Review of Epidural Spinal Cord Stimulation for Augmenting Cough after Spinal Cord Injury

Front. Hum. Neurosci., 2017 · DOI: 10.3389/fnhum.2017.00144 · Published: March 28, 2017

Spinal Cord Injury Pulmonology Neurology

Simple Explanation

Spinal cord injury (SCI) can impair the ability to cough, leading to respiratory issues. This review discusses how epidural stimulation of the lower thoracic spinal cord can help restore cough function by stimulating the muscles needed for forced exhalation. The review covers preclinical and clinical evidence of using spinal cord stimulation (SCS) to restore cough in SCI patients. It also addresses the challenges and potential benefits of this approach. The study emphasizes the importance of restoring cough function in SCI patients. It notes that current neuroprosthetic devices aren't designed to restore expiratory muscle function for cough, and successful devices rely on understanding neuromuscular mechanisms.

Study Duration

Not specified

Participants

Nine individuals with cervical SCI in clinical trial

Evidence Level

Review article

Key Findings

1
Epidural stimulation of the lower thoracic spinal cord shows promise for cough restoration by evoking expiratory muscle contraction.
2
Dual-contact stimulation, specifically targeting T9 and L1 spinal levels, has been shown to achieve near-optimal cough performance in SCI patients.
3
High-frequency spinal cord stimulation (HF-SCS) at 500 Hz may offer an alternative with lower amplitude requirements, potentially reducing adverse effects.

Research Summary

This review examines the use of epidural spinal cord stimulation (SCS) to improve cough function in individuals with spinal cord injury (SCI). Preclinical and clinical studies suggest that SCS can effectively restore cough by activating expiratory muscles, with dual-contact stimulation at specific spinal levels (T9 and L1) showing particularly promising results. High-frequency SCS (HF-SCS) is being explored as a method to reduce the required stimulation amplitude and minimize adverse effects, potentially making the approach more clinically viable.

Practical Implications

Improved Respiratory Health

Restoring cough function can significantly reduce respiratory complications, hospitalizations, and the need for caregiver assistance in SCI patients.

Enhanced Quality of Life

Effective cough restoration can improve a person's sense of well-being, independence, and ability to participate in daily activities.

Advancements in Neuroprosthetics

The development of successful SCS techniques for cough restoration may lead to the adaptation of existing devices and the creation of integrated systems for comprehensive respiratory rehabilitation.

Study Limitations

1
Lower thoracic SCS requires relatively high amplitudes to achieve adequate motor recruitment and contraction force.
2
High stimulus intensities can cause relatively broad disseminated current spread across multiple spinal levels, thereby evoking relatively nonspecific activation of adjacent nerve roots.
3
Undesired muscle contractions/spasms of the paraspinal and/or thigh muscles resulting in some trunk motion and leg jerks have occurred in all subjects with stimulation at the L1-spinal level.

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