Running head: Case Study of 21-Year-Old Nickie

Case Study of 21-Year-Old Nickie

From the Perspective of a Voice Instructor

Sierra J. Fox

Temple University
Case Study of 21-Year-Old Nickie 2

Abstract

This case study evaluates the condition of 21-year-old Nickie, a female theater major who is

interested in improving her singing voice to be competitive for musical theater roles. She is a

full-time college student nearing graduation, and works as a waitress in a local pub. She

complains of such vocal issues as chronic laryngitis, voice loss, hoarseness (especially at the end

of each day and week), throat discomfort, dryness and a low vocal range. Nickie was seen by a

speech pathologist for a voice evaluation in January 2013, which revealed vocal nodules at the

1/3 posterior 2/3 juncture of the vocal folds, an hourglass shaped glottis closure pattern, a

slightly reduced mucosal wave in the area of the lesions and increased glottic and supraglottic

compression during phonation. She also exhibited reduced pitch range and a relatively low

maximum phonation time (MPT). This case study outlines the steps that I will take to most

effectively evaluate and gather information about the condition of Nickie’s voice, using

information from her speech-language pathologist (SLP), case history, videostroboscoby and

materials such as the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and the

Voice Handicap Index (VHI). The paper will then briefly explore potential courses of action,

including trial tasks and possible referrals to other parties.

Case Study of 21-Year-Old Nickie 3

Voice Evaluation of 21-Year-Old Nickie

from the Perspective of a Voice Instructor

Twenty-one-year-old Nickie is a female theater major who is interested in improving her

singing voice to be competitive for musical theater roles. She is a full-time college student

nearing graduation, and works as a waitress in a local pub. She complains of such vocal issues

as chronic laryngitis, voice loss, hoarseness (especially at the end of each day and week), throat

discomfort, dryness and a low vocal range. Nickie was seen by a speech pathologist for a voice

evaluation in January 2013, which revealed vocal nodules at the anterior 1/3 posterior 2/3

juncture of the vocal folds, an hourglass shaped glottis closure pattern, a slightly reduced

mucosal wave in the area of the lesions and increased glottic and supraglottic compression

during phonation. Nickie has recently decided to enter my voice studio to improve her chances

of getting musical theater roles; as her voice teacher, I must evaluate her vocal condition so as to

best assess the appropriate course of action as I work with her to improve her vocal health and

performance.

Case History

To begin my evaluation, I have completed a case history (see Appendix A for completed

case history form). I also had Nickie fill out a Singing Voice Handicap Index (see Appendix B)

and a VHI (See Appendix C), to assess her interpretation of her vocal problems and how they

affect her professionally, emotionally, functionally and physically. This told me that she reports

only moderate physical and functional issues, and mild emotional issues, with her speaking voice;

however, she reports severe issues and unhappiness with her singing voice. I have also inquired

into her specific vocal requirements and exertions, including the type of amplification she uses

for her gigs (varied depending on the gig, but usually minimal), the venues in which she
Case Study of 21-Year-Old Nickie 4

performs (often small theaters, black-box style; her voice problems have prevented her from

getting roles in shows taking place in large venues), any stylistic/aesthetic vocal effects she

chooses to use (she had initially felt that her “husky” sound was a positive thing, but now she

cannot choose to sound different) as well as into her sleep habits (5-7 hours of sleep per night)

(Schwartz, 2013). When I inquired into phonotraumatic behaviors, she admitted that on a scale

from 1-5 she would rate her overall amount and volume of talking (in person and on the phone)

at 5, shouting/yelling/screaming at 4, and throat clearing, talking over background noise and

whispering at 3.

