Narrative review - telehealth showed stuttering outcomes equivalent to in-person care; VR framed as a promising next step
How this was rated
Narrative or commentary paper; not primary experimental data.
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.
This narrative review traced how technology - from telehealth to electronic devices and VR - has reshaped clinical practice for people who stutter. It highlighted telehealth trials showing equivalent outcomes to in-person services and discussed VR as an emerging platform for graduated speaking practice.
A commentary discussing the potential of VR in stuttering work; not primary experimental evidence.
Key findings
- Telehealth trials demonstrated equivalent outcomes with less clinician contact time
- The web expanded access to stuttering information and support communities
- Altered auditory feedback devices showed mixed evidence with limited long-term benefit
- VR was framed as high-potential for graduated exposure with early pilot data supporting ecological validity
Background
Technology has influenced how clinicians support people who stutter for decades, but the pace of change accelerated rapidly with the internet, mobile devices, and virtual reality. Packman and Meredith reviewed this evolution to identify which technologies had accumulated meaningful evidence and which remained promising but unproven.
What the researchers did
The authors traced the development and adoption of four categories of technology: telehealth, the internet and web-based resources, altered auditory feedback (AAF) devices, and virtual reality. For each, they examined available evidence regarding effectiveness, accessibility, and practical implementation. The review focused particularly on how technology had changed the relationship between clinician and client, and whether outcomes were comparable to traditional in-person approaches.
What they found
Telehealth emerged as the most evidence-supported technology. Randomized controlled trials demonstrated that telehealth-delivered programs achieved outcomes equivalent to in-person support, often with substantially less clinician contact time. This made services accessible to people in remote areas who previously had limited options. The internet broadened access to information and created online communities where people who stutter could connect and share experiences; the paper specifically noted Second Life as an emerging platform enabling virtual support groups for people who stutter. AAF devices - which alter the timing or frequency of a speaker’s auditory feedback - showed initial promise but produced mixed results in controlled studies, with limited evidence of long-term benefit. VR was identified as having high potential for creating graduated speaking practice environments, with early pilot data suggesting that virtual audiences could produce genuine communicative responses.
Why this matters
This review placed VR within a broader historical pattern: technologies often generate early enthusiasm before the evidence catches up. By showing that telehealth succeeded because it was held to rigorous standards - including randomized controlled trials - the authors argued that emerging tools like VR should follow the same path. The review also highlighted that technology works best as an extension of clinical relationships rather than a replacement for them.
Limitations
The review was narrative rather than systematic, so the selection of studies may not be comprehensive. It was published in 2011, meaning the VR landscape it described was limited to very early feasibility work. The rapid advancement of VR technology since publication means some of the practical barriers discussed have since been addressed.
Implications for practice
Clinicians should integrate telehealth into routine practice for underserved populations and hold emerging modalities like VR to the same evidence-based standards as traditional methods.
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.
Full VR Platform
This seminal paper traced technology's evolution in stuttering support - Therapy withVR represents the current state of the art, combining immersive VR with real-time clinician control and AI capabilities.
Cite this study
If you reference this study in your work, the canonical citation formats are:
@article{packman2011,
author = {Packman, A. and Meredith, G.},
title = {Technology and the evolution of clinical methods for stuttering},
journal = {Journal of Fluency Disorders},
year = {2011},
doi = {10.1016/j.jfludis.2011.10.003},
url = {https://withvr.app/evidence/studies/packman-2011}
}TY - JOUR
AU - Packman, A.
AU - Meredith, G.
TI - Technology and the evolution of clinical methods for stuttering
JO - Journal of Fluency Disorders
PY - 2011
DO - 10.1016/j.jfludis.2011.10.003
UR - https://withvr.app/evidence/studies/packman-2011
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
No withVR BV involvement in funding, study design, or authorship. Summary prepared independently by withVR using the published paper.