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JCPSLP Volume 15, Number 1 2013 45
virtual SLP clinical environment, an interactive larynx model,
and an educational area concerning stuttering.
Similarly, the Virtual Stuttering Support Centre (VSSC)
(Meredith, 2011), located on the University of Ballarat’s
virtual island within Second Life, houses a virtual campus
and a range of interactive virtual experiences. The VSSC
contains a series of interactive scenarios which a person
who stutters can work through in order to practise their
fluency (Packman & Meredith, 2011). The scenarios are
hosted by Bots (software-controlled avatars which look
similar in appearance to a human-controlled avatar, giving
the scenario a sense of autonomy and validity). The
VSSC also has the capabilities to hold virtual meetings,
conferences, and social functions for people who stutter all
over the world to interact with, share ideas, and build on-
line support structures.
Ethical challenges for SLPs using
web-based services
So far in this paper we have drawn on developments in
telehealth and virtual worlds, with particular reference to
applications of these technologies to people who stutter, to
illustrate the potential of the web to improve access to SLP
services for PWCD. In this section, we consider ethical
issues that may arise with telehealth and virtual worlds, and
some implications for practice with regards to Speech
Pathology Australia’s (SPA) Code of Ethics.
There are numerous ethical issues arising from the use
of the web for the delivery of SLP services including ease
of client access to information and treatments that are not
evidence-based, the impact of technology on the clinician–
client relationship, and privacy and data storage.
Unregulated and non-evidence based
information and practices
One of the dangers involved with the web is the freedom
that it offers. It is now easy for a private individual anywhere
in the world to create their own website and advertise an
unsubstantiated, non-researched claim of assistance, cure
and treatment. Such claims of instant or rapid cures may
be accessed by vulnerable individuals seeking a solution to
chronic or debilitating conditions. Concerns have been
raised within a variety of health fields ranging from
alternative medicine to autism spectrum disorder and
stuttering about such sites (British Stammering Association,
2011; Cienki & Zaret, 2010; Harmse, Pottas, & Takeda,
2010). Websites offering such interventions are difficult to
police and shut down due to being internationally hosted
and to the legislative complexity surrounding the global
governance of websites. These websites are problematic
for SLPs in at least two major ways. First, because
members of the public are often not in a position to judge
the quality of information on websites, they may not be able
to distinguish between evidence based SLP practices and
Virtual worlds
An emergent web-based platform that may be new in
concept and practice to SLPs are virtual worlds. Virtual
worlds are on-line three-dimensional (3D) environments
which attract large numbers of registered and concurrent
users for a range of purposes including commerce,
education, and socialisation. An example of a popular
virtual world is Second Life ). In
2011 the number of registered users across virtual worlds
was approximately 1.185 billion (Wasko, Teigland, Leidner,
& Jarvenpaa, 2011), indicating these virtual environments
have become well accepted in modern society. Users within
virtual worlds represent themselves as an avatar. An avatar
is a user controlled virtual character through which the user
can portray and play out their identity (Novak, 2012).
Through avatars users can personalise their appearance
and their movements to a high degree, enabling complex
interaction with other avatars in the form of virtual gestures,
instant text messaging, and speech. These virtual
environments are currently being used and trialled across
many sectors for simulated scenarios, for learning, and for
provision of support services (see Wasko et al., 2011).
Virtual worlds are currently not well utilised or researched
by SLPs (Brundage, 2007; Brundage, Graap, Gibbons, Ferrer,
& Brooks, 2006; Packman & Meredith, 2011; Meredith, Miller,
& Simmons, 2012), but they do offer new possibilities for
client services and education. For instance, Brundage and
colleagues developed and evaluated simulated job-interview
scenarios using people who stutter which were presented
to the user through the use of elaborate virtual reality (VR)
headgear. Participants were led through a simulated process
which situated them within a 3D virtual setting of an office
environment and job interview. The virtual interviewer was
controlled externally by the researchers to give it a sense of
autonomous in-world life. The ability to control the interviewer
avatar and responses enabled the researchers to inject
variability, mood, manner and stress into the environment.
Results indicated that the general fluency levels of the
participants were the same within the virtual environment as
they were in real life, and that they experienced similar
feelings and apprehensions associated with the real-world
alternative. The participants indicated that they generally
found the VR experience to be realistic. These findings
suggest that virtual environments, if designed and
implemented well, could be alternative environments within
which clients can test and practice intervention strategies.
Virtual worlds also hold great promise for education of
SLP students, and self-advocacy for consumers. There
have been significant advancements in the use of virtual
worlds for simulation and service delivery across many
health sectors. For instance, the Northern Michigan
University’s Speech-Language and Hearing Science Island
(Bickley, 2009) within Second Life was designed as a SLP
and hearing science experience for students, patients, and
other interested individuals. The island also offers a conceptual
Table 1. Websites of interest to SLPs
Name Description URL
Dropbox A storage website that allows file storage and sharing
Facebook A social networking website that allows account holders to create profiles, upload images, video
and text chat over the Internet
Second life A 3D virtual world where users can communicate using free voice and text chat
Skype A platform that allows text, voice and video calls over the Internet
Twitter A social networking website that allows account holders to post short text messages
YouTube High-quality video streaming technology that offers support for nearly every video format