A tutorial overview of how immersive VR might support people with neurogenic communication differences
How this was rated
Tutorial review (described by the author as a "pie in the sky" overview), not a primary experimental study and not a systematic review. The author explicitly acknowledges that there is little empirical evidence supporting iVR for neurogenic communication disorders at the time of writing. Two hypothetical (not real) case studies are presented to illustrate potential applications.
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An ASHA tutorial reviewing immersive VR for speech-language rehabilitation of adults with neurogenic communication disorders. The author's overall conclusion is that there is currently insufficient evidence that immersive VR directly benefits communication outcomes in this population. withVR is named once as one example of emerging applications 'being developed by and for persons with communication differences'; the paper does not use, test, or evaluate withVR.
A non-systematic tutorial orienting readers to the potential and challenges of immersive VR for adults with aphasia, cognitive-communication disorders following TBI, Parkinson's disease, apraxia of speech, dysarthria, and right-hemisphere brain damage. The author explicitly states that direct empirical evidence in this population is limited. Useful as a synthesis paper but should not be cited as evidence of effectiveness.
Key findings
- Author explicitly acknowledges 'there is little empirical or robust evidence that iVR is of direct benefit for improving communication outcomes in persons with neurogenic communication disorders' and frames the paper as a 'pie in the sky' tutorial
- Identifies six hypothetical iVR application areas in Table 1: aphasia, cognitive-communicative disorders, Parkinson's disease, apraxia of speech, dysarthria, and right-hemisphere brain damage
- Reviews adjacent evidence base, including Demeco et al. (2023) systematic review of poststroke motor rehabilitation (12 RCTs, 350 stroke survivors) and Chatterjee et al. (2022) Phase 2b RCT of the VIRTUE iVR cognitive rehabilitation system (n=40)
- Discusses generalization, dose and intensity, anxiety reduction, AI/ML integration, accessibility, ethical concerns, and cybersickness as key considerations
- Names withVR once on page 10 (in the accessibility section) as one example of 'applications being developed... developed by and for persons with communication differences'; the paper does not use, test, or evaluate withVR
Background
While much of the VR-in-speech-therapy research has focused on stuttering and voice, there is growing interest in whether immersive virtual reality could support people whose communication has been affected by neurological events - stroke, traumatic brain injury, Parkinson’s disease, and other conditions that can affect speech, language, and social communication.
Stark’s tutorial paper explores this emerging area, examining the theoretical basis for using VR in this context and surveying the tools and approaches currently available.
What the author did
Rather than conducting original research, Stark performed a narrative review spanning rehabilitation science, VR technology, and communication differences. The paper combines existing evidence, theoretical principles from motor learning and embodied cognition, and two hypothetical case studies to illustrate how VR-based practice might work in clinical settings.
Key themes
The paper identifies several areas where VR could add value for people with neurogenic communication differences:
Ecologically valid practice. VR can simulate everyday environments - a cafe, a workplace, a family gathering - where communication actually happens, offering practice that is more meaningful than traditional desk-based activities.
Adjustable complexity. Clinicians could control environmental factors like background noise, the number of conversation partners, and cognitive load, creating graded challenges tailored to each individual’s abilities.
Extended practice opportunities. Consumer-grade headsets could support home-based practice, potentially increasing the overall dose and frequency of communication practice beyond what clinic visits alone can provide.
Reduced anxiety. For individuals who experience anxiety about communication in social settings, VR offers low-risk exposure where mistakes carry no real-world consequences.
The paper specifically highlights withVR as an emerging, accessible platform, describing it as an application “developed by and for persons with communication differences.”
Why this matters
This tutorial is significant because it extends the conversation about VR in speech and language services beyond stuttering into a much broader population - people with aphasia, dysarthria, apraxia of speech, and cognitive-communication differences. It positions VR not as a replacement for clinical expertise, but as a tool that could enhance what clinicians already do by providing realistic practice environments.
The inclusion of withVR alongside other platforms (VirtualSpeech, EVA Park) indicates growing recognition of the platform within the broader speech-language pathology research community.
Limitations
The paper is explicitly nonsystematic and reflects one author’s interpretation. Most evidence referenced addresses motor recovery or cognitive rehabilitation rather than communication outcomes directly. Many proposed benefits remain conceptual. Practical concerns include cybersickness risk, digital literacy barriers among older adults, and the absence of rigorous clinical trials for communication-specific outcomes.
Implications for practice
Clinicians may consider iVR as a complement to traditional speech-language therapy that could potentially extend the intensity and ecological validity of practice beyond clinic-based sessions. The author notes that consumer-grade headsets (Meta Quest 3 at $450-$600 as of April 2025) open pathways for home-based work, potentially increasing access for rural and underserved populations. The author explicitly cautions that rigorous efficacy data in this population are limited and that further empirical work is needed before iVR is positioned as a primary approach. Customization should follow co-design principles with end-users to mitigate ethical and cultural risks.
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.
Customizable speaking environments
This tutorial argues iVR can offer ecologically valid practice contexts and adjustable difficulty - Therapy withVR provides 12+ customizable environments and real-time clinician controls of these variables. Important: the tutorial does not test Therapy withVR; this parallel is drawn editorially for context.
Real-time clinician control
The tutorial discusses the value of adjustable environmental complexity (background noise, number of avatars, pacing). Therapy withVR allows clinicians to adjust these in real time. Editorial parallel only.
Cite this study
If you reference this study in your work, the canonical citation formats are:
@article{stark2025,
author = {Stark, B. C.},
title = {Speech and Language Rehabilitation for Neurogenic Communication Disorders: The Potential Role of Immersive Virtual Reality Interventions},
journal = {Perspectives of the ASHA Special Interest Groups},
year = {2025},
doi = {10.1044/2025_PERSP-25-00035},
url = {https://withvr.app/evidence/studies/stark-2025}
}TY - JOUR
AU - Stark, B. C.
TI - Speech and Language Rehabilitation for Neurogenic Communication Disorders: The Potential Role of Immersive Virtual Reality Interventions
JO - Perspectives of the ASHA Special Interest Groups
PY - 2025
DO - 10.1044/2025_PERSP-25-00035
UR - https://withvr.app/evidence/studies/stark-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
From the paper's own disclosure: 'The author was awarded a Fulbright Scholar Award to study immersive virtual reality in persons with aphasia after acquired brain injury. This award included a monthly financial stipend, but no money toward the research. The author therefore has no financial conflict of interest (COI) but does have a professional COI, in that the award is sponsoring involvement in this area. The author has declared that no other competing financial or nonfinancial interests existed at the time of publication.' withVR is named once on page 10 of the tutorial as one example of emerging applications, alongside VirtualSpeech and others; the paper does not use, test, fund, or evaluate Therapy withVR or any other commercial platform. No withVR BV involvement in funding, design, or authorship. This summary was prepared independently from the published paper.