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FACULTATEA

DE FIZIC

SISTEME SENZORIALE IMPLICATE IN ECHILIBRU

Profesor coordonator:

Masterazi:
Dorel-Florin Fanaragiu

Dr. Irina chiopu

Camelia Siminiceanu
Oana Lazar

Echilibrul corpului uman


Procesul de meninere a echilibrului
n biomecanic echilibrul corpului uman poate fi clasificat n echilibru static i echilibru
dinamic. Echilibrul static descrie un corp n repaus, n cazul n care toate forele sunt egale,
echilibrate i neschimbtoare. Echilibru dinamic descrie un corp care se mic, dar se deplaseaz
ntr-un mod perfect previzibil.
Echilibrul poate fi clasificat ca fiind stabil sau instabil, astfel un sistem care este ntr-o stare
de echilibru stabil va reveni la poziia iniial dup o perturbaie; echilibrul instabil, pe de alt
parte, apare n cazul n care sistemul este perturbat i nu mai revine la starea iniial. [66]
Fenomenul de meninere a echilibrului nu este uor de descris, deoarece nu se "vede", "aude," sau
"simte", dar rspunde (frecvent fr contiina noastr) la diverse micri ale capului. [163] Orice
corp inclusiv corpul uman i menine starea de echilibru stabil dac suma vectorial a tuturor
forelor i momentelor, ce acioneaz asupra acestuia, este egal cu zero. Aceast afirmaie are
urmtoarea form n mecanica clasic:
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unde: F este fora vectorial [N] i M sunt momentele vectoriale [N-m].


O for ce rmne neechilibrat determin o acceleraie liniar. Orice moment neechilibrat
determin o acceleraie unghiular. [216]
Dei tipologiile locomoiei bipede sunt generate la nivelul coloanei vertebrale, acestea sunt

modulate de ctre cerebel, ganglionii bazali i cortexul motor i depind de feedback-ul de la


sistemele: proprioceptiv, vizual i vestibular. [233]
Abilitatea meninerii echilibrului constituie un proces complex care ine n mare parte de
reflexele posturale. Principalele sisteme senzoriale care ofer informaii clare asupra poziiei
corpului n relaie cu condiiile de mediu i contribuie ca i semnale de intrare (fig. 1) pentru
aceste reflexe, sunt:
1.Sistemul vizual;
2.Sistemul vestibular;
3.Sistemul somato-senzorial (Propriocepia i Exterocepia).
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Fig. 1. Reflexele stabilitii: stabilitate vizual (a); stabilitate prioceptiv (b); stabilitate
vestibular (c).
[178]
Acestora li se adaug:
Creierul care are abilitatea de a procesa aceste informaii preluate de sistemele
senzoriale;
Sistemul muscular, sistemul osos i articulaiile fiind condiionate de sistemul
neuronal, coordoneaz micrile necesare pentru meninerea echilibrului.

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Fig. 2. Schem ilustrativ a semnalelor de intrare i ieire pentru meninerea echilibrului.

n mod normal controlul echilibrului este realizat automat, prin interaciunile dintre
sistemele specializate (fig. 3), nefiind nevoie de atenia contient. n cazul n care
echilibrul este ntrerupt, este nevoie sa exercitm un efort contient pentru a nltura
senzaia anormal i pentru a menine echilibrul. Acest efort intens, la rndul su, este ceea
ce duce la simptome secundare precum scurtarea duratei de atenie i oboseala. [112]

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Fig. 3. Schema de principiu a controlului echilibrului. [108]

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Fig. 4. Interaciunile dintre sistemele de meninere a echilibrului. [97]

n vederea meninerii echilibrului, sistemul nervos central proceseaz informaiile de la


sistemul vizual, vestibular i proprioceptiv, le centralizeaz i emite semnale ctre muchii
scheletici responsabili cu locomoia. Deficienele, care apar la nivelul informaiilor de intrare n
cele trei sisteme precum i n sistemul nervos central, pot s rezulte n tulburri ale meninerii
echilibrului i implicit a stabilitii.
Receptorii senzoriali
Receptorii sunt specializai pentru a rspunde la schimbrile care apar n mediul lor; astfel
de schimbri de mediu constituie stimuli.
n principiu, exist trei modaliti de a clasifica receptorii:
1. n funcie de tipul de stimul care l detecteaz i
2. n funcie de amplasarea lor;
Clasificarea n funcie de tipul stimulului:
1. Mecanoreceptorii genereaz impulsuri nervoase atunci cnd ei, sau esuturile adiacente,
sunt deformai de o for mecanic, cum ar fi: de atingere, de presiune(inclusiv

tensiunea arterial), de vibraie, i de ntindere;


