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23 results

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Neurorehabilitation Therapy and Therapeutics
  • Edited by Krishnan Padmakumari Sivaraman Nair, Marlís González-Fernández, Jalesh N. Panicker
  • Published online:
    13 October 2018
    Print publication:
    11 October 2018
  • Cognitive impairment, dysphagia, communication issues, pain, spasticity, bladder dysfunction, sexual dysfunction and bowel incontinence are but a few problems frequently reported by individuals living with long-term neurological conditions. The management of long-term neurological conditions requires co-ordinated inputs from multiple disciplines, and this practical handbook facilitates this by combining physical, cognitive and psychological strategies to patient management. Featuring contributions from leading experts in neurology, health services and clinical rehabilitation, this book is a comprehensive overview of common neurological impairments and solutions. It adopts an evidence-based approach to both pharmacological and non-pharmacological options for alleviating neurological symptoms. An easy-to-refer to guide, bridging multiple disciplines, aided by current research, to provide effective, and practical management for all aspects and issues arising in the rehabilitation phases of the neurological patient. This unique pocketbook is intended for practitioners at all levels, and is ideally suited as a quick guide during ward rounds, out-patient clinics and therapy sessions.

Pelvic Organ Dysfunction in Neurological Disease
  • Clinical Management and Rehabilitation
  • Edited by Clare J. Fowler, Jalesh N. Panicker, Anton Emmanuel
  • Published online:
    06 December 2010
    Print publication:
    04 November 2010
  • Pelvic Organ Dysfunction in Neurological Disease describes the neurological control of human bladder, bowel and sexual function and then details the dysfunctions which may arise as a consequence of various neurological diseases. Easy to read, the book will be of value to any healthcare professional managing patients in whom pelvic organ functions have been compromised by neurological disease. The book provides a structured approach to present day understanding of the neurological control of pelvic organs and the investigation and management of each type of organ dysfunction. A unique feature of this book is that it addresses the impact of specific neurological disorders on all three functions. The authors have all been associated with the Department of Uro-Neurology at the National Hospital for Neurology and Neurosurgery, London since it was established 20 years ago. This book is a timely review of their accumulated knowledge and the latest literature.

  • Appendix 1: - Management algorithms

  • Edited by Clare J. Fowler, Jalesh N. Panicker, Anton Emmanuel, University College London
  • Book:
    Pelvic Organ Dysfunction in Neurological Disease
    Published online:
    06 December 2010
    Print publication:
    04 November 2010, pp 307-311

  • Summary

    This chapter discusses the role of the cortical and subcortical areas in the control of pelvic organs. It presents case histories, the lesion literature, effects of injury or disease at focal sites. The results of diffuse cortical and subcortical diseases are then considered. The temporal lobes have little or no apparent influence on bladder or bowel control but a major role in determining sexual behavior. Cerebrovascular disease is often accompanied by bladder dysfunction. The severity, extent and site of brain damage following brain injury are so variable that generalizations about the effect of traumatic brain injury on pelvic organ dysfunction are impossible. Recommendations have been made to treat specific aspects of sexual dysfunction following traumatic brain injury. An expected correlation is seen between the occurrence of a neurogenic bladder and the severity and extent of brain damage so that urodynamic abnormalities have been associated with motor deficits.

  • Chapter 3 - Neurological control of sexual function in health and disease

  • from Section 1 - Neurological control of pelvic organ functions
  • Edited by Clare J. Fowler, Jalesh N. Panicker, Anton Emmanuel, University College London
  • Book:
    Pelvic Organ Dysfunction in Neurological Disease
    Published online:
    06 December 2010
    Print publication:
    04 November 2010, pp 40-60

  • Summary

    Based on observations under laboratory conditions of over 300 couples, Masters and Johnson identified four discrete phases of the human sexual response as arousal (excitement), plateau, orgasm and satisfaction. This sequence was subsequently modified to include the phase of sexual drive: Kaplan proposed a triphasic response model, each phase with a distinct underlying neurophysiological basis. Libido is defined as the biological need for sexual activity (sex drive) and depends upon hypothalamic and temporal lobe functioning. This chapter outlines the roles of the subcortical and cortical regions, spinal connections and peripheral innervation involved in the phases of the human sexual cycle, with reference to the experimental animal literature and mention of the dysfunctions that can result from neurological disease at each level. Findings from recent functional imaging experiments are discussed in the context of the role of the cortical regions in human neurological control of sexual function.

  • Section 3 - Specific conditions

  • Edited by Clare J. Fowler, Jalesh N. Panicker, Anton Emmanuel, University College London
  • Book:
    Pelvic Organ Dysfunction in Neurological Disease
    Published online:
    06 December 2010
    Print publication:
    04 November 2010, pp 167-306

  • Summary

    This chapter discusses the role of the cortical and subcortical areas in the control of pelvic organs. It presents case histories, the lesion literature, effects of injury or disease at focal sites. The results of diffuse cortical and subcortical diseases are then considered. The temporal lobes have little or no apparent influence on bladder or bowel control but a major role in determining sexual behavior. Cerebrovascular disease is often accompanied by bladder dysfunction. The severity, extent and site of brain damage following brain injury are so variable that generalizations about the effect of traumatic brain injury on pelvic organ dysfunction are impossible. Recommendations have been made to treat specific aspects of sexual dysfunction following traumatic brain injury. An expected correlation is seen between the occurrence of a neurogenic bladder and the severity and extent of brain damage so that urodynamic abnormalities have been associated with motor deficits.

