Publications by authors named "Goutam Singh"

5 Publications

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Single and sequential voluntary cough in children with chronic spinal cord injury.

Respir Physiol Neurobiol 2021 03 24;285:103604. Epub 2020 Dec 24.

Department of Neurological Surgery, University of Louisville, 220 Abraham Flexner Way 15(th) floor, Louisville, KY, 40202, United States. Electronic address:

We investigated the impact of spinal cord injury (SCI) on cough capacity in 10 children (Mean ± SD, age 8 ± 4 years) and compared it to 15 typically developing children (age 8 ± 3 years). Participants underwent spirometry, single and sequential cough assessment with surface-electromyography from respiratory muscles. Inspiratory phase duration, inspiratory phase peak flow, inspiratory phase rise time, compression phase duration, expiratory phase rise time, expiratory phase peak airflow (EPPF) and cough volume acceleration (CVA) parameters of single and sequential cough were measured. Root mean square (RMS) values of right pectoralis-major, intercostal, rectus-abdominus (RA), and oblique (OB) muscles were calculated and mean of three trials were compared. The significance criterion was set at P < 0.05. The SCI group produced significantly lower lung volumes, EPPF, CVA, and RMS values of RA and OB during expiratory phases of single and sequential coughs. The decrease in activation in expiratory muscles in the SCI group accounts for the impaired expiratory flow and may contribute to risk of respiratory complications.
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http://dx.doi.org/10.1016/j.resp.2020.103604DOI Listing
March 2021

Contribution of Trunk Muscles to Upright Sitting with Segmental Support in Children with Spinal Cord Injury.

Children (Basel) 2020 Dec 8;7(12). Epub 2020 Dec 8.

Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA.

To investigate and compare trunk control and muscle activation during uncompensated sitting in children with and without spinal cord injury (SCI). Static sitting trunk control in ten typically developing (TD) children (5 females, 5 males, mean (SD) age of 6 (2)y) and 26 children with SCI (9 females, 17 males, 5(2)y) was assessed and compared using the Segmental Assessment of Trunk Control (SATCo) test while recording surface electromyography (EMG) from trunk muscles. The SCI group scored significantly lower on the SATCo compared to the TD group. The SCI group produced significantly higher thoracic-paraspinal activation at the lower-ribs, and, below-ribs support levels, and rectus-abdominus activation at below-ribs, pelvis, and no-support levels than the TD group. The SCI group produced significantly higher lumbar-paraspinal activation at inferior-scapula and no-support levels. Children with SCI demonstrated impaired trunk control with the ability to activate trunk muscles above and below the injury level.
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http://dx.doi.org/10.3390/children7120278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762575PMC
December 2020

Spinal cord injury in infancy: activity-based therapy impact on health, function, and quality of life in chronic injury.

Spinal Cord Ser Cases 2020 03 10;6(1):13. Epub 2020 Mar 10.

Kosair Charities Center for Pediatric NeuroRecovery, University of Louisville, Louisville, KY, USA.

Introduction: Spinal cord injury (SCI) in infancy magnifies the complexity of a devastating diagnosis. Children injured so young have high incidences of scoliosis, hip dysplasia, and respiratory complications leading to poor health and outcomes. We report the medical history, progression of rehabilitation, usual care and activity-based therapy, and outcomes for a child injured in infancy. Activity-based therapy (ABT) aims to activate the neuromuscular system above and below the lesion through daily, task-specific training to improve the neuromuscular capacity, and outcomes for children with acquired SCI.

Case Presentation: A 3-month-old infant suffered a cervical SCI from a surgical complication with resultant tetraplegia. Until age 3, her medical complications included scoliosis, kyphosis, and pneumonia. Even with extensive physical and occupational therapy, she was fully dependent on caregivers for mobility and unable to roll, come to sit, sit, stand or walk. She initiated ABT at ~3 years old, participating for 8 months. The child's overall neuromuscular capacity improved significantly, especially for head and trunk control, contributing to major advances in respiratory health, novel engagement with her environment, and improved physical abilities.

Discussion: From injury during infancy until 3 years old, this child's health, abilities, and complications were consistent with the predicted path of early-onset SCI. Due to her age at injury, severity and chronicity of injury, she demonstrated unexpected, meaningful changes in her neuromuscular capacity during and post-ABT associated with improved health, function and quality of life for herself and her caregivers.
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http://dx.doi.org/10.1038/s41394-020-0261-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064539PMC
March 2020

Respiratory muscle activation patterns during maximum airway pressure efforts are different in women and men.

Respir Physiol Neurobiol 2019 01 15;259:143-148. Epub 2018 Sep 15.

