Tip Top Timbre: When it comes to treating celebrities, the hardest part is slowing them down

doi:10.1044/leader.FTR1.18032013.42

Features | March 01, 2013

Tip Top TimbreWhen it comes to treating celebrities, the hardest part is slowing them down

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The ASHA Leader, March 2013, Vol. 18, 42-47. doi:10.1044/leader.FTR1.18032013.42

Be it in Hollywood, on Broadway or on tour, our best-known actors and singers need that major vocational asset—their voice—to be in top working order. Because when voices give out, bookings get dropped, gigs scrapped and tours canceled.

Enter speech-language pathologists specializing in voice disorders. They help get these celebrities back on the job by working with them on voice reconditioning and behavioral techniques, and on post-surgical rehabilitation. Getting these driven performers to just stop and give their voices much-needed rest can be the biggest challenge of all.

Here we meet three of these SLPs: one keeping Spartacus in fighting shape, one helping Broadway singers fill theaters with song, and one enabling artists like Adele and Steven Tyler to keep cranking out hits.

Poems for Kirk

Betty McMicken has a special talent for helping others— most recently one of Hollywood's most famous actors— express themselves.

By Matthew Cutter

It's 6:30 a.m. in Los Angeles, and speech-language pathologist Betty McMicken has a long day ahead of her. After a few hours of volunteering at the Anne Douglas Center for Women, where she works each week with women who are homeless, McMicken still has clients to see and classes to teach.

"I will see Kirk from 10:30 to 11:30 this morning," she says, "then I have another gentleman that Kirk referred me to, a director who has a severe apraxia, and I will see him for an hour. Then I go to school at Cal State Long Beach, I have office hours, and then I teach tonight from 4 to 6:45."

"Kirk" is none other than actor Kirk Douglas, with whom McMicken has worked since 2007. Douglas had received speech-language treatment since suffering a stroke in 1996, but never stopped giving interviews whenever he was asked. So how did McMicken become a Hollywood star's SLP?

She met Douglas at a Christmas party in 2006, where they talked all evening. "After that, we seemed to run into each other at many of the functions I was involved in," McMicken says. "I'm an ambassador for the Center Theater Group of Los Angeles, and [Kirk and Anne] support the Performing Arts Center. So, I would see them there, and of course always reintroduce myself. Many of the social events that I attended in Los Angeles, they would be there. So, within about three months, Anne said to me, 'Kirk's therapist that he's had for a number of years has taken another job. Would you be interested in helping him?' And of course I was. So that was it."

Douglas had a good reason to continue his treatment: He intended to write and perform a one-man play, and wanted McMicken's help. "At the time," she recalls, "I thought, 'Oh, my ... I don't know.' He had what I would consider a moderate dysarthria of many years' standing, and had been assisted by many SLPs. I just didn't know what else I could offer."

Typical interventions for a client with dysarthria would be a combination of strengthening articulators, applying elements of the Lee Silverman Voice Treatment® program, and emphasizing endurance during speech. But all of these elements had been a part of Douglas' previous treatment. McMicken needed to come up with something new that would hold his interest.

And McMicken is nothing if not determined, a trait she also sees in Douglas. She contacted a friend who'd worked at the Mayo Clinic for years, Arnold Aronson, and sent him tapes of Douglas speaking. "Arnie was able to really help me technically in some things that he would do to help [Douglas]."

Aronson suggested weaving LSVT and lyrics from songs of Kirk's era into McMicken's poetry, with an emphasis on humor. Aronson commented on the meter, breath phrasing and multisyllabic difficulty within the pentameter of McMicken's verse. He also urged McMicken to make each session as close to "performance" as possible. Ultimately, it was poetry and performance that would give McMicken and Douglas common ground.

"The first day I saw Kirk," McMicken says, "he read me a poem that he had written about his son Eric, who had recently passed away. I was so taken with his poetry that I shared a poem of mine. And we kind of clicked. Ever since then, I have used poetry as the basis of my therapy. I fax him one to two poems a day. They have a combination of humor and multisyllabic, challenging words."

They worked on "Before I Forget," Douglas' play about his life, family, work and philosophy, for a year and a half. They revised and re-revised, altered the phrasing, and added bits of poetry and verse to find a rhythm Douglas could catch and sustain for the show's 80 minutes. The process culminated in four sold-out shows at the Kirk Douglas Theater in Culver City, Calif., in 2009. "[Kirk] was just ... extremely excellent," says McMicken with a laugh. "He was at his best. He did the impossible.

He was 92 when he did it. It was really miraculous." He was, as McMicken and Douglas often say, "performance perfect."

"I sent all my students, people from the L.A. Mission, anyone who would gain from this extraordinary performance, who would be inspired," McMicken says. "And to this day, people still talk about it. So that was a highlight of my time with him."

