Bio••likill,: 1011; 41(1): 127-JJJ January• February 1011

Rtffarrb article
Assessment and comparison of cognitive function tests in abacus trained and untrained
students aged 8-12 years in the South-Indian population
Bhavya R.L 1, Y. Dbaaalaklbml1, Ria Aan Pb1Up1

'Dcpartmenl of Physiology, SRM Medical College Hospilal and Research Ccnlrc, SRM Nagar. Polhcri.
Ka1tankula1hur, 603203. Kanchccpurarn, Tamil Nadu. India
2 Departmcnl of Physiology. 1JIPMER. Puduchcrry 605006, India

(R,cnvd: Fdm111ry1011 Ac~pt,d: F,bn1•ry 1011)

Corresponding author: Y. Obanlllksbml. Email: saidhanalakshmi@gmail.com

ABSTRACT

Introduction and Alm: During childhood period, cognitive decline could manifest as learning disabili1y.
Cognitive abilities, which have a strong relationship with synaptic plasticity an amazing property of the brain is
mandatory for the growing demands and challenges. Our study focuses on the effect of memory tasking (abacus
training) on cognitive abilities in children. The aim of the study is to assess the cognitive functions of children who
had undergone level one abacus training in the age group of 8-12 years and to compare the cognitive functions
between childten trained and untrained in abacus.

Materials and Methods: The study was approved by ICMR-STS 2018 and institutional ethics committee. It was
conducted in children aged 8-12 years, who were age and BMI matched and were untrained and trained in abacus
level one, between June-July 2018. Seventy participants, majority being females (fourth-fifth standard), were
recruited from a school in Puducherry. Anthropometric indices were recorded, and baseline cognitive parameters
were assessed by MoCA.

Rcsuhs: The total median scores for MoCA were 28 (27-29) and 26 (23-28) in study and control groups
respectively (p=0.016). Values for trail making test A was 44.89 sec (study group), 56.20 sec (control group)
(p=0.04) and trail making test B was 94.7 sec (study group) and 125.3 sec (control group), (p=0.03) respectively. In
letter cancellation test, the scores were 3 I .8(study group) and 31 seconds (control group) (p=.019).
Conduslon: Abacus training improves all three domains of cognition and learning abilities in children.
Keywords: Abacus; BMI (body mass index); Montreal cognitive assessment test (MoCA); Neural plasticity.
boosts the confidence of a learner"s mind. Hence it is
INTRODUCTION mandatory to foster a child's cognitive development

A
part from motor, social developmental skills, with certain programs on brain training like abacus,
language and communication skills, which deals with mental arithmetic and serves as a
cognitive development is an essential part of cognitive stimulus. Abacus based mental calculations
brain development in growing children, as it plays an have been found to be stress free and play way
important role in acquisition of knowledge, problem method of learning which enhances the synaptic
solving abilities and thinking power, which is efficacy and developmental plasticity which
mandatory for the growing minds to cope up with underlies the cognitive abilities, like learning and
and understand the world around them and enhance memory (3). From time immemorial counting was
their ability to think laterally. Around 5-10% of done using stones, by carving notches on wood or
school children are found to have learning disabilities bone and counting with fingers, which paved way for
(I) and furthermore the average global prevalence of sign language and written numbers (4,5). But then
neurological impairment among children aged 0-14 these methods of counting were time consuming and
years arc found to be 5% (2). Cognitive impairment
hence it progressed with the use of abacus for
is one among the neurological impairment which
calculations. But with the evolution of computer and
needs attention in the present scenario. The other gadgets there is a downplay with the use of
components of cognition like learning and memory,
abacus.
attention, concentration, language, and
communication skills that arc interlinked with each The term abacus originates from the Latin word
other, has a positive impact on daily routine that 'abax' meaning a 'flat board' or 'tablet'. It is an
ancient tool used for fast and accurate calculation by

