An Interview: Marci Daniels Rosenberg, M.S., CCC-SLP
The new series of interviews I’ve posted here have thus far been with individuals involved in manual therapy from the massage/fitness end of the spectrum. For this interview, I wanted to branch into the other world I interact with; that of the voice and swallowing-related dysfunction. I’ve been teaching myofascial release since 1995, first assisting other nationally known teacher, and since 2006 on my own through my Foundations in Myofascial Release Seminars. In 2013 added a class titled, “Foundations in Myofascial Release Seminar for Neck, Voice, and Swallowing Disorders”, which adds a layer of manual care into the evaluation and treatment repertoire of the speech-language pathologist (SLP) and voice professionals (VP). The focus of this interview is to explore how the worlds of the SLP/VP and manual therapist can overlap.
Marci Daniels Rosenberg BM, MS, CCC-SLP, is a singer, voice teacher, and a licensed speech-language pathologist/research investigator at the Vocal Health Center in the Department of Otolaryngology at the University of Michigan Health System. As a voice and singing specialist, she works clinically to rehabilitate injured voices, with specific expertise in the musical theatre and contemporary vocal styles. She has an extensive musical theatre performance background. After completing her Bachelor of Music in classical vocal performance (Peabody Conservatory) and a Bachelor of Science in speech pathology, Ms. Rosenberg was a research fellow in the Voice and Speech Lab at the National Institute on Deafness and Other Communication Disorders before finishing her Master’s degree in speech language pathology. A nationally recognized singing voice specialist, Marci actively teaches workshops and lectures on vocal health, performance voice, managing vocal injuries, and application of kinesiology and exercise physiology principles to voice training. She co-chaired the inaugural “International Voice Conference-Multidisciplinary Rehabilitation of the Performance Voice” in 2010. She has served on the faculty for Somatic Voicework ™ the LoVetri method at the Contemporary Commercial Music Institute at Shenandoah Conservatory. Currently, she is a featured guest teacher at The New CCM Vocal Pedagogy Institute at Shenandoah. She is co-author of the popular, internationally recognized singing science textbook The Vocal Athlete Technique for the Hybrid Singer (Plural Publishing, 2014). Marci is an inaugural member of the Pan American Vocology Association (PAVA). In addition to her clinical activities, Ms. Rosenberg continues to perform locally and maintains a private voice-consulting studio in the Ann Arbor area.
I met Marci earlier this year at a class I taught at the Chicago Institute for Voice Care at the University of IL-Chicago.
Walt: Thanks for agreeing to be a part of my interview series. The readers of this blog consist of, in part, therapist/professionals, as well as the general public with an interest in (my version of) myofascial release/manual therapy. My approach is attempting to move the narrative into more scientifically and biologically plausible models of explanation. More SLPs and VPs seem to be taking notice of the potential role of manual therapy in the care of their patients/clients, though I am not certain that this is an entirely new phenomenon. Can you comment on how manual therapy enters into your practice?
Marci: I was first introduced to manual therapy through Dr. Nelson Roy in 2000. I was a very new clinician and saw a need for something beyond some of the traditional voice therapy techniques I was using. Dr. Roy taught a seminar on laryngeal massage and this revolutionized how I was practicing clinically. Over the years, I have added to my manual therapy skill set with various workshops. Another significant workshop was taught by Marina Gilman, speech pathologist and Feldenkrais ™ teacher. I knew that many of our voice patients require bodywork well beyond the neck and larynx and I was seeking to expand my competency with manual therapy. I attended a myofascial seminar for speech pathologists many years ago in Dayton hosted by Dr. Wendy LeBorgne. At this seminar, taught by an occupational therapist, we learned numerous techniques addressing the whole body. I have used many of these techniques regularly in my clinic, and I do not hesitate to refer out when I feel the patient needs something beyond my scope of competence. As I have evolved clinically over the past 15 years, I no longer do laryngeal manipulation of all my patients; rather I tailor a manual therapy program as an adjuvant therapy to other voice therapy techniques. The seminar you taught in Chicago specifically for speech pathologists added yet another dimension to my clinical practice. I work quite a lot on tongue, hyoid area and jaw and these areas were nicely covered in your seminar. I am not at all surprised that you have found such a niche in the speech pathology field.
