Electrical Stimulation Of Abdominal Muscles Research Articles

Penile vibratory stimulation in men with spinal cord injury: an educational video demonstration

To demonstrate the different techniques used to perform successful penile vibratory stimulation (PVS) to induce ejaculation in men with spinal cord injuries (SCIs). A video demonstration of the PVS procedure performed in men with SCIs using the FertiCare 2.0 medical vibrator. Major University Medical Center. Men with SCIs. Spinal cord injury is the leading cause of anejaculation in young men. After SCIs, most of these men will need a method of assisted ejaculation to achieve biological fatherhood. In this study, a newly designed and tested vibrator (FertiCare 2.0) was used to induce ejaculation. The initial assessment of each patient included a standard history, physical examination, level of injury determination using the International Standards for Neurological Classification of Spinal Cord Injury as well as assessment of the hip flexor reflex and the bulbocavernosus reflex. Patients with a level of injury at or rostral to T6 were pretreated with 10-40 mg of sublingual nifedipine to manage autonomic dysreflexia. A single vibrator was applied to the dorsum, or frenulum, of the glans penis. Stimulation is delivered in 2-minute increments to a maximum of 10 minutes per visit. Application of two vibrators or abdominal electrical stimulation concurrently with PVS was used in select patients. Ejaculated semen was collected in a sterile cup and examined after liquefaction. Bladder preparation using sperm wash medium was performed in patients suspected of experiencing retrograde ejaculation. Successful ejaculation after performing the PVS procedure in men with SCIs. Penile vibratory stimulation was successful in 86% of men whose level of injury was T10 or rostral. The total motile sperm count in antegrade ejaculates produced using PVS was >5 million (lower limit considered for intrauterine insemination) in 71% of ejaculates. No complications because of PVS were observed in 3,700 trials performed by our group and none in the patients presented in this video. Penile vibratory stimulation is a safe and effective method for the management of ejaculatory dysfunction in men with SCIs. Penile vibratory stimulation can be performed by the male partner after an initial evaluation by a specialized provider, and the ejaculate can be used to perform home insemination.

V11-09 PENILE VIBRATORY STIMULATION (PVS): THE METHOD OF CHOICE FOR ANEJACULATION AFTER SPINAL CORD INJURY

You have accessJournal of UrologyCME1 Apr 2023V11-09 PENILE VIBRATORY STIMULATION (PVS): THE METHOD OF CHOICE FOR ANEJACULATION AFTER SPINAL CORD INJURY Emad Ibrahim Emad IbrahimEmad Ibrahim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003337.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Spinal cord injury (SCI) is the leading cause of anejaculation in young men. After SCI 90% of men with SCI will need a method of assisted ejaculation to achieve biological fatherhood. Penile vibratory stimulation (PVS) was popularized in 1994 after the production of the first vibrator specifically designed for semen retrieval in men with SCI. The success of this device was based on a calculated amplitude of 2.5 mm which was proven to be optimal for successfully producing an ejaculate. PVS is safe, reliable, can be performed by the male partner at home after an initial evaluation by a health care provider and yields the best sperm quality.A newly designed vibrator was produced in 2019 and was tested by a group of international experts for safety and efficacy. The study concluded the device was safe and effective in inducing ejaculation in men suffering from anejaculation after SCI. METHODS: Initial encounter: standard history, physical exam and level of injury determination using the International Standards for Neurological Classification of Spinal Cord Injury were performed. In addition, assessment of Hip Flexor Reflex and Bulbocavernosus Reflex was performed. Procedure: Patients with a level of injury at or rostral to T6 were pretreated with 10-40 mg of sublingual nifedipine to mange autonomic dysreflexia. The patient lied supine on the exam table and the vibrator was applied to the dorsum or frenulum of the glans penis. Stimulation was delivered in 2-minute increments to a maximum of 10 minutes per visit. Stimulation using 2 vibrators (Sandwich technique) or with abdominal electrical stimulation can be performed in select patients. Semen: Ejaculated semen was collected in a sterile cup and a semen analysis was performed after liquefaction. Bladder preparation using sperm wash medium was performed in patients suspected of having retrograde ejaculation. RESULTS: PVS was successful in 86% of men whose level of injury was T10 or rostral. A total of 3,698 PVS procedures were successfully performed by our group. The total motile sperm count in antegrade ejaculates produced by PVS was >5 million (lower limit considered for IUI) in 71% of ejaculates. CONCLUSIONS: PVS is a safe and effective method to manage anejaculation in men with SCI. Sperm can be obtained non surgically from most men with SCI. Sufficient sperm are available for simple insemination procedures. PVS should be considered as the method of choice for semen retrieval in this patient population. Source of Funding: Paralyzed Veterans of America (PVA) Educational Grant #877 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1001 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emad Ibrahim More articles by this author Expand All Advertisement PDF downloadLoading ...

