Wii-habilitation to Enhance Auditory Processing Skills
Wii-habilitation to Enhance Auditory Processing Skills
Addie J. Dowell, B.A. Brittany Milligan, B.A. D. Bradley Davis, Au.D. Annette Hurley, Ph.D. Louisiana State University Health Sciences Center New Orleans, Louisiana
Auditory training programs are often included as part of the remediation plan for children with (central) auditory processing disorder [(C)APD]. Training improves performance and usually includes formal therapy; however, it may also utilize informal DFWLYLWLHV 7KHVH LQIRUPDO DFWLYLWLHV VSHFL¿FDOO\ WDUJHW GH¿FLW DUHDV RI DXGLWRU\ ZHDNQHVVHV DQG PD\ LQFOXGH ³HGXWDLQPHQW´ activities, such as board games, computer games, or recorded audio books. This brief report will review Wii video games that WDUJHW VSHFL¿F DXGLWRU\ SURFHVVLQJ VNLOOV DXGLWRU\ EOHQGLQJ SURFHVVLQJ VSHHG VKRUWWHUP PHPRU\ HWF DQG ZKLFK PD\ EH XWLOL]HGGXULQJSOD\IRUVSHFL¿FDJHJURXSV7KLVLQIRUPDWLRQFDQEHXVHIXOIRUDXGLRORJLVWVVSHHFKODQJXDJHSDWKRORJLVWVHDUO\ interventionists, or parents who wish to engage listening and auditory processing skills during play. Introduction LQDSRVLWLYHZD\´ 0XVLHN&KHUPDN :HLKLQJS Auditory training activities may be formal or informal. Formal In the past few years, there has been a renewed interest in the therapy activities are often completed in a clinical setting with a diagnosis and treatment of (central) auditory processing disorder professional who has control over the presented stimuli. Formal >&@$3' $ & $3' UHIHUV WR ³GLI¿FXOWLHV LQ WKH SHUFHSWXDO therapy activities may include computer mediated programs, processing of auditory information in the central nervous system localization training, phoneme discrimination training, speech in and the neurobiologic activity that underlies that processing and QRLVHWUDLQLQJRUIUHTXHQF\DQGLQWHQVLW\GLVFULPLQDWLRQWUDLQLQJ gives rise to the electrophysiologic auditory potentials” (ASHA, etc. (Musiek, et al., 2007). 7KLVGLDJQRVLVLVXVXDOO\PDGHE\DTXDOL¿HGDXGLRORJLVW Informal activities may be done at home and are usually after the patient has completed a comprehensive test battery (AAA, recommended to supplement formal training. These activities may $6+$ 7UHDWPHQW RI & $3' JHQHUDOO\ IRFXVHV include computer games, board games, music training, or video RQ WKUHH DUHDV HQYLURQPHQWDO FKDQJHV WR HDVH FRPPXQLFDWLRQ JDPHVWKDWWDUJHWVSHFL¿FDXGLWRU\GH¿FLWDUHDV)RUH[DPSOHWKH GLI¿FXOWLHVLQWURGXFLQJFRPSHQVDWRU\VNLOOVDQGVWUDWHJLHVIRUWKH Simon® game may be useful for temporal processing training and GLVRUGHU DQG UHPHGLDWLRQ RI WKH DXGLWRU\ GH¿FLW $$$ for auditory memory training (Musiek, 2005). This game has four Auditory training is one type of direct remediation of (C)APD. lighted, colored buttons, with a corresponding audible tone when It is known that the brain retains a lifelong capacity for plasticity activated. During play, the buttons will light up in a random pattern. DQG DGDSWLYH UHRUJDQL]DWLRQ 7KHUHIRUH DXGLWRU\ GH¿FLWV RU The player must replicate the pattern. The number of buttons in the ZHDNQHVVHVPD\EHDWOHDVWSDUWLDOO\UHYHUVLEOHWKURXJKDGH¿FLW UDQGRPVHTXHQFHLQFUHDVHVLQOHQJWKDVWKHJDPHFRQWLQXHV VSHFL¿FWUDLQLQJSURJUDP Everyday games and activities can improve auditory $XGLWRU\ WUDLQLQJ SURJUDPV VWUHQJWKHQ VSHFL¿F DXGLWRU\ processing skills in children with (C)APD (Ferre, 2002) and VNLOOV7KHVHLQFOXGHORFDOL]DWLRQDQGODWHUDOL]DWLRQVHTXHQFLQJ should be initiated whenever there is a suspicion of (C)APD of sounds, phoneme/syllable discrimination, auditory memory, (AAA, 2010). Ferre (2002) listed