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Published on: April 18, 2019
Suppression head impulse test in children-experiences in a tertiary paediatric vestibular centre
Soumit Dasgupta1,2, Rosa Crunkhorn3, John Wong1
1Department of Paediatric Audiology and Audiovestibular Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom.
Insights
The suppression head impulse paradigm (SHIMP) is a safe and effective test for assessing pediatric vestibular hypofunction. It provides valuable insights into VOR gain and saccadic velocity, aiding in the diagnosis of balance and dizziness disorders in children.
Area of Science:
- Vestibular Neuroscience
- Pediatric Neurology
- Ophthalmology
Background:
- The suppression head impulse paradigm (SHIMP) measures vestibulo-ocular reflex (VOR) suppression and associated saccades.
- While SHIMP is increasingly used in adults, pediatric applications are limited.
- Understanding pediatric vestibular function is crucial for diagnosing balance and dizziness disorders.
Purpose of the Study:
- To evaluate the safety and robustness of SHIMP in children.
- To determine if SHIMP yields meaningful data in pediatric vestibular hypofunction.
- To establish normative data for SHIMP parameters in a pediatric population.
Main Methods:
- Retrospective case note audit of 44 children (6-18 years) at a UK tertiary pediatric vestibular center.
- Measurement of SHIMP parameters including VOR gain, peak saccadic velocity (PSV), and saccade latency.
- Comparison of SHIMP parameters between children with normal vestibular function (Group A) and those with hypofunction (Group B).
Main Results:
- Normal pediatric SHIMP VOR gain averaged 0.98±0.08, with overt saccade latency at 215.68±46.16 ms.
- Significant differences in VOR gain and PSV were observed between normal and hypofunction groups.
- Overt saccades were present in 100% of children; covert saccades were rare. Asymmetry in VOR gain was also significant between groups.
Conclusions:
- SHIMP is a safe, reliable, and informative test for pediatric vestibular assessment.
- SHIMP provides valuable data on VOR gain and saccadic parameters, supplementing the standard head impulse paradigm (HIMP).
- Further research into pediatric PSV, asymmetry, and saccade generation may enhance assessment of vestibular compensation and central function.
Abstract:
The suppression head impulse paradigm (SHIMP) involves suppression of the vestibulo-ocular reflex (VOR) and anticompensatory saccades generated thereof. SHIMP is gaining importance to understand vestibular compensation with its different parameters (VOR gain/peak saccadic velocity PSV/latency of saccades). SHIMP studies are emerging in adults, but pediatric studies have hardly been performed. This study is a retrospective case note audit over a period of 2 months in a tertiary pediatric vestibular center in the United Kingdom to investigate whether SHIMP is safe/robust to be used in children conforming to existing standards/norms in normal children and whether it yields any meaningful inferences in pediatric vestibular hypofunction. This is the largest pediatric SHIMP study to date. A total of 44 referred children (6-18 years, female children>male children) with a range of complaints from dizziness, imbalance, motor incoordination, postural instability, and hearing loss were included, and their SHIMP parameters were measured. All children underwent comprehensive functional/objective audiovestibular assessments. Two groups were defined-Group A with normal vestibular function and Group B with abnormal vestibular function. The normal population showed an average SHIMP VOR gain of 0.98+/-0.08 and latency of overt saccades at 215.68+/-46.16 milliseconds agreeing with published evidence. The PSV of overt saccades was 315.39+/-56.30/s, and there was a gain asymmetry of 7.42+/-4.68 between the sides. Statistically significant differences with moderate/large effect sizes were observed between the groups in terms of VOR gain and PSV but not in saccade latencies. Covert saccades were rare in SHIMP, while overt saccades were observed in 100% of children. VOR gain difference between the head impulse paradigm (HIMP) and the SHIMP was significant as well. We observed statistically significant differences in side asymmetry of VOR gain between the groups. Furthermore, we identified a group of children with cerebellar lesions where overt saccades in SHIMP were rather low in number. Further research is recommended to investigate pediatric PSV, asymmetry, and inability to generate overt saccades that may suggest useful means to assess compensation and central function. We conclude that SHIMP yields valuable information and is a safe, easy to perform, and a reliable test that should be used in children to supplement HIMP.
