Interactive System to Improve the Skills of Children with

Dyslexia: A Preliminary Study

Jorge Buele1,2[0000-0002-7556-0286], Victoria M. López2[0000-0003-0389-5754], Franklin Salazar

L.1[0000-0002-3404-5202], Edisson Jordan H.1, Cristina Reinoso1, Sandra Carrillo1, Angel
Soria3[0000-0001-8540-7632] and Pilar Urrutia-Urrutia1
1 Universidad Técnica de Ambato, Ambato 180103, Ecuador

{jl.buele, fw.salazar, edissonpjordan, sandralcarrillor,

ci.reinoso, elsapurrutia}@uta.edu.ec
2 Universidad de las Fuerzas Armadas ESPE, Latacunga 050104, Ecuador

vmlopez2@espe.edu.ec
3 Purdue University, Lafayette 47907, United States of America

asoriach@purdue.edu

Abstract. This paper describes a virtual system for the strengthening of linguistic
abilities of children with dyslexia. To achieve this objective an intuitive interface
has been developed. The interface consists of three games (each with three levels
of difficulty) all of them being part of a rehabilitation program. These applica-
tions combine visual and auditory messages that complement each other, in order
to provide an immersive experience and to train more than one of the five senses
at a time. The virtual environment has been developed in Unity 3D software, and
the diffusion of sounds is performed through binaural hearing aids. To evaluate
the performance of the presented proposal, a sample of 8 infants (3 girls and 5
boys) with ages between 8 and 12 years were chosen. As an inclusion criterion,
it is determined that the user must have an age between greater than 7 and less
than 13 years, and as a criterion of exclusion the presence of some visual impair-
ment and/or an auditory disorder or other disorder that affect the educational en-
vironment. It must be taken into account that this is a preliminary study and that
the experimental results in the patients will be seen in the long term. Therefore,
to evaluate the acceptance of the system, and to make future corrections a SUS
usability test has been applied, with the following result (82,5 +/- 0,52). At the
end of the execution of the applications, a report is issued in which the specialist
can control how the patient has progressed during sessions.

Keywords: Human Computer Interaction, Dyslexia, Open Educational Re-

sources

1 Introduction

Children school performance depends on their physical, emotional sensory, and psy-
chological well – being [1-2]. When the child suffers from a disorder or syndrome, their
performance drops markedly, as well as its ability to relate to their environment [3-5].
Among the main learning disorders include dyscalculia, non-verbal learning disorder
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(NVT), disortography, dysgraphia, dysphasia and dyslexia [6-7]. The latter affects the
development of the infant, preventing him from acquiring efficient reading and spelling
skills despite adequate teaching and the absence of manifest sensorial and/ or neural
deficiencies [8]. This language learning disability affects to one in five people in the
world, and it can produce anxiety due to the subject imagining scenarios of mockery or
social rejection [9-10]. They also have difficulty remembering words, and problems
distinguishing certain sounds, so they pronounce words with similar sounds and this
increases confusion [11]. Determining the origin of this syndrome coupled with the
visual and/or auditory disjunction that it produces, has led to the development of several
related investigations. As shown in [8], where several prominent sensory theories of
dyslexia are evaluated. Particularly, the effects of experiencing scarce reading in the
brain of affected children are presented as a priority cause. In [12], a study is presented,
which aims to discover the nature of this disorder, to achieve this complete brain re-
gions are examined using the non-invasive auditory P300 paradigm in children with
dyslexia and neurotypical controls.
Cases of dyslexia occur in all known languages, although it differs according to the
spelling, which triggers labor problems as well. That is why identifying it at an early
age, and carrying out an adequate therapeutic process is a high priority. In [13] we
describe a cognitive behavioral therapy based on mindfulness called Mindfulness Based
Rehabilitation of Reading, Attention & Memory (MBR-RAM ©). It uses techniques of
visual meditation to improve attention focusing on formats assisted by therapists, and
practice at home to rehabilitate reading deficits, lack of visual attention, lack of visual
motor coordination and visual memory. The proposal was tested in 3 children between
8 and 10 years old, obtaining significant clinical and statistical improvements after a
trial period of 6 months. In [14] several technological proposals that seek to remedy the
reading difficulties of children who have this disability are described. "Friendly" fea-
tures are incorporated for the user, such as altering the size and format of the text and
converting text to speech. As can be seen in [15], the use of technological tools con-
tributes to the rehabilitation of users. A book that incorporates a set of mental games,
mazes and coloring pages, ideal for creative children with dyslexia, ADHD, Asperger
syndrome and autism (volume 3) is presented. The latter being an interesting proposal
that incorporates 180 pages and that is distributed at an affordable cost to parents. The
exponential development of technology has enabled greater and better benefits to be
implemented, in this case focused on medical applications. The main tools currently
available are virtual reality (VR) and interactive systems [16-17]. Therefore, in [18] a
virtual psychometric tool for the rehabilitation of patients with dyslexia is presented.
Such tool based on the Nintendo Wii videogame system. The results show that it is a
tool that improves attention, but it has no immediate effect on reading performance,
suggesting a longer protocol as future work.
The standard rehabilitation of this learning disorder involves a classic format of pa-
per and pencil training, meaning that it presents boring and routine exercises to the
subject. In this context and based on the previously cited studies, this paper proposes
the implementation of a virtual system for the rehabilitation of children suffering from
dyslexia. For this, an application has been developed in Unity software that incorporates
3 games with three levels of difficulty each (easy, medium and hard), which must be
 3

