The Effect of Body Percussion Training on Neuromotor Performance, Attention, and Functionality in Adolescents With Mild Intellectual Disability

Primary outcomes

1. Minnesota Hand Dexterity Test

   Time frame: before the intervention

   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.

2. Minnesota Hand Dexterity Test

   Time frame: 8 weeks of training

   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.

3. The Four Square Step Test

   Time frame: before the intervention

   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.

4. The Four Square Step Test

   Time frame: 8 weeks of training

   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.

5. Metronome Synchronization Test:

   Time frame: before the intervention

   This is a test that assesses sensorimotor synchronization skills using a clapping task accompanied by a metronome. Participants are asked to clap in sync with the metronome rhythm, and the accuracy of the synchronization (asynchrony (timing error), variability (rhythm variation), accuracy) is evaluated using an observational scoring system. The scoring is as follows: 0-Unable to follow the rhythm, 1-Frequent rhythm errors, 2-Moderate compliance, 3-Significant compliance with the rhythm, 4-Complete synchronization.

6. Metronome Synchronization Test:

   Time frame: 8 weeks of training

   This is a test that assesses sensorimotor synchronization skills using a clapping task accompanied by a metronome. Participants are asked to clap in sync with the metronome rhythm, and the accuracy of the synchronization (asynchrony (timing error), variability (rhythm variation), accuracy) is evaluated using an observational scoring system. The scoring is as follows: 0-Unable to follow the rhythm, 1-Frequent rhythm errors, 2-Moderate compliance, 3-Significant compliance with the rhythm, 4-Complete synchronization.

7. Stroop Test

   Time frame: before the intervention

   This is a neuropsychological test widely used for both experimental and clinical purposes. It assesses the ability to inhibit cognitive interference when the processing of one stimulus feature affects the simultaneous processing of another feature of the same stimulus. Participants must perform a less automatic task and inhibit interference from a more automatic task. This difficulty in inhibiting the more automatic process is called the Stroop effect. In addition to measuring the ability to inhibit cognitive interference, the test is also used to measure other cognitive functions such as attention, processing speed, cognitive flexibility, and working memory. The number of errors and the time taken to complete the task will be recorded.

8. Stroop Test

   Time frame: 8 weeks of training

   This is a neuropsychological test widely used for both experimental and clinical purposes. It assesses the ability to inhibit cognitive interference when the processing of one stimulus feature affects the simultaneous processing of another feature of the same stimulus. Participants must perform a less automatic task and inhibit interference from a more automatic task. This difficulty in inhibiting the more automatic process is called the Stroop effect. In addition to measuring the ability to inhibit cognitive interference, the test is also used to measure other cognitive functions such as attention, processing speed, cognitive flexibility, and working memory. The number of errors and the time taken to complete the task will be recorded.

9. The World Health Organization Disability Assessment Scale 2.0

   Time frame: before the intervention

   This tool attempts to determine how much difficulty an individual experiences while performing certain activities and consists of 6 areas that include activities considered important in many cultures (17). These are grouped under the headings: 1) Cognition, 2) Movement, 3) Self-care, 4) Interaction, 5) Life activities, 6) Social participation. In each item of the scale, the individual's difficulty in certain areas of functioning in the last 30 days should be scored on a 5-point Likert scale as none, some, quite, much, or extremely. In our study, a 12-item short form will be used, suitable for our population of mildly intellectually disabled individuals. In addition, a 12-item proxy form will be requested from parents or special education teachers for those who are able to complete it.

10. The World Health Organization Disability Assessment Scale 2.0

    Time frame: 8 weeks of training

    This tool attempts to determine how much difficulty an individual experiences while performing certain activities and consists of 6 areas that include activities considered important in many cultures (17). These are grouped under the headings: 1) Cognition, 2) Movement, 3) Self-care, 4) Interaction, 5) Life activities, 6) Social participation. In each item of the scale, the individual's difficulty in certain areas of functioning in the last 30 days should be scored on a 5-point Likert scale as none, some, quite, much, or extremely. In our study, a 12-item short form will be used, suitable for our population of mildly intellectually disabled individuals. In addition, a 12-item proxy form will be requested from parents or special education teachers for those who are able to complete it.