Effects of Cawthorne Cooksey Exercises on Balance in Children With Hearing Deficits
Condition: Hearing Disorders
MeSH terms: Hearing Disorders
Study type: Interventional

Summary: 
      Balance and weak postural control are most common in children with severe to profound hearing
      deficits. Children with hearing deficits also indicate behavioral problems related to impulse
      control, distraction, and disability to maintain attention in the visual modality. Hearing
      deficit is mostly defined as a communication deficit. Although the communication deficit is
      an important disorder, hearing deficit co-occurs with other physical impairments such as
      vestibular disorders. Development and control of the posture are important prerequisites for
      skill motor function. Children with hearing deficits and impaired sensory organization had
      weak balance and motor efficiency in many fields. Various studies on motor skills in deaf
      children have reported deficits in balance, general dynamic coordination, visual-motor
      skills, ball catching ability, and some disturbances in reaction time and speed of movements.
      Teachers of children with hearing impairment often complain of non-coordination, clumsiness,
      and balance deficit in such children, preventing the child from the desired function. So the
      aim of the study is to determine the effects of Cawthorne Cooksey Exercises on Balance and
      quality of life in children with hearing deficit It will be a Randomized Controlled Trial and
      children fulfilling exclusion-inclusion criteria will participate in the study. They will be
      divided randomly into two groups, using computer generated randomization, into control group
      and experimental group. After performing the pre-test measurements, the control group will
      perform Swiss Ball Exercises for 45 minutes and the interventional group will perform
      Cawthorne Cooksey Training Program Swiss Ball Exercises in addition, will also perform of 45
      min session three times a week for 8 weeks of training. the study subjects will be evaluated
      again by Pediatrics Berg Balance Scale, Four-Step Square test and Quality of life
      questionnaire for children to measure the quality of life. Results will be compared with the
      pretest measurements. Data will be analyzed by using SPSS scale windows software version 25.
    

Detailed description: 
      In children, vestibular function plays an important role in the gross motor development and
      postural control. Infants and children with congenitally profound hearing loss commonly
      suffer vestibular dysfunction in both ears, and poor balance. However, there have been very
      few studies have investigated the effect of exercises on balance and quality of life in
      children with the profound hearing deficit. The development and maintenance of balance is a
      multisystem process that also depends on vestibular input believe that as labyrinths and
      cochlea are anatomically and developmentally interrelated, there is a potentiality for
      vestibular impairment when the hearing mechanism is impaired.

      In a study using Barany Rotary test and caloric stimulation, found that 82% of 89 children
      with severe acquired hearing deficits and 34% of 129 children with hereditary hearing
      deficits had abnormal responses to vestibular tests. Since the vestibular system activates
      vestibular reflex mechanisms trying to stabilize the eyes, head, and body in the space,
      impairment of this mechanism may affect postural sensitivity. Maturational changes in visual
      and proprioceptive, central nervous system processing, and coordination of motor output are
      responsible for the changes in postural skills observed through adolescence . From the
      sensory systems perspective, Infants and young children are dependent on the visual system to
      maintain balance; as they grow older, begin to use somatosensory and vestibular information
      appropriately. Between the 3 sensory inputs in children, the vestibular system seems to be
      the least effective in postural control.

      Children with profound bilateral vestibular dysfunction present with delayed gross motor
      development. These children stand and walk later than their peers with typical development
      Difficulties in maintaining balance can lead to challenges in normal childhood activities,
      such as riding a bicycle or hopping. Reduced ability to participate in normal play with other
      children may result in social isolation. So, the mechanisms responsible for the lack of
      balance in children with profound hearing impairment need to be established, and holistic
      management including both auditory and vestibular function is needed. Sensory organization
      dysfunction is more prevalent in children with hearing loss and vestibular dysfunction which
      may result in a problem with balance. These children in situations needs an early address to
      their balance through balance training activities. Most children with bilateral vestibular
      dysfunction. These results suggest that due to multi-modal sensory interdependence, the
      development of visual and somatosensory effectiveness in maintaining balance is impaired
      secondary to vestibular dysfunction since birth. There is ample support for the efficacy of
      vestibular rehabilitation therapy through different exercises in adults, but very few data
      exist regarding its results in children.

      Balance is major problem associated with vestibular system specifically in the patients with
      sensory neural hearing deficits. Since vestibular rehabilitation is an important factor that
      must be achieved for balance in hearing deficits. Cawthorne Cooksey exercises may be
      considered as an effective technique to gain balance and improve quality of life.
    

Intervention name(s): Cawthorne Cooksey Exercises for Balance Training; Swiss Ball Exercises
Intervention type(s): Other; Other
Intervention description(s): Group of Exercises used to Increase balance; Swiss Ball Exercises
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment