By Guest Author Articles • • 0 Comments

National Voice Meeting 2018 – Presenter Series #3

What is Vocal Massage and could it be helpful for patients with Voice Disorders?

Vocal massage is designed to give a ‘reset’ of the muscles involved in posture and vocalization to help maintain (or help re-establish) healthy voice production. It is also increasingly being investigated as a way to decrease pain and tension from excessive contraction of the extrinsic muscles of the larynx (as found in voice disorders such as Muscle Tension Dysphonia) (Dehqan & Scherer, 2008). Vocal Massage is also starting to be used as part of a holistic treatment plan established by an ENT and Speech Pathologist by Voice centres such as the Cleveland Clinic, Vanderbilt Voice Clinic, and the Royal Throat, Nose and Ear Hospital in London.

A way to improve posture and prevent vocal problems

Singing and speaking well require a freedom and balance in the muscles around the larynx and jaw and a buoyant, free posture for the breath. A number of articles have illuminated the way in which good posture, particularly of the cervical spine, is directly related to higher levels of vocal resonance and pitch control (Arboleda & Frederick, 2008). Cardoso, Lumini-Oliveira, and Meneses (2017) have proven an effective posture allows a subject to more easily shift the tension between muscles, allowing for a free movement of the larynx without blockages and with benefits to voice production. In a study by Kooijman (2005), muscular tension and body posture were assessed in relation to voice handicap and voice quality in teachers with persistent voice complaints- the conclusion was the combination of hypertonicity of the sternocleidomastoid, the geniohyoid muscles and posterior weight bearing…[were] the most important predictor for a high voice handicap. Manual bodywork such as Vocal massage combined with rehabilitative exercises may be the way forward in helping some patients recover from a vocal disorder by addressing the body patterns contributing to the tightness in these muscles. Unfortunately, comprehensive studies on the long-term benefits of this have not yet been undertaken.

A Vocal Massage Session

The first component of a Vocal Massage is postural assessment and palpation of the area around the neck and jaw to establish if restrictions in the muscles may be affecting the patient’s ability to supply breath efficiently to the voice and vocalize well. The larynx and hyoid bone are gently assessed to establish if they are in a free, neutral position, range of motion of the jaw and head will be tested, and the therapist will check if the ribs and diaphragm are mobile and the posture is balanced. A treatment plan is then developed specific to the patient’s needs, which may include alleviating tension around the front of the neck and jaw, mobilizing the hyoid bone and larynx and addressing postural issues affecting the freedom of the breath. Myofascial techniques are used which include gentle tractioning of the muscles, trigger point work and stretches that may help reduce tension in the muscles.

May help improve respiratory function

We know that manual therapy appears to increase the respiratory function of normal individuals (Engel & Vemulpad, 2007), but more research needs to be undertaken to see if manual therapy could be helpful to those with inhibited respiratory function and voice disorders (da Cunha Pereira, de Oliveira Lemos, Gadenz, Cassol, 2017). Anecdotally many of my clients have found massage helpful after a respiratory illness such as a cough to alleviate tension and stiffness around the larynx and have found their voice more resonant and responsive after the massage session. Myofascial release techniques in this instance are used on the sternocleidomastoid and scalene muscles combined with gentle mobilization of the intercostal muscles, diaphragm attachment points and the ribcage to help free the breathing mechanism.

Countering the physical demands of workplaces- particularly for stage performers

Stage workplaces major demands on a singer’s body. Raked stages, very heavy or tight costumes, wigs, hats and high heels can all throw the alignment of the posture out and tense muscles involved in vocalisation. It can also mean the singer adjusts the position of their pelvis and neck. These adjustments may affect the singer’s capability for full breath capacity and best breath management (Staes, et al., 2011). Vocal massage used as a preventative measure to help a build-up of tension may help bring more balance back to the body and keep a voice fresh and healthy.

