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Epidural spinal cord stimulation has been used to decrease spasticity and spasms in spinal cord injury patients. However, the long-term bene®ts of this procedure have not been determined. We therefore conducted a retrospective study of the possible long-term ecacy of the epidural spinal cord stimulator for the relief of symptoms. Seventeen patients were identi®ed who had undergone implantation of an epidural spinal stimulator. The total number of implantations in these seventeen patients was 24, (seven patients had undergone a second implantation) costing a total of $566 400. In only one of the patients was the epidural stimulator providing symptomatic relief. The epidural spinal cord stimulator lacks long-term ecacy for the relief of spasticity and pain and is not cost eective.

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Background/Objective: The insufflator-exsufflator has been shown to be effective in assisting cough in individuals with spinal cord injury. However, many institutions do not use this device. The study was performed to assess use of the device and attitudes among health care providers. Methods: We developed a questionnaire with 4 categories of questions: knowledge of the device, type of facility, clinical practice with the device, and patient and provider satisfaction. The questionnaire was mailed to members of the American Paraplegia Society. Results: Eighty-six questionnaires (16%) were returned. The device was being used in 49% of the institutions. The device was most commonly used with a tracheostomy; use did not correlate with size or type of facility. Patient and provider satisfaction with the insufflator-exsufflator was high. Conclusions: The insufflator-exsufflator is used as a means of removal of secretions in approximately one half of institutions polled. Satisfaction with the device is high.