اﺛﺮﺑﺨﺸﯽ ﺗﻮاﻧﺒﺨﺸﯽ ﺷﻨﺎﺧﺘﯽ و ﻧﻮروﻓﯿﺪﺑﮏ ﺑﺮ ﺑﻬﺒﻮد ﺣﺎﻓﻈﻪ ﮐﺎري ﮐﻮدﮐﺎن ﻣﺒﺘﻼ ﺑﻪ اﺧﺘﻼل ﮐﺎﺳﺘﯽ ﺗﻮﺟﻪ/ﺑﯿﺶﻓﻌﺎﻟﯽ

The Effect of Cognitive Rehabilitation and Neurofeedback on improving Working Memory in children with Attention Deficit Hyperactivity Disorder

ﻣﻘﺪﻣﻪ: ﭘﮋوﻫﺶ ﺣﺎﺿﺮ ﺑﻪ دﻧﺒﺎل ﺑﺮرﺳﯽ اﺛﺮﺑﺨﺸﯽ ﻧﻮروﻓﯿﺪﺑﮏ، ﺗﻮاﻧﺒﺨﺸﯽ ﺷﻨﺎﺧﺘﯽ و درﻣﺎن ﺗﺮﮐﯿﺒﯽ ﺑﺮ ﺣﺎﻓﻈﻪ ﮐﺎري ﮐﻮدﮐﺎن ﻣﺒﺘﻼ ﺑﻪ اﺧﺘﻼل ﮐﺎﺳﺘﯽ ﺗﻮﺟﻪ/ ﺑﯿﺶﻓﻌﺎﻟﯽ ﺑﻮد. روش ﮐﺎر: روش ﭘﮋوﻫﺶ ﺣﺎﺿﺮ از ﻧﻮع ﻧﯿﻤﻪ ﺗﺠﺮﺑﯽ، از ﻧﻮع ﭘﯿﺶآزﻣﻮن و ﭘﺲآزﻣﻮن ﺑﺎ ﯾﮏ ﮔﺮوه ﮐﻨﺘﺮل ﺑﻮد. ﺗﻌﺪاد 100 داﻧﺶ آﻣﻮز ﺑﻪ روش ﻧﻤﻮﻧﻪﮔﯿﺮي در دﺳﺘﺮس اﻧﺘﺨﺎب و در ﭼﻬﺎر ﮔﺮوه 25 ﻧﻔﺮي ﮐﻨﺘﺮل و آزﻣﺎﯾﺶ ﻧﻮروﻓﯿﺪﺑﮏ، ﺗﻮاﻧﺒﺨﺸﯽ ﺷﻨﺎﺧﺘﯽ و ﮔﺮوه آزﻣﺎﯾﺶ ﺗﺮﮐﯿﺒﯽ از دو روش ﻧﻮروﻓﯿﺪﺑﮏ و ﺗﻮاﻧﺒﺨﺸﯽ ﺷﻨﺎﺧﺘﯽ ﺑﻪ ﺻﻮرت ﺗﺼﺎدﻓﯽ ﺟﺎﯾﮕﺰﯾﻦ ﺷﺪﻧﺪ. ﮔﺮدآوري دادهﻫﺎ ﺑﺎ اﺳﺘﻔﺎده از ﭘﺮﺳﺸﻨﺎﻣﻪ ﺣﺎﻓﻈﻪ ﮐﺎري )آزﻣﻮن ﮐﺎﻣﭙﯿﻮﺗﺮي N-Back( ﺻﻮرت ﮔﺮﻓﺖ. ﻫﻤﭽﻨﯿﻦ ﺟﻠﺴﺎت ﻧﻮروﻓﯿﺪﺑﮏ در ﻃﻮل 5 ﻫﻔﺘﻪ، ﻫﻔﺘﻪاي دو ﺟﻠﺴﻪ 40 دﻗﯿﻘﻪاي ﺑﺮ اﺳﺎس ﭘﺎراداﯾﻢ درﻣﺎﻧﯽ آﻣﻮزش رﯾﺘﻢ ﺣﺴﯽ-ﺣﺮﮐﺘﯽ ﺑﺎ اﺳﺘﻔﺎده از دﺳﺘﮕﺎه ﭘﺮوﮐﺎﻣﭗ و ﺟﻠﺴﺎت ﺗﻮاﻧﺒﺨﺸﯽ ﺷﻨﺎﺧﺘﯽ در 14 ﺟﻠﺴﻪ ﻃﯽ دو روز در ﻫﻔﺘﻪ و ﺟﻠﺴﺎت ﺗﺮﮐﯿﺒﯽ ﻧﯿﺰ ﻃﯽ 24 ﺟﻠﺴﻪ 40 دﻗﯿﻘﻪاي ﻣﺮﺑﻮط ﺑﻪ ﻧﻮروﻓﯿﺪﺑﮏ و 30 دﻗﯿﻘﻪ ﻣﺮﺑﻮط ﺑﻪ ﺗﻮاﻧﺒﺨﺸﯽ ﺷﻨﺎﺧﺘﯽ ﺑﻪ ﺻﻮرت ﻫﻔﺘﻪاي ﺳﻪ ﺟﻠﺴﻪ ﺻﻮرت ﮔﺮﻓﺖ. دادهﻫﺎ ﺑﺎ اﺳﺘﻔﺎده از ﺗﺤﻠﯿﻞ ﮐﻮرﯾﺎﻧﺲ ﯾﮏ ﻃﺮﻓﻪ ﺑﯿﻦ ﮔﺮوﻫﯽ ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ ﺷﺪﻧﺪ. ﯾﺎﻓﺘﻪﻫﺎ: ﻧﺘﺎﯾﺞ ﻧﺸﺎن داد اﺟﺮاي ﺟﻠﺴﺎت ﻧﻮروﻓﯿﺪﺑﮏ، ﺗﻮاﻧﺒﺨﺸﯽ ﺷﻨﺎﺧﺘﯽ و ﺗﺮﮐﯿﺐ دو روش اﺛﺮ ﻣﻌﻨﺎداري ﺑﺮ ﺑﻬﺒﻮد ﺣﺎﻓﻆ ﮐﺎري داﻧﺶآﻣﻮزان ﻣﺒﺘﻼ ﺑﻪ اﺧﺘﻼل ﮐﺎﺳﺘﯽ ﺗﻮﺟﻪ/ ﺑﯿﺶﻓﻌﺎﻟﯽ دارد ﺑﻪ ﻃﻮري ﮐﻪ ﺑﻪ ﺗﺮﺗﯿﺐ داﻧﺶآﻣﻮزاﻧﯽ ﮐﻪ در ﮔﺮوه آزﻣﺎﯾﺶ ﺗﺤﺖ درﻣﺎن ﺗﻮاﻧﺒﺨﺸﯽ ﺷﻨﺎﺧﺘﯽ، ﺗﺮﮐﯿﺐ دو روش و ﻧﻮروﻓﯿﺪﺑﮏ ﻗﺮار ﮔﺮﻓﺘﻪ ﺑﻮدﻧﺪ از ﺳﻄﻮح ﺑﺎﻻﺗﺮ ﺣﺎﻓﻈﻪ ﮐﺎري ﻧﺴﺒﺖ ﺑﻪ داﻧﺶآﻣﻮزان ﮔﺮوه ﮐﻨﺘﺮل ﺑﺮﺧﻮردار ﺑﻮدﻧﺪ. ﻧﺘﯿﺠﻪ ﮔﯿﺮي: ﺑﻨﺎ ﺑﺮ ﻧﺘﺎﯾﺞ ﺑﺪﺳﺖ آﻣﺪه ﻣﺸﺨﺺ ﻣﯽﺷﻮد ﮐﻪ ﻧﻮروﻓﯿﺪﺑﮏ و ﺗﻮاﻧﺒﺨﺸﯽ ﺷﻨﺎﺧﺘﯽ ﻣﯽﺗﻮاﻧﻨﺪ ﺑﻪ ﻋﻨﻮان روﺷﯽ ﻣﺆﺛﺮ در ﺑﻬﺒﻮد ﺣﺎﻓﻈﻪ ﮐﺎري ﮐﻮدﮐﺎن ﻣﺒﺘﻼ ﺑﻪ اﺧﺘﻼل ﮐﺎﺳﺘﯽ ﺗﻮﺟﻪ/ ﺑﯿﺶﻓﻌﺎﻟﯽ در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﻮﻧﺪ.

