PHYSIOLOGY EQUILIBRATION- Doc Roque

OUR LADY OF FATIMA UNIVERSITY College of Medicine

Batch 2015 SECTION E

(Cochlea- not part of vetibular apparatus because its fxn is for hearing only)

EQUILIBRATION - Defined as maintenance of normal position of man in space (Upright Position) - Extension of: Lower Extremities Upper Extremities Back Neck/Head (maintain visual field) - Equilibrium is a sensation that needs this structures: CNS

A. Utricle Receptor in Utricle- gravity receptor Otolymph/Ca carbonate on top of hair cells will compress the hair cell. Utricle detects the position of the head in respect to gravitational pull. Example: nasa ship ka dw den tumalon ka sa dagat masasave mu sarili mu pero kahit na swmmer kung wala kang utricle pde mahulog k n nlng. Reason: You do not know where is the pull of gravity when u lack utricle) **thanks utricle.. hehe Normal Stimulation for Utricle- When the head is upright, the hairs (Otolymph) will be bend equally. Even if you move forward-backward.

RECEPTOR SYSTEM EFFECTOR SYSTEM I. Vestibular I. Anti Gravity Muscle Apparatus * unique because it II. Visual Receptors always has its effector III. Proprioceptors system to compensate IV. Exteroceptors for body equilibrium RECEPTOR SYSTEM I. Vestibular Apparatus- part of membranous labyrinth. a. Saccule & Utricle otolith Organs b. Semi circular Canal

HEAD TILTED

PHYSIOLOGY EQUILIBRATION- Doc Roque

OUR LADY OF FATIMA UNIVERSITY College of Medicine

Batch 2015 SECTION E

HEAD INVERTED * When the head is tilted on one side we are aware of it because there will be equal stimulation of hair cells. Haircells

* Deafmute- no functional utricle and saccule Example: a deaf mute can be taught to sit and stand pag tinuran sila. Point of reference nila yung ground at yung ulap (taas o baba) pero once tinapon sila sa dagat so wala silang orientation, no point of reference, so pde siya malunod.. Awts :c **take note of the picture above: a and B When you are in elevator, (continuous Up and Down) Going Up: Hair cells and otolith will be pulled downward, bend because gravity will pull it Going Down: Stretched

Upper Portion- stretched and pulled Lower portion-pushed downwards and bend Max Stimulation of utricle- is when the head is inverted (upside down) because gravity will pull otolith down

Result: Dizzy because that is not a normal stimulation of utricle (You can also experienced dizziness (sea sickness) when you are in a Ship while standing and the ship rocks..) Remedy: to lie down not standing because that is the normal position of the utricle like when you are walking forward and backward. Functions: - Static Equilibrium -detects position of head with respect to the direction of gravitational pull - Detection of Gravitational Pull - Detection of Centrifugal Force

*Otolith- also called statoconium or otoconium is a structure in the saccule or utricle of the inner ear, specifically in the vestibular labyrinth of vertebrates. The saccule and utricle, in turn, together make the otolith organs. They are sensitive to gravity and linear acceleration. Because of their orientation in the head, the utricle is sensitive to a change in horizontal movement, and the saccule gives information about vertical acceleration (such as when in an elevator).

PHYSIOLOGY EQUILIBRATION- Doc Roque

OUR LADY OF FATIMA UNIVERSITY College of Medicine

Batch 2015 SECTION E

B. Semicircular Canal Functions: -Kinetic Equilibrium -Predictive Function

Jeepney- Semicircular Canal Person- Endolymph When the jeepney starts, Person displaced backward When the jeepney and person travels in same speed- no more displacement When jeepney suddenly stops, Person is displaced forward.. (oo nga naman.. haha)

