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Investigation of Transcutaneous Neuromodulation Techniques and Development of a Wearable Device for Control of the Bladder following Spinal Cord Injury

Doherty, Sean Patrick; (2019) Investigation of Transcutaneous Neuromodulation Techniques and Development of a Wearable Device for Control of the Bladder following Spinal Cord Injury. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Spinal Cord Injury (SCI) causes unwanted and uncontrolled bladder contractions (NDO). Urological management goals are to protect the upper urinary tract and eliminate incontinence. Neuromodulation is a potential treatment that may accomplish this using transcutaneous electrical stimulation. Surface stimulation of the Dorsal Genital Nerve (DGNS), Tibial Nerve (TNS), Sacral Nerves (SNS) and Spinal Cord (SS) was studied in two experiments. Five participants with no SCI received stimulation at each site and anal sphincter EMG was recorded. In 4/5 DGNS evoked a reflex response, in 2/5 SNS evoked a short latency response and in 2/5 a reflex response to TNS was recorded at 1.5 x and 1.8 x the latency of participants DGNS responses. Seven participants with SCI and NDO trialled stimulation of the four sites during cystometry. Only DGNS significantly (p=0.016) increased bladder capacity by 153±146 ml and suppressed 2 ±2 detrusor contractions. Maximum Detrusor Pressure was significantly increased by TNS only, by 10±13 cmH₂O. DGNS, TNS and SNS all significantly increased to volume from first detrusor contraction to the maximum capacity. To assess existing bladder sensation, 313 urodynamic records were analysed. 77% were found to have preserved sensation, including 45% of those with complete injuries. Of those with supra-sacral SCI, 75% reported sensation, of whom approximately 86% could replicate this during urodynamic investigation. Five participants trialled DGNS during Ambulatory Urodynamic Monitoring (AUM) and over a week at home. During AUM, self-triggered simulation was used in 4/5 and both intermittent and continuous stimulation was trialled in 1/5. DGNS significantly increased bladder capacity (p=0.008), decreased MDP (p=0.016) and decreased average peak detrusor pressure (p=0.016) from baseline. Void volumes recorded in a bladder diary did not change significantly (p=0.250), nor did ICIQ scores. All participants continued existing antimuscarinic regimes, therefore improvements were in addition to existing medication.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Investigation of Transcutaneous Neuromodulation Techniques and Development of a Wearable Device for Control of the Bladder following Spinal Cord Injury
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2019. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
Keywords: Neuromodulation, Neurogenic bladder, Spinal Cord Injury, Electrical stimulation, Wearable devices
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Ortho and MSK Science
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Med Phys and Biomedical Eng
URI: https://discovery.ucl.ac.uk/id/eprint/10078942
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