A study examining the effectiveness of Vocal Massage in relation to Reflux

While much more research needs to be undertaken, in a recent study by Gaelyn Garrett, M.D., and Duke researcher Seth Cohen, M.D. at the Vanderbilt Voice Institute (Cohen & Garrett, 2008) it was found that around 67 per cent of patients who had hoarseness over a six-month period were either on reflux medication or had been prescribed reflux medication without improvement. Two-thirds of those patients improved with specialized manual therapy aimed at muscle tightness of the neck and throat. “Medical Director Gaelyn Garrett, M.D., and her staff of speech-language pathologists had previously treated the condition with voice therapy alone for the muscles around the larynx, which include the swallowing muscles. Some patients, however, did not respond to only doing voice therapy.” “In these people who weren’t responding, we started asking a lot of questions about their daily habits and we started realizing that people talk on the phone and it affects their posture; people are at a computer and it affects their posture,” Garrett said. It was also found that typically these patients had experienced some kind of physical or emotional trauma which had begun a process of excess tension throughout the body “… they were in a car wreck, they went through a divorce, they had back surgery” (Cohen & Garrett, 2008). Cohen and Garrett (2008) report how a more holistic view revealed other causes of tension: “And you start asking people, too, about where they focus stress and if they have any cervical spine issues, neck or shoulder issues, tension headaches. It all fell in place that if we address this whole musculoskeletal area, from the backup, it would help patients relax their voice,” she said. In conclusion, while anecdotally vocal massage helps certain patients and small studies have proven its effectiveness (Rubin, Lieberman, & Harris, 2000), more comprehensive studies are needed to establish the long-term effects and benefits, the type of patient it might help and how it might be best implemented in a multidisciplinary setting.

References

Arboleda, B. M. W., & Frederick, A. L. (2008). Considerations for maintenance of postural alignment for voice production. Journal of Voice, 22(1), 90-99.

Cardoso, R., Lumini-Oliveira, J., & Meneses, R. F. (2017). Associations between Posture, Voice, and Dysphonia: A Systematic Review. Journal of Voice.

Cohen, S. M., & Garrett, C. G. (2008). Hoarseness: is it really laryngopharyngeal reflux? The Laryngoscope, 118(2), 363-366.

da Cunha Pereira, G., de Oliveira Lemos, I., Gadenz, C. D., & Cassol, M. (2017). Effects of voice therapy on muscle tension dysphonia: a systematic literature review. Journal of Voice.

Dehqan, A., & Scherer, R. C. (2018). Positive Effects of Manual Circumlaryngeal Therapy in the Treatment of Muscle Tension Dysphonia (MTD): Long Term Treatment Outcomes. Journal of Voice.

Engel, R. M., & Vemulpad, S. (2007). The effect of combining manual therapy with exercise on the respiratory function of normal individuals: a randomized control trial. Journal of Manipulative and Physiological Therapeutics, 30(7), 509-513.

Kooijman, P. G. C., De Jong, F. I. C. R. S., Oudes, M. J., Huinck, W., Van Acht, H., & Graamans, K. (2005). Muscular tension and body posture in relation to voice handicap and voice quality in teachers with persistent voice complaints. Folia Phoniatrica et Logopaedica, 57(3), 134-147.

Rubin, J. S., Lieberman, J., & Harris, T. M. (2000). Laryngeal manipulation. Otolaryngologic Clinics of North America, 33(5), 1017-1034.

Staes, F. F., Jansen, L., Vilette, A., Coveliers, Y., Daniels, K., & Decoster, W. (2011). Physical therapy as a means to optimize posture and voice parameters in student classical singers: a case report. Journal of Voice, 25(3), e91-e101.

To contact Rachael about Vocal Massage please email her at rachael@vocalease.com.au

Rachael Cunningham is a Vocal Massage Therapist in Sydney. She is a qualified Remedial Massage therapist and has undertaken extensive training in myofascial techniques for the Neck, Jaw and Head and Vocal Massage. Rachael is also very aware of demands placed upon singers in the performing arts as she has sung in the chorus of Opera Australia for the past 20 years. Currently she is performing in Aida at the Sydney Opera House and is about to travel to China to tour with Madama Butterfly. Her website is www.vocaleasemassage.com.au

“Unless stated otherwise, this article represents only the views of the author and not the views of the AVA”

By Guest Author Interviews • • 0 Comments

National Voice Meeting 2018 – Presenter Series #2

The Australian Voice Association

By Cecilia Pemberton

I am very much looking forward to returning to Adelaide to present at the 2018 Australian Voice Association’s National Voice Meeting: Voice on! The Road to Recovery.

It is interesting to reflect how far the AVA has come, since the Inaugural Voice Symposium was held in Adelaide in May 1991 at the Queen Elizabeth Hospital. I was on the organising committee for that symposium along with Alison Russell, Jan Baker, David Close and Alison Bagnall.

The Keynote speaker was Dr Robert Bastian, then Professor of Otolaryngology at Loyola University School of Medicine, Washington. He is the Founder and President of the Bastian Voice Institute. Professor Bastian’s interests in the field of laryngology encompassed both voice and swallowing with a special interest in the needs of professional voice users. What a wonderful choice of speaker he was, so generous in his knowledge and time. He had an infectious enthusiasm for the idea of collaboration of all the professionals interested in voice.

