Annals of Physical Medicine & Rehabilitation The Effect Of Corrective Exercises With The Janda Approach On Balance, Coordination, Motor Performance, And Quality Of Life In Autistic Children With Lower Cross Syndrome. *Corresponding Author: Rana oshaghi, Arak University, Sports science, Arak, Iran, Tel: 09132702962. Email: ranaoshaghi1378@gmail.com Received: 20-Feb-2025, Manuscript No. APMR-4564 ; Editor Assigned: 28-Feb-2025 ; Reviewed: 14-Mar-2025, QC No. APMR-4564 ; Published: 08-May-2025, DOI: 10.52338/appr.2025.4564 Citation: Rana oshaghi. The Effect of Corrective Exercises with the Janda Approach on Balance, Coordination, Motor Performance, and Quality of Life in Autistic Children with Lower Cross Syndrome. Annals of Physical Medicine & Rehabilitation. 2025 May; 11(1). doi: 10.52338/appr.2025.4564. Copyright © 2025 Rana oshaghi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ISSN 2770-4483 Research Article Rana oshaghi, Dr. Masoud Golpayegani, Arefeh moeini, Danial Beheshti. Arak University, Sports science, Arak, Iran. www.directivepublications.org Abstract Lower Cross Syndrome is a postural imbalance causing anterior-posterior and upper-lower muscle asymmetry in the trunk. This syndrome is observed in children with autism due to neurological impairments and motor defi-ciencies. This study aims to examine the effect of corrective exercises based on the Janda approach on balance, coordination, motor performance, and quality of life in autistic children with lower cross syndrome. This semi-experimental study included 24 autistic children who were randomly divided into two groups: 12 in the experimental group and 12 in the control group. The experimental group underwent Janda-based correc-tive exercises for eight weeks, three sessions per week, lasting 30–40 minutes per session. Pre-test and post-test assessments included balance and coordination tests (KTK test), motor performance evaluation (FMS test), autism screening questionnaire, and the modified checklist for quality of life assessment. Statistical analysis was conducted using SPSS software, employing Shapiro-Wilk, Levene’s test, independent t-test, and ANCOVA, with a significance level of p ≤ 0.05. Keywords : Lower Cross Syndrome, Autism Spectrum Disorder, Balance, Coordina-tion, Motor Performance, Quality of Life. INTRODUCTION Motor Impairments and Parental Stress in Autism Spectrum Disorder: The Impact of Lower Cross Syndrome. Individuals with autism spectrum disorder (ASD) experience complex neurodevelopmental impairments, which manifest in a heterogeneous range of symptoms. Autism is estimated to affect 13.4 per 1,000 children and is characterized by repetitive and restrictive behaviors, motor stereotypies, and communication disorders, which persist throughout life. These challenges are often accompanied by sleep and eating difficulties, non-verbal communication deficits, emotional dysregulation, and motor impairments. One of the most significant motor abnormalities in autistic children is Lower Cross Syndrome, which affects balance, coordination, motor performance, and quality of life[1-4]. Previous studies indicate that the stress levels of parents of autistic children are significantly higher than those of parents with neurotypical children or children with other disabilities. In existing research, parental stress is identified as an independent factor affecting the development and well-being of autistic children and their parents, ultimately reducing the quality of life for children with ASD[5]. Lower Cross Syndrome and Its Impact on Motor Function Lower Cross Syndrome is associated with tightness in the lumbar extensors and hip flexors , combined with weakness in the deep abdominal and gluteal muscles . Janda classified Lower Cross Syndrome into two types: Type A: Characterized by increased hip extension and lumbar movement. Type B: Characterized by greater lumbar flexion and abdominal instability[38]. One of the primary impairments in autistic children is reduced motor function. Studies indicate that physical interventions can enhance motor skills, social performance, strength,

Directive Publications Rana oshaghi and endurance in children with ASD. Initial assessments of motor skills can serve as a valuable screening tool for autism. Several aspects of motor skills in autistic individuals have been examined, revealing significant impairments in static and dynamic balance, motor planning, coordination, and fine motor precision[6-8]. Children with autism not only experience social and communication limitations but also motor impairments, including timing deficits and poor postural coordination. Developmental Coordination Disorder (DCD) is a common neurodevelopmental condition closely related to ASD . Both conditions often co-occur, making postural control and motor coordination essential components of functional independence. Postural control refers to the ability to maintain, achieve, or restore a state of balance during any activity. From a cognitive science perspective, balance control is particularly complex, as it involves the integration of sensory processing, motor planning, and precise