The Effect of Pilates Training on Physical Performance and Social Skills in Children with Autism: A Randomized Controlled Trial
Year 2023,
, 565 - 578, 30.09.2023
Nazan Öztürk
,
Ayşe Kübra Söyler
,
Selvinaz Saçan
,
Fatma Ünver
,
Derya Adıbelli
,
Selen Serel Arslan
Abstract
Objective: Aerobic training has been recommended for children with autism due to its important benefits on physical, cognitive and behavioral functions of children. Nevertheless, there is no evidence regarding the effects of pilates training in children with autism. The present study was aimed to determine the effects of pilates training by comparing the effects of AT on muscle strength, balance performance, gross motor skills and social skills in children with autism.
Method: A total of 22 children with autism were included in the study. As outcome measures, maximal isometric muscle strength, balance performance, gross motor skills and social skills were evaluated.
Results: Improvements were observed in both training groups in balance performance and gross motor skills scores, but no improvement in social skills score (p < 0.05). There was a significant improvement in muscle strength only in the aerobic training group (p < 0.05). The between group comparisons showed that all included outcome measures were statistically similar for both aerobic training and pilates training groups (p > 0.05).
Conclusion: The present study shows that aerobic training and pilates training are both effective in the improvement of balance performance and gross motor skills in children with autism, with more improvement in muscle strength in aerobic training. Pilates education can be considered as an alternative education as it increases balance performance and motor skills in children with autism.
References
- 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association. 2013.
- 2. Kern, J. K., Geier, D. A., Adams, J. B., Troutman, M. R., Davis, G. A, King, P. G., et al. (2013). Handgrip strength in
autism spectrum disorder compared with controls. J Strength Cond Res, 27(8), 2277-2281. doi:
10.1519/JSC.0b013e31827de068.
- 3. Ludyga, S., Pühse, U., Gerber, M., & Mücke, M. (2021). Muscle strength and executive function in children
and adolescents with autism spectrum disorder. Autism Res, 14(12),2555-2563. doi: 10.1002/aur.2587.
- 4. Stins, J. F., & Emck, C. (2018). Balance Performance in Autism: A Brief Overview. Front - Psychol, 5(9), 901.
doi: 10.3389/fpsyg.2018.00901. PMID: 29922206; PMCID: PMC5996852.
- 5. Wilson, R. B., Enticott, P. G., & Rinehart, N. J. (2018). Motor development and delay: advances in
assessment of motor skills in autism spectrum disorders. Curr Opin Neurol, 31(2), 134-139. doi:
10.1097/WCO.0000000000000541.PMID: 29493557.
- 6. Jones, R. A., Downing, K., Rinehart, N. J., Barnett, L. M., May, T., McGillivray, J. A., et al. (2017). Physical activity,
sedentary behavior and their correlates in children with autism spectrum disorder: A systematic review. PloS
one, 12(2), e0172482. doi: 10.1371/journal. pone.0172482.
- 7. Ruggeri, A., Dancel, A., Johnson, R., & Sargent, B. (2020). The effect of motor and physical activity
intervention on motor outcomes of children with autism spectrum disorder: A systematic review. Autism,
24(3), 544-568. doi: 10.1177/1362361319885215. Epub 2019 Nov 29. PMID: 31782658.
- 8. Healy, S., Nacario, A., Braithwaite, R. E., & Hopper, C. (2018). The effect of physical activity interventions on
youth with autism spectrum disorder: A meta‐analysis. Autism Res, 11(6), 818-833. doi: 10.1002/aur.1955. Epub
2018 Apr 25.
- 9. Reinders, N. J., Branco, A., Wright, K., Fletcher, P. C., & Bryden, P. J. (2019). Scoping review: Physical activity
and social functioning in young people with autism spectrum disorder. Front Psychol, 10, 120. doi:
10.3389/fpsyg.2019.00120.
