A virtual world gives people with aphasia more opportunities to practice communication
How this was rated
Quasi-experimental study (n=20) in aphasia. Informative for direction; lack of randomization limits causal inference.
Ratings use a simplified four-tier scheme (High, Moderate, Low, Very Low) informed by the GRADE working group. Learn more about how studies are rated.
People with aphasia who spent time communicating in a virtual world called EVA Park showed meaningful improvements in functional communication and reported greater confidence in their everyday interactions.
A quasi-experimental study suggesting that a VR platform for aphasia communication is feasible; lack of randomization limits causal inference.
Key findings
- People with aphasia showed significant gains in functional communication (Therapy Outcome Measure) after using EVA Park; 18/20 participants received at least 88% of intended treatment dose
- Communicative confidence (CCRSA) and feelings of social isolation (Friendship Scale) did NOT significantly change
- The virtual world format provided high-frequency communication practice across 5 weeks of daily sessions with a support worker
Background
Aphasia - a communication difference that often follows stroke - can profoundly affect a person’s ability to participate in conversations, maintain relationships, and engage with their community. Research suggests that intensive communication practice leads to better outcomes, but accessing enough practice opportunities is a persistent challenge. Traditional therapy sessions are limited in frequency, and real-world conversations can feel daunting when communication is difficult. EVA Park was designed to address this gap by creating a virtual world where people with aphasia could practice communicating in a social, low-pressure environment.
What the researchers did
Marshall and colleagues developed EVA Park, a multi-user virtual world featuring a variety of everyday settings - a cafe, a shopping center, a park, and other community spaces. Twenty people with aphasia were quasi-randomly assigned to either the EVA Park group or a comparison group that received the same amount of attention from a communication partner but without the virtual world. Participants in the EVA Park group attended five weeks of sessions, spending time navigating the virtual environment, interacting with other people, and engaging in communication activities. Functional communication was assessed before and after the program using standardized measures.
What they found
People in the EVA Park group showed significant improvements in functional communication as measured by the Therapy Outcome Measure (TOM). 18 of 20 participants received at least 88% of their intended treatment dose, with sessions run daily for 5 weeks with a support worker - a strong adherence finding. However, two secondary outcomes did not show significant change: communicative confidence (Communication Confidence Rating Scale for Aphasia - CCRSA) and feelings of social isolation (Friendship Scale) both failed to reach significance. Earlier characterizations of this study as showing confidence gains were incorrect - the significant finding was limited to the functional communication measure. Many participants found the virtual world format engaging and motivating, and the social nature of multi-user interactions was valued.
Why this matters
For people with aphasia, the opportunity to practice communication in realistic but supportive social situations is invaluable. EVA Park demonstrated that virtual worlds can provide this opportunity at scale, offering frequent, engaging practice that complements traditional support. The multi-user format is especially important because it captures the interactive, unpredictable nature of real conversation - something that scripted practice activities often miss. This study supports the broader idea that VR and virtual environments can meaningfully extend communication practice beyond the constraints of the therapy room.
Limitations
The sample of 20 participants was relatively small, and the quasi-randomized design means that the groups may not have been perfectly matched. The comparison group received attention but not a comparable technology-based experience, making it difficult to separate the effects of the virtual world from the novelty of using technology. Long-term follow-up data would help establish whether the communication gains were maintained. The virtual world required a desktop computer rather than immersive VR, so the experience may differ from fully immersive environments.
Implications for practice
Virtual worlds can extend communication practice beyond the therapy room for people with aphasia The social, multi-user nature of the environment provides naturalistic communication opportunities that are difficult to replicate in traditional settings VR-based practice may help address the gap between limited therapy sessions and the intensive practice people with aphasia need
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.
Café Environment
This study used virtual cafes for aphasia practice - Therapy withVR's Café with a waiter who walks to the table creates functional ordering and social interaction scenarios.
Supermarket Environment
Practice everyday communication tasks like asking for help in a shop - extending the functional communication practice this study showed improves outcomes.
Laptop Text Display
Show written cues, scripts, or prompts on a virtual laptop inside VR - supporting the multimodal communication practice this study explored.
Cite this study
If you reference this study in your work, the canonical citation formats are:
@article{marshall2016,
author = {Marshall, J. and Booth, T. and Devane, N. and Galliers, J. and Greenwood, H. and Hilari, K. and Talbot, R. and Wilson, S. and Woolf, C.},
title = {Evaluating the Benefits of Aphasia Intervention Delivered in Virtual Reality: Results of a Quasi-Randomised Study},
journal = {PLOS ONE},
year = {2016},
doi = {10.1371/journal.pone.0160381},
url = {https://withvr.app/evidence/studies/marshall-2016}
}TY - JOUR
AU - Marshall, J.
AU - Booth, T.
AU - Devane, N.
AU - Galliers, J.
AU - Greenwood, H.
AU - Hilari, K.
AU - Talbot, R.
AU - Wilson, S.
AU - Woolf, C.
TI - Evaluating the Benefits of Aphasia Intervention Delivered in Virtual Reality: Results of a Quasi-Randomised Study
JO - PLOS ONE
PY - 2016
DO - 10.1371/journal.pone.0160381
UR - https://withvr.app/evidence/studies/marshall-2016
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
The Stroke Association, Award Number TSA 2011/10. No withVR BV involvement in funding, study design, or authorship. Summary prepared independently by withVR using the published paper.