Archive for the ‘BAPAM Clinics’ Category

Hand Surgeon and Professor of Piano joint BAPAM clinic

Wednesday, May 1st, 2019

There are intrinsic relationships between health and performance excellence, and educational and clinical expertise in the performing arts. In overcoming medical problems, specialist diagnostic and medical expertise can be complemented by performance technique and lifestyle and health-related guidance. In a new joint clinic at BAPAM, Mr Mark Phillips, Hand Surgeon, and Penelope Roskell, Professor of Piano at Trinity Laban, are exploring this opportunity for clinicians and educators to provide each other with unique insight and feedback. We asked them to tell us more about this innovative approach.

Could you explain the idea behind the joint clinic and why you decided to do it?

Mark Phillips: In my experience when treating musicians I found quite an overlap between the physician’s knowledge and the specialist physiotherapist/hand therapist’s knowledge, who’s an expert in musicians. But I soon realised there was a huge gap for the third element which is filled by the expert tutor on that instrument. I happen to be a trumpet player so as a musician I have some insight into the patient but that’s not enough when it comes to some of the issues they face. I can relate to some of the psychological performance issues, but the expectation patients have is of someone that can really understand how the technical demands of the instrument interface with the physiological problems they’re having and anatomical problems they may have and the outcome of the clinical assessment.

Penelope Roskell: The knowledge we have between us is enormous. My students have included musicians with injuries for 40 years, and so we fill in the gaps. Seeing musicians together in a joint clinic is very important because you can then see the whole picture and then decide on the best way forward. Sometimes it may be steroid injection and sometimes it may be surgery. But sometimes it may be that a tweak or a change of technique will solve that problem and reduce the need for further intervention. So, seeing them together we can get to the root cause, which we can’t always do if seeing them independently.

How do you decide if a patient would benefit from this dual approach? What can a patient expect at a typical joint session? How do you each approach the patient?

How do you prepare for a joint clinic session?

Mark Philips: Normally I will contact Penelope to say I’ve got a patient or she may say she has a student. We will both select patients for this clinic.

Penelope Roskell: Sometimes Mark will send me over a video of that person playing, so I’ll have a chance to look at it and pick out the obvious problems about what I think may be causing it. I’ll also have a clinic letter which will give some sort of background.

Mr Phillips: We then meet up for a coffee and chat about the patient. So then the patient comes in, and if it’s my patient I present it to Penelope and on one occasion Penelope presented the patient. And then we do the history in the normal way, present findings and run through it all. I then suggest what may be the anatomical or physiological problem and how that relates to this person’s technique. The technique may have worked well for a long time but now there’s a problem which is unique to them. Looking at the technique can help if I’m referring to Penelope. Or similarly if Penelope is referring to me is there a way that some of my interventions such as hand therapy or injections or my approach to examination would throw some light on the matter. It’s that overlap which is invaluable really.

Penelope Roskell: So for instance one of my students came to the last clinic and she had problems for the last year and had come to me for that reason. And Mark gave her quite a different diagnosis to what she had been given in the past, which then informed me. So now we are working slightly differently in the lessons that I have with her privately, having now had this intervention from Mark and he also suggested a steroid injection which we are waiting to see the results to. We can then see the whole picture about the ways forward, because there isn’t always one solution. A patient may need a steroid injection or piano playing adjustments to the technique.

Mark Phillips: It’s multi-faceted, there may be Alexander Technique, hand therapy and it may be someone looking at their posture. I learn so much by looking at Penelope tutoring at the piano in terms of elbow position, shoulder position and what impact that has in terms of the way the fingers lie on the key for example. Each presentation has its own unique cocktail of remedies really.

There are complex multi-faceted problems by the time they come here and it comes down to how we triage these patients essentially. I don’t bring every pianist to this clinic.

Penelope Roskell: It’s inevitably going to be someone with a piano related injury. If they’ve broken their wrist by falling down the stairs then they should go straight Mark. Whereas it’s different when it’s something like accumulated stress from years of playing with a technique which is a tiny bit off balance. They may be very experienced players and their technique has lasted them well, but there’s something that just tips it over.

