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Balance Function 1

Balance Function Exam 1

What are the three components for balance/equilibrium? 1) Vestibular System 2) Vision 3) Proprioceptive (touch and pressure)
What is in our Scope of Practice regarding dizziness? Management of dizziness is a potential source of practice satisfaction and practice building (treating those with a vestibular function?
Define "Informed Consent." Documentation of discussion between patient and the professional with regard to an invasive procedure.
What are the five pieces of information that you should go over with your patient when doing an informed consent counseling? 1) Indications 2) Procedures 3) Complications 4) Alternatives 5) Understanding
Define "Vertigo." A symptom...the perception of movement when movement isn't really there.
What is the most important "dizzy" test? A comprehensive audiogram
Name some "dizzy" tests? Electronystagmography (ENG); Videonystagmography (VNG); Tests of dynamic visual acuity; Tests of active/passive rotation; Tests of postural stability; Vestibular evoked myogenic potentials (VEMP); Comprehensive audiologic tests
Define "Impairment." Any loss or abnormality of psychological, physiological, or anatomical structure of function. Refers to the body and generally is eay to quantify.
Define "Handicap." Disadvantage for a given indvidual, resulting from an impairment that limits or prevents the fulfillment of a role that is normal. Difficult to quantify. Imposed by environment, society, and even the individual.
IAW WHO, what word(s) define impairment? Handicap? Impairment = Activity Limitation Handicap = Participation Restriction
In regular terms, explain an impairment. Impairment of any of the three interdependant systems
In regular terms, explain a handicap. Individual's response to an impairment. It is multifactorial (dependant of personality, age, occupational status, psychosocial adjustment. general health)
Why assess handicap? It is difficult to determine effectiveness of med. surgicall, and rehab treatment. To measure benefit of healthcare on quality of life. Theraputic outcome affects patient, payors, & providers. What to know the subjective response pre- and post-treatment
What are the purposes of the vestibular system? 1) Maintain equilibrium 2) maintain gaze stability
What are the five neural structures of the vestibular system? 1) Utricle 2) Saccule 3) Horizontal (Lateral) Semicircular Canal 4)Superior (Anterior) Semicircular Canal 5) Posterior Semicircular Canal
What system are the utricle and saccule responsible? Linear acceleration, positional system
What system are the semicircular canals responsible for? Angular velocity system
What are the coplanar mates of the semicircular canals? Right horizonatal - Left horizontal; Right superior - Left posterior; Right posterior - Left Superior
Describe the semicircular canals. Horizontal canals tilted 20 degrees up; filed with endolymph; cupula is gelatinous strructure in thhe ampulla that seperates the vestibule from the SCC; specific gravity equal too endolymph (ie not effected by gravity); located over the crista
Describe the crisa ampullaris. Saddle shape across the canal under the cupula; contains cell bodies (hair cells with kinocilia and stereocilia) and vestibular afferents and efferents
Describe the push-pull dynamic of the horzontal SCC toward utricle. As head rotates right the hair cells oof the right SCC are excited while the hair cells of the left horizontal SCC are inhibited. Fluids move opposite of each other.
Describe fluid flow tooward utricle. Kinocilia determines the direction of activation; activates hair cells in the horizontal SCC; deactivates hair cells in posterior and superior canals
What are the basic elements of SCC? Hair cells similar to cochlea; has kinocilium; apical end has endolymph and basal end has perilymph; two types of hair cells (Type I and type II)
What is the hair cell activity in the SCC? Resting firing rate = 70-100 spikes/sec; modulates up to 400 spikes/sec; modulateds down to 0 spikes/sec
Describe the type I hair cell in SCC. Flask shaped; chalice shaped afferent; often one or two nerve endings; irregular afferents; large head accelerations
Describe type II hair cells in SCC. Cylinder shaped; bouton shaped affeent and efferent; often many nerve endings; regular afferents; low frequency and small head movements
What are the otilith organs and what are they responsible for? Saccule and utricle; Each organ has a bend to give 3-D information; sensitive to linear acceleration
What does the utricle and the saccule contain? Macula - the receptor organ. The macula has hair cells, nerve endings, otolithic membrane similar to cupula), and otoconia
What does the superior vestibular nerve innervate? Ampulla of the superior and horizontal canals and the utricle.
