Balanced Growth project: a protocol of a single-centre observational study on the involvement of the vestibular system in a child's motor and cognitive development

Vestibular function in children with neurodevelopmental disorders: A neglected sense?

OBJECTIVE

The study aimed to explore the vestibular function in children with neurodevelopmental disorders (NDDs).

METHODS

Twenty-eight participants with a NDD (6 girls, 22 boys; 6-13 years; 9;3 ± 2;4 years) were enrolled in this pilot study. Sixteen participants had a single NDD (Autism Spectrum Disorder: n = 7, Developmental Coordination Disorder: n = 3; Attention Deficit/Hyperactivity Disorder: n = 6), the remaining 12 had comorbid NDDs. The integrity of the peripheral vestibular system was evaluated using ocular and cervical Vestibular Evoked Myogenic Potentials (o/cVEMP), and a video Head Impulse Test (vHIT); motor competence was assessed with the Movement Assessment Battery for Children, and the KörperkoordinationsTest für Kinder. Results were compared to an age and sex-matched control group (n = 28; 9;7 ± 1;9 years).

RESULTS

The NDD group exhibited significantly higher interpeak amplitudes on both VEMP tests compared to the control group (p < 0.001). No significant differences were found between the groups on vHIT measurements (p > 0.05). Among the children with NDDs, 11 (39 %) showed atypical vestibular responses, including one child with vHIT correction saccades and three children with reduced or absent otolith responses (n = 3). Additionally, eight children showed abnormally elevated otolith amplitudes (cVEMP > 4.00 µV; oVEMP > 55.00 µV).

CONCLUSIONS

Clinicians are encouraged to recognize the overlap and consider the possibility of vestibular alterations in individuals with NDD.

SIGNIFICANCE

Incorporating vestibular assessments into routine clinical evaluations, particularly in children with NDD who exhibit delayed motor development, balance issues, hearing loss, or vestibular-related symptoms, is strongly recommended.

Vestibular Infant Screening-Rehabilitation (VIS-REHAB): protocol for a randomised controlled trial on Vestibular Rehabilitation Therapy (VRT) in vestibular-impaired children

INTRODUCTION

A vestibular deficit can have a substantial impact on the overall development of children. Therefore, it is of utmost importance that vestibular-impaired problems are treated early and effectively through Vestibular Rehabilitation Therapy (VRT). Although VRT is sufficiently proven and standardised in adults, there remains a lack of research examining its efficacy in children. To assess the effectiveness of VRT in vestibular-impaired children, the Vestibular Infant Screening-Rehabilitation (VIS-REHAB) protocol was developed with the following objectives: (1) to investigate the short-term effect of a combined postural control and gaze stabilisation protocol, compared with receiving no therapy and (2) to investigate the most important factors that may influence the effect of and outcome after application of the VIS-REHAB protocol in a group of vestibular-impaired children. This study aims to address lingering questions in the existing literature in a standardised manner, with the ultimate objective to establish evidence-based rehabilitation guidelines.

METHODS AND ANALYSIS

The VIS-REHAB study is a two-parallel group, superiority, randomised controlled crossover trial with 1:1 allocation ratio. The study includes patients aged 3-17 years old with identified peripheral vestibular dysfunction. Primary and secondary outcome measures assess gaze stability, postural stability, motor performance and quality of life. The effectiveness of the VIS-REHAB protocol will be evaluated through parallel group and crossover analyses using analysis of covariance (ANCOVA). Additionally, prespecified subgroup analyses will be conducted to assess influencing factors that may impact the outcome and effect of VIS-REHAB.

ETHICS AND DISSEMINATION

At the start of the VIS-REHAB study, an amendment will be submitted to the ethics committee of Ghent University Hospital for the following applications: (EC2018/0435), (EC2018/0959), (EC2015/1441) and (EC2015/1442). The trial is registered at Clinical Trials (clinicaltrials.gov) with registry name VIS-REHAB and identifier NCT06177132. All research findings will be disseminated in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT06177132.

A cross-sectional study on the neurocognitive outcomes in vestibular impaired school-aged children: are they at higher risk for cognitive deficits?

