No Voice No Job! The latest in Occupational Voice Research

The Voice at Work – Optimization and Management

The Professional Voice Practice presents a Free Paper to the 3rd Occupational Voice Symposium (OVS) UCL 23rd and 24th April 2013 OVS 2013

An information packed two days were spent in a lecture theatre listening to experts from around the world presenting their research on the monitoring and improvement of the vocal health of ‘occupational voice users’. This is the third Symposium of its kind, organised by Dr Ruth Epstein of The Royal National Throat Nose and Ear Hospital London.

‘Occupational Voice’  user is a term coined by voice experts to describe anyone who relies on their voice for work where there is high ‘vocal loading’ or voice use. #Singers, #Actors, #Teachers, #Lecturers and #Contact Centre Advisors all fall fairly obviously in to that category. But has anyone thought about hairdressers, sports coaches or tourist guides?

Whereas in previous symposia the focus had been on the relationship between occupational voice use and voice disorders, with discussion of the medico legal implications and the efficacy of ambulatory phonation monitoring, our focus was shifted this time to ‘interventions’ with discussions on the merits of telehealth (remote health monitoring and advice).

At the end of Day Two I presented my own MA research on possible prevention strategies for #Muscle #Tension #Dysphonia in Teachers. Delivering voice training that people enjoy is one thing. But how can that be sustained afterwards?  It was officially titled #‘Are You Speaking Comfortably?’ which I quickly revealed as ‘It’s No Joke if You Croak!’ As we know, it is potentially very serious: …lose our voice, lose our job, lose ourselves…’ According to the British Voice Association (BVA) absence from work through dysphonia is costing the UK an estimated £200m a year. My study focused on a trial of some media I had designed to act a means of sustaining and embedding good practice learnt during direct voice training. The results showed promise, so I was pleased to share, and all the more so from the perspective of a #Practitioner, training a wide variety of willing though unwitting #professional voice users.

Big questions were raised around the evolution of #telehealth. America has already embraced the concept with The American Well (www.americanwell.com). Telecounselling and rapid advice are the two obvious benefits, but what, as I put it to the conference, do we risk losing without the benefit of touch in diagnosis? Abraham Verghese speaks eloquently on this subject in his TED Talk ‘The Power of Touch’. (www.TED.com)The conference broadly agreed it is a delicate course we will continue to negotiate between the remote and the personal approach in dispensing health care in 21st Century.

In addition to updates on voice dosimetry and the latest development in ambulatory monitoring of the voice, we were treated to other exciting interventions and demonstrations. These included the presentation of Opera VOX, a sleek new App designed and developed by otolaryngologist Owain Rhys Hughes, and colleague Anil Alexander. Owain’s research focuses on disorders that affect the head and neck, and developing new treatments. This new App is set to become a leading tool for communication the vocal condition of the occupational voice user to their clinician or consultant. The Pro Version permits the clinician to keep data on several patients at a time on one device. It is unashamedly an ‘Apple’ product simply because of the consistency of the platform Apple is able to offer across a variety of platforms (iPad, iPhone and iPod Touch). Personally I can’t wait to try it myself, but I will leave you to take a look yourselves!

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Leslie Mathieson, co-author of the expert volume ‘The Voice and its Disorders’, presented her study and demonstration of Laryngeal Manipulation Therapy, to release muscular tension in the throat. I was struck again by the clarity, wisdom and logic of her words. A particular place she prefers to avoid is the thyro-hyoid space (the gap between the floating hyoid bone and the thyroid cartilage shielding the front of the larynx), which many concentrate on increasing, in order to relieve the excess throat tension. In fact, Leslie said, some people have a naturally small space between those two structures and so attempting to do this can be counterproductive.

Another delightfully simple and effective intervention was presented by Professor Susanna Simberg, known as #Resonance Tube Method in Voice Therapy. Ten of us were summoned to the front to blow through glass tubes into vessels of water whilst phonating to /u:/. Blowing bubbles, in effect! Amidst the laughter and splashes, the efficacy of this therapy was felt by us all through the vibration and back pressure to the vocal folds. This concept is also fundamental to the Accent Method. I have at least one client with whom this will be trialled! Professor Simberg was honest enough to say that having used it for the last 45 years, they know it works, even if they don’t fully understand why.

