Pilot RCT in 32 children with developmental language disorder (mean age 4.8y): broader language gains with VR-supported therapy and 100% retention over six months
How this was rated
Pilot RCT with 32 participants - appropriate for feasibility and initial signal detection. Multiple significance tests without adjustment for multiplicity increases the chance of spurious positive findings. 100% retention is a genuinely informative feasibility finding.
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32 children (mean age 4.8 years) with developmental language disorder were randomized to VR-supported speech intervention or standard care for six months (2 × 1-hour sessions per week). The VR system used was VRRS - a non-immersive 2D touch-screen platform, not a head-mounted display. The VR group showed within-group improvements across more language domains than the control group. Retention was 100% - no dropouts - a feasibility signal that matters in this age group.
Pilot RCT evidence suggests VR-supported speech intervention for preschool-aged children with DLD can produce broader language gains than standard treatment, with strong adherence. Given the small sample, this is a feasibility and signal study rather than a definitive effectiveness claim.
Key findings
- Experimental group showed greater gains in comprehension of total words (p=0.011)
- Greater gains in naming body parts (p=0.033) and everyday objects (p=0.011)
- Greater gains in morphosyntactic accuracy (p=0.012) and sentence construction (p=0.030)
- Greater gains in average utterance length (p=0.013) and spontaneous word production (p=0.031)
- 100% retention across the 6-month protocol
Background
Developmental language disorder affects around 7% of children and is a common reason for SLT referral. Standard treatment is effective but engagement in young children can vary, and maintaining regular attendance over long protocols is a persistent challenge. VR-supported intervention has been proposed as a way to increase engagement and broaden the contexts in which children practice language.
What the researchers did
Cappadona and colleagues at IRCCS Bonino Pulejo Neurolesi Center in Messina, Italy, randomized 32 children with DSM-5 DLD (mean age 4.8 years, 81% male) to either VRRS-supported speech therapy or standard care for six months. The VRRS (Khymeia, Padua) is a non-immersive virtual reality rehabilitation system: children interacted with 2D scenarios through a large touch-screen monitor, not a head-mounted display. Sessions ran twice weekly for one hour over six months. Multiple language outcomes were measured pre- and post-intervention (T0 to T1), including comprehension, naming, morphosyntactic accuracy, sentence construction, and utterance length.
What they found
Both groups were assessed at T0 and T1. The p-values reported reflect within-group Wilcoxon signed-rank tests (comparing each group’s own T0 to T1 scores), not direct between-group comparisons - the paper does not report a formal between-group statistical test. The experimental group showed significant within-group improvement across most language domains: comprehension of total words (p=0.011), naming of body parts (p=0.033) and everyday objects (p=0.011), morphosyntactic accuracy (p=0.012), sentence construction (p=0.030), utterance length (p=0.013), and spontaneous word production (p=0.031). The control group improved on fewer domains. Notably, 100% of children completed the six-month protocol - a meaningful feasibility finding for this age group and session intensity.
Why this matters
The breadth of improvement is striking for a pilot - gains across comprehension, production, and syntax. That pattern suggests VR may be supporting generalized language practice rather than a single narrow target. 100% retention in a preschool population over six months is practically important: engagement and attendance are common failure modes in this age group, and VR appears to help.
Limitations
Pilot sample size limits confidence in effect estimates. Multiple comparisons were made without adjustment - some positive findings may be chance. Blinding of children and families is not feasible with VR. Outcomes were standardized language measures; real-world communication was not directly assessed.
Implications for practice
For preschool-aged children with DLD: VR-supported speech intervention appears feasible across a half-year and well-tolerated. The breadth of domains showing improvement (comprehension, naming, morphosyntax, utterance length) suggests VR may support generalization rather than a single narrow skill. As always with pilot evidence, confirm in a larger trial before scaling clinical decisions.
Implications for research
Larger confirmatory trials with pre-registered primary outcomes and multiplicity correction are the logical next step. Mechanistic work to understand which VR features (engagement, visual context, repetition) drive the effects would inform targeted design.
Cite this study
If you reference this study in your work, the canonical citation formats are:
@article{cappadona2023,
author = {Cappadona, I. and Ielo, A. and La Fauci, M. and Tresoldi, M. and Settimo, C. and De Cola, M. C. and Muratore, R. and De Domenico, C. and Di Cara, M. and Corallo, F. and Tripodi, E. and Impallomeni, C. and Quartarone, A. and Cucinotta, F.},
title = {Feasibility and Effectiveness of Speech Intervention Implemented with a Virtual Reality System in Children with Developmental Language Disorders: A Pilot Randomized Control Trial},
journal = {Children},
year = {2023},
doi = {10.3390/children10081336},
url = {https://withvr.app/evidence/studies/cappadona-2023}
}TY - JOUR
AU - Cappadona, I.
AU - Ielo, A.
AU - La Fauci, M.
AU - Tresoldi, M.
AU - Settimo, C.
AU - De Cola, M. C.
AU - Muratore, R.
AU - De Domenico, C.
AU - Di Cara, M.
AU - Corallo, F.
AU - Tripodi, E.
AU - Impallomeni, C.
AU - Quartarone, A.
AU - Cucinotta, F.
TI - Feasibility and Effectiveness of Speech Intervention Implemented with a Virtual Reality System in Children with Developmental Language Disorders: A Pilot Randomized Control Trial
JO - Children
PY - 2023
DO - 10.3390/children10081336
UR - https://withvr.app/evidence/studies/cappadona-2023
ER - Know of research that should be in this hub? If a relevant peer-reviewed study is not listed here, send the reference to hello@withvr.app. The hub is kept up to date as the literature grows.
Funding & independence
Current Research Funds 2023, Ministry of Health, Italy. No withVR BV involvement in funding, study design, or authorship. Summary prepared independently by withVR using the published paper.