Högskolan i Skövde

This work-in-progress paper presents the design and development of a serious game aimed at supporting auditory rehabilitation for cochlear implant users. While cochlear implants effectively restore access to sound, many users experience challenges with pitch discrimination and listening in noisy environments. Traditional rehabilitation methods are often speech-focused and clinic-based, which may limit user engagement and training frequency. To address these limitations, this study explores the application of technical ear training, a methodology from audio engineering education, as a foundation for interactive, game-based auditory training.

Following a design science research approach, the project involves iterative prototyping and participatory design with cochlear implant users and rehabilitation professionals. The resulting game integrates technical ear training-based listening tasks, such as timbre recognition, pitch discrimination, and audio effect identification, into multiple gameplay modes. Emphasis was placed on player experience, gradual difficulty progression, and meaningful audiovisual feedback.

Findings from the design process highlight the importance of aligning gameplay mechanics with auditory training goals, accommodating variability in cochlear implant hearing, and addressing technical constraints such as audio latency. The prototype explores a language-independent and engaging complement to traditional rehabilitation. Future work will evaluate the prototype with CI users in a rehabilitation context.

A cochlear implant (CI) is an electronic device designed to assist individuals who are deaf or hard-of-hearing. It captures sound through a microphone and transmits it to electrodes, which directly stimulate the auditory nerve, bypassing the damaged areas of the ear. Although considered a very successful intervention, there is large variability in the outcomes of cochlear implantation. Patient- reported issues include difficulties hearing speech in noisy environments, disappointment in sound quality and difficulties appreciating music. A period of aural rehabilitation usually follows implantation, where patients see audiologists and speech language pathologists. There is evidence supporting the use of auditory training, actively practicing listening tasks, mainly focused on speech, at a clinic or at home. One such task, often suggested by audiologists and speech language pathologists is computer-based auditory training. There are a number of game-like computer programs and apps that are recommended to patients, most of which similarly focus on speech. In recent years there has been some research on serious games specifically aimed at CI-rehabilitation. This paper presents a literature review of studies using games for auditory training in CI-rehabilitation. The aim of this paper is to investigate how the reviewed studies relate to established game design knowledge, including how they evaluate player experience. The results reveal a gap, indicating that game design as a concept is rarely reported on, and the evaluation of player experience is seldom based on established instruments. While this study focuses on a specific and cohesive research community, it highlights the need for improved standards in the utilization and reporting of game design in such studies. We propose a set of guidelines for reporting on medical studies involving games. 

Voice acting is common in computer games in many genres. The recording and processing of voice acting is a time-consuming process that involves, for instance, voice actors, directors, audio engineers, and game writers. Changes to the script of a game after the voice acting has been recorded are expensive. At the same time, playtests of games without voice acting may give different results than testing where it is present. This creates a situation where improvements identified from play testing are either ignored or leads to extensive re-recording of voice acting. This article presents a design science research project where text-to-speech (TTS) synthesis is used as a substitute for recorded voice acting in the early stages of game production. We propose a set of design principles that have been evaluated in a sharp game production. Our results indicate several benefits of using TTS as a prototyping tool: It can be a source of inspiration for game writers, it gives good estimations on timing and pacing of the game, and it allows for early tests of how the dialog will be perceived by players. The quality and characteristics of the voices provided by the TTS system play an important role in this process. The rapid development in the speech technology field opens many future possibilities.

This article presents the result from a study comparing the perception and understanding of a game story between sighted and visually impaired players playing the same game. In particular, whether sighted and visually impaired players could experience and recount the same story construed from the plot elements that are either manifested by audio and graphics in the case of sighted players or pri- marily by audio in the case of visually impaired players. To this end, we have developed a graphical point-and-click adventure game for iOS and Android devices that aims to show how inclusive game design may be used to facilitate a shared gaming experience between sighted and visually impaired players. The game pro- vides players with audio feedback that enables visually impaired players to interact with and experience the game, but in a manner that does not interfere with the overall appearance and functionality of the game. Thus, it has been designed to be fully inclusive to both groups of players and to give the same gaming experience when it comes to story content. The game has been evaluated through formal user tests where subjects have been asked to play the first chapter of the game followed by an interview. The study shows that the perception of the story was almost identical between the two groups. Generally it took visually impaired players a little longer to play the game but they also seem to listen more carefully to the dialogue and hence also build a slightly deeper understanding of the characters. The study also shows that the sighted players did not respond negatively towards the inclusive game design employed in the game. 

The aim of the project presented in this paper is that visually impaired and sighted players should be able to play the same game and share a gaming experience. The goal is that the game should be accessible to visually impaired players without any additional tools, such as text-to-speech, that may reduce the immersion. At the same time, sighted players should perceive the game as a regular game. This paper presents an evaluation of the game where the player immersion has been evaluated through a post test immersion questionnaire. The study was conducted with three independent groups: sighted players using graphics (n=10), blindfolded sighted players (n=10) and visually impaired players (n=9). Although progress in the game and the reported sense of control differed between groups, player immersion was very high in all groups. There were differences between the three groups only in one out of five immersion factors. The result shows that it has been possible to provide an immersive experience irrespective of whether the players are playing the game with graphics or using audio only. 

In this paper, we present the result of an experiment, in which we compare the gaming experience between sighted players and visually impaired players playing the same game. Specifically we discuss whether they experience the same story construed from the plot elements that are either manifested by audio and graphics in the case of sighted players or primarily by audio in the case of visually impaired players. To this end, we have developed a graphical point-and-click adventure game for iOS and Android devices. The game has been designed to provide players with audio feedback that enables visually impaired players to interact with and experience the game, but in a manner that does not interfere with the overall appearance and functionality of the game, i.e. a design that is fully inclusive to both groups of players and that is as invisible for sighted players as possible without hindering visually impaired players to share the same gaming experience when it comes to story content. The study shows that the perception of the story were almost identical between the two groups. Generally it took visually impaired players a little longer to play the game but they also seem to listen more carefully to the dialogue and hence also build a slightly deeper understanding of the characters.

The aim of the project presented in this paper is that visually impaired and sighted players should be able to play the same game and share a gaming experience. The goal is that the game should be accessible to visually impaired players without any additional tools, such as text-to-speech, that may reduce the immersion. At the same time, sighted players should perceive the game as a regular game. This paper presents an evaluation of the game where the player immersion has been evaluated through a post test immersion questionnaire. The study was conducted with three independent groups: sighted players using graphics (n=10), blindfolded sighted players (n=10) and visually impaired players (n=9). Although progress in the game and the reported sense of control differed between groups, player immersion was very high in all groups. There were differences between the three groups only in one out of five immersion factors. The result shows that it has been possible to provide an immersive experience irrespective of whether the players are playing the game with graphics or using audio only.

A lot of video games on the market are inaccessible to players with visual impairments because they rely heavily on use of graphical elements. This paper presents a project aimed at developing a point-and-click adventure game for smart phones and tablets that is equally functional and enjoyable by blind and sighted players. This will be achieved by utilizing audio to give blind players all necessary information and enjoyment without graphics. In addition to creating the game, the aim of the project is to identify design aspects that can be applied to more types of games to include more players. This paper also presents a pilot study that has been conducted on an early version of the game and the preliminary findings are discussed.