Evaluation of vestibular function and balance control in children who are preschoolers
27 november 2017
Campus Drie Eiken, Building O, theatre O4 - Universiteitsplein 1 - 2610 WILRIJK (route: UAntwerpen, Campus Drie Eiken
Prof A. Hallemans & Prof L. Vereeck
PhD defence Evi Verbecque - Faculty of Medicine and Health Sciences
Balance strategies are crucial at a preschool age (age 3 - 6) as children then learn fundamental motor skills. The vestibular system is one of the main systems that drives balance control. Therefore, the aim of this research project was to identify adequate assessment tools for the evaluation of vestibular function and balance control in preschoolers.
A systematic literature review (Chapter 1) on the diagnostic accuracy of vestibular function tests, revealed that the Dynamic Visual Acuity test (DVA) could have potential as a cheap and easy to administer test. Therefore, the DVA’s feasibility in typically developing preschoolers was investigated in Chapter 2. Because of the high drop-out rate and the false positive results, the clinical horizontal DVA was found to be too difficult for all preschoolers. The adjusted protocol for DVA on treadmill, on the other hand, can be used for children aged 5 and older.
Based on a literature review on psychometric properties of functional balance tests in children (Chapter 3), a combination of the Timed Up and Go test (TUG) and the Pediatric Balance Scale (PBS) seems most suited for preschoolers. Subsequently, a modified TUG protocol for preschoolers was developed to improve motivation and age-specific reference values for Flemish preschoolers were reported in Chapter 4. Investigations into the usability of the PBS in Flemish preschoolers, presented in Chapter 5, suggested the need for a revised version of the PBS or the development of a new functional balance test because of the underestimation of the children’s performance when applying American reference values and the presence of several items that are too difficult.
Especially in young children reference values for postural sway are scarce in literature (Chapter 6). Therefore, the usefulness of postural sway in different sensory conditions to assess balance control in preschoolers was investigated in Chapter 7. These results indicated that not the amount of postural sway is age-dependent, but the time children can maintain the requested position. The gait pattern in preschoolers exists of three key components of which robustness is complementary in the assessment of balance control, as shown in Chapter 8.
In conclusion, further investigations into an adequate non-invasive vestibular function test in preschoolers are necessary, as both the horizontal DVA and DVA on treadmill are unfeasible for the entire group of preschoolers. Due to the shortcomings of the available balance tests, the composition of a new functional balance test for preschoolers is needed.