Abstract
Individuals with spinal cord injury or neurological disorders have problems in voiding function due to the dyssynergic contraction of the urethral sphincter. Here, we introduce a closed-loop control of intraspinal microstimulation (ISMS) for efficient bladder voiding. The strategy is based on asynchronous two-electrode ISMS with combined pulse-amplitude and pulse-frequency modulation without requiring rhizotomy, neurotomy, or high-frequency blocking. Intermittent stimulation is alternately applied to the two electrodes that are implanted in the S2 lateral ventral horn and S1 dorsal gray commissure, to excite the bladder motoneurons and to inhibit the urethral sphincter motoneurons. Asynchronous stimulation would lead to reduce the net electric field and to maximize the selective stimulation. The proposed closed-loop system attains a highly voiding efficiency of 77.2–100%, with an average of 91.28 ± 8.4%. This work represents a promising approach to the development of a natural and robust motor neuroprosthesis device for restoring bladder functions.
Highlights
Individuals with spinal cord injury or neurological disorders have problems in voiding function due to the dyssynergic contraction of the urethral sphincter
The results indicate that the two-electrode stimulation significantly improves the voiding efficiency compared to the single-electrode stimulation ( p = 5.6779 × 10−4, N-way Analysis of variance (ANOVA)) and two-electrode asynchronous compared to the two-electrode synchronous stimulation ( p = 3.6412 × 10−5, two-way ANOVA)
We proposed a closed-loop control strategy for efficient bladder voiding using intraspinal microstimulation (ISMS) without requiring rhizotomy, neurotomy, or high-frequency blocking
Summary
Individuals with spinal cord injury or neurological disorders have problems in voiding function due to the dyssynergic contraction of the urethral sphincter. Bladder hyper-reflexia or detrusor underactivity and dyssynergic contraction of the urethral sphincter are common clinical conditions affecting individuals with spinal cord injury or neurological disorders[1,2,3,4,5,6,7]. Sacral anterior root stimulation is represented as the first proposed electrical stimulation system for bladder emptying in spinal cord injury s ubjects[7,11,12]. Electrical stimulation of the pudendal nerve (PN) has been proposed as an alternative approach to restore urinary function[7] in individuals with spinal cord injury.
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