Journal
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
Volume 90, Issue 5, Pages 717-725Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.apmr.2008.11.013
Keywords
Cough; Electric stimulation; Quadriplegia; Rehabilitation; Respiratory muscles; Spinal cord injuries
Categories
Funding
- NCRR NIH HHS [UL1 RR024989, UL1 RR024989-025927, M01 RR00080, M01 RR000080-448089, M01 RR000080] Funding Source: Medline
- NINDS NIH HHS [R01 NS049516-04, R01 NS049516] Funding Source: Medline
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Objective: Evaluation of the capacity of lower thoracic spinal cord stimulation (SCS) to activate the expiratory muscles and generate large airway pressures and high peak airflows characteristic of cough, in subjects with tetraplegia. Design: Clinical trial. Setting: Inpatient hospital setting for electrode insertion; outpatient setting for measurement of: respiratory pressures; home setting for application of SCS. Participants: Subjects (N=9; 8 men, 1 woman) with cervical spinal cord injury and weak cough. Interventions: A fully implantable electrical stimulation system was surgically placed in each subject. Partial hemilaminectomies were made to place single-disk electrodes in the epidural space at the T9, T11, and L1 spinal levels. A radio-frequency receiver was placed in a subcutaneous pocket over the anterior portion of the chest wall. Electrode wires were tunneled subcutaneously and connected to the receiver. Stimulation was applied by activating a small portable external stimulus controller box powered by a rechargeable battery to each electrode lead alone and in combination. Main Outcome Measures: Peak airflow and airway pressure generation achieved with SCS. Results: Supramaximal SCS resulted in high peak airflow rates and large airway pressures during Stimulation at each electrode lead. Maximum peak airflow rates and airway pressures were achieved with combined stimulation of any 2 leads. At total lung capacity, mean maximum peak airflow rates and airway pressure generation were 8.6 +/- 1.8 (mean +/- SE) L/s and 137 +/- 30 cmH(2)O (mean +/- SE), respectively. Conclusions: Lower thoracic SCS results in near maximum activation of the expiratory muscles and the generation of high peak airflow rates and positive airway pressures in the range of those observed with maximum cough efforts in healthy persons.
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