- 10. Brand, S., Jossen, S., Holsboer-Trachsler, E., Pühse, U., & Gerber, M. (2015). Impact of aerobic exercise on
sleep and motor skills in children with autism spectrum disorders–a pilot study. Neuropsychiatr Dis Treat, 11,
1911–1920. doi: 10.2147/NDT.S85650.
- 11. Oriel, K. N., George, C. L., Peckus, R., & Semon, A. (2011). The effects of aerobic exercise on academic
engagement in young children with autism spectrum disorder. Pediatr Phys Ther, 23(2), 187-193. doi:
10.1097/PEP.0b013e318218f149.
- 12. Pitetti, K. H., Rendoff, A. D., Grover, T., & Beets, M. W. (2007). The efficacy of a 9-month treadmill walking
program on the exercise capacity and weight reduction for adolescents with severe autism. J Autism Dev
Disord, 37(6), 997-1006. doi: 10.1007/s10803-006-0238-3.
- 13. Ringenbach, S. D., Lichtsinn, K. C., & Holzapfel, S. D. (2015). Assisted Cycling Therapy (ACT) improves
inhibition in adolescents with autism spectrum disorder. J Intellect Dev Disabil, 40(4),376-387.
https://doi.org/10.3109/13668250.2015.1080352.
- 14. Elliott, R. O., Dobbin, A. R., Rose, G. D., & Soper, H. V. (1994). Vigorous, aerobic exercise versus general motor
training activities: Effects on maladaptive and stereotypic behaviors of adults with both autism and mental
retardation. J Autism Dev Disord, 24 (5), 565-576. Doi: 10.1007/BF02172138.
- 15. Kaur, M., & Bhat, A. (2019). Creative yoga intervention improves motor and imitation skills of children with
autism spectrum disorder. Physical ther, 99(11), 1520-1534. doi: 10.1093/ptj/pzz115.
- 16. Koenig, K. P., Buckley-Reen, A., & Garg, S. (2012). Efficacy of the Get Ready to Learn yoga program among
children with autism spectrum disorders: A pretest–posttest control group design. Am J Occup Ther, 66 (5),
538-546. doi: 10.5014/ajot.2012.004390.
- 17. Sarabzadeh, M., Azari, B. B., & Helalizadeh, M. (2019). The effect of six weeks of Tai Chi Chuan training on the motor skills of children with Autism Spectrum Disorder. J Bodyw Mov Ther, 23(2), 284-290. doi:
10.1016/j.jbmt.2019.01.007. Epub 2019 Jan 28.
- 18. Hornsby, E., & Johnston, L. M. (2020). Effect of pilates intervention on physical function of children and
youth: a systematic review. Arch Phys Med Rehabil, 101(2), 317-328. doi: 10.1016/j.apmr.2019.05.023. Epub 2019
May 30.
- 19. Fleming, K. M., & Herring, M. P. (2018). The effects of pilates on mental health outcomes: A meta-analysis of controlled trials. Complement Ther Med, 37,80-95. doi: 10.1016/j.ctim.2018.02.003. Epub 2018 Feb 13. PMID:
29609943.
- 20. Cibinello, F. U., de Jesus Neves, J. C., Carvalho, M. Y. L., Valenciano, P. J., & Fujisawa, D. S. (2020). Effect of Pilates Matwork exercises on posterior chain flexibility and trunk mobility in school children: A randomized
clinical trial. J Bodyw Mov Ther, (4), 176-181. doi: 10.1016/j.jbmt.2020.06.016. Epub 2020 Jul 13.
- 21. Finatto, P., Silva, E. S. D., Okamura, A. B., Almada, B. P., Oliveira, H. B., & Peyre-Tartaruga, L. A. (2018). Pilates training improves 5-km run performance by changing metabolic cost and muscle activity in trained
runners. PloS one, 13(3), e0194057. https://doi.org/10.1371/journal.pone.0196509.
- 22. Fragala-Pinkham, M. A., Haley, S. M., Rabin, J., & Kharasch, V. S. (2005). A fitness program for children with
disabilities. Phys Ther, 85(11), 1182-1200. https://doi.org/10.1093/ptj/85.11.1182.
