In a C4 ASIA A spinal cord injury patient, during breathing pattern assessment with one hand at the mid-thoracic region and one at the epigastric region, which breathing pattern would most likely be observed?

In a C4 ASIA A spinal cord injury patient, during breathing pattern assessment with one hand at the mid-thoracic region and one at the epigastric region, which breathing pattern would most likely be observed?

• A. 2-neck and 2-diaphragm pattern
• B. 4-diaphragm pattern with no chest movement
• C. 2-diaphragm and 2-chest pattern
• D. 3-diaphragm and 1-chest pattern

Answer: (A)

The key idea is that high cervical injuries often leave the diaphragm intact while knocking out the intercostal (thoracic) muscles, so patients rely on the diaphragm plus neck accessory muscles to breathe. With a C4 level complete injury, the intercostals are typically weak or paralyzed, so chest wall movement is minimal. The diaphragm, innervated by the phrenic nerve (C3–C5), can still contract, and neck accessory muscles (scalenes and sternocleidomastoid) are recruited to help lift the rib cage when more effort is needed. In this assessment, palpating the epigastric region will show diaphragmatic-driven movement (abdomen rising), and you may also detect activity in the neck region as those accessory muscles engage. Little to no movement is felt at the mid-thoracic chest wall because the intercostals aren’t contributing. So the observed pattern would reflect diaphragmatic breathing plus neck muscle involvement, with reduced chest wall excursion—described as neck and diaphragm activity.

The key idea is that high cervical injuries often leave the diaphragm intact while knocking out the intercostal (thoracic) muscles, so patients rely on the diaphragm plus neck accessory muscles to breathe.

With a C4 level complete injury, the intercostals are typically weak or paralyzed, so chest wall movement is minimal. The diaphragm, innervated by the phrenic nerve (C3–C5), can still contract, and neck accessory muscles (scalenes and sternocleidomastoid) are recruited to help lift the rib cage when more effort is needed. In this assessment, palpating the epigastric region will show diaphragmatic-driven movement (abdomen rising), and you may also detect activity in the neck region as those accessory muscles engage. Little to no movement is felt at the mid-thoracic chest wall because the intercostals aren’t contributing.

So the observed pattern would reflect diaphragmatic breathing plus neck muscle involvement, with reduced chest wall excursion—described as neck and diaphragm activity.