As a committee we were impecunious, but Professor Bastian generously agreed to present with no remuneration. We were indeed very fortunate. He was so encouraging of our endeavours not only for the symposium but also to build an association to foster collaboration.  We did of course have some anxious moments, especially as we were spending money we didn’t actually have and weren’t sure anyone would attend! We were soon rewarded when registration opened, the response was overwhelming. We quickly broke even and had soon made a profit.  200 delegates attended that inaugural symposium; speech pathologists, ENTs, teachers of singing and voice coaches.

The success of the symposium was the impetus for the formation of the AVA. By the end of 1991, Alison Russell, Jan Baker and I had established the AVA with a charter to foster collaboration between all voice professionals in the education, research and care of voice users.

The financial success of the inaugural symposium meant that, from then on, seeding funds were available for future AVA organising committees.

So it is, many successful symposia later, that the current AVA committee have put together a very exciting, diverse programme which will encompass care and rehabilitation of the singing and spoken voice in both the adult and paediatric fields.

We are so fortunate to have Leda Scearce as the keynote speaker. I recently watched an interview that Liz Johnson Schafer did of Leda as part of “Interviews on Voice Matters”. Leda talks about her background as a professional singer before retraining as a speech pathologist and also her philosophy for the rehabilitation of the singing voice. I highly recommend watching the video https//you.be/0bpwU-Fjr50 .

I also saw a webinar of Leda presenting as part of the 2018 Performance Voice Conference at The University of Utah, Voice Disorders Centre. Leda ran a very successful master class. It was so interesting to see her at work with some young singers. I’m sure she will be a treat to have at the 2018 AVA National Voice Meeting.

Also on the programme this year is Nicole Free. For those of you who don’t know Nicole, check out her 3-minute thesis: https://youtu.be/3ebmlZbJgcQ. She is now through to the Asia Pacific finals.

I look forward to seeing you in Adelaide.

Also on the programme this year is Nicole Free. For those of you who don’t know Nicole, check out her 3-minute thesis: https://youtu.be/3ebmlZbJgcQ. She is now through to the Asia Pacific finals.

Cecilia Pemberton is a speech pathologist in her private practice, Voice Care

Australia and at the Voice Assessment Centre at St Vincent’s Clinic, Sydney. In 1991, she co-founded the Australian Voice Association after the Inaugural Australian Voice Symposium in Adelaide.
Her research has covered the normative data for endoscopic examination of the larynx, changes in speaking fundamental frequency in women’s voice with age and intergenerational and most recently the effectiveness of prevention and early intervention programmes for voice problems in teachers. Cecilia is co-author of Voice Care for Teachers DVD.

In 2009 she was awarded Fellowship by Speech Pathology Australia for her contribution to the profession. Her voice care programme for teachers with the Catholic Education Diocese of Wollongong has been a finalist in both the NSW Safe Work Awards (2009) and the Australian Human Resources Institute, Martin Seligman Award for Health and Wellbeing (2015). In 2014 she won the British Voice Association Van Lawrence Prize for her paper “Efficiently and Cost Effectively Managing Teachers’ Voice Problems”.

To register for the AVA National Voice Meeting and AGM 2018 click here:

“Unless stated otherwise, this article represents only the views of the author and not the views of the AVA”

Manual of Singing Voice Rehabilitation
By Guest Author Articles • 0 Comments

National Voice Meeting 2018 – Presenter Series #1

Leda ScearceHealing Voices

By Leda Scearce

Singing is a part of virtually every culture and is fundamental to our human experience.  In the United States, singing is enormously popular, as evidenced by the vast number of people engaged in all kinds of singing activities. Over 30 million Americans participate in choral singing alone (Chorus America, 2009).  Shows like The Voice, America’s Got Talent and American Idol illustrate how passionate we are about singing. From the amateur recreational singer to the elite celebrity, we sing as soloists and in ensembles, with instruments and a cappella, in classical and contemporary styles, on stage, in concert and in the shower.

Every person’s voice is unique and identifiable, and our voices can be a big part of our identity and how we see ourselves in the world.  This is especially true for singers, for whom the voice is not only intricately tied to self-image and self-esteem, but also may be a source of income and livelihood, creative expression, spiritual engagement, and quality of life. For a singer, a voice injury represents a crisis.  Because of the specialized needs of singers, it takes a team—including a laryngologist, speech-language pathologist, and singing voice rehabilitation specialist—to get a singer back on track following an injury or voice disorder.  Singing voice rehabilitation is a hybrid profession, requiring in-depth clinical and scientific knowledge married with excellence in teaching singing.