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On day two we considered, among many other things, behaviour intervention therapies, including ‘Solution Focused Behaviour Therapy’, presented by Emma Osei-Mensah. It is a problem for many of us who are tackling psychogenic voice disorders which relate to a client’s habitual behaviours. How do we get people to register, own and change what they are doing in order to improve their voice? With similarities to Neuro Linguistic Programming as a coaching tool, Emma said that it had helped her patients  achieve their goals remarkably well as a result.

A combined approach

Reflecting on all the many contributions to the conference, I came away more convinced than ever that the value of research is in supporting the people who are most in need of its discoveries. Scientific research supports the work of Speech Pathologists and Professional Voice Practitioners and vice versa. The #Voice is one domain where the art and science must perforce be combined in order to help patients. A holistic approach that focuses on prevention and sustainability will continue to underpin all our work at the Professional Voice Practice.House

Will we one day see the formation of a Royal College of Occupational Voice #Therapists? It would certainly help concentrate the information and avoid duplication. But for now we will have to rely on the generosity and input of from everyone at the Occupational Voice Symposia, not least that of Dr Ruth Epstein, who organised the first one, in 2007. Our grateful thanks to her and all the team once again.

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Climbing personal mountains in Andalucia

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I feel the cold, am not a regular taker of tough hikes and I am not particularly fond of heights; especially where there is nothing between me and the space below! Warm sun and blue sea are much more my cup of tea.

So it was with some trepidation that I anticipated our recent climb up the eponymous ‘El Torreon‘ (see above) in Southern Spain. We were there for a week’s walking and (we hoped) a break from the British cold. Unfortunately a particularly wet and cool weather system was to hang around Andalucia for the entire week we were there. My holiday book happened to be Sir Ranulph Fiennes‘ autobiography ‘Mad, Bad and Dangerous to Know’. If ever you want to scare yourself silly about expeditions, and then be unbelievably impressed by one individual’s bravery and sheer determination to keep going in the most inhospitable of conditions, then read his story. It is truly inspirational. And I would dearly love to meet him one day.

But back to my own climb. I worried all the previous night about keeping up, not dealing with the height, and falling, painfully a long way down the rocky terrain. So I began the day sleep deprived, but pumped on adrenalin. There were three of us in the party, one of whom was my step daughter, who is already something of a veteran hiker in places such as Nepal and South America. She is also soon to be a qualified doctor. We set off in cool, cloudy conditions, me in a new pair of hiking boots, not even broken in. Nicola carried our party’s comforts (water, chocolate and picnic fare) in her rucksack. In fact she became something of a Mary Poppins, retrieving just about anything we needed at any moment including waterproof trousers, which proved wonderfully warm and protective as we ploughed upwards through the drifting cloud, brushing gorse along the way.

Ascending 2,500 feet or 1634m in one go was always going to be tough, so early on I learnt the value of a steady pace. It was important not to compete with oneself but just find a rhythm. I was so busy just breathing sufficiently for my needs that walking across a precipitous narrow ledge occasionally ceased to be a concern. It was comforting too to have one person in front and another behind. The best thing that Nicola could have said to me on the whole trip was “if we are not enjoying this, we don’t have to do it, so just say the word if you want a break or anything to eat or drink. There is no point in doing it otherwise.” Wise words. On a difficult job, give someone a get out of jail card and they instantly feel liberated.

We plodded on, talking sometimes and then enduring, when the leg muscles started to object or the intercostal muscles yelled ‘could you just breathe less hard for a minute?’ Pit stops were taken in soggy hollows. On and on we climbed, with only occasional breaks in the cloud, when the great panorama of the Grazalema National Park was briefly and awesomely revealed. I didn’t feel consciously hungry, although I did get very thirsty, but again my trusty aide quietly proposed that we should stop a while and sit for a drink or a bite to eat. Wise counsel again. A short break from the exertion with some calorific input made all the difference. You could start again feeling refreshed. On the more arduous sections one only had one’s own thoughts to commune with, conversation being impractical or a waste of energy, so then it was a matter of rehearsing one’s own deeper plans or philosophies.

