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The future of singing voice rehabilitation as a profession: a suggested curriculum of study for the training of singing voice specialists.

[The following article is a modification of a book chapter in Wicklund, Singing Voice Rehabilitation: A Guide for the Voice Teacher and Speech-Language Pathologist, 2010, and is reprinted with permission from DelMar Cengage Press.]

A voice teacher who has advanced knowledge and experience in the treatment of voice disorders in singers is called a singing voice specialist. (1) Unlike speech-language pathologists (SLPs), singing voice specialists (SVSs) do not have licensure or certification. However, SVSs are the essential third prong of the three-pronged Voice Care Team model, (2) since they may be the singing teacher of the injured singer and may have the greatest historical knowledge of that singer's voice.

There have been many recent discussions at NATS conferences and in the Journal of Singing about the creation of minimum training standards for singing teachers who want to become singing voice specialists. Articles by Radionoff, Heman-Ackah, and Titze (see Other Pertinent References, p. 414) have described suggested coursework and/or practical experiences/observations that could serve as the basis for training programs for singing voice specialists. The Wicklund SVS Certificate Program is a 56 clock-hour program that includes coursework, practicum, and continuing education requirements, and sets the stage for the future development of a nationally regulated certificate program. Certainly, someday a nationally recognized certification program similar to the ASHA Certificate of Clinical Competence could be sponsored by NATS. Since NATS does not currently sponsor any certification programs, a governing board of members from both ASHA and NATS could oversee the creation and maintenance of curriculum content, examinations, practicum, observation, and continuing education requirements. Until a nationally recognized training standard is proposed, developed, and implemented, singing teachers can continue to gain knowledge about working with injured singers in a number of ways as outlined in this article.

The singing teacher who wants to learn more about working with injured singers can do some networking with local potential work partners--the SLPs and laryngologists who are already treating singers, as well as those who want to build their practices. Singing teachers also can get to know laryngologists by attending professional meetings (NATS, and, in Chicago, the Chicago Singing Teachers Guild) and hearing physicians/SLPs as guest speakers on topics of interest. In addition, they could ask to observe a student's laryngoscopic exam or to sit in at the doctor's clinic for a few afternoons to get an idea of how the doctor works with singers. In addition, singing teachers should seek out mentorship of currently practicing SVSs to help build confidence in practicing habilitative singing techniques.

DEVELOPMENT NEEDS OF THE SVS PROFESSION

Whenever a profession is relatively new, it takes a consensus of those already working in the field to suggest minimum requirements for competence in the field. In 2005 NATS, ASHA (American Speech-Language and Hearing Association), and VASTA (Voice and Speech Trainers Association) made a joint consensus statement about the roles of the SLP, Voice Teacher and Voice/Acting trainer in voice rehabilitation. (3) This statement was an attempt to see if there is some agreement on the SVS's knowledge base, practical experience, and continuing competence. This statement is an excellent start in determining some guidelines about scope of practice and knowledge base for the singing teacher who wishes to be an SVS. I am here proposing that we need to look at four separate needs of the profession before we can formulate minimum standards for the SVS:

1) a need for recruitment and retention of interested therapists and singing teachers;

2) a need for standardized training/possible licensure/regulation;

3) a need for focused, yet varied opportunities for practical experience; and

4) a need for competence standards through continuing education requirements.

Recruitment and Retention of Interested Therapists and Singing Teachers

Already mentioned at the beginning of this article is how both singing teachers and SLPs can become more comfortable working with injured singers. The experienced singing voice specialist (SVS) must also be willing to mentor new specialists in order to keep the profession alive and well. And SVSs should always be looking to recruit singing teacher colleagues who have an avid interest in vocal anatomy and physiology and/or voice science to be SVSs.

Standard Training/Curriculum Suggestions for the SVS

One vision of an SVS curriculum is one that contains both undergraduate and graduate coursework from the university schools/departments of both speech pathology and music. The SVS should already possess at least an undergraduate degree in voice performance or pedagogy, but preferably a master's degree. Below is proposed curriculum, with rationale for each course following it.

SPEECH PATHOLOGY COURSES

REQUIRED UNDERGRADUATE COURSES

Speech Anatomy and Physiology

* Rationale: Describes physiology and function of speech systems.

Hearing Science

* Rationale: Provides groundwork for Music Voice Lab coursework.

REQUIRED GRADUATE CLASSES

Voice and Resonance Disorders

* Rationale: Emphasizes physiology and types of voice disorders.

