Translating promising strategies for bowel and bladder management in spinal cord injury

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Abstract

Loss of control over voiding following spinal cord injury (SCI) impacts autonomy, participation and dignity, and can cause life-threatening complications. The importance of SCI bowel and bladder dysfunction warrants significantly more attention from researchers in the field. To address this gap, key SCI clinicians, researchers, government and private funding organizations met to share knowledge and examine emerging approaches. This report reviews recommendations from this effort to identify and prioritize near-term treatment, investigational and translational approaches to addressing the pressing needs of people with SCI.

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Most cited references 57

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Targeting recovery: priorities of the spinal cord-injured population.

Kim D Anderson (2004)

In the United States alone, there are more than 200,000 individuals living with a chronic spinal cord injury (SCI). Healthcare for these individuals creates a significant economic burden for the country, not to mention the physiological, psychological, and social suffering these people endure everyday. Regaining partial function can lead to greater independence, thereby improving quality of life. To ascertain what functions are most important to the SCI population, in regard to enhancing quality of life, a novel survey was performed in which subjects were asked to rank seven functions in order of importance to their quality of life. The survey was distributed via email, postal mail, the internet, interview, and word of mouth to the SCI community at large. A total of 681 responses were completed. Regaining arm and hand function was most important to quadriplegics, while regaining sexual function was the highest priority for paraplegics. Improving bladder and bowel function was of shared importance to both injury groups. A longitudinal analysis revealed only slight differences between individuals injured 3 years. The majority of participants indicated that exercise was important to functional recovery, yet more than half either did not have access to exercise or did not have access to a trained therapist to oversee that exercise. In order to improve the relevance of research in this area, the concerns of the SCI population must be better known and taken into account. This approach is consistent with and emphasized by the new NIH roadmap to discovery.

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Wireless Recording in the Peripheral Nervous System with Ultrasonic Neural Dust.

Dongjin Seo, Ryan M Neely, Konlin Shen … (2016)

The emerging field of bioelectronic medicine seeks methods for deciphering and modulating electrophysiological activity in the body to attain therapeutic effects at target organs. Current approaches to interfacing with peripheral nerves and muscles rely heavily on wires, creating problems for chronic use, while emerging wireless approaches lack the size scalability necessary to interrogate small-diameter nerves. Furthermore, conventional electrode-based technologies lack the capability to record from nerves with high spatial resolution or to record independently from many discrete sites within a nerve bundle. Here, we demonstrate neural dust, a wireless and scalable ultrasonic backscatter system for powering and communicating with implanted bioelectronics. We show that ultrasound is effective at delivering power to mm-scale devices in tissue; likewise, passive, battery-less communication using backscatter enables high-fidelity transmission of electromyogram (EMG) and electroneurogram (ENG) signals from anesthetized rats. These results highlight the potential for an ultrasound-based neural interface system for advancing future bioelectronics-based therapies.

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Neural control of the lower urinary tract.

William C de Groat, Derek Griffiths, Naoki Yoshimura (2015)

This article summarizes anatomical, neurophysiological, pharmacological, and brain imaging studies in humans and animals that have provided insights into the neural circuitry and neurotransmitter mechanisms controlling the lower urinary tract. The functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. The neural control of micturition is organized as a hierarchical system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brain stem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brain stem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults can cause the re-emergence of involuntary micturition, leading to urinary incontinence. Neuroplasticity underlying these developmental and pathological changes in voiding function is discussed.

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Author and article information

Journal

Journal ID (nlm-journal-id): 0370712

Journal ID (pubmed-jr-id): 3660

Journal ID (nlm-ta): Exp Neurol

Journal ID (iso-abbrev): Exp Neurol

Title: Experimental neurology

ISSN (Print): 0014-4886

ISSN (Electronic): 1090-2430

Publication date Nihms-submitted: 5 May 2021

Publication date (Electronic): 10 May 2018

Publication date (Print): August 2018

Publication date PMC-release: 13 May 2021

Volume: 306

Pages: 169-176

Affiliations

[a ]Craig H. Neilsen Foundation, 16830 Ventura Blvd, Suite 352, Encino, CA 91436, United States

[b ]University of Pittsburgh, Department of Pharmacology and Chemical Biology, W-1352 Starzl Biomedical Science Tower, University of Pittsburgh Medical School, 200 Lothrop Street, Pittsburgh, PA 15261, United States

[c ]GI Physiology Unit, University College Hospital, London NW1 2BU, UK

[d ]Neurotech Network, PO Box 16776, Saint Petersburg, FL 33733, United States

[e ]Duke University, Department of Biomedical Engineering, Fitzpatrick CIEMAS, Room 1427, Box 90281, Durham, NC 27708-0281, United States

[f ]Carolinas HealthCare System, McKay Urology, 1023 Edgehill Road South, Charlotte, NC 28207, United States

[g ]ICORD, University of British Columbia, GF Strong Rehabilitation Centre, 818 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada

[h ]Coloplast, Holtedam 1-3, DK-3050 Humlebaek, Denmark

[i ]Rigshospitalet (2081), Blegdamsvej 9, DK-2100 Copenhagen, Denmark

[j ]University of Copenhagen, Clinic for Spinal Cord Injuries, NeuroScience Centre Havnevej 25, DK-3100 Hornbæk, Denmark

Author notes

[* ]Corresponding author: tracey@ 123456chnfoundation.org (T.L. Wheeler).

Article

Manuscript ID: NIHMS1700150

DOI: 10.1016/j.expneurol.2018.05.006

PMC ID: 8117184

PubMed ID: 29753647

SO-VID: a13630eb-9d7e-444c-ba06-3f030efdd6e2

License:

This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/BY-NC-ND/4.0/).

Translating promising strategies for bowel and bladder management in spinal cord injury

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Abstract

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Karger: Neurology and Neuroscience

Most cited references 57

Targeting recovery: priorities of the spinal cord-injured population.

Wireless Recording in the Peripheral Nervous System with Ultrasonic Neural Dust.

Neural control of the lower urinary tract.

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