Acute management of patients with spinal cord lesions
NICE guidelines (2016) Spinal injury: assessment and initial management [NG41]

Respiratory Information for Spinal Cord Injury

Allison DJ, Ditor DS (2015) Immune dysfunction and chronic inflammation following spinal cord injury. Spinal Cord; 53:14–18. doi:10.1038/sc.2014.184
• secondary injury includes communication between nervous, endocrine and immune systems, leading to endocrinal and immune impairment

Arevalo MA, Molina-Holgado E, Garcia-Ovejero D (2016) Cannabinoids to treat spinal cord injury. Prog Neuropsychopharmacol Biol Psychiatry; 64:190-9. doi: 10.1016/j.pnpbp.2015.03.008

Aslan SC, Randall DC, Krassioukov AV et al (2016) Respiratory training improves blood pressure regulation in individuals with chronic spinal cord injury. Arch Phys Med Rehabil; 97(6):964-73. doi: 10.1016/j.apmr.2015.11.018

Bach JR (2012) Noninvasive respiratory management of high level spinal cord injury. J Spinal Cord Med; 35(2):72-80. doi: 10.1179/2045772311Y.0000000051

Berney S et al (2002) Can early extubation and intensive physiotherapy decrease length of stay of acute quadriplegic patients in intensive care? Physiother Res Internat, 7, 14-22
• early extubation and intensive physio can reduce length of ICU stay

Bach JR (2012) Noninvasive respiratory management of high level spinal cord injury. J Spinal Cord Med; 35(2):72-80. doi: 10.1179/2045772311Y.0000000051

Bauman KA, Kurili A, Schotland HM et al (2016) Simplified approach to diagnosing sleep-disordered breathing and nocturnal hypercapnia in individuals with spinal cord injury. Arch Phys Med Rehabil; 97(3):363–371
• obstructive sleep apnea is found in 81.3% of patients and central sleep apnea in 23.8%

Chung BP, Cheng BKK (2010) Immediate effect of transcutaneous electrical nerve stimulation on spasticity in patients with spinal cord injury. Clin Rehabil, 24, 202-210
• TENS for spasticity causing pain, contractures and impaired mobility

Cornwell PL, Ward EC, Lim Y et al (2014) Impact of an abdominal binder on speech outcomes in people with tetraplegic spinal cord injury: perceptual and acoustic measures. Top Spinal Cord Inj Rehabil; 20(1):48-57. doi: 10.1310/sci2001-48.

Crowe J (2000) A multi-centre, randomized controlled trial of positioning on quadriplegic shoulder pain. Physiother Can, 42, 266-72

Curtis KA, Drysdale GA, Lanza RD (1999) Shoulder pain in wheelchair users with tetraplegia and paraplegia. Arch Phys Med Rehab, 80, 453-7

Dalal K, DiMarco AF (2014) Diaphragmatic pacing in spinal cord injury. Phys Med Rehab Clin N Am; 25:3, 619-29

Davies D (2002) Lifestyle risks for three disease outcomes in spinal cord injury. Clin Rehab, 16, 96-108
• cigarette smoking is the most damaging lifestyle behaviour in spinal cord-injured people

Derrickson (1992) A comparison of two breathing exercise programs for patients with quadriplegia. Phys Ther, 72, 763-69

Dalal K, DiMarco AF (2014) Diaphragmatic pacing in spinal cord injury. Phys Med Rehab Clin N Am; 25:3, 619-29

Fenton JJ, Warner ML, Lammertse D et al (2016) A comparison of high vs standard tidal volumes in ventilator weaning for individuals with sub-acute spinal cord injuries: a site-specific randomized clinical trial. Spinal Cord; 54(3):234-8. doi: 10.1038/sc.2015.145. Erratum in: Spinal Cord. 2016 Mar;54(3):245.

Findikoglu G, Gunduz B, Uzun H (2012) Investigation of cartilage degradation in patients with spinal cord injury by CTX-II. Spinal Cord, 50, 2, 136-40

Flandreau G, Bourdin G, Leray V (2011) Management and long-term outcome of patients with chronic neuromuscular disease admitted to the intensive care unit for acute respiratory failure: a single-center retrospective study. Respir Care, 56, 7, 953-60

Gabi Zeilig et al (2012)The nature and course of sensory changes following spinal cord injury: predictive properties and implications on the mechanism of central pain. Brain (2012) 135(2): 418-430 doi:10.1093/brain/awr270

Gill LC, Ross HH, Lee KZ (2014) Rapid diaphragm atrophy following cervical spinal cord hemisection. Resp Physiol Neurobiol; 192(1):66-73

