The Effects of Robotic Walking and Activity-Based Training on Bladder Complications Associated with Spinal Cord Injury

Background: Traditional Activity-based Training (ABT) and novel Robotic Locomotor Training (RLT) demonstrate promising results for reducing secondary complications associated with SCI, including bladder dysfunction. However, there is a need for increased evidence through randomised controlled trials (RCTs). This study aimed to determine the effect of RLT compared to ABT on bladder function in individuals with incomplete SCI involved in a pilot randomised controlled trial. Methods: Sixteen participants with motor incomplete tetraplegia (>1 year) were recruited. The RLT and ABT involved 60-minute sessions, 3 x per week for 24 weeks. The International Lower Urinary Tract Function Basic Data Set was used to assess self-reported bladder health and function over 24 weeks. Results: Across participants, intermittent catheterization, either by self or attendant was used by most of the participants (44%), followed by indwelling catheters (31%). No significant group differences were found for the bladder outcomes over time, except for improvements in urinary function (p= 0.04) at week 24. The odds ratio of 0.26, indicated that the RLT group was less likely to have an improvement in bladder function compared to the ABT group. Both groups tended to show a pattern of decreasing urinary incontinence over time. Conclusions: The ABT group experienced greater benefits in bladder function, but both groups showed a tendency of decreased urinary incontinence over time. Both RLT and ABT interventions may positively benefit the neural circuitries controlling urogenital functions in persons with SCI. RCTs involving larger sample sizes are warranted to further examine these preliminary results.