This study aimed to assess if children with a vestibular impairment (VI) are more prone to have neurocognitive deficits compared to typically developing (TD) peers, taking into account important confounding factors with hearing loss being the most important. The neurocognitive performance of fifteen VI children (6-13 years old) was compared to that of an age-, handedness- and sex-weighted group of TD peers (n = 60). Secondly, their performance was also compared to matched groups of TD and hearing impaired (HI) children to evaluate the involvement of HI. The protocol comprises cognitive tests assessing response inhibition, emotion recognition, visuospatial memory, selective and sustained attention, visual memory and visual-motor integration.Based on the results, the VI group had significantly reduced scores on 'social cognition' (p = 0.018), 'executive functions' (p < 0.01), and 'perceptual-motor functioning' (p = 0.020) compared to their TD and HI peers. For the categories 'complex attention' and 'learning and memory' no differences could be observed. Analogous to the findings of previous literature, the symptoms of a VI are often not limited to the primary functions of the system, but also comprise an impact on emotional and cognitive performance. Therefore, more holistic rehabilitation approaches should be encouraged, with a screening and attention for cognitive, emotional and behavioral dysfunctions in the vestibular population. Since this is one of the first studies to investigate the involvement of a VI in a child's cognitive development, these findings support the need for studies further characterizing the impact of a VI, the underlying pathophysiology and the effect of different rehabilitation procedures.

Correction system effectiveness of the children physical development of early and younger preschool age with psychomotor disorders (on the example of posture)

Purpose: to reveal the reliability of the effectiveness of the developed author's system for correcting the physical development of young and preschool children with psychomotor disorders. Material and methods. A total of 208 children of early (2-3 years) and younger preschool (3-4 years) age with psychomotor disorders took part in the study. Specially organized studies of the effectiveness of the system of corrective physical education for children of early and younger preschool age with psychomotor disorders were conducted during 2019 - 2021. They took place in specialized preschool education institutions, as well as kindergartens of the combined type in the city of Odesa, Odesa region, as well as in the cities of Kramatorsk, Kharkiv, Mykolaiv, Balaklia (Kharkiv region). I also summarized my own long-term (over 25 years) experience of individual rehabilitation activities with the specified contingent of children in the Odessa Movement Rehabilitation Center. All children were divided into two groups: 108 from experimental groups and 100 from control groups. Results. Summarizing the analysis of the results of the dynamics of physical development indicators of children with psychomotor disorders (on the example of the study of their posture), we should conclude that almost all the indicators of children from the experimental groups had a marked improvement in results, which in the absolute majority of cases was confirmed statistically (P<0,01‒0,05). Children from control groups also demonstrated some improvement of physical development indicators, but it was by no means confirmed by the methods of mathematical statistics (P>0,05). Conclusions: the conducted formative pedagogical experiment confirmed the reliability of the effectiveness of the developed author's system of correction of physical development of children of early and early preschool age with psychomotor disorders in comparison with the traditional system of their education.

Predicting Early Vestibular and Motor Function in Congenital Cytomegalovirus Infection

OBJECTIVES

Congenital cytomegalovirus (cCMV) can affect vestibular function, which is an important cornerstone for early motor development. This study aims to identify risk factors for early vestibular dysfunction with severe repercussions on the motor outcome.

METHODS

This prospective cohort study included 169 cCMV-patients with complete vestibular assessment (lateral video Head Impulse Test and cervical Vestibular Evoked Myogenic Potentials) before the age of 18 months (mean 8.9, standard deviation 3.27 months). Motor results using the Alberta Infant Motor Scale were collected in 152 of these patients. Logistic and linear regression models were applied to identify risk factors for the vestibular and motor outcomes, respectively.

RESULTS

The odds of developing early vestibular dysfunction were 6 times higher in patients presenting with hearing loss at birth compared to those born with normal hearing (p = .002). Within the latter group, significant predictors for vestibular dysfunction were (delayed-onset) hearing impairment at the time of vestibular testing (p = .003) and the presence of periventricular cysts on magnetic resonance imaging (p = .005). Remarkably, none of the patients infected during the third trimester of pregnancy (n = 14) developed early vestibular dysfunction. On average, vestibular-impaired patients had a z-score on the Alberta Infant Motor Scale that was 1.17 points lower than patients without vestibular deficit (p < .001).

CONCLUSION

Early vestibular loss can have a significant adverse effect on motor development. Hearing and cranial imaging findings could facilitate the widespread implementation of a (targeted) vestibular assessment approach in the cCMV-population.

LEVEL OF EVIDENCE

3 Laryngoscope, 2022.

Recent developments in the understanding of the interactions between the vestibular system, memory, the hippocampus, and the striatum

Over the last two decades, evidence has accumulated to demonstrate that the vestibular system has extensive connections with areas of the brain related to spatial memory, such as the hippocampus, and also that it has significant interactions with areas associated with voluntary motor control, such as the striatum in the basal ganglia. In fact, these functions are far from separate and it is believed that interactions between the striatum and hippocampus are important for memory processing. The data relating to vestibular-hippocampal-striatal interactions have considerable implications for the understanding and treatment of Alzheimer's Disease and Parkinson's Disease, in addition to other neurological disorders. However, evidence is accumulating rapidly, and it is difficult to keep up with the latest developments in these and related areas. The aim of this review is to summarize and critically evaluate the relevant evidence that has been published over the last 2 years (i.e., since 2021), in order to identify emerging themes in this research area.