• Balance is the ability to maintain the body’s

center of mass over its base of support.

• Functioning balance system :
– allows humans to see clearly while moving
– identify orientation with respect to gravity,
determine direction and speed of movement,
– and make automatic postural adjustments to
maintain posture and stability in various
conditions and activities.
 KESEIMBANGAN
• Aparatus vestibularis :
Organ sensoris yang mendeteksi sensasi
keseimbangan

• Yang mempertahankan keseimbangan :

– Vestibularis
– Penglihatan
– Propioseptif
– Eksteroseptif
 FISIOLOGI
• Informasi keseimbangan tubuh akan ditangkap
oleh reseptor vestibuler, visual dan
propioseptik.
• Dari ketiga jenis reseptor tersebut, reseptor
vestibuler yang punya kontribusi paling besar (
>50% ) disusul kemudian reseptor visual dan
yang paling kecil konstibusinya adalah
propioseptik.
 Physiology of Equilibrium
• Two types of equilibrium:
Static- maintenance of the body position
relative to the force of gravity.
Dynamic- maintenance of body position
(mainly head) in response to rotational
acceleration and deceleration.
• Receptors for equilibrium are hair cells in the
utricle, saccule and semicircular canals and
are collectively called vestibular apparatus.
Copyright 2009, John Wiley & Sons, Inc.
• Keseimbangan dibagi 2 macam:
– Keseimbangan statis /keseimbangan linier :
keseimbangan ini berhubungan dengan gerak kepala
dan badan yang tetap atau lurus. Co : menggerakan
kepala depan –belakang, bangun dari tempat tidur,
naik lift, naik turun tangga, loncat-loncat, berjalan dsb

– Keseimbangan dinamik :keseimbangan ini

berhubungan dengan pergerakan kepala dan badab
terhadap gerakan rotasi, co : kepala diputar
• Organ vestibuler terletak pada telinga dalam
• Terdiri atas :
– Urticulus
– Sacullus
– Canalis semisircularis

• Keseimbangan statis / linier : utriculus dan sacullus (vestibulum)

• Utricle is vertically oriented , untuk kecepaan horisontal
• Saccule is horizontally oriented , untuk kecepaan vertikal
Pada vestibulum terdapat reseptor keseimbangan yang disebut
makula, untuk memantau perubahan posisi / orientasi kepala
• Canalis semisircularis  Keseimbangan dinamis / rotasi
Terdapat tiga kanalis semisirkularis yang berhubungan dengan
tiga duktus semisirkularis. Masing-masing duktus ujungnya
melebar disebut ampula, yang berisi reseptor keseimbangan,
krista ampularis, berespons terhadap gerakan anguler (rotasi) dari
kepala
Keseimbangan statis

Neil R. Carlson, Physiology of Behaviour, 9th ed

Utricle
(a) Receptor unit
in utricle

Sherwood, Human
Physiology From
Cells to Systems, 6th
ed
Location and Structure of
Receptors in the Maculae

Copyright 2009, John Wiley & Sons, Inc.

 Physiology of Equilibrium
continued
• Tilting of the head forward→ sliding of the
otolithic membrane bending the hair
bundles→ receptor potential→ vestibular
branch of the vestibulocochlear nerve.

Copyright 2009, John Wiley & Sons, Inc.

Utricle
(b) Activation of the utricle by a change in head position
(c) Activation of the utricle by horizontal linear acceleration
Sherwood, Human Physiology From Cells to Systems, 6th ed
Keseimbangan dinamis

Neil R. Carlson,
Physiology of
Behaviour, 9th ed
Location and Structure of the
Semicircular Ducts

Copyright 2009, John Wiley & Sons, Inc.

 Hole, Human Anatomy & Physiology, 10th ed

Equilibrium. A.) When the head is stationary, the cupula of the crista ampullaris remains
upright. B.) When the head is moving rapidly, C.) the cupula bends opposite the motion of the
head, stimulating sensory receptors.
Sherwood, Human Physiology From Cells to Systems, 6th ed
 Activation of the hair cells in the semicircular canals

Sherwood, Human Physiology From Cells to Systems, 6th ed

 Semicircular Ducts
• Crista, a small elevation in the ampulla contain
hair cells and supporting cells.
• Cupula, a mass of gelatinous material covering
the crista.
• Head movement→ semicircular ducts and hair
cells move with it→ hair bundles bend→
receptor potential→ nerve impulses→
vestibular branch of the vestibulocochlear
nerve.
Copyright 2009, John Wiley & Sons, Inc.
Cupula in Still Position versus
Rotation

Copyright 2009, John Wiley & Sons, Inc.

• bila ada gerakan atau perubahan dari kepala
atau tubuh  perpindahan cairan endolimfe
di labirin  hair cells menekuk
• Tekukan hair sel  menyebabkan
permeabilitas membran sel berubah sehingga
ion Kalsium menerobos masuk kedalam sel
(influx)
• Influx Ca  menyebabkan depolarisasi dan
juga merangsang pelepasan NT eksitator
(glutamat)  saraf aferen (vestibularis) 
pusat-pusat keseimbangan di otak .
Struktur Organ Sensoris lain Yang Membantu
Keseimbangan
• Keseimbangan kerjasama dari mata, otot, dan alat
keseimbangan
• Mata menyampaikan pesan apakah kita berdiri tegak atau
miring
• Otot menyampaikan pesan mengenai posisi badan dan
anggota badan

• Visual info is important. Even if organs of equilibrium are

damaged, a person may be able to maintain normal balance
(eyes open and move slowly)
 Systems regulating body balance

There are three components that regulate body balance

1. Senses from the environment

2. Summation and coordination of senses in the CNS
3. Motor commands to muscle regulation of body balance
• Otolit sakulus dan utrikulus; bergerak oleh perubahan posisi
kepala
•
Rangsangan ditransmisikan sepanjang serat saraf nervus
kranialis kedelapan ( auditorius) pars vestibularis ke otak
tengah , medulla oblongata, serebelum , dan medulla spinalis.
• Rangsangan ini memulai perubahan refleks pada otot-otot
leher , mata, badan, dan ekstremitas untuk mempertahankan
keseimbangan dan postur dan mata dapat difiksasi pada objek
yang bergerak.
• Pusat Integrasi alat keseimbangan tubuh pertama di
inti vestibularis (menerima impuls aferen dari
propioseptik, visual dan vestibuler)

• Serebellum merupakan pusat integrasi kedua juga

pusat komparasi informasi yang sedang berlangsung
dengan informasi gerakan yang sudah lewat

• informasi tentang gerakan juga tersimpan di pusat

memori prefrontal korteks serebri
Gambar jaras vestibular
 Primary Reflexes of the Vestibular System

• Vestibulo-Ocular Reflex • Vestibulo-Spinal Reflex

– Maintains eye stability – Maintains the stability
during angular movement of the torso over your
of head lower extremities
• Otolith-Ocular Reflex through various tracts
– Maintains eye stability - sends information
during linear movement of regarding gravity
head
and linear
• Vestibulo-Colic Reflex acceleration to
– Maintains stability of head body muscles
on shoulders
1. The VOR is ultimately driven by signals from
the vestibular apparatus in the inner ear.
2. The semicircular canals detect head rotation
and drive the rotational VOR, whereas the
otoliths detect head translation and drive the
translational VOR.
3. It starts in the vestibular system, where
semicircular canals get activated by head
rotation and send their impulses via the
vestibular nerve (cranial nerve VIII) through
Scarpa's ganglion and end in the vestibular
nuclei in the brainstem.
4. From these nuclei, fibers cross to the
contralateral cranial nerve VI nucleus
(abducens nucleus). There they synapse with
2 additional pathways. One pathway projects
directly to the lateral rectus of eye via the
abducens nerve. Another nerve tract projects
from the abducens nucleus by the medial
longitudinal fasciculus to the contralateral
oculomotor nucleus, which contains
motorneurons that drive eye muscle activity,
specifically activating the medial rectus
muscle of the eye through the oculomotor
nerve.
1. if the head is turned clockwise as seen from
above, then excitatory impulses are sent
from the semicircular canal on the right side
via the vestibular nerve (cranial nerve VIII)
through Scarpa's ganglion and end in the
right vestibular nuclei in the brainstem.
2. From this nuclei excitatory fibers cross to the
left abducens nucleus. There they project
and stimulate the lateral rectus of the left
eye via the abducens nerve. In addition, by
the medial longitudinal fasciculus and
oculomotor nuclei, they activate the medial
rectus muscles on the right eye.
3. As a result, both eyes will turn
counterclockwise. some neurons from the
right vestibular nucleus directly stimulate the
right medial rectus motoneurons, and
inhibits the right abducens nucleus.