Functional Electrical Stimulation in Spinal Cord Injury Respiratory Care

Mechanical ventilation, while life-sustaining, comes with limitations such as reduced function and increased infection risk. Functional electrical stimulation (FES) offers an alternative by stimulating the phrenic nerve or diaphragm, potentially improving quality of life. Diaphragm pacing (DP) has been shown to reduce airway pressure, increase posterior lobe ventilation, and maintain negative chest pressures. DP has also been shown to improve speech, improve olfactory sensation, and eradicate ventilator noise There are two main FES strategies: phrenic nerve pacing (PNP) and diaphragm motor point pacing (DMPP). PNP involves direct stimulation of the phrenic nerve, while DMPP stimulates the diaphragm muscle at its motor points.

• 1
  Diaphragm pacing can improve speech and olfactory sensation.
• 2
  Diaphragm pacing may lead to neuroplasticity and, in rare instances, recovery of volitional control of breathing.
• 3
  Laparoscopic implantation of intramuscular diaphragm electrodes provides a less invasive and less costly alternative to conventional PNP.