Razi Journal of Medical Sciences

fa بهبود مهارت‌های شناختی و حرکتی کودکان با نارسایی شنوایی: طراحی یک برنامه توانبخشی شناختی Improvement of Cognitive and Motor Skills in Children with Hearing Impairment: Designing a Cognitive Rehabilitation Program روانشناسی بالینی Clinical Psychiatry پژوهشي Research <div style="text-align: justify;">زمینه و هدف: شنوایی یکی از حواس کلیدی انسان است که نقش مهمی در توسعه شناختی، زبانی و اجتماعی ایفا می‌کند. نارسایی شنوایی در کودکان می‌تواند رشد طبیعی را مختل کند و منجر به مشکلات در حافظه شنیداری، مهارت‌های حرکتی و سرعت پردازش اطلاعات شود. مطالعات نشان می‌دهد حدود 5% کودکان جهان درجاتی از نارسایی شنوایی دارند. این پژوهش با هدف طراحی و اعتباربخشی یک بسته آموزشی توانبخشی شناختی برای کودکان 8 تا 12 ساله با آسیب شنوایی تحت پوشش بهزیستی انجام شد. روش کار: پژوهش توصیفی-تحلیلی بود و طراحی بسته در چهار مرحله شامل تحلیل نیازها، طراحی اولیه، اعتباربخشی محتوایی و اجرای پایلوت انجام شد. ابزارها شامل مرور منابع، مصاحبه با متخصصان و والدین، و تحلیل نتایج پایلوت بود. بسته شامل 36 تمرین نرم‌افزاری و 24 تمرین دستی بود که طی 12 جلسه 45 دقیقه‌ای اجرا شد. جامعه آماری کودکان 8-12 ساله با آسیب شنوایی در ابهر (176 نفر) بود؛ 30 کودک به روش نمونه‌گیری در دسترس انتخاب و به دو گروه 15 نفره (مداخله و کنترل) تقسیم شدند. داده‌ها با آزمون‌های لینکلن-اوزرتسکی (برای مهارت‌های حرکتی) و وکسلر پنجم (برای حافظه شنیداری و سرعت پردازش) جمع‌آوری و با آزمون کوواریانس چندمتغیره تحلیل شد. یافته‌ها: نتایج نشان داد بسته توانبخشی به طور معنادار حافظه شنیداری، مهارت‌های حرکتی ظریف و درشت، و سرعت پردازش اطلاعات را در گروه مداخله بهبود بخشید (05/0>P) در حالی که گروه کنترل تغییر معناداری نداشت. این بهبود ناشی از تقویت فرآیندهای رمزگذاری، هماهنگی عصبی-عضلانی و عملکرد شبکه‌های عصبی بود. نتیجه‌گیری: یافته‌ها با مطالعات قبلی همخوانی دارد و اثربخشی بسته را در بهبود عملکردهای شناختی و حرکتی کودکان با آسیب شنوایی تایید می‌کند. پیشنهاد می‌شود این بسته در برنامه‌های آموزشی و درمانی کودکان با نیازهای ویژه گنجانده شود.</div> <div style="text-align: justify;">Background & Aims: Hearing is a crucial human sense playing a key role in environmental adaptation and influencing cognitive, linguistic, and social development. Any impairment disrupts natural child growth, with hearing loss—ranging from mild to severe affecting about 5% of children worldwide. Deaf individuals often struggle with language despite aids like hearing devices, while hard-of-hearing children can partially benefit from sensory input (1-4). Beyond language issues, hearing impairment impacts neuropsychological functions like information processing, memory, and motor skills, all shaped by sensory experiences. Auditory memory, part of working memory, is vital for storing and retrieving sound-based information and foundational for language and cognition (5,6). Deaf children exhibit weaker auditory memory due to sensory deprivation, leading to reduced auditory processing and language challenges (7,8). Motor skills, including fine and gross types, develop via environmental interaction and sensory input, essential for daily activities and play; hearing-impaired children often face delays (9,10). To address these, specialized rehabilitation programs are needed, with cognitive rehabilitation offering exercises to boost memory, attention, processing speed, and motor skills. Package design requires understanding needs and scientific validation, incorporating diverse exercises like auditory attention, working memory, and problem-solving, delivered digitally or manually for repeated practice (11). Limited studies examine combined effects on auditory memory, motor skills, and processing speed in hearing-impaired children, focusing on isolated components. Lamargue et al. (12) designed a package improving cognition and daily life in multiple sclerosis patients. Lawrence et al.'s (13) review showed benefits for memory, attention, and quality of life in hearing-loss adults. Yassir et al. (14) highlighted early interventions like cochlear implants enhancing child cognition. This study introduces a non-invasive package for simultaneous cognitive-motor gains. Ashouri (15) reported positive effects on memory in hearing-impaired students. Computer-based rehabilitation improves working memory and attention in autism (16). Perceptual-motor exercises enhance coordination, accuracy, and speed in cerebral palsy children, boosting independence (17). These underscore cognitive rehabilitation's value across groups. Based on neuroplasticity, targeted exercises alter brain structure/function, stimulating neural pathways for better performance (18). Thus, such programs can improve skills and life quality in hearing-impaired children. This study aims to design/validate a package for 8-12-year-olds under welfare, using evidence-based methods and expert validation for targeted use. Methods: This applied, developmental study designed a cognitive rehabilitation package for 8-12-year-old hearing-impaired children under welfare. Population: cognitive rehabilitation experts and 176 such children in Abhar, 2023. Sample: 30 children selected via convenience, randomly assigned to intervention/control groups (15 each) using random tables. Dropouts replaced for balance. Package: interactive software/manual exercises in three stages—needs analysis/initial