Bladder Rehabilitation Research Training Center
Who we are
We are national leaders in the research field of bladder dysfunction and urinary symptoms that follow nervous system injury or disease. Located at MedStar National Rehabilitation Hospital in Washington, D.C., our team works collaboratively to investigate ways to produce positive patient outcomes.
We currently receive funding from the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR), U.S. Department of Education, Department of Defense (DOD), Craig H Neilsen Foundation, and industry sponsors. The opinions expressed on these pages are those of the authors, and no official endorsement of any funding source should be inferred.
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For research interest, click here to learn more.
Research projects
Research Project 1
Intravesical Probiotic (Lactobacillus) for Urinary Symptoms Among People with Neurogenic Lower Urinary Tract Dysfunction Who Use Indwelling Catheters
We are recruiting participants nationwide for a bladder study looking at the use of a probiotic bladder flush when experiencing urinary symptoms.
Participants must:
- Be diagnosed with neurogenic bladder (SCI, MS, SB, stroke, etc.)
- Use indwelling catheterization for bladder management
- 18 years or older
- Have a history of two or more episodes of urinary symptoms in the past year
Objective 1: Participants in the metropolitan Washington, D.C., area will provide two urine samples at least two weeks apart when not experiencing urinary symptoms.
Objective 2: Participants nationwide will be randomized into a low or high dose bladder wash group using an intravesical probiotic called Lactobacillus GG. Instillations will occur when experiencing urinary symptoms.
Urine samples may be collected if residing in the metropolitan Washington, D.C. area.
If you are interested or have questions, please contact:
Margot Giannetti
Margot.Giannetti@medstar.net
202-877-1071
Chris Riegner
christopher.r.riegner@medstar.net
202-877-1560
Research Project 2
A Randomized Controlled Trial of Transcutaneous Tibial Nerve Stimulation (TTNS) for Neurogenic Lower Urinary Tract Dysfunction (NLUTD)
This study seeks to demonstrate that TTNS will improve NLUTD in SCI/D by intervening acutely, improving the quality of life by providing a feasible, non-pharmacologic, and dignified intervention to be performed at home to reduce autonomic dysreflexia.
Participants must be:
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Diagnosed with a spinal cord injury or disease
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Level of injury T1-T9
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Aged 18-65
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Currently admitted to inpatient within four weeks of SCI/D at either MedStar National Rehabilitation Hospital (Washington, D.C.,) or TIRR Memorial Hermann (Houston, TX)
Participants will be in this study for one year and randomized into a low or high TTNS group.
If you are interested or have questions, please contact:
MedStar National Rehabilitation Hospital
Emily Leonard, PhD
emily.m.leonard@medstar.net
202-877-1844
The Institute for Rehabilitation and Research (TIRR) Memorial Hermann
Jacqueline Martinez
jacqueline.b.martinez@uth.tmc.edu
713-797-7133
Research Project 3
A Mixed Methods Assessment of the Impact of Transcutaneous Tibial Nerve Stimulation (TTNS) on Quality of Life and Participation
Study Objective: The primary objective of this study is to evaluate the burden of Neurogenic Lower Urinary Tract Dysfunction (NLUTD) on
- Health-related Quality of Life (QOL)
- Participation affected by use of TTNS
- Determine what constitutes a clinically meaningful difference in Neurogenic Lower Urinary Tract Dysfunction (NLUTD)-related QOL and participation
- Identify NLUTD user-defined themes regarding bladder function and the effects of TTNS neuromodulation on the daily impacts on one’s life.
To be included in this study, participants must:
- Age 18-65 years old
- Traumatic or non-traumatic SCI
- Neurologic level of injury above T10
- Within 6 weeks of injury
- Regionally located to allow follow-up
- English speaking
If you are interested or have questions, please contact:
Emily Leonard, PhD
emily.m.leonard@medstar.net
202-877-1844
Research Project 4
Intravesical Lactobacillus rhamnosusGG versus standard care saline bladder wash: A randomized, controlled, comparative effectiveness clinical trial—Intermittent Catheters
We are recruiting participants nationwide for a bladder study looking at the use of a probiotic bladder flush versus a saline bladder flush when experiencing urinary symptoms.
