Child in wheelchair smiling with healthy lungs around.

Diaphragm Pacing: A Game Changer for Pediatric Spinal Cord Injuries?

Elliot Brynn in Health & Wellness December 2025 • 4 min read.

"Discover how diaphragm pacing is revolutionizing respiratory care and inpatient rehabilitation for children with cervical spinal cord injuries, offering new hope and improved quality of life."

Spinal cord injuries (SCI) in children, particularly at the C3 level and above, lead to tetraplegia and severe respiratory issues. These young patients often require long-term positive pressure ventilation (PPV), which, while life-saving, comes with significant complications and morbidity. The challenges are immense, impacting not only their physical health but also their overall quality of life.

Diaphragm pacing (DP) offers a promising alternative. This technique, which involves functional electrical stimulation (FES) of the diaphragm, allows for more natural negative pressure breathing. By replacing or reducing the need for PPV, diaphragm pacing can lead to numerous benefits, including improved speech, reduced caregiver burden, and decreased secretion issues.

This article reviews the limited yet compelling research on the safety and effectiveness of diaphragm pacing in pediatric SCI patients. It highlights a collaborative effort between two institutions to facilitate DP implantation for children with ventilator-assisted tetraplegia during inpatient rehabilitation. It further details the process of ventilator weaning and diaphragm conditioning, providing a comprehensive overview for healthcare professionals and families alike.

What Are the Benefits of Diaphragm Pacing for Children with SCI?

Child in wheelchair smiling with healthy lungs around.

Diaphragm pacing provides natural negative pressure ventilation by stimulating intact lower motor neuronal units in the spinal column. The system consists of surgically implanted electrodes into the diaphragm muscle, an external pulse generator (EPG), and a cable to connect the generator to the electrodes. DP was developed to replace or decrease PPV need in high level cervical spinal cord injuries. Patients and families report many benefits of diaphragm pacing.

Patients and their families have reported numerous advantages:

Ease of wheelchair mobility
Elimination of the fear of accidental ventilator disconnection
Loss of social stigma associated with attachment to a ventilator
Elimination of ventilator noise
Improved speech
Improved sense of smell
Reduced caregiver burden
Improved well-being
Overall health

Moreover, diaphragm pacing aligns well with activity-based restorative therapy (ABRT). Intensive ABRT is facilitated when therapies are no longer hindered by ventilator tubing or the constant need for the ventilator to be nearby. It enhances muscle contraction below the level of injury, promoting a more normal breathing pattern.

Looking Ahead: The Future of Diaphragm Pacing in Pediatric SCI

Diaphragm pacing offers a safe and effective alternative to long-term positive pressure ventilation for children with high-level tetraplegia and respiratory insufficiency. Early implantation may lead to faster PPV weaning times and, crucially, can allow inpatient rehabilitation to begin ventilator-free. The benefits of diaphragm pacing far outweigh the effort required to facilitate implantation during inpatient rehabilitation, paving the way for improved outcomes and enhanced quality of life for these young patients.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1007/s40141-018-0200-2, Alternate LINK

Title: Diaphragm Pacers In Pediatric Patients With Cervical Spinal Cord Injury: A Review And Implications For Inpatient Rehabilitation

Subject: Rehabilitation

Journal: Current Physical Medicine and Rehabilitation Reports

Publisher: Springer Science and Business Media LLC

Authors: Janet M. Dean, Raymond P. Onders, Mary Jo Elmo

Published: 2018-09-27

Everything You Need To Know

What is Diaphragm Pacing (DP), and how does it work?

Diaphragm Pacing (DP) is a technique that utilizes functional electrical stimulation (FES) to stimulate the diaphragm muscle. This allows for more natural negative pressure breathing in pediatric patients with cervical spinal cord injuries (SCI), particularly those with tetraplegia. It works by replacing or reducing the need for positive pressure ventilation (PPV), a common treatment for respiratory issues in these patients.

Why is Diaphragm Pacing (DP) important for children with spinal cord injuries?

For children with cervical spinal cord injuries, diaphragm pacing (DP) is significant because it offers a viable alternative to long-term positive pressure ventilation (PPV). PPV, while life-saving, can lead to several complications and significantly impacts the quality of life. DP allows for improved speech, reduced caregiver burden, and improved overall well-being. By facilitating a more natural breathing pattern, DP also aligns well with activity-based restorative therapy (ABRT), enabling more intensive and effective rehabilitation.

What are the implications of using Diaphragm Pacing (DP) for children with spinal cord injuries?

The implications of using Diaphragm Pacing (DP) for pediatric spinal cord injuries are far-reaching. It can significantly improve the quality of life by reducing or eliminating the need for positive pressure ventilation (PPV), addressing complications associated with it. Patients experience benefits such as ease of mobility, reduced social stigma, improved speech, and enhanced well-being. Furthermore, early implantation of DP can expedite ventilator weaning and facilitate earlier initiation of inpatient rehabilitation without the constraints of a ventilator. This allows for a more integrated and active lifestyle.

How is the Diaphragm Pacing (DP) system set up and used?

The Diaphragm Pacing (DP) system comprises surgically implanted electrodes in the diaphragm muscle, an external pulse generator (EPG), and a cable connecting the generator to the electrodes. It is designed to stimulate the diaphragm, enabling negative pressure breathing, which is more natural than the positive pressure ventilation (PPV) typically required for children with high-level cervical spinal cord injuries and tetraplegia. The process often involves ventilator weaning and diaphragm conditioning to allow for gradual independence from the ventilator.

What are the benefits that families often see after Diaphragm Pacing (DP) is implemented?

Families often report several advantages after Diaphragm Pacing (DP) implantation. These include easier wheelchair mobility, elimination of the fear of accidental ventilator disconnection, and reduced social stigma associated with being connected to a ventilator. Other benefits include the absence of ventilator noise, improved speech and sense of smell, a reduced caregiver burden, enhanced well-being, and overall improvement in health. These improvements profoundly enhance the daily lives of children with spinal cord injuries and their families.