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).
The purpose of the study was to determine if an effective electrode configuration and stimulation parameter(s) could be identified using scES to promote more efficient emptying of the urinary bladder in persons that have a ‘motor-complete’ SCI. A bladder function mapping exercise with different electrode configurations was designed and then tested in one individual with a motor complete SCI who had already participated in the Activity-based Training (ABT) developed here at the University of Louisville’s Kentucky Spinal Cord Injury Research Center and in cooperation with the Christopher & Dana Reeve Foundation’s NeuroRecovery Network. Then, during repeated filling of the bladder using a standard method of ‘urodynamic testing’ within recommended clinical guidelines, the team looked for increases in the efficiency of the reflexive void (the ‘normal’ impulse to empty the bladder). The same electrode combination was tested in four more individuals with SCI and all four showed improvements in bladder emptying. This ‘proof-of-principle’ study has increased our understanding of how combining ABT and scES can lead to improvement of physiological function even long after a spinal cord injury had occurred. Additional work is needed to identify the long-term effectiveness as well as potential other benefits that can enhance the general health and quality of life of individuals living with spinal cord injuries.