Vestibular sensorial input is essential for psychomotor development of the very small children. In consequence, possible vestibular impairment induced by cochlear implantation in deaf children could affect the balance and walking learning process. Some of cochlear implanted children can present congenital vestibular deficit. The anatomical and embryological relation between auditory and vestibular system explains why congenital neurosensorial hearing loss may associate vestibular impairment. The cochlear implant surgery presents a vestibular lesion risk. Bilateral vestibulopathy, as it appears in early childhood, has a poor prognosis for the psychomotor and cognitive development. Even probably rare, bilateral vestibulopathy induced by simultaneous bilateral cochlear implantation can delay the acquisition of motor skills. This pathology can be avoided by an appropriate surgical indication related to the vestibular preoperative status. This study reports the vestibular saccular functional modifications after the cochlear implantation in children. The cervical vestibular evoked myogenic potentials (cVEMPs) were performed in children before and after the cochlear implantation. Since previous studies report different vestibular impairment related to the portelectrode insertion approach, another objective of our study was to assess the saccular postoperative status depending of the insertion by cochleostomy (CO) or through the round window (RW). We performed cVEMPs for 80 patients (135 cochlear implanted ears) before and after cochlear implantation. We have detected preoperative saccular areflexia in 33 (24.4%) ears. In the group of 102 (75.6%) ears with preoperative normal saccular function, 72 (70.6%) ears preserved the cVEMP response after the surgery, while in 30 (29.4%) ears the cVEMP response was lost. Reporting our findings to the portelectrode insertion method, we found normal saccular function in 73.3% of the cochlear implanted ears by RW surgical approach and in 68.42% ears by CO approach. These results suggest that the RW portelectrode insertion is the recommended strategy in order to avoid the saccular vestibular impairment.
Objective -The Down's syndrome children present important motor problems which affect static and dynamic balance. Equilibrium represents the capacity of keeping the body steady in standing position as well as the ability to perform usual dynamic tasks (walking, jumping and running) without falling. The objective of this paper is to present by comparison the postural control in Down syndrome subjects and non-disabled persons. Method -Five young Down syndrome subjects, aged 8 to 15 years old, and five normal age-matched subjects were included in the study. Static equilibrium was evaluated on a posturograph (Smart Balance from NEUROCOM) which has a force-plate. Equipment allows time and frequency domain analysis of the centre of pressure of the subjects. Subjects have to maintain upright position as steady as they can for 20 seconds, on the stabilised force-plate in two conditions -eyes closed and eyes open. Results -Analysis of the postural control revealed lower performance in maintaining the upright position from time domain point of view in Down syndrome group. Conclusion -Motor control problems are present in Down syndrome children since birth (hypotonia, low joint stability and joint hypermobility) and impede upon the development of motor control if early rehabilitation is not provided. This characteristic lasts for the whole life of the Down syndrome person.
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