Functional magnetic stimulation of expiratory muscles: a noninvasive and new method for restoring cough

Lin, Vernon W.; Hsieh, Caleb; Hsiao, Ian; Canfield, James

doi:10.1152/jappl.1998.84.4.1144

Cited by 45 publications

(38 citation statements)

References 19 publications

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“…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).…”

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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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“…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).…”

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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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“…The abdominal muscles are typically stimulated through surface electrodes which are easy to apply, and stimulation results in uniform, well-defined muscle responses 17,18) . Alternatively, stimulation can be delivered by spinal cord stimulation using epidural electrodes 19) or microstimulators 20) , or by magnetic stimulation of the thoracic nerve roots 21,22) .…”

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A Review of Abdominal Muscle Stimulation for Patients with Spinal Cord Injury

Kathiresan¹,

Huntor

Fraser

et al. 2010

J Phys Ther Sci

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Automatic Control (H. Gollee et al., J Automatic Control 2008 18 (2): 85-92). In accordance with policies and procedures governing academic publication we concluded that the above-mentioned article published in J. Phys. Ther. Sci. be retracted. We apologize to readers of the journal that this was not detected during the submission and reviewing process. 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.[Results]The results show that the effectiveness of abdominal surface stimulation can vary widely between subjects.[Conclusions] Clinical significance and applications are discussed and future developments and the direction of research in this area are reviewed.

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“…These include studies on therapeutic manoeuvres, 7 use of abdominal binders, [8][9][10][11][12][13] the use of electrical stimulator 14,15 and functional magnetic stimulator. 16,17 Studies by Jaeger et al 7 and Linder 15 found that cough efficacy produced by electrical stimulation was as effective as manually assisted cough in subjects with tetraplegia. Lin et al 14 found that the combination of abdominal binder and electrical stimulation caused a significant increase in peak flow expiratory rate (PEFR).However, the use of the abdominal binder by itself has not been studied.…”

Section: Introductionmentioning

confidence: 99%

Benefit of triple-strap abdominal binder on voluntary cough in patients with spinal cord injury

2011

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Study design: A cross-sectional experimental study. Objective: The purpose of this study is to examine the benefit of elastic abdominal binders on voluntary cough in persons with spinal cord injury. Setting: Spinal rehabilitation unit in a teaching hospital. Methods: We measured voluntary cough peak expiratory flow rate (in 21 subjects with spinal cord injury, (18 tetraplegia, 3 paraplegia) under three conditions: without abdominal binder as the baseline, with single-strap abdominal binder and triple-strap abdominal binder. Results:The results showed that the mean cough peak expiratory flow rate in all subjects without abdominal binder was 277.1 l per min. There was a significant increase in flow rate with the use of abdominal binders: 325.7 l per min with single-strap abdominal binder and 345.2 l per min with triplestrap abdominal binder (Po0.05, paired t-test). The mean cough peak expiratory flow rate in tetraplegic subjects using triple-strap abdominal binders was significantly higher compared with those using single-strap abdominal binders (322.1 l per min and 299.4 l per min, respectively). Conclusion: Abdominal binders can be used as an effective method to improve cough ability in spinal cord injured patients, with triple-strap abdominal binder achieving greater cough peak expiratory flows.

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Functional magnetic stimulation of expiratory muscles: a noninvasive and new method for restoring cough

Cited by 45 publications

References 19 publications

Optimal electrode placement for noninvasive electrical stimulation of human abdominal muscles

Optimal electrode placement for noninvasive electrical stimulation of human abdominal muscles

A Review of Abdominal Muscle Stimulation for Patients with Spinal Cord Injury

Benefit of triple-strap abdominal binder on voluntary cough in patients with spinal cord injury

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