Texas Model Spinal Cord Injury System

Daniel E. Graves, Ph.D., Co-Director
William H. Donovan, M.D., Co-Director

The Texas Model Spinal Cord Injury System provides services along the entire continuum of care from emergency medical service to long-term follow-up and management of secondary conditions. The TMSCIS includes a site-specific research project that is designed to provide high level evidence of the efficacy of a novel treatment to prevent bladder complications. The project is a randomized double blind placebo controlled parallel groups investigation of the effects of Botulinum toxin A treatment of detrusor external sphincter dyssynergia during early spinal cord injury.

Many patients with SCI develop neurogenic bladder dysfunction associated with detrusor hyperreflexia and DESD that can lead to long-term complications in up to 50 percent of patients. These complications include hydronephrosis, vesicoureteral reflux, nephrolithiasis, sepsis, renal insufficiency or failure and even death. This investigation is intended to determine if the prevention of DESD in the early phase of recovery can prevent some of these complications. In addition, the TMSCIS includes a module designed to develop an outcome measure of trunk and postural control to be utilized in activity based therapy programs like locomotor training.

The outcomes of large scale clinical trials of locomotor training highlight the need for outcome measures that are designed to capture changes brought about by translational research that may not have been necessary for more traditional therapy programs. This scale development project incorporates item response theory methods as well as reliability and validity investigations in a minimum of four model systems.