Virtual Reality in Speech Therapy Students’ Training: a Scoping Review

1. Introduction

1.1. Background

In recent decades, the world’s demographic structure has undergone significant changes, characterised by population growth and progressive ageing [1]. Ageing represents a new challenge as patients’ clinical situations become more complex. Most countries worldwide are experiencing a shortage of health workers, which is expected to worsen in future [2,3,4]. Therefore, innovative care procedures and highly qualified healthcare professionals are needed to meet patient needs.

In addition, the professional political conditions of the health professionals is undergoing a significant transformation, promoting the transition from a vocational training model to a university-level education, focusing on scientific knowledge, research, and evidence-based practice. This change in education is driven by the necessity to enhance professionalism of practitioners and improve the quality of care, contributing to enhanced patient outcomes and ensuring alignment with international standards in healthcare education and practice [4,5]. These needs lead to the rethinking of the academic curricula of health professionals to meet the educational requirements of the university system, while ensuring the acquisition of the practical and clinical skills.

Traditionally, practical skills are acquired during training through direct experience in the field, working alongside professionals and performing therapeutic activities on real patients under supervision. However, direct “hands-on” learning has both ethical and organisational limitations, especially when it comes to inexperienced students.

To address these critical issues, the World Health Organisation has recommended the use of reality simulation-based tools [3], recognising the pedagogical value of safe and controlled environments in which students can practise without the risk of accidentally harming patients. Several studies have highlighted the efficacy of simulation-based education compared to traditional learning methods [6] and demonstrated how integrating advanced technologies with traditional learning approaches enhances the acquisition of skills and the training of healthcare professionals [7,8]. Furthermore, the advent of the COVD-19 pandemic made it necessary to develop new distance learning techniques, both to protect patients and students, and to continue to provide students with adequate and comprehensive training. This has fostered the development of simulation-based technologies, such as virtual reality (VR), in healthcare education and training.

1.1.1. Training in Speech Therapy

As every healthcare field, speech therapy (ST), also known as speech-language pathology (SLP), is facing the problems previously described. In recent years, the ageing of the population and increasing number of people who have experienced serious health problems, e.g. brain strokes, head and neck cancer, progressive neurologic diseases [9], have led to a significant increase in the number of patients suffering from communication (i.e. apraxia) and swallowing (i.e. dysphagia) disorders.

Recent advancements in the speech therapy field, both from the educational and technical point of view, are resulting in significant improvements in treatment outcomes. In fact, in addition to the shifting from the vocational to the university education, the introduction of techniques previously handled by other professionals into the training of speech therapists, such as Flexible Endoscopic Evaluation of Swallowing (FEES), highlights the need for an update of the academic curricula. Moreover, the arise of new techniques as the transcranial Direct Current Stimulation (tDCS) and the necessity of practicing complex procedures as Tracheostomy Tube Management, also known as Tracheal Cannula Management (TTM and TCM, respectively), provide the opportunity to reshape the speech therapy curricula.

Moreover, belonging to the healthcare sector, ST also requires students to achieve a certain amount of hours in order to obtain their professional certificate. As a matter of example, in Germany, 1900 hours of clinical practice are required, according to LogAPrO, 1980 [10], while in the USA, students are required to complete 375 hours of direct clinical placements with patients in order to be certified to practise [11]. In order to provide students with the necessary amount of clinical practice, to reduce the workload of clinical placements settings and to address the shortage of licensed clinical educators, some national entities have started recommending the introduction of simulation-based training in speech and language therapy programmes. Indeed, since January 2023, ASHA allows students enrolled in the graduate program to gain up to 75 direct contact hours through clinical simulation [12]. In Australia, initial efforts to integrate simulation-based learning into speech pathology courses can be found in the project led by Dr. A. Hill, within which a Simulation-based Learning Program was developed between 2014 and 2018 [13].

Clinical simulations comprehend several kinds of situations aiming at representing the reality to let students deal with real-life contexts. Clinical simulations can be categorised into “levels according to how closely the simulation replicates the real-world

experience in terms of physical, environmental and psychological elements” [14](p.6). The Council of Academic Programs in Communication Sciences and Disorders (CAPCSD) has identified five categories of healthcare simulation, ranging in levels of fidelity: standardized patients, task trainers, manikins, computer-based (gaming), and immersive virtual reality [14].

The current scoping review aims at mapping the use of VR (non-immersive, semi-immersive and immersive), hence, among the simulation types individuated by CAPCSD, here only computer-based simulations and immersive virtual reality-based tools are considered relevant.

