1Thank You for Your Attention Thank You Thank You for for Your Attention Your Attention !"#$ &"' $()"&$* + European Academv of Sports Jision www.easv.org !POSTUROLOGIE Sunday, April 6, 14 OCLUZIE A.T.M POSTURA Congresul international `` Postura, occlusione e salute: Milano, 7 mai 1997 `` Sunday, April 6, 14 Introduction Introduction Introduction · !""#$" &'(#) !"#"$%& &*+ '()*+,& &,-"$ '$.&#"$ +#,-*/ 0-11$**-&2 3&* ")((+ #4,-/5) 4(")#,$ · 65$ /(&1 7&" ,$&.5$+ 7-)5(#) &7&,$*$"" · 8)-11 -* $9(1#)-(* Per vedere questa immagine occorre QuickTime¹ e un decompressore MicrosoIt Video Utility. Sunday, April 6, 14 4 to the sphenoidal rostrum; this faint pressure allows a slight mobilization of the sphenoid which is crucial to the craniosacral system (Perroneaud-Ferré, 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 has demonstrated the presence of as many as five types of exteroceptor in the single square centimetre of the palate corresponding to the retroincisor spot (Halata, 1999). Furthermore, other researchers showed that the eleva- tion of the tongue, compared with deglutition, activates a greater total volume of cerebral cortex, with significantly increased 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, at neurophysiological level, the elevation movement of the tongue is in the stimulation of the retroincisor spot, and of the extent to which the information originating from this zone may affect the central regulation mechanisms of posture. On the other hand, if it is true that deglutition is capable of affecting posture, the opposite is also true. Correct postural alignment is important in normal processes of deglutition 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, in central regulation mechanisms of posture, of the infor- mation originating from this area. On a functional level, due to the prevalently transverse arrangement of its fibres, the tongue may be consid- ered a diaphragm linking the body’s anterior and poste- rior muscular chains. Through the lingual septum and the hyoglossus membrane, the tongue forms intimate relationships, in the fascial plane, with the hyoid bone; the correlation between tongue and general posture is thus 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 and aponeurosis 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 a functional unit; anatomically, it is made up of a very rich network of muscles and aponeurosis, which explains its importance in posture. The hyo-glossus apparatus, owing to its links with the anatomical structures at cranial, caudal, ventral, and dorsal levels, is the true “trait d’union” between the oral and postural functions of the body. In view of its relations with the maxillaries, the skull, the cervicals, the scapula, the pharynx and the larynx, it is easy 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 of compensations on the whole locomotor apparatus. The tongue and the hyoid bone, thanks to the superfi- cial cervical aponeurosis, middle cervical aponeurosis and deep cervical aponeurosis, are able to influence profoundly the morphopostural organization of the body as 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, as described 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 carotid a.; 5’ arterial vascular fascia; 6. sagittal segment wrapping the sympathetic; 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 the attachment 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. thyroid gland sheath or capsule; 17. retrovisceral space; 18. vertebral a. Sunday, April 6, 14 5 HIOID Sunday, April 6, 14 CONTROLUL POSTURII ! VESTIBULAR ! VIZUAL ! PROPRIOCEPTIV ! EXTEROCEPTIV Sunday, April 6, 14 Postura ! Rela!iile spa!iale ale diferitelor segmente ale corpului în scopul de a men!ine echilibrul în diferite pozi!ii statice "i dinamice ale corpului. ! Corela!ii culturale, geografice, aspecte sociale ! Parte a comunic#rii non- verbale 7 !"#$%&' !"#$%&' !"#$%&' ! !!"#$%#& ()&#$%*+,-%" *. /#(%*0, 1*23 ,)45)+$, 6-*,) 4*#& %, $* 5#%+$#%+ 1#&#+7) %+ 2%..)