Gaming the (Auditory) System

Holly Hosford-Dunn
July 22, 2014
Harvey Abrams PhD

Harvey Abrams PhD

Today’s post is from Guest Contributor Extraordinaire Harvey Abrams, PhD.  Last time, he treated us to a masterful discussion of Price in the hearing aid industry.  Today he switches gears to talk about brain fitness, health apps, and auditory training in the Internet age.  

The Starkey Hearing Blogs ran Dr Abram’s post on July 15, 2014, and graciously gave him permission to reformat and publish it at Hearing Economics as well.  

Gaming the (Auditory) System


It appears that my insurance company thinks I can benefit from some brain exercise (my wife is in total agreement). I just received an email from them offering to provide me with free access to an online driving training program called Drivesharp. Why was my insurance company being so generous (an $89 value)? Well, it turns out that Drivesharp was developed by Posit Science, the same company that developed and distributes Brain HQ, a “Brain Fitness” program that purports to improve such cognitive functions as attention, brain speed, and memory. According to Posit Science, Drivesharp has been proven to:

  • Reduce the risk of car crash by up to 50%
  • Increase “useful field of view” by up to 200%
  • Help drivers drive with greater confidence at night, in congested traffic, and in new places
  • Enable drivers to stop up to 22 feet sooner when traveling at 55 mph

Ah, now I get it. Play the game, improve my driving skills, reduce my risk of accidents, reduce my claims, reduce payouts for injury and collision repair, save my insurance company money, reduce my premiums (yeah, that’ll happen).

Brain Games are Part of Our Popular Culture


Figure 1.  Growth of Americans 60 years of age and older.

Figure 1. Growth of Americans 60 years of age and older.

The offer from my insurance company is an excellent example of how the pursuit of brain training and associated gaming software has become part of the popular culture. In addition to BrainHQ (which is also made available to members of AARP), there are other brain fitness games on the market, including dakim BrainFitness, Heartmath and Lumosity. The growing popularity and commercialization of brain fitness programs represent a convergence of two powerful cultural phenomena.

The first is the healthy aging movement influenced by the baby boomer generation whose members will represent a growing proportion of the American population over the next several decades (Fig 1). Just as older Americans are seeking ways to maintain their physical health, strength and vitality, they also want to remain mentally sharp in hopes of delaying the onset or reducing the effects of age-related cognitive decline. This generation sees brain fitness training as way to maintain cognitive agility. In fact, there is growing evidence supporting the benefits associated with these games, specifically in the areas of memory and language skills.

The other phenomenon that is influencing the popularity of brain fitness is the increased use of “gamefication” in our health and fitness products. Gamification is the use of gaming techniques such as competition and the drive for status and reward, for non-game applications such as diet and exercise. All you need to do is look at the proliferation of health and fitness apps available for downloading to your smartphone or tablet to get an immediate appreciation for the power associated with the intersection of gamification and wellness.

One of the benefits of gamification, as applied to health and fitness, is that its strategies are designed to keep users engaged through clever graphic design, animation, compelling story lines and some system of rewards. In my driving game (in which I “drive through” several of our national parks), I’m rewarded with park photos, postcards, fun facts and national park pins when I reach a certain level of performance. I just earned my Acadia National State Park pin earlier today!

Practice is Part of the Program


Adherence to the training schedule is critical to the success of brain fitness programs. The more you train the more you gain. The same can be said for post-fitting auditory training programs. Computer-based auditory training has been around for decades and the research has indicated that such programs improve measured and perceived communication performance; however, one of the greatest challenges facing clinicians is finding ways to ensure that patients remain engaged with these programs.

As with brain fitness, when patients comply with their auditory training schedule, performance improves. Audiology researchers, in collaboration with game developers, have been working to create auditory training approaches that can be both entertaining and clinically effective. LACE™, distributed by Neurotone, was the first commercially available auditory training programs that utilized gamification techniques designed to keep patients engaged while improving speech understanding performance. Other “gamefied” auditory training programs include ReadmyQuips™ by Sense Energy and Hear Coach developed by Starkey Hearing Technologies, currently available as an iPhone and iPad App. Both ReadmyQuips™ and Hear Coach are also available at no cost to registered users of MyStarkey.

And They Work!


The results of several research projects examining the effectiveness of computer-based auditory training have been encouraging, suggesting that gamified auditory training programs improve patient outcomes across several outcome domains including speech-in-noise{{1}}[[1]]Sweetow RW, Sabes JH. (2006). The need for and development of an adaptive listening and communication enhancement (LACETM) program. J Am Acad Audiol 17:538–558.[[1]] and the amount of time hearing aids are worn{{2}}[[2]]Bock K, Abrams H. An evaluation of the efficacy of a remotely-delivered auditory program. Poster presented at NCRAR 6th Biennial Conference, “Beyond the Audiology Clinic: Innovations and Possibilities in Connected Health” September 18-20, 2013 [[2]]. Starkey Research is currently collaborating with the University of Minnesota to explore the effects of the ReadmyQuips™ program on specific types of brain activity.

Brain Fitness and auditory training games are designed to train and improve cognitive processes: attention, speed and memory. After all, the “central processing unit” of the auditory system is located in the brain – an area called the auditory cortex. As our knowledge of the brain continues to grow, further innovations will take advantage of this understanding and training programs will become more accessible, engaging, and effective. Today’s options for auditory training are widely available through the Internet or mobile App; maybe tomorrow’s application will be fully integrated into the hearing aid and will allow us to take advantage of on-demand auditory training – anywhere, anytime.


Harvey Abrams, PhD, is the Director of Audiology Research at Starkey Laboratories. Previously, Dr. Abrams served in clinical, research, and administrative capacities with the Department of Veterans Affairs and the Department of Defense. He also teaches distance-learning courses for the University of South Florida and the University of Florida.  Dr Abrams received his master’s and doctoral degrees from the University of Florida. His research has focused on treatment efficacy and improved quality of life associated with audiologic intervention. He has authored and co-authored several recent papers and book chapters and frequently lectures on outcome measures, health-related quality of life, and evidence-based audiologic practice.

feature image courtesy of fi journey

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