BOWEL AND BLADDER CONTROL USING NEUROPROSTHETIC DEVICES

脊髓损伤患者的大小便功能障碍 导致严重的发病率和死亡率。 改善医疗和 粪便嵌塞和尿脓毒症的外科治疗导致 在更长的预期寿命。 然而，时间和 在这些活动中所花费的努力，通常是在照顾者的帮助下， 经常妨碍在家里或工作场所进行有用的社交活动。 这两种功能的部分控制最近已经实现 使用外科植入的骶前神经根刺激器 (The Finetech-Brindley装置）。 旨在 1.为了测量Brindley装置在实现肠和 膀胱排空，伴或不伴后根切断术。 2.为了提高这种神经修复技术的能力， 选择性的神经刺激形式， 在较大的神经中，神经纤维在阻断传输的同时发生。 这 方法可以允许膀胱和肠的电刺激发生， 通过细小的纤维，很少或根本没有括约肌收缩。 3.对新型电极进行人体阻断试验 科目 该电极可以允许使用较低的电流用于 选择性激活，并具有较低的机械损伤风险， 神经 方法 1. 20名脊髓损伤受试者将通过临床研究 植入前和植入后的实验室研究 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排尿反流。 结肠直肠 研究将评估排便、结肠和肛门直肠的有效性 能动性 电刺激可能造成的危险 将评估自主反射异常。 2.将使用以下方法测试更具选择性的电刺激的使用 一种计算机控制的变送器，能够更准确，灵活， 可再现的刺激和产生刺激的设计， 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电极 在植入期间，将在术前测试电流 Brindley刺激器，并与目前使用的电极进行了比较 刺激肠道和膀胱 这些目标的实现将对膀胱产生重大影响， 脊髓损伤患者的肠道控制，改善他们的健康状况， 参与教育、就业和社会生活的能力。

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.