Neuromuscular Electrical Stimulation of Abdominal Muscles to Improve Standing Balance

Neuromuscular Electrical Stimulation of Abdominal Muscles to Improve Standing Balance

Effect of Electrical Stimulation Followed by Exercises in Postnatal Diastasis Recti Abdominis via MMP2 Gene Expression.

Since abdominal muscle training is one of the most important ways to treat rectal diastasis, it is necessary to design and provide appropriate exercises to treat this problem. One of the complementary methods to achieve higher intensity training is the use of electrical muscle stimulation along with voluntary activity, which causes maximum recall in muscle units. Therefore, in the current study, the effect of electrical stimulation followed by exercises was evaluated in postnatal diastasis recti abdominis via MMP2 gene expression. For this purpose, we studied on thirty-two women who had rectal diastasis for six months and were referred to a physiotherapy clinic by a gynecologist. They were divided into the control group (n=16) and the intervention group (n=16). The distance between the two blocks of the rectus abdominis muscle and the thickness of the abdominal muscles at rest was determined by ultrasound. In the intervention group, electrical stimulation and strengthening exercises of oblique muscles were performed for six weeks. The control group did not perform any specific exercises. After six weeks, another ultrasound was performed. The expression of the MMP2 gene was measured by the real-time PCR method. Comparison of the distance between the two blocks of rectus abdominis muscle (above the umbilicus and below the umbilicus) before and after six weeks showed that in the experimental group after intervention in both areas had a significant decrease (above the umbilicus = 0.001 and below the umbilicus P = 0.03), while this distance in the control group did not decrease significantly (p >0.05). Also, in the upper part of the umbilicus, the distance between the two rectus abdominis muscle blocks in two groups after the intervention showed a significant difference (p = 0.04). Evaluation of MMP2 gene expression showed that there was no significant difference between the two groups before the intervention (p >0.05). However, after the intervention, the expression of this gene decreased significantly in the intervention group (p = 0.007). In general, the present study results showed that electrical stimulation of abdominal muscles with strengthening exercises of internal and external oblique muscles could reduce rectal diastasis and increase the thickness of these muscles in people with rectal diastasis.

Effect of transcutaneous abdominal electrical stimulation in people with constipation due to spinal cord injuries: a pilot study.

To evaluate the effect of abdominal electrical stimulation (EE) on bowel movement frequency and feces consistency and expelled amount in people with constipation due to spinal cord injuries (SCI). This is an experimental, crossover, randomized pilot study with two treatment groups: conventional intestinal rehabilitation and conventional rehabilitation associated with EE via 8- and 20-Hz Functional Electrical Stimulation (FES) of the abdominal muscles. Both groups were followed for two weeks with daily 30-minute EE sessions. Participants were hospitalized in a rehabilitation institute in the municipality of São Paulo. Data were analyzed using descriptive and inferential statistics. This study included 10 people with SCI, of which most were male (70%), with a mean age of 39 years (SD = 16.37). EE, associated with conventional treatment, was more effective in increasing defecation frequency (p = 0.029) and amount of feces expelled (p = 0.031). Abdominal EE, associated with conventional treatment, helped to increase defecation frequency and amount of feces expelled in people with constipation due to SCI. This pilot study will serve as the basis for a future clinical trial with greater sampling and statistical evidence.

Nonpharmacologic Treatment for Children with Functional Constipation: A Systematic Review and Meta-analysis

To evaluate the effectiveness and safety of nonpharmacologic interventions for the treatment of childhood functional constipation. Randomized controlled trials (RCTs) evaluating nonpharmacologic treatments in children with functional constipation which reported at least 1 outcome of the core outcome set for children with functional constipation. We included 52 RCTs with 4668 children, aged between 2weeks and 18years, of whom 47% were females. Studied interventions included gut microbiome-directed interventions, other dietary interventions, oral supplements, pelvic floor-directed interventions, electrical stimulation, dry cupping, and massage therapy. An overall high risk of bias was found across the majority of studies. Meta-analyses for treatment success and/or defecation frequency, including 20 RCTs, showed abdominal electrical stimulation (n=3), Cassia Fistula emulsion (n=2), and a cow's milk exclusion diet (n=2 in a subpopulation with constipation as a possible manifestation of cow's milk allergy) may be effective. Evidence from RCTs not included in the meta-analyses, indicated that some prebiotic and fiber mixtures, Chinese herbal medicine (Xiao'er Biantong granules), and abdominal massage are promising therapies. In contrast, studies showed no benefit for the use of probiotics, synbiotics, an increase in water intake, drycupping, or additional biofeedback or behavioral therapy. We found no RCTs on physical movement or acupuncture. More well-designed high quality RCTs concerning nonpharmacologic treatments for children with functional constipation are needed before changes in current guidelines are indicated.

Increasing Effects of Selective 5-Hydroxytryptamine Type 2C Receptor Stimulation on Evoked Momentary Urethral Closure in Female Rats and Humans.

Under healthy conditions, more than one urethra-closing reflex, including both bladder afferent-independent and -dependent actions, function during momentary elevation of intravesical (bladder) pressure to prevent urinary incontinence. In the current study, the effects of a novel selective 5-hydroxytryptamine type 2C (5-HT2C) receptor agonist, TAK-233, on evoked momentary urethra-closing functions were investigated in female rats and humans to elucidate 5-HT2C receptor functions. In anesthetized female rats, TAK-233 dose-dependently and significantly increased urethral resistance during sneezing in rats with distended vaginas and bilaterally transected pelvic nerves. The drug also dose-dependently and significantly increased urethral resistance during momentary intravesical pressure elevation by electrical stimulation of abdominal muscles in rats with a transected spinal cord at the T8-T9 level and intact pelvic nerves. The increased effects observed during electrical stimulation were abolished by either an intravenously administered selective 5-HT2C receptor antagonist, SB 242084, or bilateral transection of the pelvic nerves or somatic nerves innervating the external urethral sphincter and pelvic floor muscles. In the spinal cord-transected and pelvic nerve-intact rats, TAK-233 enlarged the urethra-closing responses induced by both passive and abrupt intravesical pressure elevation, measured by a microtip transducer located in the middle urethra. Additionally, the effects of TAK-233 on the stimulus threshold of urethral contractile responses induced by transcranial magnetic stimulation were investigated in healthy female volunteers. The drug dose-dependently and significantly lowered this stimulus threshold, indicating an increased sensitivity of the response. These results demonstrate that 5-HT2C receptor stimulation enhances the evoked momentary urethra-closing functions in both female rats and humans. SIGNIFICANCE STATEMENT: 5-hydroxytryptamine (serotonin) type 2C (5-HT2C) receptor stimulation by TAK-233 enhanced urethral resistance in rats during an evoked momentary event in which the bladder afferent-independent or -dependent reflex functions via striated muscle-mediated mechanisms. The increases in sensitivity of transcranial magnetic stimulation-evoked urethral contractile responses in healthy female subjects indicates that this mechanism also functions in humans. The evoked momentary conditions activating these reflexes provide a suitable model to demonstrate the effects of 5-HT2C receptor stimulation.

Effect of Combining Task-oriented Training and Neuromuscular Electrical Stimulation of Abdominal Muscles to Improve the Basic ADL Performance of a Patient with Bilateral Hemiplegia due to Recurrent Cerebrovascular Events: A Case Study

Effect of Combining Task-oriented Training and Neuromuscular Electrical Stimulation of Abdominal Muscles to Improve the Basic ADL Performance of a Patient with Bilateral Hemiplegia due to Recurrent Cerebrovascular Events: A Case Study

Functional electrical stimulation to the abdominal wall muscles synchronized with the expiratory flow does not induce muscle fatigue.

