PT  - JOURNAL ARTICLE
AU  - Krzysztof Kowalski
AU  - Dana Hromyak
AU  - Anthony DiMarco
TI  - Impact of chronic intermittent spinal cord stimulation (SCS) on airway pressure generation (P) for cough production in spinal cord injury (SCI)
DP  - 2014 Sep 01
TA  - European Respiratory Journal
PG  - 4431
VI  - 44
IP  - Suppl 58
4099  - http://erj.ersjournals.com/content/44/Suppl_58/4431.short
4100  - http://erj.ersjournals.com/content/44/Suppl_58/4431.full
SO  - Eur Respir J2014 Sep 01; 44
AB  - Background: SCS has been shown to restore an effective cough mechanism in SCI subjects.Following spinal cord injury however, the expiratory muscles may have developed significant atrophy with consequent reductions in their force generating capacity.Objective: To assess expiratory muscle strength following SCI and evaluate the impact of chronic intermittent SCS on P and cough production.Methods: In 10 SCI subjects, single disc electrodes were implanted at the T9, T11 and L1 spinal levels and connected to an implanted radiofrequency receiver. Post-implantation, each subject was instructed to apply stimulation as needed for secretion management.Results: P during spontaneous efforts was 28±5cmH2O. Initial T9, T11, L1 SCS alone resulted in P of 50±8, 52±8 and 48±9cmH2O, respectively. Initial combined stimulation with a 2 lead system resulted in P of 72±9cmH2O. A reconditioning program (40V, 50Hz 0.2ms, 0.6s on) 2-3 times per day for 10min, 7 days/week over a 14-21 week period resulted in substantial increases in P to 80±16, 80±14 and 68±13cmH2O, respectively. With a 2 lead system, P was 112±18cmH2O. P was maintained at the 1, 2 and mean 4.6 year follow-up points.Conclusion: SCS has the potential to reverse expiratory muscle atrophy and improve expiratory muscle strength. SCS may provide a useful method to restore an effective cough mechanism in patients with SCI.Support: NIH: NIH-NINDS (R01NS049516 and RC1NS068576), NCRR (M01RR0080 and UL1RR024989).Disclosure: Dr. DiMarco is a Founder of and has a significant financial interest in Synapse BioMedical, Inc, a manufacturer of diaphragm pacing systems.