Virtual Speech Therapist: A Clinician-in-the-Loop AI Speech Therapy Agent for Personalized and Supervised Therapy
Authors: Shakeel Sheikh, Patrick Marmaroli, MD Sahidullah, Slim Ouni, Fabrice Hirsch, Goncalo Leal, Bjorn W Schuller
Organizations: 1*The Kashmir Hub for Artficial Intelligence, The KHAIR, Basel, 4056, Switzerland. · 2Microsoft / Vocametrix, Tallinn, Estonia. · 3IAI, TCG CREST, West Bengal, India. · 4Universit´e de Lorraine, CNRS, Inria, LORIA, Nancy, 54000, France. · 5Laboratoire Praxiling, UMR5267, CNRS et Universit´e Paul-Val´ery 15 Montpellier 3, France. · 6Speechcare iStutter, Portuguese Catholic University, Portugal. · 7CHI – Chair of Health Informatics,TUM University Hospital, Germany. · 7GLAM – Group on Language, Audio, & Music,Imperial College London, United Kingdom.
Abstract
This paper develops Virtual Speech Therapist (VST), an intelligent agent-based platform that streamlines stuttering assessment and delivers customized therapy planning through automated and adaptive AI-driven workflows. VST integrates state-of-the-art deep learning-based stuttering classification, and multi-agent large language model (LLM) reasoning to support evidence-based clinical decision-making. The VST begins with the acquisition and feature extraction of patient speech samples, followed by robust classification of stuttering types. Building on these outputs, VST initiates an agentic reasoning process in which specialized LLM agents autonomously generate, critique, and iteratively refine individualized therapy plans. A dedicated critic agent evaluates all generated therapy plans to ensure clinical safety, methodological soundness, and alignment with peer-reviewed evidence and established professional guidelines. The resulting output is a comprehensive, patient-specific therapy draft intended for clinician review. Incorporating clinician feedback, the system then produces a finalized therapy plan suitable for patient delivery, thereby maintaining a clinician-in-the-loop paradigm. Experimental evaluation by expert speech therapists confirms that VST consistently generates high-quality, evidence-based therapy recommendations. These findings demonstrate the system's potential to augment clinical workflows, reduce clinician burden, and improve therapeutic outcomes for individuals with speech impairments. An interactive user interface for the proposed system is available online at: https://vocametrix.com/ai/stuttering-therapy-planning-agent , facilitating real-time stuttering assessment and personalized therapy planning.
Training psychotherapists in evidence-based interventions such as Acceptance and Commitment Therapy (ACT) requires repeated practice with meaningful feedback, yet opportunities for safe, standardized training are limited by ethical, logistical, and resource constraints. We introduce a system designed to support ACT-oriented psychotherapy training through spoken dialogue with an embodied virtual patient. The system uses large language models to simulate patient behavior conditioned on profiles derived from real therapy sessions and configurable clinical scenarios, while a separate automated evaluator provides turn-by-turn feedback on therapist responses based on established ACT fidelity criteria. Rather than aiming to replace supervision, the system is intended to support deliberate practice by enabling experimentation, reflection, and immediate feedback in low-risk settings. Expert evaluation with practicing psychologists confirmed high realism in patient behavior and demonstrated that immediate turn-by-turn ACT feedback increased therapists' awareness of intervention choices and enabled effective experimentation with alternative responses. Quantitative evaluation across 49 therapy transcripts identified GPT-4o-mini as the optimal feedback model, achieving the lowest mean absolute error (MAE = 6.12) in replicating human supervisor ACT fidelity ratings with statistically significant agreement. This work demonstrates the potential of fidelity-aware simulated patients as a scalable complement to psychotherapy training.
Atypical speech is receiving greater attention in speech technology research, but much of this work unfolds with limited interdisciplinary dialogue. For stuttered speech in particular, it is widely recognised that current speech recognition systems fall short in practice, and current evaluation methods and research priorities are not systematically grounded in end-user experiences and needs. In this work, we analyse these gaps through 1) a scoping review of papers that deal with stuttered speech and 2) a survey of 70 stakeholders, including adults who stutter and speech-language pathologists. By analysing these two perspectives, we propose a taxonomy of stuttered-speech research, identify where current research directions diverge from the needs articulated by stakeholders, and conclude by outlining concrete guidelines and directions towards addressing the real needs of the stuttering community.
The growing demand for cognitive remediation therapy, combined with limited speech therapist availability, has accelerated the adoption of remote rehabilitation tools. These systems generate large volumes of interaction data that are difficult for clinicians to review efficiently. This paper investigates automated clinical report generation for avatar-guided, home-based cognitive remediation sessions in a low-resource setting with no reference reports. We present and compare two approaches: (1) a rule-based template system encoding speech therapy domain knowledge as explicit decision rules and validated templates, ensuring clinical reliability and traceability; and (2) a zero-shot LLM-based approach (GPT-4) aimed at more fluent and concise output. Both systems use identical pre-extracted, expert-validated structured variables, enabling a controlled factual comparison. Outputs were evaluated by eight speech therapists and final-year students using a nine-criterion questionnaire. Results reveal a clear trade-off between clinical reliability and linguistic quality. The template-based system scored higher on fluidity, coherence, and results presentation, while GPT-4 produced more concise output. Directional differences are consistent across evaluation dimensions, though no comparison reached statistical significance after correction, reflecting the scale constraints of expert clinical evaluation. Based on evaluator feedback, we derive eight design recommendations for clinical reporting systems in remote rehabilitation settings. More broadly, this work contributes a replicable methodology combining expert elicitation, taxonomy-driven generation, and multi-dimensional human evaluation for clinical NLG in low-resource settings, and illustrates how controlled comparisons can inform the responsible adoption of generative AI in healthcare.