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Background and Purpose. This case report describes the use of glossopharyngeal breathing (GPB) and neck accessory muscle breathing (NAMB) in the treatment of an individual who was dependent on a ventilator secondary to a spinal cord injury. Case Description. The patient was a 19-year-old man with C2 complete tetraplegia. He received a 5-week inpatient program of GPB training 3 to 4 times per week. A 4-week NAMB training program followed. Outcome. Following GPB training, forced vital capacity increased 35-fold, time off the ventilator improved from 0 to 30 minutes, and a nonfunctional cough became a weak functional cough. After NAMB training, the patient was able to be off the ventilator for 2 minutes. Discussion. Increased ventilatory capability has the potential to affect patients' quality of life by improving cough function and decreasing dependence on a ventilator in the event of accidental disconnection. [Warren VC. Glossopharyngeal and neck accessory muscle breathing in a young adult with C2 complete tetraplegia resulting in ventilator dependency. Phys Ther. 2002;82:590-600.]
Key Words: Emergency breathing techniques, Glossopharyngeal breathing, Neck accessory muscle breathing.
The number of people living today with spinal cord injuries who are dependent on a ventilator has increased due to improved intensive medical support.1-3 One of the greatest fears of people who are dependent on ventilators is becoming accidentally disconnected from the ventilator.4 Glossopharyngeal breathing (GPB) and neck accessory muscle breathing (NAMB) are 2 alternative breathing techniques that these people can use in emergencies and to promote respiratory health.5-8
Glossopharyngeal breathing involves a series of gulps using the lips, tongue, pharynx, and larynx to pull air into the lungs when the normal inspiratory muscles are not functioning5 (Fig. 1). Glossopharyngeal breathing consists of cycles of 6 tolO gulps of air followed by exhalation. Exhalation occurs when the glottis opens and the inflated lungs deflate passively due to the elastic recoil of the lungs. In addition, GPB has been recommended to allow an individual to perform a functional cough to clear tracheal secretions, increase the volume of the speaking voice, and maintain chest wall mobility.9,10
People with high tetraplegia also can use the neck accessory muscles to breathe in the event of ventilator disconnection. Neck accessory muscle breathing uses muscles such as the sternocleidomastoid and scalenus to aid...