Cervical Vestibular-Evoked Myogenic Potentials and Balance Testing in Children with Down Syndrome

Kaya, Sule; Bas, Banu; Er, Serap; Keseroglu, Kemal; Korkmaz, Hakan

doi:10.1055/s-0040-1722174

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Original Research • iao 25 (4) • Oct-Dec 2021 • https://doi.org/10.1055/s-0040-1722174 copy

Cervical Vestibular-Evoked Myogenic Potentials and Balance Testing in Children with Down Syndrome

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Vestibular otolith function plays a major role in balance control.

Objective

To investigate the saccular and balance functions of children with Down syndrome (DS).

Methods

In total, 15 children with DS aged between 9 and 11 years were included. An age- and gender-matched control group (CG) composed of 15 normal participants was also included. The subjects with DS had trisomy 21, without hearing or organic problems, and they had independence in stance. The saccular function among the children with DS and among the controls was tested using air-conduction cervical vestibular-evoked myogenic potentials (cVEMPs). In addition, the static and dynamic balance statuses were evaluated using the following assessments; the Pediatric Balance Scale (PBS), the modified Clinical Test of Sensory Interaction on Balance (mCTSIB), the Romberg test, and the Timed Up and Go (TUG) test.

Results

In the present study, the results of the saccular function test showed that there was a significant difference between children with and without DS (p < 0.05). The DS subjects had significantly earlier N1 latancy and lower amplitude of the cVEMPs (< 70 μV) compared with the control subjects. The static-dynamic balance ability was statistically and significantly different in children with DS compared with the controls (p < 0.05).

Conclusion

These results revealed that saccular function seems to be affected in DS subjects. The dysfunction in static and dynamic balance abilities of the children with DS may be attributed to vestibular dysfunction as well as low gross motor skills. This knowledge should be taken into account when assessing motor performance in those subjects. Additional larger studies testing other dimensions of the vestibular system in children with DS are needed.

Keywords
down syndrome; cervical vestibular-evoked myogenic potentials; postural balance

	Patient Group									Control Group
	Males			Females			TOTAL			Males			Females			TOTAL
	Mean	Standard deviation	Range	Mean	Standard deviation	Range	Mean	Standard deviation	Range	Mean	Standard deviation	Range	Mean	Standard deviation	Range	Mean	Standard deviation	Range
Age, years	10.25	.70	9.00–11.00	10.14	.69	9.00–11.00	10.2	.67	9.00–11.0	10.25	.70	9.00–11.00	9.00–11.00	10.14	.69	10.2	.67	9.00–11.0

Grups			Pediatric Balance Scale	Timed Up and Go Test	P1	N1	P1-N1
Down syndrome group	N	Valid	30	30	30	30	30
	N	Missing	0	0	0	0	0
	Median		30.00	20.00	12.40	18.30	62.30
	Interquartile range		7.00	8.00	1.00	1.70	19.75
Control Grup	N	Valid	30	30	30	30	30
	N	Missing	0	0	0	0	0
	Median		56.00	9.00	12.70	20.00	104.75
	Interquartile range		0.00	1.00	1.10	2.30	59.05
Mann Withney U test			p = 0.000	p = 0.000	p = 0.08	p = 0.000	p = 0.000

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[1] Address for correspondence Sule Kaya, PhD, Department of Audiology, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey (e-mail: sulecekic@hotmail.com).

Pediatric Balance Scale (PBS)	Functional balance in everyday life activities (Franjoine et al.,⁴4 Franjoine MR, Gunther JS, Taylor MJ. Pediatric balance scale: a modified version of the berg balance scale for the school-age child with mild to moderate motor impairment. Pediatr Phys Ther 2003;15(02):114–128 2003).
Romberg test	The integrity among different sensory organs and neuronal conduction pathways utilized in the constitution of balance (Black et al.,⁵5 Black FO, Wall C III, Rockette HE Jr, Kitch R. Normal subject postural sway during the Romberg test. Am J Otolaryngol 1982; 3(05):309-318 1982).
Modified Clinical Test of Sensory Interaction on Balance (mCTSIB)	Sensory system dysfunction on a stable and unstable floor, with eyes open and closed. In the tests on unstable ground with the eyes closed, the effects of visual and somatosensory inputs are eliminated, and the effects of vestibular inputs on postural stability are evaluated more efficiently (Shumway-Cook et al.,⁶6 Shumway-Cook A, Horak FB. Assessing the influence of sensory interaction of balance. Suggestion from the field. Phys Ther 1986; 66(10):1548-1550 1986).
Timed Up and Go Test (TUG)	Functional mobility and balance through different variables such as walking speed, postural control, functional mobility, and balance are evaluated (Podsiadlo et al.,⁷7 Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39(02):142-148 1991).