• Jane E Butler, Julianne Lim, Robert B Gorman, Claire Boswell-Ruys, Julian P Saboisky, Bonsan B Lee, and Simon C Gandevia.
• Prince of Wales Medical Research Institute, Randwick, New South Wales, Australia.
• Neurorehabil Neural Repair. 2011 Feb 1;25(2):158-67.

BackgroundSpinal cord injury (SCI) patients have respiratory complications because of abdominal muscle weakness and paralysis, which impair the ability to cough.ObjectiveThis study aims to enhance cough in high-level SCI subjects (n = 11, SCI at or above T6) using surface electrical stimulation of the abdominal muscles via 2 pairs of posterolaterally placed electrodes.MethodsFrom total lung capacity, subjects performed maximum expiratory pressure (MEP) efforts against a closed airway and voluntary cough efforts. Both efforts were performed with and without superimposed trains of electrical stimulation (50 Hz, 1 second) at a submaximal intensity set to evoke a gastric pressure (P(ga)) of 40 cm H(2)O at functional residual capacity.ResultsIn the MEP effort, stimulation increased the maximal P(ga) (from 21.4 ± 7.0 to 59.0 ± 5.7 cm H(2)O) and esophageal pressure (P(es); 47.2 ± 11.7 to 65.6 ± 13.6 cm H(2)O). During the cough efforts, stimulation increased P(ga) (19.5 ± 6.0 to 57.9 ± 7.0 cm H(2)O) and P(es) (31.2 ± 8.7 to 56.6 ± 10.5 cm H(2)O). The increased expiratory pressures during cough efforts with stimulation increased peak expiratory flow (PEF, by 36% ± 5%), mean expiratory flow (by 80% ± 8%), and expired lung volume (by 41% ± 16%). In every subject, superimposed electrical stimulation improved peak expiratory flow during cough efforts (by 0.99 ± 0.12 L/s; range, 0.41-1.80 L/s). Wearing an abdominal binder did not improve stimulated cough flows or pressures.ConclusionsThe increases in P(ga) and PEF with electrical stimulation using the novel posterolateral electrode placement are 2 to 3 times greater than improvements reported in other studies. This suggests that posterolateral electrical stimulation of abdominal muscles is a simple noninvasive way to enhance cough in individuals with SCI.

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