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Introduction

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The vestibular system develops relatively early in gestation.1-4 The vestibular system is composed of vestibulo-ocular and vestibulospinal subsystems, each with distinct tasks and each requires different methods of assessment. Labyrinthine reflexes, which are mediated by the vestibulospinal system, provide postural tone necessary for the emergence of early motor milestones (e.g., rolling, sitting, standing).57 The role of the vestibulo-ocular system in visual stabilization, acuity, and the development of visual spatial and perception abilities has been well documented.811 It is therefore logical to deduce that individuals with deficits of the vestibular system since birth or very early in life will present with difficulties in either motor or visuospatial abilities or both.12,13

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The functional integrity of the vestibular system is rarely tested in young children, and thus impairments can be undetected and untreated. This may be in part a result of the child's inability to describe symptoms or even know that what they are experiencing is not “normal.”14,15 One of the major difficulties in the identification of vestibular dysfunction in children has been the unavailability or the omission of the use of traditional and more recently developed tests of vestibular function with this population. This chapter will provide a review of the types and incidence of vestibular deficits in young children, related impairments, the development of postural control and oculomotor abilities, and appropriate testing and intervention for this population.

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Incidence of Vestibular Deficits in Children and Related Functional Impairments

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Common Diagnoses of Vestibular Dysfunction and the Etiology of Vertigo in Children

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In the last decade, there is increased evidence in the literature of vestibular dysfunction or vertigo of various etiologies and consequent functional impairments in children (Table 24-1).1524 Lesions of the vestibular system may be peripheral (either unilateral or bilateral) or central in nature. Each has differing signs and symptoms that can change from the acute to chronic stage.

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Table 24-1REPORTED ETIOLOGY OF VERTIGO IN CHILDREN

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