5. Neuromodulation to control bladder over-activity following Spinal Cord Injury with the development and long term assessment of wearable devices: NEUROMOD II
Research Team. PI: Dr Lynsey Duffell, Dr Sarah Knight, Dr Anne Vanhoestenberghe, Dr Sean Doherty
Locations: University College London, London Spinal Cord Injury Centre, RNO Hospital Stanmore
Duration/Dates/Cost: 30 (+ 18) months / January 2019 – January 2023 Total project costs: £201,719
Neural control of the bladder is complex and severely compromised following Spinal Cord Injury (SCI) resulting in overactivity, high bladder pressures and incontinence. Restoration of bladder function is ranked as a high priority by people with SCI, and current management strategies are inadequate. There is strong evidence that Dorsal Genital Nerve Stimulation (DGNS) can inhibit overactivity, increase storage capacity and reduce incontinence in people with SCI when used acutely in the laboratory setting. Acceptable technology to transfer this intervention to the home is not yet available. In this project we will build on technical development from our previous project NEUROMOD I: towards a clinically acceptable device for bladder management in people with SCI. We will test the clinical effectiveness and acceptability of this technology in home-based trials. We will also explore the effects of home-based DGNS on pelvic sensations and further develop a closed-loop system for people without bladder sensation.
Management of bladder overactivity and, in particular, incontinence is still problematic following SCI. We believe DGNS presents a potent possibility for artificial control of the bladder that could be foreseeably available to patients in the short term. The outcome of this project will be to provide data on whether DGNS is an acceptable, feasible and effective technique for a small group of people with SCI. The therapy envisaged is a small wearable stimulator with electrodes placed on the penis or clitoris, to be worn on a belt or under trousers that may be triggered on urge by people with SCI to prevent early leakage in urine. The fMRI studies may provide evidence of improved sensations with conditional DGNS and enable a larger part of the SCI community to use conditional neuromodulation as part of their bladder management. In the future, this may be augmented for indwelling catheter users to include closed loop control provided by a small pressure measurement device, wirelessly connected to the same control system.