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Yeh SD, Khasanah N, Gustafson KJ, Sun C, Tsai ML, Lin BS, Wu CW, Peng CW. Beneficial carry-over effects of chronic at-home genital nerve stimulation on incontinence in individuals with spinal cord injury: A pragmatic trial. Ann Phys Rehabil Med 2024; 67:101799. [PMID: 38128350 DOI: 10.1016/j.rehab.2023.101799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/30/2023] [Accepted: 09/19/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Genital nerve stimulation (GNS) is a promising, but under-researched, alternative treatment for neurogenic detrusor overactivity (NDO) in those with spinal cord injury (SCI). OBJECTIVES To investigate the urodynamic, quality-of-life (QOL) and carry-over effects of GNS when applied at home for 2 weeks by participants with incomplete SCI and NDO during activities of daily living. METHODS Seven men and 1 woman participated in this 1-month protocol study. Urodynamic and QOL data were gathered during week 1 (baseline measurements), followed by 2 weeks of daily GNS at home using a portable device. GNS was applied either on-demand or thrice daily, depending on the individual's sensation. At week 4, post-stimulation tests were repeated to record any carry-over effect from the GNS. Participants maintained voiding diaries throughout the study. Assessments were carried out at the end of each protocol period in a randomized order. Clinical procedures were conducted at Taipei Medical University Hospital (Taipei, Taiwan). RESULTS Everyone completed the study but only 7 of the 8 participants completed their voiding diary. Two weeks after GNS, average cystometric bladder capacity was increased by 30 % compared to baseline (P< 0.05). A 1-week carry-over effect was demonstrated as this capacity remained, on average, 35 % greater than baseline in week 4 after GNS was stopped (P< 0.05). Incontinence frequency significantly decreased by the end of week 3 (P< 0.05) but no significant improvements were recorded for either detrusor pressure or bladder compliance. CONCLUSIONS Chronic at-home GNS improved cystometric bladder capacity and reduced urinary incontinence for individuals with incomplete SCI and NDO. A carry-over effect of 1 week was observed following GNS treatment. The use of portable GNS treatment that can be applied by the individual at home merits further investigation as alternative treatment for NDO in those with SCI.
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Affiliation(s)
- Shauh-Der Yeh
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan, ROC; Department of Urology, Taipei Medical University Hospital, Taipei 11031, Taiwan, ROC
| | - Nurida Khasanah
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan, ROC; Department of Obstetrics and Gynecology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Kenneth J Gustafson
- Louis Stokes Cleveland VAMC, Cleveland, OH, USA; Cleveland FES Center, Cleveland, OH, USA; Departments of Biomedical Engineering & Urology, Case Western Reserve University, Cleveland, OH, USA
| | - Chi Sun
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan, ROC
| | - Mei-Lin Tsai
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan, ROC; Department of Urology, Taipei Medical University Hospital, Taipei 11031, Taiwan, ROC
| | - Bor-Shing Lin
- Department of Computer Science and Information Engineering, National Taipei University, New Taipei City, Taiwan, ROC
| | - Chun-Wei Wu
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan, ROC
| | - Chih-Wei Peng
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan, ROC; School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan, ROC; School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan, ROC; Research Center of Biomedical Device, Taipei Medical University, Taipei 11031, Taiwan, ROC.
