Modern methods of data science have become powerful tools for analyzing complex, heterogeneous biomedical datasets, including those specific to spinal cord injury (SCI), enabling personalized predictions of recovery, identification of prognostic biomarkers, and insights into functional outcomes. This article summarizes the one-day Data Science Precourse, held at the 2025 annual scientific meeting of the American Spinal Injury Association (ASIA). The course was designed to illustrate advances in data science and their application to SCI research, while analyzing the unique challenges posed by SCI-specific data, such as sparse longitudinal measurements, variable injury characteristics, and diverse clinical and functional assessments. The precourse combined expert-led discussions with hands-on learning opportunities tailored for both clinical and data science audiences. Topics included addressing key challenges of artificial intelligence methods in SCI data analyses, such as learning from limited or incomplete datasets, implementing causal frameworks to understand recovery mechanisms, and ensuring robust and interpretable predictions for clinical decision-making. The event also showcased real-world applications of data science in SCI research, highlighting both solved and ongoing problems, including prognostic modeling, patient stratification, lesion analysis, and optimization of clinical trial design. The precourse culminated in the presentation by the winning teams of the 2025 ASIA Data Science Challenge.

The Crossroads in Spinal Cord Injury Treatment: Present and Future conference, held in Houston, Texas in January 2026, brought together a multidisciplinary group of clinicians, researchers, engineers, and individuals living with spinal cord injury (SCI) to examine future directions of SCI care and research. This narrative summarizes themes, emphasizing the need to align scientific innovation with implementation in clinical settings. The conference was structured around priorities from individuals with SCI, including upper limb function, bowel and bladder management, pain, independence, and psychosocial well-being. Across sessions, speakers highlighted gaps in translation into practice. Major topics included challenges in clinical trial design, advocacy efforts to address policy barriers and inequities, and emerging approaches in neuromodulation, surgical reconstruction, and rehabilitation technologies. Additional focus areas included under-researched domains such as neurogenic bowel and bladder, disparities in care for women, and the clinical impact of autonomic dysfunction. Psychosocial health, pain, mental health, and sexuality were emphasized as central to quality of life. Engineering discussions underscored interdisciplinary collaboration and user-centered design. Overall, the conference highlighted that the field of SCI is at a critical crossroads, where progress will depend on effective implementation, equitable access, and integration of lived experience into research and clinical care.

Spinal cord injury (SCI) remains one of the most formidable challenges in regenerative medicine, often resulting in permanent loss of motor, sensory, and autonomic function. Cell-based therapies offer a promising path toward repair by providing donor neurons and glia capable of integrating into host circuits, modulating the injury environment, and restoring function. Early studies employing fetal neural tissue and neural progenitor cells (NPCs) have demonstrated proof-of-principle for survival, differentiation, and synaptic integration. More recently, pluripotent stem cell (PSC)-derived donor populations and engineered constructs have expanded the therapeutic repertoire, enabling precise specification of interneuron subtypes, astrocytes, and oligodendrocytes tailored to the injured spinal cord. Advances in genetic engineering, including CRISPR-based editing, trophic factor overexpression, and immune-evasive modifications, are giving rise to next-generation donor cells with enhanced survival and controllable integration. At the same time, biomaterials, pharmacological agents, activity-based therapies, and neuromodulation strategies are being combined with transplantation to overcome barriers and promote long-term recovery. In this review, we summarize progress in designing and engineering donor cells and tissues for SCI repair, highlight how combination strategies are reshaping the therapeutic landscape, and outline opportunities for next-generation approaches. Together, these advances point toward a future in which tailored, multimodal cell-based therapies achieve consistent and durable restoration of spinal cord function.