- 23. Mahon, A. D., Marjerrison, A. D., Lee, J. D., Woodruff, M. E., & Hanna, L. E. (2018). Evaluating the prediction of
maximal heart rate in children and adolescents. Res Q Exerc Sport, 81(4), 466-471. doi:
10.1080/02701367.2010.10599707.
- 24. Roy, J. S., MacDermid, J. C., Orton, B., Tran, T., Faber, K. J., Drosdowech, D., et al. (2009). The concurrent
validity of a hand-held versus a stationary dynamometer in testing isometric shoulder strength. J Hand Ther,
22(4), 320-327. doi: 10.1016/j.jht.2009.04.008. Epub 2009 Jun 26.
- 25. Mentiplay, B. F., Perraton, L. G., Bower, K. J., Adair, B., Pua, Y. H., Williams, G. P., et al. (2015). Assessment of
lower limb muscle strength and power using hand-held and fixed dynamometry: a reliability and validity
study. PloS one, 10(10), e0140822. Doi: 10.1371/journal. pone.0140822.
- 26. Ortega-Pérez de Villar, L., Martínez-Olmos, F. J., Junqué-Jiménez, A., Amer-Cuenca, J. J., Martínez-
Gramage, J., Mercer, T., et al. (2018). Test-retest reliability and minimal detectable change scores for the
short physical performance battery, one-legged standing test and timed up and go test in patients
undergoing hemodialysis. PloS one, 13(8), e0201035. doi: 10.1371/journal. pone.0201035. eCollection 2018.
- 27. Menekşe, B. O. Z., & Aytar, A. G. (2012). Adaptation Study of Large Muscle Motor Development-2 (TGMD-2)
Test to Turkish Children. MJER, (12), 17-24.
- 28. Demir, Ş., & Sucuoğlu, B. (2009). Evaluation of social skills of children with autism in terms of different
variables. (Doctoral dissertation), Ankara University Institute of Educational Sciences Department of Special
Education, Ankara.
- 29. Scholes, S. (2017). Health Survey for England 2016: Physical Actviity in Adults. NHS Digital.
- 30. Alsakhawi, R. S., & Elshafey, M. A. (2019). Effect of core stability exercises and treadmill training on balance
in children with Down syndrome: randomized controlled trial. Adv Ther, 36(9), 2364-2373. doi: 10.1007/s12325-019-01024-2. Epub 2019 Jul 12.
- 31. Carmeli, E., Kessel, S., Coleman, R., & Ayalon, M. (2002). Effects of a treadmill walking program on muscle
strength and balance in elderly people with Down syndrome. J Gerontol A Biol Sci Med Sci, 57(2), M106-M110.
doi: 10.1093/gerona/57.2.m106.
- 32. El-Meniawy, G. H., Kamal, H. M., & Elshemy, S. A. (2012). Role of treadmill training versus suspension
therapy on balance in children with Down syndrome. Egypt J Medical Hum Genet, 13(1), 37-43. doi:
10.1016/j.ejmhg.2011.10.001.
- 33. Mohamed, R. A., & Sherief, A. E. A. A. (2015). Bicycle ergometer versus treadmill on balance and gait
parameters in children with hemophilia. Egypt J Med Hum Genet, 16(2), 181-187.
https://doi.org/10.1016/j.ejmhg.2014.11.001.
- 34. Bulguroglu, I., Guclu-Gunduz, A., Yazici, G., Ozkul C, Irkec, C., Nazliel, B., ve ark. (2017). The effects of Mat
Pilates and Reformer Pilates in patients with Multiple Sclerosis: A randomized controlled study.
NeuroRehabilitation, 41(2), 413-422. doi: 10.3233/NRE-162121.
- 35. Guclu-Gunduz, A., Citaker, S., Irkec, C., Nazliel, B., & Batur-Caglayan, H. Z. (2014). The effects of pilates on
balance, mobility and strength in patients with multiple sclerosis. NeuroRehabilitation, 34(2), 337-342. doi:
10.3233/NRE-130957.
- 36. Rafiei Milajerdi, H., Sheikh, M., Najafabadi, M. G., Saghaei, B., Naghdi, N., & Dewey D. (2021).The effects of physical activity and exergaming on motor skills and executive functions in children with autism spectrum disorder. Games Health J, 10(1), 33-42. doi: 10.1089/g4h.2019.0180. Epub 2020 Dec 23.
- 37. Mache, M. A., & Todd, T. A. (2016). Gross motor skills are related to postural stability and age in children
with autism spectrum disorder. Res Autism Spectr Disord, 23, 179–187. https://doi.org/10.1016/j.rasd.2016.01.001.
- 38. Hawks, Z., Constantino, J. N., Weichselbaum, C., & Marrus, N. (2020). Accelerating motor skill acquisition
for bicycle riding in children with ASD: A pilot study. J Autism Dev Disord, 50(1), 342-348. doi: 10.1007/s10803-
019-04224-5.
- 39. LaGasse, A. B. (2014). Effects of a music therapy group intervention on enhancing social skills in children
with autism. J Music Ther, 51(3), 250-275. doi: 10.1093/jmt/thu012. Epub 2014 Jul 22.
- 40. Kunzi, K. (2015). Improving social skills of adults with autism spectrum disorder through physical activity,
sports, and games: A review of the literature. Adultspan J, 14(2), 100-113. https://doi.org/10.1002/adsp.12008
Otizmli Çocuklarda Pilates Eğitiminin Fiziksel Performans ve Sosyal Becerilere Etkisi: Randomize Kontrollü Bir Çalışma
Year 2023,
, 565 - 578, 30.09.2023
Nazan Öztürk
,
Ayşe Kübra Söyler
,
Selvinaz Saçan
,
Fatma Ünver
,
Derya Adıbelli
,
Selen Serel Arslan
Abstract
Amaç: Aerobik eğitim, çocukların fiziksel, bilişsel ve davranışsal işlevleri üzerindeki önemli faydaları nedeniyle otizmli çocuklar için önerilmektedir. Buna rağmen, otizmli çocuklarda pilates eğitiminin etkilerine ilişkin herhangi bir kanıt bulunmamaktadır. Bu çalışmada, otizmli çocuklarda pilates eğitiminin kas kuvveti, denge performansı, kaba motor beceriler ve sosyal beceriler üzerindeki etkilerinin karşılaştırılması amaçlandı.
Yöntem: Çalışmaya toplam 22 otizmli çocuk dahil edildi. Sonuç ölçütleri olarak maksimal izometrik kas kuvveti, denge performansı, kaba motor beceriler ve sosyal beceriler değerlendirildi.
Bulgular: Her iki eğitim grubunda da denge performansı ve kaba motor becerileri skorlarında iyileşme gözlenirken, sosyal beceri skorunda iyileşme gözlenmedi (p < 0,05). Kas gücünde sadece aerobik eğitim grubunda anlamlı bir iyileşme görüldü (p < 0,05). Gruplar arası karşılaştırmalarda, tüm sonuç ölçümlerinin hem aerobik eğitim hem de pilates eğitim grupları için istatistiksel olarak benzer olduğunu gösterdi (p > 0,05).
Sonuç: Bu çalışma, aerobik eğitim ve pilates eğitiminin her ikisinin de otizmli çocuklarda denge performansının ve kaba motor becerilerin geliştirilmesinde etkili olduğunu ve aerobik eğitimde kas gücünde daha fazla iyileşme olduğunu göstermektedir. Pilates eğitimi, otizmli çocuklarda denge performansını ve motor becerileri arttırdığı için alternatif bir eğitim olarak düşünülebilir.
Supporting Institution
Yok
References
- 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association. 2013.
