Kim Daniels

Physical Therapy as a Means to Optimize Posture and Voice Parameters in Student Classical Singers: A Case Report

OBJECTIVES/HYPOTHESIS This study aimed at reporting on an intervention for optimizing postural alignment and voice parameters. STUDY DESIGN Case report. METHODS A clinical examination, including an evaluation of postural alignment, was performed and several voice parameters were investigated before, during, and after an individual rehabilitation program aimed at optimizing joint mobility, muscular stability, and posture. This program was given to a 26-year-old female classical singing student. RESULTS After a nine-session intervention (4 months), postural alignment was improved. The patient showed a good breath support and was able to maintain the lateral dimensions of the thorax, except for the high tones. Furthermore, she had a normalized cervical and scapulothoracic stability. At the last session, she had a lack of relaxation of the masseter muscle while singing. The vocal dynamic and pitch range were extended with smoother curves connecting the measuring points of the maximal and minimal vocal intensity, measured by means of the voice range profile. CONCLUSIONS Results show that, in this student singer, postural alignment could be changed within 4 months and that it could influence some voice parameters. Further research in larger samples is necessary to see whether these findings can be generalized to other singers.

Reliability of accessory motion testing at the carpal joints

The testing of accessory motion has become a very important part of manual therapy practice. Its value is in assessing whether joint mobility is ideal or impaired. Despite its use, there is little evidence in the literature to support the reliability of such testing. Most of the research carried out on accessory motion testing has focused on the spine. In view of this we decided to evaluate the intra- and interrater reliability of accessory motion testing of carpal joints. Two skilled therapists tested the available motion and the end-feel response of carpal joints in 30 students and 15 patients on two separate occasions. Pain scores were also obtained. In students a moderate to good percentage of agreement [67-97%] was obtained for motion testing. In patients the percentage of agreement ranged from 60% to 100% and weighted kappa values were between 0.33 and 1.0. Intrarater reliability was better than interrater reliability in both groups. Intra- and interrater agreement on end-feel was very good. Overall, the reliability of accessory motion testing of carpal joints was acceptable. The results suggest that this form of testing can be valuable in the training of manual therapists and in clinical practice.