1. Sex and Sexuality following acquired brain injury Doreen Wright, Walkergate Park International Centre for Neurorehabilitation and Neuropsycholgy

2. What is sexuality Expression of who we are Commonly expressed through physical and emotional closeness Sharing Touching Looking good Feeling good

3. What do we mean by the word sex State of being male or female Sexual intercourse between two adults Sexual feelings or behaviour

4. Brain Injury and relationships ‘Brain damage is a family affair’ Lezac 1988 Wife’s or partners experience more problems than parents or siblings ‘What is the impact of a characterologically altered partner’ (Lezac 1978)

5. Characterological alteration (Lezac 1978) Self centered behaviour Impaired self monitoring Stimulus bound with no initiative Lability irritability Lack of self learning, insight

6. Why do partner’s experience so much stress? Coping alone Lack of information Need to grieve but no acceptable format Personality change in partner Executive functioning Ways of behaving Partners in social limbo May prolong a dysfunctional relationship

7. How can we help? Always remain professional Understand the boundaries between working life and being a patient’s friend Acknowledge all limitations Find out what the problem is Seek ways to help e.g. speak to your manager or get information for your patient or their families Do not accept inappropriate behaviour Do not reinforce inappropriate behaviour Be consistent Reach a compromise that is acceptable to all parties

8. P-L-I-S-S-I-T P – PERMISSION LI – IMITED INFORMATION SS – SPECIFIC SUGGESTION IT – INTENSIVE THERAPY

9. Case study 47 year old married man Tom Happily married 25 years to Jean Suffered SVA suddenly at work Initially admitted to ITU Admitted to Walkergate Park for a period of rehabilitation Leading up to discharge the spent a couple of weeks in the interim flat and Jean was invited to spend time with Tom The purpose was to ascertain the help Jean may require in their own home First evening Tom was deluged to have Jean to himself and immediate wanted to try and have sex with her Next day Jean was very distressed

10. Why do you think Jean reacted to this How do you think it left Tom feeling Using the PLISSIT model ask yourselves What could have been done better by the staff involved? What could have prevented the situation? What support could be offered to both Tom and Jen regarding their sex life?