Bowel Biofeedback Training to Improve Bowel Function in Individuals with SCI

肠道生物反馈训练可改善 SCI 患者的肠道功能

• 批准号: 9060167
• 负责人: Mark Korsten
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9060167
• 关键词: 3-Dimensional; Aftercare; Area; Biofeedback; Caring; Cathartics; Characteristics; Classification; Clinical; Communities; Constipation; Defecation; Development; Emotional; Evaluation; Event; Exercise; External anal sphincter structure; Fecal Incontinence; Frequencies; Functional disorder; General Population; Home environment; Impairment; Incontinence; Individual; Injury; Intestines; Learning; Lesion; Manometry; Measurement; Measures; Medical; Methods; Motor; Neurologic; Occupational; Operant Conditioning; Participant; Patient Self-Report; Patients; Persons; Phenotype; Physiological; Physiology; Population; Prevention; Reflex action; Relaxation; Resolution; Rest; Social Functioning; Sphincter; Spinal cord injury; Subconscious; Surveys; Symptoms; System; Techniques; Technology; Testing; Therapeutic; Time; Training; Treatment outcome; Water; base; cell motility; chronic abdominal pain; efficacy testing; experience; gastrointestinal; improved; motor neuron injury; novel; pressure; response; sensor; social; treatment duration

Neurogenic bowel as a sequela of spinal cord injury (SCI) is characterized by difficulty with evacuation, chronic abdominal pain, and fecal incontinence. Gastrointestinal (GI) dysfunction and related symptoms can have significant adverse repercussions on emotional, occupational, community, and social functioning. There have been few advances in bowel care technology in the past decade, and dissatisfaction with bowel care management is prevalent amongst individuals with SCI. Bowel biofeedback is a novel and promising therapeutic approach which has been shown to improve constipation, fecal incontinence, and dyssynergic defecation in the general population. The concept of biofeedback is based on principles of operant conditioning, in which information concerning a normally subconscious physiological function is consciously relayed to patients, allowing them to become actively engaged in learning to consciously control this function. While the symptoms of bowel dysfunction in persons with SCI are well known, there are limited studies to date looking at anorectal (AR) function and motility. Various techniques, such as the measurement of pressure profiles during volitional activity, can facilitate assessment of GI fine motor function. These pressure assessments are known as manometric studies, and they can provide valuable information about AR physiology. In the past, water-perfused manometric systems were limited by widely spaced, unidirectional sensors, which were incapable of capturing detailed events in small, activity laden areas, such as the AR. High resolution manometry (HRM) uses tight sensor spacing and 3-D topographical representation to provide detailed information concerning sphincter strength, defecation dynamics and reflex mechanisms in the AR. To date, AR-HRM studies have not been conducted in a SCI population. In this pilot proposal, HRM will be initially employed (Part 1) to identify manometric profiles of persons with SCI, and to identify bowel phenotypes--that is, clusters of physiologic characteristics that are present in each individual which are based on HRM findings. Secondarily (Part 2), 6 weeks of biofeedback training will be performed in a subset of individuals who participated in Part 1 of the study, and to compare manometric profiles pre-post training. Finally, we will assess the effects of 6 weeks of home biofeedback exercises on bowel function by manometric evaluation to determine if the gains from this home bowel training can be sustained. The Specific Aims for Part 1 of this study are (1) to identify each subject’s functional bowel phenotype based on AR-HRM findings (baseline sphincter tone, response to balloon distension test, strength of defecation and retention maneuvers) and compare to able-bodied bowel phenotypes, (2) to determine the correlation of baseline AR-HRM characteristics with SCI completeness and lesion level, (3) and to determine the correlation of baseline AR-HRM characteristics with the 10 Question Bowel Survey (10Q-BS) score and Wexner’s Incontinence Score (WIS). The Specific Aims for Part 2 of this study are (1) to perform 6 weeks of supervised bowel biofeedback training in a subset of SCI subjects with incomplete levels of injury who participated in Part 1, (2) to assess the efficacy of bowel biofeedback after 6 weeks of home exercise, (3) to assess changes in AR-HRM characteristics pre and post each treatment period, and (4) to correlate baseline neurological and AR-HRM characteristics with post-treatment outcomes to determine factors that best predict treatment outcome. If bowel biofeedback is found to be an effective means for the reduction/prevention of incontinency or the reduction in DWE during bowel care, this novel method could be clinically offered as therapy, which would reduce reliance on purgatives and curtail maladaptive social avoidance. Additionally, if such benefits can be maintained through simple home bowel biofeedback exercises, this approach to bowel care would represent a novel, efficacious, and accessible form of therapy that many individuals suffering from neurogenic bowel could benefit from, without the burden of continuously attending clinical training sessions.

