Razi Journal of Medical Sciences

Background & Aims: This study investigates the effects of rhythmic exercise interventions on working memory and motor skills in children diagnosed with Developmental Coordination Disorder (DCD) across diverse cultural contexts.  DCD, a neurodevelopmental disorder characterized by significant impairments in motor coordination, affects approximately 5-6% of school-aged children. These motor difficulties extend beyond simple clumsiness, impacting academic performance, social participation, and overall quality of life. While the etiology of DCD remains complex and multifactorial, research emphasizes the importance of early intervention strategies aimed at enhancing motor skills and addressing associated cognitive and social-emotional challenges.  This study focuses on rhythmic exercise, a promising non-pharmacological approach, examining its effectiveness within the distinct cultural landscapes of Iran and Turkey.
Methods: Forty children aged 8-10 years, who were diagnosed with Developmental Coordination Disorder (DCD) through the MABC-2, participated in the study. Participants were recruited from the convenience sample after the administration of the MABC-2. They were subsequently studied at schools in Tehran, Iran (District 5), and Istanbul, Turkey.
Following ethical review board approval, children were randomly assigned to one of four groups (n=10 per group), with two groups in each city. This design allowed for a comparison of intervention effects across different cultural settings. The intervention comprised 16 structured rhythmic exercise sessions, each lasting approximately 40 minutes. Sessions incorporated a variety of activities designed to engage both gross and fine motor skills, including rhythmic movements synchronized with music (both traditional Persian and Turkish music were used), structured dance routines, and games involving age-appropriate equipment (sticks, balls, hoops, etc.).  Sessions were delivered by trained physical therapists experienced in working with children with DCD to ensure consistency in program implementation.
Pre- and post-intervention assessments were conducted using standardized measures. Motor skills was assessed using the Movement Assessment Battery for Children—Second Edition (MABC-2). Working memory, was evaluated using the n-back task, a validated measure of executive functions crucial for motor planning and execution. Data analysis employed a mixed three-way analysis of variance (ANOVA), using SPSS version 23. This statistical approach allowed for the examination of the main effects of the rhythmic exercise intervention on the outcome measures (motor skills, working memory), as well as potential interaction effects of culture (Iranian vs. Turkish) and music type (traditional Persian vs. traditional Turkish). Effect sizes (Eta squared) were calculated to quantify the magnitude of the intervention effects.  Statistical significance was set at p < 0.05.
Results: The results revealed a significant main effect of the rhythmic exercise intervention on motor skills (MABC-2 scores) and working memory (n-back performance).  Children in both the Tehran and Istanbul groups demonstrated significant improvements post-intervention.  Effect sizes indicated that these improvements were of practical significance, representing substantial changes in motor skills and working memory abilities.
This finding suggests that culturally sensitive aspects of the intervention may need further investigation.  No significant interaction was found concerning the type of music used.
Conclusion: According to child development specialists, play is a central part of children’s lives. Play creates joy and vitality in children while contributing to their motor development. Children have various needs—emotional, neurological, cognitive, and physical. Play, as a physical activity, significantly influences children’s growth due to its simplicity. It provides a comfortable environment for learning problem-solving. Movement-centered games enable children to explore their inner selves and stimulate brain capabilities more easily and quickly. Given the important role of play and motor skill development, it is essential to mention that a significant set of skills is formed by Fundamental Motor Skills (FMS), which are believed to be a crucial prerequisite for most complex movements. Among different types of play, rhythmic games are one of the preferred training methods for children and adolescents. These movements and activities inherently possess coordination, and their correct execution requires the regular performance of various movements in specific sequences. Since these movements are often accompanied by music and performed collectively, they are particularly engaging and motivating for participants. The combination of fundamental skills with rhythmic games can increase motivation to participate in movement activities.
This study provides compelling evidence for the efficacy of rhythmic exercise interventions in enhancing motor proficiency and working memory in children with DCD across different cultural contexts.  The significant improvements observed suggest that rhythmic exercises may offer a valuable non-pharmacological approach for addressing core deficits associated with DCD. The positive impact on working memory is particularly noteworthy, given its crucial role in motor planning and cognitive control.  The interaction effect on social development highlights the importance of incorporating culturally sensitive elements into intervention design and delivery. Future research should examine the long-term effects of such interventions and explore strategies to optimize program effectiveness across diverse populations.  Further research should also investigate the neurobiological mechanisms underlying the observed improvements in motor skills and cognitive function.  Furthermore, qualitative data gathering through interviews with children and parents could provide valuable insights into the lived experiences and perceived benefits of the rhythmic exercise program. This result is consistent with some previous findings that have reported the effectiveness of musical movement games independent of music type and gender, and on the other hand, it is inconsistent with some studies that emphasized the role of culture and specific music. The reason for this discrepancy may be related to the homogeneity of the exercise protocol and the type of activity designed. It is suggested that the effects of individual variables and musical preferences be further investigated in future studies.
Based on the obtained results, the type of music and cultural differences did not have a significant impact. Therefore, the selected training protocols by the researcher can be used at home and in environments such as schools, regardless of cultural background or music type, to improve working memory and motor proficiency in children with developmental coordination disorder. This research contributes significantly to the growing body of knowledge on evidence-based interventions for children with DCD.  The findings underscore the need for culturally sensitive and contextually relevant approaches to therapeutic and educational interventions and suggest the potential of rhythmic exercises as a viable and engaging tool for improving the lives of children with DCD.