Balance sensory organization in children with profound hearing loss and cochlear implants

Postural Sway Velocity of Deaf Children with and without Vestibular Dysfunction

BACKGROUND

Sensory information obtained from the visual, somatosensory, and vestibular systems is responsible for regulating postural control, and if damage occurs in one or more of these sensory systems, postural control may be altered.

OBJECTIVE

To evaluate and compare the postural sway velocity between children with normal hearing and with sensorineural hearing loss (SNHL), matched by sex and age group, and to compare the postural sway velocity between children with normal hearing and with SNHL, with and without vestibular dysfunction.

METHODS

Cross-sectional study that evaluated 130 children (65 with normal hearing and 65 with SNHL), of both sexes and aged between 7 and 11 years, from public schools of the city of Caruaru, Pernambuco state, Brazil. The postural sway velocity of the center of pressure (COP) was assessed by a force platform, in two directions, anteroposterior (AP) and mediolateral (ML)), in three positions, namely bipedal support with feet together and parallel (parallel feet (PF)), bipedal support with one foot in front of the other (tandem foot (TF)), and single-leg support (one foot (OF)), evaluated with the eyes open and closed.

RESULTS

Children with SNHL demonstrated greater postural sway velocity compared to children with normal hearing in all the positions evaluated, with significant differences in the AP direction, with the eyes open (PF: p = 0.001; TF: p = 0.000; OF: p = 0.003) and closed (PF: p = 0.050; TF: p = 0.005). The same occurred in the ML direction, with the eyes open (PF: p = 0.001; TF: p = 0.000; OF: p = 0.001) and closed (PF: p = 0.002; TF: p = 0.000). The same occurred in relation to vestibular function, where the children with SNHL with an associated vestibular dysfunction demonstrated greater postural sway velocity compared to children with normal hearing in all the positions evaluated, demonstrating significant differences in the AP direction, with the eyes open (TF: p = 0.001; OF: p = 0.029) and eyes closed (PF: p = 0.036; TF: p = 0.033). The same occurred in the ML direction, with the eyes open (TF: p = 0.000) and with the eyes closed (PF: p = 0.008; TF: p = 0.009).

CONCLUSIONS

Children with SNHL demonstrated greater instability of postural control than children with normal hearing in all the directions assessed. Children with SNHL and an associated vestibular dysfunction demonstrated the greatest instability of postural control in this study.

The Effects of Core Stabilization Exercises on Respiratory Muscle Strength, Respiratory Functions, and Postural Control in Children With Hearing Loss: A Randomized Controlled Trial

OBJECTIVES

To evaluate the effects of core stabilization training on respiratory muscle strength, respiratory functions, and postural control in children with hearing loss.

DESIGN

We conducted a randomized controlled trial at Bezmialem Vakif University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation. Thirty children with hearing loss who were diagnosed with prelingual sensorineural hearing loss were randomly allocated to the study (n = 15, 12.20 ± 1.69 years) and control (n = 15, 11.87 ± 2.20 years) groups. Core stabilization training protocol was performed by the study group for 8 weeks, 5 days/week, whereas the control group received no training. The primary outcome measure was respiratory muscle strength. The secondary outcome measures were: spirometry, postural control tests on Biodex Balance System, and Balance Error Scoring System (BESS). Exercise adherence was recorded via a diary for home sessions. Outcomes were assessed at baseline and the end of the 8 weeks.

RESULTS

In the study group, a significant improvement was observed in force vital capacity, peak expiratory flow of the spirometry test, maximum inspiratory pressure/expiratory pressure (MEP) of the respiratory muscle strength test; postural stability test except "anterior/posterior stability index", limits of stability test except "backward" and "forward/right", all parameters of the Modified Clinical Test for Sensory Interaction and Balance (mCTSIB) test except "eyes closed firm surface" of the Biodex Balance System, and total score of BESS. Group × time interaction was found in MEP, "overall" stability index in postural stability test, "overall," "left," and "backward left" of limits of stability test, all parameters of the mCTSIB, and BESS total.

CONCLUSIONS

Core stabilization exercises were effective in improving respiratory muscle strength, spirometry, and postural control in children with hearing loss.

Sensory Reweighting for Postural Control in Older Adults with Age-Related Hearing Loss

There is growing evidence linking hearing impairments and the deterioration of postural stability in older adults. To our knowledge, however, no study to date has investigated the effect of age-related hearing loss on the sensory reweighting process during postural control. In the absence of data, much is unknown about the possible mechanisms, both deleterious and compensatory, that could underly the deterioration of postural control following hearing loss in the elderly. The aim of this study was to empirically examine sensory reweighting for postural control in older adults with age-related hearing loss as compared to older adults with normal hearing. The center of pressure of all participants was recorded using a force platform and the modified clinical test of sensory interaction and balance protocol. The results suggest that individuals with age-related hearing loss displayed increased somatosensory reliance relative to normal hearing younger adults. This increased reliance on somatosensory input does not appear to be effective in mitigating the loss of postural control, probably due to the concomitant deterioration of tactile and proprioceptive sensitivity and acuity associated with aging. Beyond helping to further define the role of auditory perception in postural control, these results further the understanding of sensory-related mechanisms associated with postural instability in older adults.

Use of Virtual Reality-Based Games to Improve Balance and Gait of Children and Adolescents with Sensorineural Hearing Loss: A Systematic Review and Meta-Analysis

BACKGROUND

Children and adolescents with sensorineural hearing loss (SNHL) often experience motor skill disturbances, particularly in balance and gait, due to potential vestibular dysfunctions resulting from inner ear damage. Consequently, several studies have proposed the use of virtual reality-based games as a technological resource for therapeutic purposes, aiming to improve the balance and gait of this population.

OBJECTIVE

The objective of this systematic review is to evaluate the quality of evidence derived from randomized or quasi-randomized controlled trials that employed virtual reality-based games to enhance the balance and/or gait of children and adolescents with SNHL.

METHODS

A comprehensive search was conducted across nine databases, encompassing articles published in any language until 1 July 2023. The following inclusion criteria were applied: randomized or quasi-randomized controlled trials involving volunteers from both groups with a clinical diagnosis of bilateral SNHL, aged 6-19 years, devoid of physical, cognitive, or neurological deficits other than vestibular dysfunction, and utilizing virtual reality-based games as an intervention to improve balance and/or gait outcomes.

RESULTS

Initially, a total of 5984 articles were identified through the searches. Following the removal of duplicates and screening of titles and abstracts, eight studies remained for full reading, out of which three trials met the eligibility criteria for this systematic review. The included trials exhibited a very low quality of evidence concerning the balance outcome, and none of the trials evaluated gait. The meta-analysis did not reveal significant differences in balance improvement between the use of traditional balance exercises and virtual reality-based games for adolescents with SNHL (effect size: -0.48; [CI: -1.54 to 0.57]; p = 0.37; I² = 0%).

CONCLUSION

Virtual reality-based games show promise as a potential technology to be included among the therapeutic options for rehabilitating the balance of children and adolescents with SNHL. However, given the methodological limitations of the trials and the overall low quality of evidence currently available on this topic, caution should be exercised when interpreting the results of the trials analyzed in this systematic review.