1. Anterior (Vertical) Canal 2. Lateral (horizontal) Canal 3. Posterior (Vertical) PLANES: 1. Horizonal Plane- bend head 30 degrees forward Stimulates: Lateral (horizontal) Canal 2. Frontal Plane- rotating along frontal suture Stimulates: all Vertical Canals (A/P) 3. Saggital Plane- rotating along saggital suture (results: Forward or backward) Stimulates: all canals (both horizontal & vertical) Stimulation: Rotation of head will displaced the endolymph *Horizontal Plane and Vertical plane- there is fluid in semicircular canal (endlophym). It will move toward crista ampullris. Movement is along the long axis of the canal **The direction of endolymph displacement which will stimulates the crista ampularis depends on what direction the rotation of the head. Sample Scenario -same as direction of the canal

Membranous Receptor Labyrith a. Macula Utricle/Saccule -only has (Otolith otolith Organs) b. Crista Semicircular Ampullaris Canal *Afferent n- Vestibular Nerve *Center- CN 8

Hair cells

Gelatinous mass (Cupula) Gelatinous mass (Otholith

Hair cells

Post Rotatory- Endolymph displacement is the same direction as the rotation of canals.

Hair cell of the membranous labyrinth of the equilibrium apparatus *Kinocilium- Tallest Hair Cell * Stereocilia- remaining hair cell (decreasing in height) If endolymph moves it pushed the hair in one direction

PHYSIOLOGY EQUILIBRATION- Doc Roque

OUR LADY OF FATIMA UNIVERSITY College of Medicine

Batch 2015 SECTION E

DEPOLARIZATION/Activation- stereocilia moves towards kinocilium; sodium gates open HYPERPOLARIZATION/Inhibition- stereocilia moves away kinocilium EFFECTS PRODUCED BY ROTATION (Post-Rotatory Reactions)

-opposite direction of Vertigo e. REACTION TO ANS - Palor, bradycardia,, sweating, nausea and vomiting TEST FOR INTEGRITY OF SEMICIRCULAR CANAL a. Caloric Stimulation -Springed into ear- Convection current You will see NYSTAGMUS,VERTIGO -Hot water 112degrees F (44C) -Cold Water 68 degrees F (30C) *use in patient with Labyrinthitis which is an inflammation of the inner ear, allergy due to pollen, and a form of unilateral vestibular dysfunction b. Barany Test

a. NYSTAGMUSDirection- Opposite of Rotation Types: Horizontal, Vertical, Rotatory Slow and fast component movement of eyeballs Right slow, left fastleft nystagmus Side to side (horizontal nystagmus)- use horizontal canals Up and down (vertical nystagmus)- using sagital plane of roration Rotary (rotary or torsional nystagmus)- Frontal plane *command coming from cerebral cortex Test: BARANY TEST

Barany Chair- fixed on a platform and made the person to rotate by push botton Horizontal plane- head tilted forward in 30 degress then rotate the chair Frontal plane- 90 degrees forward, or head on shoulder face downward then rotate the chair Saggital Plane-head on the shoulder face forward then rotate the chair Autonomic reactions: Palor, bradycardia,, sweating. Effects produced by rotations: -Nystagmus -Vertigo -Past-pointing -Tendency to fall -Autonomic Reactions II. VISUAL INFORMATION Visual detection of position and movement

b. VERTIGO-dizzines and sees that object is moving Direction- Opposite of Rotation c. PAST POSITIONING - same direction as Rotation *voluntary error *a test for defective functioning of the vestibular nerve in which a subject is asked to point at an object with eyes open and then closed first after rotation in a chair to the right and then to the left and which indicates an abnormality if the subject does not past-point in the direction of rotation d. TENDENCY TO FALL

