Mobility Tips for teaching, coaching or consulting – Annie Strauch

A video post from Annie Strauch – Physiotherapist

In this short video, physiotherapist Annie Strauch offers mobility tips for those of us teaching, coaching or consulting online. Annie demonstrates some short and simple exercises to help us find release through the body, and to assist in a healthier and stronger vocal function. She focuses on the shoulders , neck and upper back in this series of movements that we can all enjoy throughout our working day.

How to use your voice when teaching online – Amy Hume

An Article by Amy Hume – Lecturer in Theatre (Voice) at Victorian College of the Arts
Originally posted online 21st April 2020 – reposted with permission.

Several teachers have reached out to me over the past few weeks asking why their voices feel so tired after a day of teaching online.

Vocal fatigue is common for teachers, whose job requires them to use their voice an extraordinary amount during the day with few moments for vocal rest (school teachers even have to use it at recess and lunch time whilst on duty).

So, I thought this was interesting. Teachers talk all day, so why is talking online making their voices tired?

There are a few reasons your voice may be feeling tired or sore at the end of a day of online.

1.    You may be over-compensating

It’s highly likely that the main contributor to vocal fatigue from online teaching is coming from a tendency to over-compensate.

In a face-to-face environment, you rely not only on verbal communication but your physical presence in the room. You can signal to students with a gesture or even a glance.

Teaching online is totally different because physical presence is removed and there’s a boundary between you and the learner. You may start to overcompensate with your voice in an attempt to ‘reach’ students and connect with them through the new medium of video conferencing.

This would, in turn, place extra strain on your voice as you try to be louder or more animated than you ordinarily would in a face-to-face environment.

One teacher told me that he feels his online classes are ‘not as good’, so he’s trying to mask his insecurities by being extra upbeat and animated. It only took a couple of days before his voice was giving away exactly how he was feeling – he’d exhausted himself and had barely any voice left.

Tips:

The challenge is to trust that whilst your teaching is different when delivered online, you remain a good teacher! Students are also adjusting to the new environment. Remember that less is more, trust that your energy and your lessons will reach you students.

Also, make use of the camera – experiment with how your facial expression could do the work your body language might normally be doing in the classroom.

2.    You may be talking more loudly than what’s required

 Whether you’re using a laptop or desktop computer, most in-built microphones these days are very effective. Although it might not be up to the task of recording an interview or podcast, unless your inbuilt microphone is damaged or you’re standing a few metres away, you can trust and rely on it to be working well.

That doesn’t mean you don’t need to speak clearly! As always, a microphone will only pick up the work a speaker is already doing. Always put the emphasis on clarity rather than volume for digital environments.

You also don’t need to fill your whole living room, house or apartment with your voice. Speak to the group in front of you by speaking to your mic or screen, but don’t assume you have to be any louder in order for them to hear you. Unless they tell you otherwise, assume that they can hear you fine and you don’t need to be putting any extra effort into being loud or increasing your volume.

Tips:

If in doubt of your audio quality, ask your students for feedback as to whether they can hear you or not. This will help you determine whether you need to dial up the clarity or volume.

Note that audibility and intelligibility are two different things. If your students say they can’t hear you, play with speaking more clearly (you could think of us as dialling up your consonants or putting more energy in your articulators). If increasing the clarity doesn’t change their experience, it may be an audibility issue rather than intelligibility.

You might also want to consider using a headset. I find headsets great for video conferencing as I know the mic is right in front of my mouth, plus I can hear the students more clearly, and I can gesticulate freely! Colleagues and I have worked out our favourite headsets at the moment are Logitech H800 Wireless Headset (hooray for Bluetooth) and Corsair HS45, but you could even opt for something as simple as Logitech H110 Stereo Headset.

If you’d prefer a desktop mic, the Rode NTUSB is great value for money – it comes with with a desktop stand and will plug straight into your computer. The Rode NT1A condenser mic is also a crowd favourite and a great option if you have an audio interface and mic stand at the ready.

3.    You may be using your voice more than you would in the studio or classroom

In an effort to make sure instructions are clear and your students are engaged, you could be speaking more than you would in a face-to-face environment.

Many of my colleagues in the voice profession have commented on the importance of clarity of instruction when teaching online. There’s unanimous agreement that our instructions need to be specific and deliberate. Clarity of instruction doesn’t necessarily mean giving more detail or speaking for longer, it can mean finding the simplest way to say what needs to be said.

This reduces the chance of confusion, which itself leads to frustration, annoyance or discomfort from the students. Confusing instructions also increase the vocal load of the teacher, as suddenly you’re explaining something more than you normally would.

