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Neural engineering
Published in Alex Mihailidis, Roger Smith, Rehabilitation Engineering, 2023
The loss of normal voiding function following a neurological lesion (neurogenic bladder) – such as spinal cord injury (SCI), multiple sclerosis, or stroke – poses a significant clinical challenge for providing effective long-term management of urinary function. This can manifest as either the inability to generate sufficient bladder pressure (common in sub-thoracic SCI) or as the simultaneous activation of the bladder and EUS muscles (detrusor sphincter dyssynergia, DSD), which occurs in SCI above the sacral spinal cord. This leads to large residual bladder volumes, persistent urinary tract infections, excessively high bladder pressures, vesicoureteral reflux, and kidney damage. The current gold standard for managing bladder function is clean intermittent or indwelling catheterization. While very effective, this approach is prone to recurrent urinary tract infections and urethral damage. In addition, catheterization also requires a high degree of dexterity, which may preclude some patients (e.g., quadriplegic patients) from performing self-catheterization. Given the physical and psychological burden associated with many of these therapies, it is not surprising that restoring urinary function remains a high priority for improving the quality of life in both paraplegics and quadriplegics (Anderson 2004).
Statistical shape modeling of the pelvic floor to evaluate women with obstructed defecation symptoms
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Megan R. Routzong, Ghazaleh Rostaminia, Shaniel T. Bowen, Roger P. Goldberg, Steven D. Abramowitch
The multivariate statistics suggested that both State and Group have a significant effect on the overall midsagittal pelvic floor shape—supporting our hypothesis that pelvic floor shape differs significantly during defecation and, more importantly, between women with ODS presenting as pelvic constipation without dyssynergia compared to control, asymptomatic women. Mode 1 characterized levator plate relaxation during defecation and suggested more relaxation in women with ODS, mode 2 defined straighter level III support and pelvic floor relaxation in women with ODS, and mode 3 described level III support bulging and perineal body straightening during defecation and shape variance across the general population (regardless of group). Overall, these modes suggested that the differences between Groups were structural. While the amount of shape change was similar between groups from rest to peak evacuation, ODS patient data were shifted relative to controls—slightly for mode 1 and significantly for mode 2. Case shapes at rest and at peak evacuation were consistent with a more relaxed pelvic floor, shown in Figure 6 by visualizing the mean Group shapes constructed using all 3 significant modes.