Made available in DSpace on 2016-04-27T18:47:31Z (GMT). No. of bitstreams: 1 Renata Porcel de Oliveira.pdf: 496419 bytes, checksum: b96ca2f7bdabe976ce0313c41eb0c649 (MD5) Previous issue date: 2008-10-07 / The research "Implications of vestibular dysfunction in the family and social coexistence of elderly" wide knowledge relevant to the interfaces between the areas of Social Gerontology and Health The central objective of this study is to examine the influences of the involvement of vestibular dysfunction by elderly people in their conviviality family and social relationships, seeking help in this segment can live fully the stage of old age and have a treatment with quality. The development of concepts concerning the anatomy and physiology of the vestibular system, as well as the understanding of possible malfunctions causing these diseases, particularly noted in the ageing process, are addressed recital is a broad concept of health. The search was conducted of field through the application of interviews involving nine elderly people aged over 65 years, which have the vestibular dysfunction, receive emergency medical care and carry out physiotherapy home with professionals in MEDMAR / FAMILY The Emergency Medical Service, located in the city of Santos, in the State of Sao Paulo. These elderly live with their families, which were also interviewed. Bringing up procedures methodological own qualitative research was done, initially, the characterization of the stage of vestibular dysfunction of the subject, based on existing medical diagnoses. Through semistructured guide, proceeded to the identification of the condition of personal life and family and social coexistence, before and after the onset of the disease. Data analysis shows that the vestibular dysfunction should be conceived as one of the constituent elements of the ageing process and that the symptoms of manifestation of this involvement must be properly understood and cares for the elderly by it and by their relatives, considering the impact recognized in depositions, both in family and social coexistence / A pesquisa "Repercussões da disfunção vestibular no convívio familiar e social de idosos" amplia conhecimentos pertinentes às interfaces entre as áreas da Gerontologia Social e da Saúde. O objetivo central deste estudo é analisar as influências do acometimento da disfunção vestibular por pessoas idosas, no seu convívio familiar e relacionamento social, visando contribuir para que esse segmento possa viver plenamente a fase da velhice e dispor de um tratamento com qualidade. O desenvolvimento de conceitos referentes à anatomia e fisiologia do sistema vestibular, assim como a compreensão das possíveis disfunções causadoras dessas patologias, em especial constatadas no processo de envelhecimento, são abordados considerando-se uma concepção ampla de saúde. A pesquisa de campo foi realizada através da aplicação de entrevistas envolvendo nove idosos, com idade acima de 65 anos, que possuem a disfunção vestibular, recebem atendimento médico de urgência e realizam a fisioterapia domiciliar com profissionais da MEDMAR/FAMILY Atendimento de Urgência Médica, localizada na Cidade de Santos, no Estado de São Paulo. Estes idosos vivem com suas famílias, as quais também foram entrevistadas. Adotando-se procedimentos metodológicos próprios da pesquisa qualitativa foi feita, inicialmente, a caracterização do estágio da disfunção vestibular dos sujeitos, com base em diagnósticos médicos existentes. Através de roteiro semi-estruturado, procedeu-se à identificação da condição de vida pessoal e de convivência familiar e social, antes e depois do surgimento da doença. A análise dos dados revela que a disfunção vestibular deve ser concebida como um dos elementos constitutivos do processo de envelhecimento e que os sintomas de manifestação deste acometimento devem ser devidamente compreendidos e cuidados pelo próprio pelo idoso e por seus familiares, considerando-se as repercussões reconhecidas nos depoimentos, tanto no convívio familiar como social

Description:With age and impairment due to neurodegenerative processes, the nervous system expresses symptoms of dizziness and imbalance with a dramatic increase in fall risk. While the fall risk of older individuals is well-known, the symptoms for patients with peripheral nervous system (PNS) pathology and central nervous system (CNS) degeneration are less well-known and manifest as vestibulo-ocular and vestibulo-spinal impairment. Emerging research shows a clear dysfunction in vestibular physiology in these populations, which adversely affects gaze and postural control and increases fall risk. This session will discuss the pathophysiology of vestibular function in the context of aging and PNS/CNS damage, critical examination tools, and research-based recommendations to augment vestibular motor learning in these patient populations. The presenters will use case studies to illustrate characteristic deficits in vestibular function and guide clinical decision making regarding examination and treatment. Learning Objectives:1 . Describe the natural aging process as it relates to vestibulo-ocular and vestibulospinal function. 2. Discuss the evidence for vestibular damage within 2 model neurodegenerative diseases. 3. Describe the research evidence for motor learning within the vestibulo-ocular and vestibulospinal pathways in the context of aging and neurodegeneration. 4. Identify crucial examination tools and treatment methods to measure and improve gaze and gait stability in patients with a variety of neurodegenerative diseases.

