The aim of this randomized controlled trial is to investigate the effects of group-based rhythm-based body percussion training on neuromotor performance, attention, and functionality in adolescents with mild intellectual disability.
The study will be conducted in individuals aged 14-18 years with mild intellectual disability using a two-arm, parallel-group, evaluator-blind design. Participants will be assigned to experimental and control groups using a simple randomization method.
The experimental group will receive structured body percussion training twice a week for 45 minutes over 8 weeks. This training consists of rhythmic patterns including clapping, knee tapping, chest tapping, finger snapping, and foot tapping, and will be presented as a progressively advancing program with metronome accompaniment.
The control group will receive passive music listening without intervention for the same duration and frequency.
Participants will be evaluated at two time points: before and after the intervention. Evaluation tools include: The tests cover neuromotor performance with the Minnesota Hand Skills Test and the Four Square Step Test, rhythm coordination with the Metronome Synchronization Test, attention with the Stroop Test, and functionality with the World Health Organization Disability Assessment Chart 2.0.
Being an adolescent aged 14-19 attending high school (e.g., special education high school)
Having been diagnosed with mild intellectual disability (IQ range according to relevant psychological assessment)
Having communication skills sufficient to understand simple commands and adapt to work
Being able to perform basic daily living activities (toilet hygiene and management, bladder/bowel management, eating, bathing, personal hygiene, dressing, functional mobility, etc.) independently or with minimal support, regardless of the level of disability
Painful musculoskeletal/orthopedic (rheumatic, etc.) problems that may prevent physical participation in rhythm-based body percussion training, restrict movement during training, and cause pain
Cardiovascular problems (arrhythmia, hypertension, etc.) that may prevent participants from attending training during the study period
Diagnosis of moderate or severe intellectual disability
Presence of additional diagnoses such as autism spectrum disorder, cerebral palsy, or developmental coordination disorder
Parallel
Rhythm-based body percussion training group
Other interventionBody percussion training consists of specific movement combinations and rhythmic patterns. The basic striking areas used in training are defined as the hand, chest, knee, and foot. Foot movements are divided into two sub-regions to produce different sound tones: heel strike ("dum") and toe strike ("tek"). All movements are supported by visual symbols to make it easier for participants to follow the rhythmic patterns.
Control group (passive listening) group
Other interventionThe music used for body percussion training will be played at specific intervals for 45 minutes to maintain attention (in 3 rounds: 15 minutes listening followed by a 1-2 minute break). The music volume will be adjusted so as not to disturb any of the participants. Metronome adjustments, which are important in progression, will be applied similarly to the experimental group.
Minnesota Hand Dexterity Test
This is a test used to assess upper extremity function and coordination. Participants sit in a seated position with a table in front of them and are asked to move, place, or rotate small, standard-sized, disc-shaped objects across the table to varying distances within the shortest possible time. The placement test can be performed separately for the dominant and non-dominant sides. Participants are asked to pick up 40 cylindrical objects one by one using only one hand and place them in the appropriate hole. The rotation test requires coordinated work of both hands. Individuals are asked to pick up a disc-shaped object with one hand, lift it, rotate it so that the other side is facing the floor, pass it to the other hand, and then place the object in the corresponding hole with the other hand. For individuals with mild intellectual disabilities, step-by-step guidance will be provided as needed to manage complexity during the test.
Minnesota Hand Dexterity Test
This is a test used to assess upper extremity function and coordination. Participants sit in a seated position with a table in front of them and are asked to move, place, or rotate small, standard-sized, disc-shaped objects across the table to varying distances within the shortest possible time. The placement test can be performed separately for the dominant and non-dominant sides. Participants are asked to pick up 40 cylindrical objects one by one using only one hand and place them in the appropriate hole. The rotation test requires coordinated work of both hands. Individuals are asked to pick up a disc-shaped object with one hand, lift it, rotate it so that the other side is facing the floor, pass it to the other hand, and then place the object in the corresponding hole with the other hand. For individuals with mild intellectual disabilities, step-by-step guidance will be provided as needed to manage complexity during the test.
The Four Square Step Test
The test assesses dynamic balance through multi-directional stepping. The test area will be prepared by placing four 90 cm rods on the floor to create four squares. The test requires stepping forward, backward, and sideways over the obstacles in a specific sequence. Participants attempt to complete the test by stepping between the squares in the required sequence as quickly as possible; they must avoid touching the rods and follow the correct step sequence. The timer starts when the first foot touches the first square and ends when the last foot touches the fourth square. For individuals with mild intellectual disabilities, colored numbers (1 = green, 2 = blue, 3 = black, 4 = yellow) will be placed at the corners of the squares, and a red circle indicating forward-facing position will be placed on the wall.
The Four Square Step Test
The test assesses dynamic balance through multi-directional stepping. The test area will be prepared by placing four 90 cm rods on the floor to create four squares. The test requires stepping forward, backward, and sideways over the obstacles in a specific sequence. Participants attempt to complete the test by stepping between the squares in the required sequence as quickly as possible; they must avoid touching the rods and follow the correct step sequence. The timer starts when the first foot touches the first square and ends when the last foot touches the fourth square. For individuals with mild intellectual disabilities, colored numbers (1 = green, 2 = blue, 3 = black, 4 = yellow) will be placed at the corners of the squares, and a red circle indicating forward-facing position will be placed on the wall.
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