Walt: As a solo-practitioner, my direct interdisciplinary days are behind me, though I get a fair share of referrals from SLPs and ENTs. I also see many voice and related dysfunction as secondary aspects of the primary referral. For instance, many patients with cervical pain have secondary vocal changes or swallowing disturbances, which is actually how my interest in this work started. Have you had much exposure to interdisciplinary treatment, in terms of manual therapy approaches? If so, what other professions make up that team?
Marci: Great question. I am part of a multidisciplinary team, which consists of myself (an SLP with a singing degree/background), a laryngologist and a voice professor. In a perfect world, we would also have a manual therapist under the same roof. As I indicated above, I often refer out to a local occupational therapist with specific training in myofascial release. There is no question that many things can impact voice. Often a culprit for a voice issue can be hiding elsewhere in the body. I have found in many complex cases the combined approach of having patients working with the OT in additional to me results in longer lasting, better-integrated changes.
Walt: In terms of voice, I see manual therapy engagement having the potential to improve awareness of vocal dysfunction, which in turn can allow for the option of change. I was tempted to preface that sentence with, “At a minimum”, but in reality, creating/allowing awareness may be sufficient for change to happen. I feel that improving awareness, in a contextually meaningful way, may be the primary reason why our work works. There may also be neurological and tissue-specific changes that occur with manual therapy, each on a continuum of probability. Can you comment on these thoughts?
Marci: When I am teaching workshops, I often use the analogy of the mental rolodex (unfortunately, the younger generation doesn’t know what a rolodex is!). Meaning, we have a mental representation for everything we do. The more we engage in an activity, the more we establish a firm reference for it. This goes for both efficient movements and inefficient movements and is very applicable to voice training. When I work with patients, one of the first things I discuss is that many of the exercises and techniques we are doing are establishing a dialogue with the nervous system. We want to reorganize the rolodex and add some index cards with updated information. The way we set up a lesson and structure a task can either hinder or facilitate motor learning of that new skill. Much of the work is done at rest simply noticing and observing change. This is when the nervous system is “taking notes”. Much of my voice therapy sessions and voice lessons are dedicated to “pause and observe” so that the rolodex can reorganize bringing the most efficient index cards to the front burying the inefficient cards in the back. With manual therapies, the pre and post intervention self-observation is important because we are laying hands on. Sometimes the note taking is not conscious and the observations are very subtle but the brain knows. This to me is the key to successful motor learning. We must set up lessons to facilitate learning and awareness of new, more efficient movement pattern rather than diligently perfecting errors.
Walt: In my seminar, I mention my beliefs of the overall similarity between manual circumlaryngeal treatment/massage and a gentle, sustained myofascial release/manual therapy intervention to the overall laryngeal area, at least in terms of effect. While the process/intervention is quite different, at least as its described, do you see overlap? (We can omit this section if you do not have much comment/experience with circumlaryngeal treatment)
Marci: I have been doing manual circumlaryngeal massage for 15 years and I have evolved how I approach this. Initially I viewed it simply as a muscular readjustment and release. Now, I view it more holistically as reminding the structure of a more efficient organization. As a result, a release happens, the patient is fully aware of the changes and hopefully the mental rolodex I mentioned above has reorganized.
Walt: As you recently witnessed, my seminar presentation is often difficult to grasp for many, as they are seeking not only evidence, but also firmly stated beliefs in exactly what is primarily being effected/altered, in terms of a manual therapy approach. Evidence is crucial to justify our work, but the second aspect is a tough one for me. Being a long-time student of manual therapy of all sorts, I am amused at the dozens of tissue-specific targets and effects people claim, as how can so many different things be happening under the skin? I believe in presenting the continuum of possibilities as to what is happening to cause change, but allowing for uncertainty, as there is no real certainty, which makes many people very uncomfortable. How did you view this approach? How does it jive with what you had learned about manual therapeutic effects?
Marci: As a clinician who is accountable to insurance companies I am sensitive to the need for objective data to document change and justify billing. Unfortunately, what insurance companies require and what patients need don’t always align and this is a continual challenge for those of use in a clinical setting. That aside, to answer your question, I refer again to my above thought process about the mental rolodex and a more holistic approach to voice training and voice therapy. Voice production is such a complex process that we couldn’t possibly know exactly what internal changes are happening. The best “data” for me is the patients report of how things are evolving and improving, their ability to find and execute better voice production without guidance or coaching from me, and finally the carryover into their day to day vocal existence. This is how I measure success.
