An investigation of abdominal muscle recruitment for sustained phonation in 25 healthy singers

OBJECTIVES

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.

STUDY DESIGN

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.

A three-paradigm treatment model using soft tissue mobilization and guided movement-awareness techniques for a patient with chronic low back pain: a case study

It is not uncommon for physical therapists to report difficulty in treating certain subjects with chronic idiopathic low back pain. The purpose of this case study is to present a three-paradigm model of intervention that may be adapted to the treatment of such cases. The model consists of: 1) relaxation paradigm, consisting of pain modulation procedures; 2) corrective paradigm, involving manual techniques and exercise to correct specific faulty biomechanical alignment(s) eg., pelvic asymmetry); and 3) integrative paradigm, utilizing guided movement/mobilization techniques for improving the subject's overall pattern of posture and movement. The case study of a young adult with chronic low back pain correlated with unilateral innominate bone rotation is presented to illustrate the three-paradigm approach. Over six sessions, the subject received a corrective (sessions 1-3) and an integrative treatment protocol (sessions 4-6) consisting of Rolf's method of soft tissue mobilization and Alexander's system of guided movement-awareness techniques. Before and after each session and after a 4-week follow-up, the subject was assessed for sacroiliac joint pain using a compression technique, anterior rotation of the innominate bones, pelvic angle in the standing position, and vagal tone as determined from heart rate variability. The therapist's visual analysis of sit-to-stand movement and the subject's self-reports of pain were noted. A corrective paradigm protocol of soft tissue mobilization and exercise was unsuccessful in eliminating the subject's assessed anterior rotation of the innominate bone and associated low back pain for more than 1-2 days posttreatment. Only after the implementation of a third paradigm movement/mobilization protocol did the subject begin to exhibit sustained improvement through a 4-week follow-up. Interpretations of the results, appropriate selection of corrective and integrative protocols, and physiological mechanisms are discussed.

An evaluation of the Alexander Technique for the management of disability in Parkinson's disease--a preliminary study

OBJECTIVE

To test the effect of the Alexander Technique (AT) on the management of disability and feelings of depression in patients with Parkinson's disease (PD).

DESIGN

Subjects completed four self-report questionnaires, one set before the course of lessons and a repeat set when the lessons were ended. The postal questionnaires were mailed directly to the subject's home from the university with a stamped addressed envelope.

SUBJECTS

Seven volunteers, with no previous experience of the Alexander Technique, diagnosed by consultant neurologists to have idiopathic Parkinson's disease.

SETTING

The subjects were contacted by the nearest registered AT teacher and were taught in the individual teacher's practice rooms, in the same way as other pupils.

INTERVENTIONS

Subjects received a median of 12 lessons.

MAIN OUTCOME MEASURES

The self-report measures were the BECK Depression Inventory, activities in daily living, body concept, and social functioning disability questionnaires.

RESULTS

Post-lessons the subjects were significantly (p < 0.05) less depressed. They had a significantly more positive body concept and had significantly less difficulty in performing daily activities, and significantly less difficulty on the fine movement and gross movement subscales of the activities in daily living questionnaire.

CONCLUSIONS

The statistically significant results are consistent with the hypothesis that for PD patients on drug therapy, the Alexander Technique reduces depression and improves the management of disability, but in the absence of a control group and a larger sample, they cannot be said to confirm the hypothesis. The likelihood of the AT being effective in the management of disability for many PD patients, as shown in this study, makes further controlled research desirable.