Effects of Motor Stimulation Programs on Children with Down Syndrome Development
The paper brings forward the issues of motor activities importance in the psychological development, and especially mental development of children with disabilities, from the embodied cognition theory perspective. In the context of embodied cognition approach, we expanded variable "any age" (meaning chronological age) to variable any mental age, and we assumed that if the cognitive system includes body and his conditions, than improvement of sensorimotor skills contribute to an improvement in cognitive functioning in children with development delay. This study presents some results of motor stimulation activities for 16 children with Down Syndrome, beneficiaries of the project "
Keywords: Motor stimulation programembodied cognitionchildren with Down syndromecognitive development
Educational and social integration of children with disabilities is an important goal of modern
educational systems. The process takes time, requires early intervention and related actions of several
rehabilitation services. In recent decades, the development of the cognitive sciences and neuro-
psychology emphasized the importance of early motor stimulation of the child, from the first year of his
life, for an optimal cognitive and even socio-emotional development. For children with intellectual
disabilities to stimulate the neuromotor development is essential for the recovery process and for school
integration, especially for children with Down Syndrome, which manifests retardation in motor
development, have low muscle tone, a slower rate of growth of bones and muscles, have difficulty in
acquiring basic motor skills and attitudes (such as sitting, standing up, walking, gripping, holding etc.).
Given these issues, the Special Olympics Foundation has designed and developed a series of programs
and projects aimed at stimulating and recovering through movement children and adults with intellectual
disabilities. One of them is the project titled "The development of motor skills in people with the Down
syndrome - essential step towards independent life", implemented by the Special Olympics in partnership
with fifteen institutions in the country, including Valahia University of Targoviste, Faculty of
Humanities, Department Physical Education and Sport. The project was funded by SEE grants 2009 -
2014, in The NGO Fund in Romania, and was intended to create and apply a program of early motor
initiation for children with Down syndrome, to increase social interaction and acquisition of life skills
through a system of unified sports training and competition for children and youth with and without
Down syndrome. (http://specialolympics.ro/programe/sport/dezvoltarea-de-abilitati-motorii-la-persoanele-cu-sindrom/). The
project activities were implemented in six cities (Bucuresti, Brasov, Cluj, Craiova, Iasi, Targoviste) and
in the Jiu Valley between April 1st 2014 and March 31th. 2016. In the context of the project activities
developed in Targoviste, but independent of the purposes set out in the project, we aimed at highlighting
some valences for cognitive development that the motor stimulation program can have in children with
Paper Theoretical Foundation
The research is based on the embodied cognition theory, developed in the last two decades in the
field of cognitive psychology. The new paradigm argues for consideration of the motor elements as
fundamental to "the emergence and existence of cognition" (Ionescu, 2011, p.327). For traditional
cognitive psychology the cognition was seen as a set of mechanisms and operations that processed the
primary information (sensations and perceptions) to give action. So, for the psychological system, the
cognition subsystem (or higher cognitive processes) is located between the input subsystem (sensations
and perceptions) and output subsystem (represented by action), being relatively independent of these two
(Ionescu, 2011). Traditionally cognitive researchers thought higher cognitive processes can be studied
independently of sensory-motor processes (input-output elements), irrelevant for abstract processing
mechanisms of cognition, that are using amodal symbols (Laakso, 2011). This perspective can resemble a
functionalist philosophical perspective, by that the content of a process is determined by its function in
the system, regardless of means, environments in/by which the function is performed. Respectively,
explaining cognition imply explaining transformation tool for input data (symbols) to output data/symbols, the mind being the "black box" that performs this function, independent of the body. So
cognition is limited only to the processing of information. But traditional cognitive psychology can`t
answer the question of substantiation symbols / information processed by the mind, namely how and
where they are located in the brain and how they are functional, that is loaded with different meanings
and generating different effects. Embodied cognition paradigm attempts to provide solutions to this
problem, by considering the higher cognitive processes as dependent on the anatomy and physiology of
the body, the sensory and the motor systems (Ionescu, 2011).
According to embodied cognition theory, cognitive functioning at any age depends on sensory-
motor issues and the body. In other words, higher cognitive functions are not only influenced by these
elements and processes, but they are components of the cognitive system itself. Cognition is not
independent of the brain and body, perception and action, but there is a relationship of interdependence
between them; intelligent behavior is the result of symbols processing operations at a given brain and
body in a certain time and physical and social space. So we can consider cognition not only being
"incorporated/ contained in the body" (embodied) but contained (embedded) into a more complex system
of the body located and „in service” in certain space and time.
