Related Experiment Video
Updated: Jun 9, 2026
Assessing Functional Recovery of Eupneic Diaphragm Activity Following Unilateral Cervical Spinal Cord Hemisection in Rats
Published on: June 14, 2024
Diaphragm stimulation after human spinal cord injury: Effects on respiratory function and diaphragm muscle activation
Alicia K Vose1, Kathryn Cavka, Paul Freeborn
1Department of Neurology (A.K.V.), University of Florida College of Medicine-Jacksonville, Jacksonville, FL; Division of Clinical Integration and Research (K.C., A.D.A., E.J.F.), Brooks Rehabilitation, Jacksonville, FL; Department of Clinical and Translational Science (C.N.W.), Cook Children's Health Care System, Fort Worth, TX; Division of Clinical Integration and Research (P.F., G.T.), Brooks Rehabilitation, Jacksonville, FL; Department of Surgery (A.J.K.), University of Tennessee Health Science Center, Memphis, TN; Department of Surgery (B.K.Y.), Indiana University School of Medicine, Indianapolis, IN; Department of Physical Therapy (D.F.), University of Florida College of Public Health and Health Professions, Gainesville, FL; and Department of Surgery (C.C., E.J.F.), University of Florida College of Medicine-Gainesville, Gainesville, FL.
Background:
Respiratory dysfunction is a leading cause of morbidity and mortality after cervical spinal cord injury (C-SCI). Respiratory impairment is exacerbated by mechanical ventilation, which is associated with higher infection rates and diaphragm atrophy. Intramuscular stimulation of the diaphragm, that is, diaphragm pacing (DP), is a potential strategy to facilitate ventilator weaning, enhance respiratory function, and reduce complications. However, its impact on respiratory recovery and neuromuscular activation remains understudied.
Methods:
This prospective observational case series evaluated changes in respiratory function and diaphragm activation over two months in 11 patients with acute traumatic C-SCI who underwent DP. Outcomes included tidal volume, respiratory rate, minute ventilation, maximal inspiratory/expiratory pressure generation (MIP/MEP), forced vital capacity (FVC), and diaphragm electromyography (EMG) recorded from the implanted electrodes.
Results:
Participants demonstrated severe respiratory impairment at baseline, with tidal volumes averaging 2.8±1.3 mL/kg and FVC at 19±14% of predicted. Despite this, 89% weaned from mechanical ventilation within 41±19.8 days post-injury. Significant weekly improvements were evident in tidal volume (+0.26 mL/kg), respiratory rate (-0.66 breaths/min), and minute ventilation (+0.35 L/min). MIP and MEP increased by 3% predicted function per week, and FVC increased by 2% of predicted function per week. Diaphragm EMG amplitudes during quiet breathing decreased over time, particularly in patients with high baseline activation (>80% of maximum) possibly reflecting improved neuromuscular efficiency.
Conclusions:
These findings suggest that DP may support early respiratory recovery after C-SCI improving respiratory function and diaphragm activation. Future research is needed to elucidate the underlying mechanisms and optimize clinical use of DP for respiratory recovery after C-SCI. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).
Level Of Evidence:
Therapeutic Study; Level IV.
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