Diaphragm pacing is a method to help improve breathing, speech and quality of life for people with spinal cord injuries who use a mechanical ventilator. Diaphragm pacing can potentially relieve dependence on a mechanical ventilator.

In diaphragm pacing, a lightweight, battery-powered system electrically stimulates your diaphragm muscles and nerves. This causes your diaphragm to contract so that air is pulled into your lungs to help you breathe. The devices for diaphragm pacing include parts both inside and outside the body.

Diaphragm pacing may:

  • Reduce or eliminate the time you spend using a ventilator or other assisted breathing devices
  • Help you breathe and speak more naturally
  • Increase your mobility and transportation options
  • Reduce anxiety or embarrassment about being on a ventilator
  • Make your activities easier, such as dressing, bathing and being moved
  • Improve comfort
  • Decrease your risk of respiratory infections
  • Improve your sense of smell and taste
  • Reduce the need for an external power source and concern about power outages

Diaphragm pacing involves implanting four small leads connected to tiny wires (electrodes) into your diaphragm muscle and a fifth electrode just below the skin near the other electrodes. These electrodes are connected to a wire holder outside the body. A cable on the other end of the electrode connector plugs into a small device outside your body (stimulator) that's worn on the skin.

The stimulator sends regular electrical impulses to the electrodes. This causes your diaphragm to contract and help you to breathe.

Breathing Freely

Vivien Williams: Breathing, we rarely give it a thought because we don't have to. Our brain signals our body to do it automatically. Unfortunately, spinal cord injuries can disconnect the signal. Then what? At Mayo Clinic, technology may be able to take over the job. Here is Dennis Douda for Medical Edge.

Sheila Lehnen: I came a long way from being able to do nothing to doing a lot.

Dennis Douda: Sheila Lehnen is finally getting back into the world. And this is a very big day.

Sheila Lehnen: I went a whole year without seeing any of my children's activities. And this is the first one that I'll be able to go to.

Dennis Douda: Today, she is front row at her son Matt's high school musical performance. You see, when Shelia's neck was broken in a fall down the stairs, she knew she might be paralyzed. But she at least thought the wheels on her chair could still take her places. However, also paralyzed was her diaphragm, the muscle that contracts to pull air into her lungs. Like so many people who survive a spinal cord injury, every moment of Sheila's life depended on a mechanical ventilator or vent to breathe for her. Her solution is the diaphragm pacing system. Think of it is a pacemaker for breathing, with a small, battery powered stimulator connected to the diaphragm by four electrical leads.

Ronald Reeves, M.D.: At a predictable rate, about let's say 16 times per minute, this electrical signal will tell the diaphragm to contract. We can change how long the stimulation lasts, or how strong it is, or how frequently it occurs to optimize it for each person.

Dennis Douda: Over a period of months, as Sheila's diaphragm muscle grew stronger through physical rehabilitation, her time off the ventilator grew from minutes, to hours, to complete liberation. Dr. Mark Lindsay says helping Sheila regain the ability to breathe on her own also reduces the risk of deadly respiratory complications, pneumonia posing the greatest risk.

Mark Lindsay, M.D.: The ability to get rid of the tracheostomy tube, that's a foreign body that's in the trachea. And bacteria and other bugs like to grab hold of that. So to be able to take that out is going to lower her risk of infection.

Dennis Douda: Helping to ensure there will be many more events for Sheila to enjoy with her family.

Vivien Williams: Sheila has grown strong enough that she can breathe on her own, even without the diaphragm pacer, for several hours a day. Dr. Reeves says the savings from freeing a patient from the ventilator can be considerable, which is no small accomplishment in this day of trying to control medical costs. For Medical Edge, I'm Vivien Williams.

May 12, 2022
  1. DiMarco AF. Diaphragm pacing. Clinics in Chest Medicine. 2018; doi:10.1016/j.ccm.2018.01.008.
  2. Marion DW. Pacing the diaphragm: Patient selection, evaluation, implantation, and complications. https://www.uptodate.com/contents/search. Accessed Feb. 9, 2022.
  3. Baker GS. Spinal cord injuries. Minnesota Medicine. 1949;32:1094.
  4. Provider profile. CARF International. http://www.carf.org/providerProfile.aspx?cid=8020. Accessed Feb. 9, 2022.

Diaphragm pacing for spinal cord injury