Archive for the ‘Clinicians and Practitioners’ Category

Setting and Delivering Standards in Vocal Health

Tuesday, May 8th, 2018

The singing industry is completely unregulated, meaning anyone can call themselves a singing teacher, vocal coach or even vocal rehabilitation coach regardless of training, experience or lack of clinical supervision. At BAPAM, we have many calls from actors and singers with voice problems and we have been aware of an inconsistent approach to care.

Working with a group of vocal health specialists established by our Medical Committee, comprising Ear Nose and Throat specialist doctors, speech and language therapists, physiotherapists and vocal rehabilitation coaches from across the country, we have set standards for our vocal health advice, and competencies for Vocal Rehabilitation Coaches. We are also funding sessions for specialist clinics to have a Vocal Rehabilitation Coach for a pilot period so we can evaluate the impact.

We hope this will be a major step forward improving the quality of care for vocalists who present with problems in healthcare. It will enable them to get a rapid assessment by the right professionals to accelerate the right treatment. It will also provide a set of standards for singing practitioners in the UK who wish to work with a Voice Clinic and provides an improved level of protection and quality assurance for organisations supporting arts professionals accessing specialist health care.

The literature on dysphonia demonstrates that singers presenting with voice disorders are most likely to have Muscle Tension Imbalance (MTI). General ENT Surgeons tend to look for organic pathology or structural abnormality and do not always diagnose MTI.  Diagnosis of MTI in speech is usually made by a Speech and Language Therapist with experience and training in assessing the muscular function of the whole larynx and vocal tract via nasendoscopy.  MTI in singing is being assessed in a few leading clinics by a Vocal Rehabilitation Coach with experience and training in the assessment of the larynx and vocal tract in a wide range of singing styles, also diagnosed via nasendoscopy.  Only specialist Voice Clinics have access to equipment and personnel qualified to deal with this type of problem in professional singers.  Treatment of MTI in singers is carried out by Speech and Language Therapists and Vocal Rehabilitation Coaches, jointly or in succession.

The BAPAM Vocal Health Working Group recommends multidisciplinary clinics with a surgeon and specialist speech therapist using high definition cameras with stroboscopic or high speed videos to analyse the vocal folds as standard of care. BAPAM has adopted this standard for the advice we give to patients.

BAPAM’s advice for GPs is to refer to a specialist Voice Clinic when patients with the following characteristics present with a voice problem:

Patient population

  1. Elite Performers (professional singers, actors, broadcasters, etc)
  2. Studying Performers (FE, Undergraduate and Postgraduate singers and actors)
  3. Quality of Life Performers (singers whose singing is their primary means of socialising like older local choir members)

Presenting Voice Problems

  1. Loss of range, power, flexibility
  2. Pain, fatigue, hoarseness
  3. Gaps in range, delayed onset of phonation
  4. Increased recovery or warm-up time
  5. Chronic throat-clearing, sensation of lump in throat (globus)

Referrals

A referral to a specialist Voice Clinics should be made for:

  1. Any vocal symptom lasting more than 2-3 weeks
  2. Any vocal symptom lasting more than 2 weeks following resolution of a bacterial/viral infection

Advantages of a Specialist Voice Clinic

  1. Stroboscopy to view vocal fold vibration is only available in these clinics
  2. EGG and other specialist equipment for accurate measurements
  3. Expertise in muscular function and dysfunction of the vocal tract
  4. More accurate diagnosis, improving management and decreasing patient recovery time (P.S. Phillips 2005)

The large clinic team enables a multidisciplinary assessment because performance voice problems are likely to be multifactorial and more likely to be muscular with musculoskeletal and/or psychogenic causes. Staffing includes:

  1. Voice Specialist Laryngologist*
  2. Voice Specialist Speech and Language Therapist
  3. Vocal Rehabilitation Coach (Singing Voice Specialist)
  4. Performance Specialist Osteopath/Physiotherapist (in some clinics)

*Some Specialist Clinics are SLT-led with Laryngologist review

Accurate diagnosis and specialist treatments speed up recovery times and save money in the long run.