1.1.2. Virtual Reality-based Simulation

Among the categories of simulation identified by the CAPCSD, the authors of the current review decided to focus on both VR and computer-based kinds of simulations. Since the title of the review refers to VR, the choice of considering the first category may appear obvious. In contrast, the decision to include computer-based systems may seem less intuitive. However, this choice is justified by the broad definition of virtual reality, which encompassess several kinds of systems from the least immersive ones to the most immersive ones.

VR can be categorized according to several factors such as immersion, presence and interactivity. In the current review, VR was categorised according to the level of immersion the technology was able to provide. Indeed, VR can provide different degrees of immersion which is the capacity of the technology of “delivering inclusive, extensive, surrounding and vivid illusion of reality to the senses of a human participant”[15](p.3).

For this paper, VR has been divided into three macro categories: immersive VR, semi-immersive VR and non-immersive VR. In this context, we refer to immersive VR when the technology is able to “surround”, i.e. through the use of head-mounted displays (HMDs) or CAVE systems [15]. On the contrary, we categorized as “non immersive VR” the desktop-based systems, which can be interacted through the use of mouse and keyboard, such as Virtual Patients. Systems that implement intermediate shades of immersiveness will be categorized as semi-immersive VR, these may include the use of larger screens to provide the user with a higher sense of presence.

Given this explanation, taking into account computer-based tools too aligns with the current conceptual framework of VR and ensures a comprehensive mapping of its applications in speech therapy education.

Virtual reality has been demonstrated to offer immersive, interactive learning environments that promote the acquisition of theoretical knowledge while increasing student engagement and motivation [16]. By simulating a wide range of clinical scenarios, including rare or complex cases, VR allows students to develop and refine practical skills through unlimited, self-paced repetition in a controlled setting [8]. This flexibility fosters expertise acquisition without the ethical or logistical challenges associated with treating real patients, thereby reducing stress and enhancing students’ confidence and awareness [6].

1.2. Rationale

Some studies investigated the use of VR systems in the context of medical education and clinical care [17] or in the field of communication disabilities [18] but none focused on the evaluation of these systems specifically for speech therapists’ skills training of clinical procedures. Considering the current orientation towards the simulation-based clinical training in ST, as well as the numerous studies and projects successfully developed using different simulation tools [19,20,21], the integration of virtual reality into speech pathology training programmes seems to be a promising strategy to improve clinical preparedness and support the development of essential professional skills. In the absence of dedicated reviews on this topic, in order to support the above assertion, our research team decided to conduct a scoping review to understand and analyse in a clear and structured manner whether and how virtual reality has already been considered as an educational and training tool for speech therapy students.

1.3. Objectives

The objective of this scoping review is to investigate whether extant research has considered the use of Virtual Reality as a tool to support the training of speech therapy and language pathology students to improve their practical skills and prepare them to perform clinical procedures. The aim of this study is to provide a comprehensive mapping of the integration of this technology within the domain of speech therapy, with a view to highlighting potential gaps in the current literature. In order to achieve these objectives, the following research questions guided the scoping review:

• How is virtual reality being used in the education and clinical training of speech-language pathology students?
• What are the educational, technological, and methodological characteristics of VR-based interventions in speech-language pathology training?
• What outcomes and benefits are reported in the literature regarding the use of VR in the training of speech-language pathology students? How are these assessed?

2. Materials and Methods

This scoping review was conducted in accordance with the Joanna Briggs Institute Manual for Evidence Synthesis’s Methodology for Scoping Reviews [22] and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR) guidelines [23].

2.1. Protocol and Registration

A preliminary search of PubMed, PubMed Central, ScienceDirect, EBSCOHost, the Cochrane Database of Systematic Reviews, PROSPERO and JBI Evidence Synthesis was conducted and no protocol addressing our subject of interest was identified. Therefore, our team developed a protocol that was followed to conduct the review, which has not been published but is available in Appendix A.

2.2. Eligibility Criteria

In order to perform a comprehensive literature search, the eligibility criteria were kept as broad as possible. Indeed, the search was not constrained by temporal or linguistic limitations. The opportunity for such freedom was determined by two factors. Firstly, the novelty of the topic under consideration, as virtual reality is a relatively recent technology that naturally limits the search over time. Secondly, the resources available nowadays, such as online translators and artificial intelligence aided tools, enable the possibility to consult and include sources in a wide range of languages. Additionally, sources in any publication status were considered and no restrictions regarding the study design were applied to provide a reliable map of the available literature. To provide a complete overview of the sources, the typology of study has been made available within the results of this study.

