Voice Care and Research in Canada The history of our profession’s evolution in the area of voice care and voice science in Canada parallels that of other large countries. The popularity of multidisciplinary and instrumental voice clinics provided Canadians with access to an expanded service model and clinician-researchers with a more accessible technology in the late ... World Beat
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World Beat  |   May 01, 2006
Voice Care and Research in Canada
Author Notes
  • Linda Rammage, is director of the British Columbia Provincial Voice Care Resource Program and a faculty member in the Department of Surgery and the School of Audiology and Speech Sciences at the University of British Columbia, Vancouver, Canada. She became president of the Canadian Association of Speech-Language Pathologists and Audiologists this month. Contact her at Linda.Rammage@vch.ca.
    Linda Rammage, is director of the British Columbia Provincial Voice Care Resource Program and a faculty member in the Department of Surgery and the School of Audiology and Speech Sciences at the University of British Columbia, Vancouver, Canada. She became president of the Canadian Association of Speech-Language Pathologists and Audiologists this month. Contact her at Linda.Rammage@vch.ca.×
Article Information
Speech, Voice & Prosody / World Beat
World Beat   |   May 01, 2006
Voice Care and Research in Canada
The ASHA Leader, May 2006, Vol. 11, 9-30. doi:10.1044/leader.WB4.11062006.9
The ASHA Leader, May 2006, Vol. 11, 9-30. doi:10.1044/leader.WB4.11062006.9
The history of our profession’s evolution in the area of voice care and voice science in Canada parallels that of other large countries. The popularity of multidisciplinary and instrumental voice clinics provided Canadians with access to an expanded service model and clinician-researchers with a more accessible technology in the late 1970s. Subsequently, Canadian voice care and research teams have made substantial contributions to models, theories, and understanding of vocal function and voice disorders.
At the University of Toronto, Tim Bressman directs a multidisciplinary research laboratory that is equipped with instrumentation for 2D and 3D ultrasound imaging, acoustic analysis, intelligibility assessment, electropalatography, nasalance, and airflow measurement.
The Voice Laboratory in Montreal General Hospital, directed by Françoise Chagnon, offers opportunities to investigate aspects of laryngeal dystonia using ultrasound-guided injection of botulinum toxin. Additionally, state-of-the-art equipment allows for optical biopsy of vocal fold lesions using fluorescent spectroscopy, investigation of vocal fold asymmetry using focused low-energy laser patterns, application of informatics to vocal pathology assessment, and acoustic and visual measurement of reinforced harmonic phonation.
At the University of Alberta, and at the University of Western Ontario, Jana Rieger and Philip Doyle (respectively) engage in research that is contributing to our understanding of acoustic, perceptual, and psycho-social impact of treatments for laryngeal cancer.
Over the past three decades, the multidisciplinary team at the University of British Columbia has been investigating multifactorial etiologies and best treatment outcomes for voice problems, in particular muscle misuse voice problems, occupational voice problems, and those associated with irritable larynx syndrome.
The Canadian Voice Care Foundation was founded in 1989 to provide public information and professional education. The “Care of the Professional and Occupational Voice Symposium” attracts international experts and participants on the leading edge of interdisciplinary voice care, vocal research, and education. The next symposium is being held in Banff, Alberta, in August 2006.
Canadian voice care specialists and voice scientists have some unique perspectives and experiences to share:
What is your particular interest in voice/voice disorders?
…At a very basic level, the anatomy and physiology of the vocal mechanism and its relationship to other parts of the speech system have always fascinated me. At a clinical level…clinical intervention makes a usually speedy and directly related change to the problem. From a research perspective… there are a multitude of ways to understand the vocal mechanism and to test hypotheses about it.
Jana Rieger, speech-language pathologist, speech scientist, instructor, University of Alberta
As I come from a background in theatre and singing, voice has been a lifelong interest. In particular I am interested in performance voice, speech/voice in Parkinson’s Disease and speech/voice in transgendered people.
Shelagh Davies, speech-language pathologist, Vancouver, BC
What advantages and/or challenges do you experience that you think are unique to your practice/region/Canada?
We have a rich environment of other voice specialists around us, including an extremely talented group of otolaryngologists, and a group of highly talented individuals involved in the artistic side of voice from the Faculty of Arts. The challenge to practicing in the area of voice is that is seems to have been an area of speech-language pathology that was not considered a high priority by decision makers, and so has been under-funded.
Jana Rieger, University of Alberta
Owing to its bilingual workforce, Moncton has more than its share of call centers and my voice practice at the Moncton Hospital has more than its share of call-center employees. On assessment, many of these patients exhibit severe dysphonia, presumably the result of extensive voice use. Curiously, most do not show laryngeal pathology on ENT examination. Most also achieve normal voice during the first session of voice therapy, suggesting a functional dysphonia, rather than one secondary to anatomic, neurologic, or organic conditions. Patients describe high levels of stress associated with their jobs and dream of alternate employment. These patients have reminded me to look beyond the obvious. Not all patients with dysphonia and extensive voice use show patterns of typical hyperfunction. Even if it talks like a duck, it may not be a duck.
Linda Walsh, speech-language pathologist, Moncton, New Brunswick
Do you have any specific techniques or practice approaches that you consider unique to your region/Canada?
I have made it a personal goal to promote improvements in classroom acoustics and amplifications for many years now…and we are really finally starting to see the results. It was one classroom at a time-then one series of grades at a time to finally one entire school at a time-and we are on a roll.
Andre Lafargue, audiologist, Fredericton, New Brunswick
I have developed my own therapy protocol for male to female transgendered people and, along with colleagues, modified an existing protocol for people with Parkinson’s.
Shelagh Davies, Vancouver, British Columbia
Describe your approach to teaching voice science/disorders.
I offer my speech-language pathology students an opportunity to see many people with different vocal communication problems simultaneously with their study of normal and abnormal physiological processes. We use a problem-based approach to learning: that is, we apply current theory, logic, and literature searches to discover the best way(s) to describe clinical problems from a multi-systems perspective, to test clinical hypotheses, and to propose and test best treatment approaches. This gives them an appreciation of the problem-solving nature of the informed clinical experience.
Linda Rammage, speech-language pathologist and instructor, University of British Columbia
I strongly believe that both theoretical knowledge and experiential learning are important in the development of clinical and research skills. I am fortunate in having an association with the Nova Scotia Hearing & Speech Centres, where I continue to have a clinical practice and access to other clinicians who specialize in the area of voice disorders. I try to share my knowledge and experience with my students as much as possible. I have incorporated a variety of practical experiences and assignments into the course curriculum.
Cindy Dobbelsteyn, speech-language pathologist and instructor, Dalhousie University
Interdisciplinary Voice Clinics, Agencies, and Research Centers in Canada

