Therapy Game For Children With Hearing Disabilities (Stanford University)
So Yeon Park, Kanhika Nikam


Figure 1. Creators of Rhombus Rumbles
Children with hearing impairments face problems in early language development. Their inability to hear language hinders their process of understanding and articulating. We tried to understand the challenges these children face in this learning process through their years of speech therapy. Our research revealed that while the children are learning constantly, therapy happens infrequently and at a cost. The project uses the technique of lip-reading often used by speech therapists as a learning tool to create a fun linguistic game. The game can be used by therapists, parents, or the children themselves to accelerate the process of learning language.


Figure 02. Prototype - Version 1a

Figure 03. Prototype - Version 1b
Mary Joe Osberger stated that “the devastating effect of a profound congenital hearing loss on the development of language and communication skills has been of concern to parents, physicians, educators, and clinicians for decades.1” And this “concern” still persists today.

Today’s numbers show that a better solution is very much needed. The chances of being born deaf is relatively high as “about 2 to 3 out of every 1,000 children in the United States are born with a detectable level of hearing loss in one or both ears.2” This disorder is one that is difficult to predict as “more than 90 percent of deaf children are born to hearing parents.3” So parents with deaf children easily find themselves at a loss as to how to help their kids develop various abilities, especially linguistic skills. “One of the main impacts of hearing loss is on the individual’s ability to communicate with others. Spoken language development is often delayed in children with deafness.4”

Figure 04. Prototype - Version 1c
Figure 05. Zina Jawadi
Unfortunately, the problem is worse in developing countries as access to clinicians and speech therapists is difficult, and “children with hearing loss and deafness rarely receive any schooling.4”


In addition to secondary research, we also spoke with and observed our target users, including teachers and therapists. Through our interactions we found:

Young hearing impaired patients often face speech and language problems as they grow up.

Figure 06. Bing Teachers with Toys
Figure 07. Bing Teachers with Toys
Hearing impairment is not an illness that can be cured. It needs constant therapy through which the patient can grasp language at a young age. The earlier therapy starts, the quicker the patient is able to grasp speech.

Therapy comes at a cost and it takes place few times a week in a clinic.


Our insights helped raise major questions:

Why should the young patients learning be restricted to the few hours spent at the clinic?
How can the time spent by the patient outside the clinic also be turned into a learning experience?
The biggest opportunity we saw was to create a therapy product, which the patient could use at home with their family and friends. The product would accelerate the process of grasping language, in the younger years when the learning of language is most crucial.


Figure 08. Toys at Bing

We set the following elements as the criteria to judge our ideas against. We thought the solution should be:

  1. Fun
    The children should be naturally attracted to the game. They must want to play with it without much external push.
  2. Intuitive
    The game must be easy to use by either the therapist, parents or teachers with little to no instructions. Children should be able to explain the rules of the game to new players themselves too.
  3. Creative
    The game should be simple enough that it encourages the kids to modify and try various ways of playing. It should let facilitate language learning, along with various other things like, build, sentence formation, order, sequencing etc.
  4. Figure 09. Toys at Bing
    The solution should be such that it can be played amongst able and children with disabilities. Playing together helps the children with disabilities socialise and the able children learn to empathize with the children with disabilities.


Prototype – Version 1

After prototyping different shapes, sizes, and words we decided to go ahead with a rhombus shape and an ergonomic size.

We designed the game with the goal of collecting as many rhombus pieces as possible.

  1. The following were the instruction regarding how to play the game:
  2. Split into two groups (or get into pairs) and decide which group/who is going to go first.
  3. Start with the rhombus pieces picture side up and cards upside down.
  4. Pick a card and keep it to yourself.
  5. Figure 10. Laser Cutting Rhombus Rumbles
    Mouth the word to your teammates (no sounds allowed!). You could start with saying ‘The word is (then mouth it)’. Your teammates have to guess the word you’re mouthing by lip-reading in 3 minutes (multiple times possible).
  6. If your teammates guess the word right, then your team gets the rhombus piece; if not, the turn goes over to the opposing team.
  7. The opposing team repeats steps 3 to 5.
  8. Repeat step 6 until all the rhombus pieces are gone.
  9. Count how many rhombus pieces each team has.

Figure 11. Vinyl Cutting
Testing Prototype Version 1 – Zina Jawadi

We spoke to Stanford student Zina Jawadi. She discovered she had hearing impairment at the age of 3 and underwent speech therapy until she was 10 years of age. She did 10 hours of therapy every week and recalled it as a torturous time. She also told us how lip-reading is different from speech-reading (reading the entire face) and that everyone lip-reads, even people without hearing impairment.

She was delighted with our game and give us the following feedback:

  • Could have a light flashing, to give visual feedback.
  • Allow the therapist to track the number of times the game is played.
  • Size could be bigger.
  • Kids get distracted; it needs to capture their attention.

Testing Prototype Version 1 – Teachers at Bing Nursery

Figure 12. Transferral of Vinyl to Rhombus Pieces
The teachers told us how the children like to build and showed us examples of existing toys.