Assessment of Voice and SLP Findings

Having completed a case history for Nickie, I then performed some assessments of her

voice as her voice instructor (though more specific and medical evaluations required a referral to

an ENT physician or SLP). I then utilized the CAPE-V form as provided and filled out by

Nickie’s SLP (see Appendix D for completed form) to understand Nickie’s ability to produce

sustained vowels, produce a selection of sentences and to describe vocally the functional issues

with her voice. Nickie’s SLP noted her overall severity, roughness, breathiness and strain at 75

(moderately to severely deviant), with a score of 75 also for a decrease in pitch range, and a

score of 60 (just over moderately deviant) for loudness, denoting that she spoke louder than is

normal. I asked Nickie to give me the phone number of the SLP with whom she was working,

and spoke with her to develop a better understanding of her reports. When I asked into the

specifics of her pitch and amplitude abnormalities, I was told that Nickie’s fundamental speaking

frequency was 207 Hz, as compared to the 225 Hz average for females (Schwartz, 2004, p. 26).

I was also told that her amplitude was approximately 73dB, compared to the normal mean of

approximately 65dB SPL (Gerhard and Whittaker, 2013). The SLP also noted that Nickie
Case Study of 21-Year-Old Nickie 5

displayed a slightly higher range when singing than when speaking, and that she exhibited

frequent periods of aphonia and increased musculoskeletal tension throughout the evaluation.

Nickie’s SLP reported that some of the musculoskeletal tension and discomfort was relieved

with circumlaryngial and neck palpitation/massage, which also helped to lower her thyroid bone

to increase thyrohyroid space.

This provided me with a greater understanding of Nickie’s speaking voice and range, but

as a voice teacher, I quickly moved on to an aural evaluation of some basic vocal exercises. I

asked Nickie to pick a comfortable note in her range and sustain that pitch on an “ah” vowel; she

was able to maintain the pitch for an average of 12 seconds over three trials. I then had Nickie

sing scales down and particularly up on a hum, to see if I could hear and/or see her self-ascribed

difficulty in her higher register. She was able to sing the F below middle C (F3) to the C above

middle C (C5), which is a relatively small range for someone intending to be a professional

singer, and indeed showed a reduced upper range. Because of her low MPT, as compared to the

average of 15-20 seconds (Schwartz, 2004, p. 32), I hypothesized that her vocal fatigue/exertion

was related to her breath support (or sub-par medial glottal adduction). To see if she is

experiencing possible hyperfunction when phonating, I asked Nickie to sustain an “s” sound for

as long as possible three times, followed by a “z” sound for as long as possible three times

(Schwartz, 2004, p. 34). She was able to sustain the unvoiced consonant for 18 seconds and the

voiced consonant for 15 seconds, making her s/z ration 1.2, and suggesting that there may be

excess air being released when she attempts phonation due to phonatory hyperfunction (Schwartz,

2013).

I then asked Nickie to sing a 5-note scale up and back, on any vowel she chose (she

gravitated towards an “ah” vowel). I noticed that she hyper-extended her neck when singing,
Case Study of 21-Year-Old Nickie 6

more so on ascending scales than descending scales. As descending scales seemed to create less

tension for Nickie, I asked her to perform lip trills on a descending 5-note scale, but we

discovered that she was unable to perform lip or tongue trills of any sort. This suggested to me

that there were significant tension issues preventing the consistent, relaxed flow of breath and

relaxed face necessary for lip/tongue trills. She was able to sing the 5-note descending scale on a

staccato “ah” sound, but I noticed what appeared to be tongue tension, and asked her to repeat

the exercise with her tongue extended. Nickie tried to complete the exercise, but became

frustrated with the difficulty; she laughed uncomfortably, saying that it “felt too weird,” and did

not want to continue. She said that she felt “warmed up,” and wanted to stop the vocal exercises.

I told Nickie that it was great that she was able to be open and honest with me about her feelings

about the exercises we were doing, and we moved on to discuss goals.

