OUTCOMES IN PEDIATRIC VESTIBULAR LOSS

 描述（由申请人提供）：儿童前庭丧失的结局在植入人工耳蜗（CCI）的儿童中，前庭丧失的存在可能导致粗大运动发育延迟和视力下降，需要额外的治疗。然而，前庭检查在儿科人群中并不是常规的，并且前庭障碍很少被认为是CCI。这项研究计划的长期目标是表征儿童前庭功能丧失对发育的影响，并指导开发康复工具，最大限度地减少或逆转这种影响。作为第一步，本提案的目的是描述CCI中的前庭功能，并调查前庭丧失对这些儿童的静态（头部稳定）和动态（头部运动）视力以及粗大运动发育的影响。中心假设是，静态视力（SVA），动态视力（DVA），和大运动发育退化的CCI前庭损失。这一假设是基于对前庭功能丧失的成年人的研究，这些人在站立、行走和头部运动时视力下降，影响了日常生活活动。这项研究的基本原理是，视力下降，特别是在课堂上，可能会损害CCI的学业成功。在我们实验室获得的初步数据表明，大运动发育和视力下降，在CCI与前庭损失。本提案将涉及两个具体目标：1）我们将描述前庭损失及其与CCI中粗大运动发育和DVA的关系，2）我们将评估前庭损失对这些儿童SVA的影响。我们将重点关注CCI患者，由于其听力损失的病因和程度以及植入过程，他们的前庭损失风险增加。CCI患者前庭功能丧失的可能性为50%，因此有足够的样本量来解决研究问题。将前庭功能正常的CCI（听力损失程度与前庭损失的CCI匹配）作为对照。这提供了一个人口 儿童前庭功能丧失的后果可以得到更好的研究。在目标1中，将在儿童中评价一种用于评估成人椎管功能的新方法。此外，将研究前庭功能丧失的严重程度、粗大运动表现和DVA之间的关系。在目标2中，将使用3个视觉目标复杂度水平，在头部固定在下巴托上并自然保持在稳定位置的情况下评估SVA，以确定前庭丧失对SVA的影响。由于听力损失本身就可以在言语、语言、认知和阅读中发挥重要作用，因此了解前庭损失的额外影响至关重要。这项工作将提供有关前庭功能丧失的患病率和前庭功能丧失影响CCI患者视力的程度的知识。这将进一步推进我们对CCI中前庭损失的自然补偿过程的理解，并导致进一步调查儿童前庭损失的识别，影响和阻碍。

 DESCRIPTION (provided by applicant): Outcomes in Pediatric Vestibular Loss In children with cochlear implants (CCI), the presence of vestibular loss may result in gross motor developmental delay and reduced visual acuity, requiring additional habilitation. However, vestibular testing is not routine in the pediatric population, and vestibular habilitation is seldo considered for CCI. The long-term goals of this research program are to characterize the developmental impact of pediatric vestibular loss and to guide the development of rehabilitative tools that minimize, or reverse, this impact. As a first step, the objectives in the present proposl are to characterize vestibular function in CCI, and investigate the effect of vestibular loss on static (head stable) and dynamic (head in motion) visual acuity as well as gross motor development in these children. The central hypothesis is that static visual acuity (SVA), dynamic visual acuity (DVA), and gross motor development are degraded in CCI with vestibular loss. This hypothesis is based on research in adults with vestibular loss, who experience reduced visual acuity with standing, walking and head movement, which impairs activities of daily living. The rationale for the proposed research is that reduced visual acuity, especially in the classroom, may impair academic success in CCI. Preliminary data obtained in our lab suggests that gross motor development and visual acuity are reduced in CCI with vestibular loss. Two specific aims will be addressed in this proposal: 1) we will characterize vestibular loss and its relationship with gross motor development and DVA in CCI, and 2) we will evaluate the effect of vestibular loss on SVA in these children. We will focus on CCI, who have increased risk of vestibular loss due to the etiology and magnitude of their hearing loss and the process of implantation. The likelihood of vestibular loss is 50% in CCI, allowing for a sufficient sample siz to address the research questions. CCI with normal vestibular function (matched in degree of hearing loss to the CCI with vestibular loss) will serve as controls. This provides a population of children where consequences of vestibular loss can be better studied. In Aim 1, a new approach for assessing semicircular-canal function that has been developed for use in adults will be evaluated in children. Additionally, the relationship between severity of vestibular loss, gross motor performance and DVA will be investigated. In Aim 2, SVA will be assessed with the head fixed in a chin rest and with the head held naturally in a stable position, using 3 levels of visua target complexity in order to determine the contribution of vestibular loss on SVA. Because hearing loss alone can play a significant role in speech, language, cognition, and reading, understanding the additional impact of vestibular loss is essential. This work will provide knowledge regarding the prevalence of vestibular loss and the extent to which vestibular loss affects visual acuity in CCI. This will further advance our understanding of the natural compensation process of vestibular loss in CCI and lead to further investigations regarding the identification, implications, and habilitation of pediatric vestibular loss.