2. Termoreceptorii sunt sensibili la schimbrile de temperatur;
3. Fotoreceptorii, cum ar fi cei din retina ochiului, rspund la intensitatea luminii;
4. Chemoreceptorii rspund la substane chimice n soluii;
5. Nociceptorii rspund la stimulii potenial duntori, constituii din extremele
parametrilor ambientali, care duc la durere.
Clasificarea n funcie de amplasare:
1. Exteroceptorii sunt sensibili la stimulii care apar n afara corpului Interoceptorii, numii
de asemenea visceroceptori, rspund la stimulii care apar n interiorul corpului, cum ar fi
viscere interne i vasele de snge.
2. Proprioceptorii, precum interoceptorii, rspund la stimulii interni, cu toate acestea,
locaia lor este mult mai restrns. Acetia apar n muchii scheletici, tendoane,
articulaii i ligamente i n esutul conjuctiv din oase i muchi. Proprioceptorii
informeaz in mod constant creierul de micrile corpului nostru, prin monitorizarea
efortului depus de organele care i conin. [163]

I.

Sistemul vizual

Sistemul vizual are un rol important n cadrul locomoiei datorit funciilor specifice, astfel:

Detectrii caracteristicilor mediului nconjurror, locaia i micarea acestora;

Meninerii unei direcii fixe n cazul micrii capului;

Meninerii echilibrului corpului uman.


Sute de ani dup prima publicaie (1840) a lui Romberg, cercettorii nu au fost convini de
contribuia sistemului vizual la controlul posturii ortostatice. Lee & Lishmann (1976) au fost
primii care au fcut public rezultatele care confirmau influena sistemului vizual. Rezultatele
respective au fost realizate pe un subiect n vrst de 18 luni ntr-o camera perfect stabil, ai crei
perei erau mobili. Fiecare micare a pereilor imprimau o stare micare a subiectului pe aceeai
direcie i cu acelai sens. [107]
Informaia vizual este livrat de la retin ctre cel puin dou locaii diferite ale creierului,
care se presupune c sunt specializate pentru diferite scopuri; sistemul de focalizare identificarea
obiectului i sistemul ambiental pentru controlul micrilor. [237, 214] Acesta din urm, a fost
demonstrat c afecteaz puternic att stabilitatea ct i echilibrul. [157]
Eficiena sistemului vizual n controlul posturii depinde de acuitatea vizual [188],
contrastul vizual [155], distana pn la obiect [16] i iluminarea camerei. Controlul echilibrului
de ctre sistemul vizual este optim cnd distana vizual este mai mic de 2 m, [16] S-a raportat
c, atunci cnd orizontul este manipulat, astfel nct semnalele sistemelor vestibular si vizual sunt
reciproc contradictorii, persoanele n vrst se bazeze mai mult pe indicii lor vizuali dect
persoanele mai tinere. [198, 142]

II.

Sistemul vestibular

Sistemul vestibular prezint urmtoarele funcii:

Monitorizarea poziiei capului n spaiu;

Coordonarea micrilor cap- corp pentru meninerea echilibrului;

Stabilizarea direciei n cazul micrii capului.


Pierre Flourens, un anatomist francez, a descoperit sistemul vestibular. Acesta a considerat
iniial c face parte din sistemul auditiv dar a fost surprins s observe, n anul 1824, c dup ce a
nlturat sistemul vestibular la porumbei acetia nu i-au pierdut auzul. n schimb porumbeii
prezentau reacii adverse diferite, precum n figura 5, nu i mai puteau menine postura normal a
capului n raport cu restul corpului.
Diversele pri ale urechii interne sunt inervate de ctre nervul cranian VIII, ale crui
dendrite se termin n fiecare ganglion cohlear sau vestibular al creierului, unde se analizeaz
informaia obinut.