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China, Japan, Korea, and India since 1200 A.D. (6) MATERIALS AND METHODS
An abacus consists of a rectangular frame, holding in
Study design
place a number of beads on vertical rods. There are
two horizontal rows. The lop row contains one or two This is a cross-sectional study in which cognitive
beads per column while the bottom row may have functions were assessed in level one abacus trained
four to five beads. By moving the bo1tom row beads and abacus untrained children aged 8-12 years,
upwards and the lop row beads downwards, numbers conducted in a school within the campus. This study
arc counted. Each vertical column represents place was selected by ICMR-STS 2018, approved by
value starting from the right as ones, tens, hundreds, research monitoring and institutional ethics
CIC. (7). commiltcc. The study period was conducted between
Juno-July 2018.Thc participants were divided into
A study conducted in by Lizhu et al., shows that two groups; study group being trained and control
abacus promotes the use of multiple senses including group untrained in abacus level one. Recordings
visual, auditory, and sensory system to solve obtained from abacus untrained children were
problems. This integrated approach leads 10 an considered as baseline cognitive scores. Sampling
improvement in short term memory, reading was nonrandomizcd, with 35 participants in each
efficiency, intelligence quotient and a general group. Sample size was calculated with the mean and
improvement in all academic subjects including S.D. values from data published earlier for the
mathematics (8). The trainees in abacus showed cognitive test scores of both the groups in memory
enhanced usage of posterior superior parietal cortex tasks (89.63 - 23.82) and (36.89 - 5.50) respectively.
as when compared to the untrained individuals who It was calculated based on two samples' test with
use the language centers of their brain for problem 80% power and 5% level of significance. All the
solving. This plays an important role in both working participants were enrolled based on inclusion and
and photographic memory which is essential for exclusion criteria.
visuospatial intelligence (9).
lnduslon critrria
In 2002, a research project by Chen et al.. showed
that the abacus trained group not only had a bcuer Study group:
performance in arithmclic operation than the • Age between 8 10 12 years
untrained group but also had helter ability lo store • Children trained in abacus (level I)
visual-spatial information (10). The ability to process Control group:
visual information in more than one dimension is • Age between 8 to 12 years
called the visuospalial intelligence. This enables one • Children who did not receive any training in
to excel in abstract and mechanical reasoning as well abacus
as space relations along with lateral thinking. These
abilities arc mandatory in scientific and technical Exdusion trituia
fields like Physical science, engineering, computer Participants with a history of neurological disorder,
science and mathematics. Visuospatial inlclligcncc head injury in the recent past i.e., within 3 10 5ycars.
which is important in scientific and technical fields is
found to increase in abacus training ( 11 ). With MATERIALS AND METHODS
advancing stages in abacus training, students start to
use imaginary abacus for calculations which boosts After obtaining approval from the Institutional
working memory and photographic memory which in research monitoring committee and Ethics committee
tum enhances the visuospalial learning ( 12). Thus, for human studies, informed and wriuen consent was
early exposure and structured training motivate non- obtained from the parents/guardians of all the
addictive means of brain training programs which participants who were willing lo participate in the
will enhance competency in cognitive tasks more study along with assent for students.
than merely skill acquisition. While there arc many Rttrultmrnt of study and control group
studies on abacus training, documentations on
cognitive function tests in abacus learners as a whole Age and gender matched children of the age group 8-
entity is lacking. Our study is the first of its kind to 12 years studying in fourth and fifth standard with
assess the effectiveness of abacus training in majority from fourth standard belonging 10 different
improving cognitive functions in south Indian sections were enrolled for participation in the Sludy
children aged 8-12 years. We hypothesize that abacus with many amongst them being females. There arc 10
training will improve the basic cognitive abilities like stages in abacus training and each stage goes for 3
memory, concentration, coordination, analytical months, of which we chose children, who had
