The use of software on auditory training in children : theoretical review

The auditory processing disorder refers to the inability of the central auditory system to capture and interpret sound information from the external environment. To minimize or to remedy the effects of this disorder in daily life of the subjects is indicated therapy with auditory training. The aim of this study was to present a literature review on the use of software in the training of auditory skills in children. Have been take one search in databases: Scientific Eletronic Library Online (SCIELO), Sistema da Literatura Latino-Americana em Ciências da Saúde (LILACS), National Library of Medicine (MEDLINE e PUBMED) and Índice Bibliográfico Espanhol de Ciência da Saúde (IBECS). The research was carried out from 2008 to 2014, using the keywords: auditory perception; acoustic stimulation; Software; children. Selection criteria: Publication performed after 2008 and using computerized auditory training as a means of therapeutic intervention in children independent of the condition and/or disorder involved, in Portuguese or Spanish or English. According to research in the last six years, the use of software in the auditory training in children has been shown to be an effective tool. The articles analyzed demonstrate that the use of computer programs allows engagement and motivation, besides the rehabilitation of the auditory skills.


INTRODUCTION
Auditory training (AT) provides the acoustic stimulation of auditory skills through different approaches and also through the specific demand of each patient, in order to reorganize the auditory neural system and his connections with the other related sensory systems, enabling an improvement in lagged auditory skills 1 .
There are two basic ways to accomplish the AT.The acoustically uncontrolled one (informal AT) carried out at home with the assistance of the family members or the school setting with support of the teachers, once the use of electronic devices and the acoustically controlled (formal AT), through

ABSTRACT
The auditory processing disorder refers to the inability of the central auditory system to capture and interpret sound information from the external environment.To minimize or to remedy the effects of this disorder in daily life of the subjects is indicated therapy with auditory training.The aim of this study was to present a literature review on the use of software in the training of auditory skills in children.
Have been take one search in databases: Scientific Eletronic Library Online (SCIELO), Sistema da Literatura Latino-Americana em Ciências da Saúde (LILACS), National Library of Medicine (MEDLINE e PUBMED) and Índice Bibliográfico Espanhol de Ciência da Saúde (IBECS).The research was carried out from 2008 to 2014, using the keywords: auditory perception; acoustic stimulation; Software; children.Selection criteria: Publication performed after 2008 and using computerized auditory training as a means of therapeutic intervention in children independent of the condition and/or disorder involved, in Portuguese or Spanish or English.According to research in the last six years, the use of software in the auditory training in children has been shown to be an effective tool.The articles analyzed demonstrate that the use of computer programs allows engagement and motivation, besides the rehabilitation of the auditory skills.
to identify which software were used, the attended population, the way it was used and the results of this kind of therapeutic intervention.

METHODS
It is a data collection study performed through bibliographic search in electronic databases, aiming at a theoretical review in the area of Audiology, on the theme of computerized auditory training.
For the search of papers in the literature, it was carried out some research in the following databases: Scientific Electronic Library Online (SciELO), Sistema da Literatura Latino-Americana em Ciências da Saúde (LILACS), National Library of Medicine (MEDLINE and PubMed), Índice Bibliográfico Espanhol de Ciência da Saúde (IBECS), in October of this year.For the choice of the descriptors, we used the structured and trilingual vocabulary, descriptors in Health Sciences (DeCS), prepared by the Biblioteca virtual em Saúde -Bireme.
Table 1 presents the strategies which were used to perform a search in several searched databases.As well, another recovery method of bibliographic reference, by the search for items with "words" and not with descriptors.respect a hierarchical order of complexity of the therapy program and all this in a ludic way 8,9 .Some authors 7,[9][10][11] report that the use of computers in therapeutic environment provides the child contact with computerization, enabling access to multiple strategies that enhance global and auditory development.In order to obtain the successful treatment of the patient, it is important to encourage him, as well as highlighting his correct answers during therapy, thus characterizing them as motivational sections 11 , as musical training and playing video games that allow a new learning of the subject 12 .The authors also 7,[9][10][11] refer to the AT computer programs should stimulate the neural reward centers naturally and for that the professionals who develop this kind of intervention should consider some platforms that would make this possible.
Although there are few national publications relating AT with the use of software as a therapeutic intervention in the treatment of auditory processing disorders (APD) or aiming only at the auditory stimulation, this tool proves to be relevant and contemporary, deserving more emphasis on speech therapy.
Thus, the aim of this study was to present a review of literature on computerized auditory training as a means of therapeutic intervention in children, trying First, the research was carried out considering the following inclusion criteria: current publication (subsequent to July/2009), written in Portuguese, English or Spanish, survey conducted in humans, children diagnosed with auditory processing, no other organic and/or emotional commitments besides presenting normal hearing.In the first search mode, we found 417 papers of which only one could be in this review paper.Due to this fact, the eligibility criteria have changed, like for instance, publication subsequent to 2008 and computerized auditory training as a means of therapeutic intervention in children, regardless of disease and/or disorder that was involved.The selected papers were described concerning a chronological order of publication, trying to identify the software which was used, the attended population, the way such technological resource was used and the results obtained through this kind of therapeutic intervention.
The search for papers was carried out by only one evaluator that critically analyzed the results found in the databases.A first analysis was conducted based on the content of the title and of the summary.The relevant works were read in full, once they present the topic in question.Thus, it was considered appropriate for this narrative review a total of 25 papers, of which 13 were repeated in different databases.Thus, 12 papers were relevant (appropriate to the topic) to produce this study.
The bibliographic searches of the published papers were performed during the last six years with the use of the keywords and words as shown in Table 2.As a complementary form of research, a search using search strategy with words was performed, and the following results were found (Table 3).
After the selection of the 12 abstracts, it was conducted the analysis of the complete texts.Then, it was considered in this research: aims, samples, instruments to assess hearing, found results and the method of measurement.Tables 4 to 5 systematize the papers and the data used for this study in both research strategies.

