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David J Berlowitz - One of the best experts on this subject based on the ideXlab platform.
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The effect of singing training on voice quality for people with Quadriplegia.
Journal of voice : official journal of the Voice Foundation, 2013Co-Authors: Jeanette Tamplin, Mary Buttifant, Felicity A. Baker, David J BerlowitzAbstract:Summary 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.
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auto titrating continuous positive airway pressure treatment for obstructive sleep apnoea after acute Quadriplegia cosaq study protocol for a randomized controlled trial
Trials, 2013Co-Authors: David J Berlowitz, Maree Barnes, Douglas J Brown, Najib T Ayas, Peter A Cistulli, Timothy Geraghty, Alison Graham, Bonsan B Lee, Meg E MorrisAbstract:Background: Quadriplegia is a severe, catastrophic injury that predominantly affects people early in life, resulting in lifelong physical disability. Obstructive sleep apnoea is a direct consequence of Quadriplegia and is associated with neurocognitive deficits, sleepiness and reduced quality of life. The usual treatment for sleep apnoea is nasal continuous positive airway pressure (CPAP); however, this is poorly tolerated in Quadriplegia. To encourage patients to use this therapy, we have to demonstrate that the benefits outweigh the inconvenience. We therefore propose a prospective, multinational randomized controlled trial of three months of CPAP for obstructive sleep apnoea after acute Quadriplegia. Methods/design: Specialist spinal cord injury centres across Australia, New Zealand, the UK and Canada will recruit medically stable individuals who have sustained a (new) traumatic Quadriplegia (complete or incomplete second cervical to first thoracic level lesions). Participants will be screened for obstructive sleep apnoea using full, portable sleep studies. Those with an apnoea hypopnoea index greater than 10 per hour will proceed to an initial threenight trial of CPAP. Those who can tolerate CPAP for at least 4 hours on at least one night of the initial trial will be randomized to either usual care or a 3-month period of auto-titrating CPAP. The primary hypothesis is that nocturnal CPAP will improve neuropsychological functioning more than usual care alone. The secondary hypothesis is that the magnitude of improvement of neuropsychological function will be predicted by the severity of baseline sleepiness measures, sleep fragmentation and sleep apnoea. Neuropsychological tests and full polysomnography will be performed at baseline and 3 months with interim measures of sleepiness and symptoms of autonomic dysfunction measured weekly. Spirometry will be performed monthly. Neuropsychological tests will be administered by blinded assessors. Recruitment commenced in July 2009. Discussion: The results of this trial will demonstrate the effect of nocturnal CPAP treatment of obstructive sleep apnoea in acute Quadriplegia. If CPAP can improve neurocognitive function after injury, it is likely that rehabilitation and subsequent community participation will be substantially improved for this group of predominantly young and severely physically disabled people.
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Auto-titrating continuous positive airway pressure treatment for obstructive sleep apnoea after acute Quadriplegia (COSAQ): study protocol for a randomized controlled trial
Trials, 2013Co-Authors: David J Berlowitz, Maree Barnes, Douglas J Brown, Peter A Cistulli, Alison Graham, Bonsan B Lee, Najib Ayas, Tim Geraghty, Gerard A Kennedy, Meg MorrisAbstract:Background Quadriplegia is a severe, catastrophic injury that predominantly affects people early in life, resulting in lifelong physical disability. Obstructive sleep apnoea is a direct consequence of Quadriplegia and is associated with neurocognitive deficits, sleepiness and reduced quality of life. The usual treatment for sleep apnoea is nasal continuous positive airway pressure (CPAP); however, this is poorly tolerated in Quadriplegia. To encourage patients to use this therapy, we have to demonstrate that the benefits outweigh the inconvenience. We therefore propose a prospective, multinational randomized controlled trial of three months of CPAP for obstructive sleep apnoea after acute Quadriplegia. Methods/design Specialist spinal cord injury centres across Australia, New Zealand, the UK and Canada will recruit medically stable individuals who have sustained a (new) traumatic Quadriplegia (complete or incomplete second cervical to first thoracic level lesions). Participants will be screened for obstructive sleep apnoea using full, portable sleep studies. Those with an apnoea hypopnoea index greater than 10 per hour