Respiratory dysfunction is a common problem in the high level (C-4 through C-8) spinal cord injured (SCI) population, due to neuromuscular impairment in the muscles of respiration. Ability to inspire a reasonable amount of air to produce an efficient cough and relieve pulmonary secretions is compromised by the lack of inspiratory and expiratory muscles secondary to neuromusuclar impairment. Length of phonation, such as the ability to say a sentence in one breath, is also impaired. The Appoggio technique is taught to singers in order to maximize the use of the diaphragm through mental and physical inhibition of the shoulder, chest, and accessory muscles of the neck during inspiration. In this four week, single subject study, the Appoggio technique was applied to a chronic, respiratory compromised, and complete C-4 SCI subject for six treatment sessions. It was found that the subject made remarkable improvements in length of phonation using this technique. Cough effectiveness measured as Forced Vital Capacity (FVC) improved less as compared to the gains in length of phonation.
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