Sensorimotor interactions between the lower limb and pelvic floor: neuroplasticity and implications for management of urinary dysfunction after spinal cord injury

People with spinal cord injury (SCI) often experience problems with their bladder function, resulting in symptoms like urine leakage. The bladder and its associated structures are controlled by neural circuits located in the lower part of the spinal cord. This area also contains neural circuits that help control leg movements and sensation. Studies in animals showed that sensory input from the legs can affect muscles controlling urinary function. There is also evidence for such connections between these two systems in humans. For example, gait rehabilitation and electrical stimulation of nerves in the lower leg may help with bladder symptoms in people with neural injury. The reasons for these effects are unclear. However, our recent studies indicate that the pelvic floor muscles, which are crucial for maintaining continence, are activated when people with SCI walk with the help of an exoskeleton. To better understand these phenomena, this proposal will examine how sensory input from the leg affects pelvic floor muscle activity in able-bodied individuals and people with SCI, as well as the potential of using this neural connection to develop rehabilitation-based approaches to manage urinary dysfunction after SCI.