Posterolateral surface electrical stimulation of abdominal expiratory muscles to enhance cough in spinal cord injury.
BACKGROUND
Spinal cord injury (SCI) patients have respiratory complications because of abdominal muscle weakness and paralysis, which impair the ability to cough.


OBJECTIVE
This study aims to enhance cough in high-level SCI subjects (n = 11, SCI at or above T6) using surface electrical stimulation of the abdominal muscles via 2 pairs of posterolaterally placed electrodes.


METHODS
From total lung capacity, subjects performed maximum expiratory pressure (MEP) efforts against a closed airway and voluntary cough efforts. Both efforts were performed with and without superimposed trains of electrical stimulation (50 Hz, 1 second) at a submaximal intensity set to evoke a gastric pressure (P(ga)) of 40 cm H(2)O at functional residual capacity.


RESULTS
In the MEP effort, stimulation increased the maximal P(ga) (from 21.4 ± 7.0 to 59.0 ± 5.7 cm H(2)O) and esophageal pressure (P(es); 47.2 ± 11.7 to 65.6 ± 13.6 cm H(2)O). During the cough efforts, stimulation increased P(ga) (19.5 ± 6.0 to 57.9 ± 7.0 cm H(2)O) and P(es) (31.2 ± 8.7 to 56.6 ± 10.5 cm H(2)O). The increased expiratory pressures during cough efforts with stimulation increased peak expiratory flow (PEF, by 36% ± 5%), mean expiratory flow (by 80% ± 8%), and expired lung volume (by 41% ± 16%). In every subject, superimposed electrical stimulation improved peak expiratory flow during cough efforts (by 0.99 ± 0.12 L/s; range, 0.41-1.80 L/s). Wearing an abdominal binder did not improve stimulated cough flows or pressures.


CONCLUSIONS
The increases in P(ga) and PEF with electrical stimulation using the novel posterolateral electrode placement are 2 to 3 times greater than improvements reported in other studies. This suggests that posterolateral electrical stimulation of abdominal muscles is a simple noninvasive way to enhance cough in individuals with SCI.
Prince of Wales Medical Research Institute, Randwick, New South Wales, Australia.
Jane E
JE
Butler
Julianne
J
Lim
Robert B
RB
Gorman
Claire
C
Boswell-Ruys
Julian P
JP
Saboisky
Bonsan B
BB
Lee
Simon C
SC
Gandevia
D000009:Abdominal Muscles / Q000294:innervation / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D003371:Cough / Q000150:complications / Q000503:physiopathology*; D004599:Electric Stimulation Therapy / Q000379:methods*; D045853:Exhalation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012133:Respiratory Paralysis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*