Virtual Reality: Exposure Training for Individuals Who Stutter

Lisa LaSalle

Lisa LaSalleDr. Lisa LaSalle is an ASHA-certified speech-language pathologist with specialty training in stuttering and fluency disorders. Dr. LaSalle has taught in graduate programs in Communication Sciences and Disorders for twenty years. Her research interests have focused on young children who stutter, concomitant disorders associated with stuttering and a fluency disorder known as cluttering.

Dr. LaSalle is currently mentoring University of Redlands Communicative Disorders students on a research project aimed at dissociations between language, phonology, and fluency among normally fluent two-to-four-year-olds.

Project Summary

Strides have been made toward incorporating virtual reality technology into decreasing social anxiety for public speaking (Anderson, Zimand, Hodges, & Rothbaum, 2005; Harris, Kemmerling, & North, 2002; Manivannan, Al-Amri, Postans, Westacott, Gray & Zaben, 2019; Slater, Pertaub, & Steed, 1999; Stupar-Rutenfrans et al. (2017); Walkom, 2016). However, only recently have there been gains made towards applying this emerging technology to help people who stutter (Brundage, Graap, Gibbons, Ferrer, & Brooks, 2006; Brundage, 2007; Brundage & Hancock, 2015; Scheurich, Beidel & Vanryckeghem, 2019) as well as to help other in our field, such as those who have suffered a traumatic brain injury (Manivannan, Al-Amri, Postans, Westacott, Gray & Zaben, 2019).

One benefit of teaching and supervising graduate student clinicians at the Truesdail Center for Communication Disorders is that, for my colleagues and me, we have “one foot in the classroom, one foot in the clinic/Truesdail, and one foot in the laboratory.” In my area of expertise, graduate students first learn the basics about speech fluency disorders, and then they apply what they know in clinic with individuals from our local communities who are new or continuing clients at Truesdail. We currently have 10 clients who stutter or present with a related speech fluency disorder. Brundage and Hancock (2015) suggested different type of VR environments or VREs could be used in our work with individuals who stutter, and of course, in an age-appropriate manner. Examples included:

“…a virtual party, developed to investigate the effects of cue exposure on nicotine and alcohol craving, could be used to practice introducing oneself or telling jokes to groups of strangers (Traylor, Parrish, Copp, & Bordnick, 2011). Speaking to persons in authority has been modeled in the virtual job interview (Brundage et al., 2006). Finally, the virtual convenience store could be used to practice giving specific answers such as asking for directions to specific locations or ordering fast food (Paris et al., 2011). Additional studies of what environments may be most useful and/or challenging, as well as factors influencing ecological validity of each environment, are encouraged (Brundage & Hancock, 2015, p. 148).”

Brundage and her colleagues have found that it is the behaviors of the audience members, rather than just the size of the audience, that appear to increase stuttering frequency. Thus these “altered audience/situation” VR 360 video clips are needed as they would require of the clinician and client either more use of the goals / strategies learned in stuttering therapy at Truesdail, or better, more representative speech samples for assessment. A main concern I have in effectively teaching graduate students (CDIS 629) and graduate student clinicians (CDIS 645) is that of teaching the importance and how-to’s of transfer and maintenance with individuals who stutter, as stuttering is highly variable across individuals, speaking situations, and across hours and days of one’s lifetime. Many authors (e.g., Brundage & Hancock, 2015) have suggested that researchers in our field compare the effects of VRE practice versus traditional practice in stuttering treatment. Thus, this project would allow me both teaching and scholarship opportunities.