Age and Visual Contribution Effects on Postural Control Assessed by Principal Component Analysis of Kinematic Marker Data

Postural control, the ability to control the body's position in space, is considered a critical aspect of health outcomes. This current study aimed to investigate the effects of age and visual contribution on postural control. To this end, principal component analysis (PCA) was applied to extract movement components/synergies (i.e., principal movements, PMs) from kinematic marker data of bipedal balancing on stable and unstable surfaces with eyes closed and open, pooled from 17 older adults (67.8 ± 6.6 years) and 17 young adults (26.6 ± 3.3 years), one PCA-analysis for each surface condition. Then, three PCA-based variables were computed for each PM: the relative explained variance of PM-position (PP_rVAR) and of PM-acceleration (PA_rVAR) for measuring the composition of postural movements and of postural accelerations, respectively, and the root mean square of PM-acceleration (PA_RMS) for measuring the magnitude of neuromuscular control. The results show the age and visual contribution effects observed in PM₁, resembling the anteroposterior ankle sway in both surface conditions. Specifically, only the greater PA₁_rVAR and PA₁_RMS are observed in older adults (p ≤ 0.004) and in closed-eye conditions (p < 0.001), reflecting their greater need for neuromuscular control of PM₁ than in young adults and in open-eye conditions.

Interaction of Hearing and Balance

There is increasingly assumed that, in addition to visual, vestibular and somatosensory afferents, hearing also plays a role in the regulation of balance. It seems that, especially in old age, progressive hearing loss is associated with a decrease in postural control. Several studies investigated this relationship in normal-hearing people, in patients with conventional hearing aids and with implantable hearing systems, as well as in patients with vestibular disorders. Despite the inhomogeneous study situation and lack of evidence, hearing seems to interact with the balance regulation system with potentially stabilizing effect. Furthermore, insights into audiovestibular interaction mechanisms could be achieved, which could possibly be integrated into therapeutic concepts of patients with vestibular disorders. However, further prospective controlled studies are necessary to bring this issue to an evidence-based level.

Comparing dynamic visual acuity between athletes who are deaf or hard-of-hearing and athletes who are hearing

This study examined the difference in the dynamic visual acuity test (DVAT) between collegiate athletes who are deaf or hard-of-hearing (D/HoH) (n = 38) and university club-level athletes who are hearing (n = 38). Dynamic visual acuity was assessed using the Bertec Vision Advantage (Bertec® Corporation, Columbus, Ohio, USA). No statistically significant differences between athletes who are D/HoH and who are hearing were found in DVAT for leftward (χ2 = 0.71, p = 0.40) or rightward (χ2 = 0.04, p = 0.84) head yaw rotation around an earth vertical axis. Dynamic visual acuity was similar for athletes regardless of hearing status. Baseline DVAT data may be of use for post-injury management of athletes who are D/HoH.

Something in the Sway: Effects of the Shepard-Risset Glissando on Postural Activity and Vection

This study investigated claims of disrupted equilibrium when listening to the Shepard-Risset glissando (which creates an auditory illusion of perpetually ascending/descending pitch). During each trial, 23 participants stood quietly on a force plate for 90 s with their eyes either open or closed (30 s pre-sound, 30 s of sound and 30 s post-sound). Their centre of foot pressure (CoP) was continuously recorded during the trial and a verbal measure of illusory self-motion (i.e., vection) was obtained directly afterwards. As expected, vection was stronger during Shepard-Risset glissandi than during white noise or phase-scrambled auditory control stimuli. Individual differences in auditorily evoked postural sway (observed during sound) were also found to predict the strength of this vection. Importantly, the patterns of sway induced by Shepard-Risset glissandi differed significantly from those during our auditory control stimuli - but only in terms of their temporal dynamics. Since significant sound type differences were not seen in terms of sway magnitude, this stresses the importance of investigating the temporal dynamics of sound-posture interactions.

The effect of cochlear implant surgery on vestibular function in adults: A meta-analysis study

Issue

The findings in literature indicate inconsistency in the complications caused by the implant of electrodes in the cochlea; vestibular alterations and balance disorders are mentioned as the most likely.

Purpose

To evaluate, in literature, through the results of multiple vestibular function tests, the effects of cochlear implant surgery on postural stability in adult patients and to analyze.

Hypothesis

From the PICO strategy, where the Population focuses on adults, Intervention is cochlear implant surgery, Comparisons are between implanted patients, and Outcomes are the results of the assessment of cochlear function, the research question was formulated: Are there deficits in vestibular function in adults undergoing cochlear implant placement?

Method

Systematic review based on cohort, case–control, and cross-sectional observational studies. Information sources: Databases between 1980 and 2021, namely, PubMed, Cinahl, Web Of Science, Cochrane, and Scopus. Search strategy using Mesh terms: “Adult,” “Cochlear Implant,” “Postural Balance,” “Posturography,” “Cochlear Implant,” “Dizziness,” “Vertigo,” “Vestibular Functional Tests,”and “Caloric Tests.” Populational inclusion criteria: studies with adult patients; intervention: cochlear implant placement surgery; comparison: analysis of a vestibular function with vestibular test results and pre- and postoperative symptoms; outcome: studies with at least one of the vestibular function tests, such as computerized vectoelectronystagmography (VENG), vestibular-evoked myogenic potentials (VEMPs), caloric test, video head impulse test (VHIT), head impulse test (HIT), videonystagmography, (VNG) and static and dynamic posturography. Exclusion criteria: studies without records of pre- and postoperative data collection and studies with populations under 18 years of age. Screening based on the reading of abstracts and titles was performed independently by two reviewers. In the end, with the intermediation of a third reviewer, manuscripts were included. Risk of bias analysis, performed by two other authors, occurred using the JBI “Critical Appraisal Checklist.”

Results

Of the 757 studies, 38 articles met the inclusion criteria. VEMP was the most commonly used test by the studies (44.7%), followed by the caloric test (36.8%) and vHIT (23.6%). Most studies performed more than one test to assess vestibular function.

Conclusion

Among all vestibular tests investigated, the deleterious effects on vestibular function after cochlear implant surgery were detected with statistical significance (P < 0.05) using VEMP and caloric test. Comparing abnormal and normal results after implant surgery, the vestibular apparatus was evaluated as having abnormal results after cochlear implant surgery only in the VEMP test. The other tests analyzed maintained a percentage mostly considered normal results.

Systematic review registration

identifier: CRD42020198872.

Vestibular and Balance Impairment Is Common in Children With Primary Ciliary Dyskinesia

OBJECTIVE

Primary ciliary dyskinesia (PCD) is a rare genetic disorder that presents with a wide range of respiratory complaints. The most common otologic associated disorder is middle ear effusion. We ask if children with PCD suffer from vestibular impairment.

STUDY DESIGN

Cross-sectional cohort study.

SETTING

Tertiary pediatric referral hospital.

PATIENTS/PARTICIPANTS

Children with confirmed PCD.

INTERVENTION/METHODS

All included participants were clinically assessed to be at baseline then basic demographics and medical histories were collected, including the specific genetic mutation these patients have. After which, all patients underwent two vestibular tests. The first was to assess their ability to stand on one foot with their eyes open and then with their eyes closed and the second was video head impulse test (vHIT).

