DiMarco, Anthony F., M.D.

Research Statement

The primary interest of our research team is the restoration of respiratory muscle function in individuals with spinal cord injury.

Subjects with mid thoracic and higher level spinal cord injuries suffer from paralysis of their expiratory muscles resulting in their inability to generate an effective cough mechanism. As a consequence, these individuals are prone to the development of respiratory tract infections and atelectasis, a major cause of morbidity and mortality in this patient population. An effective cough system can be implemented through restorative electrical stimulation techniques (spinal cord stimulation) resulting in a reduction in the incidence of respiratory tract infections, reduced need for caregiver support and greater mobility.

Subjects with high cervical spinal cord injury levels suffer from respiratory failure and are dependent upon mechanical ventilation. Utilizing restorative electrical stimulation techniques (diaphragm pacing), more normal breathing can be restored. Pacing systems improve mobility, speech and sense of smell, reduce the incidence of respiratory tract infections, and eliminate the need for mechanical ventilation and attached tubing.

Restoration of respiratory muscle function can significantly improve overall quality of life and reduce the morbidity and mortality associated with spinal cord injury.

We are currently pursuing two major areas of research:

  • Ongoing clinical feasibility trials of an implanted Spinal Cord Stimulation system to restore an effective cough mechanism in subjects with cervical and thoracic spinal cord injury.
  • We are also exploring a method of diaphragm and inspiratory intercostal/ accessory muscle activation to provide restoration of more normal breathing in subjects with ventilator-dependent spinal cord injury. This project is in the preliminary stages of animal testing and is not yet available for implementation in human subjects.

Professional Affiliations

  • Investigator, Cleveland FES Center
  • Professor, Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH
  • CT Physician, Research Department, MetroHealth Medical Center, Cleveland, OH

Publications (Select)

  • Kowalski KE, DiMarco AF. Comparison of wire and disc leads to activate the expiratory muscles in dogs. J Spinal Cord Med. 2011 Nov;34(6):600-8. PubMed PMID:22330116; PubMed Central PMCID: PMC3237287.
  • DiMarco AF, Kowalski KE. Distribution of electrical activation to the externalintercostal muscles during high frequency spinal cord stimulation in dogs. JPhysiol. 2011 Mar 15;589(Pt 6):1383-95. Epub 2011 Jan 17. PubMed PMID: 21242258; PubMed Central PMCID: PMC3082098.
  • DiMarco AF, Kowalski KE. Intercostal muscle pacing with high frequency spinal cord stimulation in dogs. Respir Physiol Neurobiol. 2010 May 31;171(3):218-24. Epub 2010 Mar 23. PubMed PMID: 20338266; PubMed Central PMCID: PMC2874655.
  • DiMarco AF. Restoration of ventilation and cough with functional electrical stimulation: patient evaluation and comparison of currently available systems. In: Lin V, ed. Spinal Cord Medicine: Principles and Practices, 2nd edition. New York, NY: Demos Medical Publishing. Chapter 75, pages 978-995, 2010. 
  • DiMarco AF. Phrenic nerve stimulation in patients with spinal cord injury. Respir Physiol Neurobiol. 2009 Nov 30;169(2):200-9. Epub 2009 Sep 26. Review. PubMed PMID: 19786125.
  • DiMarco AF, Kowalski KE. High-frequency spinal cord stimulation of inspiratory muscles in dogs: a new method of inspiratory muscle pacing. J Appl Physiol. 2009 Sep;107(3):662-9. Epub 2009 Jun 11. PubMed PMID: 19520839.
  • DiMarco AF, Kowalski KE, Geertman RT, Hromyak DR, Frost FS, Creasey GH, Nemunaitis GA. Lower thoracic spinal cord stimulation to restore cough in patients with spinal cord injury: results of a National Institutes of Health-Sponsored clinical trial. Part II: clinical outcomes. Arch Phys Med Rehabil. 2009 May;90(5):726-32. PubMed PMID: 19406290; PubMed Central PMCID: PMC2809374.
  • DiMarco AF, Kowalski KE, Geertman RT, Hromyak DR. Lower thoracic spinal cord stimulation to restore cough in patients with spinal cord injury: results of a National Institutes of Health-sponsored clinical trial. Part I: methodology and effectiveness of expiratory muscle activation. Arch Phys Med Rehabil. 2009 May;90(5):717-25. PubMed PMID: 19406289; PubMed Central PMCID: PMC2813808.

Research Programs

Contact Information

Contact Name: Dana Hromyak
Contact Number: (216)778-3612 or (216)778-4321
Contact Email: dhromyak@metrohealth.org