Spinal cord injury typically leads to neurogenic bladder dysfunction, often including detrusor-sphincter dyssynergia. Sacral anterior root stimulation can empty the neurogenic bladder, but this emptying can be impeded by reflex contractions of the urethral sphincter. The sacral sensory roots are typically transected (rhizotomy) to reduce these reflex contractions, but this rhizotomy also impairs desirable reflexes (e.g., sexual function) and sacral sensation, if present. Preclinical experiments have shown that sacral nerve stimulation at 600 Hz can promote bladder emptying while reducing urethral sphincter activity. In this proof-of-concept study, we tested 600-Hz sacral nerve stimulation to limit urethral sphincter activity in individuals with spinal cord injury who were already implanted with a sacral anterior root stimulation device. Bladder pressure, urethral pressure, rectal pressure, anal pressure, and pelvic floor electromyogram were measured in response to stimulation at 20 or 600 Hz. Stimulation was feasible and well-tolerated, and frequency appeared to have an effect on lower urinary tract and bowel function. In one participant, stimulation at 600 Hz produced a significant decrease in urethral pressure compared to 20-Hz stimulation. Further work is needed to explore the potential for this approach to improve bladder emptying efficiency for individuals with spinal cord injury and detrusor-sphincter dyssynergia.

The Crossroads in Spinal Cord Injury Treatment: Present and Future conference, held in Houston, Texas in January 2026, brought together a multidisciplinary group of clinicians, researchers, engineers, and individuals living with spinal cord injury (SCI) to examine future directions of SCI care and research. This narrative summarizes themes, emphasizing the need to align scientific innovation with implementation in clinical settings. The conference was structured around priorities from individuals with SCI, including upper limb function, bowel and bladder management, pain, independence, and psychosocial well-being. Across sessions, speakers highlighted gaps in translation into practice. Major topics included challenges in clinical trial design, advocacy efforts to address policy barriers and inequities, and emerging approaches in neuromodulation, surgical reconstruction, and rehabilitation technologies. Additional focus areas included under-researched domains such as neurogenic bowel and bladder, disparities in care for women, and the clinical impact of autonomic dysfunction. Psychosocial health, pain, mental health, and sexuality were emphasized as central to quality of life. Engineering discussions underscored interdisciplinary collaboration and user-centered design. Overall, the conference highlighted that the field of SCI is at a critical crossroads, where progress will depend on effective implementation, equitable access, and integration of lived experience into research and clinical care.

IntroductionNeurogenic bowel dysfunction is a consequence of almost all spinal injuries. Primary management is via conservative treatment methods with few intermediary interventions available prior to surgical management. This protocol describes a trial to determine if genital nerve stimulation (GNS) can reliably be delivered at-home for the purpose of modulating neurogenic bowel dysfunction in people living with spinal cord injury (SCI).Methods and analysisA total of 12 participants, aged 18 years or older with any severity of a traumatic SCI (at least 6 months post-injury) at or above the neurological level of T12 with severe neurogenic bowel dysfunction will be enrolled, randomized, and perform GNS or sham stimulation 6–8 h per day for 4 weeks. Daily bowel and stimulation diaries will be filled out by participants or caregivers to provide qualitative and feasibility data. Anorectal manometry (ARM) assessments will be performed at Baseline (before stimulation), at the End of Treatment (the next day after cessation of at-home stimulation), and at the End of Study (after 2 weeks of no stimulation). ARM assessments provide quantitative data for changes in anal sphincter and rectal function due to stimulation. Self-report questionnaires will be completed at each ARM assessment regarding neurogenic bowel dysfunction and impacts of bowel function on quality of life.DiscussionOutputs from this trial will inform research and clinical practice on the preliminary neuromodulatory effects of GNS on SCI-induced neurogenic bowel dysfunction and will guide the development of a properly powered efficacy trial testing GNS as an intermediary intervention.Ethics and disseminationThe study was approved by the MetroHealth Institutional Review Board (STUDY00000717) and registered at clinicaltrials.gov prior to enrollment of participants. Dissemination of results will be through presentations at academic meetings and in the community, and peer-reviewed medical journals.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT06836739, identifier NCT06836739.

