Healing Voices

Healing Voices (1)By Leda Scearce, MM, MS, CCC-SLP author of Manual of Singing Voice Rehabilitation: A Practical Approach to Vocal Health and Wellness

Singing is a part of virtually every culture and is fundamental to our human experience. In the United States, singing is enormously popular, as evidenced by the vast number of people engaged in all kinds of singing activities. Over 30 million Americans participate in choral singing alone (Chorus America, 2009). Shows such as The Voice, America’s Got Talent, and American Idol illustrate how passionate we are about singing. From the amateur recreational singer to the elite celebrity, we sing as soloists and in ensembles, with instruments and a cappella, in classical and contemporary styles, on stage, in concert, and in the shower.

Every person’s voice is unique and identifiable, and our voices can be a big part of our identity and how we see ourselves in the world. This is especially true for singers, for whom the voice is not only intricately tied to self-image and self-esteem but also may be a source of income and livelihood, creative expression, spiritual engagement, and quality of life. For a singer, a voice injury represents a crisis. Because of the specialized needs of singers, it takes a team—including a laryngologist, speech-language pathologist, and singing voice rehabilitation specialist—to get a singer back on track following an injury or voice disorder. Singing voice rehabilitation is a hybrid profession, requiring in-depth clinical and scientific knowledge married with excellence in teaching singing.

Voice problems are rarely isolated in etiology—usually multiple factors converge to create an injury. These factors may include poor vocal hygiene, inadequate vocal technique, an imbalance in vocal load and medical problems (allergies and reflux are common in singers, but thyroid, pulmonary, neurologic, and rheumatologic conditions are among the illnesses that may affect the voice). The singing voice rehabilitation process must encompass all elements that may be contributing to the problem: medical factors, vocal hygiene, vocal coordination and conditioning, vocal pacing, and emotional factors. Continue reading

The Ineffectiveness of Checklists in Diagnosing Childhood Apraxia of Speech (CAS)

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By Margaret Fish, MS, CCC-SLP, author of Here’s How to Treat Childhood Apraxia of Speech, Second Edition

Sorting through evaluation findings for young children with complex speech sound disorders can be confusing and challenging. As SLPs we strive to complete thorough evaluations and make sense of our evaluation findings to achieve an accurate diagnosis; however, many of the characteristics of CAS overlap with other types of speech sound disorders. Certain key characteristics from a CAS checklist such as inconsistency, atypical prosody, groping, or vowel errors may raise red flags for a diagnosis of CAS, but these characteristics alone should not predetermine the diagnosis until a thorough analysis of the child’s speech productions is completed.

Following are case studies of two children recently seen for consultations. Both children had an incoming diagnosis of CAS, but only one child was given a definitive diagnosis of CAS at the conclusion of the consultation. The other child demonstrated a number of characteristics commonly associated with CAS, but after careful examination of the child’s speech, the underlying nature of the challenges was not consistent with the core impairment of CAS that ASHA (2007) describes as the “planning and/or programming (of) spatiotemporal parameters of movement sequences.”

Case Study 1.

Mark, age 3 years, 7 months, had recently received a diagnosis of CAS by a diagnostic team at a local hospital. The diagnosis was based primarily on the following factors:

  • Reduced speech intelligibility (judged to be 50% intelligible)
  • A nearly complete repertoire of consonants and vowels
  • Inconsistent productions of the same word
  • Occasional vowel errors
  • Atypical speech prosody

Because of Mark’s limited speech intelligibility, inconsistency, vowel errors, and prosody differences, it was understandable how a diagnosis of CAS was made, as these characteristics often are associated with a positive diagnosis of CAS. Indeed, the use of a checklist of CAS characteristics alone could lead a clinician to conclude that Mark had CAS.

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