Otizm Spektrum Bozukluğu Olan Çocuklarda Vestibüler Fonksiyonların Objektif Değerlendirilmesi: Sistematik Bir Derleme

Öz

Otizm Spektrum Bozukluğu olan çocuklarda vestibüler, propriyoseptif, taktil, görsel ve işitsel duyusal işlemleme bozuklukları sıklıkla görülmekte ve bu durum günlük yaşam aktivitelerini olumsuz etkileyebilmektedir. Vestibüler sistemden gelen duyusal bilgi; denge, göz hareketleri, postüral kontrol ve uzaysal farkındalık için kritik öneme sahiptir. Bu sistematik derleme, otizm spektrum bozukluğu tanılı çocuklarda vestibüler fonksiyonların objektif ölçüm yöntemleriyle değerlendirildiği 2000–2025 yılları arasındaki çalışmaları kapsamlı bir şekilde incelemeyi amaçlamaktadır. PRISMA yönergelerine uygun olarak Web of Science ve PubMed veri tabanları “autism”, “vestibular” ve “children” anahtar kelimeleri kullanılarak taranmış, belirtilen yıllar arasında yayımlanan ve vestibüler fonksiyonları objektif yöntemlerle değerlendiren İngilizce çalışmalar dahil edilmiştir. Seçilen çalışmalar iki bağımsız araştırmacı tarafından değerlendirilmiş ve metodolojik kalite Newcastle-Ottawa Ölçeği kullanılarak incelenmiştir. Bulgular, otizm spektrum bozukluğu olan çocukların vestibüler sistem işlevselliğinde bazı alanlarda tipik gelişim gösteren akranlarıyla benzerlikler sergilerken, diğer alanlarda belirgin farklılıklar gösterdiğini ortaya koymuştur. Rotasyonel vestibülo-oküler refleks testlerinde çelişkili sonuçlar bildirilmiş; bazı çalışmalarda refleks kazancında artış ve düzensiz göz hareketleri gözlemlenirken, bazılarında anlamlı farklılık saptanmamıştır. Video head impulse testleri yüksek frekanslı yarım daire kanalı fonksiyonunun çoğunlukla korunduğunu gösterirken, fonksiyonel head impulse testleri vestibülo-oküler refleks fonksiyonunda bozulmaya işaret etmiştir. Vestibüler uyarılmış miyojenik potansiyel testleri otolit fonksiyonları açısından tutarsız sonuçlar sunmuştur. Göz hareketi değerlendirmelerinde sakkadik latansın arttığı, denge ve postüral kontrol değerlendirmelerinde ise özellikle görsel ipuçları ortadan kaldırıldığında postüral kontrol güçlüklerinin belirginleştiği bildirilmiştir. Sonuç olarak, otizm spektrum bozukluğunda vestibüler fonksiyonlar heterojen bir doğa sergilemekte olup, bu farklılıklar otizm spektrum bozukluğunun alt gruplarındaki değişkenliklerle ilişkili olabilir. Vestibüler değerlendirme ve müdahale uygulamaları, otizm spektrum bozukluğu olan çocuklarda denge, motor planlama, koordinasyon ve duyusal modülasyon becerilerinin desteklenmesinde umut vaat eden bir alan olarak görülmektedir. Vestibüler sistemin objektif değerlendirilmesi, otizm spektrum bozukluğunun patofizyolojisinin daha iyi anlaşılmasına, erken tanı biyobelirteçlerinin geliştirilmesine ve kanıta dayalı tedavi yaklaşımlarının oluşturulmasına katkı sağlama potansiyeline sahiptir.

Anahtar Kelimeler

• Denge
• otizm spektrum bozukluğu
• postüral kontrol
• vestibüler fonksiyon

Objective Assessment of Vestibular Functions in Children with Autism Spectrum Disorder: A Systematic Review

Öz

Sensory processing difficulties involving vestibular, proprioceptive, tactile, visual, and auditory modalities are frequently observed in children with Autism Spectrum Disorder (ASD) and can adversely affect daily living activities. Sensory input from the vestibular system is critical for balance, eye movements, postural control, and spatial awareness. This systematic review aims to comprehensively examine studies published between 2000 and 2025 that objectively assessed vestibular functions in children with ASD. In accordance with PRISMA guidelines, the Web of Science and PubMed databases were systematically searched using the keywords “autism,” “vestibular,” and “children,” including English-language studies that evaluated vestibular function with objective measures. Selected studies were independently assessed by two researchers, and methodological quality was appraised using the Newcastle-Ottawa Scale. The findings indicate that children with ASD exhibit similarities to typically developing peers in some areas of vestibular functioning, while demonstrating notable differences in others. Rotational vestibulo-ocular reflex (VOR) tests yielded inconsistent results, with some studies reporting increased reflex gain and irregular eye movements, whereas others found no significant differences. Video head impulse tests (vHIT) generally indicated preserved high-frequency semicircular canal function, whereas functional head impulse tests (fHIT) suggested impairments in VOR function. Vestibular evoked myogenic potentials (VEMPs) produced inconsistent outcomes regarding otolith function. Eye movement assessments revealed prolonged saccadic latency, and balance and postural control evaluations demonstrated pronounced difficulties, particularly when visual cues were removed. In conclusion, vestibular functions in ASD present a heterogeneous profile, which may be associated with variability across ASD subgroups. Vestibular assessment and intervention hold promise for supporting balance, motor planning, coordination, and sensory modulation skills in children with ASD. Objective evaluation of the vestibular system has the potential to advance understanding of ASD pathophysiology, facilitate the development of early diagnostic biomarkers, and inform evidence-based therapeutic approaches.

Anahtar Kelimeler

• Balance
• autism spectrum disorder
• postural control
• vestibular function

Kaynakça

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