نوع مقاله : مقاله پژوهشی

نویسندگان

1 کارشناس ارشد رفتار حرکتی، دانشگاه ارومیه، ارومیه، ایران.

2 استادیار گروه رفتار حرکتی، دانشگاه ارومیه، ارومیه، ایران.

10.22054/jpe.2023.72432.2550

چکیده

پژوهش حاضر باهدف ‏بررسی اثر تمرینات مربع گام‍برداری بر حافظه‍کاری و تعادل کودکان مبتلا به اوتیسم انجام شد. روش پژوهش نیمه آزمایشی و با طرح پیش‍آزمون و پس‍آزمون با گروه کنترل انجام شد. جامعه آماری شامل تمامی کودکان 6 تا 12 سال مبتلا به اوتیسم خفیف شهرستان ارومیه در سال 1401 بود که به‌صورت تصادفی هدفمند 30 نفر از آن‌ها انتخاب و در دو ‏گروه 15 نفری آزمایش (میانگین سنی: 56/1±12/8) و کنترل (میانگین سنی:58/1± 78/7) قرار گرفتند. آزمون لک‌لک جهت سنجش تعادل ‏ایستا، آزمون راه رفتن پاشنه به پنجه جهت سنجش ‏تعادل پویا و پرسشنامه‎ ‎کارکردهای اجرایی بریف فرم والدین بالستر جراردو همکاران (2000‏) ‏در پیش‌آزمون و پس‌آزمون به‌طور مشابه انجام دادند. گروه آزمایش طی 12 هفته، هفته‌ای سه جلسه و هر جلسه 70 دقیقه به اجرای ‏تمرینات مربع گام‍برداری پرداختند. داده‌ها از طریق آزمون تحلیل کوواریانس یکراهه تحلیل شد. نتایج نشان داد که با کنترل نمرة پیش‌آزمون، بین نمرات آزمون تعادل ایستا و پویا، حافظه‍کاری دو گروه تجربی ‏و کنترل در پس‌آزمون تفاوت معنادار وجود دارد (001/0‏p=‎‏)؛ بنابراین انجام این تمرینات می‍تواند راهبردی مؤثر برای بهبود تعادل و حافظه‍‏کاری در کودکان مبتلا به اوتیسم خفیف باشد.

کلیدواژه‌ها

عنوان مقاله [English]

The Effect of Square Stepping Exercise on Working Memory and Balance of Children with Autism

نویسندگان [English]

  • Mir Javad Mojarrad Azar 1
  • jalal dehghanizade 2

1 MA in Motor Behavior, Urmia University, Urmia, Iran.

2 Assistant Professor, Department of Motor Behavior, Urmia University, Urmia, Iran.

چکیده [English]

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.

کلیدواژه‌ها [English]

