Rehabilitation of quadriplegic patients with phrenic nerve pacers

Patients with viable phrenic nerves and adequate diaphragm and lung function can be freed from mechanical ventilation by the use of phrenic nerve pacers. Four quadriplegic patients with phrenic nerve pacers were admitted to a rehabilitation facility between April 1981 and September 1986. These patients made significant gains after undergoing a comprehensive rehabilitation program. They developed skills to maximize their independence, including independent electric wheelchair mobility and independent use of environmental control systems. They were able to communicate verbally by corking their tracheostomies, to write and type by using mouthsticks, and to use computers with mouth-sticks or pneumatic switches. All four patients were discharged to home with a family member as the primary care-provider. Successful discharge can be achieved only by adequate family teaching and counseling, optimal equipment prescription, adequate nursing and other community support for the primary care-provider, and close medical follow-up.