Stephens KE, Myers R; MossRehab, Philadelphia, Pennsylvania. katiestephenspt@yahoo.com.

PURPOSE: To describe an intervention program used to prevent pulmonary complications in a patient after acute cervical spinal cord injury. FOUNDATION: Fifty to 100% of patients with acute cervical SCI have pulmonary complications. These are the leading cause of morbidity and mortality following SCI. The number of pulmonary complications experienced by a patient explains more of the variation in hospital costs than any other single factor, including level of injury. DESCRIPTION: Patient was a 22 year-old male who sustained a C5 complete SCI secondary to a MVA. Pulmonary complications during acute hospitalization included intubation secondary to rising pCO2 and three bronchoscopies. He was placed on nasal Bi-PAP at night after the first bronchoscopy. On his third day after admission to rehab, he was transferred to the ER due to shortness of breath and SpO2 of 88% on room air. He had a suspected mucous plug that he cleared using a quad cough and subsequently returned to rehab. Initially, the patient had a VC of 1.6 L, could inspire less than 1500 mL for 2 breaths using an incentive spirometer, fair + diaphragm strength, a weak, non-functional cough, diminished breath sounds throughout all lung fields and a 100% diaphragmatic breathing pattern. Pulmonary intervention included daily pulmonary exercises performed in therapy and as part of an evening exercise program, postural drainage and patient education. Specific exercises included incentive spirometry, assisted (quad) coughing, accessory muscle facilitation, air shift maneuver for chest wall mobility, resisted diaphragmatic breathing, aquatic therapy and aerobic activity. Postural drainage was incorporated into treatment sessions by performing activities in sitting, supine, sidelying and prone over a wedge. OBSERVATIONS: After 5 weeks of training, VC increased to 2.5 L, incentive spirometry improved to 5 inspirations of 2000 mL 4 times per day, he tolerated 13 minutes of diaphragmatic breathing with 5 pounds of resistance, he had a functional cough using the assisted cough technique with caregivers, and he was able to recruit accessory neck muscles to increase depth of breathing with exertion. The most significant outcome of the pulmonary intervention is that the patient sustained no further pulmonary complications while participating in the program. CONCLUSIONS: Aggressive, early pulmonary intervention resulted in the prevention of life-threatening pulmonary complications, improvements in cardiopulmonary status leading to improved functional mobility and quality of life, and decreased overall hospital costs. FUNDING SOURCE: None.

Copyright 2004 by the American Physical Therapy Association

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