Functional magnetic stimulation for conditioning of expiratory muscles in patients with spinal cord injury

Lin, Vernon W.; Hsiao, Ian; Zhu, Ercheng; Perkash, Inder

doi:10.1053/apmr.2001.18230

Cited by 39 publications

(28 citation statements)

References 29 publications

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“…6 The inadequate clearance of the secretions related to the ineffective cough may lead to various respiratory complications in patients with an SCI. 7 In addition, the weakened respiratory muscles can neither fully expand the lungs up to the maximum capacity nor compress them to the point of the smallest residual volume, leading to a reduction in the chest wall compliance by shortening and stiffening of the unstretched tissue and fibrosis of the weakened muscles. 8 The spreading of the microatelectasis in the lungs also reduces the compliances of the lungs.…”

Section: Introductionmentioning

confidence: 99%

Relationship between inspiratory muscle strength and cough capacity in cervical spinal cord injured patients

Kang

Shin

et al. 2005

Spinal Cord

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Study design: Prospective single centre study. Objectives: Pulmonary rehabilitation focuses on improving the expiratory muscle function in order to increase the reduced cough capacity in patients with cervical spinal cord injuries (SCI). However, an improvement in the inspiratory function is also important for coughing effectively. Therefore, this study was to examine the significance of the inspiratory muscle strength on the cough capacity in the patients with a cervical SCI. Setting: SCI unit, Yonsei Rehabilitation Hospital, Seoul, Korea. Methods: The vital capacity (VC), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were measured. Moreover, the unassisted peak cough flow (PCF) and assisted PCF under three conditions were evaluated. Results: All three assisted cough methods showed a significantly higher value than the unassisted method (Po0.001). The VC correlated with the voluntary cough capacity and the MIP (R ¼ 0.749) correlated more significantly with the VC than the MEP (R ¼ 0.438) (Po0.01). The MIP showed a higher correlation with both the unassisted PCF and all three assisted PCFs than the MEP (Po0.001). Conclusions: The management of the inspiratory muscle strength should be considered in the pulmonary rehabilitation at cervical SCI patients.

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Section: Introductionmentioning

confidence: 99%

Relationship between inspiratory muscle strength and cough capacity in cervical spinal cord injured patients

Kang

Shin

et al. 2005

Spinal Cord

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“…Although functional electrical stimulation (FES) has been widely used to assist paralyzed limb muscles to regain function, there are fewer reports of the use of electrical or other types of stimulation on paralyzed human abdominal muscles, and so far they have had limited success in producing an effective cough (6,10,12,14,16,17,20,21,30,31,33).…”

mentioning

confidence: 99%

“…The benefit of magnetic stimulation is that it is relatively painless and activates a larger portion of the abdominal muscles (10,13,17,18,20,26,29). Using closely spaced pulses, magnetic stimulation of paralyzed muscles is able to generate much larger abdominal pressures than is electrical stimulation (10,17,20). Despite the relative success of the magnetic stimulation of abdominal muscles, the magnetic stimulators are bulky, expensive and contraindicated with implanted metal objects and are not a viable alternative for a portable stimulator device for personal use.…”

mentioning

confidence: 99%

Optimal electrode placement for noninvasive electrical stimulation of human abdominal muscles

