Paradoxical Respirations in SCI?

This is a good question. I am not certain but I think a non-obese patient with a T1 lesion in the supine position will have difficulty generating a diaphragmatic excursion (thus creating a tidal volume) because the abdominal viscera will pull down on the diaphragm (gravity pulling down the organs that are unsupported by any skeletal muscle tone will act like an anchor on the diaphragm). While the innervation of the diaphragm (C3-4-5) is intact and thus functional, the abdominal skeletal muscle inervation (T7 at the xyphiod process, T10 at the umbilicus) is absent leaving only the diaphragm to provide the work of breathing. I would think an abdominal binder would mitigate the effects of gravity on the abdominal viscera and subsequentally prevent the diaphragm from being anchored in largely immobile position. Placing the patient supine would make the problem with the abdominal viscera a non-issue, unless they were obese which would lead to a new set of problems.