GROWN-UPS & KIDS PRIMARY CARETM
Alan R. Vinitsky, M.D.
Letitia W. Short, M.D.
Autonomic Nervous System Monitoring
ANSAR'S non-invasive Autonomic Nervous System Monitoring is good for people with:
Your Autonomic Nervous Syestem
Your nervous system is comprised of three parts: your somatic (sensory) nervous system, your motor nervous system, and your autonomic nervous system (ANS). Your ANS is that part of your nervous system which functions to sustain your life by helping control your heart, lungs, digsetive system, blood pressure, immune system, ceratin of your reflexes (like coughing and gagging), fluid balance, pupil diameter, sweating, and sexual function.
Your ANS has two parts
There are two parts, or branches, to your ANS: the sympathetic branch and the parasympathetic branch. Generally, the sympathetic branch is more in control when you are stressed, nervous, or excited, while the parasympathetic branch is more in control when you are relaxing, sleeping, or recovering from an illness or injury.
A balance between the two branches of your ANS is essential for good health. In fact, most illnesses and injuries cause or result from an imbalance between these two branches. An imbalance in your ANS can tell your doctor many things about how healthy you are as well as what can be done to keep you as healthy as possible.
What is ANS monitoring?
Autonomic nervous system monitoring is a fast, non-invasive, and simple way to provide your doctor with information to help him or her determine how healthy you are. Monitoring your ANS, when measured frequently like your blood pressure and heart rate, can help your docotr keep you healthy. Information is collected from an easy, painless test that can be done in your doctor's office or in a hospital.
What is non-invasive?
The ANS monitoring test is non-invasive. This means that there are no needle or probes or anything else that needs to enter your body. The test is completely painless, and for most it is relaxing.
What is being monitored?
ANS monitoring records your heart rate variability and respiratory activity. Blood pressure readings are also taken. Your heart rate variability and respiratory activity are analyzed by a computer to determine how your ANS is controlling your heart and your lungs and other parts of your body. Your physician then interprets your results produced by the computer.
What is heart rate variability?
Heart rate variability (HRV) is a measure of your heart's ability to quickly respond to changes in your level of activity. Moderate variability is healthy. Too much or too little is unhealthy. ANS monitoring using HRV can provide your doctor with infomation that cannot be seen using other measures, for example on an EKG recording.
Why is including respiratory activity important?
Analyzing your respiratory activity along with your HRV is the key to monitoring the balance between the two branches of your autonomic nervous system.
Why is ANS monitoring important?
Everyone is different, and so is their autonomic nervous system. How an individual responds to disease, injury, medicines, and medical treatment largely depends on her or his ANS. By monitoring your ANS, your doctor can determine whether she or he is doing enough to keep you healthy. In this way, your doctor can better care for you and better maintain your well-being.
Who should be monitored?
Everyone from newborns to older adults can and should have their ANS monitored. Frequent monitoring, when indicated, helps your doctor better maintain your health & well-being and tailor treatments, including medications, specifically for you.
THE CLINICAL EXAM
The ANS exam is a simple test that is preformed in your doctor's office. You can take the test even if you have an implanted pacemaker or defibrillator.
A nurse or technician applies two or three small, painless pads (called leads) to your chest and places a blood pressure cuff on your left arm. The computer will measure your heart rate variability and respiratory activity. Most of the test is taken while you are seated comfortably in a chair. The entire test takes less than 30 minutes.
The exam includes several parts. It monitors you while you are relaxed, while you are breathing deeply, while you are straining(this is called a valsalva maneuver), and while you are standing. A nurse or technician will guide you through the test.
YOUR TEST RESULTS
ECG and blood pressure monitors are connected to a computer. The computer analyzes the data from these two monitors. and computes your test results in digital fashion (that is, three numbers). These numbers help your doctor understand your autonomic nervous system and its role in your health. One number represents your entire autonomic nervous system, one number respresents the sympathetic branch of your ANS, while the third number represents the parasympathetic branch of your ANS.
How these number change during the different parts of the test and how they change over time as you grow and age provides your doctor with information she or he needs to keep you as healthy as possible.
The computer will prepare a report for your doctor, who will discuss the results with you.
VNG testing is used to determine if a vestibular (inner ear) disease may be causing a balance or dizziness problem, and is one of the only tests available today that can decipher between a unilateral (one ear) and bilateral (both ears) vestibular loss.
This test also addresses the functionality of each ear and if a vestibular deficit may be the cause of a dizziness or balance problem.
VNG is used to evaluate patients with dizziness, vertigo, or balance dysfunction. The inner ear and eyes movements are connected through the vestibulo-ocular reflex. The vestibular system monitors the position and movements of the head in order to stabilize retinal images on the eye. In this test, eye movements are recorded, and give information about the central and peripheral balance system. It provides an objective assessment of the oculomotor and vestibular systems. VNG testing consists of three parts: oculomotor evaluation, positioning/positional testing, and caloric stimulation of the vestibular system
Posturography is also very useful in determining a baseline for vestibular rehabilitation therapy and in designing an individual program. By assessing what types of balance strategies are used to balance yourself our vestibular rehab therapist can better choose the types of exercises needed to expedite recovery. Once balance therapy is initiated, posturography testing can be used to assess the patient’s progress by comparing post-therapy testing to the baseline evaluation.
The posturography is a 20 minute computerized clinical test used to assess balance function. There are 3 components that we use to balance ourselves. These include the muscles and nerves in our legs (somatosensory system), our inner ear of balance (vestibular system), and our vision. The balance test isolates each one of these to assess where the deficit, if any, may be. The test also evaluates the autonomic motor system’s ability to recover after sudden unexpected movements.
There are different aspects of the balance system, which can malfunction. In some people, the problem is an irreversible injury to the nerves, which serve as the “gyroscope” of the inner ear, called the vestibular system. Fortunately, the brain has a remarkable ability to recognize when one of the vestibular systems is not working correctly. At first a person with a vestibular “weakness”, or vestibulopathy, feels disoriented and maybe sick to the stomach. With time the brain usually learns to disregard this faulty information. In other words, the brain “compensates” for the problem
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