Most significantly, clear instructions make the lesson easier for the students (who are experiencing the same amount of Zoom fatigue as their teachers). It takes the pressure off them having to dissect information that’s being delivered to them through a different medium than they’re used to.

Tips:

Find the most simple, clear and direct way to give an instruction or explain a concept to students. Rather than ramble and draw out your explanation, pause and give them the space to ask questions.

Remember that students are getting familiar with this new learning environment too. They need space to comprehend information and take in instructions

4.    Resist the temptation to fill every silence with your own voice

Silence in an online class can make you feel like the lesson isn’t landing, the students are losing focus or people are distracted. But perhaps these moments of silence are the same in-between moments that present themselves in any face-to-face class – only now they’re not filled with student chatter or background noise?

In an online environment, the background noise of a school or university disappears, and the silence can be overwhelming. The space you give students to comprehend concepts, respond to instructions or complete their work is crucial – not only to their learning, but to preserving your voice (and probably your wellbeing!).

Tips:

I know some teachers who are using the Pomodoro technique – teaching for 25 minutes, then giving students a 5 minute break, so it’s 25 mins on and 5 mins off. You could invite students to put some music on in short breaks like these, or you could play some music and the students hear that. Music or no music, any sort of break in a class is a chance to build in moments of vocal rest.

You could also embrace the silence! Rather than racing to fill every pocket of silence with your own instructions or talking, get familiar (and comfortable) with the silence. This is certainly a challenging one when teaching online, as I know a lot of teachers are feeling a need to fill every little moment of the class to keep students engaged. The best solution is probably to investigate and strike a balance.

5.    Have a look at your working-from-home set up and check that it’s supporting effective voice use

One singing teacher told me last week that she injured her neck in the first week of teaching online because she insisted on putting her laptop up high on top of her piano because she didn’t want to have a double chin.

There are few things more daunting than seeing yourself on camera all day, every day, day after day. It’s no wonder some teachers have opted for the most flattering camera angle as opposed to the most ergonomic set up!

She quickly realised how ridiculous her concern about a double chin was, but only after she injured her neck and was wondering why her voice was so tired and scratchy.

When it comes to using your voice efficiently and effectively, alignment and breath are key.

In a classroom or studio you’re probably standing, and chances are you’re moving around a bit. You may not always have the best posture when standing but at least you’re not leaning over a laptop or slouched at a desk.

Working from home, you might be sitting at a desk or table delivering classes to a screen that’s requiring you to gaze up to it or lean over to it. Preferably, your camera will be at the height of your head so that you can keep your head and neck in alignment. If your head and neck are off balance, that’s going to put extra strain on your neck and shoulders, restricting your breathing and disconnecting you from using your voice functionally.

Tips:

Find the balance between a camera angle and lighting you can cope with, and prioritise your alignment so that you’re not stretching your neck forward or slouching in your spine.

Any moments you can build into the day that allow you to stretch your neck or shoulders will be beneficial as well.

If you’d normally go between standing and sitting when teaching, aim to have the same variety in your online classes.

6.    Make sure you are breathing

One of my colleagues from New York remarked recently that on a trip to the supermarket, he felt tension in the air, and he looked around and observed that everyone was holding their breath (a voice teacher’s trained eye can quickly notice when people are breathing shallowly or holding their breath).

This phenomenon of holding your breath through the pandemic was also observed in David Marr’s article on The Guardian, One day we will tell stories of the virus, a time when we held our breath passing people on the street.

Sadly, in Australia, it feels like after going through a summer of being scared of the air due to bushfire smoke, we’re now scared of the air due to the virus.

I’m finding myself frequently holding my breath on my morning walks through Carlton Gardens and on trips to the supermarket, and whilst I thank my impulse to survive, I remind myself to reconnect to my breath when I’m back in my teaching space (aka my living room).

It’s important to acknowledge we’re not only shifting to teaching online, but doing so in the midst of a global pandemic that comes with a range of its own demands. You’re not only learning to teach online, you’re also processing what’s happening in the world, in your institution, in your family and with your students – all of which as a singular concern could be discombobulating and disconnect you from your breath.

Tips:

Whether you teach standing or sitting, take a moment to check in with your breath before teaching. You can place a hand around the level of your belly button and focus on breath moving your belly out into your hand as breath comes in, and your hand moves in towards your spine as breath leaves.

Low and slow. That’s all you need to remember.

If you can take this moment to centre your breath before class, you’ll be more likely to be using good breath support when it comes to teaching.

