Auditory-verbal therapy is crucial for hearing-impaired children. Current methods often lack personalization and engaging elements, leading to poor user engagement and compliance. Gamification, the application of game-design elements in non-game contexts, has emerged as a potential solution to enhance learning and motivation. This study addresses the gap in research on the specific effects of gamified auditory-verbal training across different rehabilitation stages. The research questions are: (1) Does gamified training improve performance in advanced-stage children? (2) Does gamified training improve performance in intermediate-stage children? (3) Do children enjoy the gamified approach? This study aims to empirically evaluate the effectiveness and user experience of a novel gamified auditory-verbal training system.

Existing auditory-verbal rehabilitation methods often lack personalization and engaging elements, hindering user engagement and compliance. Several approaches such as Auditory-Verbal Therapy (AVT), Language Experience Approach (LEA), and Augmentative and Alternative Communication (AAC) exist, but these often neglect the diverse needs of children at different rehabilitation stages. Gamification has shown promise in children's education by improving learning outcomes and engagement. While some gamified auditory-verbal training products exist (e.g., Splingo's Language Universe, LiSN & Learn, AngelSound), there's a lack of empirical evidence on their effectiveness, especially concerning different rehabilitation stages. This research aims to fill this gap by investigating the effects of a novel gamified training system.

A digital gamified auditory-verbal training system, "Hear to See," was developed. This system includes games targeting sound volume perception, auditory memory, auditory description, articulation, sentence expression, and cognitive abilities. The games were tailored to intermediate and advanced rehabilitation stages. Thirty-one children (15 intermediate, 16 advanced; 17 boys, 14 girls) aged 3-6 from a rehabilitation center participated in a two-week, weekly training program. Six therapists assisted with the experiment. Before and after the training, children underwent assessments using established tools for auditory rehabilitation, articulation, phonological skills, and language abilities. The User Experience Questionnaire (UEQ) measured user satisfaction. Paired t-tests analyzed the data, comparing performance before and after training, and between intermediate and advanced groups. Interviews with children, parents, and therapists provided qualitative insights.

Gamified training showed a positive impact on auditory memory, articulation, and expression, especially for intermediate-stage children. Significant improvements were observed in auditory memory, articulation performance, auditory description with hints, and language for expression for the intermediate group. Advanced-stage children showed significant improvements in articulation performance and language for expression, but less so in auditory memory tasks. The Lip-syncing game showed significant reductions in completion time and errors for both groups. The Dubbing game showed improvement in completion time but not errors. The Direction game (advanced group only) demonstrated improved completion times. The UEQ indicated an "Excellent" rating for attractiveness and novelty, and "Good" ratings for perspicuity, efficiency, and stimulation. Interviews confirmed the positive training experience and high preference for the gamified approach over traditional methods. Therapists also highlighted the system’s advantages in boosting engagement and compliance. However, the study also revealed a limitation; improvements were more easily observed in game-performance data compared to professional assessment tools, suggesting that short-term training primarily affects immediate performance and not necessarily underlying auditory abilities.

The findings suggest that gamified auditory-verbal training is a promising approach, especially for children at the intermediate stage, where improvements in basic skills are more readily achievable. For advanced-stage children, a focus on precise training content might be more beneficial than gamification alone. The differential impact across stages highlights the importance of tailoring gamification elements and task difficulty to suit individual needs and skill levels. The study’s success in improving immediate performance via gamification indicates that this approach is highly engaging and promotes consistent practice, which can positively influence long-term skill development. Further research with a longer training period and a larger sample size is needed to solidify these findings and investigate the long-term effects of this approach. The methodology used, combining quantitative data with qualitative feedback, provides a rich understanding of the efficacy and usability of the gamified system.

This study provides empirical evidence for the effectiveness of gamified auditory-verbal training, particularly for intermediate-stage children. The gamified approach proves enjoyable and feasible for practical application. Future research should focus on longitudinal studies with larger sample sizes and explore further refinement of the training content and gamification elements to optimize benefits for both intermediate and advanced-stage children.

The study’s limitations include a relatively small sample size (31 children, 6 therapists) and a short training period (two weeks). The short duration might have limited the observation of long-term effects on underlying auditory abilities, as opposed to immediate task performance. Future studies should address these limitations by utilizing larger samples and extended training periods. Further optimization of gamification elements is needed to find the ideal balance between engagement and effective skill development, minimizing distractions that might arise from excessive gamification.