Article
Diaphragmatic function following cervical cord injury: Neurally mediated improvement

https://doi.org/10.1016/0003-9993(85)90146-7Get rights and content

Abstract

Vital capacity measurements from 36 people rendered quadriplegic by traumatic cervical cord injuries generally increased during the first ten months after injury, indicating spontaneous improvement in respiratory muscle function. Reasoning that a renewal of neural supply to the diaphragm would probably be accompanied by a parallel renewal of neural supply to other muscles having adjacent motor pathways, the present study compared vital capacity measurements with concomitant muscle function evaluations from 20 of these people. Qualitatively, increases in vital capacity were invariably accompanied by increases in the function of a group of muscles (primarily of the shoulder and upper arm) having some segmental innervation in common with the diaphragm (C3C5) but were only sometimes accompanied by increases in the function of a group of muscles (primarily of the forearm and wrist) having segmental innervation below that of the diaphragm (C6C8). These findings suggest that the spontaneous improvement in vital capacity observed in quadriplegic people is mediated in part by corresponding improvement in the neural supply to the diaphragm. Quantitatively, however, linear regression analysis indicated that neither the rate nor the absolute amount of improvement in vital capacity could be predicted with any reliability from pulmonary function tests, neurologic examinations, or muscle function evaluations performed in the early stage of recovery.

References (22)

  • K Axen et al.

    Effect of thoracic deafferentation on loadcompensating mechanisms in humans

    J Appl Physiol

    (1982)
  • EH Bergofsky

    Mechanism for respiratory insufficiency after cervical cord injury: source of alveolar hypoventilation

    Ann Intern Med

    (1964)
  • EJM Campbell

    Accessory muscles

  • DJE Cheshire et al.

    Respiratory and metabolic management in acute tetraplegia

    Paraplegia

    (1966/1967)
  • A De Troyer et al.

    Respiratory mechanics in quadriplegia. Respiratory function of intercostal muscles

    Am Rev Respir Dis

    (1980)
  • FL Eldridge et al.

    Relationship of thoracic volume and airway occlusion pressure: muscular effects

    J Appl Physiol

    (1977)
  • JV Forner

    Lung volumes and mechanics of breathing in tetraplegics

    Paraplegia

    (1980)
  • AR Fugl-Meyer

    Effects of respiratory musele paralysis in tetraplegic and paraplegic patients

    Scand J Rehabil Med

    (1971)
  • AR Fugl-Meyer et al.

    Rib-cage and abdominal volume ventilation partitining in tetraplegic patients

    Scand J Rehabil Med

    (1971)
  • AR Fugl-Meyer et al.

    Ventilatory function in tetraplegic patients

    Scand J Rehabil Med

    (1971)
  • MD Goldman et al.

    Mechanical interaction between diaphragm and rib cage

    J Appl Physiol

    (1973)
  • Cited by (32)

    • Noninvasive Respiratory Management of Spinal Cord Injury

      2020, Physical Medicine and Rehabilitation Clinics of North America
      Citation Excerpt :

      The 4 goals of noninvasive management are to maintain or improve pulmonary compliance and lung volumes by lung volume recruitment (LVR), to maintain normal alveolar ventilation around-the-clock using noninvasive interfaces, to provide effective cough flows to prevent pneumonia and episodes of acute respiratory failure (ARF), and to train patients who have little to no vital capacity (VC) and who would otherwise be apneic in the event of disconnection from continuous tracheostomy mechanical ventilation (CTMV), the ability to breathe without a ventilator by using bulbar innervated muscles (BIM). Over time, the tendons, ligaments, and joints of the rib cage stiffen, which along with chest wall spasticity decreases lung capacity and pulmonary compliance.3–5 Whether in acute care or long-term, LVR is important to maintain lung health, compliance, and lung volumes, and it increases cough flows, VC, and vocalization.

    • Traumatic Spinal Cord Injury: Pulmonary Physiologic Principles and Management

      2018, Clinics in Chest Medicine
      Citation Excerpt :

      Continued improvement in pulmonary function is noted during the remainder of the first year following cervical SCI, during which time pulmonary function parameters, including vital capacity (VC), inspiratory capacity (IC), total lung capacity (TLC), and inspiratory and expiratory flow rates increase, whereas functional residual capacity (FRC) decreases.33,38–40 Early improvements in pulmonary function have been attributed to functional decline in the level of SCI coincident with resolution of inflammation and edema above the injury level,38 and subsequently to improvement in diaphragm function,33,41–44 in the performance of accessory neck muscles,45 to the change from flaccid to spastic paralysis,46 and to increased rib cage stability.38,43 Precise measurement of height used to calculate predicted pulmonary function values is problematic among persons with SCI, most of whom cannot stand.

    • Respiration following spinal cord injury: Evidence for human neuroplasticity

      2013, Respiratory Physiology and Neurobiology
      Citation Excerpt :

      In fact, acute recovery can account for early ventilator weaning and extubation in a significant population (Wicks and Menter, 1986), with up to 74% of individuals being extubated as soon as 5.5 days post-injury (Call et al., 2011). Compensatory plasticity not only assists early recovery but also demonstrates late changes, with findings of increased activity in multiple spared respiratory muscle groups above and below the injury level (Axen et al., 1985; Bluechardt et al., 1992; Ledsome and Sharp, 1981; Loveridge et al., 1989; McMichan et al., 1980; Ovechkin et al., 2010; Rutchik et al., 1998; Silver and Lehr, 1981). After chronic SCI, EMG recordings show increased activity of accessory trapezius and pectoralis muscles during breathing (Ovechkin et al., 2010), which are innervated by pathways arising from above the injury level.

    • Breathing patterns after mid-cervical spinal contusion in rats

      2011, Experimental Neurology
      Citation Excerpt :

      The role of central respiratory plasticity in slow improvements of respiratory function in spinally injured people is unknown. However, time-dependent improvements in diaphragmatic function in spinally injured humans occur with concurrent improvements in shoulder and upper arm muscles, all of which receive innervation from motoneurons in C3 to C6 spinal segments (Axen, et al. 1985). Thus, delayed spontaneous improvements in diaphragmatic function may reflect improvements in diaphragm innervation.

    View all citing articles on Scopus

    This study was supported by grant 16-P-56081/2 from the Rehabilitation Serv. Administration and by grant G008003038 from the National Institute of Handl capped Research. Washington, DC.

    View full text