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1. Noninvasive Neuromodulation Techniques in Difficult Tracheostomy Weaning of Patients With Spinal Cord Injury

Author

Priscila de Carvalho, Lucas de Macedo dos Santos, Clarice Tanaka, Adriana Sayuri Hirota, Cristiane Marcela da Silva Barbosa, Danilo Miyoji Nakamura de Sousa, Clara Hikari Ito, Rita Pavione Rodrigues Pereira, Abrahão Fontes Baptista, Thabata Cristina Candido Caetano, and Juliana Barbosa Goulardins

Subjects
Pulmonary and Respiratory Medicine, Transcranial direct-current stimulation, Supplementary motor area, business.industry, medicine.medical_treatment, Critical Care and Intensive Care Medicine, medicine.disease, Spinal cord, Neuromodulation (medicine), Diaphragm (structural system), 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, 030228 respiratory system, Anesthesia, medicine, Respiratory muscle, 030212 general & internal medicine, Respiratory system, Cardiology and Cardiovascular Medicine, business, Spinal cord injury
Abstract

High spinal cord injured patients (SCI) are susceptible to respiratory muscle impairments. Transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) may influence the diaphragm's central control, but until now they are not described as a therapeutic resource for difficult weaning. We present two case reports of SCI patients (P1 and P2) with long-term tracheostomy (>40 days) and hospital stay (>50 days). In association with respiratory exercise, P1 received a combined application of anodal tDCS over the supplementary motor area plus sensory PES in the thoracic-abdominal muscles, and P2 received isolated excitatory PES in the abdominal muscles, applied daily except on weekends. Maximum inspiratory/expiratory pressure, peak cough flow, diaphragm excursion, and thickening fraction were measured in the first and last days of the protocol. Both patients had improvements, with clinical impact such as cough effectiveness, decannulated after 15 applications of stimulation. Augmentation of neural respiratory drive and corticospinal excitability is suggested.

Published
2021
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2. Noninvasive Neuromodulation Techniques in Difficult Tracheostomy Weaning of Patients With Spinal Cord Injury: Report of Two Cases

Author

Priscila, De Carvalho, Juliana Barbosa, Goulardins, Danilo Miyoji Nakamura, de Sousa, Cristiane Marcela da Silva, Barbosa, Thabata Cristina Candido, Caetano, Lucas de Macedo, Dos Santos, Clara Hikari, Ito, Adriana Sayuri, Hirota, Rita Pavione Rodrigues, Pereira, Abrahão Fontes, Baptista, and Clarice, Tanaka

Subjects
Adult, Male, Tracheostomy, Cough, Cervical Vertebrae, Humans, Electric Stimulation Therapy, Length of Stay, Transcranial Direct Current Stimulation, Breathing Exercises, Spinal Cord Injuries
Abstract

High spinal cord injured patients (SCI) are susceptible to respiratory muscle impairments. Transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) may influence the diaphragm's central control, but until now they are not described as a therapeutic resource for difficult weaning. We present two case reports of SCI patients (P1 and P2) with long-term tracheostomy (40 days) and hospital stay (50 days). In association with respiratory exercise, P1 received a combined application of anodal tDCS over the supplementary motor area plus sensory PES in the thoracic-abdominal muscles, and P2 received isolated excitatory PES in the abdominal muscles, applied daily except on weekends. Maximum inspiratory/expiratory pressure, peak cough flow, diaphragm excursion, and thickening fraction were measured in the first and last days of the protocol. Both patients had improvements, with clinical impact such as cough effectiveness, decannulated after 15 applications of stimulation. Augmentation of neural respiratory drive and corticospinal excitability is suggested.

Published
2020

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