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Helou LB, Dum RP. Volitional inspiration is mediated by two independent output channels in the primary motor cortex. J Comp Neurol 2023; 531:1796-1811. [PMID: 37723869 PMCID: PMC10591979 DOI: 10.1002/cne.25540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023]
Abstract
The diaphragm is a multifunctional muscle that mediates both autonomic and volitional inspiration. It is critically involved in vocalization, postural stability, and expulsive core-trunk functions, such as coughing, hiccups, and vomiting. In macaque monkeys, we used retrograde transneuronal transport of rabies virus injected into the left hemidiaphragm to identify cortical neurons that have multisynaptic connections with phrenic motoneurons. Our research demonstrates that representation of the diaphragm in the primary motor cortex (M1) is split into two spatially separate and independent sites. No cortico-cortical connections are known to exist between these two sites. One site is located dorsal to the arm representation within the central sulcus and the second site is lateral to the arm. The dual representation of the diaphragm warrants a revision to the somatotopic map of M1. The dorsal diaphragm representation overlaps with trunk and axial musculature. It is ideally situated to coordinate with these muscles during volitional inspiration and in producing intra-abdominal pressure gradients. The lateral site overlaps the origin of M1 projections to a laryngeal muscle, the cricothyroid. This observation suggests that the coordinated control of laryngeal muscles and the diaphragm during vocalization may be achieved, in part, by co-localization of their representations in M1. The neural organization of the two diaphragm sites underlies a new perspective for interpreting functional imaging studies of respiration and/or vocalization. Furthermore, our results provide novel evidence supporting the concept that overlapping output channels within M1 are a prerequisite for the formation of muscle synergies underlying fine motor control.
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Affiliation(s)
- Leah B. Helou
- University of Pittsburgh, Department of Communication Science and Disorders, Pittsburgh, PA 15260
| | - Richard P. Dum
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260
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Pan Y, Zheng H, Xiao Y. Production of Tone 2 in disyllabic words in Mandarin Chinese speaking children aged 3-5 with a cochlear implant and a contralateral hearing aid. CLINICAL LINGUISTICS & PHONETICS 2023; 37:1013-1029. [PMID: 36214108 DOI: 10.1080/02699206.2022.2126332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
To investigate Mandarin Tone 2 production of disyllabic words of prelingually deafened children with a cochlear implant (CI) and a contralateral hearing aid (HA) and to evaluate the relationship between their demographic variables and tone-production ability. Thirty prelingually Mandarin-speaking preschoolers with CI+HA and 30 age-matched normal-hearing (NH) children participated in the study. Fourteen disyllabic words were recorded from each child. A total of 840 tokens (14 × 60) were then used in tone-perception tests in which four speech therapists participated. The production of T2-related disyllabic words of the bimodal group was significantly worse than that of the NH group, as reflected in the overall accuracy (88.57% ± 16.31% vs 99.29% ± 21.79%, p < 0.05), the accuracy of T1+T2 (93.33% vs 100%), the accuracy of T2+T1 (66.67 ± 37.91% vs 98.33 ± 9.13%), and the accuracy of T2+T4 (78.33 ± 33.95% vs 100%). In addition, the bimodal group showed significantly inferior production accuracy of T2+T1 than T2+T2 and T3+T2, p < 0.05. Both bimodal age and implantation age were significantly negatively correlated with the overall production accuracy, p < 0.05. For the error patterns, bimodal participants experienced more errors when T2 was in the first position of the tone combination, and T2 was most likely to be mispronounced as T1 and T3. Bimodal patients aged 3-5 have T2-related disyllabic lexical tone production defects, and their performances are related to tone combination, implantation age, and bimodal age.