will proceed to an initial three-night trial of CPAP. Those who can tolerate CPAP for at least 4 hours on at least one night of the initial trial will be randomized to either usual care or a 3-month period of auto-titrating CPAP. The primary hypothesis is that nocturnal CPAP will improve neuropsychological functioning more than usual care alone. The secondary hypothesis is that the magnitude of improvement of neuropsychological function will be predicted by the severity of baseline sleepiness measures, sleep fragmentation and sleep apnoea. Neuropsychological tests and full polysomnography will be performed at baseline and 3 months with interim measures of sleepiness and symptoms of autonomic dysfunction measured weekly. Spirometry will be performed monthly. Neuropsychological tests will be administered by blinded assessors. Recruitment commenced in July 2009. Discussion The results of this trial will demonstrate the effect of nocturnal CPAP treatment of obstructive sleep apnoea in acute Quadriplegia. If CPAP can improve neurocognitive function after injury, it is likely that rehabilitation and subsequent community participation will be substantially improved for this group of predominantly young and severely physically disabled people. Trial registration Australian New Zealand Clinical Trial Registry ACTRN12605000799651
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Pathogenesis of obstructive sleep apnoea in Quadriplegia
Journal of Sleep Research, 2011Co-Authors: Laura Gainche, M C Le Guen, J Trinder, Peter D. Rochford, Warren R. Ruehland, Maree Barnes, Fergal J O'donoghue, David J Berlowitz, Amy S. JordanAbstract:Background: Obstructive sleep apnoea (OSA) is estimated to be two to five times higher in patients with Quadriplegia than in able-bodied individuals. The reason for this elevated prevalence remains unknown. Aims: In order to better understand the high prevalence of OSA in Quadriplegia, the upper airway anatomy and neuromuscular function were investigated in able-bodied participants and patients with Quadriplegia with and without OSA. This exploratory project systematically characterized eight factors that are thought to contribute to OSA in the able-bodied: upper airway lining liquid, lung volumes, upper airway resistance, genioglossus muscle and brain (Respiratory-Related Evoked Potential) reflex response to negative pressure pulse stimuli during wakefulness, passive pharyngeal critical pressure during sleep, arousal threshold, and genioglossus muscle responsiveness to an event during sleep. Hypotheses: Given the large difference in OSA prevalence, most variables were expected to be worsened in patients with Quadriplegia compared to group-matched able-bodied individuals. Methods: Eleven patients with chronic Quadriplegia (> one year) caused by a traumatic spinal cord injury were recruited regardless of OSA severity. Nine able-bodied participants were recruited following the characteristics of the Quadriplegia group in order to group-match for Apnoea Hypopnoea Index, age, gender, and weight. Each subject underwent a full home polysomnography and had the eight selected factors assessed on a separate day. Results: Significant differences were identified between the groups in nasal resistance, as well as the genioglossus and brain negative pressure reflex response. At baseline, the patients with Quadriplegia had elevated nasal resistance compared to able-bodied participants (7.0 ± 1.9 and 3.0 ± 0.6 cmH2O/L/s respectively, p = 0.049), which went down to able-bodied levels with the use of phenylephrine (2.3 ± 0.4 and 2.5 ± 0.4 cmH2O/L/s respectively). The genioglossus reflex response exhibited an inhibitory-only activity in four out of ten participants with Quadriplegia and one out of nine able-bodied participants. When present, there was no significant delay or difference in amplitude in genioglossus peak excitation between the groups. Regarding the respiratory-related evoked potentials, except for the P1 (p = 0.077) and N2 (p = 0.182), all latencies were significantly longer in the Quadriplegia group compared to the able-bodied group: P1A (p < 0.001), Nf (p = 0.007), N1 (p < 0.001), P2 (p = 0.021). The other variables were not found to be different between the groups. Discussion and conclusion: We identified nasal resistance and sensory or afferent pathways as standout factors that may be implicated in the establishment of OSA in Quadriplegia. These modifications may be the consequence of one or more of the following after spinal cord injury: decreased or loss of sympathetic activity, nervous system plasticity and rearrangement, systemic neuroinflammation, undetected brain trauma. Our findings provide important insights into the development of OSA in Quadriplegia and open the door to future targeted studies of relevant treatments.
