(Kiosk 1) Diaphragmatic Pacing Allowing More Independence in Spinal Cord Injury Patients: A Case Report

Case Diagnosis: A 19-year-old female presented after being an unrestrained passenger in a motor vehicle collision, and found to have a C5-C6 spinal cord injury (SCI).

Case Description or Program Description: CT scan revealed a C5-C6 SCI from a vertebral body fracture. She subsequently underwent posterolateral arthrodesis and fusion of C5-C6. Post-operatively, MV weaning was difficult as patient had a cervical SCI that affects respiratory function on a neurological level, and thus, a diaphragmatic pacer was placed to assist with weaning.

Setting: Tertiary care academic hospital.

Assessment/Results: Physiatry was later consulted to assist with a rehabilitation plan. While in rehab, MV was weaned successfully due to the diaphragmatic pacer placement. Three weeks of diaphragmatic strengthening exercises were required prior to this. This helped improve her functional outcome as working with therapies was less cumbersome because she did not require ventilator support. She also reacquired the ability to speak more naturally, allowing for better communication and independence.

Discussion (relevance): Approximately 50% of spinal cord injury (SCI) patients develop quadriplegia, and of these, 4% require mechanical ventilation (MV) indefinitely as well. Diaphragmatic pacing is an alternative method for achieving adequate respiratory function in SCI patients. Pacing allows for better tolerability and adherence to a rehabilitation program as it is less cumbersome than a ventilator, in turn, potentially increasing the patient’s functionality and independence. Additionally, patients completely independent from MV can usually close their tracheostomy, allowing them to regain their speech, thus, increasing their independence as well.

Conclusions: Diaphragmatic pacing is an alternative method to assist SCI patients in achieving adequate respiratory support. It allows for increased quality of life as well as functional independence as it allows a patient to speak and breathe more naturally and increases their mobility on discharge.