Ce travail est constitué de trois études en plus de la revue de la littérature sur le système de l'équilibration, sur les troubles de l'équilibre d'origine vestibulaire périphérique et sur les principes de la rééducation. I. Etude normative et de la reproductibilité des tests vestibulo-spinaux et rotatoires Objectif : déterminer pour chaque tranche d'âge les valeurs normatives aux tests vestibulo-spinaux et rotatoires et vérifier l'effet de la latéralité sur les sens de déviation et de rotation ; et l'effet du sens de déplacement sur l'amplitude de l'angle. Méthodologie : 120 sujets âgés de 20 à 79 ans ont effectué les tests vestibulo-spinaux et rotatoires pour rechercher les valeurs normatives et 31 parmi ces derniers ont refait les épreuves pour vérifier la reproductibilité des résultats. Résultats :- Les tests vestibulo-spinaux augmentent avec l'âge. Il n'y a pas d'effet de la latéralité sur le sens de déviation ou de rotation. Le sens de déviation ou de rotation n'a pas d'influence significative sur l'amplitude de l'angle. Dans les tests rotatoires avec ou sans fixation, les durées de stabilisation dans le sens horaire et anti-horaire ne sont pas significativement différentes. Conclusion : - les résultats augmentent avec l'âge. Les thérapeutes doivent en tenir compte lors de l'évaluation. II. Etude normative et de la reproductibilité d'une échelle du handicap lié aux troubles de l'équilibre et aux vertiges (E.H.T.E.V.) Objectif. - Déterminer les scores normatifs, en fonction de l'âge et vérifier l'effet du sexe sur les résultats et la reproductibilité de l'E.H.T.E.V. Méthodologie : - La recherche des scores normatifs et de l'effet du sexe a été faite sur une population de 120 sujets, âgés de 20 à 79 ans, sans troubles d'équilibre. L'étude de la reproductibilité des résultats a été faite sur 47 sujets. Les résultats.- Les scores à l' E.H.T.E.V augmentent avec l'âge. Il n'y a pas d'influence significative du sexe sur les scores et la reproductibilité est importante. Conclusion.- Les scores sont influencés par l'âge et il n'y a pas d'effet du sexe sur les résultats. La reproductibilité est importante. Cependant la traduction de cette échelle de l'anglais en français nécessite la validation et la vérification de la fiabilité. III. Intérêt du traitement par exercice rotatoire chez les patients atteints du syndrome de Ménière Objectif : L'objectif de notre travail consiste à évaluer l'efficacité du traitement des troubles d'équilibre par des exercices rotatoires chez les patients souffrant du syndrome de Ménière unilatéral. Méthodologie : les patients sont soumis à des stimulations rotatoires visant à symétriser et à diminuer la réponse nystagmique post-rotatoire. Pour évaluer l'efficacité de ce traitement, les résultats pré- et post-thérapeutiques aux épreuves vestibulo-spinales et rotatoires ainsi que l'analyse de la perception des vertiges par les sujets ont été utilisés. Résultats : -Les patients ont eu en moyenne 11 séances de fauteuil rotatoire pour être subjectivement améliorés. Les épreuves objectives et subjectives montrent une amélioration significative. Conclusion : L'étude montre une amélioration des paramètres objectifs et subjectifs./ After literature review on equilibrium system and peripheral vestibular disorders, vestibular and rehabilitation techniques, Three studies are described in this work. I. “Normative and reproductibility study investigating static, dynamic and rotational testing in rehabilitation of peripheral vestibular balance disorders”. Objective: To determine for different age group, the normative values of vestibular rotational and vestibulospinal tests; to verify the effect of handedness on the direction of veering or rotation during dynamic testing ; and to verify the effect of the veering or rotation direction on angle's amplitude. Method: One hundred and twenty healthy volunteers aged from 20 to 79 years underwent vestibulospinal tests and rotational tests. Results:Vestibulospinal and rotational tests results increased significantly with age. We determined the normative values for each age group. The effect of handedness on the direction of the veering or rotation was not significant. The effect of the veering or rotation direction (left, right) on angle's amplitude was also not