Douglas has continued to do interviews and speeches, recently presenting the Kirk Douglas Award to Robert De Niro at the 2012 Santa Barbara Film Festival.

McMicken credits neuroplasticity for a modicum of Douglas' speech achievements, and his wife Anne for her constancy and unflagging support, but adds that the other 95 percent is sheer willpower—"endless motivation."

But the same is true of McMicken, in continuous practice since 1966. It's difficult to believe someone so busy and devoted to her work—traveling 800 miles per week to volunteer at the Anne Douglas Center, conduct research, provide treatment and teach classes—is 70 years old and only five weeks post-surgery for renal cell carcinoma. Although surgeons removed one cancer-ridden kidney in December 2012, it hasn't dimmed her enthusiasm.

"I'm filled with gratitude," she says.

"My day is a long one, but it is filled with gratitude for the endless opportunities in my life."

Matthew Cutter is a writer and editor for The ASHA Leader.

mcutter@asha.org

Betty McMicken, PhD, CCC-SLP, is associate professor in the Department of Communicative Disorders at California State University Long Beach.

betty.mcmicken@csulb.edu

Healing the Hitmakers

When strain threatens pop singers' most valuable asset, this SLP helps get them back in the studio.

By Bridget Murray Law

The voice is a singer's irreplaceable instrument. So when it falters, it can deal a devastating blow. And the stakes are especially high for celebrity singers because their livelihood, and that of a litany of other performers and music industry jockeys, depends on their voice health.

Speech-language pathologist Tara Stadelman-Cohen can attest to this. In her role as a voice pathologist and singing voice specialist, she works regularly with high-profile singers who have voice troubles—many of them operated on by Steven Zeitels, laryngologist and voice surgeon to the stars at Massachusetts General Hospital's Center for Laryngeal Surgery and Voice Rehabilitation.

As part of the center's medical team—whose clients have included Julie Andrews, Adele, Steven Tyler and Lionel Ritchie—a large part of Stadelman-Cohen's job is getting performers to slow down and give their voices some much-needed care.

"You hope the person can take time out to work with you ... because if you keep walking on a sprained ankle, it can fundamentally alter its structure and lead to more injury, and it's the same with an injured voice," she explains. "When singers get to elite levels, they often have higher expectations for recovery. But, your approach is similar for any patient: Assess what's problematic and strive to improve efficiency."

Treatment of these patients doesn't always involve surgery. In fact, more than half of Stadelman-Cohen's clients don't have surgery and receive strictly behavioral treatment, such as targeting laryngeal tension. But 20 to 30 percent of her work is post-surgical rehabilitation. And when the post-surgical client is an advanced or elite professional singer, as with 10 to 20 percent of her caseload, the job can be especially challenging.

In one recent case, a top-billed celebrity noticed vocal instability and reduced range while rehearsing for an upcoming performance. His personal physician sent him to Zeitels, who found that the singer had a polyp and hemorrhaged vocal fold and required surgery. Zeitels told the artist to stop performing immediately, so he had to cancel a performance that was just two days away. The voice center treatment team put the singer on strict voice rest for a week before surgery—to allow the blood to reabsorb—and three weeks afterward. When Stadelman-Cohen saw him three weeks post-surgery, he was ready to dive back into singing.

"Professional singers often don't have much time. They need to return to the recording studio or get back to their performing responsibilities," she says. "But if you resume large vocal activity too quickly, you may increase the risk for additional injury. A lot of what I do is provide education and the tools for reconditioning."

In this case, she refocused the singer on a more methodical, step-by-step approach.

"We set manageable expectations for his voice use, taking into account speaking demands, and eliminated his expectation to sing right away for an hour," she says. "We started with reducing residual muscle tension and then varied task complexity and length of practice to target strength and stamina of voicing."

After four sessions with Stadelman-Cohen, the singer headed back to the studio for some light work. Seven weeks after his surgery, he had ramped up to a full load. He has since released a CD and returned to an international tour.

"He's done very well, which is very rewarding for me," says Stadelman-Cohen. "But then I also feel rewarded when a high school student or college student does well after treatment. I think that's why most of us become SLPs in the first place—because we want to make a difference."

Bridget Murray Law is managing editor of The ASHA Leader.

bmlaw@asha.org

Tara Stadelman-Cohen, MS, CCC-SLP, is senior speech pathologist and singing voice specialist at the Center for Laryngeal Surgery and Voice Rehabilitation at the Massachusetts General Hospital.

tstadelmancohen@partners.org

Belting It Out on Broadway

SLP brings both his voice and his voice treatment techniques to the New York City www.

By Kellie Rowden-Racette

When Tom Burke was 14 years old, growing up in Cliffside Park, N.J., he wanted to learn how to sing. But his parents thought voice lessons were a waste of money. Not the kind of kid who took no for an answer, he found a local voice teacher and worked out a barter system. He was an accomplished piano player, so he agreed to play for her students for five hours a week in exchange for one weekly lesson.

