A Singer Diagnosed With Benign Essential Tremor, One Case

 

Teresa is a vital voice teacher and singer with a full private voice studio in Pennsylvania. At age 60, she restarted her own voice lessons after not studying singing since college, although she had coached and worked with many  musicians during that time.

Throughout menopause, creativity can bloom and demands new energy outlets. Teresa wanted to earn recognition as a performer of classical and musical theater music in her community and felt she had not been able to do that because of her vocal condition.

Her speaking was absolutely fine, even with teaching for hours. But her singing was characterized by a wobble/shaking of pitch throughout a limited range,  breaks throughout the lower passaggio and great pitch instability. Her body was affected by a hip issue and she walked with a minor limp. She and I talked about healing, spirituality and singing as a foundational attitude for the journey we were about to take together.

We began working with a combination of exercises and approaches informed by voice therapy for Parkinson’s patients and advanced use of Somatic VoiceWork tm: The Lovetri Method as a rehabilitation method.  I also used many Somatic Reeducation* exercises over time to stimulate her respiratory system and core, which had weak function because the muscles of the throat were not functioning well–not the other way around as many teachers and therapists believe. 

It is also effective work to take advantage of the neuroplasticity of the brain. Essential tremor is a central nervous system dysfunction that starts with brain impulses, so slowly groving new patterns in the brain itself is a large key to healing the dysfunction.

I chose not to start with standard SLP rehabilitation tools other than identification of some life style habits to change. She started practicing yoga and renewed her commitment to physical therapy and massage for her hip.

Our hips are the ‘seat’ for the pelvic diaphragm and a source for grounded energy to come through our bodies.

The only SOVT exercises that were helpful were variations on “ung,” closing to the “ng” and sliding 1-3-1 or 1-5-1. She could not slide 1-2-1 without actually staying on the same pitch, so the larger intervals were necessary at first. I did not say “you are flat, sing that second pitch higher,” because she literally could not. It was a functional problem, not a problem with her ear.

Within 6 months she could sing a slurred 5-tone scale without wobble and on pitch, on certain vowels. She began to establish some vocal flexibility. She developed some integrated head voice function that she could use to illustrate while teaching, and students and her conductor encouraged her improvements.  Her soft palate had begun to activate, although it could not stay activated and her body response would shut down. And this is why…

…she received a diagnosis of benign essential tremor after Lovetri noted that she might have an essential tremor. And the interesting thing is, the diagnosis did not change the type of work we were doing, not because I am pig-headed but because it was the most effective work in the first place. However, it did give her enormous peace of mind that she wasn’t doing something “wrong” or was a bad singer.  It was something she could share with students and directors, and let them know that she was aware of and working to improve.

She is contemplating recommended Botox injections. This can be very effective, but the injections wear off and need to be repeated. My belief is that there are deeper levels of healing to be found, which can be supplemented with effective medical therapies. It is her belief, too.

After one year of work based on the Parkinson’s voice therapy and Lovetri’s research, I added some of the exercises for essential tremor found in Leda Scearce’s fantastic  book Manual of Singing Voice Rehabilitation.  It just goes to show how important working with the person in front of you is, and that a set of specific exercises rolled out by rote can not possibly serve each pathology patient who is a singer.

Teresa’s is also an interesting case illustrating that time is needed to allow inner psychological changes of Self when we are older. Teresa thought she was a soprano based on her college self of 40 years ago, and was singing alto in her small church choir due to her limited range. All this time, in spite of not studying, she has been evolving into a possibly true contralto of a substantial size. I would say that from the time I first mentioned this possibility, to fully embracing what her voice is becoming, was almost two and a half years! She has been excited and full of wonder, processing this change in self-identification.

This year, Teresa successfully performed the role of Jack’s Mother in Into the Woods, acted in a  production of Steel Magnolias, has stabilized her alto choral singing and has started to prepare for a community concert, singing Brahms’ Two Songs for Alto, Viola and Piano!

Life isn’t about inventing yourself. It is about releasing yourself. And menopause is the time to do this with courage, humor and tenacious grit. And with a voice teacher/SVRS who takes you seriously and helps you accomplish small goals, one step at a time.

If you found this post helpful, please like, share or comment. Each post takes hours to write, I want to know that others found it valuable! Thank you.

*Two books to help introduce you to somatic reeducation concepts are

Body and Voice by Gilman

Singing With Your Whole Self: The Feldenkreis Method by Nelson and Blades-Zeller

 

 

 

7 Comments

    1. I have sometimes wondered. These things start so inconsequentially and then grow over time. But if you decide to get it looked at medically, let’s talk about who to go to. There really is no one reliable in the Baltimore/DC area, but I know of someone in Philadelphia and NYC.

      Like

  1. Cate
    I am a 53 year old singer who was recently diagnosed with essential tremor. I am a soprano and I have been teaching music for 28 years. About 3 years ago I noticed I was having issues with my speaking voice. Gradually it began affecting my singing voice. I mer with ent and singing specialists in NYC & NJ who couldn’t decide if it was spasmodic or muscle tension dysphonia. I recently saw someone in Philadelphia who believes it’s essential tremor with mtd.
    If possible, I would really love to speak with you more about this. I am really struggling with this change in my life as I consider myself to be a singer and a musician. Any information for articles to read would be of great help.

    Like

  2. Hi Cate,
    I was recently diagnosed with essential tremor. I’m seeing a specialist in Philadelphia and working with his team. Would love to discuss more with you.

    Like

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