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After reading this chapter, the reader will be able to:

  • Determine critical areas to prioritize in the physical therapy plan of care for individuals with spinal cord injury (SCI) based on respiratory function examination data

  • Select interventions to address specific areas of respiratory dysfunction in individuals with spinal injuries

  • Recognize signs and symptoms of respiratory muscle fatigue and inadequate ventilation in individuals with SCIs and suggest modifications to the physical therapy plan of care

  • List important principles required for successful physical therapy treatment of the individual with SCI who requires mechanical ventilator support

  • Discuss essential information with the health-care team, family, and individual with SCI in order to achieve optimal recovery of respiratory function

  • Determine components of a comprehensive respiratory care program for lifetime management of respiratory dysfunction in individuals with spinal injuries


Respiratory dysfunction is one of the most devastating effects occurring after an injury to the spinal cord. Respiratory insufficiency is the primary cause of death in individuals sustaining high cervical spinal cord injuries (SCIs).1 Paralysis of the respiratory muscles and poor ventilatory mechanics lead to atelectasis and decreased expiratory flow.2 There is a decreased ability to mobilize secretions, allowing bacteria to accumulate and setting the stage for pneumonia. Among all respiratory causes of mortality in individuals with SCI, pneumonia is the most common.1,3,4 However, recent reports indicate that individuals with chronic SCI have an increased prevalence of pathological vascular conditions due to inactivity while living with a disability.5,6 Diseases of the cardiovascular system contribute to recurrent pulmonary emboli, pulmonary hypertension, and ischemic heart disease in those with long-standing tetraplegia.5,7 Although the risk for mortality from respiratory disorders is greatest among individuals with tetraplegia, and especially older individuals, most individuals with paraplegia will also have decreased ventilatory capacity and limited airway clearance compared to their nondisabled counterparts.3 Jackson and Groomes3 reported more than 65% of those with paraplegia (T1 and below) had respiratory complications (pleural effusion, atelectasis, and pneumohemothorax) compared to 60% for those with injuries at C5–C8 (atelectasis, pneumonia, and ventilatory failure); however, the risks were highest in those with injuries at C1–C4, in whom 84% had respiratory complications.3

The role of the therapist includes implementing strategies for prevention of atelectasis and pneumonia as well as methods for optimizing the recovery of weakened muscles responsible for ventilation. In some cases, the effects of functional training may be limited by low ventilatory reserve and poor gas exchange. Therefore, the therapist must be aware of the individual's ventilatory limitation in order to modify treatment, select equipment that will enhance ventilation, and achieve quality cost-effective care. It is also important for the therapist to recognize the impact of chronic diseases of the cardiovascular and respiratory system in those living with SCI so that long-term lifestyle modification strategies and education are offered to ...

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