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Review
. 2017 Mar 28:11:144.
doi: 10.3389/fnhum.2017.00144. eCollection 2017.

Review of Epidural Spinal Cord Stimulation for Augmenting Cough after Spinal Cord Injury

Jan T Hachmann  1 , Jonathan S Calvert  2 , Peter J Grahn  1 , Dina I Drubach  1 , Kendall H Lee  3 , Igor A Lavrov  1
Affiliations
Review

Review of Epidural Spinal Cord Stimulation for Augmenting Cough after Spinal Cord Injury

Jan T Hachmann et al. Front Hum Neurosci. .

Abstract

Spinal cord injury (SCI) remains a debilitating condition for which there is no cure. In addition to loss of somatic sensorimotor functions, SCI is also commonly associated with impairment of autonomic function. Importantly, cough dysfunction due to paralysis of expiratory muscles in combination with respiratory insufficiency can render affected individuals vulnerable to respiratory morbidity. Failure to clear sputum can aggravate both risk for and severity of respiratory infections, accounting for frequent hospitalizations and even mortality. Recently, epidural stimulation of the lower thoracic spinal cord has been investigated as novel means for restoring cough by evoking expiratory muscle contraction to generate large positive airway pressures and expulsive air flow. This review article discusses available preclinical and clinical evidence, current challenges and clinical potential of lower thoracic spinal cord stimulation (SCS) for restoring cough in individuals with SCI.

Keywords: cough restoration; epidural spinal cord stimulation; functional electrical stimulation (FES); neuromodulation; neuroprosthetics; neurorestoration; spinal cord injury (SCI); spinal cord stimulation.

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Figures

Figure 1
Figure 1
Neurophysiological basis of cough and epidural stimulation of the lower thoracic spinal cord. The expiratory internal intercostal muscles are innervated by their respective segmental intercostal nerves and the abdominal muscles are innervated via the lower intercostal branches (thoracoabdominal nerves), as well as regional branches from the lumbar plexus (i.e., ilioinguinal and iliohypogastric nerves). Based on the reviewed literature a putative target location for an epidural electrode is shown for lower thoracic spinal cord stimulation (SCS). Co-stimulation of the lower thoracic (e.g., T9) and upper lumbar (e.g., L1) spinal levels have shown to recruit the expiratory muscles and generate high peak expiratory pressures and air flow.
See this image and copyright information in PMC

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