Singing Voice Evaluation & Rehabilitation: Top 5 Tips for SLPs

What do you do when a singer shows up on your clinical schedule? Panic and run for the hills?

When you know you have the skills to complete a voice evaluation, you can stay solidly in place and, depending on your training, treat your client or refer them to an SLP colleague who specializes in singing voice rehabilitation. Either way, these tips and recommendations will help guide you.

1. Take a thorough history.

Don’t forget your basics. When learning the singer’s story, ask questions related to onset and duration:

  • Have they had a problem with their voice in the past?
  • What type of music do they sing?
  • What is their voice part?
  • In what type of setting do they sing?
  • What is their daily vocal demand?

Break your evaluation down into speaking and singing complaints and demands. Just because your client is a singer doesn’t mean the problem is always the result of singing. Put on your detective hat and get to the bottom of it!

Voice Curriculum

2. Understand the role of voice rest.

For speakers, we often say, “Too much, too loud, and too often” gets people into vocal trouble. But for singers, we modify this statement slightly and instead say, “Too much, too loud, too often, and too high.” High-pitched voice use results in increased vocal fold vibratory cycles per second, which means more opportunities for vocal fold impact. Your clients may then ask about voice rest.

Voice rest may be indicated for an acute injury, like a vocal fold hemorrhage, or immediately following surgery. Otherwise, voice rest is like a crash diet—if a person stops eating, they will lose weight, but when they begin eating again, they will gain the weight back unless their eating patterns have changed. Likewise, if someone stops talking, the voice complaint may improve. But if new voice use patterns are not established, the same voice problem will likely re-occur. The key is to teach your clients voice management strategies like balancing vocal on-and-off time and varying vocal choices related to pitch and intensity.

3. Set expectations: Singing voice therapy is not a voice lesson.

A singer’s voice therapy may address either the speaking or singing voice (and sometimes both). Singing voice rehabilitation should specifically be provided by an SLP with specialized training in voice and, more specifically, specialized training in singing voice and vocal pedagogy.

The goal of singing voice therapy is to rehabilitate the voice to pre-injury baseline and help resolve your client’s complaints in the context of the medical diagnosis. The diagnosis will help guide therapy goal development, therapeutic decision making, and expectations for therapy outcomes.

Voice therapy is physiologically based and informed by motor learning principles and voice science. After completing voice therapy, the singer may view vocal decision-making and production through a different lens. Hopefully, your client will gain the skill to interpret voice instructions from a teacher or other vocal directors in a way that they can apply to their own specific voice.

4. Create a point of reference.

As clinicians, we want to help our clients create a point of reference while practicing voice exercises and then apply the learned voice therapy techniques throughout the day. We can establish this point of reference by helping clients connect with the goal of an exercise during each repetition.

When teaching clients to identify a point of reference, guide them through these steps:

  • Complete a body scan.
  • See how your client feels and what their body needs, related to voice. Does their throat feel tight? Is their voice focused in their throat or in their mouth? Is their body feeling low energy? Is their breathing shallow?
  • Based on your assessment and your client’s input, choose an exercise and practice it. Throughout this practice, each of you can observe differences before, during, and after practice. This is the point of reference.
  • Guide your patient to check in with this point of reference multiple times per day when they practice their exercises, speak, and sing.

5. Don’t forget to cool down!

Evidence suggests that regular, low-impact vocal fold vibration may help reduce vocal fold inflammation.1 Advise your singers (and voice users in general) to implement a vocal cool-down after periods of high vocal demand. This may be after a rehearsal, performance, meeting, or interview—or even after dinner with friends. Getting in the habit of a vocal cool-down is important for singers; just because the performance is over doesn’t mean they are done!

The next time a singer walks into your office, take a deep breath and turn to these tips to help you through. To learn more about evaluating and treating singers, check out the following MedBridge courses:

  1. Verdolini Abbott, K., Li, N. Y. K., Branski, R. C., Rosen, C. A., Grillo, E., Steinhauer, K., & Hebda, P. A., (2012). Vocal exercise may attenuate acute vocal fold inflammation. Journal of Voice, 26(6): 814.e1–814.e13.