Developing Goals

I asked Nickie what she would most like to get out of her time studying in my voice

studio. She told me that she wants to improve the quality and health of her voice so that she can

be competitive for musical theater roles again. I communicated with her prior to our first lesson

and asked her to prepare a song to sing when she came in, and a recording device to record the

session. She brought in the song “Mama Who Bore Me” from Spring Awakening, which I had

her sing so that we could asses where she was in relationship to her goals of singing musical

theater. “Mama Who Bore Me” sits mostly in the range of A3-A4, with one instance of G3.

This sits well within the confines of Nickie’s range, which we had determined to be F3-C5;

however, Nickie’s approach to belting the A4s, which are plentiful in this song, made the notes

sound uncomfortable in her range. I could see visible tension in her face and neck, which she

hyperextended frequently, especially when singing above E4. When phrases began with “Mama”
Case Study of 21-Year-Old Nickie 7

on the A4, Nickie demonstrated extreme facial tension, releasing a bit when she went lower in

her range. I could hear a lot of breath escaping in her tone, and she exhibited upper thoracic

breathing patterns, which she did not use while speaking. By the last verse of the song, Nickie’s

voice “cracked” several times, and she became tearful and was unable to finish the song. I told

Nickie that her dedication to the music was impressive, and the fact that she was having such an

emotional reaction showed how much she cares about the music. I suggested that we start from

the beginning of the song, but this time replacing the words with a hum. Her ability to sustain

breath when using the hum was much improved, and she was able to access a more resonant tone

on the hum than on text. Having heard the successful resonance on the “m,” I asked her to sing

“mama,” sustaining the “m” both times before moving to the “a,” and trying to carry over the

resonance sound into the vowel; this was, however, not successful- the resonance did not carry

over.

Having heard Nickie’s starting point, I then set about creating some specific goals for our

time together. I mentioned to Nickie that some of her main challenges were currently physical

tension and breathing, and that I would like to focus on those issues for at least several weeks. I

also suggested that she work on developing her resonant voice with her SLP, working on her

ability to carry over the resonance she displays on a hum on to vowels and full words/phrases.

Nickie agreed that tension and breath felt like significant issues, and added that she would like to

increase her range. I also warned her that several of the behaviors covered in her case history

were likely detrimental to her vocal health, and she admitted that her SLP had told her the same

things, and that she was willing to try to change her habits to improve her vocal health and help

the healing process for her vocal nodules. We drafted a goals list (see Appendix E for first
Case Study of 21-Year-Old Nickie 8

lesson goal sheet) with all of this in mind, and I asked her to keep me updated in regards to her

work with her SLP.

Continuation of Lesson Plan and Plans for the Future

At Nickie’s second lesson, she brought me her schedule of voice use, color-coded in

terms of how much voice use was required of her (as we had discussed). Together, we worked to

revise this schedule to allow for more vocal rest and less over-use of voice. Nickie told me that

her SLP had been more than happy to work with her on resonant voice, and that she had also

been teaching her how to use confidential voice with success (Gerhard and Whittaker, 2013).

We started vocalizing with descending 5-note scales on a hum, and then added the step of

opening up to an “ah” vowel on the last three notes. Nickie was already better able to bring

some of the forward, nasal resonance of the hum into the vowel, and I told her that her practicing

was already paying off. She was still unable to do a lip trill, but in the course of the lesson did

watch herself in the mirror and, though she did often hyper-extend her neck, saw this and fixed it

over half of the time. Nickie told me that she was still struggling with abdominal breathing, and

that she could remember doing it while speaking, but couldn’t seem to do it while singing. She

was able to demonstrate the breaths to me, but when she sang, she reverted to clavicular

breathing. To give her an exercise to practice to improve this, I had Nickie set a metronome and

sing a 5-ntoe scale up and down on eighth-notes, giving herself a half note to take a deep,

diaphragmatic breath in between (making sure to stay in time). When she was thinking about the

breath, she could do it, but she then reverted to hyper-extension of her neck; I reassured her that

this would be a process and that she was already doing very well, and that she should practice

these exercises over the next few weeks.

