https://doi.org/10.37815/rte.v35n2.1022

Original articles

Web app for the stimulation of auditory skills
in children

Aplicación web para la estimulación de las habilidades auditivas en niños

Fabian
Carvajal1 https://orcid.org/0000-0002-1303-5582, Esteban Crespo-Martinez1
https://orcid. org/0000-0002-3061-9045, Catalina
Astudillo-Rodriguez1 https://orcid.org/0000-0001-8369-5300,

Norma Reyes1 https://orcid.org/0000-0002-6723-1423

1Universidad del Azuay, Cuenca, Ecuador

[email-masked], [email-masked], [email-masked], [email-masked]

Sent:

2023/06/20

Accepted:

2023/08/22

Published:

2023/10/15

.

Esta obra está bajo una licencia internacional

Creative Commons Atribución-NoComercial 4.0

Abstract

The existing literature identifies various situations
related to hearing problems in children, such as difficulties in understanding
oral language, delayed speech development, or auditory discrimination problems.
In this work, we present a technological tool designed to stimulate listening skills
in children from 5 to 7 years
old, following the principles of Condemarin. This
tool offers stimulation activities and provides immediate feedback to improve
the ability to recognize, discriminate, and interpret auditory stimuli, which
contributes to the development of communication skills in children.
The tool we developed is a web application that is easy for
therapists to install, learn, and configure. For its creation, we follow the prototype methodology,
which includes the requirements, assembly, evaluation, corrections, documentation, and testing stages.
We collaborate with a multidisciplinary team of experts in information
technology, linguistic rehabilitation, education, and graphic design.
Throughout the six phases of our process, we kept user needs in mind, resulting
in a system evaluation that demonstrated high user satisfaction and good
performance both in technical and interface terms. In addition, this application benefits children with language disorders and learning difficulties and children from 5
to 7 years old since it encourages the development of their communication
skills.

Keywords: Auditory software, aural skills, prototype for listening skills,
stimulation software, web
app.

Resumen

En la literatura existente, se identifican varias situaciones relacionadas con problemas auditivos en niños, tales como dificultades en la comprensión del lenguaje oral,
retrasos en el desarrollo del habla o problemas de discriminación auditiva. En este trabajo, presentamos una herramienta tecnológica diseñada para estimular las habilidades auditivas en niños de 5 a 7 años, siguiendo los principios
de Condemarin. Esta herramienta
ofrece actividades de estimulación y proporciona
retroalimentación inmediata
para mejorar la capacidad
de reconocer, discriminar e
interpretar estímulos auditivos, lo
que contribuye al desarrollo
de las habilidades
de comunicación en los niños. La herramienta que desarrollamos es una aplicación web de fácil instalación, aprendizaje y configuración
para los terapeutas. Para su creación, seguimos la metodología
del Prototipo, que
incluye las etapas de requerimientos, montaje, evaluación, correcciones, documentación y
pruebas. Trabajamos en colaboración con un equipo multidisciplinario compuesto por expertos en tecnologías de la información,
rehabilitación lingüística,
educación y diseño
gráfico. A lo largo
de las seis fases de nuestro proceso, tuvimos en cuenta las necesidades de los usuarios, lo que resultó en una evaluación del sistema que demostró una alta satisfacción de los usuarios y un excelente rendimiento tanto en términos técnicos como en la interfaz. Además, esta aplicación
beneficia tanto a niños con trastornos del lenguaje y dificultades de aprendizaje como a niños de 5 a 7 años, ya que fomenta el desarrollo
de sus habilidades de comunicación.

Palabras clave: Aplicación web, habilidades auditivas, prototipo de habilidades auditivas, software de estimulación,
software auditivo.

Introduction

The World Health Organization (WHO) has identified significant barriers to access
to speech and language treatment in terms of cost, long-term participation, and
difficulty in extending interventions beyond the context of telemedicine.
Several studies have explored using systems to overcome these barriers through technology with untapped potential to address
these issues, enabling them to access quality rehabilitation services
through their necessary resources. Telemedicine uses information and
communication technologies (ICT) to provide remote
medical services, allowing medical consultations,
diagnoses, treatments, and follow-ups to be performed digitally. This
may include using medical devices connected to the Internet, video
conferencing, email, messaging, and other communication tools (Gačnik et
al., 2018; Morales-Acosta, 2020; Spitale et al., 2021).

