• Priscila De Carvalho, Juliana Barbosa Goulardins, Danilo Miyoji Nakamura de Sousa, Cristiane Marcela da Silva Barbosa, Thabata Cristina Candido Caetano, Lucas de Macedo Dos Santos, Clara Hikari Ito, Adriana Sayuri Hirota, Rita Pavione Rodrigues Pereira, Abrahão Fontes Baptista, and Clarice Tanaka.
• Hospital das Clínicas HC-FMUSP, São Paulo, SP, Brazil; Rede de Núcleos de Assistência e Pesquisa em Neuromodulação - NAPeN Network, São Paulo, SP, Brazil.
• Chest. 2021 May 1; 159 (5): e299-e302.

AbstractHigh spinal cord injured patients (SCI) are susceptible to respiratory muscle impairments. Transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) may influence the diaphragm's central control, but until now they are not described as a therapeutic resource for difficult weaning. We present two case reports of SCI patients (P1 and P2) with long-term tracheostomy (>40 days) and hospital stay (>50 days). In association with respiratory exercise, P1 received a combined application of anodal tDCS over the supplementary motor area plus sensory PES in the thoracic-abdominal muscles, and P2 received isolated excitatory PES in the abdominal muscles, applied daily except on weekends. Maximum inspiratory/expiratory pressure, peak cough flow, diaphragm excursion, and thickening fraction were measured in the first and last days of the protocol. Both patients had improvements, with clinical impact such as cough effectiveness, decannulated after 15 applications of stimulation. Augmentation of neural respiratory drive and corticospinal excitability is suggested.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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