JCPSLP Vol 17 Supplement 1 2015_lores

Table 1. Websites of interest to SLPs Name Description

URL

Dropbox

A storage website that allows file storage and sharing

https://www.dropbox.com/ http://www.facebook.com

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

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

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

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.

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

www.speechpathologyaustralia.org.au

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