Abdominal Binder Improves Lung Volumes and Voice in People With Tetraplegic Spinal Cord Injury

The feasibility of using mouthpiece ventilation in the intensive care unit for post-extubation breathing support after acute tetraplegia

STUDY DESIGN

A prospective cohort of patients with acute tetraplegia.

OBJECTIVES

This study aimed to determine the feasibility of using mouthpiece ventilation (MPV) in the intensive care unit (ICU) for patients who are extubated after suffering an acute cervical spinal cord injury (CSCI).

SETTING

ICU, Princess Alexandra Hospital, Brisbane Australia.

METHODS

New admissions to ICU in the 14 months between April 2017 and June 2018 with a CSCI who underwent intubation were assessed for inclusion. MPV was provided to consenting participants (who were deemed likely to be able to maintain ventilation on their own) at the time of extubation and was utilised in addition to standard care while participants were awake. MPV settings, usage, and support hours to educate and facilitate MPV were collected. Feedback from participants and clinical staff was gathered throughout the study. Pre- and post-extubation measures of forced vital capacity (FVC), the frequency of endotracheal suction of sputum, and gas exchange using ventilation-perfusion ratios were recorded along with the incidence of reintubation.

RESULTS

Fourteen participated in utilising MPV with 16 episodes of extubation. The average time per participant to have MPV titrated and bedside data collected was 178 minutes. Data from 16 episodes of extubation have been included. Three of the 14 participants failed initial extubation. Feedback from participants and clinicians has been positive and constructive, enabling MPV settings to be adapted to the person with acute CSCI during this pilot study.

CONCLUSION

MPV is feasible to use post-extubation for people with CSCI in ICU. Pressure control mode MPV was deemed the most suitable for newly extubated acute CSCI patients. Intensive clinical support is required initially to provide education prior to MPV, and at the time of extubation for both patient and treating clinicians. Both report it to be a useful adjunct to ICU treatment.

The impact of posture correction bands on the respiratory function of healthy adults in their twenties: The difference between men and women

INTRODUCTION

Recently, interest in posture correction has increased in Korea owing to increased smartphone usage. However, there have been no studies to evaluate the impact of wearing a posture correction band with an abdominal band on breathing and respiratory function.

MATERIALS AND METHODS

A total of 32 healthy adults, consisting of 16 men (mean age: 23.19 ± 2.88) and 16 women (mean age: 19.69 ± 1.49) participated in this study. Pulmonary function tests were conducted before and after wearing posture correction bands.

RESULTS

In all the participants, forced vital capacity decreased significantly (P < .05) after wearing a posture correction band. The forced expiratory volume in 1 second and maximal inspiratory pressure decreased slightly (P > .05). The maximal expiratory pressure (MEP) and peak cough flow (PCF) increased slightly (P > .05). When respiratory functions were monitored separately in men and women after wearing a posture correction band, forced vital capacity and forced expiratory volume in 1 second were significantly reduced in men (P < .05). In women, MEP and PCF increased significantly (P < .05).

CONCLUSIONS

In this study, we confirmed that the posture correction band had an effect on respiratory function. Lung capacity was statistically significantly reduced but was not clinically significant. In addition, in the case of women, it was confirmed that the abdominal band improved the MEP and PCF.

Pathophysiology, Classification and Comorbidities after Traumatic Spinal Cord Injury

The spinal cord is a conduit within the central nervous system (CNS) that provides ongoing communication between the brain and the rest of the body, conveying complex sensory and motor information necessary for safety, movement, reflexes, and optimization of autonomic function. After a spinal cord injury (SCI), supraspinal influences on the spinal segmental control system and autonomic nervous system (ANS) are disrupted, leading to spastic paralysis, pain and dysesthesia, sympathetic blunting and parasympathetic dominance resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions and uncontrolled bowel, bladder, and sexual dysfunction. This article outlines the pathophysiology of traumatic SCI, current and emerging methods of classification, and its influence on sensory/motor function, and introduces the probable comorbidities associated with SCI that will be discussed in more detail in the accompanying manuscripts of this special issue.

