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A "Balanced" Approach to Pediatric Vestibular Diagnosis, Management, and Prognosis.
Track: Audiology/Hearing Impaired
Vestibular and balance disorders are considered uncommon in children and young adults, but might be underestimated; More than 1 in 20 (nearly 3.3 million) children between the ages of 3 and 17 have a dizziness or balance problem (NIH-NIDCD, 2016). Symptoms could be misdiagnosed or overlooked; symptoms are unlike those what adults’ report. It is also hypothesized that children with vestibular loss can compensate for their impairment at a faster and higher rate compared to adults due to the mechanisms of neural plasticity (Janky & Givens, 2015); however, recent literature has revealed that functional effects in children with vestibular loss do exist. This is evidenced by documented delayed gross motor function in infancy (Kaga et al., 2008; Inoue et al., 2013), persisting throughout childhood (Rine et al., 2000; Cushing et al., 2008). In addition, reduced dynamic visual acuity (DVA) is present in children with bilateral vestibular loss, (Rine & Braswell, 2003), which has been associated with reduced reading acuity compared to peers with healthy inner ears (Braswell & Rine, 2006). The degree of vestibular loss in children is also predictive of balance and DVA performance, suggesting that children with greater vestibular dysfunction do, in fact, demonstrate greater functional difficulty than children with healthy vestibular systems (Janky & Givens, 2015). Preliminary results suggest that CCI-VL experience higher levels of fatigue at the end of the school day compared to CNH and CCI with healthy vestibular systems. Given that school-aged children will have increasing demands academically and physically; the prospect of increased fatigue is a concern. Ultimately, less is known about the compensation process in children and how it compares to the process in adults. Therefore, this presentation will discuss the consequences that children with vestibular loss endure to perform daily activities, and relate these applicable ramifications to speech-language pathologists and educators interacting with these children.
Because the simplest things such as walking, riding a bike, doing school work, and even playing can become affected in children with vestibular loss and dizziness, vestibular assessments are warranted. While videonystagmography (VNG) is considered the gold standard for vestibular assessment, current trends in pediatric vestibular assessment include: video head impulse test (vHIT), rotational chair, and vestibular evoked myogenic potentials (VEMP). However, as will be revealed in this presentation, current research has begun to explore ways to optimize the vestibular battery for children and clinicians performing the examinations. In particular, the VEMP test in children has received attention in considering the acoustical safety of the task (i.e., a high intensity stimulus is presented to ear to derive a vestibular response) (Thomas et al., 2017) However, evidenced-based methods are recommended to promote improved diagnostic capacity of VEMPs, but limit the amount of sound exposure delivered to the ear (Rodriguez et al., in press).
Once a diagnosis is made in children, management options are diverse and interdisciplinary. Literature has just begun to explore therapies, strategies to improve functionality in the pediatric population. Through case-based scenarios, this presentation will discuss evidenced-based intervention options for children with vestibular loss and dizziness. Additionally, recommendations for SLPs and educators will be discussed such as modifications for therapy sessions or the classroom.