The Nature of hearing loss relates to the CNS and semi-circular canal integrity.

1. Exercise for Balance and Coordination in Children With Hearing Impairment Michael Beavin and Jason Copelin Bellarmine University Introduction Evidence Clinical Relevance Conclusion When treating a child with a hearing impairment it is important to consider the effects the impairments have on the vestibular system. Physical therapists working with children with sensorinueral hearing loss should consider utilizing an exercise regimen which integrates somatosenory, balance, eye-hand coordination, and visual motor training as it has been shown to be an effective means of improving both balance and coordination. Exercise programs which allow children to use substitutions, such as vision, will allow for a more significant improvement in gross motor control and stability. • The Nature of hearingloss relates to the CNS and semi-circular canal integrity. • It is hypothesized these deficits are related to the damage of the vestibular system. • The effect of hearing on the CNS will refer to many common motor deficits. • Incidence5: • 79,522 children ages 3-21 received hearing services in 2003. • It is estimated between 1 to 6 per 1,000 newborns are born congenital hearing loss. • About half of the cases of childhood hearing loss are believed to be from genetic causes. • The prevalence of genetic hearing loss has been calculated at approximately 1 in 2,000 children. • Deficits include: • Static Balance • Dynamic Balance • Postural Control • Coordination • Strength • Movement speed • Exercise interventions which a focus on improving the vestibular system may be helpful in addressing these motor deficits. • . • Improvement of Motor Development and Postural Control 3 • Exercise intervention emphasizing enhancement of visual and somatosensory function : • Eye hand coordination • General coordination activities • Visual motor training • Balance training • 30 minute sessions, 3 times per week for 3 weeks • Results: Post intervention motor development scores significantly improved in exercise group. Improvement in posture was noted. • Effect of Exercise Intervention on Vestibular Impairments 1 • Static balance exercise program • Standing on toes with feet apart • Standing on toes with feet together • Standing on right foot unsupported with left foot behind right knee (followed by opposite) • 15 minute sessions for 10 days • Results: No significant improvement in static balance ability. However, single leg stance time improved significantly. • Vestibular Specific Neuromuscular Training 2 • Neuromuscular training: • Eye-hand coordination • Balance retraining exercises • Fundamental motor skill exercises • 45 min session for 6 weeks • Results: Significant improvements in throw distance, jump distance, 15 yard dash, postural control, mediolateral sway, and anteroposterior sway in experimental group compared to control. • Effect of Motor Control Program in Improving Gross Motor Function and Postural Control 4 • Motor control program to enhance visual-motor and somatosensory abilities. • Eye-hand coordination • Visual motor training • Balance training • Activities to improve coordination • Verbal Positive reinforcement • 45 minute sessions, 3 times per week for 12 weeks. • Results: There was a highly significant improvement in pediatric balance scale and test of gross motor development-2 scores. • Recent literature has determined integrating somatosensory, postural control, eye hand coordination, and balance training is effective in showing significant improvement in balance and coordination in children with sensorineural hearing loss. The literature states an exercise regimenof 30 minutes 3tmes per week for 3 weeks is an effective means of arresting the progressive motor development delay. Extending the exercise regimen to 45 minutes per day 3 days a week for 6-12 weeks has been shown to be effective in improvement of both balance and coordination. • Future Research: • Further longitudinal research needs to be conducted to determine if the balance and coordination gains were maintained over a prolonged period of time. • Deeper analysis of the relationship between the somatosensory exercise and its relationship to the vestibular system. • All studies looked at children who were already behind in motor development. A study needs to be conducted to see if the exercise regimens are effective in preventing delays in major motor milestones in children. • Studies with larger sample sizes to increase the validity of theses findings. http://www.childrenstherapystore.com/pediatric_vestibular_physical_therapy_products.html Bibliography • Effgen S. Effect of an exercise program on the static balance of deaf children. Physical Therapy [serial online]. June 1981;61:873-877. Available from: CINAHL, Ipswich, MA. Accessed November 10, 2013 • Rajendran V, Roy FG, Jeevanantham D. A preliminary randomized controlled study on the effectiveness of vestibular-specific neuromuscular training in children with hearing impairment. Clin Rehabil. 2013;27(5):459-67. Available from: CINAHL, Ipswich, MA. Accessed November 10, 2013 • Rine RM, Braswell J, Fisher D, Joyce K, Kalar K, Shaffer M. Improvement of motor development and postural control following intervention in children with sensorineural hearing loss and vestibular impairment. Int J Pediatr Otorhinolaryngol. 2004;68(9):1141-8. Clin Rehabil. 2013;27(5):459-67. Available from: CINAHL, Ipswich, MA. Accessed November 10, 2013 • Shah J, Rao K, Malawade M, Khatri S. Effect of Motor Control Program in Improving Gross Motor Function and Postural Control in Children with Sensorineural Hearing Loss-A Pilot Study. (2013) Pediat Therapeut 3: 141.  doi:10.4172/2161-0665.1000141. Clin Rehabil. 2013;27(5):459-67. Available from: CINAHL, Ipswich, MA. Accessed November 10, 2013 • http://www.asha.org/content.aspx?id=14268&LangType=1033. Accessed November 17, 2013. http://www.childrenstherapystore.com/pediatric_vestibular_physical_therapy_products.html http://www.positscience.com/media-gallery/detail/159/53