[Purpose] Continuous electrical stimulation of abdominal wall muscles is known to induce mild muscle fatigue. However, it is not clear whether this is also true for functional electrical stimulation delivered only during the expiratory phase of breathing. This study aimed to examine whether or not intermittent electrical stimulation delivered to abdominal wall muscles induces muscle fatigue. [Subjects and Methods] The subjects were nine healthy adults. Abdominal electrical stimulation was applied for 1.5 seconds from the start of expiration and then turned off during inspiration. The electrodes were attached to both sides of the abdomen at the lower margin of the 12th rib. Abdominal electrical stimulation was delivered for 15 minutes with the subject in a seated position. Expiratory flow was measured during stimulus. Trunk flexor torque and electromyography activity were measured to evaluate abdominal muscle fatigue. [Results] The mean stimulation on/off ratio was 1:2.3. The declining rate of abdominal muscle torque was 61.1 ± 19.1% before stimulus and 56.5 ± 20.9% after stimulus, not significantly different. The declining rate of mean power frequency was 47.8 ± 11.7% before stimulus and 47.9 ± 10.2% after stimulus, not significantly different. [Conclusion] It was found that intermittent electrical stimulation to abdominal muscles synchronized with the expiratory would not induce muscle fatigue.

Benefits of interventions for respiratory secretion management in adult palliative care patients-a systematic review.

BackgroundRespiratory secretions impact negatively on palliative patients. Unfortunately, a gold standard therapy is not yet available. The purpose of this study was to identify which interventions are in use to control respiratory secretions in patients with chronic disease with a poor prognosis and verify their effects on outcomes relevant for palliative care patients.MethodsA systematic review of the literature with narrative summary was conducted. We searched eight electronic databases in April 6th, 2016. Citation-tracking and reference list searches were conducted. We included randomized controlled trials, crossover trials, observational and qualitative studies regarding interventions for respiratory secretion management in adult patients with chronic diseases that met inclusion criteria indicating short prognosis.ResultsSix randomized controlled trials, 11 observational studies, ten crossover trials and one qualitative study were found. Interventions included mechanical insufflation-exsufflation (MIE), expiratory muscle training, manually-assisted cough, tracheotomy, chest physiotherapy, suctioning, air stacking, electrical stimulation of abdominal muscles, nebulized saline, positive expiratory pressure masks, percussive ventilation, high frequency chest wall oscillations. The interventions with most promising benefits to patients in palliative care were manually-assisted cough and mechanical insufflation-exsufflation to promote expectoration and percussive ventilation to improve mucous clearance.ConclusionTherapies, such as manually assisted cough, mechanical insufflation-exsufflation and percussive ventilation, which aim to deal with respiratory secretion, were the most promising treatment for use in palliative care for specific diseases. Nevertheless, the evidence still needs to improve in order to identify which treatment is the best.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0147-y) contains supplementary material, which is available to authorized users.

Successful sacral nerve modulation despite migration of tined lead

Background: Sacral nerve modulation (SNM) is a minimally invasive treatment for chronic constipation or incontinence when conservative treatment is insufficient to provide relieve of symptoms. Case description: A 74-year-old patient with an implanted sacral nerve lead is presented in this case report with a dislodged lead without an adverse change in her incontinence treatment. This phenomenon has never been described before and raises the debate on sacral lead positioning in sacral nerve stimulation. Discussion: There are a lot of conflicting data regarding ideal lead positioning, such as S3 versus S2 or S4 implantation. The lead position in our case doesn’t correspond to previously described locations and pathways which corroborate the legitimacy of new developments in this area such as percutaneous tibial nerve stimulation, transcutaneous tibial nerve stimulation and transcutaneous abdominal electrical stimulation (TEN). Conclusions: The implantation of SNM seems standardized but leaves voids in the technique where further research is needed to refine it.

[Integrated approach to correction enteral insufficiency in early postoperative period].

