<p> Cystic Fibrosis (CF) is a genetic disease that affects multiple systems including the respiratory tract. Thickened secretions in the airway must be removed to prevent deterioration of pulmonary function. Airway clearance techniques are based on physiological principles such as cephalad airflow, the combination of expiratory airflow with high frequency oscillation at the chest wall or oral cavity, and repetitive cough. Diaphragmatic breathing, respiratory muscle training, and voicing during therapy have also been shown to improve or maintain pulmonary function in CF patients. The physiology of airway clearance is similar to the physiology of singing, which involves controlled airflow resulting in pressure oscillations and vibration. Singers build awareness of their bodies and learn to manage their breath. It is also a relatively inexpensive and enjoyable activity that requires little equipment or space. Singing should not replace medically recommended therapies, but it may be a viable adjunct therapy.</p><p> In this concurrent mixed methods collective case study, the effects of nine private singing lessons on the pulmonary function, measured by FEV<sub> 1</sub> and quality of life, measured by the Cystic Fibrosis Questionnaire-Revised (CFQ-R) of four CF patients were investigated. Participants also completed an exit questionnaire to determine their satisfaction with the lessons and impressions of the study. Lessons were taught by the same teacher and tailored to the needs of each participant. The teacher kept a journal of the proceedings of each lesson. To evaluate the efficacy of the lessons, the teacher assessed each participant before and after the lessons using a rubric and helped the participants to create modified phonetograms. Two single-factor analyses of variance (ANOVAs) were performed on the phonetograms to compare the pre and post voice lesson effects in terms of maximum and minimum sound pressure levels. Due to the small sample size, no further statistical analysis was performed, and the results of the study will be pilot data for future research.</p><p> Effects on FEV<sub>1</sub> were inconclusive, but the teacher observed all participants coughed during singing and not during conversation, suggesting the mobilization of mucus. All participants improved in the domain of body image on the CFQ-R. This, combined with comments from participants on the exit questionnaire about gaining confidence, suggests an overall improvement in self-esteem resulting from the lessons. Most participants also improved in the domain of physical functioning. Two participants improved significantly in terms of maximum vocal intensity as indicated by their phonetograms. The teacher was well informed about CF but did not need to structure the musical aspects of the lessons in any specialized way, although an emphasis was placed on breathing and the allowance and encouragement of coughing from participants, which is deviant from the norm. All participants reported satisfaction with the treatment and wrote about breath control being one of the most important gains from the lessons. All but one reported they would continue lessons if given the chance. The results suggest singing lessons may provide some airway clearance and improve the quality of life of adult CF patients. Further investigation of this topic is warranted.</p>
| Identifer | oai:union.ndltd.org:PROQUEST/oai:pqdtoai.proquest.com:10000826 |
| Date | 28 January 2016 |
| Creators | Goldenberg, Rachel Brager |
| Publisher | Shenandoah University |
| Source Sets | ProQuest.com |
| Language | English |
| Detected Language | English |
| Type | thesis |
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