In spinal cord palsy , the lungs are not directly affected, but the diaphragm, chest wall, and abdominal muscles that help breathing may be affected. Therefore, various respiratory problems can be seen. While breathing, certain respiratory muscles contract, the chest cavity expands, and the air fills the lungs with the pressure change. When the muscles relax, the breath is exhaled and the air comes out of the lungs.
In C3 or higher injuries, the phrenic nerve that moves the diaphragm cannot be stimulated. Mechanical assistance (ventilator) is required for breathing. In injuries between C3 and C5 levels, the diaphragm works but the intercostal (intercostal) muscles and other chest wall muscles are weak. As a result, the diaphragm descends, but the chest wall does not expand, and respiratory failure may develop.
People with mid-back and higher-level injuries may have difficulty breathing deeply and exhaling against resistance. They may not be able to cough vigorously because their abdominal and chest wall muscles are weak. This, in turn, causes the accumulation of secretions (phlegm) in the lung and paves the way for infections.
Tips for Coping with Respiratory Problems
- Coming to a sitting position every day and changing positions regularly can prevent fluid accumulation in the lungs.
- Regularly assisted coughing.
- Using an abdominal brace can help the abdominal and intercostal muscles.
- Maintaining a normal weight with a healthy diet.
- Drinking lots of water. Thus, respiratory secretions become more fluid and easier to cough up.
- Not to smoke and not to be in smoking environments. Smoking not only causes cancer, but also causes thickening of the secretions in the respiratory tract and inability to expel sputum. Lung tissue is damaged and susceptibility to infections increases.
- Doing special exercises that strengthen the respiratory muscles both facilitate breathing and reduce the risk of infection.
- Flu (influenza) and pneumococcal vaccines should be given.
Expelling Phlegm – Clearing Secretions
The secretions in the respiratory tract are sticky, called mucous, if they are not excreted, they can cause the airway walls to stick together and not expand enough. This condition, which is characterized by the extinction of a part of the lung, is called atelectasis. Patients with spinal cord paralysis are at risk for atelectasis. The secretions can provide a breeding ground for bacteria, which can lead to the development of pneumonia (lung infection). Symptoms such as shortness of breath, pale skin, high fever, and increased sputum can be seen in pneumonia.
The secretions of people who use a ventilator with tracheostomy should be cleaned by aspirating with vacuum devices at regular intervals. The frequency of aspiration may be as frequent as half an hour or as little as once a day. Aspiration is performed according to the needs of the person and the state of obstruction.
Medications called mucolytics may be recommended to clear respiratory system secretions.
In the percussion technique, it is possible to activate the secretions in the lung by lightly tapping the chest wall. Coughing can be aided by squeezing the abdomen upward in coordination with the exhalation. In the postural drainage technique, it can be ensured that the secretions move upward from the base of the lungs by gravity. For this, the head may need to be lower than the feet for 15-20 minutes. To apply these techniques correctly, you should consult your doctor and physiotherapist.
Assistive devices may be required in spinal cord paralysis with respiratory failure. C2 and above complete (complete) injuries require mechanical respiratory support (ventilator) because the diaphragm muscle does not work. In C3 and C4 level complete injuries, there is a chance of diaphragm function and weaning from the ventilator. In C5 and lower level complete injuries, even if there is a need for a ventilator at the beginning, this need disappears in the next process.
Non-invasive breathing devices are another method that can be used in some patients with spinal cord paralysis. The advantage is the reduced risk of infection associated with an open tracheostomy. These individuals require less care than invasive mechanical ventilation (less aspiration, the convenience of not having a neck device attached). Good swallowing function is required for non-invasive ventilation.
Another option is to contract and relax the diaphragm in a rhythm that will enable breathing with phrenic nerve stimulators (pacers) in people with diaphragmatic paralysis.
The depth of breathing decreases during sleep. A decrease in respiratory volume can cause an increase in carbon dioxide in the blood. Sleep apnea may occur. This can lead to complaints such as headache, sudden awakening from sleep, daytime sleepiness, anxiety, restlessness, loss of appetite, nausea, and fatigue. Non-invasive ventilation method called BiPAP can be used in the treatment of sleep apnea. High pressure air is pumped into the lungs with the BiPAP mask. Then the pressure drops and exhalation is provided. With BiPAP, the quality of life increases and the need for invasive ventilation can be delayed.