Abstract
This study aimed to compare the effectiveness of computer-aided cognitive rehabilitation (CACR) and virtual reality (VR)-based interventions on sensorimotor skills and working memory in children with reading difficulties. To achieve this objective, this research adopted a semi-experimental pre-test, follow-up, and control group design. The statistical population encompassed all students grappling with a specific learning disorder related to reading in the city of Arak for the summer of 2023. A simple random sampling method was used to randomly select 30 participants. These individuals were then allocated to three groups, including computer-assisted, virtual reality, and control groups, to undergo intervention. Kirchner's (1985) working memory task was utilized to assess their progress. Subsequently, a follow-up test was administered after three months to evaluate the participants' performance. The control group in this study did not undergo any intervention. Multivariate analysis of variance supplemented with the Benferroni test was employed to analyze the data. The results highlighted that both computer-assisted cognitive rehabilitation and virtual reality interventions significantly improved auditory and visual attention, as well as working memory, in participants from the test group. Moreover, these positive effects persisted in the follow-up evaluation conducted three months later. The findings demonstrated that the computer-assisted cognitive rehabilitation group showed superior effectiveness in both the test and follow-up stages (p=0.0001). Based on these results, it can be concluded that both treatments, with a particular emphasis on computer-assisted cognitive rehabilitation, can be employed to improve sensorimotor abilities and working memory, ultimately mitigating the severity of reading disorders.
Keywords: Computer-Assisted Cognitive Rehabilitation, Reading Learning Disorder, Sensory-Motor Benefit, Virtual Reality, Working Memory.
 
 
 
Extended Abstract

Introduction

Specific reading disorders, commonly known as dyslexia, present a substantial neurodevelopmental challenge to children. These disorders typically involve difficulties in accurate word recognition, reading fluency, and comprehension, which subsequently lead to diminished academic performance and compromised day-to-day functioning. In addition to reading difficulties, children afflicted with learning disabilities often exhibit deficiencies in sensorimotor integration and working memory, essential elements of cognitive and academic growth. The emergence of cutting-edge technologies has ushered in novel intervention strategies, notably computer-aided cognitive rehabilitation (CACR) and virtual reality (VR)-based therapies, specifically tailored to augment these abilities. This investigation endeavors to examine the comparative efficacy of CACR and VR interventions in ameliorating sensorimotor benefits (visual and auditory attention) and working memory in children grappling with reading disabilities. The study is set in Arak, Iran, during the summer of 2023, striving to pinpoint the most effective therapeutic methods for diminishing the severity of these reading-related challenges.
Research Question
Does a substantial difference exist between the effectiveness of computer-aided cognitive rehabilitation and virtual reality-based interventions in augmenting sensorimotor benefits and working memory among children contending with reading difficulties?

Literature Review

Specific learning disorders, particularly dyslexia, exhibit persistent challenges in academic skill acquisition despite sufficient intellectual capabilities and educational prospects. In Iran, incidence rates of learning disorders vary and have been estimated at 11% for children. Notably, reading difficulties account for at least 9% of these cases. Sensorimotor integration, as posited by Ayres (1989), pertains to the brain's capacity to process sensory data efficiently for effective interaction with the environment. Notably, children grappling with learning disabilities often struggle with fine and gross motor skills, coordination, and precise temporal accuracy, indicating a link between sensorimotor functionality and learning outcomes, as suggested by various research studies. Additionally, working memory, a cognitive system for temporary storage and manipulation of information, frequently exhibits impairment among these individuals, thereby contributing to reading difficulties. Theoretical frameworks, exemplified by Piaget and Hebb, underscore the fundamental role of sensorimotor learning in cognitive development, while contemporary research highlights the significance of working memory in academic achievement. Interventions such as CACR employ structured, computer-based activities with audiovisual feedback to bolster cognitive skills, making them adaptable to individual needs and fostering neuroplasticity. In contrast, VR-based therapies immerse users in immersive 3D environments, aiming to promote motor and cognitive rehabilitation. According to prior studies, CACR can significantly improve working memory and executive functions, while VR shows potential in enhancing motor coordination and sustained attention.

