Respiratory dysfunction is the leading cause of death in individuals with spinal cord injuries (SCIs). Nearly one quarter of all SCI cases involve injury to the upper spinal cord segments which impairs neural activation of the diaphragm muscle and compromises breathing. Although mechanical ventilation can be life-saving after cervical SCI (C-SCI), it also triggers rapid and profound diaphragm muscle atrophy, thereby complicating (or even preventing) ventilator weaning. Intramuscular diaphragm stimulation, or diaphragm pacing, was developed to replace long-term ventilator support, and is now used acutely post C-SCI (\<4 months following injury) to promote ventilator weaning. The impact of diaphragm pacing on respiratory function and diaphragm muscle activation has not been formally evaluated. This is an essential step in determining the efficacy of intramuscular diaphragm stimulation and its effects on respiratory function after SCI. Accordingly, this research study will evaluate the effects of intramuscular diaphragm stimulation and test the hypothesis that diaphragm pacing enhances neuromuscular diaphragm activation and respiratory function in adults with cervical SCIs. The investigators will test the hypothesis by evaluating the effects of diaphragm pacing on neuromuscular activation of the diaphragm by directly recording electromyogram (EMG) activity from the intramuscular pacing electrodes. Recording from these surgically-implanted electrodes allows direct comparisons of EMG activity across time, minimizing methodological limitations inherent with surface or percutaneous EMG recordings. This approach, in association with respiratory assessments, will be used to investigate the impact of diaphragm pacing in adults with intramuscular diaphragm pacing electrodes following acute, traumatic C-SCIs.
Age range
18 Years
Sex
ALL
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Electromyogram (EMG) will be used to assess the neuromuscular activation of the diaphragm
Timeframe: Change in baseline to months 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12
Maximal inspiratory pressure will be used to assess diaphragm strength
Timeframe: Change in baseline to months 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12
Sniff nasal inspiratory pressure may be used to assess diaphragm strength
Timeframe: Change in baseline to months 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12
Maximal expiratory pressure will be used to assess respiratory function
Timeframe: Change in baseline to months 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12
Spirometry and flow volume curves/loops will be used to assess respiratory function at rest
Timeframe: Change in baseline to months 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12
Spirometry and forced flow volume curves/loops will be used to assess respiratory function at maximal effort
Timeframe: Change in baseline to months 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12