title: Assessment of breathing patterns and respiratory muscle recruitment during singing and speech in quadriplegia.
abstract: OBJECTIVE
  To explore how respiratory impairment after cervical spinal cord injury affects vocal function, and to explore muscle recruitment strategies used during vocal tasks after quadriplegia. It was hypothesized that to achieve the increased respiratory support required for singing and loud speech, people with quadriplegia use different patterns of muscle recruitment and control strategies compared with control subjects without spinal cord injury.
  
  
  METHODS
  Matched, parallel-group design.
  
  
  METHODS
  Large university-affiliated public hospital.
  
  
  METHODS
  Consenting participants with motor-complete C5-7 quadriplegia (n=6) and able-bodied age-matched controls (n=6) were assessed on physiologic and voice measures during vocal tasks.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Standard respiratory function testing, surface electromyographic activity from accessory respiratory muscles, sound pressure levels during vocal tasks, the Voice Handicap Index, and the Perceptual Voice Profile.
  
  
  RESULTS
  The group with quadriplegia had a reduced lung capacity (vital capacity, 71% vs 102% of predicted; P=.028), more perceived voice problems (Voice Handicap Index score, 22.5 vs 6.5; P=.046), and greater recruitment of accessory respiratory muscles during both loud and soft volumes (P=.028) than the able-bodied controls. The group with quadriplegia also demonstrated higher accessory muscle activation in changing from soft to loud speech (P=.028).
  
  
  CONCLUSIONS
  People with quadriplegia have impaired vocal ability and use different muscle recruitment strategies during speech than the able-bodied. These findings will enable us to target specific measurements of respiratory physiology for assessing functional improvements in response to formal therapeutic singing training.
authors.affiliation: Institute for Breathing and Sleep, Austin Health, Melbourne, Australia. jeanette.tamplin@austin.org.au
authors.forename: Jeanette
authors.initials: J
authors.lastname: Tamplin
authors.forename: Danny J
authors.initials: DJ
authors.lastname: Brazzale
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Pretto
authors.forename: Warren R
authors.initials: WR
authors.lastname: Ruehland
authors.forename: Mary
authors.initials: M
authors.lastname: Buttifant
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Brown
authors.forename: David J
authors.initials: DJ
authors.lastname: Berlowitz
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009146:Music; D011782:Quadriplegia / Q000503:physiopathology* / Q000534:rehabilitation*; D011999:Recruitment, Neurophysiological; D012129:Respiratory Function Tests; D012132:Respiratory Muscles / Q000503:physiopathology*; D013064:Speech Disorders / Q000503:physiopathology* / Q000534:rehabilitation*; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000534:rehabilitation*; D018709:Statistics, Nonparametric