Voice problems are rarely isolated in etiology—usually, multiple factors converge to create an injury.  These factors may include poor vocal hygiene, inadequate vocal technique, an imbalance in vocal load and medical problems (allergies and reflux are common in singers, but thyroid, pulmonary, neurological and rheumatologic conditions are among the illnesses that may affect the voice).  The singing voice rehabilitation process must encompass all elements that may be contributing to the problem: medical factors, vocal hygiene, vocal coordination and conditioning, vocal pacing, and emotional factors.

Figure 1

Vocal Coordination and Conditioning

In the context of voice rehabilitation, the singer’s vocal technique may have contributed to the voice problem and/or may be compromised by the voice injury.  In many cases (particularly for CCM singers), the singer may have never received formal training or may have been trained with a classical methodology that does not align with his or her singing style (LoVetri & Weekly, 2003; Weekly & LoVetri, 2009).  The singing voice rehabilitation specialist must design a rehabilitation exercise protocol that promotes optimal coordination of voicing subsystems to appropriately compensate for and promote resolution of the injury while ensuring the singer achieves and maintains adequate vocal conditioning, all in a manner that is consistent with the physiological and acoustic characteristics of the singer’s style.  Thus, the exercise regimen for a rock singer will be different than for an operatic singer.

An effective singing rehabilitation design goes far beyond what is necessary for building technique in a healthy instrument—it requires deep scientific and clinical knowledge to understand the differential impact of various vocal injuries on the structure, function and interaction of voicing subsystems. The rehabilitation protocol must be customized to singing style and underlying injury.  The difference in the exercise regimen for a singer with vocal nodules vs. vocal fold atrophy may be subtle but can have significant impact on the successful outcome of the intervention.

While thorough scientific and clinical preparation is indispensable, it is equally important that the singing voice rehabilitation specialist be an accomplished teacher of singing.  One must be competent in training healthy singers before delving into the more complex endeavour of interacting with an injured instrument (NCVS, 2013).  Ideally, the vocal exercise regimen should encompass the voice holistically—both speaking and singing.

Vocal Pacing

Vocal pacing refers to achieving balance in the amount, type and intensity of voice use.  This is an area that is sometimes overlooked or under-emphasized not only in singing voice rehabilitation but also in the realm of voice habilitation (the enhancement or development of technique in healthy voices).  Optimizing vocal pacing is of critical importance both for achieving and restoring vocal health, and may be a major component of the singing voice rehabilitation plan.  The singing voice rehabilitation specialist can collaborate with the singer to develop strategies for bringing voice use into balance that may include:

  • Prioritizing vocal activities and unloading or reducing those that are less important.
  • Documenting voice use to identify where the vocal load is out of balance and where there are opportunities for improving balance.
  • Planning amount and intensity of voice use in advance, scheduling periods of voice rest (especially when rehearsal and performance demands are high) and strategic planning for efficient practice time.
  • Effective use of amplification, both for singing and speaking.

In some cases, optimizing vocal pacing may mean increasing voice use on a day-to-day basis to “smooth out” the overall vocal load, as for the “weekend warrior” in a garage band or choral singer preparing for a concert.  In either situation, the singer may be engaging in extremely intense voice use episodically without getting regular vocal exercise in between.

Emotional Factors

Many singers have a strong emotional reaction to experiencing a voice problem which arises not only out of concern about the implications for continuing performing but due to long-held and misguided beliefs in the singing culture that voice injuries are the fault of the singer and that singers who experience voice problems are “damaged goods.”  The singer may undergo emotional ups and downs throughout the rehabilitation process, especially if performance has been curtailed or when financial or academic success is jeopardized by the voice problem.  In addition to the physical injury, many singers sustain an “injury of confidence” that can linger after the injury has resolved.  Throughout the rehabilitation process, the singing voice rehabilitation specialist must be mindful of and sensitive to the emotional experience of the singer and interact in a compassionate and supportive manner.

The Singing Voice Rehabilitation Package

All of these factors—medical, behavioural and emotional—must be appropriately addressed through collaboration of the voice care team to guide the singer back to a state of vocal health and wellbeing.  Obviously, singing voice rehabilitation is a complex and multi-faceted process, requiring knowledge and experience that span art and science.  Manual of Singing Voice Rehabilitation: A Practical Approach to Vocal Health and Wellness has been developed to guide the singing voice rehabilitation specialist in developing and executing effective, efficient rehabilitation plans that are customized to each individual singer, encompassing all relevant factors, so that singers are empowered to return to a state of vocal wellness and the joy of singing.

