It’s Game Time The future of audiologic rehabilitation may be in the palm of your hand—in the form of new hearing-loss gaming apps for smartphones and tablets. App-titude
App-titude  |   June 01, 2015
It’s Game Time
Author Notes
  • Dennis Barbour, MD, PhD, is an associate professor of biomedical engineering, neurobiology and otolaryngology at Washington University in St. Louis. Learn more about his laboratory at
    Dennis Barbour, MD, PhD, is an associate professor of biomedical engineering, neurobiology and otolaryngology at Washington University in St. Louis. Learn more about his laboratory at×
Article Information
Hearing Disorders / Audiologic / Aural Rehabilitation / Telepractice & Computer-Based Approaches / App-titude
App-titude   |   June 01, 2015
It’s Game Time
The ASHA Leader, June 2015, Vol. 20, online only. doi:10.1044/
The ASHA Leader, June 2015, Vol. 20, online only. doi:10.1044/
Quick—you’re a detective, and you need to interview a witness in a crowded area. Can you understand what she’s saying over all that background noise?
That’s what a new audiologic-rehabilitation app would have you do. This and other gaming apps in development could play a key role in enhancing hearing capability in people with assistive hearing devices.
Learning to understand spoken language is a complex interaction between sound representation in the ear and central auditory processing in the brain. On their own, hearing aids or cochlear implants might not bring someone with hearing deficits to peak performance. But exercises in auditory discrimination may be able to fill the gap by exploiting auditory plasticity to improve speech processing.
How best do we provide productive training for patients? There are simply not enough professionals to supply needed individualized attention, so we need to extend the reach of rehabilitation. One way to do that is through app-delivered, automated training exercises between clinic visits.
Enter the games
My research lab at Washington University in St. Louis has focused on automating structured tasks that are close to real-world listening tasks. We have devised new types of video games specifically to achieve the holy grail of training: retention of trained effects and generalization to untrained tasks. Performance inside the video game is not what’s important—trainees will want their improved speech recognition to stay with them and to apply to speakers and environments they have never encountered before. We believe our games foster these outcomes via the following features:
  • Portability: Games need to travel with patients so they can train on a regular basis. Therefore, we are designing games only for multi-touch tablets and smartphones.

  • Schedule: Training over time is much more effective than when it is all bunched together. Portability makes it much easier to spread out training.

  • Simulation: Our games try to simulate real-world listening tasks as much as possible. In other learning tasks, such as sports, the most effective training mimics the final skill to be learned: Drills, therefore, are inadequate without scrimmages.

  • Individualization: Adapting game content and difficulty to each user helps ensure that engagement persists and that exercises are challenging enough to propel training.

  • Content: The sound selection needs to vary widely, not only to provide samples from the wide variety of sounds heard normally but also to avoid repetitiveness and tedium.

Exactly which content to provide, the format to provide it in, and its selection on a trial-by-trial basis are the subjects of ongoing research in my laboratory.
Test phase
We are developing and evaluating several Android-based games along these lines. The first is a mystery role-playing game, in which players take the part of a detective trying to solve a crime. They must interview a series of suspects and witnesses, each of which is voiced by a different actor and is encountered in a different locale that carries its own unique background noise profile. To progress in the investigation, the user must understand each interviewee’s words correctly. The game simulates dialogue by providing a subset of player-selectable choices for each interaction.
We are also testing a word-presentation game that deals hands of cards, one of which corresponds to a simultaneously spoken word. Players are rewarded for selecting the correct card. The words include the 2,000 most common English words and their 1,000 closest phonological neighbors. Babble noise level is adapted on each trial to keep the difficulty relatively constant.
A third game offers an auditory scavenger hunt. Players look for particular conversation topics or words in a soundscape that requires particular search strategies. The best strategies involve maximum exposure to a wide variety of signal and noise conditions, so that users can practice their speech comprehension skills in increasingly noisy environments.
The future has never looked better for audiologic rehabilitation. Developments in hardware, software and cognitive science will enable effective training outside the clinic. Validation will ultimately tell us which exercises are most effective for which patients. At that point, audiologists will be able to recommend the best exercises to send home. Patients will experience these as novel, engaging video games, but the effect of the resulting training will be very real: more effective use of a hearing aid or cochlear implant in challenging listening conditions.
1 Comment
June 3, 2015
Sandra Aguillard
audiometric rehab
Please forward this information quickly. As an SLP with a bilateral 70 db loss in the moderate to severe range, and with no ability to re-buy HA's (I have purchased 5 over the last 15 years), I need all the assistance that I can get
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June 2015
Volume 20, Issue 6