Abhinav Singh, (2020) Modulating Spinal Reflex pathway for treatment of detrusor overactivity in patients with spinal cord injury by stimulating sacral afferents at sole of foot: A Pilot study. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: Spinal cord injury is an ailment that directly or indirectly affects all body system. One of the most distressing complaints about patients with Spinal cord injury (SCI) is urinary dysfunction. In SCI patients, the loss of supraspinal control can be responsible for overactivity of detrusor muscles, leading to small bladder capacity. As a result of which patient may have high bladder pressure, vesicoureteral reflux and renal impairment and bladder incontinence. Clean intermittent catheterization (CIC) along with antimuscarinic drugs is the gold standard for the management of spinal cord injury with neurogenic bladder. Sacral neuromodulation, tibial nerve stimulation, and pudendal nerve stimulation considered an option for the management of neurogenic bladder secondary to SCI; but, because of invasive nature, it has its limitations. Stimulation of the somatic afferent pathways can be an important factor in the efficacy of neuromodulation. Results of the phase 1 study conducted in our department in the year 2009-2011 showed improvement in urinary leaks as per voiding chart after two weeks of stimulation of the posterior tibial nerve. In our study, we tried to find if the electrical stimulation of the branch of tibial nerve at the sole of foot (i.e medial planter nerve) can help in modulating spinal reflex pathways for reducing detrusor overactivity. AIM OF THE STUDY: To reduce detrusor overactivity by modulating spinal reflex pathways using electrical stimulation at sole of foot in patients with spinal cord injury. METHODS: Twenty patients, meeting key inclusion/exclusion criteria, on clean intermittent catheterization having Cystometrogram (CMG) proven detrusor over activity with intact ankle-jerk and complaints of at least one leak per day consented for the study. All the patients maintained voiding chart one-week prior and two-weeks during the treatment. Cystometrogram was done on day 1 and 15. Electrical stimulation was given half-an-hour daily for two-weeks keeping same parameters as our previous study (1). Anode and cathode were placed at metatarsal and arch of foot respectively. In-house developed stimulator costing less than Rs2000, was used. Satisfaction questionnaire were taken on day 15. Voiding chart data was analyzed using novel Cumulative Voiding Chart Index (CvCi) developed at Department of PMR, CMC Vellore. Wilcoxon signed-ranked test was used for CMG data while Binomial distribution for voiding chart data as test of significance. The p-value < 0.05 was considered as significant. Study was approved by Institutional review board and ethics committee (CMC/IRB/11061/2017/12/20). RESULTS: Post-treatment the p-value for improvement in maximum detrusor pressure (p-value = 0.03) and cystometric capacity (p-value = 0.04) was found to be statistically significant while p-value of reflex volume (p-value = 0.13) was not significant. Eighteen patients showed improvement in bladder function and two subjects did not show any signs of improvement as reported by CvCi score derived from voiding chart. CONCLUSION: Neuromodulation by surface electrical stimulation at sole of foot is simple, non-pharmacological, non-invasive, inexpensive, promising alternative treatment modality for reducing detrusor overactivity.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 201729051 |
| Uncontrolled Keywords: | Spinal cord injury, Detrusor Overactivity, Neuromodulation, Cystometrogram, Surface electrical stimulation, Urinary Incontinence. |
| Subjects: | MEDICAL > Physical Medicine and Rehabilitation |
| Depositing User: | Subramani R |
| Date Deposited: | 04 Feb 2021 18:08 |
| Last Modified: | 04 Feb 2021 18:08 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13851 |
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