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Assessment of breathing patterns and respiratory muscle recruitment during singing and speech in Quadriplegia.
Archives of physical medicine and rehabilitation, 2011Co-Authors: Jeanette Tamplin, Warren R. Ruehland, Danny J. Brazzale, Jeffrey J. Pretto, Mary Buttifant, Douglas J Brown, David J BerlowitzAbstract:Abstract Tamplin J, Brazzale DJ, Pretto JJ, Ruehland WR, Buttifant M, Brown DJ, Berlowitz DJ. Assessment of breathing patterns and respiratory muscle recruitment during singing and speech in Quadriplegia. Objectives To explore how respiratory impairment after cervical spinal cord injury affects vocal function, and to explore muscle recruitment strategies used during vocal tasks after Quadriplegia. It was hypothesized that to achieve the increased respiratory support required for singing and loud speech, people with Quadriplegia use different patterns of muscle recruitment and control strategies compared with control subjects without spinal cord injury. Design Matched, parallel-group design. Setting Large university-affiliated public hospital. Participants Consenting participants with motor-complete C5-7 Quadriplegia (n=6) and able-bodied age-matched controls (n=6) were assessed on physiologic and voice measures during vocal tasks. Interventions Not applicable. Main Outcome Measures Standard respiratory function testing, surface electromyographic activity from accessory respiratory muscles, sound pressure levels during vocal tasks, the Voice Handicap Index, and the Perceptual Voice Profile. Results The group with Quadriplegia had a reduced lung capacity (vital capacity, 71% vs 102% of predicted; P =.028), more perceived voice problems (Voice Handicap Index score, 22.5 vs 6.5; P =.046), and greater recruitment of accessory respiratory muscles during both loud and soft volumes ( P =.028) than the able-bodied controls. The group with Quadriplegia also demonstrated higher accessory muscle activation in changing from soft to loud speech ( P =.028). Conclusions People with Quadriplegia have impaired vocal ability and use different muscle recruitment strategies during speech than the able-bodied. These findings will enable us to target specific measurements of respiratory physiology for assessing functional improvements in response to formal therapeutic singing training.
John F. Ditunno - One of the best experts on this subject based on the ideXlab platform.
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motor recovery of the upper extremities in traumatic Quadriplegia a multicenter study
Archives of Physical Medicine and Rehabilitation, 1992Co-Authors: John F. Ditunno, Samuel L Stover, Murray M Freed, J H AhnAbstract:Clinicians need to know recovery of neurologic function in the upper extremities after traumatic Quadriplegia to prognosticate function in self-care, to determine the effectiveness of various interventions, and to develop a comprehensive rehabilitation plan. This study was undertaken to determine the extent of recovery of key muscles of the arms in motor complete quadriplegic subjects. The hypothesis stated that patients with some motor power (grades 1.0 to 2.5/5) in muscles in the zone of partial preservation would recover at an earlier time and to a greater extent than those with no motor power (grade 0/5). One hundred fifty subjects, C4, C5, and C6 motor complete, were entered in the study within one week of injury from four centers. Serial muscle examinations of the biceps, wrist extensors, and triceps on the right and left sides were performed up to 24 months after spinal cord injury. The pattern of recovery in the key muscles of the 67 subjects with some motor power in the zone of partial preservation to grade 3/5 was significantly greater than the 83 subjects with no motor power (68% to 82% vs 14% to 36%, p less than .001) at three to six months postinjury. The plateau of the median manual muscle test score determined the extent of recovery and reached grade 4/5 in subjects with some motor power at three to six months. The pattern of recovery revealed more subjects with some motor power improved to grade 3/5 at all intervals earlier than those with no motor power (p less than .005).(ABSTRACT TRUNCATED AT 250 WORDS)
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The role of allergen immunotherapy in the respiratory complications of Quadriplegia
Archives of physical medicine and rehabilitation, 1992Co-Authors: John R. Cohn, John F. DitunnoAbstract:Abstract Patients with traumatic Quadriplegia have frequent respiratory complications. These complications may be exacerbated by the presence of common and previously well-tolerated allergic disease. Quadriplegic patients are limited in their ability to cope with upper and lower respiratory allergies by a reduced vital capacity and impairment of maneuvers needed to keep the upper and lower respiratory tracts clear. This report describes two patients with traumatic Quadriplegia who were treated with allergen immunotherapy. After immunotherapy, both patients had negligible long-term postinjury respiratory complications and an improved quality of life. Allergen immunotherapy should be considered early in the management of allergic patients with traumatic Quadriplegia.
