الفهرس 
Introduction and RationaleOnly 14 pages are availabe for public view
 |  | from | 251 |  |  |
| | | from | 251 | | |
Abstract
Disorders in balance are either static, dynamic, slower gait speed or poor performance in gait-related functional tasks. All these abnormalities have higher incidence in children with sensorineural hearing loss than normal-hearing children (Melo et al., 2017). Based on that, vestibular & balance rehabilitation exercises programs are needed for these children. The main objective of this study was to design a rehabilitation program that suits the hearing-impaired children.
The present study was conducted on Forty-five hearing-impaired children with balance deficits. Thirty-five were cochlear implant users and ten were hearing aid users. Their age ranged from 4 to 10 years old. Also, forty-five normal hearing children age and gender-matched with the study group, for establishing pediatric balance scale normative data.
It was done by a team of audiovestibular medicine and physical medicine physicians; it is comprised of three phases:
(I) Pre-rehabilitation Evaluation.
(II) Intervention plan.
(III) Post-rehabilitation assessment
The Intervention Plan was individually tailored vestibular and balance rehabilitation program.
(A) Vestibular Exercises: Gaze stabilization Exercises (focused on the basis of VOR adaptation), and gaze stabilization exercises (promoting alternative strategies i.e. smooth-pursuit or saccadic eye movements to substitute for the missing vestibular function) (Hall et al., 2016), should not be performed in isolation, i.e., without head movement. It was done at home using a computer-based website (Eye Can Learn).
(B) Balance, gait, and somatosensory training was designed according to each patient condition by pediatric physical medicine and rehabilitation physician and administered in one-to-one sessions by an experienced pediatric physiotherapist; each child had participated in a minimum of 24 sessions within the three-month period. The intervention consisted of 45 to 60-minute sessions, two to three times weekly. Based on each child’s progress, the difficulty level was advanced.
Instructions for home-based exercises were simple lasting for about 20 to 30 minutes in the days off. Exercises performed at home must be in the presence of the caregiver and safe support to avoid falling or injury of the child.
Balance Rehabilitation:
Three phases; the physical medicine doctor customizes the exercises according to each child’s condition and progress in rehab (Lotfi et al., 2016).
Phase I: Static balance training
Phase II: Semi-dynamic balance training.
Phase III: Dynamic balance training, i.e., hopping, jogging & diagonal bounding exercises.
The present study showed that there was a statistically significant improvement in the DHI questionnaire scores after rehabilitation, as well as, highly statistically significant difference in the all measured balance parameters after rehabilitation either static or dynamic balance regarding the PBS score, time needed to complete the test (i.e. better reaction time and speed of movement), the number of errors scored during the BESS test in both the CI & HA groups.
Although there were no statistically significant differences between HA & CI groups after the rehabilitation program either functionally by using the pediatric DHI questionnaire or by balance assessment using the PBS, there were statistically significant differences between the CI or HA groups below the age of seven when compared with their age matched normal peers after rehabilitation regarding one leg stance score and time. This suggested the immaturity of the balance and postural control of the hearing-impaired children compared to the normally developed age matched peers. This lag persisted in older CI children above seven but disappeared in the HA group.
The CI children were subdivided into two groups: thirty with combined vestibular & balance affection, five with bilateral vestibular loss without balance affection. There was a considerable improvement in the VOR in both groups, as illustrated by the DVA test & absent corrective saccades.
We can speculate that vestibular and balance disorders are more frequent in hearing-impaired children, so vestibular and balance rehabilitation programs were of great benefit for both CI and HA users children with balance deficits. However, CI children might need longer period or more frequent rehab than HA users’ children.