Text Box: We don’t always think about how much we rely on air until we are deprived of it. In this issue of The Current, we explore the vital use of neurological devices designed to help people take that critical breath. Whether it is the innate need for daily breathing, assistance with coughing or monitoring sleep disorders like apnea, the neurotechnology field is making advances to assist and monitor the pulmonary system of the human body and to improve or restore the ability to take that fresh breath. Breathing Systems Mechanical ventilator users are not limited to those with high level spinal cord injuries. Vent users include those having a wide variety of disabilities and disorders such as ALS, post-polio and Guillian Barre Syndrome to name a few. What is universally apparent to these users of mechanical breathing systems is the high cost of care. The current neurotechnology alternative to mechanical ventilation is the phrenic nerve, or diaphragmatic stimulator. Unlike ventilator systems, which use mechanical pressure to force air into the lungs, the phrenic stimulation system pulls air into the lungs. The implanted electrodes stimulate the phrenic nerve which contracts the diaphragm. As the diaphragm expands in the contraction, the chest cavity expands, and then the air is pulled into the lungs. As the diaphragm relaxes, the chest cavity retracts and the air leaves the lungs. Text Box: The system components include implanted electrodes cuffed around the phrenic nerve which controls the contraction of the diaphragm. The electrodes and a receiver are implanted under the skin while the external antenna-transmitter is taped to the skin. The small control unit which is not only the brains of the system but also the power source is also external to the body. The use of a phrenic nerve stimulator is only possible if the diaphragm, lungs, and phrenic nerves are functional thus allowing the system to work using these body components. Text Box: Users of the system have realized great rewards, but only with many hours of training. Even after surgery, the user must use the system on a regular basis and must gradually increase the time of use over several months. As you will see from the experience of Steve McPherson, the benefits must be weighed against the risks and also with respect to the time spent with the system. Those benefits can be both tangible and intangible. The tangible benefits include the elimination of a costly ventilator and the associated disposables and equipment, the production of near normal breathing and speech, and a reduction of infections. Some users have been able to close the tracheotomy tube. More important are the intangible benefits felt by those who use the phrenic nerve stimulation system. Its use has been reported as being more cosmetic than a ventilator. Finally, the ease of Text Box: Educate: A Breath of Air Text Box: Personal Experiences: Steve McPherson Text Box: The last day of high school, in June of 1982, Steve McPherson took one more dive into a friend’s pool and changed his life forever. Laying face down in the deep end with a C1/C2 fracture, Steve was saved by his friend from drowning and a new chapter of his life began. About a month after the accident, still in the ICU, Steve overheard his doctors refer to him as a “C1 quad ventilated for life” and he felt like life was over. As he contemplated his options, initially he felt no energy to do anything – digesting his current state was all consuming.During his year and a half in acute care, Steve was both creative and fortunate. Steve’s mom was blessed to meet another C1/C2 quad during a visit to a local rehab hospital who had suffered a diving accident 10 years earlier. Her name was Debbie and she was sporting a walkman-size pacemaker, instead of a ventilator the size of a dresser. The avant-garde equipment, along with Debbie’s stories of an active social life and of swimming in the middle of a lake cheered Steve up. “I realized there was someone out there just like me, and for the first time since the accident, I had hope”, says Steve. Text Box: Steve decided to undergo surgery to have the Avery Labs bilateral phrenic pacer implanted, and for about nine months, he adjusted to the pacers, learning how to “frog breathe” after going to rehab. Steve looks back on this challenging transition. “At the time the pacers were implanted”, Steve notes, “I hadn’t used my diaphragm for several months, so it was very painful learning to use that muscle again. But the benefits have been immeasurable”, Steve notes. Text Box: The pacemaker is a lot smaller (and less conspicuous) than a ventilator, so it’s easier to go out and do things. Thanks to the pacers, Steve got rid of the trach in his neck, which in turn helped him to avoid chest infections so common among quadriplegics. The phrenic pacer, Steve notes, is also more quiet, promoting a peaceful night’s sleep. Text Box: The Current Text Box: