Efficacy of vestibular rehabilitation program in children with balance disorders and sensorineural hearing loss.

OBJECTIVE: Asses the efficacy of a Vestibular-balance rehabilitation program to minimize or reverse balance disability in children with sensorineural hearing loss. METHOD: Forty-five hearing-impaired children with balance deficits (i.e., variable degrees of sensorineural hearing loss or auditory neuropathy). Thirty-five were rehabilitated with cochlear implants, and ten with hearing aids. Their age ranged from 4 to 10 years old. A Pre-rehab evaluation was done using questionnaires, neuromuscular evaluation, vestibular and balance office testing, and vestibular lab testing (using cVEMP and caloric test). Customized balances, as well as vestibular rehabilitation exercises, have been applied for three months. That was followed by post-rehab assessment, including the Arabic DHI questionnaire, PBS, BESS, HTT, and DVA test. RESULTS: There was a statistically significant difference in all measured parameters (including the Arabic DHI questionnaire, PBS, BESS, HTT, and DVA test) after rehabilitation. CONCLUSIONS: Vestibular-balance rehabilitation intervention positively impacts vestibular and balance functions in hearing-impaired children.

Multi-Scale Assessment and Spatio-Temporal Interaction Characteristics of Ecosystem Health in the Middle Reaches of the Yellow River of China.

Exploring the assessment methods and multi-scale spatiotemporal interaction characteristics of ecosystem health is of great significance for current ecosystem health theory and application research. Based on the regional differentiation theory and ecosystem service flow theory, the spatial weight coefficient and the modified coefficient of spatial proximity effect were introduced to improve the regional ecosystem health assessment model. Then, the improved VORS model was used to evaluate the ecosystem health level in the Middle Reaches of the Yellow River (MRYR) in China at multiple scales, and the ESTDA method was used to reveal the multi-scale spatiotemporal interaction characteristics of ecosystem health. The results show that: (1) From 1990 to 2018, the ecosystem health level at grid and county scale in the MRYR showed a trend of first decline and then increase, and experienced a slow decline and a steady rise from 1990 to 2005 and 2005 to 2018, respectively. The ecosystem health level at the grid and county scale presented a spatially hierarchical structure with alternating low-value and high-value zones. (2) Compared with the county scale, the grid scale can describe the spatial distribution characteristics of ecosystem health more refined, indicating the existence of spatial scale effects in ecosystem health assessment. (3) The rapid urbanization areas, the ecologically fragile areas in the central and western regions and the transitional zone between mountain and basin have more dynamic spatial structure, and stronger spatio-temporal interaction process. (4) In terms of LISA spatio-temporal transition, the regional system as a whole had strong path-dependent and lock-in characteristics, and the local spatial correlation structure of ecosystem health gradually tended to be stable during the study period. (5) In terms of spatio-temporal interaction network, there were strong spatio-temporal competition in the process of time evolution in six typical regions, such as the surrounding cities of provincial capitals, the fringe areas of cities, the transitional zone between mountain and basin, the transitional zone of ecologically fragile regions, the mountainous areas of western Henan Province, and the areas along rivers.

Effects of parameters of video head impulse testing on visually enhanced vestibulo-ocular reflex and vestibulo-ocular reflex suppression.

OBJECTIVE: To investigate the main effects of some testing and analysis variables on clinically quantified visually enhanced vestibulo-ocular reflex (VVOR) and vestibulo-ocular reflex suppression (VORS) results using video head impulse test. METHODS: This prospective observational clinical study included 19 healthy participants who underwent the VVOR and VORS tests. The effect of demographic variables, head oscillation frequency, rotation direction, visual acuity and analysis time window width and location of the recorded tests on the quantified results of both VVOR and VORS were evaluated. And specifically, for the VORS test the effect of cognitive reinforcement of the participant during testing was evaluated. RESULTS: A statistically significant difference was observed among the VVOR, non-reinforced VORS, and reinforced VORS tests for mean gain values of 0.91 ± 0.09, 0.6 ± 0.15, and 0.57 ± 0.16, respectively (p < 0.001). The optimized linear mixed-effect model showed a significant influence of frequency on the gain values for the reinforced and non-reinforced VORS tests (p = 0.01 and p = 0.004, respectively). Regarding the gain analysis method, statistically significant differences were found according to the short time interval sample location of the records for the initial location of the VVOR test (p < 0.006) and final location of the reinforced VORS test (p < 0.023). CONCLUSION: Significant differences were observed in the gain values according to VVOR and VORS testing. Head oscillation frequency is a significant factor that affects the gain values, especially in VORS testing. Moreover, in VORS testing, participant concentration has a significant effect on the test for obtaining suppression gain values. When a short time interval sample is considered for VVOR and VORS testing, intermediate time samples appear the most adequate for both tests. SIGNIFICANCE: The quantified visually enhanced vestibulo-ocular reflex (VVOR) and vestibulo-ocular reflex suppression (VORS) tests have recently been added to the assortment of available clinical vestibular tests. However, despite the clinical validity of these quantified tests that appear to be of increasing clinical interest, the effects of most of the clinical testing methods and mathematical variables are not well defined. In this research we describe what are the main collecting and analysis variables that could influence to the VVOR and VORS tests. Specially for VORS test, participant concentration on test tasks will have positive effect on the measured vestibulo-ocular reflex (VOR) suppression.