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

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.
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.
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).
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.
ClinicalTrials.gov, NCT06788184.

Integrating Virtual Reality (VR)-based auditory training with traditional auditory rehabilitation resulted in significant improvements in speech perception in noise in children with bilateral cochlear implants.
The VR-assisted intervention provided an engaging and realistic listening environment that improved auditory attention, discrimination, and memory skills, supporting better generalisation of listening skills to everyday environments.
The high usability and positive feedback from children, parents, and professionals highlight the potential of VR apps as motivating, child-friendly, and applicable tools that can complement traditional auditory rehabilitation programs.

Integrating Virtual Reality (VR)-based auditory training with traditional auditory rehabilitation resulted in significant improvements in speech perception in noise in children with bilateral cochlear implants.
The VR-assisted intervention provided an engaging and realistic listening environment that improved auditory attention, discrimination, and memory skills, supporting better generalisation of listening skills to everyday environments.
The high usability and positive feedback from children, parents, and professionals highlight the potential of VR apps as motivating, child-friendly, and applicable tools that can complement traditional auditory rehabilitation programs.

This study introduces Cooklear, the first Turkish-language VR–based auditory rehabilitation game designed specifically for children using bilateral cochlear implants.
The randomized controlled results demonstrate that VR-supported training significantly improves speech perception in noise compared to traditional rehabilitation alone.
The findings emphasise the feasibility and clinical value of incorporating VR technology into pediatric auditory rehabilitation programs.

This study introduces Cooklear, the first Turkish-language VR–based auditory rehabilitation game designed specifically for children using bilateral cochlear implants.
The randomized controlled results demonstrate that VR-supported training significantly improves speech perception in noise compared to traditional rehabilitation alone.
The findings emphasise the feasibility and clinical value of incorporating VR technology into pediatric auditory rehabilitation programs.

本研究旨在开发一款基于虚拟现实（Virtual Reality, VR）的餐厅模拟游戏，面向10~18岁双侧人工耳蜗（Cochlear Implants, CIs）植入儿童，用于训练其中枢听觉处理能力，并评估该游戏在噪声环境下言语理解能力方面的可用性与有效性。
本项随机对照研究分为两个阶段。第一阶段：开发一款包含6个关卡的VR餐厅游戏并开展可用性测试。该阶段的参与对象包括听力正常儿童、人工耳蜗植入儿童、患儿家长、游戏开发者以及听力学专家。可用性评估通过专家意见、行为观察、游戏评估量表、系统可用性量表（System Usability Scale, SUS）、访谈以及组间得分对比等方式进行。
第二阶段：招募24名双侧人工耳蜗植入儿童，将其随机分为干预组（n=12）与对照组（n=12），以评估游戏的训练效果。干预组在延续传统听觉康复训练的基础上，额外接受为期4周的VR训练；对照组仅延续传统听觉康复训练，时长同样为4周。所有受试者在干预前后均接受土耳其语噪声下言语测试（Turkish Hearing in Noise Test, HINT），以此作为噪声环境下言语理解能力的主要评估指标，测试结果采用重复测量方差分析（repeated-measures ANOVA）进行统计分析。
测试结果表明，该游戏具备良好可用性与沉浸感。原型关卡测试中，听力正常儿童的得分显著高于人工耳蜗植入儿童（p<0.05）。土耳其语噪声下言语测试结果显示，在安静与噪声环境下均存在显著的分组×时间交互效应（p<0.05），且干预组的提升幅度显著优于对照组（p<0.05）。
本研究验证了首款面向儿科双侧人工耳蜗植入用户的土耳其语VR听觉康复游戏《Cooklear》的可用性，证实其可短期改善噪声环境下的言语理解能力。未来研究可进一步拓展至更广泛的听觉处理能力评估范畴。
本研究已在ClinicalTrials.gov注册，编号为NCT06788184。
将基于虚拟现实（VR）的听觉训练与传统听觉康复相结合，可显著改善双侧人工耳蜗植入儿童在噪声环境下的言语感知能力。
VR辅助训练可提供沉浸式且贴近真实场景的聆听环境，改善听觉注意、辨别与记忆能力，助力聆听技能更好地泛化至日常生活场景。
该游戏具备高可用性，且获得了儿童、家长与专业人士的积极反馈，凸显了VR应用作为具激励性、儿童友好且可落地的工具，用于补充传统听觉康复方案的潜力。
将基于虚拟现实（VR）的听觉训练与传统听觉康复相结合，可显著改善双侧人工耳蜗植入儿童在噪声环境下的言语感知能力。
VR辅助训练可提供沉浸式且贴近真实场景的聆听环境，改善听觉注意、辨别与记忆能力，助力聆听技能更好地泛化至日常生活场景。
该游戏具备高可用性，且获得了儿童、家长与专业人士的积极反馈，凸显了VR应用作为具激励性、儿童友好且可落地的工具，用于补充传统听觉康复方案的潜力。
本研究推出了《Cooklear》——首款专为双侧人工耳蜗植入儿童设计的土耳其语VR听觉康复游戏。
随机对照试验结果表明，相较于单纯的传统康复训练，VR辅助训练可显著改善噪声环境下的言语感知能力。
本研究结果证实了将VR技术纳入儿科听觉康复方案的可行性与临床价值。
本研究推出了《Cooklear》——首款专为双侧人工耳蜗植入儿童设计的土耳其语VR听觉康复游戏。
随机对照试验结果表明，相较于单纯的传统康复训练，VR辅助训练可显著改善噪声环境下的言语感知能力。
本研究结果证实了将VR技术纳入儿科听觉康复方案的可行性与临床价值。