Aberrant reflexes and function of the pelvic organs following spinal cord injury in man
Aberrant reflexes and function of the pelvic organs following spinal cord injury in man
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DOI：
10.1016/j.autneu.2006.03.010
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发表时间：
2006-06-30
影响因子：
2.7
通讯作者：
Emmanuel, Anton V.
中科院分区：
文献类型：
--
作者：
Craggs, Michael D.;Balasubramaniam, Amirthe Vernie;Emmanuel, Anton V.
由于脊髓损伤对膀胱、肠道和性功能的影响，它会对生活质量造成毁灭性的影响，并使患者失去机会。骶骨上的脊髓损伤可以通过阻断这些通常协调膀胱、肠和括约肌的通路而导致尿失禁。从科学的角度来看，骨盆器官的神经控制是人体中最有趣的神经控制之一，涉及躯体和自主神经通路，参与腰骶反射的精细整合。这篇综述详细介绍了负责协调膀胱和括约肌的躯体和自主腰骶通路的相互作用，损伤后它们畸变的性质以及骨盆器官的神经控制的那些方面，这些方面可以通过神经生理学检查。它将更详细地关注骨盆底和括约肌反射的测量如何用于评估骶骨自主神经通路对骶骨躯体反射的调节作用，反之亦然，包括所谓的“保护反射”和膀胱抑制反射。意志调节这些反射的影响将讨论与完全和不完全病变有关的人。最后，我们将讨论这些神经生理学测量在补充已建立的神经分类和评估脊髓损伤的躯体感觉运动损伤方面的可能效用。(c) 2006 Elsevier B.V.版权所有
Spinal cord injuries can be devastating on quality of life and lost opportunities due to their impact on bladder, bowel and sexual functions. Supra-sacral spinal lesions can cause incontinence by interrupting those pathways, which normally coordinate the bladder, bowel and sphincters.From a scientific perspective, neural control of the pelvic organs is one of the most intriguing in the body, involving both somatic and autonomic pathways participating in an exquisitely fine integration of lumbo-sacral reflexes. This review details the interactions of somatic and autonomic lumbo-sacral pathways responsible for coordinating the bladder and sphincters, the nature of their aberration post-injury and those aspects of neural control of the pelvic organs that are amenable to neurophysiological examination in man. It will focus in greater detail on how measurement of pelvic floor and sphincter reflexes can be used to assess the modulatory effects of sacral autonomic pathways on sacral somatic reflexes and vice versa including the so called "guarding reflex" and vesical inhibitory reflexes. The effects of volitional modulation of these reflexes will be discussed in relation to people with both complete and incomplete lesions. Finally the possible utility of such neurophysiological measures for complementing the established neurological classification and the assessment of somatic sensory-motor impairment in spinal cord injury will be discussed. (c) 2006 Elsevier B.V. All rights reserved.