Preventing Pneumonia and Other Respiratory Problems in Persons With Spinal Cord Injury

Inclusion Criteria: * Chronic spinal cord injury that occurred more than 6 months ago * An impaired ability to cough (cough peak flow less than 300 L/min) * Oxygen saturation greater than or equal to 95% when awake and not receiving supplemental oxygen * End-tidal carbon dioxide level less than 43 mm Hg * Without a fever or other signs of an acute illness for the previous 2 weeks * Able to learn the treatment protocol and have someone available at home to assist if needed to help set-up and use the equipment Exclusion Criteria: * Under 18 years of age * Currently have a tracheotomy tube * Have a history of an acute illness in the last 2 weeks * Have lung disease as seen on chest x-ray that results in a baseline oxygen saturation decreasing below 95% during daytime hours and cannot be normalized by usual way of coughing * Already utilizing an oximetry protocol * Have a significant medical complication and psychiatric condition that would interfere with the conduct of the study or interpretation of the study results.