Effectiveness of exercise interventions to improve motor coordination and manual dexterity of deaf children: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

Vestibular disorders are frequent findings in children with sensorineural hearing loss (SNHL), impairing the sensory regulation of postural control, and the spatiotemporal relationship, and triggering disturbances in balance, motor coordination, and gross and fine motor skills in these children.

OBJECTIVE

To assess the certainty of evidence from randomized controlled trials (RCTs) that used exercise interventions to improve motor coordination and manual dexterity of children and/or adolescents with SNHL.

METHODS

This systematic review searched for articles on the topic in 10 electronic databases: MEDLINE/Pubmed, SCOPUS, EMBASE, Web of Science, CINAHL, LILACS, CENTRAL (Cochrane Central Register of Controlled Trials), PEDro, SciELO and the Google Scholar. There was no restriction on publication time or languages for the selection of articles, and the last search took place on March 1, 2025. RCTs were included, with children and/or adolescents, diagnosed with bilateral SNHL in the age group between 6-19 years old, without physical, cognitive, and/or neurological problems, except vestibular dysfunction, and who used exercise interventions to improve motor coordination and manual dexterity. Three independent reviewers performed the extraction of trials, data, assessment of risk of bias, and certainty of evidence. The presence of risk of bias in RCTs was assessed using the Cochrane risk of bias (RoB) tool and the certainty of the evidence using the GRADE approach.

RESULTS

Eleven RCTs were included in this review with a total of 475 volunteers. Five RCTs were included in the meta-analyses. One of the meta-analyses showed that practicing 18 weeks of exercise improved the general motor coefficient score of the Körperkoordinationstest für Kinder test by 9.08 more in children with SNHL, compared to those who did not exercise: (9.08 [CI:5.78, 12.3], I² = 63 %), based on low certainty evidence. Another meta-analysis observed that practicing exercise for 7 weeks improved the balance of children with SNHL by 6.69 more in the balance subtest of the Bruininks-Oseretsky test of Motor Proficiency, compared to children who did not exercise: (6.69 [CI:4.10, 9.28], I2 = 0 %), based on very low certainty evidence.

CONCLUSION

Exercise interventions were effective in improving motor coordination and manual dexterity of children with SNHL. However, these findings are not consistent, as they are based on evidence of low or very low certainty. Due to the limitations and biases present in the RCTs analyzed, it is suggested that new RCTs on the topic be performed with greater methodological rigor, to encourage and guide clinical practice on the topic, based on high-certainty evidence.