executed in order for a better recovery process. In the first, word games are presented.
Allowing the user to develop spelling and reading skills. In the remaining games the
sense of hearing is added, and through this the identification words, and if their syllables
are in the proper order. In order to corroborate the performance of this proposal, the
respective experimental tests were carried out.
This work is composed of 4 sections: Section 1 describes the introduction and the
works related to the topic. Section 2 shows the description and design of the imple-
mented system. Section 3 presents the tests and results, and finally in Section 4 the
conclusions and future work are presented.

2 Methodology

2.1 Materials

Hardware. The implemented system has a commercial brand laptop, where the key-
board and mouse are used as input devices and the screen is the visual output to the
patient. Binaural hearing aids are used to provide complementary therapy with sound
outputs, when it is required. The general diagram of the project is presented in Fig.1.

Fig. 1. General diagram of the implemented system.

Software. The software used for the development of the interactive interface is Unity
3D and its complementary packages. This software has tools that allow the implemen-
tation of virtual environments simulating real scenarios. You can develop environments
in 2D and 3D; in this case the application is set to work in 2 dimensions, since the
child's eye development is not yet complete, and taking into account the ergonomics.
4

Video games must be executed in order, since the training program has been carried
out with a pre-established sequence.

2.2 Methods

Sample. It is made up of 8 children (3 female and 5 male) and their demographic char-
acteristics are described in Table 1. The criteria for the selection of the sample are: age
(between 8 and 12 years), the diagnosis of dyslexia (with/without dysgraphia). Exclu-
sion criteria include: presence of other disorders in the educational setting, and other
psychological or neurological diseases. Also, that there is some visual deficiency and/or
an auditory disorder.

Table 1. Demographic characteristics of the sample.

Item Gender Age (year) Education (years)

1 F 8 4
2 F 11 6
3 F 11 6
4 M 9 4
5 M 9 4
6 M 10 6
7 M 12 7
8 M 12 6

Development of scripts. In this section, the development of each one of the imple-
mented scripts are explained, for example how these flat text files manage the infor-
mation entered by the user and allow him or her to interact with the environment. Based
on the flow diagram presented in Fig. 2, scripts are programmed to perform the neces-
sary tasks in the proposed rehabilitation program.
Video games designed to encourage the enrichment and compensation of language
skills and linguistic functions of children with dyslexia. The main interface requires the
child to enter their name and age, using the computer keyboard and thus start. In the
selection menu there are 3 games (with 2 levels of difficulty each) that allow the user
to train their language skills, while entertaining. In addition, an option is presented to
obtain and save the data of each user, since this can be used to evaluate their evolution.
Fig. 3 shows the main screen of the application and the screen for entering a user's data
is in Fig. 4.
 5

Fig. 2. Flowchart of the application developed.

Fig. 3. Main screen of the application.

6

Fig. 4. Screen for user registration.

Procedure. In this subsection the developed games and a brief description are shown.

(i). In the first game, an incomplete word is presented on the screen and a series of
syllables are placed, the user has to choose the complement to said word, and thus make
sense of it. Fig.5 presents the developed interface.

Fig. 5. Interface of the first game presented to the user.

