NeuroRehabilitation - Volume 41, issue 2

Authors: Moreno, Alexander | Gan, Caron | Zasler, Nathan D.

Article Type: Editorial

DOI: 10.3233/NRE-001480

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 255-259, 2017

Authors: Simpson, Grahame | Simons-Coghill, Martine | Bates, Annerley | Gan, Caron

Article Type: Research Article

Abstract: BACKGROUND: Positive sexual development is a core task in the transition from childhood/adolescence to adulthood. Little is known about the extent of research addressing this topic after acquired brain injury (ABI). OBJECTIVE: To identify publications (1980 to 2016) addressing positive sexual health among children/adolescents with ABI. METHODS: A scoping review. RESULTS: A search conducted using OVID and PubMed databases yielded 2021 citations with 28 publications meeting the inclusion criteria (six reviews, one expert account, 19 observational and two intervention studies). Teenagers with ABI reported poorer body image, feeling less sexually or physically attractive than …sex and age matched non brain-damaged controls. The one study with findings on sexual orientation, reported 15% of adolescents with ABI identified as lesbian, gay or bisexual. Precocious puberty was a rare outcome from ABI, but the most common focus of the publications (14/28). Finally, two case studies (genital touching and classroom masturbation respectively) found that behavioral interventions were an effective means of extinguishing inappropriate sexual behaviour after childhood ABI. CONCLUSIONS: Sexual health is a neglected area of research in post-ABI care for children/adolescents. A better understanding of the needs and challenges will help rehabilitation professionals and parents provide more informed and effective supports. Show more

Keywords: Neurosexuality, pediatric, adolescence, traumatic brain injury, acquired brain injury, sexual health, sexual orientation, body image, precocious puberty, inappropriate sexual behaviour, scoping review

DOI: 10.3233/NRE-172197

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 261-280, 2017

Authors: Moreno, Jhon Alexander | McKerral, Michelle

Article Type: Research Article

Abstract: INTRODUCTION: Clinicians need to understand the heterogeneity of sexual problems following traumatic brain injury (TBI) for their adequate identification and treatment. OBJECTIVE: To systematically identify groups of individuals with TBI showing similar patterns of sexual functioning. METHODS: Forty-two individuals with TBI with a mean age of 37.9 years (SD = 9.7) and an average of 3.3 years post-injury (SD = 4.3). We included four primary measures in the cluster analysis (sexual quality of life questionnaire, sexual desire inventory, generalized anxiety disorder scale, and the patient health questionnaire for depression) and two secondary measures for cluster validation (post-concussion symptom scale and …dysexecutive questionnaire). RESULTS: A hierarchical cluster analysis using the Ward method revealed the existence of two groups of individuals with TBI: a) with sexual problems who were older, showed lower levels of sexual quality of life and sexual desire, with significant symptoms of anxiety and depression, and b) without sexual problems who were younger, showed high levels of sexual quality of life and sexual desire, as well as low complaints of anxiety and depression. CONCLUSIONS: Clinicians must be more proactive in assessing sexual concerns, mostly when emotional and cognitive difficulties are present in older individuals with TBI, regardless of gender, chronicity and injury severity. Show more

Keywords: Neurosexuality, cluster analysis, traumatic brain injury, sexual quality of life, sexual desire, depression, anxiety

DOI: 10.3233/NRE-172201

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 281-291, 2017

Authors: Grenier-Genest, Anabelle | Gérard, Marina | Courtois, Frédérique

Article Type: Research Article

Abstract: BACKGROUND: Stroke has multiple impacts on patients’ sexual functioning, be it directly caused by the neurological lesion (s) or indirectly triggered via other psychophysiological processes. Despite a growing number of publications, sexuality is still rarely addressed in the stroke literature - yet, patients have indicated their need for sexual rehabilitation services. OBJECTIVE: To provide a literature review on post-stroke sexual functioning as well as available rehabilitation programs targeting patients’ sexuality. METHODS: A systematic literature review was conducted on PubMed using the following key words and their combination: “stroke”, “sexuality”, “stroke characteristics”, “hemisphere”, “sexual”, and “sexual dysfunction”. …RESULTS: Existing data suggests the existence of significant associations between stroke and male and female sexual dysfunction (SD) as well as desire/libido and sexual satisfaction. The exact contribution of patients’ neurological profile (stroke laterality, location, and severity) on their SD remains inconclusive with research providing mixed findings. Psychological factors are shown to play a significant part in the development of patients’ SDs. A few intervention programs have been developed to specifically guide health professionals when addressing patients’ needs regarding their sexual recovery. CONCLUSION: Sexual rehabilitation needs to be an integrative part of stroke patients’ rehabilitation process, preferably at the interdisciplinary level. Show more

Keywords: Stroke, sexuality, sexual rehabilitation, neurological disorders, urinary incontinence, sexual dysfunction, neurosexuality

