Hi again, Ron!

I found this sitting in my drafts box, so it doesn't really 
consider your update, but might still be useful:

Ron Carson <[EMAIL PROTECTED]> wrote:
> We've  already  identified  her  initial goal; and that is
> to
> be able to
> independently transfer without a sliding board.

Good one! Partial goals might be: Transferring lower level,
same level, higher level. Being right now in a power chair
means most likely that she sits much higher than she will in
the long run. Also, no wheel to bypass in the transfer, but
maybe other issues (steering box and armrests - how are they
moved?). Will she be alone sometimes - then might want a 
cell phone that sticks with her - until you get through 
transfer floor to chair:-)

> The  previous  rehab goals were primarily to get her to
> sit
> independently
> and  to  assist with transfers. I don't think they worked
> on
> self-care or
> home making skills.

Makes me wonder if it was actually an SCI-rehab she was in.
BTW, I've heard of people often going back for a new
SCI-rehab stay after they got out of their TLSO or halo. But
maybe the insurance issue hinders that....
(I'm also concerned about the skills of that rehab, if they
allowed eating up all her rehab time while she was not in a
state to fully benefit from it - re the TLSO)-:

> I  will  address  the issues of sexuality but will need to
> refer her to
> someone more appropriate - not sure who that might be.

Should have been addressed in depth in rehab too. Being with
peers makes a huge difference.

But for now, I think you can safely trust the PLISSIT model:
"Permission, Limited Information, Specific Suggestions, and
Intensive Therapy". Referral might be needed at step 3 or 4,
depending on your knowledge and skills. But doing it earlier
might send the message that "you think there's something
wrong" (with either her, or with talking about sexuality).
About Permission I imagine you finding ways to show her that
you're willing to talk about it - showing that it's natural
to care about it. I also imagine that what's mostly "in her
way" right now is bowels, bladder and body image. Also - her
husband might be afraid to hurt her physically during
intercourse. There are videos available - she may have
already seen them in rehab, but maybe not with her husband?
Female sexuality after SCI was "top subject" in the Danish
SCI org last year, so please ask away!

susanne 


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