These
technologies aim to help people improve access to information and communication
through specific devices and programs. Interventions
for speech therapy therapeutic purposes using technological means, whether
virtual platforms and/or software programs, have shown significant improvements
in the linguistic, cognitive, social, emotional, and behavioral development of
people in therapy, evidencing the increase in motivation and participation in different
therapeutic activities, mainly playful, whether these are in teleconsultation or in virtual
platforms or applications in electronic devices, which in turn has affected behavior, both personal
and in the ability to analyze and detect behavioral patterns in other
people (Buitrago et al., 2019; Gerosa et al., 2009; Spitale et
al., 2021; Walden, 2021).

Speech-language
pathology is a medical discipline dedicated to studying, diagnosing, and treating problems related to speech, language, hearing, and balance
(Isaías & Campra, 2021).

Telemedicine, for its part, has allowed speech
and language pathologists to reach

patients who live in remote areas or who have difficulties traveling
due to physical or cognitive

disabilities. To guarantee the quality and safety of the services provided, it is essential to regulate telemedicine and remote practice with the support of assistive communication technologies, such as screen readers, adapted keyboards, voice
synthesis devices, and sign language translation software, which can help
people with disabilities improve their access to information and communicate
with others (Acosta et al., 2020).

Literature Review

The Internet has revolutionized many areas of modern life since it became a global means of communication. Information and
Communication Technologies (ICT) offer the option of analyzing, organizing, synthesizing, and transmitting information and, therefore, can contribute to
expanding and developing valuable clinical and educational tools for speech and
language (Toki et al., 2012). In addition, it allows us to offer personalized and quality service
(Lavoie et al., 2020).

"Simone Says" is computer software designed for children with ASD to acquire functional language through an interactive environment for language recovery that brings together research on speech recognition, natural language processing, and computer-assisted instruction, allowing concentration and primarily visual and
auditory memory to work (Lehman, 1998).

The study of Glykas and Chytas (2004) describes the first web-based tool called Telelogos for diagnosis,
treatment, and digital learning in speech and language therapy. It consists of
three modules: public awareness, referral, and evaluation, which allow speech
therapists and other professionals to find the optimal treatment for each
patient. The tool was evaluated by twenty speech and language therapists and tested by potential users in Greece
and the UK. The
evaluation results were encouraging and demonstrated user satisfaction
regarding efficiency and functionality. According to Griffiths et al. (2007),
"high user satisfaction" means that users or
customers of a product, service,
or experience are very satisfied
or pleased with it. High user
satisfaction typically indicates that people find the product
or service to be effective, enjoyable, and meeting their expectations or needs. It suggests a favorable response
from the users, often
seen as a desirable outcome
for businesses and organizations aiming
to provide quality
products or services.

The
authors, Pierrakeas et al. (2005), present the use of
collaborative online environments (telemedicine) for
speech therapy, in which the therapist can guide the group of participants
through structured discussions, focusing on improving the initiation of speech.
Conversation, taking turns, clarifying ideas, repairing breaks in conversation,
and participating in role-plays of everyday communication situation. In
addition, these environments employ easy-to-use recording, editing, and storage
functions, so users can create professional recordings at their own pace in industry-standard formats using a standard computer
with a camera and speakers. One benefit of these online
collaboration environments is that they can support an unlimited number of
co-presenters and subject-matter experts.

Toki et al. (2012) developed an
online speech-language pathology expert system for diagnosing speech disorders
and difficulties. The system can answer specific questions, give an automatic
evaluation response, and generate a list of localized disorders. SLPs and other
professionals can use this feedback to plan therapy or learning tasks.

There is a large amount of research
regarding methods and technological resources implemented in speech therapy.
The most commonly used technological resources are video calls, 2D and 3D
resources, multimedia, voice recognition, and speech-to-text for patients to

obtain the necessary feedback for the correct
development of the therapeutic session. Several investigations suggest that
these tools are most accessible and convenient for everyone (Lo et al., 2017).
In addition, they support patient-centered and self-management models of
medical care (Madeira et al., 2017), significantly influencing the socio-emotional,
motivational, and cognitive aspects (Buitrago et al., 2019).

