Rehabilitation of spinal cord injured patients on long term ventilation

Recent advances in roadside management and resuscitation techniques have resulted in an increased survival rate of people with high cervical cord injury. A few become partially or permanently ventilator dependent. Not only are these people dependent on assisted ventilation, but their speech is also compromised, along with loss of voluntary control and many other bodily functions, as they are tetraplegic. By using recent technological advancements, such as portable ventilators, phrenic nerve stimulation, environmental controls and specialised wheelchairs it has been possible to manage such patients at home. Furthermore, patients on ventilators are unable to have verbal communication. There is therefore a need for them to develop either augmentative communication or the use of alternative communication aids. Recent published reports indicate the factors other than the clinical state that may prevent such patients from taking advantage of modern advances; the main issues appear to be cost factors, community care provision and ethical considerations.