Respiratory Motor Control Disrupted by Spinal Cord Injury: Mechanisms, Evaluation, and Restoration

Abstract

Pulmonary complications associated with persistent respiratory muscle weakness, paralysis, and spasticity are among the most important problems faced by patients with spinal cord injury when lack of muscle strength and disorganization of reciprocal respiratory muscle control lead to breathing insufficiency. This review describes the mechanisms of the respiratory motor control and its change in individuals with spinal cord injury, methods by which respiratory function is measured, and rehabilitative treatment used to restore respiratory function in those who have experienced such injury.

Respiratory motor function in seated and supine positions in individuals with chronic spinal cord injury

“…The mechanisms of postural effects on respiratory function are more likely to have a combinatory nature. These potential mechanisms may include: specific patterns of respiratory muscle recruitment, effect of gravity, presence of uncontrolled muscular contraction (spasticity), changes in respiratory mechanics, and others (Ovechkin et al, 2010; Terson de Paleville et al, 2011). EMG activity of diaphragm and accessory respiratory muscles shows differential recruitment patterns and amplitude during different respiratory and non-respiratory maneuvers in neurologically intact individuals (Gandevia et al, 1990; Yokoba et al, 2003).…”

“…Individuals with SCI are also at increased risk of sleep disordered breathing (Burns et al, 2000). Major causes of such dysfunction are respiratory motor control deficits associated with paresis, paralysis and spasticity of trunk and respiratory muscles (Gracies, 2005; Ovechkin et al, 2010; Schilero et al, 2009; Terson de Paleville et al, 2011). In general clinical practice and research the pulmonary function test (PFT) is used to evaluate respiratory motor function.…”

Development of a Novel Alarm System to Improve Adaptation to Non-invasive Ventilation in Patients With High Cervical Spinal Cord Injury

“…SCI also leads to respiratory failure due to complete or incomplete paralysis of numerous respiratory muscles. In the case of cervical or thoracic SCI, disruption of the descending bulbospinal respiratory pathway from the central nervous system to respiratory muscles presents distinguishing respiratory patterns which are associated with the neurological level of injury, duration and severity [1]. Accompanying diaphragmatic paralysis is often found in patients with SCI above the C6 level.…”

Translational Research in Neurotrauma: Novel Mechanisms and Emerging Therapies

“…Two papers deal with this issue, i.e., MRI imaging of vascular changes (Dijkhuizen) [9] and blood biomarkers (Zhang et al) [10]. The SCI papers also describe varied pathology and therapeutic approaches, including the role of vascular pathology (Benton and Hagg [11], Ng et al [1]), a comparison of pathophysiology between injuries induced by sPLA 2 versus by a contusion (Liu et al) [12], CSF biomarkers (Ng et al) [1], respiratory dysfunction (Terson de Paleville et al) [13], and cellular degenerative changes in the vertebral bone (Morse) [2]. Finally, a method which will enable analysis of many different components and outcome measurements across different neurotrauma studies is presented and will help to identify common pathological mechanisms that can be targeted for therapy (Ferguson et al) [14].…”

“…Significantly, this issue contains four articles with human data and review of human literature (Diringer et al [5], Ng et al [1], Terson de Paleville et al [13], Zhang et al [10]). How appropriate and stimulating to see these excellent contributions in a "Translational" journal.…”