Pitch training for children with cochlear implants: Negotiating clinical validity through mobile game-based design

Auditory pitch discrimination plays an essential role in speech communication and music perception, yet reliable training and assessment remain challenging for pediatric cochlear implant users. Cochlear implants (CIs) are mainly intended to mitigate severe-to-profound hearing loss of cochlear origin. More than 1 million cochlear implants have been implanted worldwide. However, cochlear implant users still face pitch perception challenges due to an unmatched electrode-nerve interface and the lack of effective training protocols. We developed two mobile applications for children with single-sided deafness and one CI (SSD-CI): (i) a home-based pitch identification training game and (ii) a therapist-supervised adaptive pitch discrimination assessment tool. The system integrates adaptive loudness calibration (Gaussian Process Regression), a a two-interval two-alternative forced-choice (2I–2AFC) psychoacoustic procedure, and game-based interaction to balance clinical measurement validity with developmental fit and engagement. Pre-training thresholds were consistent with the literature, confirming assessment reliability. Following training, 72.2% of SSD-CI participants showed threshold reductions, with the median improving from 9.12 to 4.8 semitones. Questionnaire data indicated high engagement and manageable workload. Beyond empirical outcomes, this work demonstrates how clinically constrained psychophysical protocols can be translated into ecologically deployable child-centered interactive environments through a codesign process operating under non-negotiable clinical constraints. These findings support personalized and adaptive home rehabilitation models and suggest an approach for clinically grounded Child-Computer Interaction interventions.