LITERATURE REVIEW
The analyzed papers showed similarity in relation to their aims, methods and findings.In general, they analyzed the effectiveness of this form of intervention by different software as: AT as a therapeutic intervention is a means to minimize the complaints reported by the patients allowing improvement in hearing, in relation to the auditory processing (AP) 13 .All studies found in this review showed that there were differences related to alterations in hearing, after hearing training with the use of software as a therapeutic strategy, consequently, considered an effective and efficient method for auditory rehabilitation.The most used software in the searches found in this review was the Fast ForWord Language®, 41.7% (n = 5).Such software stimulates the auditory skills through seven tasks that include frequency standard activities involving phonemes, words and, last of all, sentences.It also enables the daily record of performance achieved by the patient, being used to monitor the developments during the auditory training period 14 .The subjects achieve gains related to oral language and reading during the intervention 15 .
The authors 10 realized that the use of computer games in the auditory training of children with APD through the use of software, enable the development of auditory skills and building new learning possibilities, changing old behaviors and treating information might have concomitant visual aid.It was also observed that this intervention provided longer time of attention at the activities by the students 19 .Subsequently, the effects of CAT in students with learning disabilities were researched, verifying that such audience presents delayed development of auditory skills, which prevents the correct assimilation of received auditory information 20 .However, with therapeutic intervention, the development of skills to the level of auditory attention, perception of speech sounds, word recognition and listening comprehension were verified.
AT in children with dyslexia was studied again in 2011, corroborating the previous favorable results.It enables significant improvements in phonological awareness skills (syllable and phoneme), reading texts and non-verbal listening skills.This study suggests that there is a connection between verbal and non-verbal skills 21 .
In the studies found, the researchers used an electrophysiological [22][23][24][25] or behavioral 22,24 evaluation of AP as a biomarker of therapeutic evolution, aiming to measure the effectiveness of this type of therapeutic intervention, corroborating other research.Researchers 26 studied the effects of CAT in five children diagnosed with autism spectrum, concluding that the use of software generates alterations in cortical responses, which are observed by means of brainstem auditory evoked potential assessments with speech stimuli and long-latency auditory evoked potential.This study showed that the software as intervention allows the benefits seen in objective and biological changes.This finding was also found in two other studies in 2013: the first showed that the brain capacity in modifying itself through the stimulation could be seen in the evaluation of brainstem auditory evoked potential with speech stimuli, carried out pre and post CAT in two children diagnosed with APD, being this evaluation sensitive to changes by auditory stimulation 27 ; and another noted that the neuronal plasticity involves getting response with increased range while the oscillation of the activity related to temporal organization remains atypical 28 .

