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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The intradiscal lumbar pressure was measured in 10 patients with para- or tetraplegia and in one normal subject. The pressure was registered both in the horizontal position and during tilting on a table, during the performance of a standardized exercise program for the upper extremities, as well as during cough, during abdominal strain and while the subjects were being turned from the supine to the lateral position. The increase in pressure during the tilting to an angle of +30 degrees, and mostly to +50 degrees was less than the maximum pressure change during the exercises to which an immobilized patient with acute unstable fracture of the spine, was exposed daily, such as being turned, performing respiratory exercises and muscular training for the upper extremities. Provided fixation was secured with a belt, patients with unstable fractures of the thoracic and lumbar spine maybe treated with a "more active immobilization" tilting them in the bed even during the acute stage. Forward flexion exercises in the shoulder joints with hand weights produced a greater increase of the intradiscal pressure than did abduction exercises with the corresponding load. Spasticity produced a considerable increase in intradiscal pressure.
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PMID:Disc pressure measurements in para- and tetraplegic patients. A study of of mobilization and exercise in para- and tetraplegic patients. 41 93

Subjects with traumatic tetraplegia use the pectoralis major to compress the upper rib cage and increase intrathoracic pressure during cough. It is not known, however, whether they also contact the diaphragm during the expiratory phase of cough, as normal subjects do. We have investigated the action of the diaphragm during single voluntary coughing efforts in subjects with complete transection of the lower cervical (n = 5) or midthoracic (n = 2) cord. All subjects showed at least one peak of transdiaphragmatic pressure during the expiratory phase of the effort, and simultaneous bursts of electrical activity were recorded from the diaphragm. Coughing also resulted in an outward (paradoxical) motion of the abdomen during the compressive phase. We conclude that antagonistic contraction of the diaphragm is present during the expiratory phase of cough in spinal cord-injured subjects with paralysis of the abdominal muscles; this contraction, therefore, does not occur in response to activation of these muscles. The present results also indicate that the cough-induced paradoxical expansion of the abdomen is due to contraction of the pectoralis major and not of the diaphragm.
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PMID:Action of the diaphragm during cough in tetraplegic subjects. 156 63

We have previously shown that subjects with traumatic tetraplegia use the clavicular portion of the pectoralis major to expire actively. To determine if we could improve the expiratory function of these subjects, we studied six patients in whom the pectoralis major was trained by repetitive, strenuous, isometric contractions for 6 wk. Six patients receiving conventional respiratory rehabilitation served as control subjects. Training of the pectoralis major produced marked increases in the maximal isometric muscle strength (mean +/- SE: 54.6 +/- 5.8%; p less than 0.005) and in expiratory reserve volume (46.6 +/- 9.9%; p less than 0.005). Functional residual capacity did not change, such that residual volume decreased by 14.1 +/- 2.9% (p less than 0.005). In contrast, the control patients did not develop any significant alterations. We conclude that unlike conventional rehabilitation, training the pectoralis major for strength improves expiratory function in tetraplegic subjects. Therefore, training of this muscle should increase the effectiveness of coughing and might reduce the prevalence of bronchopulmonary infections in such subjects.
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PMID:The effect of pectoralis muscle training in tetraplegic subjects. 271 49

Traumatic tetraplegia produces paralysis of all the well-recognized muscles of expiration. Yet, tetraplegic subjects usually have a small expiratory reserve volume on spirographic examination. To understand the mechanism that enables these patients to empty their lungs actively, we studied the pattern of chest-wall motion during voluntary expiration. We found negligible changes in abdominal dimension, but all subjects had a marked and reproducible decrease in the dimension of the upper rib cage. Electrical measurements established that the subjects had active use of the clavicular portion of the pectoralis major, and changing the orientation of these muscle fibers by maintaining the shoulders in abduction reduced their expiratory reserve volume by about 60 percent (P less than 0.001). We therefore conclude that the clavicular portion of the pectoralis major plays a crucial part in the mechanism of active expiration in tetraplegic subjects. Training of this muscle bundle could, by increasing its strength and endurance, improve the effectiveness of coughing in such subjects and perhaps diminish the prevalence of bronchopulmonary infections.
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PMID:Mechanism of active expiration in tetraplegic subjects. 395 3

Abdominal muscle support is essential for singing. Nevertheless, it has been possible to rehabilitate a professional singer who sustained a C-5 fracture and quadriplegia. The device that has been developed has restored his ability to support singing and has improved respiratory function substantially. It appears to have potential usefulness for restoring effective coughing in other quadriplegic patients.
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PMID:Rehabilitation of a quadriplegic professional singer. Use of a device to provide abdominal muscle support. 623 83

Although all the well-recognized muscles of expiration are paralyzed after traumatic transection of the lower cervical cord, tetraplegic subjects can still empty their lungs actively by contracting the clavicular portion of the pectoralis major. It is not known, however, whether contraction of this muscle bundle may raise pleural pressure enough to cause dynamic compression of the intrathoracic airways, which is critical for the production of an effective cough. To investigate this question, we measured expiratory flow rate and esophageal pressure during a series of forced expiratory vital capacity (VC) maneuvers in twelve subjects with C5-8 traumatic tetraplegia and constructed isovolume-pressure flow (IVPF) curves. The curves were interpretable with certainty in nine patients. Three of them did not show any plateau of flow. On the other hand, six patients had clearcut plateaus of flow on all IVPF curves between 80-60 and 20% VC, suggesting they had dynamic airway compression. Videoendoscopic recordings in two patients confirmed trachea and main bronchi collapse during forced expiration and cough. We conclude, therefore, that contraction of the pectoralis major causes dynamic airway compression during expiratory efforts in a substantial proportion of tetraplegic subjects. Increasing the pressure-generating capacity of this muscle might thus improve the effectiveness of cough and reduce the prevalence of bronchopulmonary infections.
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PMID:Evidence of dynamic airway compression during cough in tetraplegic patients. 792 40

An autopsy case of meningeal spreading of glioblastoma multiforme (GBM) probably originating in the cervical cord was reported. In contrast to autopsy findings, main symptoms were similar to subacute meningitis, and any signs of myelopathy could not be detected during the clinical course. The patient was a 22-year-old man who was hospitalized because of a 2-week history of progressive headache following cough and slight fever. Vomiting and somnolence, developing 5 days before admission, were improved the day after a lumbar puncture performed at another hospital. On admission, meningeal signs, mild right abducens palsy, and depressed deep tendon reflexes were detected. There was no muscle weakness, sensory loss, or Babinski sign. Lumbar puncture yielded CSF with an opening pressure of 280 mmH2O, 21 mononuclear cells/mm3, a protein level of 645 mg/dl, and a glucose level of 7 mg/dl. Cytology for malignancy and multiple cultures were negative. Brain CT scan showed mild hydrocephalus and swelling of the brainstem and cerebellum. Intravenous administration of antimicrobial drugs was started and ventriculoperitoneal shunt surgery was performed. During the third hospital week, however, meningeal signs progressed and somnolence reappeared, followed by progressive multiple cranial neuropathy and polyradiculopathy characterized by flaccid tetraparesis, muscle atrophy, and sensory impairment without a level. Babinski sign could not be detected. MRI revealed an intramedullary lesion in the lower cervical cord, swelling of the brainstem, cerebellum, spinal cord and nerve roots, and a diffuse or nodular thickning of leptomeninges. Repeated CSF cytology disclosed atypical cells. Examinations for extraneural malignancies were negative. During the 9th hospital week, flaccid tetraplegia progressed and stupor developed, and the patient died 2 weeks later. The pathological study was limited to the brain. The brain showed a diffuse opalescent thickening of the leptomeninges, especially over the ventral aspect of the brainstem and cerebellum, where the blood vesseles and cranial nerves were obscured. Histological examination revealed the appearance of GBM. The malignant cells filled the subarachnoid space, and to a variable extent penetrated the brainstem and cerebellum along perivascular spaces. Hypertrophied optic tracts and trigeminal nerves were also infiltrated by the cells. However, there were no mass lesions assumed to be primary ones anywhere in the cerebral parenchyma. Therefore, it was thought that GBM primarily growing in cervical cord metastasized to intracranial subarachnoid space by way of the cerebrospinal fluid pathway. Spinal cord GBM usually presents signs of myelopathy from the early stage. The present case was characterized by no signs of myelopathy during the clinical course. It is speculated that the intramedullary GBM, originating near the surface of cervical cord, had been rapidly disseminated into the subarachnoid space up to the intracranial cavity before myelopathy appeared, and caused cranial and spinal nerve roots dysfunction, which covered signs of myelopathy. Cord GBM should be always considered as a differential diagnesis in a case of subacute meningitis.
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PMID:[Meningeal seeding of spinal cord glioblastoma multiforme without any signs of myelopathy]. 872 Mar 35

