Improvement in Bladder Function with Spinal Cord Electrical Stimulation.
One of the greatest impacts on quality of life for people with spinal cord injuries (SCI) is the loss of bladder and bowel control. These are conditions known as ‘neurogenic bladder’ and ‘neurogenic bowel.’ Urinary catheterization and time consuming regimens of bowel management number among the medically necessary realities of living with SCI. These requirements bring other risks to the health of the individual such as potential infections. In most cases, pharmaceutical intervention is used to encourage bladder voiding so that pressure does not cause urine to flow back up to the kidneys. This is another ‘unintended consequence’ that accompanies SCI. A new paper published today online in Scientific Reports (Scientific Reports | (2018) 8:8688 | DOI:10.1038/s41598-018-26602-2) describes the work of Dr. Charles Hubscher and his team at the University of Louisville’s Kentucky Spinal Cord Injury Research Center (KSCIRC). The key finding was improvement in bladder function using spinal cord Electrical Stimulation (scES).
Read the Complete Article at Scientific Reports.
Disruption of motor and autonomic pathways induced by spinal cord injury (SCI) often leads to persistent low arterial blood pressure and orthostatic intolerance. Spinal cord epidural stimulation (scES) has been shown to enable independent standing and voluntary movement in individuals with clinically motor complete SCI.
In this study, we addressed whether scES configured to activate motor lumbosacral networks can also modulate arterial blood pressure by assessing continuous, beat-by-beat blood pressure and lower extremity electromyography during supine and standing in seven individuals with C5-T4 SCI. In three research participants with arterial hypotension, orthostatic intolerance, and low levels of circulating catecholamines (group 1), scES applied while supine and standing resulted in increased arterial blood pressure. In four research participants without evidence of arterial hypotension or orthostatic intolerance and normative circulating catecholamines (group 2), scES did not induce significant increases in arterial blood pressure. During scES, there were no significant differences in electromyographic (EMG) activity between group 1 and group 2. In group 1, during standing assisted by scES, blood pressure was maintained at 119/72 ± 7/14 mmHg (mean ± SD) compared with 70/45 ± 5/7 mmHg without scES. In group 2 there were no arterial blood pressure changes during standing with or without scES. These findings demonstrate that scES configured to facilitate motor function can acutely increase arterial blood pressure in individuals with SCI-induced cardiovascular deficits.
Read the Complete Article at Frontiers in Physiology.
Activity-based Training PLUS Epidural Stimulation Supports the Ability of a Person with SCI to Move When the Stimulation Is Not Active.
Spinal cord injuries have devastating effects on affected individuals and, most often, lead to paralysis.
Our research team has previously shown that epidural stimulation of the spinal cord combined with intense activity-based rehabilitative training can help in the recovery of voluntary movement and standing. So far, this recovery has only been demonstrated when the spinal cord stimulation was being applied. In this paper, we show the progressive recovery of voluntary movement control and standing ability without the use of spinal cord stimulation in one individual that received 3.7 years of different rehabilitative training protocols combined with spinal stimulation. In particular, this report shows the effects of training-induced adaptations of the spinal cord that allowed this individual to advance from no ability to move his legs to the ability to move his legs and stand without spinal stimulation.
These findings show the extraordinary recovery potential of the human nervous system after severe spinal cord injury, and suggest future studies focus on better understanding the effects of different training components on spinal cord adaptations important for functional recovery.
Read the Complete Article at Scientific Reports.
Epidural Stimulation (ES) of the lumbosacral spinal cord has been used to facilitate standing and voluntary movement after clinically motor-complete spinal-cord injury.
It seems of importance to examine how the epidurally evoked potentials are modulated in the spinal circuitry and projected to various motor pools. We hypothesized that chronically implanted electrode arrays over the lumbosacral spinal cord can be used to assess functionally spinal circuitry linked to specific motor pools.
The purpose of this study was to investigate the functional and topographic organization of compound evoked potentials induced by the stimulation. Three individuals with complete motor paralysis of the lower limbs participated in the study. The evoked potentials to epidural spinal stimulation were investigated after surgery in a supine position and in one participant, during both supine and standing, with body weight load of 60%. The stimulation was delivered with intensity from 0.5 to 10 V at a frequency of 2 Hz. Recruitment curves of evoked potentials in knee and ankle muscles were collected at three localized and two wide-field stimulation configurations. Epidural electrical stimulation of rostral and caudal areas of lumbar spinal cord resulted in a selective topographical recruitment of proximal and distal leg muscles, as revealed by both magnitude and thresholds of the evoked potentials. ES activated both afferent and efferent pathways. The components of neural pathways that can mediate motor-evoked potentials were highly dependent on the stimulation parameters and sensory conditions, suggesting a weight-bearing-induced reorganization of the spinal circuitries.
Read the Complete Article at the US National Library of Medicine National Institutes of Health.