Case Study of 21-Year-Old Nickie 9

As Nickie continued to work with her SLP, I noticed significant improvements in her

tone and hoarseness. She admitted that she was having trouble quitting smoking entirely, and

kept “slipping up,” but that she was on a quitting regiment of nicotine patches and felt that it was

improving her voice. She also said that she was not always drinking enough water, especially

considering that she still drank several caffeinated beverages a day, but that she was noticing that

she felt better vocally when she was more hydrated. She said that she was working on keeping

the volume of her voice down, and talking less with friends. She also said that she had almost

entirely stopped whispering during classes. Her SLP had also encouraged her to replace her

Claritin with Singular, which has fewer vocal side-effects (www.ncvs.org/rx.html, 2013).

Though we generally began our warm-ups with humming, we began to move on to singing on a

“v,” in hopes of simulating the airflow and vibrations of the lips that would take place with lip

trills, the idea being that the inherent supraglottic pressure might relieve the pressure at the

glottis. (Gerhard and Whittaker, 2013). By the seventh lesson, Nickie began to be able to sing

brief lip trills; she could sing five notes ascending or descending, but ran out of air before being

able to go up and back down. By the tenth lesson, she was able to perform diaphragmatic

breathing 50% of the time while singing without cues, and 80% of the time with cues, and she

was able to perform a 5-note scale up and down on a lip trill.

By the sixteenth week, Nickie had completed her therapy with her SLP. The SLP

reported that Nickie had decreased the severity, roughness, breathiness and strain of her voice to

25/100 from 75/100, and had raised her fundamental speaking pitch to 225 Hz. Her recent

stroboscopy revealed that her vocal nodules had softened and diminished, though care would be

necessary to make sure she did not re-aggravate them. With me, her singing range had increased

to an E5 in her upper register, using her head voice- she was able to belt to a B with no more
Case Study of 21-Year-Old Nickie 10

tension than in her lower register, but could only access C5-E5 with her head voice, and still with

audible breathiness. We created a new goals list, keeping many of the long term goals (See

Appendix G for mid-year voice goals). I also asked Nickie to look at other repertoire she might

like to work on in later weeks.

In later weeks, Nickie brought in “Easy to be Hard” from Hair, “Buenos Aires” from

Evita and “I Don’t Know How to Love Him” from Jesus Christ Superstar. We worked on all of

them, but after a couple of weeks working on “Buenos Aires,” I suggested that we focus on the

other songs, as it utilized the very bottom of her range. I found that when she went into that very

low range (F3-A3), Nickie would lose many of the technical skills that we had been working on.

I suggested that we replace it with “Everything’s Coming up Roses” from Gypsy. She was at

first disappointed to stop singing “Buenos Aires,” because it was “easy” and enjoyable for her to

use her low range, but I told her that we could always go back to it. By the time we had reached

a year of lessons, many things had changed in Nickie’s life; she had quit smoking, graduated

college, and had been continuing work at her local pub while auditioning for theater jobs. She

kept her hours minimal at the pub, and had landed several small theater gigs. I suggested that

she wait to audition for musical theater productions until we had developed a very strong

audition packet, and until we knew that she could maintain vocal health in a full musical theater

production. By the one-year mark, I felt that these things were truly the case. Nickie auditioned

for a local company’s production of The Drowsy Chaperone, using “I Don’t Know How to Love

Him” to start and “I Cain’t Say No” and “Mama Who Bore Me” as songs for the judges to

choose from as audition songs. She landed the role of Kitty, and together we worked to assess

her vocal pacing schedule to accommodate her new needs. I suggested that Nickie avoid alcohol

the week or two before the show, and she agreed that it was a good idea. We then worked
Case Study of 21-Year-Old Nickie 11

together to create a new goal sheet as of that point (see Appendix H for one-year goal sheet), and

I agreed that she might be able to work on “Buenos Aires” again. She also expressed a desire to

increase her range to be able to sing in head voice up to G5 and belt to F5, which we worked into

her goals for the future.

