By Courtney Jacobson, MOTR, and Cathy Bowman, DOR/OTR 
Rock Canyon Respiratory & Rehabilitation, Pueblo, CO

Problem: The topic of sexuality has not been addressed in its entirety within the profession of occupational therapy in literature or practice. Sexuality has been identified by patients as a topic that needs to be addressed in order to receive comprehensive and holistic care (New, Seddon, Redpath, Currie, & Warren, 2016). More specifically, with 12,500 new cases of spinal cord injury (SCI) that occur each year, in addition to the significant impact on body functions that result from SCI, the topic of sexuality needs particular attention with this population (National Spinal Cord Injury Statistical Center, 2015).

Purpose: The purpose of this project was to create a manual supported by literature that can be used by occupational therapists to address sexuality while working with patients in the inpatient rehabilitation setting.

 Methodology: The authors conducted an in-depth literature review regarding the topic of sexuality being addressed in healthcare settings as well as sexuality within the SCI population. Based on the literature review, the authors created a manual, guided by the Ecology of Human Performance (EHP) model and the ALLOW model. These models provide structure to the occupational therapy treatment process, from the evaluation to the measurement of outcomes.

Product: The manual is to be used as a reference, a resource and a guide for occupational therapists to use when addressing sexuality with patients with SCI in the inpatient rehabilitation setting.

Literature Review

Sexuality is not being addressed by healthcare providers due to lack of knowledge/training, embarrassment, lack of time, discomfort, perception of expertise elsewhere, and readiness of the patient to receive information (Haboubi & Lincoln, 2003; New et al., 2016).

Patients with physical disabilities, some of which included SCI, report a desire to receive information about sexuality, how their disability had affected their sexuality, and that sexual rehabilitation services should be brought up by health professionals and not reliant on patients to request it (New et al., 2016; Northcott & Chard, 2000). Researchers found that inpatient rehabilitation was a particularly important setting in which the rehabilitation team, consisting of physicians, nursing, physical therapy, psychology, social work and occupational therapy, can broach the topic of sexuality with patients (Booth, Kendall, Fronek, Miller, & Geraghty, 2003; Evans, Halar, DeFreece, & Larsen, 1976; New et al., 2016).

Problem Statement

Although sexuality is defined as an activity of daily living (ADL) within the Occupational Therapy Practice Framework, it continues to be a neglected topic in occupational therapy practice.

Limitations and Recommendations


  • The authors have limited experience in working with patients who have an SCI or addressing sexuality with patients.
  • There is a lack of research available regarding sexuality.
  • The manual is currently only applicable to the inpatient rehabilitation setting.


  • Further research on the manual’s effectiveness.
  • Create modifications to the manual for use in other settings.

Contributions to Practice

  • The manual may be implemented by occupational therapists practicing within an inpatient rehabilitation setting.
  • Therapists can use the manual to gain knowledge, gain confidence, and become familiar with a possible structure to address sexuality during inpatient rehabilitation.
  • The manual can also be used as a building block to create continuing education and further training on the topic of sexuality.

 View charts and more information here: Riverwalk & Rock Canyon – Cathy Bowman, Courtney Jacobson (Sexuality and Healthcare)

View poster: Sexuality and Healthcare: A Manual for Occupational Therapy (PDF format)

By Courtney Jacobson, MOTR, and Cathy Bowman, DOR/OTR
Rock Canyon Respiratory & Rehabilitation, Pueblo, CO