Cortical and spinal cord plasticity may be induced with non-invasive transcranial magnetic stimulation to encourage long term potentiation or depression of neuronal circuits. Such plasticity inducing stimulation provides an attractive approach to promote changes in sensorimotor circuits that have been degraded by spinal cord injury (SCI). If residual corticospinal circuits can be conditioned appropriately there should be the possibility that the changes are accompanied by functional recovery. This article reviews the attempts that have been made to restore sensorimotor function and to obtain functional benefits from the application of repetitive transcranial magnetic stimulation (rTMS) of the cortex following incomplete spinal cord injury. The confounding issues that arise with the application of rTMS, specifically in SCI, are enumerated. Finally, consideration is given to the potential for rTMS to be used in the restoration of bladder and bowel sphincter function and consequent functional recovery of the guarding reflex.

Cortical TMS was effective in facilitating the PAR in some iSCI subjects. The presence of cortical facilitation of the PAR was not related to the degree of urinary continence.

Study design: Retrospective review. Objectives: The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) assesses cutaneous sensibility through light touch (LT) and sharp-dull discrimination, referred to as pin prick (PP). This project aimed to confirm a tendency for LT to score higher than PP in SCI subjects and discuss possible reasons for such disparity. Setting: Single site cohort study, the London Spinal Cord Injury Centre, United Kingdom. Methods: A retrospective analysis of LT and PP scores of 99 spinal cord injury subjects at the time of discharge (median 5 months) from acute care and rehabilitation in the London Spinal Cord Injury Centre was conducted. Subjects were aged 10-88 years (median 44 years; 78 men, 74 traumatic, 25 non-traumatic). There were 40 American Spinal Injury Association (ASIA) Impairment Scale (AIS) A, 7 B, 18 C and 34 D subjects. Results: A disparity (Po0.001) was found between LT (64.5 ± 3.2, mean ± s.e.) and PP (54.7 ± 2.9) AIS sensory scores. A similar difference in score (LT4PP) was registered both for traumatic and non-traumatic injury, but was greater for incomplete than for complete injury. Despite the difference, LT was well correlated with PP (R ¼ 0.87, Po0.001). Spinal segmental level of injury was determined more frequently by PP alone (43 of 99) than by LT (10 of 99) alone. Conclusion: The discrepancies between LT and PP could relate to the greater complexity of the PP test or a difference in the extent of injury to the posterior columns (LT) and spinothalamic (PP) tracts. Further interpretation would benefit from additional electrophysiological sensory tests.

Study design: Two case studies. Objectives: To determine whether 6 weeks of regular pelvic floor muscle training (PFMT) can improve the strength and endurance of voluntary contractions in incomplete spinal cord injury and reduce neurogenic detrusor over-activity (NDO) and incontinence. Setting: The London Spinal Cord Injury Centre, Stanmore, London, UK. Methods: A 6-week programme of PFMT was conducted in two male subjects with stable supra-sacral motor incomplete (AIS C and D) spinal cord injuries. Clinical evaluations before and after training comprised measures of strength and endurance of voluntary pelvic floor contractions both objectively by anal canal-pressure measurements and subjectively using the modified Oxford grading system. NDO was determined by standard urodynamic tests of bladder function and incontinence measured by the International Consultation on Incontinence Questionnaire-Urology. Results: Both subjects improved the strength and endurance of their pelvic floor muscle contractions by over 100% at the end of training. After training, Subject 1 (AIS D) was able to reduce bladder pressure during over-activity almost completely by voluntarily contracting the pelvic floor muscles. Subject 2 (AIS C) achieved a lesser reduction overall after training. Continence improved only in subject 1. Conclusion: These case studies provide evidence that a 6-week programme of PFMT may have a beneficial effect on promoting voluntary control of NDO and reduce incontinence in selected cases with a motor incomplete spinal cord lesion. INTRODUCTIONIncontinence remains a priority problem for many people with spinal cord injury 1 despite various current treatments including conservative therapies. 2 Control of the bladder, sphincter and pelvic floor muscles (PFM) relies on the integrity of bulbo-spinal, cortico-spinal and lumbo-sacral reflex pathways. Following a motor incomplete spinal cord injury (iSCI), voluntary control of the PFM including the striated sphincters significantly weakens, neurogenic detrusor over-activity (NDO), detrusor sphincter dyssynergia and incontinence emerge reducing quality of life. Although PFM training (PFMT) has been shown to be effective in non-SCI patients with lower urinary tract symptoms, for example, by reducing stress incontinence and suppressing bladder over-activity, 3 it appears not to have been tested as a potential therapy in iSCI. Therefore the aim of these two case studies was to determine whether 6 weeks of regular PFMT could improve the strength and endurance of voluntary PFM contractions in iSCI so as to suppress NDO and reduce incontinence. A positive outcome may then justify a pilot study with a larger cohort of iSCI subjects presenting with preserved sensorimotor pathways of the sphincters and PFMs. MATERIALS AND METHODS ParticipantsA 6-week programme of regular PFMT with clinical assessments before and after was conducted in two male subjects presenting with chronic-stable iSCI, NDO and incontinence.Local research ethics committee approval was obtained (REC Reference ...

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