(see British Voice Association leaflet on Multidisciplinary Voice Clinics)

Patient Outcomes

  1. If organic lesions are present they may be listed for surgery immediately or referred for Speech Therapy then reviewed
  2. Functional disorders will be referred for Speech and Language Therapy and/or Vocal Rehabilitation
  3. Musculoskeletal disorder will be referred for Osteopathy/Physiotherapy
  4. Psychogenic disorders will be referred to Speech and Language Therapy and onwards to access Psychology/Talking therapies as appropriate (for Psychotherapy and/or Speech Therapy)
  5. Most patients will be referred to more than one of the above

Vocal Advice

BAPAM offers 90 minute small group vocal health advice workshops to performers who have concerns about their vocal health once they have received a referral to a Specialist Voice Clinic and been put on the waiting list.

The sessions will be run by a Vocal Rehabilitation Coach with experience working with performers in Specialist Voice Clinics. Participants will receive general advice on how to look after their voice, gentle stretching to release vocal tract tension, exercises to release tension in the breathing mechanism, and information on what to expect in their Specialist Voice Clinic appointment.

These sessions are educational, not diagnostic, and are not a replacement for an appointment in a Specialist Voice Clinic.

To find our more or book a place at a BAPAM vocal health advice workshop please call us on 020 7404 8444.

The Vocal Rehabilitation Coach

In late 2017, BAPAM’s Vocal Health Working Group approved competencies for Vocal Rehabilitation Coaches to set a standard of practice in this important area. Vocal Rehabilitation Coaches on the BAPAM Directory of Practitioners must meet the following competency criteria:

  1. Hold or have previously held a contract with an NHS specialist Voice Clinic including a job description. Verified by contract document. Where an informal but significant relationship with a Voice Clinic exists or has existed in the absence of a contract, a letter from the Voice Clinic may be accepted.
  2. Have spent at least 10 years practicing as a singing teacher/vocal coach within an educational institution or in private practice. Verified by contract document or evidence of proven track record.
  3. Work under supervision from both voice specialist laryngologist and speech therapist (as appropriate) as part of a clinic team with all clients.
  4. Undertake at least 10 hours of Voice Clinic observation per year. Verified by letter from Voice Clinic.
  5. Have completed relevant anatomy/physiology training formally or in-house. Verified by attendance certificate or letter from Voice Clinic.
  6. Have completed endoscopic interpretation of singing physiology training. Verified by attendance certificate or letter from Voice Clinic.
  7. Have both basic counselling and palpation training, formal or in-house. Verified by attendance certificate or letter from Voice Clinic.
  8. Adhere to data protection standards when keeping client records.
  9. Have current appropriate liability and indemnity insurance policies. Verified by documents.
  10. Provide at least two references, one from a specialist Voice Clinic, one from a reputable professional performance-related company (ex: university or production company).
  11. Adhere to all BAPAM professional practice standards at all times.

Applicants will be included on the directory for a term of three years before needing to revalidate their application.

Information about applying to join the Directory can be found here.

We look forward to reviewing and reporting on our pilot project to support specialist Voice Clinics by funding a Vocal Rehabilitation Coach.

Vocal rehabilitation is a truly multidisciplinary endeavour, with crucial contributions from laryngologists and speech therapists.  A central member of this team is the Vocal Rehabilitation Coach who is uniquely placed between the medical clinicians and the performers to carry the scientific aspects of vocal treatment into the performance practice.  It is critical that these coaches are well schooled in vocal anatomy, physiology, pathology and rehabilitation; this schooling should be assessed with a series of measurable competencies to ensure that they are providing the best possible care. Mr. Declan Costello – Consultant Laryngologist