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Fig. 5. Postura porumbeilor dup nlturarea sistemului vestibular.

Ganglionii vestibulari sunt mnunchiuri de celule nervoase care au o gam larg de


conexiuni cu muchii aparatului locomotor, muchii ochilor, cu cerebelul i cu cortexul cerebelos
ale emisferelor creierului mare.
Din ganglionii vestibulari, impulsurile nervoase se indreapt ctre regiunile temporale ale
cortexului cerebral, unde sunt localizai centrii echilibrului i unde se exercit controlul contient
al poziiei capului i corpului. Echilibrul este definit i meninut de ctre centrii cortexului
cerebelos, care primesc informaii att de la organul echilibrului, situat n urechea interioar, ct
i de la organele senzoriale. n acest mod creierul compar semnalele primite de la aparatul
vestibular cu informaiile primite de la ochi i de la ali proprioceptori.
Urechea intern conine dou feluri de receptori total diferii ntre ei - auditivi i vestibulari,
care joac un rol direct la meninerea echilibrului. Partea vestibular a urechii interne const
dintr-o vezicul circular i una elipsoidal i trei canale semicirculare.

Canalele semicirculare au o orientare specific, delimitate de osul temporal, la unghiuri


bine determinate conform figurii 6. Aceast orientare are o importan deosebit n analiza
biomecanic a acestor organe.
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Fig. 6. Orientarea canalelor semicirculare, cu privire din: plan sagital (a);


plan transversal (b).
Receptorii canalelor semicirculare sunt sensibile la acceleraia angular. Receptorii
veziculelor (utricula - asigur informaii senzoriale despre acceleraia liniar orizontal i sacula asigur informaii senzoriale despre acceleraia liniar vertical) sunt sensibili la acceleraia
liniar. Ca rezultat al mai multor factori (rniri la cap, infecii ale urechii, mbtrnirea etc.)
receptorii veziculelor pot s se degradeze, iar cristalele de carbonat de calciu (otolitele) pot s
descompun receptorii. Mai trziu, otolitele pot ajunge la lichidul care umple canalele
semicirculare. ntr-un astfel de caz, o schimbare a poziiei capului va face s se mite otolitele,
ceea ce va cauza o hidromecanic normal a lichidelor din urechea intern i, ca urmare, va
surveni o senzaie de vertij rotaional. [131]

Modele de analiz mecanic au utilizat, pentru analiza biomecanic, dimensiuni precum


cele din figura 5.32.

Pentru o bun identificare, n biomecanica, s-a realizat o reprezentare geometric a


sistemului vestibular precum n figura 5.33. n figura 5.34, a este figurat efectul micrii de
rotaie a capului, la 900 nspre partea anterioar, asupra componentelor sensibile din otolite i
canalele semicirculare. n figura 5.34, b este identificat efectul forei gravitaionale asupra
otolitei, marcat cu 1, precum i efectul de inerie al micrii endolimfei asupra cupulei, marcat cu
2.

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III Sistemul somatosenzorial (Propriocepia i Exterocepia)


Sistemul somatosenzorial are urmtoarele funcii:
Monitorizarea contactului dintre suprafee i extremitile segmentelor corpului uman;
Monitorizarea poziiilor reciproce ale segmentelor corpului uman i n raport cu spaiul;
-

Iniierea activitii senzoriale pentru interpretarea stimulilor duntori.

Echilibrul static
n cazul echilibrului static senzorii receptori sunt macula utriculei i macula saculei.
Acetia monitorizeaz poziia capului n spaiu i joac un rol important n controlul posturii.
Receptorii sesizeaz doar acceleraiile i vitezele liniare.
Conform figurii 5.35 fiecare macul este o zon epitelial plat care conine celule
senzitive ciliare a cror structur i funcionalitate sunt asemntoare cu a celor din cohlee.
Aceste celule receptoare sunt nconjurate de celule de susinere.
Mnunchiul de cili (stereocili i un kilocili) al celulelor receptoare sunt ncorporate n
membrana otolitic, o mas gelatinoas, mpnzit cu cristale de carbonat de calciu denumite
otolite. n utricul, macula este orizontal iar cilii sunt orientai vertical n cazul corpului aflat n
poziie anatomic. Astfel, aceti receptorii sunt sensibili doar la micrile orizontale i la
nclinarea capului.
n sacul, macula este vertical iar cilii sunt orientai orizontal n cazul corpului situat n
poziie anatomic. Aceti receptori sunt sensibili la micrile n plan vertical.
Conform figurii 5.36 dac stereocilli sunt nclinai ctre kinocil, se produce o depolarizare
echivalent unei creteri a frecvenei impulsurilor nervoase. De asemenea dac stereocilii sunt
nclinai n direcia opus, receptorii se hiperpolarizeaz producnd o descretere a frecvenei
impulsurilor nervoase.

