Pawel Sliwinski

Respiratory parameters during professional flute playing

We studied three professional flautists while playing to determine: (1) what respiratory muscles and percent vital capacity (%VC) were used; (2) how mouth pressure (Pm), embouchure resistance (Rem), embouchure aperture (Aem), flow (V) and velocity (Vel) affect sound loudness (I) and frequency (F). We measured Pm, esophageal, gastric, transdiaphragmatic, transpulmonary (PL) pressures, diaphragmatic EMG, sound and chest wall displacements directly. Lung volume (VL) was estimated from PL during playing and the static deflation PL-VL curve measured separately; V from Delta VL/Delta t; Rem from Pm/(Delta VL/Delta t). Staccati and sustained notes at different F and I were performed. I increased mainly with V and F with Vel. V and Vel are independently controlled by Pm and Aem. The variation of mean Pm was small (6-11 cm H(2)O) and large for VC (72-83%) suggesting braking inspiratory muscle activity while playing. However, rib cage (RC) and abdominal (Ab) motion were different for each subject. One displaced Ab>RC at high VL and RC>Ab at low VL, another the opposite pattern; the third was in between. We conclude that while different flautists use different strategies to control Pm, the results are similar. Independent control of V and Vel by Pm and Aem allow flautists to control I and F regardless of how Pm is generated.

Association of chest wall motion and tidal volume responses during CO2 rebreathing

The purpose of this study is to investigate the effect of chest wall configuration at end expiration on tidal volume (VT) response during CO2 rebreathing. In a group of 11 healthy male subjects, the changes in end-expiratory and end-inspiratory volume of the rib cage (delta Vrc,E and delta Vrc,I, respectively) and abdomen (delta Vab,E and delta Vab,I, respectively) measured by linearized magnetometers were expressed as a function of end-tidal PCO2 (PETCO2. The changes in end-expiratory and end-inspiratory volumes of the chest wall (delta Vcw,E and delta Vcw,I, respectively) were calculated as the sum of the respective rib cage and abdominal volumes. The magnetometer coils were placed at the level of the nipples and 1-2 cm above the umbilicus and calibrated during quiet breathing against the VT measured from a pneumotachograph. The delta Vrc,E/delta PETCO2 slope was quite variable among subjects. It was significantly positive (P < 0.05) in five subjects, significantly negative in four subjects (P < 0.05), and not different from zero in the remaining two subjects. The delta Vab,E/delta PETCO2 slope was significantly negative in all subjects (P < 0.05) with a much smaller intersubject variation, probably suggesting a relatively more uniform recruitment of abdominal expiratory muscles and a variable recruitment of rib cage muscles during CO2 rebreathing in different subjects. As a group, the mean delta Vrc,E/delta PETCO2, delta Vab,E/delta PETCO2, and delta Vcw,E/delta PETCO2, slopes were 0.010 +/- 0.034, -0.030 +/- 0.007, and -0.020 +/- 0.032 1/Torr, respectively; only the delta Vab,E/delta PETCO2, slope was significantly different from zero. More interestingly, the individual delta VT/delta PETCO2 slope was negatively associated with the delta Vcr,E/delta PETCO2 (r = 0.68, P = 0.021) and delta Vcw,E/delta PETCO2 slopes (r = 0.63, P = 0.037) but was not associated with the delta Vab,E/delta PETCO2 slope (r = 0.40, P = 0.223). There was no correlation of the delta Vrc,E/delta PETCO2 and delta Vcw,E/delta PETCO2 slopes with age, body size, forced expiratory volume in 1 s, or expiratory time. The group delta Vab,I/delta PETCO2 slope (0.004 +/- 0.014 1/Torr) was not significantly different from zero despite the VT nearly being tripled at the end of CO2 rebreathing. In conclusion, the individual VT response to CO2, although independent of delta Vab,E, is a function of delta Vrc,E to the extent that as the delta Vrc,E/delta PETCO2 slope increases (more positive) among subjects, the VT response to CO2 decreases. These results may be explained on the basis of the respiratory muscle actions and interactions on the rib cage.

Modified Campbell diagram to assess respiratory muscle action in speech

Ten normal and four moderate to severe stutterers participated in the study. Pleural (Ppl) and abdominal (Pab) pressure was studied using oesophageal and gastric balloon catheter systems and VL (VL) was studied using magnetometry. The classical Campbell diagram was modified by plotting Pab versus VL. In a preliminary study we determined whether a surrogate curve could be substituted for the true curve in the Campbell diagram. We obtained true relaxation curves in six subjects. We obtained surrogate chest wall relaxation curves by joining the Pab value at functional residual capacity (FRC) to a point on the dynamic expiratory Pab,VL curve where Pab had decreased to half its maximum inspiratory excursion. In order to obtain the mirror image of the elastic recoil curve of the lung subjects breathed slowly from FRC to total lung capacity. Dynamic Pab,VL and Ppl,VL measurements during quiet breathing and speech were superimposed on static lung and chest wall curves. The simultaneous plot of Ppl and Pab provided a continuous measure of transdiaphragmatic pressure as a function of VL. We inferred non‐diaphragmatic muscle recruitment vis‐à‐vis the diaphragm by the relationship of Pab to Ppl and Pab to the relaxation curve. We compared dynamic Ppl during phonation with that during breath‐holding with the glottis open at the same VL, as an estimate of subglottic pressure (Psg). Analysis of variance testing showed that the true, surrogate and predicted relaxation slopes were not significantly different. The strategies that stutterers used to speak were either higher or lower VL than normal subjects and they had a different pattern of respiratory muscle recruitment. Stutterers were unable to achieve the appropriate degree of recruitment to develop and maintain a normal Psg for conversational speech and this contributed to dysfluency. We conclude that the quiet breathing loops can provide a reasonable approximation to the relaxation curve in normal healthy subjects and that modifications to the Campbell diagram provide useful means of measuring Psg and assessing respiratory muscle recruitment patterns.