BOWEL AND BLADDER CONTROL USING NEUROPROSTHETIC DEVICES

使用神经修复装置控制肠道和膀胱

• 批准号: 3331849
• 负责人: JOHN G BANWELL
• 金额: $ 15.47万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1993
• 资助国家: 美国
• 起止时间: 1993-07-01 至 1995-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3331849
• 关键词: autonomic reflex; biomaterial evaluation; colon; electrodes; electrostimulus; endoscopy; human subject; nervous system prosthesis; neural transmission; rectum /anus; somatic reflex; spinal cord injury; urinary bladder; urinary electronic stimulator; urinary incontinence; urinary tract infection; urinary tract prosthesis; urinary tract surgery

Bowel and urinary bladder dysfunction in spinal cord injury patients accounts for severe morbidity and mortality. Improvements in medical and surgical management of fecal impaction and urinary sepsis have resulted in greater life expectancy. Nevertheless, the duration of time and effort spent in these activities, often with caregivers' assistance, frequently precludes useful social activity at home or in the workplace. Partial control of both these functions has been achieved recently employing a surgically implantable sacral anterior nerve root stimulator (The Finetech-Brindley device). Aims 1. To measure the efficacy of the Brindley device in achieving bowel and bladder evacuation, with and without posterior rhizotomy. 2. To advance the capability of this neuroprosthetic technique using selective forms of neural stimulation which enable activation of small nerve fibers to occur while blocking transmission in larger nerves. This approach may permit electrical stimulation of bladder and bowel to occur, via small fibers, with little or no contraction of their sphincters. 3. To test anew type of electrode with blocking capability in human subjects. This electrode may permit the use of lower currents for selective activation and have a lower risk of mechanical damage to nerves. Methods 1. Twenty subjects with spinal cord injury will be studied by clinical and laboratory investigation before and after implantation of the Brindley stimulator. Urological studies will assess bladder emptying, infection, urodynamic parameters and vesico-uretic reflux. Colo-rectal studies will assess effectiveness of defecation, colonic and anorectal motility. The possible danger of electrical stimulation causing autonomic dysreflexia will be assessed. 2. Use of more selective electrical stimulation will be tested by using a computer-controlled transmitter capable of more accurate, flexible and reproducible stimulation and of generating stimuli designed to produce selective activation of the bladder or rectum without contraction of the external urethral or anal sphincters. 3. New electrodes designed to produce selective activation at low currents will be tested pre-operatively during the implantation of the Brindley stimulator, and compared with the electrodes at present in use to stimulate bowel and bladder. The achievement of these aims will have significant impact on bladder and bowel control in spinal cord injury patients and improve their health and ability to participate in education, employment and social life.

脊髓损伤患者的肠道和膀胱功能障碍 造成严重的发病率和死亡率。 医疗和医疗方面的进步 粪便嵌塞和尿路脓毒症的手术治疗已导致 更长的预期寿命。 尽管如此，时间的长短和 在这些活动中花费的精力，通常是在护理人员的帮助下， 经常妨碍在家或工作场所进行有用的社交活动。 最近已经实现了对这两个功能的部分控制 采用手术植入的骶前神经根刺激器 （Finetech-Brindley 设备）。 目标 1. 测量 Brindley 装置在实现肠道和肠道功能方面的功效 膀胱排空术，有或没有后神经根切断术。 2. 为了提高这种神经修复技术的能力 选择性形式的神经刺激，能够激活小 神经纤维发生，同时阻断较大神经的传输。 这 方法可能允许对膀胱和肠道进行电刺激， 通过小纤维，其括约肌很少或没有收缩。 3. 人体测试新型具有阻断能力的电极 科目。 该电极可以允许使用较低的电流 选择性激活，机械损坏的风险较低 神经。 方法 1. 对20名脊髓损伤受试者进行临床研究 以及植入前后的实验室检查 布林德利刺激器。 泌尿学研究将评估膀胱排空， 感染、尿动力学参数和膀胱尿路反流。 结肠直肠 研究将评估排便、结肠和肛门直肠的有效性 动力。 电刺激可能造成的危险 将评估自主神经反射异常。 2. 使用更具选择性的电刺激将通过使用进行测试 计算机控制的发射机能够更加准确、灵活、 可重复的刺激和产生旨在产生的刺激 选择性激活膀胱或直肠而不收缩 尿道外括约肌或肛门括约肌。 3. 设计用于在低温度下产生选择性激活的新型电极 电流将在术前植入期间进行测试 Brindley刺激器，并与目前使用的电极进行比较 刺激肠道和膀胱。 这些目标的实现将对膀胱和膀胱产生重大影响。 脊髓损伤患者的肠道控制并改善他们的健康 参与教育、就业和社会生活的能力。