Motor and cognitive performances in pre-lingual cochlear implant adolescents, related with vestibular function and auditory input


Background: Information about the role of auditory input and motor control is limited.

Objectives: Assessment the relationship between auditory and vestibular information with specific motor and cognitive functions.Methods: Posturography in 17 Pre-lingual Cochlear Implant Adolescents, (PCIA) age 14.06 ±3.05 in four sensory conditions was analyzed: (A) eyes open, cochlear implant (CI) on, (B) eyes open, CI off, (C) eyes closed standing on a foam over a platform (ECFP) with CI on, and (D) ECFP, CI off. Gait velocity (GV) was registered by inertial sensors using a 10-meter test. Vestibulo-ocular reflex (VOR) was evaluated with the video head impulse test (VHIT) and visual spatial skill (VS) assessed with the WISC-V test. Results: SV had no significant difference between conditions A and B (p..2461). Comparing C and D, SV values decreased when CI was turned on (p..0036). A significant linear relationship between VOR and GV (p..0064) generating the VOR gain loss lower gait. Relationship between VOR and VS scores was no significant (p..685).Conclusions and significance: Auditory information is a relevant cue when somatosensory and visual inputs are modified and range of vestibular function influence in a dynamic motor activity as gait, facts which must be considered in the neurodevelopment control.

Postural Responses Characterization in elderly Patients with Bilateral Vestibular Hypofunction

Acta Otolaryngol. 2013 Apr;133(4):361-7. doi: 10.3109/00016489.2012.739731. Epub 2013 Jan 14.



The measurement of the energy consumption (EC) of the body’s center of pressure (COP) to maintain the upright stance position was higher in elderly patients with bilateral vestibular hypofunction (BVH) compared with a control group and may be a valid parameter in the assessment of balance disorders.


The aim of the study was to evaluate the energy consumption of the COP in elderly patients with BVH.


The COP was recorded on a force platform (FP) for eight elderly patients with BVH related to aging and eight normal control group subjects. The EC of the COP was calculated using the discrete wavelet transform. The two groups were tested in standing position on the FP in three sensory conditions:1, eyes open; 2, eyes closed; and 3, standing on a foam pad placed on the force platform. Wilcoxon’s rank test and multi-factor analysis of variance were used, with the level of significance set at 0.05.


BVH patients showed higher values of EC of the COP signal measured in arbitrary units compared with the control group (conditions 1 and 2). None of the BVH patients could perform the test in condition 3. BVH patients had increased EC in the frequency band between 0.1 and 0.78 Hz when the visual information was canceled (condition 2).

Effects of balance training using a virtual-reality system in older fallers. Clinical interventions in aging

Clin Interv Aging. 2013;8:257-63. doi: 10.2147/CIA.S41453. Epub 2013 Feb 28.

Duque G1, Boersma D, Loza-Diaz G, Hassan S, Suarez H, Geisinger D, Suriyaarachchi P, Sharma A, Demontiero O.



Poor balance is considered a challenging risk factor for falls in older adults. Therefore, innovative interventions for balance improvement in this population are greatly needed. The aim of this study was to evaluate the effect of a new virtual-reality system (the Balance Rehabilitation Unit [BRU]) on balance, falls, and fear of falling in a population of community-dwelling older subjects with a known history of falls. In this study, 60 community-dwelling older subjects were recruited after being diagnosed with poor balance at the Falls and Fractures Clinic, Nepean Hospital (Penrith, NSW, Australia). Subjects were randomly assigned to either the BRU-training or control groups. Both groups received the usual falls prevention care. The BRU-training group attended balance training (two sessions/week for 6 weeks) using an established protocol. Change in balance parameters was assessed in the BRU-training group at the end of their 6-week training program. Both groups were assessed 9 months after their initial assessment (month 0). Adherence to the BRU-training program was 97%. Balance parameters were significantly improved in the BRU-training group (P < 0.01). This effect was also associated with a significant reduction in falls and lower levels of fear of falling (P < 0.01). Some components of balance that were improved by BRU training showed a decline after 9 months post-training. In conclusion, BRU training is an effective and well-accepted intervention to improve balance, increase confidence, and prevent falls in the elderly.


balance; elderly; falls; postural instability; virtual reality

Chronic balance disorders after acoustic neuroma surgery: assessment of gravitational vertical perceptionChronic balance disorders after acoustic neuroma surgery: assessment of gravitational vertical perception

Acta Otolaryngol. 2015 Apr;135(4):348-53. doi: 10.3109/00016489.2014.974287. Epub 2015 Mar 7.