Walt: I must now selfishly ask, have you had a chance to try any of the work we covered in the recent seminar?
Marci: Indeed, I have. The techniques have been very helpful and I have received positive feedback from patients.
Walt: Tell us in more detail about your work and the book that you co-wrote with Wendy LeBorge? And us about the seminars you teach?
Marci: The Vocal Athlete and the companion book The Vocal Athlete: Application and Technique for the Hybrid Singer are written and designed to bridge the gap between the art of contemporary commercial music (CCM) singing and the science behind voice production in this ever-growing popular vocal style. This book is a must have for the speech pathologist, singing voice specialist, and vocal pedagogue. Heavily referenced, this text is ripe with current research on singing science as it relates to the CCM voice.
In addition to general singing science, The Vocal Athlete is the first book of its kind to address the unique vocal and physiologic demands of commercial singing from a sound scientific and pedagogical standpoint. Historical review of classical vocal pedagogy is interwoven and transitioned to current pedagogy of CCM. Anyone who trains singers will gain insight into the current research and trends regarding the commercial music artist. Specifically, promotion and maintenance vocal wellness unique to the high demands of the CCM artist are provided for career longevity. Readers are provided additional resources on the multidisciplinary roles relative to managing vocal injury for this high-risk group of singers.
The Vocal Athlete distinguishes itself from other pedagogy texts by incorporating current peer reviewed literature in the area of CCM and its studio application. Also unique to this text are chapters on body alignment, traditional and holistic medicine, the lifecycle of the voice, and the physiology of belting.
The companion book The Vocal Athlete: Application and Technique for the Hybrid Singer is a practical array of vocal exercises and techniques described by experienced CCM vocal pedagogues. This book comes with a CD of the singing exercises to further enhance understanding of techniques and skills used in training these singers. (Learn more about The Vocal Athlete: Application and Technique for the Hybrid Singer).
These books are invaluable tools for anyone who uses or trains the singing voice.
More information can be found at Plural Publishing:
https://www.pluralpublishing.com/publication_voath.htm
Walt: Any current or future projects you wish to share?
Marci: Wendy and I are guest faculty at The New CCM Summer Pedagogy Institute this July 15-23. This is a fantastic intensive interactive workshop that covers all things pedagogy. We cover many aspects of The Vocal Athlete textbook. Additionally, there are many voice experts this summer including voice professor and artistic director Matt Edwards (So You Want to Sing Rock and Roll) and Keynote speaker Dr. Robert Sataloff . ASHA CEU’s are offered. Registration is online. For more details: https://www.ccminstitute.com/
Later this summer: OUT OF THE VOICE BOX: Kinesiology and Motor Learning in the Voice Studio…EXPANDED (for Teachers)!
REGISTER (Early Bird before 6/25: $375) HERE: https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=WMS3TV7V6QYR6
Robert Sussuma MMus., Guild Certified Feldenkrais Practitioner
Marci Rosenberg, BM, MS, CCC-Speech Pathologist/Voice & Singing Specialist
This unique 4-Day workshop delves well beyond traditional vocal pedagogy practices combining numerous exercise physiology, Feldenkrais, and motor learning principles into an experiential format to fully explore and actually experience how to train the voice. Interwoven throughout the workshop of are a series of experiential Feldenkrais-based Awareness Through Movement lessons along with science-based, interactive lectures on vocal wellness and fitness including prevention of vocal fatigue, introduction to motor learning and exercise physiology principles including the biomechanics of vocal production and belting. Additional studio tools will be introduced and explored including variations of semi-occluded vocal tract exercises and hands-on techniques for releasing the tongue and jaw.
This new, expanded curriculum will include hands-on learning and teaching practice in a group setting allowing participants to explore and try out these concepts in a “teaching” masterclass format. There will be specific emphasis on application of motor learning principals while teaching to promote internalization of new motor patterns for voice. Participants will emerge with a firm understanding of theory and application for the concepts introduced and explored providing them with an accessible “vocal roadmap” to successfully guide both themselves and their voice students with effective teaching to reach their full singing potential regardless of vocal style.
Walt: Thanks so much for taking the time to talk and share.
Marci: My pleasure. Always happy to talk shop! Thank you for continuing to bring manual therapy into the field of speech pathology.
For now,
Walt Fritz, PT
Foundations in Myofascial Release Seminars
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