1

Thank Youfor

Your Attention

Thank YouThank Youforfor

Your AttentionYour AttentionHope youenjoyed !

European Academy of Sports Visionwww.easv.org

nPOSTUROLOGIESunday, April 6, 14

OCLUZIE

A.T.M POSTURA

Congresul international`` Postura, occlusione e salute: Milano, 7 mai 1997 ``

Sunday, April 6, 14

IntroductionIntroductionIntroduction

Issues about Balance and Posturearise because during millennia, Man stood upright posture The goal was

reached without awareness

Still in evolution

Per vedere questa immagineoccorre QuickTime e un

decompressore Microsoft Video Utility.

Sunday, April 6, 14

4to the sphenoidal rostrum; this faint pressure allows aslight mobilization of the sphenoid which is crucial to thecraniosacral system (Perroneaud-Ferr, 1989; Lignon,1989; Upledger, 1996; Sutherland, 2002 a, b).The pressure of the tongue on the retroincisor spot dur-ing physiological deglutition also has considerable neuro-physiological significance, as documented by recent re-search. Particularly important is the research that hasdemonstrated the presence of as many as five types ofexteroceptor in the single square centimetre of the palatecorresponding to the retroincisor spot (Halata, 1999).Furthermore, other researchers showed that the eleva-tion of the tongue, compared with deglutition, activates agreater total volume of cerebral cortex, with significantlyincreased activation in the cingulate gyrus, supplemen-tary motor area, precentral and postcentral gyrus, pre-motor cortex, putamen and thalamus (Martin, 2004).These data give us an idea of just how important, atneurophysiological level, the elevation movement of thetongue is in the stimulation of the retroincisor spot, andof the extent to which the information originating fromthis zone may affect the central regulation mechanismsof posture.On the other hand, if it is true that deglutition is capableof affecting posture, the opposite is also true. Correctpostural alignment is important in normal processes ofdeglutition and ingestion of food: this aspect is particu-larly striking in the field of neurological pathologies(Redstone, 2004).In short, we do not feel that, to date, adequate consid-eration has been given to the fundamental nature, incentral regulation mechanisms of posture, of the infor-mation originating from this area. On a functional level, due to the prevalently transversearrangement of its fibres, the tongue may be consid-ered a diaphragm linking the bodys anterior and poste-rior muscular chains. Through the lingual septum andthe hyoglossus membrane, the tongue forms intimaterelationships, in the fascial plane, with the hyoid bone;the correlation between tongue and general posture isthus found at aponeurotic as well as at muscular level.Still on a functional level, the whole muscular-aponeu-rotic system that links the tongue with the internal or-ganism, might be termed the lingual chain (Clauzade,1989, 1992, 1998).

The lingual chain

By lingual chain we mean the ensemble of muscles andaponeurosis topographically positioned in the antero-medial region of the body, following a longitudinal se-quence (Denys-Struyf, 1982; Fig. 2).On both motor and postural levels, the lingual chain is afunctional unit; anatomically, it is made up of a very richnetwork of muscles and aponeurosis, which explains itsimportance in posture.The hyo-glossus apparatus, owing to its links with theanatomical structures at cranial, caudal, ventral, anddorsal levels, is the true trait dunion between the oraland postural functions of the body.In view of its relations with the maxillaries, the skull, thecervicals, the scapula, the pharynx and the larynx, it iseasy to appreciate the strategic influence of the hyo-glossus apparatus on the postural system.

Normally, a lingual dysfunction causes a fulcrum of ro-tation on the hyoid bone leading to rotation and imbal-ance of the scapular girdle, followed by a succession ofcompensations on the whole locomotor apparatus. The tongue and the hyoid bone, thanks to the superfi-cial cervical aponeurosis, middle cervical aponeurosisand deep cervical aponeurosis, are able to influenceprofoundly the morphopostural organization of the bodyas a whole (Fig. 3).

Annali di Stomatologia 2005; LIV (1): 27-34 29

Glosso-postural syndrome

Figure 2 - Anteromedial muscular chain (Denis-Struyf, 1982).

