Needs, priorities, and attitudes of individuals with spinal cord injury toward nerve stimulation devices for bladder and bowel function: a survey
TL;DR: Bladder and bowel dysfunction remain important unmet challenges for individuals living with SCI who answered the survey, and these individuals are willing to accept some potential risks of nerve stimulation approaches given potential benefits.
Abstract: Survey. To investigate the needs and priorities of people with spinal cord injury for managing neurogenic bladder and bowel function and to determine their willingness to adopt neuromodulation interventions for these functions. Anonymous online survey. It was advertised by word-of-mouth by community influencers and social media, and by advertisement in newsletters of advocacy groups. Responses from 370 individuals (27% female, 73% male) were included. Bladder emptying without catheters was the top priority for restoring bladder function, and maintaining fecal continence was the top priority for restoring bowel function. The biggest concerns regarding external stimulation systems were wearing a device with wires connecting to electrodes on the skin and having to don and doff the system daily as needed. The biggest concerns for implanted systems were the chances of experiencing problems with the implant that required a revision surgery or surgical removal of the whole system. Respondents were willing to accept an external (61%) or implanted (41%) device to achieve improved bladder or bowel function. Bladder and bowel dysfunction remain important unmet challenges for individuals living with SCI who answered our survey. These individuals are willing to accept some potential risks of nerve stimulation approaches given potential benefits. Additional consumer input is critical for guiding both research and translation to clinical use and personalized medicine.
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TL;DR: In this paper, a review highlights the current understanding of spinal interneuron heterogeneity, their contribution to control and modulation of motor and sensory functions, and how this role might change after traumatic spinal cord injury.
Abstract: Spinal interneurons are important facilitators and modulators of motor, sensory, and autonomic functions in the intact CNS. This heterogeneous population of neurons is now widely appreciated to be a key component of plasticity and recovery. This review highlights our current understanding of spinal interneuron heterogeneity, their contribution to control and modulation of motor and sensory functions, and how this role might change after traumatic spinal cord injury. We also offer a perspective for how treatments can optimize the contribution of interneurons to functional improvement.
32 citations
TL;DR: In this paper , spinal cord epidural stimulation (scES) was used to improve the lower urinary tract (LUT) activity and facilitate the initiation of voiding in seven individuals with motor complete spinal cord injury.
Abstract: Abstract Profound dysfunctional reorganization of spinal networks and extensive loss of functional continuity after spinal cord injury (SCI) has not precluded individuals from achieving coordinated voluntary activity and gaining multi-systemic autonomic control. Bladder function is enhanced by approaches, such as spinal cord epidural stimulation (scES) that modulates and strengthens spared circuitry, even in cases of clinically complete SCI. It is unknown whether scES parameters specifically configured for modulating the activity of the lower urinary tract (LUT) could improve both bladder storage and emptying. Functional bladder mapping studies, conducted during filling cystometry, identified specific scES parameters that improved bladder compliance, while maintaining stable blood pressure, and enabled the initiation of voiding in seven individuals with motor complete SCI. Using high-resolution magnetic resonance imaging and finite element modeling, specific neuroanatomical structures responsible for modulating bladder function were identified and plotted as heat maps. Data from this pilot clinical trial indicate that scES neuromodulation that targets bladder compliance reduces incidences of urinary incontinence and provides a means for mitigating autonomic dysreflexia associated with bladder distention. The ability to initiate voiding with targeted scES is a key step towards regaining volitional control of LUT function, advancing the application and adaptability of scES for autonomic function.
7 citations
5 citations
TL;DR: In this paper, the authors discuss the current level of inclusion of people living with spinal cord injury (SCI) in the research process, the science of engagement and benefits of partnerships in research, and emerging resources available to help promote ethical and effective partnerships in SCI research.
Abstract: Purpose of review Partnerships across all stakeholders in the research process strengthen the outcomes and ultimate usability of research. The purpose of this review is to discuss the current level of inclusion of people living with spinal cord injury (SCI) in the research process, the science of engagement and benefits of partnerships in research, and emerging resources available to help promote ethical and effective partnerships in SCI research. Recent findings Significant strides have been made in interacting with people living with SCI to help identify the problem(s) that are important to study (i.e. the first step in the research process). The SCI research field is lagging in partnering with people living with SCI throughout the rest of the research process despite a plethora of evidence-based principles and strategies for effective partnerships in the broader context of research. There are several emerging resources specific to SCI to help researchers and the community begin to build meaningful partnerships throughout the entire cycle of research. Summary The SCI research field already values partnerships with clinicians and promotes the concept of 'bench-to-bedside and back again'. Now is the time to take it a step further to 'bench-to-bedside-to-community and back again'.