The records retrieved from the search were considered as eligible for the inclusion in the current review if they met all the following criteria:

• The study was targeted to students or trainees in speech therapy and language pathology field;
• The study involved the use of virtual reality (including immersive, semi-immersive, and non-immersive formats) or, it assessed or evaluated the use of the VR technology;
• The purpose was the education and/or training of students.

2.3. Information Sources

A comprehensive search of the relevant literature was conducted, covering a range of sources including specialised databases, archives, registers, grey literature websites and artificial intelligence (AI)-driven platforms.

The interdisciplinary nature of the topic under consideration necessitated the consideration of specific databases from the healthcare field, addressing the speech therapy sector; the computer science field, addressing virtual reality technology; and the educational sector. The following academic databases and research engines were queried: ACM Digital Library, Cochrane Library, EBSCOhost, IEEE Xplore, PubMed, PubMed Central, ScienceDirect, SpeechBite and Wiley. The PROSPERO register was interrogated to identify ongoing studies and minimise bias risks of our search.

In addition to structured database searches, Google Scholar was consulted to identify grey literature and the AI research assistant Elicit [24] was used to find further records. We also performed snowballing by manually screening the reference lists of the included articles and reviewing related studies suggested by search engines and online platforms (e.g. Google Scholar, PubMed, etc…), which appeared as “related articles” or algorithm-based recommendations. These were screened manually for relevance and inclusion criteria.

A preliminary search was initiated at the beginning of April 2025, followed by the main investigation in May 2025, which was concluded on 20 May 2025. During this period, information sources were consulted repeatedly in order to refine the search strategies and adapt them to each research system, while maintaining consistency with the guiding research questions.

2.4. Search

A preliminary exploratory search was carried out before the final search. This process allowed the team to identify relevant terminology and try out different keyword combinations among the previously listed databases. The final keywords, listed in Table 1, were chosen based on insights gained during this preliminary phase. In order to avoid the potential loss of pertinent terminology, word roots were employed to encompass their potential variations wherever applicable. As a matter of example, the word “student*” was searched to include publications containing both the terms “student” and “students”.

During the search, keywords were combined using Boolean operators, and the search symbols specified by each database’s interface were employed. Where feasible, the keyword search was conducted by applying filters to restrict the search to the fields of title, abstract and keywords. The complete search strategy used for each database is provided in Appendix B.

2.4.1. Exceptions

Although the search strategy illustrated above was applied to most of the information resources, with the appropriate minor modifications, it was necessary to make more substantial modifications to the search strategy for some source of information. The current paragraph offers an overview of the strategies employed for the exceptions previously mentioned.

The SpeechBite database search strategy differed from the others due to the keywords utilised. Indeed, given the database’s specialisation in the domain of speech therapy, it was unnecessary to specify the target population. In addition, the context-related keywords “VR” and “virtual reality” were selected for the site’s advanced search system, which requires the use of one or two keywords.

The Science Direct database search procedure slightly differed from the others. Indeed, the search was performed three times via three distinct queries, owing to the search engine’s capacity constraints regarding the utilisation of no more than eight logical operators in a single query.

The search across Google Scholar was conducted in a slightly different way. Firstly, it is important to note that on Google Scholar, keywords entered can only be searched for in the titles of the records or anywhere in their text. After some initial trials, it was determined that restricting the keyword search to the title would have been too restrictive, as only a few records appeared. Consequently, it was decided to search for keywords across the entire text. However, this resulted in the query providing too many results, so to reduce the number of records resulting from the search, some terms were excluded from the search process. The platform was requested to remove records containing the following terms: “child”, “children”, “deaf”, “autism” and “rehabilitation”. These terms were selected because they frequently occurred in the titles of studies identified by Google Scholar that were not relevant to the present study. The elimination of these terms resulted in a substantial reduction in the number of results obtained. Nevertheless, the number of articles was still significant, so a manual selection process was implemented based only on the relevance of the titles. The searching process for Google Scholar is provided in Appendix C.

The research on Elicit followed a completely different process to previous studies. In fact, Elicit is not a traditional database, but rather an artificial intelligence-based platform designed to support the writing of scientific reviews. Its main functionalities include the ability to identify relevant studies based on research questions, facilitating the identification, synthesis and organisation of evidence in a targeted and efficient manner. The search questions reported above were therefore entered into Elicit, which was asked to find studies that could help address them. The search on Elicit was performed three times and 500 studies were found each time. For each iteration, artificial intelligence was used to screen the articles in detail, categorising them according to the target population, context and concept (see Table 1), and to detect the most relevant records. The three searches returned 12, 16 and 31 records, respectively. These resulting records were subsequently manually subjected to the evidence selection according to the process described in section 2.5.