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Affiliation(s)
- Yuchen Pan
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China
| | - Huiping Zheng
- Brain Heal Rehabilitation center, Hangzhou Nans Technology Co., LTD, Zhejiang, Hangzhou, China
| | - Yongtao Xiao
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China
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Mesolella M, Motta G, Allosso S, Motta G. Effects of Adenotonsillectomy on Vocal Function. J Pers Med 2023; 13:1002. [PMID: 37373991 DOI: 10.3390/jpm13061002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Correct breathing is a fundamental condition for adequate vocal production. Respiratory dynamics are able to modify the growth of facial mass and lingual posture, i.e., of the skull, the mandibular one. For this reason, infant mouth breathing can cause hoarseness. MATERIALS AND METHODS We evaluated the actual changes in the characteristics of the voice and articulation of language in a group of subjects affected by adenotonsillar hypertrophy (grade 3-4), with frequent episodes of pharyngo-tonsillitis who underwent adenotonsillectomy. Our study included 20 children-10 boys and 10 girls-aged 4 to 11 years who had adenotonsillar hypertrophy and pharyngotonsillitis episodes exceeding 5-6 per year in the previous 2 years. The control group (Group B) included 20 children-10 boys and 10 girls-aged 4 to 11 years (average age of 6.4 years) who had not undergone surgery and shared the same degree of adenotonsillar hypertrophy as those in Group A but who did not experience recurrent pharyngotonsillitis episodes. DISCUSSION The hypertrophy of adenoids and tonsils significantly impacted breathing, vocal function, and speech articulation. All this is responsible for a state of tension in the neck muscles, which at the level of the vocal tract causes hoarseness. The changes objectively observed in our study in the pre- and post-operative phase demonstrate how adenotonsillar hypertrophy is responsible for an increase in resistance to the passage of air at the glottic level. CONCLUSIONS For this reason, adenotonsillectomy has an impact on recurrent infections and can also lead to an improvement in speech, breathing, and posture.
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Affiliation(s)
- Massimo Mesolella
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80131 Naples, Italy
| | - Giovanni Motta
- Unit of Otorhinolaryngology, University Luigi Vanvitelli, 80131 Naples, Italy
| | - Salvatore Allosso
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80131 Naples, Italy
| | - Gaetano Motta
- Unit of Otorhinolaryngology, University Luigi Vanvitelli, 80131 Naples, Italy
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Fleischer M, Rummel S, Stritt F, Fischer J, Bock M, Echternach M, Richter B, Traser L. Voice efficiency for different voice qualities combining experimentally derived sound signals and numerical modeling of the vocal tract. Front Physiol 2022; 13:1081622. [PMID: 36620215 PMCID: PMC9822708 DOI: 10.3389/fphys.2022.1081622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose: Concerning voice efficiency considerations of different singing styles, from western classical singing to contemporary commercial music, only limited data is available to date. This single-subject study attempts to quantify the acoustic sound intensity within the human glottis depending on different vocal tract configurations and vocal fold vibration. Methods: Combining Finite-Element-Models derived from 3D-MRI data, audio recordings, and electroglottography (EGG) we analyzed vocal tract transfer functions, particle velocity and acoustic pressure at the glottis, and EGG-related quantities to evaluate voice efficiency at the glottal level and resonance characteristics of different voice qualities according to Estill Voice Training®. Results: Voice qualities Opera and Belting represent highly efficient strategies but apply different vowel strategies and should thus be capable of predominate orchestral sounds. Twang and Belting use similar vowels, but the twang vocal tract configuration enabled the occurrence of anti-resonances and was associated with reduced vocal fold contact but still partially comparable energy transfer from the glottis to the vocal tract. Speech was associated with highly efficient glottal to vocal tract energy transfer, but with the absence of psychoactive strategies makes it more susceptible to noise interference. Falsetto and Sobbing apply less efficiently. Falsetto mainly due to its voice source characteristics, Sobbing due to energy loss in the vocal tract. Thus technical amplification might be appropriate here. Conclusion: Differences exist between voice qualities regarding the sound intensity, caused by different vocal tract morphologies and oscillation characteristics of the vocal folds. The combination of numerical analysis of geometries inside the human body and experimentally determined data outside sheds light on acoustical quantities at the glottal level.