several board games that targeted VRXQGEOHQGLQJIUHTXHQF\DQGLQWHQVLW\GLVFULPLQDWLRQWHPSRUDO VSHFL¿FDXGLWRU\VNLOOVDVGHVFULEHGE\WKH%HOOLV)HUUHSUR¿OHVRI processing training (including temporal ordering, temporal gap (C)APD (Bellis, 2003). (The reader is referred to Bellis, (2003) for detection and discrimination), improving speech discrimination DFRPSUHKHQVLYHGHVFULSWLRQRIWKH%HOOLV)HUUH & $3'SUR¿OHV in noise, and an improvement in interhemispheric transfer of as this is beyond the scope of this report.) A very brief description information (ASHA, 2005). RI WKH %HOOLV)HUUH SUR¿OHV FKDUDFWHULVWLF DXGLWRU\ GH¿FLWV DQG Auditory training relies on plasticity in the central auditory VXJJHVWHGH[DPSOHVRIDFWLYLWLHVIRUDXGLWRU\VSHFL¿FHQULFKPHQW V\VWHPIRU LPSURYHGSHUIRUPDQFH$XGLWRU\WUDLQLQJLVGH¿QHG are provided in Table 1. as, “a set of (acoustic) conditions and/or tasks that are designed Kuster (2009) compiled a list of free listening games and to activate auditory and related systems in such a manner that activities, available on the Internet. This list of activities ranged their neural base and associated auditory behavior are altered in a hierarchy of auditory skills from detection, discrimination,
77 Journal of Educational Audiology vol. 17, 2011
7DEOH Profiles of (central) auditory processing disorder and associated deficits. potential use of Nintendo Wii games as an auditory
training tool, for informal (C)APD therapy. Primary Profile Deficits Targeted Skills for Suggested Games & Remediation Activities Method
Decoding ƔListening in background noise ƔPhoneme identification ƔRed Light-Green Light ƔSpelling and reading difficulty ƔPhonological ƔTelephone ƔSound/symbol association awareness ƔWheel of Fortune® :H GH¿QHG WKH FULWHULD IRU LQFOXVLRQ LQ WKLV ƔSound discrimination ƔSound discrimination ƔScrabble® report. $JDLQ ZH GH¿QH UHSRUW QRW DV VFKRODUO\ ƔSound blending ƔWord attack skills research project, but as a description of our research
Integration ƔCombining multi-modality ƔInterhemispheric ƔScrabble® DFWLYLW\WRIXO¿OORXUFOLQLF¶VQHHG Initially, because information transfer ƔBopit® ƔReading comprehension ƔBinaural skills ƔSimon® of its popularity, we limited our review of video ƔFollowing auditory directions ƔSound localization ƔSimon says ƔAuditory & visual ƔCard games games to the Nintendo Wii format. Secondly, we information reviewed games appropriate for use for children
Prosodic ƔUnderstanding the meaning ƔPerception ƔMadGab® over the age of 6 years. Thirdly, the Entertainment ƔComprehending main idea ƔTemporal patterning ƔSinging ƔFrequency & temporal ƔPragmatics ƔDramatic arts Software Rating Board (ESRB) ratings were also discrimination reviewed to ensure appropriate content of the video LGHQWL¿FDWLRQ WR FRPSUHKHQVLRQ 7KH )HUUH ³*DPHV :H game for children. Lastly, we also adopted the Play” and Kuster’s (2009) listening activities are useful resources SRSXODU%HOOLV)HUUHVXESUR¿OHPRGHORI & $3' %HOOLV available to parents of children diagnosed with (C)APD. DV WKH IUDPHZRUN IRU UHYLHZLQJ YLGHR JDPHV WR WDUJHW VSHFL¿F To date, we are unaware of a review of video games that would DXGLWRU\GH¿FLWV,QWKLVPRGHOWKHUHDUHWKUHHSULPDU\ & $3' enhance auditory processing skills. This review will be useful for SUR¿OHV 'HFRGLQJ ,QWHJUDWLRQ DQG 3URVRGLF 7KHVH SUR¿OHV clinicians and parents who wish to enhance auditory processing are based upon an individual’s auditory behavior and (C)APD skills during informal therapy times, outside of the formal therapy behavioral and electrophysiological test results. (See Table 1 for environment. a brief description). The genesis of computer games can be traced back to the early We began our search using popular Internet search engines to 1950s (Kent, 2001). Since this time, these games have evolved locate video gaming manufacturing Web sites, parental information with technology, increased in complexity and sophistication of Web sites, and multinational electronic commerce company Web graphics, narratives, and storylines and have grown in popularity sites (i.e., Amazon.com, GameStop.com) and searched for games RYHUWKHODVW¿YHGHFDGHV .HQW 0DQ\RIWKHHDUO\YLGHR marketed or advertised as ‘educational,’ parent-recommended, JDPHV ZHUH QRW VSHFL¿FDOO\ GHVLJQHG IRU HGXFDWLRQDO SXUSRVHV and/or listed as top-selling video games. We compiled a list of but for “fun.” However, most games promote incidental learning potential video games. as they are built around rule-based strategies, logic, memory, From this list, we researched the video game by reviewing adaptability, and motivation. the game publisher’s synopsis and consulting consumer reviews. During the recent market growth of “edutainment” (education We “sampled” each game by playing a demonstration version on through entertainment), video games and video gaming systems the manufacturer’s Web site, to determine if auditory processing DUH D ¿[WXUH LQ PRVW KRPHV (GXFDWLRQDO YLGHR JDPHV DSSHDO related skills were incorporated in the game. Video games were to young children, as well as their parents, because they make VHOHFWHGLIWKH\WDUJHWHGDWOHDVWWZRVNLOOVRID & $3'VXESUR¿OH learning fun. Some video games are referred to as families. Therefore, we did One popular gaming system that many families have in their not list each individual video game title. For example, Guitar Hero homes is the Nintendo Wii. Since its launch in November, 2006, Family would be inclusive of such games as Guitar Hero I, II, III, the Wii has sold more than 86 million units, with over 41 million in ,9DQG9*XLWDU+HUR:RUOG7RXUDQG*XLWDU+HUR :DUULRUVRI the United States alone, making it the best selling gaming system 5RFN:HGLGQRWWUDFNWKHLQLWLDOQXPEHURIYLGHRJDPHVUHYLHZHG (Sloan, 2011). PDQ\ZHUHTXLFNO\HOLPLQDWHGE\WKHPDWXUH(65%UDWLQJDQGQRW The interactive Wii Nintendo games have received positive appropriate for children. attention for their role in physical and occupational therapy (Deutsch, Borbely, Filler, Huhn, Guarrera-Bowlby, 2008). Results However, there is little information about the use of this popular gaming system for improving listening or auditory processing Based on our inclusion criterion, a total of 11 Wii games were skills. This report (a description of a clinical need) reviewed the found to be appropriate for use by individuals with Decoding
78 Wii-habilitation to Enhance Auditory Processing Skills
Table 2.9LGHRJDPHVWKDWWDUJHWGHILFLWVNLOOVDVVRFLDWHGZLWKWKH Discussion 'HFRGLQJ3URILOHRI FHQWUDO DXGLWRU\SURFHVVLQJGLVRUGHU Video Game Ages Many Wii video games target auditory processing skills and 5HDGHU5DEELW )DPLO\ !\HDUV may be incorporated as a valuable informal auditory training tool 1LFNHORGHRQ)LW !\HDUV :RUG-RQJ !\HDUV IRU & $3'9LGHRJDPHVFDQEHUHFRPPHQGHGWRWDUJHWWKHVSHFL¿F 6WRU\+RXU )DPLO\ !\HDUV DXGLWRU\GH¿FLWVRUZHDNQHVVHV,WLVLPSRUWDQWWRQRWHLQIRUPDO 6WRU\%RRN:RUNVKRS )DPLO\ \HDUV -XPS6WDUW*DPHV )DPLO\ \HDUV therapy or video games should not replace formal rehabilitation 0\:RUG&RDFK !\HDUV WHFKQLTXHVEXWVKRXOGLQVWHDGEHXVHGDVDVXSSOHPHQWWRWKHUDS\ 0DUJRW¶V:RUG%UDLQ !