1. Lecture 14 Professional Voice Users

2. Who are professional and occupational voice users ?
Anyone who needs their voice to carry out their job a professional voice user.
Professional voice users are often also considered ‘vocal athletes’ because their voice use is more extensive and strenuous than that of nonprofessional voice users.
2. Professional and occupational voice users are defined as anyone ho depends upon their voice to carry out their vocation. Professional voice users, such as singers and actors, are often referred to as ‘vocal athletes’ because their voice usage and vocal demands are more extensive and strenuous than those on nonprofessional voice users. This is especially true for singers and actors who are called upon to use their voices over wide pitch and intensity ranges, different vocal registers and various vocal timbers. That said school teachers also have vocal demands that are quite high and because they have no vocal training, often develop voice problems. In fact, 50% of school teachers will have a voice problem during their career.

3. Examples of Professional Voice Users
Professional voice users include:
singers
actors
teachers
court attorneys
clergy
salespersons
coaches
broadcasters
auctioneers
cheerleaders
choreographers, aerobics instructors
telemarketers and customer service personnel
Receptionists
and many others
3. There are many types of professional vice users. Many are listed here on this slide. I once had a horse back riding instructor that I traded with, singing lessons for riding lessons. This person spent all day in a hot, dry, dusty arena yelling instructions to her students and often by the time she came to me at 6 or 7 pm , her voice was moderately to severely hoarse and it was nearly impossible to do a singing lesson. There was also a case study done on a drill sergeant before and after boot camp. A videostroboscopic exam performed prior to boot camp showed healthy, normal appearing VFs. Pot boot camp, 6 weeks later, a repeat strobe exam showed sever VF edema, redness and uneven, irregular VF edges.

4. Vocology
Titze (1996) defines Vocology as "the science and practice of voice habilitation, with a strong emphasis on habilitation".
To habilitate means to “enable”, “equip for”, “capacitate”; to assist in performing whatever function needs to be performed".
He also says Vocology "is more than repairing a voice or bringing it back to a former state ... rather, it is the process of strengthening and equipping the voice to meet very specific and special demands".
Vocology is the study of voice, but as a professional discipline it has a narrower focus:
The science and practice of voice habilitation, which includes evaluation, diagnosis, and intervention.
4. Vocology is term coined by Dr. Ingo Titze to describe and define the study of the voice, the practice of voice habilitation and rehabilitation, including voice evaluation, diagnosis and intervention. With proper course work, one can become a certified Vocologist (see ncvs.org Summer Vocology Institute).

5. Who treats voice clients?
SLP w/ specialty in voice disorders
SLP / singing voice specialist – SLP who is a singing teacher
Singing Voice Specialist singing teacher who is not an SLP but specializes in bridging the gap between the SLP and professional singing teacher
Who may call themselves a ‘singing vice specialist is a current topic of great debate
5. Voice is a specialty area within Speech-Language Pathology. In voice clinics, SLPs w/ a specialty in voice or with a singing voice specialty see voice clients with various voice disorders. The title of ‘Singing Voice Specialist’ and who may call themselves a singing voice specialist has been a topic of great debate amongst SLPs, singing teachers, acting voice teachers and voice scientists. In a recent conference on ‘Proposed Specialty Training in Vocal Health: Why, who, what and how’ voice scientists, SLPs w/ specialty in performance and singing voice and singing teachers met in an attempt to come to an agreement on WHO may use the title ‘Singing Voice Specialist.’ In the end, most agreed to ‘disagree.’ Many SLPs who were singing voice specialists felt that the title should be reserved for SLPs who were also singing teachers, not for singing teachers certified in Vocology. I must say I stand with them.

6. Arts Medicine and the Professional Voice User
Singers
Actors
Comedians
Broadcasters
Voice Over Actors
Puppeteers
6. Arts medicine focuses upon the unique vocal problems of the professional voice user who is an actor or singer, comedian etc. These individuals are best treated by an SLP with a performance voice background who understands the vocal demands,vocal training and possible difficulties encountered in performance voice.

7. Team Members May Include
The patient (singer / actor etc)
Laryngologist
SLP with performance voice specialty
Singing or acting teacher
Maybe manager, producer, stage/music director
Allergist
Gastroenterologist
Physical therapist
7. The team members will always include a laryngologist and an SLP who is a voice specialist, but may also include the singing or acting teacher, patient’s manager or producer, and possibly other medical professionals.

8. Levels of Vocal Performers
Elite
Professional
Music educators – singing teachers, choral directors
Semi-professionals
Choir singers – church or community
Amateur
8. There are different levels of vocal performers. Elite performers are typically nationally and internationally known performers. Professional performers are those who make their living performing, such as the singer in a cover band that performs 4-5 nights per week in clubs. Musical educators are professional voice users and typically have very high vocal demands. They talk in the class room, demo the different vocal parts for the choir, and often sing in ranges other than their own. Semi professionals and amateurs may be at greatest risk, as they may not have received adequate vocal training or have no training at all.

