Journal of Voice

Vol. 15, No. 3, pp. 384394

2001 The Voice Foundation

Effects of Inhalatory Abdominal Wall Movement on

Vertical Laryngeal Position During Phonation
Jenny Iwarsson
Department of Speech, Music, and Hearing, Royal Institute of Technology, KTH, Stockholm, Sweden, and
Department of Logopedics and Phoniatrics, Karolinska Institute, Huddinge University Hospital, Huddinge, Sweden

Summary: The configuration of the body resulting from inhalatory behavior is

sometimes considered a factor of relevance to voice production in singing and
speaking pedagogy and in clinical voice therapy. The present investigation compares two different inhalatory behaviors: (1) with a paradoxical inward movement of the abdominal wall, and (2) with an expansion of the abdominal wall,
both with regard to the effect on vertical laryngeal position during the subsequent phonation. Seventeen male and 17 female healthy, vocally untrained subjects participated. No instructions were given regarding movements of the rib
cage. Inhaled air volume as measured by respiratory inductive plethysmography, was controlled to reach 70% inspiratory capacity. Vertical laryngeal position was recorded by two-channel electroglottography during the subsequent
vowel production. A significant effect was found; the abdomen-out condition
was associated with a higher laryngeal position than the abdomen-in condition.
This result apparently contradicted a hypothesis that an expansion of the abdominal wall would allow the diaphragm to descend deeper in the torso, thereby increasing the tracheal pull, which would result in a lower laryngeal position.
In a post-hoc experiment including 6 of the subjects, body posture was studied
by digital video recordings, revealing that the two inhalatory modes were clearly associated with postural changes affecting laryngeal position. The paradoxical inward movement of the abdominal wall was associated with a recession
of the chin toward the neck, such that the larynx appeared in a lower position in
the neck, for reasons of a postural change. The results suggest that the laryngeal
position can be affected by the inhalatory behavior if no attention is paid to posture, implying that instructions from clinicians and pedagogues regarding
breathing behavior must be carefully formulated and adjusted in order to ensure
that the intended goals are reached. Key words: BreathingPhonationInhalationVertical laryngeal positionTracheal pullPosture.

INTRODUCTION

Accepted for publication September 29, 2000.

Address correspondence and reprint requests to Jenny Iwarsson, Huddinge University Hospital, Department of Phoniatrics,
B69 141 86 Stockholm, Sweden.
e-mail: Jenny.Iwarsson@klinvet.ki.se

One respiratory factor that may be relevant to vocal function is the body configuration during inhalation or the respiratory posturing. In singing peda384

EFFECTS OF ABDOMINAL WALL MOVEMENT ON VERTICAL LARYNGEAL POSITION

gogy, two polar modes of torso shape have been described during the act of inhalation but also during
the subsequent phonation; one with the abdominal
wall tucked in and one with the abdominal wall
stuck out.1 The two modes, schematically illustrated in Figure 1, have also been called the pear-shapeup and the pear-shape-down method or the up-andin and down-and-out method.2
The abdomen-in condition involves a marked inward positioning of the abdominal wall (left in Figure 1), as compared to its relaxed position at corresponding lung volume. This positioning is usually
accompanied by a highly domed shaped diaphragm
and an elevated, outward rib cage wall positioning.1,3 In muscular terms, the abdomen-in condition

FIGURE 1. Schematic illustration of the two modes of torso

shape. The left illustration involves an inward positioning of
the abdomen and an elevated rib
cage wall position with an increased rib cage voulme. The
right illustration involves a more
relaxed abdomen with an increased abdominal volume and a
decreased rib cage volume.