Following treatment for any vocal problem, like any injury one might sustain during physical exercise, a patient must rehabilitate appropriately with the aim of getting back to their pre-morbid state; to allow them to sing and speak again. In the same way you must learn to walk before you can run, one must set up the larynx correctly before trying to push its limits. Speech therapy achieves this but translating this laryngeal work into the singing voice requires a vocal rehabilitation expert. The expert vocal rehabilitation practitioner will help the performer take their correct setup into their performing voice before returning to their genre specific vocal coach. It can be seen that this is an essential part of the recovery process and having trained, competent and expert help is a comfort to patients.To this end, having the appropriate knowledge and having been assessed as reaching a standard level of expertise means that you know your patient will be in good hands.  Mr Nicholas Gibbins - Consultant Laryngologist

BAPAM Vocal Health Working Group

Mr. Nicholas Gibbins ENT

Mr. Declan Costello ENT

Ms. Tori Burnay SLT

Dr. Ron Morris SLT

Ms. Linda Hutchison VRC

Mr. Dane Chalfin VRC

Mr. Ed Blake Phys.

Arts health practitioners in focus: Massage Therapy

Tuesday, March 27th, 2018

Arts professionals and students are unlikely spend much time thinking about their health until something goes wrong. Yet they work in a tough industry and often push themselves to the limit. Problems can accumulate over days and years spent practising and performing. Taking care over physical and mental health is essential to sustainable performance practice and a successful career.

Sometimes things go wrong. A health problem or injury starts to affect your performance and you need help to beat it.

If you are a student or professional in the performing arts, a call to BAPAM’s Helpline can provide advice about where to get help for work-related health problems. You can arrange a free assessment at BAPAM with a doctor or clinician who will understand the demands of your career. You should always talk to your NHS GP as well – often excellent services are accessible by GP referral.

What if you are looking for independent expertise from a physical or psychological therapist? It is easy to be confused with the number of different therapies available. How do you go about finding a practitioner with the right experience and expertise?

BAPAM’s Directory of Practitioners lists information about high quality and accessible performing arts healthcare provided by skilled professionals working in a variety of modalities. In this series of posts, we’ll look at how these different kinds of practitioners can help you stay fit, overcome problems, and give your best performance. In this post, we look at a sometimes overlooked section of our Directory, Massage Therapy.

Massage Therapists work with the soft tissues – muscles, tendons & ligaments to apply pressure, manipulate and stretch them. Often these clinicians are termed Sports Massage, Holistic Massage or Sports and Remedial Massage practitioners.

You should check Massage Therapists are properly registered with the regulatory body, the Complementary & Natural Healthcare Council, which means they are highly qualified. ITEC level 3 certificates are a good entry point into massage but for detailed knowledge of anatomy & physiology and more advanced methods of working, it is important that the therapist is qualified to diploma level or above.

We asked four BAPAM Registered Practitioners for their opinions on how arts specialist Massage Therapists can help you stay fit and give your best performance.

Rebekah Gilbert:

Rebekah Gilbert trained as a singer at the Royal Academy of Music and has sung as a concert soloist, recorded for EMI, BBC Radio, Classic FM and at Abbey Road Studios. She trained at the London School of Sports Massage and ITEC. She has a doctorate in coaching and is an Associate of Canterbury Christ Church University, working with Professor Stephen Clift on worldwide publications relating to singing and wellbeing.

“A good Massage Therapist will do a lot more than just ‘pummel’ you! First they will take a history of the issues you are consulting them on, your artistic practice and the time you put into it, lifestyle, exercise, the environments in which you work, and your medical history. If they discover anything that may need referral to another medical professional they will know when not to treat you.

Secondly, they will assess your posture as you stand and sit, the way a musician plays their instrument, and look at your walking gait. Is anything out of alignment? What are your posture habits and why? Might you need orthotics to improve how you stand and walk or just more supportive shoes?

Thirdly, they understand the difference between palpating well toned muscles and tense ones. Massage Therapists are good detectives, examining how you may have formed adhesions (knots), and can recommend changes necessary to reduce them in the future. The muscular skeletal system has an integral deep & superficial layer of facia running through it, which connects to every part of the body down to cellular level. Because of this, a Massage Therapist will know that a pain in one location may be triggered by problems in another and, within their toolkit of techniques, which will be most beneficial to apply.

