Qiao Zhengtong, Kou Ziwei, Zhang Jiazhen, Lv Daozheng, Li Dongpan, Cui Xuefen, Liu Kai
School of Special Education and Rehabilitation, Binzhou Medical University, Yantai, China.
School of Clinical Medicine, Qingdao University, Qingdao, China.
Front Physiol. 2025 Jan 13;15:1496243. doi: 10.3389/fphys.2024.1496243. eCollection 2024.
Vocal therapy, such as singing training, is an increasingly popular pulmonary rehabilitation program that has improved respiratory muscle status in patients with chronic obstructive pulmonary disease (COPD). However, variations in singing treatment protocols have led to inconsistent clinical outcomes.
This study aims to explore the content of vocalization training for patients with COPD by observing differences in respiratory muscle activation across different vocalization tasks.
All participants underwent measurement of surface electromyography (sEMG) activity from the sternocleidomastoid (SCM), parasternal intercostal muscle (PARA), seventh intercostal muscle (7thIC), and rectus abdominis (RA) during the production of the vowels/a/,/i/, and/u/at varying pitches (comfortable, +6 semitones) and loudness (-10 dB, +10 dB) levels. The Visual Analog Scale (VAS) was used to evaluate the condition of patients concerning vocalization, while the Borg-CR10 breathlessness scale was utilized to gauge the level of dyspnea following the task. Repeated-measure (RM) ANOVA was utilized to analyze the EMG data of respiratory muscles and the Borg scale across different tasks.
Forty-one patients completed the experiment. Neural respiratory drive (NRD) in the SCM muscle did not significantly increase at high loudness levels (VAS 7-8) compared with that at low loudness levels ( (2, 120) = 1.548, = 0.276). However, NRD in the PARA muscle ( (2, 120) = 55.27, < 0.001), the 7thIC muscle ( (2, 120) = 59.08, < 0.001), and the RA muscle ( (2, 120) = 39.56, < 0.001) were significantly higher at high loudness compared with that at low loudness (VAS 2-3). Intercostal and abdominal muscle activation states were negatively correlated with maximal expiratory pressure (r = -0.671, < 0.001) and inspiratory pressure (r = -0.571, < 0.001) in the same loudness.
In contrast to pitch or vowel, vocal loudness emerges as a critical factor for vocalization training in patients with COPD. Higher pitch and loudness produced more dyspnea than lower pitch and loudness. In addition, maximal expiratory/inspiratory pressure was negatively correlated with respiratory muscle NRD in the same loudness vocalization task.
声乐疗法，如歌唱训练，是一种越来越受欢迎的肺康复项目，已改善慢性阻塞性肺疾病（COPD）患者的呼吸肌状态。然而，歌唱治疗方案的差异导致临床结果不一致。
本研究旨在通过观察不同发声任务中呼吸肌激活的差异，探索COPD患者发声训练的内容。
所有参与者在发出元音/a/、/i/和/u/时，在不同音高（舒适音高、高6个半音）和响度（低10 dB、高10 dB）水平下，接受胸锁乳突肌（SCM）、胸骨旁肋间肌（PARA）、第七肋间肌（7thIC）和腹直肌（RA）的表面肌电图（sEMG）活动测量。视觉模拟量表（VAS）用于评估患者的发声状况，而Borg-CR10呼吸困难量表用于评估任务后的呼吸困难程度。重复测量方差分析（RM ANOVA）用于分析不同任务中呼吸肌的肌电图数据和Borg量表。
41名患者完成了实验。与低响度水平（VAS 2-3）相比，高响度水平（VAS 7-8）时SCM肌的神经呼吸驱动（NRD）没有显著增加（F(2, 120) = 1.548, P = 0.276）。然而，与低响度相比，高响度时PARA肌（F(2, 120) = 55.27, P < 0.001）、7thIC肌（F(2, 120) = 59.08, P < 0.001）和RA肌（F(2, 120) = 39.56, P < 0.001）的NRD显著更高。在相同响度下，肋间肌和腹肌的激活状态与最大呼气压力（r = -0.671, P < 0.001）和吸气压力（r = -0.571, P < 0.001）呈负相关。
与音高或元音相比，发声响度是COPD患者发声训练的关键因素。较高的音高和响度比较低音高和响度产生更多的呼吸困难。此外，在相同响度的发声任务中，最大呼气/吸气压力与呼吸肌NRD呈负相关。