The purpose of the research was to study the effectiveness of enteral insufficiency correction at an acute peritonitis by applying minimally invasive techniques, electrical stimulation and rehabilitation of the bowel and abdominal intestine using Remaxol drug. The analysis of the results of clinical and laboratory examination and treatment of 110 patients with acute diffuse peritonitis. In the comparison group (62 patients) in the early postoperative period applied standardized treatment, including software reorganization of the abdominal cavity, in the study group (48 patients) -- a comprehensive treatment that includes software laparoscopic sanation abdominal electrical stimulation of the duodenum, and intra-abdominal (single dose, 200 ml), and intracolonic (200 ml, 2 times daily) administration Remaxol. It was noted a significant improvement in treatment outcomes, including reduced mortality by 2.3 times, the shortening of hospital stay by 1.3 times. The major component of the positive effect of the developed scheme of therapy is its ability to promptly arrest the effects of enteral insufficiency, maintain the functional status of the liver. The relatively rapid recovery of motor and intestinal barrier function leads to a lowering of enteral insufficiency syndrome, which along with increased liver detoxification ability underlies the significant reduction of endogenous intoxication in three days. An important contribution to the effectiveness of the treatment makes intra and intracolonic administration Remaxol. The drug, possessing antioxidant, antihypoxic, hepatoprotective effects, contributes to the relatively rapid improvement of the barrier function of the peritoneum and intestines, detoxification ability of the liver recovery that significantly contributes to the relief of endogenous intoxication.

Electrical Stimulation of Abdominal Muscles to Produce Cough in Spinal Cord Injury

Background. Surface electrical stimulation of the abdominal muscles, with electrodes placed in the posterolateral position, combined with a voluntary cough can assist clearance of airway secretions in individuals with high-level spinal cord injury (SCI). Objective. To determine whether an increase in stimulus intensity of the trains of electrical stimuli delivered to the expiratory muscles has an increasing effect on a stimulated voluntary cough and to determine at which stimulus intensity a plateau of cough peak expiratory flow occurs. Methods. In 7 healthy individuals with a SCI at and above C7, gastric pressure (Pga), esophageal pressure (Pes), peak expiratory cough flow (PEFcough), and expiratory volume were measured as participants coughed voluntarily with simultaneous trains of electrical stimuli delivered over the abdominal muscles (50 Hz, 1-s duration). The intensity of the stimulation was increased incrementally. Results: A plateau in PEFcough occurred in all 7 individuals at a mean of 211 ± 29 mA (range 120-360 mA). Peak values reached for Pga, Pes, and PEFcough were 83.0 ± 8.0 cm H2O, 66.1 ± 5.6 cm H2O, and 4.0 ± 0.4 l/s respectively. Conclusions. The plateau in expiratory cough flow that was associated with increasing expiratory pressures is indicative of dynamic airway compression. This suggests that the evoked cough will be effective in creating more turbulent airflow to further assist in dislodging mucus and secretions.

Management of faecal incontinence and constipation in adults with central neurological diseases.

