Balance Function Exam 1
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| What are the three components for balance/equilibrium? | 1) Vestibular System 2) Vision 3) Proprioceptive (touch and pressure)
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| 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?
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| Define "Informed Consent." | Documentation of discussion between patient and the professional with regard to an invasive procedure.
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| 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
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| Define "Vertigo." | A symptom...the perception of movement when movement isn't really there.
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| What is the most important "dizzy" test? | A comprehensive audiogram
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| 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
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| Define "Impairment." | Any loss or abnormality of psychological, physiological, or anatomical structure of function. Refers to the body and generally is eay to quantify.
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| 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.
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| IAW WHO, what word(s) define impairment? Handicap? | Impairment = Activity Limitation Handicap = Participation Restriction
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| In regular terms, explain an impairment. | Impairment of any of the three interdependant systems
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| 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)
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| 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
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| What are the purposes of the vestibular system? | 1) Maintain equilibrium 2) maintain gaze stability
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| 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
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| What system are the utricle and saccule responsible? | Linear acceleration, positional system
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| What system are the semicircular canals responsible for? | Angular velocity system
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| What are the coplanar mates of the semicircular canals? | Right horizonatal - Left horizontal; Right superior - Left posterior; Right posterior - Left Superior
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| 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
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| 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
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| 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.
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| 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
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| 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)
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| 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
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| Describe the type I hair cell in SCC. | Flask shaped; chalice shaped afferent; often one or two nerve endings; irregular afferents; large head accelerations
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| 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
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| 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
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| 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
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| What does the superior vestibular nerve innervate? | Ampulla of the superior and horizontal canals and the utricle.
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| 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).
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| What does the inferior vestibular nerve innervate? | Ampulla of the posterior canal and the saccule
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| 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).
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| What is the scarpa's ganglia? | Cell bodies of bipolar neurons of vestibular nerve. lies within the internal auditory meatus; is superior and inferior
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| 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)
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| 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
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| What are the connections of the vestibulo-ocular reflex? | Connections between the SCC, vestibular nuclei, CN nuclei, cranial nerves, and extra-occular movements
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| What is the cervico-ocular reflex? Where are the initial receptors? | parallels VOR; Initial receptors from joints in upper cervical vertebrae
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| What is the purpose of the vestibulo-spinal reflex? | To maintain posture and center of mass over one's base of support
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| What are the connections for the vestibulo-spinal reflex? | Vestibular labyrinth and upper and lower limbs
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| What is the vestibulo-colic reflex? | Assists in maintaining the head in the horizontal gaze orientation relative to gravity (righting reflex)
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| What are the connections for the vestibulo-colic reflex? | Otolithic organs and neck and trunk muscles
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| What part of the eye should an image be focussed on? | Fovea (about 5 degree arc.
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| What is the visual field of the eye? | Remaining 200 degrees
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| Adduction of eyes | Movement of eyes toward the nose
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| Abduction of eyes | Movement of eyes away from the nose
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| Elevation of the eyes | Upward movement of the eyes
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| Depression of the eyes | Downward movement of the eyes
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| Torsion of the eyes | Twisting motion of the eyes
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| 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)
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| 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.
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| 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
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| 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
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| Muscles of the eyes are controlled by three cranial nerves and nuclei: Trochlear? | Cranial Nerve IV - controls 1) superior oblique
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| Muscles of the eyes are controlled by three cranial nerves and nuclei: Abducens? | Cranial Nerve VI - Lateral rectus
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| 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)
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| 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
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| 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
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| 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"
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| 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
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| 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.
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| What are the vestibulo-oculomotore reflex? | Stabilizes images during head mvmt; conjugate smooth, opposite head control; signals arise from SCC
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