Blue color background with a person holding a tablet device

COVID-19 and Spinal Cord Injury: Minimizing Risks for Complications

A high proportion of the United States population could become infected with the virus that causes Coronavirus Disease 2019 (COVID-19). People with disabilities like spinal cord injury (SCI) may be at higher risk for developing more serious complications from COVID-19 illness. A number of COVID-19 related resources are available for people with SCI and are provided below.

Symptoms of COVID-19 include fever, cough, and shortness of breath. Unfortunately, due to paralysis of chest and abdominal muscles, many people with SCI have an impaired ability to take a deep breath and generate a strong cough. Furthermore, a weak cough may make it difficult to clear airway secretions, increasing the risk for respiratory complications if one becomes infected with COVID-19.

Fortunately, there are techniques and devices that people with SCI can use to improve their cough. Below are links to a series of videos produced by Kessler Foundation and Kessler Institute for Rehabilitation about performing these techniques. Although focused on people with SCI, others with similar difficulty coughing may find them helpful. 

Please consult with your healthcare provider before performing any of the procedures below to verify they are appropriate for you. If you have any questions regarding symptoms you are experiencing, contact your primary care physician’s office by phone.

1. Taking a Deeper Breath: Air Stacking (Duration: 3 min 43 sec - – Air stacking is a way to increase the amount or air a person takes in—beyond his/her normal deep breath—before he/she coughs. Air stacking can be accomplished through a series of deep breaths (also known as “Frog Breathing” or “Glossopharyngeal Breathing.” (Duration: 1 min 47 sec - or though assistance from an ambu-bag (a hand-held device commonly used to provide positive pressure breathing to people who are not breathing or not breathing adequately).

2. Increasing Cough Force: Manually Assisted Coughing (Duration: 5 min 52 sec - – Manually assisted coughing involves an assistant providing a thrust to the abdomen with his/her hands during coughing. The thrust increases the force of the cough in order to help clear secretions.

3. Increasing Cough Force: Mechanically Assisted Coughing [Mechanical Insufflation/Exsufflation] (Duration: 4 min 7 sec - – Mechanically assisted coughing involves using a device that enables a deeper breath (“insufflation”) beyond the person’s limited ability to take a deep breath. This is followed immediately by an assisted cough from the device (“exsufflation”) that can also be combined with manually assisted coughing techniques described above. A mechanical assisted cough machine can be provided to you through a coordinated effort between your doctor and a trained respiratory therapist.

For the latest on COVID-19, please consult the Centers for Disease Control (CDC) at and the World Health Organization (WHO) at and local, state, and federal health authorities. For the complete Kessler video on Prevention of Pneumonia and Atelectasis after spinal cord injury go to


Additional Resources:

Podcast: COVID-19 and Spinal Cord Injury: Minimizing Risks for Complications. Listen to the podcast, view the podcast transcript and download this episode and others for free on Apple PodcastsSoundCloudPodbean, Spotify, or wherever you get your podcasts. 

Audio Description

COVID-19 and Spinal Cord Injury: Minimizing Risks for Complications - In this episode, CarolAnn Murphy, senior staff writer interviewed spinal cord injury expert Dr. Trevor Dyson-Hudson, both from Kessler Foundation discuss practical techniques and devices that people with spinal cord injury can use to improve their cough.


Tips for People with SCI during COVID 19 -


Shepherd Center…

United Spinal/New Mobility -…

Reeve Foundation -

Agency for Community Living -



The COVID-19 virus is thought to spread mainly from person-to-person when people are in close contact (within about 6 feet) or through respiratory droplets produced when an infected person coughs or sneezes. As a result, the techniques described above may expose others to increased risk for infection if the person coughing is infected with COVID-19. Please exercise recommended precautions. This may be difficult in some instances. For example, when a person with spinal cord injury is not able to wear a face mask. If a caregiver is providing assistance, then he/she should wear a face mask to reduce likelihood of exposure.


The videos linked above were made possible through the support of the Craig H. Neilsen Foundation and the Northern New Jersey Spinal Cord Injury System, which is supported by a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90SI5026).  NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS).