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

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders with heterogeneous clinical features such as inattention, hyperactivity, and impulsivity.

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 balance tasks were more pronounced than typically developing children. The motor problems seen in children with ADHD may be caused by dysfunction in some related brain regions that delayed or impaired cerebellar development may contribute to the pathophysiology of ADHD. Motor imagery skills have been investigated as the underlying cause of motor impairment in children with ADHD and Developmental Coordination Disorder (DCD). Although it has shown that motor imagery is markedly impaired in children with DID; It has been stated that this situation is not clear in children with ADHD. Motor imagery is the mental thinking of a movement without actual movement being revealed.

It has been reported that combined physical and mental 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. Pharmacological treatments, including stimulant and non-stimulant drugs, are highly effective in reducing ADHD symptoms and the disruptive behaviours associated with them. Also, physical exercises are known to reduce ADHD symptoms. Exercise methods enable patients receiving drug therapy to respond better to drugs, it has been shown to improve cognitive functions in ADHD cases.

In conclusion, the underlying aetiology of motor imagery skills and motor coordination and balance problems in ADHD is not clear. The use of telerehabilitation methods has become widespread due to the difficulties in conducting face-to-face treatment and follow-up processes during the pandemic process. In addition, there is no exercise program based on telerehabilitation and motor imagery in children with ADHD. This study aims to examine the effects of telerehabilitation-based exercise and motor imagery practices on ADHD symptoms and balance skills in children with ADHD.

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.

Eligibility Criteria:
Inclusion Criteria:

* Diagnosis of ADHD
* Between the ages of 7-12
* Volunteer
* Not using psychostimulant drugs for at least two months

Exclusion Criteria:

* Having a systemic disease that affects physical assessments
* Having severe visual impairment (color blindness, strabismus, etc.)
* Having a neurological disease
* Having a musculoskeletal disease
* Having any neuropsychiatric disorder other than Oppositional Defiant Disorder, anxiety disorders, and mood disorders
* Having Developmental Coordination Disorder
* Have previously participated in a motor imaging or motor imaging-like study/practice
* Having an IQ score of 80 and below
* Being a licensed athlete