Study design Anonymous online survey Objectives To investigate the priorities, needs and willingness to adopt nerve stimulation devices for managing neurogenic bladder and bowel function in people with spinal cord injury (SCI) living in Australia. Setting Online survey of people living with SCI in Australia. Methods This anonymous online survey used Qualtrics and was advertised via standard communication channels, such as advocacy groups representing the SCI community in Australia, social media, attending SCI sporting events and by word-of-mouth. Results Responses from 62 individuals (32% female, 68% male) were included. Bladder emptying through urethra without catheter was the highest priority for bladder function. Reducing time required for bowel routines and constipation were the top priorities regarding bowel function. The highest concern for internal/implanted devices was the 4% chance of device surgical removal, while wearing wires under the clothes was the main concern for external devices. 53% of respondents were willing to trial an implanted nerve stimulation device, while 70% would trial an external device to improve and gain independence in bladder and bowel function. Conclusion The findings of this study highlighted the potential role in which nerve stimulation can have in addressing bladder and bowel dysfunction in people with SCI, and have also identified that there was a need for Australian physiotherapists to evaluate their role in bladder and bowel dysfunction. Results from this study can help guide further research in nerve stimulation devices for bladder and bowel dysfunction in people with SCI. Sponsorship n/a

Lower urinary tract dysfunction (LUTD) is a debilitating condition that affects millions of individuals worldwide, greatly diminishing their quality of life. The use of wireless, catheter-free implantable devices for long-term ambulatory bladder monitoring, combined with a single-sensor system capable of detecting various bladder events, has the potential to significantly enhance the diagnosis and treatment of LUTD. However, these systems produce large amounts of bladder data that may contain physiological noise in the pressure signals caused by motion artifacts and sudden movements, such as coughing or laughing, potentially leading to false positives during bladder event classification and inaccurate diagnosis/treatment. Integration of activity recognition (AR) can improve classification accuracy, provide context regarding patient activity, and detect motion artifacts by identifying contractions that may result from patient movement. This work investigates the utility of including data from inertial measurement units (IMUs) in the classification pipeline, and considers various digital signal processing (DSP) and machine learning (ML) techniques for optimization and activity classification. In a case study, we analyze simultaneous bladder pressure and IMU data collected from an ambulating female Yucatan minipig. We identified 10 important, yet relatively inexpensive to compute signal features, with which we achieve an average 91.5% activity classification accuracy. Moreover, when classified activities are included in the bladder event analysis pipeline, we observe an improvement in classification accuracy, from 81% to 89.0%. These results suggest that certain IMU features can improve bladder event classification accuracy with low computational overhead.Clinical Relevance: This work establishes that activity recognition may be used in conjunction with single-channel bladder event detection systems to distinguish between contractions and motion artifacts for reducing the incorrect classification of bladder events. This is relevant for emerging sensors that measure intravesical pressure alone or for data analysis of bladder pressure in ambulatory subjects that contain significant abdominal pressure artifacts.

This protocol describes the implantation of our bladder (UroMOCA) and bowel device (ColoMOCA) in pigs.

This protocol describes the implantation procedure of the wireless bladder device (UroMOCA) and of the wireless stimulation device (StimPods) into pigs.