Participants must:
- Have had a Spinal Cord Injury, MS or Spina Bifida for at least 6 months and are over 18 years of age
- Be diagnosed with neurogenic bladder and use intermittent catherization for bladder management
If you are interested or have questions, please contact:
Emily Leonard, PhD
emily.m.leonard@medstar.net
202-877-1844
Research Project 5
A Spinal Cord Injury (SCI) stakeholder-vetted education module to mitigate early cardioendocrine health risks occurring after spinal cord injuries.
This research study aims to develop and evaluate an educational module designed to increase awareness of cardiometabolic disease (CMD) risk factors in individuals with early spinal cord injury (SCI). The study will test the effectiveness of the module in enhancing participants' knowledge and assess its impact on the diagnosis of cardiometabolic syndrome and key risk factors six months after the intervention.
To participate participants must be:
- Men and Women with SCI/D aged 18-70 years
- Neurologically complete and incomplete ASIA Impairment scale (AIS) A-D spinal cord levels C5 and below
- Enrolled no later than 4 months following discharge from initial rehabilitation from SCI
If you are interested in this study or have any further questions, please contact:
Chris Riegner
christopher.r.riegner@medstar.net
202-877-1560
Research Project 6
Randomized, Controlled, Open-Label, Parallel Group, Multi-Center, Prospective Phase 4 Study Comparing the Efficacy of Transforming Powder Dressing to NPIAP Recommended Standard of Care Therapies in Stage 2, 3 and 4 Pressure Injuries.
This study seeks to compare the efficacy of Altrazeal (Transforming Powder Dressing) in reducing primary dressing changes in the treatment of non-infected Stage 2, 3, and 4 pressure ulcers over a 12-week period versus standard of care therapies recommended within the 2019 NPIAP Guidelines.
Participants must be:
- 18 to 85 years of age
- Stage 2, 3 or 4 pressure ulcers
- Wound exudate is mild to moderate
- No active wound infection (clinical diagnosis)
- Able and willing to provide written (not proxy) informed consent
- Clinically stable, as determined by: Medical history, Vital signs, Physical exam, Laboratory testing prior to enrollment
Participants will be in this study for 12 weeks and will have to be seen in person once a week for the duration of the study.
If you are interested or have questions, please contact:
Ana Valeria Aguirre Guemez, MD
AnaValeria.AguirreGuemez@Medstar.net
202-877-1875
Coming soon
Development and Assessment of SCI Model System cUTI Consensus Guidelines
The purpose of this study is to learn more about your urinary symptoms. This will help you assess your bladder health and make informed decisions about your care.
Participants must:
- Be ≥18 years old
- Have a SCI
- Be willing to fill out the Urinary Symptom Questionnaire for Neurogenic Bladder (USQNB) every 2 weeks
- Living in the United States
Participants will be enrolled in the study for 12 months, during which electronic questionnaires will be sent every 2 weeks.
If you are interested in participating or have any questions please contact:
Ana Valeria Aguirre Guemez, MD
AnaValeria.AguirreGuemez@Medstar.net
202-877-1875
Intravesical Lactobacillus crispatus: Clinical Safety and Microbiome Evaluation
To find out if a probiotic bladder treatment with L. crispatus is safe and easy for people to use. The goal is to see if it can help treat urinary symptoms and without using antibiotics. .
Participants must:
- Be ≥18 years old
- Have had a SCI for at least 6 months
- Be using an intermittent catheter for bladder management
- Be premenopausal if female
- Be community dwelling
- Living in United States
Participants will be enrolled in the study for 23 days, during which daily electronic questionnaires will be collected, along with urine samples for DNA sequencing over 16 consecutive days. On days 8 and 9, participants will instill their assigned treatment into the bladder.