significant. Response time of stabilization for clockwise and counterclockwise rotational chair testing (with and without optic fixation): all differences were not significant. Conclusion : Age is an important factor in result of vestibulospinal and rotational tests. The handedness (left or right) does not influence vestibulospinal results. II. Normative study and reliability of french version of dizziness handicap inventory. Objective: this prospective study is to determine the normality per age group, secondly to assess the effect of sex on the scores and the reproductibility of the "Echelle du Handicap lié aux Troubles de l'Equilibre et aux Vertiges" (E.H.T.E.V) french version of the "Dizziness Handicap Inventory (D.H.I). Subjects and method.- The normative scores and the effect of the sex have been determined through the study of a group of 120 subjects. without any instability disorder. Reproductibility has been assessed on 47 individuals. The results.- The scores of the instability related handicap increase with age. There is no significant influence of sex. The reproductibility coefficient is higher.Conclusion:- The scores of the E.H.T.E.V increase with age. There is no significant influence of sex on scores and the coefficient of the reproductibility is good. But the translation of this handicap scale, need a study of validity and reliability. III. “ Benefit of rotational exercises for patients with Meniere's syndrome”. Objective: To date, the effectiveness of balance rehabilitation for patients with Meniere's syndrome has not been unanimously acknowledged by all physicians and physiotherapists. The purpose of this study is to assess the therapeutic efficacy of rotational exercises in the treatment of disequilibrium for patients with unilateral Meniere's syndrome. Methodology: Rotational stimuli were used to symmetrize and reduce postrotatory nystagmic response. Three reference sources were used to assess the efficacy of this management: vestibulospinal function tests rotational tests and the self-perceived impact of vertigo. Results: Patients required 11 sessions (mean value) to attain subjective improvement. Rotational tests and dynamic tests of the vestibulospinal function improved. Conclusion: The objective and subjective measures of disequilibrium were significantly improved.

Le récepteur aux hydrocarbures aromatiques (AhR) est un facteur de transcription de la famille bHLH/PAS, activé par différents ligands exogènes dont les hydrocarbures aromatiques polycycliques ou halogénés (dioxines). A ce titre, il est décrit historiquement comme un récepteur de xénobiotiques dont le principal rôle est l’élimination de ces composés via la régulation des enzymes du métabolisme des xénobiotiques. Toutefois, des études récentes menées à l’aide de modèles souris invalidées pour le AhR, suggèrent indirectement que cette protéine régule des fonctions endogènes, notamment dans le système nerveux de mammifères dans lequel aucun rôle du AhR n’a jusqu’à présent été démontré. Nous avons donc utilisé le modèle de souris C57BL/6J AhR-/- pour mener à la fois des études comportementales et mécanistiques afin de déterminer ce rôle. Tout d’abord, nous avons identifié un défaut oculomoteur chez les souris AhR-/-, caractérisé par des mouvements spontanés horizontaux. En étudiant l’ensemble des circuits neurosensoriels potentiellement impliqués dans ce nystagmus pendulaire, nous avons montré que son origine est liée à des déficits du système visuo-moteur. De plus, en caractérisant et comparant les profils d’expression génique des cervelets de souris AhR+/+ et AhR-/- traitées ou non par de la 2,3,7,8 TétraChloroDibenzo-p-Dioxine (TCDD), nous avons montré que ce polluant, ligand du AhR, perturbait les fonctions endogènes du récepteur. Cet effet de « perturbation endogène » a été retrouvé dans un autre organe et est associé à une toxicité (fibrose hépatique). Cette étude a permis d’identifier de nouvelles fonctions physiologiques du AhR dans le système nerveux des souris, de caractériser un nouveau modèle animal de nystagmus pendulaire et ouvre de nouvelles perspectives de travail en neurotoxicologie. / The AhR is a basic helix-loop-helix Per/ARNT/Sim family (bHLH-PAS) transcription factor which is activated by many diverse compounds