You have accessJournal of UrologyCME1 Apr 2023MP52-10 CHRONIC, NON-INVASIVE NERVE STIMULATION THERAPY TO TREAT INCONTINENCE IN PEOPLE WITH NEUROGENIC BLADDER Seth Meade, Dennis Bourbeau, Steven Brose, Kenneth Gustafson, Cesar Colasante, and Kevin Suarez Seth MeadeSeth Meade More articles by this author , Dennis BourbeauDennis Bourbeau More articles by this author , Steven BroseSteven Brose More articles by this author , Kenneth GustafsonKenneth Gustafson More articles by this author , Cesar ColasanteCesar Colasante More articles by this author , and Kevin SuarezKevin Suarez More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reduction of urinary urgency and incontinence is a top priority for individuals with neurogenic bladder (NB). Multiple clinical studies show non-invasive genital nerve stimulation (GNS) can modulate sympathetic reflexes to inhibit bladder contractions acutely and is well-tolerated. To translate GNS as an effective adjunct therapy for managing neurogenic bladder, further evidence of chronic efficacy and feasibility is needed. METHODS: In this “before-and-after” prospective cohort study, participants acted as their own controls. 9 individuals with NB were enrolled (8/9 (88.9%) male) and confirmed to: 1) have NB by urodynamics examination and 2) have bladder contractions inhibited by GNS. 5 participants (100% male) who tolerated GNS without additional medications and were adherent to voiding diaries tested the efficacy of at-home, self-administered GNS using a commercial TENS unit. Participants completed voiding diaries, each detailing at least 1 continuous week of tracked voiding, leak, and urgency events. Diaries were completed once at study initiation during a control period without GNS or medications, and then for 3 separate periods during prolonged use of GNS to manage incontinence (baseline, 6 months, 1 year). Participants also completed a bladder-related quality of life questionnaire (Qualiveen) at their initial evaluation, as well as 6 and 12 months later. RESULTS: Preliminary findings show that GNS increased bladder capacity for all 9 individuals tested by an average of 58%, and 3/5 individuals tested chronically maintained an increased bladder capacity after 6 months of GNS. 4/5 individuals reported increased bladder-related QOL by total Qualiveen after 6 months of at-home GNS. Of 2 individuals who experienced leakage with chronic voiding data one reduced their leaks/day by 90% at 6 months of use and the other by 30% at 1 year of GNS. Of 2 individuals with the primary goal of reducing bladder urgency, neither was able to reduce their urgency events/day but were able to reduce their voiding frequency by 65% and 15% after more than 1 month of use. The primary reason individuals reported for dropping from the study was difficulty placing the electrodes and keeping them in place. CONCLUSIONS: GNS can provide a durable reduction in leakage events for individuals with incontinence due to neurogenic bladder up to 6 months. Multiple subjects reported issues with electrode placement and adhesion as well as associated wires from the TENS unit leading to less-than-ideal GNS for some. Source of Funding: -RX002512 Department of Veterans Affairs -642810 Craig H. Neilsen Foundation (CHNF) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e706 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seth Meade More articles by this author Dennis Bourbeau More articles by this author Steven Brose More articles by this author Kenneth Gustafson More articles by this author Cesar Colasante More articles by this author Kevin Suarez More articles by this author Expand All Advertisement PDF downloadLoading ...

Continuous monitoring of bladder activity during normal daily activities would improve clinical diagnostics and understanding of the mechanisms underlying bladder function, or help validate how differing neuromodulation strategies affect the bladder. This work describes a urological monitor of conscious activity (UroMOCA). The UroMOCA included a pressure sensor, urine impedance-sensing electrodes, and wireless battery recharge and data transmission circuitry. Components were assembled on a circuit board and encapsulated with an epoxy/silicone molded package that allowed Pt-Ir electrode feedthrough for urine contact. Packaged UroMOCAs measured $12\times 18\times6$ mm. UroMOCAs continuously transmitted data from all onboard sensors at 10 Hz at a 30 cm range, and ran for up to 44 h between wireless recharges. After in vitro calibration, implantations were performed in 11 animals. Animals carried the device for 28 days, enabling many observations of bladder behavior during natural, conscious behavior. In vivo testing confirmed the UroMOCA did not impact bladder function after a two-week healing period. Pressure data in vivo were highly correlated with a reference catheter used during an anesthetized follow-up. Static volume sensor data were less accurate, but demonstrated reliable detection of bladder volume decreases, and distinguished between voiding and non-voiding bladder events.

This protocol describes the implantation of two bowel devices (ColoMOCA) in pigs.

