Changes of spatial and temporal characteristics of dynamic postural control in children with typical neurodevelopment with age: Results of a multicenter pediatric study

Guidelines of the French Society of Otorhinolaryngology and Head and Neck Surgery (SFORL) for vestibular rehabilitation in children with vestibular dysfunction. A systematic review

INTRODUCTION

The consequence of complete or partial uncompensated vestibular dysfunction in children is usually balance disorders, with the risk of falls and increased fatigue, particularly during tasks requiring postural control. The aim of these recommendations is to establish guidelines for vestibular rehabilitation (VR) in children with vestibular impairment.

MATERIAL AND METHODS

The guidelines were developed based on a systematic review of the international literature, validated by a multidisciplinary group of French-speaking otorhinolaryngologists, scientists, and physiotherapists. They are classified as grade A, B, C, or expert opinion according to a decreasing level of scientific evidence.

RESULTS

A PubMed search of studies published between January 1990 and December 2021 was carried out using the keywords "vestibular," "rehabilitation," and "children". After filtering and reviewing the articles, a total of 10 publications were included to establish the recommendations.

CONCLUSION

It is recommended that a vestibular assessment be carried out before VR, including a study of vestibulo-ocular reflex, otolithic function, and postural control. In cases of vestibular dysfunction, physiotherapy treatment is recommended from an early age to train different aspects of postural control, including anticipatory and reactive postural adjustments. VR adapted to the pediatric population is recommended for children whose vestibular dysfunction leads to functional disorders or symptoms of vertigo for those who have suffered head trauma. It is recommended that children with bilateral vestibular impairment be treated using gaze stabilization exercises for adaptation and substitution. Optokinetic stimulation and virtual reality are not recommended for children and young adolescents.

Community-based postural control assessment in autistic individuals indicates a similar but delayed trajectory compared to neurotypical individuals

Autistic individuals exhibit significant sensorimotor differences. Postural stability and control are foundational motor skills for successfully performing many activities of daily living. In neurotypical development, postural stability and control develop throughout childhood and adolescence. In autistic development, previous studies have focused primarily on individual age groups (e.g., childhood, adolescence, adulthood) or only controlled for age using age-matching. Here, we examined the age trajectories of postural stability and control in autism from childhood through adolescents using standardized clinical assessments. In study 1, we tested the postural stability of autistic (n = 27) and neurotypical (n = 41) children, adolescents, and young adults aged 7-20 years during quiet standing on a force plate in three visual conditions: eyes open (EO), eyes closed (EC), and eyes open with the head in a translucent dome (Dome). Postural sway variability decreased as age increased for both groups, but autistic participants showed greater variability than neurotypical participants across age. In study 2, we tested autistic (n = 21) and neurotypical (n = 32) children and adolescents aged 7-16 years during a dynamic postural control task with nine targets. Postural control efficiency increased as age increased for both groups, but autistic participants were less efficient compared to neurotypical participants across age. Together, these results indicate that autistic individuals have a similar age trajectory for postural stability and control compared to neurotypical individuals, but have lower postural stability and control overall.

Reference values of postural balance in preschoolers: Age and gender differences for 4-5 years old Tunisian children

BACKGROUND

Preschool age is a critical stage of postural balance development. Posturography normative data during this age are crucial for surveillance of postural balance and for the timely diagnosis of any dysfunction. The aim of this study was to provide normative data, specific to Tunisian preschoolers, according to age and gender, and to examine gender- and age-related differences in postural balance.

RESEARCH QUESTION

Are there postural balance gender- and age-related differences in Tunisian preschoolers?

METHODS

The study included 410 (205 boys and 205 girls) preschool children aged between 4- and 5-year-old selected within a large geographic area of Tunisia. Postural balance was assessed using a stabilometric platform under 4 sensory conditions. The mean center of pressure velocity (CoP-V) parameter was selected for analysis. Differences between gender and age groups were analysed using the Mann-Whitney U. Normative data were expressed in percentiles.

RESULTS

Significant gender effect was found in conditions where sensory inputs are most challenged with a significantly smaller mean CoP-V in girls compared to boys (p < 0.05). Moreover, 5-year-old children had significantly better postural balance than 4-year-old ones in almost all conditions (p < 0.05).

SIGNIFICANCE

The normative data established for Tunisian preschoolers provide useful comparative data for pediatricians, teachers and coaches for the early evaluation and monitoring of postural balance during this age. Gender and age-related differences should be considered in this population.

