Improving Balance Helps Both ADHD and Walking Straight Line

A program of vestibular rehabilitation for children with attention-deficit/hyperactivity disorder (ADHD) and poor balance function not only improved balance, but was associated with improved cognitive performance, in a controlled trial of the intervention.

The researchers indicate that balance function difficulties are more prevalent in children with ADHD than in unaffected peers. Among the possible reasons for poor balance are vestibular disorders, which the researchers note have been found to adversely affect adult cognitive functions such as spatial memory, attention and navigation.

While structured physical activity has been associated with improved cognitive functioning in a variety of study populations, the researchers found few studies of the effect in those with ADHD, and no previous study of whether an activity to improve balance could affect cognitive function in children with ADHD.

"Because cognitive-vestibular interaction has been well documented, it is assumed that vestibular disorder in children with ADHD results in poorer cognitive performance which adversely affects the children's progress at school," indicated Younes Lotfi, MD, Department of Audiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran and colleagues.

To test whether a vestibular rehabilitation program could benefit cognitive functioning of children with both ADHD and vestibular disorder, the researchers identified a study population of 33 children with the concurrent conditions, ages seven to 12 years of age. The children had been diagnosed with ADHD by a psychiatrist using DSM IV criteria (Diagnostic and Statistical Manual of Mental Disorders). The investigators subsequently assessed vestibular function with multiple measures, including Sinusoidal Harmonic Acceleration, oculomotor subtype of Videonystagmography, vestibular-evoked myogenic potential testing, and the Bruininks-Oseretsky test of motor proficiency.

The children were randomly assigned to the active (n=17) or control group (n=16), which were matched for age as well as age-equivalent score from motor development testing. The vestibular rehabilitation intervention was conducted by an occupational therapist twice weekly for 12 weeks. The intervention was intended to enhance gaze stability, postural stability and daily living activities, according to the researchers.

"Specifically designed protocols take advantage of the plasticity of the central nervous system to increase sensitivity and restore symmetry, which results in an improvement in vestibulo-ocular control, a gain in the vestibulo-ocular reflex, better postural strategies, and increased levels of motor control for movement," explained Lotfi and colleagues.

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Cognitive performance at baseline and following the 12-week intervention was assessed with the choice reaction time () and spatial working memory () subtests of the Cambridge Neuropsychological Test Automated Battery. Baseline and post-intervention balance performance was tested through nine exercises, including six static balance skills (such as standing on a straight line) and three dynamic tests (such as walking the line).

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The researchers report that the intervention improved some aspects of balance function as well as cognitive performance. The percentage of correct trial scores for the increased significantly more from baseline in the active group than in the controls, as did latency to reaction. No significant changes were found in spatial functioning in either group.

"Increasing of reaction time in children...could be a sign of decreasing impulsivity after receiving treatment while doing the tests with less error and more attention," Lotfi and colleagues suggest.

The study of vestibular rehabilitation for children with combined ADHD and poor balance function was published on-line February 21 in Auris Nasus Larynx. Preliminary Evidence of Improved Cognitive Performance Following Vestibular Rehabilitation in Children with Combined ADHD (cADHD) and Concurrent Vestibular Impairment

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