2.5. Selection of Sources of Evidence

All the records resulting from the search were imported into Zotero to identify and remove duplicates. Once the duplicates had been removed, a two-step screening process was initiated. Firstly, a title and abstract screening was conducted, followed by a full-text screening, in order to identify the studies to consider for the review.

The title and abstract screening was performed by two independent reviewers, one specialised in the speech and language pathology sector (EH) and one specialised in the computer science field (FG). In case the reviewers both agreed that an article met the eligibility criteria, it was included and progressed to the next step of the review. Conversely, if both agreed that the article did not meet the criteria, it was excluded from the study. In cases of disagreement between the two reviewers regarding an article’s eligibility or, in the event that the initial title and abstract screening did not clearly indicate whether all three inclusion criteria were met, the study was deemed eligible for full-text screening as well.

The records considered eligible for the full-text screening process underwent independent review by three reviewers. As part of the full-text screening process, one researcher (FG) reviewed all of the studies to ensure consistency. Two additional reviewers, an expert of the speech therapy field (MW) and one expert of the computer science field (WM), each independently screened half of the total studies. During the second phase, the full-text screening, each article was read in its entirety in order to verify whether it met all the eligibility criteria for inclusion in the review. In cases where there were divergent opinions regarding the inclusion of the study in the review, a discussion was held. If no solution was found, the third reviewer was consulted. After this stage, the articles considered relevant to the research objectives were included in the study categorized according to predefined thematic and methodological criteria.

2.6. Data Charting Process

Relevant data were extracted from each record during the full-text screening process. Each reviewer (MW, WM and FG) independently took notes on the points of interest of each study, which FG then summarised in an Excel file. The data extraction template can be found in Appendix D.

2.7. Data Items

The extracted data included the title, author(s), publication year, country, language, study type (i.e. design), VR type (i.e. non-immersive, semi-immersive or immersive), VR characteristics (tool used for the VR implementation), the population addressed by the study (e.g. Bachelor’s or Master’s students specialising in speech and language pathology and eventual sub-field), the educational and/or training purpose (e.g. enhancement of communication skills, development of interviewing capacity, etc…), and the main results and findings of the study with the evaluation method used (i.e. direct assessment, interviews or trial-based perspectives).

2.8. Critical Appraisal of Individual Sources of Evidence

As this was a scoping review conducted in order to map the literature on our topic as comprehensively as possible, a critical appraisal of individual sources of evidence included was not conducted.

2.9. Synthesis of Results

The extracted data from the records were synthesised during the data charting process (paragraph 2.6) and are reported here through descriptive and thematic analyses. Where applicable, data are presented in tables, diagrams and flowcharts and accompanied by a narrative description to provide a comprehensive overview of the results.

3. Results

3.1. Selection of Sources of Evidence

The identification, screening and inclusion processes are shown in Figure 1. The database search produced a total of 174 records. Of these, 79 were retrieved through databases and registers, while the remaining 95 were found via other methods, such as grey literature (36) and AI-aided tools (59). After removing duplicates (57), 117 records underwent title and abstract screening. Of these, 75 were deemed ineligible for full-text screening. The remaining 42 were screened in full by the reviewers. In parallel, whenever a related article was suggested or an interesting citation was identified (through snowballing), the article was also screened in terms of its title and abstract. If it was eligible for full-text screening, it was read in full. Twenty-six records were identified in this way and fully reviewed. Therefore, a total of 68 records underwent full-text screening by the reviewers. The reviewers reached a consensus on the eligibility of the articles in the majority of the cases, with a total of four articles resulting in divergent opinions. A consensus was reached by the reviewers regarding the inclusion or exclusion of the record for these four articles. In the course of the study, three of these were included, while one was excluded. Of the 68 records reviewed, 42 were defined as ineligible for the review, 12 were not retrieved and 14 were deemed appropriate for the review and were included and analysed.

3.2. Characteristics of Sources of Evidence

The included studies characteristics are summarized in Table 2.

The included studies were published between 2006 and 2025, and were primarily conducted in the USA (n = 7, 50%) and Australia (n = 3, 21,4%). Despite being published in different countries, including non-English-speaking countries, all the included articles are in English (n = 14, 100%). Figure 2 shows the geographical distribution of the included studies.

