Children's Vestibular and Balance Clinic


 
The patient is being prepped for video head impulse testing (vHIT). vHIT utilizes small glasses and cameras to assess how well the eyes and inner ears work together.

Vestibular and balance problems, like most medical conditions, are easier managed the earlier they are diagnosed. But how does a medical professional accurately diagnose vestibular disorders in young children who are not able to articulate what they are experiencing?

Children's of Alabama now offers a multidisciplinary team and a dedicated vestibular and balance clinic with state-of-the art equipment, purchased in part by money received from Wells Fargo through its annual Picks for Kids campaign. The team, which includes audiology, physical therapy, occupational therapy, sports medicine, rehabilitation medicine, and ENT, uses that equipment to diagnose and target treatment plans for children of all ages.

"The premise of this program is for us as professionals to get our children through all the services in a timely fashion, get them the strategies they need, and refer between the disciplines without delay," said Karen McCormack, OT.

The equipment includes a rotary chair that documents a patient's ability to follow objects and measure how well the eyes respond to information from the vestibular system.

The clinic also uses a Neurocom to test for balance deficits. "The Neurocom compares age norms and looks at balance to tell us the sensory area the child is having the most problems with, so that we can identify where to target treatment," Tiffany Deleonard, PT said.

Vision screening is included in the Neurocom analysis. "Many times, the child may have a vision concern," McCormack said. "We might be able to screen for that and refer them for functional vision testing to a pediatric ophthalmologist."

As the only facility in the state with much of this equipment, the team sees patients from across Alabama, and even receives referrals from Mississippi. They are able to do testing and treatment, even if the patients are young.

"We can see younger children and we have accommodations for them. We don't want doctors to hesitate to refer us patients because of the age of a child," said Missy Kemp, Audiology Supervisor.

"We can't measure as much with younger children," Ali Stefanek, AuD said. "We can't put goggles on them, for instance, because they won't tolerate them for long. We often do a test where we put electrodes on their forehead and neck to stimulate a muscle, while looking at different parts of the vestibular system to see if there is a weakness we can measure. Testing is more limited when they are young, but we can still get measurements to see if there is a peripheral or central issue."

Since pediatric patients can't always express what they are experiencing, parents and pediatricians have to learn to be aware of the warning signs that may indicate vestibular problems. "They might be clumsy," McCormack said. "They may not be able to navigate stairs well or be a bit fearful of escalators. They might not turn around when someone calls them from behind. These are red flags for us. There may be a hearing loss, which can often accompany balance issues."

Another warning sign can be delayed milestones. "A lot of kids come in because of delayed milestones or just not fitting in with their peers, although there's no apparent reason why," Deleonard said. "Once we evaluate them and see no musculo-skeletal reason, we look at the vestibular system. If kids have been this way their whole lives, they don't know how to describe what's going on, because this is how things have always been for them."

In some cases, a problem is identified that can be medically managed, while in other cases the emphasis will be more on accommodation. "One strategy we may give parents of children who have trouble managing stairs is to put painters tape along the edge of a stair. That way the child can identify the difference between the color of the stair edge and the carpet, so they can see the difference in the spatial relationship," said McCormack. "We may have to teach an older child a different way of doing things, or how to improve their awareness of their surroundings."

The caregivers meet monthly to discuss their patients, the results and recommendations. Families are considered part of the care team throughout the process. "The patient is part of a family, and we not only treat the patient, but we work with the family as well," McCormack said. "There is a give and take depending on the diagnosis and the concerns of the family. We are here to be part of the process so our patients can receive timely services, in order for them to go home and be part of the community."

For more information or to discuss a patient referral, physicians may email balance@childrensal.org.

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