If you are interested in participating or have any questions please contact:
Emily Leonard, PhD
emily.m.leonard@medstar.net
202-877-1844
Resources
Fact sheets
Bladder Rehab Buzz Newsletter
Bladder Buzz Podcast
Lay Audience Summaries
Recursos en Español
Ficha informativa
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¿Qué es la disfunción neurógena de las vías urinarias inferiores?
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Control de la disfunción neurógena de las vías urinarias inferiores
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¿Cuáles son los síntomas de la disfunción neurogénica del tracto urinario inferior?
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¿Qué es la disfunción neurógena de las vías urinarias inferiores?
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Disfunción neurógena de las vías urinarias inferiores hipoactiva
Podcasts en Español
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Infecciones de vías urinarias en vejiga neurogénica ¿Tratar o no tartar?
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¿Qué es la Vejiga Neurogénica? Para Profesionales de la Salud
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¿Qué es la Vejiga Neurogénica en el niño? Para Niños y Familiares
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¿Qué es la Vejiga Neurogénica? Para Profesionales de la Salud - Parte 2
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Disfunción sexual en el hombre con Lesión Medular Espinal – consumidor
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Disfunción sexual en la mujer con Lesión Medular Espinal – consumidora
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Incontinencia urinaria y como ponerle un alto: Para consumidores
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La Salud en la mujer con lesión en la Médula Espinal. Para consumidores y proveedores de la salud
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Género y Sexo en la Lesión Medular: Para consumidores y profesionales de la salud
Urinary symptom questionnaires
The spinal cord injury research team at MedStar National Rehabilitation Hospital has developed a series of tools to better help monitor urinary symptoms. The Urinary Symptom Questionnaire for Neurogenic Bladder (USQNB)s were developed for individuals with neurogenic bladder due to Spinal Cord Injury (SCI), Spina Bifida (SB), Multiple Sclerosis(MS) or other neurological diseases. These questionnaires will guide you to make informed decisions on how to manage your symptoms.
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Intermittent Catheterization (USQNB-IC)
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Indwelling Catheterization (USQNB-IDC)
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Voiding (USQNB-V)
Cuestionarios en Español
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Cateterismo intermitente (USQNB-IC)
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Catéter permanente (USQNB-IDC)
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Vaciamiento (USQNB-V)
Publications
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The urine microbiome of healthy men and women differs by urine collection method
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Symptom and urinalysis-based approach to diagnosing urinary tract infections in children with neuropathic bladders
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The diagnosis of UTI in the neuropathic bladder
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A single intravesical instillation of probiotics is safe in children and adults with neuropathic bladder
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Effects of intravesical Lactobacillus Rhamnosus GG on urinary Symptom Burden in People with Neurogenic Lower Urinary Tract Dysfunction
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Antibiotic prophylaxis prescribing patterns of pediatric urologists for children with vesicoureteral reflux and other congenital anomalies of the kidney and urinary tract
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The Utility of DNA Next Generation Sequencing and Expanded Quantitative Urine Culture in the Diagnosis and Management of Chronic or Persistent Lower Urinary Tract Symptoms
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Intravesical Lactobacillus Rhamnosus GG is Safe and Well-Tolerated in Adults and Children with Neurogenic Lower Urinary Tract Dysfunction
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Bladder Neuromodulation in Acute Spinal Cord Injury via Transcutaneous Tibial Nerve Stimulation
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Feasibility of Self-Administered Neuromodulation in Spinal Cord Injury Neurogenic Bladder
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Safety, Feasibility, and Efficacy of Transcutaneous Tibial Nerve Stimulation in Acute Spinal Cord Injury Neurogenic Bladder
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Pediatric Acute Kidney Injury
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Association of Systemic Antimicrobials with the Expression of Beta-Lacatamases in Bacteria Cultured from Urological Patients
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Identification of Urinary CD44 and Prosaposin as Specific Biomarkers of Urinary Tract Infections in Children with Neurogenic Bladders
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The Association Between Urodynamic Parameters and Urine NGAL Concentrations in Children with Neurogenic Bladders
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Variation in the Diagnosis of Urinary Tract Infection in Children with Neurogenic Bladders between Subspecialists
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Identification of Burkholderia fungorum in the urine of an individual with spinal cord injury and augmentation cystoplasty using 16s sequencing
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Predictive Ability of NGAL in Identifying Urinary Tract Infection in Children with Neurogenic Bladders
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Uropathogens and Pyuria in Children with Neurogenic Bladders
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Preliminary validation of a Urinary Symptom Questionnaire for individuals with Neuropathic Bladder using Intermittent Catheterization (USQNB-IC)
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Evaluation of functional outcomes in traumatic spinal cord injury with rehabilitation-acquired urinary tract infections
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The role of the genitourinary microbiome in pediatric urology.
