Singing in the Session A vocal cord cyst caused Kristie Knickerbocker to switch majors from vocal performance to speech-language pathology—and she uses her story to coach her clients. In the Limelight
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In the Limelight  |   June 01, 2018
Singing in the Session
Author Notes
  • Shelley D. Hutchins is content producer/editor for The ASHA Leader. shutchins@asha.org
    Shelley D. Hutchins is content producer/editor for The ASHA Leader. shutchins@asha.org×
Article Information
In the Limelight
In the Limelight   |   June 01, 2018
Singing in the Session
The ASHA Leader, June 2018, Vol. 23, 26-27. doi:10.1044/leader.LML.23062018.26
The ASHA Leader, June 2018, Vol. 23, 26-27. doi:10.1044/leader.LML.23062018.26
Name: Kristie Knickerbocker, MS, CCC-SLP
Title: Founder, a tempo Voice Center and Voice Diagnostix
Hometown: Fort Worth, Texas
Adele, Julie Andrews and Kristie Knickerbocker. All three women experienced an interruption to their singing careers because of vocal cord issues. For one of them, the severity stopped short her chances of becoming as famous as the other two. But she used that setback to change courses and now treats voice disorders.
When Knickerbocker found out about the cyst on her vocal cords, she was an award-winning high school singer accepted as a vocal performance major—complete with scholarships—to Texas Christian University (TCU). After surgery to remove the cyst the summer after graduating high school in 2006, Knickerbocker started college as a voice major who couldn’t sing. She had to learn to use her singing voice all over again.
“It was like the equivalent of singing nursery rhymes while everyone else sang opera,” Knickerbocker says. “Eventually, my college voice teacher suggested I change majors, and although I was hesitant, she was so right.”
Singer to SLP
As frustrated as Knickerbocker was about not being able to sing at her former level, she was equally amazed at how much the speech-language pathologist treating her knew about singing. When her otolaryngologists prescribed seeing an SLP, the vocalist was skeptical. She assumed the SLP would know nothing about singers. Knickerbocker was happily surprised, however, when she started sessions with Amy Hamilton.
“She taught me to sing differently,” Knickerbocker says. “She taught me how to use a forward-focused resonant voice, and immediately I could feel the difference.”
The rehab sessions inspired Knickerbocker to be able to offer the same help to other singers. Fortunately, TCU offers a degree in communication sciences and disorders and a master’s in speech-language pathology. Knickerbocker began working toward her new career, studying how to treat voice injuries and disorders with the goal of starting a private practice to help singers avoid career-ending issues.
Knowing exactly the types of clients she wanted to treat in her practice, Knickerbocker took advantage of her school’s voice lab and mentor Christopher Watts by becoming proficient on numerous instruments, such as rigid videostroboscopes and fiber optic endoscopes.
“I learned a lot about videostroboscopy and FEES exams, laryngectomies, Passy Muir valves, and how to manage all of the scary stuff about working with people’s throats,” Knickerbocker says. “I knew I wanted to specialize in voice as a clinical fellow, but I also needed a larger referral base, so I did my fellowship in acute care.”
Learning how to perform those assessments and treat other throat issues proved beneficial. While she began building her private practice referrals, Knickerbocker worked part-time doing assessments at an ENT clinic. She also focused on her new practice—“a tempo Voice Center”—by providing individualized services aimed at healing and protecting clients’ voices.
One client recently came to Knickerbocker with a diagnosis of vocal fold nodules, for example. Although Knickerbocker is certified to perform videostroboscopy, the referring physician had already performed it and diagnosed nodules.
After several weeks of sessions, however, her usual techniques were not working, so she decided to perform her own test. She found polyps instead of nodules. Polyps don’t respond to treatment like nodules do, so Knickerbocker sent her client for a surgical consult.
For the past five years, Knickerbocker has grown her practice and her expertise in voice and throat care. She’s treated local and national professional singers in all musical genres, along with voice students and church choir members. Knickerbocker also serves as the official voice care specialist for the Fort Worth Opera.

“We tend to not pay attention to what we can’t see. I explain and show [clients] pictures from their exams, so they see what makes the music.”

Singer and SLP
The two years Knickerbocker spent recovering from her vocal cord surgery taught the singer and SLP a lot about how to reach clients who rely on their voice for their livelihood.
“I really have to convince these professional artists to do their treatment,” Knickerbocker says. “If you have a broken leg, you don’t walk on it. But you can’t see your vocal cords, and we tend to not pay attention to what we can’t see. I explain and show them pictures from their exams, so they see what makes the music.”
Knickerbocker’s honesty about her long recovery adds a level of personal struggle when she talks to clients. The SLP also uses her story to coach young singers. In addition to teaching students how to take care of their voices, she emphasizes self-advocacy—especially when it comes to not overdoing it like she did. She remembers her choir directors and vocal coaches always wanting more, so she knows she has to persuade students to say no occasionally and value the benefits of taking a break.
Knickerbocker sees 15 to 25 clients each week in her practice. Most sessions last 45 minutes to an hour. A typical voice client works with her once a week for around six weeks. Any longer, and she re-evaluates her approach or considers if the client might need another form of intervention.
Keeping up with current research and innovative new techniques as an SLP and a singer helps Knickerbocker with her personalized treatment plans. She recently attended a master class with opera singer Isabel Leonard on voice coaching techniques. And she sings with local groups performing classical choral works and musicals.
She maintains her knowledge and expertise as an SLP, as well. She actively participates in several professional organizations and creates downloadable products for other SLPs. Knickerbocker also blogs regularly on professional topics and last year helped organize a materials drive for SLPs affected by Hurricane Harvey.
“It’s impossible to tell someone how to sing if I don’t stay current on both the artistry and techniques of singing,” Knickerbocker says, “as well as the science of and physical approaches to healthy vocal use and singing.”
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June 2018
Volume 23, Issue 6