Cough Restoration Project

Cough Restoration Project

Posted by tfallon73 on Sep 28, 2017 11:57 am

I am a Clinical Research Coordinator hoping to share information about an ongoing cough restoration research study funded by the National Institutes of Health.  To date, we have sucessfully implanted 23 patients with a spinal cord stimulation FDA approved device with the aim of reducing respiratory infections and improving one's overall quality of life.  I have outlined some general details below.  If you would like to learn more please free to contact me with any questions.  Theresa Fallon (216) 778-3612 or email at tfallon@metrohealth.org

Spinal Cord Stimulation to Restore Cough summary
Cough is a major defense mechanism for the respiratory system by which secretions from the lungs and airways are cleared.  Respiratory complications account for substantial sickness and death in patients with spinal cord injury due to their inability to cough.  Restoration of a natural cough mechanism in these patients may lead to an improved quality of life due to a greater sense of well being, less stressful method of secretion removal, and reduction in the incidence of respiratory tract infections and lung collapse. 
Cough and Spinal Cord Injury 
Paralysis of the expiratory muscles leads to a lack of a strong cough mechanism and the ability to effectively clear secretions. Accumulation of fluid in the lungs is typically seen in patients with high level injury, thereby increasing the risk of respiratory complications including lung collapse and bacterial infections such as pneumonia and bronchitis. 

Conventional Techniques for Airway Clearance; There  are  several  different  methods  of secretion clearance currently employed in the management of spinal cord injured patients who do not have a functional cough.  Gravity; With the patient lying so that the head is lower than the feet, the body is rotated to allow secretions from different areas of the lung to drain by gravitational effects alone.  Active Suctioning Secretions are cleared by inserting a catheter either through the tracheostomy, nose or mouth, to suction the airways by use of a pump. This method is generally successful for removal of heavy secretions from the large airways.  Assisted Cough; In this method, a caregiver manually compresses the abdominal wall while the patient controls the opening and closing of the upper airway. Mechanical Device; Cough efficiency can be enhanced by use of a mechanical insufflation- exsufflation device. By this technique, a variable amount of air is forced into the lungs followed by the application of negative pressure at the airway opening.
Limitations of Conventional Methods 
Unfortunately, each of these methods has significant limitations, which limit effectiveness.  The removal of secretions by gravity requires relatively awkward positioning for prolonged time periods and can be quite uncomfortable.  Active suctioning does not allow for removal of secretions from  small airways where they are produced. Furthermore, this method is uncomfortable for most patients and can result in tracheal injury and irritation. Moreover, this method may actually cause respiratory tract infections since a foreign body (suction catheter) is repeatedly placed into the lower respiratory tract.
Both the assisted cough and use of the insufflation-exsufflation device require provider-patient coordination and are costly and labor intensive requiring the constant presence of trained personnel.  Despite use of these various techniques, therefore, respiratory complications continue to be a major cause of sickness and death in patients with spinal cord injury.

Cough by Electrical Stimulation 
The spinal cord injured patient has been the focus of clinical research efforts to apply stimulation to induce muscle contraction and to restore cough. Functional electrical stimulation is the delivery of impulses to tissues to activate paralyzed muscles through electrodes implanted by a routine surgical procedure. This stimulation system imitates the natural activation of skeletal muscles. Stimulation of the abdominal muscles can be coordinated with voluntary efforts to reproduce the sequence of a natural cough.

Patient Selection: Patients must live within 300 miles of Cleveland Ohio and have a stable, chronic spinal cord injury (C8 level or higher, 6-12 months post injury) between the ages of 18 and 75 and in addition have evidence of significant expiratory muscle weakness evident by a weak or absent cough effort. Patients must be free of active lung, heart, and brain disease. Patients with significant scoliosis, other chest wall deformity, or marked obesity will be excluded as the mechanical load these conditions impose would reduce the likelihood that expiratory muscle stimulation will result in substantial positive airway pressures.

If you would like to learn more about our project please contact Theresa Fallon (216)778-3612 tfallon@metrohealth.org

Theresa Fallon, Clinical Coordinator of Spinal Cord Injury Research
MetroHealth Medical Center
2500 MetroHealth Drive
Cleveland, Ohio 44109
216 778 3612 (Office)
tfallon@metrohealth.org

 

Re: Cough Restoration Project

Posted by bradshaw48 on Oct 21, 2017 3:00 am

Well that’s quite an impressive study and I wish all the best for your work in the coming future and I hope that you research gets funded. Best Assignment Writing Service
 

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