Overall, a positive trend has been observed in the utilisation of VR in the domain of speech therapy training in recent years. Figure 3 shows the number of articles published per year and country of the authors’ institutions.

The typology of records included is broad. The included records are predominantly constituted of mixed-methods studies (n = 4, 28,6%), descriptive studies (n = 4, 28,6%), and experimental studies (n = 4, 28,6%). A further series of studies was identified, including pilot studies (n = 2, 14,3%), qualitative studies (n = 2, 14,3%), randomised controlled trials (n = 2, 14,3%), observational studies (n = 1, 7,1%), and design-based studies (n = 1, 7,1%). It is worth highlighting that the total sum exceeds 14, as some of the articles implement more than one typology. Moreover, in consideration of the objective of the present research, which is to map the present state of the literature, the following sources were included: journal articles, peer-reviewed publications, poster presentations and master theses.

3.3. Critical Appraisal Within Sources of Evidence

A critical appraisal of the sources of evidence was not performed.

3.4. Results of Individual Sources of Evidence

A range of outcomes has been reported in studies examining the use of VR in speech therapy training. The studies included in this analysis are consistent with the established criteria for the search, and each of them combines the three key focus points (virtual reality, population and training purposes) in a different way. The subsequent table (Table 3) provides a concise overview of the primary conclusions derived from each record that was covered in the review.

3.5. Synthesis of Results

On the basis of the purpose of our scoping review, the findings have been analysed under four major cores: (1) VR type and characteristics, (2) population, (3) training purposes (and sub-field of application), and (4) main outcomes and assessment methods.

3.5.1. Virtual Reality - Type and Characteristics

As outlined in the eligibility criteria that were applied in the selection of studies for inclusion, the focus was exclusively on studies that incorporated VR as a technological element. In the current review, VR was categorised according to the level of immersion the technology was able to provide. Indeed, VR can provide different degrees of immersion which is the capacity of the technology of “delivering inclusive, extensive, surrounding and vivid illusion of reality to the senses of a human participant”[15](p.3).

For this paper, VR has been divided into three macro categories: immersive VR, semi-immersive VR and non-immersive VR. In this context, we refer to immersive VR when the technology is able to “surround”, i.e. through the use of head-mounted displays (HMDs) or CAVE systems [15]. On the contrary, we categorized as “non immersive VR” the desktop-based systems, which can be interacted through the use of mouse and keyboard, such as Virtual Patients. Systems that implement intermediate shades of immersiveness will be categorized as semi-immersive VR, these may include the use of larger screens to provide the user with a higher sense of presence.

The simple categorization “VR” has been used to identify the studies in which the kind of virtual reality used was not specified. From now on, VR references will target the general use of VR, unless it is specified otherwise.

Some of the included studies also take into account or evaluate other technologies such as AR or MR that are not outlined here. Figure 4 and Figure 5 represent the VR types of the included studies and their characteristics, respectively.

In the included studies, 6 (42.9%) [26,27,30,31,32,33] of them implemented a non-immersive VR simulation. The primary objective of these studies is to furnish SLP students with screen-based simulations and the opportunity to interact with virtual patients to foster conversation, train communication [27,29,33], interpersonal [27,29], interviewing [26,32] and reasoning [26] skills.

Immersive VR systems were analysed in 5 (35,7%) [25,28,35,36,37] studies. These systems aim to immerse the user into a realistic environment within which the user can move and interact with the objects with physical body movements, providing them with a high sense of presence.

As early as 2006, the Virtual Immersion Center for Simulation Research (VICSR) expressed itself on the potential of providing computerised training in a safe, controlled, learner-centred environment for the field of speech language pathology that could promote transfer of skills into real world settings [25]. Indeed, the VICSR aimed at developing an immersive virtual reality CAVE able to provide speech pathology students with a simulation environment to practice real life scenarios.

Later on, other studies investigated the use of a more recent technology, i.e. Head Mounted Display (HMD). In 2018, Moradi et al. [28] investigated the use of a system composed of 3D glasses with an additional monitor and a pair of gloves while others proposed to use the Oculus Quest 1 [36] and the Meta Quest 3 [37].

The study conducted by Towson et al. [29] was classified as semi-immersive since it involves the use of a real-time mixed reality simulator, TechLivE, as well as a “large television screen, which features a virtual conference room and one adult avatar. There is a desk and chair in front of the screen in which the participant sits, with additional chairs around the perimeter of the room for observers.” [29](p.5).

