Higher level spinal cord injuries — particularly those at cervical and upper thoracic levels — can significantly affect breathing and respiratory function. The intercostal muscles, accessory muscles of respiration, and in high cervical injuries the diaphragm itself may be partially or completely paralysed, leading to reduced respiratory capacity, weak cough, and increased risk of respiratory complications.

Why Respiratory Management Matters

Respiratory complications including pneumonia, atelectasis, and respiratory failure are among the leading causes of morbidity and mortality in acute SCI, particularly in the first year after injury. Proactive respiratory physiotherapy from the earliest possible stage is essential to reduce these risks.

Physiotherapy Techniques

Assisted coughing techniques — including manually assisted cough and mechanical insufflation-exsufflation — help clear secretions and reduce the risk of chest infections. Breathing exercises improve lung volumes and respiratory muscle strength. Postural management influences respiratory mechanics and should be considered in all positioning decisions.

References

Reid, W.D. et al. (2010). Physiotherapy management of the respiratory complications of spinal cord injury. Physical Therapy Reviews, 15(5), 294–306. https://doi.org/10.1179/108331910X12837508971720

Berlowitz, D.J. & Tamplin, J. (2013). Respiratory muscle training for cervical spinal cord injury. Cochrane Database of Systematic Reviews, Issue 7. https://doi.org/10.1002/14651858.CD008507.pub2