Mark Phillips: What I see in my patients is that half of them have the same problem as everybody else and that may affect how they use their instrument. And the other half have instrument related problems and it may be a combination of the two. And say if someone broke their wrist a year ago and it may be throwing out their elbow, their shoulder or their posture and it may well be a good way down the line that it’ll come to me that a session with Penelope would be helpful. Because it may be to do with their elbow and shoulder which may be making some notes inaccessible and we can work around. They’re so unique each of these cases an each of them would have their own relative roles for the two of us sitting together and discussing the case. It would be good to extend this to guitar, violin and cello and get tutors to do a similar thing. And it’s pretty unique, I don’t think there’s anyone else out there in the world doing it.

What do you feel are the benefits of having an educator in a clinical setting?

Penelope Roskell: It is a very formal environment which is a positive thing and it focusses everything which is very important.

It is a sort of pilot, it’s the first of its kind and I think it is very valuable and let’s hope that other clinics may take the idea from this and develop that further.

What are the direct benefits for patients of having the educator and clinician in the same room in a clinical setting?

Mark Phillips: We often find that patients are often reticent about coming to these clinics. They really don’t want to look at their own techniques and I suppose they remember back to days when they were being tutored and they feel self-conscious. They have to want to come to this clinic and to be looked at. It isn’t like going for a piano lesson or being taught. We are looking to see whether there’s anything about their technique that may be in anyway connected to the clinical problem they have. So we’re not trying to look at the way they play from any other perspective than that. People play in lots of different ways. Also videos are really useful, anyone with a smartphone can record themselves. When we look at them we can slow them down, go back over a sequence, look at it carefully, look at it together and see how that relates to their clinical problem.

Penelope Roskell: There is something different about the joint clinics, because I’m there involved in the consultation I’m able to ask them questions from my own point of view so that I’m well informed as to how best to help them in the future. Because a piano teacher is not qualified to diagnose and that is absolutely number one and nor am I qualified to answer questions that students sometimes ask me, like should I have that steroid injection or that operation and it’s not for me to advise on that but in this situation between the three of us we can discuss the best way forward viewing it from all the different angles.

Any challenges you are finding with the joint approach?

Mark Phillips: It’s 30 minutes long, which is short. We are just getting into our flow by half an hour.

We haven’t had a chance to find out what patients think, especially how they feel about the added value of seeing us both together.

The four patients we have seen in this format have individually expressed to us they thought it was a good session and it stimulated a lot of discussion and ideas. It would be great in the future to include a hand therapist and do a proper multi-disciplinary clinic. Hand surgeons always work very closely with hand therapists. Because there are so many different joints in the hand and different diagnoses. In the hand you’ve got unique problems to one finger or there will be a combination of problems. So your hand therapy is always bespoke, it’s all tailor made to that patient so you have to discuss each patient individually and with musicians it’s even more so.

Certainly with the three most commonest instruments this is going to be a major area of growth in the next ten years and it’s very exciting.

During the half an hour the patients sense the trust we have with each other (Penelope: we work very well as a team, we both have a lot of respect for each other’s knowledge. So I think they go away feeling they’re whole picture has been seen and assessed and we are seeing them as an individual with a problem that can be resolved.)

All patients have been bought over by the end of the 30 minute sessions. You can see the reticence and slight nervousness at the start of the half an hour turning into trust and outpouring of confidence and sharing of the problem and by half an hour we are in to the nitty gritty aren’t we. The output of that is usually I will see them again or Penelope will see them again.

What they can do is continue seeing Penelope for a while and see me in the clinic two months later and see how things have been going on in the meantime. And because we know each other well we can send secure emails back and forth and stay in touch.

New Clinics in Liverpool and Belfast

Wednesday, April 17th, 2019

As part of our commitment to reach and support performers throughout the UK, we are pleased and excited to announce new regional clinics, this time in Liverpool and Belfast starting in May 2019. 

BAPAM are delighted to be working with the Royal Liverpool Philharmonic Orchestra, who will host the clinic at the Philharmonic Hall, and Dr Marie McKavanagh, a Performing Arts Medicine specialist GP (and musician).