Originally published in the Plural Publishing Community Newsletter, April 2016.

Leda combines her extensive performance experience as a classical Soprano with her roles as a speech-language pathologist and voice teacher. She has worked as a voice teacher for over 30 years, serving on the artist faculties of Bowling Green State University, Meredith College, Brigham Young University of Hawaii and the University of Southern Maine.  In 2004, she obtained a Master of Science degree in Speech-Language Pathology from Boston University. As a graduate SLP student, she completed an internship in voice disorders and voice rehabilitation for the performing voice at the Massachusetts Eye and Ear Infirmary in Boston. She is currently Clinical Singing Voice Specialist, Clinical Associate Faculty and Director of Performing Voice Programs and Development at the Duke Voice Care Center and Duke University School of Medicine, where she provides rehabilitation therapy to singers, actors and other vocal performers with voice injuries. Leda is the author of Singing Voice Rehabilitation: A Practical Approach to Vocal Health and Wellness, published by Plural, Inc.

You can find Leda’s book Singing Voice Rehabilitation: A Practical Approach to Vocal Health and Wellness, published by Plural, Inc. via this link:

http://pluralpublishing.com/publication_msvr.htm

To register for the AVA National Voice Meeting and AGM 2018 click here:

https://www.australianvoiceassociation.com.au/product/voice-on-the-road-to-recovery/

References:

  • Chorus America. (2009). The Chorus Impact Study. Washington, DC. Retrieved December 5, 2015, from https://www.chorusamerica.org/advocacy-research/chorus-impact-study
  • LoVetri, J., & Weekly, E. M. (2003). Contemporary commercial music (CCM) survey: Who’s teaching what in non-classical music. Journal of Voice, 17(2), 207–215.
  • National Center for Voice and Speech (NCVS). (2013). NCVS Symposium on Specialty Training in Vocal Health Summary Report; April 25–26, 2013, Salt Lake City, UT. Retrieved from http://www.ncvs.org/STVH_Summary_Report_2013.pdf
  • Weekly, E. M., & LoVetri, J. (2009). Follow-up contemporary commercial music (CCM) survey: Who’s teaching what in non-classical music. Journal of Voice, 23(3), 367–375.

“Unless stated otherwise, this article represents only the views of the author and not the views of the AVA”

By Guest Author Interviews • • 0 Comments

World Voice Day Interview with Meagan Rudd

Meagan Rudd

Spreading The Music with Key Word Sign.

Since its inception in 2014, the Nordoff-Robbins Key Word Sign Choir, under the guidance of Meagan Rudd, has become a regular feature at a variety of events throughout Sydney. The AVA had the opportunity sit down with Meagan on the lead up to their upcoming World Voice Day performance to learn more about the choir.

Can you tell us a bit more about how and why the Key Word Sign Choir began?

I’ve always been fascinated by all forms of sign communication and have studied them for many years. I work in Special Education in a high school setting, so many of the students have used or been exposed to Key Word Sign as a means of communication since early intervention. For me, the idea of forming a Key Word Sign choir began as a way to enhance the students’ communication skills by increasing their “sign” vocabulary in a fun way. From the outset the students loved it, I loved it and their sign vocabulary improved noticeably.

How long has the Key Word Sign Choir been up and running for?

After offering Key Word Sign choir as an extra-curricular activity for many years at school, a parent of a graduating student who particularly loved Sign Choir asked me if I knew of any similar choirs her daughter could join in the community. After some research I wasn’t able to find anything I could refer her to, so the idea of forming a Key Word Sign choir for young adults in the community started to take shape. As I’d been associated with Nordoff-Robbins Music Therapy Australia for many years, the inception of their Community Music Program was the perfect opportunity to pitch the idea of including a sign choir in the program and in 2014 it became a reality and has been going strong ever since.

How has the relationship between Key Word Sign within music and popular culture developed over the years?

The concept of using Key Word signs to perform song lyrics is not a new one but has mainly been confined to preschool & early intervention settings using songs suitable for preschoolers. What I wanted to offer was the opportunity for young adults to learn to sign the lyrics of songs that were age appropriate for them. We currently have a repertoire of more than 80 songs by artists such as Katy Perry, Pink, Sheppard, One Direction, Ed Sheeran, Miley Cyrus & Bruno Mars as well as some classics by ABBA, the Beatles & Queen, (& songs from nearly every Disney musical ever made). The songs we choose to learn are very much driven by the choir members themselves.

