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Chapter 6: Respiratory Rehabilitation

Martha F. Somers; Laura Wehrli; Vanessa Ramirez

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Chapter 6 presents information on respiratory function and respiratory care practices after spinal cord injury.

INTRODUCTION

Respiratory complications are the most common cause of death after spinal cord injury (SCI).1,2 However, many of these secondary conditions can be avoided with proper care. Rehabilitation professionals should be familiar with the respiratory sequelae of spinal cord injury and should work with their patients to develop the ability to breathe and cough, prevent complications, and optimize their respiratory health for the remainder of their lives.

Pulmonary function tests are used to examine breathing ability. Table 6-1 presents the various measures and their normal values.

TABLE 6-1Pulmonary Function Tests
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TABLE 6-1 Pulmonary Function Tests
Measure Abbreviation Definition

Normal Values*
Tidal volume TV The volume of air normally inhaled in one breath during quiet respiration ~500 mL
Inspiratory reserve volume IRV The maximum volume of air that can be inhaled after/above a normal quiet inspiration ~3,000 mL
Expiratory reserve volume ERV The maximum volume of air that can be exhaled after a normal exhalation during quiet breathing ~1,100 mL
Residual volume RV The volume of air that remains in the lungs after a maximal exhalation ~1,200 mL
Vital capacity VC The maximum volume of air that can be exhaled by forceful exhalation following maximal inhalation (equal to the sum of the TV, IRV, and ERV) ~4,600 mL
Total lung capacity TLC The volume of air in the lungs at the end of a maximal inhalation (equal to the sum of TV, IRV, ERV, and RV) ~5,800 mL
Inspiratory capacity IC The maximum volume of air that can be inspired from the end of a normal quiet exhalation (equal to the sum of the TV and the IRV) ~3,500 mL
Functional residual capacity FRC The volume of air that remains in the lungs at the end of a normal quiet exhalation (equal to the sum of ERV and RV) ~2,300 mL
Forced expiratory volume in 1 second

FEV1

 The volume of air that can be expired in 1 second by forceful exhalation following maximal inhalation (often expressed as percentage of vital capacity) ~80% of VC
Maximum positive expiratory pressure PEP The maximal positive pressure generated during forced expiration

Male: 247 cm H2O

Female: 160 cm H2O
Maximum negative inspiratory pressure NIP The maximal negative pressure generated during maximal inhalation

Male: 132 cm H2O

Female: 94 cm H2O
Peak cough flow PCF Maximum expiratory flow during cough maneuver 360–1,000 L/min

* Normal values vary with age, gender, and height. Most normal values were established in adult males. Reported normal values also vary between sources.

Sources:4,6-10

REVIEW OF NORMAL BREATHING

Breathing, or ventilation, is achieved through motions of the ribs and diaphragm. These motions ...

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