People with central neurological disease or injury have a much higher risk of both faecal incontinence and constipation than the general population. There is often a fine line between the two symptoms, with any management intended to ameliorate one risking precipitating the other. Bowel problems are observed to be the cause of much anxiety and may reduce quality of life in these people. Current bowel management is largely empirical, with a limited research base. This is an update of a Cochrane review first published in 2001 and subsequently updated in 2003 and 2006. The review is relevant to individuals with any disease directly and chronically affecting the central nervous system (post-traumatic, degenerative, ischaemic or neoplastic), such as multiple sclerosis, spinal cord injury, cerebrovascular disease, Parkinson's disease and Alzheimer's disease. To determine the effects of management strategies for faecal incontinence and constipation in people with a neurological disease or injury affecting the central nervous system. We searched the Cochrane Incontinence Group Trials Register (searched 8 June 2012), which includes searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE In-Process as well as handsearching of journals and conference proceedings; and all reference lists of relevant articles. Randomised and quasi-randomised trials evaluating any type of conservative or surgical intervention for the management of faecal incontinence and constipation in people with central neurological disease or injury were selected. Specific therapies for the treatment of neurological diseases that indirectly affect bowel dysfunction were also considered. At least two review authors independently assessed the risk of bias of eligible trials and independently extracted data from the included trials using a range of pre-specified outcome measures. Twenty trials involving 902 people were included. Oral medications There was evidence from individual small trials that people with Parkinson's disease had a statistically significant improvement in the number of bowel motions or successful bowel care routines per week when fibre (psyllium) (mean difference (MD) -2.2 bowel motions, 95% confidence interval (CI) -3.3 to -1.4) or oral laxative (isosmotic macrogol electrolyte solution) (MD 2.9 bowel motions per week, 95% CI 1.48 to 4.32) are used compared with placebo. One trial in people with spinal cord injury showed statistically significant improvement in total bowel care time comparing intramuscular neostigmine-glycopyrrolate (anticholinesterase plus an anticholinergic drug) with placebo (MD 23.3 minutes, 95% CI 4.68 to 41.92).Five studies reported the use of cisapride and tegaserod in people with spinal cord injuries or Parkinson's disease. These drugs have since been withdrawn from the market due to adverse effects; as they are no longer available they have been removed from this review. Rectal stimulants One small trial in people with spinal cord injuries compared two bisacodyl suppositories, one polyethylene glycol-based (PGB) and one hydrogenated vegetable oil-based (HVB). The trial found that the PGB bisacodyl suppository significantly reduced the mean defaecation period (PGB 20 minutes versus HVB 36 minutes, P < 0.03) and mean total time for bowel care (PGB 43 minutes versus HVB 74.5 minutes, P < 0.01) compared with the HVB bisacodyl suppository.Physical interventions There was evidence from one small trial with 31 participants that abdominal massage statistically improved the number of bowel motions in people who had a stroke compared with no massage (MD 1.7 bowel motions per week, 95% CI 2.22 to 1.18). A small feasibility trial including 30 individuals with multiple sclerosis also found evidence to support the use of abdominal massage. Constipation scores were statistically better with the abdominal massage during treatment although this was not supported by a change in outcome measures (for example the neurogenic bowel dysfunction score).One small trial in people with spinal cord injury showed statistically significant improvement in total bowel care time using electrical stimulation of abdominal muscles compared with no electrical stimulation (MD 29.3 minutes, 95% CI 7.35 to 51.25).There was evidence from one trial with a low risk of bias that for people with spinal cord injury transanal irrigation, compared against conservative bowel care, statistically improved constipation scores, neurogenic bowel dysfunction score, faecal incontinence score and total time for bowel care (MD 27.4 minutes, 95% CI 7.96 to 46.84). Patients were also more satisfied with this method.Other interventions In one trial in stroke patients, there appeared to be a short term benefit (less than six months) to patients in terms of the number of bowel motions per week with a one-off educational intervention from nurses (a structured nurse assessment leading to targeted education versus routine care), but this did not persist at 12 months. A trial in individuals with spinal cord injury found that a stepwise protocol did not reduce the need for oral laxatives and manual evacuation of stool.Finally, one further trial reported in abstract form showed that oral carbonated water (rather than tap water) improved constipation scores in people who had had a stroke. There is still remarkably little research on this common and, to patients, very significant issue of bowel management. The available evidence is almost uniformly of low methodological quality. The clinical significance of some of the research findings presented here is difficult to interpret, not least because each intervention has only been addressed in individual trials, against control rather than compared against each other, and the interventions are very different from each other.There was very limited evidence from individual trials in favour of a bulk-forming laxative (psyllium), an isosmotic macrogol laxative, abdominal massage, electrical stimulation and an anticholinesterase-anticholinergic drug combination (neostigmine-glycopyrrolate) compared to no treatment or controls. There was also evidence in favour of transanal irrigation (compared to conservative management), oral carbonated (rather than tap) water and abdominal massage with lifestyle advice (compared to lifestyle advice alone). However, these findings need to be confirmed by larger well-designed controlled trials which should include evaluation of the acceptability of the intervention to patients and the effect on their quality of life.

Effects of Electrical Stimulation of Abdominal Muscles on Voluntary Cough Intensity and Trunk Function of Stroke Patients

〔目的〕脳卒中患者における腹部電気刺激（ES）が随意的咳嗽力と体幹機能に及ぼす影響について検討した．〔方法〕対象は入院脳卒中患者で4週間ES併用したES群10名と対照群13名である．呼吸筋力は最大吸気圧（MIP）と最大呼気圧（MEP），随意的咳嗽力は最大咳嗽流速（PCF）と音圧レベル（SPL），体幹機能はtrunk control test（TCT）と起き上がり時間を測定した．〔結果〕ES群はMEP，MIP，PCF，SPLが4週間後で有意に増加したが，対照群では有意差はなかった．両群のTCTは有意に増加したが，変化率に有意差はなかった．起き上がり時間の短縮率はES群18.4％，対照群8.7％であった．〔結語〕脳卒中患者における腹部ESは随意的咳嗽力向上と体幹機能の改善が示唆された．