Fourthly, they will have a long list of stretching exercises to give you as ‘homework’. However well a Massage Therapist can work in one hour, the time until your next appointment needs your input to make a difference. They may suggest other local practitioners such as Pilates, Feldenkrais, Yoga or Physical Training instructors to help you improve core strength and posture awareness. As a singer, I also know how beneficial optimal breathing techniques are in performance.”

Felicity Vincent:

Felicity Vincent is a professional cellist and a Pilates Instructor and Massage Therapist specialising in exercise for cellists. Felicity is an experienced active performing cellist and teacher with a deep understanding of how a player’s body might accumulate problems and how these might be solved. She has gone on to study Fascial Release with Anatomy Trains. Please check the BAPAM Directory for contact details. 

“Every string player knows their body isn’t just made up of levers (bones) and pulleys (muscles) but a controlled flow of circular and rotational movement. This is made possible by your fascia, the soft tissue of the body which is now known to be a strong, bouncy, stretchy, highly intelligent and trainable cell matrix which is everywhere, joining muscles to bones, allowing muscles to glide over each other, and through and over organs. But the fascial system is the site of countless numbers and types of nerve endings. These can respond to overuse and misuse which may be caused by imbalanced body use or holding onto emotions. Some degree of hypermobility can be an advantage in playing but is a double edged sword because stretchy tissue is particularly vulnerable to injury when overworked. On the massage couch your therapist will coax adhesions to dissolve and encourage held patterns to let go.

I see regular exercise as the principal key to health and wellbeing for every string player. I enjoy Pilates because it can be challenging and, particularly using the equipment, is a sophisticated way to balance the body and strengthen it. There are many schools of cello playing; the most important thing is that playing shouldn’t be destructive.”

Zoltan Zavody

As a musician (and martial artist) himself, Zoltan Zavody understands the range of injuries, impediments to joyful playing, and pain that can result from muscular imbalances.

“Anyone who trains their body intensively is more prone to soft tissue injuries – musicians sit in the same position for hours, make countless repetitive motions at speed, and then lug their instrument or box of scores to their next session. They are perfectionists who put themselves under intense scrutiny and thus stress. In the course of their careers, many musicians are likely to experience an injury requiring time off from performing.

The conditions sustained through the playing of music vary. Some seem relatively innocent, for example tightness and soreness in the left shoulder of a violin player. Others are more insidious, like the burning pain in the wrist of a guitarist. Still others are structural, like a lower back torsion in a pianist. Massage Therapy can generally help with all of these. And they can be interconnected.

Interestingly, through years of practise, it is not only the muscles that are habituated to playing. The connective tissue, the fascia that surround the muscles, also adapt. Research shows that this connective tissue morphs, slides, and grips according to habitual movements. So a musician may end up with managing to relax their ‘playing muscles’, but unless it is released, the tissue enveloping these muscles continues to pull their body and limbs into a specific posture, like a skewed bodysuit. The person is relaxed, yet they still feel a tightness, a pull, a misalignment. This is where a Massage Therapist can help with a range of myofascial techniques; softening, stretching, and pulling the connective tissues, the bodysuit, into comfortable alignment.

Myofascial work is not all about injury and problems! All of us inevitably have muscles and tissues that are a little stuck, whether from old injuries or emotional holding or underuse, and we don’t even notice. Take a singer for example, who has no complaints but wishes to improve the smoothness of their sound. By working fascially through the diaphragm and along the ribs, a Massage Therapist can help release these areas, leading to greater lung capacity and breath control, and an easier, more joyful singing experience. We have essentially freed up the bellows – and who wouldn’t want that?

If musicians were sportspeople, they would have ‘pitch-side’ Massage Therapists and coaches to help them fulfil their potential and make life a little bit easier.”