What artery feed the superior vestibular nerve and the associated sturcures (superior and horizontal canals and utricle)? Superior vestibular artery, which branches off the anterior inferior cerebellar artery (AICA).
What does the inferior vestibular nerve innervate? Ampulla of the posterior canal and the saccule
What artery feeds the ampulla of the posterior canal and the saccule? Posterior vestibular artery, which branches off the common cochlear from the labyrinthine from the anterior inferior cerebellar artery (AICA).
What is the scarpa's ganglia? Cell bodies of bipolar neurons of vestibular nerve. lies within the internal auditory meatus; is superior and inferior
What does the anterior inferior cerebellar artery supply? Labyrinthine artery, superior vestibular artery (superior and horizontal SCC and utricle), and common cochlear .->posterior vestibular artery (posterior SCC and saccule)
What is the purpose of the vestibulo-ocular reflex? To elicit rapid compensatory eye movements that maintain stability of images on the retina during head movement
What are the connections of the vestibulo-ocular reflex? Connections between the SCC, vestibular nuclei, CN nuclei, cranial nerves, and extra-occular movements
What is the cervico-ocular reflex? Where are the initial receptors? parallels VOR; Initial receptors from joints in upper cervical vertebrae
What is the purpose of the vestibulo-spinal reflex? To maintain posture and center of mass over one's base of support
What are the connections for the vestibulo-spinal reflex? Vestibular labyrinth and upper and lower limbs
What is the vestibulo-colic reflex? Assists in maintaining the head in the horizontal gaze orientation relative to gravity (righting reflex)
What are the connections for the vestibulo-colic reflex? Otolithic organs and neck and trunk muscles
What part of the eye should an image be focussed on? Fovea (about 5 degree arc.
What is the visual field of the eye? Remaining 200 degrees
Adduction of eyes Movement of eyes toward the nose
Abduction of eyes Movement of eyes away from the nose
Elevation of the eyes Upward movement of the eyes
Depression of the eyes Downward movement of the eyes
Torsion of the eyes Twisting motion of the eyes
What are the four functional layers of the ocular motor system? 1) Final common pathway (globe, EOMs, nerves, CN Nuclei) 2) Conjugate movements coordination (horizontal and vertical neural integrator 3) Behavioral purposes (saccades, pursuit, active fixation) 4) Repair and calibration (cerebellar)
What is the "globe" final common pathway? When the eye moves the opposite muscle is stretched causing a resisting force; soft tissue around the globe have elastic forces that tend to restore the eyes to the center; it takes an active force to move the eye and then a holding force to maintain.
What are the six extra-ocular muscles? Medial and lateral recti; superior and inferior recti; superior and inferior oblique ----- when one muscle pulls the other relaxes
Muscles of the eyes are controlled by three cranial nerves and nuclei: Oculomotor? Cranial Nerve III - controls 1) medial rectus 2) inferior rectus and superior rectus 3) inferior oblique
Muscles of the eyes are controlled by three cranial nerves and nuclei: Trochlear? Cranial Nerve IV - controls 1) superior oblique
Muscles of the eyes are controlled by three cranial nerves and nuclei: Abducens? Cranial Nerve VI - Lateral rectus
For coordinated eye movements (conjugated eye mvmts accomplished by yoking of opposite nuclei) for lateral movements, makes it move? Connected via the medial longitudinal fasciculus (MLF)
What are the three types of eye movements that require level 3 (high level oculomotor control)? 1) Rapidly reposition eyes (saccades) 2) track moving objects (pursuit, optokinetic) 3) fixation
What is saccades and describe it? Rapid shift of gaze (directs fovea to object) - changing focus from one pt to another; vision blurs during saccade; latency of 200ms; many parallel (redundant pathways making it resistant to damage and age; inaccuracy = dysmetria
What is smooth pursuit? Keeps fovea on moving target; not robust and easily disturbed by age and meds; if problems occur then pt will have saccadic "catch ups"
What are optokinetics (OPK)? Stabilizes the image during movement of a visual field (not an object on fovea like SP)*; conjugate rapid & smooth alternating; when objects moves out of vision field makes rapid saccade to new object; does not require good vision & therefore more robust
What is fixation? Keeps a still object on the fovea; the process by which the brain suppresses internally generated eye movements; many areas of the brain are involved.
What are the vestibulo-oculomotore reflex? Stabilizes images during head mvmt; conjugate smooth, opposite head control; signals arise from SCC
Created by: duda713



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