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.
Vocal Coordination and Conditioning
In the context of voice rehabilitation, the singer’s vocal technique may have contributed to the voice problem and/or may be compromised by the voice injury. In many cases (particularly for contemporary commercial music singers), the singer may have never received formal training or may have been trained with a classical methodology that does not align with his or her singing style (LoVetri & Weekly, 2003; Weekly & LoVetri, 2009). The singing voice rehabilitation specialist must design a rehabilitation exercise protocol that promotes optimal coordination of voicing subsystems to appropriately compensate for and promote resolution of the injury, while ensuring the singer achieves and maintains adequate vocal conditioning, all in a manner that is consistent with the physiologic and acoustic characteristics of the singer’s style. Thus, the exercise regimen for a rock singer will be different than for an operatic singer.
An effective singing rehabilitation design goes far beyond what is necessary for building technique in a healthy instrument—it requires deep scientific and clinical knowledge to understand the differential impact of various vocal injuries on the structure, function, and interaction of voicing subsystems. The rehabilitation protocol must be customized to singing style and underlying injury. The difference in the exercise regimen for a singer with vocal nodules versus vocal fold atrophy may be subtle but can have significant impact on the successful outcome of the intervention.
While thorough scientific and clinical preparation is indispensable, it is equally important that the singing voice rehabilitation specialist be an accomplished teacher of singing. One must be competent in training healthy singers before delving into the more complex endeavor of interacting with an injured instrument (National Center for Voice and Speech, 2013). Ideally, the vocal exercise regimen should encompass the voice holistically—both speaking and singing.
Vocal pacing refers to achieving balance in the amount, type, and intensity of voice use. This is an area that is sometimes overlooked or underemphasized not only in singing voice rehabilitation but also in the realm of voice habilitation (the enhancement or development of technique in healthy voices). Optimizing vocal pacing is of critical importance both for achieving and restoring vocal health and may be a major component of the singing voice rehabilitation plan. The singing voice rehabilitation specialist can collaborate with the singer to develop strategies for bringing voice use into balance that may include:
- Prioritizing vocal activities and unloading or reducing those that are less important
- Documenting voice use to identify where the vocal load is out of balance and where there are opportunities for improving balance
- Planning amount and intensity of voice use in advance, scheduling periods of voice rest (especially when rehearsal and performance demands are high) and strategic planning for efficient practice time
- Effective use of amplification, both for singing and speaking
In some cases, optimizing vocal pacing may mean increasing voice use on a day-to-day basis to “smooth out” the overall vocal load, as for the “weekend warrior” in a garage band or choral singer preparing for a concert. In either situation, the singer may be engaging in extremely intense voice use episodically without getting regular vocal exercise in between.
Many singers have a strong emotional reaction to experiencing a voice problem that arises not only out of concern about the implications for continuing performing but due to long-held and misguided beliefs in the singing culture that voice injuries are the fault of the singer and that singers who experience voice problems are “damaged goods.” The singer may undergo emotional ups and downs throughout the rehabilitation process, especially if performance has been curtailed or when financial or academic success is jeopardized by the voice problem. In addition to the physical injury, many singers sustain an “injury of confidence” that can linger after the injury has resolved. Throughout the rehabilitation process, the singing voice rehabilitation specialist must be mindful of and sensitive to the emotional experience of the singer and interact in a compassionate and supportive manner.
The Singing Voice Rehabilitation Package
All of these factors—medical, behavioral, and emotional—must be appropriately addressed through collaboration of the voice care team to guide the singer back to a state of vocal health and well-being. Obviously, singing voice rehabilitation is a complex and multifaceted process, requiring knowledge and experience that span art and science. Manual of Singing Voice Rehabilitation: A Practical Approach to Vocal Health and Wellness has been developed to guide the singing voice rehabilitation specialist in developing and executing effective, efficient rehabilitation plans that are customized to each individual singer, encompassing all relevant factors, so that singers are empowered to return to a state of vocal wellness and the joy of singing.
Chorus America. (2009). The Chorus Impact Study. Washington, DC. Retrieved December 5, 2015, from https://www.chorusamerica.org/advocacy-research/chorus-impact-study
LoVetri, J., & Weekly, E. M. (2003). Contemporary commercial music (CCM) survey: Who’s teaching what in non-classical music. Journal of Voice, 17(2), 207–215.
National Center for Voice and Speech (NCVS). (2013). NCVS Symposium on Specialty Training in Vocal Health Summary Report; April 25–26, 2013, Salt Lake City, UT. Retrieved from http://www.ncvs.org/STVH_Summary_Report_2013.pdf
Weekly, E. M., & LoVetri, J. (2009). Follow-up contemporary commercial music (CCM) survey: Who’s teaching what in non-classical music. Journal of Voice, 23(3), 367–375.
About the Author
Leda Scearce, MM, MS, CCC-SLP has been featured in leading roles with the National Opera Company, Hawaii Opera Theatre, Long Leaf Opera Festival, Triangle Opera, the Ohio Light Opera Company, and Whitewater Opera Company, and has appeared as a concert soloist with orchestras including the North Carolina, Toledo, and Honolulu Symphonies. An active proponent of new music, Ms. Scearce has given world premiere performances of works written for her with the Berkeley Contemporary Chamber Players, Nashville Chamber Orchestra, Orchestra Nashville, Mallarme Chamber Players, the American Chamber Music Festival, and Chamber Music Hawaii. A winner of the Birmingham Opera Vocal Competition, Ms. Scearce has also been a regional finalist in the Metropolitan Opera National Council Auditions. Ms. Scearce is a graduate of Indiana University with both bachelor’s and master’s degrees in vocal performance. A voice teacher for more than 25 years, Ms. Scearce has served on the artist faculties of Bowling Green State University, Meredith College, Brigham Young University of Hawaii, and the University of Southern Maine.
Ms. Scearce obtained a master of science degree in speech-language pathology from Boston University, where she completed an internship in voice disorders and voice rehabilitation for the performing voice at the Massachusetts Eye and Ear Infirmary. She is currently singing voice specialist, clinical associate faculty, and director of performing voice programs and development at the Duke Voice Care Center, where she provides rehabilitation therapy to singers, actors, and other vocal performers with voice injuries. Ms. Scearce is a frequent speaker on the topic of the singing voice at national and international voice conferences, including the American Academy of Otolaryngology-Head and Neck Surgery, the Voice Foundation, National Association of Teachers of Singing, the International Conference on the Physiology and Acoustics of Singing, The National Center for Voice and Speech, the McIver Lecture in Vocal Pedagogy, and the North Carolina Regional Chapter of the Acoustical Society of America. She is a member of the American Speech-Language-Hearing Association, the Voice Foundation, National Association of Teachers of Singing, the American Academy of Otolaryngology-Head and Neck Surgery, and is a founding member of the Pan-American Vocology Association. Ms. Scearce maintains an active performance career.