Lower Thoracic Spinal Cord Stimulation to Restore Cough in Patients With Spinal Cord Injury: Results of a National Institutes of Health–Sponsored Clinical Trial. Part II: Clinical Outcomes

• Published in: Archives of physical medicine and rehabilitation Vol. 90; no. 5; pp. 726 - 732
• Main Authors: DiMarco, Anthony F., MD, Kowalski, Krzysztof E., PhD, Geertman, Robert T., MD, PhD, Hromyak, Dana R., BS, Frost, Fredrick S., MD, Creasey, Graham H., MD, Nemunaitis, Gregory A., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2009; Elsevier
• Subjects: Adult; Biological and medical sciences; Cough; Diseases of the osteoarticular system; Electric stimulation; Electric Stimulation - methods; Electrodes, Implanted; Female; Follow-Up Studies; Humans; Injury Severity Score; Male; Medical sciences; Middle Aged; National Institutes of Health (U.S.); Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Peak Expiratory Flow Rate; Physical Medicine and Rehabilitation; Pneumology; Probability; Quadriplegia; Quadriplegia - diagnosis; Quadriplegia - rehabilitation; Recovery of Function; Rehabilitation; Respiratory Function Tests; Respiratory Mechanics; Respiratory muscles; Respiratory Muscles - innervation; Respiratory Muscles - physiology; Respiratory system : syndromes and miscellaneous diseases; Respiratory Therapy - methods; Risk Assessment; Risk Factors; Spinal cord injuries; Spinal Cord Injuries - diagnosis; Spinal Cord Injuries - rehabilitation; Thoracic Vertebrae - innervation; Treatment Outcome; United States; Young Adult; United States; spinal cord injury; SCS; SCI; Respiratory muscles; Quadriplegia; Spinal cord injuries; spinal cord stimulation; Rehabilitation; quality of life; Electric stimulation; Cough; QOL; Human; Tetraplegia; Nervous system diseases; Prognosis; Motor system disorder; Electric; Reeducation; Respiratory muscle; Orthopedics; Spinal cord trauma; Central nervous system disease; Clinical trial; Neurological disorder; Spinal cord disease; Thoracic spinal cord
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2008.11.014

Abstract DiMarco AF, Kowalski KE, Geertman RT, Hromyak DR, Frost FS, Creasey GH, Nemunaitis GA. Lower thoracic spinal cord stimulation to restore cough in patients with spinal cord injury: results of a National Institutes of Health–sponsored clinical trial. Part II: clinical outcomes. Objective To evaluate the clinical effects of spinal cord stimulation (SCS) to restore cough in subjects with cervical spinal cord injury. Design Clinical trial assessing the clinical outcomes and side effects associated with the cough system. Setting Outpatient hospital or residence. Participants Subjects (N=9; 8 men, 1 woman) with cervical spinal cord injury. Interventions SCS was performed at home by either the subjects themselves or caregivers on a chronic basis and as needed for secretion management. Main Outcome Measures Ease in raising secretions, requirement for trained caregiver support related to secretion management, and incidence of acute respiratory tract infections. Results The degree of difficulty in raising secretions improved markedly, and the need for alternative methods of secretion removal was virtually eliminated. Subject life quality related to respiratory care improved, with subjects reporting greater control of breathing problems and enhanced mobility. The incidence of acute respiratory tract infections fell from 2.0±0.5 to 0.7±0.4 events/subject year ( P <.01), and mean level of trained caregiver support related to secretion management measured over a 2-week period decreased from 16.9±7.9 to 2.1±1.6 and 0.4±0.3 times/wk ( P <.01) at 28 and 40 weeks after implantation of the device, respectively. Three subjects developed mild hemodynamic effects that abated completely with continued SCS. Subjects experienced mild leg jerks during SCS, which were well tolerated. There were no instances of bowel or bladder leakage. Conclusions Restoration of cough via SCS is safe and efficacious. This method improves life quality and has the potential to reduce the morbidity and mortality associated with recurrent respiratory tract infections in this patient population.