Coughing

Last week's post on Incentive Spirometers is an integral part of health for quadriplegics. The diaphragm strengthening encouraged by an incentive spirometer is an important part of keeping our breathing strong and healthy. Usually inhaling is not the difficult part of breathing for someone who still retains the capacity to breathe without a respirator. The difficulty comes in exhaling with force. This limitation makes it difficult to have a good cough or sneeze, and forget about easily inflating a balloon or blowing your nose.

Being able to properly fill and empty our lungs is important to keeping them clear of phlegm and getting rid of it when sickness does set in. Having a cold is so much more difficult as a quadriplegic. It's never a pretty sight to be sick but the time spent clearing passages seems to be so much more significant when it takes that much more effort to get the job done. Before my injury I was never able to properly hock-a-lugie, that is, inhale my nasal mucus and expel it through my mouth. Necessity is the mother of invention.

More immediate is the danger when we are choking and have difficulty expelling what air is in our lungs to try to clear the passageway. I am notorious for accidentally inhaling sharply and getting some of my own saliva partway down my trachea. I believe it was only one time that I actually needed assistance in the form of abdominal thrusts to clear my airway when that happened.

As I mentioned in my post on Autonomic Dysreflexia, I was again disappointed by the rehabilitation staff as they were almost entirely unable to assist me in learning to cough properly. My education came from a fellow patient who, after two years of being discharged from rehab, returned to increase his independence. To this point he had relied on his wife's help for many, many of his daily needs but wanted greater independence. One of the things he had learned to do, and was kind enough to teach me, was to cough strongly.

The photo, indicating the motion used, demonstrates how we can compensate for the lack of abdominal muscles normally used to give the diaphragm a firm wall to press against when coughing, sneezing, blowing your nose or any other task requiring strong exhaling. By bending over quickly, either by gravity or by pulling on the frame of my wheelchair, timed with my exhale, I can cough just as hard as anyone. Unfortunately, I am not able to cover my mouth as I would like when doing this, but at least my cough is directed at my feet and not the people around me. Sneezing is much more difficult to time because it is involuntary. Often I can assist it simply by being in a slightly bent over position which adds some pressure to my abdomen, but it's still never a full, satisfying, sneeze. As for blowing my nose, I can use this technique to a degree in the shower. Otherwise, just like coughing, what comes out has to go somewhere and my hands are currently occupied and unable to hold a tissue in front of my nose.

This same technique can be used with less efficiency while in bed. When sitting up I can bend over quickly to add pressure to my abdomen but not as much pressure as when sitting in my chair, with my knees to my chest. If I am able to keep my legs straight while sitting up in bed using this technique it does add more pressure than if my legs are bent out to the side. The problem with this technique when I have a cold is that it requires me to sit up every time I need to cough. When sick this can be very often. The alternative is not pretty, but it works. By timing my exhale while pushing, almost striking, just below my ribs I can add enough pressure to cough strong enough to expel the irritant. It might look like I am beating on my stomach but when you need rest to get better, but cannot get that rest because of incessant coughing, it's better than nothing.

One final technique is a shallower throat clearing method that I am not certain I can explain well. Using your vocal cords, with your mouth closed, allowing the air and sound to exit your nasal passages, you can make a "erh-erh-erh-erhm" sound and vibrations that can very effectively clear blockages near the top of the trachea.

I hope this helps to prevent a few cases of pneumonia and to help a few people endure a chest cold a little bit easier.

Source: Respiratory therapists taught me much and could probably teach you techniques based on your physical ability.