\HDUV $ GLVDSSRLQWLQJ ¿QGLQJ RI WKLV LQYHVWLJDWLRQ ZDV WKH VKRUW :KHHORIIRUWXQH !\HDUV 'DQFH'DQFH5HYROXWLRQ )DPLO\ !\HDUV release time for a video game. Several of the Wii video games in Tables 2 through 4 have been discontinued by the gaming manufacturer. However, all of the games listed are available in new Table 3. Video games that target deficit skills associated with the Integration Profile of (central) auditory processing disorder. and used condition through multinational electronic commerce company Web sites and popular game retailers, (i.e., Amazon, Video Game Ages Sesame Street Counting Carnival >3 years GameStop). Reader Rabbit (Family) > 6 years $OWKRXJK WKLV UHSRUW UHYLHZHG JDPHV VSHFL¿F WR WKH :LL Nickelodeon Fit > 6 years Jump Start Games (Family) > 6 years format, many of these games are available for other formats or Dance Dance Revolution (Family) > 6 years gaming systems such as Xbox™, and PlayStation™. Further We Cheer (Family) > 10 years research is needed to determine the effectiveness of Wii video Hasbro Family Game Night > 6 years Family Think Smart > 6 years games as an informal therapy option. Pictionary > 6 years Many households have a Wii gaming system already. Big Brain Academy >6 years Disney’s Think Fast > 6 years 7KHUHIRUHGH¿FLWVSHFL¿FDXGLWRU\JDPHVPD\EHDQDIIRUGDEOHDQG Cosmic Family > 6 years feasible way for parents to encourage and support children “at risk”
IRU & $3'%\LQFRUSRUDWLQJGH¿FLWVSHFL¿FDXGLWRU\DFWLYLWLHV Table 4.9LGHRJDPHVWKDWWDUJHWGHILFLWVNLOOVDVVRFLDWHGZLWKWKH3URVRGLF into everyday activities, auditory remediation may improve these 3URILOHRI FHQWUDO DXGLWRU\SURFHVVLQJGLVRUGHU DXGLWRU\ GH¿FLW VNLOOV 7KH XVH RI SRSXODU LQWHUDFWLYH JDPHV Video Game Ages may be useful and convenient for audiologists, speech-language 'LVQH\6LQJ,W )DPLO\ !\HDUV :LL0XVLF \HDUV pathologists, early interventionists, or parents who wish to engage *XLWDU+HUR )DPLO\ !\HDUV 5RFN%DQG )DPLO\ !\HDUV listening and auditory processing skills during play. 'DQFH'DQFH5HYROXWLRQ )DPLO\ !\HDUV .LG]%RS )DPLO\ !\HDUV /HWV7DS !\HDUV :H6LQJ'RZQ8QGHU !\HDUV -XPS6WDUW*DPHV )DPLO\ !\HDUV .DUDRNH5HYROXWLRQ*DPHV )DPLO\ !\HDUV +LJK6FKRRO0XVLFDO )DPLO\ !\HDUV :H&KHHU )DPLO\ !\HDUV 0LFKDHO-DFNVRQWKH([SHULHQFH !\HDUV characteristics of (C)APD (see Table 2). These games targeted skills, such as sound recognition, sound blending, vocabulary, and following directions. Twelve Wii video games were found to DGGUHVVGH¿FLWVNLOOVDVVRFLDWHGZLWK,QWHJUDWLRQFKDUDFWHULVWLFVRI (C)APD and are listed in Table 3. These games addressed skills, such as combining auditory and visual information, following oral directions, auditory and verbal learning, and auditory and visual PHPRU\ 7ZHOYH :LL YLGHR JDPHV DGGUHVVHG DXGLWRU\ GH¿FLWV associated with Prosodic characteristics of (C)APD. These are listed in Table 4. These games addressed such auditory skills as auditory discrimination and temporal patterning.
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References American Academy of Audiology. (2010). Clinical practice guidelines: Diagnosis, treatment and management of children and adults with central auditory processing disorder. $YDLODEOHIURPKWWS ZZZDXGLRORJ\RUJUHVRXUFHV documentlibrary/ pages/CentralAuditoryProcessingDisorder. aspx. American Speech-Language-Hearing Association. (2005). (Central) auditory processing disorders>7HFKQLFDO5HSRUW@ Available from www.asha.org/policy. Bellis, T. J. (2003). Assessment and management of central auditory processing disorders in the educational setting: From science to practice (2nd ed 1HZ 80