Introduction: Spinal cord injury (SCI) often results in chronic secondary health conditions related to autonomic and metabolic dysfunction. Epidural electrical stimulation (EES) combined with task-specific training has been shown to enable motor function in individuals with chronic paralysis. The reported effects of EES on secondary health conditions, such as bladder function and body composition, are limited. We report the impact of EES on SCI-related secondary health changes in bladder function and body composition.

Methods: Two participants with motor and sensory complete SCI performed 6 months of rehabilitation without EES followed by 12 months of task-specific training with EES after implantation of a 16-electrode array on the surface of the lumbosacral spinal cord. Participants performed three days of training per week in the laboratory, and additionally performed task-specific activities with EES at home during this time frame. Changes in bladder and body composition were recorded via clinically-available testing of neurogenic bladder functionality and dual-energy X-ray absorptiometry, respectively.

Results: In one participant, we observed an increase in episodes of urinary incontinence with worsening bladder compliance and pressures at the end of the study. Bone mineral density changes were insignificant in both participants; however, one participant showed a substantial increase in lean mass (+9.1 kg; 6 months of training) via redistribution of body fat through an android/gynoid ratio reduction (−0.15; 6 months of training).

Conclusion: EES optimized for standing and stepping may negatively impact neurogenic bladder functionality. Close monitoring of bladder health is imperative to prevent undesirable bladder compliance, which can lead to upper urinary tract deteriorations. Conversely, EES may serve as an adjunct tool with regular exercise modalities to improve body composition through activation of musculature innervated by spinal segments that are below the SCI.

简介：脊髓损伤 (SCI) 通常会导致与自主神经和代谢功能障碍相关的慢性继发性健康状况。硬膜外电刺激 (EES) 与特定任务的训练相结合，已被证明可以使慢性瘫痪患者的运动功能发挥作用。据报道，EES 对膀胱功能和身体成分等次要健康状况的影响是有限的。我们报告了 EES 对膀胱功能和身体成分的 SCI 相关继发性健康变化的影响。

方法：两名患有运动和感觉完全性 SCI 的参与者在没有 EES 的情况下进行了 6 个月的康复，然后在腰骶脊髓表面植入 16 电极阵列后进行了 12 个月的 EES 特定任务训练。参与者每周在实验室进行三天的培训，并在此期间在家中使用 EES 进行特定任务的活动。膀胱和身体成分的变化分别通过神经源性膀胱功能的临床可用测试和双能 X 射线吸收测定法记录。

结果：在一名参与者中，我们观察到在研究结束时，随着膀胱顺应性和压力的恶化，尿失禁发作次数增加。两名参与者的骨矿物质密度变化都不显着。然而，一名参与者通过减少 android/gynoid 比率（-0.15；6 个月的训练）重新分配身体脂肪，从而显着增加了瘦体重（+9.1 公斤；6 个月的训练）。

结论：针对站立和行走进行优化的 EES 可能会对神经源性膀胱功能产生负面影响。必须密切监测膀胱健康状况，以防止可能导致上尿路恶化的不良膀胱顺应性。相反，EES 可以作为一种辅助工具，通过定期运动方式，通过激活由 SCI 下方的脊柱节段支配的肌肉组织来改善身体成分。