The roots of this approach are found with more than two centuries ago to John Dewey work, the
phenomenological philosophy and this century in Piaget`s work. In his work, John Dewey “not only
claims that embodiment is crucial for understanding the mind but also acknowledges the developmental,
dynamic nature of cognition.” (Laakso, 2011, p.411). One of the phenomenologists who looked with
more interest in scientific evidence, Merleau-Ponty, (cited in Laakso, 2011, p.412) “argued that
embodiment in the three-dimensional, physical space of the actual world is a critical fact about human
thought”. Piaget showed that cognitive development is based on sensitive and motor development in the
first years of children`s life, but he neglected the implication of motor and sensorial actions in the
cognitive functioning later in child`s and adult`s life. Researches accomplished in the last years on infants
development and abilities confirmed Piaget`s supposition regarding the role of sensoriomotor actions in
cognitive development. (e.g., Adolph and Avolio, 2000; Thelen et al., 2001, cited in Loeffler J, Raab M
and Cañal-Bruland R, 2016). In the last thirty years numerous empirical researches made on language
acquisition and development of verbal communication skills suggested that “language comprehension
involves the activation of visual motion (i.e., sensorimotor) representations”(Laakso, 2011, p.414).
However, the progress made in neuropsychology in the past decades, brings some argument that not
sustain the embodied cognition theory. These arguments come from the cases of motor pathology (like
apraxia or paraplegia) that do not affect cognitive abilities of the patient. But, this doesn`t affect entirely
the hypothesis of embodied cognition. Until now the researchers couldn`t find solid arguments to
completely exclude the fact there are some implication of motor and sensitive components in superior
The theory of embodied cognition, closed to its younger sister, the theory of embedded cognition,
has important implications in terms of educational psychology and learning, both in children with typical
development profiles, and especially for children with mental retardation or developmental retardation. In
the theoretical context offered by paradigm embodied cognition, we expanded variable "any age"
(meaning chronological age) to variable any mental age, and we assumed that if the cognitive system
includes body and his condition, then improved sensorimotor skills is associated with improved cognitive
functioning in children with Down Syndrome.
As mentioned before, the aim of the micro-research presented in this paper was to identify the
motor stimulation program`s valences for cognitive development in the case of children with Down
Syndrome. The study was conducted on two groups of children, 10 (children ages 5-8 years),
respectively, 6 children (aged 9-14 years). The research involved two stages: I- application of the motor
stimulation program, which was aimed at improving overall motor capabilities, and II - evaluation, after
the motor stimulation program, of the cognitive functions of children involved in the program.
The Motor Stimulation Program Methodology
This activity was conducted over a period of one year, with one workout per week.
As mentioned before were formed two age groups, and each group undertook an hour of
gymnastics per week. The activities were held in the gymnasium of the Valahia University, Physical
Education and Sport Department. All sport that is done with children with Down syndrome was based on
the voluntary participation of students and teachers.
Steps and types of motor stimulation activities:
a) Initial assessment; had two phases:
- Providing of assessment test for children general mobility; this was established by Special Olympics
Romania Foundation and its partners, and involved the assessment of basic motor skills (walking,
running, jumping, throwing and grip, drag, thrust.)
- Application of assessment tests and recording results.
The same tests were used at the end of the stimulation program, to measure the progress.
b) Completing the stimulation activities. These were of three types:
- WORKSHOPS of 5-7 minutes locations exercises, in which identical exercises are performed at the
same location or with the same object for 10-15 minutes.
- CIRCUIT includes 6-10 locations of exercises, and proceeded after the skills are learned.
- UNIQUE WORKSHOPS involves repeating the same habit (for maximum 2 habits). If the children
liked very much a skill you can work with it throughout the entire lesson or you can run another one.
Methodology Used in the Second Stage (For The Cognitive Development Evaluation).
The research strategy in the second stage was the case study. For reasons beyond our will, it was
not possible to undertake a direct assessment of children`s cognitive development (through psychological
tests) before the motor stimulation program, so we decided to evaluate the development of their cognitive
capabilities through alternative ways – by questioning parents and trainers about it. The research tools and
methods used were the anamnesis, to obtain information about their mental development manifested
before the program, and questionnaire (for trainers and parents), aimed to identify what tasks was the
child able to do before and after running the stimulation program. This alowed to assess any changes in
child`s cognitive development. The questionnaire aimed at obtaining information on cognitive
functioning, respectively about the qualities of attention, memory, verbal communication and
categorization skills, and about socio-emotional development. The items were constructed based on Child
development assessment sheet (3-7 years) (elaborated by the working group of professors and students
from Developmental Psychology Laboratory of Babes-Bolyai University in 2011) and tasks from the
motor stimulation programs. The anamnesis, conducted with the parents/legal guardian, aimed to obtain
data about the developmental history of motor abilities, autonomy skills, language, superior cognitive
abilities (similar to those the questionnaire focused), social interactions, and other issues (e.g. medical
history, educational history).
Data obtained from case history and questionnaires were related and analyzed for each case.
Regarding the developmental level of the children, we found, from anamnesis, that six children had easy
mental retardation (4 in the first group, and two in the second), and ten children had moderate mental
retardation (6 in the first group and four in the second). All children have basic motor acquisitions (sit,
standing, walking, grasping and running).
Answers collected from parents and trainers on questionnaire, related with the information from
anamnesis, revealed the follows:
-Enhancements to executive attention – increased attention span, by a few minutes for all children
in the first group and two children from the second group (ages nine and almost ten), and
attention shifting rose to five children from the first group (age 6, 7 and 8) and two children from
the second group (age 10 and 14).