James Wellington

James Wellington is a specialist musculoskeletal physiotherapist and Sports Massage Therapist who works extensively with circus performers and other artists. He Lectures nationally and internationally in the fields of physiotherapy, injury prevention & performance enhancement and conducts research in evidence based practice.

“Using sports massage within clinical practice is hugely beneficial, as evidenced by the hundreds of satisfied performers that receive and rave about it. However, there are few well controlled studies into its clinical efficacy.

The speculated effects are biomechanical (improved joint range of motion, reduced stiffness and tissue adherence), physiological (reduced stress hormones, improved blood flow and parasympathetic activity), neurological (less pain and muscle tension), and psychological (reduced anxiety and improved relaxation).

Let’s be honest. It does feel therapeutic getting a sports massage (depending on the pressure being applied of course). It’s my conviction, however, that its benefits rely most heavily on therapist experience and their choice of technique.

If you’re lucky enough to find a sports massage therapist that has a broad set of massage skills, the ability to clinically reason and be able to justify every technique they use – you’re way more likely to see positive results. Personally, I find it hugely beneficial in improving joint range, reducing muscle tension, decreasing pain and decreasing injury-potential factors.

My top tips for performing artists thinking about getting a Sports Massage:

1. Think about the reason(s) you want to book a Sports Massage (post-training soreness / poor flexibility / repetitive strain injury / accumulated muscle tension / a pampering treat?) and communicate this to the therapist (this will assist in selecting appropriate depth of pressure and duration of treatment).

2. Tell the therapist if you specifically intend for the Sports Massage to improve your performance and/or recovery as this may also determine the type of techniques they use.

3. Timing of the massage is important. If in doubt, ask the therapist before booking what is the most appropriate.”

Psychosocial Practitioners Peer Supervision Group

Tuesday, December 5th, 2017

BAPAM is pleased to support the establishment of a new Peer Supervision Group for psychosocial practitioners who work with performing arts clients.

The group, whose inaugural meetings took place earlier this year, hope to open up the conversation between performing arts and psychological practice. The aim is to foster a network for counselling, coaching and psychology practitioners working frontline with performance artists for interactive exploration, mutual consultation and support on professional practice issues, and for reflection on what constitutes best practice in working with performers, as well as to share specialist expertise, guidance and information according to a professional framework of rigorous evidence-based practice and practice-based evidence in the field.

The next meeting is scheduled to take place on December 9th, and thereafter every two months on Saturdays from 12 to 1:30 pm at the London Natural Health Centre, 46 Theobalds Road, NW1 8NW.

Practitioners interested in finding out more or joining the group are invited to contact Dr Jane Oakland by email: jane.oakland@btinternet.com

Chartered Society of Physiotherapy on Rehabilitation for Musicians

Wednesday, September 13th, 2017

The Chartered Society of Physiotherapy have published an informative article on Rehabilitation for Musicians in their Frontline magazine. Sarah Upjohn – a key clinician in our physiotherapy team in London – and BAPAM registered physiotherapist, Patrice Berque, share their expertise, with contributions from BAPAM and the Musicians’ Union.

Read the article here.

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.

Osteopathic Performing Arts Care Association Study Day

Wednesday, March 29th, 2017

The Osteopathic Performing Arts Care Association (OPACA) are a group of osteopaths who have a special interest in the care of performers. Members include BAPAM registered osteopaths Michael Mehta, Karolin Krell, Nikki Ellis, David Propert, Alison Judah, Toby Pollard-Smith and Lazarus Nono.

Presented by dancer and choreographer, Russel Maliphant, and Osteopath, Andrew ferguson, the first OPACA Symposium and study day, The Dancer’s Body: Integrity and Fluidity, will be held on Saturday May 6th at the General Osteopathic Council in London.

Find out more here.

Research Published into Ballet Dancers’ Experiences of Injury and Osteopathy

Friday, February 24th, 2017

Osteopath, Toby Pollard-Smith, has published his research into Professional ballet dancers’ experience of injury and osteopathic treatment in the UK  in the January 2017 issue of the Journal of Bodywork and Movement Therapies. BAPAM helped recruit participants for the project, which Toby undertook while training to be an osteopath.