Lim

Gorman²,

Saboisky³

et al. 2007

Journal of Applied Physiology

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Abdominal muscles are the most important expiratory muscles for coughing. Spinal cord-injured patients have respiratory complications because of abdominal muscle weakness and paralysis and impaired ability to cough. We aimed to determine the optimal positioning of stimulating electrodes on the trunk for the noninvasive electrical activation of the abdominal muscles. In six healthy subjects, we compared twitch pressures produced by a single electrical pulse through surface electrodes placed either posterolaterally or anteriorly on the trunk with twitch pressures produced by magnetic stimulation of nerve roots at the T 10 level. A gastroesophageal catheter measured gastric pressure (Pga) and esophageal pressure (Pes). Twitches were recorded at increasing stimulus intensities at functional residual capacity (FRC) in the seated posture. The maximal intensity used was also delivered at total lung capacity (TLC). At FRC, twitch pressures were greatest with electrical stimulation posterolaterally and magnetic stimulation at T 10 and smallest at the anterior site (Pga, 30 Ϯ 3 and 33 Ϯ 6 cmH 2O vs. 12 Ϯ 3 cmH2O; Pes 8 Ϯ 2 and 11 Ϯ 3 cmH2O vs. 5 Ϯ 1 cmH 2O; means Ϯ SE). At TLC, twitch pressures were larger. The values for posterolateral electrical stimulation were comparable to those evoked by thoracic magnetic stimulation. The posterolateral stimulation site is the optimal site for generating gastric and esophageal twitch pressures with electrical stimulation. cough; functional electrical stimulation; abdomen PEOPLE WITH HIGH-LEVEL SPINAL cord injury (SCI) are up to 150 times more likely to die from pneumonia, at any time after their injury, compared with the general population. Respiratory complications are the major cause of death in acute SCI patients (22). Reduced ability to cough and the subsequent buildup of pulmonary secretions result in respiratory complications, including atelectasis, sputum retention, pneumonia, and pleural effusion.The abdominal muscles are the major group of muscles that develop expiratory force, required to cough. Although functional electrical stimulation (FES) has been widely used to assist paralyzed limb muscles to regain function, there are fewer reports of the use of electrical or other types of stimulation on paralyzed human abdominal muscles, and so far they have had limited success in producing an effective cough (6,10,12,14,16,17,20,21,30,31,33).There have been several studies investigating the use of electrical stimulation over the anterior abdominal wall near the midline to measure the ability to generate expiratory flow or pressure (12,18,21,30,31). The most successful of these studies increased mouth pressure by 33 cmH 2 O during a tetanically stimulated maximal expiratory maneuver in tetraplegic subjects (21).As an alternative to electrical stimulation on the anterior wall of the abdomen, other groups have used magnetic stimulation over the T 10 spinous process to activate the spinal nerve roots around this level (T 8 -T 12 ). The benefit of magnetic stimulation is that it is r...

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“…Zupan et al [22] used a regime combining respiratory muscle training with short periods of stimulation. Lin et al [31] used magnetic stimulation to condition expiratory muscles, resulting in improved expiratory muscle strength. Lee et al [32] implemented an intensive training regime (daily 20-30 min for 4 weeks) in a case study with very promising results.…”

Section: B Future Directionsmentioning

confidence: 99%

Abdominal stimulation for respiratory support in tetraplegia: A tutorial review

et al. 2008

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Abstract-Neuromuscular stimulation of the abdominal wall muscles can provide respiratory support in tetraplegia, where the main expiratory muscles are affected by paralysis. Stimulation may be applied by simple surface stimulation, resulting in a uniform muscle contraction which can help to improve expiratory function for coughing and breathing. In this review, an overview of methods and approaches available for abdominal muscle stimulation is given. Studies are discussed which show that this technique can lead to improvements in expiratory flow and tidal volume, resulting in enhanced cough and breathing functions. Approaches are introduced which aim to integrate abdominal stimulation with the subject's own voluntary breathing functions. These are illustrated with experimental results from the evaluation of automatic stimulation methods in tetraplegic patients. Clinical significance and applications are discussed and future developments are outlined.

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Functional magnetic stimulation for conditioning of expiratory muscles in patients with spinal cord injury

Cited by 39 publications

References 29 publications

Relationship between inspiratory muscle strength and cough capacity in cervical spinal cord injured patients

Relationship between inspiratory muscle strength and cough capacity in cervical spinal cord injured patients

Optimal electrode placement for noninvasive electrical stimulation of human abdominal muscles

Abdominal stimulation for respiratory support in tetraplegia: A tutorial review

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