385

would be associated with a predominant activation

of rib cage muscles, i.e., nondiaphragmatic inspiratory muscles.46 When associated with inhalation
this mode is referred to as paradoxical, since the abdominal wall moves inward during an increase of
the total lung volume.712
In the abdomen-out condition on the other hand
(right in Figure 1), the abdominal wall is brought
downward and outward while no emphasis is placed
on rib cage position or movement.1319 Interpreted
in muscular terms, this mode is described as a result
of a diaphragmatic contraction.5,20
When vocally untrained persons, including those
with voice disorders, are instructed merely to take a
deep breath, the paradoxical movement of the abdomen can sometimes be observed. Most subjects,
however, would spontaneously show the behavior
of expanding both the abdominal wall and the rib
cage during inhalation.8,9 Thus, in naive subjects
different inhalatory behaviors can be expected to
occur spontaneously.
The two respiratory conditions have been assumed
to be associated with different respiratory and
phonatory advantages. Studies of respiration during
exercise have shown that the performance of the diaphragm can be optimized by a thoracic breathing
pattern, i.e., by increasing the volume of the rib cage
during inhalation while keeping the volume of the
abdomen constant. The explanation is that this
stretches the muscle fibers of the diaphragm to an
optimal length.5 This can be considered as advantageous for phonation also according to some
authors.1,5,21 Traditionally, however, this upper thoracic breathing and particularly clavicular breathing
has been regarded as disadvantageous for phonatory
purposes and related to voice problems, although
scientific support for this notion seems absent.22
Also the other, abdomino-diaphragmatic type of
breathing has been assumed to be associated with
certain advantages. It has been described as allowing
exchange of larger lung volumes and reduction of
extra tension in neck and shoulder muscles.23 However, these assumptions also seem based mainly on
experience and physiological interpretations, which
need to be experimentally tested.
Sometimes even the same argument is used in favor of both the two respiratory conditions. For example, in some literature the abdomen-out condition
has been described as allowing better control and
Journal of Voice, Vol. 15, No. 3, 2001

386

JENNY IWARSSON

timing as compared with upper thoracic breathing.23

Yet, other authors claim that the thoracic breathing
allows better control, as the intercostal muscles are
supplied by a large number of muscle spindles.5 It
seems likely that the phonatory consequences of
each strategy depend on several factors. Experimental evidence is required in order to elucidate this
problem.
The vertical laryngeal position (VLP) is a factor
that seems to link the respiratory and phonatory systems. In a previous investigation24 the effect of lung
volume on VLP was studied in healthy and vocally
untrained subjects. It was shown that phonation at
high lung volume levels was associated with a lower
position of the larynx in the neck as compared to
phonation at low lung volume levels. A possible explanation to this result could be an effect of the tracheal pull, a mechanical linkage between the breathing apparatus and the larynx. The tracheal pull
means that when the diaphragm contracts and descends for inhalation, it exerts a downward directed
force on the larynx because of the elastic structure of
the trachea.2527 If muscles elevating the larynx exert no compensatory action, the result will be a descent of the larynx during inhalation. This mechanical linkage may explain the effects of lung volume
on the larynx, as the position of the diaphragm is
lower at high lung volume levels as compared to low
lung volume levels.
The VLP may be relevant also to phonatory aspects of the abdomen-in or abdomen-out conditions.
It seems quite possible that the latter condition affects the diaphragm and hence also the tracheal pull.
In this condition the diaphragm can be assumed to
descend to a deeper position in the torso1,9 thus increasing the tracheal pull. This might result in a lower position of the larynx as compared to an abdomen-in condition, provided that the effect of the
tracheal pull overrules competing muscular and/or
mechanical effects that act in the opposite direction.
VLP is regarded as relevant to voice function.11,25,2831 A high position of the larynx is typically associated with a hyperfunctional voice source.
Therefore, a lowering of a habitually elevated larynx
is sometimes a specific goal in singing pedagogy as
well as clinical voice therapy.3234 VLP has been
shown to correlate with the factors pitch,31,3537 vocal loudness,25 and lung volume.24 In addition, some
voice exercises, such as the yawn-sigh-technique,33
Journal of Voice, Vol. 15, No. 3, 2001

the aspirate/gentle onset,37 and the extremely prolonged production of consonant /b:/,34 are reported
to lower the VLP. Other voice exercises, such as
phonating into a tube38 and producing a voiced bilabial fricative,39 seem to induce a tendency to raise
VLP.
Mitchinson and Yoffey40 studied the relationship
between VLP and respiration. Using x-ray they measured laryngeal movement at extremes of inspiration
and expiration. The purpose was to examine whether
inspiration in general is associated with a descent of
the larynx. This was found to be the case in only 4
out of 23 subjects. Five subjects showed an elevation
of the larynx, and in 14 cases no clear displacement
in any direction was observed. Thus, no consistent
respiratory effect on VLP was found. The inhalatory
behavior regarding abdominal movement was not
controlled.
Reliable recording of VLP data is associated with
various problems. Videofluoroscopic examination,
for example, is associated with practical and ethical
problems. Some imaging techniques traditionally require a supine body position, which is associated
with gravitational forces likely to affect the tracheal
pull. The major disadvantage of the twin-channel
electroglottography is that it requires phonation during measurements. However, this method allows estimation of the laryngeal movement subsequent to inhalation, a factor of prime interest for our purposes.
The aim of the present investigation was to test the
hypothesis that inhalation with an expanding abdominal wall induces a lower position of the larynx
in the neck during the subsequent phonation, as
compared to inhalation with a paradoxical inward
abdominal movement.
METHOD
Subjects
Thirty-five subjects, 18 males and 17 females, volunteered for the experiment. All subjects filled in a
questionnaire regarding health condition as well as
experience and/or training in voice and breathing.
One male subject who reported intermittent allergic
asthma, was excluded. The final group thus consisted of 17 males and 17 females. The age ranges of the
groups were 1936 years, average 29 (males), and
2557 years, average 37 (females). No selection re-