The Effect of Vocal Intonation Therapy on Vocal Dysfunction in Patients With Cervical Spinal Cord Injury: A Randomized Control Trial

In this study, the vocal intonation therapy (VIT) was compared with the standard respiratory therapy for people suffering from respiratory dysfunction as a result of cervical spinal cord injury (CSCI) to observe its effect on vocal quality. Thirty patients with vocal dysfunction after CSCI with the injury time of more than 3 months were screened for inclusion in the trial, and 18 patients completed the 12-weeks, each participant had 60 sessions in total in the clinical trial. All patients were allocated to the intervention group or the control group. The intervention group received VIT training and the control group received respiratory phonation therapy. Both groups were trained by professional therapists, and the training time was 30 min/day, 5 days/week, for 60 sessions for each group in a total of 12 weeks. In the Baseline (T0), mid-intervention period (after 6 weeks, T1), and after intervention (after 12 weeks, T2), the vocal quality of the two groups of patients was tested with a computer-aided real-time audio analyzer 2.1.6 (Adobe Systems, United States) for Sing-SPL (p &lt; 0.0001), Speech-SPL (p &lt; 0.0001), SNL (p &lt; 0.0001), and F0 (p &lt; 0.0001) of the intervention group were significantly improved compared with the control group. In comparing the spectrometry analysis of vocal quality for the 2 groups of participants, there was a significant difference in the results of Sing-SPL and Speech-SPL acoustic analysis in the intervention group of patients at T2 (after 12 weeks) compared to the control group. Vocal intonation therapy—music therapy can improve the speech sound quality of cervical CSCI patients and provide CSCI patients with a practical, highly operable treatment that has both functional training effects and can bring a pleasant experience that can be promoted in the medical field. This study was approved by the Ethics Committee of China Rehabilitation Research Center (CRRC) (approval No. 2019-83-1) on May 20th, 2019. It was registered with the National Health Security Information Platform, medical research registration, and filing information system (Registration No. MR-11-21-011802) on January 28th, 2021.

Effectiveness of non-pharmacological interventions to treat orthostatic hypotension in elderly people and people with a neurological condition: a systematic review

OBJECTIVE

The objective of this review was to summarize the best available evidence regarding the effectiveness of non-pharmacological interventions to treat orthostatic hypotension (OH) in elderly people and people with a neurological condition.

INTRODUCTION

Orthostatic hypotension is common in elderly people and people with a neurological condition and can interfere with or limit rehabilitation. Non-pharmacological interventions to treat OH could allow for longer and earlier mobilization, which is recommended in national clinical guidelines for rehabilitation in the acute or sub-acute phase following stroke or other neurological conditions.

INCLUSION CRITERIA

The review considered people aged 50 years and older, and people aged 18 years and elderly people with a neurological condition. Non-pharmacological interventions to treat OH included compression garments, neuromuscular stimulation, physical counter-maneuvers, aerobic or resistance exercises, sleeping with head tilted up, increasing fluid and salt intake, and timing and size of meals. The comparator was usual care, no intervention, pharmacological interventions, or other non-pharmacological interventions. Outcome measures included systolic blood pressure, diastolic blood pressure, heart rate, cerebral blood flow, observed/perceived symptoms, duration of standing or sitting in minutes, tolerance of therapy, functional ability, and adverse events/effects.

METHODS

Databases for published and unpublished studies available in English up to April 2018 with no lower date limit were searched. Critical appraisal was conducted using standardized instruments from JBI. Data were extracted using standardized tools designed for quantitative studies. Where appropriate, studies were included in a meta-analysis; otherwise, data were presented in a narrative form due to heterogeneity.

