Rose Marie Rine

EVIDENCE OF PROGRESSIVE DELAY OF MOTOR DEVELOPMENT IN CHILDREN WITH SENSORINEURAL HEARING LOSS AND CONCURRENT VESTIBULAR DYSFUNCTION

Gross motor development, and the effect of age, sex and vestibular function on it, was examined in 39 24- to 83-mo.-old children with sensorineural hearing impairment. Repeated testing was completed on 18 children. Delayed gross motor development was evident regardless of age, but only children Jess than 5 years of age had developmental balance deficits on initial testing. Both gross motor and balance development scores were lower on repeated testing. Furthermore, vestibular function scores facilitated identification of those children with a deficit in balance development as well as those with a progressive delay in motor or balance development. Implications for practice are discussed.

Growing evidence for balance and vestibular problems in children

Reports of vestibular deficits and related impairments in children are increasing in number. However, vestibular dysfunction in childhood appears to be an under-reported and overlooked entity. This report provides an overview of current literature regarding the incidence of vestibular deficits in children, the related impairments of gaze stability and balance and intervention for vestibular related impairments in children.

New portable tool to screen vestibular and visual function—National Institutes of Health Toolbox initiative

As part of the National Institutes of Health Toolbox initiative, we developed a low-cost, easy-to-administer, and time-efficient test of vestibular and visual function. A computerized test of dynamic visual acuity (cDVA) was used to measure the difference in visual acuity between head still and moving in yaw. Participants included 318 individuals, aged 3 to 85 years (301 without and 17 with vestibular pathology). Adults used Early Treatment of Diabetic Retinopathy Study (ETDRS) optotypes; children used ETDRS, Lea, and HOTV optotypes. Bithermal calorics, rotational chair, and light box testing were used to validate the cDVA. Analysis revealed that the cDVA test is reliable for static (intraclass correlation coefficient [ICC] >/= 0.64) and dynamic (ICC >/= 0.43-0.75) visual acuity. Children younger than 6 years old were more likely to complete cDVA with Lea optotypes, but reliability and correlation with ETDRS was better using HOTV optotypes. The high correlation between static acuity and light box test scores (r = 0.795), significant difference of cDVA scores between those with and without pathology (p </= 0.04), and the good to excellent sensitivity (73%) and specificity (69%) establish that the cDVA is a valid and reliable measure of visual acuity when the head is still and moving, as well as a good proxy of vestibular function to yaw rotation.

Balance and motor skills in young children with sensorineural hearing impairment: A preliminary study

The purpose of this study was to compare the static and dynamic balance, motor abilities, and postrotatory nystagmus (PRNT) test results of four- to five-year-old children with sensorineural hearing impairment (SNHI) to those of typically developing peers. Seven children with SNHI and six typically developing peers comprised the experimental and control groups, respectively. Static balance was measured as duration of single-leg stance with eyes open and eyes closed. Kinematic analysis of responses during tilt board perturbation with eyes open and eyes closed comprised testing of dynamic balance. Motor abilities were defined by performance on the Learning Accomplishment Profile Gross Motor Subscale. The data indicate that a majority of children with SNHI present with aberrant PRNT results, delayed maturation of equilibrium reactions, and age-appropriate performance in a general developmental screening test. Implications for clinicians working with preschool-aged children with SNHI are discussed, as are directions for future research.

Extraretinal Eye Position Signals Determine Perceived Target Location when they Conflict with Visual Cues

To examine the role of extraretinal eye position information (EEPI) in visual perception of target location in normal room illumination, subjects participated in experiments in which EEPI was manipulated using the eye press maneuver with either monocular or binocular viewing. The viewing condition and eye press caused EEPI and retinal information about target location to conflict. Pointing responses in eye press trials were all in the direction of EEPI showing that EEPI is the dominant source of information in egocentric visual space perception. In binocular viewing, version and vergence occur in response to the eye press to maintain fusion and EEPI based on these movements also determine perceived location. An unanticipated finding was that the eye press was variable in its effectiveness in rotating the eye, which contributed to large variability in pointing errors and suggested the method would be a poor choice for future work.

Enhanced Proprioceptive Acuity at the Knee in the Competitive Athlete

STUDY DESIGN Controlled laboratory study: cross-sectional. OBJECTIVE To determine if proprioception, measured by the threshold to detection of passive motion (TDPM), differed in individuals who regularly participate in moderate-intensity exercise for fitness as compared to individuals involved in high-intensity skilled exercise. BACKGROUND Previous research has been equivocal as to whether exercise training is associated with superior proprioceptive acuity, in particular, exercise that includes dynamic postural challenges such as cutting and pivoting. METHODS Two groups of 25 healthy individuals (18-32 years old) were recruited. One group consisted of individuals who performed moderate-activity level exercises for 5 to 10 hours per week. Participants in the other group performed high-activity level exercises, including high-speed cutting and pivoting activities, at least 10 hours per week. Proprioception was determined using TDPM, in which the knee was slowly extended or flexed at an angular velocity of 0.5°/s or less from a starting position of 40° of knee flexion. RESULTS Individuals participating in competitive, high-intensity skilled exercise demonstrated better acuity (average of both limbs) of TDPM (mean ± SD, 0.81° ± 0.38°; P<.001) than those participating in moderate-intensity exercise for fitness (1.53° ± 0.58°). A low but statistically significant association (r = -0.38, P = .006) was found between weekly duration of exercise and proprioceptive threshold as measured by TDPM. CONCLUSION These results suggest that perceptual thresholds of passive movement may be enhanced, depending on activity level and associated postural challenge, and that higher level and increased amount of exercise may promote enhanced neurosensory processing in these individuals. Consequently, high-intensity skilled training may deserve further emphasis in orthopaedic rehabilitation.

2015 Section on Pediatrics Knowledge Translation Lecture: Pediatric Vestibular-Related Impairments.

Key Points: Until recently, the incidence and effect of vestibular system impairments in children has been grossly underidentified and thus not addressed. Because of incidence reports (approximately 10% of the US population younger than 21 years) and evidence of the efficacy of evaluation methods and interventions, researchers and clinicians are focusing on development of optimal interventions to enhance function, thus minimizing the negative effect of vestibular hypofunction on reading, motor development, and postural control. However, research progress has been slow. How can clinicians and researchers collaborate so that (1) vestibular deficits and related impairments can be identified in children, and (2) optimal interventions can be identified and implemented so that children with peripheral and/or central vestibular dysfunction can benefit? Summary: Our participation in knowledge translation is presented, to include discussion of possible barriers, challenges, and opportunities for facilitating collaboration and joint efforts of clinical and research practice.