EFFECTS OF ABDOMINAL WALL MOVEMENT ON VERTICAL LARYNGEAL POSITION

garding body type was done but all subjects participating were considered within normal limits of body
weight. All subjects were healthy, nonsmokers, nonsingers, and unaware of the purpose of the study.
Equipment
The experimental setup is shown in Figure 2. To
document movements of the rib cage and abdomen,
as well as changes in relative lung volume, a respiratory inductive plethysmograph (RIP), equipped
with elastic transducers (respibands), was used
(Respitrace, Ambulatory Monitoring Inc., Ardsley, NY). The thoracic and abdominal volume contributions to each breathing cycle is thus reflected
in terms of the rib cage and abdominal cross-sectional areas. The upper respiband was placed around the
subjects rib cage and the lower respiband around
the abdominal wall with its upper edge at the level
of the navel. This equipment was calibrated by
means of isovolume maneuvers41 such that the sum
of the two respiband signals corresponded to relative lung volume.

387

The VLP was recorded using two-channel electroglottography (EGG) (Glottal Enterprises, MC21).36,42 The two plates containing the electrode pairs
were placed on each side of the thyroid cartilage, attached by an elastic ribbon. The vertical distance between the two electrodes in each plate was approximately 0.5 cm. The output voltage of this device was
used directly, without calibration. An oscilloscope
(Tektronix 50MHz OS2225) was used for displaying
the RIP signal from the abdomen and the signal from
the VLP. The audio signal was recorded at a fixed
distance of 30 cm, by a high-fidelity microphone
(Sony ECM 959 DT), connected to an amplifier
(Symetrix SX202). The various signals were recorded on separate tracks of a TEAC multichannel PCM
recorder (RD 200 PCM, Teac Corp., Tokyo, Japan).
Experiment
During the entire experiment, the subjects were in
a standing position, dressed in tight tricot clothes to
ensure the best possible documentation of the respiratory movements. The subjects were first instructed

FIGURE 2. Experimental setup. The amplified audio signal (AUDIO MIC), the signal from the multichannel EGG, and the RIP signals (rib cage, abdomen, and sum)
were recorded on a DAT FM recorder. One oscilloscope was used to display the EGG
and abdominal signals. Another oscilloscope was used to display the summed signal
(lung volume) as a visual feedback to the subject.
Journal of Voice, Vol. 15, No. 3, 2001

388

JENNY IWARSSON

to perform isovolume maneuvers41 for the purpose

of calibration procedure of the RIP equipment. The
amplifications of the rib cage and abdominal signals
were adjusted such that the summed signal remained
constant during this maneuver. The subjects then
performed maximum inhalations and exhalations, so
that relative vital capacity could be determined as
the maximum lung volume range of the summed
signal. As the RIP equipment is known to be sensitive to flexing or extending of the spine, the subjects
were instructed to keep a stable body position
throughout the experiment.
The lung volume signal was displayed on a second
oscilloscope (Gould 20 MHz OS300) as a visual
feedback to the subjects, together with a marker representing the individual 70% inspiratory capacity.
The subjects were asked to inhale to this target level,
so that all phonations were initiated at 70% inspiratory capacity. This lung volume was chosen as it
could be regarded as a comfortable inhalation, hopefully excluding body movements and muscle tensions associated with a more extreme inhalation.
A short training session was run to allow the subject to practice the experiment task. This task included reaching the lung volume target level and then
sustaining the vowel /a:/ at a self-chosen, comfortable pitch and loudness. The subject was then asked
to perform this procedure, following two different
instructions regarding inhalatory strategies: (1) In-

