Coughing and assisted cough in a spinal cord injury

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Coughing and assisted cough in a spinal cord injury

People who have had a spinal cord injury (SCI) do not always have the ability to cough forcefully. A forceful cough is important, because it will help you bring up mucus in the lungs, which can help prevent some lung complications, such as pneumonia.

If your cough is weak, and it is difficult to bring up mucus or you know you have lots of mucus, you need an assisted cough. In an assisted cough, another person pushes on your chest to help you cough. An assisted cough is done while you are sitting up in a bed or chair. If you are in a wheelchair, be sure to put the brakes on.

• Your caregiver places the heel of one hand on your abdomen just above your navel and places the other hand on top of the first hand. He or she interlocks the fingers so that they are pulled away from the body.
• The caregiver keeps his or her elbows straight.
• You take a deep breath and hold it.
• You cough while your caregiver pushes upward and under the rib cage, one time. It may take practice to coordinate the cough with the motion.

See an illustration of the above assisted cough .

Another technique may be used if the first one does not work or if you are obese.

• Your caregiver places his or her hands on the lower part of the rib cage, with the fingers wrapping around your sides pointing toward the back and the thumbs pointing inward, toward the center of the chest.
• You take a deep breath and hold it.
• You cough while the caregiver squeezes the ribs up and in. It may take practice to coordinate the cough with the motion.

See an illustration of the above assisted cough .

If you have enough arm strength, you may be able to help yourself cough:

• Wrap both arms around your abdomen just below the rib cage.
• Take a deep breath and hold it.
• Cough and throw your upper body forward over your arms while hugging your abdomen.

See an illustration of a self-assisted cough .

Do not use an assisted cough if you:

• Are in pain.
• Have internal problems, especially with the abdomen. Pushing on the abdomen could cause more problems.
• Have a chest injury, such as a broken rib.
• Have a flail chest. A flail chest does not move correctly because the muscles that control it do not function.
• Are pregnant. Most specialists do not recommend using an assisted cough for pregnant women, especially in the second and third trimesters of pregnancy.

Credits

Last updated:	February 22, 2007
Author:	Kathe Gallagher, MSW
Reviewed By:	Adam Husney, MD - Family Medicine, Nancy Greenwald, MD - Physical Medicine and Rehabilitation
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC