Abstract
Objective
To systematically determine whether use of the spinal cord stimulation (SCS) system
to restore cough may improve bowel management (BM) in individuals with spinal cord
injury (SCI).
Design
Experimental studies (clinical trial).
Setting
Inpatient hospital setting for electrode insertion; outpatient setting for measurement
of respiratory pressures; home setting for application of SCS.
Participants
Participants (N=5) with cervical SCI.
Intervention
A fully implantable SCS cough system was surgically placed in each subject. SCS was
applied at home, 2-3 times/d, on a chronic basis, every time bowel regimen was performed
and as needed for secretion management. Stimulus parameters were set at values resulting
in near maximum airway pressure generation, which was used as an index of expiratory
muscle strength. Participants also used SCS during their bowel routine.
Main Outcome Measures
Airway pressure generation achieved with SCS. Weekly completion of Bowel Routine Log
including BM time, mechanical measures, and medications used.
Results
Mean pressure during spontaneous efforts was 30±8 cmH2O. After a period of reconditioning, SCS resulted in pressure of 146±21 cmH2O. The time required for BM routines was reduced from 118±34 minutes to 18±2 minutes
(P<.05) and was directly related to the magnitude of pressure development during SCS.
Mechanical methods for BM were completely eliminated in 4 patients. No patients experienced
fecal incontinence as result of SCS. Each participant also reported marked overall
improvement associated with BM.
Conclusions
Our results of this pilot study suggest that SCS to restore cough may be a useful
method to improve BM and life quality for both patients with SCI and their caregivers.
Our results indicate that the improvement in BM is secondary to restoration of intra-abdominal
pressure development.
Keywords
List of abbreviations:
BM (bowel management), FRC (functional residual capacity), SCI (spinal cord injury), SCS (spinal cord stimulation), TLC (total lung capacity)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: November 04, 2020
Footnotes
Supported by the National Institute of Neurological Disorders and Stroke (grant no. U01 NS083696 ). This project was supported by the Clinical and Translational Science Collaborative (CTSC) of Cleveland, which is funded by the National Institutes of Health (NIH), National Center for Advancing Translational Science (NCATS), Clinical and Translational Science Award (CTSA) (grant no. UL1TR002548 ).
Clinical Trial Registration No.: NCT01659541.
Disclosures: Dr DiMarco holds 2 United States Patents for technology related to the content of this article: Method and Apparatus for Electrical Activation of the Expiratory Muscles to Restore Cough (5,999,855) and Bipolar Spinal Cord Stimulation to Activate the Expiratory Muscles to Restore Cough (8,751,004).
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
