Vestibular Rehabilitation for Dizziness in Hearing Impaired Children.

NCT ID: NCT04413084

Last Updated: 2021-03-09

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 20 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2020-08-01
• Study Completion Date: 2020-10-15

Brief Summary

There is a need to manage dizziness in vestibular dysfunction patients with the vestibular rehabilitation to improve the life style of these patients. Vestibular rehabilitation exercises are beneficial for the vestibular dysfunction patients because they decrease dizziness and visual symptoms, increase walking and balance functions and with this the general activity level also increases. In my study my goal is to apply two different vestibular exercise and check their effects on dizziness in hearing impaired children's.

Detailed Description

Dizziness is not a disease it is one of the most common symptoms of vestibular dysfunction. There are mainly two types of vestibular dysfunction central and peripheral vestibular dysfunction. Signs of vestibular dysfunction are vertigo, nystagmus, visual instability on head movement, spinning, double vision, May or may not have hearing loss or tinnitus. Due to these problem the patient feel difficulty in movements and in other activities, asymmetrical posture in sitting or standing. patients who experience dizziness report a significant disability that reduces their quality of life.

Vestibular system is consist of two parts central vestibular system and peripheral vestibular system. Peripheral part is consist of three semi-circular canals and otolith organs. The three semi-circular canals horizontal, posterior and anterior respond to angular acceleration and are right angle to one another. Semi-circular canals are filled with endolymph. Which move freely within each canal in response to the direction of the angular head rotation. The saccule and utricle make up the otolith organ which respond to the linear acceleration and the static head tilt. Three main functions of the peripheral vestibular system is stabilize visual images during head movement, maintain postural stability during head movement and providing information about the environment. In the central vestibular system brainstem processes provide primary control of many vestibular reflex. Connection with the thalamus, vestibular cortex and reticular system enable the vestibular system to aware of arousal and conscious awareness of the body and discrimination between the self and environment.

In children, vestibular function plays an important role in postural and gross motor development control. Children with congenitally profound hearing loss suffer vestibular dysfunction in both ears, and loss of postural control. Maintaining and development of postural stability is a multisystem process it does not only depend on vestibular input. Maturational changes in proprioceptive and visual, central nervous system processing, and coordination of motor output are responsible for the changes in postural skills observed through adolescence. Infants and young children are dependent on the visual system to maintain balance. As they grow older, begin to use somatosensory and vestibular information properly. Between the 3 sensory inputs in children, the vestibular system seems to be the slightest effective in postural control.

Children with early sensorineural hearing loss and bilateral vestibular dysfunction present with delayed gross motor development. These children stand and walk later than their peers. Difficulties in maintaining balance can lead to challenges in normal childhood activities e.g. riding a bicycle or hopping. Reduced ability to participate in normal play with other children may result in social isolation. In hearing impaired children vestibular dysfunction is common. It was mentioned in a study held in 2013 that 88% of hearing impaired children suffer from vestibular dysfunction. This could mainly be due to hearing and vestibular impulses pass via the vestibule-cochlear nerve. Another study in 2018, found that vestibular dysfunction to be around 50% in hearing impaired children.

Gaze stability and Brandt-Daroff exercises are two different type of exercises which are used for rehabilitation of dizziness in hearing impaired patients. A type of habituation exercise is Brandt- Daroff exercises which are easy to perform. Brandt- Daroff exercises cause the debris to get dislodged from the cupula of the posterior semi-circular canal and will no longer effect cupula during the head movements. Bandt-Daroff exercises are performed with quick head rotations while watching a visual target and sustaining focus on the visual target during head movements. Gaze stability exercises designed to improve the gaze stability. These exercises require the individual to fixate on a visual target during horizontal or vertical head movement.

Conditions

HEARING IMPAIRED CHILDREN

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Gaze stability exercises

Group I will receive Gaze stability exercises.

Group Type: EXPERIMENTAL

Gaze stability exercises

Intervention Type: OTHER

Business card will be placed at eye level. Begin with simpler exercises and progress toward harder one.

