Document Detail

Lower thoracic spinal cord stimulation to restore cough in patients with spinal cord injury: results of a National Institutes of Health-sponsored clinical trial. Part I: methodology and effectiveness of expiratory muscle activation.
MedLine Citation:
PMID:  19406289     Owner:  NLM     Status:  MEDLINE    
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 radiofrequency 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 cmH2O (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.
Anthony F DiMarco; Krzysztof E Kowalski; Robert T Geertman; Dana R Hromyak
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Archives of physical medicine and rehabilitation     Volume:  90     ISSN:  1532-821X     ISO Abbreviation:  Arch Phys Med Rehabil     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-01     Completed Date:  2009-06-12     Revised Date:  2014-09-20    
Medline Journal Info:
Nlm Unique ID:  2985158R     Medline TA:  Arch Phys Med Rehabil     Country:  United States    
Other Details:
Languages:  eng     Pagination:  717-25     Citation Subset:  AIM; IM    
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MeSH Terms
Electric Stimulation / methods*
Electrodes, Implanted
Follow-Up Studies
Injury Severity Score
Middle Aged
National Institutes of Health (U.S.)
Peak Expiratory Flow Rate
Prospective Studies
Quadriplegia / rehabilitation*
Recovery of Function
Respiratory Function Tests
Respiratory Mechanics / physiology
Respiratory Muscles / innervation,  physiology*
Spinal Cord Injuries / diagnosis,  rehabilitation*
Thoracic Vertebrae / innervation
Treatment Outcome
United States
Young Adult
Grant Support
M01 RR000080/RR/NCRR NIH HHS; M01 RR000080-448089/RR/NCRR NIH HHS; M01 RR00080/RR/NCRR NIH HHS; R01 NS049516/NS/NINDS NIH HHS; R01 NS049516/NS/NINDS NIH HHS; R01 NS049516-04/NS/NINDS NIH HHS; UL1 RR024989/RR/NCRR NIH HHS; UL1 RR024989/RR/NCRR NIH HHS; UL1 RR024989-025927/RR/NCRR NIH HHS

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