Medical management of vestibular disorders and vestibular rehabilitation
Oculomotor and Vestibular Function · Oculomotor and Vestibular Function Nicholas Sachs USC - BME...
Transcript of Oculomotor and Vestibular Function · Oculomotor and Vestibular Function Nicholas Sachs USC - BME...
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Oculomotor and Vestibular Function
Nicholas SachsUSC - BME 620L
11/10/2006
Outline
• Why Move the Eyes?• Mechanics of Eye Movement• Types of Eye Movement
– Interaction with the Vestibular System
• Case Study: Vestibular Stimulation• Case Study: Eyeblink Stimulation
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Why Move the Eyes?
Basic Principle Behind All Ocular Movement:
Keep Images Stable on the Retina with Target Centered on the Fovea
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Mechanics of Eye Movement
Degrees of Freedom:
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Degrees of Freedom:3 Axes of Rotation
Elevation
Depression
Extorsion
Intorsion
AbductionAdduction
Actuation:
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Actuation:3 Pairs of Muscles
Superior Rectus
Inferior ObliqueInferior Rectus
Superior Oblique
Lateral RectusMedial Rectus
Extraocular Muscles
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Axis of Rotation
Muscle Action
ExtorsionElevationInferior ObliqueIntorsionDepressionSuperior Oblique
DepressionExtorsionInferior RectusElevationIntorsionSuperior Rectus
In AbductionIn Adduction
AbductionLateral RectusAdductionMedial Rectus
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Muscle Action
ExtorsionElevationInferior ObliqueIntorsionDepressionSuperior Oblique
DepressionExtorsionInferior RectusElevationIntorsionSuperior Rectus
In AbductionIn Adduction
AbductionLateral RectusAdductionMedial Rectus
Conjugate Movements
ExtorsionElevationInferior ObliqueIntorsionDepressionSuperior Oblique
DepressionExtorsionInferior RectusElevationIntorsionSuperior Rectus
In AbductionIn Adduction
(Right Eye)AbductionLateral Rectus(Left Eye)AdductionMedial Rectus
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Conjugate Movements
ExtorsionElevationInferior ObliqueIntorsionDepressionSuperior Oblique
DepressionExtorsionInferior RectusElevationIntorsionSuperior Rectus
In AbductionIn Adduction
(Right Eye)AbductionLateral Rectus(Left Eye)AdductionMedial Rectus
Conjugate Movements
ExtorsionElevationInferior ObliqueIntorsionDepressionSuperior Oblique
DepressionExtorsionInferior RectusElevationIntorsionSuperior Rectus
In AbductionIn Adduction
(Right Eye)AbductionLateral Rectus(Left Eye)AdductionMedial Rectus
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Conjugate Movements
ExtorsionElevationInferior ObliqueIntorsionDepressionSuperior Oblique
DepressionExtorsionInferior RectusElevationIntorsionSuperior Rectus
In AbductionIn Adduction
(Right Eye)AbductionLateral Rectus(Left Eye)AdductionMedial Rectus
Conjugate Movements
ExtorsionElevationInferior ObliqueIntorsionDepressionSuperior Oblique
DepressionExtorsionInferior RectusElevationIntorsionSuperior Rectus
In AbductionIn Adduction
(Right Eye)AbductionLateral Rectus(Left Eye)AdductionMedial Rectus
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Conjugate Movements
ExtorsionElevationInferior ObliqueIntorsionDepressionSuperior Oblique
DepressionExtorsionInferior RectusElevationIntorsionSuperior Rectus
In AbductionIn Adduction
(Right Eye)AbductionLateral Rectus(Left Eye)AdductionMedial Rectus
Conjugate Movements
ExtorsionElevationInferior ObliqueIntorsionDepressionSuperior Oblique
DepressionExtorsionInferior RectusElevationIntorsionSuperior Rectus
In AbductionIn Adduction
(Right Eye)AbductionLateral Rectus(Left Eye)AdductionMedial Rectus
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Conjugate Movements
ExtorsionElevationInferior ObliqueIntorsionDepressionSuperior Oblique
DepressionExtorsionInferior RectusElevationIntorsionSuperior Rectus
In AbductionIn Adduction
