Interpreting the results

Sound Storm character art of the wise old owl.

What to expect

If you are an audiologist and using Sound Storm with a client for the first time, we want to give you an insight into what to expect from the Sound Storm journey. In particular, the progress report and how to interpret it.

The success of Sound Storm in remediating Spatial Processing Disorder in children is based on a clinical remediation algorithm.

Key to the app’s success is its engaging interface that comes to life with an immersive narrative that is compelling to children and encourages participation with daily and weekly rewards.

The success of the program is reliant on the parent/guardian’s ability to support their child’s commitment to completing the 10 -12 weeks. This can not be stressed enough.

Interpreting the Graph

A tablet device with a Sound Storm progress report displayed on its screen.
  • The horizontal axis is the total number of games played. 100 games is the minimum target for successful remediation, therefore this axis is fixed at 100 games. If a player plays Sound Storm for more than 100 games, data points for the most recent 100 games will be displayed.
  • The vertical axis is the Noise-to-Signal Ratio (NSR). This is how loud the noise is compared to the signal. 20dB NSR, means that the child can interpret sounds (i.e. signals) at a level when the background noise is 20 times louder. Or put another way, when the target sentence is 20 dB softer than the background noise.
  • The default range of the vertical (NSR) axis is 0 dB to 20 dB NSR. This adjusts adaptively to a maximum (softest) NSR of -7 dB and an unlimited minimum (loudest) NSR.
  • The child's progress (in games) is mapped by using the blue dots at a decibel level at which the child can understand 62.5% of the words presented in noise. Each blue dot represents the score for one game.
  • The blue line is the starting average and is calculated by the average of the first 10 games that the child plays. This is an important benchmarking device and is used to measure progress over time.
  • The red line represents the running average of all games played at that point in time.
  • Improvement (dB) is the difference between the running average and the starting average.
  • At the end of training it is expected that the NSR will have improved by approximately 10 dB, depending on the magnitude of the Spatial Processing Disorder diagnosed. For example, a player may improve from an NSR of 12 to 22.
  • Incomplete games refer to any games that are exited before 40 sentences are completed. The NSR for incomplete games does not count towards progress or rewards.

What is ‘normal’ and what can I expect?

There are extensive ‘norms’ for the processing performance of children of different ages built into the LiSN-S diagnostic test used to diagnose Spatial Processing Disorder (the deficit that Sound Storm has been designed to treat). However, there are no separate age-related norms for Sound Storm itself.

Any measurement on LiSN-S (and other tests) have some measurement uncertainty due to multiple factors such as the test environment, the attention levels of the subject and other contributing factors. As a result, when considering what is ‘normal’, it is useful to think about the change from the starting average rather than a comparison to other children and environments where the app is being used.

Typically, however, we see performance gradually improve from wherever the child starts [often a noise-to-signal ratio (NSR) of between 0-10 dB, up to an NSR around 15-20 dB]. That is, the child can then function in much more noise than before training. Of course, there are day-to-day fluctuations up and down, but that is the typical long-term trend.

What if the running average is not moving up and to the right?

This can happen for a number of reasons, firstly the child may have lost interest in the game or is not getting appropriately rewarded. If this is the case, try using rewards other than those contained within the game.

Alternatively, they might be young and have developed as much as possible for the age they are at when playing the game or have suffered from a middle ear infection and/or hearing loss while using the app.

Are results permanent?

Sound Storm has been proven to completely remediate Spatial Processing Disorder, long term. However, an audiologist should retest the child using the LiSN-S test to compare their pre- and post-training scores and to confirm if their spatial processing deficit has been resolved.

The Cameron (2011) study looked at the test-retest reliability of the LiSN-S and reported critical difference scores. These values show how much the scores need to change in order to infer a genuine improvement for each condition.

Table 5. Calculation o the one-sided critical differences needed to infer a genuine improvement in auditory performance on retest at the 95% confidence level while taking into account mean pracice effects and day-to-day fluctuations on performance.

If you are unable to reassess the child using the LiSN-S test, you can also look at ‘real world’ changes.

Additionally, questionnaires, for parents, teachers or the child, can be used to evaluate listening difficulty include the Listening Inventory For Education - Revised (LIFE-R), the paediatric Speech, Spatial and Qualities of Hearing Scale (SSQ) or the Client Oriented Scale of Improvement – Child version (COSI-C). If you plan to use the COSI-C, remember to set goals prior to commencing the training, and then check if the goals have been met at the training’s conclusion.

How can compliance be improved?

Parents/guardians play a critical role in their child’s successful completion of the Sound Storm game. Encourage them to sit with their child in a quiet room, without distractions, while each day’s games is completed. Children under 8 years of age, in particular, will benefit from this.

Verbal encouragement and support is recommended, such as: “You’re doing great, keep going!

Remind parents/guardians that the game is not a ‘set and forget’ tool – their commitment is as important as their child’s. Encourage parents/guardians to listen to the program before their child starts so they know what their child will be experiencing.

It is advisable for parents/guardians to share audio while their child is playing Sound Storm. A headphone jack allows two users to use headphones to share sound or pair Bluetooth headphones to the device. This is useful on occasions when their child is having difficulty staying on task or as a way to provide positive reinforcement when their child is doing well.

At the end of each session, a parent/guardian should talk their child through the Progress report and explain what they mean. This will encourage further compliance and improvement.

Weekly and end of program rewards (separate to the rewards built into the Sound Storm game) are also useful for encouraging compliance. For example, a parent/guardian may implement a visual reward chart for the child with a reward at 50 games and then 100 games.

If a child is getting frustrated or upset during a session, let them take a break for a few days.

Once the program is completed (100–120 games), a clinical retest with LiSN-S is recommended to check for successful remediation of the child’s Spatial Processing Disorder.

Frequently asked questions

What happens if a child presents with an ear infection or fluctuating hearing during the Sound Storm treatment?
Down arrow.

It is advisable to stop using Sound Storm and wait until the infection or other condition has cleared.

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