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The Role of Allergen Immunotherapy in the Complications of Quadriplegia
1992Co-Authors: John R. Cohn, John F. DitunnoAbstract:Cohn JR, Ditmmo JF. The role of allergen immunotherapy in the respiratory complications of quadriple- gia. Arch Phys Med Rehabil1992;73:101-3. Patients with traumatic Quadriplegia have frequent respiratory complications. These complications may be exacer- bated by the presence of common and previously well-tolerated allergic disease. Quadriplegic patients are limited in their ability to cope with upper and lower respiratory allergies by a reduced vital capacity and impairment of maneuvers needed to keep the upper and lower respiratory tracts clear. This report describes two patients with traumatic quadriple- gia who were treated with allergen immunotherapy. After immunotherapy, both patients had negligible long-term postinjury respiratory complications and an improved quality of fife. Allergen immunotherapy should be considered early in the management of allergic patients with traumatic Quadriplegia. It has been estimated that up to 20% of the population in the United States has allergy symptoms,* including allergic rhinitis and asthma. The incidence of asthma itself varies among studies, with estimates up to 8.5% in the United States and other developed countries.' It is therefore not surprising that patients with traumatic injuries, including Quadriplegia, present with both severe neurologic damage and atrophy. The treatment of allergic problems in patients with trau- matic Quadriplegia is complicated by their injuries and re- sulting disabilities. Antihistamines, which are a mainstay of the ambulatory management of allergic rhinitis, can be as- sociated with anticholinergic effects and sedation.2 Drying of secretions may be a potential problem in these patients who are already prone to atelectasis.3 In addition, quadriple- gic patients may have difficulty coordinating their breath- ing to effectively use metered dose inhalers. With increased emphasis in the allergy literature on the use of anti-inflam- matory therapy for the treatment of asthma,4 this is a seri- ous problem, since anti-inflammatory drugs such as cromo- lyn sodium and inhaled corticosteroids require the use of metered dose inhalers for convenient direct delivery. Cro- molyn sodium can be nebulized, but it is not always effec- tive; and the systemic use of corticosteroids has well-docu- mented side effects, making them less than ideal for long-term use.' This may be a particular problem in pa- tients whose immobility already predisposes them to infec- tion and osteoporosis.
A T Thornton - One of the best experts on this subject based on the ideXlab platform.