DOI: 10.3233/NRE-001481

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 293-315, 2017

Authors: Delaney, Kate E. | Donovan, Jayne

Article Type: Research Article

Abstract: BACKGROUND: Multiple sclerosis (MS) is an autoimmune condition affecting young women and men, resulting in varied disabilities, including sexual dysfunction. OBJECTIVE: This narrative review aims to describe the prevalence, pathophysiology, and impact of sexual dysfunction in people with MS (PwMS); provide a review of current assessment and treatment strategies; and offer considerations for future care. METHODS: Literature review was performed to identify primary and secondary sources discussing sexual dysfunction in PwMS. RESULTS: Sexual dysfunction is common in PwMS and can occur throughout the disease course. Sexual dysfunction is associated with depression, reduced quality of …life, and may have broader implications related to relationships, fertility, pregnancy, and parenting. The etiology is often multifactorial and can be classified as primary, secondary, or tertiary dysfunction. Sexual dysfunction in PwMS is underdiagnosed and undertreated; however, many healthcare providers may already have the skills required to care for PwMS with sexual dysfunction. CONCLUSIONS: Additional education for providers regarding the approach to assessment and management of sexual dysfunction, their potential role in treatment, and available specialized resources is needed. The role of interdisciplinary care with collaboration among providers should be considered. Further research should evaluate the impact of specific assessment tools and treatments on sexual dysfunction in PwMS. Show more

Keywords: Multiple sclerosis, neurosexuality, sexual dysfunction, sexual function, quality of life, interdisciplinary

DOI: 10.3233/NRE-172200

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 317-329, 2017

Authors: Shahbazi, Mona | Holzberg, Shara | Thirunavukkarasu, Saeyoan | Ciani, Gioia

Article Type: Research Article

Abstract: INTRODUCTION: Amyotrophic Lateral Sclerosis (ALS) may not affect an individual’s sexual function directly, but it can indirectly impact their sexual activity. Sexual partners often become caregivers, diminishing sexuality within a relationship. This can result in decline of quality of life. OBJECTIVE: The study aimed to explore the perspectives of individuals with ALS and their treating clinicians regarding the importance of sexuality in rehabilitation within a multidisciplinary ALS center. We hypothesize that individuals with ALS will express the need for sexuality-related discussions as a therapy. METHOD: Electronic 11-item questionnaires were anonymously completed by individuals with ALS (n … = 21) and ALS healthcare professionals (n  = 81) between August 2014 to June 2016. Descriptive statistics were performed in STATA 14. RESULTS: Majority (90%, n  = 92) of respondents stated that ALS impacts the sexuality of an individual with ALS, and agreed that sexuality-related discussion is needed as a complementary therapy. Over 75% of clinicians reported they were not familiar with any strategies or interventions to help the patients. CONCLUSION: ALS indirectly affects sexuality, thus confirming the need for promoting awareness regarding sexuality-related topics among individuals with ALS and healthcare professionals. ALS multidisciplinary clinics need to improve their delivery of care to address sexual rehabilitation as a complementary therapy. Show more

Keywords: ALS, sexual education, multidisciplinary care, neurosexuality, quality of life; sexuality

DOI: 10.3233/NRE-172204

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 331-342, 2017

Authors: Alexander, Marcalee Sipski | Aisen, Carrie Mlynarczyk | Alexander, Sterling Morrison | Aisen, Mindy Lipson

Article Type: Research Article

Abstract: BACKGROUND: Spinal Cord Injury (SCI) causes neurological impairment with resultant neurogenic sexual dysfunction which can compound preexisting psychological and medical sexual concerns. Understanding these concerns is important in managing the lifelong needs of persons with SCIs. OBJECTIVES: To provide an overview of the impact of SCI on sexuality along with a framework for treatment of sexual concerns. To briefly review male infertility and its treatments and pregnancy in females after SCI. METHODS: Interdisciplinary literature review and synthesis of information. RESULTS: The average age at SCI is increased, thus persons with SCIs may have preexisting …sexual concerns. Sexual activity and satisfaction are decreased after SCI. Psychogenic sexual arousal is related to remaining sensation in the T11-L2 dermatomes. Orgasm occurs in approximately 50% of persons with SCIs with all injuries except subjects with complete lower motor neuron (LMN) injuries affecting the lowest sacral segments A structured approach to treatment including assessing preinjury function, determining the impact of injury, education, assessing and treating iatrogenic sexual dysfunction and treatment of concomitant problems is recommended. Basic and advanced methods to improve sexual arousal and orgasm are discussed and treatment of anejaculation and issues associated with pregnancy and SCI are reviewed. CONCLUSIONS: Sexual satisfaction is impaired after SCI; however, education and new therapies can improve responsiveness. Future research is warranted to improve sexual function and fertility potential in persons with SCIs. Show more

Keywords: Spinal Cord Injury, neuro-sexuality, sexuality, fertility, autonomic nervous system, neurologic disorders,pregnancy, erectile dysfunction, electro-ejaculation, anejaculation

DOI: 10.3233/NRE-172202

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 343-357, 2017

Authors: Roelofs, Tineke S.M. | Luijkx, Katrien G. | Embregts, Petri J.C.M.

