Question
Would you expect a 3-year-old with an immature vestibular system to still remain upright on conditions 5 and 6 on Computerized Dynamic Posturography (CDP)?
Answer
It depends on the child and what type of dysfunction is taking place;however, the child certainly may not be able to remain upright during these very difficult conditions that rely on vestibular cues alone. Certainly I would try, but in this case one may not be able to perform all of the subtests or all of the trials. I would keep the parent there as it would take a lot of coaxing and reinforcement. It would be important to reassure the child that he's secure, that he has a harness, that we are there to catch him, and that he's not going to fall. This may be a case where testing approaches more of a screening;whether or not a child is able to remain upright for a good portion of the 20 seconds may reveal at least some gross screening information. One very crucial factor is the child's weight and the examiner should check with the equipment manufacturer to make certain that reliable measures may be obtained within such a weight range. Other very critical aspects of such a testing session, of course, are that norms must be available for that 3 year old and the techniques should be adapted for the pediatric patient. Finally, observation of the child's performance may provide insights toward remediation counseling. For example, if he/she isn't able to remain upright when visual and/or proprioceptive cues are compromised, caution may be exercised and strategies implemented in similar, real-world situations.
This Ask the Expert question was based on information in the recorded course, "Pediatric Vestibular Evaluation".
Maureen Valente, Ph.D., earned her Bachelor of Science and Master of Science degrees in Speech and Hearing Science from the University of Illinois in Champaign-Urbana. She spent her Clinical Fellowship Year in the Chicago area, in the office of G.E. Shambaugh, M.D. Subsequent work experiences included private practice and medical settings in the Kansas City and Omaha areas, including employment at Boys Town National Research Hospital in Omaha. After moving to the St. Louis area, Dr. Valente was employed as a full-time faculty member for 18 years at Saint Louis University. She graduated with her Doctor of Philosophy degree in Speech and Hearing Sciences from Washington University in St. Louis. Shortly thereafter, she was delighted to accept a position as the Director of Audiology Studies within the Program in Audiology and Communication Sciences (PACS) at Washington University School of Medicine. She carries a joint appointment within PACS and as an Assistant Professor within the university's Department of Otolaryngology. Areas of interest include development of Au.D. education, diagnostic audiology, auditory processing disorders and vestibular evaluation in the pediatric patient.