Tramadol enhances urethral continence function through µ‐opioid receptors in rats

(±)-Tramadol hydrochloride (tramadol) is a widely used analgesic that stimulates the µ-opioid receptor and inhibits the reuptake of serotonin and noradrenalin. Although tramadol is also known to inhibit the micturition reflex in rats, its effects on urethral continence function have not been reported. We therefore examined whether intravenous tramadol (1, 3, and 10 mg/kg) affects intraurethral pressure, bladder leak point pressure, and leak volume in urethane-anesthetized female rats. (1) The intraurethral pressure was recorded with a microtip pressure transducer placed at the maximum pressure zone of the intrinsic urethral sphincter. (2) Gentle pressure was directly applied to the saline-filled bladder with a cotton bud until leakage occurred, and the bladder pressure at the moment of leakage was taken as the bladder leak point pressure. (3) The leak volume was measured as the amount of fluid leakage from the urethral orifice after electrical stimulation of abdominal muscles. Tramadol significantly increased the intraurethral pressure. Both tramadol and morphine increased the bladder leak point pressure and decreased the leak volume. These changes were reversed by subcutaneous pretreatment with naloxone. Tramadol improved urethral function and inhibited urinary incontinence through µ-opioid receptors.

Severity of autonomic dysfunction in patients with complete spinal cord injury

There is limited information on the relationship between the level and completeness of the spinal cord injury (SCI) lesion and the degree of autonomic dysfunction. We aimed to study the impairment of sympathetic function in chronic SCI patients presenting with a motor and sensory complete lesion above T6. 26 consecutive traumatic SCI patients were enrolled (14 tetraplegics and 12 paraplegics). They took a battery of tests that included pressor stimuli above (mental arithmetic, hand cold pressor test, sympathetic skin responses (SSR)) and below the lesion (foot cold pressor test, abdominal electrical stimulation), and Valsalva maneuver. All patients showed abolished plantar SSR, while a significant rise in systolic blood pressure in at least one of the pressor tests below the lesion was seen in all but one paraplegic patient. Palmar SSR and blood pressure overshoot at the end of the Valsalva maneuver were abolished in all tetraplegics, whereas at least one of those responses was seen in each paraplegic. Hand cold pressor test and mental arithmetic induced cardiovascular changes in most patients. A complete loss of supraspinal control was observed in all, with a reflex isolated spinal cord in all but one patient. We confirm that in most SCI subjects there is concordance between the impairment of sympathetic function and somatic impairment. To assess autonomic dysfunction, a battery of tests should include SSR, abdominal electrical stimulation and Valsalva maneuver, as they combine pressor stimuli above and below the lesion and assess both cholinergic and sudomotor pathways.

Posterolateral Surface Electrical Stimulation of Abdominal Expiratory Muscles to Enhance Cough in Spinal Cord Injury

Background. Spinal cord injury (SCI) patients have respiratory complications because of abdominal muscle weakness and paralysis, which impair the ability to cough. Objective. This study aims to enhance cough in high-level SCI subjects (n = 11, SCI at or above T6) using surface electrical stimulation of the abdominal muscles via 2 pairs of posterolaterally placed electrodes. Methods. From total lung capacity, subjects performed maximum expiratory pressure (MEP) efforts against a closed airway and voluntary cough efforts. Both efforts were performed with and without superimposed trains of electrical stimulation (50 Hz, 1 second) at a submaximal intensity set to evoke a gastric pressure (P ga) of 40 cm H2O at functional residual capacity. Results. In the MEP effort, stimulation increased the maximal P ga (from 21.4 ± 7.0 to 59.0 ± 5.7 cm H2O) and esophageal pressure (P es; 47.2 ± 11.7 to 65.6 ± 13.6 cm H2O). During the cough efforts, stimulation increased P ga (19.5 ± 6.0 to 57.9 ± 7.0 cm H2O) and P es (31.2 ± 8.7 to 56.6 ± 10.5 cm H2O). The increased expiratory pressures during cough efforts with stimulation increased peak expiratory flow (PEF, by 36% ± 5%), mean expiratory flow (by 80% ± 8%), and expired lung volume (by 41% ± 16%). In every subject, superimposed electrical stimulation improved peak expiratory flow during cough efforts (by 0.99 ± 0.12 L/s; range, 0.41-1.80 L/s). Wearing an abdominal binder did not improve stimulated cough flows or pressures. Conclusions. The increases in P ga and PEF with electrical stimulation using the novel posterolateral electrode placement are 2 to 3 times greater than improvements reported in other studies. This suggests that posterolateral electrical stimulation of abdominal muscles is a simple noninvasive way to enhance cough in individuals with SCI.