Two studies were classified as generic VR [34,38] since they do not specify which level of immersion the VR provides to the user.

3.5.2. Population

As outlined in the eligibility criteria that were applied in the selection of studies for inclusion, the focus was exclusively on studies that were targeting the population of speech and language pathology students. The selected studies involved students from both the graduate and undergraduate courses, who were enrolled in different academic years. Figure 6 represents the target population of the included studies.

All studies considered have speech therapy students as their target population. The target population is characterised by homogeneity with regard to undergraduate and graduate students. Rondon-Melo & Andrade [31] concentrate their study on hearing sciences students, given that Speech-Language and Hearing Sciences (SLHS) students are enrolled in a unique course. In addition to conducting these studies to verify the effectiveness of VR in academic curricula, some researchers have addressed their search to clinical educators to assess their point of view regarding this innovation [27]. Xonbabayeva Madinabonu Asqarjon kizi also conducted a structured survey among both SLP and educators to assess the use and effectiveness of ICT in the SLP training programs [38]. Finally, the study conducted by Williams [25] also presents its technology as a valid tool for training patients with communication disorders, as well as a positive educational tool for training students.

3.5.3. Training Purposes (and Sub-Fields of Application)

As outlined in the eligibility criteria that were applied in the selection of studies for inclusion, the focus was exclusively on studies that aimed at providing or enhancing SLP students’ skills. Five main kinds of skills emerged: (1) communication and interpersonal collaborative skills, (2) clinical interviewing or reasoning skills, (3) performance knowledge, (4) clinical skills and (5) person-centered care intervention and awareness. Figure 7 illustrates the training purposes of the included studies.

Among the included studies, 3 (21,4%) [27,29,33] addressed the communication and interpersonal collaborative skills training being a core capacity for speech therapists. Indeed, communication is fundamental to understand patients’ necessities and to exchange information with different stakeholders, i.e. patients’ families and other clinicians. Two studies (14,3%) [26,32], focused on clinical interviewing or clinical reasoning processes aimed at enhancing students’ capacity of investigating and diagnosing the correct disease and to find the correct therapy to treat the patient.

Other two studies (14,3%) faced the thematic of the performance knowledge [30,31]. In 2019, Carter et al. [30] utilised the non-immersive SimuCase platform to facilitate students in practising with virtual patients, with the objective of enhancing their performance in the domain of paediatric language disorders. In the same year, Rondon-Melo et al. [31] conducted an experiment comparing the level of knowledge students gained from three different educational methods on the subject of the anatomy and physiology of the orofacial myofunctional system.

Two studies (14,3%) highlight the importance for students to understand the importance of delivering person-centered care to patients [34,35]. Blaydes et al. and Deman et al., independently, describe in their studies how letting students feel what patients do experience in everyday life is helpful to foster empathy and, therefore, being more focused on delivering a patient-centered care therapy and cure.

A total of five studies (35,7%) focused on training and enhancing the clinical skills of students [25,28,36,37,38]. These studies aimed at using VR as a tool to train speech-therapy specific procedures whose knowledge is fundamental but which are difficult to train prior to clinical placements. Already in 2006, thought about providing a simulated environment (i.e. CAVE) to students to let them train clinical procedures related to communication diseases [25]. Later, in 2018, Moradi et al. [28] described an immersive VR-based technology to let students train with oral organs assessment. In 2023, Kelly at al. [36] described the positive perspectives of SLP students regarding training Oral Musculature Assessment (OMA) through the use of the Oculus Quest 1. The most recent studies, conducted in 2025, also propose the training of practical skills [38] and of specific speech therapy clinical skills related to complex techniques such as TTM, FEES and tDCS [37].

The majority of the included studies, in addition to focusing on the type of skill to be trained, consider a particular clinical practice and/or clinical condition as an example. The following subfields emerge from the analysis of the extant studies: dysphagia, dementia, OMA, communication disorders, FEES, TTM, tDCS, oral organs assessment, stuttering-related anxiety and stuttering.

3.5.4. Main Outcomes and Assessment Methods

The included studies reported a range of outcomes related to the effectiveness of VR-based training in the field of speech therapy. These outcomes were assessed in different ways, based on the necessities of each study.