(Right Eye)AbductionLateral Rectus(Left Eye)AdductionMedial Rectus
Conjugate Movements
ExtorsionElevationInferior ObliqueIntorsionDepressionSuperior Oblique
DepressionExtorsionInferior RectusElevationIntorsionSuperior Rectus
In AbductionIn Adduction
(Right Eye)AbductionLateral Rectus(Left Eye)AdductionMedial Rectus
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Conjugate Movements
ExtorsionElevationInferior ObliqueIntorsionDepressionSuperior Oblique
DepressionExtorsionInferior RectusElevationIntorsionSuperior Rectus
In AbductionIn Adduction
(Right Eye)AbductionLateral Rectus(Left Eye)AdductionMedial Rectus
Innervation
IIIInferior Oblique(Trochlear)IVSuperior Oblique
IIIInferior RectusIIISuperior Rectus
(Abducens)VILateral Rectus(Oculomotor)IIIMedial Rectus
NerveMuscle
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Injury:Trochlear
Nerve Damage Affecting
Left Superior Oblique
Types of Eye Movement
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6 Main Types of Movement
• Saccades• Smooth Pursuit• Vergence• Fixation
• Vestibulo-ocular Reflex• Optokinetic Reflex
Target Selection
CompensatoryMovement
6 Main Types of Movement
• Saccades• Smooth Pursuit• Vergence• Fixation
• Vestibulo-ocular Reflex• Optokinetic Reflex
Gaze: combinationof head and eyemovement
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Saccadic Movement
Tonic and Burst Activity
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Tonic and Burst
Neurons
Saccadic Pathway
Motor Circuits for Saccades Lie in Brain Stem
Different Centers for Horizontal and Vertical
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Cortical Planning of Saccades
LGN
V1Parietal
MT and MST
SuperiorColliculus
CaudateNucleus
SubstantiaNigra
Cerebellum
Mesenceph.Ret. Form.
PontineRet. Form.
OculomotorNerves
FrontalEye Field
Using Saccades to Diagnose ADHD - Antisaccade
InstinctNormal
InstinctPathological
Flash
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Smooth Pursuit
Smooth Pursuit
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Cortical Initiation of Smooth Pursuit
Dorsolat.Pont. Nucl.
Cerebellum
VestibularNuclei
PontineRet. Form.
OculomotorNerves
LGN
V1Parietal
MT and MST
FrontalEye Field
Damage to the Smooth
Pursuit Pathway Results in
Saccade-like Movement
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Vergence
Involves Rectus Muscles Only
Organized in Midbrain
Fixation
Rostral Portion of Superior Colliculus
Inhibit Caudal Superior Colliculus and Activate Omnipause Nuerons
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Interaction with the Vestibular System
Vestibular Labyrinth
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Vestibular Hair Cells
Vestibular Hair Cells
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Response of Vestibular System to Rotation
Otolith Organs (Utricle)
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Semicircular Canals(Hair Cells in the Ampulla)
Bilateral Symmetry
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Orientation of Canals Relative to Extraocular
Muscles
Relation Between
Canal Stimulus
and Muscle Activity
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VOR Pathway
Response from the Left Side
When Turning the Head Left
VOR Pathway
Response from the Right Side
When Turning the Head Left
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Tonic and Burst
Activity in VOR
VOR Nystagmus
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VOR and OKN Function
Summary of Oculomotor System
• Purpose - Maintain Foveation• Relatively Simple
– 3 Axes of Rotation, Muscle Pairs, Nerves• 6 Specific Types of Movement• Damage to Parts of the System Results
in Specific Dysfunctions• Tied Closely to Vestibular System
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Case Study:Vestibular Nerve Stimulation
C Della SantinaIEEE-EMBS 2005Shanghai, China
How to Design a Prosthetic System for Sensory Function
• What does it sense?– (How can we replicate it?)
