Functional Magnetic Stimulation of Inspiratory and Expiratory Muscles in Subjects With Tetraplegia

Background: Respiratory complications are major causes of morbidity and mortality in persons with a spinal cord injury, partly because of respiratory muscle paralysis. Earlier investigation has demonstrated that functional magnetic stimulation (FMS) can be used as a noninvasive technology for activating expiratory muscles, thus producing useful expiratory functions (simulated cough) in subjects with spinal cord injury. Objective: To evaluate the effectiveness of FMS for conditioning inspiratory and expiratory muscles in persons with tetraplegia. Design: A prospective before and after trial. Setting: FMS Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH. Participants: Six persons with tetraplegia. Method: Each subject participated in a 6-week FMS protocol for conditioning the inspiratory and expiratory muscles. A magnetic stimulator was used with the center of a magnetic coil placed at the C7-T1 and T9-T10 spinous processes, respectively. Pulmonary function tests were performed before, during, and after the protocol. Main Outcome Measurements: Respiratory variables included maximal inspiratory pressure (MIP), inspiratory reserve volume (IRV), peak inspiratory flow (PIF), maximal expiratory pressure (MEP), expiratory reserve volume (ERV), and peak expiratory flow (PEF). Results: After 6 weeks of conditioning, the main outcome measurements (mean +/- standard error) were as follows: MIP, 89.6 +/- 7.3 cm H2O; IRV, 1.90 +/- 0.34 L; PIF, 302.4 +/- 36.3 L/min; MEP, 67.4 +/- 11.1 cm H2O; ERV, 0.40 +/- 0.06 L; and PEF, 372.4 +/- 31.9 L/min. These values corresponded to 117%, 107%, 136%, 109%, 130%, and 124% of pre-FMS conditioning values, respectively. Significant improvements were observed in MIP (P = .022), PIF (P = .0001), and PEF (P = .0006), respectively. When FMS was discontinued for 4 weeks, these values showed decreases from their values at the end of the conditioning protocol, which suggests that continual FMS may be necessary to maintain improved respiratory functions. Conclusion: FMS conditioning of the inspiratory and expiratory muscles improved voluntary inspiratory and expiratory functions. FMS may be a noninvasive technology for respiratory muscle training in persons with tetraplegia.