Are there any other choirs like this around Australia and the world?

There are quite a few choirs in Australia & around the world using the sign language of the Deaf community of their country (AUSLAN is the language of the Australian Deaf community). Some schools & preschools teach individual songs in Key Word Sign but I don’t know of any other Key Word Sign choirs in Sydney or NSW that are open to people of any age or ability.

Can you share any favourite moments or memories of your time with the Key Word Sign Choir?

Being part of the Key Word Sign choir gives these young adults the opportunity to showcase their unique skills by performing at mainstream events which otherwise might not be available to them. My favourite moments are watching them blossom when they perform and seeing them bask in the audiences’ applause. It never fails to bring a smile to my face (and a tear to my eye). Among the choir’s most memorable moments are performances at various events with well known Australian artists Melinda Schneider & David Taylor. The choir had the privilege of being on stage with them, signing the song with the artist as they sang.

How did you get involved with World Voice Day and where and when can we catch the Key Word Sign Choir performing?

The choir first became involved with World Voice Day in 2015 through our affiliation with Nordoff-Robbins music therapy Australia, who is one of the sponsors of the annual event. The choir also performs regularly at a variety of other events throughout the year such as eisteddfods, festivals, fairs, Carols nights & events celebrating International Day for People with Disabilities.

What inspires you to continue working with the Key Word Sign Choir?

My inspiration to continue working with the Key Word Sign choir is, quite simply, the joy the choir members give me every time we meet. They’re enthusiastic, talented, funny, cheeky and great to be around. It’s my favourite time of the week and seeing each choir members’ confidence and self-esteem grow never fails to make my day.

Thanks to Meagan and each of the members of the Key Word Sign Choir for their time and sharing their talent with Australia.

The Nordoff-Robbins Key Word Sign Choir is performing at the World Voice Day event in Penrith, “Voices in the Valley”, at the Joan Sutherland Performing Art Centre on Saturday 7th April 2018 7:30 pm. Tickets can be purchased here: http://thejoan.com.au/whats-on/voices-valley-world-voice-day-2018/

“Unless stated otherwise, this article represents only the views of the author and not the views of the AVA”

 

 

By Guest Author Interviews • • • 0 Comments

World Voice Day Interview with Louise Bale

Louise Bale

In the lead up to this year’s World Voice Day, the Australian Voice Association sat down with Louise Bale to find out what is in store for 2018 and how her own journey with dysphonia has influenced her life.

How and why did World Voice Day start?

WVD began in Brazil in 1999. It was the brainchild of a group of scientists who believed the voice was an amazing, yet under-recognised aspect of the human existence…and that it needed and deserved a day of recognition.

Since it’s inception, WVD has expanded well beyond the scientific community, to become a global celebration of the role our voices play in every aspect of daily life.

What is your role with World Voice Day and what got you interested in the event?

I have been the National Coordinator of WVD in Australia since 2013.

In my ‘real’ world, I work as a Health Promotion professional. While most aspects of health and wellbeing fascinate me – I had never really given much thought to the voice, until I lost mine.  In 2006 I developed a neurological voice disorder called spasmodic dysphonia, and life as I knew it has never been the same.

When I first became aware of WVD I embraced the idea of getting involved and raising awareness of the voice and celebrating its uniqueness, magic and beauty.

Over the years the event’s focus has broadened to include voice care initiatives for teachers, performers and the general population; voice screening clinics for vocal performers, professional development events for voice health practitioners and vocal variety concerts. Since the establishment of the Australian Dysphonia Network in 2016, the various concerts have also been used to draw closer attention to dysphonia and raise funds for research.

Can you tell us a little bit about your journey with spasmodic dysphonia (SD)?

It’s been a very strange experience.  Like so many others, my story began as a mysterious hiccup in an otherwise fairly unremarkable period of my life…that was twelve years ago.

After noticing some voice breaks and feeling like my voice was letting me down, I made a quick trip to see an Ear Nose and Throat Doctor, who ruled out anything like nodules.  It was then off to the speech pathologist to look for bad habits / poor vocal technique.  But, after a few months of correcting the minor technical problems came the crunch, “you have spasmodic dysphonia”.

I was happy to have a diagnosis and thought “OK – Let’s just fix it and get on with life”. But, as we all know, nothing is ever simple.

The ‘gold standard treatment’ is Botox injections into the muscles that control the vocal folds. But I resisted Botox for about a year, trying all things alternate instead. You know the stuff, hypnotherapy, nutritional medicine, acupuncture, massage, mindfulness, kinesiology. etc etc etc. I FELT fantastic, but my voice remained an issue.

