Self-Assessment Questions

This section provides a review. Mark each statement on the Answer Sheet according to the factual materials contained in this issue and the opinions of the authors.

Article One (pp. 229–242)

1. Which protocol for bilateral cochlear implantation includes the least amount of risk for producing bilateral complete vestibular loss?

   • Implantation without vestibular testing.

   • Implant the most functional vestibule.

   • Simultaneous cochlear implantation.

   • Implant only bilateral vestibular loss simultaneously.

   • None of the above protocols will decrease risk of vestibular loss.

2. Which etiologies of balance disorders are the most prevalent in preadolescent children?

   • Scoliosis.

   • Somatoform vertigo.

   • Migraine equivalent.

   • Ophthalmologic disorders.

   • C and D are correct.

3. What is the main objective for vestibular testing in children?

   • To differentiate migraine equivalent and ophthalmologic disorders.

   • To diagnose headache and migraine.

   • To differentiate neurological and vestibular delayed posturomotor development.

   • To distinguish vestibular neuritis from inner ear malformation.

   • To diagnose inner ear malformation.

4. What are the two principal causes of balance disorders in children?

   • Congenital CMV infection and vestibular neuritis.

   • Vestibular neuritis and migraine equivalent.

   • Migraine equivalent and hearing loss.

   • Migraine and ophthalmological disorders.

   • Ophthalmological disorders and congenital CMV.

5. Which is/are most associated with delayed posturomotor development in children?

   • Partial vestibular impairment.

   • A complete bilateral vestibular loss.

   • Congenital nystagmus.

   • A neurological disorder.

   • Both B and D are correct.

   Article Two (pp. 243–256)

6. What discipline refers most patients for pediatric balance function testing?

   • Nursing.

   • Neurology.

   • Rehabilitative medicine.

   • Otolaryngology.

7. According to the literature, what percent of children with sensorineural hearing loss have coexisting balance dysfunction?

   • 0-10%.

   • 0-25%.

   • 30-70%.

   • 90-100%.

8. What is one of the most important considerations when designing the evaluation space for a pediatric balance center?

   • Having a swimming pool nearby.

   • Making sure there is enough room to accommodate multiple family members in the testing room.

   • Making sure there is room for a playhouse in the testing room.

   • Making sure the room is sound-proofed.

9. Which of the following professionals is not considered a key member of the mul-tidisciplinary pediatric balance team?

   • Audiologists.

   • Physical therapists.

   • Athletic trainer.

   • Otolaryngologist.

10. Prior to evaluation of the first patient in a newly developed pediatric balance center, which of the following is not required to occur?

    • Normative data should be collected for all tests.

    • A referral and scheduling system must be set up.

    • Clinicians should be well educated on how to administer and interpret the tests in the vestibular battery and have experience working with children.

    • The team should meet to discuss the possible outcomes of the tests.

    Article Three (pp. 257–274)

11. Factors that can impact the reliability of a cervical vestibular-evoked myogenic potential response include all of the following except:

    • Age.

    • Ear canal volume.

    • Muscle contraction.

    • Electrode placement.

12. In children, reliable ocular vestibular-evoked myogenic potential responses can be obtained by:

    • 5 days.

    • 12 months.

    • 24 months.

    • 48 months.

13. Video head impulse test provides information regarding the following except:

    • Posterior canal.

    • Inferior vestibular nerve.

    • Superior vestibular nerve.

    • Saccule.

14. Rotary chair can be affected by:

    • Middle ear effusion.

    • Height.

    • Muscle tension.

    • Neck length.

15. The following can be used as a screening for vestibular loss except:

    • Dynamic visual acuity.

    • Gait speed.

    • Severity of hearing loss.

    • Single leg stance.

    Article Four (pp. 275–287)

16. Which class of eye movements is used to shift gaze to explore our environment?

    • Saccades.

    • Smooth pursuit.

    • Optokinetic.

    • Gaze.

    • Foveal.

17. In most instances, when the target speed exceeds_per second, the pursuit system will no longer be able to keep the eyes on the target and the saccade system will be recruited to reacquire the object of interest.

    • 130 degrees.

    • 70 degrees.

    • 50 degrees.

    • 250 degrees.

    • 90 degrees.

18. All of the pediatric oculomotor age effects have been noted in the literature except:

    • Longer saccade latency.

    • Reduced smooth pursuit gain.

    • Increased optokinetic asymmetry.

    • Decreased optokinetic nystagmus.

    • Increased overall variability of results.

19. Which of the following oculomotor tests are most susceptible to age effects during clinical evaluation in the pediat-ric population?

    • Saccades and optokinetic.

    • Optokinetic and pursuit.

    • Saccades and pursuit.

    • Only saccades.

    • Only pursuit.

20. Which of the following oculomotor tests are most susceptible to artifact effects during clinical evaluation in the pediatric population?

    • Saccades and optokinetic.

    • Optokinetic and pursuit.

    • Saccades and pursuit.

    • Only saccades.

    • Only pursuit.

    Article Five (pp. 288–304)

21. According to this scoping review, which oculomotor abilities were potentially abnormal in children with CP?

    • Saccadic eye movement.

    • Volitional smooth pursuit.

    • Optokinetic nystagmus (OKN).

    • All of the above.

    • None of the above.