skills, processing speed, visuospalial abilities, undergone level one abacus training and then
naming skills, aucntion, alertness, and awareness in compared them with children who did not undergo
children. abacus training at all .Then they were enrolled under
the study group and control group respectively based
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on the inclusion and exclusion criteria as mentioned points and a score of less than 26 indicates mild
above. Thirty- five students were selected for the cognitive impairment. The forward and reverse digit
study under each group based on the sample size spans arc two of the many components of MoCA
calculation. The participants were from a school in (13).
the Puducherry. Aller obtaining the informed and
wrinen consent from the parents/guardians and assent
Fon"8rd digit span test
for the students, the procedure was explained to them
following which the anthropometric parameters like This test is used lo determine the immediate verbal
weight, height and BMI were measured. Then the memory span of the subject. The examiner reads out
students were subjected to neurocognilive lest a sequence of digits which contain any numbers from
ballcry. Baseline cognitive scores were assessed in 3 lo 8. The sequence will be read out only once
both the abacus trained and untrained participants which the subject must repeat. Two chances are
where in the untrained participants (matched for age given for each digit and the score is based upon the
and BMI) serve as controls and the cognitive number of digits recalled correctly. (14).
parameters tested in them serve for the baseline
cognitive scores (MoCA). Re\'tne digit span test:
PROCEDURE The subject is asked to repeal the reverse of the
sequence dictated by the examiner. The score is
Anthropometric parameters measured were weight, calculated based on the number of digits the subject
height and BMI manages 10 repeat in the reverse order (14).
Measurement of Height
Trail making lest
Height of each study subject was measured with a
wall mounted stadiomctcr. The students were asked Pan A: The subject is asked to connect the numbers
to stand with both heels and knees together on a flat which are randomly scattered on the sheet. The score
surface with straight legs. With the occiput, shoulder is based on the time taken for the subject to finish the
blade, hips and heels pressed against the vertical bar, test.
the height of each study subject was measured in Pan B: The subject is asked to connect numbers to
centimeters by bringing the slider and pressing on to the leucrs. For example, I to A, 2 lo B etc. Scores arc
the top of the head. decided by the time taken by the individual lo finish
the test. (14)
Measurement of,.·elght
Lettrr cancellation test
The study subjects were asked 10 wear light clothing.
They were made to stand with bare foot on a This test helps in evaluating the allcntion span of the
standardized weighing machine with legs positioned subject. It is a pencil and paper test where the subject
on either side of the digital scale and the weight was is asked to strike out the letter H placed at random
measured in kilograms. intervals in a series of letters. The subject will be
Measurement of body mass Index (BMI) scored based on the time taken to complete the test
and the number of errors made by the subject ( 15).
BMI was calculated using Quctclct's index. Statlstkal anal)•sls
Quetclct's index= weight/ [height) 2 Normality of the data was tested using Kolmogorov-
Weight - in kilograms. Smimov test. The normally distributed data has been
expressed as mean ± S.D. ·p• value < 0.05 is
Height- in meters.
considered statistically significant. Non-normally
distributed data has been expressed as median and
Cognitive function tests interquartile range. The data was analyzed using
The cognitive function tests include Montreal unpaired'!' test with SPSS vcrsionl9. Sample size
cognitive assessment test, letter cancellation test, trail was calculated with the differences in cognitive test
making tests A and B. scores between the abacus untrained and abacus
trained children, from the data published earlier. The
Montreal Cognill,·e Assessment Test (MoCA) mean and S.D. values for the cognitive lest scores for
children untrained and trained in memory tasks, as
It is a highly sensitive screening test for cognitive per the previous studies were found lo be (36.89-
impairment. II consists of seven domains namcly- 5.50) and (89.63- 23.82) respectively. Hence our
visuospatial function, namjng, attention, language, study includes 35 subjects in each group. Sample size
abstraction, delayed recall, and orientation- calculation was based on two sample 'I' tests with
distributed over 22 questions. It is scored out of 30 80% power and 5% level of significance.