5 citations
TL;DR: In this paper , the authors present a review of the most recent developments and problems associated with exoskeleton control systems, particularly during the last few years (2017-2022).
Abstract: Effective control of an exoskeleton robot (ER) using a human-robot interface is crucial for assessing the robot's movements and the force they produce to generate efficient control signals. Interestingly, certain surveys were done to show off cutting-edge exoskeleton robots. The review papers that were previously published have not thoroughly examined the control strategy, which is a crucial component of automating exoskeleton systems. As a result, this review focuses on examining the most recent developments and problems associated with exoskeleton control systems, particularly during the last few years (2017–2022). In addition, the trends and challenges of cooperative control, particularly multi-information fusion, are discussed.
3 citations
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TL;DR: A novel survey was performed in which subjects were asked to rank seven functions in order of importance to their quality of life, and regained arm and hand function was most important to quadriplegics, while regaining sexual function was the highest priority for paraplegics.
Abstract: 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.
1,714 citations
708 citations
TL;DR: The first 500 patients to have sacral anterior root stimulators implanted for bladder control are described and of 479 survivors, 424 were using their stimulators when last followed up between 3 months and 16.1 years after implantation.
Abstract: The first 500 patients to have sacral anterior root stimulators implanted for bladder control are described. Of 479 survivors, 424 were using their stimulators when last followed up between 3 months and 16.1 years (mean 4 years) after implantation.
316 citations
"Needs, priorities, and attitudes of..." refers background in this paper
...One approach, sacral anterior root stimulation, has been provided to thousands of individuals with SCI to promote bladder and bowel emptying [7-9]....
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TL;DR: High frequency (HFAC) sinusoidal waveforms on the pudendal nerves to produce block of the external urethral sphincter (EUS) in animals showed three phases: a high onset response, often a period of repetitive firing and usually a steady state of complete or partial block.
Abstract: A reversible electrical block of the pudendal nerves may provide a valuable method for restoration of urinary voiding in individuals with bladder–sphincter dyssynergia. This study quantified the stimulus parameters and effectiveness of high frequency (HFAC) sinusoidal waveforms on the pudendal nerves to produce block of the external urethral sphincter (EUS). A proximal electrode on the pudendal nerve after its exit from the sciatic notch was used to apply low frequency stimuli to evoke EUS contractions. HFAC at frequencies from 1 to 30 kHz with amplitudes from 1 to 10 V were applied through a conforming tripolar nerve cuff electrode implanted distally. Sphincter responses were recorded with a catheter mounted micro-transducer. A fast onset and reversible motor block was obtained over this range of frequencies. The HFAC block showed three phases: a high onset response, often a period of repetitive firing and usually a steady state of complete or partial block. A complete EUS block was obtained in all animals. The block thresholds showed a linear relationship with frequency. HFAC pudendal nerve stimulation effectively produced a quickly reversible block of evoked urethral sphincter contractions. The HFAC pudendal block could be a valuable tool in the rehabilitation of bladder–sphincter dyssynergia.
141 citations
TL;DR: It is described how applied neuromodulation of some specific peripheral pathways can help to overcome the incontinence resulting from these dysfunctions, especially bladder overactivity.
Abstract: The urinary bladder has only two functions, to store urine and to eliminate it from the body at socially convenient times. These functions depend on total integrity of the nervous system from brain to bladder. Many different neurotransmitter pathways are involved, modulating proper voluntary control over the reciprocal relationship between the storage function of the bladder and the outlet sphincters of the urethra. When voluntary control is lost or disrupted through neurological disease or damage then aberrant reflexes can take over resulting in incontinence. Such reflexes often involve the loss of those inhibitory mechanisms which normally suppress bladder contractions during the filling phase or sphincter contractions during the emptying phase. Treatment of incontinence by applied neuromodulation probably utilizes residual reflex pathways by which electrical stimulation can inhibit unwanted detrusor contractions or suppress the overactive urethral sphincter. With improvements in our understanding of the pathophysiology of voiding dysfunction, better diagnosis and the latest technical advances, for example, combining neuromodulation for detrusor hyper-reflexia with sacral anterior root stimulation for emptying the paralysed bladder (Brindley, 1988), we might hope to develop a new generation of implantable devices for treating people with incontinence (Craggs, 1997).There are still many gaps in our knowledge of neuromodulation of the lower urinary tract, for example we know little about the cerebral control of micturition in man. Such knowledge may be important for a better understanding of the many conditions we currently label 'idiopathic'. Future opportunities offered by functional magnetic resonance imaging and spectroscopy may help us to identify pathways and neurotransmitters in the brain of humans to complement the latest animal studies using transneuronal virus tracing to identify central micturition pathways.
117 citations