Posted by Nurse Linda in Life After Paralysis on September 29, 2021 # Health

Woman with her dog on a dock. She is a wheelchair userGravity is one of the many concepts that can be used to your advantage in rehabilitation. Many people do not see the value of gravity because it can prevent movement from happening, but it can be harnessed in your child’s favor. Gravity can be quite an asset in helping a child’s body function.

The bladder is a muscular collection organ that holds urine until the appropriate time for expulsion. Without spinal cord or neurological injury, when the sphincters of the bladder are relaxed, urine will pass right out of the bladder if an individual is upright. Muscle function assists in pushing out urine; however, urine can be eliminated just by being upright with the sphincters open. Children do not have urinary nervous system development until between the age of two and three, so before this age, the sphincters just allow urine to pass out of the body. This is why diapers are used with potty training at the appropriate time. It is not the treatment for a child of any age with a diagnosis of neurogenic bladder, which can include closed sphincters.

With a neurogenic bladder, filling sensations and the sphincters may not be receiving messages for the automatic expulsion of urine. Urine can overfill the bladder leading to overstretching or backing up the ureters into the kidneys (reflux). Damage can occur as kidneys have no capacity for urine storage. Sometimes, parents or caregivers note some expulsion of urine, but with neurogenic bladder, this is typically overflow expulsion as the bladder will retain urine. Retained urine is not only a possible source for reflux into the kidneys but also a great source for bacteria to grow to create an infection.

The treatment for the neurogenic bladder is a bladder elimination program. This is typically accomplished by using intermittent catheterization (I.C.). Your healthcare professional will direct you in how to do the catheterization, how often and any supplemental medications that will assist your child. The catheterization program must be followed carefully to avoid damage to the bladder from overstretching the bladder muscle or reflux into the kidneys, which can lead to permanent kidney damage. Bladder infections can be reduced by following the catheterization procedure.

Sometimes an indwelling catheter is used to keep the bladder empty, depending on the situation. Typically, intermittent catheterization (I.C.) is used. In this process, a catheter of appropriate size for your child is inserted using the clean technique (scrupulous hand washing and cleaning of the urethra). A well-lubricated catheter is inserted, urine is drained, and the catheter is removed.

Gravity can help completely drain the urine from the bladder. Think of the bladder like a balloon. The catheter is inserted into the center of the bladder, but the bladder wall may not contract as quickly with a neurogenic bladder, leaving a small amount of urine. Withdrawing the catheter slowly can assist with the removal of all the urine. Sitting upright or propping up the smaller child will help the ability of the catheter to remove all the urine using gravity.

Bowel evacuation is typically performed by individuals in the sitting position. In many countries, bowel evacuation is done in a squatting position to take advantage of abdominal muscle function. After a diagnosis of neurogenic bowel, much like neurogenic bladder, communication of the messages to and from the brain and bowel are either not communicated or miscommunicated. These messages can be that the bowel needs to be emptied or that evacuation should occur at the time when the individual is ready. Sometimes, stool might be automatically expelled, but this is an occurrence of overflow with the bowel being full, resulting in some, but not all, stool forced out at the location of lease resistance, the rectum. If there is tone (spasticity) in the bowel, stool can back up in the colon. If the internal sphincter of the bowel is closed due to tone, the stool will remain tightly held in the bowel. If the internal sphincter lacks tone, stool often is expelled when the child sits up. A bowel program will help control the timing of bowel movements.

A bowel program is a treatment for neurogenic bowel. Your healthcare professional will direct you to manage your child’s bowel that will be the most effective process for them as individuals. For example, children with higher-level injury in the cervical or thoracic area will use a suppository followed by digital stimulation. Children with lower-level injury in the thoracic or sacral area might use manual removal.

Sitting for bowel evacuation can be aided by gravity. For smaller children, propping up will help. Gravity will aid in the stool traveling to the lower rectum as well as for expulsion. If the bowel program is performed with the child in bed, the bowel is parallel with the bed, not affected by gravity. But when an individual is upright, gravity can enhance, not replace, the bowel program.

Standing is an effective treatment for a variety of bodily activities that are affected by gravity. A standing frame is used for children that have issues with standing or balance. Standing takes advantage of gravity to assist in pulling the diaphragm down, creating a deeper breath into the lungs. The body’s natural position is with the diaphragm relaxed, so return to that position for exhaling is a natural body function.

Standing has many benefits. It allows the child’s weight to be put through the bones. It also stretches the muscles, which contain a stretch reflex that wants to be extended with movement or weight through the standing position. Bladder and bowel function can be boosted standing. Being at the same height as peers can assist with a psychological boost and offer activities at a different level.

Ask your healthcare professional for an evaluation for a standing frame for your child. A physical examination is needed to ensure your child is ready and healthy to stand. Often school personnel will request a standing frame for some learning activities. This can be added to your child’s Individual Education Plan (IEP) for incorporation into the school day. Standing frames are often paid for by your insurer, both private and public.

Gravity helps the body function in so many ways, but it can also hinder some activities. Moving against gravity can be a challenge. Some techniques can be used to reduce gravity.

Even with a small amount of movement in a muscle, devices can be used to overcome gravity making your child more independent. We all know sitting upright improves the ability to swallow without choking. An example of anti-gravity devices is supported to facilitate arm movement. This equipment can augment arm function through the use of springs and pullies. Children with slight arm movement may be able to feed themselves using this technology. There are many kinds of feeding support devices. I randomly chose these for you to see as they are hard to describe!

Other equipment that can help reduce gravity resistance include reciprocal gait orthotics (RGO), which can help move the legs through hip movement. Partial weight-supported walking is a therapy that takes off the bodyweight to allow small muscle functions in the legs to move.

Aquatic therapy uses the buoyancy of water to support the body. If you are in the water splashing hard, water is quite resistant, increasing the effects of gravity. But slow, gentle movements work with buoyancy to reduce gravity. Often small movements can be learned in the water. With additional therapies, these movements can be translated to everyday use.

These are just some ideas about the use of gravity as a friend and foe. Thinking about how gravity affects daily life is actually quite huge. However, more and more ways are being discovered to harness gravity into effective treatments. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.