In work carried out by Buitrago et
al. (2019), a technological device is presented to support the therapeutic
processes of children with learning problems to develop the following skills:
memory, concentration, mathematical operations, laterality, and spatial
orientation. The device consists of a
mobile application for Android devices, three hardware interfaces, and a Lego
mobile robot. The app has three activities (challenge, math, and maze). After the validation, it was possible
to confirm an improvement in the children’s abilities in the activities
(memory, concentration, mathematical operations, laterality, and spatial orientation), as well as improvements in their self-esteem and
general performance.

The main objective of the study by
Lavoie et al. (2020) was to investigate the efficacy of a self-administered
therapy for people with primary progressive aphasia (PPA) using a smart tablet
to improve function
word naming and assess generalization to a conversation task. The treatment was administered to five adults diagnosed
with PPA four times a week for four
consecutive weeks. As a result,
a significant improvement was determined for the trained
words in the five participants, and the gains
were maintained two months after
the treatment in four of them. In addition, evidence of
generalization in conversation was found in three participants. Two aspects
of the system stand out: i) a self-applicable type of therapy can be carried out where the person has control
over their therapeutic process and their subsequent performance, and ii) it makes it possible
to keep a detailed record of the evolution of the patient
in different aspects of the therapy.

In
the study carried
out by Catania et al. (2022), a system was designed and developed
that encourages children to describe themselves through questions and
suggestions to create an avatar consistent with what is said, thought,
and seen in reality, allowing
the user to have a positive impact in different areas such as i) self-awareness, ii) self-knowledge, iii) communication
skills, and iv) vocabulary of the mother tongue and foreign language.

Besides, Condemarín et al.
(2016) identified five critical areas
of auditory stimulation:

i)
Sound Recognition Stimulation, Activities to identify and recognize diverse
sounds, strengthening hearing capacity;
ii) Stimulation of Auditory Discrimination: Development of the ability to differentiate similar sounds,
improving speech comprehension; iii) Sound Localization Stimulation: Helps determine the direction of sounds, crucial for spatial awareness;

iv) Stimulation of Auditory Comprehension: Improves the
interpretation and processing of auditory information, facilitating
communication; and v) Stimulation of Auditory Memory: Reinforces the retention
of auditory information in the short and long term.

Regarding this software, there is identified software with similar
purposes available on the market. Among others: i) Lingokids is primarily focused on learning the
English language and providing an engaging educational experience for children; ii) CogniFit is an application that offers auditory
stimulation exercises and other cognitive activities to improve
general auditory and cognitive
skills. This app is available
in multiple languages, including Spanish, and offers
a free version with limited features and a paid version that provides complete
access to all features and exercises. iii) Auditory Processing Studio is an application designed
to help people with central auditory
processing difficulties. It provides a variety of ear training
exercises and

is available
in multiple languages, including Spanish. This app offers a free trial version,
but it

also has a paid version with additional features and more advanced
exercises.

Methods

The
prototyping methodology allows the developer
to create, refine,
and test a working version. Despite the increasing
focus on the detailed and controlled administration of the design process of a
system, the prototyping methodology could offer data on the application's
performance generated in the design phase (Armenta Benitez et al., 2018).

The prototype model of Armenta Benitez et al. (2018) was
considered to develop the software prototype that supports the stimulation of auditory skills
in children from 5 to 7 years old. Figure 1 (SPEM 2.0 (OMG, 2008)) visualizes the methodology applied
in the construction of the prototype. This methodology consisted
of six phases: i) Requirements, ii) Assembly and development, iii) Evaluation, iv)
Documentation, and v) Testing.

Figure 1

Stages of the prototyping methodology

Results of the instantiation of the methodology

Requirements Phase

The Requirements phase is developed
in a unidirectional way between three activities adapted to the domain of this
study (Amado-Salvatierra et al., 2015): i) definition
of the problem, which includes
i) defining the auditory stimulation program (guidelines proposed
by Condemarín) and formulate the
objectives to be achieved; ii) identification of requirements: identify the activities to be carried
out, define the rules to be followed
to guarantee accessibility/ usability, and select or create graphic
and multimedia resources, for which the use case diagram
was defined; and iii) use cases: where
the requirements for the implementation of the prototype are defined. As a result of this phase, the use cases were defined based on the use case diagram
and stimulation modules, as shown in Tables 1 and 2 and Figure 2.

