Since the early days of clinical audiology, when Raymond Carhart pioneered a comprehensive listening skills program for WWII veterans fitted with hearing aids, the importance of auditory training has received a lot of lip service from hearing healthcare providers. Although many clinicians believe in its intrinsic value, and a handful of studies support its effectiveness, auditory training, in practice, often falls by the wayside because of a lack of time or interest from patients.
Just over a decade ago, Robert Sweetow and colleagues introduced a computerized version of auditory training that initially gained some traction, but eventually interest in it waned. Their version of auditory training, Listening and Communication Enhancement or LACE, laid the groundwork for newer auditory training exercises using gamification. Gamification, which is the application of game-design elements and game principles in non-game contexts is found in many places and its applications are growing.
A good example of gamification in our everyday, smartphone-driven lives is the GPS mapping app, Waze. Waze uses gamification by rewarding users as they contribute to road information. Users of Waze, for example, can earn points, titles, achievements, and mood options as they continue to use the app….and who doesn’t want mood options when they are sitting on gridlocked highways on a late Friday afternoon?
One auditory training program that uses gamification is clEAR, which stands for customized learning: Exercises for Aural Rehabilitation. clEAR has been available for almost two years and considering some of the changes in how hearing care is delivered, such as the rise of unbundled service options for individuals choosing to purchase hearing devices online, it’s a program that more and more professionals might be giving more than lip service. There is even a reasonable chance, according to authorities, that Medicare and other third party payers will reimburse for the service.
Brian Taylor, AuD, Editor-in-Chief of Hearing News Watch, sat down with the creator of clEAR, Nancy Tye-Murray, PhD, professor at Washington University to learn more about some of the gamification updates to clEAR and how some of the business models that can be applied to its use in the clinic.
Gamified Auditory Training and Audiology Service Packages
BT: Please remind our readers, what is auditory training and how does clEAR provides it using gamification?
NM: clEAR auditory brain training incorporates both analytic and synthetic training activities, and also trains those cognitive skills that are necessary for understanding speech, including auditory attention, auditory processing speed, and auditory working memory. We have gamified training because, quite simply, auditory training only works if the patient is engaged and enjoying the experience. Pleasure causes the brain to increase dopamine, dopamine enhances neural plasticity, and neural plasticity potentiates perceptual learning. Also, if training isn’t fun, patients won’t do it.
BT: Since you launched this web-based subscription program in May, 2017, what are some of the updates to clEAR?
NM: We listened carefully to feedback from both our clinicians and patients and will be implementing exciting changes into the website and the games by March 15th. These updates include:
- A recurring monthly subscription. Instead of buying a three-month subscription, patients and clinicians will now be able to buy a month-by-month subscription and stop the subscription at any time.
- A lower price tag. Patients may purchase clEAR for as little as $24.95. We also have a “coupon” system, so audiologists can provide a discount for their patients, at no charge to their practice.
- Minimal time or effort required from the audiologist. We give audiologists the option of having a clEAR in-house audiologist follow the patients (or they can follow), at no additional cost.
- New games. Not only have we updated all of our existing games—giving them a more sophisticated look and feel—we’re about to introduce two new games that have received great reviews from our beta test users, EARplane and pokEAR (i.e., five-card draw), which are designed to develop auditory processing speed and auditory working memory, respectively.
BT: Ideally, many individuals with hearing loss of gradual onset could benefit from auditory training, however, I think a lot of clinicians, due in part to time constraints, need to be somewhat selective on who they offer this type of program to. Based on the data you’ve collected on clEAR, since its launch, what patient populations are most likely to experience benefit from it?
NM: Great question! And a reason that we have the philosophy of “one size does NOT fit all.” clEAR has lesson plans for various listening challenges. Here are the most popular:
- Lesson plan for the new hearing aid user. This plan not only helps patients adapt to their new devices but also demonstrates experientially the benefit derived from using them.
- Lesson plans for patients who complain of listening challenges, even though they use hearing aids. Namely, we have a lesson plan for the patient who complains of listening in noise and a lesson plan for the patient who can’t hear certain voices, such as those of women and children.
- Lesson plan for the person worried about cognitive decline. The general public is becoming increasingly aware of the research linking hearing healthcare with prevention of cognitive decline, thanks to articles in the popular press.
A surprising patient group, at least for me, is the group that believes they don’t yet need a hearing aid but they want to address their listening difficulties. In several cases, by playing the clEAR games, they realize that they aren’t hearing as well as they thought they were, and they end up going back to their audiologist and purchasing hearing aids.
BT: That brings me to some business-related questions. For example, we are seeing direct-to-consumer companies bringing hearing devices to market that allow persons with hearing loss aged 18 and older purchase products without a face-to-face visit with a licensed professional in a brick and mortar office. Is there a version of clEAR that can be purchased directly by patients from your website? If so, please describe the transaction process.
NM: We do have a direct purchase option for clEAR. Patients simply have to log-on and create an account and purchase a subscription. They then receive a lesson plan that is customized to their listening challenges and they receive regular coaching and support from an in-house clEAR audiologist.
BT: Because of these direct-to-consumer hearing device options, as well as the continued rise in popularity of big-box hearing aid retailers and Medicare Advantage programs, more and more hearing care professionals are beginning to offer service packages that can be sold to patients who might have purchased their hearing aids elsewhere. Let’s talk about how clEAR could be used as part of an unbundled service package?
NM: We have audiologists who charge for orienting their patients to clEAR and who charge for the ongoing coaching and support that they provide through clEAR’s messaging system and patient feedback charts. Some also charge for pre- and post-training testing. If the Patient Audiology Choice Act passes, then charging for auditory training will become even more feasible. (Click here for recent developments on the Audiology Patient Choice Act)
In addition, patients gain a closer working relationship with their local hearing healthcare provider which is seen often as an important value added service from their local provider.
BT: I’m curious, are some clinicians who offer an unbundled version of clEAR “lessons” adding some personal face-to-face counseling time with the patient? If so, how do clinicians typically package this service?
NM: Some clinicians are indeed adding personal face-to-face counseling and use clEAR as a means to provide “concierge audiology” to their patients. My favorite example is a practice that creates competitions between groups of patients. For example, in preparation for Christmas, they had a “red group”’ and “green group”, and the groups competed between each other for clEAR coins, awarded during game play. At the end of the competition, the winning group had a wine and cheese party. This created comradery amongst people who formerly didn’t know one another and loyalty to the practice. Other practices have incorporated clEAR auditory training into their group aural rehabilitation or hearing aid orientation classes.
BT: In addition to offering clEAR as part of a service package, I would imagine some clinicians might like to offer clEAR as part of a comprehensive, bundled service package when a pair of new hearing aids purchased from a clinic. Please tell us about how some clinicians bundle clEAR with the sale of new hearing aids.
NM: We believe the hearing healthcare journey has three distinct stages:
- Diagnostics
- Hearing aids
- Follow-up listening therapy
By bundling clEAR into the hearing healthcare journey, audiologists provide that third stage that is so often neglected by the competition, and so distinguish themselves as a superior service. With our new lower price, I suspect that more and more audiologists will be including clEAR auditory brain training in the price of the hearing aids.
BT: How can clinicians learn more about clEAR?
NM: Our website is easy to navigate and can be accessed here. We also offer orientation sessions by phone, and these can be scheduled at a clinician’s convenience by emailing [email protected]. Finally, we have a three-piece patient educational package that includes brochures for the practice’s waiting room. Simply email us and we will send a package at no cost. Thanks so much for asking.
Nancy Tye-Murray, PhD is a professor at Washington University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, St. Louis, MO. She can be contacted at [email protected]