PHYSIOLOGY EQUILIBRATION- Doc Roque

OUR LADY OF FATIMA UNIVERSITY College of Medicine

Batch 2015 SECTION E

III. PROPRIOCEPTORS - Neck Proprioceptors Orientation of head with respect to body - Body Proprioceptors Orientation of body with head Orientation of different parts of body with each other Test: RHOMBERG TEST Patient is requested to stand with their feet together and their arms at their side (observe for a swaying motion). Then they are requested to close their eyes. This can initiate a proprioceptive deficit and result in the individual staggering or falling. Loss of balance, staggering or falling is indicative of a positive Rombergs sign and cerebral disorders. This test should be performed anytime you suspect head trauma or organic dysfunction of the central nervous system. No malequilibrium,utricle will be stimulated IV. EXTEROCEPTORS -Pressure EFFECTOR SYSTEM I. Anti Gravity Muscle -Ext of LE (Knee and Ankle) -Ext of Back -Retraction of Neck - Elev. Of jaw -Contraction of ventral muscles of the abdominal wall Muscle Tone -maintained with little expenditure of energy - Posture is maintained for long periods(several hours) w/o fatigue - Influenced by Higher centers and spinal centers like: Vestibular Nuclei (labyrinthine Reflex) Midbrain (Righting Reflex) Cerebral, Cerebellar, Midbrain- centers for fine adj. Spinal Centers- Neck Reflexes Common Reflexes (Posture and Equilibrium) a. Simple Cord Reflexes Static Myotatic Reflex (stretch) Muscles is StretchedReflex Contraction Reciprocal Inhibition of Antagonistic Muscle 2 types: Static Stretch Reflex

Continous Stretch Weak Reflex Maintenance of Posture Phasic Stretch Reflex Very strong Reflex Sudden Example: Knee and Ankle jerk b. Flexor Reflex Withdrawal/ Nociceptive Reflex Ex: When a person touches a hot object and withdraws their hand from it without thinking about it, the heat stimulates temperature and danger receptors in the skin, triggering a sensory impulse that travels to the central nervous system. The sensory neuron then synapses within interneurons that connect to motor neurons. Some of these send motor impulses to the flexors to allow withdrawal; some motor neurons send inhibitory impulses to the extensors so flexion is not inhibited Crossed- Extensor Reflex Reaction-- When the reflex occurs the flexors in the withdrawing limb contract and the extensors relax, while in the other limb, the opposite occurs. Example- when a person steps on a nail, the leg that is stepping on the nail pulls away, while the other leg takes the weight of the whole body. The crossed extensor reflex is contralateral, meaning the reflex occurs on the opposite side of the body from the stimulus. Positive Supportive Reaction- where the unaffected side is over-active and when weight is transferred to the unaffected side (e.g. in standing) the unaffected lower limb would push away towards the affected side.

Reflex

Stimulus

Response

Receptor

Stretch reflex Stretch

Contraction Muscle spindles of muscle

Positive supporting reaction (magnet

Foot Contact extended with sole to support or palm body

Proprioceptors in distal flexors

PHYSIOLOGY EQUILIBRATION- Doc Roque

reaction)

OUR LADY OF FATIMA UNIVERSITY College of Medicine

Batch 2015 SECTION E

Spinal Cerebellum Muscle Tone and Posture Equilibrium during movement

Righting Reflex - to go back to Normal position in space - reflex that occurs when the body of an animal becomes inverted. It causes the body to turn around so that the animal is on its feet -center: Midbrain except: #5 Optical RR 1. Labyrinth RR--- Neck Muscles--- Neck 2. Neck RR---Body 3. Blind folded??RR---Head 4. BRR---Body 5. Optical RR **use 1-2= You can use your righting reflex when thrown to window even if blind folded with your labyrinth intact **cannot use 5 destroy labyrinth and thrown to window **use 3-4= there must be equal pressure on sides of animal (both sides) Attudinal Reflex Tonic LR and NR---Limbs

Neo Cerebellum - Control and Coordination of: -Voluntary Movements - Learned Movements Prediction of Movements Breaking Action Damping Action

PS. Lec combination of doc roque and wikipedia D po to complete from attidunal reflex-end po.. pa supply nalng yung iba.d ko din kc nagets..Tnx po.. At PACHECK po ang mga mali :P HAPPY ARAL GUYS.. -mara DETOX time :P

EXAMPLE: 1. TONIC Labyrinth R and Neck RLIMBS 2. TONIC Labyrinth R and Neck REYES Other Influences of CNS: - Effects of SC TransectionSpinal Shock - Effects of Decebrate Decebrate Rigidity - Cerebellar Influences Vestibular Cerebellum Maintenance of Body equilibrium and posture