Substitution of Paralysed Functions in Para- And Tetraplegia

Thoma, H.; Battisti, Carla; Frey, Martin; Holle, J.; Mayr, Winfried; Schwanda, G.; Stöhr, H

doi:10.1007/978-1-349-09609-1_27

Cited by 13 publications

(16 citation statements)

References 2 publications

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“…1,2 However, electroventilation 3 has become a choice again through its modern versions such as diaphragm pacing (DP), 4,5 carousel stimulation (CS) 6 and four-pole-sequential phrenic nerve stimulation (PNS). 7 In electroventilation, an electrical system rhythmically stimulating the phrenic nerves takes over for the malfunctioning or inaccessible respiratory centre; a normal phrenic nerve and normal diaphragm muscle are prerequisites.…”

Section: Introductionmentioning

confidence: 99%

“…7 In electroventilation, an electrical system rhythmically stimulating the phrenic nerves takes over for the malfunctioning or inaccessible respiratory centre; a normal phrenic nerve and normal diaphragm muscle are prerequisites. 8 The reason to develop the Diaphragm Pacer 4 and similar devices 6,7 was to 'free the patient from the mechanical ventilator'. 4 By using the mechanical energy of the patient's diaphragm, the patient is freed from the ventilator tube, the tracheostoma and with his helpers from the bulky energy supply of mechanical ventilators (MVs).…”

Section: Introductionmentioning

confidence: 99%

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Mechanical ventilation or phrenic nerve stimulation for treatment of spinal cord injury-induced respiratory insufficiency

et al. 2008

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Study design: Prospective clinical study of two treatments. Objective: To compare mechanical ventilation (MV) with phrenic nerve stimulation (PNS) for treatment of respiratory device-dependent (RDD) spinal cord-injured (SCI) patients. Setting: Department for spinal cord-injured patients of an insurance-company-run trauma hospital in Hamburg, Germany. Methods: Prospective data collection of treatment-related data over 20 years. Results: In total, 64 SCI-RDD patients were treated during the study period. Of these, 32 of the patients with functioning phrenic nerves and diaphragm muscles were treated with PNS and 32 patients with destroyed phrenic nerves were mechanically ventilated. Incidence of respiratory infections (RIs per 100 days) prior to use of final respiratory device was equal in both groups, that is (median (interquartile range)) 1.43 (0.05-3.92) with PNS and 1.33 (0.89-2.21) with MV (P ¼ 0.888); with final device in our institution it was 0 (0-0.92) with PNS and 2.07 (1.49-4.19) with MV (Po0.001); at final location it was 0 (0-0.02) with PNS and 0.14 (0-0.31) with MV (Po0.001). Thus, compared to MV, respiratory treatment with PNS significantly reduces frequency of RI. Quality of speech is significantly better with PNS. Nine patients with PNS, but only two with MV, were employed or learned after rehabilitation (P ¼ 0.093). The primary investment in the respiratory device is higher with PNS, but it can be paid off in our setting within 1 year because of the reduced amount of single use equipment, easier nursing and fewer RIs compared to MV. Conclusions: PNS instead of MV for treatment of SCI-RDD reduces RIs, running costs of respiratory treatment and obviously improves patients' quality of life.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mechanical ventilation or phrenic nerve stimulation for treatment of spinal cord injury-induced respiratory insufficiency

et al. 2008

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“…MEDIMPLANT BIOTECHNISCHES LABOR (VIENNA, AUSTRIA).-This system is also unique in terms of electrode design (50), involving multiple electrode contacts with the nerve (49,50). A microsurgical technique is required to suture 4 electrode leads to the epineurium of each phrenic nerve.…”