Case Study of 21-Year-Old Nickie 12

BIBLIOGRAPHY

Gerhard, J., & Whitaker, N. (2013). Voice Disorders: Special Populations. Philadelphia, PA.

McCoy, S. (2012). Your Voice: An Inside View (2 ed.). Delaware, OH, USA: Inside View Press.

Schwartz, S. (2004). The Source for Voice Disorders: Adolescent & Adult. (B. Truman, Ed.)

East Moline, IL, USA: LinguiSystems.

Schwartz, S. A. (2013, March 4). Professional Voice Considerations for Singers: Therapist Point

of View. Philadelphia, PA.

The University of Utah. (n.d.). NCVS: The National Center for Voice and Speech. Retrieved

from www.ncvs.org/rx.html
Case Study of 21-Year-Old Nickie 13

Appendix A
Case History Form (Schwartz, 2004, pp. 39-40)

Nickie

21
Student (Theater, Senior Undergraduate), Waitress

Chronic laryngitis, voice loss, hoarseness (especially at the end of each day and week), throat
discomfort, dryness and a low vocal range

yes Half a pack per day

yes 15 beverages weekly

6 caffeinated beverages
0-2 glasses

Claritin for seasonal allergies, advil for frequent headaches, pepto-bismol for occasional
heartburn and stomach problems

Yes
Case Study of 21-Year-Old Nickie 14

Appendix A

Case History Form, continued

Frequent headaches, poor diet/erratic eating schedule

Difficulty singing high notes, “husky” voice, difficulty sustaining notes, pitch “cracking”
Case Study of 21-Year-Old Nickie 15

Appendix B

The Singing Voice Handicap Index 10.

(Gerhard & Whitaker, 2013)

These are statements that many people have used to describe their singing and the effects of
their singing on their lives. Circle the response that indicates how frequently you have the same
experience in the last 4 weeks.

0 = Never 1 = Almost Never 2 = Sometime 3 = Almost Always 4 = Always1)

1)It takes a lot of effort to sing. 0 1 2 3 4

2) I am unsure of what will come 0 1 2 3 4

out when I sing.

3) My voice “gives out” on me 0 1 2 3 4

while I am singing.

4) My singing voice upsets me. 0 1 2 3 4

5) I have no confidence in my 0 1 2 3 4
singing voice.

6) I have trouble making my 0 1 2 3 4

voice do what I want it to.

7) I have to “push it” to produce 0 1 2 3 4

my voice when singing.

8) My singing voice tires easily. 0 1 2 3 4

9) I feel something is missing 0 1 2 3 4

in my life because of my inability
to sing.

10) I am unable to use my “high 0 1 2 3 4

voice.”
Case Study of 21-Year-Old Nickie 16

Appendix C

Voice Handicap Index (VHI) (Schwartz, 2004, p. 43)

Case Study of 21-Year-Old Nickie 17

Appendix D

Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) (Schwartz, 2004, p. 42)

Case Study of 21-Year-Old Nickie 18

Appendix E:

First Lesson Goals

Student name: Nickie Date: April 2, 2013

Short term goals:

Nickie will take 10 diaphragmatic breaths without cues in the course of the second lesson, to
improve breath support and healthy breathing.

Nickie will hum “Mama Who Bore Me” in its entirety at least once every day until the next
lesson, to reinforce the healthy behaviors she exhibits when using a hum, such as resonant tone
and greater breath support.

Nickie will request to work with her SLP to create resonant tone on vowels following an “m,”
perhaps utilizing the Lessac-Madsen technique of Resonant Voice (Gerhard and Whittaker, 2013)

Nickie will perform ascending 5-note scales in front of a mirror, and will decrease hyper-
extension of her neck by at least 50% to improve neck tension and alignment, facilitating breath
flow

Nickie will limit her cigarette use to two cigarettes a day for a week, working towards quitting
entirely, due to their harmful effect on the voice.

