Improvements in bladder, bowel and sexual outcomes following task specific training in human SCI

Abstract
The loss of urogenital and bowel functions are some of the most important sequalae as a result of spinal cord injury (SCI). In an upper motor neuron (UMN) injury, a neurogenic bladder may manifest as a failure to store, characterized by uninhibited bladder contractions and an areflexic outlet or as a failure to empty with an areflexic bladder and a sphincter that is unable to relax. An UMN injury also results in increased colonic and anal tone and as a result, constipation and fecal retention are prevalent. Depending on the degree of preserved neurologic function, in men with SCI, reflexogenic erections may be achieved but not necessarily maintained and most often ejaculation is impaired. In females with SCI, impairments in genital responses and sexual arousal are common, while the impact of injury on fertility is not as severe as it is in men. While standard pharmacological therapy aims to manage the prevalent urogenital and bowel issues, therapies addressing recovery of function are still needed. Locomotor training (LT) is one such tool which has been shown to be effective for improving post-SCI motor outcomes, but has also been shown to have a beneficial impact on responses from autonomic systems, such as with cardiovascular and respiratory. Given the overlap of neural networks controlling the pelvic viscera and locomotor function in the lumbosacral cord, we hypothesized that a viscerosomatic relationship is influenced by LT resulting in improved bladder, bowel and sexual function. In this study, eight subjects who sustained a SCI received 80 daily 1-hr sessions of LT on a treadmill, using body-weight support, or 1-hr of LT and stand training (on alternate days). Urodynamic assessments were performed at pre-and post-training time points, revealing significant increases in bladder capacity, voiding efficiency and detrusor contraction time as well as a significant decrease in voiding pressure post-training. Questionnaires were used to assess bowel and sexual function management and it was found that post-training there was a significant decrease in the time required for defecation as well as a significant increase in sexual desire. These results suggest there is an appropriate level of sensory information provided to the spinal cord, generated through task-specific stepping and/or loading, which appears to influence the neural circuitry involved urogenital and bowel control.

Authors
*A. N. HERRITY1, C. HUBSCHER2, L. MONTGOMERY2, A. WILLHITE1, C. ANGELI1, S. HARKEMA1;
1Univ. of Louisville, Frazier Rehab Neurosci. Collaborative Ctr., Louisville, KY; 2Anatom. Sci. & Neurobiol., Univ. of Louisville, Louisville, KY
Disclosures
A.N. Herrity: None. C. Hubscher: None. L. Montgomery: None. A. Willhite: None. C. Angeli: None. S. Harkema: None.

LINK: Session 158 – Spinal Cord Injury and Plasticity

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