Suarez H, Ferreira E, Arocena S, Bagalciague F, San Roman C, Sotta G, Geisinger D, Suarez A.



The head tilt response (HTR) test performed in a group of patients with chronic dizziness after acoustic neuroma surgery showed alterations in the gravitational vertical perception (GV).


The assessment of the accuracy in the GV through the HTR test in patients with long-term balance disorders after acoustic neuroma surgery.


The HTR was performed in two groups of patients that had undergone acoustic neuroma surgery: six uncompensated patients (UPs) who maintained vestibular symptoms 1 year after surgery and two compensated patients (CPs) without vestibular symptoms. Twelve healthy control adults were also tested (control group, CG). Three parameters were measured in the HTR test: steady-state error (SSE), rise time (TRS), and mean energy of the error signal per step (MEE).


The UP group showed higher values for the TRS and MEE parameters compared with the CG (p < 0.05) when performing the HTR test to the side of the lesion and to the contralateral side, while the SSE only showed significant higher values when the patient estimated the GV towards the side of the lesion. The two patients in the CP group did not have differences in the three parameters assessed when compared with the CG.


Head tilt response test; chronic dizziness; vestibular symptoms

Sensorimotor interaction in deaf children. Relationship between gait performance and hearing input during childhood assessed in prelingual cochlear implant users


Hamlet Suarez, Rafael Alonso, Sofia Arocena, Enrique Ferreira, Cecilia San
Roman, Alejo Suarez & Valeria Lapilover

Conclusions: The results suggest that auditory input is not neutral in motor skills and the complex interaction between them is generated in the earlier stages of childhood development.
Objective: The assessment of gait performance in pre-lingual deaf  children with cochlear implant (CI).
Methods: Gait velocity (GV), using a 10-meter test, was measured by means of three inertial sensors in 10 pre-lingual cochlear implant users (CIU) (10–16 years old) in three sensory conditions: (1) cochlear implant turned on with environmental noise (EN), (2) cochlear implant turned on with EN and with cognitive dual task (DT), and (3) CI turned off (CI-OFF). GV with EN and DT was assessed in a normal hearing control group (CG) (n = 14). Mann-Whitney and Wilcoxon Signed ranked test were used for significance validation.
Results: (1) GV in CG was lower in DT than with EN (p= 0.019). (2) GV was faster in CG with EN compared with the three conditions in CIU (EN, p= 0.006; DT, p= 0.0001; CI-OFF, p= 0.03). (3) CIU had slower GV walking with EN (p=0.037) and with DT (p=0.022). (4) Dividing the CIU sample by age, the acoustic information generates a slower gait for those implanted after 3 years old.

Postural responses applied in a control model in cochlear implant users with pre-lingual hearing loss.

Acta Otolaryngol. 2016 Apr;136(4):344-50.

Suarez H1, Ferreira E2, Alonso R3, Arocena S1, San Roman C1, Herrera T1, Lapilover V1.



Conclusions The assessment of postural responses (PR) based in a feedback control system model shows selective gains in different bands of frequencies adaptable with child development. Objective PR characterization of pre-lingual cochlear implant users (CIU) in different sensory conditions. Methods Total energy consumption of the body’s center of pressure signal (ECCOP) and its distribution in three bands of frequencies: band 1 (0-0.1 Hz), band 2 (0.1-0.7 Hz), and band 3 (0.7-20 Hz) was measured in a sample of 18 CIU (8-16 years old) and in a control group (CG) (8-15 years old). They were assessed in a standing position on a force platform in two sensory conditions: 1 = Eyes open. 2 = Eyes closed and standing on foam. Results In condition 1, total ECCOP of PR and its proportion of energy consumption in the three bands of frequencies were similar between CIU and CG (p > 0.05). In condition 2, CIU have significantly higher ECCOP, mainly in high frequencies (bands 2 and 3) (p < 0.05). ECCOP values decreased with age also, mainly in bands 2 and 3. This behavior is interpreted in the control system model proposed as an adaptation process related with child development.


Posture; cochlear implant; postural control model