Comparison of incidence, prevalence, severity and profile of health problems between male and female elite youth judokas: A 30-week prospective cohort study of 154 athletes

OBJECTIVES

To describe and compare the incidence, prevalence, severity, and profile of injuries (acute and overuse) and illness between female and male youth elite judokas during 30 weeks of a sports season.

DESIGN

Prospective cohort study.

METHODS

A total of 154 elite youth judokas (83 males and 71 females) were assessed from January to August 2019 in a training period organized by the Brazilian Judo Confederation. We conducted a prospective 30-week follow-up study on acute and overuse injuries and illness among youth female and male judokas through the Oslo Sports Trauma Research Center questionnaire on health problems (OSTRC-H). Every week, the OSTRC-H was sent to all youth judokas electronically, starting in the first week of preseason. The incidence rate, prevalence, and severity of illnesses and acute and overuse injuries were compared between sexes using an independent t-test (variables with normal distribution) or Mann Whitney U test (variables with non-normal distribution) with α set a 0.05.

RESULTS

Female and male judokas showed 16.96 and 16.57 injuries per 1000 athletic exposures, respectively (p = 0.383). Female judokas showed a higher average weekly prevalence of health problems (38.8%) than male judokas (29.0%). In addition, females had a greater prevalence of substantial health problems (p < 0.001), injuries (p < 0.001), and overuse injuries (p < 0.001) than males.

CONCLUSION

There were no differences in the incidence rate of injuries between sexes. Youth female judokas showed a higher prevalence of all health problems than youth male judokas. For both sexes, the knee and shoulder were the most affected joints for acute and overuse injuries, respectively.

Postural sway in young female artistic and acrobatic gymnasts according to training experience and anthropometric characteristics

BACKGROUND

Gymnastics training enhances the development of postural control in children and adolescents. In competitive gymnastics, the training regimen is specific to the given gymnastic discipline and is usually followed from the early years of practicing. This study aimed to determine whether postural steadiness differed between young gymnasts practicing two distinct disciplines, and whether it was related to the duration of their training experience, age, and their anthropometric characteristics.

METHODS

Thirty 10-13-year-old females ̶ ten artistic gymnasts, ten acrobatic gymnasts (training as "tops"), and ten non-athletes ̶ were examined during 60-s quiet standing trials on a force platform with the eyes open and closed. Their postural sway was represented by directional components of centre of foot pressure mean velocity. Mann-Whitney U, Wilcoxon and Spearman's ρ tests were used for analyses.

RESULTS

Anterior-posterior and medial-lateral centre of foot pressure mean velocities were not different between the artistic and acrobatic gymnasts (p > 0.05). In the artistic gymnasts, the duration of training experience, age, body height, body mass, and maturity offset were negatively correlated with the anterior-posterior centre of foot pressure mean velocity under eyes-open conditions. The acrobatic gymnasts' body mass and BMI percentiles were negatively correlated with their anterior-posterior and medial-lateral centre of foot pressure mean velocities under both visual conditions (r ranged from - 0.64 to - 0.93; p < 0.05). The non-athletes' centre of foot pressure mean velocities were non-significantly correlated with their age and anthropometric measures under both visual conditions (p > 0.05).

CONCLUSIONS

The artistic gymnasts' longer training experience, greater age, body height, body mass, and biological maturity were associated with better anterior-posterior postural steadiness when vision was available; the acrobatic gymnasts' greater body mass and BMI percentiles were associated with better overall postural steadiness regardless of visual conditions. Relationships were observed between postural steadiness and discipline-specific training experience and anthropometric characteristics; however, causes and effects were not proven.

Characteristics of Functional Stability in Young Adolescent Female Artistic Gymnasts