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Eventually we came close to the top. I had become conscious of my legs not quite going where my brain was intending them to be and starting to make bad decisions. I felt tired. Suddenly Nicola said, ‘shall we just stop for some lunch before we get to the top?’ The ascent was looking a lot steeper now, rocks disappearing above us at hefty incline. I gratefully agreed. And so she fished out some fodder from her bag, which included bread cheese and chocolate, and we ate it sitting serenely on a rock not able to see very much thanks to wafts of cloud. A few minutes later we packed up and then the fun of the final stage started. A clamber up the rocks to an invisible summit. I couldn’t stop thinking ‘how the hell will I ever get down?’ (I hate descending anything, let alone mountainsides). I said as much to Nicola who said calmly ‘let’s just cross that bridge when we come to it.’ And so it was that I found myself ascending goat like up the rocks, finding hand holds here and foot holds there, with little prompts of ‘excellent’, ‘lovely’ or ‘oh yes great, you’re a natural’ from below. It was both encouraging and liberating! Suddenly with one last grapple, I found myself at the top! We all stood there, in and above the clouds, puffed, exhilarated and amazed that we had finally made it. A further bite of celebratory chocolate and then the cold took hold and it was time to get down.

Amazingly, I was able to clamber, if a little inelegantly, using my bottom and hands as anchors over the difficult section we had just tackled with my dignity in tact. I just went at my own pace. There was no room for worrying about heights or anything else because the job of descending safely was the only important thing, and required total concentration. It was a tremendous relief when a little voice said, ‘that’s it – you’ve done the hardest bit now!’ After that we had a further brief picnic and then began the long toil down which was very hard on the knees and toes. How strange it felt at the end to saunter across the road and step back into the car. The whole sortie had taken a bit over 5 hours. But it had felt as though a much bigger journey had been taken.

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Now what, I can hear you ask, has all this got to do with Professional Voice Practice?

The greatest fear of many people is standing up in front of others to make a speech or give a presentation. It comes in a bundle of ‘I’ll make a fool of myself,’ ‘I’ll make a mistake,’ ‘My voice will give up’ etc. As voice coaches we then have the job of coaxing someone out of ‘funk’ into co-ordinating themselves sufficiently to handle the situation, and getting their voice to function without quavering or petering out. And then to sound convincing! If we ourselves are already experienced and competent, it is easy to ignore the personal effort it requires for someone else to challenge themselves and take risks. It is easy to push too hard. And equally we may not demand enough or over praise. We have to build trust, gain a person’s confidence and give them the tools to do the job. We can’t do it for them, but we can support and see someone through the process.

I recently had the privilege of working with a client who was reduced to quivering wreck status before presenting to two hundred people. She bravely put herself in my hands, rehearsing the walk to the podium, standing tall and getting her body and breath ready for speech. We then rehearsed the sound and shape of the message. Time and time again! On the night, it all came together and she performed well, beyond her expectations. She did not fall down her own personal mountain.

My trip up El Torreon, was an excellent reminder of how it feels NOT to be in charge; the value of support, of the partnership between ‘coach’ and ‘student’ and the inestimable value of the challenge. I felt ten feet tall at the end of my walk, and am already working out where I will take my boots next. My client has said she wants to do some more voice work when she is next in London, because it has finally turned into a positive experience. I got up my mountain because the person guiding me was already competent, thoughtful, honest. I was given the option of a parachute (we don’t have to do this) and so I felt free. And I accepted some help! I have always believed in a compassionate but strong approach to coaching, and on this trip I discovered just how effective that can be. It’s all about instilling confidence.

Confidence sets us free, to do just about anything, including speaking!

Post Script:

Sir Ranulph Fiennes describes how in the toughest of moments on the ice or during his seven marathons in seven days he would think of his wife and his closest friends back home, supporting him and willing him on. I must confess I just thought of him, and derived strength from his towering example.

Vision

“The Professional Voice Practice believes that learning about your voice should be fun, memorable and informative. Through a carefully tailored approach, we aim to improve skills and develop confidence in partnership with each person, at whatever level they are. It takes a little time and practice, but the journey is well worth the reward.”