Vestibular Stimulation: Intervention Protocols, Efficacy and Therapeutic Application in Children Rehabilitation (a Narrative Study)

Document Type : Review Article

Authors

1 Department of Occupational Therapy , Rehabilitation school, University of Medical Sciences Shiraz, Shiraz, Iran

2 Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

3 Department of Occupational Therapy , Rehabilitation School, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Physiotherapy, School of Rehabilitation, Iran University of Medical Science, Tehran, Iran

5 Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran

6 Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

7 Department of Occupational Therapy, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

Abstract

Purpose:
According to the widespread application of vestibular stimulation in clinics, organized treatment protocols seem to be necessary. This narrative article aimed to investigate the evidence-based current protocols and to guide this clinical flow into structured direction.
Methods:
In this narrative study, valid sites and databases such as PubMed, Web of science, Scopus, Medline and Google scholar were searched from 1972 till 2014. The Key words were “Mechanical Vestibular Stimulation”, “Children”, “Semicircular Canals”, “Otolits” and “Rehabilitation”.
Results:
203 articles were found and finally, 34 studies were analyzed according to the inclusion criteria. Their treatment protocols were discussed. Most studies have proved vestibular stimulation to be an effective treatment method and the overall evidence suggests the efficacy of the vestibular interventions in improvement of children with disability. Additionally, suggested protocols are categorized and presented. Studies showed that treatment would be effective if all the vestibular receptors including utricle, saccule and all semicircular canals were stimulated in different positions such as prone, supine, side lying, quadruped, sitting, kneeling and standing.
Conclusion:
In the light of the present evidence about the efficacy of mechanical vestibular stimulation, organized vestibular stimulation with specialized protocol is strongly recommended to be as one part of children therapeutic schedule in order for empowering rehabilitation process. It is suggested to be careful about the age in which stimulation is received, type of diagnosis, intensity of deficits, history of receiving stimulation, head position control, type of stimulation, frequency, amplitude and sequence of stimulation. Direction of stimulation, length of stimulation, even the duration of each single stimulation during one session and number of sessions, body position during receiving the stimulation, the break and stop intervals immediately after each movement, the delay between two back to back stimulations, health of peripheral and central vestibular system itself along with suitable assessment tools are better to be considered in defining and designing clinical intervention protocol of vestibular stimulation.