What does a Voice Coach Do? – Jennifer Innes

When someone asks me what I do, and I say, “I’m a Voice Coach”, the conversation usually continues a little something like this:

 

Them: “oh, you’re a singing teacher?”

Me: “No, I don’t teach singing; I teach spoken voice.”

Them: “Oh, so you’re a speech path?”

Me: “No, not that either, though some of our goals are similar”

Them: “Erm….so, you teach elocution and how to speak properly.”

Me: “That’s closer to it. But not really right either”.

 

Don’t get me wrong, I don’t blame them.  For people outside the performing arts world, there’s no reason for them to know what I do.  Sometimes when I say I teach accents as part of my job, that is familiar (and often inspires QUITE the conversation), but otherwise, how should they know what a Voice Coach is? If I’m honest with you, many people within the performing arts field also don’t realise the full scope of my job.  This is a topic of much discussion and some frustration among ‘Voicies’. Sure, we can warm up the actors, but what we do goes way beyond that.  As a colleague recently observed – half our job is in educating others about what we actually do.

 

We often butt up against the dated and inaccurate perception that we Voice Coaches function solely to teach and drill technical skills, and to craft our students’ voices into some standard and universal ideal.   As a trained and practising actor, who had studied Spoken Voice myself at drama school, even I had a limited idea of the full depth and creative potential of my job before I retrained in Voice at the Victorian College of the Arts. During my immersive training, and since entering into my new career of University teaching, private practice and production coaching, my eyes have been opened to the full potential of my profession. Which leads us back to the original question, what is it that I do?

 

Before I describe my job, I want to state that other Voice Coaches might offer different perspectives or opinions on the role.  There’s a range of different approaches out there, and I’m sure that many vary from mine to some degree.  However, I’m certain that many of my colleagues, both in Australia and overseas, share many of my guiding principles.

 

So yes, we do teach technical skills.  We teach people how to use their bodies in a way that supports a flexible and healthy voice.  For me, this is step one.  Sometimes this means we need to undo: undo patterns of physical tension that might be unconscious and habitual, but which might restrict a full and free breath; undo habits of movement that contribute to tension or inhibit vocal freedom; undo patterns of thinking which restrict or limit vocal and creative potential.  Blocks and restrictions can be physical, mental and emotional (which is where things can get tricky. But more on that later).  As Cicely Berry, former Voice Director for the Royal Shakespeare Company put it: ‘Voice work is a matter of finding a way past people’s fears and defences, connecting them with the full potential of their voice’[i].

 

In a basic sense, I think about my practice as teaching people how to walk and talk.  Don’t laugh – it’s harder than you think.  Because talking with a fully expressive, flexible, and embodied voice takes practice, patience and a delicate awareness of your physical (and mental) habits.  My job is to facilitate an environment in which the student or client (I’ll call them the ‘person’ from now on) can develop that awareness.  I feel strongly that in order to create that environment, I need to build trust with the person. I must not criticise their voice, or seek to ‘fix’ it, but provide tools to expand the possibilities of their unique voice while celebrating that very uniqueness.  I (and many peers) avoid using terms such as ‘wrong’, ‘bad’ and even ‘normal’ in our teaching. Because the voice is more than a sequence of physical processes resulting in sound vibrations – it is part of our identity, and opening up the full range of the person’s voice can be a confronting and emotional process.

 

Here I must comment on what I am not. I am not a therapist.  I don’t claim to be, I don’t have any relevant qualifications (beyond Mental Health First Aid Training), and I will never seek out dramatic emotional responses in the person just for the sake of it. If a Voice or Acting teacher ever asks a student to dredge up some past emotional trauma in order to really ‘get there’ emotionally, I believe they are entering into an area that is unsafe for the student.  There is research to support this assertion[ii], but that’s a whole other can of worms, and we needn’t go there now.

 

An oft-heard refrain when coaching Shakespeare is ‘play the thought, not the emotion’.  If an emotional response does occur, as a result of the text, it should serve the story and leave the person unharmed.  If the emotional response is separate to the story and the character, if it lingers, or if it is clearly disproportionate to the task at hand, I will care for the person in the moment and take appropriate action if needed.  Sometimes moving the body can help to release lingering emotions[iii], and sometimes rituals[iv] can help people step out of character.  In some cases, the person should be referred to a mental health professional.   In my experience, this rarely happens.  More often, I have seen the process of breathing deeply result in tears which signify little more than a release of long-held tension.  Still, it is important to recognise our duty of care and practice our craft with awareness and professionalism.

