With a spinal cord injury of C4 and higher, all the muscles which control breathing will be paralysed. these are the intra costal muscles, the diaphragm and the abdominal muscles. In order to breath, the person will need a ventilator to breath for them, this machine forces air in and out of the lungs to re-oxygenate the blood. In order to cough, the person will need the help of a carer, performing an assisted cough procedure. By having someone assist you in coughing, your cough will be more forceful and productive and you will be able to both prevent and treat some respiratory complications by bringing up secretions normally present in the lung.
Place the fist of one hand, immediately below the breastbone, and the heel of the other hand on top of the breastbone. The hands need to be over the diaphragm area.
Take a breath and cough, as you exhale the air your assistant should push inward and upwards as you cough.
Injuries between C4 and T6 will leave the person able to breath on their own, however, because the intra costal muscles may be weakened, depending on the level of injury, coughing may also be a problem. Quadriplegics may need help in coughing, whilst paraplegics may have enough abdominal movement to clear airways on their own. If sat in a wheelchair throwing yourself forward at the same time as coughing will exert enough pressure for a good cough.
Injuries between T6 and T12 do not normally affect breathing, however the ability to cough will be impaired. It is only with injuries below T12 that normal breathing and cough reflexes are preserved.
The inability to cough is of major importance to a person with a spinal cord injury, as failure to remove dust, mucus or saliva from the lungs can lead to infection. The most common infections are common colds, bronchitis, bronchiolitis and pneumonia. If an infection does occurred in the lungs it may be necessary to take a course of antibiotics to help clear the chest. With all infections of the chest, it may be necessary to clear the lungs with an assisted cough.
Physical exercise is a good way of keeping healthy lungs, along with deep breathing exercises.