Voice SLPs and their patients evaluate a fully immersive VR prototype for the transfer phase of voice therapy
How this was rated
Qualitative study (n=20) with seven voice speech-language pathologists and thirteen patients with voice disorders. Provides useful context and experience-based evidence; different in kind from effect-size evidence.
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A user-centered qualitative evaluation of ProVoiceVR - a fully immersive head-mounted VR prototype - found that both voice speech-language pathologists and patients with voice disorders saw clear potential for using VR to help patients practice and consolidate voice techniques in realistic everyday speaking situations.
A qualitative study offering experience-based evidence on how voice speech-language pathologists and patients with voice disorders perceive fully immersive VR as a tool for the transfer phase of voice therapy; complements rather than substitutes for effect-size evidence.
Key findings
- All participants considered the VR application to have therapeutic benefits in voice therapy, particularly for the transfer phase from clinic to everyday life
- Three core potentials were identified: (a) identifying individual treatment goals by observing patients in situations similar to everyday life, (b) applying and consolidating acquired voice behaviors in realistic simulated situations, and (c) using the headset's built-in microphone for biofeedback
- Participants emphasized the importance of being able to customize scenarios - audience size, audience reactions, background noise - to adjust the level of difficulty for each patient
- Three SLPs additionally identified strong potential for using the application beyond voice therapy, particularly in fluency disorders (stuttering) where in-vivo training is otherwise difficult to arrange
- Key limitations noted: physical-space constraints in therapy rooms, mismatch between the acoustics of the real room and the simulated environment, headset weight, and the need for therapist preparation before patient use
Background
A long-standing challenge in voice therapy is the transfer phase - helping patients use the voice techniques they learn in the clinic when speaking in their everyday lives. Real-world speaking situations involve varying levels of noise, audience size, social pressure, and communicative demand that are difficult to recreate in a treatment room. Virtual reality (VR) offers the possibility of creating realistic, immersive speaking environments where patients can practice voice techniques under clinician-controlled conditions.
Hansa and Hansen (University of Applied Sciences Osnabrück, Germany) carried out the first user-centered qualitative evaluation of a fully immersive head-mounted VR prototype designed specifically for the transfer phase of voice therapy. The prototype evaluated, ProVoiceVR, was developed by the German company VReedback GmbH as a research-collaboration partner.
What the researchers did
Twenty participants took part in the evaluation: seven speech-language pathologists with at least two years of experience treating voice disorders, and thirteen patients with voice disorders currently in the transfer phase of voice therapy. Patients were professional speakers or individuals for whom voice use plays a major role in everyday life.
Each participating SLP first received 1-2 hours of training on the VR application. They were not given a prescribed protocol; they were free to decide how to use the prototype across three therapy sessions per patient between March and August 2023. Hardware consisted of an Apple iPad 9th generation (for the clinician’s control panel) and a Meta Quest 2 headset (worn by the patient), connected over Wi-Fi.
After the trial, semi-structured interviews were conducted with all participants (40-60 minutes for patients, 50-90 minutes for SLPs). Sixteen interviews took place in person; four were conducted by video call. Qualitative content analysis (Kuckartz and Rädiker) was used to code the material and identify themes related to perceived usefulness, usability, and recommendations for development.
What they found
All participants considered the VR application to have therapeutic benefits in voice therapy. Three core potentials emerged as the most strongly endorsed:
- Identifying individual treatment goals through observation. Two SLPs particularly emphasized that observing patients in simulated everyday situations revealed behavioral patterns (posture, breathing, vocal tension) that did not appear in conventional face-to-face therapy.
- Applying and consolidating acquired voice behaviors in realistic situations. Five SLPs and eight patients described the value of practicing voice techniques in simulated scenarios that would be impossible to reliably create in a clinic - speaking with many listeners, speaking with background noise, addressing a group.
- Easy-to-use biofeedback. SLPs who already use biofeedback or are considering it saw potential in the headset’s integrated microphone for capturing and displaying vocal parameters during or after exercises.
Beyond voice therapy, three SLPs identified strong potential for using the application in fluency disorders (stuttering) and other in-vivo training contexts. Participants emphasized the importance of customizable scenario variables (audience size, audience reactions, background noise) to adjust the level of difficulty for each individual patient.
Why this matters
This is the first qualitative study to gather perspectives from both clinicians and patients with voice disorders on a fully immersive VR voice therapy tool. The consensus that VR could meaningfully address the transfer-phase gap in voice therapy is significant, as this challenge has persisted across decades of clinical practice. The user-centered approach ensures that future development of VR voice tools is guided by the needs and preferences of the people who will actually use them.
Limitations
The study evaluated perceptions and preferences, not voice outcomes - it does not provide effect-size evidence. Final coding was carried out by the first author only, raising the possibility that relevant statements were overlooked or coded inappropriately. Participating patients were selected by the SLPs, with no documentation of how many were initially approached or who declined. Member checking with participants was not used due to time constraints. The sample was drawn near a single university in Germany, limiting transferability. The study did not assess long-term engagement or whether initial enthusiasm would be sustained over repeated use. The authors believe data saturation was achieved for the thirteen patient participants but note that additional SLP perspectives would have extended the range of practice approaches captured.
Implications for practice
Fully immersive VR could address a longstanding challenge in voice therapy - helping patients transfer voice techniques learned in the clinic to vocally stressful everyday situations. User-centered design involving both clinicians and the patients they support is essential for creating practical and meaningful VR tools. VR voice therapy applications should include adjustable difficulty levels (audience, noise, scenario complexity) and integrated biofeedback options for clinicians who use them, while remaining intuitive enough for time-pressured outpatient settings.
Where this connects to Therapy withVR
The study above is independent research and does not endorse any product. The notes below are commentary from withVR on how the themes in this research relate to features of Therapy withVR. The research findings are not claims about Therapy withVR.
Multiple speaking environments
The evaluated prototype (ProVoiceVR) offered 14 scenarios. Therapy withVR provides 12+ fully customizable environments for practicing voice in varied real-world contexts.
Clinician control of scenario variables
Participants in this study emphasized the importance of adjusting audience size, audience reactions, and background noise. Therapy withVR allows the clinician to adjust these and other variables in real time from the web app.
Web-only mode for individuals who cannot or do not want a headset
Some patients in this study found the Quest 2 headset weight or fit a barrier. Therapy withVR includes a web-only mode that delivers the same scenarios on a laptop screen without a headset.
Cite this study
If you reference this study in your work, the canonical citation formats are:
@article{hansa2025,
author = {Hansa, J. and Hansen, H.},
title = {User-centered qualitative evaluation of a fully immersive, head-mounted virtual reality application prototype to facilitate real-life transfer in voice therapy},
journal = {International Journal of Speech-Language Pathology},
year = {2025},
doi = {10.1080/17549507.2025.2473075},
url = {https://withvr.app/evidence/studies/hansa-2025}
}TY - JOUR
AU - Hansa, J.
AU - Hansen, H.
TI - User-centered qualitative evaluation of a fully immersive, head-mounted virtual reality application prototype to facilitate real-life transfer in voice therapy
JO - International Journal of Speech-Language Pathology
PY - 2025
DO - 10.1080/17549507.2025.2473075
UR - https://withvr.app/evidence/studies/hansa-2025
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
Funded by the German Federal Ministry of Education and Research (Grant No. 16SV8918). The prototype evaluated in this study (ProVoiceVR) was developed by VReedback GmbH, Germany, who provided technical support to the research team. No withVR BV involvement in funding, study design, or authorship. Summary prepared independently by withVR using the published paper.