Posts Tagged ‘Speech and Language Therapy’

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.

BAPAM Training Day: The Professional Voice User in Trouble

Monday, September 4th, 2017

Our November 2017 Training Day brings a multidisciplinary focus to bear on vocal health issues affecting professional voice users. Presented in collaboration with voice care experts at the forefront of the field, this event is ideal for medical professionals and students, voice coaches, professional voice users, teachers, healthcare practitioners, and all those engaged in wellbeing in the creative arts, who want to develop specialist knowledge and skills. BAPAM Training Days are also a great opportunity for discussion, sharing insights with peers, making new connections and growing our performing arts medicine network.

Book your place here

Our timetable for the day will be confirmed shortly. Presentations include:

Mr Nick Gibbins, Laryngologist
The Surgeon’s Perspective

Nick Gibbins will take us through the types of vocal injuries and disorders that face professional performers including musculoskeletal issues, inflammatory problems, and organic lesions of the vocal folds. The laryngologist’s role in the multidisciplinary voice clinic will be explored including diagnosis and surgical intervention.

Tori Burnay, Voice Specialist Speech and Language Therapist
The Therapist’s Perspective

Tori Burnay will show us the therapist’s side of endoscopic examination including the muscular behaviour of the larynx and vocal tract in healthy and disordered speech. Muscle tension issues, vocal hygiene, workload management and potential therapy plans will be discussed.

Dr Carol Chapman, Counselling Psychologist and Performance Coach

Dr Jane Oakland, Music Psychologist and Singer
Psychological Perspectives

Examining the difference in presentation, conceptualisation and treatment between professional voice users who have a medical diagnosis and those for whom no diagnosis has emerged and whose problems appear to have a purely psychogenic origin. Discussing the psychological and social/career impact of having voice problems in these circumstances and at different stages during a performing career. Using illustrations from client work, suggesting what clinicians should look out for. Illustrating techniques for rehabilitation and coping.

Prof. Dane Chalfin, Vocal Rehabilitation Coach
The Singing Perspective

Dane Chalfin will guide us through the Vocal Rehabilitation Coach’s role in the interpretation of the laryngopharyngeal gestures in healthy and disordered singing in various styles. Muscle tension issues in the singing voice and rehabilitative pedagogy will be discussed. This will also include a live scoping session where Mr Nick Gibbins will perform nasendoscopy on Professor Chalfin live in front of the audience. We will be inviting attendees to submit requests for singing gestures they would like to see in situ.

Ed Blake, Physiotherapist
The Physiotherapist’s Perspective

Ed Blake presents on physiotherapy treatment for professional voice users suffering voice related symptoms.

Occupational Voice Symposium 2013

Tuesday, April 2nd, 2013

The Voice at Work – Optimization & Management

The third Occupational Voice Symposium takes place on 23rd & 24th April 2013 at University College London. National and international speakers will present on topics including:

Remote Monitoring and Tracking of Vocal Load
Ambulatory Monitoring of Voice: Past and Future
Long Term Voice Use Based on the VoxLog Database
The app – OperaVOX™

Challenges and Treatment Outcomes of Occupational Voice Disorders
EU Legislation Update and Current Challenges
Laryngeal Manual Therapy
Workshop in the Resonance Tube Method in Voice Therapy

Telehealth and Behavioural Interventions for Vocal Health
The Cleveland Clinic Approach
Self-Managing Occupational Dysphonia
How to Change Behavior
Solution Focused Approach to Voice Therapy

Etiology, Impact and Intervention in Occupational Voice Disorders
Medicolegal Evaluation of Physical Impairment Due to Occupational Dysphonia
Genetic and Environmental Effects in Dysphonia
Semi-Occlusion Exercises

Please note, this event is not organised by BAPAM

Further information and registration please visit the OVS website here: http://bit.ly/103bYZk 

BVA Study Day – How the Breath Inspires

Wednesday, August 15th, 2012

Experts including Alan Watson (The Biology of Musical Performance), Jeannette Nelson (Head of Voice, National Theatre) and Ed Blake (specialist physiotherapist) investigate the physiology of breathing. How does the mechanism of breathing relate to speech and singing?

How the Breath Inspires – the next British Voice Association Study Day, on Sunday 23rd September 2012, covers anatomy, physiology and function, and practical applications for voice, both spoken and sung. Workshop sessions explore links between breathing and voice.

