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Glenn G. Reynolds, MD
The Rehabilitation Center Tacoma, Wash

JAMA. 1992;267(19):2602.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—The article by Sack et al¹ has caused me to reflect on approximately 30 years of management of spinal cord injuries with individuals who frequently have levels of lesion above T-8 and in particular those who are quadriplegic patients. One of the goals in rehabilitation is to attempt to remobilize the patient in a sitting position in a wheelchair and hopefully to provide some assisted standing such as on a tilt table or a standing frame. During the early posttraumatic period, a large majority of these individuals are frequently encumbered with orthostatic hypotension.

In addition, many of them have significant difficulty in ventilation and, in particular, expiratory force for a cough to clear accumulated secretions in the airway. I have been providing assisted abdominal compression in synchrony with the normal ventilatory cycle in these individuals. This has provided excellent results in recompensating the individual for his . . . [Full Text PDF of this Article]

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