CONCLUSION
From this review it was noticed that the choice of software as a strategy in the AT is not commonly used in children.With this study it was possible to visualize a current panorama, which is still limited, by linking research with computer training for stimulation of auditory skills, which have incidence of alteration in the population of school age.
The new research with case studies may also assist in the dissemination and understanding of the possible hearing difficulties.The subjects of that research were able, gradually, to assimilate the information stored in memory, as well as developed auditory attention.Corroborating the findings of other researchers 16 who observed improvement related to attention, memory, as well as the reports of children in the self-assessment questionnaire associated to listening skills.The questionnaires are important because they show the perception of the subject himself in terms of limitations and the limitations of his family members or teachers, with hearing improvement after CAT 17 .
APD may be associated with reading and writing disorders, and it was important to study the effectiveness of CAT in this audience.In a study of three subjects with alteration of the most predominant AP types: auditory-linguistic association, decoding and auditory-linguistic association and auditory integration and or prosody, respectively.The authors showed that CAT has been effective once the first two subjects reached normality and the third, even with progress during activities, remained difficult in evidenced auditory integration in AP behavioral assessment pre and post CAT 14 .
The efficiency of using a computer program in the (re)habilitation of hearing impaired child, user of hearing aids or cochlear implants, was shown in a research 9 , with an improvement in speech perception in quiet and in noise.The researchers verified that these children needed more time to do the activities, especially those ones which involved non-verbal and verbal sounds directly related to sustained attention 18 .In relation to the software, the authors refer to the need of the internet with fast and stable speed as a negative aspect, which is not always possible in care centers.They also emphasize that "the use of software should be an aid in speech therapy and not a substitute, as the guidance and assistance from the audiologist during the application of SARDA was essential" (p.40).Two children with severe hearing loss and four with profound hearing loss showed to have presented benefits with the auditory stimulation, which was observed through a better discrimination of sounds of speech 18 .
The use of software is also used as interventional tool in other disorders, not the ones related to alterations in hearing skills like the APD.A study carried out in children with dyslexia, which aimed to verify the effectiveness of CAT in this population, showed an improvement in reading and writing activities, in phonological awareness and also in auditory processing.The subjects had such positive results because the used software allows easy handling and the information is presented clearly, allowing the subject with difficulty in perceiving auditory presence of risk factors for communication alterations, linguistic or auditory.It is emphasized the importance of using such contemporary means, attractive and motivating the therapeutic approach, especially considering children.benefits and effectiveness of AT in the population with therapy indication with sound stimulation.In addition, greater recognition of these therapeutic approaches extends the option and possibility of therapeutic success for professionals who work with rehabilitation or stimulation of children with the RESUMO O distúrbio do processamento auditivo refere-se incapacidade do sistema auditivo central em captar e interpretar as informações sonoras oriundas do ambiente externo.Para minimizar ou sanar os efeitos deste distúrbio no cotidiano dos sujeitos, é indicado terapia com treinamento auditivo.O objetivo deste estudo foi apresentar uma revisão de literatura sobre o uso de software no treinamento de habilidades auditivas em crianças.Como estratégia de pesquisa realizou-se busca em bases de dados: Scientific Eletronic Library Online (SCIELO), Sistema da Literatura Latino-Americana em Ciências da Saúde (LILACS), National Library of Medicine (MEDLINE e PUBMED) e Índice Bibliográfico Espanhol de Ciência da Saúde (IBECS) considerando estudos publicados em 2008 a 2014, utilizando as palavras-chave: percepção auditiva; estimulação acústica; software; crianças.Para inclusão, os artigos deveriam possuir publicação posterior a 2008 e treinamento auditivo computadorizado como forma de intervenção terapêutica em crianças, independente da patologia e/ou distúrbio envolvida, idioma em inglês português ou espanhol.Nos estudos realizados nos últimos seis anos, o uso de software no treinamento auditivo em crianças tem se mostrado uma ferramenta eficaz.Os artigos analisados mostraram que o uso de programas computadorizado permite engajamento e motivação, além da reabilitação das habilidades auditivas alteradas.DESCRITORES: Percepção Auditiva; Estimulação Acústica; Software; Criança; Audição

Table 2 -Number of articles found in each database searched by descriptors
Caption: SCIELO= Scientific Eletronic Library Online, LILACS= Sistema da Literatura Latino-Americana em Ciências da Saúde, MEDLINE e PUBMED= National Library of Medicine, IBECS= Índice Bibliográfico Espanhol de Ciência da Saúde

Table 3 -Number of articles found in each database searched by words related to the subject
Caption: SCIELO= Scientific Eletronic Library Online, LILACS= Sistema da Literatura Latino-Americana em Ciências da Saúde, MEDLINE e PUBMED= National Library of Medicine, IBECS= Índice Bibliográfico Espanhol de Ciência da Saúde

Table 5 -Studies that performed computerized auditory training in children, considering words as search strategy
Fast ForWordCaption: CAT: Computerized Auditory Training; APD: Auditory Processing Disorder; CG: Control group; SG: Study Group; IC: Informed Consent; CONFIAS: Phonological Awareness -Sequential Assessment Instrument; CELF-4: Clinical Evaluation of Language Fundamentals -Fourth Edition; WRMT-R: Woodcock Reading Mastery Tests -Revised; WASI: Wechsler Abbreviated Scale of Intelligence.