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Maintaining primacy of the patient perspective in the development of patient-centered patient reported outcomes
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Does NGAL Reduce Cost?
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Utility of a Routine Urinalysis in Children Who Require on Clean Intermittent Catheterization
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Urinary NGAL Deficiency in Recurrent Urinary Tract Infections
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Unique Transcriptional Programs Identify Subtypes of “Acute Kidney Injury”
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Frequency of Multidrug-Resistant Organisms Cultured From Urine of Children Undergoing Clean Intermittent Catheterization
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Redefining healthy urine
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Right Test, Wrong Patient
Meet our team
Suzanne Groah, MD, MSPH
Dr. Groah is the Project Director for the RRTC and National Capital Spinal Cord Injury Model System
Principal Investigator for research project 1 and research project 4
Co-Principal Investigator for research project 2 and research project 3
Dr. Groah the Director of the Spinal Cord Injury and Disease Rehabilitation and Recovery Program (inpatient, outpatient, and day program) and the Director of Spinal Cord Injury Research at MedStar National Rehabilitation Hospital, as well as Professor of Rehabilitation Medicine at Georgetown University. Currently, Dr. Groah is the Principal Investigator of several investigator-initiated projects on urinary symptoms in individuals with SCI, multiple sclerosis, and spina bifida.
Ana Valeria Aguirre, MD
Dr. Aguirre is an early career physician and Research Fellow at MedStar NRH. She is coordinating the SCI model systems database, and modular activities.
Dr. Aguirre has clinical and research experience in the field of Spinal Cord Injury (SCI), particularly in the development of upper extremity and gait training rehabilitation programs. Currently focusing on strategies and standards to reinforce prevention, diagnosis, and early treatment of complications to improve quality of life of people living with SCI.
Elizabeth-Sarah Bile, MS
Ms. Bile is clinical research coordinator working with research project 1, and research project 5
With past experience working in the field of healthcare, Elizabeth-Sarah was always passionate about patient care and the improvement of quality life for all. Her passion for spinal cord research emerged as she was working on a research centered around axon regeneration after SCI in zebrafish. At MedStar NRH, she hopes to gain invaluable experience with clinical study coordination and to contribute to the prevention and early treatment research to improve the wellbeing and comfort of people living with SCI.
Barbara Bregman, PhD
Dr. Bregman is the Co-Project Director of the RRTC and Director of Training.
Dr. Bregman is Director of Education and Training for the MedStar NRH Research Division, and Professor of Neuroscience and Rehabilitation Medicine at Georgetown University (GU). She is currently Co-Program Director of the NIH K12 Neurorehabilitation and Restorative Neuroscience Training Network, which targets the development of junior faculty in neurorehabilitation. As Chair of the Department of Neuroscience at Georgetown University, faculty development and mentorship were key components of her activities.
Carter Denny, MD, MPH
Dr. Denny is an early career physician scientist and a Co-Principal Investigator for research project 2.