design, content validation, pilot. Design used game models/gamification for engagement. Stage 1: Analyzed limitations in auditory memory, motor delays, processing speed via literature review and Sohlberg-Mateer protocol (19), emphasizing memory/attention recovery. References: Powell's workbook (20), brain rehab exercises (21), Nejati's handbook (22), Haskins et al. guide (23). Included 36 software/24 manual exercises on memory/processing/motor areas, tailored for age, 45-minute sessions. Models: user/activity analysis, game conceptualization, visual/interaction design, prototypes. Semi-structured parent/teacher interviews refined needs. Stage 2: Content validity via 5 experts; CVR=0.99 (>0.78 acceptable). Suggestions (sequence/more interactivity) applied. Experts: ≥5 years experience, research, modern methods knowledge. Stage 3: 8 weekly 45-minute pilot sessions; simultaneous memory/processing start improved results, motor from session 3. Enhanced software with feedback. Sessions avoided routine interference; parents supervised, provided input per Zhao-Chang (25) on involvement boosting efficacy. Collected opinions, obtained consent; data confidential. Data collection: Oct-Dec 2023 at welfare centers. Pre-test in calm setting using Lincoln-Oseretsky (motor) and WISC-V (memory/processing). Intervention: 8 sessions by first author, games/exercises for motivation. Stage 4: Quasi-experimental with pre/post/follow-up. Intervention received package; control school routine. Data: three times via tools. Analysis: MANCOVA controlling confounders; Kolmogorov-Smirnov normality, Levene homogeneity. Bonferroni post-hoc/between-group effects. SPSS-24. Post-test same conditions; 2-month duration. Tools: Demographic (age/gender); Lincoln-Oseretsky (36 items, 6-14 years, scoring 0-3, total 0-108; higher=better; validity/reliability: Sloan 81% content, alpha 0.59-0.93; Bialer 0.83 construct, 0.85 test-retest; Iran: Sadeghi 0.78/0.82 criterion, 0.86 test-retest; Sheikh 88% content, 0.87 alpha) (20-24, but aligned to list: references adjusted to 26-29 for related validity); WISC-V (21 subtests, indices like verbal comprehension, processing speed; validity/reliability: Watkins 81% content, 0.71 criterion, test-retest 0.65-0.82; Schoenberg alpha 0.80-0.89/0.86; Iran: Karami 0.60-0.72 criterion, alpha 0.80-0.92, split-half 0.78-0.91, test-retest 0.70-0.89) (25-28, but aligned: 34-39 for WISC-V specifics). Present: Face validity acceptable; alpha 0.82 Lincoln, 0.86 WISC. Package: Based on Sohlberg-Mateer (19); 36 software/24 manual games; content validity 89%; memory/processing first, motor session 3+. These stages, using models/expert/practical input, prepared package for implementation/evaluation. Ethics: IR.IAU.Z.REC.1403.100; confidential, consent. Qualitative thematic analysis for needs/feedback. Results: Demographic data from interviewees revealed that among 20 participants, 8 (40%) were female and 12 (60%) male. Age distribution showed 5 (25%) aged 35-45 years, 11 (55%) aged 45-55 years, and 4 (20%) aged 55-65 years. Work experience varied with 2 (10%) having less than 10 years, 3 (15%) 10-15 years, 4 (20%) each for 15-20 and 20-25 years, 6 (30%) 25-30 years, and 1 (5%) 30-35 years. Education levels included 8 (40%) with master's degrees and 12 (60%) with PhDs. Based on library resources, interviews, and semantic/conceptual links, all dimensions, components, and indicators were defined. Coding results from documents included open, axial, and selective categories: for example, from books on cognitive rehabilitation principles, initial communication as K1 under therapeutic alliance in preparation/familiarization; program introduction from articles as K1 in goals/methods familiarity; pre-test from clinical guides as K1 in initial assessment. Auditory memory exercises from techniques articles as K2 in memory strengthening under memory/processing focus; complex processing from advanced skills books as K2 in attention improvement. Conclusion: Results align with prior studies, confirming the package's effectiveness in enhancing cognitive and motor functions in hearing-impaired children. Recommend inclusion as an intervention in special needs programs.</div> توانبخشی شناختی, حافظه شنیداری, مهارت حرکتی, سرعت پردازش اطلاعات, آسیب شنوایی Cognitive Rehabilitation, Auditory Memory, Motor Skills, Information Processing Speed, Hearing Impairment 1 14 http://rjms.iums.ac.ir/browse.php?a_code=A-10-8625-1&slc_lang=fa&sid=1 Nazanin Davoodi نازنین داودی 3900319475328460088906 0009-0009-8009-1275 No PhD Candidate, Department of Psychology, Zanjan Branch, Islamic Azad University, Zanjan, Iran دانشجوی دکتری، گروه روانشناسی، واحد زنجان، دانشگاه آزاد اسلامی، زنجان، ایران Fatemeh Nazari فاطمه نظری fateme.nazariaz@gmail.com 3900319475328460088907 3900319475328460088907 Yes Assistant Professor, Department of Psychology, Zanjan Branch, Islamic Azad University, Zanjan, Iran استادیار، گروه روانشناسی، واحد زنجان، دانشگاه آزاد اسلامی، زنجان، ایران Homam Moayedfar همام مؤیدفر 3900319475328460088908 3900319475328460088908 No Assistant Professor, Department of Psychology, Zanjan Branch, Islamic Azad University, Zanjan, Iran استادیار، گروه روانشناسی، واحد زنجان، دانشگاه آزاد اسلامی، زنجان، ایران