After a spinal cord injury, breathing may not be easy. The better you can breathe, the better you can speak, eat, cough, laugh and even sing. This video explores how a spinal cord injury impacts the main four breathing muscles, explains the importance of keeping those muscles strong in order to prevent infection and provides information needed to manage breathing for good health.

The Living With a Spinal Cord Injury series is made possible by a gift from David and Barbara Loeb.  

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Narrator: As easy as breathing, so the saying goes. But after a spinal cord injury, breathing might not be so easy. But the better you can breathe, the better you can speak eat, cough, laugh, even sing. Breathing gives you energy and is made possible by four main muscle groups.  Neck muscles help expand your upper chest when you take a breath. Intercostal muscles between each of your ribs help your chest move in and out.  Your diaphragm is a dome-shaped muscle in your stomach area that is your main breathing muscle. And your abdominal muscles are used for deep breathing and coughing. Weak breathing muscles can lead to lung congestion and infections, such as pneumonia. Strengthening weak breathing muscles is a critical part of your rehab program.

Goldsborough: After you have a spinal cord injury, especially if you have an injury in your neck. That's where all the nerves and muscles are that affect the breathing of your lungs, and your abdomen, and your diaphragm. So, if those nerves and muscles are affected and impaired, then you're not going to be able to breathe very well. You have mucus in your lungs and secretions. We all have that. And all that stuff just sits in your body. So, we need to try to get that out. That's why we do all of these devices and exercises, to try to help you breathe better, move the mucus and the secretions from your lungs. Help you cough it back out. Normally, we do that all day long without thinking about it. Not that people walking around coughing all day, but you are moving so that the lungs are not just keeping all that secretion in there.

Narrator: You may wear an elastic binder around your waist. The binder supports weak stomach muscles to help you breathe better. Worn while you're out of bed or sitting up, it should fit tightly below your ribs and down to your hips. If worn under clothing, make sure it doesn't rub or irritate your skin. Deep breathing exercises will strengthen your breathing muscles and can be done anytime, anywhere. Take a slow breath in through your nose, hold your breath for a few seconds if you can. Now gently blow out of your mouth. Repeat these steps ten times.

Wright: And the deep breathing and coughing. I say smell, the roses and blow out the candles. That's a best way to breathe every day. And coughing and clearing your secretions. If you feel junky or if you feel like you can't take a deep enough breath. Deep breath and cough is a good way to do every day.

Narrator: An acappella device can be used to strengthen breathing muscles.

Goldsborogh: I use the acapella very often, which is an expiatory muscle strength trainer. So, it's a device that you put in your mouth, and you blow into it, and it has a little flutter valve in it and so you're creating a pressure, and there's resistance. So, it actually has a dial on the bottom that you can turn to make it harder. Start out usually with the easier level and you have the patient blow into it and they're gonna do this ten times. Once an hour or as often as they can during the day. I usually tell people try to shoot for three or four times a day, if you can do more than that, that's better. So, the idea is you're blowing against this valve and that's going to help create a pressure that gets that mucus and the secretions out of your lungs. We want to bring that up. And then after that you have to try to cough to bring it up.

Narrator: Sometimes having a spinal cord injury may make it difficult to cough. Coughing is important as it clears mucus stuck in your lungs.  You can use assisted coughing when your stomach muscles are weak.

Goldsborogh: You could either lean against a table if you're gonna do it yourself. Or a family member is gonna put their hands here, on your abdomen, and they're gonna push up with effort as you try to cough. And so, they're gonna do that a few times push in, you try to cough, and you try to move those secretions out of the lungs through your throat. Hopefully expectorate if you can, but at least get them moving, so everything's not just sitting in your system.

Narrator: For individuals with significant respiratory muscle weakness an assisted cough might be used after each treatment with a respiratory breathing device called a “coughilater.”

Wright: So, the coughilater is actually a machine. It's a device that kind of works like a ventilator, but not quite. It's a machine that uses positive and negative equal pressures. If it can be used with patients who have trachs, or patients who don't have trachs. For Patients who have trachs, we connect it straight to the inner cannula. For patients who don't have trachs, there's a face mask that we use for the patients. Patients who have trachs use higher pressures because there's more resistance getting the secretions up through the inner cannula.  You can help prevent breathing problems by following these simple steps:

• Get out of bed daily and move around as much as possible
• Wear an abdominal binder if needed
• Do your breathing exercises daily
• Cough or get help to cough to clear mucus
• Drink as much fluid as your bladder program allows
• Keep good, eating sleeping and exercise habits and don't smoke
• Get a flu shot every year and a pneumo vaccination every five years

Wright: Typically, we would ask patients to monitor their breathing so that they know their baseline. So, if anything is different from what their baseline is then I would say be concerned. If your respiratory rate has changed, if you're breathing faster, you're a little bit more to kipnuk, or even if you're taking more shallow breaths, you're not able to get enough air. Some patients, if you're not able to clear your secretions, if you're having trouble coughing, if your cough has become weaker and you can't clear your secretions, then I would call your doctor.

Ed: I'm only breathing from up here. No diaphragm. I have to be careful not to let fluid buildup in my lungs, which for me girl isn't that much of an issue because I keep pretty busy. Colds, you know, all that kind of stuff you have to be careful. You don't want to get pneumonia.

Tyra: Well, both of my lungs collapse due to the gunshot wounds. So, learning how to breathe again on my own. Learning how to speak fluently. Being around my friends, family, and music. Music was always a big thing in my life, so that really helped a lot.

Brad: But I really think the rapping and the music-making was really what helped a lot. Trying to get my voice control. Just trying to take a deep breath and because I let it go as long as possible.

Narrator: Following these guidelines will help prevent respiratory complications and hospitalizations. And give you energy to live your life. Listening, learning, asking questions, and following up with your Rehabilitation doctor, and the rehab team, will provide you with the best education and recommendations to assure you stay healthy and limit the potential complications you might experience as someone living with an STI.