Aural Habilitation Boardgame

10 weeks, 2018

  • User research
  • Game design
  • Visual design

With a team of four designers, I designed a collaborative boardgame to help kids with cochlear implants or hearing aids engage with their aural habilitation therapy.

Image of the boardgame and cards.
Image of boardgame with cards.

What's the opportunity?

Per the CDC, 1 in 500 infants are born with or will develop hearing loss in early childhood. Depending on the type and severity of hearing loss, either a cochlear implant or hearing aid will be recommended. Aural habilitation therapy is a process that helps children with hearing loss develop listening, language, and communication skills.

Working with Seattle Children’s Hospital and a team of four designers, we contributed a collaborative boardgame to engage children with their aural habilitation therapy.

Image of our how might we question.
Image of our how might we question.
A graphic of design process undertook to create the boardgame.
A graphic of design process undertook to create the boardgame.
A graphic of design process undertook to create the boardgame.

Investigative research

To understand and scope our problem space, we carried out a mixed methods study involving interviews, field observations, and a literature review. From the research, we created the following requirements:

One challenge we faced in this stage was getting access to children with cochlear implants or hearing aids and their families. We worked with Seattle Children’s to find connections but ultimately, were unable to speak with our target user group directly. To make up fo this, we conducted extensive secondary research to learn as much as we could.

Design requirements


Design for use by both parents and children.


Should be both visual and auditory for patients to create the neural pathways needed for learning to hear language.


Should stimulate conversation between parents and children.


Should be fairly silly and playful as this prompts children to engage and respond more enthusiastically.

Observational study

We observed an aural habilitation therapy session led by a speech and language pathologist. The patient was a 5 year old girl who was accompanied by her grandmother. The purpose of the observational study was to understand the interactions between patients, families, therapists, and artifacts in the hospital therapy environment. Furthermore, we wanted to interpret the actual experiences of patients; specifically, what they actually did and how they behaved. Due to patient confidentiality, we did not record audio or take pictures during the observation session but we did take handwritten field notes. After cleaning up our notes, we open-coded them and performed a thematic analysis.

Image of observation room
The observation room from where we observed an aural habilitation session with a speech and language pathologist, a five year old patient, and the patient's grandmother.

Expert interviews

We interviewed a pediatric otolaryngology surgeon (inserts cochlear implants) and a psychologist that works with families during the cochlear implant surgery process. The purposes of these interviews was to understand the practical process of getting a cochlear implant and to hear from the point of view of experts the common pain points and important stages in the process.

Literature review

We watched videos and read articles posted by young adults with cochlear implants and hearing aids to empathize and build an understanding for living with hearing loss. In addition to these self-authored sources, we also researched various ethnographies from medical literature to learn from a larger number of patients. Each of us read the graphic memoir, El Deafo by Cece Bell which was pointedly influential in our research and later design phases.


After reviewing our research findings and design requirements, each member of the team individually sketched out design ideas. As a group, we discussed our ideas, categorized them based on similarity, and then decided to focus on the most frequent or promising ideas. We ultimately filtered down to two ideas based on how well they satisfied our design requirements.

Two promising designs


The first idea was an iPad game which could help kids clearly discern words that rhyme or sound similar. The system would encourage kids to think about the context in which words were spoken as a way to aid interpretation.


The second idea was a multiplayer boardgame that would encourage conversation amongst patients, parents, and peers. The boardgame would be played to strengthen specific listing and speaking skills.

Pictures of sketches of both of our ideas.
The iPad game on the left helps kids discern words based on how they are used in a scenario. The boardgame on the right is a collaborative game to strengthen listening and speaking skills.

Low fidelity prototyping

We then created low fidelity representations of our ideas—paper prototypes for both the app and boardgame. We presented the prototypes to our peers and instructor, who provided feedback and further guidance.

Image of paper prototypes of iPad app idea..
A paper prototype of the iPad game. On each screen, a scenario is presented and the child will be asked which of a few similar sounding words would most likely be said. This game emphasizes the importance of understanding the context of a situation and the words that might be spoken within.
Image of boardgame paper prototype idea.
The boardgame prototype. The goal is to identify common sounds and words one might hear in a home. Players draw cards from a deck which have unique QR codes. Scanning the codes will play the audio of a sound—the player will then need to identify where in the house the sound can be found. To win the game, players need to identify all the objects in the house before the family gets home. Special “family” cards are interspersed in the deck and when drawn, a game-piece representing the family will be advanced forward, closer to coming home. Image source.

Deciding on the design to pursue

After careful consideration of our design requirements and user needs, we decided to focus on the boardgame.

The boardgame would afford easier collaboration, involving patients, friends, and parents. A multiplayer boardgame with the right gameplay would invite conversation amongst players that help strengthen listening and speaking skills.

Image of a table comapring criteria for each idea.

Playtest with kids

We brought our boardgame prototype to a support group for children with hearing loss at Seattle Children’s Hospital. We taught them how to play the game and then observed and asked questions about what they thought.

Feedback & findings

  • Facilitation by an adult or older child is needed to teach game mechanics and ensure turn-taking.
  • Kids were enthused by racing against the clock (to beat the game before the family came home).
  • Kids found scanning QR codes to be fun, engaging, and novel.
  • Kids felt the game was too easy.
Image of playtesting with kids.
We tested the boardgame prototype with kids from a monthly hearing loss support group meeting at Seattle Children’s Hospital.

Expert evaluation

In addition to playing the game with kids, we also got feedback from a speech and language pathologist on how we could improve the game from a learning perspective.

She expressed concern over specific words and phrases used in context for the game. She then gave us materials on the sorts of sounds and phrases that therapists focus on to support children in aural habilitation therapy.

Image of learning to listen sounds handout.
One of the learning resources that the speech and language pathologist gave us to make the learning component of our game more robust.

High fidelity prototype

Incorporating feedback from both kids and speech / language experts, we created our high fidelity prototype. We focused on improving the learning components of gameplay as well as the visual design of the game’s assets.

Picture of entire boardgame and cards.
Final boardgame product The final game consists of the boardgame spread, different decks of cards (based on difficulty), and the game “timer.”

Different card decks represent different levels of difficulty. So the game can be tailored to a child’s stage of language learning development.

Picture of cards.
Different decks represent specific elements of language learning development.

Finalized gameplay

The game is most engaging with three to six players. Begin by shuffling the deck and then drawing a card from the top.

Picture of entire boardgame and cards.
On each player’s turn, they draw a card from the deck and scan it with a smartphone. There will be a sound played and the player along with the group decide where best to place that sound in the house.

Scan the card with a smartphone QR code reader. Play the sound from the website and think about where in the house the sound would be most appropriate. Discuss with the group and decide.

The goal is to identify at least three objects that different sounds could represent per room in the house. Each card can correspond to one object or multiple depending on how a player justifies.

Picture of cards and game 'timer.''
Shuffled in each deck are “The family is coming!” cards. When drawn, players advance the car by one space on the road. The goal is to place at least three sounds in each room of the house by the time the family gets back.


  • Seattle Children's Hospital
  • Laura Dickinson
  • Samuelle Saliba
  • Courtney Smith
  • Timothy Sun