FMS conditioning of the inspiratory and expiratory muscles improved voluntary inspiratory and expiratory functions. FMS may be a noninvasive technology for respiratory muscle training in persons with tetraplegia.

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protocol utilizes vital signs and nursing identification of rigors, altered mental status and suspicion for infection. The purpose of this study was to determine how many patients on a Spinal Cord Injury (SCI) and Traumatic Brain Injury (TBI) Rehabilitation unit met the criteria for sepsis based on this new protocol. Of those who met the criteria for sepsis, we sought to determine how many cases were true positives versus false positives. Lastly, determining which of the criteria best predicted true sepsis cases would facilitate the development of an SCI and TBI specific protocol. Design: Retrospective chart review. Setting: Inpatient SCI and TBI Rehabilitation units. Participants: All admitted patients over the age of 18 in 2014 and 2015.Interventions: Not applicable. Main Outcome Measures: Primary outcome measures included number of sepsis cases, true positives and false positives. Secondary outcome measures comprised work-up initiated, treatment, specific sepsis parameters that were met, and diagnosis. Results: There were 81 cases that met the criteria for sepsis. 70% of all cases met sepsis criteria due to the combination of fever, tachycardia and suspicion for infection. 60% of cases were false positives and 40% were true sepsis cases. Of those that were true sepsis, the most common diagnoses were urinary tract infection (36%), pneumonia (36%), skin infection (14%), meningitis (7%) and osteomyelitis (7%). Of the false positive cases, the most common alternative diagnosis was dysautonomia (38%), chronic infection (24%), orthostatic hypotension (14%), and error (24%). Conclusions: Autonomic dysregulation is common in patients with SCI and TBI and therefore can limit the utility of a hospital wide sepsis prevention protocol. Vital sign parameters that take this into account would prevent needless sepsis work-ups, the inappropriate use of broad-spectrum antibiotics, and prevent missed cases of true sepsis.

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