Methodology

This study utilized a quasi-experimental pretest-follow-up design with a control group. The statistical population consisted of students diagnosed with reading-specific learning disorders in Arak, Iran, during the summer of 2023, with 30 participants randomly selected via simple random sampling from the Hope Learning Disorders Rehabilitation Clinic and subsequently randomly assigned to three groups: CACR (n=10), VR (n=10), and Control (n=10). For participants to be eligible, they had to meet the following criteria: a confirmed reading disorder diagnosis, willingness to participate, and absence of concurrent psychiatric conditions or medication use. The participants in the CACR group engaged in a series of 12 sessions (each session lasting 30 minutes) focused on enhancing sustained, selective, focused, and divided attention, along with working memory skills, based on a protocol adapted from Shokri et al. The VR group completed 12 sessions (each session lasting 30 minutes, twice weekly) in accordance with the protocol established by Nijman et al. (2020), emphasizing the enhancement of visual and auditory selective attention, as well as cognitive flexibility. In contrast, the control group received no intervention. Kirchner’s (1985) working memory task served as the assessment tool, with data being analyzed using Multivariate Analysis of Variance (MANOVA) supplemented with Bonferroni's post-hoc tests in SPSS 26.

Results

A comparative analysis revealed that both CACR and VR interventions yielded significant improvements in both auditory and visual attention and working memory in the respective experimental groups, compared to the control group. Furthermore, the positive effects persisted during the three-month follow-up period. Notably, no significant intergroup differences were observed in the baseline scores (p > 0.05). Post-intervention, the CACR group exhibited greater improvements in auditory attention (M=110.00, SD=13.27) and visual attention (M=115.80, SD=9.05) compared to the VR group (M=109.30, SD=4.64; M=113.80, SD=7.02, respectively) and control (M=75.20, SD=16.12; M=76.30, SD=12.10). Working memory scores followed a similar trend, with CACR (M=4.71, SD=0.79) outperforming VR (M=4.25, SD=0.57) and control (M=2.97, SD=0.97) in the posttest phase (p < 0.0001). Follow-up results confirmed the persistence of these gains, with CACR maintaining superior efficacy (p < 0.0001). Statistical significance was supported by MANOVA (Wilks’ Lambda, p < 0.0001) and Bonferroni tests, highlighting CACR’s greater effectiveness across all measured domains.
Table 1. Results of interventions carried out




Follow


Posttest


Source


Variable




22.29


25.96


F


Auditory Attention




0.001


0.0001


Significance




0.62


0.65


Eta




40.78


53.48


F


Visual Attention




0.0001


0.0001


Significance




0.75


0.79


Eta




9.81


12.70


F


Working Memory




0.001


0.0001


Significance




0.42


0.48


Eta




The observed outcomes suggested that both CACR and VR interventions were effective, with CACR demonstrating enhanced performance in sensorimotor benefits and working memory improvement, possibly due to the structured, feedback-driven approach inherent in CACR.

Discussion

The results of the study demonstrated that both interventions yielded significant improvements compared to the control group, with a maintenance of effects observable at the three-month follow-up (p<0.0001). Notably, CACR outshone VR in the pre-test and follow-up phases (p<0.0001), aligning with prior research emphasizing its efficacy in enhancing cognitive abilities through structured feedback (Bbrarjanian Behrnariri et al., 1400; Bavonita et al., 2015). These findings revealed that VR demonstrated potential, in alignment with studies highlighting immersive benefits (Fu & Ji, 2023). Notably, however, VR was found to be less effective than CACR (Bbrarjanian Behrnariri et al., 1400; Bavonita et al., 2015) in comparison to control group (Bbrarjanian Behrnariri et al., 1400; Bavonita et al., 2015).

Conclusion

Despite certain limitations such as a small sample size, the study substantiated CACR as a superior tool for mitigating the severity of reading disorders. Meanwhile, VR emerged as a promising emerging option requiring further investigation.
Acknowledgments
We extend our heartfelt gratitude to all the parents and participants who graciously took part in this study.