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اثربخشی موسیقی درمانی بر مهارت¬های بازی کودکان و نوجوانان اوتیسم

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کمبود مهارت­های بازی در کودکان اوتیسم به شیوه­های مختلف خود را نشان می­دهد. پذیرش اجتماعی پایین در میان همسالان ، فقدان مهارت­های توجه ، اشکال در تقلید از دیگران اشکال در درک هیجانات دیگران و زل­زدن­های نابهنجار از نشانه­های بارز کمبود مهارت­های بازی این کودکان است.

مدل­های مداخلاتی متنوعی برای مهارت­های بازی کودکان اوتیسم مورد استفاده قرار گرفته که از جمله می­توان به تعدیل رفتار، آموزش به وسیله همسالان، داستان­های اجتماعی، مدل­سازی ویدیوئی، آموزش توجه و آموزش مسئولیت شخصی اشاره کرد. در بین رویکردهای مداخلاتی مختلف، موسیقی­درمانی نیز به عنوان فنی شناخته شده که تاثیر زیادی بر رفتارهای ارتباطی و مهارت­های بازیکودکان اوتیسم دارد  به نظر می­رسد جنبه غیر کلامی موسیقی تاثیر بسیار زیادی بر ارتباط موسیقایی- هیجانی کودک اوتیسم با دیگران ایفا می­کند. اکثر مطالعات انجام شده در حیطه موسیقی­درمانی بر جنبه تحریکی موسیقی برای این کودکان و تمایل کودکان اوتیسم به موسیقی اشاره کرده­اند.

موسیقی باعث برانگیخته شدن هیجانات می­شود و از طرف دیگر اعتقاد بر این است که گوش دادن به موسیقی واکنش­های هیجانی فرد را نیز به دنبال دارد. مطالعات نشان داده که گوش دادن به موسیقی باعث کاهش انقباض ماهیچه­های کودکان و نوجوانان دارای نشانگان اوتیسم  می­شود مایکل و چسکی نیز در مطالعه خود نشان دادند که موسیقی­درمانی باعث کاهش درد می­شود. همچنین مطالعات، تاثیر آموزش موسیقی و موسیقی­درمانی را بر کاهش اضطراب افراد دچار اختلال اوتیسم نشان داده است. اسکیل و ویگرام در مطالعه دیگر نیز دریافتند که موسیقی درمانی بر سیستم عصبی خودمختار و فشارخون این افراد اثر می­گذارد

افراد دچار اختلال اوتیسم در مقایسه با افراد عادی از سطح اضطراب بالاتری نیز برخوردارند به نظر می­رسد که مشکلات رفتاری می­تواند ارتباط نزدیکی با اضطراب تجربه شده در این افراد داشته باشد به علاوه اکثر افراد دچار اختلال اوتیسم علائمی از اختلال در عملکرد فیزیولوژیکی را نشان می­دهند  و به احتمال فراوان مشکلات رفتاری کودکان و نوجوانان اوتیسم تحت کنترل این اختلال است

شواهدی وجو د دارد که نشان می­دهد بین بدکاری نورون­های آیینه­ای در کودکان دچار اختلالات اوتیسم با ضعف رفتاری آنان رابطه وجود دارد. همچنین یافته­هایی که به وسیله تصویرداری از نورون­ها به دست آمده نشان داده که سیستم حسی- حرکتی نقش عمده­ای در پردازش زبان ایفا می­کند. پس از تایید نقش مهم نورون­های آیینه­ای در درک رفتاری و پردازش زبانی و همچنین رابطه نزدیکی که بین ناهنجاری­های نورون­های آیینه­ای و ضعف در مهارت­های بازیوجود دارد، رویکردهای درمانی متنوعی شکل گرفت که هدفشان درگیر ساختن نورون­های آینه­ای و به حداکثر رساندن پتانسیل این نورون­ها بود  موسیقی­درمانی یکی از این رویکردهای درمانی است که به دلیل تحریک و تقویت پردازش شنیداری، دیداری و حسی- حرکتی می­تواند به درگیر ساختن نورون­های آیینه­ای بینجامد فرضیه­ی مطرح شده­ی دیگر این است که فعالیت­های موسیقایی از جمله تقلید و هماهنگی حرکتی به بخش­های از مغز مرتبط است که می­تواند با نورون­های آیینه­ای موجود در سیستم عصبی همپوشی داشته باشد

