Acquired Brain Injury-Related Sexuality Measure (ABI-RSM)

Abstract

The Acquired Brain Injury-Related Sexuality Measure (ABI-RSM), introduced by Ek, Holmström, and Elmerstig in 2023, is a 34-item comprehensive psychological inventory. It is specifically designed to evaluate the multifaceted experiences of sexuality among individuals who have sustained an Acquired Brain Injury (ABI). The measure systematically assesses how the injury impacts individual sexual function, relational dynamics, and the critical need for post-injury support.

The instrument’s development was grounded in prior empirical literature and extensive qualitative interview studies conducted with both ABI survivors (Ek, 2010) and their partners (Ek, 2011). It explores both individual and relational dimensions of sexuality, alongside evaluating the quality and quantity of information individuals received about sexuality during their rehabilitation phase. The ABI-RSM was initially validated using data from individuals who participated in non-stroke brain injury rehabilitation in Sweden.

Keywords

Acquired Brain Injury, Cognitive Functions, Sexual Rehabilitation, Needs Assessment, Intimacy, Psychosexual Behavior, Sexual Functions, Partner Communication, Neuropsychological Rehabilitation, Treatment Process, Health Information.

Authors

Ek, Ann-Sofie, Holmström, Charlotta, Elmerstig, Eva.

Purpose

The primary purpose of the Acquired Brain Injury-Related Sexuality Measure is to serve as a diagnostic and evaluative tool to identify and quantify the persistent unmet need for sexual rehabilitation among the population affected by ABI. It aims to provide concrete, measurable insights into the challenges and information gaps related to sexuality experienced by survivors.

By providing structured data on functional changes, relationship difficulties, and counseling deficiencies post-injury, the instrument allows researchers and clinicians to develop and implement more targeted and effective interventions. Ultimately, the measure is intended to facilitate improvements in the clinical delivery of sexual health services and enhance the overall quality of life and intimate relationships for individuals navigating life after brain injury.

Construct

The ABI-RSM is a multidimensional inventory comprising 34 items designed to capture the complexity of sexual adjustment following an Acquired Brain Injury. The instrument is structured around several distinct psychological constructs that address both functional deficits and psychosocial factors related to intimacy and sexual activity.

The core constructs measured by the subscales include factors related to Cognitive Functions (as they impact sexual behavior), Sexual Functions (physical and biological aspects), the subjective value placed on the Importance of Sexuality and Intimacy, the quality of relational support captured by Partner’s Acceptance and Communication, and specific measures of Orgasm and Satisfaction in Sexual Activity. The scale is unique in its focus on assessing the patient’s experience with and need for information and counseling regarding sexuality during the rehabilitation process.

Validity

As of the initial publication of the inventory (2023), specific comprehensive data regarding the scale’s construct validity, content validity, or criterion validity were not explicitly detailed in the source documentation. The initial study focused primarily on establishing the internal consistency of the instrument across its subscales.

Further psychometric validation studies, including factor analytic methods, are required to formally establish the structural integrity, predictive power, and generalizability of the ABI-RSM across diverse clinical populations and settings outside of the initial Swedish non-stroke ABI sample.

Reliability

The reliability of the ABI-RSM was assessed through internal consistency analysis using Cronbach’s Alpha. The resulting alpha coefficients demonstrate strong internal consistency across the measured dimensions, indicating that the items within each subscale reliably measure the same underlying construct. These coefficients generally fall within the range considered acceptable to excellent for psychological measures:

• Cognitive functions: Alpha = 0.859

• Sexual functions: Alpha = 0.818 for males and 0.855 for females

• Importance of sexuality and intimacy: Alpha = 0.779

• Partner’s acceptance and communication: Alpha = 0.830

• Orgasm and satisfaction in sexual activity: Alpha = 0.870

Factor Analysis

Data concerning the specific results of exploratory or confirmatory factor analysis (EFA/CFA) used to define or confirm the factor structure of the Acquired Brain Injury-Related Sexuality Measure were not provided in the source documentation. Factor analysis is typically required to verify that the empirical structure of the 34 items aligns with the intended theoretical subscales (e.g., Cognitive functions, Partner communication).