The aim of this study was to determine whether young adolescent female artistic gymnasts demonstrate better functional stability than age- and sex-matched non-athletes. Different characteristics of the gymnasts’ postural control were expected to be observed. Twenty-two 10- to 13-year-old healthy females (ten national-level artistic gymnasts and twelve non-athletes) participated in the study. To assess their forward functional stability, the 30-s limit of stability test was performed on a force plate. The test consisted of three phases: quiet standing, transition to maximal forward leaning, and standing in the maximal forward leaning position. Between-group comparisons of the directional subcomponents of the root mean squares and mean velocities of the center of pressure and rambling-trembling displacements in two phases (quiet standing and standing in maximal leaning) were conducted. Moreover, anterior stability limits were compared. During standing in maximal forward leaning, there were no differences in the center of pressure and rambling measures between gymnasts and non-athletes (p > 0.05). The values of trembling measures in both anterior-posterior and medial-lateral directions were significantly lower in gymnasts (p < 0.05). Both groups presented similar values for anterior stability limits (p > 0.05). The comparisons of rambling components may suggest a similar supraspinal control of standing in the maximal leaning position between gymnasts and healthy non-athletes. However, decreased trembling in gymnasts may indicate reduced noise in their postural control system possibly due to superior control processes at the spinal level. The anterior stability limit was not influenced by gymnastics training in female adolescents.

Changes in the Sensory Weighting Strategies in Balance Control Throughout Maturation in Children

BACKGROUND

 The central nervous system integrates information from different sensory inputs (vestibular, visual, and somatosensory) to maintain balance. However, strategies for weighing sensory information change as maturation occurs.

PURPOSE

 The purpose of this study was to: (1) evaluate postural control development in a large sample of healthy children aged 5 to 17 years old, (2) analyze changes in sensory weighting strategies as maturation occurs, and (3) determine the extent to which anthropometric characteristics (height, weight, body mass index [BMI]) influence postural control.

SAMPLE SIZE

 This study recruited 120 healthy children, equally distributed in gender and number, into four age groups (5-8 years, 9-11 years, 12-14 years, and 15-17 years) and compared them to a control group of 20 healthy adults (aged 20-25 years).

RESEARCH DESIGN

 The sensory organization test (SOT) was used to assess overall balance and the use of specific sensory inputs to maintain postural control. All children underwent the six SOT conditions: (1) eyes open, surround and platform stable, (2) eyes closed, surround and platform stable, (3) eyes open, sway-referenced surround, platform stable, (4) eyes open, sway-referenced platform, (5) eyes closed, sway-referenced platform, and (6) eyes open, sway-referenced surround and platform.

DATA ANALYSIS

 Condition-specific equilibrium scores (ES), composite equilibrium scores (CES), and sensory analysis ratios were analyzed to determine whether the performance was related to age, gender, or specific anthropometric characteristics (height, weight, and BMI).

RESULTS

 Data showed a significant age-associated improvement in ES for all 6 conditions (p < 0.05) and in CES (p = 0.001). For both genders, (1) somatosensory function was adult-like by age 5 to 8 years, (2) visual function peaked around age 12 years, and (3) vestibular function reached maturity by age 15 to 17 years (p < 0.05). A moderate positive correlation (r(140) = 0.684, p = 0.01; two-tailed) between height and CES was found and a weak positive correlation (r(140) = 0.198, p = 0.01) between height and somatosensory ratio was noted. Lower vestibular ratio scores were observed in children who had a higher BMI (p = 0.001).

CONCLUSION

 The efficient use of individual sensory system input to maintain balance does not occur at the same age. Age and gender affect the changes in sensory weighting strategies, while height and BMI influence postural control in children. These factors need to be accounted for in child assessment.

Is Postural Control Different in Boys and Girls? Comparison Between Sex

ABSTRACT The purpose of this study was to compare the postural control between eight-year-old boys and girls, considering the nutritional classification and level of physical activity. This was a cross-sectional study, with a sample of 346 participants, classified by the WHO AnthroPlus software, evaluated on the force platform and the Questionnaire Physical Activity for Children. The results demonstrated that girls showed lower values in relation to the opposite sex (p<0.001), in the center of pressure area (COP) (girls: 11.88 vs boys: 15.86cm2), Antero-posterior Amplitude (girl: 5.40 vs boy: 6.05cm), Medial-lateral Amplitude (girl: 3.97 vs boy: 4.40cm), Antero-posterior velocity (girl: 3.98 vs boy: 4.94cm/s), Medial-lateral velocity (girl: 3.98 vs boy: 4.59cm/s), Antero-posterior frequency (girl: 0.70 vs boy: 0.84Hz). Physical activity was associated with male sex (p=0.001; X2=11.195; odds ratio=0.372). In relation to the center of pressure of sedentary children, girls showed better postural control (p<0.001), but when we analyzed the center of pressure of both sexes who were active there was no statistically significant difference (p=0.112). The Z score of both sexes presented no difference in the center of pressure area (p=0.809 and p=0.785 respectively). Girls showed better postural control, while boys are more active; when both sexes performed physical activity COP area was similar. Therefore, special care should be taken when assessing postural control in boys and girls due to their differences in test performance and stage of development. As for interventions, exercise should be considered for better performance of the COP.

