Investigation of the Effects of Kinesthetic Brain Exercises in Preschool Children

Children will participate in a physiotherapist-supervised kinesthetic brain exercise program for 8 weeks, twice weekly, for 30-40 minutes per session. The program will include warm-up, exercise, and cool-down activities delivered in an age-appropriate, play-based format.

The program consists of three phases. Warm-up activities include brain buttons, the thinking cap, the elephant, the owl, and cross crawl. The exercise phase includes throwing balls into the air, jumping to either side of a straight line, stepping while throwing a ball, stepping in response to instructions, bouncing a ball with one hand while drawing circles with the other, and touching the head with one hand while drawing circles with the other. Cool-down activities include the double doodle, lazy eights, arm activity, foot flex, and calf pumping.

Children will continue their routine preschool education without receiving the study exercise program during the 8-week study period. After the final assessments, they will be offered the kinesthetic brain exercise program on an optional basis.

Gross motor skills will be assessed using the Test of Gross Motor Development-Second Edition (TGMD-2). The test includes two subtests: locomotor skills and object control skills, each comprising six skills. The total raw score ranges from 0 to 96, with higher scores indicating better gross motor skill performance. The change in total raw score from baseline to the end of the 8-week intervention period will be evaluated.

Posture will be assessed using the New York Posture Rating Chart, which evaluates 13 body regions. Each region is scored as 5 for normal alignment, 3 for moderately impaired alignment, or 1 for severely impaired alignment. Total scores range from 13 to 65, with higher scores indicating better postural alignment. The change in total score from baseline to the end of the 8-week intervention period will be evaluated.

Lower-limb functional performance will be assessed using the Five Times Sit-to-Stand Test. The child will be asked to stand up from and sit down on a standard chair five consecutive times as quickly as possible, with arms crossed over the chest. Completion time will be recorded in seconds using a stopwatch. Three trials will be performed, and the mean completion time will be calculated. Shorter completion times indicate better functional performance. The change in mean completion time from baseline to the end of the 8-week intervention period will be evaluated.

Fatigue will be assessed using a visual faces rating scale adapted for children. The scale contains six facial expressions scored as 0, 2, 4, 6, 8, and 10. Children will select the face that best represents their fatigue level, with 0 indicating no fatigue and 10 indicating very severe fatigue. Higher scores indicate greater fatigue. The change in score from baseline to the end of the 8-week intervention period will be evaluated.

Attention will be assessed using the Frankfurter Attention Test. Children will be asked to identify and mark pear symbols among apple symbols within 90 seconds. The raw score is the number of correctly marked pears, ranging from 0 to 42. Higher scores indicate better attention performance. The change in raw score from baseline to the end of the 8-week intervention period will be evaluated.

Social skills will be assessed using the 23-item Social Skills Scale of the Turkish version of the Preschool and Kindergarten Behavior Scales (PKBS). The scale evaluates social cooperation, social independence and acceptance, and social interaction. Items are rated according to the frequency of the observed behavior. Higher total scores indicate better social skills. The change in total score from baseline to the end of the 8-week intervention period will be evaluated.

Problem behaviors will be assessed using the 27-item Problem Behavior Scale of the Turkish version of the Preschool and Kindergarten Behavior Scales (PKBS). Items are rated according to the frequency of the observed behavior. Higher total scores indicate more frequent problem behaviors. The change in total score from baseline to the end of the 8-week intervention period will be evaluated.

Sleep habits will be assessed using the parent-reported Children's Sleep Habits Questionnaire (CSHQ). The questionnaire includes 33 scored items covering bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night wakings, parasomnias, sleep-disordered breathing, and daytime sleepiness. Items are scored from 1 to 3, with reverse scoring where applicable. Total scores range from 33 to 99, with higher scores indicating greater sleep-related difficulties. The change in total score from baseline to the end of the 8-week intervention period will be evaluated.

Problematic media use will be assessed using the 27-item parent-reported long form of the Problematic Media Use Measure (PMUM). Parents will rate their child's behavior during the previous month on a five-point scale from 1 (never) to 5 (always). The overall score is calculated as the mean of the 27 item scores and ranges from 1 to 5. Higher scores indicate greater problematic media use. The change in mean score from baseline to the end of the 8-week intervention period will be evaluated.

Health-related quality of life will be assessed using the parent-proxy report of the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales. The questionnaire assesses physical, emotional, social, and school functioning during the previous month. Responses are reverse-scored and transformed to a scale from 0 to 100. The total score is calculated as the mean of the scored items, with higher scores indicating better health-related quality of life. The change in total score from baseline to the end of the 8-week intervention period will be evaluated.