"All I had to convince my parents was to drive me there," he says, laughing at his precocious entrepreneurial spirit.

Today Burke lives in Manhattan and still auditions and performs, but also has another entrepreneurial focus. As a speech-language pathologist, he trains and treats the voices of corporate leaders as well as actors and singers performing on Broadway, some from such well-known shows as "Newsies," "Rock of Ages" and "Spiderman," among others. His private practice, Thomas

Burke Voice Studio, began in 2002 with only 30 people on his e-mail list. Today he has almost 1,200 clients.

"It's been growing pretty steadily," he says. "My intention was for it to grow on the side while I nurtured my own Broadway career, but it took off earlier than expected. It was actually pretty surprising."

Although a performer at heart, Burke knew that he wanted to be an SLP. When he was in a performing arts center in high school, his voice teacher, Anna Freund, not only taught him how to increase his range, but also modeled for him a way to balance his artistry with a way to make a living.

"Most SLPs who do what I do are singers and actors first and then go back to school for speech-language pathology in their 30s or 40s," Burke says. "I went for the profession right away because I saw early on how I could still be an artist and have an allied health career. My private practice is based on Anna's business model, and basically from the time I was in high school I kind of wanted to be Anna Freund."

Although he never really changed identities (after all, he is still Tom Burke), he found a way to combine the two professions successfully. About a third of his clientele want help making their voices more versatile for a variety of musical styles, he says. Another third are already in a show and are trying to transition out of a show or have a voice injury. His clients, he says, really benefit from his professional knowledge.

"Many of my clients are singing and performing in eight or more shows a week and they oftentimes are exhausted, have muscle fatigue, are performing through illnesses, and go at this nonstop pace," he says. "It's a perfect storm that converges and creates injuries."

Many of the exercises he uses are what other SLPs use in voice rehabilitation, but he is rehabilitating not only for speech, but also to withstand an often brutal performance schedule. In an attempt to help prevent injuries, he shows his voice-lesson clients—those who aren't injured and are usually auditioning for parts—techniques that could protect them from future injuries. For example, for warm-ups he uses trills and forward-focus exercises that go beyond typical two-octave ranges and will span two and a half or even three octaves. And, if these same clients should become injured, he says, they often recognize the rehabilitative exercises from their previous voice lessons.

"I have to acclimate people to this slowly—the thing is that performers don't usually come to me to prevent problems, but only when they have the problem," he says. "I have to remember that we're all going at this crazy New York pace, balancing lots of gigs, staying out late, eating dinner at 10 at night. I'm guilty of it, too. But I try to be a model for them in a way that's real and I think that gives me credibility with them."

Kellie Rowden-Racette is print and online writer and editor for The ASHA Leader.

krowden-racette@asha.org

Thomas Burke, MS, CCC-SLP, is the owner of Thomas Burke Voice Studio in New York City.

tom@tomburkevoicestudio.com

Two Poems for Kirk

Here are a few of the many poems Betty McMicken has written for Kirk Douglas to perform as part of his speech therapy.

Shipwreck

Kirk, something's been found that is older than you!
In the deep waters, the cobalt blue
Off Italy's rugged coast
Yes, French divers discovered the ancient wreck
After someone gave them a very big check
To basically search out a myth
You know:
A legend, fable, fairytale, allegory, parable
And if a moral was involved in this centuries old log
It would be called an apologue
Whatever
A 2,000-year-old ship's been found
Buried so deep in mud-packed ground
That it's perfectly preserved
In fact, it has been observed
To contain 200 clay amphora
It was sailing during the diaspora
When Jews were exiled to Babylonia

This Roman-era commercial vessel
Obviously snapped its well laid trestle
On way to Italy's shore
It was laden with goods, specific for trade
Researchers can tell the amphora were made
In a western Egypt or perhaps Spain
Ah but, they cannot explain
What brought on her demise
There's a plan to raise her, and if she should rise
Trade history of the time will surely revise
Perhaps your ancestors, the ones that weren't wise
Left Babylonia, headed for Estonia
You could boast, they washed up on Italy's coast

Halloween Poem

Kirk, will you please dress up for me?
Then grab a guitar in the key of G
Sing a song, most distinctively
About tonight, sneakily
Keep the tenor, deviously
Scary like Halloween
Cause all grown-ups, past their teens
Can create a scene, with verboten verse

Tell tales of things
That go bump in the night
Paint a picture of a creepy sight
Evoke an eerie, hair-raising sound
Like a dog who howls to be free from the pound
Like the wind as it whips and rips a curtain
You can be certain
Your audience will see things not there
They will visualize goblins everywhere
You might even take the dare
To stick your hand in a gooey glob
Or grab a slimy, slippery door knob
To enter a haunted house
There to find your costume is doused
By a water pail over the door
That's enough, I bet you want no more
Time to go to bed

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