Balance and posture along with Vestibular System

it is a brief description of balance and posture for pharmacists in order to explain a topic of physiology. It is an easy handmade presentation.

1. Group Presentation

2. Introduction Group Members 1 2 3 4 5

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4. Static Reflexes Posture General static reflexes Contents Postural Reflexes Statokinetic Reflexes Statotonic reflexes Local static reflexes

5. Posture The particular position of our body is called posture. Posture is the position in which we hold our bodies while standing, sitting, or lying down. Posture is the way our body holds itself in a particular position. Examples are Standing Posture, Sitting Posture, Upright Posture etc.

6. Good posture involves body positions where the least strain is placed on supporting muscles and ligaments during movement or weight-bearing activities. Good Posture helps us to keep bones and joints in position so that our muscles used correctly. Good Posture helps decrease the abnormal wearing of joint surfaces that could result in arthritis. Poor posture results from certain muscles tightening up or shortening while others lengthen and become weak which often occurs as a result of one's daily activities. Poor Posture consists of several factors: Good Posture Bad Posture Good Posture helps to prevent muscle strain, backache and muscular pain. Poor Posture occurs from repetitive motion without frequent breaks and sustained immobile posture for long periods of time. Stress Obesity Pregnancy Weak postural muscles. Good Posture contribute to good appearance.

7. Standing Posture Good & Poor Sitting Posture Good & Poor Normal Posture Lumbar Lordosis Swayback Kyphosis

8. The responses that are responsible for the maintenance of the posture are called postural reflexes. How posture is maintained? Postural Reflexes Afferent impulses for the maintenance of posture arise from proprioceptors , Vestibular apparatus , retina of eye and reach the centers in central nervous system [CNS]. The centers, which maintain the posture, Located at different levels of CNS particularly cerebral cortex , Cerebellum , Brain stem and spinal cord. These centers send motor impulses to the different group of skeleton muscles, So the appropriate movements occur to maintain the posture.

9. Posture Mechanism Skin Afferent Nerve Efferent Nerve Spinal Cord Muscle

10. Classification of postural reflexes Postural reflexes are classified into two groups: Static reflexes Statokinetic reflexes

11. Static Reflexes Statokinetic Reflexes Static reflexes are involved in establishing and maintaining posture when the body is at rest. Statokinetic reflexes allow the movement of the body to change posture. Static reflexes are further divided into three types: General static reflexes Statotonic or attitudinal reflexes Local static reflexes Statokinetic reflexes , through stimulation of the receptors in the neck muscles and semicircular canals, brings about movements of the limbs and eyes appropriate to a given movement of the head.

12. Statotonic or attitudinal reflexes 2 For Example : While Standing on an inclined plane Statotonic reflexes are initiated when the attitude of the body is changed. General static reflexes 1 It corrects the orientation of the body when it is taken out of its normal upright position. General static reflexes are also called righting reflexes because these reflexes help to maintain an upright position of the body. It is initiated by the vestibular system, which detects that the body is not erect and causes the head to move back into position as the rest of the body follows

13. Local static reflexes 3 The center of local static reflex are located in spinal cord. They exert their effect on the same limb from which the stimulus was initiated.

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15. Areflexia Spinal Shock Hyperreflexia,Spasticity Contents Phases Initial Reflex return Hyperreflexia Symptoms Causes

16. Spinal Shock Spinal Shoc k is the temporary suppression of all reflex activity below the level of injury. It is a rare medical condition occurring as a result of a spinal cord injury and is a combination of autonomic and motor dysreflexia Spinal shock is presented in four phase: Areflexia (loss of reflexes) Initial Reflex return Hyperreflexia Hyperreflexia Spasticity

17. History In 1750- Whytt first described this phenomenon. In 1841-Hall introduced the term spinal shock. In 1890- Bastian defined it as a complete severance of the spinal cord that results in total loss of mortor and sensory functions below the level of lesion.

18. Posture Mechanism

19. Phases of Spinal Shock Spinal Shock is presented in four phases: Areflexia (loss of reflexes) Initial Reflex return Hyperreflexia,Spasticity Hyperreflexia

20. Areflexia (0-1 days) 1 Spinal concussion caused the neurons involved in various reflex arc and the neural input from the brain become hyperpolarized and unresponsive. A complete loss or weakening of all reflexes below the level of spinal cord injury. Initial Reflex return (1-3 days) 2 The reason reflexes return is the hypersensitivity of reflex muscles following denervation; more receptors for neurotransmitters are expressed and are therefore they are easier to stimulate. Characterized by the return of some reflexes. The first reflexes to reappear is the bulbocavernosus reflex.