 

OK, Jen – I hear you say – I still don’t know what you actually do, like, in the studio.

 

Fair question.

 

After I work with the person to build an awareness of their body and move toward releasing extraneous tension, we work together to develop strength where it is helpful.  We redirect effort to the back and abdominal region, which in turn relieves the muscles in and around the shoulders, neck and larynx of the urge to over-compensate and strain to push out the voice. If there is a medical condition, or I suspect there might be, the person is referred to a medical professional. I am not a therapist, and I’m certainly not a doctor. My work does not replace the work of the ENT or Speech Pathologist.

 

After some breath and  body work, I assist the person to stretch their speaking voice by building and strengthening resonance and pitch range. We exercise the articulators (not so that the person sounds like a robot but so that they have increased vocal possibility – notice a pattern here?).  And many Voice Coaches work with text. Lovely, rich, muscular, invigorating text. And we work creatively, not mechanically. If you watched many of us working with text, you might think we’re teaching acting; and you’d kinda be right.

 

And here is the element to our work which is, to me, most important, most valuable, and most thrilling: connection.  We teach (allow? remind?) people how to connect.  In an age of illusionary connections (posts, feeds, likes, message notifications pinging up a storm), it is a pretty special thing to stand, breathe, look another human in the eye and tell them a story.  It can also be terrifying.  Often,  we’re so out of practice that many of us are overcome with self-consciousness in the moment of actually being seen. I have worked with students who physically shrink themselves, or blurt out jokes at their own expense to cover their discomfort.  I’ve seen people cry and people launch into critical attacks on themselves or tell me how ‘bad’ their voices are.  But we persist, and this is why: to witness the effect of a true, human, completely in-the-moment connection; to see someone stand tall and take up the space to which they are entitled; to hear someone send their voice out into the room with assurance, rather than retract it apologetically at the end of every phase.  We persist in order to witness the charge and change we humans can experience and bestow when we truly access freedom in our voices, and let language move through us.  This is what I do. What a thrill.

 

For those who perceive my job as fixing, or standardising voices, or pushing actors towards perfect, crisp but inflexible elocution (as it was once called), I offer this quote from renowned Voice Coach and Pedagogue Kristin Linklater: ‘the natural voice is transparent, it reveals, not describes, inner impulses of emotion and thought, directly and spontaneously. The person is heard, not the person’s voice’[v].

 

Oh, and I teach accents. But please don’t ask me to do one for you if I see you at a party.

 

[i] C Berry, ‘Transforming Texts’, in Well-Tuned Women: Growing Strong Through Voicework, , F. Armstrong & J Pearson, Pirate Jenny Publications, 2013, p.45

[ii] S Burgoyne, K Poulin & A Rearden, ‘The Impact of Acting on Student Actors: Boundary Blurring, Growth, and Emotional Distress’, Theatre Topics, vol. 9, no. 2, 1999, pp. 157-179; M Seton, ‘Post-Dramatic’ stress: Negotiating Vulnerability for Performance’ Proceedings of the 2006 Annual Conference of the Australasian Association for Drama, Theatre and Performance Studies, 2006; SL Taylor, ‘Actor training and emotions: finding a balance’, PhD thesis, Edith Cowan University, Perth, 2016, p.52

[iii] M Seton, ‘Post-Dramatic’ stress: Negotiating Vulnerability for Performance’ Proceedings of the 2006 Annual Conference of the Australasian Association for Drama, Theatre and Performance Studies, 2006, p.4

[iv] R Barton, ‘Therapy and Actor Training’, Theatre Topics, vol. 4, no. 2, September 1994, p 112

[v] K Linklater, Freeing the Natural Voice: Imagery and Art in the Practice of Voice and Language, Drama Publishers, Hollywood, 2006, p.8

Air for an Audience

An article by Nathan Curnow.

June 2018. We’re about to perform in the German city of Heidelberg. It’s a beautiful evening, and we’re trying to keep calm as the sun dips below the rooftops of the baroque streetscape. It’s the opening night of their annual literary festival. The Spiegeltent has been erected in one of the cobblestone squares of the old town district and now sound check is over, the stage is set, the venue is filling up. I have to be cool, but it’s easy to be undone by the significance of all this. The city of Heidelberg has flown us halfway around the world to be the headline act in the birthplace of Romantic poetry.

