C6-assisted cough (S7)

An assisted cough is used to help people with spinal cord injury clear secretions. The therapist uses his/her hands to apply a sudden and forceful overpressure to the chest or abdominal wall as the patient attempts to cough. The overpressure substitutes for paralysis of the intercostal and abdominal muscles.

Equipment:

• Height-adjustable bed
• Tissues
• Suctioning equipment (not shown in video clip)

Key Points:

• The top arm is positioned across the chest. Pressure is applied in a downward and latero-medial direction
• The heel of the bottom hand is positioned over the epigastic area, below xiphoid process. Pressure is applied in a downward and superior direction
• Ensure that the overpressure is timed with the patient’s attempt at coughing
• Ensure that the overpressure is applied quickly and forcefully
• Ensure that therapist uses his/her body weight and position rather than upper limb strength to attain sufficient force

Common Errors:

• The bed is positioned too high
• Therapist applies overpressure which is too strong or too weak
• Therapist fails to remind patient to turn head away (provided this in not medically contra-indicated)
• The overpressure is not timed with the patient’s attempts at coughing
• The neck of recently-injured patients with tetraplegia is not adequately stabilized
• Assisted coughs are performed when medically contra-indicated

Progression and Variety:

• Mechanically inflate the lungs prior to coughing to maximize initial lung volume
• Administer nebulised saline prior to treatment to help loosen secretions
• Use an in-exsufflator to enhance the effectiveness of the assisted cough
• A number of different strategies may be used with one, two and three therapists assisting