Presentation on theme: "Balance Function Testing"— Presentation transcript:
1 Balance Function Testing Shashidhar S. Reddy, MD, MPHArun Gadre, MD
2 Physiology of Balance Humans use three systems: Visual Proprioceptive Vestibular
3 Visual:Orientation and balance are maintained via several visual properties:SaccadesSmooth pursuitOptokinetic reflexThe optokinetic response can also impart a sense of acceleration in an individualDepth perceptionVisual cortex centers specially designed to respond to vertical and horizontal stimuli
4 Proprioceptive:Proprioception contributes to balance in the following ways:Myototic reflex (deep tendon reflex)Functional stretch responseCervical proprioceptionIncludes a cervical-ocular reflex arc that can lead to physiologic or pathologic nystagmus
6 Semicircular CanalsRespond to angular acceleration in the plane of the canal.Are functionally paired:
7 Otolith organs:Contain calcium carbonate crystals of higher density than endolymphThis allows response to gravity (head tilt)Respond to linear acceleration
8 Vestibular Reflexes:VestibulospinalHelps maintain center of gravity
9 Vestibular Reflexes Vestibulo-ocular Helps maintain stability of visual fieldLeads to physiologic nystagmus
10 Vestibular Reflexes Vestibulo-cervical: Helps to maintain stability of the head during movement of the torso.
11 Balance Function Testing History is the most important tool in evaluationMust obtain a concrete description of symptomsDefine vertigo for the patientAsk about onset, duration of symptoms, aggravators, associated symptoms (hearing loss), tinnitus, affect on daily life.
12 Bedside Evaluation: General physical examination Vascular exam for possible posterior circulation problemCranial nerve examCerebellar function (disdiadokinesis)