Review paper: introduction of pediatric balance therapy in children with vestibular dysfunction: review of indications, mechanisms, and key exercises

The veStibular system is important for the development of normal movement reactions, motion tolerance, and motor control for poStural alignment, balance, and vision

A veStibular system that is damaged by disease or injury in childhood can have a major impact on a child's development In addition, the emergence of veStibular lesions may also lead to cognitive deficits, including attention deficit Despite the advances in testing and documentation of veStibular deficits in children, the veStibular problems continue to be an overlooked entity. Many children do not receive treatment that could significantly improve function and address the developmental delays caused by veStibular disorders

VeStibular rehabilitation therapy [VRT] has been defined as an effective modality for moSt individuals with disorders of the veStibular or central balance system disorders. The basis for the success of VRT is the use of existing neural mechanisms in the human brain for adaptation, plasticity, and compensation. The veStibular syStem cannot be considered as a separate entity ignoring other balance subsystems. Hence, a modified VRT program, named pediatric balance therapy with special modifications in exercises, was developed for children with veStibular disorders, in accordance to the whole balance system

Prevalence of auditory neuropathy in a population of children with severe to profound hearing loss

The purpose of this investigation is to determine auditory neuropathy in the students with severe to profound hearing losses in Ahwaz. In this cross-sectional study, 212 children of 7-11 year old with severe to profound hearing loss performed ordinary audiometric evaluations as well as ABR and OAE. The patients with normal DPOAE who had no record of acoustic reflex having normal ABR, were considered as the patients with auditory neuropathy. The neuropathic complication found in 14 children was appeared in 8 ones as one-sided [57.14%] and in 6 ones [42.86%] as two-sided. 68% of the patients as diagnosed had a very low Speech Discrimination Score [SDS]. We must be very vigilant in auditory neuropathy diagnosis for the purpose to be successful in appropriate treatment of severe to profound hearing losses

[Correlation between acoustically evoked short latency negative response and vestibular evoked myogenic potentials in children with profound sensorineural hearing-loss]

Vestibular evoked myogenic potentials and acoustically evoked short latency negative response are two non-cochlear responses with probably saccular origin. The present study was conducted to determine the percentage of presence and the relation between these two responses in children with hearing loss. Thirty children with profound congenital sensorineural hearing loss were studied. Vestibular evoked myogenic potentials elicited by tone burst stimuli and acoustically evoked short latency negative response elicited by click stimuli were recorded. Both responses were recorded at air conduction threshold level monaurally via an internal receiver. Vestibular evoked myogenic potentials in 53.3% of children and acoustically evoked short latency negative response in 40.0% of cases were recorded. There was a significant correlation between the percentage of recording these two responses [p=0.005]. Gender and the stimulated ear had no effect on the results. In almost half of these disabled children, both vestibular evoked myogenic potentials and acoustically evoked short latency negative response were recorded. This finding may both indicate that hearing loss has no effect on the function of otolith organs in some children and vestibular deficits probably exist along with hearing impairment in others. This finding reiterates the importance of evaluation of vestibular system as part of standard auditory evaluations

[Static and dynamic balance in congenital severe to profound hearing-impaired children]

Research conducted since the early 1900s has consistently identified differences between deaf and hearing children on performance of a wide variety of motor tasks, most notably balance. Our study was performed to test static and dynamic balance skills in congenital severe to profound hearing impaired children in comparison with normal age-matched children. This cross-sectional study was conducted on 30 severe to profound hearing impaired and 40 normal children with age 6 to 10 years old. Bruininks-Oseretsky test of motor proficiency 2, balance subset with 9 parts was used for evaluation of balance skills. Hearing-impaired children showed 16.7 to 100% fail results in 7 parts of the balance subset. In normal children fail result was revealed just in 3 parts of the balance subset from 2.5 to 57.5%, and differences between two groups were significant [p<0.0001]. There was a significant difference between two groups in two static balance skills of standing on one leg on a line and standing on one leg on a balance beam with eyes closed [p<0.0001]. It seems that development of static balance skills are longer than dynamic ones. Because severe to profound hearing-impaired children showed more weakness than normal children in both static and dynamic balance abilities, functional tests of balance proficiency can help to identify balance disorders in these children

[Brainstem auditory evoked potential study in children with autism]

Autism is a neurodevelopmental disorder of the brain, which occures in first few years of life, and characterized by symptoms such as qualititative impairments in verbal and non verbal communication, reciprocal social interactions, inability to communicate with others, stereotyped patterns of behavior, loss of eye contact and inappropriate facial expressions. Its prevalence in 2-5 in 10000 children and is greater in boys. Due to retarded language development, differential diagnosis other than those used with communication, behavioral and sensorial deficits should be made with Sensorineural or conductive hearing loss. The aim of this study was to determine whether children with autism have abnormalities affecting the cohlear nerve or auditory pathway in brainstem. In this case- control study, auditory brainstem responses were recorded from 12 autistic children and 12 normal children aged 3-12 years in rehabilitation Zafar central in Tehran - Iran during 2005. Absolute latency values of waves I, III and V and interpeak latencies of I-III, III-V and I-V were compared with the results of 12 normal children as control group. Wave V could be traced down to 25 dB nHL in both normal and autistic groups. Absolute latency of Wave V and Interpeak latencies of III-V and I-V were significantly prolonged in Autisitc children in comparison with control group. This study showed a slowing in nerve conduction in auditory pathways in brainstem of autism patients. The brainstem lesion may be a part of neurological damage in autistic children that accounts for deviant language, cognition and social development. Prolongation of wave V, III-V and I-V IPLs can be a marker for early diagnosis of autism

Comparison of short tone burst-evoked and click-evoked vestibular myogenic potentials in healthy adults

Vestibular evoked myogenic potential [VEMPs] is one of the clinical tools to evaluate vestibular function. The VEMPs can be recorded from sternocleidomastoid muscle by auditory stimulation with various sound stimuli and are thought to have saccular origin. The aim of this study was to compare the VEMP responses evoked by short [500 Hz] tone burst [STB] with those evoked by click stimuli in healthy young individuals. Thirty healthy volunteers [15 males, 15 females] with ages of 18 to 30 years were enrolled in this study. Subjects were instructed to sit on a chair and rotate their head to the opposite side of the recording muscle. The VEMPs was recorded using 500 Hz STB and then click sound stimuli to each ear. The p13 and n23 latencies, p13-n23 peak-to-peak amplitude and VEMPs thresholds were obtained for further analysis. The VEMP responses were present in all subjects for STB and ware not recorded in one subject for click. The latencies of p13 and n23 of STB-VEMP were significantly longer, and the p13-n23 amplitudes were significantly greater for STB-VEMP [p < 0.05], and thresholds were higher for clicks [p < 0.05]. No significant difference was obtained between both ears and genders. [p > 0.05]. The VEMP responses were significantly different between the stimuli of STB and click, and the norms of different stimuli should be established for clinical interpretations. According to these data, we recommend STB stimuli in comparison with clicks for clinical diagnosis