Noninvasive Neuromodulation Techniques in Difficult Tracheostomy Weaning of Patients With Spinal Cord Injury: Report of Two Cases.

Chest

Hospital das Clínicas HC-FMUSP, São Paulo, SP, Brazil; Rede de Núcleos de Assistência e Pesquisa em Neuromodulação - NAPeN Network, São Paulo, SP, Brazil; Laboratory of Medical Investigations - LIM-54, São Paulo, SP, Brazil; São Paulo University, São Paulo, SP, Brazil.

Published: May 2021

AI Article Synopsis

  • High spinal cord injury patients often struggle with respiratory issues, making it hard for them to wean off mechanical ventilation.
  • Transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) were used in two case studies to help improve diaphragm control and respiratory function in patients with long-term tracheostomies.
  • Both patients showed significant improvements in respiratory measurements after the stimulation treatments, leading to better cough effectiveness and eventual decannulation after the therapy sessions.

Article Abstract

High spinal cord injured patients (SCI) are susceptible to respiratory muscle impairments. Transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) may influence the diaphragm's central control, but until now they are not described as a therapeutic resource for difficult weaning. We present two case reports of SCI patients (P1 and P2) with long-term tracheostomy (>40 days) and hospital stay (>50 days). In association with respiratory exercise, P1 received a combined application of anodal tDCS over the supplementary motor area plus sensory PES in the thoracic-abdominal muscles, and P2 received isolated excitatory PES in the abdominal muscles, applied daily except on weekends. Maximum inspiratory/expiratory pressure, peak cough flow, diaphragm excursion, and thickening fraction were measured in the first and last days of the protocol. Both patients had improvements, with clinical impact such as cough effectiveness, decannulated after 15 applications of stimulation. Augmentation of neural respiratory drive and corticospinal excitability is suggested.

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Source
http://dx.doi.org/10.1016/j.chest.2020.11.065DOI Listing

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