4. Neuromodulation as an alternative to pharmaceutical therapies for bladder, bowel and lower limb spasticity in spinal cord injury: NEUROMOD

Locations:         London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, Stanmore & University College London

INSPIRE Grant:              £85,595

Date/Duration:  October 2015-18/ 36 months

Abstract of Research

Restoration of bladder and bowel function is a top priority for patients who have suffered a life changing spinal cord injury.  Appropriate patient-focused bladder and bowel management approaches reduce morbidity and improve quality of life.  Pelvic functions are controlled by complex interactions between the voluntary and autonomic nervous systems, at both brain and spinal reflex levels. Following SCI these pathways are disrupted leading to un-inhibited reflex activity causing spasticity and incontinence.  Neuromodulation (electrical stimulation of neural pathways to modify their activity) of the sacral nerves can be effective at inhibiting these unwanted reflexes.

The anticipated outcome

The over-arching aim of this study is to investigate an alternative to pharmaceutical therapies for bladder and bowel management, and explore its impact on spasticity.  This alternative relies on neuromodulation, delivered by a stimulator, a prototype of which will be produced as part of the PhD study.  Should the clinical studies indicate that this alternative is likely to be successful, we will seek further funding to develop our prototype and guarantee patient impact as soon as feasibly possible.   We have already identified suitable product development calls from the Technology Strategy Board and the National Institute for Health Research (NIHR).  We anticipate that by providing alternatives to pharmaceutical management, we can alleviate some of the side effects that are experienced when managing spasticity such as dry mouth, constipation and drowsiness.  We hope that this will eventually lead to improvements in the quality of life of patients living with a spinal cord injury.  We also envisage that if these techniques are successful and a prototype device is developed, its use may not be confined to just the spinal cord injury population but also be utilized in patients with other neurological disorders such as multiple sclerosis and perhaps the broader range of pelvic problems in the general population.