Physicians take into consideration the overall health of the patient, the severity of symptoms as well as any underlying cause for the paralysis: Diaphragmatic plication, a surgical procedure that pulls the diaphragm down, is commonly used in patients with unilateral paralysis. The surgery allows the diaphragm to moves so as to expand better and improve ventilation. Patients with more severe symptoms, such as a respiratory infection, asthma or COPD (chronic obstructive pulmonary disease), can benefit from diaphragmatic plication. Breathing pacemakers may be used in patients who have functioning phrenic nerves, such as patients with ALS or spinal cord injury. The devices may result in improved respiratory function and lower infection rates. Thoracoscopic diaphragm plication may be an option for some patients, resulting in a shorter hospital stays than other techniques. The prognosis for unilateral paralysis is quite good, providing there is no underlying pulmonary disease. Sometimes, patients recover without any medical intervention.The prognosis for bilateral paralysis also depends on the overall health of the patient but surgery may be the best option for patients who continue to have a poor quality of life.