Figure 3 - The visceral cavity in the inferior zone of the neck, asdescribed by Testut (1971). 1. superficial cervical fascia; 1, ster-nocleidomastoid m.; 1 trapezius m.; 2. middle cervical fascia; 3.deep cervical fascia; 4. prevertebral fascia; 5. common carotida.; 5 arterial vascular fascia; 6. sagittal segment wrapping thesympathetic; 7. anterior scalenus wrapped in its fascia; 8. inter-nal jugular v.; 8 venous vascular fascia; 9. sternothyroideus m.wrapped in its fascia; 10. transverse cervical venous fascia, de-pending on the external jugular v.; 11. vagus n. included in theattachment of the vascular laminae; 12. lymph nodes; 13. viscer-al cavity; 14. vasa fascia of the cephalic intestine; 15. tracheoe-sophageal sheath where the recurrent n. resides; 16. thyroidgland sheath or capsule; 17. retrovisceral space; 18. vertebral a.

Sunday, April 6, 14

5 HIOID

Sunday, April 6, 14

CONTROLUL POSTURII

n VESTIBULARn VIZUAL n PROPRIOCEPTIVn EXTEROCEPTIV

Sunday, April 6, 14

Posturan Relaiile spaiale ale

diferitelor segmente ale corpului n scopul de a menine echilibrul n diferite poziii statice i dinamice ale corpului.

n Corelaii culturale, geografice, aspecte sociale

n Parte a comunicrii non-verbale

7

PosturePosturePosture

Spatial relationship of various body segments whose goal is to maintain balance in different body positions, static and dynamic Also correlated with cultural,

geographical, social aspects Part of non-verbal

communication

Sunday, April 6, 14

Postura este o adaptare la condiiile mediului extern

8

Behavioral model of postureBehavioral model of postureBehavioral model of posture

Posture is a dynamic learned pattern Posture is an adaptation to the needs of

internal and external environments Posture can be re-learned

Sunday, April 6, 14

Sunday, April 6, 14

10

Sunday, April 6, 14

Controlul vizual al posturii prin lentile de corecie

11

Clinical evidenceof the link between

Vision, Posture and Balance

Clinical evidenceClinical evidenceof the link betweenof the link between

Vision, Posture and BalanceVision, Posture and BalanceChanges in visual input produce

changes in postural outputThe easiest and fastest way is by

using lenses and prisms

Clinical evidence #5Clinical evidence #5Clinical evidence #5

Convergence produces a balance shift backward Similar during Stress-

Point Retinoscopy

Clinical evidence #5Clinical evidence #5Clinical evidence #5

Convergence produces a balance shift backward Similar during Stress-

Point Retinoscopy

Sunday, April 6, 14

12

The role of dental occlusion on vision focusing

The role of dental occlusion on The role of dental occlusion on vision focusingvision focusing

The alteration of dental occlusion (using mandibular devices) can induce some fluctuations in visual focusing

Milani, de Periere and Micallef, 1998

The role of dental occlusion on vision focusing

The role of dental occlusion on The role of dental occlusion on vision focusingvision focusing

The alteration of dental occlusion (using mandibular devices) can induce some fluctuations in visual focusing

Milani, de Periere and Micallef, 1998

The role of dental occlusion on vision focusing

The role of dental occlusion on The role of dental occlusion on vision focusingvision focusing

The alteration of dental occlusion (using mandibular devices) can induce some fluctuations in visual focusing

Milani, de Periere and Micallef, 1998

Cranio. 1998 Apr;16(2):109-18.Relationship between dental occlusion and visual focusing.Sharifi Milani R, Deville de Periere D, Micallef JP.

AbstractThe purpose of this study is to show the effects of dental occlusion on visual focusing. Thirty subjects were divided into two groups: an experimental group who had worn mandibular orthopedic repositioning appliances and a control group who had not worn any oral device. All of the subjects underwent the same visual focusing tests with a Maddox rod and the Berens prismatic bars, from over five meters to 30 centimeters. The results seemed to confirm that the alteration of dental occlusion can induce some fluctuations in visual focusing. The phenomenon occurs after wearing a MORA (Mandibular Orthopedic Repositioning Appliance) for a while. Feedback effects are gradual after removing the mandibular splint.

Sunday, April 6, 14

Sunday, April 6, 14

14

Sunday, April 6, 14

15

Sunday, April 6, 14

EXTENSIA COLOANEI CERVICALE =POZIIONAREA ANTERIOAR A

CAPULUI

n CAUZEAZ MODIFICRI ALE POZIIEI DE POSTUR ORTOSTATIC A MANDIBULEI

n ALTERRI ALE TRAIECTORIEI DE NCHIDERE A GURII

n MODIFICRI ALE CONTACTULUI DENTAR INTERARCADIC INIIAL LA NCHIDERE !