MAIN OUTCOME MEASURES

Ability standing on one foot with the eyes closed and vHIT.

RESULTS

During this period, 25 children with PCD were recruited for the study. The mean age at recruitment was 11.26 years (4-18 yr). There were 11 women and 14 men. All patients were able to participate in both tests. Nineteen participants (76%) had vestibular impairment. Fifteen of them failed to stand on one foot with their eyes closed and six of 25 had abnormal vHIT. The most common involved gene was DNAH5 8/25 (32%) and it was associated with vestibular impairment in seven of eight participants (87.5%).

CONCLUSION

The majority of children with PCD that we tested suffered from vestibular impairment that was previously undiagnosed. This potentially indicates that imbalance and vestibular pathology is under-diagnosed in children with PCD.

Vestibular Evaluation and Management of Children with Sensorineural Hearing Loss

Vestibular dysfunction is the most common comorbidity associated with childhood sensorineural hearing loss. Early identification of vestibular dysfunction enables early intervention to mitigate its impact of motor, behavioral, and neurocognitive deficits of developing children. Screening for vestibular impairment can be achieved in the busy clinical setting.

Repercussions of the Degrees of Hearing Loss and Vestibular Dysfunction on the Static Balance of Children With Sensorineural Hearing Loss

OBJECTIVE

The purpose of this study was to assess the static balance of children with sensorineural hearing loss (SNHL) according to the degrees of SNHL and the function of the vestibular system.

METHODS

This cross-sectional study was conducted in public schools located in Caruaru, Pernambuco state, Brazil, with 130 children (65 with normal hearing and 65 with SNHL as documented by air and bone conduction audiometry) of both sexes between 7 and 11 years old. Static balance was assessed by a stabilometric analysis using a force platform consisting of the circular area of center-of-pressure displacement of the children evaluated in 3 positions: bipedal support with feet together and parallel (PF), tandem feet (TF), and 1 foot (OF), carried out under 2 sensory conditions each, with eyes open and eyes closed. After balance assessments, the children with SNHL received examinations of auditory and vestibular functions-through audiometry and computerized vectoelectronystagmography, respectively-to compose the groups according to degrees of SNHL and vestibular function.

RESULTS

The children with severe and profound SNHL demonstrated more static balance instabilities than the children with normal hearing in 5 positions assessed with eyes open (PF, TF, and OF) and eyes closed (PF and TF). The same phenomenon occurred in children with SNHL and associated vestibular dysfunction in all of the positions assessed with eyes open and eyes closed (PF, TF, and OF).

CONCLUSION

The larger the degree of SNHL, the greater the balance instability of the children. The children with SNHL and associated vestibular dysfunction showed the highest balance instabilities in this study.

IMPACT

Children with larger degrees of SNHL and associated vestibular dysfunction might require prolonged periods to rehabilitate their balance.

Vestibular status: A missing factor in our understanding of brain reorganization in deaf individuals

The brain of deaf people is definitely not just deaf, and we have to reconsider what we know about the impact of hearing loss on brain development in light of comorbid vestibular impairments.

Concussion Epidemiology in Athletes Who Are Deaf or Hard-of-Hearing Compared With Athletes Who Are Hearing

OBJECTIVE

To compare the epidemiology of concussion between athletes who are deaf or hard-of-hearing (D/HoH) and athletes who are hearing.

DESIGN

Descriptive epidemiology study.

SETTING

Data were collected from 2 Division III athletic programs. One institution is the world's only university designed to be barrier-free for students who are D/HoH.

PARTICIPANTS

Six hundred ninety-three athletes who are D/HoH and 1284 athletes who are hearing were included in this study. Athletes participated in collegiate athletics during the 2012 to 2013 through the 2016 to 2017 academic years.

INTERVENTIONS

Concussion data were provided by the athletic training staff at each institution.

MAIN OUTCOME MEASURES

Concussion counts, concussion rate, and injury rate ratios (IRRs) with 95% confidence intervals (95% CIs).

RESULTS

Thirty athletes who are D/HoH and 104 athletes who are hearing suffered concussions. Athletes who are hearing had an increased injury rate compared with athletes who are D/HoH for all sports combined (IRR = 1.87, 95% CI, 1.26-2.78). Football athletes who are hearing also had an increased injury rate compared with football athletes who are D/HoH (IRR = 3.30, 95% CI, 1.71-6.37). Concussion rate was higher for male athletes who are hearing than male athletes who are D/HoH (IRR = 2.84, 95% CI, 1.62-4.97). No other significant differences regarding concussion risk were identified.

CONCLUSIONS

Athletes who are D/HoH in sex-comparable sports may not have a higher rate of concussion than athletes who are hearing. Rate of concussion in football may be greater among athletes who are hearing compared with athletes who are D/HoH.

Vestibular, Gaze, and Balance Disorders in Asymptomatic Congenital Cytomegalovirus Infection

BACKGROUND AND OBJECTIVES

Congenital cytomegalovirus (cCMV) is the leading nongenetic cause of sensorineural hearing loss and developmental disabilities. Because there are limited data from studies of vestibular involvement in select groups of children with cCMV, the true frequency of vestibular disorders in cCMV is likely underestimated. Our objective for this study is to determine the prevalence of vestibular, gaze, and balance disorders in a cohort of children with asymptomatic cCMV.

METHODS

Comprehensive vestibular, gaze, and balance assessments were performed in 40 children with asymptomatic cCMV. The function of semicircular canals of the inner ear and vestibulo-visual tract were assessed by measuring vestibulo-ocular reflex in a computer-driven motorized rotary chair; inner ear saccular function was assessed by using cervical vestibular evoked myogenic potential; gaze stability during head movement was assessed by using clinical dynamic visual acuity, and balance was assessed by using the sensory organization test and the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition. Test results for each variable were compared with those of a control group without cCMV and/or compared to age-matched normative published data.

RESULTS

Vestibular disorders were evident in 45% of the cohort on the basis of rotary chair and cervical vestibular evoked myogenic potential testing, suggesting abnormalities in semicircular canals, the utricle and saccule of the inner ear, and vestibulo-visual tracts. Additionally, 46% of the cohort had difficulties maintaining gaze during head movement, and one-third to one-half of the cohort had difficulties maintaining balance.

CONCLUSIONS

Vestibular, gaze, and balance disorders are highly prevalent in children with asymptomatic cCMV. Systematic screening for vestibular disorders will be used to determine the full clinical impact for the development of effective interventions.

Evaluation of balance in children with sensorineural hearing loss according to age

PURPOSE

Hearing is an important sensory skill for psychomotor development. As the cochlea and vestibule share the membranous labyrinth of the inner ear, children with sensorineural hearing loss (SNHL) may have vestibular dysfunction. This study aimed to evaluate static, dynamic, functional balance, and mobility as a whole in children with SNHL.

MATERIAL AND METHODS

Eighty children, 40 with bilateral severe-to-profound SNHL (20 children between the ages of 6-10 were included in the Group 1, and 20 children between the ages of 11-15 were included in the Group 2) and 40 with normal-hearing (the Group 3 included 20 children between the ages of 6-10 and the Group 4 of 20 children between the ages of 11-15) were included in the study. The Single-Leg Stance (SLS) Test, Functional Reach Test (FRT), Time Up and Go (TUG) Test, and Pediatric Balance Scale (PBS) were used to evaluate the balance skills of children.