Department of Neurological Surgery, University of Louisville, Louisville, KY, USA; Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA. Electronic address:

Maximum inspiratory and expiratory pressure values (PI and PE) are indirect measures of respiratory muscle strength that, in healthy adults, are known to be significantly lower in women compared to men. In part, sex differences in breathing kinematics, lung size, body composition, muscle mass, and muscle fiber composition are thought to be responsible for these effects. However, it is not known whether respiratory muscle activation during maximum respiratory efforts is also sex-specific. In this study, we addressed whether respiratory multi-muscle activation patterns during PI and PE efforts are different between healthy women and men. Forced vital capacity (FVC), forced expiratory volume in one second (FEV), PI, PE, and surface electromyographic (sEMG) activity recorded from respiratory muscles during these maximum airway pressure efforts were obtained in 13 women and 11 men. Percent predicted values of FVC and FEV were not significantly different in these two groups (women vs. men: 112 ± 14 vs. 105 ± 15%, p = 0.29; and 92 ± 12 vs. 93 ± 13, p = 0.82, Mean ± SD, respectively), while PI and PE measures were significantly lower in women compared to men (68 ± 16 vs. 88 ± 19 cmHO, p = 0.011; and 69 ± 13 vs. 94 ± 17, p = 0.0004, respectively). Using vector-based methodology, by calculating the Similarity Index (SI) as measure of the resemblance between two sEMG patterns and the Magnitude (Mag) representing the overall amount sEMG during motor task, we have found that although the Mag values for both PI and PE tasks were not significantly different in two groups, the SIs revealed significant sex-dependent differences in muscle activation patterns (0.89 ± 0.08 vs. 0.97 ± 0.02, p = 0.016; and 0.77 ± 0.11 vs. 0.92 ± 0.04, p = 0.0006, respectively). During the PI effort, presented as the percentage of total sEMG amplitude, activity of upper trapezius muscle was significantly larger (p = 0.001) while activation of rectus abdominus, oblique, and lower paraspinal muscles were significantly smaller (p = 0.002, p = 0.040, p = 0.005, respectively) in women when compared to the men (50 ± 21 vs. 22 ± 11%; 2 ± 2 vs. 8 ± 7; 4 ± 3 vs. 9 ± 7, 2 ± 3 vs. 7 ± 6, respectively). During PE effort, the percentage of sEMG activity were significantly larger in upper and lower trapezius, and intercostal muscles (p = 0.038, p = 0.049, p = 0.037, respectively) and were significantly smaller in pectoralis, rectus abdominus, and oblique muscles (p = 0.021, p < 0.0001, p = 0.048, respectively) in women compared to men (16 ± 10 vs. 9 ± 4%; 16 ± 9 vs. 8 ± 5; 36 ± 12 vs. 25 ± 9; 6 ± 3 vs. 15 ± 5; 14 ± 5 vs. 20 ± 7, respectively). These findings indicate that respiratory muscle activation patterns during maximum airway pressure efforts in healthy individuals are sex-specific. This information should be considered during respiratory motor control evaluation and treatment planning for people with compromised respiratory motor function.
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http://dx.doi.org/10.1016/j.resp.2018.09.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252128PMC
January 2019

Respiratory functional and motor control deficits in children with spinal cord injury.

Respir Physiol Neurobiol 2018 01 28;247:174-180. Epub 2017 Oct 28.

Department of Physiology, University of Louisville, Louisville, KY, USA; Department of Neurological Surgery, University of Louisville, Louisville, KY, USA. Electronic address:

Children with spinal cord injury (SCI) are at high risk for developing complications due to respiratory motor control deficits. However, underlying mechanisms of these abnormalities with respect to age, development, and injury characteristics are unclear. To evaluate the effect of SCI and age on respiratory motor control in children with SCI, we compared pulmonary function and respiratory motor control outcome measures in healthy typically developing (TD) children to age-matched children with chronic SCI. We hypothesized that the deficits in respiratory functional performance in children with SCI are due to the abnormal and age-dependent respiratory muscle activation patterns. Fourteen TD (age 7±2 yrs., Mean±SD) and twelve children with SCI (age 6±1 yrs.) were evaluated by assessing Forced Vital Capacity (FVC); Forced Expiratory Volume in 1sec (FEV); and respiratory electromyographic activity during maximum inspiratory and maximum expiratory airway pressure measurements (PI and PE). The results indicate a significant reduction (p<.01) of FVC, FEV and PE values in children with SCI compared to TD controls. During PE assessment, children with SCI produced significantly decreased (p<.01) activation of respiratory muscles below the neurological level of injury (rectus abdominous and external oblique muscles). In addition, children with SCI had significantly increased (p<.05) compensatory muscle activation above the level of injury (upper trapezius muscle). In the TD group, age, height, and weight significantly (p<.05) contributed towards increase in FVC and FEV. In children with SCI, only age was significantly (p<.05) correlated with FVC and FEV values. These findings indicate the degree of SCI-induced respiratory functional and motor control deficits in children are age-dependent.
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http://dx.doi.org/10.1016/j.resp.2017.10.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5698146PMC
January 2018
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