New Cough Clinical Trials Program

In Australia, there are 350 cases of traumatic spinal cord injury each year. More than half of these injuries will be to the cervical area of the spine (neck), leading to quadriplegia. While quadriplegia is commonly associated with paralysis of all four limbs, it also affects the major respiratory muscles. This reduces cough strength, which can lead to associated respiratory infections.

Respiratory complications, such as pneumonia and atelectasis, are the leading cause of morbidity and mortality in the first year of quadriplegia. These respiratory complications are particularly prevalent in the first six weeks of injury, with an incidence rate of up to 68 per cent. As well as delaying rehabilitation and reducing quality of life, the number of these complications is a critical determinant of hospital costs.

Dr Bonne Lee and Dr Euan McCaughey, together with Professors Gandevia and Butler and Drs Boswell-Ruys and Hudson, all from NeuRA, are leading the first global trial to investigate the effectiveness of electrical stimulation of the abdominal muscles to reduce respiratory complications in the first 6 weeks of quadriplegia.

The three-year international collaboration brings together leading research and medical teams from: NeuRA, the Prince of Wales Hospital, and the Royal North Shore Hospital in Australia; The Indian Spinal Cord Injury Centre; Chang Mai University Hospital in Thailand; The Queen Elizabeth National Spinal Injuries Unit and the University of Glasgow in Scotland.

The technique being studied, known as Abdominal Functional Electrical Stimulation (FES), has been pioneered at NeuRA, with our researchers showing that it can improve respiratory function in quadriplegia. However, while respiratory function is a predictor of respiratory complications in quadriplegia, the effectiveness of Abdominal FES to reduce respiratory complications remains unknown.

Definitive evidence of the effectiveness of Abdominal FES to reduce respiratory complications in quadriplegia will drive the rapid worldwide translation of this low cost and easily applied technology for this vulnerable patient group. This will lead to decreased morbidity and mortality, reduced rehabilitation time, improved quality of life and result in a large cost saving for global health systems.