CheerBrush: A Novel Interactive Augmented Reality Coaching System for Toothbrushing Skills in Children with Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a common neurodevelopmental disorder that impacts one in every 54 children in the United States. Some children with ASD have learning and fine motor skill challenges that contribute to difficulties completing daily living tasks such as toothbrushing. Lack of toothbrushing skills may cause increased need for dental care and negative social feedback from peers. Technology based intelligent support systems offer the advantages of being accessible, engaging, and cost-effective. In this work, we present a novel interactive augmented reality coaching system, CheerBrush, to improve the toothbrushing skills of children with ASD. CheerBrush allows children to manipulate virtual objects like a toothbrush and toothpaste with their actual hand motions to practice the steps of toothbrushing. The virtual tasks of CheerBrush demonstrate these steps using audio and visual cues, while also showing the brushing process through a virtual avatar. CheerBrush also assesses toothbrushing skills with a custom designed mechatronic toothbrush to evaluate the system's coaching effectiveness. A feasibility study with 12 children (six children with ASD and six typically developing children) was conducted to evaluate the acceptability and effectiveness of CheerBrush. The data showed improvements in the toothbrushing motions and reduced stress for the children in the post-test. CheerBrush detects real-time movement of children and interacts with them by augmented reality, feedback and multimodal hints. We believe that CheerBrush has the potential to provide a low-cost, engaging and, beneficial intelligent support system to improve the toothbrushing skills of children with ASD.