including polyphenols and aromatic hydrocarbons such as 2,3,7,8 TétraChloroDibenzo-p-Dioxin (TCDD). Initially, the AhR was described as a ubiquitous xenobiotic-activated transcription factor which promotes the elimination of xenobiotics by regulating the expression of genes involved in xenobiotic metabolism. However, mouse AhR knockout models have demonstrated that the AhR also regulates other normal physiological functions. In particular, functioning of the nervous system of mammals, previously unexplored in this respect, might depend upon the activity of the AhR. We, thus, performed behavioral and gene expression studies in AhR-/- mice to discover these functions. We, first, found that AhR-/- mice exhibit an oculomotor deficit which is characterized by spontaneous horizontal pendular eye movements that are probably due to a deficit in the visuo-motor circuitry. Second, we found that the cerebellar gene expression profiles of AhR-/- as compared to AhR+/+ mice resembled those of AhR+/+ mice treated with TCDD (the ligand with the highest affinity for the AhR). This suggests that TCDD disrupts some normal physiological functions of the AhR in the nervous system. Third, AhR-/- mice and AhR+/+ treated with TCDD both develop liver fibrosis. This further suggests a role for the AhR in normal liver function. In conclusion, this study reveals new physiological functions for the AhR in the mouse nervous system and describes a new model of pendular nystagmus. Moreover, the results also provide novel research perspectives in the field of neurotoxicology.

Athletic potential is one of the most complex human traits. An elite athlete is produced from a complex interaction of an innumerable number of traits exhibited by the athlete. However, it’s not clear whether these traits are innate, allowing the athlete to excel, or, alternatively, are a consequence of practice. To be successful, athletes rely heavily on sensory information from the visual and vestibular systems. This study investigated the relationship eye movement control has with innate athleticism by comparing the saccadic and Vestibulo-Ocular Reflex (VOR) responses of former, no longer practicing, elite athletes against their age and gender matched counterparts who were non-elite or non-athletes. Results showed subjects who participated in athletic activities longer (regardless of type or level achieved), showed both significantly better VOR suppression capabilities, as well as higher head velocities while suppressing their VOR. Although, these results are correlative in nature, they do not support the potential that VOR suppression is a learned trait of athletes. A longitudinal study would be required to assess this relationship fully.

The vestibuloocular reflex can be manually elicited by tilting or rotating the head. Manual techniques serve their purpose well and is the golden standard in the clinical work, but they lack control of velocity and movement pattern. However, motion simulation platforms enable automatic control of both velocity and movement pattern. One motion simulation platform, named BIRGIT, has been built at the Department of Clinical Neurosciences at Karolinska Institutet but has not yet been in service and require a performance evaluation. The objectives with this thesis is to evaluate the accuracy and precision of BIRGIT and evaluate how bodyweight and movement direction impact the performance. The thesis also evaluate whether it is possible to stabilize the head of the patient during the acceleration phase. Repeated measurements of acceleration with different loads, desired ac- celeration, direction and motion type (rotational and translational), are per- formed. Dummies are used to simulate bodyweight in the performance study and real persons are used in the head stabilization study. Analysis of variance (ANOVA) is the main statistical tool. The results suggest that the platform does not perform equally at dif- ferent load or directions and that there is a bias between desired and true acceleration. The main problems are an inclination of the rails, upon which the chair is mounted, that causes differences between directions and an un- desirable performance characteristic for rotational motions. The stabilization study suggest that the head