Neck breathing: a form of voluntary respiration for the spine-injured ventilator-dependent quadriplegic child.

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.

Late spinal deformity in quadriplegic children and adolescents.

Sixty-four quadriplegic children and adolescents were evaluated to determine the benefits of bracing and spinal fusion on the progression and extent of their spinal curves. All those injured before 14 years of age developed a spinal deformity. Bracing in a body jacket assists in maintaining sitting balance and posture and also helps to minimize complications of quadriplegia such as pressure sores. Bracing within 6 months of injury, when the spine is still straight, lessens the incidence, extent, and progression of deformity. Spinal fusion and instrumentation are often necessary for progressive curves to maintain sitting balance and preserve existing function.