muscle activation[9-12] . Motor coordination difficulties in autistic individuals emerge in early childhood and persist into adulthood, often affecting fine motor control, eye-hand coordination, and postural stability. These challenges may also impact motor imagery and movement visualization[12-9]. The Importance of Corrective Exercises Numerous studies have highlighted the positive impact of balance training (13-15), coordination exercises (16- 17), and motor skill interventions (18-19) on the quality of life (20-22) in children with autism. Given these findings, the present study aims to investigate the effects of Janda- based corrective exercises on balance, coordination, motor performance, and quality of life in autistic children with Lower Cross Syndrome. MATERIALS AND METHODS From among the autistic children at the Doost Autism Center in Tehran, 24 children with Lower Cross Syndrome, identified through the Thomas Test, were selected based on the inclusion criteria for the study. They were randomly divided into two equal groups, and informed consent forms along with a modified screening checklist were given to their families. The consent form explained that participants could withdraw at any stage of the research if they wished. One group was the experimental group (12 children), consisting of autistic children who performed Janda-based corrective exercises. The control group (12 children) included autistic children who did not participate in the corrective exercise program. The inclusion criteria consisted of boys and girls aged 6–16 years diagnosed with Lower Cross Syndrome and autism , possessing medical records, and having an IQ between 50 and 80, as classified by the Stanford-Binet Intelligence Scale. The exclusion criteria included injuries and pain during the study, absence of medical records, missing more than two or three non-consecutive training sessions, and parents’ unwillingness to continue participation. The Janda-based corrective exercise protocol included three sessions per week, each lasting 30–40 minutes, over a period of eight weeks (two months).

Research Instruments In this study, the Thomas Test was used to diagnose Lower Cross Syndrome in autistic children. The measurements were recorded using a goniometer. The child was placed in a supine position on a platform, and their dominant leg was brought towards the abdomen . Some children were able to hold their own leg, while others required assistance. The non-dominant leg was measured using the goniometer , with its center positioned at the greater trochanter. The movable arm of the goniometer was aligned with the midline of the femur, while the fixed arm was positioned along the body’s midline. The initial angle of measurement was 180 degrees, and as the stationary leg bent, the movement of the goniometer’s arm was recorded. The same test was repeated for the non-dominant leg. The Thomas Test allows practitioners to assess four muscles that are prone to tightness: • Iliopsoas muscle, • Rectus femoris muscle, • Tensor fasciae latae, • Iliotibial band[23]. To assess quality of life, the modified autism screening checklist for toddlers was used. To evaluate balance and coordination, the KTK Test was administered, which includes four components: 1. Walking on three beams (BB): Participants walk forward and backward on three beams of different widths (3m length, 6cm, 4.5cm, and 3cm widths, and 5cm height). Each participant had three attempts, taking 24 steps per beam, with a maximum total score of 72 points (3 × 3 × 8 = 72). 2. Side jump (JS): Jumping laterally over a 60cm-long, 4cm-wide, and 2cm-high beam for 15 seconds. The number of correct jumps was recorded. 3. Lateral movement (MS): Participants were required to move a wooden plank (25cm × 25cm × 2.5cm) from one side to another within 20 seconds while stepping onto each plank. The total number of moved planks was counted. 4. Single-leg hopping (HH): Hopping on foam pads (60cm length, 20cm width, 5cm height). Each successful Page - 2Open Access, Volume 11 , 2025

Rana oshaghi Directive Publications hop added an extra foam layer, with a maximum score of 78 points. The first foam scored 3 points, the second scored 2, and the third scored 1[24-26]. The KTK test demonstrated a reliability coefficient of 0.97, ensuring sufficient validity for raw scores (WB: 0.80, MS: 0.84, HH: 0.96, JS: 0.95)[26]. To assess motor function, the FMS (Functional Movement Screen) was used, consisting of: 1. Squat 2. Step-over hurdle 3. Inline lunge 4. Shoulder mobility 5. Active straight leg raise 6. Core stability 7. Rotary stability

