RSPH4A encodes a structural component of the axonemal radial spoke head required for normal motility of 9+2 motile cilia, and its loss causes primary ciliary dyskinesia (PMID:19200523). RSPH4A builds the distal head architecture of radial spokes: in human respiratory cilia its loss eliminates the radial spoke heads of RS1 and RS2 (but spares RS3) and produces additional defects in the arch domains adjacent to those heads, with secondary heterogeneous abnormalities of the central pair complex (PMID:33852348). In mouse tracheal cilia Rsph4a is required for assembly of all three radial spoke heads (RS1, RS2, RS3), and it supports planar ciliary beating across tracheal, ependymal, and oviduct epithelia (PMID:32203505). Loss-of-function mutations, including a splice-site allele generating premature termination, abolish this function and yield central-apparatus ultrastructural defects, reduced beat frequency, and abnormal waveform (PMID:19200523, PMID:23798057); correction of the RSPH4A sequence in patient-derived cells partially restores normal ciliary motion (PMID:42050778).