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RESULTS two groups showed difference in score with the
The anthropometric parameters measured include abacus trained children showing better performance
age, height, and weight. BMI was calculated using than the untrained. Naming skill scores are nonnally
these values. The mean age for the study group was distributed and arc expressed as mean ± standard
IO years and that for the control group was 9.8 years deviation. The study and control group rcponed mean
(p= 0.2). The difference was not found to be scores of 3/3 and 2.83/3 respectively for naming
statistically significant. Similarly, the mean height for skills, which was found to be statistically significant
the study group and control group being 139.49 cm
(p=0.0 I). The median score for attention in study and
and 137.77 cm, which was also not statistically
significant (p= 0.4). The average weight in this age control group was 5/6 each having an interquartile
group was found to be 33.83 Kg in the study group range of 5 to 6 percentile and 4 to 6 percentiles
and 31.09 Kg in the control group. This was respectively. This difference was not significant
statistically insignificant (p= 0.17). The BMI was (p=0. I I5).Thc median score for language was 2/3 in
17.19 for the study group and 16.25 for the control both study and control groups with an interquartile
group. The variation was not statistically significant. range of 2 to 3 percentile and I to 3 percentiles
(p= 0.188)
respectively. This difference was statistically
Visuospatial skills rcponed a median score of 5/5 in significant (p=0.017). The median score for
the study group and 4/5 in the control group. Though abstraction was 2/2 in both study and control groups
there was no statistical significance (p=0.106), the with an interquartile range of I to 2 percentile for
both. It was not statistically significant (p=0.44).

