Abstract
This paper discusses the development of a pilot project in respiratory rehabilitation as part of the total rehabilitation of the tetraplegic and high paraplegic. The principles of neuromuscular exercise and of behaviouristic psychology introduce the subject of operant learning in the rehabilitation setting. Incentive spirometry is described as the basic element in the development of a respiratory rehabilitation programme. The preliminary results are analysed and a recommendation made that such a programme materially increases the respiratory function of the tetraplegic, and, not least, assists in his ability to combat intercurrent respiratory infection.
Similar content being viewed by others
Article PDF
References
Barlett, R H, Gazzaniga, A B & Geraghty, T R (1973). Respiratory maneuvers to prevent post-operative pulmonary complications. J. Amer. Med. Assoc., 224, 1017–1021.
Bergofsky, E H (1964). Quantitation of the function of respiratory muscles in normal individuals and quadraplegic patients. Arch. Phys. Med., 45, 575–580.
Burke, D C & Murray, D D (1975). Handbook of Spinal Cord Medicine, p. 32. Macmillan Press Ltd., London.
Cameron, G S, Scott, J W, Jousse, A T & Botterell, E H (1955). Diaphragmatic respiration in a quadriplegic patient and effect of position on his vital capacity. Ann. Surg., 141, 451–456.
Campbell, E J M (1958). The Diaphragm, the Respiratory Muscles and the Mechanics of Breathing, pp. 8–16. Lloyd-Luke, London.
Cheshire, D J E & Coats, D A (1966). Respiratory and metabolic management in tetraplegia. Paraplegia, 4, 1–23.
Collins, V J (1961). Principles of Anesthesiology, p. 827. Lea & Febinger, Philadephia.
Conroe, J H, Jr. (1971). Physiology of Respiration, p. 99. Year Book Medical Publishers, Inc., Chicago.
Cotes, J E (1975). Lung Function, 3rd edn., p. 67. Blackwell Scientific Publications, Oxford.
Crofton, J & Douglas, A (1975). Respiratory Diseases, 2nd edn., p. 679. Blackwell Scientific Publications, Oxford.
Egan, D F (1973). Fundamentals of Respiratory Therapy, 2nd edn., p. 65. The C. V. Mosby Co., St Louis.
Fordyce, W E (1968). Psychology and Rehabilitation: Rehabilitation and Medicine, pp. 129–151. E. Licht, New Haven.
Fordyce, W E, Fowler, R S, Lehmann, J F, Delabeur, B J, Sand, P L & Triesch-mann, R B (1973). Operant conditioning in the treatment of chronic pain. Arch. Phys. Med. Rehab., 54, 399–408.
Fordyce, W E, Sand, P L, Trieschman, R B et al. (1971). Behavioural systems analyzed. J. Rehab., 33, 29–33.
Fugl-Meyer, A R (1971a). Effects of respiratory muscle paralysis in tetrgic andaple paraplegic patients. Scand. J. Rehab. Med., 3, 141–150.
Fugl-Meyer, A R (1971b). A model for treatment of impaired ventilatory function in tetraplegic patients. Scand. J. Rehab. Med., 3, 168–177.
Fugl-Meyer, A R & Grimby, G (1971a). Ventilatory function in tetraplegic patients. Scand. J. Rehab. Med., 3, 151–160.
Fugl-Meyer, A R & Grimby, G (1971b). Rib cage and abdominal volume ventilation partitioning in tetraplegic patients. Scand. J. Rehab. Med., 3, 161–167.
Gilliat, R W, Guttmann, L & Whitteridge, D (1948). Inspiratory vasoconstriction after spinal injuries. J. Physiol., 1071, 67.
Grimby, G, Bunn, J & Mead, J (1968). Relative contributions of the rib cage and abdomen to ventilation during exercise. J. Appl. Physiol., 24, 159–166.