Toby’s previous career as a professional ballet dancer contributed to his interest and expertise in treating dance injuries, and we were recently pleased to welcome him to our Directory of Practitioners. Toby, who is also a keen trumpet player, treats dancers, musicians and other performing artists in Ascot and Marlow. Find Toby Pollard-Smith on the BAPAM Directory.

Induction Day: An Introduction to Performer Health and BAPAM’s Work

Friday, January 20th, 2017

London, National Council For Voluntary Organisations
Saturday 22 April

10:00 - 16:00

BAPAM is a specialist medical charity providing performing arts focused clinical advice, free information resources, education and training expertise, supporting research in the field, and working with a growing network of healthcare professionals through our Directory of Practitioners. Our Induction Days provide an informal introduction to this work and are a great opportunity to find out more about BAPAM, network with colleagues and  share insights into performer health issues and support.

Presentations include talks from BAPAM team members, doctors and therapists working in BAPAM clinics, and performing arts professionals who have experienced problems and benefited from our help.

Attendance is free for healthcare practitioners who are joining our clinical team or have been accepted as members of our Directory of Practitioners. We also welcome (for a small fee) other participants including educators, industry members, researchers and performers. Paying attendees who go on to join our Directory or clinical team will have their fee refunded.

Advance booking is essential.

Book your place now.

The Good Musculoskeletal Doctor – Have Your Say

Wednesday, April 22nd, 2015

A deliberative conference organised by the British Institute of Musculoskeletal Medicine (BIMM)

View/download the full programme details here: Programme & Details Good MSK Doctor 2015

To register interest in attending the conference, or simply to contribute your observations or remarks, you can use this form, which should be returned to BIMM: Register Interest Good MSK Doctor 2015

Thursday 18th June 2015

The Royal Orthopaedic Hospital
Bristol Road
South Birmingham
B31 2AP.

Medical involvement in musculoskeletal services at the interface: do you provide patient care at grades from GPSI to clinical independence; manage or commission such services; lead clinical teams; are you training doctors for this role, or in such training?

If so, this conference is aimed at you.

Musculoskeletal services need medical input but it is by no means clear or agreed what that input should be. Currently, service design varies around the UK, so
experience with different models is available to inform progress. Obstacles to development come in many forms but lack of communication, consultation and consensus are major adverse factors that this conference will address.

The programme will draw contributions from all relevant medical specialists involved in provision of musculoskeletal services. Presentations will address the
roles, competences and training of the musculoskeletal doctors of the future, with contributions also from those affected by medical care in this area: physiotherapists, patients, purchasers, educators.

It is intended that an active audience will bring their experiences and expectations of the field to test ideas emerging from the panel debates. Outcomes from this process will be available to inform the work of the Musculoskeletal Clinical Networks on Workforce and Training established by ARMA under the auspices of NHSE.

When expressing interest in the conference, you will be asked what your particular field of interest and experience is: You may be invited, or you can offer, to give a specific input so that the platform presentations can cover the field geographically and by approach. All attending are encouraged to contribute from the floor at each stage.

Christopher Wynn Parry (1924 – 2015)

Friday, April 17th, 2015

Performing Arts Medicine lost a great practitioner, friend and advocate in February with the death of Dr Christopher Wynn Parry. Kit, as he was known to countless friends and colleagues, grew up strongly influenced by his maternal grandfather, the eminent surgeon Lord Moynihan. After Eton and Oxford, his chosen career path into surgery was interrupted by TB from which he made a slow recovery and was subsequently advised not to continue with rigorous surgical training.  He opted for the medical specialty of Rheumatology but soon fell under the influence of Sir Herbert Seddon, Professor of Orthopaedic Surgery at Oxford, who was researching, with the help of the Medical Research Council, nerve injuries, their treatment and prognosis, and the most troublesome neuropathic pain.  He was proud to be one of ‘Seddon’s Boys’, the others being young surgeons, many of whom would become eminent in hand surgery and with whom Kit remained professionally close.