Scoring Criteria • 3 points: If the participant performed the movement correctly without compensation . • 2 points: If the movement was completed but with compensatory mechanics . • 1 point: If the movement could not be performed correctly, even with compensation . • 0 points: If the participant experienced pain during the movement[27]. The maximum score for the FMS test was 21 points, and a score ≤14 indicated a high risk of sports-related injuries. The FMS test reliability coefficient was reported at 0.97, confirming its accuracy for adolescent assessments[27]. Table 1. Week 1 Warm-up: Walking on a balance beam forward and backward. Seated squats 2 sets of 10 reps Standing STR (front) 2 sets of 10 reps Standing STR (back) 2 sets of 10 reps Hip bridge 2 sets of 10 reps Leg stepping over obstacles 3 rounds with a 3-second pause Pilot sit-ups 2 sets of 10 reps Week 2 Warm-up: Walking on a balance beam forward and backward with a futsal ball. Wall squats 3 sets of 15 seconds Standing STR (side) 3 sets of 10 reps Lying under-belly straight leg raise 3 sets of 10 reps Hip bridge with foot on step 3 sets of 10 reps Step-up with knee raise 2 sets of 10 reps Hamstring stretch 3 sets of 10 seconds Week 3 Warm-up: Walking on a narrow balance beam forward and backward with a futsal ball. Squats with a physio ball 3 sets of 12 reps STR with weights on a physio ball (back) 3 sets of 12 reps Straight leg kick with resistance band (hamstring strengthening)3 sets of 20 seconds STR with weights (front, lying down) 3 sets of 12 reps Kickback 3 sets of 12 reps Hamstring stretch with an extended leg 3 sets of 10 seconds Week 4 Warm-up: Moving cubes. Step squats with mini loop resistance band 3 sets of 12 reps Page - 3Open Access, Volume 11 , 2025

Rana oshaghi Directive Publications Dead Bug (leg movement only) 3 sets of 10 reps Hamstring strengthening with mini loop resistance band 3 sets of 12 reps Side STR lying down with a mini loop resistance band 3 sets of 12 reps Step jump + landing – 3 sets of 12 reps 3 sets of 12 reps Side jump onto a marked target 4 sets of 10 reps Back extensions with opposite arm and leg (quadru-ped position) 3 sets of 30 seconds Balance on a BOSU ball (disturbance with resistance band, both feet) 3 sets of 30 seconds Week 5 Warm-up: Cube Transfer, Balance on Balance Beam Standing STR with resistance band (front) 3 sets of 12 reps Pelvic movement in standing position 3 sets of 12 reps Lunges with resistance band 3 sets of 12 reps Stork balance with disturbance (using resistance band) 3 sets of 20 seconds Single-leg balance on BOSU ball with disturbance (using resistance band) – 3 sets of 20 seconds Pelvic rotation stretch 3 sets of 12 reps Week 6 Warm-up: Moving cubes and walking on a balance beam . Step-up + squat 3 sets of 12 reps Single-leg hip bridge 3 sets of 12 reps Two-leg balance on a stability platform 3 sets of 30 seconds Single-leg balance on a stability platform 3 sets of 30 seconds Balance on BOSU ball with disturbance (using re-sistance band)3 sets of 30 seconds Step-down + stork balance 3 sets of 12 reps + 10 seconds balance in stork posi- tion Week 7 Warm-up: Moving cubes and balancing on a balance beam . Lunges 3 sets of 10 reps Single-leg balance on a balance board while holding a ball 3 sets of 30 seconds Plank with hands on BOSU ball 3 sets of 20 seconds Single-leg balance on a trampoline with disturbance (using resistance band) 3 sets of 30 seconds Forward jumps onto marked targets 3 sets of 12 reps Landing + squat 3 sets of 12 reps Week 8 Warm-up: Moving cubes and walking on a balance board . Single-leg balance on a stability platform 3 sets of 30 seconds Balance on a stability platform with disturbance (using resistance band) 3 sets of 30 seconds Landing + squat + double-leg jump 3 sets of 12 reps FINDINGS

In the descriptive statistics section, the demographic characteristics of the participants were first examined. The descriptive indicators, including minimum and maximum age, mean age, mean weight, mean height, and mean BMI, were analyzed and presented for each research group. Page - 4Open Access, Volume 11 , 2025

Rana oshaghi Directive Publications Table 2. Group Number Mean Weight Mean AgeMean Height Mean BMI Min AgeMax Age Experimental Group 10 21.1 9.8 1.32 16.87 6 14 Control Group 10 41.49 9.5 1.37 22.17 5 14 In the table below, the descriptive statistical results of the dependent variables, sepa-rated by groups, were measured for pre-test and post-test Table 3. Variable Measurement Stage Experimental Group Control Group Mean SD Mean SD Balance and Coordination Pre-test 43.33 24.53 55.58 23.16 Post-test 78.91 22.87 56.50 22.93 Motor Performance Pre-test 17.08 5.63 16.08 5.74 Pre-test 24.83 6.27 17.50 5.90 Lower Crossed Syndrome (Using a Goniometer: Dominant Leg on the Edge of the Table in Prone Position or Measuring the Non- Dominant Leg) Pre-test 69.50 7.99 62.91 11.57 Pre-test 74 6.99 62.83 10.72 Lower Crossed Syndrome (Using a Goniometer: Non-Dominant Leg on the Edge of the Table in Prone Position or Measuring the Dominant Leg) Pre-test 59.91 14.02 63 12.007 Pre-test 66.50 12.62 63.58 11.01 Lower Crossed Syndrome (Using a Goniometer: Non-Dominant Leg on the Edge of the Table in Prone Position or Measuring the Dominant Leg) Pre-test 19 19.02 15 5.64 Pre-test 17 20.14 13.91 4.90 Lower Crossed Syndrome (Using a Goniometer: Non-Dominant Leg on the Edge of the Table in Prone Position or Measuring the Dominant Leg) Pre-test 17.41 18.79 13.91 6.93 Pre-test 16 20.10 13.25 5.98 The variable test for coordination and balance consists of four items, and we have sep-arately provided the descriptive statistics for each stage of the coordination and bal-ance test in the table below. Table 4. Variable Measurement Stage Experimental Group Control Group Mean Standard Deviation Mean Standard Deviation Walking (BB) Pre-Test 30.08 20.34 44.08 20.58 Post-Test 61.75 10.34 43.58 20.18 Jumping Sideways (JS) Pre-Test 4.58 4.75 3.91 4.07 Post-Test 5.75 6.06 4.16 4.48 Sideways Movement (MS) Pre-Test 4.66 3.93 4.33 2.53 Post-Test 8.33 4.49 5.50 3.08 Single-Leg Stance (HH) Pre-Test 4 5.90 3.25 4.13 Post-Test 4.75 7.05 3.25 4.13 Page - 5Open Access, Volume 11 , 2025