RESULTS

Forty-three studies - a combination of randomized controlled trials (n = 13), quasi-experimental studies (n = 28), a case control study (n = 1), and a case report (n = 1) - with 1069 participants were included. Meta-analyses of three interventions (resistance exercise, electrical stimulation, and lower limb compression bandaging) showed no significant effect of these interventions. Results from individual studies indicated physical maneuvers such as leg crossing, leg muscle pumping/contractions, and bending forward improved orthostatic hypotension. Abdominal compression improved OH. Sleeping with head up in combination with pharmacological treatment was more effective than sleeping with head up alone. Eating smaller, more frequent meals was effective. Drinking 480 mL of water increased blood pressure.

CONCLUSIONS

The review found mixed results for the effectiveness of non-pharmacological interventions to treat OH in people aged 50 years and older, and people with a neurological condition. There are several non-pharmacological interventions that may be effective in treating OH, but not all have resulted in clinically meaningful changes in outcome. Some may not be suitable for people with moderate to severe disability; therefore, it is important for clinicians to consider the patient's abilities and impairments when considering which non-pharmacological interventions to implement.

Forkhead box protein O1 (FoxO1) /SERPINB1 ameliorates ROS production in diabetic nephropathy

With the increasing prevalence of diabetes in recent years, diabetic nephropathy (DN) has become a severe disease that greatly threatens human health. DN not only is a common complication of diabetes, but also takes an important place in kidney disease. To this end, the present study was designed to explore the effects of Forkhead box protein O1 (FoxO1) on reactive oxygen species (ROS) production in DN mice. DN mice were treated with recombinant protein of FoxO1. Afterward, inflammation ELISA kits were used to measure the levels of TNF-α, IL-1β, IL-6, and IL-18. The levels of MDA, SOD, GSH, and GSH-PX were measured using kits according to the manufacturer's instructions. In addition, the production of ROS was assessed. Interestingly, the expression of FoxO1 was down-regulated in DN mice. The treatment of FoxO1 recombinant protein ameliorated MDA levels, increased the levels of SOD, GSH, and GSH-PX, and induced both mRNA and protein expression of hepatic serine protease inhibitor B1 (serpinB1) in ND mice. Similarly, FoxO1 reduced MDA levels and ROS production, increased the levels of SOD, GSH, and GSH-PXs, and induced the mRNA and protein expression of serpinB1 in in vitro model of DN. The inhibition of serpinB1 attenuated the effects of FoxO1 on ROS production-induced oxidative stress in in vitro model of DN. Overall, FoxO1/SERPINB1 ameliorated ROS production-induced oxidative stress in DN.

Initial assessment and management of respiratory infections in persons with spinal cord injuries and disorders in the COVID-19 era

As the COVID-19 pandemic unfolds, emergency department (ED) personnel will face a higher caseload, including those with special medical needs such as persons living with spinal cord injuries and disorders (SCI/D). Individuals with SCI/D who develop COVID-19 are at higher risk for rapid decompensation and development of acute respiratory failure during respiratory infections due to the combination of chronic respiratory muscle paralysis and autonomic dysregulation causing neurogenic restrictive/obstructive lung disease and chronic immune dysfunction. Often, acute respiratory infections will lead to significant mucus production in individuals with SCI/D, and aggressive secretion management is an important component of successful medical treatment. Secretion management techniques include nebulized bronchodilators, chest percussion/drainage techniques, manually assisted coughing techniques, nasotracheal suctioning, and mechanical insufflation-exsufflation. ED professionals, including respiratory therapists, should be familiar with the significant comorbidities associated with SCI/D and the customized secretion management procedures and techniques required for optimal medical management and prevention of respiratory failure. Importantly, protocols should also be implemented to minimize potential COVID-19 spread during aerosol-generating procedures.

Comparison of abdominal compression devices in persons with abdominal paralysis due to spinal cord injury

Study Design

Single subject design with five subjects.

