Abstract
Vestibular dysfunction in children and adolescents has recently gained tremendous attention, with more child-friendly investigations and rehabilitation protocols emerging.Reports have shown that children with vestibular impairment tend to develop speech and language acquisition delay, fine and gross motor delay, which in the long-termresults in an overall poor quality of life. In an extreme situation, vestibular dysfunction can lead to dissociative syndromes such as depersonalisation/derealisation symptomsthat occur following a mismatch between the vestibular signals and other sensory inputs, which may, in turn, lead to suicidal thoughts and behaviour 1. Whilst measuresto incorporate vestibular assessment as a part of routine practice in paediatric patients have been carried out in most centres, pediatric vestibular medicine appears to beunfathomed in some parts of the world, notably the South-East Asian region.
Keywords: Resilience culture, Vestibular dysfunction, Children, Adolescent
Dear Sir,
Vestibular dysfunction in children and adolescents has recently gained tremendous attention, with more child-friendly investigations and rehabilitation protocols emerging. Reports have shown that children with vestibular impairment tend to develop speech and language acquisition delay, fine and gross motor delay, which in the long-term results in an overall poor quality of life. In an extreme situation, vestibular dysfunction can lead to dissociative syndromes such as depersonalisation/derealisation symptoms that occur following a mismatch between the vestibular signals and other sensory inputs, which may, in turn, lead to suicidal thoughts and behaviour [1]. Whilst measures to incorporate vestibular assessment as a part of routine practice in paediatric patients have been carried out in most centres, pediatric vestibular medicine appears to be unfathomed in some parts of the world, notably the South-East Asian region.
Now the question remains that, although there is distinct variation between race and ethnic groups between the eastern and western populations of the globe, it does not justify why vestibular impairment is so scarcely reported amongst children from the eastern population as compared to the western population. One main hypothesis is the variation between cultural and background resilience among children from various parts of the globe. It is worth noting that, from a very young age, Asian children are expected by their families to be tougher and to be able to endure all challenges faced in order to succeed in life.
What is resilience, and how does resilience result in coping with vestibular impairment?
The term resilience can be addressed in several ways, according to Kirby and Fraser, 1997 although it can be summed up as traits possessed by children to persist and endure challenges albeit adversity faced in order to overcome a difficult situation or to succeed [2]. In the same vein, resilience has been demonstrated to be influenced by a child’s interaction with his/her external environment, society and community, as cultural differences significantly influence children’s resilience [3]. Interestingly, it has been postulated that the innate temperament variations in children across different cultural backgrounds result in variation in reactivity, which tends to persist beyond the neonatal period [4]. For example, east Asian infants are considered to have a higher threshold to pain, cry less and quiet faster [5]. Furthermore, as these children grow, their outward reflection diminishes, especially towards negative emotional expression. Moreover, children who frequently complain are regarded as spoilt or attention-seeking and their parents are generally blamed for poor upbringing.
In contrast, children in western countries have been encouraged to express their discomfort from an early age. Thus, these children tend to verbalise any perturbations felt, resulting in early rehabilitation and intervention without feeling any pressure, improving the overall quality of life. Hence, great strides to create awareness regarding vestibular dysfunction in children ought to be carried across the globe, especially in Asian countries, to increase the likeliness of early diagnosis and intervention.
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References
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