Rana oshaghi Directive Publications Quality of Life Another variable in this research is the quality of life. In this study, we assessed quality of life using a modified checklist for autism screening in early childhood, which was provided to families (this form was given to families only once). Each question had a score that we calculated. Table 5. Description of the Variable (Quality of Life) in the Research. Variable Experimental Group Control Group Mean Standard Deviation Mean Standard Deviation Quality of Life 13.50 2.57 14.33 3.02 Since the independent variable of the study is corrective exercises with a Janda approach, which divides our sample into two groups (experimental and control), and the dependent variable is measured continuously, a two-way analysis of covariance (ANCOVA) was used to examine the variables of balance, coordination, motor performance, and lower cross syndrome. Table 6. Variable sig F Partial Eta Squared Walking Path (BB) 0.001 37.401 0.640 Side Jumping (JS) 0.042 0.042 0.183 Sideways Movement (MS) 0.008 8.715 0.293 HH Test (HH) 0.040 4.811 0.186 KTK Test 0.001 49.269 0.701 Motor Performance 0.001 53.682 0.719 Selective Mutism Syndrome with Toe-Walking Test (Dominant Foot) 0.269 1.289 0.058 Selective Mutism Syndrome with Toe-Walking Test (Non-Dominant Foot)0.142 2.333 0.100 The Effect of Corrective Exercises with the Janda Approach on Balance, Coordination, Motor Performance, and Lower Crossed Syndrome in Children with Autism As seen in the table above, the significance level for balance and coordination (walking, side jumping, sideways movement, and hopping) and motor performance is less than the predetermined threshold (P-value = 0.05). This indicates a significant relationship between the independent variable of the study and the dependent variable. Therefore, the null hypothesis is rejected, meaning that corrective exercises with the Janda approach positively impact balance, coordination, and motor performance in children with autism and lower crossed syndrome. However, as observed in the table, the significance level for the Thomas test with the dominant foot and non-dominant foot at the edge of the table is greater than the predetermined threshold (P-value = 0.05). This indicates that there is no significant relationship between the independent and dependent variables. As a result, the null hypothesis is confirmed, meaning that corrective exercises with the Janda approach do not affect lower crossed syndrome. Given that the independent variable of the study (corrective exercises with the Janda approach) divides the sample into two groups (experimental and control) and the dependent variable (quality of life) is measured continuously, the independent t-test (a parametric test) was used. Table 7. Variable F T Df Sig Quality of Life 0.800 -0.727 22 0.475 Given that the significance level (0.475) obtained from the independent t-test is greater than the predetermined threshold (0.05), we conclude that there is no significant difference in the quality of life factor between the experimental and control groups. Therefore, the null hypothesis is confirmed, meaning that corrective exercises with the Janda approach do not affect the quality of life of children with autism and lower crossed syndrome. Page - 6Open Access, Volume 11 , 2025

Rana oshaghi Directive Publications DISCUSSION

Morteza Taheri (2016), in a study titled “Comparison of Reaction Time and Balance in Children with Autism and Typically Developing Children,” examined 15 children with autism and 15 healthy boys aged 8 to 10 years, selected randomly. To assess reaction time, a reaction time measurement tool was used, and the Biodex device was employed to evaluate balance in both groups. The results showed that children with autism had weaker performance in all three aspects of balance: overall balance, lateral balance, and anterior- lateral balance. Additionally, both simple and choice visual reaction times were lower in children with autism. This study concluded that children with autism have impaired balance performance and weaker reaction times compared to typically developing children . This study aligns with previous research. Akbar Moeini et al. (2019) conducted a study titled “The Effect of Eight Weeks of Proprioceptive Training on Motor Coordination in Children with Autism Spectrum Disorder.” The study included 16 children aged 5 to 12 with autism, who were randomly assigned into homogeneous control and experimental groups based on the results of the Bruininks-Oseretsky subtests. The experimental group participated in 24 sessions of proprioceptive training, while the control group