- 2. Kern, J. K., Geier, D. A., Adams, J. B., Troutman, M. R., Davis, G. A, King, P. G., et al. (2013). Handgrip strength in
autism spectrum disorder compared with controls. J Strength Cond Res, 27(8), 2277-2281. doi:
10.1519/JSC.0b013e31827de068.
- 3. Ludyga, S., Pühse, U., Gerber, M., & Mücke, M. (2021). Muscle strength and executive function in children
and adolescents with autism spectrum disorder. Autism Res, 14(12),2555-2563. doi: 10.1002/aur.2587.
- 4. Stins, J. F., & Emck, C. (2018). Balance Performance in Autism: A Brief Overview. Front - Psychol, 5(9), 901.
doi: 10.3389/fpsyg.2018.00901. PMID: 29922206; PMCID: PMC5996852.
- 5. Wilson, R. B., Enticott, P. G., & Rinehart, N. J. (2018). Motor development and delay: advances in
assessment of motor skills in autism spectrum disorders. Curr Opin Neurol, 31(2), 134-139. doi:
10.1097/WCO.0000000000000541.PMID: 29493557.
- 6. Jones, R. A., Downing, K., Rinehart, N. J., Barnett, L. M., May, T., McGillivray, J. A., et al. (2017). Physical activity,
sedentary behavior and their correlates in children with autism spectrum disorder: A systematic review. PloS
one, 12(2), e0172482. doi: 10.1371/journal. pone.0172482.
- 7. Ruggeri, A., Dancel, A., Johnson, R., & Sargent, B. (2020). The effect of motor and physical activity
intervention on motor outcomes of children with autism spectrum disorder: A systematic review. Autism,
24(3), 544-568. doi: 10.1177/1362361319885215. Epub 2019 Nov 29. PMID: 31782658.
- 8. Healy, S., Nacario, A., Braithwaite, R. E., & Hopper, C. (2018). The effect of physical activity interventions on
youth with autism spectrum disorder: A meta‐analysis. Autism Res, 11(6), 818-833. doi: 10.1002/aur.1955. Epub
2018 Apr 25.
- 9. Reinders, N. J., Branco, A., Wright, K., Fletcher, P. C., & Bryden, P. J. (2019). Scoping review: Physical activity
and social functioning in young people with autism spectrum disorder. Front Psychol, 10, 120. doi:
10.3389/fpsyg.2019.00120.
- 10. Brand, S., Jossen, S., Holsboer-Trachsler, E., Pühse, U., & Gerber, M. (2015). Impact of aerobic exercise on
sleep and motor skills in children with autism spectrum disorders–a pilot study. Neuropsychiatr Dis Treat, 11,
1911–1920. doi: 10.2147/NDT.S85650.
- 11. Oriel, K. N., George, C. L., Peckus, R., & Semon, A. (2011). The effects of aerobic exercise on academic
engagement in young children with autism spectrum disorder. Pediatr Phys Ther, 23(2), 187-193. doi:
10.1097/PEP.0b013e318218f149.
- 12. Pitetti, K. H., Rendoff, A. D., Grover, T., & Beets, M. W. (2007). The efficacy of a 9-month treadmill walking
program on the exercise capacity and weight reduction for adolescents with severe autism. J Autism Dev
Disord, 37(6), 997-1006. doi: 10.1007/s10803-006-0238-3.
- 13. Ringenbach, S. D., Lichtsinn, K. C., & Holzapfel, S. D. (2015). Assisted Cycling Therapy (ACT) improves
inhibition in adolescents with autism spectrum disorder. J Intellect Dev Disabil, 40(4),376-387.
https://doi.org/10.3109/13668250.2015.1080352.
- 14. Elliott, R. O., Dobbin, A. R., Rose, G. D., & Soper, H. V. (1994). Vigorous, aerobic exercise versus general motor
training activities: Effects on maladaptive and stereotypic behaviors of adults with both autism and mental
retardation. J Autism Dev Disord, 24 (5), 565-576. Doi: 10.1007/BF02172138.