Objectives

The objetive of this study is to compare the effectiveness and usability of alternative commercial abdominal compression garments with participants' usual medical binders.

Setting

Private residences in Pierce and King Counties, WA, USA.

Methods

Participants wore each garment for 5 days followed by a 2-day washout in personal binder. Week 1: Personal binder. Weeks 2 and 3: Randomly ordered test garments (tank, bodysuit). Physiologic measurements: blood pressure (SBP, DBP), blood oxygen saturation (SaO2), forced expiratory volume in one second (FEV1), and heart rate (HR). Participants completed logs twice daily for 5 days per garment regarding ease of use, comfort, respiration, and appearance. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

Results

The use of a personal binder results in significant increases in SBP and FEV1. Personal binders support FEV1 significantly better than test garments. There is no difference in SBP between test garments and personal binders. There are no significant differences between DBP, SaO2, or HR between participants' personal binders and no binder. Participants reported that neither tank nor bodysuit felt adequately supportive or easy to use.

Conclusions

Abdominal compression improves respiratory function and supports SBP in individuals with chronic SCI. Further research is needed to guide the development of an easy-to-use and physiologically supportive abdominal compression garment.

SIRT1 inhibits apoptosis in in vivo and in vitro models of spinal cord injury via microRNA-494

The aim of the present study was to investigate the function and mechanism of sirtuin 1 (SIRT1) in spinal cord injury (SCI). Reverse transcription-quantitative polymerase chain reaction was used to measure the expression levels of microRNA (miR)-494. MTT assay, lactate dehydrogenase activity assay and flow cytometry were used to analyze the effects of miR-494 on cell growth and apoptosis in a model of SCI. The present study demonstrated that SIRT1 expression was reduced; whereas miR-494 expression was increased in a rat model of SCI. Overexpression of miR-494 suppressed the protein expression levels of SIRT1, and induced p53 protein expression. Conversely, knockdown of miR-494 induced SIRT1 protein expression in an in vitro model of SCI. Furthermore, overexpression of miR-494 promoted cell apoptosis and decreased cell growth in an in vitro model of SCI; however, miR-494 knockdown enhanced cell growth and inhibited cell apoptosis. Administration of a SIRT1 agonist reduced the effects of miR-494 overexpression on cell apoptosis in an SCI model, whereas treatment with a p53 agonist reduced the effects of miR-494 knockdown on cell apoptosis in an SCI model. Together, these findings suggested that SIRT1 may inhibit apoptosis of SCI in vivo and in vitro through the p53 signaling pathway, whereas miR-494 suppressed SIRT1 and induced apoptosis.

Sparstolonin B attenuates spinal cord injury‑induced inflammation in rats by modulating TLR4‑trafficking

The present study used a spinal cord injury (SCI) model to evaluate whether sparstolonin B was able to prevent SCI, and to investigate the underlying signaling mechanism. Sparstolonin B attenuated the SCI‑induced Batto, Beattie and Bresnahan score and water content in rats. Sparstolonin B attenuated the mRNA expression of proinflammatory cytokines interleukin (IL)‑18, IL‑6, IL‑1β, and IL‑23, decreased the levels of tumor necrosis factor‑α and interferon‑γ, and decreased caspase‑3 activity and apoptosis regulator Bax protein expression in SCI rats. Similarly, sparstolonin B inhibited monocyte chemoattractant protein‑1 mRNA levels, and Toll‑like receptor (TLR) 4, myeloid differentiation primary response protein MyD88 (MyD88) and nuclear factor (NF)‑κB protein levels in SCI rats. The present results suggested that sparstolonin B may attenuate SCI‑induced inflammation and apoptosis in rats by modulating the TLR4/MyD88/NF‑κB signaling pathway.

