Vestibular Balance Therapy Intervention for Children
- Conditions
- Vestibular DisorderBilateral Vestibular LossVestibulocochlear Nerve Diseases
- Interventions
- Other: Vestibular Balance TherapyOther: Sham Intervention
- Registration Number
- NCT05741515
- Lead Sponsor
- University of Alabama at Birmingham
- Brief Summary
The goal of this within groups clinical trial is to determine the feasibility of a home-based vestibular balance therapy program for children with vestibular hypofunction. The main questions to be answered are: 1) what is the intervention's feasibility and 2) what is the intervention's preliminary impact on function? Participants will receive a comprehensive battery of vestibular function and balance tests, then an 8-week home-based intervention to be done 5 times/week with weekly checks from the physical therapist. Data will be used to design a larger clinical trial with a comparison group.
- Detailed Description
Approximately 60-75% of children with severe/profound sensorineural hearing loss (SNHL) also have vestibular hypofunction (VH), resulting in delayed gross motor development, poor postural control, and gaze instability. Although clinical practice guidelines provide recommendations for adults with VH, no statements exist for children due to a paucity of high- level studies. The long-term objective of this proposal is to assess feasibility of a home-based vestibular balance therapy (VBT) program for children so that a larger well-powered controlled study can be designed. The specific aims are to assess the intervention's feasibility (Aim 1), estimate its preliminary impact on functional outcomes (Aim 2), and assess participant engagement (secondary Aim). To accomplish this, we will use a prospective single arm feasibility design. We will enroll 15 children with SNHL, aged 4-17 years; 12 with confirmed VH for the VBT, and 3 with normal vestibular function to test the sham intervention. All children will be tested on the functional outcomes: computerized dynamic visual acuity, modified functional gait assessment, and sensory organization test at baseline, 4, and 8 weeks. A physical therapist (PT) will train children/caregivers in the 8-week structured VBT home program consisting of 4 categories of exercises (Times 1 viewing, gaze shifting, static and dynamic balance) done 5 times/week, 5 minutes/exercise. The PT will meet weekly with the child/caregiver in person to systematically progress the exercises. The children in the sham intervention (10 minutes of reading, 10 minutes of play) will also receive weekly meetings with the PT to control for attention bias. To assess Aim 1 (Feasibility) metrics will include process (e.g., recruitment rates), resources (e.g., communication needs), management (e.g., data collection/entry), experience (e.g., barriers). To assess Aim 2 (impact) we will analyze within group changes and effect sizes to design the larger study.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 15
- confirmed diagnosis of severe to profound SNHL
- age 4-17 years
- caregiver/child verbal willingness to commit to the home vestibular balance therapy or sham intervention
- vision screening/testing within 1 year or willingness to get a vision test.
- neurologic condition other than SNHL
- inability to read at a kindergarten level or identify pictures
- currently receiving vestibular therapy
- uncorrected vision problems unrelated to a vestibular deficit
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description VBP Intervention Group Vestibular Balance Therapy Children coded as abnormal on functional tests (FT) (n=12) will participate in an 8-week 5X/week home-based VBT program. At the initial visit (T0), the PI will instruct the participants (caregiver and child) in the program and provide all materials. The exercises will be led by the caregiver, with weekly in person checks by the PI to progress and provide coaching. The child/caregiver will complete a daily log to report activities and level of enjoyment. VBT will be done 5 days/week and will include 4 key categories of exercises, each lasting 5 minutes (20 minutes total of exercise per day). The 4 categories, explained below, include: 1) Times 1 (X1) Viewing, 2) Gaze Shifting, 3) Static Balance, 4) Dynamic Balance. The proposed VBT home program will include 10 minutes of gaze stabilization exercises, and 10 minutes of balance training. Sham Intervention Sham Intervention Sham Intervention (not to be compared to intervention - for feasibility only): Aim 1 is to establish the feasibility of a control intervention to be used in future studies. Therefore, 3 participants who score above the set criterion for the Functional Tests (FT) (i.e., they do not need VBT) will participate in an 8-week sham intervention. At T0, the PI will instruct the participants to do the sham intervention, led by the caregiver with weekly checks to control for attention bias. The sham intervention will be done for 20 minutes per day and will consist of 10 minutes of focused reading a book of the child's choice and 10 minutes of active play. The child and caregiver will complete a daily activity log documenting the activity and level of enjoyment.
- Primary Outcome Measures
Name Time Method Change in Sensory Organization Test at 4 and 8 weeks Baseline (pre), 4 weeks (mid), 8 weeks (post) A standardized test of static postural control
Change in Computerized Dynamic Visual Acuity at 4 and 8 weeks Baseline (pre), 4 weeks (mid), 8 weeks (post) Difference in visual acuity with the head stationary versus moving
Change in Functional Gait Assessment at 4 and 8 weeks Baseline (pre), 4 weeks (mid), 8 weeks (post) A standardized test of dynamic balance
- Secondary Outcome Measures
Name Time Method Process Feasibility (Retention Rates) through study period at 2 years % of retention
Participant Experience Feasibility (Enjoyment) through the study period at 2 years Enjoyment level for each participant (ordinal scale of 0=no enjoyment to 10=extreme enjoyment)
Management Feasibility (training) through year 1 time in minutes to train data collectors
Participant Experience Feasibility (Strategies) through study period at 2 years participant strategies that helped them with participation in the study (interview)
Participant Experience Feasibility (Testing Difficulty) baseline only - initial testing session Participants will rate the level of difficulty of the initial testing session (0=not difficult to 10=extreme difficulty)
Process Feasibility (Refusal Rate Frequency) through study completion at 2 years Frequency of refusal to participate in the study
Process Feasibility (Completion Rates) through study period at 2 years % of participants who complete 80% of intervention sessions
Resource Feasibility (frequency) through study period at 2 years Frequency of communication with participants
Process Feasibility (Recruitment Rates) through study completion at 2 years % of individuals who follow through with enrollment procedures
Process Feasibility (Attrition Rates) through study period at 2 years % of attrition
Management Feasibility (data entry) through year 1 time in minutes for data entry
Participant Experience Feasibility (Intervention Difficulty) once, at each participant's final testing session (8 weeks) Participants will rate the level of difficulty of the overall intervention (0=not difficult to 10=extreme difficulty)
Resource Feasibility (time) through study period at 2 years Total time in minutes to communicate with participants
Trial Locations
- Locations (1)
UAB
🇺🇸Birmingham, Alabama, United States