An Augmented Reality Audio-Motor Training Game (ARIA) for Improving Speech-in-Noise Perception: A Single-Arm Pilot Feasibility Study (Preprint)

BACKGROUND Difficulty understanding speech in noisy environments is a primary challenge of hearing impairment, inadequately addressed by hearing aids alone. While auditory training can enhance selective attention and speech perception, current digital programs face poor user adherence and lack realistic three-dimensional spatial audio. OBJECTIVE This pilot study evaluated the feasibility, usability, and preliminary efficacy of ARIA (Augmented Reality Immersive Auditory training), a novel gamified audio-motor intervention for at-home auditory training in older adults. METHODS In this single-arm pre-post-follow-up pilot, 11 adults (mean age 53.0, SD 3.0 years) with self-reported normal-to-mild hearing difficulties completed 4-week at-home training using ARIA on provided devices (iPhone 14, AirPods Pro 2). Speech-in-noise perception was assessed via Korean Matrix Sentence Test at baseline, 4 weeks, and 8 weeks at three signal-to-noise ratios (SNR, 0dB, -6dB, -9dB). Feasibility, usability (System Usability Scale), user experience (Player Experience of Need Satisfaction), in-game performance, and qualitative feedback were collected. RESULTS Protocol completion was 100% (11/11), demonstrating technical feasibility. Exploratory efficacy analyses revealed statistically significant speech-in-noise improvements post-training across all conditions (0dB: t₁₀=3.43, P=.019; -6dB: t₁₀=5.34, P