For me, it’s the culmination of twenty years as a poet and spoken word performer. I’ve worked countless rowdy bars, quiet libraries, country halls and tin sheds, using nothing but my voice. Spoken worders aren’t singers, comedians or musicians. We don’t have tunes, punchlines or a guitar to hang around our necks. We don’t even have a piece of paper to read from. All we have is a bare stage, a microphone and our memory, which we hope works, plus some experience in rhythm, rhyme and intonation. We manage air for an audience, the air across our vocal cords, the air that we form into words.

Now jump back twenty years to when I first got up at an open mic. Imagine a dark, upstairs room, with bodies jammed onto couches so rundown that no undergrad would want them in their share house. It’s a hot and stuffy Wednesday night on Brunswick St in Melbourne, windows jammed open for fresh air, tram’s dinging their bells as they pass. You’re in a room full of weirdos and wannabees, each one waiting for their name to be pulled from a baby doll’s head. You’re at Babble. And suddenly you’ve been chosen to have your three minutes on stage.

It was do or die back then. And most of us died. Some were a three-minute train wreck. Each night was an electric circus of danger and possibility, the room supercharged by failure, success and expectation. It was there that I began exploring voice. I’d listen for hours, asking why some people hit and some completely missed. Mostly it was a total drag of a night, except for one magical moment when someone got up and did something amazing, something that gave us enough reason to return the following week and endure it all again.

So what makes a voice hit its target? It’s obviously a combination of what’s said, how it’s said, plus when, where and why. There’s the anger and urgency in the orations of Malcom X or the fierceness of Nina Simone. There’s the dramatic delivery of Alan Rickman, the charm of Jeff Goldblum, the sultry heat of Eartha Kitt or the creepiness of John Malkovich. I don’t have the clinical knowledge of a specialist. All I know comes from my years on stage and from being part of a listening audience.

Earlier I said that I had to keep cool before taking to the stage. Everyone has doubts, especially performers, but staying cool and present gives your voice the best possible chance of sounding believable in the moment. People respond to what they perceive as real, so like a magician, you’re hiding the tricks. You’re managing your nerves so that the audience won’t see the techniques of your delivery. People want to think it’s natural, effortless, even though deep down they know it’s not.

I contend that there are three elements to manage an effective voice. Now, these aren’t Toastmasters or TED Talk techniques. They’re not ways to sound as captivating as Maya Angelou or James Earl Jones. They may not give your voice the X factor, but they’re fundamental to working a microphone or to just having a conversation down at your local supermarket.

The Internal

When I was six years old I had a debilitating stutter. I was unable to say the smallest words like ‘hi’ or ‘and’, the sounds refusing to complete their release of me. My mother suspected it was due to the tantrums of my Grade One teacher, a lady whose face lit up redder than the planet Mars before she exploded at the little children before her. My mother was right, I was petrified of the woman, and this fear manifested as a stutter.

It’s almost impossible to find your voice when your inner world is in chaos. Performers might commonly suffer stage fright, but we can all feel that same intense pressure in our daily lives—the threat of judgement, the fear of failure, the weight of expectation. When we’re constantly overwhelmed we’re not safe to feel ourselves, and being ourselves is the key to voice. If eyes are windows to the soul then perhaps voice is the orchestra of it. The sounds we make reveal us—who we are, what we fear, what we want or what we’re hiding.

For a performer, nerves and adversity can be a wonderful motivator in the short term, bringing a necessary edge to the voice, but if left unmanaged the performance will eventually suffer. This goes for anyone, no matter where or what the occasion. It’s hard to speak if you’re in distress, and sometimes the smallest audiences are the most terrifying.

The Meaning

Have you ever seen a music video that bears no relationship to what the song is about? If not, check out the Look of Love by ABC. It’s bizarre! Or have you ever listened to a good audiobook that’s read badly? There’s a disconnect between the message and the delivery. The voice seems to ring untrue. To deliver a believable voice we must understand our message and what it means.

Sometimes a well-intentioned producer will employ trained actors to read the work of poets, instead of the actual poets themselves. I understand the idea, but I’ve never really known it to work out. Why? Because actors tend to overshoot it, emoting it to death, putting themselves and what they do before the message. Rather than being stewards of the poem, they think it’s about themselves doing it.

In A Hard Rain’s Gonna Fall, Bob Dylan sings: ‘I’ll know my song well before I start singing’. It’s a simple line, one that’s always meant a lot to me. The clarity of the idea combined with his sing-speak sound has made it unforgettable. If you truly know your ‘song’, you’ll know its meaning. This guides your delivery so that you can get out of the way of your own performance. Now that’s a kind of irony, isn’t it? How can a performer get out of the way of their performance? Simply, by managing the ego. Realising that it’s not all about you gives your voice room for the message, providing the best chance of bringing people together.

