Complete Restoration of Respiratory Muscle Function in Three Subjects With Spinal Cord Injury: Pilot Interventional Clinical Trial.
Anthony F DiMarco, Robert T Geertman, Kutaiba Tabbaa and 1 others
PMID 30119089WHAT IT FOUND
Three cervical spinal cord injury patients using diaphragm pacing reported easier secretion clearance after added spinal cord stimulation, and measured cough airflow and pressure increased.
This is a three-person pilot, not proof of broad benefit.
Key findings
01With bipolar spinal cord stimulation, mean peak expiratory airflow was 9.0 ± 1.9 L/s and mean pressure was 90 ± 6 cmH2O when pacing volume was combined with subject inspiratory and expiratory efforts.
02Each of the three patients reported moderate to marked difficulty raising secretions before spinal cord stimulation and none to only mild difficulty at 20, 24, and 28 weeks.
03Two of the three patients had asymptomatic increases in blood pressure and reductions in heart rate during conditioning, and reducing stimulation frequency returned values to baseline, usually within 10 minutes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only three patients were studied, so this is a pilot report and cannot establish how common the benefit is. The study did not describe a control group, randomisation, or blinding, so the results are not comparable with usual care. Follow-up was short, with outcomes collected to 28 weeks, so long-term benefit and risk are unknown. Secretion outcomes were self-reported, and the paper did not report a blinded or independent outcome assessment. Uncuffed tracheostomy leakage and discarded data from glottic closure or large mask leakage may have affected airflow and pressure measurements. Two of three patients had blood pressure and heart rate changes during conditioning, so safety monitoring was required. All patients already had diaphragm pacing, so the study does not separate the effect of diaphragm pacing from spinal cord stimulation.
Declared interests
No conflicts of interest were reported by the authors. The article is listed as supported by NIH extramural research funding.
The easy way to misread this
Do not conclude that spinal cord stimulation alone safely restores cough for all people with spinal cord injury. All three patients already used diaphragm pacing, this was a three-person pilot with no control group described, follow-up reached 28 weeks, and two patients had blood pressure and heart rate changes during conditioning.