Archive for the ‘Voice’ Category

NHS Specialist Voice Clinics Vocal Rehabilitation Coach Pilot

Friday, May 10th, 2019

BAPAM is excited to announce the start of a new pilot project, in which we are funding a Vocal Rehabilitation Coach (VRC) to work alongside clinicians in NHS Professional Voice User Clinics.

Vocal health problems in singers and actors are often multifactorial, requiring a specialised multi-disciplinary approach to diagnosis, in order to get patients onto the right pathways of treatment and rehabilitation and back to performing as quickly as possible. Over the last two years, we have been working with a group of clinical experts in this area, including Laryngologists and Voice-specialist Speech and Language Therapists, who have advised us that adding a Vocal Coach into this team – an experienced singing teacher with understanding of the clinical processes in vocal health – would further help the diagnosis and rehabilitation of performer patients. Lewisham and Greenwich NHS Trust already employ a Vocal Rehabilitation Coach and BAPAM has agreed to fund a VRC post across up to three NHS hospitals for a pilot year, with funding support from PPL, Help Musicians UK, Musicians’ Union and Equity, following which the pilot will be independently evaluated to assess the requirements for the VRC role and the effectiveness of this model in the care of performers. Dane Chalfin, an experienced VRC and singing teacher, is taking on the role for the initial 12 months’ pilot. The first of these BAPAM-funded clinics has just started at Wythenshawe Hospital, part of Manchester University NHS Foundation Trust. Guy’s and St. Thomas’ NHS Foundation Trust is expecting to start to offer this additional service from September, and a third NHS Trust is expected to be confirmed soon.

BAPAM undertook a survey across existing specialist Voice Clinics in order to develop the competencies required to work in this new role and these were reviewed and approved by our Vocal Health clinical experts and adopted by the BAPAM Medical Committee. There is currently no professional body able to provide formal registration of VRCs and BAPAM hopes that by facilitating a process whereby experienced vocal coaches can demonstrate that they meet a set of competencies, we can help provide a level of confidence in this role both to the NHS and to performers themselves, and reassure our funders that we are investing in the best services. Four practitioners who meet these competencies have so far been approved to join a new section of the BAPAM Directory of Practitioners as VRCs, and we are hoping to expand this number in the near future. We can provide guidance to practitioners interested in this field towards appropriate training that may be required to meet our competences.

We hope that this pilot will provide some initial evidence to support the involvement of practitioners with an educational background in the rehabilitation of performers and, specifically, the wider adoption of this practice to improve patient care in vocal health. If the pilot is successful, we hope to be able to secure funding to support substantive VRC appointments going forward via an open appointments process. This work takes place against a backdrop of developing education and science in vocal health, with practitioners at the UCL Performing Arts Medicine MSc and the MA in Vocal Pedagogy at the University of Wales undertaking exciting new studies which are increasing our understanding in this area of performing arts health. BAPAM is pleased to be able to make this small contribution to continuing improvement in vocal health for performers.

Further enquiries are welcome via info@bapam.org.uk

Related information:

BAPAM VRC Competencies

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

Vocal Health Workshop in Glasgow

Friday, September 7th, 2018

Top vocal and performance coach Lucy Heyman will be conducting an afternoon workshop for vocalists in Glasgow.

The BAPAM training session organised by the Musicians Union will take place at the Scottish Trades Union Centre in Glasgow on 13th September. It will cover essential skills for enhancing vocal performance with the aim of giving tools and skills needed to succeed and thrive in music careers.

As a manager Lucy Heyman has worked with a range of artists including some of the UK’s biggest names, so has a real understanding of the trials and tribulations a performer goes through.

The topics she will cover include vocal techniques and warm-ups, preparation for performance and psychological skills for optimal performance.

BAPAM’s healthy performance training sessions are designed to avoid health problems which are often encountered in the course of an arts career and are led by the experts in the field. To enquire about booking a BAPAM training session email info@bapam.org.uk

We also run free medical assessing clinics for performing artists in Glasgow every month. (Next one is 5th October) To register as a patient and book an appointment call our helpline on 0207 404 8444/5888

The Accent Method Course

Thursday, June 28th, 2018

A 3-day course conducted by two of the leading names in vocal health will be taking place in Birmingham.

The course which is organised by the British Voice Association will be fairly practical with some time devoted to explaining the scientific rationale behind the technique. It is used widely in rehabilitation for voice disorders, but also used for training healthy voices and developing the dynamic range of performers.

The first two days of the course will take place on 12th and 13th July 2018 with a five month break followed by a final day in January 2019.

The technique is well researched and has a good evidence base and is designed to co-ordinate respiration, phonation, articulation and resonance to produce clear and well modulated speech.

Specialist speech and language therapist Sara Harris and singing teacher and voice coach Dinah Harris have been working together for many years, most notably at the multidisciplinary voice clinic in Lewisham Hospital.

Vocal Health Advice Workshops

Monday, June 4th, 2018

Many people come to BAPAM for help with voice problems. In most cases the best care is available through the NHS at a Specialist Voice Clinic. Our new Vocal Health Advice Workshops are designed to provide accessible support to arts professionals and students who are waiting for a clinical assessment in the Voice Clinic.

Look after your voice

Release vocal tract tension

Release tension in the breathing mechanism

Find out what to expect in the Specialist Voice Clinic

These 90 minute small group vocal health advice sessions are run by a Vocal Rehabilitation Coach with experience of working with performers in Specialist Voice Clinics. Participants will receive 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. They are preparatory and educational, not diagnostic, and are not a replacement for an appointment in a Specialist Voice Clinic.

