Optimal function of the respiratory system is essential for successful rehabilitation. This chapter discusses the normal physiology, respiratory dysfunction in spinal cord injury, principles of pulmonary rehabilitation (PR), neuromuscular respiratory failure, and management of tracheostomies. Management of the respiratory system in the rehabilitation setting should center on expanding the lungs and clearing secretions. The goal of PR is to improve the symptoms associated with respiratory disease, optimize function, and facilitate healthy behaviors in patients with chronic respiratory illness. This chapter discusses the PR management for obstructive pulmonary disease and restrictive disorders (intrinsic). Tracheostomy tubes are commonly encountered in the rehabilitation setting and are used for airway patency, for mechanical ventilation, to prevent aspiration, and for ease of access to the lower respiratory tract to allow for secretion management. Choosing the right tracheostomy tube is essential to maintaining an unobstructed airway and preventing complications.