()+$ 1*23 "*,%$%*+,8 ,$#$%7 #+2 23+#5%7" ! #$%& (&))*$+,*- ./,0 (1$,1)+$2 3*&3)+40/(+$2 %&(/+$ +%4*(,% ! 5+), &6 7&789*):+$ (&;;17/(+,/&7 Sunday, April 6, 14 Postura este o adaptare la condi!iile mediului extern 8 BehavioraI modeI of posture BehavioraI modeI of posture BehavioraI modeI of posture ! !"#$%&' )# * +,-*.)/ 0'*&-'+ 1*$$'&- ! !"#$%&' )# *- *+*1$*$)"- $" $2' -''+# "3 )-$'&-*0 *-+ '4$'&-*0 '-5)&"-.'-$# ! !"#$%&' /*- 6' &'70'*&-'+ Sunday, April 6, 14 Sunday, April 6, 14 10 Sunday, April 6, 14 Controlul vizual al posturii prin lentile de corec!ie 11 CIinicaI evidence of the Iink between Vision, Posture and BaIance CIinicaI evidence CIinicaI evidence of the Iink between of the Iink between Vision, Posture and BaIance Vision, Posture and BaIance !"#$%&' )$ *)'+#, )$-+. -/01+2& 2"#$%&' )$ -0'.+/#, 0+.-+. 3"& &#')&'. #$1 4#'.&'. 5#6 )' 76 +')$% ,&$'&' #$1 -/)'8' CIinicaI evidence #5 CIinicaI evidence #5 CIinicaI evidence #5 ! !"#$%&'%#(% *&"+,(%- . /.0.#(% -1234 /.(56.&+ ! 72820.& +,&2#' 74&%--9 :"2#4 ;%42#"-("*< CIinicaI evidence #5 CIinicaI evidence #5 CIinicaI evidence #5 ! !"#$%&'%#(% *&"+,(%- . /.0.#(% -1234 /.(56.&+ ! 72820.& +,&2#' 74&%--9 :"2#4 ;%42#"-("*< Sunday, April 6, 14 12 The roIe of dentaI occIusion on vision focusing The roIe of dentaI occIusion on The roIe of dentaI occIusion on vision focusing vision focusing ! !"# %&'#(%')*+ *, -#+'%& *..&/0)*+ 1/0)+2 3%+-)4/&%( -#5).#06 .%+ )+-/.# 0*3# ,&/.'/%')*+0 )+ 5)0/%& ,*./0)+2 !"#$%"& () *)+")+) $%( !",$##)-& .//0 The roIe of dentaI occIusion on vision focusing The roIe of dentaI occIusion on The roIe of dentaI occIusion on vision focusing vision focusing ! !"# %&'#(%')*+ *, -#+'%& *..&/0)*+ 1/0)+2 3%+-)4/&%( -#5).#06 .%+ )+-/.# 0*3# ,&/.'/%')*+0 )+ 5)0/%& ,*./0)+2 !"#$%"& () *)+")+) $%( !",$##)-& .//0 The roIe of dentaI occIusion on vision focusing The roIe of dentaI occIusion on The roIe of dentaI occIusion on vision focusing vision focusing ! !"# %&'#(%')*+ *, -#+'%& *..&/0)*+ 1/0)+2 3%+-)4/&%( -#5).#06 .%+ )+-/.# 0*3# ,&/.'/%')*+0 )+ 5)0/%& ,*./0)+2 !"#$%"& () *)+")+) $%( !",$##)-& .//0 Cranio. 1998 Apr;16(2):109-18. Relationship between dental occlusion and visual focusing. Sharifi Milani R, Deville de Periere D, Micallef JP. Abstract The 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 = POZI!IONAREA ANTERIOAR" A CAPULUI ! CAUZEAZ! MODIFIC!RI ALE POZI"IEI DE POSTUR! ORTOSTATIC! A MANDIBULEI ! ALTER!RI ALE TRAIECTORIEI DE ÎNCHIDERE A GURII ! MODIFIC!RI ALE CONTACTULUI DENTAR INTERARCADIC INI"IAL LA ÎNCHIDERE ! " 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 ! EXTENSIA COLOANEI ACTIVITATEA MUSCULAR$ (MAS., TEMP.) RIDICAREA %I RETRUZIA MANDIBULEI ! FLEXIA COLOANEI ACTIVITATEA MUSCULAR$ (MAS., TEMP.) COBORÂRE %I RETRUZIE Sunday, April 6, 14 20 Proceedings of the 14 th Triennial Congress of the International Ergonomics Association. (2000, vol. 5, pp. 565-568). HEAD AND NECK POSTURE AT COMPUTER WORKSTATIONS – WHAT’S 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 C 2 and C 7 vertebrae 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 C 3 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 C 2 and C 7 vertebrae. The same procedures were conducted for the cephalometric measures, where the outlines of the C 3 and C 4 vertebrae and the hyoid bone were traced, along with the most anterior and inferior points of the C 3 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 C 3 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 11Æ0). As data were normally distributed, independent Student’s t-tests were carried out to investigate differences between groups for all outcome variables with a significance level of a < 0Æ05. Results Subject characteristics The TMJ group consisted of 17 subjects (16 women and one man), with a mean age of 23Æ47 Æ 3Æ59 years (ranging from 20 to 35), body mass of 57Æ27 Æ 7Æ64 kg (ranging from 44 to 77), height of 1Æ65 Æ 0Æ07 m (ranging from 1Æ52 to 1Æ87), and a body mass index of 20Æ92 