  • Square Steppin
  • Working Memory
  • Balance
  • Autis
References
Aadland, KN., Ommundsenm Y., Anderssen, S.A., Bronnick, K.S., Moe, V,F., Resaland, G.K., Skrede, T., Stavnsbo, M., Aadland, E. (2019.).Effects of the Active Smarter Kids (ASK) Physical Activity School-Based Intervention on Executive Functions: A Cluster-Randomized Controlled Rrial. Scandinavian Journal of Educational Research, 63(2), 214-228.
Ahmadi, J., Safari, T., Hematian, M., Khalili, Z. (2012). Guidance of Gilliam Autism Rating Scale (GARS-2). Isfahan: Jahad daneshgahi Publication, 32-54.
Akbarifar, H., Sharifidaramad, P., Rahimzade, H., Pezeshk,S. (2019). The Effectiveness of the Intervention of Active Plays on Working Memory in Students with Dyslexia. Neuropsychology, 5(16), 149-162.
Ament, K., Mejia, A., Buhlman, R., Erklin, S., Caffo, B., Mostofsky, S., Wodka, E. (2015). Evidence for specificity of motor impairments in catching and balance in children with autism. Journal of Autism and Developmental Disorders, 45(3), 742–751.
American Psychiatric Association. (2013). American Psychiatric Association Diagnostic and statistical manual of mental disorders (5th Ed.).
Anderson, J. R. (2014). Cognitive psychology and its implications, 8 Edn. New York, NY: Worth Publishers.
Ansari, S., Hosseinkhanzadeh, A. A., AdibSaber, F., Shojaei, M., Daneshfar A. (2020). The effects of aquatic versus kata techniques training on static and dynamic balance in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 51(9),3180–3186.
Asadi, Z., Rahnama, N., Reis, J., Lenjan Nejadian, S.H. (2019). Comparison of the effect of square walking exercises with resistance exercises on balance, falling, fear of falling and neurotrophic factor derived from the brain of elderly women. Isfahan:Isfahan University.
Barrios-Fernández, S., Carlos-Vivas, J.,Muñoz-Bermejo, L.,Mendoza-Muñoz, M., Apolo-Arenas, M.D., García-Gómez, A., Gozalo, M., Adsuar, J.C. (2022). Effects of Square- Stepping Exercise on Motor and Cognitive Skills in Autism Spectrum Disorder Children and Adolescents: A Study Protocol. Healthcare, 10, 450.
Bodner, K.E, Beversdorf D.Q., Saklayen S.S., Christ S.E. (2012).Noradrenergic moderation of working memory impairments in adults with autism spectrum disorder. J Int Neuropsychol Soc,18:556–64.
Chen, Y. (2023). The Impact of Autism on Children’s Memory.‏ ‏ Journal of Education, Humanities and Social Sciences,8, 2314- 2318
Chiarotti F, Venerosi A (2020). Epidemiology of autism spectrum disorders: a review of worldwide prevalence estimates since 2014. Brain Sci, 10(5): 274.
Edmunds, S. R., Colman, C., Vidal, P., and Faja, S. (2021). Brief report: Examining the links between language processes and working memory impairments in toddlers and preschoolers with ASD. J. Autism Dev. Disord, 52, 1872–1880.
Ershad N, Kahrizi S. (2007). Balance and posture in low back pain patients. Research in Rehabilitation Sciences,3(1),85-92.
Fathabadi, R., Nosrati, F., Ahmadi A., Roatami, B. (2020). The Impact of Rhythmic Motor Exercises on Executive Functions in Behavioral Inhibition Components and Working Memory of High- Functioning Autistic Male Children. Applied Psychological Research, 11(2), 143-163.
Fournier K. A., Hass C. J., Naik S. K., Lodha N., Cauraugh J. H. (2010). Motor coordination in autism spectrum disorders: A synthesis and meta-analysis. Journal of Autism and Developmental Disorders.2010; 40(10): 1227–1240.
Giannouli, E., Morat, T., Zijlstra, W. (2020). A Novel Square-Stepping Exercise Program for Older Adults (StepIt): Rationale and Implications for Falls Prevention. Front. Med, 6, 318
Gilliam J E. (2006). GARS-2: Gilliam Autism rating scale-second edition. Austin, TX: Pro- Ed Inc.
Huang, J., Du, C., Liu, J., Tan, G. (2020). Meta-analysis on intervention effects of physical activities on children and adolescents with autism. Int. J. Environ. Res. Public Health, 17,1950.
Johnstone A, Hughes AR, Janssen X, Reilly JJ. (2017). Pragmatic Evaluation of the Go2Play Active Play Intervention on Physical Activity and Fundamental Movement Skills in Children. Preventive Medicine Reports, 7,58-63.
Kaufmann L., et al. (2013). Brief report: CANTAB performance and brain structure in pediatric patients with Asperger syndrome. J Autism Dev Disord, 43(6),1483–1490.
Kim S. A., Kasari, C. (2023). Working memory of school-aged children on the autism spectrum: Predictors for longitudinal growth. Autism Online First,, Article Reuse Guidelines, https://doi.org/10.1177/13623613231165599
Kohen-Raz, R., Volkman, F.R., Cohen, D.J. (1992). Postural control in children with autism. J Autism Dev Disord, 22(3),419-32.
Kosari, S., Hemayattalab, R., Arab Ameri, E., Maleki, F. (2012).Effects of selected physical activity on the development of fine motor skills of childhood with attention deficit hyperactivity disorder (ADHD). Motion behavior, 11,99-116.
Lahtinen, U., Rintala, P., & Malin, A. (2007). Physical performance of individuals with intellectual disability: A 30-year follow-up. Adapted Physical Activity Quarterly, 24(2), 125-14
MacDonald, M., Lord, C., Ulrich, D. (2013). The relationship of motor skills and adaptive behavior skills in young children with autism spectrum disorders. Research in Autism Spectrum Disorders,7(11),1383–1390.
Maenner M.J. (2020). Prevalence of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States, 2016 MMWR Surveillance Summaries (2020), p. 69
Marzouki, H., Soussi, B., Selmi, O., Hajji, Y., Marsigliante, S., Bouhlel, E., Muscella, A., Weiss, K., Knechtle, B. (2022). Effects of Aquatic Training in Children with Autism Spectrum Disorder. Biology, 11,657
Memari, A. H., Ghanouni, P., Shayestehfar, M., Ghaheri, B. (2014). Postural control impairments in individuals with autism spectrum disorder: A critical review of current literature. Asian journal of sports medicine, 5(3), e22963.
 Okubo, Y., Schoene, D., Lord S.R. (2017). Step training improves reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis. Br J Sports Med,51(7),586-593.
Pan, C. Y. (2014). Motor proficiency and physical fitness in adolescent males with and without autism spectrum disorders. Autism, 18(2): 156-165
Radonovich K., Fournier K., Hass C. (2013). Relationship between postural control and restricted, repetitive behaviors in autism spectrum disorders [original research. Frontiers in Integrative Neuroscience, 7(28): 1–7.
Rajendranm G., Mitchell, P. (2007). Cognitive theories of autism. Dev Rev,27:224–60.
Ruggeri A., Dancel A., Johnson R., Sargent B. (2019). The effect of motor and physical activity intervention on motor outcomes of children with autism spectrum disorder: A systematic review. Autism, 24(3): 544–568.
Sadeghi, S., Marandi, S.M., Esfarjani,F., Zolaktaf,V., Sortiji,H. (2023). The effect of 12 weeks practicing stepping patterns with a light screen on the static and ‎dynamic balance of children with autism. Studies in Sport Medicine,14(34), 119-142‎
Sherrington, C., Whitney, J.C., Lord, S.R. Herbert, R.D., Cumming, R.G., Close, J.C. (2008). Effective exercise for the prevention of falls: a systematic review and meta‐analysis. Journal of the American Geriatrics Society,56(12),2234-43.
Shigematsu, R., Okura, T, Nakagaichi, M/, Nakata, Y. (2014). Effects of exercise program requiring attention, memory and imitation on 524 cognitive function in elderly persons: A non-randomized pilot study. Journal of Gerontology & Geriatric Research, 3(2),2-6.
Shigematsu, R., Okura, T. (2006). A novel exercise for improving lower-extremity functional fitness in the elderly. Aging clinical and experimental research,18(3),242-248.
Shigematsu, R., Okura, T., Nakagaichi, M., Nakata, Y. (2013). Adherence to and effects of multidirectional stepping exercise in the elderly: a long-term observational study following a randomized controlled trial. The Journal of Physical Fitness and Sports Medicine,2(1),127-34.
Shigematsu, R., Okura, T., Nakagaichi, M., Tanaka, K., Sakai, T., Kitazumi, S., Rantanen, T. (2008). Square-Stepping Exercise and Fall Risk Factors in Older Adults: A Single-Blind, Randomized Controlled Trial. J. Gerontol. A Biol. Sci. Med. Sci, 63, 76–82.
Somogyi, E., Kapitány, E., Kenyeres, K., Donauer, N., Fagard, J., Kónya, A. (2016).Visual feedback increases postural stability in children with autism spectrum disorder. Research in Autism Spectrum Disorders, 29–30: 48–56.
Teixeira, C.V., Gobbi S., Pereira, J.R., Vital, T.M., Hernandez, S.S, Shigematsu, R., Gobbi, LT. (2013). Effects of square-stepping exercise on cognitive functions of older people. Psychogeriatrics, 13(3),148-156.
Travers, B. G., Mason, A. H., Mrotek, L. A., Ellertson, A., Dean, D. C., Engel, C., Gomez, A., Dadalko, O. I., McLaughlin, K. B(2018). iofeedback-based, videogame balance training in autism. Journal of Autism and Developmental Disorders, 48(1), 163–175.
Tse, A. C. Y. (2020). Brief report: impact of a physical exercise intervention on emotion regulation and behavioral functioning in children with autism spectrum disorder. J. Autism Dev,50(11),4191-4198
Valeri, G., Casula, L., Napoli, E., Stievano, P., Trimarco, B., Vicari, S., et al. (2020). Executive functions and symptom severity in an Italian sample of intellectually able preschoolers with autism spectrum disorder. J. Autism Dev. Disord. 2020; 50: 3207–3215.
World Health Organization (2022). Autism Spectrum Disorder. Available at: https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders.
Yilmaz, I., Yanardağ, M., Birkan, B., Bumin, G. (2004). Effects of swimming training on physical fitness and water orientation in autism. Pediatr Int, 46(5),624-6.
Yin, C. L. C., Yin T. K. (2019). A review on the efficacy of physical therapy intervention on motor skills of children with autism spectrum disorder. In 3rd International Conference on Special Education (ICSE 2019), Atlantis Press