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Transforming from quadrupedal to bipedal method in evolution has brought in special system to regulate the right posture and balance. We also go through this evolutionary process as a child first to learning to roll down, head holding, moving with four limbs and finally standing and walking on the feet alone.
This goes well with the development and maturation of different systems in the brain and the entire nervous system. All mothers consider this complicated process as routine unless in a situation when a child fails to walk. By the end of one year the child acquires the skill of standing and gradually walking and balancing in various situations with time and practice. By then the neural centres will develop, connect within and mature a process called myelination.
Maintaining posture against gravity is a complex process. This involves literally entire brain but the frontal lobe, parietal lobe, cerebellum, brainstem and vestibular system in that order. In addition, temporal lobe, occipital lobe, spinal cord, inner ear, neck muscles and other muscles of the body adds the required support. In fact all the muscles and joints particularly the neck plays a significant role in this process.
Frontal lobe has the primary motor cortex which controls all the voluntary muscles of the opposite side of the body. In addition the thought to move the body also comes from the frontal lobe. The thought is converted into action by moving the necessary muscles in sequence. When the opposite muscles are moving to perform an action the frontal also stabilises the muscles of the same side to maintain the required posture. This combination actually provides movement and stability simultaneously. While the movement is in progress particularly the sequential ones the parietal lobe with the feedback received offers times adjustments and necessary corrections. Parietal lobe has the primary sensory cortex receives information about the range of muscle movement, joint movement, joint position from the special receptors located in the muscles, tendons, ligaments and joints.
These receptors pass on the information constantly through the sensory nerves to the spinal cord. The information will then move to brain through posterior columns to the neck and then relay to Thalamus the sensory hub. From there it will go to the parietal cortex the sensory homunculus. In the parietal lobe all the information is processed, analysed and then sent to motor cortex of frontal lobe and cerebellum for maintenance of posture and balance. The neck muscles and joints have the highest number of such receptors to give constant feedback about the neck position and accordingly the eyes and body position is adjusted constantly to see and act. The occipital lobe provides all the visual information to maintain the visual focus in all the movements of the body and neck. The temporal lobe is important for balance and memory related to those movements. In fact each individual has a different posture called stance, and a characteristic gait that at times gives the identity to an individual. This is very important I doing certain works as a routine like eating and coordination of moments in unusual situations and in darkness.
Brainstem has some special nuclei called Ponto medullary reticular formation. These nuclei are connected the balance organ located in the ear called vestibular organ through the vestibular nuclei of brainstem. In addition they are connected to cerebellum even. These reticular nuclei mail control the antigravity muscles. Thus facilitating the vertical posture the humans adopt most of the time. They inhibit the antigravity muscles in order to stand walk and do many activities. Any default in the system creates stooping posture in an individual often associated with old age. This has a direct connection to neck muscles to hold the head erect.
The inner ear has the most complex balance organ which the semi-circular canals. These canals are designed to have vertical, horizontal and oblique orientation. Each one generates the signals depending on the position of the neck and pass on to the vestibular nuclei of the brain stem through a pair of superior and inferior vestibular nerves. These nerves keep the vestibular nuclei informed constantly about the position of the body particularly the neck. This information will be passed on the cortex to plan and execute further actions without losing balance. At the same time it maintains and modulates the different actions of muscles through two descending tracts of the spinal cord. The medial vestibulo spinal tract exclusively connected to the neck and the upper trunk whereas the lateral vestibulo spinal tract two the rest of the trunk.
Cerebellum or the small brain manages the tone, steady ness of movement adding balance and elegance to every movement. Particularly for those who perform specialised skilled complex movements it is very important. Therefore this system plays a significant role in dancers, surgeons, acrobats and painters. Essentially cerebellum is responsible for quality and timing of movement with precision. Thus all the movements will become polished adding to the precision including the culture.
Giddiness or dizziness is a common problem at all ages particularly in the elderly. This can get complicated by imbalance, unsteadiness, vomiting, frequent falls and loss of posture. There are a variety of reasons through which this entire balancing system of the body can get affected. Once there is a malfunction in of the systems the problem of balancing, walking can happen. This can be sudden in onset or gradual can be short lasting or long-standing or permanent. The long standing defects can be quite disabling leading to temporary or permanent incapacitation. This can affect the quality of life interfering with every activity of like including mundane things like eating, walking and bathing. Any infection or the disturbance of blood supply to these structures such as stroke can cause sudden severe symptoms.
Whereas, other diseases can evolve slowly. Any injury, tumours, inflammation, infection, demyelination such as multiple sclerosis, stroke, auto immunity and degenerative neurological conditions can cause these symptoms. In addition certain drugs and many systemic conditions also can cause similar symptoms. These can be quite dangerous at times making an individual fall and sustain injuries, vomit continuously making them dehydrated and can be a sign of vertebro basilar stroke. The cause can be benign and self-limiting, but certain conditions such as brainstem stroke or brain haemorrhage can be life threatening. It is essential that every giddiness is evaluated properly and treated.
An exclusive clinic has been designed to treat people with such simple looking yet complicated brain illness. Often giddiness is taken lightly and many will have purely symptomatic treatments only. However this justified in sudden situations to tide over the crisis. In case giddiness is severe, not responding to routine treatment, associated with incessant vomiting, associated with neurotically deficits, recurring frequently or becoming chronic and long standing must be investigated. Knowing number of brain centres involved in the maintenance of balance this should be given enough consideration for systematic evaluation. Once the cause and the underlying defect is identified the treatment can be very specific. The causes can differ from age to age and can be seasonal often. In addition all the systemic diseases and associated co morbid medical conditions also needs evaluation and correction.
To asses properly Brains Super Speciality Hospital has installed a very special machine that performs several combination of tests to identify the source of the defect. A team of specialists that include Neurologists, Endovascular specialists, ENT specialists, Physicians, Therapists will provide specific therapies including medications. In addition advice regarding exercises, diet, life style modifications, avoiding the trigger factors and balance exercises will be given as tailor made personalised treatments. Some special tests of hearing, evoked brainstem potentials, carotid and vertebral Doppler to study the blood flow, angiogram or MRI will be done where ever indicated. The treatments can be preventive, curative purely based on the cause and condition. It is important to adopt the lifestyle and prevent falls particularly in the elderly with such symptoms.
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