Sensory organization for postural control in children with strabismus-A systematic review and meta-analysis
Prasath Jayakaran1, Wali Aman1, Udari Fernando1
1School of Physiotherapy, University of Otago, Dunedin, New Zealand.
Insights
Children with strabismus exhibit poorer postural control compared to their peers. This systematic review highlights deficits in sensory organization for maintaining balance in individuals with strabismus.
Area of Science:
- Ophthalmology
- Neuroscience
- Biomechanics
Background:
- Postural control relies on integrating somatosensory, vestibular, and visual systems.
- Strabismus, a visual impairment, can disrupt this integration and lead to postural instability.
- Understanding these deficits is crucial for addressing developmental challenges in children.
Purpose of the Study:
- To systematically review and synthesize evidence on the impact of strabismus on postural control in children.
- To investigate whether strabismus affects sensory organization crucial for maintaining balance.
- To identify gaps in current research regarding sensory system contributions to postural control in pediatric strabismus.
Main Methods:
- A comprehensive systematic search of multiple electronic databases was conducted.
- Included were peer-reviewed studies evaluating sensory organization and postural performance in children with strabismus.
- Methodological quality was assessed using the modified Downs and Black tool, with 10 articles included.
Main Results:
- Meta-analysis revealed significantly poorer postural control in children with strabismus compared to controls.
- Specific deficits were noted in Centre of Pressure (CoP) velocity and surface area.
- A significant effect favoring eyes-open conditions over eyes-closed was observed, indicating reliance on visual input.
Conclusions:
- Children with strabismus demonstrate inferior postural control performance compared to age-matched controls.
- This systematic review provides the first collation of evidence on strabismus and pediatric postural control.
- Further research is essential to elucidate the specific roles of somatosensory, vestibular, and visual systems in strabismus-related postural deficits.
Background:
Postural control requires the interaction of somatosensory, vestibular and visual systems to prevent disequilibrium. Children with strabismus have an impaired visual input which can lead to postural control deficits.
Research Question:
Does strabismus affect sensory organization for postural control in children?
Methods:
A systematic comprehensive search of multiple electronic databases for relevant articles was performed using a predetermined search strategy. Peer-reviewed journal publications that assessed sensory organization and postural performance in children with strabismus were included in this review. Methodological quality of the articles was evaluated using the modified Downs and Black quality assessment tool. A total of 10 articles were included in this review.
Results:
Eight of the 10 articles reviewed were included in the meta-analysis. Meta-analysis for Centre of Pressure CoP velocity (n = 3) (eyes open, stable support), was statistically significant (P = 0.01) in favor of controls over children with strabismus (MD, 3.08; 95 % CI -0.66, 5.51). Meta-analysis for CoP surface area (n = 5) (eyes open, stable support) was also statistically significant (P < 0.001) in favor of the control group (MD, 130.14; 95 % CI 70.01, 190.260). Meta-analysis with standardized mean difference (n = 6) for eyes open vs closed, stable support was statistically significant (P = 0.02) in favor of eyes open (MD, -0.94; 95 % CI, -1.74, -0.15). Overall, there was a high level of heterogeneity throughout the studies.
Significance:
This is the first systematic review of its kind to collate and synthesize evidence on the effect of strabismus on postural control in children. This review suggests that postural control performance in children with strabismus is inferior to that of age-matched control children. Further investigation is needed to understand the influence of the three sensory systems.
