there was a significant difference between males (84%, 118/140) and females (69%, 76/110, p = 0.004). Among all participants, 95% reported physical intimacy as important, 80% considered sex as important on an individual level, and 91% stated sexuality as important for the relationship (no gender differences). Significantly more females (52%) than males (22%) reported that they had tried sexual aids (p = 0.000), and more males (29%) than females (16%) reported that professionals addressed sexuality issues during brain injury rehabilitation (p = 0.024). However, only a few participants were offered specific sexual counseling during brain injury rehabilitation, such as individual counseling (3%), couples counseling (2%), and group counseling (3%). To conclude, the vast majority valued both individual and relational aspects of sex and sexuality highly, and more males than females had resumed sexual activity. Few had received information about sexuality after ABI, and even fewer females compared to males reported that the issue was raised during rehabilitation. Clinical implications are discussed in relation to sexual rehabilitation.

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Talking About Sexuality in the Context of Rehabilitation Following Traumatic Brain Injury: An Integrative Review of Operational Aspects

Cited by 10 publications

References 37 publications

Evaluating a Novel Treatment Adapting a Cognitive Behaviour Therapy Approach for Sexuality Problems after Traumatic Brain Injury: A Single Case Design with Nonconcurrent Multiple Baselines

Evaluating a Novel Treatment Adapting a Cognitive Behaviour Therapy Approach for Sexuality Problems after Traumatic Brain Injury: A Single Case Design with Nonconcurrent Multiple Baselines

Mild traumatic brain injury/concussion and female sexuality, a scoping review of the literature

Unmet Need for Sexual Rehabilitation after Acquired Brain Injury (ABI): A Cross-Sectional Study Concerning Sexual Activity, Sexual Relationships, and Sexual Rehabilitation after ABI

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