To determine the prevalence of respiratory symptoms in subjects with chronic spinal cord injury (SCI), 180 subjects completed a standard respiratory questionnaire modified for subjects with limited mobility. Subjects were categorized as high tetraplegia (HT:C5 and above not requiring mechanical ventilation), low tetraplegia (LT: C6-8), high paraplegia (HP: T1-7), or low paraplegia (LP: T8-L3). Overall, 68% of subjects reported one or more respiratory symptom. Breathlessness, the most prevalent complaint, was associated with level of lesion: HT = 73%, LT = 58%, HP = 43% and LP = 29%, whereas complaints of cough, phlegm, cough and phlegm, and wheeze did not differ significantly among subjects in the four groups. Breathlessness occurred significantly more often in the group with HT during rest or following exposure to hot air or passive smoke. Awareness of phlegm or wheeze was reported with increased prevalence among subjects with tetraplegia who had complete injuries. Among subjects with tetraplegia, respiratory complaints did not differ significantly in current smokers, former smokers, and non-smokers, whereas among subjects with paraplegia, phlegm and wheeze were reported more frequently, among current smokers.
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PMID:Self-reported prevalence of pulmonary symptoms in subjects with spinal cord injury. 934 93

Techniques for augmenting, when necessary, the normal mucociliary and cough clearance mechanisms of the lungs are not new, but, in more recent years, techniques have been developed which are effective, comfortable and can be used independent of an assistant in the majority of adolescents and adults. Postural drainage with chest clapping and chest shaking has, in most parts of the world, been replaced by the more effective techniques of the active cycle of breathing, autogenic drainage, R-C Cornet, Flutter, positive expiratory pressure mask, high-frequency chest wall oscillation and intrapulmonary percussive ventilation. Glossopharyngeal breathing is being considered again and is often a useful technique for increasing the effectiveness of cough in patients with tetraplegia or neuromuscular disorders. The evidence in support of these techniques is variable, and the literature is confusing and conflicting. There may or may not be significant differences among the techniques in the short or long term. Many of the regimens now include the forced expiratory manoeuvre of a "huff" and this has probably increased the effectiveness of airway clearance. If objective differences are small, individual preferences and cultural influences may be significant in increasing adherence to treatment and in the selection of an appropriate regimen or regimens for an individual patient.
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PMID:Physiotherapy for airway clearance in adults. 1062 75

A 2 year-old Malay girl was admitted to our institution with a chesty cough and breathlessness but later found to have a chronic C1/C2 subluxation for one and half year with tetraplegia. Her cervical cord was decompressed and occipito-cervical fusion performed. Her neurological status improved significantly post-operatively and is able to care for her personal hygiene. The authors believe that the ability of the cervical cord to recover in the paediatric age group is remarkable that surgical option should be considered even when all seen lost. We believe that this is the first report in the literature to support this potential.
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PMID:Delayed decompression of chronic C1C2 subluxation in a pediatric patient with tetraplegia--is recovery possible? 1181 56


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