  • Chapter 4 - Approach and evaluation of neurogenic bladder dysfunction

  • from Section 2 - Evaluation and management
  • Edited by Clare J. Fowler, Jalesh N. Panicker, Anton Emmanuel, University College London
  • Book:
    Pelvic Organ Dysfunction in Neurological Disease
    Published online:
    06 December 2010
    Print publication:
    04 November 2010, pp 61-78

  • Summary

    Lower urinary tract dysfunction (LUTD) can result from a wide range of neurological conditions. This chapter provides the clinician with an approach to neurogenic bladder dysfunction based on the history, physical examination and investigations, in order to optimize patient management and follow-up. Classification helps with understanding the functional disturbances occurring in neurogenic LUTD. Understanding the underlying dysfunction is paramount before starting treatment. History-taking should address potential dysfunction in both the storage and voiding phases of micturition. Several symptom scales have been validated for the evaluation of urinary disorders, but none are specific for neurogenic LUTD. Physical examination should include neurological, urological, gynecological, abdominal and rectal examination. History, bladder diary and clinical examination may not always be sufficient for understanding the nature of LUTD. Urodynamic tests involve functional and dynamic assessment of the lower urinary tract and are used to assess detrusor and bladder outlet function.

  • Section 1 - Neurological control of pelvic organ functions

  • Edited by Clare J. Fowler, Jalesh N. Panicker, Anton Emmanuel, University College London
  • Book:
    Pelvic Organ Dysfunction in Neurological Disease
    Published online:
    06 December 2010
    Print publication:
    04 November 2010, pp 1-60

  • Summary

    Afferent nerve endings in the bladder wall are important in conveying the sensations associated with degrees of bladder fullness and also bladder pain to the spinal cord. This chapter discusses the peripheral control of micturition, cellular signaling pathways in normal bladder function, spinal control of bladder function, and interoceptive sensations. Acetylcholine (ACh) and adenosine triphosphate (ATP) are released by the bladder urothelium during urine storage, in increasing concentrations as the bladder wall distends. Muscarinic, nicotinic and purinergic receptors have been identified in the bladder urothelium and/or suburothelium in human or animal studies. In normal adults information about the bladder is passed from the periaqueductal gray (PAG) to higher regions of the brain. This type of interoception is mediated by afferent input through small-diameter fibers in lamina 1 of the spinal cord. A number of spinal reflex mechanisms are involved in the control of the urethro-vesical unit.

  • 18 - Neuromuscular disorders

  • from Section 3 - Specific conditions
  • Edited by Clare J. Fowler, Jalesh N. Panicker, Anton Emmanuel, University College London
  • Book:
    Pelvic Organ Dysfunction in Neurological Disease
    Published online:
    06 December 2010
    Print publication:
    04 November 2010, pp 278-292

  • Summary

    Evidence to support management of neurogenic bowel dysfunction remains sparse in comparison to other areas of care; such evidence as is available arises mostly from the spinal cord injury arena. This chapter discusses the clinical and investigational assessment, management of fecal impaction, gastrocolic reflex, abdominal massage, rectal stimulation, and feces evacuation methods. Dysfunction of the bowel has considerable implications for quality of life. Assessment of an individual for neurogenic bowel management is a multidisciplinary activity. Anorectal manometry tests can quantify more precisely the functional status of the anorectum. Irregular or too infrequent management is associated with incontinence and constipation. The majority of individuals with neurogenic bowel dysfunction will use the conservative methods to manage their bowel dysfunction. Biofeedback, Transanal irrigation, surgical interventions, and antegrade continence enema (ACE) are some useful options when conservative methods are not effective.

  • 19 - Urinary retention

  • from Section 3 - Specific conditions
  • Edited by Clare J. Fowler, Jalesh N. Panicker, Anton Emmanuel, University College London
  • Book:
    Pelvic Organ Dysfunction in Neurological Disease
    Published online:
    06 December 2010
    Print publication:
    04 November 2010, pp 293-306

  • Summary

    Sexual function is recognized as an important factor determining quality of life and dysfunction in neurological patients may significantly add to the burden of their disease. Any disruption in the sexual response cycle results in sexual dysfunction (SD). Laboratory testing should be tailored according to patient symptoms and risk factors. Fasting glucose and lipid profile may be measured to assess atherosclerotic risk factors for erectile dysfunction (ED). Oral drugs should be considered as first-line therapy for neurogenic ED. There are fewer evidence-based therapeutic options for treatment of female SD. However it is an area of increasing interest and marketing of therapies by pharmaceutical companies. Therapies relate to treatment of sexual desire, arousal, orgasm and/or sexual pain. The term hypoactive sexual desire disorder (HSDD) is used to describe low sexual desire and distress, and many therapies aim to address this aspect of female sexual function.

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