Quadriplegia/Immobility

Quadriplegia, or paralysis of all four limbs resulting in inability to move without assistance, may result from traumatic injury to the head or spinal cord or from a variety of congenital or acquired diseases and conditions. Immobility without quadriplegia may occur in severe forms or advanced stages of many conditions including neuromuscular weakness disorders, cerebral palsy, multiple sclerosis, spinal muscular atrophy, and dependence upon mechanical ventilation. Because quadriplegic/immobile patients cannot use exercise to maintain aerobic capacity, bellows function, and lung volume, they are at risk for developing restrictive lung disease. As a result, mechanisms for mobilizing airway secretions, including cough and effective mucociliary clearance (MCC) functions, are diminished or absent. Consequently, secretions accumulate in the lungs, triggering recurrent episodes of respiratory illness. In patients with quadriplegia/immobility, the most common cause of death is acute respiratory failure due to pneumonia and severe mucus plugging precipitated by retention of stagnant airway mucus.

Regular airway clearance therapy (ACT) is recognized as an essential component in the standard respiratory care plan for quadriplegic/immobile patients. Many physicians prescribe high frequency chest compression (HFCC) for those patients who cannot mobilize airway secretions without therapeutic intervention. ACT methods requiring active participation are generally unsuitable for this population. In patients with ineffective cough, additional techniques or devices to clear secretions from central airways are also required.

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  • Braverman J, Nozzarella M. High-frequency chest compression: Advanced therapy for obstructive lung disease. Respir Therp 2007; 2 (2): 48-51. [Link]