Mir Javad Mojarrad Azar; jalal dehghanizade
Abstract
Abstract
The purpose of the present study was to investigate the effect of the Square Stepping Exercise on working memory and balance of children with autism. The research method was quasi-experimental with pre-test and post-test design with a control group. The statistical population included all children ...
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Abstract
The purpose of the present study was to investigate the effect of the Square Stepping Exercise on working memory and balance of children with autism. The research method was quasi-experimental with pre-test and post-test design with a control group. The statistical population included all children aged 6 to 12 with mild autism in Urmia city, 30 of them were randomly selected and tested in two groups of 15 (average age: 12.8±1.56) and control (mean age: 7.78 ± 1.58). Stork test is used to measure static balance, the heel-to-toe walking test to measure dynamic balance, and the parent executive functions questionnaire of Balster et al. (2000) in pre-test and post-test similarly. The experimental group performed square stepping exercises for 12 weeks, three sessions a week, and each session lasted 70 minutes. The data were analyzed through a one-way analysis of covariance in SPSS software version 24. The results showed that by controlling the pre-test score, there is a significant difference between the scores of the static and dynamic balance test and working memory of the two experimental and control groups in the post-test (p=0.001). Therefore, performing these exercises can be an effective strategy for improving balance and working memory in children with mild autism.
Keywords: Square Steppin, Working Memory, Balance, Autis.
Extended Abstract
Introduction
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with an unknown cause that manifests in difficulties and barriers associated with social communication and repetitive and stereotyped behaviors (American Psychiatric Association, 2013). There has been a recent increase in the prevalence of ASD among children, as in the mid-1990s it was thought to affect 11.6 out of 1,000 people in this age group (Baird et al., 2006), while more recent studies have put this figure as high as 18.5 per 1,000 (Maenner et al., 2020). In addition to impaired social and communication skills, people with autism are deficient in fine motor skills (Choi and colleagues, 2018) and gross motor skills (Staples and Reid, 2010). Up to 83 percent of children with autism have difficulty communicating with age (Ruggeri et al., 2019). Failure in motor skills is in turn linked to the problems of adaptive behavior and daily performance (MacDonald et al., 2013). However, not all motor skills are equally affected by autism. Some studies showed that static balance is significantly more impaired than other motor skills (Ament et al., 2015; Whyatt & Craig., 2012), which indicates that there are features of movement disorder in autism that affect balance. Another feature of children with autism disorder is executive function. Executive function is an umbrella term that includes several skills such as planning, shifting, working memory, problem-solving, monitoring, inhibition, and self-control (Rajendran G, Mitchell., 2007). Working memory is an important component of executive function that plays a role in daily functioning (Wang et al., 2017). Many studies have been conducted in developed countries to evaluate working memory performance in individuals with high-performance autism, which have been reported differently. some studies showed weaknesses in working memory and found no difference in the working memory of individuals with autism compared to conventional controls (Bodner et al., 2012). According to the results of the research and the positive effects of this type of exercise and considering the challenges and cognitive, emotional, communication, social, and movement problems of children with autism, including balance, and working memory, it is necessary to solve these problems as much as possible for these children. reduce and fill the scientific gaps that exist in this field as much as possible, therefore the purpose of this research is to investigate the effect of square stepping exercises on working memory and balance of children with autism.
Research Question(s)
Do square stepping exercises have an effect on the working memory and balance of children with autism?
Literature Review
Various physical exercises are often prescribed as a method to improve postural control and reduce the risk of injury in this population (Brussel et al., 2007). On the other hand, despite the challenges in executive functioning experienced by children with autism, and the potential of exercise to reduce these challenges, little work in this field has focused specifically on this population. There is evidence of behavioral improvements in the areas of social-emotional functioning and reduction of repetitive or stereotyped behaviors following exercise in children with autism (Ferreira et al., 2019; Huang et al., 2020; Tse, 2020), with these improvements assuming can be related to improved executive performance (Bremer et al., 2016). Furthermore, a recent meta-analysis of the effect of exercise interventions on cognition reported a large effect in improving specific aspects of cognition (time on task) for children with autism (Tan et al., 2016).
Methodology
The research method was quasi-experimental with pre-test and post-test design with a control group. The statistical population included all children aged 6 to 12 with mild autism in Urmia city, 30 of them were randomly selected and tested in two groups of 15 (average age: 12.8±1.56) and control (mean age: 7.78 ± 1.58). Stork test is used to measure static balance, the heel-to-toe walking test to measure dynamic balance, and the parent executive functions questionnaire of Balster et al. (2000) in pre-test and post-test similarly. The experimental group performed square stepping exercises for 12 weeks, three sessions a week, and each session lasted 70 minutes. The data were analyzed through a one-way analysis of covariance in SPSS software version 24.
Results
The results showed that the average of the experimental group improved from the pre-test to the post-test in dynamic and static balance variables. This improvement was also observed in the working memory variable. Therefore, the difference between the two groups in the post-test phase is in favor of the experimental group.
Regarding working memory, the results of covariance analysis showed that there is a significant difference between the experimental and control groups. In other words, according to the average of the test group (0.60) compared to the average of the correct answer of the control group (1.27), square stepping exercises lead to a significant improvement in memory. Something has been tested in the group.
There is a significant difference between the experimental and control groups in terms of static balance. In other words, according to the average balance of the experimental group (7.89) compared to the average balance of the control group (6.83), the square stepping exercises significantly improved the balance in the experimental group.
There is a significant difference between the experimental and control groups in terms of dynamic balance. In other words, according to the average balance of the experimental group (11.46) compared to the average balance of the control group (6.93), the square stepping exercises significantly improve the balance in the group. It has been tested.
Conclusion
Part of the research results showed that the square stepping exercise program significantly improved the static and dynamic balance of autistic children. In the interpretation of this result, it can be said that balance includes nerve impulses from peripheral sensory receptors to the cerebellum, integrated neural connections in the cerebellum and other related centers, and finally extrapyramidal output to the lower motor neuron. Exercise combined with practice and repetition can facilitate transmission in these neural circuits. A variety of physical activities can likely improve balance. It seems that the effective mechanism of square stepping exercises is such that when the person's balance is disturbed while taking a step and is on the verge of falling, a quick and firm compensatory step is needed to prevent falling, which is done by bending the hips and knees and opening of the ankles.
Another part of the research results showed that based on the report of the parents in this research, the practice of square stepping has improved working memory in these children, the results are in line with the findings of Akbari Far et al. (2019); Johnston et al. (2017) and Fathabadi et al. (2020). The participation of children with autism disorder in planned physical exercises with a cognitive aspect (square stepping exercises) leads to involvement and brain activities of areas related to movement in the brain, and this can probably be the reason that with the increase in the activity of the areas a movement in children's brain, their cognitive performance also increases. It can also be said that square-stepping exercises improve the ability of the brain structure to repair itself after ischemic damage by increasing the number of neurotrophic factors (factors that nourish brain nerve cells). As a general conclusion, it can be acknowledged that square stepping exercises can be an ideal intervention method to improve executive functions in children with autism.
Acknowledgments
We are grateful to all children aged 6 to 12 with autism in Urmia and their families who helped us in this research.