Neurofeedback effect on perceptual-motor skills of children with ADHD

Objectives: This study investigates the impact of neurofeedback on perceptual-motor skills of 5 to 12 years old children with Attention Deficit Hyperactive Disorder (ADHD). Methods: In this clinical study, 40 children between the ages of 5-12 years, who were patients of the Tavanesh Clinic and diagnosed with ADHD, were randomly chosen and divided into two groups of control and test. 20-neurofeedback intervention sessions were performed. The tools utilized in this study included Bruninks-Oseretsky Test of Motor Proficiency and Child behavior checklist (CBCL) survey questionnaire. For evaluation after the intervention, Bruninks-Oseretsky Test of Motor Proficiency scale for children, along with CBCL questionnaire surveys were asked to fill up by the participants' mothers. Results: After the intervention, the analysis of the scores in all perceptual-motor skills showed significant differences in both groups, but no significant difference was observed in the subtest of strength. The CBCL survey questionnaire revealed that the average scores on attention disorder, aggression, lack of attention and hyperactivity, externalizing and general problems in the test group is significantly less than that of the control group. However, in the confrontational behavior (internalization), there was no statistically significant difference between the test and control groups. There was a correlation between the change of motor skills and change of behavioral patterns in ADHD children. Discussion: Neurofeedback intervention can have positive effects on improving the perceptualmotor skills of children with ADHD

Balance performance of deaf children with and without cochlear implants

The aim of this study was to compare the static and dynamic balance performance of deaf children with and without cochlear implants. This is a cross-sectional study of 145 school children, aged between 7 and 12 years comprising 85 children with congenital or early acquired bilateral profound sensorineural hearing loss (the hearing loss group) and 60 normal hearing aged-matched control counterparts were assessed using the balance subtest of Bruininks-Oseretsky test of Motor Proficiency (BOTMP). The hearing loss group, 50 without cochlear implants (the non-implant group) and 35 of them with unilateral cochlear implants (the implant group) were recruited from schools for the deaf and normal hearing children (the control group) randomly selected from two randomly selected elementary schools of Tehran city. The scores were analyzed using one-way ANOVA. The total score of deaf children especially the implant group were significantly lower than the control group)P<0.001). The balance performance of the control group was better than the implant group in all of the items as well as the non-implant group except the fourth tested item (walking forward on a line) (P<0.05). The balance score of the implant group was significantly lower than the non-implant group except for the third tested item (standing on the preferred leg on a balance beam with eyes closed). The findings suggested that deaf children, specifically those with cochlear implants are at risk for motor and balance deficits. Thus, vestibular and motor evaluations, as well as interventions to improve balance and motor skills, should be prioritized for this population. © 2016 Tehran University of Medical Sciences. All rights reserved

Effect of a visual tracking intervention on attention and behavior of attention deficit hyper activity children

Attention deficit hyperactivity disorder is characterized by several cognitive and behavioral problems such as inattention and impulsivity, abnormal control of eye movements and relocation, visual fixation and visuospatial perception. There is a link between core motor functions such as oculomotor function and cognition to the extent that the oculomotor system acts as a mediator between the motor and cognitive functions. Therefore, the effects of eye-tracking intervention were investigated on attention in these children. Thirty - nine boys with ADHD, 6 to 10 years of age were recruited and randomized to receive current occupational therapy (control group), or occupational therapy accompanied with eye-tracking exercises (experimental group). They were evaluated using the Conner's Parent Rating Scale, the Continuous Performance Task-2, and the Test of Visual-Motor Skills-Revised before and after the intervention. Significant improvements in the mean scores of cognitive problems (F=9/22), coping behavior (F=6.03) and hyperactivity (F=9.77) were detected in the posttest between the two groups (p<0.05). Furthermore, in the Continuous Performance Test scores, detectability (F=5.68), omission errors (F=17.89), commission errors (F=19.45), reaction time (F=8.95), variability (F=7.07), and preservation (F=6.33) showed significant differences between control and experimental groups (p<0.01). It appears that eye-tracking interventions designed based on the isolation of neck and eye movement might have an important role in improving cognitive function and coping behaviors in these children. It seems that these exercises could increase eye movement control; improve cognitive function and response inhibition

Review paper: Introduction of pediatric balance therapy in children with vestibular dysfunction: Review of indications, mechanisms, and key exercises

The vestibular system is important for the development of normal movement reactions, motion tolerance, and motor control for postural alignment, balance, and vision. A vestibular system that is damaged by disease or injury in childhood can have a major impact on a child's development. In addition, the emergence of vestibular lesions may also lead to cognitive deficits, including attention deficit. Despite the advances in testing and documentation of vestibular deficits in children, the vestibular problems continue to be an overlooked entity. Many children do not receive treatment that could significantly improve function and address the developmental delays caused by vestibular disorders. Vestibular rehabilitation therapy (VRT) has been defined as an effective modality for most individuals with disorders of the vestibular or central balance system disorders. The basis for the success of VRT is the use of existing neural mechanisms in the human brain for adaptation, plasticity, and compensation. The vestibular system cannot be considered as a separate entity ignoring other balance subsystems. Hence, a modified VRT program, named pediatric balance therapy with special modifications in exercises, was developed for children with vestibular disorders, in accordance to the whole balance system