engaged in standard occupational therapy for the same duration. After the intervention, post- tests were conducted for both groups. The results showed no significant differences in subtests related to eye-hand coordination and bilateral coordination, but the study concluded that proprioceptive training improved motor coordination in children with autism. These findings are consistent with the present study. Amir Hossein Haghighi et al. (2023) explored “The Impact of Combined Physical Education Strategies on Physical Fitness, Behavior, and Social Skills in Children with Autism.” Their study included 16 children with autism aged 6 to 10, randomly divided into experimental and control groups. The experimental group participated in a two-month program (three sessions per week), including ball games, dancing, and resistance training. They were assessed on physical fitness (PF)—including hand grip strength, upper and lower body strength, flexibility, balance, and agility— as well as behavioral characteristics before and after training. The results indicated improvements in social skills and PF, with balance being one of the key factors. This study aligns with the findings of the present research. Hossein Chaleshtari Baharak et al. (2014) examined “The Effect of Rhythmic Movements on Gross and Fine Motor Skills in Children with Autism Spectrum Disorder.” They selected 22 children with autism from an educational and rehabilitation center and divided them into two groups of 11. The experimental group participated in rhythmic movement exercises three times per week, each session lasting 1.5 hours. The Bruininks-Oseretsky Test of Motor Proficiency was used to evaluate motor competence before and after the intervention. The results showed significant improvements in the experimental group compared to the control group, indicating that rhythmic movements enhance both gross and fine motor skills in children with autism. The study concluded that through repetition, practice, and imitation of rhythmic movements, children strengthened their sensory and motor perception skills. These findings are also consistent with the present study. Balance and coordination exercises in Janda’s approach help improve proprioception and visual-motor coordination. This improvement directly affects the balance, coordination, and motor performance of children. Janda’s exercises, focusing on visual-motor coordination, help improve both fine and gross motor skills. Dasa and colleagues (2018), in a study titled “Ground Reaction Force Patterns During Walking in Children with Autism Spectrum Disorder,” examined 30 children with ASD and 30 healthy children aged 4 to 12 years. A three-dimensional motion analysis system with eight cameras and two force plates was used to collect VGRF data while the participants walked barefoot at their usual pace. The significant differences revealed that children with autism have difficulty bearing weight during the final standing phase, and this condition affects their walking instability. The results were similar to two other studies (32). Hadi Moradi and colleagues (2019), in a study titled “The Effect of a Movement Activity Program with Music on Balance, Running Speed, and Agility in Children with Autism,” involved 16 children with autism aged 6 to 9 years in Isfahan. These children participated in a movement activity program with music to assess balance performance, running speed, and agility. The children were divided into two groups of eight after assessing their balance, running speed, and agility using the Oseretsky Bruininks test. The experimental group received the movement activities with music for 8 weeks, with 3 sessions per week. Afterward, post-tests for balance, running speed, and agility were conducted. The evidence showed that the movement activities with music had a positive impact on the balance, running speed, and agility of children with autism. Movement activities with music can be considered a beneficial method for children with autism. This study is similar to the research by Hadi Moradi and colleagues (33). Strengthening exercises in corrective training with Janda’s approach help strengthen weak muscles and improve muscle power. This contributes to better motor performance, increased independence, and reduced fatigue in children with autism. Janda’s corrective exercises focus on improving Page - 7Open Access, Volume 11 , 2025