Respiratory problems and management in people with spinal cord injury

Spinal cord injury (SCI) is characterised by profound respiratory compromise secondary to the level of loss of motor, sensory and autonomic control associated with the injury. This review aims to detail these anatomical and physiological changes after SCI, and outline their impact on respiratory function. Injury-related impairments in strength substantially alter pulmonary mechanics, which in turn affect respiratory management and care. Options for treatments must therefore be considered in light of these limitations.

KEY POINTS

Respiratory impairment following spinal cord injury (SCI) is more severe in high cervical injuries, and is characterised by low lung volumes and a weak cough secondary to respiratory muscle weakness.Autonomic dysfunction and early-onset sleep disordered breathing compound this respiratory compromise.The mainstays of management following acute high cervical SCI are tracheostomy and ventilation, with noninvasive ventilation and assisted coughing techniques being important in lower cervical and thoracic level injuries.Prompt investigation to ascertain the extent of the SCI and associated injuries, and appropriate subsequent management are important to improve outcomes.

EDUCATIONAL AIMS

To describe the anatomical and physiological changes after SCI and their impact on respiratory function.To describe the changes in respiratory mechanics seen in cervical SCI and how these changes affect treatments.To discuss the relationship between injury level and respiratory compromise following SCI, and describe those at increased risk of respiratory complications.To present the current treatment options available and their supporting evidence.

Transporter Protein-Coupled DPCPX Nanoconjugates Induce Diaphragmatic Recovery after SCI by Blocking Adenosine A1 Receptors

Respiratory complications in patients with spinal cord injury (SCI) are common and have a negative impact on the quality of patients' lives. Systemic administration of drugs that improve respiratory function often cause deleterious side effects. The present study examines the applicability of a novel nanotechnology-based drug delivery system, which induces recovery of diaphragm function after SCI in the adult rat model. We developed a protein-coupled nanoconjugate to selectively deliver by transsynaptic transport small therapeutic amounts of an A1 adenosine receptor antagonist to the respiratory centers. A single administration of the nanoconjugate restored 75% of the respiratory drive at 0.1% of the systemic therapeutic drug dose. The reduction of the systemic dose may obviate the side effects. The recovery lasted for 4 weeks (the longest period studied). These findings have translational implications for patients with respiratory dysfunction after SCI.

SIGNIFICANCE STATEMENT

The leading causes of death in humans following SCI are respiratory complications secondary to paralysis of respiratory muscles. Systemic administration of methylxantines improves respiratory function but also leads to the development of deleterious side effects due to actions of the drug on nonrespiratory sites. The importance of the present study lies in the novel drug delivery approach that uses nanotechnology to selectively deliver recovery-inducing drugs to the respiratory centers exclusively. This strategy allows for a reduction in the therapeutic drug dose, which may reduce harmful side effects and markedly improve the quality of life for SCI patients.

Peak expiratory flow in healthy, young, non-active subjects in seated, supine, and prone postures

OBJECTIVE

To compare the PEFs in healthy, young, non-active subjects in seated, supine, and prone postures.

METHODS

A total of 30 healthy volunteers (15 male, mean age 22.7 years, non-smokers, sedentary) underwent a physical examination, spirometry to confirm normal pulmonary function, and PEF using the Mini-Wright Peak Flow Meter while wearing a nose clip. PEF measurements were repeated three times in each of three positions (seated, prone, and supine) in random order and differed by less than 20 L/min for a given position. Paired Student's t-tests were used to analyze the results, and the significance level was set at 5%.

RESULTS

The PEF values obtained when the study participants were in a seated position (481.0 ± 115.1 L/min) were higher than those obtained when participants were in prone (453.7 ± 112.1 L/min) or supine (453.2 ± 114.3 L/min) positions (p < 0.05). No significant difference in PEF values was observed between the prone and supine positions.

CONCLUSION

Body posture affects PEF in healthy, young, non-active subjects. PEFs are higher when subjects are in a seated position compared to prone or supine positions, but no difference in PEF is observed between the prone and supine positions.