60% PEDRONI et. al. Prevalence study and symptoms of temporomandibular disorders in university students,

J.Oral Rehabil, 2003;30: 283-289

Sunday, April 6, 14

17

Sunday, April 6, 14

Sunday, April 6, 14

MODIFICAREA LORDOZEI CERVICALE

n EXTENSIA COLOANEI ACTIVITATEA

MUSCULAR (MAS., TEMP.)

RIDICAREA I

RETRUZIA MANDIBULEI

n FLEXIA COLOANEI ACTIVITATEA

MUSCULAR (MAS., TEMP.)

COBORRE I RETRUZIE

Sunday, April 6, 14

20

Proceedings of the 14th Triennial Congress of the International Ergonomics Association. (2000, vol. 5, pp. 565-568).

HEAD AND NECK POSTURE AT COMPUTER WORKSTATIONS WHATS NEUTRAL?

Dennis R. Ankrum

Human Factors Research, Nova Solutions, Inc., Effingham, Illinois USA Kristie J. Nemeth

University of Dayton Research Institute, Dayton, Ohio USA In a study of comfortable head/neck posture in the absence of a visual target for 24 seated subjects, mean head tilt (Ear-Eye Line) angle was 7.7 above horizontal, and mean head/neck posture (C7-tragus against vertical) was 43.7. Using these and other studies findings as reference points for neutral, studies examining posture at different computer monitor heights were reviewed: eye- level monitors resulted in head/neck extension.

INTRODUCTION

Viewing a VDT involves an interaction

between two systems: vision and posture. From a visual system standpoint, lower monitor positions have been shown to be beneficial in terms of accommodation, convergence and reduced risk of Dry Eye Syndrome when compared to those at eye level (see Ankrum, 1997 for a review). The postural tradeoffs can be evaluated by several methods, including that of comparing observed postures to neutral postures. A valid estimate of neutral neck posture is critical to any such analysis. Neck posture recommendations in the literature

Most studies measuring neck flexion/extension have not defined the zero starting point. For example, Chaffin (1971) has been cited as the basis for the recommendation not to exceed 30 of flex-ion over sustained periods. The RULA workstation assessment method (McAtamney and Corlett, 1993) considers neck flexion to be of progressively greater risk over 10 and assigns the highest risk level to any amount of extension. However, neither article defines the zero point from which flexion/extension was measured. Such a reference point would be necessary in order to apply any recommendations. Definition of Neutral Several attempts have been made to define neutral of the head/neck region, but most are reference points rather than postures of least musculoskeletal stress. The zero point (dividing

flexion from extension) has been variously described as: the posture of the head/neck when standing erect and looking at a visual target at eye level; the posture of the head/neck when standing erect and looking at a visual target 15 below eye level; and normal erect posture. Physiological landmarks in measuring head/neck posture Head tilt.

Several landmarks have been used in defining head tilt (see Figure 1). The simplest metric can be called head tilt angle. Head tilt angle definitions have utilized angles defined by the true horizontal

Figure 1. Head posture landmarks and metrics .

Jampel &Shi, 1992

Sunday, April 6, 14

Sunday, April 6, 14

22

Sunday, April 6, 14

VISSCHER et al., 2002

( LINIA POSTURII CERVICALE)

Dens axis

C7 processus spinosus

Sunday, April 6, 14

HACK, KORITZER, ROBINSON (1995)

Maryland University

m.rectus capitis post. min.

Tuberculul posterior al atlasului

DURA MATER

Text

Text

Sunday, April 6, 14

25

Sunday, April 6, 14

26

Sunday, April 6, 14

SOLOW&TALLGREN, 1971

TANGENTA LA APOFIZA ODONTOIDA PRIN C2 TANGENTA VERTEBRELOR CERVICALE PRIN C4

Sunday, April 6, 14

28

Sunday, April 6, 14

29

rotation for each lower limb. The subjects were also

instructed to keep their mandibles relaxed, without

having contact between the upper and lower teeth, so

that there was minimum space between the superior

and inferior tooth arcades, according to the protocol

described by Henriquez et al. (21).

To obtain lateral X-rays for the measurement of

cervical lordosis, subjects were also asked to assume a

standing position, but were instructed to maintain a

natural position of the head, so that there were no

changes of the cervical curve.

X-ray data processing

To obtain the angular measurements of cervical lordo-

sis, the Cobb method was employed (31). This method

has been widely used as the gold standard to assess

sagittal cervical spine alignment and uses, as illustrated

in Fig. 1, with the inferior border of the C2 and C7vertebrae as references to obtain the angular measure

of the cervical alignment.