Rana oshaghi Directive Publications muscle tone and reducing hypotonia or hypertonia in children with autism. This improvement directly impacts motor performance, balance, and coordination. Children with inappropriate muscle tone may have difficulty performing both fine and gross motor movements. Janda’s exercises aim to strengthen weak muscles and stretch tight muscles, helping to improve this condition. Stretching and flexibility exercises in Janda’s approach increase joint range of motion. This contributes to better motor performance, reduced joint stiffness, and greater independence in daily activities. Down Adams and colleagues (2019), in a study titled “The Relationship Between Child Anxiety and Quality of Life in Children and Parents of Children with Autism Spectrum Disorder,” had 64 parents of children with autism complete questionnaires related to autism characteristics, anxiety symptoms, and the quality of life for both the child and the parents. Parents of children with high anxiety reported lower quality of life for both the child and the parents. Anxiety symptoms may be an important factor that influences specific aspects of the quality of life of children within the autism spectrum. The results of both studies were consistent (34). Peyman Zamani and colleagues (2023), in a study titled “Examining Quality of Life, Anxiety Levels, and Satisfaction with Rehabilitation Services in Mothers of Children with Autism in Ahvaz,” selected 128 mothers of children with autism and 30 mothers of children requiring non-autistic rehabilitation services. They provided the mothers with a quality of life questionnaire, perceived anxiety scale, and satisfaction questionnaire. The quality of life of mothers with autistic children was lower than that of mothers of non- autistic children; however, no significant difference in anxiety levels and satisfaction between the two groups was found. The mothers’ age, education, and employment status influenced the results. Mothers who had received rehabilitation services for less than one month reported lower quality of life and higher anxiety levels compared to those who had received over six months of rehabilitation services. The results of this study indicated that middle-aged, stay-at-home mothers had a lower quality of life than all other mothers. Higher satisfaction was observed among educated mothers, reflecting their higher expectations from rehabilitation services. Both studies reported lower quality of life for children with autism (35). Improvement in physical, emotional, and mental aspects generally leads to an increased quality of life for children with autism. This improvement can be observed in various areas of the child’s life, including social interactions, independence in daily activities, and academic performance. Saeed Salehi and colleagues (2023), in a study titled “Effect of 12-Week Gait Pattern Training with Light Table on Static and Dynamic Balance in Children with Autism,” divided 20 children with autism, aged 6 to 12 years, into two groups of 10. The training group used a light table, while the control group used a plain table to perform gait pattern exercises for 12 weeks (4 sessions of 45 minutes each week) under the supervision of coaches. Static balance was assessed using a foot scan device, and dynamic balance was evaluated using the heel-to-toe walking test. The evidence showed significant improvements in balance status, center of pressure displacement, and dynamic balance, with notable differences between the groups. These results suggest that gait pattern exercises with the light table improve balance and motor performance in children with autism. The findings of this study differ from those of Saeed Salehi and colleagues (36). Saeed Sadeghi Dinani and colleagues (2024), in a study titled “The Impact of a Movement Program with Gait Pattern Light Table on Cortisol Levels and Sleep Disorders in Children with Autism Spectrum Disorder,” involved 20 children with autism, aged 6 to 12 years, divided into two groups of 10. The exercise group used a light table, while the control group used a plain table for the movement program for 12 weeks, with 4 sessions of 45 minutes each week under the supervision of coaches. The results showed a significant reduction in cortisol levels in the exercise group with the light table compared to the control group. Additionally, there was a significant improvement in sleep disorders in the exercise group compared to the control group. Therefore, gait pattern exercises combined with visual and auditory feedback can be effective in reducing cortisol levels and sleep disorders in children with autism. The results of this study do not align with those of Saeed Sadeghi Dinani and colleagues (37). Zahra Malekirami and colleagues (2016), in a study titled “The Impact of Swiss Ball Exercises on Sensory-Motor Functioning in Three Boys with Autism,” involved three children with autism who performed Swiss ball exercises for nine weeks. Sensory- motor function was assessed using the Neuropsychological Assessment of Sensory-Motor Functioning test during the intervention and two weeks after its conclusion, with final assessments conducted two months after participation. The interventions proved effective. The results showed significant improvements in sensory-motor functioning in boys with autism who participated in Swiss ball exercises. The findings of this study do not align with those of Zahra Malekirami and colleagues (38). Corrective exercises with Janda’s approach, by impacting physical, emotional, and mental aspects, can significantly contribute to the improvement of balance, coordination, motor performance, and quality of life for children with autism. However, these exercises should be designed and implemented by trained specialists, taking into account the specific needs of each child with autism.

