A patient with a C6 ASIA A SCI has a fully innervated diaphragm but lacks abdominal and intercostal muscle innervation. The cough attempt yields no expulsion of air and airway cannot be cleared. What type of cough would the therapist MOST likely classify?

A patient with a C6 ASIA A SCI has a fully innervated diaphragm but lacks abdominal and intercostal muscle innervation. The cough attempt yields no expulsion of air and airway cannot be cleared. What type of cough would the therapist MOST likely classify?

• A. Weak functional
• B. Nonfunctional
• C. Functional
• D. Zero

Answer: (B)

Cough effectiveness hinges on the ability to generate a strong expiratory phase, which depends on the abdominal and intercostal muscles. If those muscles are paralyzed but the diaphragm can still contract for inspiration, you can take in air, but you cannot push it out forcefully to clear secretions. In this scenario, the patient makes a cough attempt but no air is expelled and secretions cannot be cleared. That fits a nonfunctional cough: there is an effort to cough, but the expulsive phase is absent or insufficient to clear the airway. It’s not zero because there is an attempt to cough, indicating some motor activity, whereas zero would imply no cough attempt at all. A functional cough would clear secretions; a weak functional cough would have some expulsive airflow but not enough to clear the airway, and a true zero cough would be no cough effort whatsoever.

Cough effectiveness hinges on the ability to generate a strong expiratory phase, which depends on the abdominal and intercostal muscles. If those muscles are paralyzed but the diaphragm can still contract for inspiration, you can take in air, but you cannot push it out forcefully to clear secretions.

In this scenario, the patient makes a cough attempt but no air is expelled and secretions cannot be cleared. That fits a nonfunctional cough: there is an effort to cough, but the expulsive phase is absent or insufficient to clear the airway. It’s not zero because there is an attempt to cough, indicating some motor activity, whereas zero would imply no cough attempt at all. A functional cough would clear secretions; a weak functional cough would have some expulsive airflow but not enough to clear the airway, and a true zero cough would be no cough effort whatsoever.