Respiratory management / Diaphragmatic breathing spinal cord injury
Air containing oxygen goes through nose and mouth to trachea. It then enters bronchi and then into the lungs. Lungs contain millions of air sacs called alveolar. From alveolar oxygen enters the blood stream from where it is supplied to the whole body. Carbon dioxide separate from blood at alveolar which is excreted out of the body.
Breathing is a voluntary action controlled by a centre in the brain. During breathing messages from the brain travel to spinal cord and then to the breathing muscles which then move the air in and out of the body. The main muscle for taking the air in is diaphragm. The abdominal and intercostal muscles are the main muscles responsible for taking the air out with force such as during coughing and sneezing.
As after spinal cord injury flow of messages from brain to breathing muscles is disturbed so breathing is effected and various problems arise. In fact one of the major cause of death in people with spinal cord injury is insufficient supply of oxygen and because of various complications that develop afterward due to poor breathing.
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Effects of spinal cord injury on Diaphragmatic breathing
How much diaphragmatic breathing is effected after sci depends on the neurological level of injury.
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In injury above C3 majority of the breathing muscles are paralyzed and one cannot breath at its own. Such quadripledics are ventilator dependent.
In C3-C8 injury the diaphragm works partially. Ventilator is not required for breathing. But coughing and sneezing are weak.
In T1-T6 diaphragm works well. Intercostal and abdominal muscles are weak due to which cough or sneeze is weak.
In T6-T12 diaphragm and intercostal muscles work well. Abdominal muscles are weak. Cough and sneeze are weak.
In L1 and below all respiratory muscles work well.
Diaphragmatic breathing Respiratory problems after spinal cord injury
Respiratory problems are more common in cervical injury and upper thoracic injury. As people carrying such injury cannot take deep breath, cough or sneeze or take secretion from lungs outside so various respiratory problems arises. Some of which are listed below.
Congestion
Congestion is a big diaphragmatic breathing problem especially for quadriplegics and higher paraplegics because they cannot push secretions out of lungs by forceful coughing . It can lead to various other problems like cold, pneumonia, bronchitis and collapsed lungs. If you feel congested drink plenty of water and turn more frequently in bed, this will help secretion going out of body. Use assisted coughing or postural drainage to get mucous out. Avoid alcohol and smoking because it produces more mucous.
Pneumonia
Pneumonia is a very serious problem after spinal cord injury especially for quadriplegics. Infect it is one of the main reason of death in people with spinal cord injury. It is caused by irritation of lungs which is caused by germs or virus. Pneumonia should be avoided at all costs. The first thing you should do is to keep moving. Keep moving in bed. Transfer to wheelchair and live a mobile and active life Drink plenty of water too . This way mucous will get soft, will not stick to the wall of lungs and will be easy to go out. Contact doctor as soon as you feel symptoms of pneumonia like increased congestion, fever and pale skin.
Pulmonary embolism
It is the second big cause of death in people with spinal cord injury with in the first year of injury. It is caused by the blockage of blood vessels in lungs due to blood clots which is more common in people with higher cervical injury (C1-C4).
Assisted Coughing
To avoid respiratory problems it is very important to get secretions out of body by coughing forcefully. As in people with quadriplegia and higher paraplegia it is difficult to cough forcefully because of paralysis of abdominal and intercostal muscles so they can use technique of assisted coughing. In this method another person will put hands on your abdomen and will push with rhythm as you try to cough. This will help secretions getting out of lungs.
Postural Drainage
Postural drainage can also be very helpful to get secretions out in case you are suffering from quadriplegia and cannot cough forcefully. In this method a body position is adopted with head below legs for 15 to 20 minutes. Gravity will help pulling secretions out of lungs.
Incentive Spiro meter
It is a breathing exercise device used for making chest muscles used in breathing stronger. It can be helpful to people suffering from spinal cord injury from C3-C8. Daily exercise on this device will make their available chest muscles stronger helping them to breath and cough better
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