(PLEASE KEEP IN WORD, DO NOT PDF) Abstract Spinal cord epidural stimulation (scES), which creates an electrical field directly over the spinal cord, has shown early promise for the restoration of voluntary and reflex control of the lower urinary tract (LUT) among individuals with spinal cord injuries (SCI). A major advantage of the proposed multi-electrode array over the Interstim system and transcutaneous approach is the versatility of the multi-electrode and the ability to activate multiple structures and functions simultaneously with a single electrode placement and device. The goal of this pre-clinical research is to optimize scES for functional benefits and identify mechanism(s) to better facilitate daily management and improve quality of life. It is hypothesized that effective scES for both bladder storage and emptying occurs when initiated chronically post-SCI through activation of spinal bladder circuits including neurons within the dorsal commissure, superficial dorsal horn, sacral parasympathetic nucleus, and Onuf’s nucleus, with the requirement of intact hypogastric/pelvic/pudendal nerves, and with greater effectiveness when given in combination with locomotor training. For Aim 1, previously identified optimal parameters will be used to identify neural components of the spinal networks contributing to scES-induced LUT effects with different chronicity’s post-SCI in urethane-anesthetized rats using two approaches: a) Fos protein induction (a marker for postsynaptic activation of spinal neurons), and b) select peripheral nerve transections. Examining the contributing spinal central regions activated with scES and key peripheral components for different aspects of LUT function will provide novel targets for further development and refinement of epidural arrays and controllers. For Aim 2, the impact of scES on LUT functions in SCI rats after treatment with differing periodicities of locomotor training will be examined to address the potential added benefit of a combinatory approach (neuromodulation with rehabilitation). A sub-aim examines the underlying Fos induced central neural components, as plasticity is likely induced with training. Both aims will also include bladder histology/molecular biology assessments re the effects of chronicity/training. These studies will significantly move the SCI field forward by providing optimal parameters and locations for targeting LUT function that will be key for advancing the existing technology.

Spinal cord epidural stimulation, which creates an electrical field directly over the spinal cord, has shown early promise with clinical effectiveness for restoration of voluntary and reflex control of the lower urinary tract. The goal of this pre-clinical research is to optimize epidural stimulation alone and in combination with neurorehabilitation for functional urological benefits and identify mechanism(s) to better facilitate daily management and improve quality of life for those with spinal cord injuries.