Nickie will increase her intake of water to 8 glasses a day, with caffeinated beverages counting
as one negative glass of water (requiring an extra glass to make up the difference) for one week.

Nickie will draft a schedule of her necessary voice use in a normal week for the next lesson, for
us to review together to find ways to reduce over-use of her voice.

Long term goals:

Nickie will increase her range from F4-C5 to F4-F5, to be able to sing a wider variety of musical
theater repertoire.

Nickie will replace upper thoracic breathing with low, diaphragmatic breathing 85% of the time
while singing, to improve breath support and healthy breathing..

Nickie will eliminate tension to the extent that she will be able to perform a lip trill on an 8-note
scale.

Nickie will be able to sing “Mama Who Bore Me” from Spring Awakening and “I Cain’t Say No”
from Oklahoma without pitch cracks, to the extent that they could be used as audition songs.

Nickie will quit smoking, because of their harmful effects on vocal health.
 Case Study of 21-Year-Old Nickie 19

Appendix F: Voice Pacing Schedule and Updates

First schedule, provided by Nickie:

Time Monday Tuesday Wednesday Thursday Friday Saturday Sunday

8:00 English Math English Math

9:00 English Math English Math

10:00

11:00 Therapy Therapy Class

12:00 Class Class Class

1:00 Class Class Rehearsal

2:00 Theater Theater Rehearsal

3:00 Theater Theater Therapy Rehearsal

4:00 Dance Dance Rehearsal

5:00 Voice Rehearsal

Lesson
6:00 Work Rehearsal Rehearsal Rehearsal

7:00 Work Rehearsal Rehearsal Rehearsal

8:00 Work Rehearsal Rehearsal Rehearsal Friends Friends

9:00 Work Rehearsal Rehearsal Rehearsal Friends Friends

10:00 Work Rehearsal Rehearsal Rehearsal Friends Friends

11:00 Work Homework Homework Friends Friends Friends

12:00 Work Homework Friends Friends Friends

 Case Study of 21-Year-Old Nickie 20

Nickie’s plans for voice use:

Green: requires full voice, Yellow: requires some voice use, Red: no voice use

Time Monday Tuesday Wednesday Thursday Friday Saturday Sunday

8:00 English Math English Math Work Work

9:00 English Math English Math Work Work

10:00 Work Work

11:00 Therapy Therapy Theater Work Work

Seminar
12:00 History History Work Work

1:00 History History Work Work

2:00 Theater Theater Work Work

3:00 Friends Theater Theater Therapy Rehearsal Rehearsal

4:00 Dance Dance Rehearsal Rehearsal

5:00 Voice Rehearsal Rehearsal

Lesson
6:00 Work Rehearsal Rehearsal Rehearsal Rehearsal Rehearsal

7:00 Work Rehearsal Rehearsal Rehearsal Rehearsal Rehearsal

8:00 Work Rehearsal Rehearsal Rehearsal Friends Friends

9:00 Work Rehearsal Rehearsal Rehearsal Friends Friends

10:00 Work Rehearsal Rehearsal Rehearsal Friends Friends Homework

11:00 Work Homework Homework Friends Friends Friends Homework

12:00 Work Homework Friends Friends Friends Homewor

 Case Study of 21-Year-Old Nickie 21

Revised plans for voice use:

