Recent advances in roadside management and resuscitation techniques have resulted in an increased survival rate of people with high cervical cord injury. A few become partially or permanently ventilator dependent. Not only are these people dependent on assisted ventilation, but their speech is also compromised, along with loss of voluntary control and many other bodily functions, as they are tetraplegic.
By using recent technological advancements, such as portable ventilators, phrenic nerve stimulation, environmental controls and specialised wheelchairs it has been possible to manage such patients at home. Furthermore, patients on ventilators are unable to have verbal communication. There is therefore a need for them to develop either augmentative communication or the use of alternative communication aids. Recent published reports indicate the factors other than the clinical state that may prevent such patients from taking advantage of modern advances; the main issues appear to be cost factors, community care provision and ethical considerations.
Tribe C R (1963) Causes of death in the early and late stages of paraplegia. Paraplegia 1: 19–46.
Guttmann L, Silver J R (1965) Electromygraphic studies on reflex activity of the intercostal and abdominal muscles in cervical cord lesions. Paraplegia 3: 1–22.
Bellamy R, Pitts F W, Shannon Stauffer E (1973) Respiratory complications in traumatic quadriplegia. Analysis of 20 years experience. J Neurosurg 39: 596–600.
Carter R E (1980) Unilateral diaphragmatic paralysis in spinal cord injured patients. Paraplegia 18: 267–273.
Forner J V (1980) Lung volumes and mechanics of breathing in tetraplegics. Paraplegia 18: 258–266.
Fugl-Meyer A R, Grimby G (1971) Ventilatory function in tetraplegic patients. Scand J Rehabil Med 3: 151–160.
Wicks A B, Menter R R (1985) Longterm outlook in quadriplegic patients with initial ventilation dependency. Chest 86: 415–420.
Gardner B P, Watt J H W, Krishnan K R (1986) Artificial ventilation of acute spinal cord damaged patients. Paraplegia 24: 208–220.
Gross D, Ladd H W, Riley E J, Macklem P T, Grasino A (1980) The effect of training on strength and endurance of the diaphragm in quadriplegia. Am J Med 68: 27–35
Roper E (1977) Consideration of respiratory function in cervical cord injuries. Paper presented in Englewood, Colorado.
Weingarden S I, Belen J G (1987) Alternative approach to the respiratory management of the high cervical spinal cord injury patient. Int Disabil Studies 9: 132–133.
Miller H J, Thomas E, Wilmot C B (1988) Pneumobelt use among high quadriplegic population. Arch Phys Med Rehabil 69: 369–372.
Dingermans L M, Hawn J M (1978-79) Mobility and equipment for ventilator-dependent tetraplegics. Paraplegia 16: 175–183.
Glenn W W L, Hogan J F, Phelps M S (1980) Ventilatory support of the qaudriplegic patient with respiratory paralysis by diaphragm pacing. Surg Clin North Am 60: 1055–1078.
Leiberman J S, Corkhill G, Nayak N N, French B N, Taylor R G (1980) Serial phrenic nerve conduction studies in candidates for diaphragm pacing. Arch Phys Med Rehabil 61: 528–531.
Kirby N A (1989) The individual with high quadriplegia. Nurs Clin N Am 24: 1: 179–191.
Harris P, Patel S, Greer W, Naughton J (1973) Psychological and social reactions to acute spinal paralysis. Int J Paraplegia 11: 132–136.
Caywood T (1974) A quadriplegic young man looks at treatment. J Rehabil 49: 22–25.
Furhrer M J, Carter R E, Donovan W H, Rossi C D, Wilkerson M A (1987) Post discharge outcomes for ventilator-dependent quadriplegics. Arch Phys Med Rehabil 68: 353–356.
Polatty R C 1983) Signs and symptoms in pulmonary medicine. In: Glausser FL, editor. Muscles of Respiration. JB Lippincot, Philadelphia: 107–124.
Efthimiou J, Fleming J, Spiro S G (1987) Sternomastoid muscle function and fatigue in breathless patients with severe respiratory disease. Am Rev Respir Dis 136: 1099–1105.
Rochester D F, Braun N M T, Laine S (1977) Diaphragmatic energy expenditure in chronic respiratory failure. The effect of assisted ventilation with body respirators. Am J Med 63: 223–232.
Maynard F M, Muth A S (1987) Choice to end life as a ventilator-dependent quadriplegic. Arch Phys Med Rehabil 68: 862–864.
Purtilo R B (1986) Ethical issues in the treatment of chronic ventilator-dependent patients. Arch Phys Med Rehabil 67: 718–721.
Paper read at the first European Conference on Domiciliary Ventilation and High Spinal Cord Lesion in Southport, England, in October 1991.
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Chawla, J. Rehabilitation of spinal cord injured patients on long term ventilation. Spinal Cord 31, 88–92 (1993). https://doi.org/10.1038/sc.1993.15
- assisted ventilation
- domiciliary ventilation