Posterolateral Surface Electrical Stimulation of Abdominal Expiratory Muscles to Enhance Cough in Spinal Cord Injury

Background. Spinal cord injury (SCI) patients have respiratory complications because of abdominal muscle weakness and paralysis, which impair the ability to cough. Objective. This study aims to enhance cough in high-level SCI subjects (n = 11, SCI at or above T6) using surface electrical stimulation of the abdominal muscles via 2 pairs of posterolaterally placed electrodes. Methods. From total lung capacity, subjects performed maximum expiratory pressure (MEP) efforts against a closed airway and voluntary cough efforts. Both efforts were performed with and without superimposed trains of electrical stimulation (50 Hz, 1 second) at a submaximal intensity set to evoke a gastric pressure (Pga) of 40 cm H2O at functional residual capacity. Results. In the MEP effort, stimulation increased the maximal Pga (from 21.4 ± 7.0 to 59.0 ± 5.7 cm H2O) and esophageal pressure (Pes; 47.2 ± 11.7 to 65.6 ± 13.6 cm H2O). During the cough efforts, stimulation increased Pga (19.5 ± 6.0 to 57.9 ± 7.0 cm H2O) and Pes (31.2 ± 8....