Keywords

Main Subjects


  1. Ayres AJ. Learning disabilities and the vestibular system. J Learn Disabil 1978; 11(1): 30-41.
  2.  Dieterich M, Bucher SF, Seelos KC, Brandt T. Horizontal or vertical optokinetic stimulation activates visual motion-sensitive, ocular motor and vestibular cortex areas with right hemispheric dominance. An fMRI study. Brain 1998; 121(8): 1479-95.
  3.  Herdman SJ, Clendaniel R. Vestibular rehabilitation. FA Davis, Philaddelphia; 2nd edition 2000; 24: 561-562.
  4.  Fisher AG, Mixon J, Herman R. The validity of the clinical diagnosis of vestibular dysfunction. OTJR: Occupation, Participation and Health 1986; 6(1): 3-20.
  5. Gioacchini FM, Alicandri-Ciufelli M, Kaleci S, Magliulo G, et al. Prevalence and diagnosis of vestibular disorders in children: a review. International journal of pediatric otorhinolaryngology 2014; 78(5): 718-24.
  6.  Allum J. Organization of stabilizing reflex responses in tibialis anterior muscles following ankle flexion perturbations of standing man. Brain Res 1983; 264(2): 297-301.
  7. Allum J, Pfaltz C. Visual and vestibular contributions to pitch sway stabilization in the ankle muscles of normals and patients with bilateral peripheral vestibular deficits. Exp Brain Res 1985; 58(1): 82-94.
  8.  Zeynalzadeh Ghoochani B, Hosseini S A, Talebian S, Biglarian A, et al. Healthy older adults balance pattern under dual task conditions: exploring the strategy and trend.  Health Promot Perspect 2016; 6(4): 207-12.
  9. Hosseini SA, Zeynalzadeh Ghoochani B, Talebian S, Pishyare E, et al. Investigating the Effects of Vestibular Stimulation on Balance Performance in Children with Cerebral Palsy: A Randomised Clinical Trial Study. JRSR 2015; 2(2): 41-6.
  10. Schilder P. The vestibular apparatus in neurosis and psychosis. J Nerv Ment Dis 1933; 78(2): 137-64.
  11.  De Quirds JB. Diagnosis of vestibular disorders in the learning disabled. J Learn Disabil 1976; 9(1): 39-47.
  12.  McKeone SC. Case studies of the effects of vestibular stimulation on reading skills in children with learning disability and accompanying vestibular dysfunction [Thesis]. San Jose State University; 1994.
  13. Ayres AJ. Sensory integration and learning disorders. Los Angeles; Western Psychological Services;1ST edition; 1972: 113-129
  14. Ayres AJ. Improving Academic Scores through Sensory Integration. J Learn Disabil 1972; 5(6): 338-43.
  15. Ayres AJ. The development of sensory integrative theory and practice: A collection of the works of A. Jean Ayres: Kendall/Hunt Publishing Company;3rd edition 1974. 301.
  16. Ottenbacher K, Short-DeGraff MA, Watson PJ. The effects of a controled program of clinically applied vestibular stimulation on the neuromotor development of children with severe developmental delay. Physical & Occupational Therapy in Pediatrics 1981; 1(3): 1-12.
  17.  Grossman G, Leigh RJ, Abel L, Lanska D, Thurston S. Frequency and velocity of rotational head perturbations during locomotion. Exp Brain Res 1988; 70(3): 470-6.
  18.  Green JH. Basic clinical physiology. Oxford Medical Publication, 6th edition; 1992: 189.
  19.  Baloh R, Honrubia V. Clinical neurophysiology of the vestibular system. Contemporary neurology series, 1st edition, Philadelphia F A Davis; 1979: 18.
  20. Kornhuber HH. Hand book of sensory physiology, 1ST Volume ,Vestibular system part 1; basic mechanisms: Springer Science & Business Media; 2012: 546-548
  21.  Wilson V, Peterson B. The role of the vestibular system in posture and movement. Medical Physiology St Louis, MO CV Mosby Co, 1st edition; 1980: 813-36.
  22.  Hosseini SA, Ray GG. Vestibular Stimulation on cerebral palsy Designing a vestibulator [thesis]. India; School of biosciences and bioengineering IITB, Indian Institute of Technology: 2007.
  23.  Chee FK, Kreutzberg JR, Clark DL. Semicircular canal stimulation in cerebral palsied children. Physical therapy 1978; 58(9): 1071-1075.
  24.  Shepard NT, Telian SA. Practical management of the balance disorder patient: Singular publishing group, INC; SanDiego London 1996: 169-179.
  25.  Akbarfahimi N,  Hosseini S A, Rassafiani M, Shahshahani S, et al. [Investigating the effect of active and passive vestibular stimulation on balance and function in 7 to 12 year old cerebral palsy children [Thesis]].  University of social welfare and rehabilitation; 2014 .[Persian]
  26.  Kenneth J, Over S R. Effects of Vestibular Stimulation on Motor Development of Cerebral‐palsied Children. Dev Med Child Neurol 1980; 22(4): 476-83.
  27. Rogos R. Clinically applied vestibular stimulation and motor performance in children with cerebral palsy. [Thesis]: Columbus, OH, The Ohio State University; 1977.
  28.  Frank J, Levinson HN. Compensatory mechanisms in CV dysfunction, dysmetric dyslexia, and dyspraxia. Academic Therapy 1976; 12(1): 5-27.
  29.  Polatajko HJ. A critical look at vestibular dysfunction in learning‐disabled children. Dev Med Child Neurol 1985; 27(3): 283-92.
  30.  Keating NR. A comparison of duration of nystagmus as measured by the Southern California Postrotary Nystagmus Test and electronystagmography. Am J Occup Ther 1979. 33(2): 92-97
