Journal
NEUROREHABILITATION AND NEURAL REPAIR
Volume 27, Issue 9, Pages 834-843Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/1545968313496324
Keywords
functional electrical stimulation; spinal cord injury; abdominal muscle training; stimulated cough
Categories
Funding
- Laurie Cowled Scholarship
- New South Wales Office of Science and Medical Research Spinal Cord Injury Grant Program
- National Health and Medical Research Council of Australia
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Background. Respiratory complications in people with high-level spinal cord injury (SCI) are a major cause of morbidity and mortality, particularly because of a reduced ability to cough as a result of abdominal muscle paralysis. Objective. We investigated the effect of cough training combined with functional electrical stimulation (FES) over the abdominal muscles for 6 weeks to observe whether training could improve cough strength. Methods. Fifteen SCI subjects (C4-T5) trained for 6 weeks, 5 days per week (5 sets of 10 coughs per day) in a randomized crossover design study. Subjects coughed voluntarily at the same time as a train of electrical stimulation was delivered over the abdominal muscles via posterolaterally positioned electrodes (50 Hz, 3 seconds). Measurements were made of esophageal (P-es) and gastric (P-ga) expiratory pressures and the peak expiratory flow (PEFcough) produced at the 3 time points of before, during, and after the training. Results. During voluntary coughs, FES cough stimulation improved P-ga, P-es, and PEFcough acutely, 20-fold, 4-fold, and 50%, respectively. Six weeks of cough training significantly increased P-ga (37.1 +/- 2.0 to 46.5 +/- 2.9 cm H2O), P-es (35.4 +/- 2.7 to 48.1 +/- 2.9 cm H2O), and PEFcough (3.1 +/- 0.1 to 3.6 +/- 0.1 L/s). Cough training also improved pressures and flow during voluntary unstimulated coughs. Conclusions. FES of abdominal muscles acutely increases mechanical output in coughing in high-level SCI subjects. Six weeks of cough training further increases gastric and esophageal cough pressures and expiratory cough flow during stimulated cough maneuvers.
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