By: Sharon L Radionoff
What Do I Do?
So what do you do when something is wrong with your voice and you can’t fix it? This is a frightening situation for a singer. Fortunately, singers today can find hope, and help, from within a field called performing arts medicine.
Professional voice care is a branch of performing arts medicine that attends to the needs of those who depend on their voices for their livelihood: singers, actors, preachers, etc. (Sataloff). The field of professional voice care brings a team approach to vocal health. The current voice care team consists of a laryngologist, a speech-language pathologist and a singing voice specialist (Heman-Ackah et al.). Additional members may include a voice scientist, an acting voice specialist, and a nurse or a physician’s assistant. Consultants—such as a stress manager/speaking coach, a medical psychologist, a neurologist, a gastroenterologist, an endocrinologist, and a nutritionist—may also be part of the team.
When a singer schedules an appointment to see a professional voice care team, the team follows a patient protocol that consists of a medical diagnosis, an objective measures analysis, and a functional diagnosis of both the speaking and singing voice. A speech-language pathologist evaluates the speaking voice and the singing voice specialist evaluates the singing voice.
Many people are familiar with the term “speech-language pathologist” but may not be familiar with “singing voice specialist.” In a 2002 article in the Journal of Singing, Heman-Ackah, Sataloff and Hawkshaw define the singing voice specialist as a singing teacher with special training that equips him or her to practice in a medical environment with patients who have sustained vocal injury (Heman-Ackah et al.).
The singing voice specialist’s job is to look for functional misalignment of the singing system. The SVS must assess what is wrong quickly and be able to move forward to fix the problem. The singer and the SVS discuss use of the voice, along with the singer’s patient history, and view the stroboscopy and pertinent objective analysis prior to a systems evaluation of vocal production. The systems evaluation (respiration, phonation, and resonance) also includes examining a singer’s technique, specifically stance/posture, breathing and support, placement, quality of voice, current range, and tension points.
The intent is to get the maximum amount of information in a minimum amount of time. After the patient sings through a vocalise to determine range and technique, the SVS observes the patient sing something in his or her style or styles of music.
After the evaluation, the team develops a treatment plan based on the medical diagnosis and recommendations, the functional diagnosis, the type of performance or voice use, and the immediacy of the need. The treatment plan works best when the SVS and the speech-language pathologist assigned to the case cooperate.
The role of the singing voice specialist in the team management of voice patients includes four main facets. The first is as a liaison between the singer and the laryngologist, the voice scientist, the speech-language pathologist, and the voice teacher.
The second is as an educator. Education includes helping the singer understand the anatomy and physiology of phonation, understand what the diagnosis means for the current function of his or her voice, and know what to expect vocally. It also helps singers reduce their anxiety level and cope emotionally.
The third facet is as a trainer. A trainer helps the singer to balance the vocal system. The term “trainer” is synonymous with its use in the athletic world. Professional athletes who have a physical problem are most likely to see a sports medicine specialist for therapy to mediate the problem. Singers are vocal athletes—but since there is no licensure for a singing voice specialist, legally the term “therapist” is not advocated.
The fourth facet is as a problem solver. This facet varies greatly, depending on the patient’s area of expertise. It may include discussing lesson plans, classroom management, and classroom layout with the music educator; rehearsal preparation, rehearsal style, and conducting techniques with the choral director; and character development with the professional performer, and how this affects the voice.
Additionally, some counseling occurs during a session. This facet does not take the place of a medical psychologist or psychiatrist, but it is helpful if the patient knows that the SVS understands how devastating the situation makes him or her feel. In Psychology of Voice Disorders, D.C. Rosen and R.T. Sataloff write that professional voice users can perceive the voice as “self,” instead of as a vehicle in which to express “self.” When a singer is unable to see that the voice is a vehicle of expression and not “self,” he or she can suffer a loss of identity and self-worth, and depression may result (Rosen & Sataloff). If this situation goes unrecognized, psychological factors may impair the singer’s response to medical and surgical therapy. The SVS may be the first member of the team to recognize this problem (Radionoff).
What knowledge does an SVS need to gain to adequately prepare to work with the variety of cases? The SVS must use experience and observation to acquire a knowledge of the anatomy and physiology of both the normal and the disordered voice, a basic understanding of the principles of laryngology and medications, and a fundamental knowledge of the principles and practices of speech-language pathology. Much of the training is acquired by apprenticeship and observation, since formal training or fellowship programs that assist singing teachers to become singing voice specialists are as yet not available.
The fundamental approach to training (rehabilitating) singers with vocal injuries is different from the approach used commonly with training (habilitating) healthy voices (Heman-Ackah et al.). Even excellent and experienced voice teachers may cause harm if they work with an injured voice without knowing the special considerations it requires (Radionoff).
It is necessary, then, for the SVS to receive cross-disciplinary training to adequately prepare to work in a medical setting. This includes knowledge from different fields of music, science, and medicine, as well as communication disorders. Areas of preparation also need to include experience/observation (live performance, studio recording, classroom teaching, voice lessons, choral ensembles, and conducting), clinical preparation, and research (Radionoff).
When should a singer seek help? It is imperative for the singer who is experiencing vocal problems to obtain a diagnosis from a medical doctor. Singers must be very careful to be examined by a laryngologist specializing in professional voice care. The laryngologist will diagnose and provide medical treatment, but the singer must also work with a speech-language pathologist and an SVS to remedy the functional problems. Search the website www.thevoicefoundation.org to find a laryngologist and professional voice care team in an area near you.