After about a year, I finally ‘succumbed’ to Botox and found my voice. A slightly different voice, but smooth, sultry and without spasms, I was in heaven…initially.

Since then the results of Botox have been mixed for me. It’s been a rollercoaster while my brain has adapted, adapted and adapted again (almost saying… ‘bring it on… I will NOT be silenced’). We’ve stopped the Botox, pumped up the vocal folds, restarted the Botox, retrained my brain, and I’ve even been to vocal boot camp.

My diagnosis has changed…from adductor SD to abductor SD…to “is this really SD?” and then back to abductor SD…I started to wonder ‘what’s in a name?’ (Funny really, after having been so keen to have one back at the beginning.)

What led you to seek treatment?

At first, I noticed that my voice was dropping out, kind of like a bad mobile phone signal really. Bits were missing, and it felt like my voice was tripping over itself in otherwise easy and robust conversations. Of course, I imagined that it was all in my head until people started to complain about the “poor mobile reception” (when I was on a landline – now that was a hint).

I had been asked to be MC at a 2-day conference, and needed to do something fast – the rest (and the conference) as they say…”is history”

Has it influenced your day-to-day life and professional life?

Absolutely! I was born to talk, and for many years I had been the public face of my workplace in Health Promotion. The conference facilitator, the presenter and the media spokesperson for all things sex, drugs…. interesting and fun.

BUT that all changed.

I became withdrawn and felt that I was no longer useful. My ability to speak up at meetings, contribute to decision-making discussions, join in lunchtime conversations with the team or even answer phones…had gone. I felt like people thought I was unintelligent because I couldn’t speak up and contribute opinions…I wanted to quit.  But I am fortunate to have a very supportive Director and team who were willing to accommodate whatever I needed.

I saw a psychologist to help me grieve the life I had lost and to regain a sense of self-worth. Since then I have been able to change the way I do my work – carve out new ways of doing old tasks, and also take on some new and exciting roles using social media and web-based technology – I have a unique role in the same workplace and have again found my passion for the work I do.

At home, there are many daily challenges too. A simple thing like going out to dinner is problematic because restaurants and bars are such noisy places. Talking to friends or my husband in the car is extremely hard work. TV or any background noise just creates a wall between others and me in the room BUT…thank goodness for text messaging because the telephone is IMPOSSIBLE for most of us who live with dysphonia.

One of my biggest losses is the ability for natural and spontaneous conversation…the stuff of easy relationships, where conversations just flow.

What are some of your favourite World Voice Day memories from years gone by?

From the outset, I was keen to ensure that the focus was not ONLY on professional/performing voice users but that EVERYBODY’S voice was seen as valued and important. As a result, our annual concerts have seen acclaimed celebrities sharing the stage with members of the community from all walks of life.

Without a doubt, the sentimental favourites have been: the Sydney Street Choir; an inspiring group of homeless and disadvantaged people from our community who embrace the pure joy of singing…the Nordoff Robbins Children’s Signing Choir who express their own unique voice through key-word sign language…and the Newcastle Stroke Choir who demonstrate such determination and tenacity while they celebrate the ability to perform and be heard.

In 2017 the Australian Dysphonia Network team joined forces with a similar organization in the United States to host a 6-day long online symposium which focused on all aspects of dysphonia management. It was an enormous feat bringing together over 3,500 people across the globe; something we hope will become a bi-annual event into the future.

None of the activities or events of the past 5 years would have been possible without the amazing generosity of people who share a passion for giving a voice to EVERYONE. I have also been enormously grateful for the ongoing trust and financial support from the Australian Voice Association, both as an organization and the individuals who represent the AVA.

How is World Voice Day different this year and what are some of the upcoming events you are most excited about?

This year we have decided to extend the opportunity to get involved by expanding from a single day of celebration to an entire month of raising awareness and events.

April this year will become Voice Awareness Month – with the tagline “Value your Voice – Love your Larynx – Be alert for changes”. This will allow people in clinical settings like hospitals and private practices to get involved by utilizing promotional material, organizing events, offering screening clinics, and taking advantage of local internal/external media opportunities…or just getting the platform to TALK about the importance of voice with colleagues and clients.

A master class “Care of the Performing Voice” will be held for tutors, teachers and senior students of the Conservatorium of Performing Arts – Penrith.  This is a first and signifies the beginning of a partnership with the Joan Sutherland Performing Arts Centre which we hope will continue to grow.

