Effectiveness of Audio-Tactile Performance Technique With Sing-Along Lyrics on Oral Hygiene Instruction to Visually Impaired Individuals: A Matched-Pair Randomized Study

The goal of this match-pair randomized study is to compare the effectiveness of the standard Audio-Tactile Performance (ATP) technique with a song-based adaptation (ATP/S) in teaching oral hygiene in visually impaired individuals aged 6 to 20 years in Kathmandu, Nepal.

1. Can the ATP/S approach achieve a greater improvement in plaque control, as measured by the Patient Hygiene Performance (PHP) index, compared to standard ATP instruction over a two-week period?
2. Does the rhythmic structure of a song lead to a more continuous improvement in toothbrushing task performance and theoretical oral health knowledge?

Researchers will compare a control group receiving standard ATP with an audio information file to an intervention group receiving ATP with a sing-along song to see if rhythmic auditory stimuli help regulate sequencing and reduce working-memory demands during complex motor tasks.

Study Overview

• Status: Completed
• Conditions: Oral Hygiene; Visually Impaired Persons
• Intervention / Treatment: Procedure: ATP; Behavioral: ATP with song

Detailed Description

This study is divided in to 2 groups where visually impaired individuals are allocated after inclusion and exlusion criteria.

In this matched-pair randomized study, 40 VI participants aged 6-20 years were allocated to ATP or ATP/S groups. Outcomes were assessed at baseline, immediately post-intervention, and at two-week follow-up using the Patient Hygiene Performance (PHP) index, a 16-step toothbrushing task analysis, and an eight-item oral health knowledge questionnaire. Intra-group changes were analyzed using the Friedman test; inter-group comparisons used the Mann-Whitney U test (p < 0.05).

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Nepal
  • Kathmandu
    • Ki̇̄rtipur, Kathmandu, Nepal, 44600
      • Laboratory boarding Secondary school
  • Lagankhel
    • Lalitpur, Lagankhel, Nepal, 44600
      • Namuna Macchindra secondary school

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Bilateral visually impaired in age 6-20yrs. (as verified in school medical record)

Exclusion Criteria:

1. Visual impairment associated with any disabilities that affected arm motor skill/loss of upper dexterous extremity/abnormal mental development/deaf.
2. Using any chemical plaque control agent.
3. Individuals with calculus on examining teeth
4. On medications that could affect the gingival status.
5. Inability to brush due to pain from severe caries/oro-mucosal conditions.
6. Have less than 4 teeth in each quadrant.
7. Presented with orthodontic or prosthodontic appliance.
8. Subject with good oral hygiene ; plaque score = 0
9. Un co-operative children.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: ATP with audio information file; Participants in this arm receive Oral Hygiene Instruction (OHI) using the standard Audio-Tactile Performance (ATP) technique. This involves hands-on training with a tooth model (dentoform) paired with a pre-recorded audio information file that provides verbal instructions on brushing techniques.	Procedure: ATP; ATP with standard audio file
Experimental: ATP with informational song; Group B (Intervention Group): Participants in this arm receive OHI using the ATP technique enhanced with a sing-along song. This method utilizes the same hands-on training with a tooth model but replaces the standard audio file with a culturally adapted song containing the brushing instructions, leveraging rhythmic entrainment to aid memory and coordination.	Behavioral: ATP with song; ATP with informational song used to provide guidance to the participants

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
tooth brushing task analysis	The oral cavity is divided into 16 surface areas. Scoring Criteria: For each area, participants are scored on four specific criteria: Maintaining a 45-degree angle of the bristles.; Using an appropriate back-and-forth vibrating motion.; Ensuring adequate surface coverage.; Brushing for at least 5 seconds per surface. Calculation: Each correctly executed criterion earns 1 point, and the total skill level is determined by the percentage of points achieved out of the total possible points.	from baseline to intervention, reinforment (1 week) & Final data collection (end of 2 weeks)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient hygiene performance (PHP score)	The secondary outcome evaluates the objective effectiveness of the brushing by measuring the amount of dental plaque (debris) left on the teeth. The Process: Teeth are stained with erythrosin dye, which highlights plaque. Scoring Method: Six specific index teeth are examined, with each tooth surface divided into five sections. Binary System: A section receives a 1 if debris is present and a 0 if it is absent. Calculation: The final PHP score is the sum of these points divided by the number of surfaces examined; a lower score indicates better oral hygiene.	from baseline to intervention, reinforment (1 week) & Final data collection (end of 2 weeks)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Oral Health Knowledge Questionnaire	A pre-test and post-test consisting of 8 questions are administered verbally to accommodate visual impairment. 8 questions are asked based on the audio information and song file Correct answers are recorded to track how well the instructional formats (standard audio vs. song) reinforce theoretical knowledge over time	from baseline, intervention, reinforcement (1 week) and final data collection (end of 2 week)

Collaborators and Investigators

• Sponsor: Mahidol University
• Investigators: Study Director: woranun Prapansilp, Masters pediatric dentistry, Mahidol University

Study record dates

Study Major Dates

• Study Start (Actual): June 9, 2025
• Primary Completion (Actual): August 22, 2025
• Study Completion (Actual): October 30, 2025

Study Registration Dates

• First Submitted: May 7, 2026
• First Submitted That Met QC Criteria: May 7, 2026
• First Posted (Actual): May 13, 2026

Study Record Updates

• Last Update Posted (Actual): May 13, 2026
• Last Update Submitted That Met QC Criteria: May 7, 2026
• Last Verified: January 1, 2025

More Information

Terms related to this study

• Keywords: audio-tactile performance technique; sing along song; tooth brushing task analysis
• Additional Relevant MeSH Terms: Heterocyclic Compounds; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Nucleic Acids, Nucleotides, and Nucleosides; Purines; Ribonucleotides; Nucleotides; Adenine Nucleotides; Purine Nucleotides; Adenosine Triphosphate
• Other Study ID Numbers: 61_2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No