Brandt-Daroff Exercises

Group II will receive Brandt-Daroff Exercises.

Group Type: EXPERIMENTAL

Brandt-Daroff Exercises

Intervention Type: OTHER

Brandt-Daroff Exercises

1. Start sitting upright on the edge of the bed.

2. Turn your head 45 degrees to the left, or as far as is comfortable.

3. Lie down on your right side.

4. Remain in this position for 30 seconds or until any dizziness has subsided.

5. Sit up and turn head back to center.

6. Turn your head 45 degrees to the right, or as far as is comfortable.

7. Lie down on your left side.

8. Remain in this position for 30 seconds or until any dizziness has subsided.

9. Sit up and turn head back to center.

Interventions

Gaze stability exercises

Business card will be placed at eye level. Begin with simpler exercises and progress toward harder one.

Intervention Type: OTHER

Brandt-Daroff Exercises

Brandt-Daroff Exercises

1. Start sitting upright on the edge of the bed.

2. Turn your head 45 degrees to the left, or as far as is comfortable.

3. Lie down on your right side.

4. Remain in this position for 30 seconds or until any dizziness has subsided.

5. Sit up and turn head back to center.

6. Turn your head 45 degrees to the right, or as far as is comfortable.

7. Lie down on your left side.

8. Remain in this position for 30 seconds or until any dizziness has subsided.

9. Sit up and turn head back to center.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Children with hearing impairment of both genders, those diagnosed with vestibular dysfunction by ear nose and throat specialist.
• Bilateral hearing loss
• Mild to moderate hearing loss
• Age between 8 to 17 years.
• Any test of the following four tests positive (Dix Hall Pike test, Supine Roll's test, Fukuda Stepping Test and Sharpened Romberg's test) were included in the study

Exclusion Criteria

• Children receiving some other form of treatment for vestibular dysfunction.
• Suffering from other systemic disorders.
• Musculoskeletal disorders like fractures, strains, sprains leading to imbalance, central or peripheral neurologic diseases leading to disturbed balance.
• Those who were handicapped were excluded from the study.

• Minimum Eligible Age: 8 Years
• Maximum Eligible Age: 17 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Riphah International University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Misbah Ghous, MSNMPT

Role: PRINCIPAL_INVESTIGATOR

Riphah International University Islamabad

Locations

. National Special Education Center Muzaffarabad department of social welfare & women development.

Muzaffarabad, Azad Kashmir, Pakistan

Countries

Pakistan

References

Khandare S, Gonsalves N, Palekar DT, Rathi DM, Desai R, Deshmukh MJIJoCRiLS. Efficacy of two different vestibular rehabilitation approaches for dizziness in vestibular dysfunction in hearing impaired children". 2018;7(05):1985-8.

Reference Type: BACKGROUND

Hsiao CJ, Cherry DK, Beatty PC, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2007 summary. Natl Health Stat Report. 2010 Nov 3;(27):1-32.

Reference Type: BACKGROUND

PMID: 21089986 (View on PubMed)

Lakhani H, Saxena PP, Shethia UJp. Effectiveness of Brandt-daroff exercises on hearing impaired children: A Comparative Study.2:100.

Reference Type: BACKGROUND

Hall CD, Heusel-Gillig L, Tusa RJ, Herdman SJ. Efficacy of gaze stability exercises in older adults with dizziness. J Neurol Phys Ther. 2010 Jun;34(2):64-9. doi: 10.1097/NPT.0b013e3181dde6d8.

Reference Type: BACKGROUND

PMID: 20588090 (View on PubMed)

Suarez H, Angeli S, Suarez A, Rosales B, Carrera X, Alonso R. Balance sensory organization in children with profound hearing loss and cochlear implants. Int J Pediatr Otorhinolaryngol. 2007 Apr;71(4):629-37. doi: 10.1016/j.ijporl.2006.12.014. Epub 2007 Feb 2.

Reference Type: BACKGROUND

PMID: 17275927 (View on PubMed)

Other Identifiers

REC/00653 Poshmal butt

Identifier Type: -

Identifier Source: org_study_id