Case study : Peter

Peter was a 45 year old man who sustained a severe TBI as well as leg fractures
as the result of a serious fall. He was admitted to the rehabilitation inpatient unit for
treatment. It is now 16 months post-injury. His recovery has stabilised and his current
situation is as follows:

Physical: His right shoulder was damaged and still caused him pain. He has only limited range of movement in his right arm and his right hand is curled up and cannot be used for much. His left shoulder was undamaged and he has good range of movement in his left arm although he moves it slowly and he still has fine motor skills in his left hand. Prior to the injury he was dominant right hand.

His legs were badly injured in the fall. He is only able to stand on the legs for short periods of time with two staff supporting him and is unable to move his legs in any co-ordinated fashion. However, his legs give him no pain. He is not able to turn independently in bed and needs staff to turn him. He normally sleeps on his back but also likes to lie on his left side. However, he is quite robust and does not experience pain in being turned in bed.

He uses a catheter to manage urinary incontinence and has an enema three times per week.

Cognition: His memory is mildly impaired. He needs to have every appointment written
down but his concentration is usually good. He can normally recall a reasonable amount of previous interviews.

Mood: He has been depressed over the past 8 months and is currently on anti-depressants. His mood has been improving over the past 4 weeks.

Social: He got married 6 months ago to a woman he had known prior to the injury. It was his first leave from the hospital as he lives in rural NSW. The marriage was not consummated during the five days he was away.

Pre-injury sexual functioning: He reported that he had a normal and active sex life before the injury.

Current sexual concerns for Peter and his partner: Peter reports that he has trouble getting erections since the injury . He states that he doesn't feel horny a lot of the time. Before the injury he felt as if he couldn't live without sex but now he only sexually aroused on occasions. He is concerned about whether he can still ejaculate. He has tried masturbating a couple of times but this did not result in orgasm or ejaculation. His wife is concerned about his incontinence and how that might affect any lovemaking. She feels a bit daunted but both are keen to try and establish a sexual relationship.