Diaphragmatic function following cervical cord injury: neurally mediated improvement

Vital capacity measurements from 36 people rendered quadriplegic by traumatic cervical cord injuries generally increased during the first ten months after injury, indicating spontaneous improvement in respiratory muscle function. Reasoning that a renewal of neural supply to the diaphragm would probably be accompanied by a parallel renewal of neural supply to other muscles having adjacent motor pathways, the present study compared vital capacity measurements with concomitant muscle function evaluations from 20 of these people. Qualitatively, increases in vital capacity were invariably accompanied by increases in the function of a group of muscles (primarily of the shoulder and upper arm) having some segmental innervation in common with the diaphragm (C3-C5) but were only sometimes accompanied by increases in the function of a group of muscles (primarily of the forearm and wrist) having segmental innervation below that of the diaphragm (C6-C8). These findings suggest that the spontaneous improvement in vital capacity observed in quadriplegic people is mediated in part by corresponding improvement in the neural supply to the diaphragm. Quantitatively, however, linear regression analysis indicated that neither the rate nor the absolute amount of improvement in vital capacity could be predicted with any reliability from pulmonary function tests, neurologic examinations, or muscle function evaluations performed in the early stage of recovery.