- 15. Kaur, M., & Bhat, A. (2019). Creative yoga intervention improves motor and imitation skills of children with
autism spectrum disorder. Physical ther, 99(11), 1520-1534. doi: 10.1093/ptj/pzz115.
- 16. Koenig, K. P., Buckley-Reen, A., & Garg, S. (2012). Efficacy of the Get Ready to Learn yoga program among
children with autism spectrum disorders: A pretest–posttest control group design. Am J Occup Ther, 66 (5),
538-546. doi: 10.5014/ajot.2012.004390.
- 17. Sarabzadeh, M., Azari, B. B., & Helalizadeh, M. (2019). The effect of six weeks of Tai Chi Chuan training on the motor skills of children with Autism Spectrum Disorder. J Bodyw Mov Ther, 23(2), 284-290. doi:
10.1016/j.jbmt.2019.01.007. Epub 2019 Jan 28.
- 18. Hornsby, E., & Johnston, L. M. (2020). Effect of pilates intervention on physical function of children and
youth: a systematic review. Arch Phys Med Rehabil, 101(2), 317-328. doi: 10.1016/j.apmr.2019.05.023. Epub 2019
May 30.
- 19. Fleming, K. M., & Herring, M. P. (2018). The effects of pilates on mental health outcomes: A meta-analysis of controlled trials. Complement Ther Med, 37,80-95. doi: 10.1016/j.ctim.2018.02.003. Epub 2018 Feb 13. PMID:
29609943.
- 20. Cibinello, F. U., de Jesus Neves, J. C., Carvalho, M. Y. L., Valenciano, P. J., & Fujisawa, D. S. (2020). Effect of Pilates Matwork exercises on posterior chain flexibility and trunk mobility in school children: A randomized
clinical trial. J Bodyw Mov Ther, (4), 176-181. doi: 10.1016/j.jbmt.2020.06.016. Epub 2020 Jul 13.
- 21. Finatto, P., Silva, E. S. D., Okamura, A. B., Almada, B. P., Oliveira, H. B., & Peyre-Tartaruga, L. A. (2018). Pilates training improves 5-km run performance by changing metabolic cost and muscle activity in trained
runners. PloS one, 13(3), e0194057. https://doi.org/10.1371/journal.pone.0196509.
- 22. Fragala-Pinkham, M. A., Haley, S. M., Rabin, J., & Kharasch, V. S. (2005). A fitness program for children with
disabilities. Phys Ther, 85(11), 1182-1200. https://doi.org/10.1093/ptj/85.11.1182.
- 23. Mahon, A. D., Marjerrison, A. D., Lee, J. D., Woodruff, M. E., & Hanna, L. E. (2018). Evaluating the prediction of
maximal heart rate in children and adolescents. Res Q Exerc Sport, 81(4), 466-471. doi:
10.1080/02701367.2010.10599707.
- 24. Roy, J. S., MacDermid, J. C., Orton, B., Tran, T., Faber, K. J., Drosdowech, D., et al. (2009). The concurrent
validity of a hand-held versus a stationary dynamometer in testing isometric shoulder strength. J Hand Ther,
22(4), 320-327. doi: 10.1016/j.jht.2009.04.008. Epub 2009 Jun 26.
- 25. Mentiplay, B. F., Perraton, L. G., Bower, K. J., Adair, B., Pua, Y. H., Williams, G. P., et al. (2015). Assessment of
lower limb muscle strength and power using hand-held and fixed dynamometry: a reliability and validity
study. PloS one, 10(10), e0140822. Doi: 10.1371/journal. pone.0140822.
- 26. Ortega-Pérez de Villar, L., Martínez-Olmos, F. J., Junqué-Jiménez, A., Amer-Cuenca, J. J., Martínez-
Gramage, J., Mercer, T., et al. (2018). Test-retest reliability and minimal detectable change scores for the
short physical performance battery, one-legged standing test and timed up and go test in patients
undergoing hemodialysis. PloS one, 13(8), e0201035. doi: 10.1371/journal. pone.0201035. eCollection 2018.