You have accessJournal of UrologyCME1 Apr 2023PD23-06 FELINE AMBULATORY BLADDER PRESSURE AND VOLUME TRANSMITTED BY A CATHETER-FREE WIRELESS INTRAVESICAL MONITOR Steve Majerus, Brett Hanzlicek, Dario Cabal, Mohamed Elazab, Margot Damaser, and Dennis Bourbeau Steve MajerusSteve Majerus More articles by this author , Brett HanzlicekBrett Hanzlicek More articles by this author , Dario CabalDario Cabal More articles by this author , Mohamed ElazabMohamed Elazab More articles by this author , Margot DamaserMargot Damaser More articles by this author , and Dennis BourbeauDennis Bourbeau More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003296.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As with clinical urodynamics, investigations into lower urinary tract physiology using animal models require catheter-based systems to measure bladder pressure while filling the bladder, often under anesthesia. However, anesthesia, and rapid catheter filling of the bladder can affect filling pressures, urinary leakage and voiding reflexes. To enable recordings representative of normal physiology, we developed a catheter-free, wireless, intravesical sensor which is implanted in the feline bladder lumen and wirelessly transmits bladder pressure and volume data. We validated sensor function by recording volume and pressure over 4-week implantations in felines. METHODS: The Urological Monitor of Conscious Activity (UroMOCA) measured 18×12×5.6mm and transmitted data to a radio placed worn by the animal. The UroMOCA battery was recharged wirelessly via a charging mat placed under the subject. Platinum electrodes measuring urine concentration and conductance estimated urine volume and were paired with an onboard pressure sensor. Under anesthesia, a UroMOCA was implanted into the bladder lumen via cystotomy in male felines. Baseline cystometry was performed. Anesthetized cystometry with UroMOCA recording and imaging were repeated 2 and 4 weeks post-implantation. Ambulatory recordings of up to two hours were performed multiple times during the four weeks prior to device explantation. Sham surgeries and sham devices were implanted in some animals to assess the impact of the UroMOCA on the bladder. Bladder tissue was saved for histology. RESULTS: Ten feline cats were enrolled: 3 were sham implants (no device), 1 received an inactive device, and 6 received a functional UroMOCA. Non-anesthetized recordings were performed for more than 73 hours over 33 ambulatory data collection sessions. After 2 weeks, all animals resumed normal voiding volume. Urinary retention requiring intermittent catheterization was seen in 1 feline; there was no evidence of obstruction. Wireless pressure data linearly correlated with anesthetized cystometry (R2=0.96). Volume measurement was variable but decreased during voiding and increased during filling. Histology showed normal bladder tissue. CONCLUSIONS: A small, wireless, catheter-free, intravesical sensor enabled conscious recordings of bladder function in felines during natural bladder filling over 4 weeks. The volume sensor enabled detection of bladder filling and emptying phases. Source of Funding: This work was funded by the NIH Stimulating Peripheral Activity to Relieve Conditions (SPARC) program, NIH grant number OT2OD023873 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e672 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steve Majerus More articles by this author Brett Hanzlicek More articles by this author Dario Cabal More articles by this author Mohamed Elazab More articles by this author Margot Damaser More articles by this author Dennis Bourbeau More articles by this author Expand All Advertisement PDF downloadLoading ...

This protocol is for the daily testing of StimPods implanted in a pig. Data from the StimPods and UroMOCA are recorded during these sessions.

Context: Individuals with SCI typically live with neurogenic bowel dysfunction and impaired colonic motility that may significantly impact health and quality of life. Bowel management often includes digital rectal stimulation (DRS) to modulate the recto-colic reflex to promote bowel emptying. This procedure can be time-consuming, caregiver-intensive, and lead to rectal trauma. This study presents a description of using electrical rectal stimulation as an alternative to DRS to help manage bowel emptying in a person with SCI. Methods: We conducted an exploratory case study with a 65-year-old male with a T4 AIS B SCI who normally relies on DRS as the main component of his regular bowel management strategy. In randomly selected bowel emptying sessions during a 6-week period, the participant received burst-pattern electrical rectal stimulation (ERS) (50 mA, 20 pulses/s at 100 Hz), via a rectal probe electrode until bowel emptying was achieved. The primary outcome measure was number of cycles of stimulation required to complete the bowel routine. Results: 17 sessions were performed using ERS. In 16 sessions, a bowel movement was produced after only 1 cycle of ERS. In 13 sessions, complete bowel emptying was achieved with 2 cycles of ERS. Conclusions: ERS was associated with effective bowel emptying. This work represents the first time ERS has been used to affect bowel emptying in someone with SCI. This approach could be investigated as a tool to evaluate bowel dysfunction, and it could be further refined as a tool for improving bowel emptying.