Breathing seems pretty basic. Inhale. Exhale. Repeat. When you stop … well … you have a problem.
Obviously, if you can't breathe, you've got problems. For some spinal cord injury survivors, that's just a part of the injury. For others - those to whom this article is addressed - it could become or is becoming a problem. The issues boil down to four major categories:
Believe it or not, your lungs are not affected by spinal cord injury. However, the muscles of your chest, abdomen, and maybe even your diaphragm can be affected - and, except for perhaps the lowest para, every person with a spinal cord injury needs to understand how these muscles affect your breathing. As your various breathing muscles contract, they allow your lungs to expand, which changes the pressure inside your chest so that air rushes into your lungs. This is inhaling. Normally as you relax those same muscles, the air flows back out of your lungs, and you exhale. It is during exhalation that we talk and speak. In normal breathing, inhaling is work, requiring muscle strength, but exhaling is passive - it just happens as those inhalation muscles relax. There are exceptions. Examples of active or forced exhalations - where you use muscle strength - include blowing and coughing. So, if any or all of your breathing muscles are weakened or paralyzed, how much and how deeply you can breathe in will be affected, as will your ability to cough.
Anything that makes breathing difficult or shallow can lead to problems. Your whole lung is ready and able to process oxygen to give you … well … life. A shallow breath fills up only part of the lungs - typically, the upper part. Deeper breaths, which use your whole lungs, give your body more oxygen per breath, since every part of your lung works at pulling oxygen out of the air. Perhaps more important, moving the air through all of your lungs reduces the collections of natural secretions in your lungs, and breaks up and moves the secretions that are there. Also, the frequent moving around of highly active people helps break up and move around the fluid in the lungs. Otherwise, these secretions can act as glue causing the sides of your airways to stick together and not inflate properly. This is called atelectasis or a collapse of part of the lung. Many people with SCI are at risk for this. First, because of muscle weakness they may breathe more shallowly, "neglecting" the lower areas of their lungs. Secondly, they are less mobile, and so don't have the advantage of frequent position changes to break up any secretions that are there. Third, many of them can't get the same strong cough that they had before they were injured and so are further unable to clear secretions. They may have a harder time getting rid of any colds or respiratory infections that they do catch, leaving what feels like a constant chest cold. And, if all those secretions become the breeding ground for various nasty organisms, you're likely to end up with pneumonia.
Another issue that can affect breathing for people with spinal cord injuries is posture. Postural changes can impair breathing ability even for those able to use all the breathing muscles. They can squeeze the lungs, making it harder to expand the lungs and get air. SCI survivors who experience severe scoliosis - a sideways spinal deformity - or severe kyphosis - which causes a person to slump forward - can find their breathing significantly compromised. While not always avoidable, these spinal deformities can be at least partially treated with wheelchair modifications, postural supports, or corsets. Treating or avoiding scoliosis and kyphosis can improve your endurance and fatigue by helping you breathe easier and deeper.
What are things you can do to stack the respiratory odds more in your favor?
The thing is: breathing is important. Most respiratory problems are easily treatable. None of these problems should be taken casually, because all of them, if not properly treated, can cause serious permanent damage. A doctor, nurse, or physical or respiratory therapist can help you with more information.
We first wrote this article on breathing for Paraplegia News, where it appeared in the April 2001 issue. It is reprinted here with the permission of PVA Publications. It is part of a library of educational brochures developed by Craig Hospital with a federal grant titled, "Marketing Health Promotion, Wellness, and Risk Information for Spinal Cord Injury Survivors in the Community." The opinions expressed here are not necessarily those of the funding agency, the National Institute on Disability and Rehabilitation Research of the US Department of Education.
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