After patients have been intubated for a sufficient time during the earliest phase of SCI treatment, a decision must be made as to whether patients will 1) remain on long-term mechanical ventilation through the endotracheal tube, 2) receive a tracheostomy for long-term ventilation or to assist in weaning, or 3) will be extubated and breathing independently. Traditionally, immediate extubation has been viewed as risky and often leads to pulmonary infections or the need for urgent reintubation. Alternatively, long-term ventilation through an endotracheal tube prolongs the weaning process and the duration of hospital stay. The routine practice has been to receive a tracheostomy to initiate weaning and accelerate discharge from the hospital and not be as abrupt as extubation (Berlly & Shem, 2007). However, in patients who tolerate independent breathing and are weaned successfully off the ventilator, respiratory muscle training or acute physiotherapy can be initiated. Acute physiotherapy is an emerging non-invasive option to help patients resume normal pulmonary functioning and timely discharge. Early prophylactic treatment in the form of physiotherapy has been shown to improve diaphragm function and reduce secretions in patients with acute SCI (McMichan et al. 1980). Assisted coughing, intermittent positive pressure breathing, and regular changes in body positioning are some of the techniques used to help keep patients’ airways clear and breathing independently (Berney et al. 2002). In addition, breathing exercises and diaphragm strengthening can also improve lung functioning and assist in weaning from mechanical ventilation. Resistive inspiratory muscle training (RIMT) and abdominal weights training (Gross et al. 1980; Lin et al. 1999) as well as cough training combined with functional electrical stimulation (McBain et al. 2013) are techniques that have been implemented for physiotherapy in chronic SCI patients. RIMT (Derrickson et al. 1992; Postma et al. 2014), expiratory resistive muscle training (Roth et al. 2010) and abdominal weights training (Derrickson et al. 1992) have been studied in the acute SCI population and are reviewed below.