Foreword

Although it may appear that virtual reality (VR) has only recently come into its own, early uses occurred in the 1940s when the U.S. Navy applied virtual programming to create flight simulators (Makulowich, 2000). Since then, a variety of hardware and software configurations have been developed that employ virtual experiences for diverse purposes. This issue of Topics in Language Disorders (TLD) addresses therapeutic applications of VR for people who face communication challenges that range from autism spectrum disorder (ASD) and other developmental cognitive communication disorders—to adult aphasia—to stuttering. The options for technological supports for simulated experiences also vary widely. For example, head mounted devices can be combined with stereo headphones and hand controls to enhance the modes of input (sound and movement) provided to the user. Data gloves can allow individuals to interact with the virtual environment through hand gestures, such as pointing or making a fist. Another VR environment, the CAVE is a surround-screen, surround-sound, projection-based virtual reality system. “CAVE dwellers”do not wear helmets to experience VR. Instead, they put on lightweight stereo glasses and walk around inside the CAVE as they interact with virtual objects. As noted in some of the articles in this issue, some VR equipment can be overstimulating for individuals with some disorders. Less invasive configurations have been constructed to address these concerns and also to make VR systems more accessible in size and affordability. These systems include the use of personal computer systems (PC and/or laptops) coupled with stereoscopic wireless LCD (liquid crystal display) glasses or circular polarized glasses that create the illusion of three-dimensional images by restricting the light that reaches each eye. The potential of applying these virtual configurations has been realized by various health care professionals. For example, the medical field has taken advantage of virtual technology for training purposes. Systems have been developed to train interns to practice surgical procedures; obstetricians can rehearse delivery techniques; and dentists now engage in virtual oral restorations. Treatment purposes also have been developed. For example, occupational therapists Weiss and Katz (2004) suggested potential applications of VR in therapeutic and rehabilitation settings. Other professionals in the fields of rehabilitation and special education who work with individuals who have communication and/or cognitive deficits have realized the potential of accessing a virtual environment for their clients. This issue of TLD describes a number of their contributions, and how the interdisciplinary focus of the work, in which engineers and computer programmers work with clinicians and special educators, has evolved. VR environments offer unique opportunities to provide individuals with a safe setting in which to practice various skills with immediate feedback and reinforcement. This coupled with the fact that the physical environment can be altered for individual users numerous times within a single treatment session to promote generalization and transfer is exciting! This issue highlights evolutional studies that have investigated potential uses and evidence for the effectiveness of VR applications in the assessment and treatment of individuals with communication and cognitive deficits. The virtual journey offered to readers of this issue begins with an article by Dr. Sue Cobb, in which she transports readers through her development of virtual environments with colleagues in the VIRART Human Factors Research Group at the University of Nottingham in the United Kingdom. Cobb describes VR applications in educational settings focused on learning and communication for children with complex special needs. Included are experiential learning of physical activities, life skills, sign language, and social skills. Outcomes for the children and adolescents in the studies are described and the author poses interesting questions for further development and use of VR. Dr. Dorothy Strickland and colleagues at Do2Learn, the Departments of Computer Science and Education, North Carolina State University, and the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, then take us through the development of VR training designs for teaching safety skills to children with autism and fetal alcohol spectrum disorders. They describe the evolution of study methods and lessons learned from different VR configurations and training methods. The authors also describe the design success of an animated character (avatar) for younger children, as well as other program designs. Continuing the journey, the coeditors of this issue, Drs. Trisha Self and Rosalind Scudder, along with our coauthors, computer engineer, Dr. Gamal Weheba, and clinician, Ms. Daiquirie Crumrine, describe a series of VR studies for children with autism spectrum disorder (ASD). These studies were conducted in public school settings as well as in our laboratory at Wichita State University. The purpose of this part of the journey was to compare traditional training modules to user-friendly computer VR modules for teaching safety skills in an educational setting. Evidence for VR effectiveness and efficiency is presented in comparison with traditional training approaches. Dr. Shelley Brundage, The Speech and Hearing Research Department, George Washington University, extends the VR voyage by immersing readers in the assessment and treatment of people who stutter. Brundage describes how the goal of effective communication can be reached with this clinical population. She relates the affective, behavioral, and cognitive components of stuttering with other disorders that have been successfully treated using VR environments. Job interview and audience reaction studies demonstrate the potential usefulness of VR in the treatment of stuttering. Brundage concludes by considering other potential applications. Dr. Linda Garcia and colleagues at the University of Ottawa, Ottawa, Ontario, Canada, take readers to the future by suggesting a potential use of VR to evaluate functional communication in patients with aphasia. They describe how the assessment of real-world situations may be possible by simulating events in virtual environments. Interviews with speech-language pathologists yielded ideas about different target populations, desirable technical features, and other potential uses. As you read these articles, we encourage you to reenvision your own experience of being in a video arcade awaiting your turn to play the race car game. There was nothing like sitting in the driver's seat, holding on to the steering wheel, pushing on the accelerator, and feeling as though you were actually in the car experiencing the twists and the turns and the bumps as you maneuvered down the track to the finish line with the sound of the crowd cheering you on. Now, accelerate to virtual experiences of today in which children and adults are immersed in a virtual world through the use of a special headset that allows participants to “look around”and engage in a virtual environment. As you journey through these articles and imagine applying similar concepts and technologies to your current practice and research, we encourage you to consider “what if?”or “how can I…?” As we reflect on our own journey in editing this issue, we are grateful to the contributing authors for their important and unique contributions and their willingness to share the inside story on the wrong turns and bumps in the roads down which they traveled, as well as their successes. We believe that the information presented in this issue has shown a realistic picture of the challenges and futuristic possibilities, but also that virtual reality is in the here and now. We hope that you sense after reading this issue that you have arrived at an exciting destination, or at least a starting point. As Tanner (2003) suggested, in the not-too-distant future, communication disorder specialists may be saying “Welcome to the Cyber Clinic.” Trisha L. Self, PhD, CCC-SLP Issue Editor Assistant Professor Department of Communication Sciences and Disorders, Wichita State University, Wichita, Kansas Rosalind R. Scudder, PhD, CCC-SLP Issue Editor Professor and Graduate Coordinator Department of Communication Sciences and Disorders, Wichita State University, Wichita, Kansas

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