The positioning of the hyoid bone was obtained by

measuring the vertical and horizontal distances from

the C3 vertebra (21). To determine the positioning of

the hyoid bone, the highest and anterior aspects were

identified, which have been frequently used as a

reference to locate the hyoid bone in cephalometric

tracings (23, 32).

The procedures were conducted in two phases to

obtain the measures of the cervical curve and location

of the hyoid bone. First, the outlines of the cervical

bone structures and the hyoid bone were traced. To

measure cervical lordosis, as shown in Fig. 1, the

following points were identified: the most anterior

and inferior, as well as posterior and inferior points of

the C2 and C7 vertebrae. The same procedures were

conducted for the cephalometric measures, where the

outlines of the C3 and C4 vertebrae and the hyoid bone

were traced, along with the most anterior and inferior

points of the C3 vertebra (Fig. 2).

During the second phase, all tracings were digitized

and the images were transferred to locally created

software. The Cobb angle (Fig. 1) and the vertical and

horizontal distances of the hyoid bone in relation to the

C3 vertebra (Fig. 2) were directly calculated to ensure

measurement precision.

Statistical analyses

Descriptive statistics and tests for normality were

performed, using SPSS for Windows (release 110). Asdata were normally distributed, independent Students

t-tests were carried out to investigate differences

between groups for all outcome variables with a

significance level of a < 005.

Results

Subject characteristics

The TMJ group consisted of 17 subjects (16 women

and one man), with a mean age of 2347 ! 359years (ranging from 20 to 35), body mass of 5727 !764 kg (ranging from 44 to 77), height of 165 !007 m (ranging from 152 to 187), and a body massindex of 2092 ! 141 kg m)2 (ranging from 1887 to2367). The CG was made up of 17 gender- and age-matched participants with a mean age of 2371 !339 years (ranging from 21 to 36), body mass of5541 ! 796 kg (ranging from 45 to 74), height of163 ! 008 m (ranging from 150 to 176), and a bodymass index of 2077 ! 181 kg m)2 (ranging from 1772to 2389). No significant differences were foundbetween groups for any demographic parameter.

Fig. 1. Measurement of cervical lordosis (reference value of 17! oflordosis).

Fig. 2. Measurement of hyoid bone positioning (reference values

of 36 cm for the horizontal and of 04 cm for the vertical distancesbetween the hyoid bone and C3).

TMD , C E R V I C A L A L I G NMEN T AND H YO I D P O S I T I O N I NG 769

2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 34; 767772

rotation for each lower limb. The subjects were also

instructed to keep their mandibles relaxed, without

having contact between the upper and lower teeth, so

that there was minimum space between the superior

and inferior tooth arcades, according to the protocol

described by Henriquez et al. (21).

To obtain lateral X-rays for the measurement of

cervical lordosis, subjects were also asked to assume a

standing position, but were instructed to maintain a

natural position of the head, so that there were no

changes of the cervical curve.

X-ray data processing

To obtain the angular measurements of cervical lordo-

sis, the Cobb method was employed (31). This method

has been widely used as the gold standard to assess

sagittal cervical spine alignment and uses, as illustrated

in Fig. 1, with the inferior border of the C2 and C7vertebrae as references to obtain the angular measure

of the cervical alignment.

The positioning of the hyoid bone was obtained by

measuring the vertical and horizontal distances from

the C3 vertebra (21). To determine the positioning of

the hyoid bone, the highest and anterior aspects were

identified, which have been frequently used as a

reference to locate the hyoid bone in cephalometric

tracings (23, 32).

The procedures were conducted in two phases to

obtain the measures of the cervical curve and location

of the hyoid bone. First, the outlines of the cervical

bone structures and the hyoid bone were traced. To

measure cervical lordosis, as shown in Fig. 1, the

following points were identified: the most anterior

and inferior, as well as posterior and inferior points of

the C2 and C7 vertebrae. The same procedures were

conducted for the cephalometric measures, where the

outlines of the C3 and C4 vertebrae and the hyoid bone

were traced, along with the most anterior and inferior

points of the C3 vertebra (Fig. 2).

During the second phase, all tracings were digitized

and the images were transferred to locally created

software. The Cobb angle (Fig. 1) and the vertical and

horizontal distances of the hyoid bone in relation to the

C3 vertebra (Fig. 2) were directly calculated to ensure

measurement precision.

