A simple cough never sounded so sweet;
Man first to clear throat with aid of implant
Saturday, July 30, 2005

By Diana Keough
Plain Dealer Reporter

On cue, Ronnie Moore clumsily moved the pencil grasped tightly in his right hand over the pad of the black control box sitting on the tray of his wheelchair and pressed down hard on the number 1.

Seconds later, Moore's body lurched up and back against his chair as the muscles in his abdomen rippled. With his face straining in anticipation, Moore coughed. Loud. Hard. Deep from within.

Moore smiled. So did Dr. Anthony DiMarco, research scientist at MetroHealth Medical Center and Moore's doctor.

"That was the first cough performed electronically by a quadriplegic," said DiMarco.

Five weeks ago, Moore became the first to have three electrodes the size of a pencil eraser surgically implanted near the surface of his spinal cord to activate the nerves emanating from his lower thoracic spinal cord. The electrodes are connected by wires to a small receiver implanted under his skin, just below his rib cage.

A small external battery pack attached to the receiver activates the electrodes to contract the abdominal muscles, causing them to generate a cough. The device is powered by a 9-volt battery.

"I feel air moving out of my throat," said Moore, 52, of Madison. "It's not painful. I've had muscle spasms that hurt worse than that."

The control pad is programmed to give Moore a single cough when he presses 1, a series of three coughs when he presses 2.

Moore's surgery is the culmination of 12 years of research by DiMarco and part of a $1.5 million study paid for by the National Institutes of Health. DiMarco said three quadriplegics are scheduled to receive the implants in September.

Moore lost his ability to cough after a car accident seven years ago left him paralyzed from the neck down. That made it impossible to clear his throat of food or secretions without help from an attendant at the nursing home where he lives. It also made him more susceptible to respiratory infections like bronchitis and pneumonia - a leading cause of hospitalization and death in paraplegics and quadriplegics.

"Not being able to cough can create an emergency situation for quadriplegics," said DiMarco.

He said it will take at least three weeks before medical personnel can determine how much electrical current is needed to give Moore consistent, strong coughs. Until then, Moore will continue to make the trip once a week from the nursing home in Madison to MetroHealth, to "train" with the electrodes.

DiMarco said the device will eliminate Moore's need for an attendant to help him clear his throat.

"This will make him more like a normal person who can cough anytime he wants to," the doctor said.

Moore said he looks forward to eating dinner at his brother's house without having to worry about choking.