RESULTS

The present study found out that children with SNHL in both age groups performed worse than those with normal-hearing in FRT, SLS, and PBS. In the TUG test, children with SNHL in the younger age group had lower performance compared to their peers with normal-hearing while the TUG performance of children with SNHL in the older age group was similar to their normal-hearing peers.

CONCLUSION

It was concluded that the static, dynamic and functional balance skills of children with SNHL were impaired compared to their normal-hearing peers. Including balance assessment in the routine test battery in children with SNHL may be decisive for early diagnosis and rehabilitation of balance disorders. It may be beneficial to add static, dynamic and functional balance tests to the test battery in addition to mobility assessment, especially in children with SNHL in the older age groups.

The Influence of Hearing Aids on Balance Control: A Systematic Review

AIM

To assess the current opinion on the effects of hearing loss treatment by hearing aids (HAs) and the benefits of HA use on imbalance.

METHODS

PRISMA-compliant systematic review was done, including observational studies in patients affected by mild to severe sensorineural hearing loss with HAs, investigating the benefits of HAs on balance. Electronic searches were performed through Medline, Cochrane, Embase, Web of Science, and Scopus.

RESULTS

A total of 200 patients in 8 studies were included in this systematic review. Four studies were cross-sectional, 3 cross-sectional controlled and 1 prospective nonrandomized study. Static and dynamic balance in the aided condition improved in patients assessed using clinical investigations including Romberg test and Functional Ambulation Performance/mini-BESTest, respectively. Variable outcomes were found measuring static and dynamic balance during the aided condition with objective tests (computerized posturography, Mobility Lab device). Improved quality of life outcomes and self-confidence were noted, while subjective measurements of balance had conflicting results.

CONCLUSION

Although an improvement in balance in patients with HAs has been shown in certain conditions, the overall benefit is still unclear and it is only possible to speculate that HAs may also improve static, dynamic, or subjective perception of balance function in adults affected by hearing loss.

Impact of the sensory environment on balance in children with bilateral cochleovestibular loss

BACKGROUND

The aim of the present study was to determine the role of auditory and visual sensory input on balance in children with bilateral cochlevestibular loss. The prevalence of vestibular impairment, and specifically bilateral vestibular loss (BVL) in children with sensorineural hearing loss (SNHL) is high and children with profound cochleovestibular loss (SNHL-BVL) have impaired balance (Suarez et al., 2007; Suarez et al., 2019). Given that both hearing and vestibular impairments are often congenital or acquired in early life, it remains difficult to tease out the individual developmental impact of either one on balance and spatial awareness in children who experience both of these sensory deficits. While cochlear implants (CI) can provide or restore access to sound in children with SNHL-BVL, there is currently no vestibular prosthetic available for clinical use in this population. These children may also use their intact sensory inputs (i.e. vision) to a greater extent to support balance. Alternately, restoring or providing access to sound may, on its own, help these children to balance better. We hypothesized that balance in children with SNHL-BVL who use bilateral CIs is: 1) improved in the presence of directional sound and 2) impaired when visual cues are dynamic (moving) rather than static.

METHODS

Balance was assessed in 18 children with SNHL-BVL and 34 typically developing children with intact vestibular function and normal hearing by performing the Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) balance subtest in a virtual-reality simulator under 4 sensory conditions of graded complexity. Randomized conditions combined 2 auditory (moving directional street sounds vs. directionless static white noise) and 2 visual (dynamic street scene vs. stationary street scene) stimuli designed to recreate a "real-world" busy downtown street. Balance ability in children with SNHL-BVL was also compared with CI on and off.

RESULTS

As expected and similar to previous work, balance was significantly worse in the children with SNHL-BVL compared to typically developing children in all sensory conditions (p<0.0001). As a group, the mean balance skills of the children with SNHL-BVL were equivalent to that of a 4.4-year-old child despite being much older (mean age =13.8 years). Balance ability improved slightly but significantly when children with SNHL-BVL had access to any sound through their CI (p=0.047) and was positively correlated with duration of implant use (p=0.02). Balance ability did not change further in the presence of moving directional sounds compared to static white noise (p=0.42), or when coupled to a moving visual environment (p=0.32) in children with SNHL-BVL, however opposite to what was hypothesized, in the typically developing group, there was a decrement in performance that occurred in the presence of moving directional sound compared to directionless, static white noise (p=0.02).

CONCLUSIONS

Balance ability in children with SNHL-BVL who use bilateral CI was, as expected, poorer than their typically developing peers in all sensory conditions but improved slightly when they had access to any sound through their implants, with this benefit increasing as duration of implant use increased. This suggests that providing sound inputs through bilateral CIs positively affects balance in children with SNHL-BVL where vestibular and/or auditory inputs are compromised. This benefit was achieved even with auditory inputs that were devoid of moving directional cues (i.e. directionless static white noise) and is consistent with poor spatial hearing in children using bilateral CI.

The effects of Pilates training on static and dynamic balance of female deaf students: A randomized controlled trial

INTRODUCTION

To evaluate the effect of Pilates training on static and dynamic balance of deaf female.

METHODS

This study is a randomized, controlled trial with concealed randomization and blinded assessments. 19 female deaf students participated in this study and were randomly assigned into experimental (EXP, n = 9) and control (CON, n = 10) groups. Static balance was examined by Balance Error Scoring System (BESS), and dynamic balance was examined by Y balance test (YBT). The experimental group performed a Pilates training program for 8 weeks (three sessions of 60 min).

RESULTS

The findings showed that experimental group showed a significant change in static balance (with open eye and close eye) and dynamic balance (dominant limb and non-dominant limb) after 8 weeks Pilates training (p < 0.05). The control also showed no significant changes after training duration (p > 0.05).

CONCLUSIONS

This study showed that Pilates training significantly improve balance in female deaf students.

Postural control characterization according to age and auditory input in cochlear implant users

Aims/Objectives: Understand the relationship between auditory input and balance motor control. Material and Methods: Twelve prelingual adolescent cochlear implant users (CIU) and 12 adult postlingual CIU were tested by posturography on a force platform with eyes open in two conditions, with the cochlear implant (CI) on and off. Energy consumption (EC) of the body center of pressure sway signal was measured, calculating total EC and divided into three bands of frequencies; low (B1) 0-0.1 Hz, medium (B2) 0.1-1 Hz, and high (B3)1-2 Hz. Wilcoxon and Mann-Whitney tests were used for statistical analysis and the significance level was P ≤ 0.05. Results: Prelingual CIU decrease the EC in low and high frequencies throughout the adolescence (P < 0.05) assessed with the CI turned on, while it did not show any modification with the CI off. Postlingual CIU showed a deterioration of PR related to aging when evaluated with the CIU turned off, P < 0.05 in band 1. However, with the CI turned on they had no significant increase in this age range. Conclusions and Significance: The acoustic input improved EC of postural responses in higher and lower frequencies in adolescence and with aging which suggests a relationship with gross and fine movements involved in postural control.

Balance function after cochlear implant and inner ear anomaly: Comparison of dynamic posturography

INTRODUCTION

Patients with sensorineural hearing loss suffer concomitant vestibular dysfunction that is more prevalent in patients with inner ear anomaly and could be aggravated with cochlear implantation. To assess the vestibular dysfunction in patients with cochlear implantation, we compared their results with those of patients with and without inner ear anomaly.

MATERIALS AND METHODS

This is a historical cohort study lasting for 20 years on 50 patients with cochlear implantation. All patients underwent dynamic posturography and Bruininks-Oseretsky Test.

RESULTS

Twenty-two (44%) of the participants showed some types of inner ear anomaly. The frequency of abnormal Bruininks-Oseretsky Test was 45.5% and 10.7% (P = .005, odds ratio [OR] = 6.9). Abnormal composite was seen in 77.3% and 21.4%, respectively (P < .001; OR = 12.5). The mean strategy score in the fifth condition of the sensory organization test was 25.0 ± 20.4 in patients with inner ear anomaly, whereas it was 44.1 ± 18.9 in those without it (P = .001).

CONCLUSION

Balance capability in cochlear implantation patients with inner ear anomaly compared to those without inner ear anomaly was worse. More vestibular rehabilitation treatment plans are suggested for these patients.

Does the practice of sports or recreational activities improve the balance and gait of children and adolescents with sensorineural hearing loss? A systematic review

BACKGROUND

Balance and gait disorders have been observed in children and adolescents with sensorineural hearing loss (SNHL), justified by vestibular dysfunctions that these children may present, due to the injury to the inner ear. Therefore, some investigations have suggested that the practice of sports or recreational activities can improve the balance and gait of this population.

OBJECTIVE

Assess the evidence quality from randomized or quasi-randomized controlled trials that used sports or recreational activities as an intervention to improve the balance and /or gait of children and/or adolescents with SNHL.

METHODS

Systematic review that surveyed articles in nine databases, published up to January 10, 2019, in any language, using the following inclusion criteria: (1) Randomized or quasi-randomized controlled trials. (2) Participants from both groups with the clinical diagnosis of SNHL, aged 6-19 years old, without physical problems, cognitive or neurological deficits, except the vestibular dysfunction. (3) Using the practice of sports or recreational activities as an intervention, to improve the balance and/or gait outcomes.

RESULTS

4732 articles were identified in the searches, after the removal of the duplicates articles and the reading of the titles and their abstracts, remained 16 articles for reading in full, being 5 trials eligible for this systematic review. Of the five eligible trials, three used sports activities and two recreational activities as intervention and presented very low-quality evidence for balance and gait outcomes.

SIGNIFICANCE

Sports and recreational practices seem to represent promising modalities to improve the balance and gait of children and adolescents with SNHL. However, due to the methodological limitations of the trials and the low quality of the current evidence on the topic, the results of the trials should be interpreted with caution. Due to the low quality of evidence observed, we suggest that new trials be proposed on this topic, with greater methodological rigor, to provide high-quality evidence on the effectiveness of sports and recreational practices to improve the balance and gait of children and adolescents with SNHL.

Vestibular rehabilitation exercises programs to improve the postural control, balance and gait of children with sensorineural hearing loss: A systematic review

BACKGROUND

Several studies have demonstrated that children with sensorineural hearing loss (SNHL) exhibit postural instabilities, as well as balance and gait disorders, due to the vestibular dysfunction that they are prone to display as a consequence of inner ear injury. Thus, some experiments have proposed vestibular rehabilitation exercises programs as a treatment to improve these motor skills in children with SNHL.

OBJECTIVE

Assess the evidence quality of the trials that used vestibular rehabilitation exercises programs to improve the postural control, balance and gait of children with SNHL.

METHODS

This is a systematic review that surveyed articles in nine databases, published up to July 4, 2019, in any language, using the following inclusion criteria: (1) Randomized or quasi-randomized controlled trials. (2) Participants of both groups with clinical diagnosis of SNHL, aged up to 12 years old, with no physical problems, cognitive or neurological impairments, except the vestibular dysfunction. (3) Using vestibular rehabilitation exercises programs to improve the following outcomes: postural control, balance and/or gait.

RESULTS

Six experiments, including 153 children, met the inclusion criteria of this systematic review. Two randomized controlled trials (45 children) on the postural control exhibited low evidence quality and four others; three randomized and controlled trials (90 children) on the balance and one quasi-randomized (18 children) on the gait demonstrated very low evidence quality, respectively.

CONCLUSION

There is promising evidence that vestibular rehabilitation exercises programs improve the postural control, balance and gait of children with SNHL. However, due to the methodological limitations of the trials and low quality of current evidence on this topic, the trials results analyzed by this systematic review should be interpreted with caution. Due to the low quality of evidence observed in this review, we suggest that new trials be proposed on this topic, with better methodological quality, to prove the effectiveness of vestibular rehabilitation exercises programs to improve the postural control, balance and gait of children with SNHL.

Early general development and central auditory system maturation in children with cochlear implants - A case series

OBJECTIVES

A cochlear implant (CI) has the potential to improve the functioning of a deaf child in many aspects. Nevertheless, the dynamics of the general development, beyond the typically measured language abilities, directly after CI, is still unknown, especially if a child is implanted early. In this study we present a methodological framework for assessment of different domains of development, as well as the central auditory nervous system (CANS) maturation in infants and toddlers with a CI.

METHODS

Three children with bilateral congenital hearing loss and a unilateral CI, aged below 2.5 years, participated in a longitudinal study. Children were tested at three time points after cochlear implantation using the Polish Children Development Scale (CDS) consisting of a comprehensive battery of tests, as well as recordings of Cortical Auditory Evoked Potentials (CAEP).

RESULTS

All three children revealed gradual improvement in the overall CDS result as well as most of the CDS subscales. After 9 months of CI experience two younger children showed age-appropriate performance. In CAEP measurements a decrease of latency of the P1 component (an established biomarker of cortical auditory maturation) was observed in the same two children, with one achieving normal ranges of P1 latency after 9 months of CI use.

CONCLUSIONS

Our novel methodological framework can be successfully applied in small children with cochlear implants. It contributes to better understanding of the general development in early implanted children. The preliminary results indicate variability in children's performance in various developmental domains and thus the need to monitor the development of each child individually and holistically.

Vestibular testing in children with severe-to-profound hearing loss

Many studies showed that children with sensorineural hearing loss (SNHL) have possible vestibular affection which is related to the severity of cochlear pathology.

OBJECTIVES

this work is designed to evaluate vestibular function in children with congenital severe to profound SNHL and correlate the degree of hearing loss with the results of vestibular tests.

METHODS

this work included 52 children divided into two groups; control group consisted of 20 normal hearing children with no vestibular complaints, and study group consisted of 32 children with congenital severe to profound SNHL. All children were submitted to basic audiologic evaluation, combined vestibular evoked myogenic potentials, sinusoidal harmonic acceleration test (SHA) of rotatory chair test.

RESULTS

all children in the control group had normal oVEMP and cVEMPs results while abnormal cVEMPs and oVEMPs results were found in 89% and 96.9% of the tested ears of the study group respectively. Sinusoidal harmonic acceleration test results were normal in control group with significant reduction in gain, phase lead and higher level of asymmetry in 50% of the children in study group. There was a significant relation between the degree of hearing loss and the cVEMPs, oVEMPs abnormalities, while SHA test results showed no such relationship.

