Abstract
Background: In spinal cord injury (SCI), paralysis of the expiratory muscles often results in an ineffective cough and consequent inability to effectively clear airway secretions. SCS is an effective method of expiratory muscle activation.
Design: Clinical trial assessing the clinical outcomes and side effects of SCS to restore an effective cough in 12 SCI subjects.
Main outcome measure(s): Ease in raising secretions, requirement for trained caregiver support for secretion management and incidence of acute respiratory tract infections.
Results: Based upon questionnaire responses, the degree of difficulty in raising secretions improved markedly, and the need for alternative methods of secretion removal was virtually eliminated in each subject. Requirement of trained caregiver support over a 2 week period decreased from 18.0±6.8 (baseline) to 3.4±2.0 and 2.6±2.3 and 2.8±2.5 times/week (p<0.05)at 28, 40 and 52 weeks following device implantation, respectively. The incidence of respiratory tract infections fell from 1.6±0.4 to 0.6±0.2 events/subject year (p<0.05). Some subjects experienced mild leg jerks during SCS. There were no instances of bowel or bladder leakage.
Conclusion(s): Restoration of cough via SCS significantly reduces the difficulty in raising secretions, need for caregiver support and incidence of respiratory tract infection. Moreover, this method improves life quality and has the potential to reduce the morbidity and mortality associated with respiratory tract infections in SCI.
Support: NIH: R01NS049516, RC1NS068576, M01RR0080 & UL1RR024989.
Disclosure: Dr. DiMarco is a Founder of and has a significant financial interest in Synapse BioMedical, Inc, a manufacturer of diaphragm pacing systems.
- © 2011 ERS
