The loss of normal respiratory functions is usually seen following high cervical spinal cord injuries. Since respiration is mainly a function of the diaphragm and intercostal muscles, paralysis of these groups will result in respiratory insufficiency. The traditional management approach of bedside ventilator support has been supplemented in recent years with more sophisticated and technologically advanced equipment, such as the use of portable ventilators and phrenic nerve stimulators. These advances have allowed for increased independence and improved mobility and, as a result, more patients are now managed at home than
in past years. Unfortunately, it is not possible for all patients to take advantage of these advances because of cost factors, a lack of 24-hour providers of care with sufficient nursing skills in the home, and the reluctance of nursing homes to accept patients needing any type of respiratory therapy. Moreover, phrenic nerve stimulators can only be used in patients with viable phrenic nerves. Ventilator use may make home or nursing home placement impossible. A patient with a high cervical spinal cord injury with resultant quadriplegia was admitted into the Southeastern Michigan Spinal Cord Injury System and an alternative respiratory programme was developed which allowed the patient to return home.