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Echilibrul dinamic
n cazul echilibrului dinamic senzorul receptor se numete crista ampullaris i se gsete n
fiecare canal semicircular sub forma prezentat n figura 5.37. Acetia monitorizeaz poziia
capului n spaiu i joac un rol important n controlul posturii. Receptorii sesizeaz doar
acceleraiile, vitezele unghiulare n micarea de rotaie. Principiul de funcionare este asemntor
cu al unui giroscop.

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Conform figurii 5.37, b fiecare crista este compus din celule de susinere i celule

receptoare asemntoare cu cele anterioare cu diferena ca substana gelatinoas, n care se afl


situate, poart denumirea de cupula.
Conform figurii 5.37, b i d, crista este sensibil la schimbrile survenite n urma micrilor
de rotaie ale capului datorit ineriei endolimfei care are direcia de deplasare, n canalul
semicircular, opus micrii de rotaie a capului. Principiul de polarizare, depolarizare este
asemntor cu cel prezentat anterior n cazul unei macule. Dar datorit axelor de sens opus dintre
2 canale complementare, precum n figura 5.37,d, n momentul n care datorit micrii de rotaie
dup o anumit direcie receptorii unui canal sunt depolarizri iar ceilali complementari sunt
hiperpolarizai.
Impulsurile transmise de canalele semicirculare sunt de o mare importan i pentru
reflexele micrii ochilor cunoscut i sub denumirea de reflex vestibulo-ocular.

Conexiunile sistemului de orientare i echilibru


Reflexele corpului de contracarare a dezechilibrului trebuie s fie ct mai rapide i eficiente
pentru pstrarea echilibrului i a unei posturi corecte n cazul in care corpul este supus la diveri
factori ambientali, care ar putea atenta la dezechilibru.

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Dei conexiunile nervoase ale aparatului vestibular cu creierul sunt slab trasate s-a stabilit
conform figurii 5.38 o diagram a conexiunilor sistemului de orientare i echilibru. Astfel
informaiile transmise de la receptorii vestibulari sunt direcionate ctre cerebel i complexul de

nuclee verstibulare pe cnd ceilali receptori respectiv cei vizuali si cei somatici transmit
informaiile ctre cerebel, complexul de nuclee vestibulare i ctre nucleul reticular. n cadrul
complexului de nuclee vestibulare are loc integrarea acestor informaii cu scopul generrii de
semnale de control motor ocular i spinal(muchi scheletici). Aceste semnale au scopul de
meninere sau de recuperare a echilibrului. Modalitatea de integrare a informaiilor recepionate
de la diverii receptori se face conform diagramei din figura 5.38.
Liniile trasate punctat ntre receptorii vizuali, receptorii somatici i respectiv nucleul
reticular sunt datorit nedefinirii importanei acestora n meninerea echilibrului.
Aparatul vestibular nu are rolul de compensare automat a dezechilibrului ci doar de
transmitere a semnalelor ctre sistemul nervos central de unde pornesc semnalele de compensare,
de meninere a greutii egal distribuite, de focusare a ochilor. [163]
Principiul de funcionare al tuturor acestor receptori vestibulari, de care depinde
transmiterea informaiilor legate de poziia capului n spaiu, este acela al ineriei conform cruia:
Un corp i pstreaz starea de repaus sau de micare rectilinie i uniform att timp ct nu
intervine vreo for s-i modifice aceast stare. [182]
5.6.5.2. Circuitele care stau la baza reflexului vestibulo-ocular (RVO)
RVO acioneaz pentru a contracara micarea capului prin provocarea micrii de rotaie a
ochilor n direcia opus. Exist circuite separate pentru micarea de rotaie i translaie a capului.
Senzorii pentru micarea de rotaie sunt canalele semicirculare iar pentru micarea de translaie
sunt otolitele (utricula i sacula).