After Oxford, Kit took his skills and knowledge into the RAF where he became Director of Rehabilitation at the combined services rehabilitation centres at Chessington and Headley Court. He established specialised services for neuro-rehabilitation and peripheral nerve injuries which, with Kit’s enthusiasm and skill and with the large number of injured soldiers providing clinical experience, soon became nationally and internationally renowned. He was also an early researcher into EMG as a diagnostic tool. The results of this work were summarised in Rehabilitation of the Hand, published in 1958, which was the first such specialised text in English and which ran to 3 editions and 3 reprints. Another result of this work was the recognition of Rehabilitation as a separate sub-specialty and the development of the Diploma in Physical Medicine, which Kit established, subsequently training a generation of young doctors. All the while he worked closely with hand surgeons at the RAF Plastic Surgical Centre and at the Royal National Orthopaedic Hospital (RNOH).

Retiring from the RAF, he was persuaded to establish a centre for neuro-rehabilitation and peripheral nerve injuries at the RNOH. This became nationally and internationally renowned and continues today.  A by-product of this work was Surgical Disorders of the Peripheral Nerves, co-written with professors Bonney and Birch, a book of which Kit was very proud.

On retiring from the NHS, he continued to work privately in rehabilitation in the Devonshire Hospital in London and the King Edward VII Hospital in Sussex but he devoted an increasing amount of his considerable energy to his interest in musicians.

Kit was always interested in music. As a pupil at Eton (where a Dixieland jazz revival was taking place led by a fellow pupil, Humphrey Lyttelton, who was to become Britain’s foremost jazz trumpeter), he sang in the choir but also played trombone in a jazz band. He continued choral singing in adulthood as a tenor in the Bach choir. His interest in musicians’ medical problems stemmed from Sunday soirees held by his friend and neighbour, the conductor Sir Charles Mackerras. At the conclusion of these gatherings Kit was often besieged by the performers with their medical problems.  He and Ian James, another like-minded doctor, realised the gap in care for such musicians, many of them with very limited financial resources, and in 1989 created BAPAM, a charity charged with providing medical advice and care to performers which continues to this day.

He carefully monitored all those attending with upper extremity problems, ultimately publishing his findings and observations in over 1000 cases. He noted that only 40% had a recognised ‘organic or structural lesion’ and that many were suffering as much from misuse or a mismatch with the instrument - with tired, aching arms - as were suffering true overuse. He also noted the contribution to the performers’ physical problems made by psychological and emotional factors, not helped by job and financial insecurities and the demanding and sometimes destructive lifestyles of the performer.  He was an eloquent speaker and took this message to music schools, cajoling pupils and their teachers to respect the physical nature of music making and to avoid injury. He also highlighted the sometimes appalling conditions instrumentalists were exposed to and forced to work under, such as cramped orchestral pits and inadequate venues, suffering for their art and being thankful they had a paid gig. For this work he was elected an honorary member of The Royal College of Music in 2011.

I had the privilege and good fortune to observe Kit in his RAF time at his upper limb neurological clinics and, over the last 20 years, to work with him at BAPAM and with many of his musician patients. He encouraged us to develop an MSc in Performing Arts Medicine and he was proud to give the inaugural lecture to the first cohort of students at University College London in 2011. We combined our clinical and surgical experiences in The Musician’s Hand which was published in 1997, which was, again, a first in the English language and of which he was duly proud. He states in the preface ‘an apology for this book from a physician and a surgeon is that we not only love music but believe it to be fundamental to civilised living’ and this sums up Kit.

Many national and international honours were bestowed upon him and he was particularly proud of being elected, as the only non-surgeon to have been so honoured, President of the British Society of Surgery of the Hand in 1982.  He continued working until health problems forced him to reluctantly retire from BAPAM in 2014. We shall miss him.

Ian Winspur, London, 7 April 2015