Archive for the ‘Publications’ 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.

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.

The Foundations of Good Mental Health

Wednesday, May 10th, 2017

To coincide with Mental Health Awareness Week 2017,  BAPAM Registered psychologist and performance coach Dr Carol Chapman, writes for Spotlight with essential tips for actors (and all performers) on building good mental health and resilience.

Read the article here

ISM Trust Publish Performance Anxiety Guidance for Music Teachers

Friday, March 10th, 2017

The ISM Trust, the sister charity of the Incorporated Society of Musicians, has published Performance Anxiety – a practical guide for music teachers, a ground-breaking publication designed to provide music teachers with a comprehensive guide to the identification and management of performance anxiety over three key time periods: long-term strategies, the week leading up for a performance, and 24 hours leading up to, throughout and after a performance.

Full information and free download here.

Musician’s Focal Dystonia Factsheet

Wednesday, November 2nd, 2016

Download our new Musician’s Focal Dystonia Factsheet here.

Dystonia is a neurological condition that causes involuntary muscle spasm leading to abnormal movements. While they are unlikely to encounter this condition, musicians may develop a rare form of task-specific dystonia known as ‘Musician’s Focal Dystonia (MFD)’. Most cases of MFD affect the upper limb (hands, fingers, wrist or forearm) in guitarists, pianists and string players. However, brass or wind players may also experience MFD in the hands and in areas relating to embouchure (mouth, lips, cheeks, jaw or tongue). Percussionists may develop dystonia in the foot.

To meet the need for guidance about Musician’s Focal Dystonia, we have developed our new Factsheet in partnership with the Association for British Orchestras (ABO) and the Musicians’ Union (MU). The Factsheet provides a brief overview of symptoms and possible risk factors, and suggestions for prevention and management plus advice for employers, including orchestra managers, and sources of further advice and support.

This publication was produced in consultation with our Dystonia Advisory Group: Dr Rebecca Whiticar (Chair), Dr Deborah Charnock, Dr David Fielding, Dr Mike Shipley, Dan Hayhurst (BAPAM); Dawn Day (ABO); Diane Widdison (MU); Katherine Butler (Clinical Specialist in Hand Therapy); Dr Mark Edwards (Consultant Neurologist); Mr John White (Upper limb orthopaedic surgeon).

We are extremely pleased to have collaborated with the ABO and BAPAM on producing this guidance which we hope will be useful to both musicians and the engagers of musicians. Although FD is relatively rare we know that being able to access the correct information for diagnosis and pathways to treatments is invaluable to the musicians that are affected. We hope that the guidance, that has had input from the top medical specialists in the field, helps contribute to the increased awareness of FD in musicians – Diane Widdison, Musicians’ Union National Organiser – Education and Training

Download our Musician’s Focal Dystonia Factsheet here.

‘Time for a Creators’ Health Service?’

Thursday, July 7th, 2016

In recent months we’ve seen a new enthusiasm throughout the arts community for meeting the unique health needs of creators and performers. In particular, mental health in the music industry has been the focus of much recent discussion. With this in mind, PRS for Music, the royalty collecting society for songwriters, composers and publishers in the UK, invited us to contribute to the latest edition of M Magazine.

In our article, Time for a Creators’ Health Service?, BAPAM CEO, Dr Deborah Charnock, asks some vital questions and considers what can be learnt from our experience providing free specialist health services to music creators and other artists over more than 25 years.

Do we need a performing arts industry-specific healthcare service and what should this uniquely provide?

What relationship should this have with existing healthcare providers?

What will ensure that such a service is effective, safe and accessible to people in widely varying circumstances?

What role should the music business and related performer support organisations play, including record companies, publishers, collecting societies, unions, educators and charities?

Read the article here.

Choosing a Psychotherapist or Counsellor

Thursday, February 18th, 2016

Ours is an industry that puts intense pressure on individuals. People working and studying in the performing arts frequently consult BAPAM clinicians about a wide range of psychological problems affecting their careers. Often, simple management advice and psychological self-care are enough to empower people to beat problems and achieve their goals, but sometimes it is helpful to seek further expert help from a psychotherapist or counsellor. Dr Carol Chapman, Counselling Psychologist and Performance Coach, has authored our new BAPAM Factsheet, Choosing a Psychotherapist or Counsellor, to assist people who are deciding on the most appropriate practitioner to see.

We also include links to excellent resources produced by Mind who provide advice and support to empower anyone experiencing a mental health problem.

If you are experiencing a mental health problem you should always consult your NHS GP. BAPAM clinicians can also advise performing arts professionals and students about psychological issues relating to their work.

Resources: 

Choosing a Psychotherapist or Counsellor

I Can’t Go On: Managing Performance Anxiety (Stage Fright)

Psychological Self-Care

 

2014 Annual Review

Wednesday, June 3rd, 2015

BAPAM is a unique healthcare charity. Our aim is to support performing arts professionals and students faced with an injury or health issue which affects their ability to work and perform. We do this through one-to-one advice and clinical assessment services and through our national programme of education and training. In 2014, demand for our services continued to rise.

More detail about our activity is now available in our 2014 Annual Review.

 

I Can’t Go On! Managing Performance Anxiety

Wednesday, May 13th, 2015

Dr Carol Chapman and Karen O’Connor, experts in performance psychology and coaching, have authored our new Factsheet, I Can’t Go Ona resource all about overcoming performance anxiety (stage fright), one of the most common challenges facing any performer. Constantly striving for the very highest standards is essential but when, for whatever reason, a performer experiences less than perfection, they can be excessively hard on themselves and a vicious circle of worry and self-doubt can follow. The good news is, there are tried and tested strategies to deal with this.

All our information resources can be found here: BAPAM Health Resources.

We are grateful to Help Musicians UK, the Musicians’ Union and Equity for financial support in producing these materials.

New and Updated Health Information Factsheets

Wednesday, January 21st, 2015

We know that a career in the performing arts can be physically and psychologically tough. Whether you’re on stage or behind the scenes, it takes a lot to keep the show on the road. BAPAM helps many people overcome health challenges that arise while they are working or studying in our industry.

Our free online Factsheets are designed to help you look after yourself and perform at your peak. They include advice about preparing for performance, from physical warm-ups to psychological self-care, coping with anxiety and challenging working conditions, caring for your voice, hearing, taking care of nutrition and alcohol consumption.

Click here for all of our Factsheets.

These materials are a developing resource, as we bring the expertise gained through our clinical practice and Trainer Network to focus on making key information available to all performing arts professionals and students. Look out for new BAPAM health resources throughout 2015 and please get in touch with Information Officer, Dan Hayhurst (dan@bapam.org.uk), with any comments and suggestions.

BAPAM Warm Ups Leaflet

Our Warm-up Exercises for Musicians pocket-sized leaflet is just one of our updated health resources