hale to this level and let the abdomen move inward

during inhalation and (2) Inhale to this level, and
let the abdomen expand during inhalation. The two
inhalatory strategies are schematic illustrated in Figure 1. Each condition was repeated three times. The
experimenter documented the pitch chosen by the
subject, so that this pitch was kept throughout the
experiment. The abdominal signal was monitored by
the experimenter to ensure that the subjects produced the required abdominal movements in both
conditions. To ensure consistent behavior the subjects were instructed to perform all inhalations
through the mouth. None of the subjects failed to
fulfill three productions of each condition according
to these instructions. No instructions were given regarding rib cage movement, nor concerning respiratory movements during the expiratory phase. The
isovolume and the maximum lung volume maneuvers were repeated twice after the experiment to
check the reliability of the lung volume signal
throughout the experiment.
Analysis
All performances were transferred from the tape
recorder into data files, using the Soundswell signal
workstation.43 These files included five channels:
audio, rib cage, abdomen, lung volume, and VLP
(see Figure 3). A one-second long segment of the
VLP signal, occurring one second after the audio

FIGURE 3. An example of a Soundswell analysis window showing three repetitions of the abdomen-in-inhalation
(Abd in) and the subsequent vowel production. From top to bottom the channels represent audio, rib cage, abdomen,
lung volume, and vertical laryngeal position (EGG), all given in arbitrary scales.
Journal of Voice, Vol. 15, No. 3, 2001

EFFECTS OF ABDOMINAL WALL MOVEMENT ON VERTICAL LARYNGEAL POSITION

Ve rtic al Laryngeal
L ar yn geal Position
Vertical
Position
(arbitrary scale
)
(arbitrary
scale)
0,6

After abd-OUT inhalation

signal onset, was selected for analysis, in order to

avoid laryngeal gestures affected by the onset and
offset of the tone. The mode value of this segment
was measured to represent the value of VLP for that
tone. The main question regarded the difference between the two inhalatory conditions, but also the effects of replication such as an eventual training effect was analyzed. The data were statistically tested
by an 2  3  2 analysis of variance (ANOVA)
(SPSS 10.0 for Windows), with condition and replication as within-subjects-factors and gender as between-subjects factor.

389

0,4
0,2
0
-0,2
-0,4

RESULTS
A clear effect of inhalatory strategy was found; the
abdomen-out condition was associated with a clearly
higher position of the larynx in the neck as compared to the abdomen-in condition, thus contrary to
the expectations based on the tracheal pull effect.
Hence, the hypothesis that an expansion of the abdominal wall lowers the VLP by means of a greater
tracheal pull, must be rejected.
In Figure 4 the effect is illustrated in terms of a
scatter plot, comparing the same subjects VLP as
captured during the two different inhalatory strategies. The effect of inhalatory condition was statistically significant [F(1,32) = 11.3, p= 0.002], see
Table 1. No statistical effects were observed for gender or replication. The three replications within each
condition showed very small differences and are
shown in terms of different symbols in Figure 4.
POST-HOC EXPERIMENT
A plausible interpretation of these unexpected results seemed to be that the two inhalatory strategies
induced effects on body posture that affected the position of the larynx. In order to test this hypothesis, a
post-hoc experiment was conducted. A digital video
recording was made of 4 male and 2 female subjects
who had participated in the main experiment and
who could easily volunteer in a post-hoc experiment.
They were asked to repeat the two inhalatory strategies, by the same instructions as before, standing in
front of a square patterned screen. The subjects were
instructed to make a normal inhalation but lung
volume was not monitored.

-0,6
-0 ,6

-0,4

-0 ,2

0,2

0,4

0,6

After
inhalation
Afterabd-IN
abd-IN inhalation
FIGURE 4. Scatter plot showing the comparison of vertical laryngeal position. Each data point refers to a given vowel production in one subject, compared between the two inhalatory
conditions. The three symbols represent the three replications:
circles, squares, and triangles refer to the first, second, and third
takes, respectively. White and gray symbols refer to females and
males, respectively.

TABLE 1. Results of the 2  3  2 analyses of

variance, with condition and replication as withinsubjects-factors and gender as between-subjects factor.
Significance at alpha level 5% is marked with *.
Source

df

Condition (abd-in, abd-out)

1, 32

Replication (1, 2, 3)

2, 64

F
11.3
1.767

p
0.002*
0.179

Gender (female, male)

1, 32

0.164

0.688

Condition * Gender

1, 32

0.000

0.991

Condition * Replication

2, 64

1.274

0.287

Gender * Replication

2, 64

1.971

0.148

Condition*Gender*Replication

2, 64

0.525

0.594

The video recordings were analyzed using a digital still image capturing system (Sony DV Capturer
Version 1.02). Single frames were captured from the
moment after inhalation, see Figure 5. Using facilities in the Paint Shop Pro program (Jasc Software
Journal of Voice, Vol. 15, No. 3, 2001

390

JENNY IWARSSON

FIGURE 5. Images captured from the digital video recording of the post-hoc experiment, the moment after the abdomen-in inhalation (left) and after the abdomen-out inhalation (right), respectively.