Introduction: This study aimed to assess the Effectiveness of Cognitive Rehabilitation, neurofeedback and combination of these two methods on Working Memory in children whit Attention deficit hyperactivity disorder (ADHD). Methods: This pre-test and post-test quasi-experimental study was performed on 100 children with ADHD (6 to 12 years) referring to Tehran Psychiatric center in 2017 who were selected by convenience method and randomly assigned to four group of experimental and control (25 subjects in the experimental group based on Cognitive Rehabilitation, 25 in the experimental group based on neurofeedback, 25 in the experimental group based on combination of these two methods and 25 in the control group). Data were collected by using Kirchner working memory questionnaire (N-Back test). The neurofeedback sessions were conducted during 5 weeks, weekly two 40-minute sessions based on training paradigm sensory-motor rhythm by using the pro-camp device, cognitive rehabilitation in 14 sessions during two days a week and combined sessions were performed in 24 sessions of 40 minutes for neurofeedback and 30 minutes for cognitive rehabilitation in a weekly three sessions. The data was analyzed by Repeated Measures Analysis of Multiple Covariance (MANCOVA). Results: The results showed that the implementation of neurofeedback sessions, cognitive rehabilitation, and combination of two methods have a significant effect on improving the working memory of students with attention deficit hyperactivity disorder, so in the experimental groups, the students had higher levels of working memory respectively in cognitive rehabilitation, combination of two methods and neurofeedback than control group. Conclusions: Therefore, it can be said that neurofeedback and cognitive rehabilitation can be considered as effective interventions to improve the working memory of children with (ADHD).