Instrument

Test Type: Original Inventory/Questionnaire

Format: The questionnaire is organized around four major thematic sections: Background information, Functional ability, Sexuality after ABI, and Rehabilitation. Response formats are varied: the majority of questions provide fixed response alternatives, while some are multiple-choice, permitting multiple selections. Notably, two specific questions related to partner acceptance and communication utilize Likert scales ranging from 1 (not at all) to 6 (very high degree). A limited number of questions are open-ended, allowing for qualitative, free-text responses.

Language Available: English, Swedish

Population Group: Human (Male, Female)

Age Group: Adulthood (18 years and older)

Population Details: The initial study sample consisted of adult participants who had undergone non-stroke Acquired Brain Injury rehabilitation in Sweden.

Test Methodology: The psychometric properties established for the instrument were primarily derived from internal consistency analysis (using Cronbach’s Alpha) to assess reliability.

Keywords

Acquired Brain Injury, Brain Injuries, Sexual Attitudes, Sexual Functions, Intimacy, Needs Assessment, Rehabilitation, Psychosexual Behavior, Information Needs, Orgasm, Satisfaction, Sexology.

Authors

Author ORCID Identifier: orcid.org/0000-0001-6446-6553 (Ann-Sofie Ek)

Affiliation Email addresses: [email protected]

Correspondence Address: Malmö University, Faculty of Health and Society, Centre for Sexology and Sexuality Studies, Malmö, Sweden, 20506, [email protected]

Permissions & Fee and Test Year

Permissions: May use for Research/Teaching

Fee: No

Test Year: 2023

Reference’s

Ek, A.-S., Holmström, C., & Elmerstig, E. (2023). Unmet need for sexual rehabilitation after acquired brain injury (ABI): A Cross-Sectional Study concerning sexual activity, sexual relationships, and sexual rehabilitation after ABI. Sexuality and Disability, 41(2), 387–410. doi:10.1007/s11195-023-09788-w. (Source Reference)

The work is published under the Creative Commons license: creativecommons.org/licenses/by/4.0/

Items of the Acquired Brain Injury-Related Sexuality Measure (ABI-RSM)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The Acquired Brain Injury-Related Sexuality Measure consists of 34 items, organized into the following subscales:

• Cognitive functions

• Sexual functions

• Importance of sexuality and intimacy

• Partner’s acceptance and communication

• Orgasm and satisfaction in sexual activity

Information and Counseling on Sexuality Post-ABI

• Did you receive written information about sexuality after ABI?

• Did someone during rehabilitation ask you whether your sexuality was affected by ABI?

• When did someone within rehabilitation ask you if your sexuality was affected by ABI?

• Did you receive group information or attend a talk regarding sexuality after ABI?

• Were you offered individual counseling concerning sexuality after ABI?

• Were you and your partner offered couple-counseling concerning sexuality after ABI?

• Did you ask someone about sexuality after ABI?

  • When?

• Did you want to ask someone about sexuality after ABI?

• Do you feel that you are missing information about sexuality after ABI?

• What would you have wanted information about, concerning sexuality after ABI?

Adjustment and Experience of Sexuality Post-ABI

• Have you adjusted your sexual life due to ABI?

• What did you try out that worked well?

• What did you try that did not work well?

• Other?

Relationships and Social Impact

• Are you currently in a relationship?

• Were you in a relationship at the time of the injury?

• How do you experience that the following are affected after ABI:

  • My role among family and/or friends has changed after ABI.

  • Sometimes others do not notice that I have an ABI.

  • It is harder to have contact with others after ABI.

• Do you consider sexuality important in a relationship?

• Is sex important to you?

• Is physical intimacy important to you?

Sexual Activity Post-ABI

• When was the first time you had sex after ABI?

• How was sex after ABI resumed?

• How did you experience sex the first time after ABI?

• When was the last time you had sex with a partner?

• What do you think about sexual aids (for example dildos, vibrators, penis-rings, vacuum-pumps)?

• Sometimes I want to have sex, but I do not because…

• In the past, I sometimes have had sex with a partner even though I did not want to.

Partner Communication and Acceptance

• In the context of sexual activity, to what degree do you feel accepted by your partner?

• To what degree do you experience that you can communicate with your partner regarding sex and your situation?

• Do you experience appreciation from your partner regarding your situation in general?