title: Abdominal functional electrical stimulation to enhance mechanical insufflation-exsufflation.
abstract: Respiratory complications, attributed to the build-up of secretions in the airway, are a leading cause of rehospitalisation for the tetraplegic population. Previously, we observed that the application of Abdominal Functional Electrical Stimulation (AFES) improved cough function and increased demand for secretion removal, suggesting AFES may aid secretion clearance. Clinically, secretion clearance is commonly achieved by using Mechanical insufflation-exsufflation (MI-E) to simulate a cough. In this study the feasibility of combining AFES with MI-E is evaluated.
  
  
  
  AFES was successfully combined with MI-E at eight fortnightly assessment sessions conducted with one sub-acute participant with tetraplegia. By using the signal from a pressure sensor, integrated with the MI-E device, AFES was correctly applied in synchrony with MI-E with an accuracy of 96.7%. Acute increases in exhaled volume and peak flow were observed during AFES assisted MI-E, compared to MI-E alone, at six of eight assessment sessions.
  
  
  
  The successful integration of AFES with MI-E at eight assessment sessions demonstrates the feasibility of this technique. The acute increases in respiratory function observed at the majority of assessment sessions generate the hypothesis that AFES assisted MI-E may be more effective for secretion clearance than MI-E alone.
authors.affiliation: a Centre for Health Systems and Safety Research, Australian Institute for Health Innovation , Macquarie University , Sydney , Australia.|b Centre for Rehabilitation Engineering, School of Engineering , University of Glasgow , Glasgow , Scotland , UK.|c Scottish Centre for Innovation in Spinal Cord Injury , www.scisci.org.uk , Scotland , UK.
authors.forename: Euan J
authors.initials: EJ
authors.lastname: McCaughey
authors.affiliation: c Scottish Centre for Innovation in Spinal Cord Injury , www.scisci.org.uk , Scotland , UK.|d Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital , Glasgow , Scotland , UK.
authors.forename: Alan N
authors.initials: AN
authors.lastname: McLean
authors.affiliation: c Scottish Centre for Innovation in Spinal Cord Injury , www.scisci.org.uk , Scotland , UK.|d Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital , Glasgow , Scotland , UK.
authors.forename: David B
authors.initials: DB
authors.lastname: Allan
authors.affiliation: b Centre for Rehabilitation Engineering, School of Engineering , University of Glasgow , Glasgow , Scotland , UK.|c Scottish Centre for Innovation in Spinal Cord Injury , www.scisci.org.uk , Scotland , UK.
authors.forename: Henrik
authors.initials: H
authors.lastname: Gollee
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation* / Q000502:physiology; D000368:Aged; D003371:Cough / Q000209:etiology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007327:Insufflation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011782:Quadriplegia / Q000150:complications / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000150:complications / Q000628:therapy*
keywords: Abdominal muscles; Functional electrical stimulation; Mechanical insufflation-exsufflation; Spinal cord injury; Tetraplegia