Canadian Voice Care Foundation, Calgary, Alberta: www.canadianvoicecarefdn.com

Children’s and Women’s Health Centre of BC, Vancouver, British Columbia: www.cw.bc.ca

Dalhousie University School of Human Communication Disorders, Halifax, Nova Scotia: www.humancommunicationdisorders.healthprofessions.dal.ca

Glenrose Rehabilitation Hospital and University of Alberta Hospital, Edmonton, Alberta: www.capitalhealth.ca/HospitalsandHealthFacilities/Hospitals/GlenroseRehabilitationHospital/default.htm

Health Sciences Centre, Winnipeg, Manitoba: www.hsc.mb.ca

London Health Sciences Centre, Victoria Hospital, London, Ontario: www.schulich.uwo.ca/ent/

McGill University Department of Communication Sciences and Disorders, Montreal, Quebec: www.mcgill.ca/scsd

Moncton Hospital, Moncton, New Brunswick: www.serha.ca/moncton_hospital/default.htm

Montreal Children’s Hospital, Montreal, Quebec: www.muhc-telecom.mcgill.ca

Montreal General Hospital, Montreal, Quebec: http://www.mcgill.ca/ent/research/

Nova Scotia Hearing and Speech Centres, QE Health Sciences Centre-Dickson Site, Halifax, Nova Scotia: http://www.cdha.nshealth.ca/default.aspx?Page=75&category.Categories.1=98&centerContent.Id.0=8486

Pacific Voice Clinic-Provincial Voice Care Resource Program, Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia. www.pvcrp.com

Rockyview General Hospital, Calgary, Alberta: http://www.albertahealthservices.ca/2572.htm

St. Clare’s Mercy Hospital, St. John’s Newfoundland: www.easternhealth.ca/AboutEH.aspx?d=2&id=119&p=75

St. Michael’s Hospital, Toronto, Ontario: www.stmichaelshospital.com

University of Alberta Department of Speech-Language Pathology, Edmonton, Alberta: www.uofaweb.ualberta.ca/rehabmed/SPAStaff.cfm

University of Toronto Department of Speech-Language Pathology Voice and Resonance Laboratory, Toronto, Ontario: www.slp.utoronto.ca

University of Western Ontario School of Communicative Disorders, London, Ontario: http://www.uwo.ca/fhs/csd/

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May 2006
Volume 11, Issue 6