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Introduction: The Balance System. Integration of Multiple Cues To facilitate orientation & navigation To maintain upright posture visual focus Through stimulation of postural muscles eye muscles. Balance Is…. the ability to control the center of gravity over the base of support

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Introduction the balance system
Introduction: The Balance System

  • Integration of Multiple Cues

  • To facilitate orientation & navigation

  • To maintain

    • upright posture

    • visual focus

  • Through stimulation of

    • postural muscles

    • eye muscles


Balance is
Balance Is…

the ability to control the

center of gravity

over the

base of support

in any given

sensory environment


Disorders of the balance system
Disorders of the Balance System

  • Can Produce:

    “dizziness,” vertigo, lightheadedness, presyncope, nausea, unsteadiness, vexion, pulsion, ataxia, diplopia, oscillopsia, ...

    With varying degrees of influence on functional health and lifestyle.


Disorders of balance
Disorders of Balance

Benign Paroxysmal Positional Vertigo

Meniere’s Disease

Vestibular Neuronitis

Autoimmune Inner Ear Disease

Trauma

Toxic Substances/Medications


Disorders of balance1
Disorders of Balance

Migraine

Acoustic Neuroma

Vascular Disorders

Multiple Sclerosis

Cervical Vertigo


The audiologist s role
The Audiologist’s Role:

  • Detection

  • Assessment

  • Rehabilitation

  • Referral


Case history
Case History

  • Nature of the dizziness (true vertigo, imbalance, presyncope)

  • Timing/Duration of Spells

  • What triggers spells?

  • Other otologic symptoms

  • General Health issues

  • Neurologic symptoms


Electronystagmography
Electronystagmography

  • Recording eye movements (nystagmus)

  • Using electrodes to measure

  • the Corneo-retinal potential



The eng battery
The ENG Battery

Gaze Testing

Tracking/Oculomotor Testing

Dix-Hallpike Maneuver

Positional Testing

Caloric Testing



Rotary testing
Rotary Testing

  • Rotary Chair

  • Vestibular Autorotation Test (VAT)




Dynamic posturography
Dynamic Posturography

Analysis of Sway under conditions which remove or attenuate:

Visual Cuesand/orProprioceptive Cues


Cdp sensory organization test
CDP: Sensory Organization Test


Medical management
Medical Management

  • Vestibular Suppressants: benzodiazepenes, antihistimines, anticholinergics

  • Steroids, Glucocorticoids

  • Calcium channel blockers

  • Beta blockers

  • Diuretics

  • Dietary changes


Surgical management
Surgical Management

  • Endolymphatic Sac decompression/shunt

  • Labyrinthectomy

  • Gentamycin/Streptomycin Perfusion

  • Vestibular nerve section

  • Posterior Canal Occlusion

  • Perilymph Fistula Exploration


Vestibular rehabilitation
Vestibular Rehabilitation

  • Habituation

  • Adaptation

  • Substitution


Bppv management
BPPV Management

  • Canalith Repositioning

    • Epley,

    • Semont

  • Horizontal Canal Procedures

    • Barbecue Roll

    • Appiani

    • Casani



Cawthorne cooksey exercises
Cawthorne-Cooksey Exercises

  • Regime of movements

  • Graded in difficulty/challenge

  • Eye

  • Head

  • Shoulder & Trunk

  • Sit to Stand

  • Walking up and down slope/steps

(Lying in bed, sitting, then standing)


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