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sleep apnoea in patients with Quadriplegia
Thorax, 1995Co-Authors: Ronald Mcevoy, I Mykytyn, Dimitar Sajkov, H Flavell, R Marshall, Ral Antic, A T ThorntonAbstract:BACKGROUND--This study was undertaken to establish the prevalence of, and the factors contributing towards, sleep disordered breathing in patients with Quadriplegia. METHODS--Forty representative quadriplegic patients (time since injury > 6 months, injury level C8 and above, Frankel category A, B, or C; mean (SE) age 35.0 (1.7) years) had home sleep studies in which EEG, EOG, submental EMG, body movement, nasal airflow, respiratory effort, and pulse oximetry (SpO2) were measured. Patients reporting post traumatic amnesia of > 24 hours, drug or alcohol abuse or other major medical illness were excluded from the study. A questionnaire on medications and sleep was administered and supine blood pressure, awake SpO2, spirometric values, height, and neck circumference were measured. RESULTS--A pattern of sustained hypoventilation was not observed in any of the patients. Sleep apnoeas and hypopnoeas were, however, common. Eleven patients (27.5%) had a respiratory disturbance index (RDI, apnoeas plus hypopnoeas per hour of sleep) of > or = 15, with nadir SpO2 ranging from 49% to 95%. Twelve of the 40 (30%) had an apnoea index (AI) of > or = 5 and, of these, nine (75%) had predominantly obstructive apnoeas-that is, > 80% of apnoeas were obstructive or mixed. This represents a prevalence of sleep disordered breathing more than twice that observed in normal populations. For the study population RDI correlated with systolic and diastolic blood pressure and neck circumference. RDI was higher in patients who slept supine compared with those in other postures. Daytime sleepiness was a common complaint in the study population and sleep architecture was considerably disturbed with decreased REM sleep and increased stage 1 non-REM sleep. CONCLUSIONS--Sleep disordered breathing is common in quadriplegic patients and sleep disturbance is significant. The predominant type of apnoea is obstructive. As with non-quadriplegic patients with sleep apnoea, sleep disordered breathing in quadriplegics is associated with increased neck circumference and the supine sleep posture.
Anthony J Lauder - One of the best experts on this subject based on the ideXlab platform.
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progression of scoliosis in patients with spastic Quadriplegia after the insertion of an intrathecal baclofen pump
Spine, 2007Co-Authors: Glen M Ginsburg, Anthony J LauderAbstract:STUDY DESIGN: Medical and radiographic review of 19 consecutive patients with spastic Quadriplegia before and after intrathecal baclofen pump insertion with special attention paid to progression of scoliosis. OBJECTIVE: Many orthopedic surgeons who treat spastic quadriplegic patients have noticed a trend of marked scoliosis progression after the administration of intrathecal baclofen (ITB) via subcutaneous pump and catheter. The purpose of this study is to quantify scoliosis progression in this patient population before and after baclofen administration and compare this to published natural history data. SUMMARY OF BACKGROUND DATA: The authors had noted rapid progression of scoliosis in spastic quadriplegic patients after intrathecal baclofen pump insertion. This had been noted at other centers, but no significant statistical analysis had been done comparing prepump to postpump scoliosis progression in these patients. METHODS: To document the magnitude and rate of scoliosis progressions after the placement of an ITB pump, the charts and radiographs of 19 consecutive nonambulatory patients with spastic Quadriplegia and an ITB pump were reviewed. To document the rate of scoliosis progression, each patient had at least 2 pre and 2 postpump insertion spinal radiographs made. All radiographs were made with the patients in the supine position without orthoses. A board-certified orthopedic surgeon reviewed these radiographs. Skeletal maturity was assessed using Risser grading. Catheter tip location and rate of baclofen administration were recorded. RESULTS: For 19 patients with complete radiographic data, average Cobb angles were 10.2 degrees before pump insertion and 25 degrees at an average of 20.9 months after pump insertion (P < 0.0001). These 19 patients had a mean rate of change in their Cobb angles of 1.825%/year before pump insertion and 10.95 degrees /year at an average of 23.9 months after pump insertion (P = 0.024). These results represent a 6-fold increase in the curve progression rate after pump insertion. There was no association between catheter tip location or rate of Baclofen infusion on curve progression. CONCLUSION: In published data, the rate of progression of scoliosis in skeletally immature nonambulatory patients with cerebral palsy was 4.5 degrees /year. In this study, the average rate of progression of the scoliosis for the immature was 9.02 degrees /year. For the skeletally mature bed-ridden patients, the worst-case natural history progression was 4.4 degrees /year. The comparable rate of change in skeletally mature (Risser 5) nonambulatory patients (n = 6) in this study was 28.4 degrees /year. This study demonstrates a significant increase in the rate of scoliotic curve progression after ITB pump placement when compared with published natural history data. The evidence of the beneficial effects of ITB on spasticity has been confirmed, and as larger, prospective randomized studies are conducted, the authors think that support for continued use of this treatment will increase. However, early bracing and spinal fusion may be warranted to prevent significant increases in spinal deformity if scoliosis is anticipated to progress more than 10 degrees /yr for patients with spastic Quadriplegia and ITB pump. The authors are now performing spinal fusions for curves that exceed 40 degrees to 50 degrees in the presence of an ITB pump as recommended by previous reviews of scoliosis and accompanying Quadriplegia.