Effect of lower limb compression on blood flow and performance in elite wheelchair rugby athletes

OBJECTIVE

To investigate the effects of compression socks worn during exercise on performance and physiological responses in elite wheelchair rugby athletes.

DESIGN

In a non-blinded randomized crossover design, participants completed two exercise trials (4 × 8 min bouts of submaximal exercise, each finishing with a timed maximal sprint) separated by 24 hr, with or without compression socks.

SETTING

National Sports Training Centre, Queensland, Australia.

PARTICIPANTS

Ten national representative male wheelchair rugby athletes with cervical spinal cord injuries volunteered to participate.

INTERVENTIONS

Participants wore medical grade compression socks on both legs during the exercise task (COMP), and during the control trial no compression was worn (CON).

OUTCOME MEASURES

The efficacy of the compression socks was determined by assessments of limb blood flow, core body temperature, heart rate, and ratings of perceived exertion, perceived thermal strain, and physical performance.

RESULTS

While no significant differences between conditions were observed for maximal sprint time, average lap time was better maintained in COMP compared to CON (P<0.05). Lower limb blood flow increased from pre- to post-exercise by the same magnitude in both conditions (COMP: 2.51 ± 2.34; CON: 2.20 ± 1.85 ml.100 ml.(-1)min(-1)), whereas there was a greater increase in upper limb blood flow pre- to post-exercise in COMP (10.77 ± 8.24 ml.100 ml.(-1)min(-1)) compared to CON (6.21 ± 5.73 ml.100 ml.(-1)min(-1); P < 0.05).

CONCLUSION

These findings indicate that compression socks worn during exercise is an effective intervention for maintaining submaximal performance during wheelchair exercise, and this performance benefit may be associated with an augmentation of upper limb blood flow.

Physiology in Medicine: physiological basis of diaphragmatic dysfunction with abdominal hernias-implications for therapy

An incisional hernia is a common complication after abdominal surgery. Complaints of dyspnea in this population may be attributed to cardiopulmonary dysfunction or deconditioning. Large abdominal incisional hernias, however, may cause diaphragm dysfunction and result in dyspnea, which is more pronounced when standing (platypnea). The use of an abdominal binder may alleviate platypnea in this population. We discuss the link between diaphragm dysfunction and the lack of abdominal wall integrity and how abdominal wall support partially restores diaphragm function.

Nonpharmacologic management of orthostatic hypotension: a systematic review

OBJECTIVE

To systematically review the literature on nonpharmacologic treatment of orthostatic hypotension.

DATA SOURCES

MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane Central Register of Controlled Trials, and SPORTDiscus were searched for human studies written in the English language between January 1980 and April 2013. Reference lists of relevant articles were reviewed for citations to expand the data set.

STUDY SELECTION

Prospective experimental studies assessing nonpharmacologic interventions for management of orthostatic drop in blood pressure in various patient populations were included. All studies identified through the literature search were reviewed independently in duplicate. Of the 642 studies, 23 met the selection criteria.

DATA EXTRACTION

Two reviewers independently extracted data for analysis, including systolic and diastolic blood pressure and orthostatic symptoms in response to postural challenge before and after the intervention. All 23 studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database scale for randomized controlled trials and the Downs and Black tool for nonrandomized trials.

DATA SYNTHESIS

There were 8 identified nonpharmacologic interventions for management of orthostatic hypotension under 2 general categories: physical modalities (exercise, functional electrical stimulation, compression, physical countermaneuvers, compression with physical countermaneuvers, sleeping with head up) and dietary measures (water intake, meals). Owing to the clinically diverse nature of the studies, statistical comparison (meta-analysis) was deemed inappropriate. Instead, descriptive comparisons were drawn. Levels of evidence were assigned.

CONCLUSIONS

Strong levels of evidence were found for 4 of the 8 interventions: functional electrical stimulation in spinal cord injury, compression of the legs and/or abdomen, physical countermaneuvers in various patient populations, and eating smaller and more frequent meals in chronic autonomic failure. However, this conclusion is based on a limited number of studies with small sample sizes. Further research into all interventions is warranted.