تاکنون مطالعات متعددی درباره تاثیرات موسیقی­درمانی بر جنبه­های مختلف روان­شناختی، اجتماعی، ارتباطی، و مهارتی افراد دچار اختلال اوتیسم صورت گرفته است. کاپلان و استیل طی یک مطالعه دقیق دو ساله به بررسی تاثیر موسیقی­درمانی بر جنبه­های مختلف زندگی افراد اوتیسم پرداختند. طی این مطالعه آنها یک برنامه موسیقی­درمانی منظم را بر روی ۴۰ فرد دچار اختلال اوتسیم در دامنه سنی ۴۹-۲ سال اجرا کردند. نتایج حاکی از آن بود که موسیقی­درمانی به ترتیب بیشترین تاثیر را بر مهارت­های زبانی، ارتباطی (۴۱%)، بازی (۳۹%)، شناختی (۸%)، موسیقایی (۷%) و اداراکی، حرکتی (۵%) داشته است

بوسو و همکارانش نیز در مطالعه­ای مشابه به بررسی تاثیر موسیقی­درمانی تعاملی بلندمدت بر بازی و مهارت­های موسیقایی افراد جوان دچار اختلال اوتیسم پرداختند. برنامه مداخله­ای طی ۵۲ هفته بر روی ۸ نفر فرد دچار اختلال اوتیسم انجام شد. نتایج بیانگر تفاوت معنادار نمرات بازی و مهارت­های موسیقایی افراد گروه کنترل و گروه آزمایش در پیش­آزمون و پس­آزمون بود. این بدین معناست که در این مطالعه نیز موسیقی بر نیمرخ رفتاری بازی و مهارت­های موسیقایی این افراد تاثیر گذاشته است.

ریتمن نیز طی مطالعه­ای به بررسی تاثیر مداخلات موسیقی­درمانی بر مهارت­های توجه مشترک کودکان اوتیسم پرداخت. این مطالعه طی دو سال و بر روی کودکان ۱۰-۴ سال انجام شد. نتایج این مطالعه نیز بیانگر تاثیر موسیقی­درمانی و آموزش موسیقی بر مهارت­های توجه و بازی کودکان اوتیسم است

جینا کیم و همکارانش در مطالعه­ای شبیه به مطالعه ریتمن به مقایسه تاثیر موسیقی­درمانی و بازی درمانی بر افزایش توجه در کودکان اوتیستیک پیش­دبستانی پرداختند. در این مطالعه، ۱۴ کودک اوتیستیک ۵-۳ سال را به طور تصادفی در دو گروه قرار داده و با یک گروه طی ۱۲ جلسه ۳۰ دقیقه­ای به موسقی­درمانی پرداختند و با گروه دیگر نیز ۱۲ جلسه ۳۰ دقیقه­ای بازی­درمانی صورت گرفت. نتایج کلی این مطالعه نشان داد که موسیقی­درمانی در مقایسه با بازی­درمانی تاثیر کمتری بر افزایش توجه کودکان اوتیستیک دارد. همچنین نتایج آنان بیانگر تاثیر موسیقی­درمانی بر ارتباطات اجتماعی غیرکلامی بوده است.

لانکویست نیز در مطالعه­ای به بررسی تاثیربازی بر رفتارهای چالشی افراد اوتیستیک و دچار اختلالات رشدی پرداخت. در مطالعه وی تعداد ۲۰ نفر از افراد مبتلا به اختلال اوتیسم و اختلالات رشدی طی ۵ هفته در جلسات ۲۰-۱۰ دقیقه ای به موسیقی آرام بخش گوش می­دادند و بازی تعاملی انجام میدادند. نتایج بیانگر این بوده که گوش دادن به موسیقی آرام بخش و بازی باعث کاهش هر سه طیف رفتار کلیشه­ای، رفتار پرخاشگرانه و رفتار خودآزاری شده است

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