Development and evaluation of a virtual reality game targeting Central auditory processing skills in children using cochlear implants: a randomized controlled trial

Abstract

Purpose: To develop a virtual reality (VR)-based restaurant simulation game targeting central auditory processing skills for children aged 10-18 with bilateral cochlear implants (CIs) and to evaluate its usability and effectiveness on speech understanding in noise.

Materials and methods: This randomized controlled study had two phases. In Phase 1, a six-level VR restaurant game was developed and usability tested. This stage involved children with normal hearing and CIs, parents, a game developer, audiologists. The usability was examined using expert opinions, observation, game evaluation forms, the System Usability Scale, interviews, group score comparisons. In Phase 2, the game's effectiveness was tested in 24 children with bilateral CIs randomly assigned to intervention (n = 12) and control (n = 12) groups. The intervention group continued traditional rehabilitation and additionally received VR-based training for four weeks. The control group continued traditional rehabilitation only for four weeks. All participants were administered the Turkish Hearing in Noise Test (HINT) pre- and post-intervention as the primary outcome measure of speech understanding in noise, results analysed via repeated-measures ANOVA.

Results: The game was usable and engaging. Normally hearing children scored higher than children with CIs on prototype levels (p<.05). Significant group × time effects were obtained in Turkish HINT under quiet and noise conditions (p<.05). The intervention group showed significantly greater improvement than controls (p<.05).

Conclusion: This study demonstrated the usability of Cooklear, the first Turkish VR-based aural rehabilitation game for paediatric bilateral CI users, showing short-term improvements in speech understanding in noise. Further studies should examine broader auditory processing skills.