The Audience

There are those magical moments when a performer feels perfectly in tune with the audience. It feels like you’ve become involved in something bigger, a shared experience you can’t explain. For the performer, it’s like they’re delivering the show but receiving it as well. Spoken worder Sean M Whelan says:

‘It’s about being inside that moment for the duration of the performance, but it’s about being outside of it at the same time.’ (2012, Verity La)

Our voice reveals our relationship with our audience. It reveals how we consider them, whether their loved, feared or loathed.

Some ‘page poets’ resent having to read their work in public. They’d rather be one step removed, speaking only to the reader through the printed words in their new book. And yet live readings are where most poetry books sales occur, so they’re thrust onto the reading circuit. What results is something that’s excruciating to sit through. You can hear their disdain and discomfort in every word.

As I said earlier, people respond to what they perceive as real, and in my experience the only thing an audience won’t forgive is contempt. You have a role to fulfil beyond your own doubts or misgivings, and they want you to fulfil it. If we’re uncomfortable with this role then our voice suffers. In this sense, our attitude toward our audience completely relates to the who, what, where, when, why and how of speaking.

Now as you already know, these three elements connect and overlap. They relate to us being in the present, whatever the context, wherever the stage. These moments are full of pressure, irony and expectation but we have to find peace with that in order to speak. Ultimately, I think it’s about acceptance. To deliver our best voice we must accept that things may fail, and that failure is a success if it’s genuine. We must fool ourselves into thinking that our own magic trick is trick-less. Because it is, and it isn’t, and that’s exactly how real magic happens.

June 2018. I step up to the microphone in Heidelberg, breathing in the air that’s mine and all of ours. By recognising this I can find my voice, managing it out of respect for myself, my message and my audience. I breathe out and the air is formed into words that hopefully hit their target. Then through my voice, I begin the show, which is all of us creating something.

Bio

Nathan Curnow is an award-winning poet, spoken word performer and past editor of Going Down Swinging. His books include The Ghost Poetry Project, RADAR, The Right Wrong Notes and The Apocalypse Awards. He has taught Creative Writing at Federation University; been a peer assessor for the Literature Board of the Australia Council, Creative Victoria and Arts Queensland; and recently co-judged the Newcastle Poetry Prize. In 2018 toured Europe with loop artist, Geoffrey Williams, performing at the OFFMilosz festival in Poland and opening the Heidelberg Literature Festival in Germany.

 


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

Look how far we have come!

An article by Dr Malcolm Baxter.

When I trained in ENT in the mid-1970s, laryngology was somewhat in the doldrums and not regarded as a subspecialty, which is surprising given its great importance in Victorian times with contributions from outstanding laryngologists in Europe, the UK and the USA.

Certainly, laryngeal malignancy was to the forefront, and in general, in Melbourne, laryngeal carcinoma was treated by radiotherapy and salvage laryngectomy although primary partial laryngectomy was increasingly used in some centres.

The options for benign laryngeal disorders were somewhat more limited.  We were almost unaware of the seminal work of Hirano.  Microlaryngoscopy was done for biopsy and removal of laryngeal lesions, although the instruments were fairly gross, which made it sometimes difficult to produce good results.  There was one C02 laser in Melbourne for laryngeal work during my training, and this was at the Royal Children’s Hospital, used for laryngeal papillomatosis which was then considered to be a paediatric disease largely.  The occasional adult patient with the disease could be treated there by special dispensation.

Concerning other benign lesions, a popular operation at the time was so-called “vocal cord stripping”, a procedure which sounds as bad as its name and produced expected results.  Although various procedures on the external larynx such as the Woodman procedure were described, these were seldom done. We used Teflon injections  for the paralysed vocal cord, an excellent solution for those people with a malignant cause who was not expected to live more than six months but unfortunately this was sometimes carried over in some cases to people who did not have a malignant cause for their paralysis, often with unfortunate  late results such as local laryngeal granulomata and even Teflon spreading to distant organs.

My interest in laryngology was stimulated by one patient I remember who had a so-called vocal cord stripping and on review in the outpatients on indirect laryngoscopy had beautiful looking vocal cords which moved and apposed beautifully without a sign of any lesion but unfortunately with an absolutely dreadful voice.  Of course, the vocal cord stripping ignored the principles of preserving the lamina propria, but without videostroboscopy, I was unable to appreciate the vibration of the vocal cords (or rather the probable total lack of vibration!).