Full programme and booking form here.

BVA Study Day – From Pathology to Performance

Wednesday, June 13th, 2012

News about the next British Voice Association Study Day:

From Pathology to Performance

Sunday 1st July, 2012 9.30am – 5.00pm

Baden Powell House, Conference Centre, 65-67 Queens Gate, London SW7 5JS

This study day is suitable for Speech Therapists, Singing/Voice Teachers and ENT Surgeons who work with injured performers. It will also be of interest to singers. The day will focus on the challenges injured performers present for their teachers and voice clinic teams and the possible treatments approaches they may need to help them return to successful performance.

Speakers include:

Tony Aymat – Consultant Otolaryngologist
Rehab Awad –
Voice Specialist Speech and Language Therapist
Dane Chalfin
– Vocal Rehabilitation Coach
Melanie Mehta
– Voice Teacher (Spoken Voice) and Voice Specialist, Speech and Language Therapist
Linda Hutchison
– Singing Teacher and Vocal Rehabilitation Coach, Lewisham & Medway Voice Clinics

Click here for Applications and Booking

I See a Voice

Wednesday, February 29th, 2012

Practical Acoustics for Speech and Singing

The forthcoming British Voice Association Research Day on Sunday May 20th is all about acoustics. Acoustics of the vocal tract, vowel production, the way the ear processes voice signals plus a presentation on acoustic analysis software in the teaching studio.

Further details and application form here.

 

 

 

Weak, Wobbly or Working?

Monday, January 30th, 2012

The next British Voice Association study day, at the Royal Northern College of Music in Manchester, focuses on the effects of ageing on the voice and the vocal problems associated with ageing. Surgical, voice therapy and singing solutions will be discussed.

Follow the link for detailed information and to book your place:

“Weak, Wobbly or Working?” The Multidisciplinary Management of the Ageing Voice

Sunday 25th March, 2012 11.30am – 5.15pm

Speakers include:

•Sue Anderson (Singing Teacher and Researcher)

•Phil Jones (Consultant Otolaryngologist)

•Liz McNaughton (Specialist in the Singing and Speaking Voice)

•Jane Shaw (Voice Specialist Speech and Language Therapist)

•Mark Watson (Consultant Otolaryngologist)

Voice and the Brain

Wednesday, October 12th, 2011

On Sunday 15th January 2012, the British Voice Association hold a study day suitable for all voice professionals (speech
therapists, surgeons, singing teachers, voice teachers).

More information and application form

Topics include:

Brain function in relation to voice, in both therapy and education.

Recent research into neural processing for both spoken and
sung voice

The role of brain plasticity in rehabilitation and learning.

Gender differences between child and adult voices explored from
an evolutionary basis.

SPEAKERS:

Prof Sophie Scott (Professor of Cognitive Neuroscience, UCL)
Dr Katie Overy (Senior Lecturer in Music Psychology, University of Edinburgh)
Prof John Rothwell (Professor of Neurophysiology, UCL)
Dr David Reby (Senior Lecturer in Psychology, University of Sussex)

British Voice Association Events

Tuesday, July 12th, 2011

On Friday 18th November the BVA host a Voice Clinics Forum (click link for details and application form) at University Hospital of South Manchester.

Speakers include Professor Paul Carding, Mr John Rubin and Mr Julian McGlashan, and topics to be covered include meeting the challenges faced in voice clinics and new technologies such as high speed, high definition and 3D imaging.

BAPAM’s next Training Day for Performing Arts Medicine practitioners is scheduled in London the next day, Saturday 19th November, and covers areas relating to woodwind and lower strings players, disability rehabilitation, chronic pain, lifestyle and injury prevention. The full programme is to be announced.

In the nearer future, the BVA have organised an Interactive Rock & Pop Day for singers, teachers and voice therapists. It takes place on Sunday 25th September in Chiswick, London. Click here for more details and an application form.

Speech and Language Therapy at BAPAM

Tuesday, June 29th, 2010

Full and part time professional and student performing artists who have been referred to a Speech and Language therapist can now see Mei Lei at BAPAM in London. Mei specialises in voice disorders and has worked in Voice Clinics for the last 7 years with ENT Consultants, John Rubin and Tom Harris. We are able to arrange appointments for the reduced cost of £45 and we are grateful to Mei for discounting her usual fee so generously.

If you’d like more information or to book an appointment please call us on 020 7404 8444.