The bladder is a very complex system …
We look at this (SCI research) as a sort of buffet; there’s lots of things that can help right now. I have patients coming in who think they want to wait for the stem cell treatment that will get them tap dancing, but from my perspective they’re trading away what they could have back today.
There’s a lot we can do. The lower motor neuron is sort of the red-headed stepchild of the SCI research world, but it’s what we have to work with if we’re going to restore bladder function to certain populations.
(I can’t do justice to this talk in real time because so much of it depends on the very beautiful and helpful images he’s got on the screen. The idea — and Justin Brown has been doing this for a long time — is that you can graft nerves and then retrain them to contract the muscles you need to contract. He’s talked at previous conferences about how to do this with nerves in the hand. u2fp has the video up on this page, https://vimeo.com/album/2158577, but you have to scroll down to see it. I promise it’s worth the effort, and also it’s what he’s spending most of his time talking about right now.)
At the very end, we get to the question of how to make this kind of process work on bladder function. Justin is saying that they’ve done bladder nerve transfer successfully with a dog, and that it is doable with humans. The dogs take several months to recover peeing, which means that this is going to be an option at some point for people.
Question: Wait, what is it that can only be fixed if you’re 1-2 years post?
Flaccid things are what we CAN’T fix outside that time frame. If there’s tone or spasticity, you can still fix it 10 or more years later with this kind of technology.
Question: How long does this take? If you get a nerve transfer?
In long term injuries, it can take 9-12 months. In more acute situations, more like 3-6 months.
Question: Is this a standard of care?
Yes, insurance covers this. Justin says he has done this kind of nerve transfer for all kinds of patients OUTSIDE the spinal cord injury world, and he comes to this conference to let people with SCI know that they also have this option available.