• How does it code for this?– (How can we replicate it?)
• Where are signals sent?– (Where can we intervene?)
• How do we know it’s working?
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How to Design a Prosthetic System for Sensory Function
• What does it sense? - acceleration– (How can we replicate it?) -
accelerometers• How does it code for this? - spike freq.
– (How can we replicate it?) - stim. w µ-contr.• Where are signals sent? - vest. nerve
– (Where can we intervene?) - vest. nerve• How do we know it’s working? - VOR
Natural aVOR for Chinchilla Rotated in Each Vestibular
Plane
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aVOR Response in Chinchilla with Electrical Stimulation
Crosstalk in aVOR Response with Electrical Stimulation
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Case Study:Eyeblink Stimulation
N Sachs, E Chang, and J WeilandDoheny Eye Institute
USC - BME
The Pain• Damage to the 7th cranial
(facial) nerve can cause loss of eye blink function
• Without treatment this can lead to eye damage and loss of vision
• Current treatments are functionally unappealing
Paralyzed Functional
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Palpebral Part (blinking)
Orbicularis Oculi(innervated by 7th nerve)
Levator Palpebrae(innervated by 3rd nerve)
Orbital Part (squinting)
Electrical stimulation of paralyzed orbicularis oculi can restore a functionally and cosmetically acceptable blink
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Methods• Developed animal model
of orbicularis paralysis by sectioning 7th nerve
• Separated rabbits into groups based on duration of paralysis
• At end of specified period inserted electrode into upper eyelid
• Stimulated acutely with biphasic current pulses and recorded response with high speed camera
Electrode PlacementElectrode Contacts
Upper Lid Margin
Lower Lid Margin
Medial Canthus
Nictitating Membrane
Electrode Inserted into Rabbit Upper Eyelid
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Experimental Setup
PC
SBC Connector
Block
DAQ
PCI-6025E
Stimulus Isolator (V → I)
IMAQ
PCI-1428
Camera
1M75
Power Supply
Camera Link Cable
Analog Out
190 frames/s0.083mm res
c(chronaxie)
b(rheobase)
* Geddes and Bourland, 1985
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* Geddes and Bourland, 1985
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Chronaxie & Rheobase Values
Rheobase (mA) Chronaxie (ms)Normal 0.480 +/- 0.259 0.367 +/- 0.1111-week 0.044 +/- 0.011 50.97 +/- 10.854-week 0.054 +/- 0.042 47.34 +/- 21.358-week 0.034 +/- 0.015 56.93 +/- 27.4016-week 0.570 +/- 0.342 0.518 +/- 0.549
Motor Nerve 0.08 – 0.60*Denervated Muscle 11 – 30*
* Geddes, 1999
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Data Analysis
1. Trace outline of palpebral fissure prior to stimulation and measure area in pixels.
2. Trace outline of palpebral fissure at peak of closure during stimulation and measure area in pixels.
3. Divide area during stimulation by area prior to stimulation to get percent closure.
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Experimental Setup
PC
SBC Connector
Block
DAQ
PCI-6025E
Stimulus Isolator (V → I)
IMAQ
PCI-1428
Camera
1M75
Power Supply
Camera Link Cable
Analog Out
190 frames/s0.083mm res
EMG Amplifier
Mirror Setup
Measuring Eye Movement
• High Speed Video
• EMG of Active Muscle
• Eye Coils in External Magnetic Field
• Electro-oculogram (EOG)
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Electro-oculogram(EOG)
Measuring DC corneoretinal potential caused by high
metabolic rate in the retina
EOG Electrode Setup
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EOG Recording
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Vestibular Hair Cells
Bilateral Symmetry
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VOR Pathway
3 Axes of RotationElevation
Depression
Extorsion
Intorsion
AbductionAdduction