Improvements in bladder, bowel and sexual outcomes following task-specific locomotor training in human spinal cord injury

Abstract

ObjectiveLocomotor training (LT) as a therapeutic intervention following spinal cord injury (SCI) is an effective rehabilitation strategy for improving motor outcomes, but its impact on non-locomotor functions is unknown. Given recent results of our labs’ pre-clinical animal SCI LT studies and existing overlap of lumbosacral spinal circuitries controlling pelvic-visceral and locomotor functions, we addressed whether LT can improve bladder, bowel and sexual function in humans at chronic SCI time-points (> two years post-injury).Study designProspective cohort study; pilot trial with small sample size.MethodsEight SCI research participants who were undergoing 80 daily one-hour sessions of LT on a treadmill using body-weight support, or one-hour of LT and stand training on alternate days, as part of another research study conducted at the Kentucky Spinal Cord Injury Research Center, University of Louisville, were enrolled in this pilot trial. Urodynamic assessments were performed and International Data Set questionnaire forms completed for bladder, bowel and sexual functions at pre-and post-training time points. Four usual care (non-trained; regular at-home routine) research participants were also enrolled in this study and had the same assessments collected twice, at least 3 months apart.ResultsFilling cystometry documented significant increases in bladder capacity, voiding efficiency and detrusor contraction time as well as significant decreases in voiding pressure post-training relative to baseline. Questionnaires revealed a decrease in the frequency of nocturia and urinary incontinence for several research participants as well as a significant decrease in time required for defecation and a significant increase in sexual desire post-training. No significant differences were found for usual care research participants.ConclusionsThese results suggest that an appropriate level of sensory information provided to the spinal cord, generated through task-specific stepping and/or loading, can positively benefit the neural circuitries controlling urogenital and bowel functions.Trial registrationClinicalTrials.gov NCT03036527

A new bladder‐emptying method in females with neurogenic bladder: A randomized, phase II trial

“…These results are in agreement with data from the previous reports that showed bladder capacity gain due to the reduction of urinary loss . Experimental studies have also presented an improvement of bladder compliance after detrusor musculature distension …”

“…These results are in agreement with data from the previous reports that showed bladder capacity gain due to the reduction of urinary loss. 17,18 Experimental studies have also presented an improvement of bladder compliance after detrusor musculature distension. 12,19,20 The proportion of total adverse events in the ISRD group was approximately half of those found in the CIC group, while more than 50% of the patients in the ISRD group did not present any side effects.…”

Activity-based Training on a Treadmill with Spinal Cord Injured Wistar Rats

“…Our methods of ABT on rats after SCI is a novel therapeutic intervention. While other methods of exercise and step training in animal models may exist 35,36,37 , this method mimics LT carried out clinically in the SCI human population, where we have seen promising results 23 . With the combination of our setup, regimen, and use of control animals, the results obtained from utilizing our training paradigm will help to understand the benefits of ABT after SCI.…”

“…LT benefits regarding autonomic functions have not been well characterized. For this reason, we implement our training paradigm with a focus on autonomic outcome measures, using four distinct groups that include two non-trained controls and a metabolic/exercise nonweight bearing group alongside an LT group that mimics the timing, session duration, manual assistance and weight support that are used in clinical studies 19,21,22,23,24 .…”

International spinal cord injury urodynamic basic data set (version 2.0)

“…Use of a standard format is essential for combining data from multiple investigators and locations. The SCI Urodynamic Data Set seems to be well suited for this purpose, as its first version has already been used in several studies [14][15][16][17] and has been translated into Chinese [https://www. iscos.org.uk//international-sci-urodynamic-data-sets].…”