Targeting bladder function with network-specific epidural stimulation after chronic spinal cord injury.

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.

Successful pregnancy and cesarean delivery in a tetraplegic, home-invasively-mechanically-ventilated patient - case report.

Introduction: Pregnancies are rare in patients with severely disabilitating spinal cord injuries (SCI) but increasing alongside social awareness concerning reproductive equality. Physicians should be aware of several potential complications during pregnancy and delivery, particularly autonomic dysreflexia.

Case Presentation: We report a successful pregnancy of a 32-year-old woman with a severe SCI at the C2 level (C1-4 ASIA Impairment Scale grade A) and total dependency on home invasive mechanical ventilation (HIMV), an extremely rare treatment.

Pediatric Spina Bifida and Spinal Cord Injury.

Pediatric spina bifida (SB) and spinal cord injury (SCI) are unfortunately common in our society, and their unique findings and comorbidities warrant special consideration. This manuscript will discuss the epidemiology, pathophysiology, prevention, and management strategies for children growing and developing with these unique neuromuscular disorders. Growth and development of the maturing child places them at high risk of spinal cord tethering, syringomyelia, ascending paralysis, pressure injuries, and orthopedic abnormalities that must be addressed frequently and judiciously.

Neurogenic Bladder Physiology, Pathogenesis, and Management after Spinal Cord Injury.

Urinary incontinence is common after spinal cord injury (SCI) due to loss of supraspinal coordination and unabated reflexes in both autonomic and somatic nervous systems; if unchecked, these disturbances can become life-threatening. This manuscript will review normal anatomy and physiology of the urinary system and discuss pathophysiology secondary to SCI. This includes a discussion of autonomic dysreflexia, as well as its diagnosis and management.

Pharmacologic and Acute Management of Spinal Cord Injury in Adults and Children.

Purpose Of Review: This review provides guidance for acute spinal cord injury (SCI) management through an analytical assessment of the most recent evidence on therapies available for treating SCI, including newer therapies under investigation. We present an approach to the SCI patient starting at presentation to acute rehabilitation and prognostication, with additional emphasis on the pediatric population when evidence is available.

Recent Findings: Further studies since the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) demonstrated a potential functional outcome benefit with ultra-early surgical intervention ≤ 8 h post-SCI.

Heart rate changes associated with autonomic dysreflexia in daily life of individuals with chronic spinal cord injury.

Study Design: Secondary data analysis.

Objective: To characterize heart rate (HR) changes during autonomic dysreflexia (AD) in daily life for individuals with chronic spinal cord injury (SCI).

Setting: University-based laboratory/community-based outpatient.

The past, present, and future of traumatic spinal cord injury therapies: a review.

This review provides a concise outline of the advances made in the care of patients and to the quality of life after a traumatic spinal cord injury (SCI) over the last century. Despite these improvements reversal of the neurological injury is not yet possible. Instead, current treatment is limited to providing symptomatic relief, avoiding secondary insults and preventing additional sequelae.

Perioperative Complications and Anesthesia Practices in Managing Patients With Quadriplegia Undergoing Surgery: A Systematic Review.

Quadriplegia is associated with a multitude of health complications affecting numerous organ systems. Complications during the perioperative periods are not uncommon in this patient population due to abnormal responses to surgical stressors. Such complications include autonomic dysreflexia, cardiac ischemia, and respiratory compromise.

Trans-Spinal Electrical Stimulation Therapy for Functional Rehabilitation after Spinal Cord Injury: Review.

Spinal cord injury (SCI) is one of the most debilitating injuries in the world. Complications after SCI, such as respiratory issues, bowel/bladder incontinency, pressure ulcers, autonomic dysreflexia, spasticity, pain, etc., lead to immense suffering, a remarkable reduction in life expectancy, and even premature death.

Thoracic VGluT2 Spinal Interneurons Regulate Structural and Functional Plasticity of Sympathetic Networks after High-Level Spinal Cord Injury.

