Abstract
Objectives
To investigate whether the urogenital and bowel functional gains previously demonstrated
post-locomotor step training after chronic spinal cord injury could have been derived
due to weight-bearing alone or from exercise in general.
Design
Prospective cohort study; pilot trial with small sample size.
Setting
Urogenital and bowel scientific core facility at a rehabilitation institute and spinal
cord injury research center in the United States.
Participants
Men and women (N=22) with spinal cord injury (American Spinal Injury Association Impairment
Scale grades of A-D) participated in this study.
Interventions
Approximately 80 daily 1-hour sessions of either stand training or nonweight-bearing
arm crank ergometry. Comparisons were made with previously published locomotor training
data (step; N=7).
Main Outcome Measures
Assessments at both pre- and post-training timepoints included cystometry for bladder
function and International Data Set Questionnaires for bowel and sexual functions.
Results
Cystometry measurements revealed a significant decrease in bladder pressure and limited
improvement in compliance with nonweight-bearing exercise but not with standing. Although
International Data Set questionnaires revealed profound bowel dysfunction and marked
deficits in sexual function pretraining, no differences were identified poststand
or after nonweight-bearing exercise.
Conclusions
These pilot trial results suggest that, although stand and weight-bearing alone do
not benefit pelvic organ functions after spinal cord injury, exercise in general may
contribute at least partially to the lowering of bladder pressure and the increase
in compliance that was seen previously with locomotor training, potentially through
metabolic, humoral, and/or cardiovascular mechanisms. Thus, to maximize activity-based
recovery training benefits for functions related to storage and emptying, an appropriate
level of sensory input to the spinal cord neural circuitries controlling bladder and
bowel requires task-specific stepping.
Keywords
List of abbreviations:
AD (autonomic dysreflexia), AIS (American Spinal Injury Association Impairment Scale), BWSS (body weight support system), CIC (clean intermittent catheterization), Fr (French), FSFI (female sexual function index), IIEF (International Index of Erectile Function), LT (locomotor training), NBD (neurogenic bowel dysfunction), SCI (spinal cord injury), SP (suprapubic catheter), UDS (urodynamic study), UE (upper extremity)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 02, 2020
Footnotes
Supported by the National Institute of Child Health and Human Development (R01HD080205), the Leona M. and Harry B. Helmsley Charitable Trust, and the Christopher & Dana Reeve Foundation.
Disclosures: none.
Clinical Trial Registration No.: NCT03036527.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
