Clinical Protocol for Identifying and Managing Bladder Dysfunction during Acute Care after Traumatic Spinal Cord Injury

Effects of a self-efficacy-centered self-management program on neurogenic bladder after spinal cord injury: A randomized controlled trial

PURPOSE

The present research aimed to investigate the effects of a self-efficacy-centered self-management program on persons with neurogenic bladder (NGB) after spinal cord injury (SCI).

DESIGN

A randomized controlled trial.

MATERIALS AND METHODS

Eighty-two individuals with NGB after spinal cord injury (SCI) were randomized into either the control or intervention group. The control group received standard admission and discharge education and follow-up. The intervention group received the self-efficacy-centered self-management program. Self-efficacy was assessed at preintervention, 4, 8, and 12 weeks post-intervention. Self-management ability, the incidence of urinary tract infection (UTI), residual urine volume, bladder safety capacity, and quality of life were assessed at 12 weeks post-intervention.

RESULTS

Of the 82 recruited participants, only 79 participants (control group: n = 39, 67% males, intervention group: n = 40, 58% males) received the full intervention. A significant difference was observed in self-efficacy score between the control and intervention groups (2.54 ± .247 versus 2.71 ± .218, mean difference = .174, 95% confidential interval: .070-.278, p = .001) at 12 weeks post-intervention. The intervention group demonstrated significantly better outcomes than the control group at 12 weeks post-intervention in self-management ability, urinary tract infection (UTI) incidence, residual urine volume and bladder safety capacity. There were significant differences in quality of life (vitality [VT] and mental health [MH] subscales) between the two groups.

CONCLUSIONS

The self-efficacy-centered self-management program developed in this study can significantly increase participants' self-efficacy and bladder self-management ability, thereby improving their bladder functional status and quality of life.

Efficacy of combined electroacupuncture and moxibustion for treatment of neurogenic bladder after spinal cord injury: A retrospective analysis

This retrospective study evaluates the clinical efficacy of combined electroacupuncture and moxibustion for the treatment of neurogenic bladder in patients with spinal cord injury. Ninety patients with neurogenic bladder after spinal cord injury who were admitted to the hospital between January 2021 and August 2023 were included. The patients were divided into the study and control groups (n = 45 each) using a random number table method. The study group was treated with electroacupuncture combined with moxibustion, while the control group was treated with electroacupuncture alone. The variables evaluated to assess the clinical efficacy of each treatment included number of cases in which bladder function reached a balanced state, initial bladder capacity sensation, maximum detrusor pressure before versus after treatment, maximum urine flow rate, maximum renal pelvic separation width, urine white blood cell count, and subjective quality of life profile score. In the study group, bladder pressure, residual urine volume, frequency of urination, and subjective quality of life profile score increased after versus before treatment (P < .05), whereas the maximal renal pelvis separation width and urinary white blood cell count decreased after versus before treatment (P < .05). Moreover, the study group exhibited significantly greater improvement than the control group (P < .05). The efficacy rates in the study and control groups were 75.6% and 95.6%, respectively; this difference was statistically significant (P < .05). Compared to electroacupuncture alone, electroacupuncture combined with moxibustion reduced the incidence of urinary tract infection, reduced residual urine volume, increased bladder capacity, and achieved balanced bladder function in patients with neurogenic bladder.

Do all patients with functional motor-incomplete (AIS-D) traumatic spinal cord injury need specialized inpatient functional rehabilitation? A prospective observational cohort study proposing clinical criteria for home-based rehabilitation after acute care

CONTEXT/OBJECTIVE

Functional motor-incomplete AIS-D traumatic spinal cord injury (tSCI) represents an important growing population in neuro-traumatology. There is thus an important need for establishing strategies to optimize SCI rehabilitation resources. This study aims at proposing eligibility criteria to select individuals who could be discharged home (home-based rehabilitation) after acute care following an AIS-D tSCI and investigate its impact on the long-term functional status and quality of life (QOL), as compared to transfer to inpatient functional rehabilitation (IFR) resources.

DESIGN

An observational prospective cohort study.

SETTING

A single Level-1 specialized trauma center.

PARTICIPANTS

213 individuals sustaining an AIS-D tSCI.

INTERVENTIONS

Home-based rehabilitation based on clinical specific criteria to be assessed by the acute care team.

