Session Information
Session Title: AA 2021 Virtual Posters - Pain and Spine Medicine
Session Time: None. Available on demand.
Disclosures: Peter K. Park, DO: No financial relationships or conflicts of interest
Case Diagnosis: C4 AIS B SCI
Case Description: A 76-year-old male with diffuse idiopathic skeletal hyperostosis was involved in a motor vehicle collision, resulting in a C4 ASIA Impairment Scale B SCI. He underwent cervical posterior fusion and transferred to the rehabilitation hospital for SCI recovery. His high level tetraplegia necessitated a power wheelchair (PWC) with head array and Sip and Puff control for increased independence in mobility. Progress in PWC training was limited by reduced cervical range of motion, and constant occlusion of the Sip and Puff straw due to the following impairments: restricted cervical movement following cervical fusion, cervical orthosis, spine precautions, lack of dentition, and increased secretions. A multidisciplinary effort by SCI physiatry, therapists (physical, occupational, respiratory) and wheelchair vendors led to an innovative creation of a “Sniff and Puff” (SNP) device by connecting the Sip and Puff straw to a nasal pillow mask of a CPAP, to be used in conjunction with the head array.
Setting: Tertiary care hospital, inpatient spinal cord injury (SCI) unitAssessment/
Results: The SNP modification allowed for early and meaningful mobility training. Straw occlusion was mitigated by use of nasal pillows, which required less troubleshooting of the device, leading to increased wheelchair training time and independence.
Discussion: The Sip and Puff device is a useful but arduous interface that has been found to be difficult or impossible in up to 40% of users in one survey. This task becomes even more difficult if complicated by other barriers such as neck immobility or oropharyngeal impairments. The SNP is a cost-effective innovative modification that enables early and meaningful participation in mobility training.
Conclusion: The SNP innovation enables early mobility training and highlights the value of multidisciplinary efforts to reduce barriers to accessibility of traditional adaptive equipment.
Level of Evidence: Level V
To cite this abstract in AMA style:
Park PK, Tam K, Fordonski A, Helton K, Ikpeama A. The Sniff and Puff: A Case Report of a Unique Multidisciplinary Innovation in an SCI Patient [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/the-sniff-and-puff-a-case-report-of-a-unique-multidisciplinary-innovation-in-an-sci-patient/. Accessed May 21, 2025.« Back to AAPM&R Annual Assembly 2021
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-sniff-and-puff-a-case-report-of-a-unique-multidisciplinary-innovation-in-an-sci-patient/