title: An investigation of abdominal muscle recruitment for sustained phonation in 25 healthy singers.
abstract: OBJECTIVE
  The purpose of this study was to investigate the baseline muscle thickness and recruitment patterns of the transversus abdominis muscle (TAM) and the internal oblique muscle (IOM) during semisupine phonation in a group of healthy performers.
  
  
  METHODS
  This was a 2 × 3×2 within-group, repeated-measure study in which 25 professional vocalists--12 male and 13 female performed a series of sustained pitches in differing vocal qualities. Measurements were taken with ultrasound (Sonosite Micromaxx Ultrasound System) of the baseline thickness and % recruitment during voicing, of two deep abdominal muscles--TAM and the IOM. Correlations between TAM and IOM absolute change scores, TAM and IOM percentage change scores, and changes in muscle thickness (absolute and percentage) and age were examined using Spearman's correlations. Gender differences in the four types of change scores within each combination of pitch and quality were conducted with one-way analysis of variances. Differences in muscle thickness change 1) absolute scores and 2) percentage change in TAM and IOM, by pitch and quality (and their interactions) were analyzed using linear mixed models, using restricted maximum likelihood estimations, employing a Toeplitz variance-covariance matrix structure in SPSS (IBM, 2011). Post hoc analyses for independent variable group differences used Sidak's correction for multiple comparisons. Alpha level was set to 0.05.
  
  
  RESULTS
  In terms of absolute contractions (changes in the actual millimeter thickness of the muscle), the IOM was greater than the TAM. However in terms of percentage changes in muscles during phonation, the TAM was always greater than the IOM. The TAM as a percentage change was recruited preferentially and significantly in most vocal qualities tested. Although there were differences in muscle mass and recruitment patterns between genders, and males had thicker muscle mass at rest, differences due to muscle mass were not conclusive.
  
  
  CONCLUSIONS
  Overall this study supports the argument that the peri-abdominal muscles do indeed play a role in supporting the "performing" or athletic voice in healthy subjects, and will hopefully act as a database for further research in individuals with healthy and injured voices.
authors.affiliation: Royal National Throat, Nose, & Ear Hospital, London, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Macdonald
authors.forename: John S
authors.initials: JS
authors.lastname: Rubin
authors.forename: Ed
authors.initials: E
authors.lastname: Blake
authors.forename: Shashi
authors.initials: S
authors.lastname: Hirani
authors.forename: Ruth
authors.initials: R
authors.lastname: Epstein
mesh_terms: D000009:Abdominal Muscles / Q000000981:diagnostic imaging / Q000502:physiology*; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D007830:Larynx / Q000502:physiology*; D016014:Linear Models; D008297:Male; D009119:Muscle Contraction; D009146:Music; D010699:Phonation; D011187:Posture; D063346:Singing; D013061:Speech Acoustics; D014463:Ultrasonography; D014833:Voice Quality; D055815:Young Adult