Douglas J Brown - One of the best experts on this subject based on the ideXlab platform.
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Auto-titrating continuous positive airway pressure treatment for obstructive sleep apnoea after acute Quadriplegia (COSAQ): study protocol for a randomized controlled trial
Trials, 2013Co-Authors: David J Berlowitz, Maree Barnes, Douglas J Brown, Peter A Cistulli, Alison Graham, Bonsan B Lee, Najib Ayas, Tim Geraghty, Gerard A Kennedy, Meg MorrisAbstract:Background Quadriplegia is a severe, catastrophic injury that predominantly affects people early in life, resulting in lifelong physical disability. Obstructive sleep apnoea is a direct consequence of Quadriplegia and is associated with neurocognitive deficits, sleepiness and reduced quality of life. The usual treatment for sleep apnoea is nasal continuous positive airway pressure (CPAP); however, this is poorly tolerated in Quadriplegia. To encourage patients to use this therapy, we have to demonstrate that the benefits outweigh the inconvenience. We therefore propose a prospective, multinational randomized controlled trial of three months of CPAP for obstructive sleep apnoea after acute Quadriplegia. Methods/design Specialist spinal cord injury centres across Australia, New Zealand, the UK and Canada will recruit medically stable individuals who have sustained a (new) traumatic Quadriplegia (complete or incomplete second cervical to first thoracic level lesions). Participants will be screened for obstructive sleep apnoea using full, portable sleep studies. Those with an apnoea hypopnoea index greater than 10 per hour will proceed to an initial three-night trial of CPAP. Those who can tolerate CPAP for at least 4 hours on at least one night of the initial trial will be randomized to either usual care or a 3-month period of auto-titrating CPAP. The primary hypothesis is that nocturnal CPAP will improve neuropsychological functioning more than usual care alone. The secondary hypothesis is that the magnitude of improvement of neuropsychological function will be predicted by the severity of baseline sleepiness measures, sleep fragmentation and sleep apnoea. Neuropsychological tests and full polysomnography will be performed at baseline and 3 months with interim measures of sleepiness and symptoms of autonomic dysfunction measured weekly. Spirometry will be performed monthly. Neuropsychological tests will be administered by blinded assessors. Recruitment commenced in July 2009. Discussion The results of this trial will demonstrate the effect of nocturnal CPAP treatment of obstructive sleep apnoea in acute Quadriplegia. If CPAP can improve neurocognitive function after injury, it is likely that rehabilitation and subsequent community participation will be substantially improved for this group of predominantly young and severely physically disabled people. Trial registration Australian New Zealand Clinical Trial Registry ACTRN12605000799651
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auto titrating continuous positive airway pressure treatment for obstructive sleep apnoea after acute Quadriplegia cosaq study protocol for a randomized controlled trial
Trials, 2013Co-Authors: David J Berlowitz, Maree Barnes, Douglas J Brown, Najib T Ayas, Peter A Cistulli, Timothy Geraghty, Alison Graham, Bonsan B Lee, Meg E MorrisAbstract:Background: Quadriplegia is a severe, catastrophic injury that predominantly affects people early in life, resulting in lifelong physical disability. Obstructive sleep apnoea is a direct consequence of Quadriplegia and is associated with neurocognitive deficits, sleepiness and reduced quality of life. The usual treatment for sleep apnoea is nasal continuous positive airway pressure (CPAP); however, this is poorly tolerated in Quadriplegia. To encourage patients to use this therapy, we have to demonstrate that the benefits outweigh the inconvenience. We therefore propose a prospective, multinational randomized controlled trial of three months of CPAP for obstructive sleep apnoea after