Tablet: Comparison of demographic and anthropometric data between study group (children trained
in abacus level one) and control group (children untrained in abacus)

Sr. Study croup Control

Paramettt 'p' Valu•
No. (n•J5) croup (a-35)

I. Age (years) 10.2± 1.28 9.83± I.IS 0.206

2. Height (cm) 139.49± 11.43 137. 77± 8.69 0.482

3. Wcight(Kg) 33.83± 7.92 31.09± 8.54 0.168

4. BMl(Kg/m2) 17.19±2.30 16.25± 3.51 0.188

Note: The parameters were found to be normally d1stnbutcd and were hence represented
as mean± S.D. (Standard deviation) cm- centimeter, Kg- kilogram, m2- meter square

Table 2: Comparison of Montreal cognitive assessment test (MoCA) data between study
group children trained in abacus level oneland control 2rouo (children untrained in abacus).
Study group Control group
SI.No. Parameter p value
(n•35) (n•35)
I Visuospatial skills (x/5) 5(4-5) 4(4-5) 0.106
2 Naming skills (x/3) 3.00±0.00 2.83± 0.38 0.01•
3 Attention (x/6) 5 (5-6) 5 (4-6) 0.115
4 Language(x/3) 2 (2-3) 2 (1-3) 0.011•
5 Abstraction(x/2) 2 (1-2) 2 (1-2) 0.444
6 Delayed rccall(x/5) 4 (3-5) 4 (4-5) 0.623
7 Orientation(x/6) 6 6 0.079
8 Total MoCA(x/30) 28 (27-29) 26 (23-28) 0.016*
Note: Orientation is a constant value. The parameters 1,3,4 - 8 was found to be non-nonnally distributed
and have been expressed as median with interquartile range. • values arc statistically significant.
x/30 - numerator denotes score obtained by the participant; denominator denotes maximum score
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The median score for delayed recall was 4/5 in both functional reorganization of brain ( 17). Our study has
study and control groups with an interquartile range of proved that long term abacus training, apart from
3 to 5 and 4 to 5 percentile respectively. It was not improving the precision and speed of mental
statistically significant (p=0.6). The score for arithmetic skills, also stimulates various functions like
orientation in study group was a constant of 6/6. The visual organization, visual and verbal attention, and
median score in control group was 6/6. The difference visual and verbal memory. Thus, the students trained
was statistically insignificant (p= 0.07). The total in abacus have better visuospatial skill when
median scores for MoCA were 28 (27-29) and 26 (23- compared to the untrained students. Though it showed
28) in study and control group respectively. It was no statistical significance, abacus trainees came up
statistically significant (p=0.016). with a better score. This goes hand in hand with the
study done by l-lanakawa et al., (9). During abacus
The time taken for completion of trail making test A training students are ought to create an imaginary
was 44.89 seconds for the study group and 56.20 abacus for computation. This imaginary abacus
seconds for the control group. It was found to be replaces the object as such and serves as a tool for
statistically significant (p=0.04). Similarly, the time computing in both forward and backward directions.
taken for completion of trial making test 8 was 94.7 This enhances coordination as well as visuospatial
seconds for the study group and 125.3 seconds for the ability of the learner. This is essential for the
control group. It also shows statistical significance perception of distance, depth and movement which is
with a p value of 0.03. In letter cancellation test, the essential for understanding and recollecting, the
mean of time taken for the completion of task was spatial relationship between the objects which acts as
31.83 seconds for the study group as when compared a platform for excelling in space studies and spatial
to 31 seconds for the control group. This difference is navigation which needs mental computational
not statistically significant (p = 0.19). capacity to visualize and solve the problems of
navigation. Apart from visuospatial abilities abacus
Tabl• 3: Comparison of trail making test A and 8, learners showed a better score in both naming skill
letter cancellation test data between study group and language which was statistically significant. Total
(children trained in abacus level one) and control MoCA showed a better score in abacus trainees when
group (children untrained in abacus). compared to the untrained. This is consistent with the
research work of Tanaka et al., (18). Naming skill and
Control language is an essential part of our day to day lives
Study group 'p'
Panmdtr group which is a measure of cognitive flexibility. Naming is
(n=35) valu•
ln=35) crucial for communication, language comprehension
Trail making and for learning. Regular abacus training serves as a
44.89± 19.66 56.20± 26.68 0.047•
A stimulation program for cognition as the developing
brain has the excellent ability of activity dependent
Trail making 94.74± 50.02 125.31± 65.09 0.031•
B
modification of the strength and efficacy of the
preexisting synapses. This plays a vital role in
Letter
cancellation 31.83± 2.89 31.00± 2.43 0.199 transforming short term memory and experiences into
test lx/351 long term memory. Thus, change in synaptic strength
The parameters were found to be normally distributed on a long-term basis helps in storage of memories
and arc expressed as mean ± S.D which helps the developing brain to achieve and excel
• values arc statistically significant. x/35- numerator in the cognitive domain of learning (19,20). Abacus
denotes score obtained by the participant; learners took less time for completing both trial
denominator denotes maximum score making test (TMT) A and B. Trail making test A tests
awareness, alertness and speed of processing data
DISCUSSION which is inversely proportional to the time taken to
finish the task. Trail making test 8 tests mental
In an individual's life early growth period plays a vital elasticity and cognitive shifting which is found to be
role. Studies show that for the neural system, better in students trained in abacus as when compared
developmental plasticity may change at a time which to the students untrained in it. This is in accordance
is referred to as the critical period (16). Hence during with the study conducted by the Japanese
this period, activity dependent modification and psychological research (21 ). This denotes those
strengthening of synapse is possible in children if they children who arc undergoing abacus training show
are given memory tasks which serves as cognitive much better attention and concentration capacity as
stimulus. This is likely to improve the cognitive when compared to the untrained. Also, the
efficiency of the developing brain, which in tum will visuomotor, visuospatial abilities along with
enhance the work efficiency. Abacus is one such play conceptual tracking seems to be better in abacus
way method of memory tasking, which when trained students as when compared to the students
practiced regularly can lead to structural as well as untrained in abacus. Along with cognitive domain

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even psychomotor skill seems to be good in students

skilled in abacus. In letter cancellation test which ACKNOWLEDGEMENT
measures the altention span, visual scanning of an
This project was approved by ICMR under STS
individual, the time taken to complete task shows no Number: 2018-02859. We express our sincere thanks
statistical significance between the two groups. lo ICMR for giving us an opportunity to explore
Though there is no statistical significance between the different options in this scientific world. We also
two groups, the omission and commission errors were
convey our gratitude to our institute, the school, and
found to be less in the study group when compared to the abacus institute, for their valuable support at every
the control group. This shows that there is a good stage. We express our deep sense of grnlitude to all
hand eye coordination along with a good scanning the participants in our study.
ability in abacus trained children. This is attributable
to enhanced usage of posterior superior parietal cortex CONFLICT OF INTEREST
in abacus users. Studies show that people without
problems of spatial neglect arc also prone for fall in The authors dc-clarc that there is no conflict of interest.
attention span and target detection as in letter
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