مقایسه تأثیر توان‌بخشی شناختی و بازی‌های حرکتی هدفمند بر انعطاف‌پذیری شناختی و هماهنگی حرکتی کودکان دارای اختلال هماهنگی رشدی

Extended Abstract
Background and Purpose
Developmental Coordination Disorder (DCD) is a prevalent neuro-motor condition affecting school-aged children, marked by significant impairments in motor performance that interfere with academic and everyday functioning. Cognitive functions, particularly cognitive flexibility, are closely intertwined with motor skill acquisition, and deficits in these areas often co-occur in children with DCD. Historically, interventions have focused separately on motor or cognitive domains; however, limited evidence exists comparing the efficacy of cognitive rehabilitation, purposeful-movement play, and their combined application. Purposeful-movement play involves physically engaging tasks with structured goals, potentially promoting both motor coordination and cognitive skills by enhancing motivation and active participation. Cognitive rehabilitation, especially computerized modalities, aims to restore executive functions through repetitive, targeted exercises. This study aimed to compare the effects of cognitive rehabilitation, purposeful-movement play, and a combined intervention on cognitive flexibility and motor coordination in girls with DCD. We hypothesized that integrating cognitive and motor interventions would yield superior therapeutic benefits.
 
Methods
This semi-experimental, applied study employed a mixed factorial design with a between-subjects factor (intervention type: cognitive rehabilitation, purposeful-movement play, combined, control) and a within-subjects factor (time: pre-test, post-test). Sixty girls aged 7–10 years diagnosed with DCD were recruited from elementary schools in Boroujen through multi-stage screening with the Developmental Coordination Disorder Questionnaire (parent version) and the Lincoln–Oseretsky Motor Proficiency Scale. Inclusion criteria were defined by age- and sex-specific cutoffs indicative of suspected DCD. Participants were randomly allocated into four groups of 15.
The cognitive rehabilitation group received training using the “Captain Log” software, which provides progressively challenging tasks targeting executive function domains including attention, memory, visual-motor coordination, and processing speed. The purposeful-movement play group engaged in selected motor games that progressively developed gross and fine motor skills, adapted from prior validated protocols and designed to maintain engagement and enjoyment (see Table 1). The combined group alternated between the two modalities across sessions. Interventions spanned eight weeks (24 sessions, three per week, 45 minutes each). The control group received no intervention.
Primary outcomes were cognitive flexibility—assessed via the Wisconsin Card Sorting Test (completed categories and perseverative errors)—and motor coordination, measured by five items from the Lincoln–Oseretsky scale. Data analysis used mixed ANOVA with Tukey post hoc tests for between-group comparisons. Statistical significance was set at p < 0.05.
 
Results
Baseline comparisons indicated no significant group differences in any outcome. Mixed ANOVA identified significant main effects of time on completed categories (F(1,56) = 239.5, p < 0.001, ηp² = 0.81), perseverative errors (F(1,56) = 280.3, p < 0.001, ηp² = 0.83), and motor coordination (F(1,56) = 693.6, p < 0.001, ηp² = 0.92). Significant main effects of group emerged for perseverative errors (p = 0.019) and motor coordination (p < 0.001), while completed categories showed no group effect (p = 0.098). Time × group interactions were significant for all measures, exhibiting large effect sizes for motor coordination and moderate for cognitive flexibility indices.
Post hoc comparisons revealed that all three intervention groups improved significantly more than controls for completed categories, perseverative errors, and motor coordination. No significant differences surfaced between intervention groups for completed categories, indicating equivalent efficacy. However, the combined intervention significantly outperformed purposeful-movement play in reducing perseverative errors (p < 0.05), matching cognitive rehabilitation’s effect, while purposeful-movement play and cognitive rehabilitation did not differ on this measure.
Regarding motor coordination, both combined and purposeful-movement play groups showed superior improvement compared to cognitive rehabilitation (p < 0.05), with no difference between combined and purposeful-movement play. These findings suggest both cognitive and motor-specific interventions enhance cognitive flexibility and coordination independently, but purposeful-movement play exerts a stronger influence on motor skills, whereas integrating cognitive rehabilitation yields additional cognitive flexibility improvements.
Overall, results support the hypothesis that simultaneous cognitive–motor interventions may effectively address the multifaceted deficits characteristic of DCD.
 
Conclusion
The study demonstrates that cognitive rehabilitation, purposeful-movement play, and their combination effectively improve cognitive flexibility and motor coordination in girls with DCD. Purposeful-movement play, as a dynamic and task-oriented approach, delivered greater gains in motor coordination than cognitive rehabilitation alone, while the combined approach yielded enhanced reduction in perseverative errors—a key marker of cognitive flexibility. These outcomes underscore the importance of integrated approaches targeting both cognitive and motor impairments in DCD, consistent with its complex clinical presentation.
The combined intervention is especially promising for therapeutic contexts aiming to concurrently improve executive function and motor skill domains. Practitioners in school, rehabilitation, and clinical settings are encouraged to adopt structured purposeful play alongside cognitive training to maximize functional improvements. Future research should examine the long-term efficacy, ideal sequencing of interventions, and generalizability across genders and broader age ranges.
Keywords: Neuro-motor Disability, Perseveration, Executive Functions, Motor Development, Play Therapy
 
Article Message
This investigation provides comparative evidence on the relative efficacy of cognitive rehabilitation, purposeful-movement play, and their combination for enhancing cognitive flexibility and motor coordination in children with Developmental Coordination Disorder. While all approaches produced significant benefits, purposeful-movement play favored motor improvements, and the combined protocol offered superior gains in cognitive flexibility. The findings highlight the value of integrative interventions addressing DCD’s multidimensional nature. Such strategies may be effectively implemented in educational, clinical, and rehabilitation settings to promote functional development and daily activity participation.
Ethical Considerations
Throughout the study, full adherence to research ethics principles and standards of scientific conduct was maintained.
 Authors’ Contributions
Conceptualization: Dr. S. Rafiee and Dr. M. Namazizadeh
Data Collection: R. Abbasian Borujeni
Data Analysis: Dr. F. Tojari
Manuscript Writing: R. Abbasian Borujeni
Review and Editing: Dr. S. Rafiee
Responsible for Funding: Dr. S. Rafiee
Literature Review: Dr. S. Rafiee, R. Abbasian Borujeni, Dr. M. Namazizadeh
Project Management: Dr. S. Rafiee
Other Contributions: N/A
Conflict of Interest
The authors declare no conflicts of interest in relation to this study.
 
Acknowledgments
This research is derived from a doctoral dissertation. The authors express sincere gratitude to all participants and organizations involved in facilitating this study.