Æ 1Æ41 kg m )2 (ranging from 18Æ87 to 23Æ67). The CG was made up of 17 gender- and age- matched participants with a mean age of 23Æ71 Æ 3Æ39 years (ranging from 21 to 36), body mass of 55Æ41 Æ 7Æ96 kg (ranging from 45 to 74), height of 1Æ63 Æ 0Æ08 m (ranging from 1Æ50 to 1Æ76), and a body mass index of 20Æ77 Æ 1Æ81 kg m )2 (ranging from 17Æ72 to 23Æ89). No significant differences were found between groups for any demographic parameter. Fig. 1. Measurement of cervical lordosis (reference value of 17° of lordosis). Fig. 2. Measurement of hyoid bone positioning (reference values of 3Æ6 cm for the horizontal and of 0Æ4 cm for the vertical distances between the hyoid bone and C 3 ). T MD, C E R V I C AL AL I GNME NT AND HY OI D P OS I T I ONI NG 769 ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 34; 767–772 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 C 2 and C 7 vertebrae 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 C 3 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 C 2 and C 7 vertebrae. The same procedures were conducted for the cephalometric measures, where the outlines of the C 3 and C 4 vertebrae and the hyoid bone were traced, along with the most anterior and inferior points of the C 3 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 C 3 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 11Æ0). As data were normally distributed, independent Student’s t-tests were carried out to investigate differences between groups for all outcome variables with a significance level of a < 0Æ05. Results Subject characteristics The TMJ group consisted of 17 subjects (16 women and one man), with a mean age of 23Æ47 Æ 3Æ59 years (ranging from 20 to 35), body mass of 57Æ27 Æ 7Æ64 kg (ranging from 44 to 77), height of 1Æ65 Æ 0Æ07 m (ranging from 1Æ52 to 1Æ87), and a body mass index of 20Æ92 Æ 1Æ41 kg m )2 (ranging from 18Æ87 to 23Æ67). The CG was made up of 17 gender- and age- matched participants with a mean age of 23Æ71 Æ 3Æ39 years (ranging from 21 to 36), body mass of 55Æ41 Æ 7Æ96 kg (ranging from 45 to 74), height of 1Æ63 Æ 0Æ08 m (ranging from 1Æ50 to 1Æ76), and a body mass index of 20Æ77 Æ 1Æ81 kg m )2 (ranging from 17Æ72 to 23Æ89). No significant differences were found between groups for any demographic parameter. Fig. 1. Measurement of cervical lordosis (reference value of 17° of lordosis). Fig. 2. Measurement of hyoid bone positioning (reference values of 3Æ6 cm for the horizontal and of 0Æ4 cm for the vertical distances between the hyoid bone and C 3 ). T MD, C E R V I C AL AL I GNME NT AND HY OI D P OS I T I ONI NG 769 ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 34; 767–772 Text M#surarea lordozei cervicale $i a pozi%iei 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 OFTALMOLOGIC TORTICOLLIS INTRINSEC CAUZELE DEFICITELOR POSTURALE : Intrinseci Dobandite Oculare Globale Sunday, April 6, 14 Implica!ii directe în protetica dentar" : • transferul în articulator al pozi!iei modelului superior; • determinarea planului de ocluzie • alterarea pozi!iei condililor mandibulari în 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 # ROMBERG # CYONAS, FUKUDA # REFLEXE POSTURALE LABIRINTICE # POSTUROMETRIA # EMG; EEG # EXAMINARE OFTALMOLOGICA Sunday, April 6, 14 LINIA GRAVITATIEI ( BARRE) : Din norm! lateral!: Linia gravita"ional! trece prin: a. Vertex. b. Inaintea mastoidei. c. Anterior de axa de flexie !i extensie a gâtului d.Intersecteaz" acromionul e. Corpul vertebrelor C1,C6,T11, L5, S1 ( trece posterior de axele de rota#ie a vertebrelor cervicale !i lombare !i anterior de cele toracale) f. Prin sau înaintea axului articula#iei !oldului g. Anterior de axa articula#iei genunchiului h. 5 cm anterior de maleol" Sunday, April 6, 14 70º 60º 45º Sunday, April 6, 14 40º 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 You for Your Attention Thank You Thank You for for Your Attention Your Attention !"#$ &"' $()"&$* + European Academv of Sports Jision www.easv.org Sunday, April 6, 14