Table 1

Stimulation modules

CODE

STIMULATION
MODULES

DESCRIPTION

ACT1

Module
1 Activities

Auditory memory

ACT2

Module
2 Activities

Auditory Awareness

CODE

STIMULATION MODULES

DESCRIPTION

ACT3

Module 3 Activities

Auditive discrimination

ACT4

Module 4 Activities

Initial sounds

ACT5

Module 5 Activities

final sounds

Figure 2

Use Case Diagram

Table 2

Use Cases

Code

Case
of use

Actor

Description

Priority

CU1

Administration of Institutions

Super Admin

It allows one to take control
of the different institutions.

Mandatory

CU2

Management administrators

Super Admin

It allows one to take control
of the different administrators

who will take control of
the platform.

Mandatory

CU3

Administration of teachers

Administrator

Allows one to take
control of the different teachers who will

take control of the
stimulation activities.

Mandatory

CU4

Generation of reports

Administrator, Teacher

It allows
one to take
control of the
reports, with the
results for the students
when carrying out the activities. Stimulation.

Necessary

CU5

Configuration of

stimulation activities

Teacher

It allows one to configure the necessary stimulation activities

for students (ACT 1 - ACT
7).

Mandatory

CU6

Carry
out stimulation activities

Students

It allows
one to carry
out the stimulation activities generated
by the teacher (ACT 1 - ACT7).

Necessary

CU7

Student Administration

Teacher

It allows one to keep track
of the different students who carry

out the activities. Stimulation.

Mandatory

Assembly and development
phase

Based on use cases, the second phase
was developed unidirectionally between two activities adapted to the domain of
this study: i) Assembly and ii) Development (Amado-
Salvatierra et al., 2015). In this way, a generic plan was created for how the
software will be

built, which includes choosing the optimal instructional
method or methods to create objects or materials that help support the
therapeutic processes of children with learning disabilities (Buitrago et al.,
2019).

Assembly Activity: As a result of this activity,
the interfaces (mockups)
were designed for the
activities ACT1 to ACT7.

Development Activity: The architecture used to implement the web prototype is based on the Model View Controller (MVC) (Rojas et al., 2019). The implementation of this model was
based on the platform (Yii,
PHP, MARIADB, speech
recognition, and the Visual Studio
Code IDE) to develop
a web application compatible with mobile devices,
tablets, and computers. As a result of this activity, the first version of the software
prototype was obtained with the Use Cases CU1 to CU7 implemented. During the internal tests of the software among the developers,
performance evaluations
were made for each implemented item.
As an output, the partial solution software
prototype was obtained.

Evaluation Phase

The evaluation phase is carried
out in a unidirectional way between three activities

(Amado-Salvatierra et al., 2015) adapted to the core of this study: i) Planning the evaluation;

ii)  Gathering information; iii) Analysis of the information obtained. These activities determine

if the software prototype
achieves the planned
objectives and what changes are necessary.

For
this phase, it was considered necessary to evaluate
the requirements fulfilled and the system's functionality through the type of software
tests known as "black boxes". The input was the first version of the prototype
obtained in the previous stage. The checklists for evaluating fulfilled
requirements and functionality were based on the model (Aristegui, 2010). Tables 3 and 4 show the compilation of the evaluation carried out by the expert
in the field of speech
therapy.

Table 3

Requirements Assessment Checklist

Requirements

Met the requirement

Comments observations

YES

NO

The system will allow
the creation of different stimulation activities the

teacher generates.

X

Works correctly

The system
will allow one to view
the options of each stimulation activity randomly.

X

Works correctly

The system
will allow one to reproduce the texts of the answers in audio form.

X

Works correctly

The system will allow
the playback of the audio
files uploaded by the

teacher to stimulate the activity.

X

Works correctly

The system
will allow, through voice recognition, to select the
response of the stimulation
activity in the form of an image.

X

Works correctly

The system will allow,
through voice recognition, to say the answer.

X

Works correctly

The system
will allow visualizing feedback between each
stimulation activity.