Giner-Pascual M, Alcanyis-Alberola M, Gonzalez M et al (2011) Shoulder pain in cases of spinal injury: influence of the position of the wheelchair seat. Internat J Rehabil Res, 34, 4, 282-289
doi: 10.1097/MRR.0b013e32834a8fd9
• wheelchair seats positioned parallel to the ground may be a risk factor for shoulder pain

Goldstein R (2000) Musculoskeletal conditions after spinal cord injury. Phys Med Rehab Clin N Am, 11, 91-108
• a third to a half of patients develop shoulder pain

Harris K, Bull J (2004) The role of respiratory clinical specialist physiotherapists in two spinal cord injury units. ACPRC Journal, 36, 37-40

Harvey LA et al (2003) Quantifying the magnitude of torque physiotherapists apply when stretching the hamstrings of people with spinal cord injury. Arch Phys Med Rehab, 84, 1072-5
• wide variety of force applied by different physiotherapists

Harvey LA (2016) Physiotherapy rehabilitation for people with spinal cord injuries. J Physiother, 62(1): 4–11. doi: 10.1016/j.jphys.2015.11.004
• people with tetraplegia place the highest priority on regaining upper limb function while those with paraplegia ranked return of sexual function as their main priority

Inoue T, Manley GT, Patel N et al (2014) Medical and surgical management after spinal cord injury: vasopressor usage, early surgerys, and complications. J Neurotrauma; 31(3):284-91. doi: 10.1089/neu.2013.3061

Jia X, Kowalski RG, Sciubba DM (2013) Critical care of traumatic spinal cord injury. J Intensive Care Med, 28, 1, 12-23. doi: 10.1177/0885066611403270

Khalil RE et al (2013) The role of nutrition in health status after spinal cord injury. Aging Dis. 4(1): 14–22.

Kressler J, Cowan RE, Bigford GE et al (2014) Reducing cardiometabolic disease in spinal cord injury. Phys Med Rehab Clin N Am; 25:3, 573-604

Kushner DS, Alvarez G (2014) Dual diagnosis: traumatic brain injury with spinal cord injury. Phys Med Rehab Clin N Am; 25:3, 681-96

Laffont I, Durand M-C, Rech C et al (2003) Breathlessness associated with abdominal spastic contraction in a patient with C6 tetraplegia. Arch Phys Med Rehab, 84, 906-8
• spastic abdominal muscles impose significant load on diaphragm, relieved by baclofen

Leicht CA (2013) Spinal cord injury: known and possible influences on the immune response to exercise. Exerc Immunol Rev, 19:144-63
• exercise training should be initiated early in the rehabilitation process to improve immunity and autonomic function

Lin KH (1999) Abdominal weight and inspiratory resistance. Arch Phys Med Rehab, 80, 741-5

Lindberg J, Kreuter M, Person L-o et al (2013) Patient Participation in Rehabilitation Questionnaire (PPRQ)-development and psychometric evaluation. Spinal Cord; 51(11):838-42

Lohne V (2008) The battle between hoping and suffering: a conceptual model of hope within a context of spinal cord injury. Adv Nurs Science, 31(3): 237-248.
• hope of improvement was the main focus in early rehabilitation, whereas hope as being just fine was the main focus after 3 to 4 years’ rehabilitation

Maldonado BS, Peters K, Woller SA et al (2016) Inflammation is increased with anxiety- and depression-like signs in a rat model of spinal cord injury. Brain Behav Immun; 51:176-95. doi: 10.1016/j.bbi.2015.08.009

Matsumoto S, Suda K, Iimoto S et al (2015) Prospective study of deep vein thrombosis in patients with spinal cord injury not receiving anticoagulant therapy. Spinal Cord; 53(4): 306–309; doi:10.1038/sc.2015.4;

Mehta W et al (2013) Neuropathic pain post spinal cord injury part 1: systematic review of physical and behavioral treatment. Top Spinal Cord Inj Rehabil; 19(1):61–77

Miccinilli S, Morrone M, Bastianini F et al (2016) Optoelectronic plethysmography to evaluate the effect of posture on breathing kinematics in spinal cord injury: a cross sectional study. Europ J Phys Rehab Med; 52(1):52:36-47

Mitate E, Kubota K, Ueki K et al (2015) Speaking tracheostomy tube and modified mouthstick stylus in a ventilator-dependent patient with spinal cord injury. Case Rep Emerg Med: 320357. doi: 10.1155/2015/320357

Nam HS, Kim KS, Shin HI (2012) ICF based comprehensive evaluation for post-acute spinal cord injury. Ann Rehab Med, 36, 6, 804–814. doi: 10.5535/arm.2012.36.6.804