Examination in ENT, including the larynx, throughout most of my training, was still using the frontal mirror, beloved of American cartoonists, using a reflecting lamp which shone from behind the patient on to the surgeon’s head-worn mirror back to the patient. The larynx was examined by indirect laryngoscopy; a technique described first by the singing teacher Garcia in 1862 and which still gave a good visualisation of the larynx in those people whose gag reflex did not completely preclude it but not allowing assessment of connected speech or vibration.

Our speech pathology colleagues usually attended Outpatients but were somewhat frustrated by not being able to visualise the cords and having to rely on our description.  Ros Frank, a leading speech pathologist at the Royal Melbourne Hospital, had acquired an attachment which fitted on the surgeon’s frontal mirror and by standing behind the patient looking at the examining surgeon, you could see a reflected image of what the surgeon saw with his mirror – a sort of doubly indirect laryngoscopy!  Slightly later the frontal mirror was superseded by the Vorroscope now widely used in Australia by ENT specialists.  One further refinement was the use of a half-silvered mirror which was attached to the Vorroscope, which allowed some vision to an external observer.

Even after I did my post-fellowship work overseas, flexible endoscopes were only just making an appearance, although by the end of the ’80s most ENT specialists had converted to using this instrument which obviated the need for indirect mirror laryngoscopy and also thankfully the more difficult technique of mirror nasopharyngoscopy to visualise the nasopharynx.

The general management pattern in the pre-flexible laryngoscope era was that the patient who presented with dysphonia would have an indirect laryngoscopy and if they could not tolerate this or cords not visualised adequately, they would have to be booked for a microlaryngoscopy under a general anaesthetic.  The flexible laryngoscope, besides giving better vision, also greatly reduced the number of GA’s which needed to be given.

Once the patient’s vocal cords were seen, they were usually divided into those which had an observable lesion which were usually booked for biopsy or other surgery or those which did not, in which case they disappeared behind the door marked Speech Pathologist (or possibly in those days, Speech Therapist) never to be seen again.  There was a generally unspoken assumption that if a person had dysphonia with nothing observable on the larynx, then it was obviously something “in the mind” and who better to deal with this than the speech therapist/pathologist!

Stroboscopy of the larynx had been experimented with previously in several centres overseas but nowhere in Australia at that stage to my knowledge.  I do remember reading about this technique before I qualified and thinking it would be something that I would be interested in, but I forgot about it with the pressure of going overseas for post-fellowship work.

On return to Australia, I entered general ENT practice with a special interested in Otology and in the mid-1980’s I asked Laurie Ryan if I could join him at the Royal Victorian Eye & Ear Hospital as a visiting consultant which I duly did.  I was a little lost for a role at that stage and decided that acoustic neuroma surgery was probably not for me, but Laurie suggested,  knowing that I was interested in singers and music, that I consider setting up a voice clinic at the hospital, a suggestion for which I am always grateful.

A short time before, the hospital had bought an early model laryngeal video stroboscope, the Danish Bruel and Kjaer system, a behemoth of a machine on which one could occasionally see pictures of the vocal cords.

Together, I started the Royal Victorian Eye & Ear Hospital Voice Clinic with  Jenni Oates, speech pathologist and we developed a technique of seeing voice patients that presented to us in a joint consultation model which allowed each of us to contribute our own particular special skill sets towards the diagnosis and management.  Mercifully the Bruel and Kjaer system was replaced with a new Kay video stroboscope which was updated once or twice and remained the instrument of choice.  The Kay system, later Kay Pentax, was the standard workhorse for video stroboscopy for many years both in the public system and our private clinic, although in later years in our private rooms we converted to the Xion.

We started the Eye and Ear Voice Clinic around 1989 and in 1991 we recruited Andrew Hughes, Neurologist, and started a laryngeal Botox service which ran very successfully for several years until Andrew left around 2008 closely followed by me.  Unfortunately, this meant that the hospital lost the Botox service although the Voice Clinic was taken up by others, and Jenni continued.  Despite this, Andrew, I and Jenni continued to work closely together as Andrew now had a wide experience with Botox injections and although we now no longer worked in the same location, we still maintained close contact and referred patients between ourselves.

Approximately 25 years ago, Jenni and I joined with Neil Vallance (ENT) and Debbie Phyland (Speech Pathologist), to form the Melbourne Voice Analysis Centre, a private Voice Clinic which had so many locations over the years we probably should have used a caravan.

