Diagnosis: Glee

Watching Glee with my boyfriend – a med student –  is awesome.  The boyfriend hadn’t seen it yet, so I thought I was pointing out some awesome trivia (it was my 2nd time watching it)

Me: Fun fact: The paralyzed character there? He’s actually played by a guy who’s paralyzed in real life.
: Yeah, I figured he was either coached really well or was paralyzed, leaning towards paralyzed.
: … Wait, how?
: See him breathing there, in between lines? His diaphragm is moving, but his chest isn’t expanding at all.
: Hey, yeah, that’s true.
: And the diaphragm is innervated by C3, C4, and C5, while the intercostal muscles in the ribcage are innervated bythoracic spinal nerves.

So if you become paralyzed from the neck down, you’ll still have some combination of C3/4/5 (or else you wouldn’t be alive) – so your diaphragm can let you breathe, but you won’t have anything further down, so you won’t have the thoracic spinal nerves and therefore no intercostal muscles in your rib cage to expand/contract your ribs and therefore your lungs. Therefore, someone with cervical paralysis will move their diaphragm but not their ribcage. An actor who doesn’t know this would probably just continue to breathe the way almost all of us (the exception: very trained singers) do – chest expansion.

It’s crazy. I mean, I know the innervations, too, but I guess you need to actually have an eye towards diagnosing patients to figure out that a guy on TV is most likely actually paralyzed and not just acting.

I wanna be a smart med student someday.

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