High-frequency semicircular canal deficit affects postural control in hearing-impaired children

OBJECTIVES

The present study aimed to analyse the impact of vestibulo-ocular reflex (VOR) gain deficit on postural control (PC) in children with sensorineural hearing loss.

METHODS

A retrospective study included 55 children with sensorineural hearing loss between 4 and 17 years of age. The Video Head Impulse Test (vHIT®) was used to assess semicircular canal function. PC was assessed on the Balance Quest® posturographic platform testing sensory organisation.

RESULTS

Spatial and temporal postural parameters (area and mean speed of centre of pressure oscillation, spectral power index) in the OKN-U condition (optokinetic with unstable platform) were significantly better in children with than without VOR deficit.

CONCLUSION

Posturographic exploration in the OKN-U condition can screen for semicircular canal deficit in hearing-impaired children. VOR deficit also seems to predict PC deficit.

Body-Worn Sensors Are a Valid Alternative to Forceplates for Measuring Balance in Children

Aims

Clinical evaluation of balance has relied on forceplate systems as the gold standard for postural sway measures. Recently, systems based on wireless inertial sensors have been explored, mostly in the adult population, as an alternative given their practicality and lower cost. Our goal was to validate body-worn sensors against forceplate balance measures in typically developing children during tests of quiet stance.

Methods

18 participants (8 males) 7 to 17 years old performed a quiet stance test standing on a forceplate while wearing 3 inertial sensors. Three 30-second trials were performed under 4 conditions: firm surface with eyes open and closed, and foam surface with eyes open and closed. Sway area, path length, and sway velocity were calculated.

Results

We found 20 significant and 8 non-significant correlations. Variables found to be significant were represented across all conditions, except for the foam eyes closed condition.

Conclusions

These results support the validity of wearable sensors in measuring postural sway in children. Inertial sensors may represent a viable alternative to the gold standard forceplate to test static balance in children.

How sacculo-collic function assessed by cervical vestibular evoked myogenic Potentials correlates with the quality of postural control in hearing impaired children?

OBJECTIVE

Functional integrity of vestibular end organs is essential for gaze stabilization, dynamic visual acuity, postural control and spatial orientation. Some authors hypothesized on the importance of saccules for postural control and motor development in children, including achievements such as standing up and walking. The purpose of this article was to observe how saccular dysfunction assessed by cervical Vestibular Evoked Myogenic Potentials (cVEMPs) correlates with the quality of postural control in non-syndromic deaf children.

METHOD

Seventy-six non-syndromic hearing-impaired children were retrospectively included. Sacculo-collic pathway was assessed with cVEMPs elicited in bone conduction. The response was quoted "normal" if a reproducible wave P13-N23 of at least 50μV in amplitude was present, if not, it was quoted "absent". The sample was divided in 3 groups depending on the presence of the sacculo-collic responses: normal bilateral group (Group 1), normal unilateral (Group 2) and absent bilaterally group (Group 3). Motor assessment was achieved with Movement Assessment Battery for Children, second edition (MABC-2). Postural control (PC) was assessed using the dynamic Balance Quest platform. The scores obtained with MABC-2, and the postural parameters recorded on the Balance Quest platform (sway of Centre of Pressure and spectral power index) were analyzed and compared throughout the groups.

RESULTS

Group 1 (normal bilateral) showed the best scores regarding motor abilities and postural stability within available normative data. Group 3 (absent bilateral) had the lowest motor and postural control skills. A good correlation between the scores obtained by MABC-2 motor test and dynamic posturography (Balance Quest) was observed.

CONCLUSIONS

The presence of at least one sacculo-collic response would predict satisfactory static and dynamic motor and postural control skills in non-syndromic hearing-impaired children. MABC-2 and Dynamic Posturography Balance Quest appears reliable and comparable tools for PC assessment in hearing impaired children. In the light of these results, it appears that in young children candidates for uni- or bilateral CI whose walking is not yet acquired, should receive a vestibular assessment before surgery to avoid the risk of bilateral sacculo-collic function impairment.