Behavioral Principles

* Rationale: Outlines behavioral guidelines for treatment efficacy.

OPTIONAL GRADUATE COURSEWORK

Neuroscience for Communication Disorders

* Rationale: Describes neurological connections/innervations to vocal mechanism.

Professional and Scientific Methods

* Rationale: Designs and executes single-subject and group study protocols.

OPTIONAL UNDERGRADUATE COURSEWORK

Articulation Disorders

Rationale: Uses placement, manner, and voicing knowledge to create effective therapeutic singing exercises.

MUSIC COURSES (POSTBACHELOR'S DEGREE IN MUSIC)

REQUIRED GRADUATE COURSES

Upper Level Voice Pedagogy/Anatomy Course

* Rationale: Describes singing voice physiology and function of voice systems.

UNDERGRADUATE

Piano Lessons (if not already proficient)

* Rationale: Pianist may not always be needed in the studio for a singer undergoing habilitation.

Sibelius/Finale Software Course

* Rationale: SVS needs facility to transpose vocalises and songs for individual needs of singers.

VoceVista/Voice Lab Course

* Rationale: Applies spectrographic analysis/formant mapping to singing for charting progress during habilitation.

OPTIONAL COURSEWORK/INTERNSHIP

Nonclassical Singing Styles Lessons/Instruction

* Rationale: Many injured singers are not primarily classical singers, so familiarity with nonclassical singing techniques is helpful.

Though there may be more courses that would be helpful, the aforementioned curriculum could serve as a place to start. There may also be short-term seminars offered by singing voice specialists (such as this author), or workshops by NATS or ASHA.

Focused, Yet Varied Opportunities for Practice

The term "practice" as it applies to the medical field is somewhat amusing. The idea that a medical professional may need to "practice" his skills in the same way a trombonist practices his scales is humorous. However, it makes sense, as the dictionary definition of "practice" also can mean to professionally engage in someone's work. Clinicians cannot build their skills without time and experience treating many different patients. SLPs have a nine month practicum that contains at least 650 clock hours among three different settings: rehab, schools, and medical. Within each setting, certain types of patient disorders need to be seen to fulfill the ASHA requirement.

In the same way, the SVS needs to find practical/ practicum experiences that will be both focused (limited to singers with injuries) and varied (containing five categories of voice disorders). Minimally, this practicum would include work with at least one injured singer from at least three or four of the following five voice disorder categories: (4)

* structural changes in the vocal fold;

* neurogenic voice disorders;

* systemic disease contributors to laryngeal pathology;

* disorders of voice use; and

* idiopathic voice disorders.

Ideally, though, as with the SLP Practicum and Clinical Fellowship, the student SVS would be mentored by an experienced SVS while the student works with at least several injured singers in each of the disorder categories. The nightmare about setting up such a practicum is that in my own practice, I sometimes don't get an injured singer referral for a few weeks or more. Perhaps this could be remedied by sending the student SVS to observe and work with singers of another SVS until he or she finishes the practicum. The downside to this approach is that it could take a while to finish this process, and that could possibly detrimentally affect the competence levels attained in the practicum.

However, I get requests for observations from therapists and singing teachers all over the world and am happy to oblige them if they are ever in Chicago, and when I have asked permission of an appropriate client. There is burgeoning interest in learning voice care team techniques for speech-language pathologists as well, as demonstrated by a letter I received recently from an interested party (name and location have been removed for privacy purposes).

Dear Sir/Madam,

I would like to enquire about clinical attachments for Speech Pathologist with an interest in care and treatment of the professional voice.

I have been working for the last 4 1/2 years, with a specialization in voice therapy in the last 2 1/2 years. I have had the chance of treating a few professional voice users who developed voice problems, and would like to further my experience in this area. I am currently practicing in a general hospital in XXXX, with a small team of ENT doctors and speech pathologists, who have a vision to develop our services to better serve the professional voice users.

I do not have a background in vocal pedagogy, but do have some musical background in classical piano. Do you offer learning attachments programs for speech pathologist with an interest in voice therapy with the professional voice users and what are the charges like? Are there any requisite requirements to enter into such a program?

Thank you for your time. Hope to hear from you soon!

