ABSTRACT
Children with respirator-dependent quadriplegia because of C-2 spinal cord injuries are now surviving the acute stages of their injury. The major cause of mortality and morbidity in the chronic stage is due to respiratory complications. Surveillance, 24 h/d, is the best way to prevent accidental disconnection of respirator equipment from the patient and its inherent catastrophic consequences. The constant risk of disconnection adds tension to the home environment and takes away from the patient any degree of independence or privacy. Because of this, an alternative method of respiration using neck accessory muscles was developed to restore a patient-controlled, voluntary system of respiration. This method, neck breathing, is described in detail in seven children varying in age from 3 years to 16 years 3 months. All seven patients had complete paralysis of the intercostal muscles and the diaphragm. An eighth patient who was unable to learn the technique is also described. Neck breathing is also compared to glossopharygeal breathing, an alternative method of respiration developed during the polio era.
Subject(s)
Muscles , Neck Muscles , Quadriplegia/rehabilitation , Spinal Cord Injuries/rehabilitation , Ventilator Weaning/methods , Adolescent , Age Factors , Child , Child, Preschool , Humans , Physical Therapy Modalities , Ventilators, MechanicalABSTRACT
The ischial tuberosities, the sacral coccygeal area, and the greater and lesser trochanters and intertrochanteric crests receive excessive pressures when an individual is in the sitting position. Prolonged sitting by patients with insensitive skin and physical disability can cause pressure sores. Pressures below 20 to 30 mmHg are required to prevent capillary occlusion. Pressures are measured with a transducer system as the patient sits in his natural sitting posture in his wheelchair. A seat cushion is then "customized," which will redistribute excessive pressures. The most common cushion used is made of 3-in or 4-in high-density polyurethane foam. This material is easily modified when making ischial tuberosity cutouts and constructing a preischial bar. Because there is no single safe sitting pressure, each patient must be provided with a cushion support system that best reduces his excessive pressures. Although a properly fitted cushion can redistribute pressure, it can never substitute for relief of weight-bearing areas routinely carried out several times each hour.
