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Published on: December 17, 2014
An evidence-based approach to the recovery of bladder and bowel function after pediatric spinal cord injury
April N Herrity1, Nicholas Dietz2, Ashley Ezzo3
1Department of Neurological Surgery, University of Louisville, Louisville, KY, United States; Department of Physiology, University of Louisville, Louisville, KY, United States; Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States; School of Medicine, University of Louisville, Louisville, KY, United States.
Insights
Activity-based recovery locomotor training (ABR-LT) improved bladder function in children with spinal cord injury (SCI). This rehabilitative program showed reduced detrusor leak point pressure and enhanced bladder awareness, suggesting potential for dynamic improvements in bladder and bowel control.
Area of Science:
- Pediatric rehabilitation
- Neuroscience
- Urology
Background:
- Spinal cord injury (SCI) in children leads to significant bladder dysfunction, impacting quality of life.
- Pediatric lower urinary tract deficits include overactive bladder, inefficient emptying, and incontinence.
- Activity-based recovery locomotor training (ABR-LT) shows promise in improving bladder function, based on adult studies and anecdotal reports.
Purpose of the Study:
- To investigate the effects of ABR-LT on bladder function in children with upper motor neuron SCI.
- To assess changes in bladder capacity, detrusor pressure, and incontinence following ABR-LT.
Main Methods:
- A within-subjects repeated measures study involving three children (ages 2.5, 3, 6 years) with SCI.
- Participants underwent at least 60 sessions of ABR-LT over 12-14 weeks.
- Bladder function was evaluated using urodynamics and Common Data Elements questionnaires.
Main Results:
- All participants demonstrated awareness of bladder filling during cystometry.
- A decrease in detrusor leak point pressure (LPP) was observed in all three children post-ABR-LT.
- One participant showed improved bladder capacity and reduced bowel incontinence after training.
Conclusions:
- ABR-LT may enhance bladder capacity, perception of fullness, and decrease LPP in pediatric SCI.
- These findings suggest an interaction between ABR-LT and neural networks controlling bladder and bowel function.
- Further research is needed to assess the long-term durability of these improvements in children with SCI.
Introduction:
Bladder dysfunction and associated complications of the urinary system negatively impact the quality of life in children living with spinal cord injury (SCI). Pediatric lower urinary tract deficits include bladder over-activity, inefficient emptying, decreased compliance, and incontinence. Recent evidence in adults with SCI indicates significant improvements in bladder capacity and detrusor pressure following participation in an activity-based recovery locomotor training (ABR-LT) rehabilitative program. Additionally, anecdotal self-reports from parents in our Pediatric NeuroRecovery Program reference changes in bladder function, ranging from awareness of bladder fullness to gains in voluntary control while undergoing ABR-LT.
Case Presentation:
In a within-subjects repeated measures study, we investigated the effect of ABR-LT on bladder function in three children (ages: 2.5, 3, and 6 years) who sustained upper motor neuron SCI. Each child received at least 60 sessions of ABR-LT (5x/week) for 12-14 weeks. Bladder function was assessed via urodynamics and the Common Data Elements questionnaires. Awareness of bladder filling during cystometry was present in all children and detrusor leak point pressure (LPP) was reduced post-ABR-LT relative to pre-training. A decrease in LPP after locomotor training was observed in all three participants. One out of the three participants had substantial improvements in bladder capacity post-ABR-LT and experienced less bowel incontinence following training.
Discussion:
Like our evidence in adults, the changes in bladder function suggest an interaction between lumbosacral networks regulating spinal reflex control of bladder filling, voiding, and afferent input (including potential descending supraspinal commands) and those activated by ABR-LT. Locomotor training may be associated with increased bladder capacity, enhanced perception of bladder filling, and decreased LPP as well as improvements in bowel control in pediatric SCI. This research suggests that children and adolescents with traumatic SCI could experience dynamic improvements in bladder and bowel function with the aid of various therapies. Studies assessing the durability of training on the recovery of bladder and bowel dysfunction in children with SCI are needed.