Call 020 7404 8444 for information and to book your place for just £20.

We can also advise you about asking your GP for an NHS Voice Clinic referral, as well as private options. We will need to see proof that you are on the waiting list at a Voice Clinic before we can book you into a Vocal Health Advice Workshop at BAPAM. We cannot offer this session to people who are already receiving medical care for a voice problem but we can advise you about appropriate sources of further care if required.

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.

Research: Vocal Health Awareness in Singing Students and Teachers

Thursday, February 16th, 2017

Dr Anneliese Sayes is a medical doctor and researcher at the Royal College of Music who is investigating the current knowledge levels of vocal anatomy, physiology and pathology in singing students (within the conservatoire and university systems) and singing teachers.

She is inviting participants to fill in a questionnaire (that should take around 10-15 minutes to complete). There is a separate questionnaire for students and teachers. Full information about the study, which has research ethics approval from Conservatoires UK, is also provided. The survey can be accessed online via the following links:

Vocal Awareness questionnaire for student singers

Vocal Awareness questionnaire for singing teachers

Event Report: BVA Rock & Pop Day, September 2015

Wednesday, September 30th, 2015

BAPAM Clinician, Dr Shareen Chua, reports from the British Voice Association (BVA) Interactive Rock & Pop Day, London, 13th September 2015. 

A quiet Sunday morning on Chiswick High Street – one man on his morning run, a dog with a tennis ball in its mouth and a woman driving an empty double decker bus. Through the entrance of a pub, empty tables, a smiling bartender, but beyond its courtyard, a large chattering crowd was audible. Vocal coaches, singers, songwriters, voice specialist Speech and Language Therapists, instrumentalists, voice rehabilitation specialists, voice researchers, performance coaches and consultant laryngologists, amongst all present at this event organised by the BVA. Also in attendance from BAPAM were Dr Frances Carter, Dr Miranda Godfrey & I.

At the start of the programme, Canadian singer songwriter, Selena Evangeline  took to stage to demonstrate the range and variety of vocal effects available to a solo live performer, in her case using vocal audio equipment by TC-Helicon.

Kim Chandler (vocal coach & lecturer) got our vocal cords going by getting us to attempt various vocal onsets, characterising them and offering suggestions on alternative ways of achieving particular sounds and reducing glottal stops.

Hearing loss associated with onstage noise was thereafter explored by John Rubin (Consultant ENT Surgeon, Royal National Throat, Nose and Ear Hospital). He spoke about various sound levels encountered within the music industry, covering a variety of sound monitors and hearing protection.

Two singers were subsequently brought on stage. In a live setting, Dane Chalfin, current President of the BVA, used song interpretation and emotion to offer them solutions that improved their technique and performance.

Tom Harris (Consultant Otolaryngologist) & Sara Harris (Speech and Language Therapist), no strangers to the realms of vocal health, engaged the audience in their talk about vocal nodules, with Sara Harris sharing several strategies and exercises that might be helpful in such an instance.

Applying the Primal Sound Model to an instantly familiar Pharrell Williams number, Craig Lees got everyone on our feet creating various vocal sounds, forming a Pop Choral group thus concluding the day’s programme – on a high note!

Although the BVA holds their Interactive Rock & Pop Day every two years, their Voice Clinics Forum will take place on Friday, 23 October 2015 at St Thomas’ Hospital, London SE1. The October event will cover topics such as the role of Voice Clinics in the NHS, training in laryngology for ENT surgeons, training for singing teachers involved with Voice Clinics and a discussion of ongoing research & audit papers on the aspect of voice or voice care in the UK.

BAPAM and the BVA are actively exploring opportunities to collaborate on future projects. Suggestions are welcome!

Voice Clinics Forum 2015

Thursday, September 10th, 2015

The British Voice Association‘s (BVA) forthcoming Voice Clinics Forum convenes on Friday, 23rd October at The Governor’s Hall, St Thomas’s Hospital, London.

Topics in planning include:

For those in training:
Preparing to run a voice clinic: current training trends in Laryngology for ENT surgeons
Preparing to be the Voice Clinic Speech and Language Therapist – what education and training do we need?
Developing a programme for singing teachers to work in the Voice Clinic

For current voice clinic staff:
Ensuring voice clinic survival in the modern NHS
The role of voice clinics in the NHS – a GP/commissioners view
Round table panel discussion
Voice analysis software reviewed: application in voice clinic and daily practice
Technology in the voice clinic: what is really useful?

Clinical  session: “One easy, one not so easy!”: a multidisciplinary case discussion panel

Please note: these topics may be subject to change

Adobe Acrobat - icon View provisional programme

Adobe Acrobat - icon Download application/booking form

NB: This course has been awarded 5 CPD points

BVA Rock and Pop Study Day

Friday, August 21st, 2015

The British Voice Association Rock and Pop Study Day takes place in London on Sunday 13th September. Training topics include alternative vocal onsets, technique through interpretation, the truth about nodules, ear protection and monitoring, rock and pop in a choral setting and using live performance technology. Participants will also be in for some fantastic performances and exclusive discounts from the exhibitors.

10:00 – 17:00

The George IV, Chiswick, London

For more details and to book your place take a look here: www.bvarockandpop.eventbrite.co.uk.

Registration will close on 06/09/15.