Green: requires full voice, Yellow: requires some voice use, Red: no voice use

Time Monday Tuesday Wednesday Thursday Friday Saturday Sunday

8:00 English Math English Math Work Work

9:00 English Math English Math Work Work

10:00 Work Work

11:00 Therapy Therapy Theater Work Work

Seminar
12:00 History History Work Work

1:00 History History Work Work

2:00 Theater Theater Work Work

3:00 Friends Theater Theater Therapy Rehearsal Rehearsal

4:00 Dance Dance Rehearsal Rehearsal

5:00 Voice Rehearsal Rehearsal

Lesson
6:00 Work Rehearsal Rehearsal Rehearsal Friends

7:00 Work Rehearsal Rehearsal Rehearsal Friends

8:00 Work Rehearsal Rehearsal Rehearsal Friends Friends

9:00 Work Rehearsal Rehearsal Rehearsal Friends Friends

10:00 Work Rehearsal Rehearsal Rehearsal Friends Friends Homework

11:00 Work Homework Homework Friends Friends Friends Homework

12:00 Work Homework Friends Friends Friends Homewor

Case Study of 21-Year-Old Nickie 22

Appendix G:

Mid-Year, Post-Therapy Lesson Goals

Student name: Nickie Date: July 16, 2013

Short term goals:

Nickie will take diaphragmatic breaths without cues 75% of the time when singing “Mama Who
Bore Me” in the course of the lesson, to improve breath support and healthy breathing.

Nickie will continue utilizing the circumlaryngeal/neck massage as taught by her SLP once or
more every day, to improve thyrohyroid space and relieve tightness of neck muscles (Gerhard
and Whittaker, 2013)

Nickie will sing “I Cain’t Say No” with no visible hyper-extension of the neck for 70% of the
song, to improve neck tension and alignment, facilitating breath flow

Nickie will limit her cigarette use to two cigarettes a week, working towards quitting entirely,
due to their harmful effect on the voice.

Long term goals:

Nickie will increase her intake of water to 8 glasses a day, with caffeinated beverages counting
as one negative glass of water (requiring an extra glass to make up the difference)

Nickie will increase her range from F4-C5 to F4-F5, to be able to sing a wider variety of musical
theater repertoire.

Nickie will increase her belting range from F4-C5 to F4-E5, to be able to sing a wider variety of
musical theater repertoire.

Nickie will replace upper thoracic breathing with low, diaphragmatic breathing 85% of the time
while singing, to improve breath support and healthy breathing..

Nickie will eliminate tension to the extent that she will be able to perform a lip trill on an 8-note
scale, up and down.

Nickie will be able to sing “Mama Who Bore Me” from Spring Awakening and “I Cain’t Say No”
from Oklahoma without pitch cracks or visible tension, to the extent that they could be used as
audition songs.

Nickie will quit smoking entirely, because of its harmful effects on vocal health.
Case Study of 21-Year-Old Nickie 23

Appendix H:

One Year Later Lesson Goals

Student name: Nickie Date: April 1, 2014

Short term goals:

Nickie will consume no alcoholic beverages for two weeks before the first performance of The
Drowsy Chaperone, to allow for ideal hydration and vocal hygiene.

Nickie will sing through all of her music for The Drowsy Chaperone on lip trills once every day
to facilitate relaxed airflow and good technique.

Nickie will sing through all of her music for The Drowsy Chaperone in her lesson with no visible
hyper-extension of the neck for 80% of the music, to improve neck tension and alignment,
facilitating breath flow

Nickie will bring a new schedule of her vocal pacing for us to review at our lesson, to create a
plan for vocal rest.

Long term goals:

Nickie will increase her intake of water to 8 glasses a day, with caffeinated beverages counting
as one negative glass of water (requiring an extra glass to make up the difference).

Nickie will increase her range from F4-C5 to F4-G5, to be able to sing a wider variety of musical
theater repertoire.

Nickie will increase her belting range from F4-C5 to F4-F5, to be able to sing a wider variety of
musical theater repertoire.

Nickie will replace upper thoracic breathing with low, diaphragmatic breathing without cues
90% of the time while singing, to improve breath support and healthy breathing.

Nickie will be able to sing “Buenos Aires” without noticeable tension or hoarseness in the F3-C4
range of the song, to facilitate healthy singing in her lower register.