Vestibular Rehabilitation for Dizziness in Hearing Impaired Children.
Condition: HEARING IMPAIRED CHILDREN
MeSH terms: Vertigo; Deafness; Hearing Loss; Dizziness
Study type: Interventional

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.
    

Intervention name(s): Gaze stability exercises; Brandt-Daroff Exercises
Intervention type(s): Other; Other
Intervention description(s): Business card will be placed at eye level. Begin with simpler exercises and progress toward harder one.; Brandt-Daroff Exercises
Start sitting upright on the edge of the bed.
Turn your head 45 degrees to the left, or as far as is comfortable.
Lie down on your right side.
Remain in this position for 30 seconds or until any dizziness has subsided.
Sit up and turn head back to center.
Turn your head 45 degrees to the right, or as far as is comfortable.
Lie down on your left side.
Remain in this position for 30 seconds or until any dizziness has subsided.
Sit up and turn head back to center.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Dizziness; Hearing Impaired children; Vestibular rehabilitation