CONCLUSION

There is an evident vestibular abnormalities in children with severe to profound sensorineural hearing loss as revealed by the rotatory chair testing and VEMPs recordings. Vestibular assessment is very important in such group as it has an impact on their rehabilitation plan.

Electrical Vestibular Stimulation in Humans: A Narrative Review

BACKGROUND

In patients with bilateral vestibulopathy, the regular treatment options, such as medication, surgery, and/or vestibular rehabilitation, do not always suffice. Therefore, the focus in this field of vestibular research shifted to electrical vestibular stimulation (EVS) and the development of a system capable of artificially restoring the vestibular function. Key Message: Currently, three approaches are being investigated: vestibular co-stimulation with a cochlear implant (CI), EVS with a vestibular implant (VI), and galvanic vestibular stimulation (GVS). All three applications show promising results but due to conceptual differences and the experimental state, a consensus on which application is the most ideal for which type of patient is still missing.

SUMMARY

Vestibular co-stimulation with a CI is based on "spread of excitation," which is a phenomenon that occurs when the currents from the CI spread to the surrounding structures and stimulate them. It has been shown that CI activation can indeed result in stimulation of the vestibular structures. Therefore, the question was raised whether vestibular co-stimulation can be functionally used in patients with bilateral vestibulopathy. A more direct vestibular stimulation method can be accomplished by implantation and activation of a VI. The concept of the VI is based on the technology and principles of the CI. Different VI prototypes are currently being evaluated regarding feasibility and functionality. So far, all of them were capable of activating different types of vestibular reflexes. A third stimulation method is GVS, which requires the use of surface electrodes instead of an implanted electrode array. However, as the currents are sent through the skull from one mastoid to the other, GVS is rather unspecific. It should be mentioned though, that the reported spread of excitation in both CI and VI use also seems to induce a more unspecific stimulation. Although all three applications of EVS were shown to be effective, it has yet to be defined which option is more desirable based on applicability and efficiency. It is possible and even likely that there is a place for all three approaches, given the diversity of the patient population who serves to gain from such technologies.

Motor and cognitive performances in pre-lingual cochlear implant adolescents, related with vestibular function and auditory input

BACKGROUND

Information about the role of auditory input and motor control is limited.

OBJECTIVES

Assessment the relationship between auditory and vestibular information with specific motor and cognitive functions.

METHODS

Posturography in 17 Pre-lingual Cochlear Implant Adolescents, (PCIA) age 14.06 ± 3.05 in four sensory conditions was analyzed: (A) eyes open, cochlear implant (CI) on, (B) eyes open, CI off, (C) eyes closed standing on a foam over a platform (ECFP) with CI on, and (D) ECFP, CI off. Gait velocity (GV) was registered by inertial sensors using a 10-meter test. Vestibulo-ocular reflex (VOR) was evaluated with the video head impulse test (VHIT) and visual spatial skill (VS) assessed with the WISC-V test.

RESULTS

SV had no significant difference between conditions A and B (p = .2461). Comparing C and D, SV values decreased when CI was turned on (p = .0036). A significant linear relationship between VOR and GV (p = .0064) generating the VOR gain loss lower gait. Relationship between VOR and VS scores was no significant (p = .685).

CONCLUSIONS AND SIGNIFICANCE

Auditory information is a relevant cue when somatosensory and visual inputs are modified and range of vestibular function influence in a dynamic motor activity as gait, facts which must be considered in the neurodevelopment control.

Assessment of balance skills and falling risk in children with congenital bilateral profound sensorineural hearing loss

OBJECTIVE

To evaluate the balance skills and falling risk in children with a congenital bilateral profound sensorineural hearing loss (CBPSNHL).

METHODS

25 children with CBPSNHL and healthy 25 children with similar age and gender were included in the study. The flamingo balance test, the tandem stance test, and the one-leg standing test were performed to assess the patients' static balance skills. The pediatric balance scale (PBS) was used to evaluate the dynamic balance. Visual analog scale (VAS) was applied to the patients assess the frequency of falls.

RESULTS

The flamingo balance test, the tandem stance test, and the one-leg standing test in the children with CBPSNHL were all significantly worse than the control group. Although the scores of PBS in patients with CBPSNHL were significantly lower than the control group (p < 0.001), the results of both groups were consistent with a low risk of falls. There was no significant difference between the VAS scores indicating the frequency of falls among the groups (p = 0.552).

CONCLUSION

Static and dynamic balance skills of the children with CBPSNHL are significantly impaired compared to their healthy peers. Children with CBPSNHL also have a lower risk of falling just like their healthy peers and there is no significant difference between their falling frequencies. Balance skills of children with CBPSNHL can be assessed quickly and effectively on a hard floor (eyes closed), with a tandem standing test or a one-leg standing test.

Study of the effects of hearing on static and dynamic postural function in children using cochlear implants

OBJECTIVE

The present study aimed to evaluate the postural control perturbations by the center of pressure parameters in two main approaches, cochlear implant turned "on" and "off".

METHODS

We included 25 children aged 8-10 years with unilateral cochlear implants and bilateral vestibular hypofunction deficit. To evaluate the postural function, each children was asked to stand on the force plate under 3 different conditions and cochlear implant turned "on" and "off": Condition (A) double stance from open eyes to closed eyes, Condition (B) double stance with open eyes engaging in the dual task and Condition (C) From double leg stance to one leg stance with open eyes for assessment of dynamic postural control. Also to calculate the center of pressure parameters, we designed new software for the force plate RESULTS: In condition A: although the results demonstrated an overall reduction in the mean of center of pressure parameters when the cochlear implant was "on", only the significant differences were seen in mean and standard deviations for anterior-posterior displacement, mediolateral displacement, area and mean velocity (P =0.00, P=0.04, P=0.02 and P=0.00, respectively) in open eyes In condition B: no significant difference was found between "on" and "off" cochlear implant in single or dual-task situations. In condition C: mean velocity variable demonstrated a significant difference (P=0.00) in the cochlear implant "on" condition in double leg stance only. Also, anterior-posterior displacement demonestrated a significant difference (P=0.00) when the cochlear implant was turned "on" in one leg stance situation.

CONCLUSION

The results of our study show that auditory information can improve postural stability and reduce body sways in different situations as an underlying system for reinforcement of the postural control in children without complete normal balance subsystems.

Static and dynamic balance of children and adolescents with sensorineural hearing loss

OBJECTIVE

To assess the static and dynamic balance performance of students with normal hearing and with sensorineural hearing loss.

METHODS

A cross-sectional study assessing 96 students, 48 with normal hearing and 48 with sensorineural hearing loss of both sexes, aged 7 and 18 years. To evaluate static balance, Romberg, Romberg-Barré and Fournier tests were used; and for the dynamic balance, we applied the Unterberger test.