acute Quadriplegia. Methods/design: Specialist spinal cord injury centres across Australia, New Zealand, the UK and Canada will recruit medically stable individuals who have sustained a (new) traumatic Quadriplegia (complete or incomplete second cervical to first thoracic level lesions). Participants will be screened for obstructive sleep apnoea using full, portable sleep studies. Those with an apnoea hypopnoea index greater than 10 per hour will proceed to an initial threenight trial of CPAP. Those who can tolerate CPAP for at least 4 hours on at least one night of the initial trial will be randomized to either usual care or a 3-month period of auto-titrating CPAP. The primary hypothesis is that nocturnal CPAP will improve neuropsychological functioning more than usual care alone. The secondary hypothesis is that the magnitude of improvement of neuropsychological function will be predicted by the severity of baseline sleepiness measures, sleep fragmentation and sleep apnoea. Neuropsychological tests and full polysomnography will be performed at baseline and 3 months with interim measures of sleepiness and symptoms of autonomic dysfunction measured weekly. Spirometry will be performed monthly. Neuropsychological tests will be administered by blinded assessors. Recruitment commenced in July 2009. Discussion: The results of this trial will demonstrate the effect of nocturnal CPAP treatment of obstructive sleep apnoea in acute Quadriplegia. If CPAP can improve neurocognitive function after injury, it is likely that rehabilitation and subsequent community participation will be substantially improved for this group of predominantly young and severely physically disabled people.
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Assessment of breathing patterns and respiratory muscle recruitment during singing and speech in Quadriplegia.
Archives of physical medicine and rehabilitation, 2011Co-Authors: Jeanette Tamplin, Warren R. Ruehland, Danny J. Brazzale, Jeffrey J. Pretto, Mary Buttifant, Douglas J Brown, David J BerlowitzAbstract:Abstract Tamplin J, Brazzale DJ, Pretto JJ, Ruehland WR, Buttifant M, Brown DJ, Berlowitz DJ. Assessment of breathing patterns and respiratory muscle recruitment during singing and speech in Quadriplegia. Objectives To explore how respiratory impairment after cervical spinal cord injury affects vocal function, and to explore muscle recruitment strategies used during vocal tasks after Quadriplegia. It was hypothesized that to achieve the increased respiratory support required for singing and loud speech, people with Quadriplegia use different patterns of muscle recruitment and control strategies compared with control subjects without spinal cord injury. Design Matched, parallel-group design. Setting Large university-affiliated public hospital. Participants Consenting participants with motor-complete C5-7 Quadriplegia (n=6) and able-bodied age-matched controls (n=6) were assessed on physiologic and voice measures during vocal tasks. Interventions Not applicable. Main Outcome Measures Standard respiratory function testing, surface electromyographic activity from accessory respiratory muscles, sound pressure levels during vocal tasks, the Voice Handicap Index, and the Perceptual Voice Profile. Results The group with Quadriplegia had a reduced lung capacity (vital capacity, 71% vs 102% of predicted; P =.028), more perceived voice problems (Voice Handicap Index score, 22.5 vs 6.5; P =.046), and greater recruitment of accessory respiratory muscles during both loud and soft volumes ( P =.028) than the able-bodied controls. The group with Quadriplegia also demonstrated higher accessory muscle activation in changing from soft to loud speech ( P =.028). Conclusions People with Quadriplegia have impaired vocal ability and use different muscle recruitment strategies during speech than the able-bodied. These findings will enable us to target specific measurements of respiratory physiology for assessing functional improvements in response to formal therapeutic singing training.