Neural Prosthetic Control of Continence and Micturition

由于神经疾病或损伤如脊髓损伤（SCI）导致的膀胱控制丧失具有破坏性的后果。 方面的影响.脊髓损伤导致膀胱排空的自主控制丧失、膀胱反射亢进和膀胱括约肌功能障碍 协同障碍这些因素往往导致输尿管反流和梗阻，肾脏感染，长期肾损害， 自主神经反射障碍发作，伴有血压危险升高，尿失禁，导致皮肤 以及频繁的尿路感染。膀胱失控也有深刻的社会影响， 导致生活质量下降，以及来自程序、用品和药物的大量直接医疗成本。的 这项研究的长期目标是开发一种神经假体，以恢复膀胱功能（排尿和排尿） 在患有神经系统疾病，特别是脊髓损伤的人中。 电刺激骶神经恢复脊髓损伤患者的膀胱排空功能 根和骶骨感觉神经根的手术横切（背根切断术）已经导致了有记录的医学， 生活质量和经济效益。然而，现有技术的广泛应用受到限制， 潜在候选人反对不可逆背根切断术和复杂的外科植入手术。 我们提出了一种创新的方法来恢复膀胱功能，使用一个单一的多电极神经袖口 植入阴部神经，通过电记录检测超反射性膀胱收缩的开始， 通过电刺激阴部生殖器传入神经纤维来阻止新生的过度反射性膀胱收缩， 并通过电刺激阴部尿道传入神经纤维产生按需膀胱排空。这 本发明的方法与现有的使用脊神经根电刺激的方法的显著不同之处在于 它不需要脊柱椎板切除术，不需要不可逆的骶骨感觉神经横断手术 根，并刺激系统的传入侧而不是传出侧。预计这将增加人口 的个人谁可以受益于神经假体技术，同时保持记录的好处。的 所提出的工作的目的是证明这种方法的可行性，使用补充实验， 动物模型和脊髓损伤患者。该项目的成功完成将导致 开发一种有效的神经假体系统，用于恢复膀胱功能。

Loss of bladder control as a result of neurological disease or injury such as spinal cord injury (SCI) has devastating effects. SCI results in loss of voluntary control of bladder evacuation, bladder hyper-reflexia, and bladder sphincter dysynergia. These factors often lead to ureteric reflux and obstruction, infection of the kidneys, long-term renal damage, episodes of autonomic dysreflexia with dangerous rises in blood pressure, incontinence which contributes to skin breakdown, as well as frequent urinary tract infections. Loss of bladder control also has profound social impact and leads to decreased quality of life, as well as large direct medical costs from procedures, supplies, and medication. The long-term goal of this research is to develop a neural prosthesis to restore bladder function (continence and micturition) in persons with neurological disorders, particularly spinal cord injury. Restoration of bladder evacuation and continence in individuals with SCI by electrical stimulation of the sacral nerve roots and surgical transection of sacral sensory nerve roots (dorsal rhizotomy) has resulted in documented medical, quality of life, and financial benefits. However, the widespread application of existing technology is limited by the objection of potential candidates to the irreversible dorsal rhizotomy and the complex surgical implant procedure. We propose an innovative approach to restoration of bladder function using a single multi-electrode nerve cuff implanted on the pudendal nerve to detect the onset of hyper-reflexive bladder contractions by electrical recording, to arrest nascent hyper-reflexive bladder contractions by electrical stimulation of pudendal genital afferent nerve fibers, and to produce on-demand bladder evacuation by electrical stimulation of pudendal urethral afferent nerve fibers. This innovative approach differs substantially from existing approaches using electrical stimulation of the spinal roots in that it does not require a spinal laminectomy, does not require irreversible surgical transection of the sacral sensory nerve roots, and stimulates the afferent rather than the efferent side of the system. This is expected to increase the population of individuals who can benefit from neural prosthetic technology, while maintaining the documented benefits. The objective of the proposed work is to demonstrate the feasibility of this approach using complementary experiments in an animal model and in persons with spinal cord injury. Successful completion of this project will lead to the development of an effective neural prosthetic system for restoration of bladder function.