Pulmonary complications are the major contributor to mortality and morbidity following spinal cord injury (SCI), especially during the first year. Patients who are at increased risk of pulmonary complications include SCI individuals with cervical and high thoracic injuries, patients with unstable injuries who must be immobilized, patients with multiple injuries and individuals over the age of 65 years. Although research exists on many of the elements of pulmonary hygiene, there is a paucity of systematic research linking therapeutic interventions with patient outcomes during the acute phase following SCI. This area is rich for the development of collaborative empirical studies which contribute to the science of preventing pulmonary complications following acute SCI. Research is needed which tests specific pulmonary hygiene protocols in relation to patient outcomes during the acute phase of SCI and in the early months after the patient returns home.