Acceptability and User Experience
How clinicians, clients, families, and researchers experience VR in speech therapy - comfort, immersion, attitudes, expectations, and barriers.
Acceptability research examines how the people who use VR actually experience it. This includes clinicians adopting VR into their practice, clients putting on a headset for the first time, families observing or participating in sessions, and researchers assessing whether VR is suitable for their study populations. Acceptability is not the same as effect - a program can work well on paper and still fail in practice if nobody wants to use it.
Questions in this area include: is the headset comfortable to wear across a full session? Does the VR environment feel welcoming and safe? What concerns do clients raise about privacy, cybersickness, or how VR might be perceived? How do clinicians weigh setup time against the benefits of controlled environments?
User experience research in VR draws on methods from human-computer interaction as well as from clinical research. Qualitative interviews, surveys, think-aloud sessions, and ergonomic assessments all contribute. For a clinical technology to become a regular part of practice, its acceptability matters as much as its effects.
15 Studies
First scoping review of immersive VR in speech-language pathology maps two decades of research
A scoping review in AJSLP synthesized 11 peer-reviewed studies (2007-2025) using immersive VR with people who have communication differences. Across populations, immersive VR elicited communicative and emotional responses comparable to real-world contexts, with consistent presence and engagement findings. Sample sizes ranged from 3 to 36 participants, ages 9-81 years. The review describes the field as still early-stage and disproportionately focused on stuttering (5 of 11 studies).
Pilot of Immersive VoiceSpace VR (N=17, vocally healthy plus people with dysphonia) - participants scaled loudness and pitch across graded virtual restaurant conditions
A within-subjects pilot of Immersive VoiceSpace (IVS), a custom VR voice-training platform developed by the sole author. Seventeen adults (10 vocally healthy speakers and 7 people with dysphonia) completed a menu-ordering task in a virtual restaurant under four conditions - a baseline plus three graded IVS levels manipulating avatar distance, voice-activation thresholds, and walkaway timeouts. Sound pressure level and mean speaking f0 increased significantly across IVS levels in both groups; pitch flexibility was more constrained in the dysphonia group. Feasibility ratings were good overall (4.0/5), with comfort and safety excellent (4.5/5) and no cybersickness reported.
VR-based meditation reduced anxiety before voice therapy in a small exploratory RCT, with lower attrition in the VR arm
Twenty-six dysphonia patients with elevated state anxiety were randomized to a brief 10-12 minute meditation either with immersive VR (TRIPP app on Quest 2) or audio-only, delivered before each of four voice therapy sessions; 21 were analyzed. Both groups significantly reduced state anxiety with no Group x Time interaction (p=.207) - the modalities were comparable on the primary outcome.
Brief VR voice therapy with clinician feedback elicited teaching-style prosody in pre-professional teachers - but also significantly increased reported vocal discomfort
A single-session within-subjects pilot with 10 pre-professional teachers (9 analyzed). Both a teaching-style mock lesson and a clinician-controlled VR teaching intervention elicited teaching-style prosody vs a conversation control. CTT-style clinician feedback inside VR produced short-term modulations in SPL, fo, and Dt%. Critically, the VR condition also significantly increased self-reported vocal discomfort vs control (+20.5 VAS, p=.023) - a caveat that should travel with any clinical citation.
Qualitative study of patient and therapist experiences with immersive VR-assisted therapy for distressing auditory hallucinations (voices) in psychosis - from the Danish Challenge Trial multi-site collaboration
A qualitative study of participants' and therapists' experiences with Immersive VR-Assisted Therapy for distressing voices in psychosis, conducted within the Challenge Trial. Multi-site Danish + Australian + UK collaboration (Aalborg University Hospital, Copenhagen Mental Health Services, Orygen Melbourne, Swinburne University, Institute of Psychiatry London). Examines how patients with psychotic disorders experiencing distressing auditory hallucinations relate to immersive VR therapy and how therapists deliver it. Complements Pot-Kolder 2018 (VR-CBT for paranoid ideation in psychosis) with a focused qualitative lens on the distressing-voices subtype of psychosis.
Most SLTs know VR exists - almost none have used it with autistic children - and what would change that is very specific
A UK and Ireland survey of 53 speech and language therapists working with autistic children found that 92% were aware of VR but had not used it clinically. Only one SLT (1.8%) had used it with an autistic child. The barriers cited were specific and addressable: autism-specific VR knowledge, workplace support, training, and clear clinical guidelines. 80% said they would try VR with proper training and evidence.
