Her teachers at the University of Toronto included Leo Smith and Healey Willan; she took summer courses in Orff-Schulwerk at the RCMT in 1962, 1963, and 1965; and with Margaret Murray at the Orff Institute in Salzburg in 1966, 1975, and 1976. She lectured in Canada, the USA, France, Finland and South Africa on Orff techniques and the musical development of children with special needs. Many of her workshops, lectures and courses were presented to provincial and national associations, music educators and therapists, as well as university departments. She became course director of the Orff programs for children, teacher training and music for the special learner at York University in 1977; at the RCMT in 1989; was head of the Orff program for the Toronto Board of Education 1962-89; and was president of the Ontario chapter of the Canadian Orff Association 1979-82. She was a member of both Canadian and American Orff Schulwerk Associations, the Canadian Music Therapy Association, CMEA, and ISME, and won the Hillroy fellowship award (1975) for her development of programs for teaching music to deaf children. Birkenshaw-Fleming has written books and articles pertaining to music education and children with learning disabilities, among them Come On Everybody, Let's Sing (Toronto 1989) and Music for Fun, Music for Learning (Toronto 1982).