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JCPSLP

Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology

43

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

those promoted on websites that are not evidence based.

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

(http://secondlife.com/). 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 speech language pathology

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

https://www.dropbox.com/

Facebook

A social networking website that allows account holders to create profiles, upload images, video

http://www.facebook.com

and text chat over the Internet

Second life A 3D virtual world where users can communicate using free voice and text chat

http://www.secondlife.com

Skype

A platform that allows text, voice and video calls over the Internet

http://www.skype.com

Twitter

A social networking website that allows account holders to post short text messages

http://www.twitter.com/

YouTube

High-quality video streaming technology that offers support for nearly every video format

http://www.youtube.com