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Dr. Kern L.D. Rebello Masters in Rehabilitation Sciences – Neurology University of Pittsburgh, USA

Multidisciplinary intervention for a child with hearing loss and vestibular concerns November 27, 2017. Dr. Kern L.D. Rebello Masters in Rehabilitation Sciences – Neurology University of Pittsburgh, USA Physical Therapist, New Horizons Child Development Centre, India. Introduction.

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Dr. Kern L.D. Rebello Masters in Rehabilitation Sciences – Neurology University of Pittsburgh, USA

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  1. Multidisciplinary intervention for a child with hearing loss and vestibular concerns November 27, 2017 Dr. Kern L.D. Rebello Masters in Rehabilitation Sciences – Neurology University of Pittsburgh, USA Physical Therapist,New Horizons Child Development Centre, India

  2. Introduction

  3. Introduction Children with profound hearing impairments are known to have dysfunctions in the inferior and superior vestibular nerve systems. The development of gross motor function is also dependent on these systems. Systematic reviews have indicated that children having hearing loss exhibit sub-optimal motor skills, especially with respect to balance and coordination This is serious as gross motor skills determine the interaction of a child with the outside world , or the perception, ability and action to acquire academic and other life skills

  4. Public Health Burden in India WHO estimates 2.4% for South Asia Total prevalence of pediatric vestibular dysfunction (average) ~ 16.7%

  5. An underemphasized problem Yet, postural control and motor assessments are not a routine procedure in paediatric settings in developing countries. Consequently, pediatric balance and motor deficits remain underemphasized Moreover, we have shortage of documented studies to address vestibular and motor concerns in children This case report aims to bridge the evidence gap by documenting a comprehensive evaluation of a child with congenital hearing loss and vestibular concerns, under various clinical disciplines within the same setting, and the interdisciplinary intervention that the child received.

  6. CASE REPORT

  7. Presenting Concerns The child (female) was first presented in 2015, at 12 years 9 months of age, with speech delay, behavioural (e.g. hyperactivity, impulsivity and tantrums) and sensory (e.g. hand flapping, body rocking) concerns.

  8. Pedigree Chart 37 years 38 years 12 years (2015) 25 years

  9. History

  10. MEDICAL HISTORY

  11. NORMAL

  12. DEVELOPMENTAL PEDIATRIC OPD EVALUATION

  13. INTERVENTION MODEL

  14. The Child Developmental Pediatrician Pediatric Psychiatrist Pediatric Orthopedic Surgeon Pediatric Neurologist Genetic Counselor Occupational Therapist Clinical Psychologist Physical Therapist Speech Therapist Remedial Educator Nutritionist

  15. OT and ADHD

  16. New Horizons Developmental Program (NHDP) TM

  17. OT and ADHD

  18. INTERVENTION TIMELINE

  19. The following table presents pre-intervention results of assessment of balance. (CITSIB-m) visual, somato-sensory and vestibular systems need to operate optimally, for balance

  20. POST- INTERVENTION OUTCOMES

  21. The following table presents pre- and post-intervention results of assessment of balance. (CITSIB-m) visual, somato-sensory and vestibular systems need to operate optimally, for balance

  22. SUSPECTED GENETIC SYNDROME

  23. DIFFERENTIAL DIAGNOSIS Wildervanck syndrome: first described in 1952 (L.S. Wildervanck), nearly 90 cases have been reported in literature. Approximately one percent of females with hearing impairment may be affected by Wildervanck syndrome. Klippel-Feil syndrome (KFS) Oculo-auriculo-vertebral spectrum (OAVS) Penred Syndrome DiGeorge Syndrome

  24. TAKE-HOME MESSAGES Pediatric healthcare professionals should be aware of signs of vestibular impairment. Evaluation of vestibular impairments should be mandatory for all children with hearing loss. Interdisciplinary intervention including Pediatrics, Physical Therapists, Occupational therapist, Speech Therapist and Remedial Educators are essential for complete rehabilitation to improve quality of life. An inherited syndrome must be suspected and evaluated in children with hearing loss and vestibular impairments . Children with Gross motor ability delay must also be evaluated for vestibular impairment.

  25. Signs of vestibular impairment in children Over-arousal or under-arousal Excessive movement Avoiding movement at all costs; refusal to climb stairs/escalators Difficulty maintaining attention Motion sickness (car, boat, airplane), dizziness or nausea caused by watching things move Excessive spinning or excessive watching of things spin Inability to read or write in cursive Decreased auditory processing Inability to sustain listening without moving or rocking Problems with balance (static or moving) and/or vertigo Difficulty walking on uneven ground, and difficulty navigating stairs Head banging History of traumatic brain injury, shaken child syndrome, ear cuffing, etc.

  26. REFERENCES 1.Motor Skills in Hearing Impaired Children with or without Cochlear Implant--A Systematic Review. Vidranski T, FarkašD.CollAntropol. 2015 Jul;39Suppl 1:173-179. 2. Postural control, motor skills, and health-related quality of life in children with hearing impairment: a systematic review.Rajendran V1, Roy FG, JeevananthamD.Eur Arch Otorhinolaryngol. 2012 Apr;269(4):1063-71. doi: 10.1007/s00405-011-1815-4. Epub 2011 Nov 5. 3.Global Estimates on Prevalence of Hearing Loss. WHO. Accessed: June 01, 2016. Available from: http://www.who.int/pbd/deafness/WHO_GE_HL.pdf. Accessed June 16, 2017. 4.Census 2011 report. Government of India, Ministry of Home Affairs. Available from: http://www.censusindia.gov.in/vital_statistics/srs_report/9chap%202%20-%202011.pdf. Accessed: June 16, 2017 5.Raj P, Gupta A. Vestibular dysfunction in children with sensorineural hearing loss: A cross-sectional study. Indian J Otol [serial online] 2017 [cited 2017 Nov 19];23:74-7. Available from: http://www.indianjotol.org/text.asp?2017/23/2/74/208035

  27. REFERENCES • 6.Garg, S., Singh, R., &Khurana, D. (2015). Infant Hearing Screening in India: Current Status and Way Forward. International Journal of Preventive Medicine,6, 113. http://doi.org/10.4103/2008-7802.170027 • 7.Report No. 485: Disabled Persons in India, July-December 2002. NSS 58th Round.National Sample Survey Organisation Ministry of Statistics and Programme Implementation Government of India. 2003 Dec • 8.Prevalence and diagnosis of vestibular disorders in children: A review Gioacchini, Federico Maria et al. International Journal of Pediatric Otorhinolaryngology , Volume 78 , Issue 5 , 718 – 724. • 9. National Organization for Rare Disorders. Accessed: July 25, 2016. Available: http://rarediseases.org/rare-diseases/wildervanck-syndrome • 10. Vestibular Function in US Adults, Data From the National Health and Nutrition Examination Survey, 2001-2004 • Yuri Agrawal, MD; John P. Carey, MD; Charles C. Della Santina, MD, PhD; et alMichael C. Schubert, PhD; Lloyd B. Minor, MDAuthor Affiliations Article InformationArch Intern Med. 2009;169(10):938-944. doi:10.1001/archinternmed.2009.66. • 11. Rine RM, Braswell J, Fisher D, Joyce K, Kalar K, Shaffer M. Improvement of motor development and postural control following intervention in children with sensorineural hearing loss and vestibular impairment. International journal of pediatric otorhinolaryngology. 2004 Sep 30;68(9):1141-8.

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