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Rana oshaghi Directive Publications CONCLUSION The aim of the present study was to investigate the impact of corrective exercises with Janda’s approach on balance, coordination, motor performance, and quality of life in children with autism affected by lower cross syndrome. The results indicated that corrective exercises with Janda’s approach positively influenced balance, coordination, and motor performance. However, no improvement was observed in quality of life or lower cross syndrome. In this study, corrective exercises with Janda’s approach can be considered an effective method for improving balance, coordination, and motor performance. REFERENCES 1. Jones EJ, Gliga T, Bedford R, Charman T, Johnson MH. Developmental pathways to autism: A review of prospective studies of infants at risk. Neuroscience & Biobehavioral Reviews. 2014;39:1-33. 2. Wuang Y-P, Huang C-L, Tsai H-Y. Sensory integration and perceptual-motor profiles in school-aged children with autistic spectrum disorder. Neuropsychiatric Disease and Treatment. 2020:1661-73. 3. Kilroy E, Gerbella M, Cao L, Molfese P, Butera C, Harrison L, et al. Specific tractography differences in autism compared to developmental coordination disorder. Scientific Reports. 2022;12(1):19246. 4. Bhat A. Multidimensional motor performance in children with autism mostly remains stable with age and predicts social communication delay, language delay, functional delay, and repetitive behavior severity after accounting for intellectual disability or cognitive delay: A SPARK dataset analysis. Autism Research. 2023;16(1):208-29. 5. Cheng S, Cheng S, Liu S, Li Y. Parents’ pandemic stress, parental involvement, and family quality of life for children with autism. Frontiers in Public Health. 2022;10:1061796. 6. Perochon S, Matias Di Martino J, Carpenter KL, Compton S, Davis N, Espinosa S, et al. A tablet-based game for the assessment of visual motor skills in autistic children. NPJ digital medicine. 2023;6(1):17. 7. Ikezawa N, Yoshihara R, Kitamura M, Osumi A, Kanejima Y, Ishihara K, Izawa KP. Web-based exercise interventions for children with neurodevelopmental disorders. Pediatric Reports. 2023;15(1):119-28. 8. Helsel BC, Foster RN, Sherman J, Ptomey LT, Montgomery RN, Washburn RA, Donnelly JE. A remotely delivered yoga intervention for adolescents with autism spectrum disorder: feasibility and effectiveness for improving skills related to physical activity. Journal of autism and developmental disorders. 2023;53(10):3958-67. 9. Stins JF, Emck C. Balance performance in autism: A brief overview. Frontiers in psychology. 2018;9:901. 10. Kiran Q, Naeem B, Ashfaq A, Altaf A, Atif MM, Ehsan A. Comparison of Developmental Coordination Disorder at Different Levels of Autism in Children. Annals of Punjab Medical College. 2023;17(1):54-7. 11. Gowen E, Edmonds E, Poliakoff E. Motor imagery in autism: a systematic review. Frontiers in Integrative Neuroscience. 2024;18:1335694. 12. Pollock AS, Durward BR, Rowe PJ, Paul JP. What is balance? Clinical rehabilitation. 2000;14(4):402-6. 13. Sefen JAN, Al-Salmi S, Shaikh Z, AlMulhem JT, Rajab E, Fredericks S. Beneficial use and potential effectiveness of physical activity in managing autism spectrum disorder. Frontiers in behavioral neuroscience. 2020;14:587560. 14. Adolph KE. Learning to keep balance. Advances in child development and behavior. 2003;30:1-40. 15. Yilmaz I, Yanardag M, Birkan B, Bumin G. Effects of swimming training on physical fitness and water orientation in autism. Pediatrics International. 2004;46(5). 16. Zolghadr, Sadeghati, Daneshmandi, Hasan. The Effect of Eight Weeks of Selected Balance-Corrective Exercises on the Motor Performance of Mentally Disabled Students with Developmental Coordination Disorder. Journal of Complementary Medicine. 2019;9(2):3694-706. 17. Ustinova KI, Chernikova LA, Dull A, Perkins J. Physical therapy for correcting postural and coordination deficits in patients with mild-to-moderate traumatic brain injury. Physiotherapy theory and practice. 2015;31(1):1-7. 18. Hallett M, Lebiedowska MK, Thomas SL, Stanhope SJ, Denckla MB, Rumsey J. Locomotion of autistic adults. Archives of neurology. 1993;50(12):1304-8. 19. Vilensky JA, Damasio AR, Maurer RG. Gait disturbances in patients with autistic behavior: a preliminary study. Page - 9Open Access, Volume 11 , 2025

