Effect of Telerehabilitation-Based Exercise and Motor Imagery Training in Children With ADHD

Overview

The study was prospectively planned and conducted as per protocol. However, registration was completed retrospectively due to administrative oversight. No changes were made to the protocol after study initiation. Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. About one-third of children with ADHD have difficulties with fine and gross motor skills. Motor problems during dynamic balance tasks are more pronounced in these children compared to their typically developing peers. These issues may result from dysfunction in brain regions, possibly linked to delayed cerebellar development. Motor imagery-the mental simulation of movement without actual execution-has been studied as a cause of motor impairments in ADHD and Developmental Coordination Disorder (DCD). While motor imagery deficits are clear in DCD, evidence in ADHD remains unclear. Studies show that motor imagery training, alone or combined with physical exercise, can improve postural control. In children with DCD, motor imagery training improved movement skills. ADHD treatment is multidimensional, including pharmacological and psychosocial interventions. Medications are effective in reducing symptoms and associated behaviors. Physical exercise also helps reduce ADHD symptoms, improving medication response and cognitive functions. This study aims to examine the effects of telerehabilitation-based exercise and motor imagery training on ADHD symptoms and balance in children. Telerehabilitation has become popular due to pandemic-related restrictions, yet no exercise program combining telerehabilitation and motor imagery exists for children with ADHD.

The study was prospectively planned and conducted as per protocol. However, registration was completed retrospectively due to administrative oversight. No changes were made to the protocol after study initiation. Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in children. 7.2% in the world; ADHD with a prevalence of approximately 13% in Turkey; It is a disorder that affects impulsivity, inattention and hyperactivity symptoms, and affects daily life activities and causes inadequacies. Children with ADHD have lower motor skills and performance than healthy children; reported to have higher motor coordination disorders. It has been shown that one-third of children with ADHD have problems with tasks that require fine and gross motor skills. In addition, it was stated that the motor skill problems experienced during dynamic situations were more pronounced than healthy children. It has been reported that motor disorders seen in children with ADHD may result from dysfunction in some related brain regions, and that especially delayed or impaired cerebellar development may contribute to the pathophysiology of ADHD. ADHD can cause significant academic, social and psychiatric problems. If left untreated, these problems continue for life. Motor imagery was investigated as the underlying cause of motor impairment in children with ADHD and Developmental Coordination Disorder (DDD). It was stated that motor imagery was significantly impaired in children with ADHD. But this situation was not clear in children with ADHD. Motor imagery is defined as the mental thinking of a movement without actual movement being revealed. It has been reported that combined physical and motor imagery programs applied at different rates, as well as motor imagery training without physical exercise, are effective in improving postural control. In a study conducted with children with DCD, it was shown that motor imagery training improves children's movement skills. In the treatment of ADHD, there are multidimensional treatment approaches that include medical and psychosocial interventions. Psychostimulants are the drugs most commonly used in the treatment of ADHD. Pharmacological treatments, including stimulant and non-stimulant drugs, are highly effective in reducing ADHD's attention deficit and hyperactivity/impulsivity features and associated destructive behaviors. In addition, from psycho-educational interventions; Multiple approach models that combine psychosocial intervention such as family education, school-oriented regulation, cognitive behavioral therapy, and social education have also been found to be effective methods. When looking at the effective exercise methods on ADHD symptoms, there are mostly studies on aerobic exercises and other physical exercises. Also, other physical exercises are known to reduce ADHD symptoms. It has been shown that exercise methods enable patients receiving drug therapy to respond better to drugs and improve cognitive functions in ADHD cases. Due to the Coronavirus disease (Covid-19), which started in the last months of 2019 and whose negative effects are still continuing, some difficulties are experienced in the health systems. This situation has led to a greater tendency towards telerehabilitation applications during the treatment and follow-up process. Telerehabilitation is a method that aims to provide rehabilitation to patients and clinicians by using information and communication technologies by reducing obstacles such as distance, time and cost. Although telerehabilitation programs have been used in different disease groups in recent years, these programs use is not common in children with ADHD. In conclusion, motor imagery disorder is unclear in children with ADHD. In addition, there are different opinions about the underlying aetiology of motor coordination and balance problems that cause children with ADHD to have difficulties in daily life and sports activities. The use of telerehabilitation methods has become widespread due to the difficulties in conducting face-to-face treatment and follow-up processes due to the pandemic. In addition, there is no exercise program based on telerehabilitation and motor imagery in children with ADHD.