Norrbrink C, Lφfgren M (2016) Needs and requests - patients and physicians voices about improving the management of spinal cord injury neuropathic pain. Disabil Rehabil; 38(2):151-8. doi: 10.3109/09638288.2015

Paleg G, Livingstone R (2015) Systematic review and clinical recommendations for dosage of supported home-based standing programs for adults with stroke, spinal cord injury and other neurological conditions. BMC Musculoskelet Disord;16(1):358. doi: 10.1186/s12891-015-0813-x
• patients should aim at supported standing for 30-60 mins a day

Pelletier CA (2013) Importance of exercise in the rehabilitation process after spinal cord injury. Crit Rev Phys Rehab Med, 25(1-2):143-158. doi: 10.1615/CritRevPhysRehabilMed.2013008225

Postma K, Haisma JA, Hopman MT et al (2014) Resistive inspiratory muscle training in people with spinal cord injury during inpatient rehabilitation: a randomized controlled trial. Phys Ther; 94(12):1709-19. doi: 10.2522/ptj.20140079.
• inspiratory muscle training can improve inspiratory muscle function

Ramakrishnan (1991) Bronchial mucus hypersecretion in acute quadriplegia. Am Rev Respir Dis, 143, 640-48.

Raurich JM et al (2014) Respiratory CO2 response in acute cervical spinal cord injury (CO2 response in spinal cord injury). Spinal Cord; 52(1):39-43

Rice LA, Smith I, Kelleher AR (2013) Impact of the Clinical Practice Guideline for preservation of upper limb function on transfer skills of persons with acute spinal cord injury. Arch Phys Med Rehabil, 94, 7, 1230-1246

Sieg EP, Payne RA, Hazard S et al (2016) Evaluating the evidence: is phrenic nerve stimulation a safe and effective tool for decreasing ventilator dependence in patients with high cervical spinal cord injuries and central hypoventilation? Childs Nerv Syst; 32(6):1033-8. doi: 10.1007/s00381-016-3086-2

Soundy A, Smith B, Cressy F, Webb L (2009) The experience of spinal cord injury. Physiotherapy, 96, 1, 52-58

Stambolis V (2003) Dysphagia after anterior cervical spinal surgery. Arch.Phys.Med.Rehab, 84, E37 (
• dysphagia is present in 67.4% of patients, leading to aspiration

Tanhoffer RA (2012) Comparison of methods to assess energy expenditure and physical activity in people with spinal cord injury. J Spinal Cord Med, 35, 1, 35–45. doi: 10.1179/2045772311Y.0000000046

Tedde ML (2012) Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management. Clinics (Sao Paulo), 67, 11, 1265–1269. doi: 10.6061/clinics/2012(11)07

Tederko P, Besowski P, Jakubiak K et al (2015) Influence of wheelchair footrest height on ischial tuberosity pressure in individuals with paraplegia. Spinal Cord 53: 471-475. doi: 10.1038/sc.2014.242
• wheelchair footrest should be low enough to minimise ischial tuberosity pressure

Thomas CK, Bakels R, Klein CS et al (2014) Human spinal cord injury: motor unit properties and behaviour. Acta Physiologica; 210(1): 5–19. doi: 10.1111/apha.12153

Van Diemen T, Lankveld WV, Christel van Leeuwen C et al (2016) Multidimensional fatigue during rehabilitation in persons with recently acquired spinal cord injury. J Rehab Med; 48(1): 27-32. doi: 10.2340/16501977-2018

Warren VC (2002) Glossopharyngeal and and neck accessory muscle breathing in a young adult with C2 tetraplegia resulting in ventilator dependency. Phys Ther, 82, 590-610
• glossopharyngeal breathing can provide 30 minutes’ ventilator-free time, a functional cough and a 35-fold increase in FVC

Wouda MF, Wejden L, Lundgaard E et al (2016) Energetic and cardiovascular responses to treadmill walking and stationary cycling in subjects with incomplete spinal cord injury. Spinal Cord; 54(1):51-6. doi: 10.1038/sc.2015.120
• subjects with incomplete spinal cord injury were able to perform high-intensity weight-bearing exercise as healthy controls

Zhang X, Plow E, Ranganthan V et al (2016) Functional magnetic stimulation of inspiratory and expiratory muscles in subjects with tetraplegia. PM R; 8(7):651-9. doi: 10.1016/j.pmrj.2016.01.016

ACPRC = Association of Chartered Physiotherapists in Respiratory Care
JAMA = Journal of American Medical Association