RESULTS

Hearing loss students showed more changes in static and dynamic balance as compared to normal hearing, in all tests used (p<0.001). The same difference was found when subjects were grouped by sex. For females, Romberg, Romberg-Barré, Fournier and Unterberger test p values were, respectively, p=0.004, p<0.001, p<0.001 and p=0.023; for males, the p values were p=0.009, p<0.001, p<0.001 and p=0.002, respectively. The same difference was observed when students were classified by age. For 7 to 10 years old students, the p values for Romberg, Romberg-Barré and Fournier tests were, respectively, p=0.007, p<0.001 and p=0.001; for those aged 11 and 14 years, the p values for Romberg, Romberg-Barré, Fournier and Unterberger tests were p=0.002, p<0.001, p<0.001 and p=0.015, respectively; and for those aged 15 and 18 years, the p values for Romberg-Barré, Fournier and Unterberger tests were, respectively, p=0.037, p<0.001 and p=0.037.

CONCLUSION

Hearing-loss students showed more changes in static and dynamic balance comparing to normal hearing of same sex and age groups.

Spatial Cues Provided by Sound Improve Postural Stabilization: Evidence of a Spatial Auditory Map?

It has long been suggested that sound plays a role in the postural control process. Few studies however have explored sound and posture interactions. The present paper focuses on the specific impact of audition on posture, seeking to determine the attributes of sound that may be useful for postural purposes. We investigated the postural sway of young, healthy blindfolded subjects in two experiments involving different static auditory environments. In the first experiment, we compared effect on sway in a simple environment built from three static sound sources in two different rooms: a normal vs. an anechoic room. In the second experiment, the same auditory environment was enriched in various ways, including the ambisonics synthesis of a immersive environment, and subjects stood on two different surfaces: a foam vs. a normal surface. The results of both experiments suggest that the spatial cues provided by sound can be used to improve postural stability. The richer the auditory environment, the better this stabilization. We interpret these results by invoking the “spatial hearing map” theory: listeners build their own mental representation of their surrounding environment, which provides them with spatial landmarks that help them to better stabilize.

The Severity of Vestibular Dysfunction in Deafness as a Determinant of Comorbid Hyperactivity or Anxiety

Attention-deficit/hyperactivity disorder (ADHD) and anxiety-related disorders occur at rates 2-3 times higher in deaf compared with hearing children. Potential explanations for these elevated rates and the heterogeneity of behavioral disorders associated with deafness have usually focused on socio-environmental rather than biological effects. Children with the 22q11.2 deletion or duplication syndromes often display hearing loss and behavioral disorders, including ADHD and anxiety-related disorders. Here, we show that mouse mutants with either a gain or loss of function of the T-Box transcription factor gene, Tbx1, which lies within the 22q11.2 region and is responsible for most of the syndromic defects, exhibit inner ear defects and hyperactivity. Furthermore, we show that (1) inner ear dysfunction due to the tissue-specific loss of Tbx1 or Slc12a2, which encodes a sodium-potassium-chloride cotransporter and is also necessary for inner ear function, causes hyperactivity; (2) vestibular rather than auditory failure causes hyperactivity; and (3) the severity rather than the age of onset of vestibular dysfunction differentiates whether hyperactivity or anxiety co-occurs with inner ear dysfunction. Together, these findings highlight a biological link between inner ear dysfunction and behavioral disorders and how sensory abnormalities can contribute to the etiology of disorders traditionally considered of cerebral origin.SIGNIFICANCE STATEMENT This study examines the biological rather than socio-environmental reasons why hyperactivity and anxiety disorders occur at higher rates in deaf individuals. Using conditional genetic approaches in mice, the authors show that (1) inner ear dysfunction due to either Tbx1 or Slc12a2 mutations cause hyperactivity; (2) it is vestibular dysfunction, which frequently co-occurs with deafness but often remains undiagnosed, rather than auditory dysfunction that causes hyperactivity and anxiety-related symptoms; and (3) the severity of vestibular dysfunction can predict whether hyperactivity or anxiety coexist with inner ear dysfunction. These findings suggest a need to evaluate vestibular function in hearing impaired individuals, especially those who exhibit hyperactive and anxiety-related symptoms.

The Contribution of Hearing and Hearing Loss to Balance Control

This study investigated the hypothesis that a hearing ‘map' of our surroundings is used to maintain balance control. We investigated the effects of sound on postural sway using centre of pressure analysis in 50 subjects with normal hearing, 28 with hearing loss and 19 with vestibular dysfunction. The acoustic environments utilized sound cues that were either present or absent. It was found that auditory cues are utilized by subjects with normal hearing to improve postural sway. The ability to utilize sound for postural control is diminished when there is a hearing loss, but this appears to be overcome by the use of a hearing aid. Patients with additional vestibular deficits exploit auditory cues to a greater degree, suggesting that sensory weighting to enhance the use of auditory cues may be applied when there is diminished sensory redundancy.

Paediatric Cochlear Implantation in Patients with Waardenburg Syndrome

OBJECTIVE

To analyse the benefit of cochlear implantation in young deaf children with Waardenburg syndrome (WS) compared to a reference group of young deaf children without additional disabilities.

METHOD

A retrospective study was conducted on children with WS who underwent cochlear implantation at the age of 2 years or younger. The post-operative results for speech perception (phonetically balanced standard Dutch consonant-vocal-consonant word lists) and language comprehension (the Reynell Developmental Language Scales, RDLS), expressed as a language quotient (LQ), were compared between the WS group and the reference group by using multiple linear regression analysis.

RESULTS

A total of 14 children were diagnosed with WS, and 6 of them had additional disabilities. The WS children were implanted at a mean age of 1.6 years and the 48 children of the reference group at a mean age of 1.3 years. The WS children had a mean phoneme score of 80% and a mean LQ of 0.74 at 3 years post-implantation, and these results were comparable to those of the reference group. Only the factor additional disabilities had a significant negative influence on auditory perception and language comprehension.

CONCLUSIONS

Children with WS performed similarly to the reference group in the present study, and these outcomes are in line with the previous literature. Although good counselling about additional disabilities concomitant to the syndrome is relevant, cochlear implantation is a good rehabilitation method for children with WS.

To Hear or Not to Hear: Sound Availability Modulates Sensory-Motor Integration

When we walk in place with our eyes closed after a few minutes of walking on a treadmill, we experience an unintentional forward body displacement (drift), called the sensory-motor aftereffect. Initially, this effect was thought to be due to the mismatch experienced during treadmill walking between the visual (absence of optic flow signaling body steadiness) and proprioceptive (muscle spindles firing signaling body displacement) information. Recently, the persistence of this effect has been shown even in the absence of vision, suggesting that other information, such as the sound of steps, could play a role. To test this hypothesis, six cochlear-implanted individuals were recruited and their forward drift was measured before (Control phase) and after (Post Exercise phase) walking on a treadmill while having their cochlear system turned on and turned off. The relevance in testing cochlear-implanted individuals was that when their system is turned off, they perceive total silence, even eliminating the sounds normally obtained from bone conduction. Results showed the absence of the aftereffect when the system was turned off, underlining the fundamental role played by sounds in the control of action and breaking new ground in the use of interactive sound feedback in motor learning and motor development.