9. Etiology of Dysphonia in Singers and Actors
Physiological over compensation of the laryngeal mechanism as a result of infection or irritation to larynx
Excessive muscle tension
Phonotrauma
Poor or absent vocal training
Poor amplification and /or performance environment
Emotional reactions to life stress
Use of character voices, singing/speaking in unnatural pitch range or vocal timber, or for prolonged periods at high intensity
Allergy or Reflux
9. The causes of voice disorder for performance voice client range from physiological over compensation as a result of reflux, throat infection, allergies or other irritation of the larynx. When the voice is not responding normally , due to irritation or illness, most professional voice users will attempt to compensate in some way and alter their physiological behavior or use excessive muscle tension. Phonotrauma form misuse or vocal abuse is another common etiology. Most voice problems are the result of a ‘constellation’ of circumstance, problems, issues and demands that come together at the same time, a type of ‘perfect storm.’ For example, a professional singer has been training to extend his singing range and is doing very well. He then gets bronchitis, but while still recovering he is offered a demanding role that requires he use his ‘newly’ extended vocal range. He is still coughing but accepts the role anyway, goes through rehearsals, and then goes on the road, still coughing. A month into the tour his voice begins to give out, his range begins to decrease and vocal fatigue and vocal instability set in. He sees a laryngologist and is diagnosed with a large VF cyst. Singers and actors should never push themselves but many do. The danger is that sometimes the damage is permanent.

10. Compensatory /Cover Techniques
Use of extrinsic laryngeal muscles
FVF approximation
Supraglottic muscle tension
Pushing of breath
Singing or speaking in a different range or timbre
10. Singers and actors will try to compensate for vocal changes and instability by increasing muscle activity which then results in excessive supraglottic and extrinsic muscle tension, pushing of breath and alteration of timbre or pitch range. Any of these compensations can result in an imbalance of the components of the phonatory system (respiration, phonation and resonance) and result in a voice disorder.

11. Assessment for Singers and Actors
Voice case hx, medical hx
SINGING HX – training, use of warm up /cool down, singing styles, performance schedule, performance environment, voice type, singing style
Speaking HX – speech training, use of warm up /cool down, performance schedule, performance environment, TV actor or stage ?
VOCAL HYGIENE
Singer’s Voice Handicap Index
Info on singer’s rehearsal and practice schedules
Use of amplification and monitors ?
Singing/acting in costumes ?
11. While voice assessment for performance voice users is very similar to voice assessment for nonprofessional voice uses, there are specific areas of assessment that need to be addressed, such as singing or acting voice hx and voice information specific to singing and acting.

12. Speaking Voice Assessment
Acoustic and aerodynamic evaluation PLUS special attention to:
Habitual speaking pitch
End of phrase pitch
Phrase duration ( too long on one breath?)
Rate of speech
Breathing
Posture, muscle tension
Resonance, glottal fry, glottal attacks
Vocal loudness
12. The patient will have seen a laryngologist and come to us with a medical dx. If the laryngologist did not perform a videostroboscopic exam, we’ll request one. In addition to a detailed hx and interview, we’ll perform an acoustic and aerodynamic assessment. We’ll pay special attention to habitual speaking pitch, end of phrase pitch, presence of glottal fry, utterance duration, rate of speech, frequency of breath replenishment, and muscle tension. We’ll listen for differences between our client’s habitual speaking pitch and their reading pitch. Many times trained voice users will have a ’performance’ voice they use for reading and for their craft that is different in pitch or quality from their habitual speaking voice.

13. Singing Voice Assessment
Singing voice disorders can be a challenge to hear, especially to the untrained ear!
Singer complaints :
air in the tone
sticky feeling on high notes
vocal fatigue and incr. effort and strain
unstable midrange, register transition
trouble singing loud or soft
loss of flexibility /control
decr. duration or running out of air
physical discomfort and pain
13. For the singer with a voice disorder one must determine if the disorder is due problems with the speaking voice, singing voice or both. Many singers have great singing technique and breath support for singing, but inadequate speaking techniques and/or inadequate breath support for speech. Assessment involves a voice hx with singing voice hx details, speaking voice hx details, breath and muscle tension assessment for speech and singing, vocal hygiene hx, performance and rehearsal schedule, performance environment, daily practice schedule, etc. You would assess muscle tension and breath support during speech and during singing. You will also ask about voice type (soprano, alto, tenor, baritone or bass) and singing styles.

14. Singing Voice Assessment
Assess singing pitch range
Vocal pitch range produced w/ greatest ease
Phonation breaks, abrupt changes vocal quality
Areas in vocal range produced w/ effort or strain
Posture and breathing during singing
Maladaptive jaw, neck and shoulder postures
Have singer sing an ‘easy’ song and a challenging ‘song’
14. We will also assess singing pitch range, ease of register transitions, listen for phonation and pitch breaks, abrupt changes in quality, and have the client demonstrate singing tasks they’re having difficulty performing.

15. Voice Therapy Performance Voice
Approach will depend on whether problem is speaking voice or singing voice
If speaking voice, choose appropriate therapy techniques
If singing voice, singing voice rehabilitation w/ correction of faulty techniques, decr. muscle tension, address breath control issues
Rehab of singing voice is a hierarchy from easy scales to longer scales and songs.
Referral to professional singing teacher or singing voice specialist post therapy
15. The voice therapy approach we choose for our actor or singer client will depend on the assessment findings and whether or not the problem stems from the speaking voice, singing vice or both. If the issue is the singing voice, then the client must be seen by an SLP who is a singing voice specialist.

16. Voice Therapy for Non-arts Professional Voice Users
Consider dx and cause of voice disorder
Consider daily vocal demands
Consider medical , voice and vocal hygiene hx
Consider muscle tension and breath support issues if present
Design treatment plan accordingly choosing techniques and goals to best serve client’s dx and vocal demands and type of voice use.
16. The voice therapy considerations for non-arts professional voice users are the same as those we’ve discussed in lectures 9, 10, and 11.