Augmented reality-based assistive technology for executive function rehabilitation in students with hearing impairments: a mixed methods usability and effectiveness study

Background Students with hearing impairments face elevated risks of executive function (EF) deficits due to limited auditory-linguistic scaffolding. Augmented reality (AR) offers visually grounded cognitive rehabilitation affordances aligned with these learners’ visual-spatial strengths.Objectives This study designed and evaluated an AR-based assistive technology to enhance EF in hearing-impaired elementary students and explored usability from learners’ perspectives.Methods An explanatory sequential mixed methods design was employed. In Phase 1 (QUAN), 50 hearing-impaired students (Grades 1–6) were randomly assigned to experimental (n = 25) or control (n = 25) groups across eight AR intervention sessions. In Phase 2 (QUAL), 12 participants were purposively selected via maximum variation sampling for group semi-structured interviews facilitated by Thai Sign Language teachers. Quantitative and qualitative strands were integrated via a joint display.Results Between-group analysis revealed a significant improvement in verbal working memory (p = .005, r = 0.43; surviving Bonferroni correction, α = 0.008); inhibition response time showed a marginal effect (p = .029) that did not reach the corrected threshold. Codebook thematic analysis (κ = 0.80) produced five themes. Joint display integration yielded four meta-inference types: confirmation (QUAN and QUAL mutually reinforce findings), expansion (QUAL extends interpretation of marginal QUAN effects), discordance–explanation (null cognitive-flexibility effect attributed to limited task variety), and confirmation of null (QUAL corroborates practice/maturation as alternative explanation for within-group TMT gains).Conclusion AR-based assistive technology grounded in visual-spatial learning principles shows promise for cognitive rehabilitation in hearing-impaired students. Mixed methods integration revealed intervention mechanisms that neither strand could yield independently.