Liverpool Philharmonic have pioneered an exemplary approach to developing and supporting performance excellence through providing specialist health and wellbeing services to orchestra musicians. The positive effects of this investment are proving that performer wellbeing and artistic excellence are interlinked. Taking care of both also makes good business sense. Performers are healthier, happier, take less time off sick and are better prepared for elite performance. Through their key support for the new BAPAM clinic, Liverpool Philharmonic are now helping to bring this approach to the whole performing arts community.

The first clinic will be held on Wednesday 1st May. 

Belfast

BAPAM are also delighted to be working with the Oh Yeah Centre, Belfast’s music hub, who will host the clinic, providing vital support for a healthy and vibrant performing arts community.

The clinic is led by Dr Christine Hunter, a BAPAM and  NHS GP and Medical Adviser to the Ulster Orchestra.

BAPAM’s Belfast Clinic will be held monthly from May 22

Who is the clinic for?

If you make a proportion of your living from, or study in the performing arts, and have a physical or psychological health problem related to your work, BAPAM can help you. BAPAM clinicians can provide an accurate diagnosis and information to help you overcome problems. The BAPAM team can identify the best sources of ongoing care, both in the NHS and from other specialists, and advise you about sources of financial support for people experiencing health problems affecting their ability to work or study.

Other regional clinics:

Glasgow: Friday 10th May, 7th June

Leeds: Thursday 2nd May

How to book a FREE confidential appointment?

Call 020 7404 8444 to register | Or email info@bapam.org.uk

New BAPAM Clinics

Tuesday, February 5th, 2019

We now hold free Performing Arts Medicine clinics in London, Glasgow, Birmingham, Cardiff and Leeds. 

If you make a proportion of your living from, or study in the performing arts, and have a health problem related to your work, we can help you.

Our clinicians are experienced at dealing with the problems performing arts workers frequently face, and can help with an accurate diagnosis and advice including identifying efficient care pathways, both in the NHS and from other specialist individuals and services. The BAPAM team can also advise about the availability of financial support for people experiencing health problems affecting their ability to work or study.

To make an appointment, give us a call on 020 7404 8444.

BAPAM Physiotherapist Supports Team GB at World Games

Wednesday, July 19th, 2017

The 2017 World Games commence in Wroclaw, Poland on July 20th, and we wish the very best of luck to the Team GB athletes and BAPAM physiotherapist, Louise Curley who returns to her role supporting gymnasts, acrobats and tumblers as the British Gymnastics Delegation Physiotherapist.

Here at BAPAM, Louise gives expert help to musicians, actors, dancers, circus and physical performers, providing free physiotherapy assessments and subsidised, affordable follow up sessions at our London clinic. She also runs her own practice Rejuven8 Physiotherapy in Warwickshire.

BAPAM Clinic in Glasgow to Close from March 2017

Friday, March 10th, 2017

Our Glasgow clinician, Dr Faith Gardner, who has been helping performers in Scotland at free BAPAM clinics since 2004, will be retiring later this month. We are very grateful to Faith for her expertise and the support she’s given us during this time, and we wish her all the best for the future.

BAPAM is in the midst of a review of our funding and national services provision. We are unable to recruit a replacement for Dr Gardner or make plans for our clinics beyond 2017 until discussions with key stakeholders have been completed, hopefully later this year. Our Glasgow clinic will therefore close from 14th March.

BAPAM clinics provide free, performing arts-specific medical advice, enabling people to make informed decisions and facilitating effective ongoing care. Dr Gardner worked with us in developing a network of colleagues in Scotland, and building relationships with local institutions including educators, orchestras, unions and employers, as well as individual performers. The clinic has been held for many years at Scottish Opera’s Technical Centre and we are grateful for their essential support. If in future we are able to re-open a clinic in Scotland, we hope to work collaboratively and build on our experience to develop an effective, sustainable service, accessible to all performing arts professionals and students.

Information about performing arts health support services and advice is available from the BAPAM team and website.

New Location for our London Clinics

Friday, March 4th, 2016

BAPAM’s London clinic has re-opened following our move. Free sessions now take place on Tuesdays and Fridays at the South Camden Centre for Health in Euston, a modern and very well-equipped NHS facility.

We help all performing arts professionals & students with work and study related health problems.

