Relationship between respiratory muscle electromyogram and rib cage motion in tetraplegia

In an attempt to understand the intersubject variation in rib cage motion in tetraplegia, and to assess the isolated action of the diaphragm on the human rib cage, we studied the pattern of rib cage motion in relation to the pattern of nondiaphragmatic respiratory muscle electromyogram (EMG) in 20 tetraplegic patients breathing at rest in the seated posture. The general pattern included a greater expansion of the lower than of the upper rib cage, and a greater and earlier expansion of the lower rib cage in its transverse than in its anteroposterior (AP) diameter. However, whereas the upper rib cage moved paradoxically inward with inspiration in 11 patients, it did not move or slightly expanded in 9 patients; in 1 of these, all rib cage diameters increased in the same proportion during inspiration as during relaxation. This intersubject variation was not related to the duration of tetraplegia, the pattern of the abdominal muscle EMG, or the presence of continuous spastic EMG activity in the parasternal intercostals. By contrast, it was related in part to the pattern of scalene EMG activity: upper rib cage AP paradox was present in 7 of 8 patients with spastic or silent scalenes but only in 4 of 12 patients with phasic inspiratory scalene EMG activity. When studied during quiet breathing in the supine posture, the 8 subjects with denervated scalene, intercostal, and abdominal muscles still showed inspiratory increase in the rib cage transverse diameter, but in 7 patients the lower rib cage AP diameter decreased in concert with the upper rib cage AP diameter.(ABSTRACT TRUNCATED AT 250 WORDS)