Overall, the studies reported positive results both in terms of soft skills and hard skills. In line with the prediction that Williams made in 2006 in his study, VR systems foster the increase of competencies [25,26,27,33,38] and skills transfer [25]. Different studies assessed the acquisition and enhancement of skills [30,38] and, therefore, enhancements in the performance [28,29]. Additionally, also improvements in reasoning, empathy [26,34] and confidence [27,38]. Deman et al. [35], stated that students reported fear and physiological fear due to the aim of the VR experience to let users feel the anxiety usually proven by people who stutter.

The VR is generally well accepted and considered as a valid tool to simulate real-life situations that are difficult to face and to train with before clinical placements. Indeed, the included studies report high acceptability [29], positive reaction of students’ intrinsic and extrinsic value for the training experience [36] and positive feedback [26].

The studies used both qualitative and quantitative evaluation methods to evaluate the VR under several aspects in the context of ST training. Some authors preferred to evaluate their systems using standard questionnaires and/or standardized minimum requirements scales, some examples are: International Classification of Functioning Disability and Health (ICF) [32] Situation - Background - Assessment - Recommendation - Communication (SBAR-C) [29]; Communication Competence in Interpersonal Settings (CCIS) and Patient Relationship Questionnaire (PRQ) [33]; usability, presence, acceptance, user experience questionnaires [37]; Standardized Clinical Skills Inventory (SCSI) and Critical Thinking in Clinical Skill Development (CTCSD) [30]. Additionally, qualitative interviews to SLP students and educators were carried on to record their considerations regarding the use of VR in ST training [26,27,32,36,38].

4. Discussion

4.1. Summary of Evidence

The number of records found that regard the use of VR in SLP training is limited, with only fourteen studies retrieved during the review process. As stated in several studies [18,28,36], there is a lack of search for simulation-based systems for SLP students, and this is clearly reflected in the VR context too. This paucity of records suggests that the topic is still in its infancy, with VR-based systems representing a new potential subject of search within speech therapy.

In speech therapy education and training, the use of simulation has increased significantly over time, with numerous studies evaluating its effectiveness in enhancing students’ learning outcomes and clinical readiness [28,29,30,33,34,39]. Despite the absence of constraints in the current review, the included studies span a period of almost 20 years, with only one study published in 2006 and the others in the last nine years. This trend may suggest that, already in 2006, the potential of this technology was emerging but only in the last few years, the wide range of applications that VR has and the positive outcomes reported in education and training contexts, caught the attention of the SLP field. Indeed, this field has been undergoing significant changes in terms of university curricula, reflecting the evolving demands of clinical practice and the integration of simulation-based educational technologies.

During the screening process conducted for this review, various forms of simulation were identified, including the use of mannequins, virtual learning environments (VLEs), standardized patients, role-playing activities, and computer-based scenarios. However, the studies specifically focusing on VR are few. Although the limited number of studies, our team identified some common features and emerging patterns across the included research.

Analysing the data, it emerges that, in most cases, non-immersive and semi-immersive VR are primarily employed to train communication, interpersonal and collaborative skills while immersive VR is used to develop practical and clinical skills. Moreover, while the purpose of training the first kind of systems is more homogeneous, the skills that immersive VR applications aim to train are practical and procedure-specific.

On the one hand, the first kind of systems often feature virtual patients or avatars that simulate realistic clinical scenarios, allowing users to engage in interview-based interactions (mainly chat-based) and practice clinical reasoning in a structured yet flexible and controlled environment. These have resulted in being effective for students in practicing dialogues with patients while investigating the diagnosis and reasoning on the following steps to perform. In addition to the enhancement of these soft skills, VR turned out to be a useful tool to improve awareness with regard to patients’ clinical situations and foster empathy towards them, allowing for a more dedicated approach. the patient’s conditions.

On the other hand, immersive VR systems have been investigated for training procedures that usually require a direct hands-on approach toward the patient. Except for the cave-based immersive system [25], which provides an environment where to practice communicative skills, and the system described by Deman [35], which aims at letting the users experience stuttering-related social anxiety, the other three studies describe systems focusing on very specific and different topics. Indeed, these tools provide specific scenarios to gain practical experience in specific clinical procedures, i.e. oral functional assessment [28], FEES, TTM and tDCS [37], and OMA [36]. It is worth to note that only Moradi and colleagues [28] managed to assess the effectiveness of the system, registering an increase of student’s score through independent-T test while Kelly et al. [36] qualitatively assessed the perspectives of VR-OMA across ST students. The project carried on by Gentile et al. [37] is still in its prototype phase and has not been tested yet. To the best of authors’ knowledge, these observations led to the thought that recent technologies effectiveness, i.e. Oculus Quest 1 and Meta Quest 3, have not been tested yet in ST training contexts therefore highlighting a gap in the literature. Given Moradi’s opinion assessing that “Virtual Reality technology results in increase in attention, concentration, and motivation” and that “Virtual Reality structure is so flexible in training and lets the students know this technology in different situations and sometimes new situations to choose, each one can be a type of learning.” [28](p. 89), the authors of this review believe that it is worth investigating this sector.