Find out about our free performing arts medicine clinics

BAPAM is Moving

Friday, November 13th, 2015

New Address: BAPAM, 31 Southampton Row, Holborn, London, WC1B 5HJ

To patients, staff, volunteers, funders and supporters of BAPAM.

BAPAM has been located at 34 Gray’s Inn Road for around ten years in premises that have proved convenient for patients, volunteer clinicians, staff and other stakeholders in the charity.

But, alas, we have to move. In January 2016 our lease expires. Our landlord has asked for rent of more than double the current level. Additionally, any new tenancy elsewhere would require us to enter into a lease of several years duration. It is currently uncertain whether BAPAM’s funding beyond 2016 will be sufficient for us to sign such a lease.

In early 2016 we will move our administration into smaller but non-permanent premises. We believe we will be able to locate separate consulting rooms which can be used by our clinicians during those times when they are most needed. Splitting the locations of our administration and our clinical consulting is not ideal, but is the most realistic option in view of the constraints that are described above.

We have consulted various BAPAM stakeholders including, of course, our staff, and we are grateful that they are ready to make things work as well as possible for the charity as we undertake these changes.

We are determined to continue the committed service we offer to those many performing artists and other professionals and students in the industry who come to us for help but it is realistic to point out that over the next few months we will not be able to provide clinical services at the same level as at present, and we ask for everyone’s understanding. The London clinic will be closed from December 2015 to March 2016.

We hope that the arrangements we now make for 2016 will be temporary and that we will in future be able to secure a new permanent home, even if not as centrally located as at present, but one that is appropriate for the thousands of performing artists who turn to us, and for our volunteer clinicians.

BAPAM provides, of course, much more than just those clinical services in London. It is our firm intention that those other strands of our work will continue uninterrupted.

BAPAM’s board of trustees asks for your understanding and, of course, for your continued support.

Richard Price, Chair of the BAPAM Board of Trustees

From 14 December 2015 our new address will be: BAPAM, 31 Southampton Row, Holborn. London, WC1B 5HJ.

Cambridge Clinics

Tuesday, February 10th, 2015

Dr Patricia Halliwell, NHS GP and graduate of the UCL MSc in Performing Arts Medicine, holds our Cambridge clinic for all performing arts professionals and students with work-related health concerns. The clinic takes place monthly at West Road Concert Hall. Forthcoming dates are February 26 and March 19.

Please get in touch if you’d like a free appointment for specialist advice.

Clinics Update, January 2015

Tuesday, January 20th, 2015

We’re delighted to welcome three new clinicians to our London team this year.

BAPAM gives free advice to those working or studying in the performing arts to help overcome work-related problems, both physical and psychological. Dr Anne Doherty, Consultant Psychiatrist, loves Opera and is a keen amateur musician. She is looking forward to applying her expertise to the psychological impact of performing and mental health issues affecting performance.

The performing arts can be a physically demanding industry to work in and our physiotherapy assessment service at the London clinic is always very busy. Our new physiotherapist, Sarah Upjohn, has been treating playing related injuries at The Purcell School for Young Musicians since 2008. Her doctoral research at the University of Cambridge involves developing an injury prevention, health promotion and performance wellness programme within the school. She is passionate and knowledgeable about injury prevention in instrumental musicians.

Dr Hara Trouli joins our team of medics, assessing work-related musculoskeletal problems. Hara has a background in orthopaedics, is a graduate of UCL’s Performing Arts Medicine MSc course, and a classically trained pianist. She is the Chair of ISSTIP, The International Society for the Study of Tension in Performance.

Activity and Feedback – January to June 2014

Thursday, October 9th, 2014

BAPAM is committed to excellence in providing care for performing arts professionals and students. Effective monitoring and feedback is vital to the delivery of our services. Our clinical activity also enables our development as a research hub in performing arts health and practice. Service data for the first 6 months of 2014 is now published.

The full report is available to read and download here.

The information has been compiled from 2 main sources:

1. BAPAM patient registration database demographic and appointments data.

2. Anonymous patient feedback (using Survey Monkey web surveys) collected from new patients attending their first free assessment at a BAPAM clinic.

Additional anonymous feedback information collected from our follow-up survey is also summarised.