Statistical analyses

Descriptive statistics and tests for normality were

performed, using SPSS for Windows (release 110). Asdata were normally distributed, independent Students

t-tests were carried out to investigate differences

between groups for all outcome variables with a

significance level of a < 005.

Results

Subject characteristics

The TMJ group consisted of 17 subjects (16 women

and one man), with a mean age of 2347 ! 359years (ranging from 20 to 35), body mass of 5727 !764 kg (ranging from 44 to 77), height of 165 !007 m (ranging from 152 to 187), and a body massindex of 2092 ! 141 kg m)2 (ranging from 1887 to2367). The CG was made up of 17 gender- and age-matched participants with a mean age of 2371 !339 years (ranging from 21 to 36), body mass of5541 ! 796 kg (ranging from 45 to 74), height of163 ! 008 m (ranging from 150 to 176), and a bodymass index of 2077 ! 181 kg m)2 (ranging from 1772to 2389). No significant differences were foundbetween groups for any demographic parameter.

Fig. 1. Measurement of cervical lordosis (reference value of 17! oflordosis).

Fig. 2. Measurement of hyoid bone positioning (reference values

of 36 cm for the horizontal and of 04 cm for the vertical distancesbetween the hyoid bone and C3).

TMD , C E R V I C A L A L I G NMEN T AND H YO I D P O S I T I O N I NG 769

2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 34; 767772

Text

Msurarea lordozei cervicale i a poziiei osului hioid (Andrade et al., 2007- Journalof Oral Rehabilitation; 34:767-772

Sunday, April 6, 14

30

Sunday, April 6, 14

31

Sunday, April 6, 14

32

Sunday, April 6, 14

33

Sunday, April 6, 14

34

Sunday, April 6, 14

35

Sunday, April 6, 14

36

Sunday, April 6, 14

37

Sunday, April 6, 14

TORTICOLLIS OFTALMOLOGICTORTICOLLIS INTRINSEC

CAUZELE DEFICITELOR POSTURALE :IntrinseciDobanditeOculare Globale

Sunday, April 6, 14

Implicaii directe n protetica dentar :

transferul n articulator al poziiei modelului superior;

determinarea planului de ocluzie alterarea poziiei condililor mandibulari n

plan frontal

39

Sunday, April 6, 14

Sunday, April 6, 14

41

Sunday, April 6, 14

42

Sunday, April 6, 14

Sunday, April 6, 14

Sunday, April 6, 14

45

Sunday, April 6, 14

46

Sunday, April 6, 14

Sunday, April 6, 14

Aqualiser

Sunday, April 6, 14

49

Sunday, April 6, 14

50

Sunday, April 6, 14

Sunday, April 6, 14

Sunday, April 6, 14

Sunday, April 6, 14

EXAMENUL CLINIC POSTURAL

MORFOLOGIC DINAMIC FUNCTIONAL

v ROMBERG v CYONAS, FUKUDA v REFLEXE POSTURALE

LABIRINTICE v POSTUROMETRIAv EMG; EEGv EXAMINARE OFTALMOLOGICA

Sunday, April 6, 14

LINIA GRAVITATIEI ( BARRE) :

Din norm lateral:

Linia gravitaional trece prin:a. Vertex.b. Inaintea mastoidei.c. Anterior de axa de flexie i

extensie a gtuluid.Intersecteaz acromionule. Corpul vertebrelor C1,C6,T11,

L5, S1 ( trece posterior de axele de rotaie a vertebrelor cervicale i lombare i anterior de cele toracale)

f. Prin sau naintea axului articulaiei oldului

g. Anterior de axa articulaiei genunchiului

h. 5 cm anterior de maleolSunday, April 6, 14

70 60 45

Sunday, April 6, 14

40

Sunday, April 6, 14

58

ROMBERG

Sunday, April 6, 14

59

REACTIA POSTURAL OCULOMOTORIE

Sunday, April 6, 14

60

TESTUL POSTURAL CERVICAL CYON-PAILLARD (pentru membrele superioare)

Sunday, April 6, 14

61

TESTUL POSTUROLOGIC CERVICAL FUKUDA

Sunday, April 6, 14

62

TESTUL POSTURAL LABIRINTIC

Sunday, April 6, 14

63

Sunday, April 6, 14

64

Sunday, April 6, 14

65

Thank Youfor

Your Attention

Thank YouThank Youforfor

Your AttentionYour AttentionHope youenjoyed !

European Academy of Sports Visionwww.easv.org

Sunday, April 6, 14