Postural responses applied in a control model in cochlear implant users with pre-lingual hearing loss

Conclusions The assessment of postural responses (PR) based in a feedback control system model shows selective gains in different bands of frequencies adaptable with child development. Objective PR characterization of pre-lingual cochlear implant users (CIU) in different sensory conditions. Methods Total energy consumption of the body's center of pressure signal (ECCOP) and its distribution in three bands of frequencies: band 1 (0-0.1 Hz), band 2 (0.1-0.7 Hz), and band 3 (0.7-20 Hz) was measured in a sample of 18 CIU (8-16 years old) and in a control group (CG) (8-15 years old). They were assessed in a standing position on a force platform in two sensory conditions: 1 = Eyes open. 2 = Eyes closed and standing on foam. Results In condition 1, total ECCOP of PR and its proportion of energy consumption in the three bands of frequencies were similar between CIU and CG (p > 0.05). In condition 2, CIU have significantly higher ECCOP, mainly in high frequencies (bands 2 and 3) (p < 0.05). ECCOP values decreased with age also, mainly in bands 2 and 3. This behavior is interpreted in the control system model proposed as an adaptation process related with child development.

Body Perception and Action Following Deafness

The effect of deafness on sensory abilities has been the topic of extensive investigation over the past decades. These investigations have mostly focused on visual capacities. We are only now starting to investigate how the deaf experience their own bodies and body-related abilities. Indeed, a growing corpus of research suggests that auditory input could play an important role in body-related processing. Deafness could therefore disturb such processes. It has also been suggested that many unexplained daily difficulties experienced by the deaf could be related to deficits in this underexplored field. In the present review, we propose an overview of the current state of knowledge on the effects of deafness on body-related processing.

Effects of Unilateral Cochlear Implantation on Balance Control and Sensory Organization in Adult Patients with Profound Hearing Loss

Many studies were interested in the consequence of vestibular dysfunction related to cochlear implantation on balance control. This pilot study aimed to assess the effects of unilateral cochlear implantation on the modalities of balance control and sensorimotor strategies. Posturographic and vestibular evaluations were performed in 10 patients (55 ± 20 years) with profound hearing loss who were candidates to undergo unilateral multichannel cochlear implantation. The evaluation was carried out shortly before and one year after surgery. Posturographic tests were also performed in 10 age-matched healthy participants (63 ± 16 years). Vestibular compensation was observed within one year. In addition, postural performances of the patients increased within one year after cochlear implantation, especially in the more complex situations, in which sensory information is either unavailable or conflicting. Before surgery, postural performances were higher in the control group compared to the patients' group. One year after cochlear implantation, postural control was close to normalize. The improvement of postural performance could be explained by a mechanism of vestibular compensation. In addition, the recovery of auditory information which is the consequence of cochlear implantation could lead to an extended exploration of the environment possibly favoring the development of new balance strategies.

Cochlear implantation and vestibular function in children

OBJECTIVES

To analyze vestibular function Q2 (VF) after cochlear implantation (CI) in children.

METHODS

Retrospective cohort study at a tertiary pediatric referral center. 43 children that had vestibular testing (VT) after unilateral cochlear implantation, from 2001 to 2010, were included. CT scan of the temporal bone was done systematically before surgery. VT included three tests: head-impulse test, caloric tests, vestibular evoked myogenic potentials. VF was graded in: normal (type 1), partial dysfunction (type 2), severe dysfunction and areflexia (type 3). In 12 cases, VT was done before and after CI. Vestibular function was analyzed looking to side, etiology and preoperative status.

RESULTS

Mean age at CI was 2.9 years. Bilateral inner ear malformation were retrieved in 16%. Before surgery, 50% of children had normal vestibular responses, 4/12 had bilateral type 2, two had asymmetrical VF. In this group, after surgery, 2 children had VF worsening, none on the CI side only. Considering all 43 patients, post operative VT showed normal response in 48.8% and type 2&3 in 16.2%. Children had asymmetrical poorer vestibular function on the side of CI in 19%. Among them, 75% had normal contralateral VF. Sensorineural hearing loss etiologies known to be associated with vestibulopathy (Usher/Meningitis/Inner Ear Malformations/CMV) were associated to abnormal vestibular function more frequently than in other causes (p=0.01).

CONCLUSION

Half of the children had initial vestibular dysfunction. In our study, 20% of cochlear implantation could have worsened vestibular function. As vestibular function should be part of the choice in cochlear implantation, side of implantation and survey; and vestibular tests are uneasy to achieve in pediatric population, we propose a three-steps evaluation and gradation which allow easier comparison.

A study of safety and tolerability of rotatory vestibular input for preschool children

The objectives of this study were to determine a safe rotatory vestibular stimulation input for preschool children and to study the effects of grade level and sex of preschool children during active, passive, clockwise, and counterclockwise rotation vestibular input. This study adopted purposive sampling with 120 children from three kindergarten levels (K1, K2, and K3) in Taiwan. The subjects ranged in age from 46 to 79 months of age (mean: 62.1 months; standard deviation =9.60). This study included testing with four types of vestibular rotations. The number, duration, and speed of rotations were recorded. The study found that the mean number of active rotations was 10.28; the mean duration of rotation was 24.17 seconds; and the mean speed was 2.29 seconds per rotation. The mean number of passive rotations was 23.04. The differences in number of rotations in clockwise, counterclockwise, active, and passive rotations were not statistically significant. Sex and grade level were not important related factors in the speed and time of active rotation. Different sexes, rotation methods (active, passive), and grades made significant differences in the number of rotations. The safety and tolerability of rotatory vestibular stimulation input data obtained in this study can provide useful reference data for therapists using sensory integration therapy.

Desempenho do equilíbrio dinâmico de escolares ouvintes e com perda auditiva sensorioneural

Introdução: O equilíbrio corporal humano é regulado pela atuação sensorial do sistema vestibular, situado na orelha interna. Crianças com perda auditiva sensorioneural podem apresentar alterações no sistema vestibular e, consequentemente, no equilíbrio corporal, em decorrência da lesão na orelha interna.Objetivos: Avaliar o equilíbrio dinâmico em escolares ouvintes e com perda auditiva sensorioneural e comparar os dados entre os grupos considerando os sexos e as faixas etárias.Métodos: Estudo de corte transversal, que avaliou 96 escolares, sendo 48 ouvintes e 48 com perda auditiva sensorioneural, de ambos os sexos, na faixa etária entre sete e 18 anos. A avaliação do equilíbrio dinâmico foi realizada por meio do teste de Babinski-Weil e do teste de Fukuda. Para a análise dos dados foi utilizado o teste do qui-quadrado de Pearson, tendo em vista a distribuição de normalidade dos dados.Resultados: Os escolares com perda auditiva apresentaram maior ocorrência de alterações no equilíbrio dinâmico comparado aos ouvintes: teste de Babinski-Weil e teste de Fukuda: (p<0,001). A mesma diferença foi observada quando os voluntários foram agrupados pelos sexos: feminino e masculino: teste de Babinski-Weil e teste de Fukuda: (p<0,001). Estratificando-se pelas faixas etárias, os resultados apontaram diferenças, entre todos os grupos etários avaliados: teste de Babinski-Weil: sete a 14 anos: (p<0,001) e 15-18 anos: (p= 0,004), teste de Fukuda: sete a 18 anos: (p<0,001).Conclusão: Os escolares com perda auditiva apresentaram maior ocorrência de alterações no equilíbrio dinâmico que os ouvintes do mesmo sexo e faixa etária.