Application of Digital Games for Speech Therapy in Children: A Systematic Review of Features and Challenges

Table 3

The characteristics of reviewed articles.

Authors, year	Country	Target group	Type of speech skill	Children age ranges	Type of support	Supported language level (phoneme/syllable/word/phrase/sentence)	Type of evaluation	Results of evaluation
Takagi et al. [29]	Japan	Children with hearing impairment	(i) Vocalization	Pre-school children	Children can practice with parents at home	(i) Word	Not evaluated	Not evaluated
Lopes et al. [30]	Portugal	Children with dysphonia	(i) Sustained vowel exercise	4-5 years old	Therapist involved	(i) Phoneme	Test with users	The game gives children the motivation to continuing practicing.
Duval et al. [31]	USA	Children with developmental disabilities	(i) Articulation	Not mentioned	Not mentioned	(i) Word	Usability evaluation	This study yielded refined functional requirements based on user feedback, relevant reward systems to implement based on user interest, and insights on the preferred hybrid game structure.
						(ii) Phrase
						(iii) Sentence
Zajc et al. [32]	Slovenia	Children with speech and language disorders	(i) Phonological awareness exercise	3–12 years old	Not mentioned	(i) Phoneme	Test with users	The game had positive impact on the children’s motivation and satisfaction.
Hair et al. [21]	USA	Children with speech sound disorders	(i) Articulation	4–12 years old	Children can practice with parents at home	(i) Word	Test with users	The results indicate that game successfully engages children and speech exercises. Children are willing to complete the required speech exercises while playing a game they enjoy.
Elhady et al. [33]	Egypt	Children with dyslalia	(i) Articulation	7–10 years old	Children can practice with parents at home	(i) Word	Test with users/evaluation performance of the speech recognition system	A noticeable progress in children dyslalia appeared with the proposed system/recognition accuracy: 82.1–95.6.
Anjos et al. [34]	Portugal	Children with speech sound disorders	(i) Articulation	5–9 years old	Children can practice with parents at home	(i) Phoneme	Giving feedback from children and SLP	The feedback from children confirmed that children liked the game. The SLPs showed interest in game and considered it a good method for children training.
Ahmed et al. [14]	Australia	Children with childhood apraxia of speech and typically developing speech	(i) Articulation	6–11 years old	Children can practice with parents at home	(i) Word	Feasibility study/evaluation performance of the speech recognition system	Children and SLPs found speech-controlled games interesting and fun/ASR accuracy: specificity: 77%; sensitivity: 51%.
Nasiri et al. [35]	Turkey	Children with speech disorders and hearing problems	(i) Articulation	2–6 years old	Children can practice with parents at home	(i) Word	Not evaluated	Not evaluated
Madeira et al. [36]	Portugal	Children with phonological disorders	(i) Metaphon therapy	3–8 years old	Not mentioned	(i) Phoneme	Usability evaluation	Super-Fon’s usability was acceptable and very near to a good ranking.
						(ii) Word
Fardoun et al. [37]	Saudi Arabia	Children with speech difficulties	(i) Respiratory exercises	Not mentioned	Children can practice with parents at home	(i) Phoneme; (ii) Word	Not evaluated	Not evaluated
			(ii) Labial exercises
			(iii) Vocalization exercises
Cler et al. [38]	USA	Children with velopharyngeal dysfunction	(i) Nasalization practice	4–14 years old	Children can practice with parents at home	(i) Word	Pilot testing with users	Over 90% of the participants reported that the game was at least “kind of fun” and the equipment was at least “kind of comfortable.”
Liu et al. [39]	China	Children with hearing impairment	(i) Articulation	Not mentioned	Children can practice with parents at home	(i) Word	Usability evaluation	They had an emotional value recovery.
						(ii) Sentence
Rubin et al. [40]	USA	Children with cleft	(i) Not mentioned	2–5 years old	Children can practice with parents at home	(i) Phoneme	Pilot testing with users	Children enjoyed the game but grew bored due to the delays of phrase-based speech recognition.
						(ii) Sentence
Navarro-Newball et al. [41]	Colombia	Children with hearing impairment	(i) Articulation	3–11 years old	Not mentioned	(i) Syllable	Informal summative evaluation for assessing user experience/evaluation performance of the speech recognition system	The results of evaluation showed it to be a suitable tool to maintain the attention and enthusiasm in repetitive tasks. Correct percentage: 80.51
Lan et al. [42]	USA	Children with apraxia of speech	(i) Timing and vocal loudness exercise	4–12 years old	Not mentioned	(i) Not mentioned	Pilot testing with users	Results support the feasibility of the game as a speech training tool.
Tan et al. [43]	Australia	Children with speech disorders	(i) Vocalization	Not mentioned	Not mentioned	(i) Word	Pilot testing with users	The children appear to be engaged and interested in playing.
King et al. [44]	USA	Children with hyperfunctional voice disorder	(i) Resonance voice exercise	School-age children	Not mentioned	(i) Syllable	Feasibility study	This study found that a purely entertaining video game can be implemented as a voice therapeutic protocol.
						(ii) Word
						(iii) Phrase
Cagatay et al. [45]	Turkey	Children with speech and language disorders	(i) Not mentioned	Not mentioned	Therapist involved	Not mentioned	Pilot testing with users	They showed increasing interest in the game.
Rahman et al. [46]	Bangladesh	Children with ASD	(i) Making intelligible sounds and correct sentences with words	Not mentioned	Therapist involved	(i) Word	Pilot testing with users	The results indicated the supremacy of gaming method for learning worlds quickly and efficiently.
						(ii) Sentence
Frutos et al. [23]	Spain	Children with ASD	(i) Articulation	Not mentioned	Not mentioned	(i) Word	Evaluation performance of the speech recognition system	The game had good accuracy (100%).
Umanski et al. [47]	Netherlands	Children with various speech disorders	(i) Speech rhythm exercise	4–6 years old	Therapist involved	(i) Syllable	Usability evaluation	The result showed that although the game prototype requires improvement, the initiative is very welcome, and further prototypes will be anticipated.
Hoque et al. [48]	USA	Children with ASD	(i) Improving speech intelligibility	Not mentioned	Therapist involved	(i) Sentence	Pilot testing with users	Preliminary results demonstrated that the game is engaging and effective.
Bunnell et al. [49]	USA	Children with articulation problems	(i) Articulation	4–7 years old	Therapist involved	(i) Syllable	Evaluation performance of the speech recognition system	The difference in log likelihood between /r/ and /w/ models correlates well with perceptual ratings of utterances containing substitution errors but very poorly for correctly articulated examples.
						(ii) Word
						(iii) Phrase
Soleymani et al. [50]	USA	Children with hearing impairment	(i) Articulation	Young school-aged	Children can practice with parents at home	(i) Syllable	Test with users	The system’s operation was found to be reliable.
Javkin et al. [51]	USA	Children with hearing impairment	(i) Articulation	Not mentioned	Children can practice with parents at home	(i) Phoneme	Pilot testing with users	The game was proving highly motivating to the children and encouraged them to experiment with their speech production.
Mahshie et al. [52]	USA	Children with hearing impairment	(i) Sustained vocalization	3–11 years old	Children can practice with parents at home	(i) Syllable	Test with users	The game was found to be easily incorporated into clinic activities and useful for diagnosis and therapy.
			(ii) Production of repeated syllables
			(iii) Control of voice intensity and fundamental frequency