The development of postural control in 6-17 old years healthy children. Part II Postural control evaluation - Limits of Stability Test (LOS) in 6-17 old year children

&lt;b&gt;Introduction&lt;/b&gt;: The ability to Reach quickly to changing external stimuli, to move the body quickly and precisely in any direction and to maintain the centre of gravity above the support base, all contribute to maintaining balance in dynamic conditions. The Limits of Stability Test (LOS) provides information on the state of dynamic equilibrium in a standing position.&lt;br&gt; &lt;b&gt;Aim&lt;/b&gt; : Assessment of dynamic postural control in developmental age.&lt;br&gt; &lt;b&gt;Material&lt;/b&gt; : 127 healthy children (65 girls and 62 boys) aged 6 - 17years. &lt;br&gt; &lt;b&gt;Methods&lt;/b&gt;: All children underwent LOS test (posturograph NeuroCom) with registration of reaction time (RT), movement velocity (MVL), directional control (DCL) , maximum excursion (MXE) and endpoint excursion (EPE).&lt;br&gt; &lt;b&gt;Results&lt;/b&gt;: At the age of 6-7 years, not fully developed jumping strategy and visual feedback mechanism in the control of movement were observed. All tested parameters were significantly worse in children aged 6 - 9 years. After this period, a significant improvement in TR and MVL was observed, with no significant changes in subsequent age groups while significant improvement in MXE up to 12 , EPE and DCL up to 13 years of age was noted. No significant gender differences were fund in the LOS test parameters. &lt;br&gt; &lt;b&gt;Conclusions&lt;/b&gt;: 1 The LOS test showed significantly lower dynamic balance development in children aged 6 - 7 years. 2 The study showed a significant improvement in all parameters of the LOS test up to 13 years of age, which supports the termination of the function at that time.

The cross-sectional relationships between age, standing static balance, and standing dynamic balance reactions in typically developing children

BACKGROUND

Static balance performance is a common metric for evaluating the development of postural control in children. Less is known about the potentially independent development of dynamic balance performance.

RESEARCH QUESTION

How does age relate to static (i.e. postural sway) and dynamic (i.e. stepping thresholds) standing balance performance, and what is the relationship between postural sway and stepping thresholds?

METHODS

Twenty-six typically developing children (12 males, 14 females; 5-12 years of age) were recruited for this cross-sectional study. Static balance performance was quantified as the total path length during a postural sway assessment using a force platform with conditions of eyes open and eyes closed. Dynamic balance performance was quantified using a single-stepping threshold assessment, whereby participants attempted to prevent a step in response to treadmill-induced perturbations in the anterior and posterior directions. Relationships between age and body-size scaled measures of static and dynamic balance performance were assessed using Spearman rank correlations.

RESULTS

There was a weak correlation between age and postural sway (|r_s| < 0.10, p >  0.68), but a moderate-to-strong correlation between age and single-stepping thresholds (r_s > 0.68, p < 0.001). A weak correlation was found between postural sway and single-stepping thresholds (|r_s| < 0.20, p >  0.39).

SIGNIFICANCE

Dynamic, but not static standing balance performance, may improve with typical development between the ages of 5 and 12 years. Static and dynamic balance should be considered as unique constructs when assessed in children.

Postural Instability in Subjects With Usher Syndrome

This study investigated postural performances and vestibular impairment in Usher patients. The three groups studied were: 11 patients with Usher type I (with visual and vestibular impairment), 14 patients with Usher type II (with only visual impairment), and 14 healthy control subjects. Postural stability was measured with a Framiral Multitest Equilibre platform with three visual conditions: eyes open (EO), eyes closed (EC), and vision disturbed by optokinetic stimulation (OPT), and two different postural conditions: stable or unstable platform. The surface and mean velocity of the center of pressure displacement (CoP) were measured and a postural instability index (PII) was calculated. Usher type I and II patients were more unstable than control subjects, but only for the unstable platform. Patients with Usher type I (with severe vestibular impairment) were also significantly more unstable than patients with Usher type II (with normal vestibular function) on the unstable platform. The severity of the vestibular impairment was correlated with the surface of the CoP displacement. We suggest that poor postural control of Usher patients is due to the abnormalities in their visual and, when defective, vestibular inputs. Measurements of postural stability on an unstable platform can distinguish type I from type II Usher patients. We emphasize the importance of multisensory evaluation in these patients to guide development of personalized visuo-vestibular rehabilitation techniques to improve their postural stability and improve their quality of life.