Guttmann, L (1976). Spinal Cord Injuries. Comprehensive Management and Research, 2nd Edition. Blackwell Scientific Publications, Oxford.
Guttmann, L & Silver, J R (1965). Electromyographic studies on reflex activity of the intercostals and abdominals in cervical cord injuries. Paraplegia, 3, 1–22.
Hemingway, A, Bors, E & Hobby, R P (1958). An investigation of the pulmonary function of paraplegics. J. Clin. Invest., 37, 773–782.
Kokkola, K, Moller, K & Lehtonen, T (1975). Pulmonary function in tetraplegic and paraplegic patients. Ann. Clin. Res., 7, 76–79.
Kory, R C, Callahan, R, Boren, H G & Syner, J C (1961). Clinical spirometry in normal men. Amer. J. Med., 30, 243–258.
McCredie, J Lovejoy, F W, Jr. & Kaetreider, N L (1962). Pulmonary function in diaphragmatic paralysis. Thorax, 17, 213.
McKinley, A C, Auchinloss, J H, Jr., Gilbert, R & Nicholas, J J (1969). Pulmonary function, ventilatory control and respiratory complications in quadriplegic subjects. Amer. Rev. Respir. Dis., 100, 526–532.
Michael, J L (1970). Rehabilitation in C. Neuring and J. L. Michael, (eds.), Behaviour Modification in Clinical Psychology, pp. 52–85. Appleton-Century-Crofts, New York.
Ohry, A, Molho, M & Rozin, R (1975). Alterations of pulmonary function in spinal cord injured patients. Paraplegia, 13, 101–108.
Sand, P L, Fordyce, W E & Fowler, R S (1973). Fluid intake behaviour in patients with spinal cord injury: prediction and modification. Arch. Phys. Med. Rehab., 54, 254–262.
Silver, J R & Gibbon, N O K (1968). Prognosis in tetraplegia. Brit. Med. J., 4, 79–83.
Silver, J R & Abdel-Halim, R E (1971). Chest movements and electromyography of the intercostal muscles in tetraplegic patients. Paraplegia, 9, 123–131.
Silver, J R & Moulton, A (1969). The physiological and pathological sequelae of paralysis of the intercostal and abdominal muscles in tetraplegic patients. Paraplegia, 7, 131–141.
Skinner, B F (1972). Cumulative Record: A Selection of Papers, 3rd edition. Appleton-Century-Crofts, New York.
Skinner, B F (1974). About Behaviourism, pp. 39–40, 47–73. Alfred A. Knopf, Inc., New York.
Stone, D J (1962). Some aspects of lung function in patients with respiratory muscle paralysis due to spinal cord injury. Proc. 11th Ann. Clin. Spinal Cord Injury Conf., 11, 153–156.
Stone, D J & Keltz, H (1963). The effect of respiratory muscle dysfunction on pulmonary function. Studies in patients with spinal cord injuries. Amer. Rev. Respir. Dis., 88, 621–629.
Trombly, C A (1966). Principles of operant conditioning: related to orthotic training of quardiplegic patients. Amer. J. Occup. Ther., 21, 217–220.
Van Der Water, J M, Waring, W G, Linton, L A, Murphy, M, Byron, R L (1972). Prevention of post-operative pulmonary complications. Surg. Gynecol. Obstet., 135, 229–233.
Wang, C S, Josenhau, W T (1972). Year Book of Anesthesia, p. 280. Year Book Publishers, Inc., Chicago.
Wingo, C F (1957). Pulmonary ventilation studies in a group of twenty quadriplegic patients. Roc. 6th Ann. Clinc. Spinal Cord Injury Conf., 6, 23–32.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Cheshire, D., Flack, W. The use of operant conditioning techniques in the respiratory rehabilitation of the tetraplegic. Spinal Cord 16, 162–174 (1978). https://doi.org/10.1038/sc.1978.29
Issue Date:
DOI: https://doi.org/10.1038/sc.1978.29