can be stabilized. / Den vestibulo-okul ̈ara reflexen kan framkallas genom att manuellt rotera eller rycka p ̊a huvudet. Att manuellt framkalla reflexen fungerar i de flesta sam- manhang va ̈l och a ̈r standard i m ̊anga underso ̈kningar. Dock g ̊ar det inte att till fullo kontrollera vare sig hastighet eller ro ̈relsebana perfekt. Emellertid g ̊ar detta att kontrollera genom att anva ̈nda sig av en s ̊a kallad ro ̈relsesimu- leringsplatform. En s ̊adan platform, d ̈opt till BIRGIT, har byggts vid Institutionen f ̈or kliniska neurovetenskaper vid Karolinska Institutet. Denna har ej bo ̈rjat anva ̈ndas ̈annu d ̊a dess prestanda fo ̈rst beho ̈ver utv ̈arderas. Syftet med denna uppsats ̈ar att utva ̈rdera precision och noggrannhet hos BIRGIT. Dessutom, att utv ̈ardera hur kroppsvikt och ro ̈relseriktning inverkar p ̊a prestandan. I arbetet ing ̊ar ̈aven att testa om det a ̈r m ̈ojligt att stabilisera huvudet under accelerationsfasen. Repeterade ma ̈tningar av sann acceleration med olika last, riktning, bo ̈rac- celeration och r ̈orelsetyp (rotation eller sidledes) genomfo ̈rdes. Testdockor anva ̈ndes fo ̈r att simulera lasten i prestandatesterna och riktiga testpersoner anva ̈ndes i huvudstabiliseringsdelen. Variansanalys (ANOVA) var det hu- vudsakliga statistiska verktyget. Resultatet antyder att last och ro ̈relseriktning inverkar p ̊a acceleratio- nen och prestandan och att den sanna accelerationen alltigenom a ̈r la ̈gre a ̈n bo ̈raccelerationen. Det finns tv ̊a sto ̈rre problem hos plattformen, det fo ̈rsta a ̈r att uppha ̈ngningen till stolen lutar och detta resulterar i en skillnad mellan riktningarna (det g ̊ar fortare nedf ̈ors). Det andra problemet a ̈r ett cykliskt uppfo ̈rande na ̈r flera rotationsr ̈orelser skall fo ̈lja p ̊a varandra. Stabiliseringsstudien visade att det g ̊ar att stabilisera huvudet.

La navigation visuelle des robots mobiles s'appuie traditionnellement sur des imageurs de type « caméra », dotés de plusieurs centaines de milliers de pixels lus séquentiellement. Le traitement de tels flux d'images nécessite une puissance de calcul qu'il serait difficile d'embarquer à bord d'un micro-aéronef de quelques grammes ou dizaines de grammes. Il existe pourtant déjà quelques agents aériens dont les performances de navigation en milieu inconnu sont remarquables, et qui pourtant fonctionnent de toute autre façon. Les oiseaux et les insectes, en particulier, montrent une capacité inégalée à éviter les obstacles et à poursuivre leurs proies ou leurs congénères. Cette capacité étonnante découle de leur perception particulière de l'environnement. Si les insectes, aux faibles capacités cognitives, perçoivent leur environnement de manière si efficace, c'est grâce aux capteurs minimalistes qu'ils embarquent. Certains insectes comme la mouche améliorent encore leur perception de l'environnement en stabilisant leur système visuel avec à un découplage tête-corps associé à un réflexe inertiel, équivalent au réflexe vestibulo-oculaire des mammifères. Cette stabilisation de la « plate-forme visuelle » permet de simplifier les traitements visuels subséquents et de mettre en œuvre des stratégies efficaces de navigation. Toute la première partie (« capteurs visuels ») de ce travail prend appui délibérément sur un œil élémentaire composé de seulement deux photorécepteurs (deux pixels). Nous avons d'abord amélioré les performances d'un capteur de vitesse angulaire bio-inspiré et revu le principe du capteur OSCAR, tous deux construits précédemment au laboratoire. Puis, nous avons développé et construit un nouveau type de capteur visuel, appelé VODKA, qui localise de manière ultrafine la position angulaire d'une cible visuelle. Dans la seconde partie (« réflexes visuo-inertiels »), nous avons développé un robot aérien miniature, appelé OSCAR II. Equipé de nos capteurs visuels et d'un réflexe « vestibulo-oculaire », OSCAR II, qui ne pèse que 100 grammes, est capable non seulement de fixer du regard une cible visuelle stationnaire, mais aussi de la poursuivre en lacet si elle vient à se déplacer, et ce même lors de fortes perturbations aérodynamiques. Avec sa capacité additionnelle de faire des saccades oculaires, OSCAR II préfigure les micro-véhicules aériens de demain, qui se dirigeront là où portera leur regard.