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Affiliation(s)
- Mario Fleischer
- Department of Audiology and Phoniatrics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,*Correspondence: Mario Fleischer,
| | | | - Fiona Stritt
- Medical Center, Institute of Musicians’ Medicine, University of Freiburg, Freiburg, Germany,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Fischer
- Faculty of Medicine, University of Freiburg, Freiburg, Germany,Medical Center, Department of Radiology, Medical Physics, University of Freiburg, Freiburg, Germany
| | - Michael Bock
- Faculty of Medicine, University of Freiburg, Freiburg, Germany,Medical Center, Department of Radiology, Medical Physics, University of Freiburg, Freiburg, Germany
| | - Matthias Echternach
- Department of Otorhinolaryngology, Ludwig-Maximilians-Universität München, Division of Phoniatrics and Pediatric Audiology, LMU Klinikum, Munich, Germany
| | - Bernhard Richter
- Medical Center, Institute of Musicians’ Medicine, University of Freiburg, Freiburg, Germany,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Louisa Traser
- Medical Center, Institute of Musicians’ Medicine, University of Freiburg, Freiburg, Germany,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Traser L, Schwab C, Burk F, Özen AC, Bock M, Richter B, Echternach M. Differences of respiratory kinematics in female and male singers - A comparative study using dynamic magnetic resonance imaging. Front Psychol 2022; 13:844032. [PMID: 36544443 PMCID: PMC9760878 DOI: 10.3389/fpsyg.2022.844032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Breath control is an important factor for singing voice production, but pedagogic descriptions of how a beneficial movement pattern should be performed vary widely and the underlying physiological processes are not understood in detail. Differences in respiratory movements during singing might be related to the sex of the singer. To study sex-related differences in respiratory kinematics during phonation, 12 singers (six male and six female) trained in the Western classical singing tradition were imaged with dynamic magnetic resonance imaging. Singers were asked to sustain phonation at five different pitches and loudness conditions, and cross-sectional images of the lung were acquired. In each dynamic image frame the distances between anatomical landmarks were measured to quantify the movements of the respiratory apparatus. No major difference between male and female singers was found for the general respiratory kinematics of the thorax and the diaphragm during sustained phonation. However when compared to sole breathing, male singers significantly increased their thoracic movements for singing. This behavior could not be observed in female singers. The presented data support the hypothesis that professional singers follow sex-specific breathing strategies. This finding may be important in a pedagogical context where the biological sex of singer and student differ and should be further investigated in a larger cohort.
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Affiliation(s)
- Louisa Traser
- Institute of Musicians’ Medicine, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany,Faculty of Medicine, University of Freiburg, Freiburg, Germany,*Correspondence: Louisa Traser,
| | - Carmen Schwab
- Faculty of Medicine, University of Freiburg, Freiburg, Germany,Department of Prosthetic Dentistry, Center for Dental Medicine, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Fabian Burk
- Institute of Musicians’ Medicine, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany,Department of Phoniatrics and Pediatric Audiology, University Medical Center Münster, Münster, Germany
| | - Ali Caglar Özen
- Faculty of Medicine, University of Freiburg, Freiburg, Germany,Department of Radiology, Medical Physics, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Bock
- Faculty of Medicine, University of Freiburg, Freiburg, Germany,Department of Radiology, Medical Physics, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernhard Richter
- Institute of Musicians’ Medicine, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Echternach
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Munich University Hospital (LMU), Munich, Germany
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Yu X, Jiang HY, Zhang CX, Jin ZH, Gao L, Wang RD, Fang JP, Su Y, Xi JN, Fang BY. The Role of the Diaphragm in Postural Stability and Visceral Function in Parkinson's Disease. Front Aging Neurosci 2022; 13:785020. [PMID: 35002681 PMCID: PMC8733584 DOI: 10.3389/fnagi.2021.785020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background: In normal subjects, the diaphragm plays a key functional role in postural stability, articulation, respiration, defecation, and urination. Objectives: The aim of this study was to investigate the role of the diaphragm in postural stability and visceral function in patients with Parkinson’s disease (PD) and to compare the diaphragm function by gender, Hoehn and Yahr (H&Y) staging, and motor subtypes. Methods: In total, 79 patients were enrolled in this cross-sectional study. The severity of the disease was assessed by the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale III and by H&Y staging. Postural stability was quantitatively recorded, and respiratory function was evaluated by spirometry. Several scales were used to evaluate visceral function in patients with PD. In addition, diaphragm ultrasound was used to measure the excursion, contraction velocity, and thickness of the diaphragm during quiet breathing, deep breathing, and the sniff test. Significant features were selected by the least absolute shrinkage and selection operator (LASSO) regression and fitted in the multivariate linear regression and Pearson’s correlation analysis. Results: Diaphragm thickness and excursion during quiet breathing were significantly different between men and women and between H&Y stage 1–2 and stage 2.5–3, whereas the diaphragm function was not influenced by motor subtypes. It was shown that the diaphragmatic function was significantly correlated with postural stability, voice function, respiratory function, constipation, and urological function to varying degrees in patients with PD. Conclusion: The diaphragmatic function is associated with dysfunction in PD although it remains unclear as to whether the observed changes in the diaphragm are primary or secondary.
