DiMarco Anthony F, Geertman Robert T, Kim Chong, Nemunaitis Gregory A, Kowalski Krzysztof E
Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA.
Department of Research, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA.
J Spinal Cord Med. 2025 Jul;48(4):739-742. doi: 10.1080/10790268.2024.2395082. Epub 2024 Nov 4.
Paralysis of the expiratory muscles in cervical and high thoracic spinal cord injury (SCI) results in an impaired ability to clear airway secretions effectively and increases the risk of atelectasis and respiratory tract infections (RTI). Spinal cord stimulation (SCS) applied via the Cough Stimulation System (CSS) has been shown to restore an effective cough mechanism in subjects with SCI. In this study, we evaluated the specific impact of use of the CSS by one study participant with SCI, subsequent discontinuation of usage, and then re-institution of this modality. Airway pressure generation (P) and peak expiratory airflow rate (F) achieved with CSS and clinical assessment questionnaires were assessed.
With the CSS, this subject was able to generate P and F rates of 103 cmHO and 7.1 l/s, respectively, with associated significant clinical benefits, including, much greater ease in raising secretions and reduction in the incidence of RTIs. However, following a 2-year period of regular use, the CSS became non-functional and a 2-year period elapsed before it could be replaced. During this time, he again experienced great difficulty managing airway secretions and an increased frequency of RTIs. Re-institution of the CSS system resulted in the restoration of an effective cough mechanism and similar clinical benefits.
CONCLUSION/CLINICAL RELEVANCE: This report demonstrates the very high degree of the clinical utility of the CSS as it had made a substantial beneficial impact on this participant's respiratory status and life quality.
颈髓和高位胸髓损伤（SCI）导致呼气肌麻痹，有效清除气道分泌物的能力受损，增加肺不张和呼吸道感染（RTI）的风险。通过咳嗽刺激系统（CSS）进行脊髓刺激（SCS）已被证明可恢复SCI患者的有效咳嗽机制。在本研究中，我们评估了一名SCI研究参与者使用CSS、随后停止使用以及重新使用该模式的具体影响。评估了使用CSS时产生的气道压力（P）和呼气峰值流速（F）以及临床评估问卷。
使用CSS时，该受试者能够分别产生103 cmH₂O的P值和7.1 l/s的F值，并带来显著的临床益处，包括更容易咳出分泌物以及降低RTIs的发生率。然而，在定期使用2年后，CSS出现故障，2年后才得以更换。在此期间，他再次出现气道分泌物管理困难以及RTIs频率增加的情况。重新启用CSS系统后，有效咳嗽机制得以恢复，并带来了类似的临床益处。
结论/临床意义：本报告证明了CSS具有非常高的临床实用性，因为它对该参与者的呼吸状况和生活质量产生了重大有益影响。
