Balanced Growth project: a protocol of a single-centre observational study on the involvement of the vestibular system in a child’s motor and cognitive development
Authors: Van Hecke Ruth , Deconinck Frederik J A , Wiersema Jan R , Clauws Chloe , Danneels Maya , Dhooge Ingeborg , Leyssens Laura , Van Waelvelde Hilde , Maes Leen 
Published: June 2021

IntroductionThe involvement of the vestibular system in the motor and higher (cognitive) performances of typically developing or vestibular-impaired children is currently unknown or has only scarcely been explored. Interestingly, arguments for an interaction between vestibular, motor and cognitive functions in children can also be supported by research on children known for their difficulties in motor and/or cognitive processing (eg, children with neurodevelopmental disorders (NDD)), as they often present with vestibular-like characteristics. Therefore, in order to elucidate this interaction, and to increase the understanding of the pathophysiology and symptomatology of vestibular disorders and NDD in children, the Balanced Growth project was developed. It includes the following objectives: (1) to understand the association between motor skills, cognitive performances and the vestibular function in typically developing school-aged children, with special focus on the added value of the vestibular system in higher cognitive skills and motor competence; (2) to investigate whether a vestibular dysfunction (with/without an additional auditory disease) has an impact on motor skills, cognitive performances and motor–cognitive interactions in children and (3) to assess if an underlying vestibular dysfunction can be identified in school-aged children with NDD, with documentation of the occurrence and characteristics of vestibular dysfunctions in this group of children using an extensive vestibular test battery.Methods and analysisIn order to achieve the objectives of the observational cross-sectional Balanced Growth study, a single-task and dual-task test protocol was created, which will be performed in three groups of school-aged children (6–12 years old): (1) a typically developing group (n=140), (2) (audio) vestibular-impaired children (n=30) and (3) children with an NDD diagnosis (n=55) (ie, autism spectrum disorder, attention deficit/hyperactivity disorder and/or developmental coordination disorder). The test protocol consists of several custom-made tests and already existing validated test batteries and includes a vestibular assessment, an extensive motor assessment, eight neurocognitive tests, a cognitive–motor interaction assessment and includes also additional screenings to control for potential confounding factors (eg, hearing status, intelligence, physical activity, etc).Ethics and disseminationThe current study was approved by the ethics committee of Ghent University Hospital on 4 June 2019 with registration number B670201940165 and is registered at Clinical Trials (clinicaltrials.gov) with identifierNCT04685746. All research findings will be disseminated in peer-reviewed journals and presented at vestibular as well as multidisciplinary international conferences and meetings.Trial registration numberNCT04685746.