Cough in Humans with Spinal Cord Injury: What We Know and What Is Next

Individuals with spinal cord injury (SCI) experience great difficulty while clearing respiratory secretions, resulting in an ineffective cough. Despite advances in respiratory care, there is a lack of mechanism-based rehabilitative intervention specifically designed to restore effective cough after SCI. This narrative review provides an extensive overview of current knowledge on cough, translational research gaps, advances in interventions, and future perspectives for enhancing coughing ability in individuals with SCI. The literature on cough and related studies in SCI population were reviewed and a narrative review was undertaken to report the necessary information that could assist in developing a respiratory rehabilitation framework for improving impaired cough capacity after SCI. This review highlights the need for introducing cough recovery program into pulmonary rehabilitation. Future research should adopt a coordinated translational framework that integrates improved understanding of voluntary cough mechanisms, standardized assessment of cough effectiveness, careful characterization of neurological and respiratory impairment, and rigorous evaluation of rehabilitative interventions to develop evidence-based strategies for respiratory recovery following SCI.