Targeting Improvements in Bowel Function and Quality of Life Using Epidural Stimulation and Training After Severe Spinal Cord Injury
Abstract
Spinal cord injury (SCI) interrupts communication between the brain and the nerves in the spinal cord that control bowel function. As a result, altered function in the gastrointestinal tract occurs with complications such as constipation, bloating, and abdominal discomfort as well as having uncontrolled bowel accidents. Most individuals with an SCI rely on various types of supplemental methods to achieve bowel emptying. Due to difficulties with elimination, including the increased risk of incontinence and elevated blood pressure associated with rectal distention, large amounts of time are devoted to bowel care programs. Bowel dysfunction after SCI is rarely studied in the experimental human subject research setting, yet is overwhelmingly one of the most significant daily concerns for those suffering from SCI. Previous work from our laboratory demonstrated that individuals who underwent daily, 1-hour locomotor training sessions (80 sessions) had a significant reduction in the time it took them to complete their bowel program by the post-training time point. Anecdotal reports from participants in our center receiving spinal cord epidural stimulation indicate that stimulation parameters aimed at improving trunk and core control also enhance toileting procedures. These reductions in defecation time could represent a substantial gain in the quality of life for individuals with SCI. It is not known whether the improvements in bowel function are due to the rehabilitative strategies that include weight-bearing activity or whether specific stimulation configurations that activate the nervous system may have a beneficial effect on bowel transit. In this proposal, we will test these two hypotheses, with the goal of demonstrating that spinal cord epidural stimulation can be used to recover significant levels of autonomic control of bowel function. This study will assess bowel function and quality of life in participants enrolled in an existing epidural stimulation training study within our center. We anticipate that spinal cord epidural stimulation parameters that aim to normalize blood pressure will also improve bowel motility in one group of participants and stimulation parameters used to enhance trunk control will improve bowel emptying/evacuation in the other group. The added effect of stimulation for standing will also be tested. We anticipate that improvements in bowel function will be associated with quality of life gains as well. Interviews conducted with participants and caregivers (if appropriate) will allow us to uncover what matters most, in terms of recovering bowel function, from the perspective of the SCI consumer.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910734
Entities
People
- April Herrity
Organizations
- United States Army
- University of Louisville