Dr. Denny has a research interests in systems of care delivery and secondary stroke prevention. Dr. Denny has participated in several stroke clinical trials. With the support of a MHRI New Investigator grant, Dr. Denny is now recruiting hypertensive stroke survivors into a home blood pressure self-management study that she designed with the critical appraisal of the MedStar Research Scholars Program. She was awarded an NIH StrokeNet fellowship as a Georgetown junior faculty member for the 2017-2018 academic year.
Catherine Forster, MD
Dr. Forster is an early career physician scientist and Site-PI at Children’s Hospital of Pittsburgh for research project 1.
Dr. Forster is a pediatric hospitalist at Children’s Hospital of Pittsburgh and an Assistant Professor of Pediatrics at University of Pittsburgh. Her research focuses on identifying improved ways to diagnose urinary tract infections in people with NLUTD. She has expertise in the analysis and interpretation of urine biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), one of the proteins that will be measured in this study. For this project, Dr. Forster will be responsible for processing and analyzing the urine samples provided by participants in one of the research studies.
Margot Giannetti, BA
Ms. Giannetti is the study coordinator for research project 1.
Margot has a long history as a Clinical Research Coordinator at MedStar NRH. Through her experience in coordinating multiple stroke, cerebral palsy and spinal cord injury studies, she has gained invaluable experience in study coordination and also working with people with multiple types of physical disability.
Shashwati Geed, PT, PhD
Dr. Geed is the Biostatistician on research project 1 and research project 3.
Dr. Geed is an Assistant Professor in the Department of Rehabilitation Medicine at the Georgetown University. Her research focuses on both rehabilitation outcomes and the neurophysiology of motor function recovery after stroke. Dr. Geed has particular expertise in longitudinal models to measure recovery, clinical trial design in the context of neurorehab, and refining assessments that measure neurorehabilitation outcomes.
Madison Hughes, MS
Ms. Hughes is clinical research coordinator working with research project 1, and research project 2
Madison has an educational background in biomedical engineering and experience in stroke rehabilitation research. At MedStar NRH, she strives to improve the health outcomes and quality of life in the patients she serves through clinical research.
Emily Leonard, PhD
Dr. Leonard is an early career scientist, Co-Investigator for research project 3, and Clinical Research Coordinator for research project 2, and research project 5.
Dr. Leonard’s research background was centered around the improvement of motor function and social-psychological outcomes within a neurological population. As an early Rehabilitation Scientist and Clinical Research Coordinator at MedStar NRH, she focuses on the implementation of clinical research projects to improve patient outcomes and overall quality of life in patients with neurological injury or disease.
Inger Ljungberg, MPH
Ms. Ljungberg is the Director of Research Operations
Inger is the director of research operations at MedStar NRH where she has a long history of both coordinating research studies and serving as the project manager on Dr. Groah’s ongoing research projects. Through her work she has gained invaluable experience in the ability to monitor timely progression of multiple concurrent studies, facilitate cross team communication and supervision of budget expenditures.
Chris Riegner, MPH
Mr. Riegner is clinical research coordinator for research project 1, and research project 4
Chris is a clinical research coordinator with experience in neurological trauma research and mental illness studies. He coordinates recruitment and enrollment for several studies. He received his MPH from George Washington University with a focus on communication of healthcare research to the community.
Argy Stampas, MD
Dr. Stampas is an early career physician researcher and Site-Principal Investigator at TIRR for research project 2.
As a physician researcher, I want to advance the field of rehabilitation using electric stimulation to prevent problems commonly found in spinal cord injury (SCI), including neurogenic bladder and bowel, autonomic dysreflexia, neuropathic pain, and spasticity. In my position as the SCI Medicine Research Director, I can pursue research interests with the support of TIRR Memorial Hermann, UT Health Science Center at Houston, and their research infrastructure to support high-level clinical research. I am involved in the care of hundreds of SCI patients annually, and the institution serves one of the largest SCI populations in the country.
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For research interest, click here to learn more.