Decreased postural control in adolescents born with extremely low birth weight

The survival rates of infants born preterm with extremely low birth weight (ELBW ≤ 1000 g) have gradually improved over the last decades. However, these infants risk to sustain long‐term disorders related to poor neurodevelopment. The objective was to determine whether adolescents born with ELBW have decreased postural control and stability adaptation. Twenty‐nine ELBW subjects performed posturography with eyes open and closed under unperturbed and perturbed standing by repeated calf vibration. Their results were compared with twenty‐one age‐ and gender‐matched controls born after full‐term pregnancy. The ELBW group had significantly decreased stability compared with controls in anteroposterior direction, both during the easier quiet stance posturography (p = 0.007) and during balance perturbations (p = 0.007). The ELBW group had similar stability decrease in lateral direction during balance perturbations (p = 0.013). Statistically, the stability decreases were similar with eyes closed and open, but proportionally larger with eyes open in both directions. Both groups manifested significant adaptation (p ≤ 0.023) to the balance perturbations in anteroposterior direction, though this adaptation process could not compensate for the general stability deficits caused by ELBW on postural control. Hence, adolescent survivors of ELBW commonly suffer long‐term deficits in postural control, manifested as use of substantially more recorded energy on performing stability regulating high‐frequency movements and declined stability with closed and open eyes both in anteroposterior and lateral direction. The determined relationship between premature birth and long‐term functional deficits advocates that interventions should be developed to provide preventive care in neonatal care units and later on in life

Late effects on hearing and balance after treatment for childhood cancer

During the last several decades, improvements in diagnostic skills and in the treatment of children with cancer have substantially increased the number of long term survivors of childhood cancer. Treatment of children with cytostatic drugs is known to create a range of late adverse effects. Among these are damage to certain structures of the inner ear and hearing impairment. In children, a hearing loss can delay speech and language development, as well as influence educational achievements and social and emotional development. Chemotherapy in childhood may also cause other significant functional disturbances, such as postural instability, impaired motor control of the eyes and difficulties in processing visual information. The overall objective of this thesis is to increase the knowledge of the late effects on hearing and balance in individuals who have received chemotherapy during childhood. The results show a continuous impairment of hearing in subjects with deficiencies related to chemotherapy. The treated subjects had severe difficulties with word recognition in noise, compared to subjects with the same degree of hearing impairment from other causes. With proper hearing aids, their ability for word recognition in noise improved up to 46%. The subjects had poorer postural stability and postural adaption during balance perturbation than healthy subjects. They also had a reduced accuracy in smooth pursuit gain and velocity accuracy, a faster saccade velocity, as well as shorter smooth pursuit and saccade latencies. The subjects were more visually dependent in orientation than healthy controls. There was a high incidence of symptoms related to hearing disabilities: poor concentration, visual disturbances, headaches and unsteadiness, light-headedness or the feeling that things around them were spinning or moving. Age at time of treatment and the time elapsed since the end of treatment seem to be critical factors. Those treated at a younger age had poorer postural stability, more oculomotor deficits and subjective disabilities, which tended to worsen with increased time since the treatment. This study further emphasises the need of regular follow-up of patients treated with chemotherapy for cancer during childhood, and the inclusion of assessment of hearing and balance function, as such dysfunctions may advance, or not be evident until several years after treatment

