Impact of treadmill gait training with neuromuscular electrical stimulation on the urodynamic profile of patients with high cervical spinal cord injury.

Carlos Arturo Levi D’Ancona,Walter Da Silva Júnior,Renato Jesus Pedro,Lia Yumi Ikari,Alberto Clilclet

doi:10.1590/s1679-45082010ao1691

Carlos Arturo Levi D’Ancona, Walter Da Silva Júnior + Show 3 more

Open Access

https://doi.org/10.1590/s1679-45082010ao1691

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Abstract

To evaluate the impact of gait training with neuromuscular electrical stimulation on urodynamic parameters of patients with neurogenic bladder. Eight male quadriplegic patients with complete cervical injury level ranging from C4 to C7 comprised the study population. They underwent treadmill gait training with neuromuscular electrical stimulation for six months, only after having their quadriceps and tibialis anterior muscles stimulated for five months in order to support at least 50% of their body weight (pre-gait training). Urodynamic testing was performed before the treadmill gait training and six months after. The mean time after cervical lesion was 74.63 months. The urodynamic parameters before and after neuromuscular training by electrical stimulation did not show significant difference. This study demonstrated that neuromuscular training with electrical stimulation can benefit the urinary tract. This promising minimally invasive field requires further and more complete studies to confirm a possible benefit to the low urinary tract.

Highlights

High cervical spinal cord injury resulting in tetraplegia involves impairment of motor, sensory and sympathetic nervous system (SNS)
Inclusion criteria were intact lower motor neurons on surface electrical stimulation that would allow muscle contraction and treadmill gait, with 30 to 50% body weight support (BWS) for 20 consecutive minutes, with no skin damage or ulcers; no history of cardiopulmonary disease and radiological and clinical evidence of lower limbs integrity. They were submitted to treadmill gait training with neuromuscular electrical stimulation (NMES) for six months, twice a week, 20 minutes per session, only after having their quadriceps and tibialis anterior muscles stimulated for 5 months in order to support at least 50% of their body weight
The average number of involuntary detrusor contractions (IDC) during bladder filling phase presented in the pretreatment studies was 6.25 ± 4.4, and it was not significantly different in the post-treatment studies that showed an average of 5.00 ± 5.10 (p = 0.5840)

Summary

Introduction

High cervical spinal cord injury resulting in tetraplegia involves impairment of motor, sensory and sympathetic nervous system (SNS). Quadriplegic patients lose central voluntary and spinal autonomic control of the bladder function, what defines an entity called neurogenic bladder. The spinal cord micturion center is primarily located at the S2-S4 level and it depends on the integrity of spinal neurologic pathways to exert perfect and synchronized control of bladder emptying and storage of urine[1]. After the spinal shock period, complete suprasacral (S2-S4 level) injuries classically result in detrusor hyperactivity and detrusor sphincter dyssynergia. Most cervical spinal cord injuries lead to. 326 D’Ancona CAL, Clilclet A, Ikari LY, Pedro RJ, Silva Júnior W detrusor hyperactivity and/or dyssynergia (42 and 68%), low bladder compliance (44%), and high detrusor leak point pressures (40%)(2). Urodynamic evaluation is the gold standard for evaluation and definition of lower urinary tract dysfunction[3]

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