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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…. 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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  1. 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

  2. Balance Is… the ability to control the center of gravity over the base of support in any given sensory environment

  3. 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.

  4. Disorders of Balance Benign Paroxysmal Positional Vertigo Meniere’s Disease Vestibular Neuronitis Autoimmune Inner Ear Disease Trauma Toxic Substances/Medications

  5. Disorders of Balance Migraine Acoustic Neuroma Vascular Disorders Multiple Sclerosis Cervical Vertigo

  6. The Audiologist’s Role: • Detection • Assessment • Rehabilitation • Referral

  7. 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

  8. Electronystagmography • Recording eye movements (nystagmus) • Using electrodes to measure • the Corneo-retinal potential

  9. Video-nystagmography

  10. The ENG/VNG Battery Gaze Testing Visual Tracking/Oculomotor Testing Dix-Hallpike Maneuver Positional Testing Caloric Testing

  11. The Dix-Hallpike Maneuver

  12. Rotary Testing • Rotary Chair • Vestibular Autorotation Test (VAT)

  13. VAT Results

  14. Dynamic Posturography Analysis of Sway under conditions which remove or attenuate: Visual Cuesand/orProprioceptive Cues

  15. CDP: Sensory Organization Test

  16. Medical Management • Vestibular Suppressants: benzodiazepenes, antihistimines, anticholinergics • Steroids, Glucocorticoids • Calcium channel blockers • Beta blockers • Diuretics • Dietary changes

  17. Surgical Management • Endolymphatic Sac decompression/shunt • Labyrinthectomy • Gentamycin/Streptomycin Perfusion • Vestibular nerve section • Posterior Canal Occlusion • Perilymph Fistula Exploration

  18. Vestibular Rehabilitation • Habituation • Adaptation • Substitution

  19. BPPV Management • Canalith Repositioning • Epley, • Semont • Horizontal Canal Procedures • Barbecue Roll • Appiani • Casani

  20. Brandt-Daroff

  21. 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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