21. Hyperreflexia (1-4 days), Spasticity (1-12 Months) 3 4 In these phases neurons below the injury attempt to reestablish the synapses. This is characterized by hyperreflexia.

22. Spinal Cord injury leads to spinal shock which can occur as a result of: Motor vehicle accidents Penetrating injuries and accident at work place Domestic accidents Causes of Spinal Shock

23. If the level of spinal cord injury is at the Neck Entire spinal cord is not functioning or is paralyzed. Severe hypotension and bradycardia observed. Abnormal reflexes ( dysreflexia ) are observed in all four extremities. All four extremities are paralyzed also known as Quadriplegia. Dilatation of bladder. hypotension Symptoms of Spinal Shock

24. If the level of spinal cord injury is at the Chest and Abdomen: Spinal cord in neck is intact and functions normal Entire spinal cord in chest and abdomen is not functioning. Moderate hypotension since blood vessels in chest, abdomen and lower leg are dilated. Heart rate is increased Lower extremity is paralyzed also known as paraplegia. Symptoms of Spinal Shock

25. If the level of spinal cord injury is at Sacral Segment then spinal shock signs : Spinal cord injury in sacral segment causes injuries to sacral autonomic nerves. Vasoconstriction of blood vessels of legs dominated by sympathetic action resulting in hypertension and dilatation of urinary bladder. The reflexes are normal in all four extremities. Symptoms of Spinal Shock

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27. Symptoms Balance BPPV Contents Balance Disorders Causes Labyrinthitis Meniere's disease Vestibular neuronitis

28. Balance It is an even distribution of weight enabling someone or something to remain upright and steady. It is the ability of a body or object to move or to remain in a position without losing control or falling. The state of having your weight spread equally so that you do not fall.

29. Balance Balance Balance

30. A condition that makes unsteady or dizzy, if you are moving, spinning, floating, standing still or lying down. Symptoms Balance Disorder If you have a balance disorder, you may stagger when you try to walk, or teeter or fall when you try to stand up. You might experience symptoms such as: Dizziness or vertigo (a spinning sensation) Lightheadedness, faintness, or a floating sensation Falling or feeling as if you are going to fall Blurred vision Confusion or disorientation.

31. Other Symptoms Other symptoms might include: Nausea Diarrhea Vomiting Fear Anxiety panic Changes in heart rate and blood pressure

32. Fear Blurred Vision Dizziness /Vertigo Panic Anxiety Disorientation

33. Causes of Balance Disorder Balance disorders can be caused by: Change in health conditions Ear infection Medication A head injury Low blood pressure A rthritis or eye muscle imbalance Age Factor B lood circulation disorder

34. Types of Balance Disorder Balan ce Disorder is classified into four types: Benign paroxysmal positional vertigo (BPPV) Labyrinthitis Vestibular neuronitis Meniere's disease

35. Benign paroxysmal positional vertigo (BPPV) 1 BPPV occurs when loose otoconia tumble into one of the semicircular canals and weigh on the cupula. The cupula doesn't flex properly and sends wrong information about your head’s position, causing vertigo A brief, intense episode of vertigo triggered by a specific change in the position of the head. BPPV can result from a head injury, or can develop just from getting older.

36. Labyrinthitis 2 It is often associated with an upper respiratory infection such as the flu. An infection or inflammation of the inner ear that causes dizziness and loss of balance. Meniere's disease 3 It may be associated with a change in fluid volume within parts of the labyrinth, but the cause or causes are still unknown. Continuity of Dizziness, hearing loss, tinnitus (TIN- nih - tuss , a ringing or buzzing in the ear), and a feeling of fullness in the ear

37. Vestibular neuronitis 4 An inflammation of the vestibular nerve that can be caused by a virus.

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39. Balance Contents Balance Disorders Diagnosis Treatment

40. Diagnosis of Balance Disorder Diagnosis of a balance disorder is difficult. To find out if you have a balance problem, your doctor may suggest that you see an otolaryngologist. An otolaryngologist is a physician and surgeon who specializes in diseases and disorders of the ear, nose, neck, and throat. The otolaryngologist may ask you to have a: Hearing examination Blood test Electronystagmogram Posturography

41. Electronystagmogram (ENG) It is a test that measures normal eye movement and involuntary rapid eye movements called nystagmus. It also checks the muscles that control eye movements. ENG checks how well the eyes, inner ears , and brain help you keep your balance and position (such as when you change from lying down to standing). ENG is done to help see whether there is damage or a problem in how the inner ear, brain, or nerves connecting them work. These problems may cause  dizziness, vertigo, or loss of balance . During ENG, electrodes are attached to the face near the eyes to record eye movements. The movements are recorded on graph paper. A series of recordings is done.