Rana oshaghi Directive Publications Archives of neurology. 1981;38(10):646-9. 20. Eapen V, Karlov L, John JR, Beneytez C, Grimes PZ, Kang YQ, et al. Quality of life in parents of autistic children: A transcultural perspective. Frontiers in Psychology. 2023;14:1022094. 21. Im DS. Treatment of aggression in adults with autism spectrum disorder: A review. Harvard review of psychiatry. 2021;29(1):35-80. 22. Karadaş C, Bakkaloğlu H, Demir Ş. Exploring the effect of motor coordination on repetitive behaviours in children with autism spectrum disorder. International Journal of Developmental Disabilities. 2023;69(2):238-47. 23. Bashyal P, Bhatbolan S, Billore N, Sindhu N. Flexibility in muscles around the hip among middle aged Indian men engaging in prolonged desk jobs: A cross-sectional study. 2018. 24. Salami, Shams, Dehkhordi ShP, Parvaneh. Psychometric Properties (Validity and Reliability) of the Persian Version of the Körperkoordinationstest für Kinder (KTK) in Children Aged 5 to 14 in Tehran: A Preliminary Study. Motor Behavior. 2019;11(38):71-96. 25. Li K, Bao R, Kim H, Ma J, Song C, Chen S, Cai Y. Reliability and validity of the Körperkoordinationstest Für Kinder in Chinese children. PeerJ. 2023;11:e15447. 26. Giuriato M, Biino V, Bellafiore M, Battaglia G, Palma A, Baldari C, et al. Gross motor coordination: we have a problem! A study with the körperkoordinations test für kinder in youth (6–13 years). Frontiers in Pediatrics. 2021;9:785990. 27. Chang W-D, Chou L-W, Chang N-J, Chen S. Comparison of functional movement screen, star excursion balance test, and physical fitness in junior athletes with different sports injury risk. BioMed research international. 2020;2020(1):8690540. 28. Taheri. Comparison of Reaction Time and Balance in Children with Autism and Typically Developing Children. Scientific Journal of Rooyesh Psychology. 2016;4(4):49-60. 29. Moeini, Zadgan N, Hossein Gh, Rostami, Rababe. The Effect of Eight Weeks of Proprioceptive Training on Motor Coordination in Children with Autism Spectrum Disorder. Growth and Motor Learning in Sports. 2019;10(4):505-17. 30. Haghighi AH, Broughani S, Askari R, Shahrabadi H, Souza D, Gentil P. Combined physical training strategies improve physical fitness, behavior, and social skills of autistic children. Journal of Autism and Developmental Disorders. 2023;53(11):4271-9. 31. Baharak HJ, Hayedeh S, Ali ZM. The Effect of Rhythmic Movements on Gross and Fine Motor Skills in Children with Autism Disorder. 2013. 32. Hasan C, Jailani R, Tahir N, Desa H. Vertical ground reaction force gait patterns during walking in children with autism spectrum disorders. International Journal of Engineering. 2018;31(5):705-11. 33. Hadi M, Mahdi S, Hamidreza T, Ezzat Kh, Ahmadreza M. The Effect of a Period of Motor Activities with Music on Balance Performance, Running Speed, and Agility in Children with Autism Disorder. 2018. 34. Adams D, Clark M, Simpson K. The relationship between child anxiety and the quality of life of children, and parents of children, on the autism spectrum. Journal of Autism and Developmental Disorders. 2020;50(5):1756- 69. 35. Payman Z, Hasan Kh, Nasrin Kh, Saeed H. Examination of Quality of Life, Anxiety Levels, and Satisfaction with Rehabilitation Services in Mothers of Children with Autism in Ahvaz. 2023.

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