Balanced Growth project: a protocol of a single-centre observational study on the involvement of the vestibular system in a child's motor and cognitive development

Ruth Van Hecke, Frederik J A Deconinck, Jan R Wiersema, Chloe Clauws, Maya Danneels, Ingeborg Dhooge, Laura Leyssens, Hilde Van Waelvelde, Leen Maes, Ruth Van Hecke, Frederik J A Deconinck, Jan R Wiersema, Chloe Clauws, Maya Danneels, Ingeborg Dhooge, Laura Leyssens, Hilde Van Waelvelde, Leen Maes

Abstract

Introduction: The involvement of the vestibular system in the motor and higher (cognitive) performances of typically developing or vestibular-impaired children is currently unknown or has only scarcely been explored. Interestingly, arguments for an interaction between vestibular, motor and cognitive functions in children can also be supported by research on children known for their difficulties in motor and/or cognitive processing (eg, children with neurodevelopmental disorders (NDD)), as they often present with vestibular-like characteristics. Therefore, in order to elucidate this interaction, and to increase the understanding of the pathophysiology and symptomatology of vestibular disorders and NDD in children, the Balanced Growth project was developed. It includes the following objectives: (1) to understand the association between motor skills, cognitive performances and the vestibular function in typically developing school-aged children, with special focus on the added value of the vestibular system in higher cognitive skills and motor competence; (2) to investigate whether a vestibular dysfunction (with/without an additional auditory disease) has an impact on motor skills, cognitive performances and motor-cognitive interactions in children and (3) to assess if an underlying vestibular dysfunction can be identified in school-aged children with NDD, with documentation of the occurrence and characteristics of vestibular dysfunctions in this group of children using an extensive vestibular test battery.

Methods and analysis: In order to achieve the objectives of the observational cross-sectional Balanced Growth study, a single-task and dual-task test protocol was created, which will be performed in three groups of school-aged children (6-12 years old): (1) a typically developing group (n=140), (2) (audio) vestibular-impaired children (n=30) and (3) children with an NDD diagnosis (n=55) (ie, autism spectrum disorder, attention deficit/hyperactivity disorder and/or developmental coordination disorder). The test protocol consists of several custom-made tests and already existing validated test batteries and includes a vestibular assessment, an extensive motor assessment, eight neurocognitive tests, a cognitive-motor interaction assessment and includes also additional screenings to control for potential confounding factors (eg, hearing status, intelligence, physical activity, etc).

Ethics and dissemination: The current study was approved by the ethics committee of Ghent University Hospital on 4 June 2019 with registration number B670201940165 and is registered at Clinical Trials (clinicaltrials.gov) with identifier NCT04685746. All research findings will be disseminated in peer-reviewed journals and presented at vestibular as well as multidisciplinary international conferences and meetings.

Trial registration number: NCT04685746.

Keywords: audiology; paediatric otolaryngology; paediatrics; psychiatry; rehabilitation medicine.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
The vestibular system and its most important input and output structures. After permission of the authors, the figure was adapted and translated from Dhondt et al.
Figure 2
Figure 2
The balanced growth protocol including vestibular, cognitive, motor and cognitive–motor interaction assessments, and also several additional screenings to control for potential confounding factors.
Figure 3
Figure 3
Vestibular test battery of the balanced growth protocol. A cervical (air conduction) and ocular (using a minishaker) vestibular evoked myogenic potential (c/oVEMP) assessment; video Head Impulse Test (vHIT) in all planes of the semicircular canals (lateral, anterior, posterior).
Figure 4
Figure 4
Motor and balance test battery of the balanced growth protocol, which includes the motor assessment battery for children (M ABC, second edition), the first subtest of the Körperkoordination test für Kinder (KTK, backward balance beam walking) and the modified clinical test of sensory interaction on balance (m-CTSIB) performed on a Wii balance board.
Figure 5
Figure 5
The extensive cognitive test battery of the balanced growth protocol based on the six neurocognitive domains of the DSM-5; NEPSY II NL, developmental neuropsychological assessment, second edition, Dutch version, BRIEF, the parent-report questionnaire behaviour rating inventory of executive function. DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Figure 6
Figure 6
Test set up, including a touch screen monitor, for the spatial span task (forward/backward).
Figure 7
Figure 7
Test set up for the digit span (forward/backward) and continuous performance task.
Figure 8
Figure 8
Test set up for the cognitive–motor interference assessment of the balanced growth project.

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