Hearing impairment after platinum-based chemotherapy in childhood

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldBACKGROUND: Chemotherapy is used in the treatment of children and adolescents with malignant diseases. Some of the chemotherapeutic agents are highly toxic and may cause a number of side effects. The primary objective of this study was to evaluate the long-term effects on hearing in cancer survivors who had received platinum-based chemotherapy in childhood or adolescence. PROCEDURE: Medical records of 297 patients, who had received treatment for cancer at the Children's Hospital, Landspitali University Hospital in Iceland between 1981 and 2006, were retrospectively reviewed. Fifteen subjects fulfilled the eligibility criteria for the study and underwent an extended audiometric evaluation. RESULTS: The results showed that three of the subjects had a high frequency hearing loss. In one subject, we observed a hearing recovery just after the completion of chemotherapy, but the hearing deteriorated again some years later. Nine of the 15 subjects (60%) had tinnitus after the cancer treatment. An evaluation of subjective hearing disability and handicap (The Hearing Measurements Scale) revealed that some subjects had great difficulties with hearing in certain situations. The Hearing Measurement Scale showed that the pure-tone audiogram findings were only partly associated with the apparent hearing difficulties. CONCLUSION: Regular follow-up hearing examinations, which include both pure-tone audiogram investigations and subjective hearing disability assessments, should be performed during and after chemotherapy to identify subjects who require particular attention. This will ensure that hearing impaired individuals are provided with the most suitable listening devices, to promote good speech and social developmen

Differences between body movement adaptation to calf and neck muscle vibratory proprioceptive stimulation

Adaptation is essential in maintaining stability during balance-challenging situations. We studied, ill standing subjects with eyes open and closed, adaptive responses of the anteroposterior head, shoulder, hip and knee movements: gastrocnemius and tibialis anterior EMG activity and anteroposterior body Posture when proprioceptive information from the neck or calf muscles underwent vibratory perturbations. After 30 s of quiet stance, vibratory stimuli were applied repeatedly for 200 s, and adaption to stimulation was analyzed in four successive 50 s periods. Repeated neck and calf vibration significantly increased linear body movement variance at all recorded sites (p < 0.001, except neck stimulation with eyes closed, EC-neck), increased tibialis anterior (p < 0.001, except EC-neck) and gastrocnemious muscle activity (p < 0.001). Most body movement variances and tibialis anterior EMG activity decreased significantly over time (most p-values < 0.01 or lower) and overall, the body leaning forward increased from 5.5 degrees to 6.5 degrees (p < 0.01). The characteristics of the responses were influenced by vision and site of vibration, e.g., neck vibration affected body Posture more rapidly than calf vibration. Our findings support the notion that proprioceptive perturbations have different effects in terms of nature, degree and adaptive response depending on site of vibratory proprioceptive stimulation, a factor that needs consideration in clinical investigations and design of rehabilitation programs. (C) 2009 Elsevier B.V. All rights reserved

Decreased postural control in adolescents born with extremely low birth weight

This is an accepted manuscript of an article published by Springer in Experimental Brain Research on 14 March 2015, available online: https://doi.org/10.1007/s00221-015-4239-3 The accepted version of the publication may differ from the final published version.The survival rates of infants born preterm with extremely low birth weight (ELBW ≤ 1000 g) have gradually improved over the last decades. However, these infants risk to sustain long-term disorders related to poor neurodevelopment. The objective was to determine whether adolescents born with ELBW have decreased postural control and stability adaptation. Twenty-nine ELBW subjects performed posturography with eyes open and closed under unperturbed and perturbed standing by repeated calf vibration. Their results were compared with twenty-one age- and gender-matched controls born after full-term pregnancy. The ELBW group had significantly decreased stability compared with controls in anteroposterior direction, both during the easier quiet stance posturography (p = 0.007) and during balance perturbations (p = 0.007). The ELBW group had similar stability decrease in lateral direction during balance perturbations (p = 0.013). Statistically, the stability decreases were similar with eyes closed and open, but proportionally larger with eyes open in both directions. Both groups manifested significant adaptation (p ≤ 0.023) to the balance perturbations in anteroposterior direction, though this adaptation process could not compensate for the general stability deficits caused by ELBW on postural control. Hence, adolescent survivors of ELBW commonly suffer long-term deficits in postural control, manifested as use of substantially more recorded energy on performing stability regulating high-frequency movements and declined stability with closed and open eyes both in anteroposterior and lateral direction. The determined relationship between premature birth and long-term functional deficits advocates that interventions should be developed to provide preventive care in neonatal care units and later on in life.Published versio