42. Posturography This test is used to quantify postural control in upright stance in either static or dynamic conditions. During this test you have to stand on a special movable platform in front of a patterned screen. The doctor measures how your body responds to movement of the platform, the patterned screen, or both.

43. Treatment of Balance Disorder The first thing a doctor will do if you have a balance problem is determine if another health condition or a medication is to blame. If so, your doctor will treat the condition, suggest a different medication, or refer you to a specialist if the condition is outside his or her expertise. BPPV: If you have BPPV, your doctor might recommend a series of simple movements, such as the Epley maneuver, which can help dislodge the otoconia from the semicircular canal. In many cases, one session works; other people need the procedure several times to relieve their dizziness. Meniere’s Disease: If you are diagnosed with Meniere's disease, your doctor may recommend that you make some changes to your diet and, if you are a smoker, that you stop smoking. Anti-vertigo or anti-nausea medications may relieve your symptoms, but they can also make you drowsy

44. Treatment of Balance Disorder Anti-vertigo or anti-nausea medications may relieve the symptoms of Meniere's disease, but they can also make us drowsy. Other medications, such as gentamicin (an antibiotic) or corticosteroids may be used In some severe cases of Meniere's disease, surgery on the vestibular organs may be needed.

45. Treatment Precautions To reduce your risk of injury from dizziness you should : Avoid walking in the dark Wear low-heeled shoes or walking shoes outdoors If necessary, use a cane or walker Modify conditions at your home and workplace, such as by adding handrails

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47. Vestibular System A system that control our body balancing is called as vestibular system. It consist of all the parts in inner ear except Cochlea. It consists of two main parts: Semicircular Canals Utricle and Saculla

48. Posture Mechanism

49. Semicircular Canals 1 These Canals contain a fluid called Endolymph . These Canals are Sensitive to Rotational motion (contain Hair cells). These are three in number . These Canals are orientated in Three Dimensional Space. Horizontally: One which lies in X-axis (allow motion as we move left and right) Vertically: One which lies in Y-axis (allow motion as we move up and down). In Space: One which lies in Z-axis (allow motion as we move forward and backward)

50. Semicircular Canals Directions

51. Semicircular Canals Movement of Endolymph cause the bending of hair cells that help in rotational perception. Bending of the Hair cells cause Action potential in Nerves of Vestibular system. Our clockwise movement cause the fluid to move in clockwise direction and vice versa. Semicircular Canals

52. Motion of Brain & VBS When we are looking Forward and our Head is in static condition. Our vestibular nerves are beating continuously and regularly. This condition of continuous nerve propagating or beating is called Tonically Active Condition . Semicircular Canals

53. Motion of Brain & VBS When we move our head first time then change in frequency of beating or propagation of nerve impulse take place. In this condition movement of endolymph cause the motion of hair cells that cause change in nervous signals . In this condition frequency of nerve propagation decrease Semicircular Canals

54. Motion of Brain & VBS When we move our head second time then change in frequency of beating or propagation of nerve impulse occurs. In this condition our frequency of beating of nerves increase. Semicircular Canals

55. Utricle and Saccule 2 They are orientated Horizontally and Vertically (have an angle of 90 C with each other). They are involve in perception of Gravitational Pull, Acceleration and Deacceleration. These are ''Otolith Organs'' which means ''Ear Stone'' so are called Little Rock Organs. Semicircular Canals

56. Utricle and Saccule Anatomy & Action Process In Saccule and Utricle, Gravitational force pull the stone toward itself which cause a force on hair cells present in it. These hair cell are further connected with Nerves that transmit impulse to our brain. In Space this stone lie in center which cause no Action Potential to brain via vestibular nerve. i.e. tilting our head, motion in Elevator, up side down etc. Semicircular Canals

57. Transmission of Nerve Impulse from Inner ear to Brain 1 Nerve fibers relay into the Vestibular Reflex center of Medulla Oblongata. Nerve fibers then relay into Thalamus and then relay to primary sensory area located in Parietal Lobe of the Cerebral Cortex. Nerve Fibers in Vestibulocochlear Nerve Vlll .

58. Posture Mechanism Skin Afferent Nerve Efferent Nerve Spinal Cord Muscle

59. T H A N S K A A Z N S