X

Works correctly

Note: Table 3 provides eight successful sample request requests that can be performed on the
prototype. Therefore,

the success rate for evaluating fulfilled
system requirements is 100% (Sasmito & Nishom, 2020).

Table 4

Functionality Assessment
Checklist

Action

Scenery

Met the requirement

Comments observations

YES

NO

Does the system start
without a problem?

The student enters his username, password, and institution

X

Works correctly

The student
presses continue and is
redirected correctly.

X

Works correctly

The student accesses the
system.

X

Works correctly

Does the system display
the correct information?

When accessing the system, the correct
student information is displayed.

X

Works correctly

Does
the system allow stimulation activities to be carried out correctly?

Auditory awareness module.

X

Works correctly

Auditory memory module.

X

Works correctly

Auditory discrimination module.

X

Works correctly

Initial sounds
module.

X

Works correctly

Final sounds
module.

X

Works correctly

Does voice
recognition work correctly?

By pressing the voice recognition button, an answer
can be selected .

X

Works correctly

In stimulation activities, does the system reproduce the orders?

Pressing the play button
plays the command.

X

Works correctly

Does the system show
feedback on the stimulation activities carried out?

Upon completing the stimulation activities, it displays a message with
"Well done."

X

Works correctly

At the
end of the
stimulation activity, it shows the general result.

X

Works correctly

Does
the system display the information according to roles?

Super Admin

X

Works correctly

Administrator

X

Works correctly

Teacher

X

Works correctly

Student

X

Works correctly

Note: Table 6 provides
seven successful sample
actions that can be executed
on the software prototype. Therefore,

the success rate for the
functionality of the system is 100% (Sasmito & Nishom, 2020).

During the evaluation, five observations for improvements are listed in Table 6.

Table 5

List of improvements

Improvement number

Improvements to perform

Roles affected

1

Correction of the list
in user report
module: Display a list of users in the user report.

Super Admin Administrator
Teacher

2

Filter correction in the
general report module: Implement a search engine in

the general report to filter the
report by a teacher.

Super Admin Administrator
Teacher

3

Correction of the list
in the general report module: Implement a table in the
general report to view the teachers.

Super Admin Administrator
Teacher

Improvement number

Improvements to perform

Roles affected

4

Correction of information in the general report module: Eliminate unnecessary data in the
general report.

Super Admin Administrator
Teacher

5

Correction of behavior for teacher role in user module: Disable
the option to select the institution and manager of
the user when creating the student.

Teacher

Corrections phase

Based on the initial prototype and the list of improvements as inputs, the correction phase is carried out in a unidirectional way in four activities adapted
to this study (Amado-Salvatierra
et al., 2015): (1) daily
meetings: (2) reuse/adaptation of pre-existing material; (3) Development/
Modification; and iv) Software error testing.

As a result of this phase, the Final
Prototype was obtained, shown in Figure 3, and accessible at the following
link: https://github.com/luchV/PrototipoSofware.git.

Figure 3

Final prototype

Documentation Phase

The documentation phase is carried out in a unidirectional way in two activities (Amado- Salvatierra
et al., 2015) adapted to the project: i) Preparation
of the Data Dictionary and ii) Preparation of the User Manual. In this phase, the documentation that will allow us to understand
the operation of the prototype is generated. As an output of this phase, the data dictionary and user manual
were obtained (https://n9.cl/manual-de-usuario).

Implementation phase

The implementation phase is executed
in a unidirectional way between three activities (Amado-Salvatierra et al., 2015):
i) Perform software
usability tests; ii) Organization technical support; and iii) Retrospective. This way, the prototype created in the Assembly and Development
phase was tested in the field (Cheung, 2016). As a result of this phase,
the final Prototype Usability report was obtained.

A survey was applied that was based
on the System Usability Scale (SUS) (Bangor, 2009). Google Forms was used to extract the information using a 5-item Likert scale. In this case,
the participants were 36 students
from the Universidad del Azuay in the Educational Psychology
career who carried
out a representative sample of tasks for the product
(usability tests) and then
completed the survey before any discussion with the moderator.

The
statistical analysis process
was based on the work of (Cedillo
Orellana, 2017) . The
collected results validated the questionnaire through Cronbach's alpha, obtaining a value of 0.81. Since Cronbach's alpha was more significant than 0.7, it suggests that the questionnaire is valid and
consistent in measuring the desired construct.

