Figure 1｜Flow chart of participant recruitment and group allocation.
After being approved for study inclusion, the subjects were screened by SCI specialists. Patients with CSCI with ASIA grade A or B, C4 and C5 injuries, and with respiratory dysfunction were referred to the MT department. Researchers evaluated the subjects and designed the intervention based on the inclusion and exclusion criteria. After the subjects were confirmed, the researchers sent them a research invitation to explain the purpose, procedures, and interests of the study, as well as inform them of the risks, confidentiality policy, and participant rights. After the subjects signed the informed consent form, the researchers randomly assigned the subjects into one of the two groups according to a computer-generated sequence (Excel 2013, Microsoft office software, Seattle, WD, USA). The participants in the intervention group received one-on-one VRT training, conducted by a professional music therapist, for 12 weeks (0.5 hours/session, five sessions per week). The control group received bedside training delivered by a respiratory physiotherapist for 12 weeks (0.5 hours/session, five sessions per week). Figure 1 shows the study procedure.
Figure 3｜Neural plasticity in the respiratory center on the anterior-posterior and left-right planes in patients with cervical spinal cord injury treated with vocal respiratory training versus respiratory physical therapy.
According to the 246 brain regions obtained after the PANDA analysis, the fractional anisotraphy (FA), FN, and path length of the medial thalamic nucleus, nucleus anterior thalami, nuclei lateralis thalami, dorsal ventral thalamus nucleus, ventral posterior nucleus of thalamus, spinothalamic tract, posterior parietal lobe of thalamus, lateral frontal lobe of the thalamus, ventral cortex of the occipital lobe, gyrus lingualis, rostral area of the cuneate gyrus, ventromedial parietooccipital sulcus, inferior occipital gyrus, inferior gyri occipitales superiores, lateral gyri occipitales superiores, and lateral occipital cortex were markedly increased in the VRT group compared with the control group (Figure 3).