Bladder Neuromodulation in Acute Spinal Cord Injury via Transcutaneous Tibial Nerve Stimulation: Cystometrogram and Autonomic Nervous System Evidence From a Randomized Control Pilot Trial

Figures

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  FIGURE 1. Study Timeline. tSCI, traumatic spinal cord injury; I/E, inclusion/exclusion criteria; CMG, cystometrogram; HRV, heart rate variability; TTNS, transcutaneous tibial nerve stimulation.

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  FIGURE 2. Bar graphs of significant differences between control (green) and TTNS (red) groups, pre- (top) and post-trial (bottom). DSD, detrusor-sphincter dyssynergia. All symbols are significant p < 0.05 and color-coded: ∧between group difference; ∼ pre- vs. post-difference.

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  FIGURE 3. Significant blood pressure (BP) changes during bladder filling, pre- and post-trial. Dashed line represents transition to post-trial testing, red brackets and green brackets are within group differences in the TTNS and controls, respectively. Blue brackets are pre- post-trial differences. (A) In both groups, SBP increases with filling pre-test. Post-test, this is only seen in the TTNS group. (B) Diastolic BP is significantly different in the controls post-trail compared to pre-trial. Pre, pre-trial; Post, post-trial; E, empty bladder; F1, filling phase 1; F2, filling phase 2; TTNS, transcutaneous tibial nerve stimulation; SBP, systolic blood pressure; DBP, diastolic blood pressure; ¥p = 0.04; ∗p = 0.01; £p < 0.01; ˆp = 0.03.

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  FIGURE 4. Significant HRV changes during bladder filling, pre- and post-trial. Dashed line represents transition to post-trial testing, red brackets and green brackets are within group differences in the TTNS and controls, respectively. Blue brackets are pre- post-trial differences. (A) STDHR increases pre-stimulation in the controls, not seen post-test. (B) pNN50 increases in the controls post-test during the first filling phase. (C) Decrease in LF during initial filling is maintained in the TTNS group post-trial. Pre, pre-trial; Post, post-trial; E, E = empty bladder; F1, filling phase 1; F2, filling phase 2; TTNS, transcutaneous tibial nerve stimulation; STDHR, standard deviation of heart rate; bpm, beats per minute; pNN50, the proportion of pairs of successive R–R beat lengths that differ by more than 50 ms (NN50) for total number of beats. LF, low frequency; ms2, milliseconds squared; ¥p = 0.04; #p = 0.03; ∗p = 0.01; £p < 0.01.