Incorporating a Graded Vestibular Spinning Program into the Plan of Care of a 17-Month Old with Gross Motor Delay: A Case Report

Background: Delays in gross motor skills can occur in patients with diagnosed damage to the vestibular system or vestibulocochlear nerve. However, without a diagnosed impairment, dysfunction in the vestibular system may go unnoticed and still be contributing to developmental delay. Case Description: The patient in this case study was a 17-month old male with gross motor delays who continued to demonstrate aversion to standing and walking and presented with delayed balance abilities. Purpose: The purpose of this case study is to describe a vestibular assessment and associated treatment to include in the plan of care of a 17-month old male with gross motor delay. Intervention: Tolerance to 10 spins in the clockwise and counterclockwise directions in sitting and prone with associated nystagmus was assessed. This patient demonstrated decreased tolerance to spinning in both the sitting and prone positions and showed no nystagmus in prone. As a result of this assessment, graded spinning program in both the sitting and prone positions was added to the plan of care to be performed once daily and assessed at weekly therapy appointments for five weeks. Outcome Measures: Tolerance and nystagmus following clockwise and counterclockwise spinning in each position were assessed at each weekly appointment. Standing tolerance, gait ability and degree of toe walking were objectively assessed at each appointment. Discussion: Improvements were seen in toe walking, standing tolerance and gait distance after five weeks of this treatment. These results indicate graded spins in sitting and prone may benefit the progression of gross motor skills in pediatric patients with delays in gross motor skills