We will have the support of celebrity ambassadors: singer/songwriter Melinda Schneider, comedian Anthony Ackroyd, and country music artist Drew McAllister. These amazing people have loaned their voices to our cause and will perform at 2 fundraising events on behalf of dysphonia research.

What would be your advice to someone wanting to get involved this year and/or put on an event for World Voice Day?

Don’t be scared – have fun, be creative and do what feels good. It does not need to be huge to make a difference and raise awareness. Remember (almost) everyone has a voice so it makes it easy to talk about!

If appropriate, you can consider using your event/activity as a charity fundraising opportunity. The Australian Dysphonia Network is currently fundraising for a number of exciting voice initiatives. For further details on how to donate you can find us here.

Feel free to also email me with details of your event, or for ideas at loubale@gmail.com

Where can we find information on events?

Thanks so much to Louise Bale for her time and dedication.

“Unless stated otherwise, this article represents only the views of the author and not the views of the AVA”

Lou Bale is the National World Voice Day Coordinator, President of the Australian Dysphonia Network and is recognised by her work and contribution to the field of Health Promotion with NSW Health for the past 28 years.

woman texting
By Guest Author Articles • 0 Comments

Posture and how it affects your speech

How many times has someone advised you to stand up/sit up straight, so that you sound better?

Or received some comment about your posture?

This article is not about body language, or how to stand when you are speaking per se.

I will be discussing how our posture affects us all overall and how our daily habits interfere with our voice! Strange isn’t it. You will be thinking, how does my habit affect my speaking?

Habit by definition, as quoted by F.M Alexander, “A habit is composed of a sequence of acts that follow upon some cue. It is a chain of neural events, with response in all our tissues.”

The way you hold your body, the way you hold your shoulders, your knees, and the way you hold your jaw…all of them impact how you are able to vocally express yourself. My favourite example is the way all of us use our phones or IT gadget. In today’s society, we are plugged in more often than not and get caught up with that task. Have you ever wondered what that posture does for your voice?

Often, we get so engrossed in reading/replying sot our head falls right forwards and we don’t even realize how much strain we are putting on our neck and shoulders! When the head is pushed forwards for constant periods of time, either when sitting or standing, the larynx (voice box area) is not free to move as it can, and the voice cannot function smoothly.

woman texting

When we stand or sit without stiffening our muscles, we are well balanced and coordinated, and send out a clear strong signal. Below are some habitual patterns people have when standing. Which one are you?

  1. Over-arching back: Most of us have been advised to sit up straight/stand up straight or to stand properly. As a response, we subconsciously lift our sternum/chest, and throw our shoulders back and tilt pelvis forwards. This ‘straightness’ will be followed by overly tense muscles of the torso

  2. Stiffening of neck and throat: One of the biggest tendencies for singers and speakers is to stiffen the neck and throat muscles. Have you ever seen someone’s neck with their muscles bulging out when they speak? The breathing airway is affected when we constrict muscles in hour head/neck region.

  3. TMJ problems: TMJ joint simply refers to the joint where your jaw is fixed.  There is a close relationship between stiff necks and tense TMJ joints. Do you speak with minimal jaw movement, and hardly open your mouth? Do you have pain at your TMJ joints? Pay attention to your jaw

  4. Knee-lockers: Sometimes when you try to stand up straight, and ground yourself, you inadvertently lock your knees. Now, why is that a problem? Locked knees mean excess tension in hip joints, which interferes with range of arm movements, which tightens neck and throat muscles and makes your voice work harder than it needs to!

  5. Stiffening of the rib cage: This happens when the ribs are held very still, with no lateral expansion. In this position, the person holds the rib cage up and out after practising deep inhalation. The diaphragm moves, however the ribs do not move laterally ( sideways)

  6. Overworking the facial muscles: Singers, actors and public speakers often consciously or subconsciously over work the facial muscles, when they try to articulate the specific vowel or consonant sounds. Overdoing articulation means you are holding some part of your face too effortfully. Be it your: lips, tongue, eyebrows etc

A great way to start noticing your posture, and where you hold excessive tension, is to lie down comfortably, in a safe space with your knees up. Choose any sound, and make that sound. Notice which part of your body stiffens/tenses or simply works too hard when you make that sound. You can even practice with a few simple sentences or if you are really stuck, sing “ Happy Birthday” when you are lying down.

“Unless stated otherwise, this article represents only the views of the author and not the views of the AVA”

Thila Raja is a Speech Pathologist, who specializes in voice training. She helps people recognize their vocal skills and express themselves clearly. Thila loves helping professionals communicate to their best. Find more from Thila here: www.speakforlife.com.au