Bladder dysfunction significantly impacts quality of life in people with SCI, but rehabilitation options for managing bladder symptoms in SCI have been scarcely considered. Previous research has shown that there is important overlap between the part of the spinal cord that sends nerves to the bladder and the part of the spinal cord that receives sensory information from the legs. Other research has shown that walking programs, which inherently involve giving sensation to the feet through the soles, can improve bladder function in people with SCI. In this pilot study, we will continue to explore these relationships by evaluating the potential effects of combining electrical leg stimulation and standing therapy on bladder symptoms. We will also explore the neural mechanism of this training by studying changes in reflex connections between the sole of the foot and the pelvic floor muscles.
There are three purposes to this pilot study: 1) to understand how posture can affect the reflexes between the legs and pelvic floor muscles; 2) to explore the feasibility of combining standing therapy and tibial nerve stimulation therapy in people with SCI; and 3) to explore the effects of a 12-week combined standing therapy and tibial nerve stimulation program on bladder symptoms in people with SCI.
Knowledge gained from this pilot program may be used to inform the design of tailored pelvic floor muscle therapy regimens for people with SCI in future research and clinical practices.
Why should you participate?
It is possible that some participants may experience positive changes in their bladder function, but the extent and duration of any change is neither known nor guaranteed. The results of this study will help researchers understand the neural links between the legs and bladder. This information will be important in developing effective therapies for people with SCI in the future.
You may be eligible to participate in this study if you:
- Are at least 19 years of age
- Have a motor-complete spinal cord injury (AIS A or B) that occurred at least 12 months ago and is between the C7-T10 neurological levels
- Have symptoms of urinary dysfunction from your spinal cord injury
- Meet the manufacture requirements to use the standing frame (this will be evaluated by the research team)
- Are able to speak and understand English
You may not be eligible to participate if you:
- Have changed your bladder management program in the past month
- Have received an injection of Botulinum toxin-A in any bladder structure in the past 6 months, or intend to receive an injection while participating in the trial
- Have a progressive or non-stable SCI (e.g. spinal tumor)
- Have signs of a lower motoneuron injury (e.g. cauda equina syndrome)
- Have other neurological injury besides SCI (e.g. stroke, cerebral palsy)
- Have an implanted metallic or electronic device (e.g. pace maker, nerve stimulator)
- Have a condition for which exercise or transcutaneous stimulation is contraindicated
- Have a severe acute medical issue that in the investigator’s judgement would adversely affect the your participation in the study (e.g. acute urinary tract infections, pressure sores, musculoskeletal injury, or unmanaged blood pressure)
- Are currently pregnant or have given birth within the past 12 months
Time commitment: This study requires a 14 weeks commitment for the initial assessments and intervention: the intervention will last 12 weeks with 3 60minute sessions per week. One week before and one week after the intervention, we will test your reflexes and ask you to complete a series of questionnaires. If you agree, we will also call you at 1, 2 and 3-months after finishing the intervention, to ask you some long-term questions about your bladder health.
Compensation for participation: The decision to participate is up to you. If you decide to participate, you will receive an honourarium.
This study will take place at: At the Blusson Spinal Cord Centre.
For more information or to sign up to participate, please contact study coordinator Alison Williams by email or phone at 604-675-8815.
