Effects of Cawthorne Cooksey Exercises on Balance and Quality of Life in Children With Hearing Deficits

In children, vestibular function plays an important role in the gross motor development and postural control. Infants and children with congenitally profound hearing loss commonly suffer vestibular dysfunction in both ears, and poor balance. However, there have been very few studies have investigated the effect of exercises on balance and quality of life in children with the profound hearing deficit. The development and maintenance of balance is a multisystem process that also depends on vestibular input believe that as labyrinths and cochlea are anatomically and developmentally interrelated, there is a potentiality for vestibular impairment when the hearing mechanism is impaired.

In a study using Barany Rotary test and caloric stimulation, found that 82% of 89 children with severe acquired hearing deficits and 34% of 129 children with hereditary hearing deficits had abnormal responses to vestibular tests. Since the vestibular system activates vestibular reflex mechanisms trying to stabilize the eyes, head, and body in the space, impairment of this mechanism may affect postural sensitivity. Maturational changes in visual and proprioceptive, central nervous system processing, and coordination of motor output are responsible for the changes in postural skills observed through adolescence . From the sensory systems perspective, Infants and young children are dependent on the visual system to maintain balance; as they grow older, begin to use somatosensory and vestibular information appropriately. Between the 3 sensory inputs in children, the vestibular system seems to be the least effective in postural control.

Children with profound bilateral vestibular dysfunction present with delayed gross motor development. These children stand and walk later than their peers with typical development Difficulties in maintaining balance can lead to challenges in normal childhood activities, such as riding a bicycle or hopping. Reduced ability to participate in normal play with other children may result in social isolation. So, the mechanisms responsible for the lack of balance in children with profound hearing impairment need to be established, and holistic management including both auditory and vestibular function is needed. Sensory organization dysfunction is more prevalent in children with hearing loss and vestibular dysfunction which may result in a problem with balance. These children in situations needs an early address to their balance through balance training activities. Most children with bilateral vestibular dysfunction. These results suggest that due to multi-modal sensory interdependence, the development of visual and somatosensory effectiveness in maintaining balance is impaired secondary to vestibular dysfunction since birth. There is ample support for the efficacy of vestibular rehabilitation therapy through different exercises in adults, but very few data exist regarding its results in children.

Balance is major problem associated with vestibular system specifically in the patients with sensory neural hearing deficits. Since vestibular rehabilitation is an important factor that must be achieved for balance in hearing deficits. Cawthorne Cooksey exercises may be considered as an effective technique to gain balance and improve quality of life.