Christian Beyaert

Introduction: Children with cerebral palsy (CP) have gross motor and balance disorders altering standing, walking and activities. Since trunk control is central for balance, rehabilitation targeting the trunk is developing. In children with CP aged 5–12 years, rehabilitation by activities involving the trunk (RAIT) based on activities in intermediate postures for 3 months has been demonstrated to significantly improve trunk control while standing and early trunk deceleration and coupled negative ankle power due to plantar flexors while walking autonomously. As motor disorders develop early, the effects of RAIT are investigated in younger children and for longer time: the adapted design of this study is presented. Initial motor disorders in children with CP aged 18 months to 5 years and 6 months are expected to show at least a 30% reduction after RAIT compared to UR (based on prior findings in older children), with progressive improvements of 40% and 50% at 6 and 12 months, respectively, reflecting cumulative training effects. Methods: The studied motor disorders include −1- during gait, excessive early anterior deceleration of the sternum (primary outcome) measured by inertial measurement unit, excessive anterior location of center of pressure on affected leg(s), Enhanced Gait Variability Index and step width measured by a walkway equipped with pressure sensors, −2- Altered gross motor, balance and trunk function measured by the item set version of the Gross Motor Function Measurement 66 and by the Early Clinical Assessment of Balance. Expected results: All these variables would be influenced by trunk balance and control, and therefore reduced after RAIT. Trial registration: ClinicalTrials.gov: NCT06438432 .

Introduction: Children with cerebral palsy (CP) have gross motor and balance disorders altering standing, walking and activities. Since trunk control is central for balance, rehabilitation targeting the trunk is developing. In children with CP aged 5 to 12 years, rehabilitation by activities involving the trunk (RAIT) based on activities in intermediate postures for 3 months has been demonstrated to significantly improve trunk control while standing and early trunk deceleration and coupled negative ankle power due to plantar flexors while walking autonomously. As motor disorders develop early, the effects of RAIT are investigated in younger children and for longer time: the adapted design of this study is presented. Initial motor disorders in children with CP aged 18 months to 5 years and 6 months, compared with typically developing children, are expected to be better reduced after RAIT during its first 3 months application than after usual rehabilitation, and to be increasingly reduced after 3, 6 and 12 months of RAIT. Methods: The studied motor disorders include −1-during gait, excessive early anterior deceleration of the sternum (primary outcome) measured by inertial measurement unit, excessive anterior location of center of pressure on affected leg(s), excessive enhanced gait variability index and step width measured by a walkway equipped with pressure sensors, −2-Altered gross motor, balance and trunk function measured by the item set version of the Gross Motor Function Measurement 66 and by the Early Clinical Assessment of Balance. Expected results: All these variables would be influenced by trunk balance and control, and therefore reduced after RAIT. Trial registration: ClinicalTrials.gov ID: NCT06438432 What this paper adds?: Balance control is essential in motor control with a central role of the trunk. Children with cerebral palsy (CP) have motor, balance and trunk deficits. A trunk-focused rehabilitation by activities in intermediate postures presented (RAIT). Study design to assess the long-term effects of RAIT in young children with CP. RAIT would improve trunk and foot dynamics during gait and gross motor function.

The European Society for Clinical Evaluation of Balance Disorders (ESCEBD), based in Nancy, France, has been meeting yearly since 2005 to discuss equilibrium-related themes that are not yet clearly defined or standardized. One of our latest discussions was with regard to outlining strategies of internal and external compensation that may be used to cope with balance disorders. A Committee was elected to discuss the mechanisms of compensation that may be involved in coping with balance system disorders. Compensation, referring to the immediate or short-term adaptive mechanisms that are used to counterbalance the effects of deficiencies that disrupt balance maintenance, can include alternative strategies, resources, or environmental supports to overcome deficits or challenges associated with a deficiency. The strategies can be internal (i.e. utilizing the individual’s own multi-sensory neural integration, motor, and cognitive resources) or external (i.e. modifying the environment, or using assistive or adaptive devices) to reduce fall hazard and enhance safety. This report focuses principally on internal compensation, generated by sensorimotor processes of the central nervous system (CNS) in response to impairment of either sensory information (e.g. vestibular pathologies), the musculoskeletal system (e.g. lower limb amputation and myopathies) or the CNS itself (e.g. upper motor neuron syndrome). The multifactorial process of compensation may explain the limitations encountered by the CNS in compensating for complex bodily impairments and may also limit our understanding of how the CNS adapts to balance disorders. Newly developed devices, such as wearable sensory substitution devices, are on the horizon as possible tools.

In children with cerebral palsy (CP), with impaired trunk control and toe-walking, trunk-focused rehabilitation (TFR) based on postural activities was hypothesized to improve trunk postural control...

OBJECTIVES: Traumatic brain injury occurs frequently worldwide. Half of traumatic brain injuries are related to falls or motor vehicle accidents. The term “concussion” is often used to describe a minor form of traumatic brain injury. These often involve decelerative events to the head (e.g., flexion/extension injury) and can also cause damage to the vestibular system of the inner ear. MATERIALS AND METHODS: The European Society for Clinical Evaluation of Balance Disorders meets yearly and has proposed an investigation and analysis of the vestibular consequences of traumatic brain injury. This review paper outlines these discussions. RESULTS: The Society discussed all aspects of trauma-induced vestibular disorders along with diagnosis and management. They also assessed the diagnostic tests available to investigate these disorders. CONCLUSION: Trauma-induced vestibular disorders are difficult to manage, as our level of understanding of the pathology can be poor and anatomical localization can also be difficult. Accordingly, a definitive diagnosis cannot be pinpointed in many patients, but an extensive history taking is crucial to determine the nature and extent of vestibular involvement. Trauma can not only result in microtrauma to the central nervous system but can also significantly affect peripheral vestibular structures, particularly the otolith organs. The committee hopes that better understanding of trauma to the vestibular system, along with improvements in the field of radiology and vestibular assessments, will aid in more precise techniques of pinpointing pathology in order to develop an adapted treatment plan. Cite this article as: Mallinson A, Maire R, Beyaert C, et al. Understanding and managing trauma induced vestibular deficits. J Int Adv Otol. 2021;17(6):559-565.