National guidelines for cognitive assessment and rehabilitation of Iranian traumatic brain injury patients

Background: Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran. Methods: The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME). Following a systematic literature search and selection process, four guidelines were included for adaptation. Clinical recommendations of the source guidelines were tabulated as possible clinical scenarios for 90 PICO clinical questions covering all relevant phases of care. After summing up the scenarios, our initial list of recommendations was drafted according to the Iranian patients� conditions. The final decision-making, with the contribution of a national interdisciplinary panel of 37 experts from across the country, was conducted in two rounds using online and offline survey forms (Round 1), and face-to-face and telephone meetings (Round 2). Results: A total of 63 recommendations in six sections were included in the final list of recommendations, among which 24 were considered as key recommendations. In addition, some of the recommendations were identified as fundamental, meaning that proper implementation of the other recommendations is largely dependent on their implementation. Conclusion: Iranian health policy makers and rehabilitation program managers are recommended to address some fundamental issues to provide the necessary infrastructure to set up an efficient cognitive rehabilitation service system. © 2020 Academy of Medical Sciences of I.R. Iran. All rights reserved

Effects of transcranial direct current stimulation combined with cognitive orientation to daily occupational performance in children with cerebral palsy: A protocol for a randomised controlled trial

Background/Aims Children with hemiplegic cerebral palsy have limitations in activities requiring reach and manipulation of objects with their affected upper extremity. Transcranial direct current stimulation and the cognitive orientation to occupational performance approach are relatively new interventions that may lead to promising results for these children. This article describes the method of a randomised clinical trial that will compare the effects of the combination of transcranial direct current stimulation and cognitive orientation to daily occupational performance with transcranial direct current stimulation and neurodevelopmental treatment. Methods A four-armed clinical trial with a sample size of 36 participants will be performed in Tehran. Participants will be randomly divided into four groups. Group A will receive neuro-developmental treatment with sham transcranial direct current stimulation, group B will receive neurodevelopmental treatment with transcranial direct current stimulation, group C will receive cognitive orientation to daily occupational performance with sham transcranial direct current stimulation, and group D will receive cognitive orientation to daily occupational performance with transcranial direct current stimulation. The examiner will be blind to the study and assessments will be done at baseline, after the end of the intervention and 1 month after the completion of the intervention (as follow up). Data analysis will be as repeated measure analysis of variance and intention to treat. Conclusions This article describes the protocol of a clinical trial that compares the effects of the combination of transcranial direct current stimulation and cognitive orientation to daily occupational performance with the combination of transcranial direct current stimulation and neurodevelopmental treatment on upper extremity goals and functions of children with hemiplegic cerebral palsy. © 2020 MA Healthcare Ltd. All rights reserved

Preliminary evidence of improved cognitive performance following vestibular rehabilitation in children with combined ADHD (cADHD) and concurrent vestibular impairment

Objective Balance function has been reported to be worse in ADHD children than in their normal peers. The present study hypothesized that an improvement in balance could result in better cognitive performance in children with ADHD and concurrent vestibular impairment. This study was designed to evaluate the effects of comprehensive vestibular rehabilitation therapy on the cognitive performance of children with combined ADHD and concurrent vestibular impairment. Methods Subject were 54 children with combined ADHD. Those with severe vestibular impairment (n = 33) were randomly assigned to two groups that were matched for age. A rehabilitation program comprising overall balance and gate, postural stability, and eye movement exercises was assigned to the intervention group. Subjects in the control group received no intervention for the same time period. Intervention was administered twice weekly for 12 weeks. Choice reaction time (CRT) and spatial working memory (SWM) subtypes of the Cambridge Neuropsychological Test Automated Battery (CANTAB) were completed pre- and post-intervention to determine the effects of vestibular rehabilitation on the cognitive performance of the subjects with ADHD and concurrent vestibular impairment. ANCOVA was used to compare the test results of the intervention and control group post-test. Results The percentage of correct trial scores for the CRT achieved by the intervention group post-test increased significantly compared to those of the control group (p = 0.029). The CRT mean latency scores were significantly prolonged in the intervention group following intervention (p = 0.007) compared to the control group. No significant change was found in spatial functioning of the subjects with ADHD following 12 weeks of intervention (p > 0.05). Conclusion The study highlights the effect of vestibular rehabilitation on the cognitive performance of children with combined ADHD and concurrent vestibular disorder. The findings indicate that attention can be affected by early vestibular rehabilitation, which is a basic program for improving memory function in such children. Appropriate vestibular rehabilitation programs based on the type of vestibular impairment of children can improve their cognitive ability to some extent in children with ADHD and concurrent vestibular impairment (p?> 0.05). © 2017 Elsevier B.V