The use of the neurologic exam to predict awareness and control of lower urinary tract function post SCI

Aslam

Marino

2017

Marked inconsistency exists in the performance of the ISNCSCI anal examination. Researchers and clinicians need more education about the performance of the examination. Consideration should be given for the components of deep rectal sensation and anal pressure to be separately documented in the neurologic exam and for researchers to focus separately on recovery of sacral function vs. ambulatory function in clinical trials.

Section: Discussionmentioning

confidence: 99%

Pulse article: How do you do the international standards for neurological classification of SCI anorectal exam?

Aslam

Marino

2017

“…The urodynamic and examination methods have been previously described in a prospective study assessing specific patterns of sensory retention and bladder control [3]. Institutional review board approval was obtained for the study.…”

Section: Methodsmentioning

confidence: 99%

“…As compared to studies pertaining to ambulation, few reports have addressed the recovery of bladder [3][4][5] and bowel function, based upon injury pattern. With regard to the lower urinary tract, continence and bladder emptying 1 year after SCI were predicted by the sensation in S3 for light touch, Spinal Cord Indepence Measure subscales for sphincter management and respiration, and lower extremity motor score [4].…”

Section: Introductionmentioning

confidence: 99%

Assessing the ability of the Sacral Autonomic Standards to document bladder and bowel function based upon the Asia Impairment Scale

Carr

et al. 2019

Study design Retrospective review of data. Objective To determine if there is a relationship between the Asia Impairment Scale (AIS) and the bladder and bowel components of the International Standards to Document Remaining Autonomic Function after SCI (ISAFSCI). Setting University-Based Academic Rehabilitation Program. Methods Retrospective cross-sectional study assessing International Standards for Neurologic Classification After SCI (ISNCSCI) examination along with bladder and bowel components of the ISAFSCI. Results Subjects with AIS A injuries were statistically less likely to have history of bladder control and bowel control per investigator determination and bladder sensation via self-report versus patients categorized with AIS B injuries. Self-reported history of bowel sensation and control of voiding were more likely in subjects with C, D, or E injuries than with B injuries. Bowel and bladder control as determined by investigator and bladder and bowel sensation and control as self-reported were all statistically less likely in persons with AIS A injuries versus CDE. Conclusions This retrospective study provides initial data regarding components of the bladder and bowel sections of the sacral ISAFSCI and AIS. Further prospective research is needed to further characterize the relationship between retention of bladder and bowel sensation and function and the AIS. We suggest that incorporation of the sacral components of the ISAFSCI into the ISNCSCI may be beneficial to obtain further information about retention of sacral function with specific patterns of injury.

“…Rossolimo [31] described the anal reflex and reported its constant appearance in normal subjects [32]. The anal reflex is also known as the anal wink [33], anocutaneous [34], and cutaneo-anal reflex [1,35] and is a multisynaptic spinal reflex [36,37] mediated mainly by S2-4 [38], while others report S2-5 [39][40][41]. The anal reflex has been also found to be a clinically feasible approach to assessment of sacral integrity [42] and a good predictor of recovery of the bladder and bowel functions in cauda equina syndrome [43].…”

Section: Anal Reflexmentioning

confidence: 99%

Anal reflex versus bulbocavernosus reflex in evaluation of patients with spinal cord injury

Kirshblum

Eren

2020

The examination of sacral reflexes provides an important method to differentiate an upper motor neuron vs lower motor neuron spinal cord injury (SCI). Two common sacral mediated reflexes used as part of the neurological assessment include the bulbocavernosus reflex (BCR) and anal reflex. As the clinical information from these tests are similar, we suggest that the anal reflex provides a better first option as a non-invasive clinical assessment of sacral reflex status in clinical practice in SCI as the testing for the anal reflex is less intrusive and already being performed as part of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) by pinprick stimulation of the S4-5 dermatome.