Version 5.01), the vertical and horizontal coordinates

of two landmarks were determined: the mental protuberance of the chin and a reference point on the
collar. These landmarks were chosen because movements of the entire body were sometimes identified
and it turned out to be inappropriate to use a reference point on the square patterned background. First,
the horizontal and vertical distance between the chin
and collar landmarks was determined for the two
conditions. Then, using the theorem of Pythagoras,
the overall distance was calculated. All values were
transformed from pixels to millimeters, taking the
distance from the camera into acount.
The results confirmed that the two inhalation patterns affected body posture in all these subjects. The
abdomen-out condition was associated with a posture characterized by either a slightly posterior tilt of
the head (right part of Figure 5), or a protrusion of
Journal of Voice, Vol. 15, No. 3, 2001

the chin (not seen in the subject in this picture). Both

these gestures would induce a rise of the VLP as
measured by EGG. The abdomen-in condition
seemed associated with an expansion of the rib cage
and a recession of the chin toward the neck (left part
of Figure 5). The vertical distance between the mental protuberance of the chin and the reference point
was found to be longer in the abdomen-out condition
than in the abdomen-in condition for all 6 subjects
(see Table 2). The overall distance was shown to be
greater in the abdomen-out condition in all subjects
except F02.
The results of the post-hoc experiment support the
assumption that the effect on larynx height observed
in the main experiment may have been caused by
postural gestures associated with the inhalatory
strategies. Further research on this particular effect
seems worthwhile.

EFFECTS OF ABDOMINAL WALL MOVEMENT ON VERTICAL LARYNGEAL POSITION

391

TABLE 2. Results of the post-hoc experiment, presented as the distances of the mental protuberance of the chin relative
to a reference point on the collar in mm. Letters M and F in the subject names refer to male and female subjects.
Subject

Horizontal distance relative reference

Abd-out
Abd-in
Difference

Vertical distance relative reference

Abd-out
Abd-in
Difference

Distance relative reference

Abd-out
Abd-in
Difference

M01

61.8

74.2

12.4

90.7

80.4

10.3

109.7

109.4

0.4

M02

41.5

36.3

5.2

36.3

28.5

7.8

55.1

46.2

9.0

M14

40.7

50.4

9.7

44.6

23.3

21.3

60.4

55.5

4.9

M15

61.0

53.1

8.0

106.1

98.1

8.0

122.4

111.6

10.8

F02

115.4

117.5

2.1

15.0

8.5

6.4

116.4

117.8

1.5

F05

44.7

33.5

11.2

44.7

26.1

18.6

63.2

42.4

20.7

DISCUSSION AND CONCLUSIONS

The suspension of the larynx in the neck is complex, and any movement, in any direction, must be
understood as the net result of a number of muscular and mechanical forces.31,4446 The observed effect of the present investigation indicated that the
forces lifting the larynx, i.e., forces opposed to
those lowering it, gained the battle of larynx direction. Lifting forces can be assumed to result from
contraction of the supralaryngeal muscles and/or an
elevation of structures that serve as superior anchor
points of these muscles. For example, a tilting
backward of the head will move the chin upward
and hence exert an elevating force on the larynx.
Likewise, a protrusion of the chin will exert a
pulling force that contains a cranial component.
Both these gestures were observed in the post-hoc
experiment, which thus provided a plausible explanation of the higher VLP found in the abdomen-out
condition in the main experiment.
In the main experiment, the subjects were asked to
keep a stable body position because of the sensitive
RIP equipment. In the post-hoc experiment, this
equipment was not used and no such instructions
were given. It is possible that this enhanced the postural effects noted in the post-hoc experiment.
The results of the present study relate to those of
an earlier investigation, in which the VLP was found
to be significantly lower in phonation at high lung
volume compared to phonation at low lung volume.24 That effect could have been caused by an increased tracheal pull at high lung volume. In the
present study it was assumed that the strategy to ex-