Traumatic spinal cord injury (SCI) above the major spinal sympathetic outflow (T6 level) disinhibits sympathetic neurons from supraspinal control, causing systems-wide "dysautonomia." We recently showed that remarkable structural remodeling and plasticity occurs within spinal sympathetic circuitry, creating abnormal sympathetic reflexes that exacerbate dysautonomia over time. As an example, thoracic VGluT2 spinal interneurons (SpINs) become structurally and functionally integrated with neurons that comprise the spinal-splenic sympathetic network and immunological dysfunction becomes progressively worse after SCI.

Role of Descending Serotonergic Fibers in the Development of Pathophysiology after Spinal Cord Injury (SCI): Contribution to Chronic Pain, Spasticity, and Autonomic Dysreflexia.

As the nervous system develops, nerve fibers from the brain form descending tracts that regulate the execution of motor behavior within the spinal cord, incoming sensory signals, and capacity to change (plasticity). How these fibers affect function depends upon the transmitter released, the receptor system engaged, and the pattern of neural innervation. The current review focuses upon the neurotransmitter serotonin (5-HT) and its capacity to dampen (inhibit) neural excitation.

Menstrual changes after spinal cord injury.

Study Design: This was a single-centre, prospective, descriptive, hospital-based study in females with spinal cord injuries (SCI).

Objectives: To study menstrual changes after SCI.

Setting: The in-patient and out-patient services of the Department of Physical Medicine and Rehabilitation of a tertiary care institute in India between October 2018 and October 2020.

Pregnancy, labor, and delivery outcomes of women with and without spinal cord injury.

Compare outcomes in pregnant women with and without Spinal Cord Injury (SCI). Case study and inception cohort comparison. Community, primary care/referral center and university practice.

Special surgical aspects of radical cystectomy in spinal cord injury patients with bladder cancer.

Purpose: Radical cystectomy in people with spinal cord injury (SCI) provides numerous additional difficulties, compared to able-bodied people. Therefore, it is important to obtain information from an experienced team about optimally managing these patients.

Methods: Surgical procedures, based on the experience of 12 radical cystectomies in SCI patients with bladder cancer between January 1st, 2001, and December 31st, 2020, were recorded and the operative and perioperative clinical data were evaluated.

Reduced Reflex Autonomic Responses Following Intradetrusor OnabotulinumtoxinA Injections: A Pre-/Post-study in Individuals With Cervical and Upper Thoracic Spinal Cord Injury.

Urodynamic studies (UDS) can provoke autonomic dysreflexia (AD) in individuals with spinal cord injury (SCI) at and above the sixth thoracic spinal segment potentially leading to profound vagally mediated heart rate (HR) reductions. In this study, we test the hypothesis that intradetrusor onabotulinumtoxinA injections will improve HR and its variability (HRV) responses to UDS in individuals with cervical and thoracic SCI. A total of 19 participants with chronic SCI (5 women, mean age 42.

Autonomic Dysreflexia After Hip Fractures Managed by Regional Anesthesia: A Case Report.

Autonomic dysreflexia occurs after a spinal cord injury usually at the level of T6 or above, and its hallmark feature is exaggerated autonomic response to noxious stimuli resulting in uncontrolled hypertensive episodes with reflexive bradycardia that can be fatal if not controlled. We present a case highlighting regional anesthetic techniques, including peripheral nerve blocks, to ameliorate the symptoms of autonomic dysreflexia triggered by hip fractures in a 57-year-old woman with an old C5-C6 spinal cord injury before definitive hip surgery. The regional techniques described provide anesthesiologists with a simple strategy to potentially mitigate a life-threatening situation.

Diagnostic and Therapeutic Particularities in Abdominal Trauma Associated with Spinal Cord Injuries - Review of the Literature.

Post-traumatic morbid associations may evolve by themselves, or can interact, with effects of adding or potentiating gravity. Sometimes cumulative or potentiating effects are associated with clinical and paraclinical confusing manifestations induced by one of the components of the lesion complex, or by mutually aggravating effects. It is also the case of vertebromedular traumas associated with other post-traumatic lesions, where the neurological signal is distorted, and may induce particularities of associated lesions.