(ii). In the second game, the child is presented with a word composed of two syllables
and in parallel an auditory message is reproduced. It must be determined if the sound
corresponds to the word that is shown on the screen; meaning that if the order of the
syllables is the right one or is the other way around; according to that, "yes" or "no" are
chosen. Fig.6 shows the interface.
 7

Fig. 6. Interface of the second game running.

(iii). In the third application a word is played through the headphones and on the screen
two words of two or three syllables (depending on the level of difficulty) each one are
presented. The user has to choose between these two options, which is the word that
has the correct order of their syllables. Fig.7 shows the developed interface.

Fig. 7. Interface of the third game that the user uses

3 Tests and Results

3.1 Tests

The participants were subjected to sessions of 30 minutes, 2 times per week, for a period
of 5 weeks. Figure 8 shows how the tests were developed in two of the eight users. For
the execution of tasks, it is recommended that a psychologist or educational therapist
conducts the session and supervise each video game. Although it has been designed
intuitively so that an adult that is not specialized can direct it. The exercises were held
in private sessions, and outside school hours with the intention of avoiding some kind
of social pressure, and the indications were repeated until the child understands them.
8

Fig. 8. Patients runs the games as part of their rehabilitation sessions.

3.2 Results

At the end of the execution of the games, the interface has an option that exports the
data to a file with a .txt extension. This report contains information detailing the name
of the patient and his score obtained, so that the specialist can verify if there has been
an improvement. In addition, the SUS evaluation test has been applied to users, also
known as the system usability scale created by John Brooke in 1986. The System Usa-
bility Scale (SUS) provides a reliable and fast tool for the measurement of usability.
Thus, allowing the evaluation of a wide variety of products and services, including
hardware, software, mobile devices, websites and applications. The SUS test can be
used in small samples with very reliable results and is valid since it can effectively
differentiate between usable and non-usable systems. For this reason, in the developed
application the scores have been normalized in order to obtain a percentile classifica-
tion; which is (82,5 +/- 0,52), as the obtained result is superior to 68, it means that the
developed system has a good degree of acceptance.

4 Conclusions and Future Work

Through this research, patients with dyslexia have been given a virtual tool to
strengthen their linguistic abilities. It is a valid technological proposal because it has
visual and audible feedback to improve concentration and the learning process. In this
way conventional exercises have been set aside, with the intention of providing greater
understanding, confidence and better experiences to the student. It should be clarified
that the present work is a preliminary study that shows the development and application
of video games with the use of Unity 3D software in a mixed set of children. Being an
approved system, there are different types of experimental results in each patient, and
it depends on the reactions each of them presents. As a metric to determine the validity
of this prototype, the SUS usability test was implemented, which has demonstrated that
 9

the interface presented to the user is easy to use, intuitive and friendly since it is focused
in evaluating infants. As an important remark, this research has been evaluated from
the point of view of the acceptance generated by this system, but not by evaluating the
approach of educational therapy, which is part of a broader investigation scope.
Despite obtaining positive results, the authors of this research are making modifica-
tions to the system based on the feedback obtained from the comments of the users. In
addition, what is proposed, as future work is to present a more personalized interface
that can be applied to a larger sample, also enabling the assessment of what is the impact
it has on adolescents, and even on adults who have this syndrome. It should be empha-
sized that for the test users, 3D games could already be implemented, which will pro-
vide another type of experimental results.

Table 2. SUS results.

Result (N=8)
Question
Mean SD
1. I think I would like to use this Virtual Reality system frequently. 4 0,63
2. I found the Virtual Reality system to be unnecessarily complex. 2,2 0,4
3. I thought that the Virtual Reality system was easy to use. 4,4 0,8
4. I think I would need the support of a technical person to be able to use
2,8 0,4
this Virtual Reality.
5. I found that the various functions in this Virtual Reality System were well
4,2 0,75
integrated.
6. I thought there was too much inconsistency in this Virtual Reality system. 1,8 0,4
7. I would imagine that most people would learn to use this Virtual Reality
4,8 0,4
system very quickly.
8. I found the Virtual Reality system to be very cumbersome to use. 1,4 0,48
9. I felt very confident using the Virtual Reality system. 4,8 0,4
10. I needed to learn a lot of things before I could get going with this Virtual
2,6 0,48
Reality system.
Global score (total) 82,5 0,52

Acknowledgments. To the authorities of Universidad Técnica de Ambato (UTA) and

Dirección de Investigación y Desarrollo (DIDE), for supporting this work and future
research.

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