Sensory Organization of Postural Balance in a Child with Joubert Syndrome: A Case Report

Joubert syndrome with hypotonia and ataxia due to the defect in cerebellar vermis causes severe balance and coordination problems and this may prevent therapists to achieve functional goals. Therefore, one of the important purposes in rehabilitation is improving postural balance in these children. In this study, the effect of multi-sensory intervention on a child with Jubert's syndrome was investigated.

Subject was a 6-year-old girl with Joubert syndrome. The program for strengthening the sensory organization of balance using tilt-board was run in 16 30-40-minutes sessions. The outcome was measured by Pediatric Balance Scale (PBS) and Clinical Test of Sensory Interaction for Balance (CTSIB) at first, fourth, eighth, twelfth, and sixteenth sessions. Based on the assessments, the balance time of standing changed from 5.6 seconds to more than 5 minutes, 3.5 to about 12 seconds, 0 to 12 seconds, and 0 to about 5 seconds on the firm surface/opened-eyes, firm surface/closed-eye, foam surface/opened-eye, and foam surface/closed-eyes, respectively. The PBS score increased from 50% to 84% of the total score that shows 34% improvement in dynamic balance.

Sensory organization intervention for balance can play an effective role to improve postural balance in children with neurological deficits. Maintaining posture on the unstable surface/closed-eyes that there is no visual input and perturbed somatosensory input is the most difficult condition to process sensory information for postural balance. To enhance balance in children with Joubert syndrome, because of visual deficits, it is necessary to intervene in the visual system with greater accuracy and finer grading to facilitate the ability of the nervous system to process visual inputs.