Introduction the balance system
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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

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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


Video nystagmography

Video-nystagmography


The eng battery

The ENG Battery

Gaze Testing

Tracking/Oculomotor Testing

Dix-Hallpike Maneuver

Positional Testing

Caloric Testing


The dix hallpike maneuver

The Dix-Hallpike Maneuver


Rotary testing

Rotary Testing

  • Rotary Chair

  • Vestibular Autorotation Test (VAT)


Vat results

VAT Results


Nasa s version of rotary chair

NASA’s version of Rotary Chair


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


Brandt daroff

Brandt-Daroff


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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