A systematic review of vestibular stimulation in cerebral palsy

Abstract

Purpose

Identify the types and dosage of vestibular stimulation interventions in persons with cerebral palsy (CP), and establish the efficacy of these interventions on balance and function.

Materials and Methods

This systematic review followed Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols to search for studies evaluating vestibular stimulation interventions in persons with CP. Information sources included MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, clinicaltrials.gov and the World Health Organisation registry. Methodological quality was assessed by two independent reviewers using the Methodological Index of Non-Randomised Studies (MINORS) and Cochrane Risk of Bias Tool.

Results

Five articles were included. Three randomised studies were judged to have high risk of bias in at least one domain of the Cochrane Risk of Bias Tool. Two non-randomised studies were rated as low methodological quality using the MINORS tool. All studies used exercise-based vestibular stimulation, but there was little homogeneity regarding dosage. Findings related to efficacy of vestibular stimulation were inconsistent.

Conclusions

Clinical practice recommendations cannot be made due to lack of high quality studies and heterogeneity of treatment protocols. Future research should address theory-driven selection of intervention, establish dosage, use psychometrically robust tools and include all ages of persons with CP.

IMPLICATIONS FOR REHABILITATION

• Optimal intervention parameters for vestibular stimulation cannot be determined from existing literature.

• Further studies to describe vestibular stimulation intervention components and duration are warranted.

• In practice, use of valid and reliable balance and gross motor function outcome measures are essential if using vestibular stimulation techniques with people with CP, as the efficacy of these interventions has not been clearly demonstrated.

• Investigation of electrical Vestibular Nerve Stimulation in people with CP is warranted.

Keywords:

• Vestibular stimulation
• cerebral palsy
• balance
• rehabilitation
• function

Disclosure statement

Interest in this area resulted from conversations with Neurovalens, a company that have developed a headset to deliver electrical vestibular stimulation. Neurovalens were not involved in the design, conduct or reporting of this systematic review.

Additional information

Funding

This study was funded by the Medical Research Council Project to Discovery Fund. The study authors would like to acknowledge Dr Jason McKeown, CEO Neurovalens.