22. What part of the vestibular system was found to be abnormal in children with cerebral palsy, according to one article by Akbarfahimi et al (2016)?

    • Semicircular canals.

    • Saccule.

    • Utricle.

    • All of the above.

    • None of the above.

23. Which of the following is not one of the stages of Arksey's and O'Malley's framework for conducting a scoping review?

    • Identifying the research question.

    • Identifying relevant studies.

    • Study selection.

    • Charting the data.

    • Study appraisal.

24. Which of the following tools were used in the reviewed studies to assess saccadic eye movement?

    • Developmental eye movement (DEM) test.

    • Clinical testing (using 2 targets).

    • Eye-tracking recordings.

    • All of the above.

    • None of the above.

25. What is the clinical test that describes the functional use of the vestibulo-ocular reflex?

    • Computerized rotatory chair.

    • Subjective visual vertical and horizontal.

    • Cervical vestibular-evoked myogenic potentials.

    • Clinical dynamic visual acuity.

    • None of the above.

    Article Six (pp. 305–320)

26. The most common associated condition of SNHL is:

    • Renal dysfunction.

    • Vestibular impairment.

    • Vision abnormalities.

    • Cardiac rhythm abnormalities.

    • Cutaneous abnormalities.

27. Children presenting with the following etiologies of SNHL are at high risk of vestibular impairment:

    • Meningitis.

    • Congenital cytomegalovirus.

    • Cochleovestibular anomalies.

    • Connexin 26 mutations.

    • A, B, and C.

28. The most frequent sign/symptom of vestibular impairment in children presenting with SNHL is:

    • Vertigo.

    • Spontaneous nystagmus.

    • Motor delay/imbalance.

    • Nausea and vomiting.

    • Headache.

29. Screening for vestibular impairment in a child presenting with SNHL can be done by:

    • Reviewing motor milestone.

    • Having them perform one foot standing, eyes open and eyes closed.

    • Performing a head impulse test.

    • Looking for per/postrotary nystagmus.

    • All of the above.

30. An infant presents with bilateral profound SNHL, delay in motor milestones, and has a 3-year-old sister with bilateral implants who did not walk until she was 22 months. Imaging (MRI) is normal in both children, neither has any obvious syndromic features and there is no other family history. What etiology of SNHL needs to be assessed?

    • Type 1 Usher syndrome.

    • Branchio-oto-renal (BOR) syndrome.

    • Connexin mutations.

    • Meningitis.

    • Waardenburg.

    Article Seven (pp. 321–333)

31. Which statement best describes motor development of children with peripheral vestibular hypofunction?

    • Motor development is unaffected in this population.

    • Motor development is delayed at first, but then they catch up.

    • Motor development is delayed, and the delay is progressive.

    • Motor development has not been tested in this population.

    • Motor development is better than normal in this population.

32. Which of the following is/are considered part of the central vestibular system?

    • Semicircular canals.

    • Otoliths.

    • Cerebellar flocculus.

    • Vestibular nuclei.

    • C and D are correct.

33. Which of the following diagnoses have evidence for vestibular system impairments?

    • Attention-deficit hyperactivity disorder.

    • Childhood cancer.

    • Adolescent idiopathic scoliosis.

    • Vestibular migraine.

    • All of the above.

34. Which of the following is an appropriate gaze stabilization exercise?

    • X1 viewing.

    • Saccades.

    • Smooth pursuit.

    • Gaze shifting.

    • A and D.

35. What is an appropriate screening tool to determine if a child has gaze instability?

    • Modified clinical test of sensory interaction on balance.

    • Sensory organization test.

    • Dynamic visual acuity.

    • Dizziness handicap inventory for patient caregivers.

    • Bruininks-Oseretsky test of motor proficiency.

    Article Eight (pp. 334–344)

36. Vestibular rehabilitation protocol for unilateral vestibular hypofunction is based on which of the following mechanisms?

    • Motor learning.

    • Adaptation.

    • Substitution.

    • A and B above.

    • All the above.

37. The impairments seen in children with vestibular loss or hypofunction since or shortly after birth are determined by:

    • Critical periods of development.

    • Age at the time of lesion.

    • Nature of the lesion.

    • d. Only B and C above.

    • A, B, and C above.

38. Which of the following statements is/are not true regarding vestibular rehabilitation for children?

    • BPPV is observed only in children older than 12 years.

    • The dynamic compensation following VR that is seen in children is better than that seen in adults.

    • In children, vestibular dysfunction is seen as a comorbidity of cytomegalo-virus and concussion.

    • Vestibular dysfunction may affect cognitive development in children.

    • None of the statements are false, all are true.

39. As a result of vestibular dysfunction before the age of 3 years, it may be assumed or expected that the ability to use so-matosensation for balance is below normal performance. This is an example of which of the following?

    • Passive adaptation.

    • Intermodal interdependence and critical period of development.

    • Effect of environmental enrichment.

    • Sensorimotor learning.

    • False presumption.

40. Which of the following statement(s) are true regarding vestibular rehabilitation for children?

    • There is no evidence that VR is warranted for children.

    • Although children over 7 years of age require VR to improve function, children less than 7 years of age will recover and develop typically without intervention.

    • Three-year-old children should be able to complete DVA testing.

    • Habituation should not be used with children.

    • Although BPPV is identified in children, the repositioning techniques are not successful.