The usability measurement scale (SUS)
was used to obtain the descriptive statistics through the Excel 2019 software.
The result was 85.6, so the prototype corresponds to the " excellent
" category with high usability. (Bangor, 2009).

This
application is a web platform
that will be hosted on the servers
of the Universidad del Azuay.
It is important to note that access to the application is free for public and
private institutions in Cuenca. In this way, we ensure the application is
accessible and beneficial to a broad spectrum of users in the city's
educational community.

Conclusions

To respond to the research question, which focuses on the skills considered in developing software for auditory stimulation, observing that, according
to the literary review, a significant
percentage of the articles (42%) focus on activities to stimulate auditory skills, such as detection,
localization, discrimination, and auditive identification. Another 42%
is related to activities that stimulate linguistic and extra-linguistic skills,
such as attention, concentration, memory, behavior, and interpersonal relationships. In addition, 24% of the articles address the control and management of frustration and the teaching
of vocal acoustics, among other aspects.
Based on the literature review, these findings
align with the listening skills
proposed by Condemarin and provide valuable information for the
development of auditory stimulation software.

The web application prototype to
stimulate listening skills is beneficial for children with speech disorders and
learning difficulties and typically developing children between 5 and 7 years
of age. The application offers stimulation activities and immediate feedback to
improve the ability to recognize, discriminate, and interpret auditory stimuli,
which can help develop communication in children. In addition, this prototype has great potential to complement
traditional therapies and expand therapists' ability to meet their
patients' needs.

Unlike other auditory stimulation
applications, the developed prototype stands out for its voice recognition feature, which provides notable benefits: i) Practice Pronunciation: Speech
recognition helps users
perfect their pronunciation of words and sounds, providing accurate and
effective feedback; and ii) Interactive instructions: Especially in apps for
children, interactive verbal instructions make activities more dynamic and personalized, allowing users to give voice commands
and receive interactive responses.

The system evaluation results showed
high user satisfaction and excellent efficiency in technical and interface terms. Users found the system
extremely useful due to its ability to customize
stimulation activities and quickly generate reports. In general, the prototype
is believed

to improve the quality of speech and language therapy
services thanks to the implementation of advanced technologies such as voice recognition.

This tool is intended to
significantly improve listening comprehension in high school students, a
crucial skill for linguistic learning and communication. It is adapting the
activities proposed by Condemarín in areas such as auditory
awareness (recognizing natural
and human- produced
sounds), auditory memory (repeating words and associating them with images, verifying
animal sounds), auditory
discrimination (differentiating animal sounds and environment), and the recognition of initial, incorrect, and final sounds in words. Importantly, consistently fostering
these listening skills from an early age is essential for language
development, knowledge acquisition, and academic success.

Limitations and future works

In this first stage, the application was used only by professors
acting as testers.
In the

next stage of this research,
we must include
kids to evaluate their reactions to the solution.

Regarding security, the code does not incorporate significant security measures like data input
validation or attack prevention. It is essential to implement adequate security
measures, mainly if the code handles sensitive information or interacts with
users. For example, it is recommended to use the functions and methods provided
by the Yii software framework to manage sessions, as they ensure the security
and integrity of the application. Furthermore, validating and filtering all
data inputs is essential to preventing vulnerabilities such as SQL injection or
cross-site scripting (XSS) attacks.

The
implementation of future
improvements in the auditory stimulation web application includes:

1.
Advanced Hearing Evaluation: It
seeks to incorporate more advanced hearing evaluations that allow users to
measure their listening skills more accurately, including their ability to
comprehend and answer oral questions.

2.
Improvement in Voice Control: It is intended to improve voice control functionality,
mainly aimed at users with hearing disabilities, to further
facilitate navigation and interaction through more precise and varied voice
commands.

3.
Intelligent Adaptation: The application will focus on developing a more intelligent adaptation to users' verbal responses. This will allow the app to adjust activities and difficulty levels more precisely, providing a more personalized and practical learning
experience based on user performance.

These enhancements are intended to enrich the user experience and maximize the benefits

of auditory
stimulation through technology and voice interaction.

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