Again, we had the same model of using a joint ENT and speech pathology assessment, and we insisted on this pattern if a person wished to see us for an assessment.  Some patients wondered why they should see a speech pathologist when they wanted a diagnosis or vice versa why they should see an ENT surgeon when they were told they needed therapy, but we have always insisted that the model was the best for optimal diagnosis and therapy.

The Melbourne Voice Analysis Centre has continued over the years.  We have recruited several other speech pathologists working for Debbie over the years, and Paul Paddle and Charlie Giddings (ENT) have recently joined as laryngologists.  We have seen and treated a wide variety of pathologies, benign and malignant.  Patients who require an operation have been treated either at a private hospital or by Monash Medical Centre ENT Unit, which both Neil and I were involved with.  Over the years, we have taken part in research, therapy and attended international workshops and conferences and made contact with international laryngologists and speech pathologists.

About six years ago we were instrumental in the formation of the Laryngology Society of Australasia, which provides a forum for research and clinical focus for all professionals that are interested in the larynx and voice, particularly laryngologists, other ENT specialists, speech pathologists and voice scientists.  Laryngology has now happily reached the stage where some registrars, here and interstate have gone away and done laryngology Fellowships in the US and brought their skills back. Laryngology is firmly established here, as overseas, as a subspecialty and one which engages the interest of many trainees

Over the years I consider there have been many important advances such as better imaging and documentation due to progress in video stroboscopy, better operative results due to respect for the physical principles of the structure and function of the vocal cord and the advent of finer delicate laryngeal instruments. I had a special interest in the paralysed vocal cord, and we have used a variety of techniques both by injection laryngoplasty and external thyroplasty to correct this problem.  I myself mainly used autologous fat for injections as I was comfortable with it and felt I achieved better results but there are now excellent newer synthetics on the market.  Similarly, the laser is becoming increasingly important in its various manifestations and another particular interest has been the treatment of adult laryngeal papillomatosis for which we have used various techniques including laser, micro debridement and Cidofovir injection in an attempt to control this dreadful disease.

A focus of course both in public and private has been the so-called “professional voice user”, a concept I have never been entirely comfortable with as I believe that a person’s voice is important to them irrespective of occupation. Whilst recognising that singers and actors are totally dependent on their voice people such as teachers and call centre workers are economically dependent on it as well.  We have seen a wide variety of people from all walks of life including singers at all stages of their profession.  Apart from those reliant on it for their living, there are of course the students and aspiring singers but also a large variety of people who sing for the love of it and for whom dysphonia is a significant handicap in that it is often such as major interest in their life.

Of course, laryngeal disease may manifest as airway problems also which I became increasingly interested in. One unexpected consequence of this was suddenly becoming an apparent magnet for Chronic Cough referrals, often from Respiratory Physicians. Thankfully I fell back on the earlier principle of sending them to the Speech Pathologist but many came back leaving us trialling things like Gabapentin with variable results.

A few years ago, Professor Phil Bardin at Monash Lung and Sleep Department, Monash Medical Centre formed a Laryngeal Clinic because of their interest in vocal cord dysfunction as it impacted on respiratory conditions and its relationship with difficult to control asthma.  Although this was a source of some turf war mutterings, it is, in fact, logical that the Respiratory Physician should be equally interested in this condition of vocal cord dysfunction or VCD, now increasingly becoming known as ILO (Inducible Laryngeal Obstruction).

Phil and I ultimately joined together to form a Multidisciplinary Team and clinic to tackle this problem at Monash.  Debbie Phyland joined us as a speech pathologist plus Ken Lau as a radiologist with Laurie Ruane, respiratory scientist and we conduct outpatient clinics and injecting session for laryngeal Botox as well. Our treatment protocol involves “Laryngeal Retraining” (Speech Pathologist again!) in the first instance and those not responding may be offered laryngeal botox or other modalities. We have now seen over 80 patients with some encouraging results and have published our results.

I no longer operate apart from squirting the odd amount of Botox into the vocal cords and do not see many voice patients these days.  I have, however, become increasingly interested in patients with VCD /ILO.  These are generally fairly sick patients, and I believe our clinic is helping them greatly although whether it is the therapies we offer or the psychological support we give, I am not entirely sure.  Watch this space as this is a work in progress!

If you had told me at the beginning of my career that I would at the end be managing chronic cough and asthmatics and working with Respiratory Physicians, I would have thought you were mad, or possibly changed specialities.

In summary, it is gratifying looking back over the last 40 odd years to see what has happened to laryngology in this country. It is now definitely at the point where it is recognised as being a separate sub-speciality of Otolaryngology, and this must be for the good of our practice and our patients.


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

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”

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

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”

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”

 

 

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.