Diaphragm Pacing and a Model for Respiratory Rehabilitation after Spinal Cord Injury

J Neurol Phys Ther, 2021 · DOI: 10.1097/NPT.0000000000000360 · Published: July 1, 2021

Simple Explanation

Cervical spinal cord injury can lead to respiratory problems. Diaphragm pacing is a method to help patients breathe and reduce dependence on mechanical ventilation. Diaphragm pacing may also improve diaphragm function and overall respiratory ability. This suggests the need to rethink respiratory rehabilitation for patients with cervical spinal cord injury. A new model called Respiratory Rehabilitation and Recovery (RRR) is introduced, which focuses on improving respiratory function and lifelong respiratory health through various methods, including diaphragm pacing.

Study Duration

Not specified

Participants

34 patients with CSCI

Evidence Level

Perspective Paper

Key Findings

1
Early use of diaphragm pacing after cervical spinal cord injury can promote weaning from mechanical ventilation and minimize related complications.
2
Diaphragm pacing may have benefits beyond maintaining respiratory rhythm, potentially improving diaphragm muscle health and voluntary diaphragm activation.
3
A Respiratory Rehabilitation and Recovery (RRR) model, incorporating an interdisciplinary team, quantitative assessment, training, and adjunctive approaches like diaphragm pacing, is introduced for individuals with CSCI.

Research Summary

This article discusses the rationale for using diaphragm pacing (DP) as a rehabilitative strategy, especially when combined with established respiratory interventions. It introduces a Respiratory Rehabilitation and Recovery (RRR) model for patients with cervical spinal cord injury (CSCI), promoting respiratory recovery, independence, and lifelong respiratory health through interdisciplinary care and adjuvant strategies like DP. The model's application is shown through a description of an inpatient rehabilitation program using the model's components for CSCI patients needing DP.

Practical Implications

Advancement of Rehabilitation Approaches

The increasing use of DP for acute CSCI patients necessitates the development and advancement of tailored rehabilitation strategies to improve outcomes.

Implementation of RRR Model

The Respiratory Rehabilitation and Recovery (RRR) model provides a framework for goal setting, care guidelines, and research priorities in respiratory rehabilitation post-CSCI.

Integration of DP into SCI Care

Comprehensive rehabilitation programs should prioritize respiratory rehabilitation and recovery, considering the unique needs of patients using DP, especially regarding earlier inpatient rehabilitation.

Study Limitations

1
Further research is needed on the physiology of DP effects after SCI.
2
There is a lack of established adjunctive interventions to enhance the benefits of respiratory strength training (RST).
3
Better understanding and development of approaches to adjust DP stimulation parameters is needed.

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