Vestibular and Oculomotor Function in Children with CP: Descriptive Study

Publication date: Available online 2 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): A. Almutairi, G. Cochrane, J.B. Christy

Objective

We aimed to describe vestibular/oculomotor function of 7-12-year-old children with CP, Gross Motor Function Classification System (GMFCS) levels (I-III), in comparison to an age-matched control group to understand the effect of the vestibular system on activities and participation of children with CP.

Methods

Vestibular, oculomotor and balance function were tested in children with CP. Central and peripheral vestibular function was examined using an enclosed rotary chair and infrared video goggles (100Hz) that measured eye movements. Oculomotor tests included smooth pursuit and optokinetic nystagmus (OKN). Vestibulo-Ocular Reflex (VOR) tests, done in complete darkness, included step rotation (STEP), sinusoidal harmonic acceleration (SHA) test, VOR cancellation and enhancement, and subjective visual vertical and horizontal (SVV/SVH). The integrity of the saccule was tested with the Cervical Vestibular Evoked Myogenic Potential. If able, the participants' balance abilities were examined using the Sensory Organization Test (SOT) to determine ability to maintain standing balance during six conditions that challenged the visual, somatosensory and vestibular systems. Independent t-tests and Mann-Whitney U tests were used to compare results between groups.

Results

Forty-one children with CP (mean age=9.44 years, SD= 1.66; 23F/18M; Gross Motor Function Classification System levels: I (n=19), II (n=7), III (n=15) and thirty-three typically developing (TD) children (mean age=10.16 years, SD= 1.6; 13F/20M) were recruited from the Birmingham, AL community. There was no significant difference between children with CP and TD children in saccular function (i.e. C-VEMP test), and peripheral vestibular end organ (i.e. SHA test and STEP test), VOR enhancement, or OKN gain. Velocity gain for horizontal smooth pursuit was significantly worse in children with CP (p=0.009), compared to TD children. Poor mediation of central vestibular function were that evident with significantly higher VOR cancellation gain in children with CP (p<0.0001), compared to TD children and significantly higher SVV variance (p=0.002), SVH mean (p=0.001), and SVH variance (p<0.0001) in children with CP compared to TD children. Compromised balance abilities in children with CP was evident with significantly lower composite scores (p<0.0001), vestibular ratio (p<0.0001), and visual ratio (p=0.021). The somatosensory ratio (p=0.798) of children with CP was similar to children with TD.

Conclusions

Although peripheral vestibular function was intact, children with CP had difficulty coupling eye and head movement (VOR cancellation), using the vestibular system for postural control (SOT), demonstrated poor perception of upright (SVV/SVH), and had difficulty following a slow moving target (smooth pursuit eye movement). These results implicate a central vestibular and oculomotor function impairment the severity of which corresponded with severity of the level of CP.

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