OUTCOME MEASURES

Functional status and QOL as assessed by the Spinal Cord Independence Measure version 3 and WHOQOL-BREF questionnaire one year following the injury, respectively.

RESULTS

A total 37.9% of individuals fulfilled proposed criteria for home-based rehabilitation after acute care. As expected, this group was significantly younger, experienced lesser comorbidities and acute complications, and showed higher motor and sensory function compared to the IFR group. Home-rehabilitation was associated with a higher long-term functional status, physical and psychological QOL, when accounting for relevant confounding factors after an acute AIS-D tSCI. There was no readmission due to failure of home-based rehabilitation.

CONCLUSION

Home-based rehabilitation in selected individuals sustaining an acute AIS-D tSCI is a safe and interesting strategy to optimize the long-term outcome in terms of functional recovery, physical and psychological QOL, as well as to optimize inpatient rehabilitation resources. The proposed eligibility criteria can be used by the acute care team to select the optimal discharge orientation in this important subpopulation.

Curcumin-Containing Polyphosphazene Nanodrug for Anti-Inflammation and Nerve Regeneration to Improve Functional Recovery After Spinal Cord Injury

The microenvironment of excessive inflammation and the activation of apoptotic signals are primary barriers to neurological recovery following spinal cord injury (SCI). Thus, long-lasting anti-inflammation has become an effective strategy to navigate SCI. Herein, a curcumin (CUR)-containing nanosystem (FCTHPC) with high drug loading efficiency was reported via assembling hydrophobic CUR into cross-linked polyphosphazene (PPZ), and simultaneous loading and coordinating with porous bimetallic polymers for greatly enhanced the water-solubility and biocompatibility of CUR. The nanosystem is noncytotoxic when directing its biological activities. By inhibiting the expression of pro-inflammatory factors (IL-1β, TNF-α and IL-6) and apoptotic proteins (C-caspase-3 and Bax/Bcl-2), which may be accomplished by activating the Wnt/β-catenin pathway, the versatile FCTHPC can significantly alleviate the damage to tissues and cells caused by inflammation and apoptosis in the early stage of SCI. In addition, the long-term in vivo studies had demonstrated that FCTHPC could effectively inhibit the formation of glial scars, and simultaneously promote nerve regeneration and myelination, leading to significant recovery of spinal cord function. This study emphasises the promise of the biocompatible CUR-based nanosystem and provides a fresh approach to effectively treat SCI.

Concomitant Brain Injury and Spinal Cord Injury Management Strategies: A Narrative Review

Spinal cord injury (SCI) is a catastrophic event with multiple comorbidities including spastic paralysis, sensory loss, autonomic dysfunction with sympathetic blunting, neurogenic orthostatic hypotension, neurogenic restrictive and obstructive lung disease, neuropathic pain, spasticity, neurogenic bladder, neurogenic bowel, immobilization hypercalcemia, osteopenia/osteoporosis, neurogenic obesity, and metabolic dysfunction. Cervical and thoracic SCI is all too often accompanied by traumatic brain injury (TBI), which carries its own set of comorbidities including headaches, seizures, paroxysmal sympathetic hyperactivity, aphasia, dysphagia, cognitive dysfunction, memory loss, agitation/anxiety, spasticity, bladder and bowel incontinence, and heterotopic ossification. This manuscript will review the etiology and epidemiology of dual diagnoses, assessment of both entities, and discuss some of the most common comorbidities and management strategies to optimize functional recovery.

Neurogenic Bladder Physiology, Pathogenesis, and Management after Spinal Cord Injury

Urinary incontinence is common after spinal cord injury (SCI) due to loss of supraspinal coordination and unabated reflexes in both autonomic and somatic nervous systems; if unchecked, these disturbances can become life-threatening. This manuscript will review normal anatomy and physiology of the urinary system and discuss pathophysiology secondary to SCI. This includes a discussion of autonomic dysreflexia, as well as its diagnosis and management. The kidneys and the ureters, representing the upper urinary tract system, can be at risk related to dyssynergy between the urethral sphincters and high pressures that lead to potential vesicoureteral reflux, urinary tract infections, and calculi associated with neurogenic lower urinary tract dysfunction (NLUTD). Recent guidelines for diagnosis, evaluation, treatment and follow up of the neurogenic bladder will be reviewed and options provided for risk stratification and management. Mechanical, pharmacological, neurolysis and surgical management will be discussed.