pand the abdomen during inhalation would allow the

diaphragm to descend deeper in the torso, thus increasing the downward force on the trachea and larynx. The results can be interpreted in two ways: either there is no increase in the tracheal pull by
inhalation with expanding abdomen, or the effect of
the tracheal pull is not strong enough to overrule
competing forces associated with the postural effects
found.
In the earlier investigation24 the subjects were
asked to perform all inhalations with an expansion
of the abdominal wall, thus avoiding paradoxical
movements. However, using this experimental condition raised the question whether the observed VLP
descent at high lung volumes was induced by the inhalatory strategy, or postural changes related to it,
rather than by the lung volume factor alone. The results of the present investigation indicate that an abdominal expansion strategy tends to induce an ascending rather than a descending movement of the
larynx. Therefore, the findings of the present investigation support the conclusion of the previous investigation, that the effect on VLP was related to lung
volume and cannot be explained by the inhalatory
strategy or associated postural effects.
The experimental task of the present investigation
was somewhat artificial. Even though none of the
subjects failed to follow the instructions, some perceived either one of the inhalation strategies as unfamiliar. No controlled collection of such information
was done. A potential risk of having subjects perform an unfamiliar task is that it may induce unintended effects on the respiratory system as well as on
the larynx height. For example, subjects who spontaJournal of Voice, Vol. 15, No. 3, 2001

392

JENNY IWARSSON

neously expand the abdominal wall during inhalation are likely to experience the task of a paradoxical
inhalatory behavior as particularly unfamiliar.9 Earlier studies have shown that there is considerable
variation of prephonatory configuration of the respiratory system between and within subjects,12 and
that vocal task and lung volume at the time of voice
initiation are influential factors.47 Both these factors
were held constant in the present investigation.
The post-hoc experiment demonstrated the risk associated with instructions that are overly simplified
or narrowly focused on respiration patterns. If a student or a patient is given the sole instruction to expand the abdomen during inhalation, the result may
be that he or she considers the abdominal expansion
a purpose in itself, rather than a result of air intake.
Emphasizing one single aspect of inhalatory behavior may increase the risk that undesired postural effects pass unnoticed. Another risk possibly associated with focusing only on abdominal expansion
during inhalation is that the expansion is performed
at the cost of a decreased thoracic volume, such as in
an isovolume maneuver. The voluntarily increased
circumference of the abdomen may restrict the expansion of the lower costal margin. Such a restriction could possibly affect the shape and the movement of the diaphragm, which seems to be a subject
worthwhile for future research.
Postural effects of breathing behavior seem relevant to vocal training. The risk that the position of
the larynx is changed in an undesired way, involuntarily and unconsciously, as a side effect of a specific
inhalatory behavior, may exist also in a pedagogical
situation. The observations made in the post-hoc experiment are in accordance with the fact that great
attention is generally paid to body posture in almost
all vocal training.
After the present experiment was carried out,
Laukkanen and coworkers48 published an investigation of the accuracy of the twin-channel electroglottography method. They concluded that the agreement between the videofluoroscopic and EGG
measurements was generally good and that the
method offers a reliable way of measuring vertical
laryngeal position, especially on separately phonated
vowels. However, small inaccuracies were reported
which may be significant to the present results. The
Journal of Voice, Vol. 15, No. 3, 2001

tendency to protrude the chin in the abdomen-out

condition would induce an anterior movement of the
thyroid cartilage. This would tend to improve the
contact between the EGG electrode and the neck. If
the upper border of the thyroid cartilage moves anteriorly more than the lower border, the contact of the
upper electrode pair will be improved as compared
to the lower pair. Laukkanen et al showed that this
may be reflected as a rise in VLP, even when no rise
occurs. Likewise, if an anterior movement improves
the contact of the lower electrode pair, the EGG
would falsely register a lowering of the VLP. Although these inaccuracies were reported to be small
they must be taken into consideration when interpreting the results. The VLP effect may have been
enhanced by an improved electrode contact with the
upper electrode pair that resulted from the protrusion
of the chin.
Summarizing, the surprising results of the present
investigation invite various interpretations and speculations rather than conclusions. It seems likely,
however, that the effects found on VLP were due to
postural gestures associated with the inhalatory
strategies. The finding suggests that instructions regarding breathing behavior in voice training must be
carefully formulated and adjusted to body posture in
order to ensure that the intended goals are achieved.
Moreover, the results suggest that further research in
the area of body posture, breathing, and voice will
be rewarding.
Acknowledgments: The kind cooperation of all subjects is acknowledged. I gratefully thank my supervisor
Johan Sundberg for helping me improve the study and
the manuscript. In addition, Britta Hammarberg, Maria
Sdersten, Eva Holmberg, and Eva Borell offered valuable comments on the manuscript. Statistical help was
offered by Joakim Westerlund. Eva Hall made the illustration in Figure 1. This study was supported by a grant
from Axel and Margaret Ax:son Johnsons foundation
and Karolinska Institute.