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Conform figurii 5.39, a nucleii vestibulari(I- inferior, L- lateral, M- medial, S- superior)


recepioneaz semnal excitator de intrare de la canalul orizontal corespunztor i l transmit la
nucleii motori (VI). Acetia transmit semnalul direct la muchiul rectus lateral i indirect, prin
fasciculul longitudinal medial (FLM) i nucleii motori (III) contralaterali, la muchiul rectus
medial. Neuronii excitatori (transmitori) sunt reprezentai n rou iar cei inhibitori n albastru.
Conform figurii 5.39. b, fluxul informaiei, indus de micarea de rotaie a capului spre stnga, n
circuitul RVO este reprezentat prin ngroarea prilor cu activitate crescut i subierea prilor
cu activitate sczut, fa de figura 5.39. a.

III.

Sistemul somatosenzorial (Propriocepia i Exterocepia)

Numeroase publicaii au adus un aport la influena i consecinele severe pe care le are


pierderea informaiilor periferice ale senzorilor somatici asupra stabilitii i echilibrului uman.
[26, 46, 52, 81, 141, 149] Alte publicaii au investigat rolul semnalelor somato- senzoriale de-a
lungul perturbrilor posturale. [4, 99, 213, 21]
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Fig. 5.40. Rolul feeback-ului senzorial, feedback-ului mecanic i al feedforward-ului. [28]

Senzaiile proprioceptive i exteroceptive provin din subcontient, primele oferind


informaii cu privire la poziia tendoanelor, articulaiilor i tensiunea din muchi, care combinat

cu semnalele de la sistemul vestibular al urechii interne, rezult n gradul de contientizare a


orientrii corpului i membrelor n spaiu, independent de semnalele sistemului vizual. [173]
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Fig. 5.41. Resurse necesare pentru meninerea stabilitii posturale si a orientrii. [98]

Senzaiile exteroceptive sunt derivate din diferii receptori de presiune de pe talpa


piciorului, situai la nivelul esutului cutanat i subcutanat. [137]
Funcia sistemului nervos central (SNC) n cadrul micrii este de a:
transmite comenzile motoare de la creier ctre sistemul efector muscular;
regula activitatea sistemelor respirator i cardiovascular;
monitoriza modificrile, de la receptori, din mediul nconjurtor care afecteaz micarea.
[238]

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Fig. 5.42. O diagram schematic de identificare a integrrii sistemelor responsabile pentru


adaptarea posturii la condiiile din mediu ambiental i meninerea echilibrului i a
stabilitii.
Modificrile redate de aspectele biomecanice i ale mediului nconjurtor afecteaz, n mod
continuu, echilibrul stabil iar corpul are nevoie de mecanisme, proactiv, predictiv i reactiv, care
s echilibreze aceste influene n mod anticipativ.
Mecanismele proactive reprezint mecanismele bazate n principal pe informaiile noi

obinute de la sistemul vizual.


Mecanismele predictive reprezint mecanismele bazate n principal pe informaiile obinute
de la sistemul vestibular i somatic a unor modele cunoscute de SNC. Aceste mecanisme
contracareaz efectul destabilizant al forelor gravitaionale i ineriale.
Mecanismele reactive reprezint mecanismele bazate n principal pe informaiile obinute
sub forma unor reflexe la nite stimuli particulari.
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Tipuri comune, patologice, de tulburri ale echilibrului:


Accident vascular cerebral (AVC);
Leziuni ortopedice ale articulaiilor;
Boala Parkinson;
Boala Alzheimer;
Boli degenerative ale articulaiilor;
Atrofia muscular;
Disfuncia vestibular datorat vertijului (senzaie de rotire):
- Vertijul paroxistic poziional benign (BPPV- Benign Paroxysmal Positional
Vertigo) - este un tip aparte de vertij(senzaie de rotire) cauzat de aparatul
vestibular al urechii interioare;
- Labirintit - este cauzat de canalele semicirculare;
- Boala Meniere - cauzat de schimbrile degenerative ale coloanei cervicale;
- Nevrit vestibular - cauzat de o infecie a nervului vestibular;
- Fistula perilimfatic. [131]

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