Their feedback on the game was as follows:

  • The tiles could be bigger and colorful.
  • Children don’t need motivation like winning the game; they are intrinsically motivated.
  • Liked the wood and the tactility.
  • The game can be used during snack time, when children are requested to be quiet.

Prototype – Version 2

Based on the feedback we got on our first prototype we redesigned the game and also made a deck of cards.

Testing Prototype Version 2 – Children at Bing

Figure 13. Children at Bing Playing with Rhombus Rumbles
From the prototyping session at the Bing Nursery School, we were able to observe how the children interacted with our game.

Firstly, some children were confused as to what the images represented. Since the children were between two and five years old, they couldn’t read words yet, and a word we had labeled as “doll” was mistaken for “teddy bear.” From this we realized that we should be more selective when choosing images for the nouns.

Figure 14. Children at Bing Playing with Rhombus Rumbles
Secondly, there was a preference toward yellow pieces. We used various colors to represent different places of articulation of the word in the mouth, reflective of levels of difficulty in the guessing the words. However, the children naturally gravitated towards the yellow cards. To remove the bias towards one color, we need to think about what colors we use to indicate the difficulty levels.

We observed that the kids liked to twist the cards in their hands in an attempt to hide it from the guessers. With the current thickness, the cards easily got mangled and weren’t durable in the long run.

Figure 15. Children at Bing Playing with Rhombus Rumbles
It also wasn’t clear as to what to do with the cards after someone guessed the word right, so already-played cards went back into the pile and they were replayed. In order to address this, we would need to keep already-drawn cards separate from the words that haven’t been drawn.

Lastly, some kids just guessed every word possible in one pile, in effect defying the main purpose of the game, which was to practice lip-reading. Seeing this, we realized we would need to limit the number of guesses.

Our game particularly excited one of the shyest, quietest kid in class and we realized that this was a game that helped anyone join in. It is the inclusive game that we were envisioning, and we hope that it will also help children with hearing disabilities to play with other friends easily.


  1. Features
    The rhombus shape is easy to tesselate. The size and thickness were chosen for ease of grip and for safety. Colorful images support the text below them and the various colors represent the various levels in the point of articulation.
  2. Benefits
    The game allows children with hearing disabilities to practice lip-reading within a fun context. It’s a game that can be played by children with and without hearing disabilities, so it’s an inclusive game that everyone can play together.
  3. Aesthetics
    The pieces have vibrant colors on them. Also, for an intuitive understanding of the corresponding pieces, we’ve used the negative vinyl cuts for the rhombus cards. The streamlined and minimalistic design conveys that this game is intuitive and easy.
  4. Safety
    The size of the rhombus discourages children from putting it into their mouths. The rounded corners of our rhombus pieces prevent children from getting themselves hurt.
  5. Reliability
    Duron is a hardy material that won’t break easily and is reliable.
  6. Usability
    There are only two components to this game and they are all of the same shape, hence easy to use. We have also shaped and sized the pieces to optimize usability.


We will make the following changes to the current prototype that we have:

  1. Thicker word cards
    The cards would get less mangled and allow for better grasp (the cards were sometimes difficult to pick up because they were so flat).
  2. Revised instructions
    Specify that there are a maximum number of guesses allowed, because otherwise the children would keep guessing every word in the stack instead of making the effort to lip-read.
  3. Better graphics that refer to only one word
    We will be more selective when choosing the images for the corresponding nouns to avoid confusions.
  4. Choose brighter colors
    We will choose brighter colors that stand out against the darker duron.
  5. More ways for kids to play with the tiles
    Cover the perimeter of the tiles with magnetic tape so that the children can arrange them into shapes they want. This will also allow kids to expand their rearrangement into 3D structures.


Provided that only one of the entire set of Rhombus Rumbles is manufactured, we would expect the total to come to an approximate $300 as per the breakdown below.

Cost Breakdown
Material Duron & Vinyl $10
Technology Laser engraving $60
  Laser cutting $80
  Vinyl cutting $50
Labor Transfer vinyl $100
TOTAL   $300


Mary Joe Osberger from ‘Language and Learning Skills of Hearing-Impaired Students’ of MONOGRAPHS #23

Centers for Disease Control and Prevention (CDC). Identifying infants with hearing loss – United States, 1999-2007. MMWR Morb Mortal Wkly Rep. 59(8): 220-223.

Vohr B. Overview: infants and children with hearing loss—part I. Ment Retard Dev Disabil Res Rev. 2003;9:62–64.

WHO Deafness and hearing loss Factsheet”>


We would like thank Jennifer Winter, the director of Bing Nursery for welcoming us to try our prototype with the children. We would also like to thank Beth, Chia-wa, and Pecky at Bing for giving us great feedback on our prototypes.

We would like to thank the children for their real responses. We enjoyed seeing them playing with our game! Their excitement gave us conviction that we were going in the right direction and provided greater momentum in producing our prototypes.

We would also like to thank Zina for sharing her story and providing feedback on our prototypes.

Last but not least, we would like to thank our professor Dave Jaffe. His class was the perfect opportunity to start this project, and we’re excited to see what it will become!

Kanhika Nikam
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