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Jiang Y, Li X, Guo S, Wei Z, Xu S, Qin H, Xu J. Transcutaneous Electrical Stimulation for Neurogenic Bladder After Spinal Cord Injury: A Systematic Review and Meta-Analysis. Neuromodulation 2023:S1094-7159(23)00674-8. [PMID: 37642626 DOI: 10.1016/j.neurom.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/04/2023] [Accepted: 06/05/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES This review aims to assess the efficacy of transcutaneous electrical nerve stimulation (TENS) for neurogenic bladder after spinal cord injury (SCI). MATERIALS AND METHODS A systematic search was conducted of seven electronic data bases from inception to Dec 31, 2022, to identify randomized controlled trials that studied TENS for neurogenic bladder after SCI. The primary outcomes were maximum cystometric capacity (MCC) and residual urine volume (RUV). Secondary outcomes included maximum detrusor pressure, flow rate, and bladder diary. Random effects models were used in all analyses. RESULTS Eleven trials involving 881 participants were included. Meta-analysis showed that TENS in addition to conventional treatment had larger MCC (mean difference [MD] 50.55 ml, 95% CI 27.81-73.29, p<0.0001) and lower RUV (MD -22.96 ml, 95% CI -33.45 to -12.47, p<0.0001) than did conventional treatment only. Compared with magnetic stimulation, no differences were observed with TENS for MCC (MD -14.49 ml, 95% CI -48.97 to 19.98, p = 0.41) and RUV (MD 25 ml, 95% CI -61.79 to 111.79, p = 0.57). There also were no differences in MCC (MD -7.2 ml, 95% CI -14.56 to 0.16, p= 0.06) and (MD -5.2 ml, 95% CI -60.00 to 49.60, p = 0.851) when compared with solifenacin succinate and pelvic floor biofeedback, respectively. CONCLUSIONS TENS may be an effective treatment option for neurogenic bladder after SCI.
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Affiliation(s)
- Yangyang Jiang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiang Li
- The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Suhui Guo
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhengshu Wei
- The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Senming Xu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China; Affiliated Hospital of You Jiang Medical University for Nationalities, Baise, Guangxi, China
| | - Huiqing Qin
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jianwen Xu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
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Cvitkovic-Roic A, Mikulic D, Turudic D, Milosevic D, Roic G, Matijevic V. Rehabilitation approach and results of using the biofeedback method (GIGER MD device) in children with neurogenic bladder. Front Neurol 2023; 14:1198232. [PMID: 37545722 PMCID: PMC10403197 DOI: 10.3389/fneur.2023.1198232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Background GIGER MD device applies a biofeedback method through stimulated coordinated rhythmic and dynamic movements of the trunk and extremities in an anti-gravity position, thus helping to regain lost motor functions. Methods In this article, the performance of the GIGER MD device was evaluated in 36 children with neurogenic bladder measuring gait speed, voiding bladder capacity, deviation from the age-adjusted bladder capacity (measured using the Koff scale), and urinary incontinence. Results Children using the GIGER MD device had an increase in voiding bladder capacity (33.79%, median volume increase of 50 ml) with a subsequent median decrease in median age-adjusted bladder capacity by 45.50% (median deviation before was 36% vs. 16% after treatment). The number of urinary incontinence episodes also reduced by 55.57% (7-3 episodes per day), and the 20-meter motor gait speed increased by 14.26% (from 23 to 19 s). Conclusion Children who follow the GIGER MD therapy regularly for a period of 6 months show that CNS functional damage can be significantly improved.
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Affiliation(s)
- Andrea Cvitkovic-Roic
- Helena Clinic for Pediatric Medicine, Zagreb, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Faculty of Medicine, University of Rijeka, Zagreb, Croatia
| | - Danijel Mikulic
- Department of Emergency, University Hospital Centre “Sisters of Charity”, Zagreb, Croatia
| | - Daniel Turudic
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Danko Milosevic
- Croatian Academy of Medical Sciences, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Goran Roic
- Faculty of Medicine, University of Rijeka, Zagreb, Croatia
- Children's Hospital Zagreb, Zagreb, Croatia
| | - Valentina Matijevic
- Department of Rheumatology, Physical Medicine and Rehabilitation, University Hospital Centre “Sisters of Charity”, Zagreb, Croatia
- Libertas International University, Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia
