Breathing Coach. The diaphragm pacer aims to boost the stamina of the weakening breathing muscles in people with ALS by electrically conditioning them. Video: Synapse Biomedical.

Breathing is a precisely choreographed dance of the diaphragm and intercostal muscles. An electric slide of the diaphragm enables the chest to contract or expand - allowing air to enter and exit the lungs. But in people with ALS, these breathing muscles gradually weaken and atrophy- leading to respiratory distress and failure.

Scientists are developing treatments that aim to strengthen the respiratory muscles in hopes to help people with ALS keep breathing longer. One emerging therapy called diaphragm pacing uses an electrical device (the NeuRX DPS) to regularly stimulate the diaphragm. The strategy strives to boost the stamina of these breathing muscles by conditioning them.

A phase II clinical trial of the NeuRX DPS for ALS is expected to begin in the US in the summer of 2013. The randomized controlled study aims to determine whether the device can improve the quality of life and boost the survival of people with ALS.

ALS Today’s Michelle Pflumm PhD talked to principal investigator Kirsten Gruis MD of the State University of New York to learn more about diaphragm pacing and its potential benefits for people with ALS going forward.

To  learn more about diaphragm pacing, check out Clearing the air on the DPS? and DPS sleep.  To find out about ongoing clinical trials of the NeuRX DPS around the globe, read UK team gears up to put the DPS through its paces and French team rethinks the potential of the DPS.


Gonzalez-Bermejo, J., et al. (2011) Diaphragm pacing improves sleep in patients with amyotrophic lateral sclerosis. Amyotrophic Lateral Sclerosis. doi:10.3109/17482968.2011. 597862  Abstract | Full Text (Subscription Required)

Onders, R.P., et al. (2009) Complete worldwide operative experience in laparoscopic diaphragm pacing: results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients. Surgical Endoscopy, 23(7): 1433-1440.  Abstract | Full Text (Subscription Required)

Further Reading

Scherer, K. and Bedlack, R.S (2012) Diaphragm pacing in amyotrophic lateral sclerosis: a literature review. Muscle and Nerve 46(1), 1-8. Abstract Full Text (Subscription Required)

Gruis, K.L. and Lechtzin, N. (2012) Respiratory therapies for amyotrophic lateral sclerosis: a primer. Muscle and Nerve 46(3), 313-331.  Abstract  Full Text  (Subscription Required)

Patient Resources

Early Stage Amyotrophic Lateral Sclerosis Phrenic Stimulation (RespiStimALS). Contact | ALS TDI Website 

Diaphragm Pacing in Motor Neuron Disease (DiPALS) Study  Contact  |  ALS TDI  Website