VR for speech therapy with children with cerebral palsy is feasible at home - with kids rating it higher than clinicians do
This pilot feasibility study tested the VRRS (Khymeia) system for speech therapy assessment with 28 children with cerebral palsy at IRCCS Stella Maris Foundation (Pisa, Italy), and followed three children with unilateral CP through a home-based tele-rehabilitation program. VRRS is a non-immersive 2D touch-screen platform (the same system used in Cappadona 2023), not a head-mounted VR system. Both assessment and home delivery worked. Children consistently rated the system higher than clinicians on usability and acceptability.
Qualitative feasibility study (JADD 2024): focus groups with 8 autistic adolescents (ages 12-17) + 5 parents on VR-delivered social skills programs - 7 primary themes identified through open thematic coding
A qualitative study published in Journal of Autism and Developmental Disorders exploring the feasibility of VR-delivered social skills programs for autistic youth. Eight autistic adolescents (ages 12-17) and five parents participated across five focus groups, with semi-structured interview format. Open thematic analysis with inductive coding produced seven primary themes covering adolescent and parent perceptions of social skills development needs, attitudes toward VR-delivered interventions, and concerns/desires for clinical implementation. Critical adolescent-voice work for the autism+VR field.
Single-group pre-post pilot study of immersive VR 'outworld' experiences for 13 in-patients with dementia: feasible, well-tolerated, and qualitatively engaging
A single-group pre-post pilot study of immersive virtual reality experiences delivered to 13 hospital in-patients with dementia (mean age 73.2, range not reported; 13 women in the Nudelman scoping review listing). Patients used an HTC VIVE Pro Eye HMD to access curated 'outworld' VR environments (places they could no longer visit in person). Mixed-methods evaluation combined pre-post quantitative measures with qualitative interviews. The VR experience was well-tolerated and produced positive engagement, though the small single-group design without a control limits causal inference about therapeutic benefit.
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
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.
Speech-language pathologists see potential in VR for TBI cognitive-communication work - if training, guidelines, and evidence catch up
A qualitative study of 14 speech-language pathologists and 3 VR researchers explored attitudes toward using VR with adults who have cognitive-communication difficulties after traumatic brain injury. Participants were broadly positive about VR as a way to rehearse real-world communication, but raised concrete concerns about safety, access, cost, and the absence of clinical guidelines. The study surfaces what clinicians need before VR can move from interesting to routine.
Mixed-methods study of 15 speech-language pathologists' acceptance, barriers, and enablers of using an immersive VR kitchen environment for communication rehabilitation
Fifteen speech-language pathologists participated in everyday-life communication activities inside an immersive VR kitchen environment, then completed system-usability and motion-sickness surveys plus semi-structured interviews. System usability was average; motion sickness was low. The qualitative analysis identified five themes - attitude toward VR in communication rehabilitation, perceived usefulness, perceived ease of use, intention to use, and clinical adoption barriers and enablers. SLPs were broadly positive about VR's potential as an ecologically valid communication-rehab tool while identifying real-world implementation barriers.
Mixed-methods study of 31 autistic children (ages 6-16) using VR head-mounted displays in schools - the high-fidelity HTC Vive was preferred, HMDs were reported as enjoyable, comfortable, easy to use, and useful for relaxation + pre-visit familiarization + school learning
A mixed-methods study placing 31 autistic children aged 6-16 at the center of a school-based investigation of VR head-mounted displays. Three research questions: which HMD do autistic children prefer, how do they experience HMDs physically and emotionally, and what would they want to use VR for in school? The high-end HTC Vive was preferred over lower-fidelity HMDs. Children reported VR as enjoyable, physically and visually comfortable, easy to use, exciting, and reusable. Identified uses: relaxation / feeling calm, virtual pre-visit to anxiety-inducing locations before real-world visit, learning opportunities in school.
Fully automated VR therapy delivered by a virtual coach significantly reduced fear of heights
In a 100-person single-blind RCT, a fully automated VR program with a virtual therapist coach produced large reductions in fear of heights - achieving outcomes comparable to therapist-delivered care without requiring a clinician in the room.
Umbrella review: clinical VR has matured into a viable tool, with caveats clinicians should know
An umbrella review by two senior figures in clinical VR examined the breadth of evidence across psychological and neurocognitive applications, concluding that VR is ready for routine clinical use in many contexts while flagging implementation challenges that practitioners should plan for.
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