Activity-based training has resulted in unexpected benefits for individuals with severe spinal cord injury (SCI). Researchers at the Kentucky Spinal Cord Injury Research Center (KSCIRC) have discovered that the activity-based training improves motor function, also leads to improved bladder and bowel function and increased sexual desire.

Research participants receiving activity-based training conducted by KSCIRC at Frazier Rehab Institute initially reported improvements in the bladder, bowel, and sexual function anecdotally.

For individuals with severe spinal cord injury, bladder and bowel dysfunction are among the most detrimental factors to their quality of life, even more than the loss of independent mobility.

Bladder dysfunction associated with SCI results in numerous health complications, requiring catheterization, drug and surgical interventions, peripheral electrical stimulation and urethral stents. All of these therapies bring with them serious side effects and none substantially improves the basic functions.

To document changes in bladder, bowel and sexual function resulting from activity-based therapy, The research team performed urological testing (urodynamics) and asked research participants with severe spinal cord injury (SCI) to complete surveys about their bladder and other functions.

Eight of the participants received activity-based training, which includes locomotor training, stepping on a treadmill with their body weight supported, and stand training in a specially designed frame. Four participants did not receive training.

Following 80 daily sessions of locomotor training with or without stand training, the active individuals were found to store significantly more urine at safer pressures, reported fewer incidents of nighttime voiding and reduced general incontinence, as well as improved bowel functioning and increased sexual desire.

"Today's published research indicates that activity-based training strengthens the neural circuits that control urogenital and bowel functions," said Charles Hubscher, professor, and researcher at KSCIRC.

"We hope to further validate those findings by determining if the improvements can lead to elimination of related medications and/or long-term reduction in the number of daily catheterizations. In addition, we are evaluating the effects of spinal cord epidural stimulation on those circuitries."

Epidural Stimulation Research

Researchers at KSCIRC are also investigating the use of spinal cord epidural stimulation (scES) to facilitate the ability of SCI patients to stand, voluntarily control leg movements, and improve other functions. Spinal cord epidural stimulation involves the delivery of electrical signals to motor neurons in the spine by an implanted device.

In concert with this research, Hubscher is investigating the effects of scES on bladder, bowel and sexual function in SCI patients. He has mapped the lumbosacral spinal cord for multiple aspects of bladder function. This work will identify locations on the spine and device configurations for using scES to improve bladder storage and voiding efficiency.

Hubscher's SPARC project has a three-year timeline and includes concurrent investigations in both animals and humans. His team will enlist six human research participants who have received scES devices and have completed the initial epidural stimulation study to assist with the development of device parameters, then test those parameters at home.

For the estimated 1,275,000 people in the United States who live with paralysis from SCI, therapies resulting from this research have the potential to increase their quality of life as well as reduce health-care costs.