Article

Respiratory complications in people with high-level spinal cord
injury (SCI) are a major cause of morbidity and mortality, particularly because
of a reduced ability to cough as a result of abdominal muscle paralysis.
We investigated the effect of cough training combined with
functional electrical stimulation (FES) over the abdominal muscles for 6 weeks to
observe whether training could improve cough strength. METHODS: Fifteen SCI
subjects (C4-T5) trained for 6 weeks, 5 days per week (5 sets of 10 coughs per
day) in a randomized crossover design study. Subjects coughed voluntarily at the
same time as a train of electrical stimulation was delivered over the abdominal
muscles via posterolaterally positioned electrodes (50 Hz, 3 seconds).
Measurements were made of esophageal (Pes) and gastric (Pga) expiratory pressures
and the peak expiratory flow (PEFcough) produced at the 3 time points of before,
during, and after the training. RESULTS: During voluntary coughs, FES cough
stimulation improved Pga, Pes, and PEFcough acutely, 20-fold, 4-fold, and 50%,
respectively. Six weeks of cough training significantly increased Pga (37.1 +/-
2.0 to 46.5 +/- 2.9 cm H2O), Pes (35.4 +/- 2.7 to 48.1 +/- 2.9 cm H2O), and
PEFcough (3.1 +/- 0.1 to 3.6 +/- 0.1 L/s). Cough training also improved pressures
and flow during voluntary unstimulated coughs. CONCLUSIONS: FES of abdominal
muscles acutely increases mechanical output in coughing in high-level SCI
subjects. Six weeks of cough training further increases gastric and esophageal
cough pressures and expiratory cough flow during stimulated cough maneuvers.

Langue : ANGLAIS