TCU alumnae help patients find their true voices

Fort Worth, TX

5/7/2010

By: Stephanie Patrick

Kim Chachere Coker, M.S., CCC-SLP, entered TCU with dreams of becoming a physician, but the opportunity to take a speech pathology class early in her undergraduate studies helped Coker find her calling.

“I took the course to fill a degree requirement and I had an interest because my brother had speech issues related to a cleft palate,” she said. “That first class at TCU really intrigued me.

“I thought working in speech pathology might be a better fit for me than being a physician because I would be able to spend more quality time with the patients, but still keep my brain active and challenged.”

Now, after earning her bachelor’s degree in speech-language pathology in 1990, Fort Worth resident Coker helps others find their true voices. As founder and an outpatient speech pathologist at The D. Wayne Tidwell Voice, Speech and Swallowing Center at Baylor All Saints Medical Center at Fort Worth, Coker and her staff help patients overcome voice disturbances including chronic cough, spastic dysphonia, reflux, polyps and vocal cord paralysis. Head and neck cancer patients often receive therapy related to voice, speech and swallowing at various points in their treatment.

“We help anyone who depends on his or her voice for his or her livelihood,” said Coker, who went on to earn a master’s degree from Vanderbilt University and then worked at Saint Joseph’s Hospital in Atlanta. “That could be anyone working in retail to professional voice users, including speakers and singers, attorneys, ministers and teachers.”

Sometimes a patient says his or her vocal quality has changed, or the individual may experience vocal fatigue or pain or discomfort when speaking, she said.

Athletes, often teen-age girls, also seek therapy for breathing problems that mimic asthma, but learn it’s vocal cord dysfunction. Behavioral intervention therapy is similar to physical therapy, in that it’s neuromuscular re-education of muscles. Coker said most insurance plans cover the sessions. Many times, problems can be corrected in four to eight sessions.

“More often, we are coordinating vocal subsystems, including respiration, phonation and resonation,” she said. “We teach patients to eliminate muscular tension in the upper body (jaw, tongue, larynx, neck), and replace these maladaptive compensations with efficient voice production.”

Voice therapy also can eliminate certain benign growths in the larynx, Coker said.

Following industry guidelines, she said anyone experiencing hoarseness or other vocal problems for two weeks or more should seek medical advice. The Tidwell Center records about 3,000 patient visits each year.

Coker said she never tires of assisting patients.

“Voice disorders can have a dramatic impact on a person’s life, and can also be emotionally isolating,” she said. “Often, patients are referred who have been to countless healthcare providers and no one knows how to help them. They are excited just to have someone who is familiar with their symptoms.”

But, centers such as Tidwell are rare and few speech pathologists nationwide specialize in voice care. Coker said that’s because voice problems are under-referred by physicians and the general public is very accepting of variations in voices. Even when there are noticeable problems, it’s often assumed nothing can be done to correct them.

When Coker began working at Baylor All Saints in 1998, her position was part time. D. Wayne Tidwell, a patient and a founder of the famed Weaver and Tidwell LLP accounting firm -- now known as Weaver -- provided seed money for more equipment a few years later, and the center grew from there. The center now has four full-time speech pathologists, including Shelby Diviney, M.S., CCC-SLP, who earned her master’s degree from TCU in 2006 and interned at the center before graduation.

Tidwell is the only freestanding clinic of its kind in Fort Worth. Coker and Diviney said the closest comparable clinic is at The University of Texas Southwestern Medical Center at Dallas.

“We see primarily adults, drawing patients from all over North Texas and receiving referrals from as far away as Houston and San Antonio,” Coker said. “It often depends where the doctors are. It’s only recently that North Texas has had a physician who specializes in voice; he’s at UT Southwestern.”

The center also receives referrals from as far away as Nashville.

“We are always trying to keep up with advancements in technology,” Coker said. “Currently, we are providing the same diagnostics/standard of care found in the best voice centers in the country.

“One piece that we are about to add is aerodynamic or airflow diagnostics. This provides information regarding the amount of air a patient is using when they speak. It is helpful for the therapist in pinpointing and substantiating problems in voice production, as well as in guiding patient’s therapy. It will also be useful in providing the patient feedback to assist with implementing techniques presented by the clinician.”

Diviney, who earned her undergraduate degree at Abilene Christian University and whose mother is a speech pathologist, said the team also welcomes opportunities to speak to community groups about voice problems and therapies.

“The voice is often overlooked, but we’ll come to anyone who calls,” she said.

Each credits TCU for providing a strong base in communications and hearing sciences.

“The professors completely prepared me for graduate school and I wouldn’t have had as many opportunities at Vanderbilt had I not come into the program with such a strong base,” Coker said.