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Affiliation(s)
- Xin Yu
- Beijing Rehabilitation Medical College, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Hong-Ying Jiang
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Chen-Xi Zhang
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Zhao-Hui Jin
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Lei Gao
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Rui-Dan Wang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jin-Ping Fang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yuan Su
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jia-Ning Xi
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Bo-Yan Fang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
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The influence of gravity on respiratory kinematics during phonation measured by dynamic magnetic resonance imaging. Sci Rep 2021; 11:22965. [PMID: 34824315 PMCID: PMC8617256 DOI: 10.1038/s41598-021-02152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/03/2021] [Indexed: 11/08/2022] Open
Abstract
Respiratory kinematics are important for the regulation of voice production. Dynamic MRI is an excellent tool to study respiratory motion providing high-resolution cross-sectional images. Unfortunately, in clinical MRI systems images can only be acquired in a horizontal subject position, which does not take into account gravitational effects on the respiratory apparatus. To study the effect of body posture on respiratory kinematics during phonation, 8 singers were examined both in an open-configuration MRI with a rotatable gantry and a conventional horizontal MRI system. During dynamic MRI the subjects sang sustained tones at different pitches in both supine and upright body positions. Sagittal images of the respiratory system were obtained at 1-3 images per second, from which 6 anatomically defined distances were extracted to characterize its movements in the anterior, medium and posterior section of the diaphragm as well as the rip cage (diameter at the height of the 3rd and 5th rip) and the anterior-posterior position of the diaphragm cupola. Regardless of body position, singers maintained their general principles of respiratory kinematics with combined diaphragm and thorax muscle activation for breath support. This was achieved by expanding their chest an additional 20% during inspiration when singing in the supine position but not for sole breathing. The diaphragm was cranially displaced in supine position for both singing and breathing and its motion range increased. These results facilitate a more realistic extrapolation of research data obtained in a supine position.
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Manes JL, Herschel E, Aveni K, Tjaden K, Parrish T, Simuni T, Corcos DM, Roberts AC. The effects of a simulated fMRI environment on voice intensity in individuals with Parkinson's disease hypophonia and older healthy adults. JOURNAL OF COMMUNICATION DISORDERS 2021; 94:106149. [PMID: 34543846 PMCID: PMC8627501 DOI: 10.1016/j.jcomdis.2021.106149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/14/2021] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Functional magnetic resonance imaging (fMRI) has promise for understanding neural mechanisms of neurogenic speech and voice disorders. However, performing vocal tasks within the fMRI environment may not always be analogous to performance outside of the scanner. Using a mock MRI scanner, this study examines the effects of a simulated scanning environment on vowel intensity in individuals with Parkinson's disease (PD) and hypophonia and older healthy control (OHC) participants. METHOD Thirty participants (15 PD, 15 OHC) performed a sustained /ɑ/ vowel production task in three conditions: 1) Upright, 2) Mock Scanner + No Noise, and 3) Mock Scanner + MRI noise. We used a linear mixed-effects (multi-level) model to evaluate the contributions of group and recording environment to vowel intensity. A second linear mixed-effects model was also used to evaluate the contributions of PD medication state (On vs. Off) to voice intensity. RESULTS Vowel intensity was significantly lower for PD compared to the OHC group. The intensity of vowels produced in the Upright condition was significantly lower compared to the Mock Scanner + No Noise condition, while vowel intensity in the Mock Scanner + MRI Noise condition was significantly higher compared to the Mock Scanner + No Noise condition. A group by condition interaction also indicated that the addition of scanner noise had a greater impact on the PD group. A second analysis conducted within the PD group showed no effects of medication state on vowel intensity. CONCLUSION Our findings demonstrate that performance on voice production tasks is altered for PD and OHC groups when translated into the fMRI environment, even in the absence of acoustic scanner noise. For fMRI studies of voice in PD hypophonia, careful thought should be given to how the presence of acoustic noise may differentially affect PD and OHC, for both group and task comparisons.
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Affiliation(s)
- Jordan L Manes
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA.
| | - Ellen Herschel
- Brain and Creativity Institute, University of Southern California, Los Angeles, CA
| | - Katharine Aveni
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Kris Tjaden
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY
| | - Todd Parrish
- Department of Radiology, Northwestern University, Chicago, IL
| | - Tanya Simuni
- Ken and Ruth Davee Department of Neurology, Northwestern University, Chicago, IL
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL
| | - Angela C Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
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