Additionally, SLP related studies [41,42], which were not included in the review due to inclusion and exclusion criteria restrictions, highlight the effectiveness of VR training systems for professionals and providers. This may suggest that the inclusion of such tools into the SLP student’s training could have positive effects on future speech therapists, if adequately adapted to educational contexts.

Future search may investigate the outcomes derived from the use of immersive, new and cutting-edge VR training systems in ST training and define a framework for the development of specific scenarios to train with.

Additional Considerations

The included studies were conducted in various countries, with a particularly high concentration in the USA and Australia. A deeper insight of the data reveals a rise in interest in the use of VR for ST education and training, with a significant increase observed beginning in 2016 for the USA and in 2018 for Australia. This increase may be associated with institutional support and guidance provided by national associations such as ASHA in the USA and SPA in Australia. Indeed, both ASHA and SPA have actively supported the integration of simulation-based training in ST curricula. In the USA, up to 75 hours of mandatory practicum can be delivered through simulation based systems while, in Australia, an inter-university research was carried out to develop simulation-integrated curricula. These suggestions and recommendations at national level probably fostered the interest of universities in conducting research in this direction.

In Europe, research in this area remains limited, which may be due to the decentralized nature of professional regulation and the absence of guidelines from a pan-European body such as the European Speech and Language Therapy Association (ESLA). To the best of the authors’ knowledge, there are no specific guidelines or recommendations for simulation-based learning in the field of speech and language therapy. Within the European context, the authors are aware of more general recommendations, such as the “SimNAT Pflege Leitlinie Simulation als Lehr-Lernmethode.”

4.2. Limitations

Although the intention was to make this review a faithful representation of the current literature by conducting unrestricted research, the authors acknowledge its limitations.

Firstly, some potentially relevant articles may not have been identified due to limited academic access to certain databases and subscription-based journals, which could have affected the comprehensiveness of the review. Secondly, although Google Scholar was used as an additional information source, some relevant articles may not have been retrieved due to the constraints introduced in the query. Indeed, because of the large number of studies retrieved (15800) using the query used for other databases, some restrictions were imposed on the search. Some recurrent words referring to irrelevant topics such as “rehabilitation” were excluded from the search to reduce the number of records to be screened. Future studies in this context could broaden this search even more, including all the sources we weren’t able to access.

Additionally, during the keyword search, particularly the preliminary search, it was observed that the duties of speech therapists sometimes overlap with those of other healthcare professionals. Moreover, this overlap is difficult to delineate since speech therapy regulations differ from country to country. As a result, some speech therapy-related practices may have been developed and studied under other allied health disciplines, and thus may not have been identified using our search keywords. Future research could expand the scope to investigate the use of VR technology in the training of speech therapy allied professions or for speech-therapy specific procedures.

5. Conclusions

The importance of practice-based learning to promote the acquisition of skills, situated learning approach, and the potential of immersive virtual reality to support this learning paradigm have been known for more than two decades. Several reviews assessed the lack of VR systems for specific healthcare fields [40] and, more specifically in the field of speech therapy [34,43]. Indeed, only 14 studies were found relevant in the context of ST training through a VR-based tool. VR in speech therapy training is generally used to enhance communication competencies of ST students towards different stakeholders, improve their empathy and awareness regarding the importance of providing patient-centered care and foster the acquisition of clinical and practical skills. Most of the studies included focus on the effects of non-immersive VR while, regarding the use of immersive VR-based tools there are no concrete results yet, except from the positive perspectives of students regarding their integration into curricula [36] and the literature-based evidence provided by other healthcare fields [34]. Overall, the results reported by the included studies generally indicate the positive impact of VR in the domain of speech therapy training.

In conclusion, this scoping review provides a general overview of the utilisation of VR in the training context of speech therapy. Despite the paucity of literature in this field, a lack of studies and applications based on immersive virtual reality to train future speech therapists has been identified. This analysis has the potential to pave the way for future research and studies regarding the inclusion of immersive virtual reality in the domain of speech therapy training to facilitate the acquisition of practical skills for specific-oriented ST clinical procedures.