SINGERS, VOICE PEDAGOGUES, AND CHORAL CONDUCTORS of all ages have experienced vocal abuse and damage due to the constant teaching and use of their voices during the day. Increasingly prevalent, however, are singers who have suffered some sort of brain injury, damage, or stroke. Some injuries and their rehabilitation have been investigated scientifically and reported in periodicals such as the Journal of Voice. This article, however, is written not from the point of view of a medical professional or speech-language pathologist (SLP), but as one who has had a stroke, and has had to design vocal rehabilitation largely for himself, outside the scope of physical, occupational, and speech therapy, and without benefit of an otolaryngologist.
It has been over twelve years since I had a stroke. Fortunately, it was relatively mild, and nearly all my vocal facility has been regained. Several years ago I wrote an article for the Choral Journal on "One-Handed Choral Conducting," but that seemed easy by comparison.1 Recovery has not been easy nor without frustration. Further, the process has had manifold effects on my work as a singer and pedagogue.
BRIEF DESCRIPTION OF STROKE
Cerebrovascular accident or brain attack-these are often used to describe a stroke. Briefly stated, blood clots in the brain, or a vessel that weakens or breaks, causes blood loss to that area which can destroy vital nerves controlling other parts of the body. Mine, an ischemic attack, which is blood starvation from a clot blockage, affected a two-centimeter area in the left brain, just above the basal ganglia, and resulted in numbness on the right side. Over twelve years much function has been regained, save my right hand's fine motor skills. At the outset, there was also some vocal fold paresis (slight weakening of one side of the vocal folds). As a singer and voice teacher, this was most frustrating and required the most attention and creativity in developing my own methods of rehabilitation, both in speaking (with the assistance of a SLP),2 and singing (developed mostly on my own, from traditional vocalises with the aid of a sensitive singing teacher).3
There are different gradations and types of cerebrovascular and other brain diseases. My problem might not be the same as that of another individual, nor of someone with a stroke or injury affecting another part of the brain, because each case is unique. Traditional therapy deals with larger motor skills, and a few fine motor and speech skills, but does little with the singing voice, especially considering financial coverage limitations of health insurance carriers in the United States, which often pay only for what is needed to return a person to basic functioning skills. Singing therapy is available mainly to those who live in or near large population centers with a base of well trained specialists in voice therapy. My rehabilitation as a singer had to be self-designed because of my health insurance at the time-an individual policy from a major insurer, which would pay only for returning me to society as a functional speaker. It would not cover the cost of rehabilitating my singing voice, even though this was my wage-earning profession.
PERSONAL HISTORY AND RECOVERY
My stroke happened during the night of June 27, 1998. Waking in the morning, I gradually became aware that I had difficulty signing my name throughout the day, and felt exhausted. I checked myself into the emergency room, where I was hospitalized for five days, having CAT scans, MRIs, and heart blockage tests. The MRI showed a two-centimeter ischemic attack near the basal ganglia on the left side of the brain, near the center.4
Following my stay at a regular hospital, I was transferred to a rehabilitation hospital, where I spent another seven intensive days, and continued outpatient therapy for another three months, being discharged in late September. In the regular hospital, I became aware of numbness in my right hand, arm, and leg, and some sluggishness of speech, droopiness of the right side of my mouth (later, when more cognizant, some slight vocal fold paresis), and slightly later, some difficulty in singing. …