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Fan G, Yang S, Liu H, Xu N, Chen Y, He J, Su X, Pang M, Liu B, Han L, Rong L. Machine Learning-based Prediction of Prolonged Intensive Care Unit Stay for Critical Patients with Spinal Cord Injury. Spine (Phila Pa 1976) 2022; 47:E390-E398. [PMID: 34690328 DOI: 10.1097/brs.0000000000004267] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE The objective of the study was to develop machine-learning (ML) classifiers for predicting prolonged intensive care unit (ICU)-stay and prolonged hospital-stay for critical patients with spinal cord injury (SCI). SUMMARY OF BACKGROUND DATA Critical patients with SCI in ICU need more attention. SCI patients with prolonged stay in ICU usually occupy vast medical resources and hinder the rehabilitation deployment. METHODS A total of 1599 critical patients with SCI were included in the study and labeled with prolonged stay or normal stay. All data were extracted from the eICU Collaborative Research Database and the Medical Information Mart for Intensive Care III-IV Database. The extracted data were randomly divided into training, validation and testing (6:2:2) subdatasets. A total of 91 initial ML classifiers were developed, and the top three initial classifiers with the best performance were further stacked into an ensemble classifier with logistic regressor. The area under the curve (AUC) was the main indicator to assess the prediction performance of all classifiers. The primary predicting outcome was prolonged ICU-stay, while the secondary predicting outcome was prolonged hospital-stay. RESULTS In predicting prolonged ICU-stay, the AUC of the ensemble classifier was 0.864 ± 0.021 in the three-time five-fold cross-validation and 0.802 in the independent testing. In predicting prolonged hospital-stay, the AUC of the ensemble classifier was 0.815 ± 0.037 in the three-time five-fold cross-validation and 0.799 in the independent testing. Decision curve analysis showed the merits of the ensemble classifiers, as the curves of the top three initial classifiers varied a lot in either predicting prolonged ICU-stay or discriminating prolonged hospital-stay. CONCLUSION The ensemble classifiers successfully predict the prolonged ICU-stay and the prolonged hospital-stay, which showed a high potential of assisting physicians in managing SCI patients in ICU and make full use of medical resources.Level of Evidence: 3.
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Affiliation(s)
- Guoxin Fan
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yatsen University, Guangzhou, China
- Intelligent and Digital Surgery Innovation Center, Southern University of Science and Technology Hospital, Shenzhen, Guangdong, China
| | - Sheng Yang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huaqing Liu
- Artificial Intelligence Innovation Center, Research Institute of Tsinghua, Pearl River Delta, Guangzhou, China
| | - Ningze Xu
- Tongji University School of Medicine, Shanghai, P. R. China
| | - Yuyong Chen
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yatsen University, Guangzhou, China
- Intelligent and Digital Surgery Innovation Center, Southern University of Science and Technology Hospital, Shenzhen, Guangdong, China
| | - Jie He
- Intelligent and Digital Surgery Innovation Center, Southern University of Science and Technology Hospital, Shenzhen, Guangdong, China
| | - Xiuyun Su
- Intelligent and Digital Surgery Innovation Center, Southern University of Science and Technology Hospital, Shenzhen, Guangdong, China
| | - Mao Pang
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yatsen University, Guangzhou, China
| | - Bin Liu
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yatsen University, Guangzhou, China
| | - Lanqing Han
- Artificial Intelligence Innovation Center, Research Institute of Tsinghua, Pearl River Delta, Guangzhou, China
| | - Limin Rong
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yatsen University, Guangzhou, China
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Ghoniem G, Moskowitz D, Nguyen C. Urological Care After Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00347-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dodd W, Motwani K, Small C, Pierre K, Patel D, Malnik S, Lucke-Wold B, Porche K. Spinal cord injury and neurogenic lower urinary tract dysfunction: what do we know and where are we going? JOURNAL OF MEN'S HEALTH 2022; 18:24. [PMID: 35106100 PMCID: PMC8803268 DOI: 10.31083/j.jomh1801024] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
One of the well reported but difficult to manage symptoms of spinal cord injury (SCI) is neurogenic lower urinary tract dysfunction (NLUTD). The type of NLUTD is variable based on location and extent of injury. SCI affects more males and NLUTD is especially debilitating for men with incomplete injury. This review summarizes the anatomical basis of NLUTD in SCI and discusses current diagnostic and management strategies that are being utilized clinically. The last two sections address new innovations and emerging discoveries with the goal of increasing scientific interest in improving treatment options for people with SCI. Areas warranting further investigation are pinpointed to address current gaps in knowledge and/or appropriate technology.
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Affiliation(s)
- William Dodd
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
| | - Kartik Motwani
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
| | - Coulter Small
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
| | - Kevin Pierre
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
| | - Devan Patel
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
| | - Samuel Malnik
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
| | - Ken Porche
- Department of Neurosurgery, University of Florida,
Gainesville, FL 32601, USA
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