Impact of an abdominal binder on speech outcomes in people with tetraplegic spinal cord injury: perceptual and acoustic measures

BACKGROUND

An abdominal binder (AB) is routinely used for patients who have suffered a spinal cord injury (SCI) resulting in tetraplegia. It is thought to restore abdominal pressure and consequently improve breathing capacity and reduce postural hypotension in patients who do not have functioning abdominal muscles.

OBJECTIVE

To examine the early effects of an AB on respiratory and speech outcomes.

METHODS

Thirteen individuals who sustained an acute motor complete SCI between C3 and T1 were assessed after a 6-week trial of using an elasticized AB from the time of first mobilizing in an upright wheelchair. Assessments were made using spirometry and perceptual and acoustics speech measures based on sustained phonation, sentence recitation, and passage reading.

RESULTS

Significant improvements were found in the AB-on condition for 3 of 5 respiratory parameters (vital capacity, forced vital capacity, and forced expiratory volume in 1 second). Predominantly mild voice and speech dysfunction were noted in participants. No significant difference was found for any of the acoustic and perceptual speech parameters (maximum phonation time, vocal intensity for sentence recitation, perceptual speech characteristics, or vocal quality) between the AB conditions.

CONCLUSIONS

Despite the finding that an AB results in significant improvements in respiratory function for individuals with tetraplegic SCI, the current study did not provide evidence that an AB improves speech production.

The effect of singing training on voice quality for people with quadriplegia

OBJECTIVES

Despite anecdotal reports of voice impairment in quadriplegia, the exact nature of these impairments is not well described in the literature. This article details objective and subjective voice assessments for people with quadriplegia at baseline and after a respiratory-targeted singing intervention.

STUDY DESIGN

Randomized controlled trial.

METHODS

Twenty-four participants with quadriplegia were randomly assigned to a 12-week program of either a singing intervention or active music therapy control. Recordings of singing and speech were made at baseline, 6 weeks, 12 weeks, and 6 months postintervention. These deidentified recordings were used to measure sound pressure levels and assess voice quality using the Multidimensional Voice Profile and the Perceptual Voice Profile.

RESULTS

Baseline voice quality data indicated deviation from normality in the areas of breathiness, strain, and roughness. A greater percentage of intervention participants moved toward more normal voice quality in terms of jitter, shimmer, and noise-to-harmonic ratio; however, the improvements failed to achieve statistical significance.

CONCLUSIONS

Subjective and objective assessments of voice quality indicate that quadriplegia may have a detrimental effect on voice quality; in particular, causing a perception of roughness and breathiness in the voice. The results of this study suggest that singing training may have a role in ameliorating these voice impairments.

Phonation after cervical spinal cord injury (CSCI): prospective case examinations of the acute and sub-acute stages of recovery

The aim of the investigation was to examine the changes in phonation and related quality-of-life in the acute and sub-acute stages of recovery post-cervical spinal cord injury (CSCI). A prospective examination of phonation was conducted using perceptual and instrumental measures of respiratory and laryngeal functioning alongside a quality-of-life rating scale. Change was present across measures for both cases at each time point. Overall, a general pattern of recovery was seen, although some areas deteriorated between 6-12 months. Severity of impairments, extent of change, and impact on quality-of-life differed between the cases. Measures varied in sensitivity to change in function. Phonation can be impaired following both complete and incomplete CSCI, with type and severity of impairment/s undergoing change throughout the acute and sub-acute period post-injury. Spontaneous physiological recovery does not necessarily result in improved phonation and/ or quality-of-life. Potential exists for targeted speech-language therapy in this population, throughout recovery, to best capitalize on the physical changes that are occurring and to maximize functional application of skills to improve quality- of-life. Further research is warranted to examine this recovery period on a larger scale.