The limited innervation of muscles supporting pulmonary functioning in spinal cord injured (SCI) patients indicates that these individuals are at a particularly high risk for atelectasis and other sequelae of ventilator dependency. As an alternative strategy to endotracheal suctioning for secretion management, our acute rehabilitation facility utilizes an assistive cough device. This device has not been commonly utilized in the SCI population, and studies concerning this device have primarily focused on individuals with neuromuscular diseases. In our experience, utilization of mechanical in-exsufflation has produced positive outcomes in terms of patient satisfaction, low rates of ventilator-acquired pneumonia, low incidence of complications, and ease of home discharge with patient or family using the device long term. This article describes the device, as well as the protocols associated with its use in one ventilator spinal cord center.