Patients with high-level cervical spinal cord injury are at high risk of respiratory insufficiency and related complications. Paralysis of respiratory muscles often requires the use of mechanical ventilation. In this case, we present an approach to respiratory care for a 66-year-old male patient with C4-C5 spinal cord injury (ASIA-B). A weaning progression from mechanical ventilation was presented through the following programs: nocturnal support, intensive chest care, lung expansion therapy, speaking valve training, and inspiratory muscle training.