b'are unable to eciently inhale and exhale the space around the lungs, resulting inoutside air. The problem is due to their phrenic inhalation. When the pulses stop, the diaphragmnerve sending a weak or no signal to the relaxes, causing exhalation to occur. Thisdiaphragm for it to relax and contract, which process is repeated to produce a normalis necessary in a normal breathing process. breathing pattern.The phrenic nerve is a nerve which starts in The use of diaphragm pacemakers can bethe neck and continues down between the lung a safe and effective means of providingand heart to the diaphragm. It is comprised respiratory support for people living with MSofmotor,sensory,andsympatheticnerve who meet the key criteria that includes havingbers. Its role in breathing is to send motor functional lungs and diaphragm muscle, asinformation to the diaphragm and receive well as an intact or repaired phrenic nerve(s).sensory information from it. To assess a patients phrenic nerve, a neurologistFor some individuals, diaphragm paralysis performs a phrenic nerve conduction study.can be contained to just one side of the The study, which mimics diaphragm pacing,diaphragm, whileothersexperienceafull stimulates the phrenic nerves in the neckparalysis of the entire diaphragm. To diagnose across the depth of the skin. The diaphragmthis condition, imaging tests (e.g., as X-rays, muscles response to the stimulation is thenMRIs,orultrasounds),bloodtests,arterial recorded to see if the patient is a good candidateblood gas analysis and pulmonary function for a diaphragm pacemaker.tests are conducted. To treat both the conditionand help patients with MS realize a better DDiiaapphhrraaggmmppaacceemmaakkeerrsseelleeccttiioonnquality of life, diaphragm pacemakers may aannddssuurrggiiccaallpprroocceedduurreebe specied. There are several manufacturers ofDDiiaapphhrraaggmmppaacceemmaakkeerrss diaphragm pacemakers. When selecting aDiaphragmpacemakerswerefirst diaphragm pacemaker, make sure that device:commercially introduced in 1971 by AveryHas full PMA premarket approval from theLaboratories, now Avery Biomedical Devices. U.S. Food and Drug Administration and CEThe company has since implanted its device MarkingprivilegesundertheEuropeanin more than 2,000 patients in 40 countries. Active Implantable Medical Device DirectiveThe device works with surgically implanted for adult and pediatric;components,anexternaltransmitter,andantennas that are worn on the skin. In operation,Has no external wires protruding from thethe battery-powered transmitter sends a series skin, an infection source that requires dailyofelectricalpulsestotheantennas.The professional wound care; pulses are then converted into radio wavesHas bilateral redundancy, which means ifand transmitted through the intact skin to an one side stops working, the other sideimplanted receiver. Pulses inside the body continues to pace without any interruption;are sent to the phrenic nerve through a small andelectrode implanted close to the nerve,causing the diaphragm to contract eciently.Has demonstrated long-term safe andThis diaphragm contraction, in turn, increases reliable performance.29 msfocusmagazine.org'