-Improved working memory: towards the end of the program all children remembered better and
faster the position and function of the objects viewed for the first time in the gymnastic hall,
learned faster a series of actions (1-4) in the shown order etc.
-Improvement of verbal communication skills (better describe the shown image, or the activity
they finished earlier, they recognize better all the words in the complex sentences they heard
etc.) observed only in children from the first group.
-Regarding categorization skills, both parents and trainers perceived an improvement of the
children`s capacity to group items based on one or two criteria (by the end of the stimulation
program it was easier for them to form groups of children by height or shirt color or to group
balls by color and size). The children from the second group, who had difficulties in attentions
tasks, had also difficulties in categorization tasks.
Also, the program had an impact on children social skills (children manifested improved
cooperation during the play, better perseverance in accomplishing the exercises, supporting play-mate to
finish the set of exercises etc.) and emotional development (children express their feelings congruent with
the situation in which they are, show sympathy for an injured colleague, show little distress related to the
difficulties during the activity, express better their desires, children have a better emotional state).
Besides some progress made on cognitive and emotional abilities, trainers also pointed an
improvement of children`s autonomy and self-confidence, due to group activities, interactions and
support from peers with the same problem and also from children with normal development.
Trainers and parents observations based on specific criteria for cognitive functions reveled
improvements on executive functions (like working memory, executive attention), on language (better
semantics and vocabulary), and on thinking operations (categorization). There are differences noticed
between the two groups: older children with Down syndrome manifest in a smaller measure progresses in
cognitive functions (respectively attention, categorizations and verbal communication skills). These
differences can support the importance of early interventionprinciplefor the recovery programs of
children with disabilities, especially for those with mental disability.
Although the research was not focused on identifying what kind of sensorimotor elements is
involved in cognitive processes and how or to what extend are involved, the data gathered allow us to
conclude that motor stimulation activities have the potential to contribute to the improvement of some
cognitive functions in children, even for mental disabled ones. The contribution of motor abilities
development (different movements, the balance, types of locomotion) to development of intellectual and
academic abilities was also showed in previous research done by Bornstein et al. (2013). The
research followed, in a longitudinal design, the relation between motor-exploratory competence of infants
and academic competences of those children later, at different ages (at 4-, 10-, and 14-year). They found
that good motor competence in infancy is associated with good mental, academic competences later in
One might say that some or all of the improvements observed in this research in cognitive
functions of children with Down syndrome are the effects (even partially) of other factors (emotional or
social) offered through the program. But these other factors, like emotional one, could also imply
sensoriomotor elements, and, on the other hand, embodied cognition refers to cognition dependence to all
the body states: the morphology, sensations and actions, including emotional ones. In other words,
cognition is situated, embedded, because cognition happens in a given body (with a specific
morphological structure and specific state) and in a certain type of physical and social environment
The context of Special Olympics motor program for children with Down syndrome offered the
opportunity to exam if a simple motor stimulation can improve mental functions in children with mental
disabilities, based on embodied /embedded cognition theory. The research showed an improvement of a
few cognitive functions in younger children with Down syndrome, compared to older children,
highlighting the importance of early intervention in recovery and therapeutic programs of disabled
children. Also, these cognitive improvements are evidence sustaining that, to some extent, cognition
development, at least in childhood, is dependent to sensoriomotor stimulation and achievements. The
study is opening new directions for designing educational programs for children with Down syndrome, in
particular, but also for other categories of children with intellectual disabilities.
We are very grateful to all the teachers, students and parents/legal guardians that helped us
accomplished this study. Without their help it couldn't have been carried out all the activities from the
motor stimulation program and from the research.
- Bornstein M. H., Hahn C.-S, Suwalsky J. T. D. (2013). Physically developed and exploratory young infants contribute to their own long-term academic achievement. Psychological Science, Vol. 24, Issue 10, (October) 1906–1917 Ionescu Thea. (2011). Abordarea embodied cognition şi studiul dezvoltării cognitive. (The embodied cognition approach and the study of cognitive development). Revista de Psihologie, Vol.57, nr. 4, 326–339 Laakso Aarre. (2011). Embodiment and Development in Cognitive Science. Cognition, Brain, Behavior. An Interdisciplinary Journal. Vol. XV, No. 4 (December), 409-425 Loeffler J, Raab M and Cañal-Bruland R (2016) .A Lifespan Perspective on Embodied Cognition. Frontiers in Psycholog, Vol. 7: 845. doi: 10.3389/fpsyg.2016.00845 *** (2011).Fisa de evaluare a dezvoltarii copiilor (3-7 ani) /Child development assessment sheet (3-7 years), retrieved from: http://www.devpsychology.ro/wp-content/uploads/FISA-DE-EVALUARE-A-DEZVOLTARII-3-7-ANI-ianuarie2011.pdf, December, 2015 *** (2016).Prezentarea programului de dezvoltarea a abilităților motorii la persoane cu sindromul Down/ Presentation of motor skills development program in people with Down syndrome, retrieved from: http://specialolympics.ro/programe/sport/dezvoltarea-de-abilitati-motorii-la-persoanele-cu-sindrom/, May, 2016
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