- 27. Menekşe, B. O. Z., & Aytar, A. G. (2012). Adaptation Study of Large Muscle Motor Development-2 (TGMD-2)
Test to Turkish Children. MJER, (12), 17-24.
- 28. Demir, Ş., & Sucuoğlu, B. (2009). Evaluation of social skills of children with autism in terms of different
variables. (Doctoral dissertation), Ankara University Institute of Educational Sciences Department of Special
Education, Ankara.
- 29. Scholes, S. (2017). Health Survey for England 2016: Physical Actviity in Adults. NHS Digital.
- 30. Alsakhawi, R. S., & Elshafey, M. A. (2019). Effect of core stability exercises and treadmill training on balance
in children with Down syndrome: randomized controlled trial. Adv Ther, 36(9), 2364-2373. doi: 10.1007/s12325-019-01024-2. Epub 2019 Jul 12.
- 31. Carmeli, E., Kessel, S., Coleman, R., & Ayalon, M. (2002). Effects of a treadmill walking program on muscle
strength and balance in elderly people with Down syndrome. J Gerontol A Biol Sci Med Sci, 57(2), M106-M110.
doi: 10.1093/gerona/57.2.m106.
- 32. El-Meniawy, G. H., Kamal, H. M., & Elshemy, S. A. (2012). Role of treadmill training versus suspension
therapy on balance in children with Down syndrome. Egypt J Medical Hum Genet, 13(1), 37-43. doi:
10.1016/j.ejmhg.2011.10.001.
- 33. Mohamed, R. A., & Sherief, A. E. A. A. (2015). Bicycle ergometer versus treadmill on balance and gait
parameters in children with hemophilia. Egypt J Med Hum Genet, 16(2), 181-187.
https://doi.org/10.1016/j.ejmhg.2014.11.001.
- 34. Bulguroglu, I., Guclu-Gunduz, A., Yazici, G., Ozkul C, Irkec, C., Nazliel, B., ve ark. (2017). The effects of Mat
Pilates and Reformer Pilates in patients with Multiple Sclerosis: A randomized controlled study.
NeuroRehabilitation, 41(2), 413-422. doi: 10.3233/NRE-162121.
- 35. Guclu-Gunduz, A., Citaker, S., Irkec, C., Nazliel, B., & Batur-Caglayan, H. Z. (2014). The effects of pilates on
balance, mobility and strength in patients with multiple sclerosis. NeuroRehabilitation, 34(2), 337-342. doi:
10.3233/NRE-130957.
- 36. Rafiei Milajerdi, H., Sheikh, M., Najafabadi, M. G., Saghaei, B., Naghdi, N., & Dewey D. (2021).The effects of physical activity and exergaming on motor skills and executive functions in children with autism spectrum disorder. Games Health J, 10(1), 33-42. doi: 10.1089/g4h.2019.0180. Epub 2020 Dec 23.
- 37. Mache, M. A., & Todd, T. A. (2016). Gross motor skills are related to postural stability and age in children
with autism spectrum disorder. Res Autism Spectr Disord, 23, 179–187. https://doi.org/10.1016/j.rasd.2016.01.001.
- 38. Hawks, Z., Constantino, J. N., Weichselbaum, C., & Marrus, N. (2020). Accelerating motor skill acquisition
for bicycle riding in children with ASD: A pilot study. J Autism Dev Disord, 50(1), 342-348. doi: 10.1007/s10803-
019-04224-5.
- 39. LaGasse, A. B. (2014). Effects of a music therapy group intervention on enhancing social skills in children
with autism. J Music Ther, 51(3), 250-275. doi: 10.1093/jmt/thu012. Epub 2014 Jul 22.
- 40. Kunzi, K. (2015). Improving social skills of adults with autism spectrum disorder through physical activity,
sports, and games: A review of the literature. Adultspan J, 14(2), 100-113. https://doi.org/10.1002/adsp.12008