Article Type: Research Article

Abstract: BACKGROUND: The person-centered perspective of residential care facility (RCF) residents with dementia with regard to their intimate and sexual lives is largely neglected in research. OBJECTIVE: We aim to provide methodological considerations and reflections on a performed qualitative study. Recommendations and a guide to study design are provided to inform and encourage future research on the inclusion of people with dementia as participants. METHODS: Methodological recommendations and reflections are described in chronological order of the procedure. Fragments of interviews are included for further illustration and clarification. RESULTS: Considering preparation, close involvement of clinical practice, …and extensive deliberation regarding study design tended to be important. Considering procedure, investment in contacts with clinical practice and authorized representatives; an introduction meeting; person-centered inclusion and consent; profound skills in interviewing participants with dementia; and flexibility in data collection were proven of importance. Considering data analysis and study quality, including field notes and aiming at a balance between study quality and practicability to enhance study ‘rigor’ were found important. CONCLUSION: Including the person-centered perspective in research on intimacy and sexuality of RCF residents with dementia, is challenging and takes a flexible and creative approach. It is, however, worthwhile to close the gap in literature. Show more

Keywords: Neurosexuality, dementia, person-centered, guide to study design, methodology

DOI: 10.3233/NRE-172205

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 359-373, 2017

Authors: Moreno, Alexander | Laoch, Ari | Zasler, Nathan D.

Article Type: Research Article

Abstract: BACKGROUND: There is an increasing interest in sexual and gender diversity in neurorehabilitation. Healthcare professionals wanting to improve their practice know the importance of understanding the needs and expectations of specific communities. OBJECTIVE: To critically review the literature about neurological disorders in people who identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual, and people with other sexual orientations and forms of gender expression (LGBTQIA+). METHODS: Systematic search in electronic databases (CINAHL, EMBASE, Medline, PsycINFO, Scopus, and Web of Science) and identification of relevant studies. RESULTS: Quantitative and qualitative findings are summarized and reported …by neurological disorders: a) neurodisability/epilepsy (17.7%), b) intellectual disability/autism spectrum disorders (19.6%), c) dementia/HIV-related dementia (39.2%), d) spinal cord injury (7.8%), and e) traumatic brain injury/stroke (15.7%). CONCLUSIONS: LGBTQIA+ people with neurodisabilities and their partners/families of choice can conceal their sexual orientation or gender identity for fear of diminished quality of care. Their invisibility translates into health disparities, lack of policies and services that meet their unique needs. Dementia is the most common neurodisability documented in LGBTQIA+ people. We provide recommendations to increase LGBTQIA+ cultural competency for clinical practice, research, and policy to help different stakeholders to promote a positive change in the culture of neurodisability. Show more

Keywords: Neurosexuality, LGBTQIA+, LGBT, neurodisability, sexual diversity, gender identity, sexual orientation

DOI: 10.3233/NRE-172187

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 375-393, 2017

Authors: Taylor, Tessa | Kozlowski, Alison M. | Girolami, Peter A.

Article Type: Research Article

Abstract: BACKGROUND: Feeding disorders are multifaceted with behavioral components often contributing to the development and continuation of food refusal. In these cases, behavioral interventions are effective in treating feeding problems, even when medical or oral motor components are also involved. Although behavioral interventions for feeding problems are frequently employed with children with autism, they are less commonly discussed for children with cerebral palsy. OBJECTIVE: The purpose of this study was to compare the effectiveness of using applied behavior analytic interventions to address feeding difficulties and tube dependence in children with autism and children with cerebral palsy. METHOD: …Children ages 1 to 12 years who were enrolled in an intensive feeding program between 2003 and 2013, where they received individualized behavioral treatment, participated. RESULTS: Behavioral treatment components were similar across groups, predominately consisting of escape extinction (e.g., nonremoval of the spoon) and differential reinforcement. For both groups, behavioral treatment was similarly effective in increasing gram consumption and in decreasing refusal and negative vocalizations. A high percentage of individualized goals were met by both groups as well as high caregiver satisfaction reported. CONCLUSIONS: Behavioral interventions for food refusal are effective for children with cerebral palsy with behavioral refusal, just as they are for children with autism. Show more

Keywords: Cerebral palsy, autism spectrum disorder, inappropriate mealtime behavior, food refusal, pediatric feeding disorders, tube dependence

DOI: 10.3233/NRE-162071

Citation: NeuroRehabilitation, vol. 41, no. 2, pp. 395-402, 2017