title: Functional magnetic stimulation for restoring cough in patients with tetraplegia.
abstract: OBJECTIVE
  To evaluate the usefulness of functional magnetic stimulation (FMS) as a noninvasive method for assisting cough in patients with tetraplegia.
  
  
  METHODS
  A prospective before-after trial.
  
  
  METHODS
  The functional magnetic stimulation laboratory of a spinal cord injury (SCI) service.
  
  
  METHODS
  Thirteen male SCI patients, with injury levels between C4 and C7.
  
  
  METHODS
  A commercially available magnetic stimulator with a round magnetic coil (MC) was used. Expiratory muscle activation was achieved by placing the MC along the lower thoracic spine.
  
  
  METHODS
  The planned major outcome measures were the maximal expired pressure (MEP), expiratory reserve volume (ERV), and forced expiratory flow rate (FEF) by FMS compared with voluntary maximal efforts. Another outcome was the optimal MC placement and stimulation intensity that would result in highest expired pressure.
  
  
  RESULTS
  The mean (+/-SEM) MEP, ERV, and FEF generated by FMS were 66.40 +/- 6.69 cmH2O, .77 +/- .14 L, and 5.28 +/- .42 L/sec, respectively. They were 118%, 169%, and 110% of voluntary maximum efforts. MC placement at the T10 to T11 spinous process and stimulation intensity at 80% produced the highest MEP and FEF.
  
  
  CONCLUSIONS
  FMS of the expiratory muscles produced significant expired pressures, volumes, and flow rates when compared with voluntary maximum efforts; therefore, FMS can be used as an effective method to restore cough in tetraplegic patients.
authors.affiliation: Functional Magnetic Stimulation Laboratory, Spinal Cord Injury Service, VA Palo Alto Health Care System, CA 94304, USA.
authors.forename: V W
authors.initials: VW
authors.lastname: Lin
authors.forename: H
authors.initials: H
authors.lastname: Singh
authors.forename: R K
authors.initials: RK
authors.lastname: Chitkara
authors.forename: I
authors.initials: I
authors.lastname: Perkash
mesh_terms: D000009:Abdominal Muscles / Q000503:physiopathology; D000328:Adult; D002908:Chronic Disease; D003371:Cough / Q000503:physiopathology / Q000534:rehabilitation*; D004558:Electric Stimulation; D006801:Humans; D008280:Magnetics; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D011446:Prospective Studies; D011782:Quadriplegia / Q000534:rehabilitation*; D012129:Respiratory Function Tests; D012132:Respiratory Muscles / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D013900:Thoracic Nerves / Q000502:physiology