An evidence-based approach to the recovery of bladder and bowel function after pediatric spinal cord injury

Introduction: Bladder dysfunction and associated complications of the urinary system negatively impact the quality of life in children living with spinal cord injury (SCI). Pediatric lower urinary tract deficits include bladder over-activity, inefficient emptying, decreased compliance, and incontinence. Recent evidence in adults with SCI indicates significant improvements in bladder capacity and detrusor pressure following participation in an activity-based recovery locomotor training (ABR-LT) rehabilitative program. Additionally, anecdotal self reports from parents in our Pediatric NeuroRecovery Program reference changes in bladder function, ranging from awareness of bladder fullness to gains in voluntary control while undergoing ABR-LT.Case presentation: In a within-subjects repeated measures study, we investigated the effect of ABR-LT on bladder function in three children (ages: 2.5, 3, and 6 years) who sustained upper motor neuron SCI. Each child received at least 60 sessions of ABR-LT (5x/week) for 12-14 weeks. Bladder function was assessed via urodynamics and the Common Data Elements questionnaires. Awareness of bladder filling during cystometry was present in all children and detrusor leak point pressure (LPP) was reduced post-ABR-LT relative to pre-training. A decrease in LPP after locomotor training was observed in all three participants. One out of the three participants had substantial improvements in bladder capacity post-ABR-LT and experienced less bowel incontinence following training. Discussion: Like our evidence in adults, the changes in bladder function suggest an interaction between lumbosacral networks regulating spinal reflex control of bladder filling, voiding, and afferent input (including potential descending supraspinal commands) and those activated by ABR-LT. Locomotor training may be associated with increased bladder capacity, enhanced perception of bladder filling, and decreased LPP as well as improvements in bowel control in pediatric SCI. This research suggests that children and adolescents with traumatic SCI could experience dynamic improvements in bladder and bowel function with the aid of various therapies. Studies assessing the durability of training on the recovery of bladder and bowel dysfunction in children with SCI are needed.