神经源性肠作为脊髓损伤(SCI)的后遗症，其特点是排空困难， 慢性腹痛和大便失禁。胃肠(GI)功能障碍及相关症状可 对情绪、职业、社区和社会功能有显著的负面影响。那里 在过去的十年里，肠道护理技术几乎没有什么进步，对肠道护理的不满 管理在脊髓损伤患者中很普遍。肠道生物反馈是一种新颖而有前途的方法。 一种治疗方法，已被证明可以改善便秘、大便失禁和协同失调 在一般人群中排便。生物反馈的概念是基于运算符的原理。 条件反射，即有关正常潜意识生理功能的信息被有意识地 传递给患者，让他们积极参与学习，有意识地控制这一功能。 虽然脊髓损伤患者的肠道功能障碍症状是众所周知的，但迄今为止的研究有限。 观察肛门直肠(AR)功能和运动情况。各种技术，如压力测量 在意志性活动期间的轮廓，可以帮助评估胃肠道精细运动功能。这些压力 评估称为测压研究，它们可以提供有关AR的有价值的信息 生理学。在过去，注水测压系统受到大范围、单向的限制。 传感器，不能捕捉活动频繁的小区域的详细事件，如AR。高 分辨率测压(HRM)使用紧密的传感器间距和3-D地形表示来提供 关于AR的括约肌力量、排便动力学和反射机制的详细信息。至 迄今为止，AR-HRM研究尚未在脊髓损伤人群中进行。在这一试点提案中，人力资源管理最初将 使用(第1部分)确定脊髓损伤患者的测压曲线，并确定肠道表型-- 是指以人力资源管理结果为基础，存在于每个个体身上的一系列生理特征。 其次(第2部分)，6周的生物反馈训练将在符合以下条件的一组人中进行 参加了研究的第一部分，并比较了培训前的测压曲线。最后，我们将评估 通过测压评价6周家庭生物反馈训练对肠功能的影响 确定从这种家庭肠道训练中获得的收益是否可以持续。 本研究第一部分的具体目标是(1)确定每个受试者的功能性肠道表型 AR-HRM结果(基线括约肌张力、对球囊扩张试验的反应、排便强度和 保留动作)，并与身体健全的肠道表型进行比较，(2)确定 基线AR-HRM特征与脊髓损伤的完全性和损伤程度，(3)并确定相关性 基线AR-HRM特征与10个问题肠道调查(10Q-BS)和Wexner‘s评分的关系 尿失禁评分(Wis)。本研究第二部分的具体目标是(1)进行为期6周的监督 部分参与不完全损伤的脊髓损伤受试者的肠道生物反馈训练 1，(2)评估6周在家锻炼后的肠道生物反馈的效果，(3)评估 每个疗程前后的AR-HRM特征，以及(4)将基线神经学和 AR-HRM特征与治疗后结果的关系，以确定最佳预测治疗的因素 结果。如果发现肠道生物反馈是减少/预防大小便失禁或 在肠道护理期间减少DWE，这一新方法可以作为治疗方法在临床上提供，它将 减少对泻药的依赖，减少适应不良的社交回避。此外，如果这样的好处可以 通过简单的家庭肠道生物反馈练习来维持，这种肠道护理方法将代表一种 一种新颖、有效和可接受的治疗形式，许多神经原性肠病患者可以 受益于，没有连续参加临床培训课程的负担。