ABSTRACT
Bladder function is controlled by the autonomic and somatic nervous system in the spinal cord. It is coordinated in the brainstem. Different areas of the brain are involved in the voluntary control of this reflex functioning. Brain lesions often cause an overactive bladder syndrome with increased voiding frequency and urgency. Urinary incontinence, frequently present, may be linked to overactive bladder and associated motor and cognitive disorders. Urinary retention occurs in the acute phase of a hemispherical lesion and following brainstem lesions. The identification, evaluation and treatment of urinary disorders in brain-damaged patients require a global assessment and integrated management taking the other neurological consequences of brain damage into account.
Le fonctionnement vésical est commandé par les systèmes nerveux autonome et somatique situés dans la moelle épinière. Le tronc cérébral gère et coordonne leur action. Différentes zones du cerveau sont impliquées dans le contrôle volontaire du fonctionnement réflexe. Les lésions cérébrales provoquent souvent un syndrome d'hyperactivité vésicale (HAV) avec une augmentation de la fréquence mictionnelle et une urgenturie. L'incontinence urinaire, souvent présente, pourrait être liée à l'HAV et aux troubles moteurs et cognitifs associés. La rétention urinaire survient à la phase aiguë d'une lésion hémisphérique et suite aux lésions du tronc cérébral. L'identification, l'évaluation et le traitement des troubles urinaires chez les cérébrolésés nécessitent un bilan global et une gestion intégrée aux autres conséquences des lésions cérébrales.
Subject(s)
Brain Injuries/complications , Urinary Bladder, Overactive/complications , Urinary Incontinence/complications , Brain Injuries/physiopathology , Humans , Reflex , Urinary Bladder, Overactive/physiopathology , Urinary Incontinence/physiopathologyABSTRACT
Urinary incontinence is a frequent symptom rarely spontaneously reported. This emphasizes the need to address it in every patient. Once disclosed, its origin needs to be specified so that therapeutic issues may be reached. These being often efficient, patient quality of life will improve significantly. In order to improve urinary incontinence management, a multidisciplinary group of healthcare professionals of our institution have proposed to spread basic knowledge, screening tools and evaluation scales of this bothersome worldwide symptom. This team enables healthcare providers to unite themselves in a network which will help to orientate patients in order to fulfill their needs.
Subject(s)
Quality Improvement , Urinary Incontinence/therapy , Humans , Surveys and QuestionnairesSubject(s)
Nursing Records/standards , Urination Disorders/nursing , Urine Specimen Collection/nursing , Drinking , Humans , Male , Middle AgedSubject(s)
Nervous System Diseases/complications , Urination Disorders/etiology , Adult , Aged , Cerebral Hemorrhage/complications , Fecal Incontinence/diagnosis , Fecal Incontinence/etiology , Fecal Incontinence/therapy , Female , Humans , Male , Middle Aged , Multiple Sclerosis/complications , Nervous System Diseases/therapy , Parkinson Disease/complications , Urinary Incontinence/diagnosis , Urinary Incontinence/etiology , Urinary Incontinence/therapy , Urination Disorders/diagnosis , Urination Disorders/therapyABSTRACT
OBJECTIVE: To investigate changes in body ownership and chronic neuropathic pain in patients with spinal cord injury (SCI) using multisensory own body illusions and virtual reality (VR). METHODS: Twenty patients with SCI with paraplegia and 20 healthy control participants (HC) participated in 2 factorial, randomized, repeated-measures design studies. In the virtual leg illusion (VLI), we applied asynchronous or synchronous visuotactile stimulation to the participant's back (either immediately above the lesion level or at the shoulder) and to the virtual legs as seen on a VR head-mounted display. We tested the effect of the VLI on the sense of leg ownership (questionnaires) and on perceived neuropathic pain (visual analogue scale pain ratings). We compared illusory leg ownership with illusory global body ownership (induced in the full body illusion [FBI]), by applying asynchronous or synchronous visuotactile stimulation to the participant's back and the back of a virtual body as seen on a head-mounted display. RESULTS: Our data show that patients with SCI are less sensitive to multisensory stimulations inducing illusory leg ownership (as compared to HC) and that leg ownership decreased with time since SCI. In contrast, we found no differences between groups in global body ownership as tested in the FBI. VLI and FBI were both associated with mild analgesia that was only during the VLI specific for synchronous visuotactile stimulation and the lower back position. CONCLUSIONS: The present findings show that VR exposure using multisensory stimulation differently affected leg vs body ownership, and is associated with mild analgesia with potential for SCI neurorehabilitation protocols.