No description available.

The human vestibulo-ocular reflex (VOR) stabilizes gaze during head movement. The reflex is typically tested in a clinic or laboratory using passive rotations or artificial stimuli which measure the amount of damage the vestibular apparatus has suffered. However, during everyday activities the vestibular system is stimulated by active, self generated head movements. Head movements are often rapid and associated with the goal of achieving either gaze-fixation or re-fixation. Patients who complain of on-going symptoms will typically identify a particular position or movement that aggravates their symptoms in their everyday life. There is a need to identify objective parameters which correlate with the subjective complaints of patients whose symptoms persist after vestibular damage. In the first study, a gaze-refixation task, patients who complain of ongoing symptoms (poorly-compensated), during rapid head turns, after unilateral vestibular de-afferentation (uVD) were compared with those who did not have the same complaints (well-compensated) and normal subjects. Well- and poorly-compensated groups were sorted according to responses on a standardized questionnaire. All subjects were then located in a real-world, non-laboratory environment in which poorly-compensated subjects reported experiencing symptoms. Each subject’s head, eye and gaze displacement and velocity, head rotation frequency and blink or eye-lid closure were measured and analysed and compared between ipsi- and contra-lesional head rotations within and between subject groups. When subjects are able to generate their own active head rotations it has been suggested that a number of vestibular and extra-vestibular strategies might be employed to compensate for an impaired VOR. In subsequent studies, high resolution scleral search coils were used to identify the compensatory mechanisms used during active head rotations during a gaze-fixation task. A corrective saccade is typically observed during passive ipsilesional head rotations or “impulses” and might be potentiated during rapid, active or self-generated head rotations. The conditions which predict or contribute to the generation of the rapid, corrective eye movement were investigated. The results were compared with responses to passive head impulses of matched velocity and acceleration to determine if active head impulses could be used to identify a lesioned vestibular apparatus as is routinely clinically achieved with passive head impulses.

The human vestibulo-ocular reflex (VOR) stabilizes gaze during head movement. The reflex is typically tested in a clinic or laboratory using passive rotations or artificial stimuli which measure the amount of damage the vestibular apparatus has suffered. However, during everyday activities the vestibular system is stimulated by active, self generated head movements. Head movements are often rapid and associated with the goal of achieving either gaze-fixation or re-fixation. Patients who complain of on-going symptoms will typically identify a particular position or movement that aggravates their symptoms in their everyday life. There is a need to identify objective parameters which correlate with the subjective complaints of patients whose symptoms persist after vestibular damage. In the first study, a gaze-refixation task, patients who complain of ongoing symptoms (poorly-compensated), during rapid head turns, after unilateral vestibular de-afferentation (uVD) were compared with those who did not have the same complaints (well-compensated) and normal subjects. Well- and poorly-compensated groups were sorted according to responses on a standardized questionnaire. All subjects were then located in a real-world, non-laboratory environment in which poorly-compensated subjects reported experiencing symptoms. Each subject’s head, eye and gaze displacement and velocity, head rotation frequency and blink or eye-lid closure were measured and analysed and compared between ipsi- and contra-lesional head rotations within and between subject groups. When subjects are able to generate their own active head rotations it has been suggested that a number of vestibular and extra-vestibular strategies might be employed to compensate for an impaired VOR. In subsequent studies, high resolution scleral search coils were used to identify the compensatory mechanisms used during active head rotations during a gaze-fixation task. A corrective saccade is typically observed during passive ipsilesional head rotations or “impulses” and might be potentiated during rapid, active or self-generated head rotations. The conditions which predict or contribute to the generation of the rapid, corrective eye movement were investigated. The results were compared with responses to passive head impulses of matched velocity and acceleration to determine if active head impulses could be used to identify a lesioned vestibular apparatus as is routinely clinically achieved with passive head impulses.