Regards,

Ms. XXXX

Though this person is an SLP, she desires to know more about voice care team practices and how to work with professional voice users. I encouraged her to join NATS as an associate member and ASHA (if she is not already a member), and to also attend all the voice conferences she can--PAS (Physiology and Acoustics of Singing), Voice Care Symposium in Philadelphia, and Voice Care Network are just a few that come to mind. Their contact information is available through any search engine. That leads to the fourth, and perhaps the most important, development need for the profession: Competence.

Competence through Continuing Education Opportunities

The previously mentioned letter writer was looking for continuing education opportunities, as most SVSs up to this point have done. If and when the SVS profession is regulated in some way through a certification or license, a continuing competence requirement will need to be established. Online or module coursework at ASHA and NATS conventions could be created with continuing education unit credit given for each. Continuing competence models already exist at ASHA and at other regulated organizations such as the ADA (American Dietetic Association), as well as physical therapy and occupational therapy groups. Perhaps the joint committee could also review some of these and other models for ideas on SVS continuing competency formulation.

All in all, voice care teams cannot function without well trained and experienced SVSs and SLPs. It is hoped that this article has reminded us that there is still a lot of work on the road ahead in encouraging the recruitment, training, practical work, and continuing education of professionals who work with injured singers and other professional voice users. But in work is opportunity, and in opportunity, great intrinsic rewards. I look forward to many more years on this journey with my colleagues and singing clients alike.

OTHER PERTINENT REFERENCES

Gilman, M., J. Nix, and E. Hapner. "The Speech Pathologist, the Singing Teacher, and the Singing Voice Specialist. Where's the Line?" Journal of Singing 67, no. 2 (November/December 2010): 171-178.

Heman-Ackah, Y., R. Sataloff, and M. Hawkshaw. "Who Takes Care of Voice Problems? A Guide to Voice Care Providers." Journal of Singing 59, no. 2 (November/December 2002): 139-146.

Radionoff, S. "Preparing the Singing Voice Specialist Revisited." Journal of Voice 18, no. 4 (December 2004): 513-521.

Titze, I. "Rationale and Structure of a Curriculum in Vocology." Journal of Voice 6, no. 1 (1992): 1-9.

NOTES

(1.) K. Wicklund, Singing Voice Rehabilitation: A Guide for the Voice Teacher and Speech-Language Pathologist (Clifton Park, NY: DelMar Cengage Learning, 2010), 71; K. Emerich, M. Baroody, L. Carroll, and R. Sataloff, "The Singing Voice Specialist," in R. Sataloff, Vocal Health and Pedagogy (San Diego: Singular Publishing, 1998).

(2.) Wicklund, 67-76.

(3.) American Speech-Language-Hearing Association (ASHA), "The Role of the Speech-Language Pathologist, the Teacher of Singing, and the Speaking Voice Trainer in Voice Habilitation" (2005); www.asha.org/policy.

(4.) J. Stemple, L. Glaze, and B. Klaben, Clinical Voice Pathology, 3rd ed. (San Diego: Singular-Thomson Learning, 2000).

Dr. Karen Wicklund, DM, MHS, CCC-SLP, SVS is Director of Chicago Center for Professional Voice, where she provides singing lessons, licensed voice therapy, and singing voice specialist training for voice teachers. An operatic soprano with San Francisco, Santa Fe, Lake George, and other companies, as of December 2011 she is an emerita voice professor and speech-language pathologist at Western Michigan University. She has also taught at Roosevelt University, Northwestern University, Washington State University, and the University of Nebraska at Omaha. Dr. Wicklund is a specialist in Healthy Belting techniques for music theater singers, and also teaches classical, pop, jazz, and rock styles of singing. She also collaborates with many local laryngologists as voice team SLP and/or singing voice specialist (SVS) to many of Chicago's singers and other professional voice users with voice disorders. Dr. Wicklund is the author of the highly acclaimed Singing Voice Rehabilitation: A Guide for the Voice Teacher and Speech-Language Pathologist (Delmar Cengage Press, 2010); and she maintains www.singershealth.com, a website of health information for professional voice users. Dr. Wicklund has also presented at the national conventions of NATS, ASHA, PAS, and the Occupational Voice Symposium. In July 2011, Dr. Wicklund joined a select group of speech-language pathologists who have been awarded the ASHA ACE Award for Continuing Education, by earning over 70 hours in continuing education credits within a three-year period.
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Title Annotation:Singing Voice Rehabilitation: A Guide for the Voice Teacher and Speech-Language Pathologist
Author:Wicklund, Karen
Publication:Journal of Singing
Geographic Code:1USA
Date:Mar 1, 2012
Words:2293
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