REFERENCES
1. Hixon TJ, Hoffman C. Chest wall shape in singing. In: Van
Lawrence, ed. Transcripts of the Seventh Symposium: Care of
the Professional Voice. New York, NY: 1978;910.
2. Titze IR. Principles of Voice Production. Englewood Cliffs,
New Jersey: Prentice-Hall Inc.; 1994:7479.
3. Emmons S. Breathing for singing. J Voice. 1988;2(1):3035.

EFFECTS OF ABDOMINAL WALL MOVEMENT ON VERTICAL LARYNGEAL POSITION

4. Aliverti A, Cala SJ, Duranti R, Ferrigno G, Kenyon CM,
Pedotti A, Scano G, Sliwinski P, Macklem PT, Yan S. Human respiratory muscle actions and control during exercise.
J Appl Physiol. 1997;83(4):12561269.
5. Estenne M, Zocchi L, Ward M, Macklem P. Chest wall motion and expiratory muscle use during phonation in normal
humans. J Appl Physiol. 1990;68(5):20752082.
6. Gould WJ. Effect of respiratory and postural mechanisms upon action of the vocal cords. Folia Phoniatr. 1971;23:21124
7. Sataloff RT. Vocal Health and Pedagogy. San Diego, Calif:
Singular Publishing Group, Inc.; 1998:265286.
8. Hixon TJ, Hoit JD. Physical examination of the abdominal
wall by the speech-language pathologist. Am J Speech Lang
Pathol. 1999;8:335346.
9. Hixon TJ, Hoit JD. Physical examination of the diaphragm
by the speech-language pathologist. Am J Speech Lang
Pathol. 1998;7:3745.
10. Hixon TJ, Goldman MD, Mead J. Kinematics of the chest
wall during speech production: volume displacements of
the rib cage, abdomen and lung. J Speech Hear Res.
1973;16:78115.
11. Aronsson AE. Clinical voice disorders. 3rd ed. New York,
NY: Thieme Inc.; 1990:380, 121122.
12. Hixon TJ, Watson PJ, Harris FP, Pearl NB. Relative lung
volume changes of the rib cage and abdomen during
prephonatory chest wall posturing. J Voice. 1988;2(1):
1319.
13. Forchhammer E. Stemmens funktioner og fejlfunktioner.
Copenhagen, Denmark: Munksgaard; 1974:1216.
14. Sovijrvi A. Some therapeutic exercises for rehabilitating
functional dysphonias presented on videotape. In: The Study
of Sounds: The Proceedings of the Fourth World Congress
of Phoneticians. The Phonetic Society of Japan, Tokyo,
Japan 1984:445457.
15. Smith S, Thyme K. Accentmetoden [The Accent Method].
Special-paedagogisk forlag. Herning; Denmark: 1978:
1828.
16. Kotby MN, El-Sady SR, Basiouny SE, Abou-Rass YA,
Hegazi MA. Efficacy of the accent method of voice therapy.
J Voice. 1991;5(4):316320.
17. Kotby MN, Shiromoto O, Hirano M. The accent method of
voice therapy: effect of accentuations on F0, SPL, and airflow. J Voice. 1993;7(4):319325.
18. Fex B, Fex S, Shiromoto O, Hirano M. Acoustic analysis of
functional dysphonia: before and after voice therapy (accent
method). J Voice. 1994;8(2):163167.
19. Murry T, Woodson GE. A comparison of three methods for
the management of vocal fold nodules. J Voice. 1992;6(3):
271276.
20. Xu JH, Ikeda Y, Komiyama S. Bio-feedback and the yawning breath pattern in voice therapy: a clinical trial. Auris,
Nasus, Larynx (Tokyo). 1991;18:6777.
21. Watson PJ, Hoit JD, Lansing RW, Hixon TJ. Abdominal
muscle activity during classical singing. J Voice. 1989;3(1):
2431.
22. Colton RH, Casper JK. Understanding Voice problems. A
Physiological Perspective for Diagnosis and Treatment. 2nd
ed. Baltimore, Md: Williams & Wilkins; 1996:308309.

