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
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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 - PowerPoint PPT Presentation
Transcript of 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…
the ability to control the
center of gravity
over the
base of support
in any given
sensory environment
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
Benign Paroxysmal Positional VertigoMeniere’s DiseaseVestibular NeuronitisAutoimmune Inner Ear DiseaseTraumaToxic Substances/Medications
Disorders of Balance
MigraineAcoustic NeuromaVascular DisordersMultiple SclerosisCervical Vertigo
The Audiologist’s Role:
• Detection• Assessment• Rehabilitation• Referral
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
• Recording eye movements (nystagmus)• Using electrodes to measure• the Corneo-retinal potential
Video-nystagmography
The ENG Battery
Gaze TestingTracking/Oculomotor TestingDix-Hallpike ManeuverPositional TestingCaloric Testing
The Dix-Hallpike Maneuver
Rotary Testing• Rotary Chair• Vestibular
Autorotation Test (VAT)
VAT Results
NASA’s version of Rotary Chair
Dynamic Posturography
Analysis of Sway under conditions which
remove or attenuate:
Visual Cuesand/or
Proprioceptive Cues
CDP: Sensory
Organization Test
Medical Management
• Vestibular Suppressants: benzodiazepenes, antihistimines, anticholinergics
• Steroids, Glucocorticoids• Calcium channel blockers• Beta blockers• Diuretics• Dietary changes
Surgical Management
• Endolymphatic Sac decompression/shunt• Labyrinthectomy• Gentamycin/Streptomycin Perfusion• Vestibular nerve section• Posterior Canal Occlusion• Perilymph Fistula Exploration
Vestibular Rehabilitation
• Habituation• Adaptation• Substitution
BPPV Management• Canalith Repositioning
–Epley,–Semont
• Horizontal Canal Procedures– Barbecue Roll– Appiani– Casani
Brandt-Daroff
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)
