Effect of Singing on Respiratory Function, Voice, and Mood After Quadriplegia: A Randomized Controlled Trial

Published:October 26, 2012DOI:



      To explore the effects of singing training on respiratory function, voice, mood, and quality of life for people with quadriplegia.


      Randomized controlled trial.


      Large, university-affiliated public hospital, Victoria, Australia.


      Participants (N=24) with chronic quadriplegia (C4-8, American Spinal Injury Association grades A and B).


      The experimental group (n=13) received group singing training 3 times weekly for 12 weeks. The control group (n=11) received group music appreciation and relaxation for 12 weeks. Assessments were conducted pre, mid-, immediately post-, and 6-months postintervention.

      Main Outcome Measures

      Standard respiratory function testing, surface electromyographic activity from accessory respiratory muscles, sound pressure levels during vocal tasks, assessments of voice quality (Perceptual Voice Profile, Multidimensional Voice Profile), and Voice Handicap Index, Profile of Mood States, and Assessment of Quality of Life instruments.


      The singing group increased projected speech intensity (P=.028) and maximum phonation length (P=.007) significantly more than the control group. Trends for improvements in respiratory function, muscle strength, and recruitment were also evident for the singing group. These effects were limited by small sample sizes with large intersubject variability. Both groups demonstrated an improvement in mood (P=.002), which was maintained in the music appreciation and relaxation group after 6 months (P=.017).


      Group music therapy can have a positive effect on not only physical outcomes, but also can improve mood, energy, social participation, and quality of life for an at-risk population, such as those with quadriplegia. Specific singing therapy can augment these general improvements by improving vocal intensity.


      List of abbreviations:

      ASIA (American Spinal Injury Association), FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), IC (inspiratory capacity), MEP (maximal expiratory pressure), MIP (maximal inspiratory pressure), POMS (Profile of Mood States), SCI (spinal cord injury), SCM (sternocleidomastoid), sEMG (surface electromyographic), SNIP (sniff nasal inspiratory pressure), SPL (sound pressure level), TLC (total lung capacity)
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