393

23. Kotby MN. The Accent Method of Voice Therapy. San

Diego, Calif: Singular Publishing Group, Inc.; 1995:3979.
24. Iwarsson J, Sundberg J. Effects of lung volume on vertical
larynx position during phonation. J Voice. 1998;12(2):
159165.
25. Shipp T. Effects of vocal frequency and effort on vertical laryngeal position. J Res Sing. IARS; Denton, 1984; 6:15.
26. Zenker W. Questions regarding the function of external laryngeal muscles. In: Brewer D, ed. Research Potentials in
Voice Physiology. Syracuse, NY: State University of New
York; 1964:2040.
27. Vilkman E, Sonninen A, Hurme P, Krkk P. External laryngeal frame function in voice production revisited: a review. J Voice. 1996;10(1):7892.
28. Shipp T, Izdebski K. Vocal frequency and vertical larynx
positioning by singers and nonsingers. J Acoust Soc Am.
1975;58(5).
29. Hertegrd S, Gauffin J, Sundberg J. Open and covered
singing as studied by means of fiberoptics, inverse filtering,
and spectral analysis. J Voice. 1990;4(3):220230.
30. Sonninen A. Paratasis-gram of the vocal folds and the dimensions of the voice. In: Proceedings of the Fourth International Congress of Phonetic Sciences. The Hague: Mouton; 1962:250258.
31. Sonninen A. The external frame function in the control of
pitch in the human voice. Ann NY Acad Sci. 1968;155:68-90.
32. Boone DR. The Voice and Voice Therapy. Englewood
Cliffs, New Jersey: Prentice Hall; 1977.
33. Boone DR, McFarlane SC. A critical view of the yawn-sigh
as a voice therapy technique. J Voice. 1993;7(1):7580.
34. Elliot N, Sundberg J, Gramming P. Physiological aspects of
a vocal exercise. J Voice. 1997;11(2):171177.
35. Shipp T. Vertical laryngeal position during continous and
discrete vocal frequency range. J Speech Hear Res.
1975;18(4):707718.
36. Pabst F, Sundberg J. Tracking multi-channel electroglottograph measurement of larynx height in singers. Scand J Log
Phon. 1993;18:143152.
37. Casper JK, Colton RH, Woo P, Brewer D. Physiological
characteristics of selected voice therapy techniques: a preliminary research note. Voice. 1992;1:131141.
38. Laukkanen A-M, Lindholm P, Vilkman E. Phonation into a
tube as a voice training method: Acoustic and physiologic
observations. Folia Phoniatr Logop. 1995;47:331338.
39. Laukkanen A-M, Lindholm P, Vilkman E, Haataja K, Alku
P. A physiological and acoustic study on voiced bilabial
fricative /B:/ as a vocal exercise. J Voice. 1996;10(1):6777.
40. Mitchinson AG, Yoffey JM. Respiratory displacement of
larynx, hyoid bone and tounge. J Anat. 1947;81:118121.
41. Konno K, Mead J. Measurement of the separate volume
changes of the rib cage and abdomen during breathing. J
Appl Physiol. 1967;22:407422.
42. Rothenberg M. A multichannel electroglottograph. J Voice.
1992;6(1):3643.
43. Ternstrm S. Soundswell signal workstation. AB Nyvalla
DSP, Stockholm, Sweden, 1996.
Journal of Voice, Vol. 15, No. 3, 2001

394

JENNY IWARSSON

44. Sonninen A, Hurme P, Laukkanen A-M. The external frame

function in the control of pitch, register, and singing mode:
radiographic observations of a female singer. J Voice.
1999;13(3):319340.
45. Fink BR, Demarest RJ. Laryngeal Biomechanics. Cambridge, Mass: Harvard University Press; 1978:1543.
46. Laver J. The Phonetic Description of Voice Quality. Cambridge studies in linguistics 31. Cambridge University
Press; Cambridge, Mass: 1980:2392.

Journal of Voice, Vol. 15, No. 3, 2001

47. McFarland DH, Smith A. Effects of vocal task and respiratory phase on prephonatory chest wall movements. J Speech
Hear Res. 1992;35:971982.
48. Laukkanen A-M, Takalo R, Vilkman E, Nummenranta J,
Lipponen T. Simultaneous videofluorographic and dualchannel electroglottographic registration of the vertical laryngeal position in various phonatory tasks. J Voice.
1999;13(1):6071.