Two Kinds of Urinary Continence Reflexes during Abrupt Elevation of Intravesical Pressure in Rats

Urethral closure mechanisms during abrupt elevation of intravesical pressure (P(ves)) were investigated. During sneezing, the middle urethral closing response was observed and it still remained after opening the abdomen. The middle urethral response was almost completely abolished after bilateral transection of somatic nerves innervating the external urethral sphincter and the pelvic floor muscles, while bilateral transection of both pelvic nerves and hypogastric nerves had no effects. Somatic nerve transection resulted in fluid leakage from the urethral orifice during sneezing. Passive increments of P(ves) for 120 seconds by elevating a saline reservoir connected to the bladder also induced the middle urethral closing response in rats with spinal cord transection at T8-T9. The response was totally abolished by cutting pelvic nerves bilaterally, and partially reduced after bilateral transection of pudendal nerves, nerves to pelvic floor muscles or hypogastric nerves. Electrical stimulation of abdominal muscles (ESAM) for 1 second elevated P(ves) in a stimulus-dependent manner in the spinal cord-transected rats, and the P(ves) rise was almost lost when the abdomen was opened. The P(ves) inducing fluid leakage from the urethral orifice was lowered in rats when pelvic nerves or somatic nerves were cut bilaterally, while transection of bilateral hypogastric nerves showed smaller effects. These results indicate that at least two kinds of urinary continence reflexes close the middle urethra during abrupt elevation of P(ves); one reflex observed during sneeze is preprogrammed so as to close the urethra automatically irrespective of bladder afferent activity, and the other reflex is triggered by bladder afferent excitation. During momentary stress events such as sneezing (<0.15 seconds) and ESAM (1 second), the striated muscles mainly contribute to the urethral closure, while during events for a relatively long period like passive P(ves) elevation for 120 seconds, both striated and smooth muscles are involved in the prevention of stress urinary incontinence.

Involvement of reflex urethral closure mechanisms in urethral resistance under momentary stress condition induced by electrical stimulation of rat abdomen

A novel method for evaluating the urethral resistance during abrupt elevation of abdominal pressure was developed in spinalized female rats under urethane anesthesia. Electrical stimulation of abdominal muscles for 1 s induced increases in both the intra-abdominal and the intravesical pressure in a stimulus-dependent manner, and the bladder response was almost lost when the abdomen was opened. The lowest intravesical pressure during electrical stimulation that induced fluid leakage from the urethral orifice (leak point pressure) and the maximal intravesical pressure without urine leakage below the leak point pressure were evaluated as the indexes of urethral resistance. Lower urethral resistance was obtained in the rats whose pelvic nerves or somatic nerves containing pudendal nerves and nerves to iliococcygeus/pubococcygeus muscles were transected bilaterally. In contrast, transection of bilateral hypogastric nerves showed smaller effects. Duloxetine, a drug for stress urinary incontinence, enlarged the reflex urethral closing contractions that were induced by an increase in intravesical pressure and measured using a microtip transducer catheter in the middle urethra. This drug also increased the urethral resistance (leak point pressure), whereas it did not show any effect in the rats whose pelvic nerves were bilaterally transected, showing that the augmentation of the reflex urethral closure by the drug resulted in the elevation of the urethral resistance. From these findings, it was concluded that during momentary elevation of abdominal pressure, the reflex urethral closure mechanisms via bladder-spinal cord-urethral sphincter and pelvic floor muscles greatly contribute to the increase in the urethral resistance to prevent the urinary incontinence.