[Urinary Bladder Cancer as a Long-term Sequela of Spinal Cord Injury - Relevance to Practice].

Urinary bladder cancer is the second most common tumour disease after lung cancer leading to death in people with a spinal cord injury. This paper provides a comprehensive overview of the differences relevant to urologists between urinary bladder tumours in this population compared with urinary bladder tumours in the general population.People with a spinal cord injury are 1 to 2 decades younger on average at the time of tumour diagnosis than patients without a spinal cord injury.

Management of blood pressure disorders in individuals with spinal cord injury.

Blood pressure regulation is impacted by a spinal cord injury (SCI) due to impaired descending sympathetic vascular control. Common blood pressure problems in the SCI population include persistently low blood pressure with bouts of orthostatic hypotension and autonomic dysreflexia, which are more prevalent in individuals with lesions above the sixth thoracic vertebral level; however, they may occur regardless of the neurological level of injury. Although blood pressure disorders adversely impact daily function and quality of life, most individuals with SCI do not acknowledge this association.

Peripherally delivered Adeno-associated viral vectors for spinal cord injury repair.

Via the peripheral and autonomic nervous systems, the spinal cord directly or indirectly connects reciprocally with many body systems (muscular, intengumentary, respiratory, immune, digestive, excretory, reproductive, cardiovascular, etc). Accordingly, spinal cord injury (SCI) can result in catastrophe for multiple body systems including muscle paralysis affecting movement and loss of normal sensation, as well as neuropathic pain, spasticity, reduced fertility and autonomic dysreflexia. Treatments and cure for an injured spinal cord will likely require access of therapeutic agents across the blood-CNS (central nervous system) barrier.

An Assessment of Which Sociodemographic and Spinal Cord Injury-Specific Characteristics Influence Engagement With Experimental Therapies and Participation in Clinical Trials.

Although a number of experimental therapies for spinal cord injury (SCI) have recently emerged, few authors have examined the goals of individuals with SCI considering experimental therapies, and none have determined whether sociodemographic and injury-specific characteristics influence that engagement. To determine (a) the goals of individuals with SCI who are considering experimental therapies; (b) whether sociodemographic factors, injury-specific characteristics, and concerns over adverse events influence those goals and/or participation in experimental therapies and clinical trials; and (c) whether people with SCI feel they have adequate information about experimental therapies and clinical trials. An online survey that yielded 364 responses.

Nurses and physiotherapists' knowledge levels on autonomic dysreflexia in a rehabilitation hospital.

Objective: Autonomic dysreflexia is a clinical syndrome that affects people with spinal cord lesions at or above the sixth thoracic vertebral level (T6). This study aims to determine the level of knowledge about autonomic dysreflexia among nurses and physiotherapists involved in spinal cord rehabilitation.

Design: Single-center survey study.

[Autonomic dysreflexia in spinal cord injury patients: recognition is vital].

Depending on the level and severity of spinal cord injury (SCI), SCI patients may suffer from loss of autonomic nervous system function besides the well-known motor and sensory function loss. Changes in the autonomic control of the cardiovascular system can lead to the life-threatening phenomenon of autonomic dysreflexia (AD), especially in patients with cervical or high thoracic SCI. AD is defined as a sudden increase in systolic blood pressure of at least 20 mmHg above baseline.

Toward rebalancing blood pressure instability after spinal cord injury with spinal cord electrical stimulation: A mini review and critique of the evolving literature.

High-level spinal cord injury commonly leads to blood pressure instability. This manifests clinically as orthostatic hypotension (OH), where blood pressure can drop to the point of loss of consciousness, and autonomic dysreflexia (AD), where systolic blood pressure can climb to over 300 mmHg in response to an unperceived noxious stimulus. These blood pressure fluctuations can occur multiple times a day, contributing to increased vessel shear stress and heightened risk of cardiovascular disease.