Section: Equipment and Methods Of Applicationmentioning

confidence: 99%

“…As with the Atrotech device, only a portion of the nerve is stimulated at any given time, allowing more time for recovery. This form of stimulation, referred to as carousel stimulation, is also thought to reduce the incidence of fatigue compared with the unipolar design (49,50). PHRENIC NERVE STIMULATION THROUGH INTRAMUSCULAR DI-APHRAGM ELECTRODES.-Recent studies (20,21,51) indicate that phrenic nerve stimulation can also be accomplished with intramuscular electrodes placed directly into the diaphragm, as described in the case report.…”

Section: Equipment and Methods Of Applicationmentioning

confidence: 99%

Inspiratory Muscle Pacing in Spinal Cord Injury: Case Report and Clinical Commentary

DiMarco

Onders

Ignagni

et al. 2006

The Journal of Spinal Cord Medicine

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Background/Objective: A significant fraction of patients with cervical spinal cord injury suffer from respiratory muscle paralysis and dependence on chronic mechanical ventilation. In selected patients, diaphragm pacing (DP) through electrical stimulation of the phrenic nerves provides an alternative to mechanical ventilation with significant advantages in life quality.Methods: A case report of an individual who successfully underwent DP using intramuscular diaphragm electrodes. A brief review of the state of the art of DP including the clinical benefits of DP, patient selection and evaluation, description of equipment, methods of transition from mechanical ventilation to DP, potential complications and side effects, long-term outcome, and potential future developments in this field is included.Results: Several available DP systems are available, including conventional ones in which electrodes are positioned directly on the phrenic nerves through thoracotomy and less invasive systems in which electrodes are placed within the diaphragm through laparoscopy. For patients with only unilateral phrenic nerve function, a combined intercostal and unilateral diaphragm pacing system is under development. Conclusions:In patients with ventilator-dependent tetraplegia, there are alternative methods of ventilatory support, which offer substantial benefits compared to mechanical ventilation. Med. 2006;29:95-108 J Spinal Cord

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“…31 Atrotech (Tampere, Finland) and Medimplant (Vienna, Austria) systems differ from the Avery system in the electrode technology. 11,20,33,34 The Atrotech system has the ability to stimulate different portions of the nerve each time with the intention of reducing muscle fatigue. The Vienna phrenic pacer (Medimplant, Vienna, Austria) system also has multiple electrode contacts with the phrenic nerve.…”

Section: Phrenic Nerve Pacing Systemsmentioning

confidence: 99%

Functional Electrical Stimulation in Spinal Cord Injury Respiratory Care

Jarosz

Littlepage

Creasey

et al. 2012

Topics in Spinal Cord Injury Rehabilitation

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The management of chronic respiratory insufficiency and/or long-term inability to breathe independently has traditionally been via positive-pressure ventilation through a mechanical ventilator. Although life-sustaining, it is associated with limitations of function, lack of independence, decreased quality of life, sleep disturbance, and increased risk for infections. In addition, its mechanical and electronic complexity requires full understanding of the possible malfunctions by patients and caregivers. Ventilator-associated pneumonia, tracheal injury, and equipment malfunction account for common complications of prolonged ventilation, and respiratory infections are the most common cause of death in spinal cord-injured patients. The development of functional electric stimulation (FES) as an alternative to mechanical ventilation has been motivated by a goal to improve the quality of life of affected individuals. In this article, we will review the physiology, types, characteristics, risks and benefits, surgical techniques, and complications of the 2 commercially available FES strategies -phrenic nerve pacing (PNP) and diaphragm motor point pacing (DMPP).

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Substitution of Paralysed Functions in Para- And Tetraplegia

Cited by 13 publications

References 2 publications

Mechanical ventilation or phrenic nerve stimulation for treatment of spinal cord injury-induced respiratory insufficiency

Mechanical ventilation or phrenic nerve stimulation for treatment of spinal cord injury-induced respiratory insufficiency

Inspiratory Muscle Pacing in Spinal Cord Injury: Case Report and Clinical Commentary

Functional Electrical Stimulation in Spinal Cord Injury Respiratory Care

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