The purpose of our studies is to restore respiratory muscle function in patients with spinal cord injury.

We are developing systems for electrical activation of the inspiratory muscles to maintain full-time ventilatory support in patients with ventilator-dependent tetraplegia and electrical activation of the expiratory muscles to provide an effective cough mechanism in patients with expiratory muscles paralysis. Ventilatory support systems decrease the cost of medical care, improve speech, increase patient comfort, increase the ease of transportation and, overall improve life quality. Restoration of an effective cough mechanism has the potential to significantly decrease the risk of respiratory complications, which still account for most of the morbidity and mortality in traumatic tetraplegia.

Research Programs

Restoration of respiratory muscle function in subjects with spinal cord injury:

  • Spinal cord stimulation to restore an effective cough mechanism in subjects with cervical and thoracic spinal cord injury. – Clinical Trial
  • High Frequency Spinal Cord Stimulation (HF-SCS) to restore inspiratory muscle function in spinal cord injury. – Pre-Clinical Stage

Publications (Select)

Entire publication list can be found here.

  • Kowalski KE. Romaniuk JR, Kirkwood PA, and DiMarco AF. Inspiratory Muscle Activation via Ventral Lower Thoracic High Frequency Spinal Cord Stimulation. J Appl Physiol 126:977-983, 2019. PMID: 30763163.
  • DiMarco AF, Kowalski KEHigh Frequency Spinal Cord Stimulation in a Sub-Acute Animal Model of Spinal Cord Injury. J Appl Physiol (1985). 2019 May 16. doi: 10.1152/japplphysiol.00006.2019. PMID: 31095462.
  • DiMarco AF, Geertman RT, Tabbaa K, Nemunaitis GA and Kowalski KECase Report: Effects of Lower Thoracic Spinal Cord Stimulation on Bowel Management in a Person with Spinal Cord Injury. Journal of Neurology and Neurobiology (2019) Volume 5 - Issue 1 | DOI:
  • DiMarco AF, Geertman RT, Tabbaa K, Kowalski KE. Complete Restoration of Respiratory Muscle Function in Three Subjects with Spinal Cord Injury. Pilot Interventional Clinical Trial. Editorial. Am J Phys Med Rehabil. 2019 Oct 25. doi: 10.1097/PHM.0000000000001338. PMID:31688014
  • DiMarco AF, Geertman RT, Tabbaa K, Nemunaitis GA and Kowalski KE. Restoration of Cough via Spinal Cord Stimulation Improves Pulmonary Function in Tetraplegics. J Spinal Cord Med. 2019 Dec 6;:1-7. doi: 10.1080/10790268.2019.1699678. [Epub ahead of print] PubMed PMID: 31809251.
  • DiMarco AF, Kowalski KE. Activation of the expiratory muscles via lower thoracic high frequency spinal cord stimulation in awake animals. Respiratory Physiology and Neurobiology, 2020 Feb 8:103360. doi: 10.1016/j.resp.2019.103360.



Cleveland FES Center

Staff Scientist, MetroHealth Research Institute
MetroHealth Medical Center

Bioscientific Staff
MetroHealth Medical Center

Clinical Professor of Physical Medicine & Rehabilitation
Case Western Reserve University


Program Contact
Krzysztof E. Kowalski, PhD

Contact Number
(216) 778-8239

Contact Email