Training after SCI
spinal cord injury, instituting an effective bladder management program is key
to ensuring optimal patient health. The overall goal is to develop a bladder management
program that will allow the patient to reintegrate most easily back into the community.
Specific goals include the prevention of bladder overdistention, urinary tract
infections, and kidney damage. A practical bladder management program, in both
the hospital and outpatient settings, is a critical component of an overall SCI
The type of management program
will depend on many factors. Some of them include:
- Level of injury and extent
of loss of normal urinary system function
- Susceptibility to infection,
including overall medical and surgical history
- Can/will the client adhere
to the program?
- Hand function should
be assessed to determine ability to perform self-catheterization, as well
as sitting, standing and ambulating.
- Lifestyle (is the
client active, working, etc.?)
- Availability of clinically
The object of bladder training
after SCI is to maintain the patient's bladder at the appropriate volumes for
optimum overall health. Methods of bladder retraining are supplemented by monitoring
fluid intake to prevent UTIs and control urine volume and concentration, developing
scheduled times for urination, and using body positions to facilitate voiding.
goals of a bladder training program after SCI include prevention of bladder
overdistention, urinary tract infections and kidney damage.
Successful bladder training
is an interdisciplinary function. In many spinal cord centers, nursing implements
a urinary plan of care based on identified criteria. These criteria include important
issues, such as level of injury and often the results of urodynamic assessments.
is the only way to properly diagnose and treat the neurogenic bladder. After
spinal cord injury, urodynamics will help determine which patients will
develop complications, therefore permitting early treatment and intervention.
The role of urodynamics in neurogenic voiding dysfunction include:
The timing of urodynamics
after SCI is important. While a patient is still in spinal shock, the bladder
doesn't contract, so testing detrusor function, etc. won't be fruitful. The
tests would be most accurate if performed at 3 - 4 months after SCI.
of the detrusor function during bladder filling,
- the evaluation of
the bladder outlet including the urethral sphincter, and
- the diagnosis of
For ideal bladder training,
the 3 disciplines of nursing, physical therapy (PT) and occupational therapy
(OT) work hand-in-hand.
- Bladder training often
begins when OT and Nursing agree that the patient is physically and functionally
able to begin.
- In general, PT assesses
the ability of the patient to "transfer" him/herself. They also
assess if a wheelchair is needed, and if so, what type.
- OT assesses if other
equipment is needed and the patient's actual abilities and disabilities.
- Finally, nursing provides
the follow-through and reinforcement on a daily basis. As always, nursing
is also responsible for overall physical assessment, and is often the coordinator
or "case manager" of the efforts of other disciplines.
- All disciplines are expected
to document the effectiveness (or lack of) of their efforts.
- Ideally, the plan is
to train the patient as well as a significant other and/or caregiver. Training
also includes education about medications and their side effects, recognizing
symptoms of a UTI and urine volume issues.
best time to perform urodynamic assessment testing after spinal cord injury
is during the period of spinal shock.
The next page will offer some
practical matters related to bladder management and training after SCI