  31.  Clark DL, Arnold LE, Crowl L, Bozzolo H, et al. Vestibular Stimulation for ADHD: randomized controlled trial of Comprehensive Motion Apparatus. Journal of attention disorders 2008; 11(5):599-611
  32.  Sandler AG, Voogt K. Vestibular stimulation: Effects on visual and auditory alertness in children with multiple disabilities. Journal of Developmental and Physical Disabilities 2001; 13(4): 333-41.
  33.  Kantner RM, Kantner B, Clark DL. Vestibular stimulation effect on language development in mentally retarded children. Am J Occup Ther 1982; 36(1): 36-41.
  34.  Igarashi M, Takahashi M, Alford B, Johnson P. Inner ear morphology in Down's syndrome. Acta oto-laryngologica 1977; 83(1-6): 175-81.
  35.  Arendt RE, Maclean WE, Halpern LF, Youngquist GA, et al. The influence of rotary vestibular stimulation upon motor development of nonhandicapped and Down syndrome infants. Res Dev Disabil 1991; 12(3): 333-48.
  36.  Lydic JS, Windsor MM, Short MA, Ellis TA. Effects of controlled rotary vestibular stimulation on the motor performance of infants with Down syndrome. Physical & Occupational Therapy In Pediatrics 1985; 5(2-3): 93-118.
  37. Sandler AG, McLain SC. Sensory reinforcement: effects of response-contingent vestibular stimulation on multiply handicapped children. American journal of mental deficiency 1987; 91(4): 373-378
  38.  Magrun WM, Ottenbacher K, McCue S, Keefe R. Effects of vestibular stimulation on spontaneous use of verbal language in developmentally delayed children. Am J Occup Ther 1981; 35(2): 101-4.
  39.  Cass MA. The Effects of Vestibular Stimulation on the Sensory-Motor Performance of Handicapped Individuals: A Critical Review of the Literature. Can J Occup Ther 1984; 51(3): 121-5.
  40.  Salamati A, Hosseini SA, Haghgou H. [Effectiveness of Vestibular Stimulation on Visual Attention in Children with Attention Deficit Hyperactivity Disorder]. Journal of Rehabilitation 2014; 15(3): 18-25.[Persian]
  41.  Bhatara V, Clark D, Arnold LE, Gunsett R, et al. Hyperkinesis treated by vestibular stimulation: An exploratory study. Biological Psychiatry 1981; 16(3): 269-279
  42.  Smith SA, Press B, Koenig KP, Kinnealey M. Effects of sensory integration intervention on self-stimulating and self-injurious behaviors. Am J Occup Ther 2005; 59(4): 418-25.
  43.  Clark DL, Chee F. Vestibular stimulation influence on motor development in infants. Science 1977; 196(4295): 1228-9.
  44.  Dura JR, Mulick JA, Hammer D. Rapid clinical evaluation of sensory integrative therapy for self-injurious behavior. Mental Retardation 1988; 26(2): 83.
  45.  Freeman B, Frankel F, Rito E. The effects of response contingent vestibular stimulation on the behavior of autistic and retarded children. J Autim Child Schizophr 1976; 6(4): 353-8
  46.  Freedman D, Boverman H. Effects of kinesthetic stimulation on certain aspects of development in premature infants. American Journal of Orthopsychiatry 1966; 36(2): 223-4.
  47.  MacLean WE, Baumeister AA. Effects of vestibular stimulation on motor development and stereotyped behavior of developmentally delayed children. J Abnorm Child Psychol 1982; 10(2): 229-45.
  48.  Weeks Z. Effects of the vestibular system on human development, Part I. Overview of functions and effects of stimulation. Am J Occup Ther: official publication of the American Occupational Therapy Association 1979; 33(6): 376.
  49.  Weeks Z. Effects of the vestibular system on human development, part 2: Effects of vestibular stimulation on mentally retarded, emotionally disturbed, and learning-disabled individuals. Am J Occup Ther: official publication of the American Occupational Therapy Association 1979; 33(7): 450-7.
  50.  Kreutzberg JR. Effects of vestibular stimulation on the reflex and motor development in normal infants [Thesis]. Columbus, OH, The Ohio State University; 1976.
  51.  Gregg CL, Haffner ME, Korner AF. The relative efficacy of vestibular-proprioceptive stimulation and the upright position in enhancing visual pursuit in neonates. Child development 1976 ;47(2): 309-14.
  52.  Pederson DR, Vrugt DT. The influence of amplitude and frequency of vestibular stimulation on the activity of two-month-old infants. Child development 1973; 44(1): 122-8.
  53.  Pederson DR. The soothing effect of rocking as determined by the direction and frequency of movement. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement 1975; 7(3): 237-243.
  54.  Thelen E, Fisher Thompson D. The effects of supplemental vestibular stimulation on stereotyped behavior and development in normal infants. Physical & Occupational Therapy In Pediatrics 1986; 6(2): 57-70.
  55. Levine SB. An investigation of the effects of vestibular stimulation on object permanence in infants with sensorimotor dysfunction [Thesis]. Loyola University of Chicago; 1983.
  56.   Casler L. Supplementary auditory and vestibular stimulation: Effects on institutionalized infants. J Exp Child Psychol 1975; 19(3): 456-63.
  57.   Barnard KE, Bee HL. The impact of temporally patterned stimulation on the development of preterm infants. Child Development 1983: 54(5); 1156-1167.