AI-Integrated Virtual Reality Speech Therapy in Children With Speech Sound Disorders

This was a two-arm, parallel-group, assessor-blinded randomized controlled trial comparing AI-Integrated Virtual Reality Speech Therapy (AI-IVR-ST) with conventional speech therapy. Participants were children aged 5 to 12 years with articulation disorder and/or phonological disorder diagnosed by a qualified speech-language pathologist. Computer-generated block randomization with variable block sizes was used and allocation was concealed using sequentially numbered opaque sealed envelopes. Each group received three 45- to 50-minute clinic sessions per week for 12 weeks. The experimental intervention combined Kinect-based non-immersive virtual reality, AI-assisted Speech Blubs practice, therapist-guided speech generalization, and caregiver-supervised home practice. The control arm received conventional face-to-face speech therapy with a printed home exercise programme. Outcomes were assessed at baseline, Week 6, and Week 12; FACES III and ASHA NOMS were assessed at baseline and Week 12.

• AI-Integrated Virtual Reality Speech Therapy (AI-IVR-ST) (Other), also known as AI-IVR-ST: The multicomponent programme combined approximately 15 minutes of Kinect-based non-immersive virtual reality, 15 to 20 minutes of AI-assisted Speech Blubs practice, and 10 to 15 minutes of therapist-guided speech generalization. The intervention progressed from isolated sounds and syllables to words, phrases, sentences, conversation, and spontaneous communication. Caregivers supervised home Speech Blubs practice for approximately 15 to 20 minutes per day on five days per week.
• Conventional Speech Therapy (Other): Conventional face-to-face speech therapy included articulation therapy, phonological intervention, auditory discrimination, minimal-pair therapy, cycles-based elements, mirror therapy, picture and object naming, word-to-sentence practice, storytelling, conversational speech, and a printed home exercise programme. Sessions lasted approximately 45 to 50 minutes, three times per week for 12 weeks.

Primary outcomes

• Percentage of Consonants Correct (PCC) [Baseline, Week 6, and Week 12]: PCC is the percentage of intended consonants produced correctly in a defined speech sample, calculated as the number of correctly produced consonants divided by total intended consonants and multiplied by 100. Higher percentages indicate greater phonological accuracy.

Secondary outcomes

• Goldman-Fristoe Test of Articulation, Third Edition (GFTA-3) Standard Score [Baseline, Week 6, and Week 12]: Standardized measure of speech sound production. Higher standard scores indicate better articulation performance.
• Peabody Picture Vocabulary Test, Fourth Edition (PPVT-4) Standard Score [Baseline, Week 6, and Week 12]: Standardized measure of receptive vocabulary. Higher standard scores indicate better receptive-vocabulary performance.
• Therapy Engagement Composite Score Assessed Using the Study-Specific Therapist-Rated Engagement Checklist [Baseline, Week 6, and Week 12]: Therapy engagement was assessed using the Study-Specific Therapist-Rated Engagement Checklist, a structured therapist-rated measure assessing attention, task participation, responsiveness, motivation, completion of therapeutic activities, interaction with the therapist, and interaction with the virtual environment. Item ratings were combined to produce a total Therapy Engagement Composite Score ranging from 0 to 24 points, with higher scores indicating greater therapy engagement.
• Therapy Adherence [Weekly during the 12-week intervention; summary at Week 6 and Week 12]: Adherence was monitored using clinic attendance, home-practice completion, and an adherence composite. The planned clinic dose was three sessions per week for 12 weeks.
• FACES III Total Score [Baseline and Week 12]: Family functioning was assessed using the FACES III total score.
• ASHA NOMS Functional Communication/Participation Score [Baseline and Week 12]: Functional communication, activity, and participation were assessed using ASHA NOMS on the study's recorded 1-to-7 scale.

Sex: All, ages: 5 Years to 12 Years

Inclusion Criteria:

* Age 5 to 12 years.
* Confirmed articulation disorder and/or phonological disorder diagnosed by a qualified speech-language pathologist.
* Ability to follow simple verbal instructions.
* Normal or corrected-to-normal vision and hearing.
* Written caregiver consent and age-appropriate child assent where applicable.
* Availability to participate throughout the 12-week intervention period.

Exclusion Criteria:

* Autism spectrum disorder.
* Cerebral palsy.
* Intellectual disability.
* Hearing impairment incompatible with study assessment.
* Cleft lip and/or palate.
* Neurological disorders affecting speech.
* Severe behavioural disorders that prevented participation.
* Intensive speech therapy during the preceding three months.
* Medical conditions that prevented safe participation in the intervention.

• Fariha Ambreen Chaudhry, Principal investigator, Superior University