Vestibular Function Examination And Vestibular Training In Children With Spastic Cerebral Palsy

Objective To analyze the vestibular function of children with spastic cerebral palsy by cervical vestibular-evoked myogenic potential(c VEMP),video head impulse test(v HIT)and caloric test(CT),and to explore the diagnostic value of these three tests for vestibular dysfunction.The effects of individualized vestibular training on gross motor ability,spasticity,balance ability,walking ability,language ability and cerebral hemodynamics were observed,and the clinical application value of vestibular training was discussed.Methods This experiment is divided into the first part and the second part.The first part: From August 2019 to March 2020,59 children with spastic cerebral palsy were selected from the second affiliated hospital of guangxi medical university,including 17 of gross motor function classification system(GMFCS)I,28 of GMFCS II and 14 of GMFCS III.All patients underwent vestibular function examination(c VEMP,v HIT and CT),and the prevalence of vestibular dysfunction in children with spastic cerebral palsy was analyzed.A week later,the vestibular test was conducted again to analyze the test-retest reliability in children with spastic cerebral palsy.The second part: A total of 85 patients were included,of which 28 were from the first part,and the other 57 were children with spastic cerebral palsy who visited the second affiliated hospital of Guangxi medical university from April2020 to December 2020.The conventional group received conventional rehabilitation treatment,and the experimental group received individualized vestibular training on the basis of conventional treatment.Gross motor function measure(GMFM),modified Ashworth Scale(MAS),Berg Balance Scale(BBS),10 meter walking test(10MWT),simple oral motor score(SOMS)and complex oral motor score(COMS),speech intelligibility(SI)and transcranial Doppler ultrasound were used to evaluate gross motor function,spasticity,balance,walking ability,language ability and cerebral hemodynamics before and after treatment.Results The first part.1.The prevalence of vestibular dysfunction in children with spastic cerebral palsy was 47.5%,42.4% and 37.3% in c VEMP,v HIT and CT,respectively.Among them,the prevalence rates of I,II and III of GMFCS in c VEMP were 10.2%(6/59),28.8%(17/59)and 8.5%(5/59)respectively,and the differences were not statistically significant(P>0.05).In v HIT,the prevalence rates of GMFCS I,II and III were 8.5%(5/59),22.0%(13/59)and 11.9%(7/59)respectively,and the differences were not statistically significant(P>0.05).In CT,the prevalence rates of GMFCS I,II and III were 10.2%(6/59),20.3%(12/59)and 6.8%(4/59)respectively,and the differences were not statistically significant(P>0.05).2.Cohen’s Kappa coefficient analysis showed that the Kappa value of c VEMP was 0.682(95%CI= 0.482-0.882),with high reliability.the Kappa value of was v HIT 0.629(95%CI= 0.411-0.847),with high reliability;the Kappa value of CT was 0.579(95%CI=0.334-0.824),with medium reliability.The second part.1.After treatment,the GMFM-D scores of two groups of children were higher than before treatment(P<0.05),and the scores of the experimental group increased higher than those of the conventional group(t=2.37,P=0.02).The GMFM-E scores of the two groups of children were higher than before treatment(P<0.05),and the scores of the experimental group were higher than those of the conventional group(t=3.38,P=0.001).After treatment,the MAS scores of the two groups of children were lower than before treatment(P<0.05),and the degree of reduction in the experimental group was significantly lower than that in the conventional group(t=3.44,P=0.001).2.After treatment,the BBS scores of the two groups of children were higher than before treatment(P<0.05),and the increase in scores of the experimental group was higher than that of the conventional group(t=3.65,P<0.001).After treatment,the time spent on 10 MWT of the two groups of children was lower than that of the conventional group(P<0.05),and the time spent in the experimental group was significantly lower than that of the conventional group(t=-13.77,P<0.001).3.After treatment,the total effective rate of speech therapy in the experimental group(92.1%)was higher than that of conventional(74.4%),and the difference was statistically significant(z=-2.65,P=0.008).After treatment,the SOMS scores of the two groups of children were higher than the treatment(P<0.05),and the experimental group was significantly higher than the conventional group(t=11.82,P<0.001).The COMS scores of the two groups of children were higher than the treatment(P<0.05),and the experimental group was significantly higher than the conventional group(t=2.77,P=0.007).After treatment,the speech intelligibility of the two groups of children was higher than before treatment(P<0.05),and the experimental group was better than the conventional group(t=3.02,P=0.003).4.After treatment,the Vm values of MCA,PCA and BA of the two groups of children were higher than before treatment(P<0.05),and the degree of increase in the experimental group was better than that of the conventional group(P<0.05).The PI values of the two groups of children after treatment with MCA,PCA,and BA were lower than before treatment(P<0.05),and the degree of reduction in the experimental group was better than that in the conventional group(P<0.05).Conclusion 1.The prevalence of vestibular dysfunction in children with spastic cerebral palsy is between 37.3% and 47.5%.c VEMP,v HIT and CT have moderate to high test-retest reliability in children with spastic cerebral palsy.2.Individualized vestibular training can improve the gross motor level of children with spastic cerebral palsy,reduce the degree of spasticity,improve the ability of posture control,balance ability,language ability,and cerebral hemodynamic indexes.