diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/--NSL4WI0xw.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/--NSL4WI0xw.srt new file mode 100644 index 0000000000000000000000000000000000000000..b382991ca0b15fcf5e25bd5c6d2be9e2d5e1d81b --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/--NSL4WI0xw.srt @@ -0,0 +1,1026 @@ +1 +00:00:00,910 --> 00:00:05,590 +بسم الله الرحمن الرحيم، بنواصل مع محاضرات حوال واحد + +2 +00:00:05,590 --> 00:00:10,030 +واتوقفنا المرة الماضية أو أنهينا المرة الماضية + +3 +00:00:10,030 --> 00:00:13,110 +موضوعين الـ suppression والـ abnormal retinal + +4 +00:00:13,110 --> 00:00:18,350 +correspondence حكينا أنه اليوم هنحكي عن وسائل فحص + +5 +00:00:18,350 --> 00:00:21,310 +الـ suppression، وسائل فحص الـ suppression يعني كيف + +6 +00:00:21,310 --> 00:00:23,990 +.. كيف أفحص أنه المريض عنده suppression ولا + +7 +00:00:23,990 --> 00:00:29,110 +ماعندهش suppression عشان نعرف لازم نتأكد إنه كل عين + +8 +00:00:29,110 --> 00:00:32,930 +في نفس اللحظة التقطت صورة .. التقطت صورة عشان أعرف + +9 +00:00:32,930 --> 00:00:36,230 +إنه العينين شغالين ومافيش في واحدة منهم + +10 +00:00:36,230 --> 00:00:40,750 +suppression، لازم أتأكد إنه كل عين التقطت صورة + +11 +00:00:40,750 --> 00:00:47,560 +بمعنى آخر لو أنا يعني سؤلت أني أفحص شخص وأشوف إذا + +12 +00:00:47,560 --> 00:00:52,860 +فيه عنده suppression في عين دون عين، فبدي أنا أتأكد + +13 +00:00:52,860 --> 00:00:58,820 +من أن كل عين شغالة، لازم تعرض صورة مختلفة لكل عين + +14 +00:00:58,820 --> 00:01:02,900 +.. صورة مختلفة لكل عين، يعني لو إجيت أنا خلت هذا + +15 +00:01:02,900 --> 00:01:07,120 +الشخص يطلع مثلا على target زي الشمعة، لو عندي شمعة + +16 +00:01:07,120 --> 00:01:11,660 +وقلت له اتطلع على الشمعة بعينيك التنتين، ممكن في + +17 +00:01:11,660 --> 00:01:13,960 +نفس اللحظة اللي هو بتطلع على الشمعة في عينيه + +18 +00:01:13,960 --> 00:01:18,160 +التنتين، في حقيقة الأمر هو شايف أو الدماغ بيستجيب + +19 +00:01:18,160 --> 00:01:21,800 +الصورة .. صورة الشمعة من عين واحدة، والعين + +20 +00:01:21,800 --> 00:01:24,520 +التانية في وضع suppression، مش هقدر أعرف بهذه + +21 +00:01:24,520 --> 00:01:29,580 +الطريقة، طيب كيف أعرف؟ لازم أنا أقدم لكل عين على + +22 +00:01:29,580 --> 00:01:33,820 +حده صورة مختلفة، عشان أعمل هذه القضية لازم أستعمل + +23 +00:01:33,820 --> 00:01:39,830 +وسائل أو أجهزة أو أدوات تفصل بين العينين في طلاق + +24 +00:01:39,830 --> 00:01:46,130 +الصورة، هذه الأدوات تسمى haploscopic devices، نكتب + +25 +00:01:46,130 --> 00:01:46,770 +الكلمة + +26 +00:01:55,730 --> 00:02:00,970 +haploscopic devices، بمعنى آخر أي أداة بستخدمها أو + +27 +00:02:00,970 --> 00:02:06,770 +أي جهاز بستخدمه وبلاقي مكتوب عليه أو أي حد + +28 +00:02:06,770 --> 00:02:10,890 +بيشرح لي عنه إنه هذا haploscopic device يعني أداة + +29 +00:02:10,890 --> 00:02:15,490 +بتشتغل على فكرة الـ haploscopic، إيش هي فكرة الـ + +30 +00:02:15,490 --> 00:02:19,150 +haploscopic؟ الـ haploscopic إن أفصل بين العينين في + +31 +00:02:19,150 --> 00:02:23,150 +الصورة، شايفين المنظر هذا العين اليمين بتطلع في + +32 +00:02:23,150 --> 00:02:27,210 +أنبوبة، طبعا في عدسة هنا وهنا في عندي صورة، عندي + +33 +00:02:27,210 --> 00:02:32,670 +صورة هنا، هذه الصورة في وراها مصدر ضوء بيضوي على + +34 +00:02:32,670 --> 00:02:38,510 +الصورة، في هنا بالظبط في داخل الأنبوب الأسود في + +35 +00:02:38,510 --> 00:02:43,870 +مراية، بتيجي الصورة على مراية وبتنعكس باتجاه عين + +36 +00:02:43,870 --> 00:02:47,810 +اليمين للمريض أو للطفل زي ما احنا شايفين، نفس + +37 +00:02:47,810 --> 00:02:52,470 +القضية في على الناحية التانية نفس هذه القطعة بس + +38 +00:02:52,470 --> 00:02:56,490 +للعين الشمال .. للعين الشمال، بتنحط فيها صورة أخرى، + +39 +00:02:56,490 --> 00:03:00,290 +الآن هذا الـ .. الـ .. الجهاز بيسموه sinoptophore أو + +40 +00:03:00,290 --> 00:03:03,070 +إله اسم تاني الـ amblyoscope .. الـ amblyoscope + +41 +00:03:03,070 --> 00:03:08,770 +sinoptophore هو الاسم الدارج، في اسم أقدم منه اسم + +42 +00:03:08,770 --> 00:03:12,370 +الـ amblyoscope .. الـ amblyoscope هذا يعتبر + +43 +00:03:12,370 --> 00:03:16,290 +haploscopic device ليش؟ لأنه بيفصل بين العينين، إنه + +44 +00:03:16,290 --> 00:03:20,290 +بيقدم للعين اليمين صورة وبيقدم للعين الشمال صورة + +45 +00:03:20,290 --> 00:03:24,070 +أخرى، على سبيل المثال الشرائح اللي بتوضع في جهاز + +46 +00:03:24,070 --> 00:03:28,170 +الـ synaptophore ممكن توضع أمام العين اليمين شريحة + +47 +00:03:28,170 --> 00:03:33,960 +فيها صورة الأسد، وتوضع أمام العين الشمال شريحة فوق + +48 +00:03:33,960 --> 00:03:38,540 +.. يعني فيها القفص خالي من الأسد، مافيش فيه، يعني + +49 +00:03:38,540 --> 00:03:41,960 +هذه صورة وهذه صورة تختلف عنها تماما، تختلف عنها + +50 +00:03:41,960 --> 00:03:45,520 +تمامًا، فلو قلنا له المريض أو لهذا الطفل اللي جالس + +51 +00:03:45,520 --> 00:03:49,400 +وحط عينيه أمام الـ Sinoptophore، لو قلنا غمض عينك + +52 +00:03:49,400 --> 00:03:53,820 +لشمال، هيشوف فقط شريحة واحدة اللي هي مثلا الأسد، + +53 +00:03:53,820 --> 00:03:57,140 +لو قلنا له غمض عينك اليمين وافتح عينك لشمال، هيشوف + +54 +00:03:57,140 --> 00:04:01,550 +الشريحة الأخرى، الآن كيف نختبر أنه عنده binocular + +55 +00:04:01,550 --> 00:04:04,570 +single vision أو كيف نختبر عنده أنه فيه + +56 +00:04:04,570 --> 00:04:07,830 +simultaneous perception، إن عينيه التنتين قادرين + +57 +00:04:07,830 --> 00:04:11,650 +على الالتقاط في نفس الوقت وإن الدماغ بيستجيب + +58 +00:04:11,650 --> 00:04:16,070 +صورتين، لما بقول له افتح عينيك التنتين، إذا شاف صورتين + +59 +00:04:16,070 --> 00:04:20,250 +مع بعض، بمعنى آخر شاف الأسد داخل القفص أو حتى لو مش + +60 +00:04:20,250 --> 00:04:24,280 +داخل القفص المهم أنه شاف شاف الصورتين في نفس اللحظة، + +61 +00:04:24,280 --> 00:04:27,440 +صورة القفص وصورة الأسد بعرف إنه عينيه التنتين في + +62 +00:04:27,440 --> 00:04:31,380 +نفس اللحظة شغالين وبيكون مافيش عندي suppression .. + +63 +00:04:31,380 --> 00:04:37,360 +بيكون مافيش عندي suppression، إذا إحدى وسائل اللي هو + +64 +00:04:37,360 --> 00:04:41,060 +اختبار الـ suppression أني أستعمل جهاز الـ sine of + +65 +00:04:41,060 --> 00:04:45,140 +four وأضع slides مختلفة، هذا بيسموه slide وهذا + +66 +00:04:45,140 --> 00:04:49,040 +بيسموه slide، طبعًا ممكن إنسان يقول طب ضروري يشوف + +67 +00:04:49,040 --> 00:04:54,080 +الأسد داخل القفص، هو المطلوب إنه يشوف الأسد داخل + +68 +00:04:54,080 --> 00:04:57,740 +القفص، بس إذا ما شافوش .. شافوه خارج القفص بسبب + +69 +00:04:57,740 --> 00:05:02,640 +وجود سبب معين زي الـ squint زي الحول، فبالتالي .. + +70 +00:05:02,640 --> 00:05:06,440 +فبالتالي بيكون عندي simultaneous perception، أهم + +71 +00:05:06,440 --> 00:05:11,140 +نقطة في إني أعرف إنه مافيش suppression وبأكد أهم نقطة + +72 +00:05:11,140 --> 00:05:13,760 +في إني أعرف إنه مافيش suppression عند هذا الطفل أو + +73 +00:05:13,760 --> 00:05:17,620 +هذا المريض، إنه يشوف الصورتين المختلفتين في نفس + +74 +00:05:17,620 --> 00:05:21,960 +اللحظة، في نفس اللحظة، فساعتها أنا بتأكد إنه هذا + +75 +00:05:21,960 --> 00:05:26,160 +الطفل أو هذا المريض ماعندهوش suppression، طيب لو + +76 +00:05:26,160 --> 00:05:30,500 +قلنا مثلا حطينا slide الأسد قدام العين اليمين و + +77 +00:05:30,500 --> 00:05:33,520 +slide القفص، طبعا في slides أخرى كتيرة بس احنا هنا + +78 +00:05:33,520 --> 00:05:37,440 +المثال عنا اللي أنا أوردته هو الأسد والقفص، لو احنا + +79 +00:05:37,440 --> 00:05:41,100 +حطينا صورة الأسد أمام العين اليمين وصورة القفص + +80 +00:05:41,100 --> 00:05:45,640 +أمام العين الشمال، وشاف صورة القفص فقط وهم فتح + +81 +00:05:45,640 --> 00:05:48,740 +عينه التنتين باعرف إنه في عنده right suppression + +82 +00:05:48,740 --> 00:05:52,060 +ليش right suppression؟ right eye suppression لأن + +83 +00:05:52,060 --> 00:05:56,620 +الـ .. الـ .. الأسد اللي هو هذه الصورة مقابل العين + +84 +00:05:56,620 --> 00:05:59,320 +اليمين وبتقدر تشوفها العين اليمين بس وهم فتح + +85 +00:05:59,320 --> 00:06:03,040 +عينه التنتين ما شافش إلا القفص وهم فتح عينه + +86 +00:06:03,040 --> 00:06:06,330 +التنتين، بس نتج إنه فقط العين الشمال اللي هي + +87 +00:06:06,330 --> 00:06:10,230 +بتستقبل أو الدماغ بيسمح لصورتها إنها توصل إليه + +88 +00:06:10,230 --> 00:06:14,690 +وبيستقبلها، بينما صورة الأسد اللي هي التقطتها العين + +89 +00:06:14,690 --> 00:06:17,810 +اليمين بيصير لها suppression، يعني الدماغ بيرفض + +90 +00:06:17,810 --> 00:06:22,210 +استقبالها، لو هذا المريض شاف الأسد فقط دون القفص + +91 +00:06:22,210 --> 00:06:26,170 +عنده ساعتها left suppression، left suppression، وهيك + +92 +00:06:26,170 --> 00:06:30,190 +بكون أنا اختبرت إذا في suppression ولا لا وحددت أي + +93 +00:06:30,190 --> 00:06:34,840 +عين اللي فيها الـ suppression، أحيانا أحيانا ممكن + +94 +00:06:34,840 --> 00:06:38,020 +يشوف صورة الأسد مرة، واللحظة اللي بعديها يشوف صورة + +95 +00:06:38,020 --> 00:06:42,240 +القفص، بعدين يرجع يشوف صورة الأسد، بعدين يرجع يشوف + +96 +00:06:42,240 --> 00:06:46,680 +صورة القفص وهكذا، هذا ساعتها لما مرة بيشوف هاي و + +97 +00:06:46,680 --> 00:06:50,100 +مرة بيشوف هاي، بنقول عنده alternating suppression + +98 +00:06:50,100 --> 00:06:54,120 +.. alternating suppression، ماننساش أنه من ضمن الـ + +99 +00:06:54,120 --> 00:06:56,820 +classification أو أنواع الـ suppression فيه + +100 +00:06:56,820 --> 00:07:00,050 +molecular مركز في عين واحدة مثلا right suppression + +101 +00:07:00,050 --> 00:07:02,390 +أو left suppression، وبيضل right suppression أو + +102 +00:07:02,390 --> 00:07:05,810 +بيضل left suppression، بتغيرش، بس في عندي حاجة + +103 +00:07:05,810 --> 00:07:09,210 +اسمها alternating suppression، يعني بسأل المريض + +104 +00:07:09,210 --> 00:07:15,300 +إيش شايف؟ والله أنا شايف مرة بشوف الأسد بعدين بختفي + +105 +00:07:15,300 --> 00:07:19,200 +وفي لحظة اختفاء الأسد بشوف القفص، وفي لحظة مباراة + +106 +00:07:19,200 --> 00:07:22,100 +الأسد بختفي القفص، يعني بشوفهم مش مع بعض في نفس + +107 +00:07:22,100 --> 00:07:26,760 +اللحظة، لأنه لو شافهم مع بعض في نفس اللحظة معناته + +108 +00:07:26,760 --> 00:07:29,960 +مافيش عندي أنا suppression .. مافيش عندي أنا suppression + +109 +00:07:29,960 --> 00:07:35,620 +..الآن هذه الـ .. يعني رسمة تمثلية كيف .. كيف الـ + +110 +00:07:35,620 --> 00:07:38,160 +synaptophore بيشتغل؟ الـ synaptophore عبارة عن + +111 +00:07:38,160 --> 00:07:44,330 +أنبوبة متنية بشكل عمودي، هي الأنبوبة وفي انثناء + +112 +00:07:44,330 --> 00:07:47,310 +عمودي فيها وهاي أنبوبة تانية فيها انثناء عمودي + +113 +00:07:47,310 --> 00:07:52,230 +هنا في المريض بده يحط عينيه تنتين أو يتطلع من .. + +114 +00:07:52,230 --> 00:07:55,850 +في كل عين ده يتطلع في أنبوبة، كيف بده يشوف الصورة؟ + +115 +00:07:55,850 --> 00:08:00,090 +الصورة في slide carrier، حامل للسلايدات، حامل + +116 +00:08:00,090 --> 00:08:05,330 +للشرائح، خلفه مصدر ضوء بيضوي على الـ slide أو على + +117 +00:08:05,330 --> 00:08:09,730 +الرسمة زي رسمة الأسد أو السيارة أو الكراج أو القفص + +118 +00:08:09,730 --> 00:08:13,050 +أو .. فيها يعني رسومات كتيرة، هذه الصورة تحمل إلى + +119 +00:08:13,050 --> 00:08:16,130 +المراية هنا في مراية، المراية جاية في الـ .. في + +120 +00:08:16,130 --> 00:08:21,090 +الزاوية بتاعة الأنبوبة فبتنعكس .. بتنعكس .. بتبين + +121 +00:08:21,090 --> 00:08:24,110 +كأنها جاية من عند النقطة هاي، بتبين .. يعني .. يعني + +122 +00:08:24,110 --> 00:08:29,120 +بتبين الصورة داخل المراية، طبعا هو هيشوف الصورة في + +123 +00:08:29,120 --> 00:08:31,760 +العين اليمين ويشوف صورة بتختلف عنها في العين + +124 +00:08:31,760 --> 00:08:35,560 +الشمال، ومفروض إذا الـ two fovea ليهم نفس الاتجاه + +125 +00:08:35,560 --> 00:08:38,600 +الصورتين يكونوا في نفس المكان، بمعنى الأسد ينشاف + +126 +00:08:38,600 --> 00:08:43,280 +داخل القفص، الأسد ينشاف داخل القفص وساعتها .. + +127 +00:08:43,280 --> 00:08:47,980 +ساعة بنقول إنه هذا عنده simultaneous perception + +128 +00:08:47,980 --> 00:08:51,320 +simultaneous perception، فهذه فكرة عمل الـ sign of + +129 +00:08:51,320 --> 00:08:55,170 +the four اللي اتفجنا إنها عبارة عن haploscopic + +130 +00:08:55,170 --> 00:08:59,970 +device، أيضًا من الـ haploscopic devices الباجوليني + +131 +00:08:59,970 --> 00:09:06,230 +striated glasses، الباجوليني striated glasses بدنا + +132 +00:09:06,230 --> 00:09:10,410 +يعني نوضح أشياء الباجوليني striated glasses برسمة + +133 +00:09:27,340 --> 00:09:34,100 +الباجوليني striated glasses عبارة عن .. عن glasses + +134 +00:09:34,100 --> 00:09:39,800 +عادية فيها striation، فيها يعني فرزات وكأنه .. + +135 +00:09:39,800 --> 00:09:43,080 +وكأنه أنا ماسك الـ Maddox rod، يعني على فكرة بينفع + +136 +00:09:43,080 --> 00:09:46,400 +أنه نعمل الـ test هذا باستخدام الـ Maddox rod، إذا + +137 +00:09:46,400 --> 00:09:50,910 +ملاحظين الـ striation هنا ميلة بزاوية خمسة وأربعين + +138 +00:09:50,910 --> 00:09:55,570 +درجة، والـ striation أمام العين التانية ميلة بزاوية + +139 +00:09:55,570 --> 00:09:59,290 +مية وخمسة وتلاتين درجة، فبالتالي خلينا احنا ناخد + +140 +00:09:59,290 --> 00:10:03,870 +الصورة هاي ننجلها للـ power point هنا + +141 +00:10:33,740 --> 00:10:42,680 +نقول كالعادي المريض + +142 +00:10:42,680 --> 00:10:47,590 +بده يرتدي الباجوليني striated glasses وأنا بس بدي + +143 +00:10:47,590 --> 00:10:52,930 +أ .. امسك الـ pin torch ضوء صغير وأوجهه باتجاه + +144 +00:10:52,930 --> 00:10:58,510 +عيني المريض وأعمل الـ test، طبعًا إيش فايدة + +145 +00:10:58,510 --> 00:11:02,450 +illustration هذه التعريجات البسيطة وكأنه لابس + +146 +00:11:02,450 --> 00:11:06,640 +كل تعريجة كأنها عبارة عن cylindrical lens، يعني هنا + +147 +00:11:06,640 --> 00:11:09,120 +عندي بيه cylindrical lens كمان cylindrical lens + +148 +00:11:09,120 --> 00:11:12,020 +كمان cylindrical lens، هدى الـ striation وظيفتها + +149 +00:11:12,020 --> 00:11:15,300 +تحول الـ point source of light، اتحوله لـ streak + +150 +00:11:15,300 --> 00:11:19,540 +يعني أنا اللي هضويه على عين المريض point source of + +151 +00:11:19,540 --> 00:11:24,190 +light، point source of light يعني مصدر صغير للضوء، + +152 +00:11:24,190 --> 00:11:27,110 +pen torch أو شيء من هذا القبيل، هذا اللي حدوي، بس + +153 +00:11:27,110 --> 00:11:30,130 +اللي هيشوفه المريض عبارة عن خط مضيق، ليش؟ هو أنا + +154 +00:11:30,130 --> 00:11:37,490 +بودي نقطة مضيقة أو ضوء laser أو pen torch، يعني جلم + +155 +00:11:37,490 --> 00:11:42,760 +مضيق، فاتحول لخط مضيق، بسبب هذه الـ striation، طيب، + +156 +00:11:42,760 --> 00:11:45,760 +الآن السؤال التاني، ليش الـ striation هنا ميلة على + +157 +00:11:45,760 --> 00:11:49,320 +خمسة وأربعين وهنا ميلة على خمسة و .. مية وخمسة + +158 +00:11:49,320 --> 00:11:53,600 +وتلاتين، يعني بينهم تسعين درجة؟ طبعًا كل .. كل + +159 +00:11:53,600 --> 00:11:58,400 +عين هتشوف خط مائل، هذه هتشوف خط مائل، وهذه خط + +160 +00:11:58,400 --> 00:12:02,620 +مائل، اتجاه الخط المائل دائما وأبدا، هيكون عمودي + +161 +00:12:02,620 --> 00:12:05,760 +على اتجاه الـ striation، يعني هنا الـ striation + +162 +00:12:05,760 --> 00:12:10,890 +ميلة .. ميلة على خمسة وأربعين درجة، لما بضوي point + +163 +00:12:10,890 --> 00:12:15,930 +source of light، المريض حيشوف بعينه الشمال خط + +164 +00:12:15,930 --> 00:12:23,190 +بالشكل هذا .. خط بالشكل هذا حيشوف + +165 +00:12:23,190 --> 00:12:28,470 +المريض بالشكل هذا الخط ليش؟ + +166 +00:12:28,470 --> 00:12:32,790 +لأنه دائما اتجاه الخط اللي بتراه العين عمودي على + +167 +00:12:32,790 --> 00:12:41,360 +اتجاه illustration، وبالنسبة للعين التانية طالما + +168 +00:12:41,360 --> 00:12:44,800 +ما يلان الـ striation على مية وخمسة وتلاتين، إذا + +169 +00:12:44,800 --> 00:12:49,320 +الخط هينشاف على خمسة وأربعين، على خمسة وأربعين، طب + +170 +00:12:49,320 --> 00:12:53,000 +هو عبارة عن إيش الخط؟ الخط هذا والخط هذا صورة + +171 +00:12:53,000 --> 00:12:56,720 +النقطة اللي أنا ضويتها قدام العينين، هو target واحد + +172 +00:12:56,720 --> 00:13:02,300 +هو target واحد بس حولته لصورتين مختلفتين باستعمال + +173 +00:13:02,300 --> 00:13:05,880 +الباجوليني striated glasses، طبعًا ممكن السيد يقول لأ + +174 +00:13:05,880 --> 00:13:09,400 +هذا .. هذا العين الشمال بتشوف خط والعين اليمين + +175 +00:13:09,400 --> 00:13:1 + +201 +00:14:59,370 --> 00:15:03,690 +وماشافش الخط الآخر .. ماشافش الخط الآخر معناته + +202 +00:15:03,690 --> 00:15:08,470 +الخط الآخر مين المفروض تشوفه؟ ميلانه على مية و + +203 +00:15:08,470 --> 00:15:11,270 +خمسة و ثلاثين هو العين الشمال .. الشمال المفروض + +204 +00:15:11,270 --> 00:15:14,370 +تشوفه، إذا في عندي left suppression .. إذا في عندي + +205 +00:15:14,370 --> 00:15:20,190 +left suppression، هو شاف الخط هذا وماشافش الخط هذا + +206 +00:15:20,190 --> 00:15:23,750 +فبالتالي عنده left suppression طيب نفرض العكس هو + +207 +00:15:23,750 --> 00:15:27,310 +شاف الخط هذا وماشافش الخط العمودي عليه إذا في عندي + +208 +00:15:27,310 --> 00:15:30,570 +right suppression عندي right suppression طيب الآن + +209 +00:15:30,570 --> 00:15:35,650 +بدنا نطلع على المنظر هذا احنا لازلنا بنحكي عن ال + +210 +00:15:35,650 --> 00:15:39,150 +suppression هو المفروض يشوف خط كامل متقاطع مع خط + +211 +00:15:39,150 --> 00:15:44,130 +كامل متقاطع مع خط كامل عشان أقول ماعندهوش + +212 +00:15:44,130 --> 00:15:48,190 +suppression طيب شاف الخط هذاهذا الخط مين اللي + +213 +00:15:48,190 --> 00:15:52,490 +بتشوفه؟ العين الشمال إذا العين الشمال شغالة طيب + +214 +00:15:52,490 --> 00:15:56,490 +الخط الثاني .. الخط الثاني بتشوفه العين اليمين بس + +215 +00:15:56,490 --> 00:16:00,550 +في عندي هنا ملاحظة أن الخط الثاني فيه في نصه فراغة + +216 +00:16:00,550 --> 00:16:06,450 +فيه في نصه فراغة وكأنه استقبل الخط الثاني بس في + +217 +00:16:06,450 --> 00:16:10,610 +النص مستقبلش النص عجبالي الفوفيا بالظبط هذا الشخص + +218 +00:16:10,610 --> 00:16:16,520 +عنده right أن هذا لل right central suppression is + +219 +00:16:16,520 --> 00:16:20,200 +كتومة يعني في عنده central suppression طيب هل في + +220 +00:16:20,200 --> 00:16:22,640 +حاجة اسمها central suppression؟ طبعا في حاجة اسمها + +221 +00:16:22,640 --> 00:16:25,320 +central suppression احنا قولنا ال separation يقسم + +222 +00:16:25,320 --> 00:16:29,300 +ل peripheral central و peripheral central و + +223 +00:16:29,300 --> 00:16:32,680 +peripheral و أن ال central عشان مايصيرش عندي + +224 +00:16:32,680 --> 00:16:36,360 +confusion ال central suppression ال central + +225 +00:16:36,360 --> 00:16:40,940 +suppression بيخلصني من ال confusion ال confusion + +226 +00:16:40,940 --> 00:16:46,020 +تمام فبالتالي central suppression in central + +227 +00:16:46,020 --> 00:16:48,460 +suppression the image from the fovea of the + +228 +00:16:48,460 --> 00:16:52,480 +deviating eye is inhibited to avoid confusion عشان + +229 +00:16:52,480 --> 00:16:56,160 +نتجنب ال confusion لازم يصير عندي central + +230 +00:16:56,160 --> 00:16:59,060 +suppression كيف اعرف ال central suppression أحد + +231 +00:16:59,060 --> 00:17:03,180 +الوسائل بوسط البجولين striated glasses إذا كانت ال + +232 +00:17:03,180 --> 00:17:07,860 +result أعطتني خط كامل للعين السليمة وخط فيه defect + +233 +00:17:07,860 --> 00:17:11,790 +بسموه central gap أو central suppression + +234 +00:17:11,790 --> 00:17:15,190 +scotoma يعني الجزء اللي في النص من الخط ما انشافش + +235 +00:17:15,190 --> 00:17:19,770 +لأنه الخط صورته هتيجي على الفوفيا وعلى ال + +236 +00:17:19,770 --> 00:17:22,630 +paraphobia و ال periphoria يعني هتيجي على كل ال + +237 +00:17:22,630 --> 00:17:26,170 +retina بما فيها ash أو على جزء كبير من ال retina + +238 +00:17:26,170 --> 00:17:29,350 +بما فيها الفوفيا لوحد بيركز بالفوفيا لكن طالما + +239 +00:17:29,350 --> 00:17:32,730 +الفوفيا في وضع suppression هيكون الخط من ال feet + +240 +00:17:32,730 --> 00:17:36,090 +فيه يعني انقطاع في النص فهتتسمى central + +241 +00:17:36,090 --> 00:17:39,250 +suppression scotoma إذا ممكن أكتشف إنه مافيش + +242 +00:17:39,250 --> 00:17:43,200 +suppression simultaneous perception ممكن أكتشف أنه + +243 +00:17:43,200 --> 00:17:46,220 +في عندي left suppression لما أشوف الخط على العين + +244 +00:17:46,220 --> 00:17:49,840 +اليمين فقط ممكن أكتشف أنه right suppression إذا + +245 +00:17:49,840 --> 00:17:53,280 +أنا شوفت الخط على العين الشمال فقط ممكن أكتشف أنه + +246 +00:17:53,280 --> 00:17:56,660 +alternating suppression مرة بشوف خط ميل هيك بعد + +247 +00:17:56,660 --> 00:18:00,240 +بلحظة بشوف خط ميل هيك بعدين برجع بشوف خط ميل هيك + +248 +00:18:00,240 --> 00:18:03,380 +بعدين برجع بشوف خط ميل هيك بس مابشوفهم مش في نفس + +249 +00:18:03,380 --> 00:18:07,180 +اللحظة فهذا يسمى alternating suppression ممكن أشوف + +250 +00:18:10,200 --> 00:18:12,900 +central suppression في عين في هذه الحالة في الرسم + +251 +00:18:12,900 --> 00:18:15,820 +هاي في العين اليمين central suppression scotoma + +252 +00:18:15,820 --> 00:18:21,580 +عشان مايصيرش عندي أنا confusion عند المريض، + +253 +00:18:21,580 --> 00:18:26,700 +confusion، هاي عندي نفس الشيء المريض لابس الباجولين + +254 +00:18:26,700 --> 00:18:30,280 +striated glasses هنا ال right eye ال striation على + +255 +00:18:30,280 --> 00:18:33,520 +مئة وخمسة وثلاثين درجة ال striation على مئة و + +256 +00:18:33,520 --> 00:18:36,740 +خمسة وثلاثين درجة إذا ال right eye هتشوف على خمسة + +257 +00:18:36,740 --> 00:18:40,600 +وأربعين ال left eye ال striation التخطيطات أو + +258 +00:18:40,600 --> 00:18:43,860 +التعريجات في ال .. في ال glasses على .. على خمسة و + +259 +00:18:43,860 --> 00:18:46,920 +أربعين degree إذا ال left eye هتشوف عمودي على ال + +260 +00:18:46,920 --> 00:18:52,620 +striation عندي هيكون على مئة وخمسة وثلاثين طالما + +261 +00:18:52,620 --> 00:18:55,990 +ال striation على خمسة وأربعين هنا في عندي central + +262 +00:18:55,990 --> 00:18:59,070 +suppression scotoma في ال right eye .. في ال right + +263 +00:18:59,070 --> 00:19:02,830 +eye و هنا عندي right suppression .. عندي right + +264 +00:19:02,830 --> 00:19:05,950 +suppression يعني suppression of the right eye ال + +265 +00:19:05,950 --> 00:19:13,070 +.. ال .. ال .. ال test ممكن ينعمل على بعد يعني ستة + +266 +00:19:13,070 --> 00:19:17,520 +متر وممكن ينعمل على بعد ثلاثين سنتي أو ثلاثة و + +267 +00:19:17,520 --> 00:19:21,660 +ثلاثين سنتي مافي أي مشكلة هو نفس الفكرة .. نفس + +268 +00:19:21,660 --> 00:19:25,720 +الفكرة بنتوقف عند فحوصات ال submission high و + +269 +00:19:25,720 --> 00:19:30,920 +المرة القادمة إن شاء الله تعالى بنبدأ في درس جديد + +270 +00:19:30,920 --> 00:19:34,150 +اللي هو ال microtopia والـ Microtropia على فكرة + +271 +00:19:34,150 --> 00:19:37,350 +فيها ميزتين، الميزة الأولى، في عندي central + +272 +00:19:37,350 --> 00:19:40,170 +suppression scotoma وكان لابد من المحاضرة هذه + +273 +00:19:40,170 --> 00:19:44,470 +للتقدمة لها عشان نعملها كمقدمة لقضية الـ central + +274 +00:19:44,470 --> 00:19:47,610 +suppression scotoma يعني الـ Microtropia ممكن الـ + +275 +00:19:47,610 --> 00:19:50,750 +Microtropic patient يشوف الـ central suppression + +276 +00:19:50,750 --> 00:19:54,970 +scotoma ويلاحظها وتاني حاجة في عندنا abnormal + +277 +00:19:54,970 --> 00:19:58,150 +retinal correspondence اللي حكينا عنه في المحاضرة + +278 +00:19:58,150 --> 00:20:01,500 +القادمة إذا الميكروتروبيا من ضمن الأشياء اللي + +279 +00:20:01,500 --> 00:20:04,920 +بلاحظها فيها central suppression scotoma وأيضا + +280 +00:20:04,920 --> 00:20:10,040 +بلاحظ أنه في عندي ظاهرة ال abnormal retinal + +281 +00:20:10,040 --> 00:20:13,840 +correspondence ويعطيكم العافية والسلام عليكم ورحمة + +282 +00:20:13,840 --> 00:20:15,140 +الله وبركاته diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/--NSL4WI0xw_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/--NSL4WI0xw_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..df6860bb406971a52413d98a86cccedae049b17d --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/--NSL4WI0xw_postprocess.srt @@ -0,0 +1,1128 @@ +1 +00:00:00,910 --> 00:00:05,590 +بسم الله الرحمن الرحيم بنواصل مع محاضرات حوال واحد + +2 +00:00:05,590 --> 00:00:10,030 +واتوقفنا المرة الماضية أو أنهينا المرة الماضية + +3 +00:00:10,030 --> 00:00:13,110 +موضوعين ال suppression و ال abnormal retinal + +4 +00:00:13,110 --> 00:00:18,350 +correspondence حكينا أنه اليوم هنحكي عن وسائل فحص + +5 +00:00:18,350 --> 00:00:21,310 +ال suppression وسائل فحص ال suppression يعني كيف + +6 +00:00:21,310 --> 00:00:23,990 +.. كيف أفحص أنه المريض عنده suppression ولا + +7 +00:00:23,990 --> 00:00:29,110 +ماعندهش suppression عشان نعرف لازم نتأكدإنه كل عين + +8 +00:00:29,110 --> 00:00:32,930 +في نفس اللحظة التقطت صورة .. التقطت صورة عشان أعرف + +9 +00:00:32,930 --> 00:00:36,230 +إنه العين تان شغالين ومافيش في واحدة منهم + +10 +00:00:36,230 --> 00:00:40,750 +suppression لازم أتأكد إنه كل عين التقطت صورة + +11 +00:00:40,750 --> 00:00:47,560 +بمعنى آخرلو أنا يعني سؤلت أني أفحص شخص و أشوف إذا + +12 +00:00:47,560 --> 00:00:52,860 +فيه عنده suppression في عين دون عين فبدي أنا أتأكد + +13 +00:00:52,860 --> 00:00:58,820 +من أن كل عين شغالة لازم تعرض صورة مختلفة لكل عين + +14 +00:00:58,820 --> 00:01:02,900 +.. صورة مختلفة لكل عين يعني لو إجيت أنا خلت هذا + +15 +00:01:02,900 --> 00:01:07,120 +الشخص يطلع مثلا على target زي الشمعةلو عندي شامعة + +16 +00:01:07,120 --> 00:01:11,660 +و قولتله اتطلع على الشامعة بعينيك التنتين ممكن في + +17 +00:01:11,660 --> 00:01:13,960 +نفس اللحظة اللي هو بتطلع على الشامعة في عينيه + +18 +00:01:13,960 --> 00:01:18,160 +التنتين في حقيقة الأمر هو شايف أو الدماغ بيستجبل + +19 +00:01:18,160 --> 00:01:21,800 +الصورة .. صورة الشامعة من عين واحدة و العين + +20 +00:01:21,800 --> 00:01:24,520 +التانية في وضع suppression مش هقدر أعرف بهذه + +21 +00:01:24,520 --> 00:01:29,580 +الطريقة طيب كيف أعرف؟ لازم أنا أقدم لكل عين على + +22 +00:01:29,580 --> 00:01:33,820 +حدة صورة مختلفة عشان أعمل هذه القضية لازم أستعمل + +23 +00:01:33,820 --> 00:01:39,830 +وسائلأو أجهزة أو أدوات تفصل بين العنتين في طلاق + +24 +00:01:39,830 --> 00:01:46,130 +الصورة هذه الأدوات تسمى haploscopic devices نكتب + +25 +00:01:46,130 --> 00:01:46,770 +الكلمة + +26 +00:01:55,730 --> 00:02:00,970 +haploscopic devices بمعنى آخر أي أداة بستخدمها أو + +27 +00:02:00,970 --> 00:02:06,770 +أي جهاز بستخدمه و بلاقي مكتوب عليه أو أي حد + +28 +00:02:06,770 --> 00:02:10,890 +بيشرحلي عنه إنه هذا haploscopic device يعني أداة + +29 +00:02:10,890 --> 00:02:15,490 +بتشتغل على فكرة ال haploscopic إيش هي فكرة ال + +30 +00:02:15,490 --> 00:02:19,150 +haploscopic؟ ال haploscopic إن أفصل بين الأنتين في + +31 +00:02:19,150 --> 00:02:23,150 +الصورةشايفين المنظر هذا العين اليمين بتطلع في + +32 +00:02:23,150 --> 00:02:27,210 +انبوبة طبعا في عدسة هنا و هنا في عندي صورة عندي + +33 +00:02:27,210 --> 00:02:32,670 +صورة هنا هذه الصورة في وراها مصدر ضوء بيضوي على + +34 +00:02:32,670 --> 00:02:38,510 +الصورة في هنا بالظبط في داخل الانبوب الأسود في + +35 +00:02:38,510 --> 00:02:43,870 +مراية تيجي الصورة علي مراية و بتنعكس باتجاه عين + +36 +00:02:43,870 --> 00:02:47,810 +اليمين للمريض او للطفل زي ما احنا شايفين نفس + +37 +00:02:47,810 --> 00:02:52,470 +القضية فيعلى الناحية التانية نفس هذه القطعة بس + +38 +00:02:52,470 --> 00:02:56,490 +للعين الشمال .. للعين الشمال بتنحط فيها صورة أخرى، + +39 +00:02:56,490 --> 00:03:00,290 +الآن هذا ال .. ال .. الجهاز بيسموه sinoptophore أو + +40 +00:03:00,290 --> 00:03:03,070 +إله اسم تاني الamblyoscope .. الamblyoscope + +41 +00:03:03,070 --> 00:03:08,770 +sinoptophore هو الاسم الدارج، في اسم أقدم منه اسم + +42 +00:03:08,770 --> 00:03:12,370 +الamblyoscope .. الamblyoscopeهذا يعتبر + +43 +00:03:12,370 --> 00:03:16,290 +haploscopic device ليش؟ لأنه بيفصل في العينتين أنه + +44 +00:03:16,290 --> 00:03:20,290 +بيقدم للعين اليمين صورة وبيقدم للعين الشمال صورة + +45 +00:03:20,290 --> 00:03:24,070 +أخرى على سبيل المثال الشرائح اللي بتوضع في جهاز + +46 +00:03:24,070 --> 00:03:28,170 +الـ synaptophore ممكن توضع أمام العين اليمين شريحة + +47 +00:03:28,170 --> 00:03:33,960 +فيها صورة الأسدوتوضع أمام العين الشمال شريحة فوق + +48 +00:03:33,960 --> 00:03:38,540 +.. يعني فيها القفص خالي من الأسد، مافيش فيه، يعني + +49 +00:03:38,540 --> 00:03:41,960 +هذه صورة وهذه صورة تختلف عنها تماما، تختلف عنها + +50 +00:03:41,960 --> 00:03:45,520 +تماما، فلو قلنا له المريض أو لهذا الطفل اللي جالس + +51 +00:03:45,520 --> 00:03:49,400 +وحط عينيه أمام الـ Sinoptophore، لو قلنا غمض عينك + +52 +00:03:49,400 --> 00:03:53,820 +لشمال، هيشوف فقط شريحة واحدة اللي هي مثلا الأسد، + +53 +00:03:53,820 --> 00:03:57,140 +لو قلنا له غمض عينك اليمين وافتح عينك لشمال، هيشوف + +54 +00:03:57,140 --> 00:04:01,550 +الشريحة الأخرىالان كيف نختبر انه عنده binocular + +55 +00:04:01,550 --> 00:04:04,570 +single vision او كيف نختبر عنده انه فيه + +56 +00:04:04,570 --> 00:04:07,830 +semioletaneous perception ان عينيه التنتين قادرين + +57 +00:04:07,830 --> 00:04:11,650 +على الالتقاط في نفس الوقت و ان الدماغ بستجبل + +58 +00:04:11,650 --> 00:04:16,070 +صورتين لما بقوله افتح عينيك التنتين اذا شاف صورتين + +59 +00:04:16,070 --> 00:04:20,250 +مع بعض بمعنى اخر شاف الأسد داخل القفص او حتى لو مش + +60 +00:04:20,250 --> 00:04:24,280 +داخل القفص المهم انه شافشاف الصورتين في نفس اللحظة + +61 +00:04:24,280 --> 00:04:27,440 +صورة القفص وصورة الأسد بعرف انه عينيه التنتين في + +62 +00:04:27,440 --> 00:04:31,380 +نفس اللحظة شغالين وبيكون مافيش عندي subversion .. + +63 +00:04:31,380 --> 00:04:37,360 +بيكون مافيش عندي subversion اذا احدى وسائل اللي هو + +64 +00:04:37,360 --> 00:04:41,060 +اختبار ال subversion اني استعمل جهاز ال sine of + +65 +00:04:41,060 --> 00:04:45,140 +fourو أضع slides مختلفة هذا بيسموه slide و هذا + +66 +00:04:45,140 --> 00:04:49,040 +بيسموه slide طبعا ممكن إنسان يقول طب ضروري يشوف + +67 +00:04:49,040 --> 00:04:54,080 +الأسد داخل القفص هو المطلوب إنه يشوف الأسد داخل + +68 +00:04:54,080 --> 00:04:57,740 +القفص بس إذا ما شافوش .. شافوا خارج القفص بسبب + +69 +00:04:57,740 --> 00:05:02,640 +وجود سبب معين زي ال squint زي الحوال فبالتالي .. + +70 +00:05:02,640 --> 00:05:06,440 +فبالتالي بيكون عندي simultaneous perception أهم + +71 +00:05:06,440 --> 00:05:11,140 +نقطة في إني أعرف إنه فيش suppressionوبأكد أهم نقطة + +72 +00:05:11,140 --> 00:05:13,760 +في أني أعرف أنه فيش suppression عند هذا الطفل أو + +73 +00:05:13,760 --> 00:05:17,620 +هذا المريض أنه يشوف الصورتين المختلفتين في نفس + +74 +00:05:17,620 --> 00:05:21,960 +اللحظة في نفس اللحظة فساعتها أنا بتأكد أنه هذا + +75 +00:05:21,960 --> 00:05:26,160 +الطفل أو هذا المريض ماعندهوش suppression طيب لو + +76 +00:05:26,160 --> 00:05:30,500 +قلنا مثلا حطينا slide الأسد قدام العين اليمين و + +77 +00:05:30,500 --> 00:05:33,520 +slide القفص طبعا في slides أخرى كتيرة بس احنا هنا + +78 +00:05:33,520 --> 00:05:37,440 +المثال عنا اللي أنا أوردته هو الأسد و القفصلو احنا + +79 +00:05:37,440 --> 00:05:41,100 +حطينا صورة الأسد أمام العين اليمين وصورة القفص + +80 +00:05:41,100 --> 00:05:45,640 +أمام العين الشمال وشاف صورة القفص فقط و هم فتح + +81 +00:05:45,640 --> 00:05:48,740 +عينه التنتين باعرف انه في عنده right suppression + +82 +00:05:48,740 --> 00:05:52,060 +ليش right suppression؟ right eye suppression لأن + +83 +00:05:52,060 --> 00:05:56,620 +ال .. ال .. الأسد اللي هو هذه الصورة مقابل العين + +84 +00:05:56,620 --> 00:05:59,320 +اليمين و بتقدر تشوفها العين اليمين بس و هم فتح + +85 +00:05:59,320 --> 00:06:03,040 +عينه التنتين ماشافش الا القفص و هم فتح عينه + +86 +00:06:03,040 --> 00:06:06,330 +التنتينبس تنتج انه فقط العين الشمالي اللي هي + +87 +00:06:06,330 --> 00:06:10,230 +بتستقبل او الدماغ بيسمح لصورتها انها توصل اليه + +88 +00:06:10,230 --> 00:06:14,690 +وبيستقبلها بينما صورة الأسد اللي هي التقطتها العين + +89 +00:06:14,690 --> 00:06:17,810 +اليمين بيسرها suppression يعني الدماغ بيرفض + +90 +00:06:17,810 --> 00:06:22,210 +استقبالها لو هذا المريض شاف الأسد فقط دون القفص + +91 +00:06:22,210 --> 00:06:26,170 +عنده ساعتها left suppression left suppression وهيك + +92 +00:06:26,170 --> 00:06:30,190 +بكون انا اختبرت اذا في suppression ولا لا وحددت اي + +93 +00:06:30,190 --> 00:06:34,840 +عين اللي فيها ال suppression أحيانااحيانا ممكن + +94 +00:06:34,840 --> 00:06:38,020 +يشوف صورة الأسد مرة و اللحظة اللي بعديها يشوف صورة + +95 +00:06:38,020 --> 00:06:42,240 +القفص، بعدين يرجع يشوف صورة الأسد، بعدين يرجع يشوف + +96 +00:06:42,240 --> 00:06:46,680 +صورة القفص و هكذا، هذا ساعتها لما مرة بيشوف هاي و + +97 +00:06:46,680 --> 00:06:50,100 +مرة بيشوف هاي، بنقول عنده alternating suppression + +98 +00:06:50,100 --> 00:06:54,120 +.. alternating suppression ماننساش أنه من ضمن ال + +99 +00:06:54,120 --> 00:06:56,820 +classification أو أنواع ال suppression فيه + +100 +00:06:56,820 --> 00:07:00,050 +molecular مركز في عين واحدةمثلا right suppression + +101 +00:07:00,050 --> 00:07:02,390 +او left suppression و بيضل right suppression او + +102 +00:07:02,390 --> 00:07:05,810 +بيضل left suppression، بتغيرش، بس في عندي حاجة + +103 +00:07:05,810 --> 00:07:09,210 +اسمها alternating suppression، يعني بسأل المريض + +104 +00:07:09,210 --> 00:07:15,300 +ايش شايف، والله انا شايف مرة بشوف الأسدبعدين بختفي + +105 +00:07:15,300 --> 00:07:19,200 +و في لحظة اختفاء الأسد بشوف القفص و في لحظة مباراة + +106 +00:07:19,200 --> 00:07:22,100 +الأسد بختفي القفص يعني بشوفهم مش مع بعض في نفس + +107 +00:07:22,100 --> 00:07:26,760 +اللحظة لأنه لو شافهم مع بعض في نفس اللحظة معناته + +108 +00:07:26,760 --> 00:07:29,960 +مافيش عندي أنا صابرش .. مافيش عندي أنا صابرش + +109 +00:07:29,960 --> 00:07:35,620 +..الآن هذه ال .. يعني رسمة تمثلية كيف .. كيف ال + +110 +00:07:35,620 --> 00:07:38,160 +synaptophore بيشتغل؟ ال synaptophore عبارة عن + +111 +00:07:38,160 --> 00:07:44,330 +أنبوبة متنية بشكل عمودي، هي الأنبوبةو في انثناء + +112 +00:07:44,330 --> 00:07:47,310 +عمودي فيها و هاي انبوبة تانية فيها انثناء عمودي + +113 +00:07:47,310 --> 00:07:52,230 +هنا في المريض بده يحط عينية تنتين او يتطلع من .. + +114 +00:07:52,230 --> 00:07:55,850 +في كل عين ده يتطلع في انبوبة كيف بده يشوف الصورة؟ + +115 +00:07:55,850 --> 00:08:00,090 +الصورة في slide carrier حامل للسلايدات، حامل + +116 +00:08:00,090 --> 00:08:05,330 +للشرائح، خلفه مصدر ضوء بيضوي على ال slide او على + +117 +00:08:05,330 --> 00:08:09,730 +الرسمةزي رسمة الأسد أو السيارة أو الكراج أو القفص + +118 +00:08:09,730 --> 00:08:13,050 +أو .. فيها يعني رسومات كتيرة هذه الصورة تحمل إلى + +119 +00:08:13,050 --> 00:08:16,130 +المرأة هنا في مراية المراية جاية في ال .. في + +120 +00:08:16,130 --> 00:08:21,090 +الزاوية بتاعة الأنبوبة فبتنعكس .. بتنعكس .. بتبين + +121 +00:08:21,090 --> 00:08:24,110 +كأنها جاية من عند النقطة هاي بتبين .. يعني .. يعني + +122 +00:08:24,110 --> 00:08:29,120 +بتبين الصورة داخل المرأة طبعا هو هيشوف الصورةفي + +123 +00:08:29,120 --> 00:08:31,760 +العين اليمين ويشوف صورة بتختلف عنها في العين + +124 +00:08:31,760 --> 00:08:35,560 +الشمال ومفروض إذا ال two fove يالهم نفس الاتجاه + +125 +00:08:35,560 --> 00:08:38,600 +الصورتين يكونوا في نفس المكان بمعنى الأسد ينشاف + +126 +00:08:38,600 --> 00:08:43,280 +داخل القفص الأسد ينشاف داخل القفص و ساعتها .. + +127 +00:08:43,280 --> 00:08:47,980 +ساعتها بنقول إنه هذا عنده simultaneous perception + +128 +00:08:47,980 --> 00:08:51,320 +simultaneous perception فهذه فكرة عمل ال sign of + +129 +00:08:51,320 --> 00:08:55,170 +the four اللي اتفجنا إنها عبارة عنhaploscopic + +130 +00:08:55,170 --> 00:08:59,970 +device أيضا من ال haploscopic devices الباجوليني + +131 +00:08:59,970 --> 00:09:06,230 +striated glasses الباجوليني striated glasses بدنا + +132 +00:09:06,230 --> 00:09:10,410 +يعني نوضح أشياء الباجوليني striated glasses برسمة + +133 +00:09:27,340 --> 00:09:34,100 +البجولين striated glasses عبارة عن .. عن glasses + +134 +00:09:34,100 --> 00:09:39,800 +عادية فيها striation فيها يعني فرزات وكأنه .. + +135 +00:09:39,800 --> 00:09:43,080 +وكأنه أنا ماسك ال Maddox rod يعني على فكرة بينفع + +136 +00:09:43,080 --> 00:09:46,400 +أنه نعمل ال test هذا باستخدام ال Maddox rod إذا + +137 +00:09:46,400 --> 00:09:50,910 +ملاحظين ال striation هناميلة بزاوية خمسة واربعين + +138 +00:09:50,910 --> 00:09:55,570 +درجة وال استرايشن أمام العين التانية ميلة بزاوية + +139 +00:09:55,570 --> 00:09:59,290 +مية وخمسة وتلاتين درجة فبالتالي خلينا احنا ناخد + +140 +00:09:59,290 --> 00:10:03,870 +الصورة هاي ننجلها لل power point هنا + +141 +00:10:33,740 --> 00:10:42,680 +نقول كالعادي المريض + +142 +00:10:42,680 --> 00:10:47,590 +بده يرتدي الباجوليني striated glassesو انا بس بدي + +143 +00:10:47,590 --> 00:10:52,930 +ا .. امسك ال pin torch ضوء صغير و اوجهه باتجاه + +144 +00:10:52,930 --> 00:10:58,510 +عيني المريض و اعمل ال test طبعا ايش فايدة + +145 +00:10:58,510 --> 00:11:02,450 +illustration هذه التعريجات البسيطة و كأن هو لابس + +146 +00:11:02,450 --> 00:11:06,640 +كل تعريجة كأنها عبارة عنcylindrical lens يعني هنا + +147 +00:11:06,640 --> 00:11:09,120 +عندي بيه cylindrical lens كمان cylindrical lens + +148 +00:11:09,120 --> 00:11:12,020 +كمان cylindrical lens هدى ال astrayation وظيفتها + +149 +00:11:12,020 --> 00:11:15,300 +اتحول ال point source of light اتحوله ل streak + +150 +00:11:15,300 --> 00:11:19,540 +يعني انا اللى هضويه على عين المريض point source of + +151 +00:11:19,540 --> 00:11:24,190 +lightpoint source of light يعني مصدر صغير للضوء، + +152 +00:11:24,190 --> 00:11:27,110 +pen torch أو شيء من هذا القبيل، هذا اللي حدوي، بس + +153 +00:11:27,110 --> 00:11:30,130 +اللي هيشوفه المريض عبارة عن خط مضيق، ليش؟ هو أنا + +154 +00:11:30,130 --> 00:11:37,490 +دود نقطة مضيقة أو ضوء laser أو pen torch، يعني جلم + +155 +00:11:37,490 --> 00:11:42,760 +مضيق، فاتحول لخط مضيق، بسبب هذه ال astrayationطيب، + +156 +00:11:42,760 --> 00:11:45,760 +الآن السؤال التاني، ليش الـ striation هنا ميلة على + +157 +00:11:45,760 --> 00:11:49,320 +خمسة و أربعين و هنا ميلة على خمسة و .. مية و خمسة + +158 +00:11:49,320 --> 00:11:53,600 +و تلاتين، يعني بينهم تسعين درجة؟ طبعا، كل .. كل + +159 +00:11:53,600 --> 00:11:58,400 +عين هتشوف خط مائل، هذه هتشوف خط مائل، وهذه خط + +160 +00:11:58,400 --> 00:12:02,620 +مائل، اتجاه الخط المائل دائما و أبدا، هيكون عمودي + +161 +00:12:02,620 --> 00:12:05,760 +على اتجاه الـ striation يعني هنا الـ striation + +162 +00:12:05,760 --> 00:12:10,890 +ميلة .. ميلة على خمسة و أربعين درجةلما بضوي point + +163 +00:12:10,890 --> 00:12:15,930 +source of light المريض حيشوف بعينه الشمال خط + +164 +00:12:15,930 --> 00:12:23,190 +بالشكل هذا .. خط بالشكل هذا حيشوف + +165 +00:12:23,190 --> 00:12:28,470 +المريض بالشكل هذا الخط ليش؟ + +166 +00:12:28,470 --> 00:12:32,790 +لأنه دائما اتجاه الخط اللي بتراه العين عمودي على + +167 +00:12:32,790 --> 00:12:41,360 +اتجاه illustration و بالنسبة لالعين التانية طالما + +168 +00:12:41,360 --> 00:12:44,800 +ما يلان ال استرايشين على مية و خمسة و تلاتين إذا + +169 +00:12:44,800 --> 00:12:49,320 +الخط هينشاف على خمسة و أربعين على خمسة و أربعين طب + +170 +00:12:49,320 --> 00:12:53,000 +هو عبارة عن إيش الخط الخط هذا و الخط هذا صورة + +171 +00:12:53,000 --> 00:12:56,720 +النقطة اللي أنا ضويتها قدام العنتين هو target واحد + +172 +00:12:56,720 --> 00:13:02,300 +هو target واحد بس حولته لصورتين مختلفتين باستعمال + +173 +00:13:02,300 --> 00:13:05,880 +الباجوليني striated glassesطبعا ممكن السيد يقول لأ + +174 +00:13:05,880 --> 00:13:09,400 +هذا .. هذا العين الشمال بتشوف خط و العين اليمين + +175 +00:13:09,400 --> 00:13:12,860 +بتشوف خط طالما الخط هذا ما يلانه في الفرق غير ما + +176 +00:13:12,860 --> 00:13:15,540 +يلان هذا الخط إذا هذه صورة و هذه صورة تختلف عنها + +177 +00:13:15,540 --> 00:13:19,640 +وإن كان كل منهم أنا بسميه خط، إذا هي نقطة واحدة + +178 +00:13:20,530 --> 00:13:25,470 +نقطة واحدة حولتها ل two targets باستعمال .. + +179 +00:13:25,470 --> 00:13:29,470 +باستعمال الباجولين striated glasses العين الشمال + +180 +00:13:29,470 --> 00:13:34,210 +هتشوف خط مائل على زاوية 135 درجة على المحور الأفقي + +181 +00:13:34,210 --> 00:13:39,550 +و هذه العين اليمين هتشوف خط مائل على 45 درجة على + +182 +00:13:39,550 --> 00:13:43,880 +المحور الأفقيفبالتالي هذه هتشوف صورة و هذه هتشوف + +183 +00:13:43,880 --> 00:13:48,040 +صورة بتختلف عنها لما أنا بقوله المريض يفتح عينيه + +184 +00:13:48,040 --> 00:13:54,680 +التنتين .. لما بقوله يفتح عينيه التنتينو يتطلع على + +185 +00:13:54,680 --> 00:13:57,520 +ال point source of light هيقوللي أنا شايف ال cross + +186 +00:13:57,520 --> 00:14:02,140 +ايش يعني شايف ال cross؟ يعني شايف خط و شايف خط هذا + +187 +00:14:02,140 --> 00:14:05,620 +الخط اللي انا بقشر عليه الآن ال result ايه؟ يعني + +188 +00:14:05,620 --> 00:14:10,020 +في عندي نتائج كتيرة محتملة لل test اول نتيجة ممكن + +189 +00:14:10,020 --> 00:14:14,500 +تصير معايا او ممكن تطلع معايا انه يشوف ال cross ال + +190 +00:14:14,500 --> 00:14:18,440 +cross عبارة عن خط مائلبالميلان هذا اللي أنا بأشر + +191 +00:14:18,440 --> 00:14:21,340 +عليه معناته العين اليمين شغالة لأن العين اليمين هي + +192 +00:14:21,340 --> 00:14:24,260 +اللي بتشوف الميلان هذا، ليش هي؟ ليش مش العين + +193 +00:14:24,260 --> 00:14:28,180 +الشمال؟ أه لأن العين الشمال خط ميل هيك طالما شاف + +194 +00:14:28,180 --> 00:14:33,730 +الخطينمعناته في عنده simultaneous perception مافيش + +195 +00:14:33,730 --> 00:14:39,010 +عنده صبرش مافيش عنده صبرش ليش؟ لأنه شاف الخطين خط + +196 +00:14:39,010 --> 00:14:43,110 +مائل على خمسة واربعين خط مائل على خمسة واربعين هذا + +197 +00:14:43,110 --> 00:14:46,710 +شافته العين اليمين وخط مائل على مية وخمسة وتلاتين + +198 +00:14:46,710 --> 00:14:52,110 +هذا شافته العين الشمال طيب إذا مرة .. إذا شاف فقط + +199 +00:14:52,110 --> 00:14:55,210 +خط مائل على خمسة واربعين يعني هذا الخط هو اللي + +200 +00:14:55,210 --> 00:14:58,910 +شافه وهم فت عين التنتين ضروري وهم فت عين التنتين + +201 +00:14:59,370 --> 00:15:03,690 +وماشافش الخط الآخر .. ماشافش الخط الآخر معناته + +202 +00:15:03,690 --> 00:15:08,470 +الخط الآخر مين المفروض تشوفه؟ ميلانه على مية و + +203 +00:15:08,470 --> 00:15:11,270 +خمسة و تلاتين هو العين الشمال .. الشمال المفروض + +204 +00:15:11,270 --> 00:15:14,370 +تشوفه، إذا في عندي left suppression .. إذا في عندي + +205 +00:15:14,370 --> 00:15:20,190 +left suppression، هو شاف الخط هذاوماشافش الخط هذا + +206 +00:15:20,190 --> 00:15:23,750 +فبالتالي عنده left suppression طيب نفرض العكس هو + +207 +00:15:23,750 --> 00:15:27,310 +شاف الخط هذا وماشافش الخط العمودي عليه إذا في عندي + +208 +00:15:27,310 --> 00:15:30,570 +right suppression عندي right suppression طيب الآن + +209 +00:15:30,570 --> 00:15:35,650 +بدنا نطلع على المنظر هذا احنا لازلنا بنحكي عن ال + +210 +00:15:35,650 --> 00:15:39,150 +suppression هو المفروض يشوف خط كامل متقاطع مع خط + +211 +00:15:39,150 --> 00:15:44,130 +كامل متقاطع مع خط كامل عشان أقول ماعندهوش + +212 +00:15:44,130 --> 00:15:48,190 +suppression طيب شاف الخط هذاهذا الخط مين اللي + +213 +00:15:48,190 --> 00:15:52,490 +بتشوفه؟ العين الشمال إذا العين الشمال شغالة طيب + +214 +00:15:52,490 --> 00:15:56,490 +الخط التاني .. الخط التاني بتشوفه العين اليمين بس + +215 +00:15:56,490 --> 00:16:00,550 +في عندى هنا ملاحظة أن الخط التاني فيه في نصه فراغة + +216 +00:16:00,550 --> 00:16:06,450 +فيه في نصه فراغة وكأنه استقبل الخط التاني بس في + +217 +00:16:06,450 --> 00:16:10,610 +النص مستقبلش النص عجبالي الفوفيا بالظبط هذا الشخص + +218 +00:16:10,610 --> 00:16:16,520 +عنده right أن هذا لل rightcentral suppression is + +219 +00:16:16,520 --> 00:16:20,200 +كتومة يعني في عنده central suppression طيب هل في + +220 +00:16:20,200 --> 00:16:22,640 +حاجة اسمها central suppression؟ طبعا في حاجة اسمها + +221 +00:16:22,640 --> 00:16:25,320 +central suppression احنا قولنا ال separation يقسم + +222 +00:16:25,320 --> 00:16:29,300 +ل peripheral central و peripheral central و + +223 +00:16:29,300 --> 00:16:32,680 +peripheral و ان ال central عشان مايصيرش عندي + +224 +00:16:32,680 --> 00:16:36,360 +confusion ال central suppression ال central + +225 +00:16:36,360 --> 00:16:40,940 +suppression بيخلصني من ال confusion ال confusion + +226 +00:16:40,940 --> 00:16:46,020 +تمام فبالتاليcentral suppression in central + +227 +00:16:46,020 --> 00:16:48,460 +suppression the image from the fovea of the + +228 +00:16:48,460 --> 00:16:52,480 +deviating eye is inhibited to avoid confusion عشان + +229 +00:16:52,480 --> 00:16:56,160 +نتجنب ال confusion لازم يصير عندي central + +230 +00:16:56,160 --> 00:16:59,060 +suppression كيف اعرف ال central suppression أحد + +231 +00:16:59,060 --> 00:17:03,180 +الوسائل بوسط البجولين striated glasses إذا كانت ال + +232 +00:17:03,180 --> 00:17:07,860 +result أعطتني خط كامل للعين السليمة وخط فيه defect + +233 +00:17:07,860 --> 00:17:11,790 +بسموه gap central gapأو central suppression + +234 +00:17:11,790 --> 00:17:15,190 +scotoma يعني الجزء اللي في النص من الخط ماانشافش + +235 +00:17:15,190 --> 00:17:19,770 +لإنه الخط صورته هتيجي على الفوفيا وعلى ال + +236 +00:17:19,770 --> 00:17:22,630 +paraphobia و ال periphobia يعني هتيجي على كل ال + +237 +00:17:22,630 --> 00:17:26,170 +retina بما فيها ash أو على جزء كبير من ال retina + +238 +00:17:26,170 --> 00:17:29,350 +بما فيها الفوفيا لوحد بيركز بالفوفيا لكن طالما + +239 +00:17:29,350 --> 00:17:32,730 +الفوفيا في وضع suppression هيكون الخط من ال feet + +240 +00:17:32,730 --> 00:17:36,090 +فيه يعني انقطاع في النص فهتتسمى central + +241 +00:17:36,090 --> 00:17:39,250 +suppression scotoma إذا ممكن أكتشف إنه مافيش + +242 +00:17:39,250 --> 00:17:43,200 +suppressionsimultaneous perception ممكن أكتشف أنه + +243 +00:17:43,200 --> 00:17:46,220 +في عندي left suppression لما أشوف الخط على العين + +244 +00:17:46,220 --> 00:17:49,840 +اليمين فقط ممكن أكتشف أنه right suppression إذا + +245 +00:17:49,840 --> 00:17:53,280 +أنا شوفت الخط على العين الشمال فقط ممكن أكتشف أنه + +246 +00:17:53,280 --> 00:17:56,660 +alternating suppression مرة بشوف خط ميل هيك بعد + +247 +00:17:56,660 --> 00:18:00,240 +بلحظة بشوف خط ميل هيك بعدين برجع بشوف خط ميل هيك + +248 +00:18:00,240 --> 00:18:03,380 +بعدين برجع بشوف خط ميل هيك بس مابشوفهم مش في نفس + +249 +00:18:03,380 --> 00:18:07,180 +اللحظة فهذا يسمى alternating suppression ممكن أشوف + +250 +00:18:10,200 --> 00:18:12,900 +central suppression في عين في هذه الحالة في الرسم + +251 +00:18:12,900 --> 00:18:15,820 +هاي في العين اليمين central suppression scotoma + +252 +00:18:15,820 --> 00:18:21,580 +عشان مايصيرش عندي انا confusion عند المريض، + +253 +00:18:21,580 --> 00:18:26,700 +confusion، هاي عندي نفس الاشي المريضلابس الباجولين + +254 +00:18:26,700 --> 00:18:30,280 +striated glasses هنا ال right eye ال striation على + +255 +00:18:30,280 --> 00:18:33,520 +مية و خمسة و تلاتين درجة ال striation على مية و + +256 +00:18:33,520 --> 00:18:36,740 +خمسة و تلاتين درجة إذا ال right eye هتشوف على خمسة + +257 +00:18:36,740 --> 00:18:40,600 +و أربعين ال left eye ال striation التخطيطات أو + +258 +00:18:40,600 --> 00:18:43,860 +التعريجات في ال .. في ال glasses على .. على خمسة و + +259 +00:18:43,860 --> 00:18:46,920 +أربعين degree إذا ال left eye هتشوف عمودي على ال + +260 +00:18:46,920 --> 00:18:52,620 +striation عندي هيكون على مية و خمسة و تلاتين طالما + +261 +00:18:52,620 --> 00:18:55,990 +ال striation على خمسة و أربعينهنا في عندي central + +262 +00:18:55,990 --> 00:18:59,070 +suppression scotoma في ال right eye .. في ال right + +263 +00:18:59,070 --> 00:19:02,830 +eye و هنا عندي right suppression .. عندي right + +264 +00:19:02,830 --> 00:19:05,950 +suppression يعني suppression of the right eye ال + +265 +00:19:05,950 --> 00:19:13,070 +.. ال .. ال .. ال test ممكن ينعمل على بعد يعني ستة + +266 +00:19:13,070 --> 00:19:17,520 +متر و ممكن ينعمل على بعدتلاتين سانتي او تلاتة و + +267 +00:19:17,520 --> 00:19:21,660 +تلاتين سانتي مافي اي مشكلة هو نفس الفكرة .. نفس + +268 +00:19:21,660 --> 00:19:25,720 +الفكرة بنتوقف عند فحوصات ال submission high و + +269 +00:19:25,720 --> 00:19:30,920 +المرة القادمة ان شاء الله تعالى بنبدأ في درس جديد + +270 +00:19:30,920 --> 00:19:34,150 +اللي هو ال microtopiaوالـ Microtropia على فكرة + +271 +00:19:34,150 --> 00:19:37,350 +فيها ميزتين، الميزة الأولى، في عندي central + +272 +00:19:37,350 --> 00:19:40,170 +suppression scotoma وكان لابد من المحاضرة هذه + +273 +00:19:40,170 --> 00:19:44,470 +للتقدمة لها عشان نعملها كمقدمة لقضية الـ central + +274 +00:19:44,470 --> 00:19:47,610 +suppression scotoma يعني الـ Microtropia ممكن الـ + +275 +00:19:47,610 --> 00:19:50,750 +Microtropic patient يشوف الـ central suppression + +276 +00:19:50,750 --> 00:19:54,970 +scotoma ويلاحظها وتاني حاجة في عنا abnormal + +277 +00:19:54,970 --> 00:19:58,150 +retinal correspondence اللي حكينا عنه في المحاضرة + +278 +00:19:58,150 --> 00:20:01,500 +القادمةإذا الميكروتروبيا من ضمن الأشياء اللي + +279 +00:20:01,500 --> 00:20:04,920 +بلاحظها فيها central suppression scotoma وأيضا + +280 +00:20:04,920 --> 00:20:10,040 +بلاحظ أنه في عندي ظاهرة ال abnormal retinal + +281 +00:20:10,040 --> 00:20:13,840 +correspondence ويعطيكم العافية والسلام عليكم ورحمة + +282 +00:20:13,840 --> 00:20:15,140 +الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/--NSL4WI0xw_raw.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/--NSL4WI0xw_raw.srt new file mode 100644 index 0000000000000000000000000000000000000000..df6860bb406971a52413d98a86cccedae049b17d --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/--NSL4WI0xw_raw.srt @@ -0,0 +1,1128 @@ +1 +00:00:00,910 --> 00:00:05,590 +بسم الله الرحمن الرحيم بنواصل مع محاضرات حوال واحد + +2 +00:00:05,590 --> 00:00:10,030 +واتوقفنا المرة الماضية أو أنهينا المرة الماضية + +3 +00:00:10,030 --> 00:00:13,110 +موضوعين ال suppression و ال abnormal retinal + +4 +00:00:13,110 --> 00:00:18,350 +correspondence حكينا أنه اليوم هنحكي عن وسائل فحص + +5 +00:00:18,350 --> 00:00:21,310 +ال suppression وسائل فحص ال suppression يعني كيف + +6 +00:00:21,310 --> 00:00:23,990 +.. كيف أفحص أنه المريض عنده suppression ولا + +7 +00:00:23,990 --> 00:00:29,110 +ماعندهش suppression عشان نعرف لازم نتأكدإنه كل عين + +8 +00:00:29,110 --> 00:00:32,930 +في نفس اللحظة التقطت صورة .. التقطت صورة عشان أعرف + +9 +00:00:32,930 --> 00:00:36,230 +إنه العين تان شغالين ومافيش في واحدة منهم + +10 +00:00:36,230 --> 00:00:40,750 +suppression لازم أتأكد إنه كل عين التقطت صورة + +11 +00:00:40,750 --> 00:00:47,560 +بمعنى آخرلو أنا يعني سؤلت أني أفحص شخص و أشوف إذا + +12 +00:00:47,560 --> 00:00:52,860 +فيه عنده suppression في عين دون عين فبدي أنا أتأكد + +13 +00:00:52,860 --> 00:00:58,820 +من أن كل عين شغالة لازم تعرض صورة مختلفة لكل عين + +14 +00:00:58,820 --> 00:01:02,900 +.. صورة مختلفة لكل عين يعني لو إجيت أنا خلت هذا + +15 +00:01:02,900 --> 00:01:07,120 +الشخص يطلع مثلا على target زي الشمعةلو عندي شامعة + +16 +00:01:07,120 --> 00:01:11,660 +و قولتله اتطلع على الشامعة بعينيك التنتين ممكن في + +17 +00:01:11,660 --> 00:01:13,960 +نفس اللحظة اللي هو بتطلع على الشامعة في عينيه + +18 +00:01:13,960 --> 00:01:18,160 +التنتين في حقيقة الأمر هو شايف أو الدماغ بيستجبل + +19 +00:01:18,160 --> 00:01:21,800 +الصورة .. صورة الشامعة من عين واحدة و العين + +20 +00:01:21,800 --> 00:01:24,520 +التانية في وضع suppression مش هقدر أعرف بهذه + +21 +00:01:24,520 --> 00:01:29,580 +الطريقة طيب كيف أعرف؟ لازم أنا أقدم لكل عين على + +22 +00:01:29,580 --> 00:01:33,820 +حدة صورة مختلفة عشان أعمل هذه القضية لازم أستعمل + +23 +00:01:33,820 --> 00:01:39,830 +وسائلأو أجهزة أو أدوات تفصل بين العنتين في طلاق + +24 +00:01:39,830 --> 00:01:46,130 +الصورة هذه الأدوات تسمى haploscopic devices نكتب + +25 +00:01:46,130 --> 00:01:46,770 +الكلمة + +26 +00:01:55,730 --> 00:02:00,970 +haploscopic devices بمعنى آخر أي أداة بستخدمها أو + +27 +00:02:00,970 --> 00:02:06,770 +أي جهاز بستخدمه و بلاقي مكتوب عليه أو أي حد + +28 +00:02:06,770 --> 00:02:10,890 +بيشرحلي عنه إنه هذا haploscopic device يعني أداة + +29 +00:02:10,890 --> 00:02:15,490 +بتشتغل على فكرة ال haploscopic إيش هي فكرة ال + +30 +00:02:15,490 --> 00:02:19,150 +haploscopic؟ ال haploscopic إن أفصل بين الأنتين في + +31 +00:02:19,150 --> 00:02:23,150 +الصورةشايفين المنظر هذا العين اليمين بتطلع في + +32 +00:02:23,150 --> 00:02:27,210 +انبوبة طبعا في عدسة هنا و هنا في عندي صورة عندي + +33 +00:02:27,210 --> 00:02:32,670 +صورة هنا هذه الصورة في وراها مصدر ضوء بيضوي على + +34 +00:02:32,670 --> 00:02:38,510 +الصورة في هنا بالظبط في داخل الانبوب الأسود في + +35 +00:02:38,510 --> 00:02:43,870 +مراية تيجي الصورة علي مراية و بتنعكس باتجاه عين + +36 +00:02:43,870 --> 00:02:47,810 +اليمين للمريض او للطفل زي ما احنا شايفين نفس + +37 +00:02:47,810 --> 00:02:52,470 +القضية فيعلى الناحية التانية نفس هذه القطعة بس + +38 +00:02:52,470 --> 00:02:56,490 +للعين الشمال .. للعين الشمال بتنحط فيها صورة أخرى، + +39 +00:02:56,490 --> 00:03:00,290 +الآن هذا ال .. ال .. الجهاز بيسموه sinoptophore أو + +40 +00:03:00,290 --> 00:03:03,070 +إله اسم تاني الamblyoscope .. الamblyoscope + +41 +00:03:03,070 --> 00:03:08,770 +sinoptophore هو الاسم الدارج، في اسم أقدم منه اسم + +42 +00:03:08,770 --> 00:03:12,370 +الamblyoscope .. الamblyoscopeهذا يعتبر + +43 +00:03:12,370 --> 00:03:16,290 +haploscopic device ليش؟ لأنه بيفصل في العينتين أنه + +44 +00:03:16,290 --> 00:03:20,290 +بيقدم للعين اليمين صورة وبيقدم للعين الشمال صورة + +45 +00:03:20,290 --> 00:03:24,070 +أخرى على سبيل المثال الشرائح اللي بتوضع في جهاز + +46 +00:03:24,070 --> 00:03:28,170 +الـ synaptophore ممكن توضع أمام العين اليمين شريحة + +47 +00:03:28,170 --> 00:03:33,960 +فيها صورة الأسدوتوضع أمام العين الشمال شريحة فوق + +48 +00:03:33,960 --> 00:03:38,540 +.. يعني فيها القفص خالي من الأسد، مافيش فيه، يعني + +49 +00:03:38,540 --> 00:03:41,960 +هذه صورة وهذه صورة تختلف عنها تماما، تختلف عنها + +50 +00:03:41,960 --> 00:03:45,520 +تماما، فلو قلنا له المريض أو لهذا الطفل اللي جالس + +51 +00:03:45,520 --> 00:03:49,400 +وحط عينيه أمام الـ Sinoptophore، لو قلنا غمض عينك + +52 +00:03:49,400 --> 00:03:53,820 +لشمال، هيشوف فقط شريحة واحدة اللي هي مثلا الأسد، + +53 +00:03:53,820 --> 00:03:57,140 +لو قلنا له غمض عينك اليمين وافتح عينك لشمال، هيشوف + +54 +00:03:57,140 --> 00:04:01,550 +الشريحة الأخرىالان كيف نختبر انه عنده binocular + +55 +00:04:01,550 --> 00:04:04,570 +single vision او كيف نختبر عنده انه فيه + +56 +00:04:04,570 --> 00:04:07,830 +semioletaneous perception ان عينيه التنتين قادرين + +57 +00:04:07,830 --> 00:04:11,650 +على الالتقاط في نفس الوقت و ان الدماغ بستجبل + +58 +00:04:11,650 --> 00:04:16,070 +صورتين لما بقوله افتح عينيك التنتين اذا شاف صورتين + +59 +00:04:16,070 --> 00:04:20,250 +مع بعض بمعنى اخر شاف الأسد داخل القفص او حتى لو مش + +60 +00:04:20,250 --> 00:04:24,280 +داخل القفص المهم انه شافشاف الصورتين في نفس اللحظة + +61 +00:04:24,280 --> 00:04:27,440 +صورة القفص وصورة الأسد بعرف انه عينيه التنتين في + +62 +00:04:27,440 --> 00:04:31,380 +نفس اللحظة شغالين وبيكون مافيش عندي subversion .. + +63 +00:04:31,380 --> 00:04:37,360 +بيكون مافيش عندي subversion اذا احدى وسائل اللي هو + +64 +00:04:37,360 --> 00:04:41,060 +اختبار ال subversion اني استعمل جهاز ال sine of + +65 +00:04:41,060 --> 00:04:45,140 +fourو أضع slides مختلفة هذا بيسموه slide و هذا + +66 +00:04:45,140 --> 00:04:49,040 +بيسموه slide طبعا ممكن إنسان يقول طب ضروري يشوف + +67 +00:04:49,040 --> 00:04:54,080 +الأسد داخل القفص هو المطلوب إنه يشوف الأسد داخل + +68 +00:04:54,080 --> 00:04:57,740 +القفص بس إذا ما شافوش .. شافوا خارج القفص بسبب + +69 +00:04:57,740 --> 00:05:02,640 +وجود سبب معين زي ال squint زي الحوال فبالتالي .. + +70 +00:05:02,640 --> 00:05:06,440 +فبالتالي بيكون عندي simultaneous perception أهم + +71 +00:05:06,440 --> 00:05:11,140 +نقطة في إني أعرف إنه فيش suppressionوبأكد أهم نقطة + +72 +00:05:11,140 --> 00:05:13,760 +في أني أعرف أنه فيش suppression عند هذا الطفل أو + +73 +00:05:13,760 --> 00:05:17,620 +هذا المريض أنه يشوف الصورتين المختلفتين في نفس + +74 +00:05:17,620 --> 00:05:21,960 +اللحظة في نفس اللحظة فساعتها أنا بتأكد أنه هذا + +75 +00:05:21,960 --> 00:05:26,160 +الطفل أو هذا المريض ماعندهوش suppression طيب لو + +76 +00:05:26,160 --> 00:05:30,500 +قلنا مثلا حطينا slide الأسد قدام العين اليمين و + +77 +00:05:30,500 --> 00:05:33,520 +slide القفص طبعا في slides أخرى كتيرة بس احنا هنا + +78 +00:05:33,520 --> 00:05:37,440 +المثال عنا اللي أنا أوردته هو الأسد و القفصلو احنا + +79 +00:05:37,440 --> 00:05:41,100 +حطينا صورة الأسد أمام العين اليمين وصورة القفص + +80 +00:05:41,100 --> 00:05:45,640 +أمام العين الشمال وشاف صورة القفص فقط و هم فتح + +81 +00:05:45,640 --> 00:05:48,740 +عينه التنتين باعرف انه في عنده right suppression + +82 +00:05:48,740 --> 00:05:52,060 +ليش right suppression؟ right eye suppression لأن + +83 +00:05:52,060 --> 00:05:56,620 +ال .. ال .. الأسد اللي هو هذه الصورة مقابل العين + +84 +00:05:56,620 --> 00:05:59,320 +اليمين و بتقدر تشوفها العين اليمين بس و هم فتح + +85 +00:05:59,320 --> 00:06:03,040 +عينه التنتين ماشافش الا القفص و هم فتح عينه + +86 +00:06:03,040 --> 00:06:06,330 +التنتينبس تنتج انه فقط العين الشمالي اللي هي + +87 +00:06:06,330 --> 00:06:10,230 +بتستقبل او الدماغ بيسمح لصورتها انها توصل اليه + +88 +00:06:10,230 --> 00:06:14,690 +وبيستقبلها بينما صورة الأسد اللي هي التقطتها العين + +89 +00:06:14,690 --> 00:06:17,810 +اليمين بيسرها suppression يعني الدماغ بيرفض + +90 +00:06:17,810 --> 00:06:22,210 +استقبالها لو هذا المريض شاف الأسد فقط دون القفص + +91 +00:06:22,210 --> 00:06:26,170 +عنده ساعتها left suppression left suppression وهيك + +92 +00:06:26,170 --> 00:06:30,190 +بكون انا اختبرت اذا في suppression ولا لا وحددت اي + +93 +00:06:30,190 --> 00:06:34,840 +عين اللي فيها ال suppression أحيانااحيانا ممكن + +94 +00:06:34,840 --> 00:06:38,020 +يشوف صورة الأسد مرة و اللحظة اللي بعديها يشوف صورة + +95 +00:06:38,020 --> 00:06:42,240 +القفص، بعدين يرجع يشوف صورة الأسد، بعدين يرجع يشوف + +96 +00:06:42,240 --> 00:06:46,680 +صورة القفص و هكذا، هذا ساعتها لما مرة بيشوف هاي و + +97 +00:06:46,680 --> 00:06:50,100 +مرة بيشوف هاي، بنقول عنده alternating suppression + +98 +00:06:50,100 --> 00:06:54,120 +.. alternating suppression ماننساش أنه من ضمن ال + +99 +00:06:54,120 --> 00:06:56,820 +classification أو أنواع ال suppression فيه + +100 +00:06:56,820 --> 00:07:00,050 +molecular مركز في عين واحدةمثلا right suppression + +101 +00:07:00,050 --> 00:07:02,390 +او left suppression و بيضل right suppression او + +102 +00:07:02,390 --> 00:07:05,810 +بيضل left suppression، بتغيرش، بس في عندي حاجة + +103 +00:07:05,810 --> 00:07:09,210 +اسمها alternating suppression، يعني بسأل المريض + +104 +00:07:09,210 --> 00:07:15,300 +ايش شايف، والله انا شايف مرة بشوف الأسدبعدين بختفي + +105 +00:07:15,300 --> 00:07:19,200 +و في لحظة اختفاء الأسد بشوف القفص و في لحظة مباراة + +106 +00:07:19,200 --> 00:07:22,100 +الأسد بختفي القفص يعني بشوفهم مش مع بعض في نفس + +107 +00:07:22,100 --> 00:07:26,760 +اللحظة لأنه لو شافهم مع بعض في نفس اللحظة معناته + +108 +00:07:26,760 --> 00:07:29,960 +مافيش عندي أنا صابرش .. مافيش عندي أنا صابرش + +109 +00:07:29,960 --> 00:07:35,620 +..الآن هذه ال .. يعني رسمة تمثلية كيف .. كيف ال + +110 +00:07:35,620 --> 00:07:38,160 +synaptophore بيشتغل؟ ال synaptophore عبارة عن + +111 +00:07:38,160 --> 00:07:44,330 +أنبوبة متنية بشكل عمودي، هي الأنبوبةو في انثناء + +112 +00:07:44,330 --> 00:07:47,310 +عمودي فيها و هاي انبوبة تانية فيها انثناء عمودي + +113 +00:07:47,310 --> 00:07:52,230 +هنا في المريض بده يحط عينية تنتين او يتطلع من .. + +114 +00:07:52,230 --> 00:07:55,850 +في كل عين ده يتطلع في انبوبة كيف بده يشوف الصورة؟ + +115 +00:07:55,850 --> 00:08:00,090 +الصورة في slide carrier حامل للسلايدات، حامل + +116 +00:08:00,090 --> 00:08:05,330 +للشرائح، خلفه مصدر ضوء بيضوي على ال slide او على + +117 +00:08:05,330 --> 00:08:09,730 +الرسمةزي رسمة الأسد أو السيارة أو الكراج أو القفص + +118 +00:08:09,730 --> 00:08:13,050 +أو .. فيها يعني رسومات كتيرة هذه الصورة تحمل إلى + +119 +00:08:13,050 --> 00:08:16,130 +المرأة هنا في مراية المراية جاية في ال .. في + +120 +00:08:16,130 --> 00:08:21,090 +الزاوية بتاعة الأنبوبة فبتنعكس .. بتنعكس .. بتبين + +121 +00:08:21,090 --> 00:08:24,110 +كأنها جاية من عند النقطة هاي بتبين .. يعني .. يعني + +122 +00:08:24,110 --> 00:08:29,120 +بتبين الصورة داخل المرأة طبعا هو هيشوف الصورةفي + +123 +00:08:29,120 --> 00:08:31,760 +العين اليمين ويشوف صورة بتختلف عنها في العين + +124 +00:08:31,760 --> 00:08:35,560 +الشمال ومفروض إذا ال two fove يالهم نفس الاتجاه + +125 +00:08:35,560 --> 00:08:38,600 +الصورتين يكونوا في نفس المكان بمعنى الأسد ينشاف + +126 +00:08:38,600 --> 00:08:43,280 +داخل القفص الأسد ينشاف داخل القفص و ساعتها .. + +127 +00:08:43,280 --> 00:08:47,980 +ساعتها بنقول إنه هذا عنده simultaneous perception + +128 +00:08:47,980 --> 00:08:51,320 +simultaneous perception فهذه فكرة عمل ال sign of + +129 +00:08:51,320 --> 00:08:55,170 +the four اللي اتفجنا إنها عبارة عنhaploscopic + +130 +00:08:55,170 --> 00:08:59,970 +device أيضا من ال haploscopic devices الباجوليني + +131 +00:08:59,970 --> 00:09:06,230 +striated glasses الباجوليني striated glasses بدنا + +132 +00:09:06,230 --> 00:09:10,410 +يعني نوضح أشياء الباجوليني striated glasses برسمة + +133 +00:09:27,340 --> 00:09:34,100 +البجولين striated glasses عبارة عن .. عن glasses + +134 +00:09:34,100 --> 00:09:39,800 +عادية فيها striation فيها يعني فرزات وكأنه .. + +135 +00:09:39,800 --> 00:09:43,080 +وكأنه أنا ماسك ال Maddox rod يعني على فكرة بينفع + +136 +00:09:43,080 --> 00:09:46,400 +أنه نعمل ال test هذا باستخدام ال Maddox rod إذا + +137 +00:09:46,400 --> 00:09:50,910 +ملاحظين ال striation هناميلة بزاوية خمسة واربعين + +138 +00:09:50,910 --> 00:09:55,570 +درجة وال استرايشن أمام العين التانية ميلة بزاوية + +139 +00:09:55,570 --> 00:09:59,290 +مية وخمسة وتلاتين درجة فبالتالي خلينا احنا ناخد + +140 +00:09:59,290 --> 00:10:03,870 +الصورة هاي ننجلها لل power point هنا + +141 +00:10:33,740 --> 00:10:42,680 +نقول كالعادي المريض + +142 +00:10:42,680 --> 00:10:47,590 +بده يرتدي الباجوليني striated glassesو انا بس بدي + +143 +00:10:47,590 --> 00:10:52,930 +ا .. امسك ال pin torch ضوء صغير و اوجهه باتجاه + +144 +00:10:52,930 --> 00:10:58,510 +عيني المريض و اعمل ال test طبعا ايش فايدة + +145 +00:10:58,510 --> 00:11:02,450 +illustration هذه التعريجات البسيطة و كأن هو لابس + +146 +00:11:02,450 --> 00:11:06,640 +كل تعريجة كأنها عبارة عنcylindrical lens يعني هنا + +147 +00:11:06,640 --> 00:11:09,120 +عندي بيه cylindrical lens كمان cylindrical lens + +148 +00:11:09,120 --> 00:11:12,020 +كمان cylindrical lens هدى ال astrayation وظيفتها + +149 +00:11:12,020 --> 00:11:15,300 +اتحول ال point source of light اتحوله ل streak + +150 +00:11:15,300 --> 00:11:19,540 +يعني انا اللى هضويه على عين المريض point source of + +151 +00:11:19,540 --> 00:11:24,190 +lightpoint source of light يعني مصدر صغير للضوء، + +152 +00:11:24,190 --> 00:11:27,110 +pen torch أو شيء من هذا القبيل، هذا اللي حدوي، بس + +153 +00:11:27,110 --> 00:11:30,130 +اللي هيشوفه المريض عبارة عن خط مضيق، ليش؟ هو أنا + +154 +00:11:30,130 --> 00:11:37,490 +دود نقطة مضيقة أو ضوء laser أو pen torch، يعني جلم + +155 +00:11:37,490 --> 00:11:42,760 +مضيق، فاتحول لخط مضيق، بسبب هذه ال astrayationطيب، + +156 +00:11:42,760 --> 00:11:45,760 +الآن السؤال التاني، ليش الـ striation هنا ميلة على + +157 +00:11:45,760 --> 00:11:49,320 +خمسة و أربعين و هنا ميلة على خمسة و .. مية و خمسة + +158 +00:11:49,320 --> 00:11:53,600 +و تلاتين، يعني بينهم تسعين درجة؟ طبعا، كل .. كل + +159 +00:11:53,600 --> 00:11:58,400 +عين هتشوف خط مائل، هذه هتشوف خط مائل، وهذه خط + +160 +00:11:58,400 --> 00:12:02,620 +مائل، اتجاه الخط المائل دائما و أبدا، هيكون عمودي + +161 +00:12:02,620 --> 00:12:05,760 +على اتجاه الـ striation يعني هنا الـ striation + +162 +00:12:05,760 --> 00:12:10,890 +ميلة .. ميلة على خمسة و أربعين درجةلما بضوي point + +163 +00:12:10,890 --> 00:12:15,930 +source of light المريض حيشوف بعينه الشمال خط + +164 +00:12:15,930 --> 00:12:23,190 +بالشكل هذا .. خط بالشكل هذا حيشوف + +165 +00:12:23,190 --> 00:12:28,470 +المريض بالشكل هذا الخط ليش؟ + +166 +00:12:28,470 --> 00:12:32,790 +لأنه دائما اتجاه الخط اللي بتراه العين عمودي على + +167 +00:12:32,790 --> 00:12:41,360 +اتجاه illustration و بالنسبة لالعين التانية طالما + +168 +00:12:41,360 --> 00:12:44,800 +ما يلان ال استرايشين على مية و خمسة و تلاتين إذا + +169 +00:12:44,800 --> 00:12:49,320 +الخط هينشاف على خمسة و أربعين على خمسة و أربعين طب + +170 +00:12:49,320 --> 00:12:53,000 +هو عبارة عن إيش الخط الخط هذا و الخط هذا صورة + +171 +00:12:53,000 --> 00:12:56,720 +النقطة اللي أنا ضويتها قدام العنتين هو target واحد + +172 +00:12:56,720 --> 00:13:02,300 +هو target واحد بس حولته لصورتين مختلفتين باستعمال + +173 +00:13:02,300 --> 00:13:05,880 +الباجوليني striated glassesطبعا ممكن السيد يقول لأ + +174 +00:13:05,880 --> 00:13:09,400 +هذا .. هذا العين الشمال بتشوف خط و العين اليمين + +175 +00:13:09,400 --> 00:13:12,860 +بتشوف خط طالما الخط هذا ما يلانه في الفرق غير ما + +176 +00:13:12,860 --> 00:13:15,540 +يلان هذا الخط إذا هذه صورة و هذه صورة تختلف عنها + +177 +00:13:15,540 --> 00:13:19,640 +وإن كان كل منهم أنا بسميه خط، إذا هي نقطة واحدة + +178 +00:13:20,530 --> 00:13:25,470 +نقطة واحدة حولتها ل two targets باستعمال .. + +179 +00:13:25,470 --> 00:13:29,470 +باستعمال الباجولين striated glasses العين الشمال + +180 +00:13:29,470 --> 00:13:34,210 +هتشوف خط مائل على زاوية 135 درجة على المحور الأفقي + +181 +00:13:34,210 --> 00:13:39,550 +و هذه العين اليمين هتشوف خط مائل على 45 درجة على + +182 +00:13:39,550 --> 00:13:43,880 +المحور الأفقيفبالتالي هذه هتشوف صورة و هذه هتشوف + +183 +00:13:43,880 --> 00:13:48,040 +صورة بتختلف عنها لما أنا بقوله المريض يفتح عينيه + +184 +00:13:48,040 --> 00:13:54,680 +التنتين .. لما بقوله يفتح عينيه التنتينو يتطلع على + +185 +00:13:54,680 --> 00:13:57,520 +ال point source of light هيقوللي أنا شايف ال cross + +186 +00:13:57,520 --> 00:14:02,140 +ايش يعني شايف ال cross؟ يعني شايف خط و شايف خط هذا + +187 +00:14:02,140 --> 00:14:05,620 +الخط اللي انا بقشر عليه الآن ال result ايه؟ يعني + +188 +00:14:05,620 --> 00:14:10,020 +في عندي نتائج كتيرة محتملة لل test اول نتيجة ممكن + +189 +00:14:10,020 --> 00:14:14,500 +تصير معايا او ممكن تطلع معايا انه يشوف ال cross ال + +190 +00:14:14,500 --> 00:14:18,440 +cross عبارة عن خط مائلبالميلان هذا اللي أنا بأشر + +191 +00:14:18,440 --> 00:14:21,340 +عليه معناته العين اليمين شغالة لأن العين اليمين هي + +192 +00:14:21,340 --> 00:14:24,260 +اللي بتشوف الميلان هذا، ليش هي؟ ليش مش العين + +193 +00:14:24,260 --> 00:14:28,180 +الشمال؟ أه لأن العين الشمال خط ميل هيك طالما شاف + +194 +00:14:28,180 --> 00:14:33,730 +الخطينمعناته في عنده simultaneous perception مافيش + +195 +00:14:33,730 --> 00:14:39,010 +عنده صبرش مافيش عنده صبرش ليش؟ لأنه شاف الخطين خط + +196 +00:14:39,010 --> 00:14:43,110 +مائل على خمسة واربعين خط مائل على خمسة واربعين هذا + +197 +00:14:43,110 --> 00:14:46,710 +شافته العين اليمين وخط مائل على مية وخمسة وتلاتين + +198 +00:14:46,710 --> 00:14:52,110 +هذا شافته العين الشمال طيب إذا مرة .. إذا شاف فقط + +199 +00:14:52,110 --> 00:14:55,210 +خط مائل على خمسة واربعين يعني هذا الخط هو اللي + +200 +00:14:55,210 --> 00:14:58,910 +شافه وهم فت عين التنتين ضروري وهم فت عين التنتين + +201 +00:14:59,370 --> 00:15:03,690 +وماشافش الخط الآخر .. ماشافش الخط الآخر معناته + +202 +00:15:03,690 --> 00:15:08,470 +الخط الآخر مين المفروض تشوفه؟ ميلانه على مية و + +203 +00:15:08,470 --> 00:15:11,270 +خمسة و تلاتين هو العين الشمال .. الشمال المفروض + +204 +00:15:11,270 --> 00:15:14,370 +تشوفه، إذا في عندي left suppression .. إذا في عندي + +205 +00:15:14,370 --> 00:15:20,190 +left suppression، هو شاف الخط هذاوماشافش الخط هذا + +206 +00:15:20,190 --> 00:15:23,750 +فبالتالي عنده left suppression طيب نفرض العكس هو + +207 +00:15:23,750 --> 00:15:27,310 +شاف الخط هذا وماشافش الخط العمودي عليه إذا في عندي + +208 +00:15:27,310 --> 00:15:30,570 +right suppression عندي right suppression طيب الآن + +209 +00:15:30,570 --> 00:15:35,650 +بدنا نطلع على المنظر هذا احنا لازلنا بنحكي عن ال + +210 +00:15:35,650 --> 00:15:39,150 +suppression هو المفروض يشوف خط كامل متقاطع مع خط + +211 +00:15:39,150 --> 00:15:44,130 +كامل متقاطع مع خط كامل عشان أقول ماعندهوش + +212 +00:15:44,130 --> 00:15:48,190 +suppression طيب شاف الخط هذاهذا الخط مين اللي + +213 +00:15:48,190 --> 00:15:52,490 +بتشوفه؟ العين الشمال إذا العين الشمال شغالة طيب + +214 +00:15:52,490 --> 00:15:56,490 +الخط التاني .. الخط التاني بتشوفه العين اليمين بس + +215 +00:15:56,490 --> 00:16:00,550 +في عندى هنا ملاحظة أن الخط التاني فيه في نصه فراغة + +216 +00:16:00,550 --> 00:16:06,450 +فيه في نصه فراغة وكأنه استقبل الخط التاني بس في + +217 +00:16:06,450 --> 00:16:10,610 +النص مستقبلش النص عجبالي الفوفيا بالظبط هذا الشخص + +218 +00:16:10,610 --> 00:16:16,520 +عنده right أن هذا لل rightcentral suppression is + +219 +00:16:16,520 --> 00:16:20,200 +كتومة يعني في عنده central suppression طيب هل في + +220 +00:16:20,200 --> 00:16:22,640 +حاجة اسمها central suppression؟ طبعا في حاجة اسمها + +221 +00:16:22,640 --> 00:16:25,320 +central suppression احنا قولنا ال separation يقسم + +222 +00:16:25,320 --> 00:16:29,300 +ل peripheral central و peripheral central و + +223 +00:16:29,300 --> 00:16:32,680 +peripheral و ان ال central عشان مايصيرش عندي + +224 +00:16:32,680 --> 00:16:36,360 +confusion ال central suppression ال central + +225 +00:16:36,360 --> 00:16:40,940 +suppression بيخلصني من ال confusion ال confusion + +226 +00:16:40,940 --> 00:16:46,020 +تمام فبالتاليcentral suppression in central + +227 +00:16:46,020 --> 00:16:48,460 +suppression the image from the fovea of the + +228 +00:16:48,460 --> 00:16:52,480 +deviating eye is inhibited to avoid confusion عشان + +229 +00:16:52,480 --> 00:16:56,160 +نتجنب ال confusion لازم يصير عندي central + +230 +00:16:56,160 --> 00:16:59,060 +suppression كيف اعرف ال central suppression أحد + +231 +00:16:59,060 --> 00:17:03,180 +الوسائل بوسط البجولين striated glasses إذا كانت ال + +232 +00:17:03,180 --> 00:17:07,860 +result أعطتني خط كامل للعين السليمة وخط فيه defect + +233 +00:17:07,860 --> 00:17:11,790 +بسموه gap central gapأو central suppression + +234 +00:17:11,790 --> 00:17:15,190 +scotoma يعني الجزء اللي في النص من الخط ماانشافش + +235 +00:17:15,190 --> 00:17:19,770 +لإنه الخط صورته هتيجي على الفوفيا وعلى ال + +236 +00:17:19,770 --> 00:17:22,630 +paraphobia و ال periphobia يعني هتيجي على كل ال + +237 +00:17:22,630 --> 00:17:26,170 +retina بما فيها ash أو على جزء كبير من ال retina + +238 +00:17:26,170 --> 00:17:29,350 +بما فيها الفوفيا لوحد بيركز بالفوفيا لكن طالما + +239 +00:17:29,350 --> 00:17:32,730 +الفوفيا في وضع suppression هيكون الخط من ال feet + +240 +00:17:32,730 --> 00:17:36,090 +فيه يعني انقطاع في النص فهتتسمى central + +241 +00:17:36,090 --> 00:17:39,250 +suppression scotoma إذا ممكن أكتشف إنه مافيش + +242 +00:17:39,250 --> 00:17:43,200 +suppressionsimultaneous perception ممكن أكتشف أنه + +243 +00:17:43,200 --> 00:17:46,220 +في عندي left suppression لما أشوف الخط على العين + +244 +00:17:46,220 --> 00:17:49,840 +اليمين فقط ممكن أكتشف أنه right suppression إذا + +245 +00:17:49,840 --> 00:17:53,280 +أنا شوفت الخط على العين الشمال فقط ممكن أكتشف أنه + +246 +00:17:53,280 --> 00:17:56,660 +alternating suppression مرة بشوف خط ميل هيك بعد + +247 +00:17:56,660 --> 00:18:00,240 +بلحظة بشوف خط ميل هيك بعدين برجع بشوف خط ميل هيك + +248 +00:18:00,240 --> 00:18:03,380 +بعدين برجع بشوف خط ميل هيك بس مابشوفهم مش في نفس + +249 +00:18:03,380 --> 00:18:07,180 +اللحظة فهذا يسمى alternating suppression ممكن أشوف + +250 +00:18:10,200 --> 00:18:12,900 +central suppression في عين في هذه الحالة في الرسم + +251 +00:18:12,900 --> 00:18:15,820 +هاي في العين اليمين central suppression scotoma + +252 +00:18:15,820 --> 00:18:21,580 +عشان مايصيرش عندي انا confusion عند المريض، + +253 +00:18:21,580 --> 00:18:26,700 +confusion، هاي عندي نفس الاشي المريضلابس الباجولين + +254 +00:18:26,700 --> 00:18:30,280 +striated glasses هنا ال right eye ال striation على + +255 +00:18:30,280 --> 00:18:33,520 +مية و خمسة و تلاتين درجة ال striation على مية و + +256 +00:18:33,520 --> 00:18:36,740 +خمسة و تلاتين درجة إذا ال right eye هتشوف على خمسة + +257 +00:18:36,740 --> 00:18:40,600 +و أربعين ال left eye ال striation التخطيطات أو + +258 +00:18:40,600 --> 00:18:43,860 +التعريجات في ال .. في ال glasses على .. على خمسة و + +259 +00:18:43,860 --> 00:18:46,920 +أربعين degree إذا ال left eye هتشوف عمودي على ال + +260 +00:18:46,920 --> 00:18:52,620 +striation عندي هيكون على مية و خمسة و تلاتين طالما + +261 +00:18:52,620 --> 00:18:55,990 +ال striation على خمسة و أربعينهنا في عندي central + +262 +00:18:55,990 --> 00:18:59,070 +suppression scotoma في ال right eye .. في ال right + +263 +00:18:59,070 --> 00:19:02,830 +eye و هنا عندي right suppression .. عندي right + +264 +00:19:02,830 --> 00:19:05,950 +suppression يعني suppression of the right eye ال + +265 +00:19:05,950 --> 00:19:13,070 +.. ال .. ال .. ال test ممكن ينعمل على بعد يعني ستة + +266 +00:19:13,070 --> 00:19:17,520 +متر و ممكن ينعمل على بعدتلاتين سانتي او تلاتة و + +267 +00:19:17,520 --> 00:19:21,660 +تلاتين سانتي مافي اي مشكلة هو نفس الفكرة .. نفس + +268 +00:19:21,660 --> 00:19:25,720 +الفكرة بنتوقف عند فحوصات ال submission high و + +269 +00:19:25,720 --> 00:19:30,920 +المرة القادمة ان شاء الله تعالى بنبدأ في درس جديد + +270 +00:19:30,920 --> 00:19:34,150 +اللي هو ال microtopiaوالـ Microtropia على فكرة + +271 +00:19:34,150 --> 00:19:37,350 +فيها ميزتين، الميزة الأولى، في عندي central + +272 +00:19:37,350 --> 00:19:40,170 +suppression scotoma وكان لابد من المحاضرة هذه + +273 +00:19:40,170 --> 00:19:44,470 +للتقدمة لها عشان نعملها كمقدمة لقضية الـ central + +274 +00:19:44,470 --> 00:19:47,610 +suppression scotoma يعني الـ Microtropia ممكن الـ + +275 +00:19:47,610 --> 00:19:50,750 +Microtropic patient يشوف الـ central suppression + +276 +00:19:50,750 --> 00:19:54,970 +scotoma ويلاحظها وتاني حاجة في عنا abnormal + +277 +00:19:54,970 --> 00:19:58,150 +retinal correspondence اللي حكينا عنه في المحاضرة + +278 +00:19:58,150 --> 00:20:01,500 +القادمةإذا الميكروتروبيا من ضمن الأشياء اللي + +279 +00:20:01,500 --> 00:20:04,920 +بلاحظها فيها central suppression scotoma وأيضا + +280 +00:20:04,920 --> 00:20:10,040 +بلاحظ أنه في عندي ظاهرة ال abnormal retinal + +281 +00:20:10,040 --> 00:20:13,840 +correspondence ويعطيكم العافية والسلام عليكم ورحمة + +282 +00:20:13,840 --> 00:20:15,140 +الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/064Gnt3Exc8_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/064Gnt3Exc8_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..60dce51fb3f3ee15b5098cb3ae481005f846c344 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/064Gnt3Exc8_postprocess.srt @@ -0,0 +1,1916 @@ +1 +00:00:01,840 --> 00:00:05,760 +بسم الله الرحمن الرحيم بنواصل مع محاضرات حوال واحد + +2 +00:00:05,760 --> 00:00:12,910 +واتوقفنا عند tests for sensory anomaliesيعني + +3 +00:00:12,910 --> 00:00:16,210 +الفحوصات اللي بنستخدمها عشان نعرف إذا في عندي + +4 +00:00:16,210 --> 00:00:19,470 +sensory anomalies ولا لأ بنذكر ال sensory + +5 +00:00:19,470 --> 00:00:23,610 +anomalies زي مثلا ال diplopia عبارة عن sensory + +6 +00:00:23,610 --> 00:00:28,530 +anomaly يعني حاجة مش طبيعية وعبارة عن sensation مش + +7 +00:00:28,530 --> 00:00:32,670 +طبيعية، أيضا ال separation ممكن في هذه ال testات + +8 +00:00:32,670 --> 00:00:36,670 +أكتشفه، أيضا ال abnormal retinal correspondence أو + +9 +00:00:36,670 --> 00:00:41,030 +حتى ال normal binocular single visionالديبلوبيا ال + +10 +00:00:41,030 --> 00:00:44,450 +suppression ال abnormal retinal correspondence + +11 +00:00:44,450 --> 00:00:49,130 +والnormal binocular single vision ممكن يعني تكتشف + +12 +00:00:49,130 --> 00:00:55,670 +بواسطة هذه الاختبارات أو هذه الفحوصات ال worth for + +13 +00:00:55,670 --> 00:00:59,670 +dot test عبارة عن dissociation test ايش يعني + +14 +00:00:59,670 --> 00:01:04,250 +dissociation test؟ اي test بيفرق بين العينتين في + +15 +00:01:04,250 --> 00:01:07,780 +الرؤيةيعني بيخلي العين اليمين تشوف شيء والعين + +16 +00:01:07,780 --> 00:01:12,720 +الشمال تشوف شيء آخر مختلف عنه أي test بيعمل هذه + +17 +00:01:12,720 --> 00:01:19,300 +القضية بيعتبر dissociation Test فبالتالي ال worth + +18 +00:01:19,300 --> 00:01:23,640 +for dot test لأنه بيقدم للعين اليمين صورة وبيقدم + +19 +00:01:23,640 --> 00:01:28,020 +للعين الشمال صورة أخرى تختلف عنها بشكل أو بآخر + +20 +00:01:28,020 --> 00:01:32,880 +يعتبر dissociation Test إذا this dissociation test + +21 +00:01:33,470 --> 00:01:38,650 +الو ال word for dot test which can be used على ال + +22 +00:01:38,650 --> 00:01:43,130 +distance و على ال near fixation and differentiate + +23 +00:01:43,130 --> 00:01:46,490 +between binocular single vision اللي هو مبني على + +24 +00:01:46,490 --> 00:01:49,630 +normal retinal correspondence أو ال binocular + +25 +00:01:49,630 --> 00:01:52,330 +single vision اللي مبني على abnormal retinal + +26 +00:01:52,330 --> 00:01:57,070 +correspondenceand subversion إذا أول شيء ممكن + +27 +00:01:57,070 --> 00:02:00,950 +يفرقلي بين ال binocular single vision الطبيعي وال + +28 +00:02:00,950 --> 00:02:04,970 +binocular single vision اللي مبني على abnormal + +29 +00:02:04,970 --> 00:02:08,170 +retinal correspondence يعني بيقدر يحدد هذا إذا كان + +30 +00:02:08,170 --> 00:02:13,260 +المريض عنده normal PSV أوabnormal retinal + +31 +00:02:13,260 --> 00:02:16,380 +correspondence بيقدر يحددلي إذا المريض عنده + +32 +00:02:16,380 --> 00:02:20,160 +suppression ولا لا بيقدر يحددلي إذا في دبلوبيا ولا + +33 +00:02:20,160 --> 00:02:23,700 +لا و أيضا نوع الدبلوبيا هل هي horizontal دبلوبيا + +34 +00:02:23,700 --> 00:02:27,300 +ولا vertical دبلوبيا زي ما هنشوف في ال test بعد + +35 +00:02:27,300 --> 00:02:31,480 +قليل results can only be interpreted in the + +36 +00:02:31,480 --> 00:02:35,880 +presence or absence if the presence or absenceof a + +37 +00:02:35,880 --> 00:02:39,600 +manifest squint is known at the time of testing + +38 +00:02:39,600 --> 00:02:44,820 +الآن قبل ما نبدأ في ال test بدنا نقول في يعني + +39 +00:02:44,820 --> 00:02:50,660 +شرطين مهمين لأداء ال test أول شرط لازم انا ك + +40 +00:02:50,660 --> 00:02:54,680 +examiner ابجي عارف في عندي manifest squint ولا + +41 +00:02:54,680 --> 00:02:58,540 +مافيش ليش بدي ابجي عارف ان في من manifest squint + +42 +00:02:58,540 --> 00:03:03,120 +ولا لأ لأنه بناء على ال manifest squint بتم تفسير + +43 +00:03:03,120 --> 00:03:08,580 +ال results داهذا ال test ال manifest squint اللي + +44 +00:03:08,580 --> 00:03:12,960 +هو الحوال الظاهر أو التروبيا ليش احنا ميزنا الحوال + +45 +00:03:12,960 --> 00:03:16,280 +الظاهر عن الحوال الخافي لأن الحوال الخافي العينين + +46 +00:03:16,280 --> 00:03:20,960 +بيكونوا معتدلات زي كأنه عينيه straight فعلا .. زي + +47 +00:03:20,960 --> 00:03:24,000 +كأنه عينيه straight فعلاأما في الحوالي الظاهر + +48 +00:03:24,000 --> 00:03:27,280 +بيكون في عندي Etropia واضحة إما Esotropia أو + +49 +00:03:27,280 --> 00:03:31,980 +Exotropia أو Hypertropia أو Hypodropia وبالتالي + +50 +00:03:31,980 --> 00:03:35,480 +بيكون عندي في اختلاف في التفسير في اختلاف في + +51 +00:03:35,480 --> 00:03:41,060 +التفسير لا يعامل معاملة الانسان الطبيعي في هذا ال + +52 +00:03:41,060 --> 00:03:47,300 +test إذا أول شرط لازم أنا ك examiner أكون عارفيعني + +53 +00:03:47,300 --> 00:03:50,700 +إذا كان في Trauma عند المريض و لا مافيش Trauma عند + +54 +00:03:50,700 --> 00:03:54,000 +المريض، هاي أول شرط الشرط التاني و اللي هو مهم جدا + +55 +00:03:54,000 --> 00:03:58,740 +أنه المريض مايفهم طبيعة ال test قبل أداءه يعني + +56 +00:03:58,740 --> 00:04:01,040 +إنسان بيجي بيقول أنا عندي .. أنا بشوف الحاجة + +57 +00:04:01,040 --> 00:04:04,020 +حاجتين، عندي ازدواجية في النظر و بدي تقرير بهذا + +58 +00:04:04,020 --> 00:04:10,470 +الموضوعتقرير طبي أو تقرير طبي أتقدم فيه لل .. يعني + +59 +00:04:10,470 --> 00:04:14,910 +مثلا للجهات القانونية لأنه أنا دخلت مثلا في إشي + +60 +00:04:14,910 --> 00:04:19,850 +جار مع شخص آخر و .. يعني طلقيت يعني ضربة على الرأس + +61 +00:04:19,850 --> 00:04:25,850 +أصبحت بعدين أشوف يعني الشيء مزدوج فيعني إذا أحنا + +62 +00:04:25,850 --> 00:04:28,810 +بنشرح للمريض ال test ونقوله والله إذا شوفت مثلا + +63 +00:04:28,810 --> 00:04:34,830 +خمس نقاط معناته أنتبتشوف فعلا شئ اتنين أو عندك + +64 +00:04:34,830 --> 00:04:38,690 +ازدواجية في الرؤية او diplopia ساعتها المريض أخد + +65 +00:04:38,690 --> 00:04:42,150 +المعلومة ان والله اللي بيشوف خمسة .. خمس .. خمسة + +66 +00:04:42,150 --> 00:04:46,070 +target بدل أربعة معناته عنده diplopia فساعتها هو + +67 +00:04:46,070 --> 00:04:52,370 +ممكن يكون مجرد مدعي لا .. يعني لا يشكو من diplopia + +68 +00:04:52,370 --> 00:04:56,550 +وإنما يعني هو أخد المعلومة مني فبالتالي ضروري جدا + +69 +00:04:56,550 --> 00:05:02,010 +المريض الشرط التاني من شروط ال testإنه مايعرفش سر + +70 +00:05:02,010 --> 00:05:06,570 +ال test أو يعني تفسير النتائج دا عن ال test اللي + +71 +00:05:06,570 --> 00:05:12,880 +هو شايفهإذا الشرطين شرط مختص بالفاحس أنه يكون عارف + +72 +00:05:12,880 --> 00:05:17,820 +هل في manifest squint ولا لأ، شرط مختص بالمريد أنه + +73 +00:05:17,820 --> 00:05:22,640 +المريض مايفهمش إيش تفاصيل ال test وإنما يتم يعني + +74 +00:05:22,640 --> 00:05:28,320 +إجراء ال test عليه ويعني مطلوب منه فقط أنه يقول + +75 +00:05:28,320 --> 00:05:34,950 +إيش شايف أمامه .. إيش شايف أمامهالان نجي لـ ال + +76 +00:05:34,950 --> 00:05:38,250 +test بس قبل ما نجي ل ال procedure نقول عبارة عن + +77 +00:05:38,250 --> 00:05:43,490 +ايش الجهاز اللي بيعملي ال four dot test هذه ال + +78 +00:05:43,490 --> 00:05:52,050 +results ال four dot test عبارة عن يعني مصدر ضوء + +79 +00:05:52,050 --> 00:05:58,210 +بيعطيني four lights اتنين منهم greenواحد white + +80 +00:05:58,210 --> 00:06:03,490 +واحد red اذا عشان هيك سر التسمية اسمه four dot + +81 +00:06:03,490 --> 00:06:08,270 +test على فكرة هو المفروض يتسمى four targets test + +82 +00:06:08,270 --> 00:06:12,910 +لانه كتير من التستات يعني مثلا هذه اللي نطلع على + +83 +00:06:12,910 --> 00:06:18,430 +العرض المكبر هذا projector chart بيعرض حاجات كتيرة + +84 +00:06:18,430 --> 00:06:21,650 +ومن ضمنها بيعرض four target test هي عبارة مش عن + +85 +00:06:21,650 --> 00:06:27,520 +dot وانما عبارة عن two cross بالجرينone red circle + +86 +00:06:27,520 --> 00:06:32,820 +او اخر one white circle و one red diamond one red + +87 +00:06:32,820 --> 00:06:38,840 +diamond اذا هي الأفضل نسميه four target test بس هو + +88 +00:06:38,840 --> 00:06:42,100 +الاسم دارج فبالتالي بدناش نختلف مع غيرنا في هذا + +89 +00:06:42,100 --> 00:06:47,000 +الموضوع اذا ال test عبارة عن اربع dots او اربع + +90 +00:06:47,000 --> 00:06:52,900 +targets اتنين green one red and one white و معاه + +91 +00:06:52,900 --> 00:06:59,300 +مرفقred green goggles نضارة فلتر أحمر و فلتر أخضر + +92 +00:06:59,300 --> 00:07:03,400 +بيرتدي المريض النضارة هتيجي الفلتر الأحمر أمام + +93 +00:07:03,400 --> 00:07:07,040 +العين اليمين و هيجي الفلتر الأخضر أمام العين + +94 +00:07:07,040 --> 00:07:11,060 +الشمال لأن هو لابس النضارة بعينه اليمين فقط بيشوف + +95 +00:07:11,060 --> 00:07:15,880 +two dots ال red لأنه الأشعة أو ال red light هينفذ + +96 +00:07:15,880 --> 00:07:21,650 +من هناو ال white أيضًا هيشوفه .. هيشوفه على أحمر + +97 +00:07:21,650 --> 00:07:26,550 +بس هيكون أحمر فاتح لأن ال white أيضًا بحتوي على ال + +98 +00:07:26,550 --> 00:07:31,010 +red wavelengths إذا بالعين اليمين بيشوف فقط two + +99 +00:07:31,010 --> 00:07:31,410 +dots + +100 +00:07:34,100 --> 00:07:38,440 +بالعين الشمال فقط بيشوف three dots اتنين ال green + +101 +00:07:38,440 --> 00:07:42,980 +و واحد هيبين ال green بس فاتح لأن ال white light + +102 +00:07:42,980 --> 00:07:47,200 +ايضا بيحتوي على green wavelengths اذا بالشمال شايف + +103 +00:07:47,200 --> 00:07:52,160 +تلاتة و باليمين شايف اتنين لما بيكون انفتح عين + +104 +00:07:52,160 --> 00:07:55,380 +التنتين مع بعض و بيكون hand of eugen و normal + +105 +00:07:55,380 --> 00:07:59,320 +retinal corresponders هيشوف four lights مش five + +106 +00:07:59,320 --> 00:08:03,180 +لأن هذا هو عبارة عن نقطة واحدة صحيح شافها باليمين + +107 +00:08:04,410 --> 00:08:09,070 +على حمار و شفا في الشمال على خضار إلا إنها في نفس + +108 +00:08:09,070 --> 00:08:12,390 +المكان يعني صادرة من نفس المكان فعشان عنده fusion + +109 +00:08:12,390 --> 00:08:16,410 +هيقدر يدمجها تمام فبالتالي هو هيشوف four lights + +110 +00:08:16,410 --> 00:08:21,270 +هذا هيتردد بين أنه يكون لونه مرة على حمار خفيف و + +111 +00:08:21,270 --> 00:08:27,610 +مرة على خضار خفيف حسب يعني شعور المريض إذا نيجي + +112 +00:08:27,610 --> 00:08:31,670 +احنا لل procedureThe patient wears a green lens in + +113 +00:08:31,670 --> 00:08:35,250 +front of the right eye طبعا ممكن انسان يقول احنا + +114 +00:08:35,250 --> 00:08:38,910 +هنا green lens جدام ال left eye ممكن .. ممكن + +115 +00:08:38,910 --> 00:08:43,330 +الفلاتر تكون ممكن تغييرها بمعنى أنا ألبس المريض ل + +116 +00:08:43,330 --> 00:08:47,970 +trial frame و أحطله مرة red filter هنا و مرة green + +117 +00:08:47,970 --> 00:08:50,670 +filter هنا و بعدين أعكسه .. و بعدين أعكسه + +118 +00:08:53,130 --> 00:08:56,250 +The patient wears green lens in front of the right + +119 +00:08:56,250 --> 00:09:00,750 +eye which filters out all colors except green and + +120 +00:09:00,750 --> 00:09:04,090 +red lens in front of the left eye which will + +121 +00:09:04,090 --> 00:09:08,670 +filter out all colors except red يعني الأحمر هينفذ + +122 +00:09:08,670 --> 00:09:14,390 +الأحمر طبعا و الأخضر هينفذ الأخضر The patient then + +123 +00:09:14,390 --> 00:09:18,730 +views a box with four lights, one red, two green, + +124 +00:09:19,030 --> 00:09:25,230 +one whiteبيشوف ال box هدا، one red, two green, one + +125 +00:09:25,230 --> 00:09:30,810 +light طيب، ماذا يحدث بعد ذلك؟ ال result if + +126 +00:09:30,810 --> 00:09:35,130 +binocular single vision is present all four lights + +127 +00:09:35,130 --> 00:09:38,570 +are seen if all four lights are seen in the + +128 +00:09:38,570 --> 00:09:43,090 +presence of manifest deviation طب لو هو شاف لو هو + +129 +00:09:43,090 --> 00:09:50,180 +شاف أربعة زي ما المنظر أيه بيوضحوعنده manifest + +130 +00:09:50,180 --> 00:09:53,740 +squint بنقول عنده abnormal retinal correspondence + +131 +00:09:53,740 --> 00:09:58,660 +ليش؟ لأنه رغم وجود ال manifest squint هو جدر يشوف + +132 +00:09:58,660 --> 00:10:03,900 +طبيعي زيه زي الإنسان الطبيعي وبالتالي بنقول عنده + +133 +00:10:03,900 --> 00:10:07,080 +abnormal retinal correspondence عنده binocular + +134 +00:10:07,080 --> 00:10:10,900 +single vision مبني على abnormal retinal + +135 +00:10:10,900 --> 00:10:14,080 +correspondence ليش قررنا أنه مبني على abnormal + +136 +00:10:14,080 --> 00:10:17,120 +retinal correspondence؟ لأن اللي عنده manifest + +137 +00:10:17,120 --> 00:10:21,570 +squint معناتهالنقاط المتناظرة عنده في الشبكية + +138 +00:10:21,570 --> 00:10:27,510 +اتجاهاتها في الفراغ مش نفس الاتجاهات ومع ذلك هو + +139 +00:10:27,510 --> 00:10:31,350 +شاف زيه زي الإنسان الطبيعي معناته عنده في ترتيبة + +140 +00:10:31,350 --> 00:10:34,190 +أخرى اللي هي ترتيبة الـ abnormal retinal + +141 +00:10:34,190 --> 00:10:41,710 +correspondence طيب لو شاف two red lightsفقط + +142 +00:10:41,710 --> 00:10:45,270 +وماشافش ال green طبعا ال two red lights واحد فعلا + +143 +00:10:45,270 --> 00:10:49,630 +red وواحد white بس هو هيشوفه على حمار لو شاف two + +144 +00:10:49,630 --> 00:10:53,710 +red light معناته العين اللي قدامها ال green filter + +145 +00:10:53,710 --> 00:10:57,310 +فيها suppression في هذه الحالة في هذه الحالة هنقول + +146 +00:10:57,310 --> 00:10:59,810 +في عنده lift suppression ليش lift suppression لأنه + +147 +00:10:59,810 --> 00:11:05,790 +شاف two red lights طب لو شاف three green lightsهنا + +148 +00:11:05,790 --> 00:11:09,170 +مش كتير الصورة مواضحة إن هم green بس هم green + +149 +00:11:09,170 --> 00:11:14,470 +lights، three green lights معناته عندي أنا بيشوف + +150 +00:11:14,470 --> 00:11:16,890 +بالعين اللي جدامها ال green filter و العين اللي + +151 +00:11:16,890 --> 00:11:20,030 +جدامها ال red filter sub rest، إذا ساعتها بقول أنا + +152 +00:11:20,030 --> 00:11:26,840 +هذه في عيني right sub restبنقول if two red lights + +153 +00:11:26,840 --> 00:11:31,040 +are seen right suppression is present ليش هنا two + +154 +00:11:31,040 --> 00:11:34,420 +red lights؟ لما شوف two red قولنا في عنده right + +155 +00:11:34,420 --> 00:11:37,400 +suppression لأن ال red lights أو ال red filter + +156 +00:11:37,400 --> 00:11:40,660 +قدام العين الشمال، إذا العين الشمال هي اللي شغالة، + +157 +00:11:40,660 --> 00:11:43,960 +معناته في عندي right suppression if three green + +158 +00:11:43,960 --> 00:11:47,980 +lights are seen left suppression is present كيف + +159 +00:11:47,980 --> 00:11:52,760 +أنا قررت أنه left suppression؟ لأنه ال green light + +160 +00:11:53,410 --> 00:11:56,510 +هو الـ green filter الـ green lens قدام العين + +161 +00:11:56,510 --> 00:12:00,310 +اليمين معناته طالما شاف الـ green dots معناته + +162 +00:12:00,310 --> 00:12:04,090 +العين اليمين شغالة و العين الشمال مش شغالة لأنه + +163 +00:12:04,090 --> 00:12:09,270 +ماشافش ال red إذا في عندي lift suppression طيب لو + +164 +00:12:09,270 --> 00:12:14,260 +شاف five dotsتلاتة green و two red معناته فيها انه + +165 +00:12:14,260 --> 00:12:18,600 +دبلوبيا مش قادر يعمل fusion للنقطة الرابعة مش قادر + +166 +00:12:18,600 --> 00:12:21,940 +يعمل fusion للنقطة الرابعة احنا قولنا العين اليمين + +167 +00:12:21,940 --> 00:12:26,740 +بتشوف في هذا المثال بتشوف two redوالعين الشمال + +168 +00:12:26,740 --> 00:12:30,600 +بتشوف 3 green بس هذه النقطة اللي هي مرة راح تكون + +169 +00:12:30,600 --> 00:12:33,980 +red و مرة تكون green هي نفس النقطة يعني في نفس + +170 +00:12:33,980 --> 00:12:36,620 +المكان الفراغي فبالتالي المفروض يصير ال affusion + +171 +00:12:36,620 --> 00:12:39,760 +إذا عنده diplopia معناته مش هيصير ال affusion + +172 +00:12:39,760 --> 00:12:43,600 +فهيصير يشوف بالعين اليمين 2 red بالعين الشمال 3 + +173 +00:12:43,600 --> 00:12:47,400 +green مش هيقدر يدمج النقطة هذه اللي هي رقم 4 + +174 +00:12:47,400 --> 00:12:53,560 +فهيشوف خمس نقاط لأنههذه النقطة انفصلت لنقطتين .. + +175 +00:12:53,560 --> 00:12:57,320 +طبعا هذه النقطتين هدول بينفصلوش لأنهم فقط بتشوفوا + +176 +00:12:57,320 --> 00:13:00,340 +من العين الشمال وهذه النقطة بتنفصلش لأنه فقط + +177 +00:13:00,340 --> 00:13:03,360 +بتشوفها العين اليمين وغير مرئية للعين الشمال .. + +178 +00:13:03,360 --> 00:13:07,700 +إذا حيصير عندي ال five dots معناته Dyplopia .. + +179 +00:13:07,700 --> 00:13:11,280 +Dyplopia طيب لازم أسأل المريض أنه أنت شايف خمس + +180 +00:13:11,280 --> 00:13:17,580 +نقاط اوصفهم هل هما في نقطتين وجنبهم تلت نقاطإذا + +181 +00:13:17,580 --> 00:13:21,520 +هذه horizontal diplopia أو نقطتين وفوقهم أو تحتهم + +182 +00:13:21,520 --> 00:13:25,440 +تلت نقاط إذا هذه vertical diplopia vertical + +183 +00:13:25,440 --> 00:13:31,480 +diplopia إذا if two red and three green lights are + +184 +00:13:31,480 --> 00:13:35,900 +seen diplopia is present if the green and red + +185 +00:13:35,900 --> 00:13:39,420 +lights alternate alternating suppression is + +186 +00:13:39,420 --> 00:13:42,840 +present ما معنى هذا الكلام إذا كان المريض مرة + +187 +00:13:42,840 --> 00:13:44,840 +بيشوف اتنين + +188 +00:13:46,720 --> 00:13:50,140 +و مرة بيشوف تلاتة و اللحظة اللي بعدها بيشوف اتنين + +189 +00:13:50,140 --> 00:13:52,440 +و اللحظة اللي بعدها بيشوف تلاتة معناته عنده + +190 +00:13:52,440 --> 00:13:55,380 +alternating suppression .. alternating suppression + +191 +00:13:55,380 --> 00:14:00,760 +طيب لو بيشوف تلاتة وجنبهم اتنين يعني خمسة في نفس + +192 +00:14:00,760 --> 00:14:05,450 +اللحظةجنبهم مش فوجهم ولا تحتهم يعني هدولة two red + +193 +00:14:05,450 --> 00:14:09,610 +lights شايفهم على الجانب إما على اليمين على الشمال + +194 +00:14:09,610 --> 00:14:12,910 +عفوا أو على اليمين معناته هدى diplopia horizontal + +195 +00:14:12,910 --> 00:14:17,150 +طب لو شاف three green وفجيهم أو تحتهم two red + +196 +00:14:17,150 --> 00:14:21,090 +معناته هو شايف خمسة بس في عندي vertical diplopia + +197 +00:14:21,090 --> 00:14:24,530 +وهيك تفسر هيك أنا قدرت أعرف إذا كان المريض عنده + +198 +00:14:25,110 --> 00:14:28,690 +normal و لا abnormal retinal correspondence اقدرت + +199 +00:14:28,690 --> 00:14:32,030 +اعرف عنده suppression و هل هو right suppression و + +200 +00:14:32,030 --> 00:14:35,810 +لا left suppression و لا alternating suppression و + +201 +00:14:35,810 --> 00:14:39,470 +اقدرت اعرف انه هل عنده diplopia و اذا عنده + +202 +00:14:39,470 --> 00:14:43,770 +diplopia هل هي يعني + +203 +00:14:43,770 --> 00:14:48,310 +horizontal diplopia و لا vertical diplopia طيب، + +204 +00:14:48,310 --> 00:14:53,120 +الآن قبل ما ننتقل لل test التانيبنقول بعض الأشياء + +205 +00:14:53,120 --> 00:14:58,220 +أو بعض التنبيهات بنقول يعني ال four dot test ليس + +206 +00:14:58,220 --> 00:15:02,140 +شرطا انه يكون red و green يعني مثلا هاي red و blue + +207 +00:15:02,140 --> 00:15:06,780 +عندي ال green استبدل بال blue filter و عندي ال + +208 +00:15:06,780 --> 00:15:13,400 +green dots استبدلت بال blue dots نفس الفكرة و نفس + +209 +00:15:13,400 --> 00:15:18,050 +النتائج و نفس التفسيرزي ما حكينا أيضا مش شرط انه + +210 +00:15:18,050 --> 00:15:21,130 +يكونوا dots، يعني ممكن يكونوا أي أشكال ممكن، أي + +211 +00:15:21,130 --> 00:15:25,090 +أشكال ممكن، فبالتالي هذا الكلام ضروري احنا يعني + +212 +00:15:25,090 --> 00:15:29,580 +ناخد بالنا منهطبعا في كتير applications على ال .. + +213 +00:15:29,580 --> 00:15:33,840 +ال smartphones بتخلي الإنسان يعني يمتلك هذا ال + +214 +00:15:33,840 --> 00:15:38,900 +test بس بيكون بده يعني red green أو red blue + +215 +00:15:38,900 --> 00:15:44,900 +glasses و بالتالي ممكن يقدي هذا ال test بكل سهولة + +216 +00:15:44,900 --> 00:15:49,160 +موجود على ال smartphones موجود على .. يعني ممكن + +217 +00:15:49,160 --> 00:15:53,020 +تنزيله على ال laptop أو ال computer من ال internet + +218 +00:15:53,020 --> 00:15:56,730 +موجود في ال projector chartsفي الـ new projector + +219 +00:15:56,730 --> 00:16:01,050 +charts تقريبا كلها تحتوي على يعني option يخليني + +220 +00:16:01,050 --> 00:16:06,010 +أفحص اللي هو ال four dot test اللي بيكشفلي ال + +221 +00:16:06,010 --> 00:16:09,250 +sensory anomalies من suppression من diplopia من + +222 +00:16:09,250 --> 00:16:12,970 +abnormal retinal correspondence إلى آخرى إلى آخرى + +223 +00:16:12,970 --> 00:16:17,410 +فبالتالي ضروري جدا احنا ناخد بالة من هذا النقطة + +224 +00:16:17,410 --> 00:16:24,060 +بقى برضه من ضمن التنبيهات نقول كالقاتلمعروف انه + +225 +00:16:24,060 --> 00:16:27,980 +الإنسان لما بيكون ينظر إلى target بعيد حجم صورة ال + +226 +00:16:27,980 --> 00:16:32,140 +target بتكون صغيرة حجم صورة ال target بتكون صغيرة + +227 +00:16:32,140 --> 00:16:39,300 +يعني احنا نقول كالقاتي size of image of distance + +228 +00:16:39,300 --> 00:16:44,180 +image under + +229 +00:16:44,180 --> 00:16:50,080 +retina لأن هذا بدنا .. يعني في تفسير معين في مرض + +230 +00:16:50,080 --> 00:16:51,800 +معين يعني هاي مثلا عندي + +231 +00:17:13,910 --> 00:17:27,150 +بنكبر الصورة عساس توضح الفكرة الصورة + +232 +00:17:27,150 --> 00:17:29,150 +مش واضحة، ندور على صورة أخرى + +233 +00:17:53,640 --> 00:18:07,220 +تمام ربما تكون هذه أوضح الصور تمام + +234 +00:18:07,220 --> 00:18:11,820 +مفائدة + +235 +00:18:11,820 --> 00:18:15,020 +إجراء ال test هذا على ال distance اللي هو ال four + +236 +00:18:15,020 --> 00:18:21,990 +dot test وعلى ال nearالان لما بيكون الانسان او ال + +237 +00:18:21,990 --> 00:18:24,770 +target اللى احنا بتطلع عليه اللى عيننا بتطلع عليه + +238 +00:18:24,770 --> 00:18:29,430 +لما بكون بعيد كتير صورته بتكون صغيرة كتير على ال + +239 +00:18:29,430 --> 00:18:34,990 +retina و هو بيبين صغير كتير طيب صورته صغيرة على ال + +240 +00:18:34,990 --> 00:18:38,890 +retina يعني الصورة كلها محتوى ضمن ال fovea ضمن ال + +241 +00:18:38,890 --> 00:18:43,550 +fovea بينما لما بيقترب هذا الشخص يعني ال distance + +242 +00:18:43,550 --> 00:18:49,280 +بتقترب معناته ببدأ نشعر بيه أطولأو أكبر، ليش؟ لأن + +243 +00:18:49,280 --> 00:18:54,040 +هذا ال target أصبح صورته على ال retina أكبر صورته + +244 +00:18:54,040 --> 00:18:57,140 +على ال retina أكبر فبنشعر بيه أكبر، إذا صورته على + +245 +00:18:57,140 --> 00:19:00,800 +ال retina أكبر يعني صورته جزء منها جاية على + +246 +00:19:00,800 --> 00:19:04,180 +الفوفيا و خارج نطاق الفوفيا، هنا صورته جاية كلها + +247 +00:19:04,180 --> 00:19:08,140 +على الفوفيا طيب، لما أنا باجري ال four dot test + +248 +00:19:08,140 --> 00:19:13,120 +على ال distance و + +249 +00:19:13,120 --> 00:19:17,350 +بطلع عندي suppression في عين من العينتينيعني شاف + +250 +00:19:17,350 --> 00:19:20,550 +اما two dots او three dots two red او three green + +251 +00:19:20,550 --> 00:19:23,230 +معناته هذا ال suppression بنسميه central + +252 +00:19:23,230 --> 00:19:29,110 +suppression central suppression لو انا عندي اجريت + +253 +00:19:29,110 --> 00:19:33,110 +ال test ال four dot test على ال nearوطلع عندي فيه + +254 +00:19:33,110 --> 00:19:35,450 +suppression معناته هذا peripheral suppression لأن + +255 +00:19:35,450 --> 00:19:39,190 +ال four dot test على ال .. على ال near حجمه على ال + +256 +00:19:39,190 --> 00:19:42,970 +retina حجمه تباعد ال four dots لا تشمل الفوبيا + +257 +00:19:42,970 --> 00:19:46,890 +وإنما أوسع من الفوبيا فبالتالي إذا كان ال test + +258 +00:19:46,890 --> 00:19:50,890 +أجري على ال distance وطلع عندي suppression معناته + +259 +00:19:50,890 --> 00:19:56,970 +عندي central suppression لو أجري على ال near ال + +260 +00:19:56,970 --> 00:19:59,430 +four dot test وطلع عندي suppression معناته هذا + +261 +00:19:59,430 --> 00:20:04,960 +peripheral suppression طيبفي مرض مر علينا بيكون + +262 +00:20:04,960 --> 00:20:07,860 +فيه central suppression يعني إذا أجريت ال test على + +263 +00:20:07,860 --> 00:20:13,350 +ال distance هيشوف إما two dots أو three dotsيعني + +264 +00:20:13,350 --> 00:20:16,610 +فيه central suppression ولو أجريت ال test على + +265 +00:20:16,610 --> 00:20:19,410 +النية راح يشوف four dots يعني binocular single + +266 +00:20:19,410 --> 00:20:23,270 +vision يعني peripheral fusion هذا المرض اسمه ال + +267 +00:20:23,270 --> 00:20:27,170 +microtropia syndrome في ال microtropia syndrome في + +268 +00:20:27,170 --> 00:20:30,250 +عندي حاجة اسمها central suppression scotoma زي ما + +269 +00:20:30,250 --> 00:20:33,470 +بنتذكر central suppression scotoma ويرجى الرجوع + +270 +00:20:33,470 --> 00:20:37,090 +للمحاضرة بتاعة ال microtropia syndrome ايش يعني + +271 +00:20:37,090 --> 00:20:40,030 +central suppression scotoma يعني واحدة من العينتين + +272 +00:20:40,030 --> 00:20:43,420 +فيهافي الـ Center وهو فاتح عينيه تنتين في الـ + +273 +00:20:43,420 --> 00:20:46,080 +Center في عندي Central Subversion Eschotomy يعني + +274 +00:20:46,080 --> 00:20:49,280 +الفوفيا مش شغالة بمعنى لو أجريت ال four dot test + +275 +00:20:49,280 --> 00:20:53,180 +على ال distance أما هيشوف two dots أو three dots + +276 +00:20:53,180 --> 00:20:57,130 +حسب ال filter قدام أي عينالذن هيكون عنده central + +277 +00:20:57,130 --> 00:20:59,630 +suppression ال micro tropic patient او ال micro + +278 +00:20:59,630 --> 00:21:04,430 +tropia syndrome بيكون عنده central suppression كيف + +279 +00:21:04,430 --> 00:21:07,650 +عرفت انه عنده central suppression ال four dots تست + +280 +00:21:07,650 --> 00:21:12,060 +على ال distance اما شاف اتنين او شاف تلاتة dotsعلى + +281 +00:21:12,060 --> 00:21:15,340 +الـ near عنده peripheral fusion يعني بيقدر يدمج ال + +282 +00:21:15,340 --> 00:21:19,140 +.. لأنه كل ال peripheral ال retina عنده شغالة + +283 +00:21:19,140 --> 00:21:21,800 +وقلنا ال peripheral fusion أهم من ال central + +284 +00:21:21,800 --> 00:21:25,880 +fusion for binocular single vision فبتتالي على ال + +285 +00:21:25,880 --> 00:21:29,140 +.. على ال near بيكون ال four dot test أداءه طبيعي + +286 +00:21:29,140 --> 00:21:33,240 +جدا وشوف four dots اذا في .. على ال distance بيكون + +287 +00:21:33,240 --> 00:21:35,760 +فيه عندي suppression وعلى ال near بيكون عندي + +288 +00:21:36,170 --> 00:21:39,350 +binocular single vision fusion مع binocular single + +289 +00:21:39,350 --> 00:21:44,590 +vision فضروري جدا هذه القضية يعني الكون استوعبتنا + +290 +00:21:44,590 --> 00:21:52,170 +نيجي لالباجوليني striated glasses الباجوليني + +291 +00:21:52,170 --> 00:21:56,470 +striated glasses أيضا dissociation test قلنا ال + +292 +00:21:56,470 --> 00:22:00,430 +dissociation test لما حكينا عن ال four dot test ال + +293 +00:22:00,430 --> 00:22:05,420 +dissociation test هو عبارة عنtest بتنبي واسطته + +294 +00:22:05,420 --> 00:22:09,600 +التفريق في الرؤية بين العين اليمين والعين الشمال + +295 +00:22:09,600 --> 00:22:14,700 +يعني يقدم للعين اليمين صورة ويقدم للعين اليسار + +296 +00:22:14,700 --> 00:22:19,050 +صورة أخرى تختلف عنهاإذاً this is a test for + +297 +00:22:19,050 --> 00:22:22,390 +detecting binocular single vision زيها .. زي ال .. + +298 +00:22:22,390 --> 00:22:26,930 +ال four dot test و أيضًا for detecting ال abnormal + +299 +00:22:26,930 --> 00:22:30,710 +retinal correspondence و السبريشين و الدبلوبيا، + +300 +00:22:30,710 --> 00:22:35,130 +بالظبط كل النتائج اللي ممكن أنا يعني أتوصل إلى في + +301 +00:22:35,130 --> 00:22:38,850 +ال four dot test ممكن أستنتجها أيضًا بواسطة + +302 +00:22:38,850 --> 00:22:42,350 +الباجولين استرياتيد إجلاصةممكن إنسان يقول طب إيش + +303 +00:22:42,350 --> 00:22:45,250 +معناته فايدة ال .. باجوليني striated classes إذا + +304 +00:22:45,250 --> 00:22:48,930 +أنا عندي ال four dot test طبعا لما بيكون عندي أكتر + +305 +00:22:48,930 --> 00:22:52,790 +من وسيلة بيكون هدفي أريحية في العمل لأن ممكن بعض + +306 +00:22:52,790 --> 00:22:56,670 +الناس يكون متوفر عنها ال four dot test بينما مش + +307 +00:22:56,670 --> 00:22:59,890 +متوفر عند الباجوليني striated classes أو العكس + +308 +00:22:59,890 --> 00:23:04,750 +ممكن الباجوليني striated classes تكون متوفرة بينما + +309 +00:23:04,750 --> 00:23:09,880 +ال four dot test مش متوفرطيب بقوليني striated + +310 +00:23:09,880 --> 00:23:14,480 +glasses ممكن إذا مش موجودة عندي أستعمل two Maddox + +311 +00:23:14,480 --> 00:23:19,020 +road، two Maddox road بيقوموا مقام اللي بقوليني + +312 +00:23:19,020 --> 00:23:24,310 +striated glassesإذاً this is a test for detecting + +313 +00:23:24,310 --> 00:23:27,130 +binocular single vision abnormal retinal + +314 +00:23:27,130 --> 00:23:30,790 +correspondence or suppression أيضًا يضاف إليهم + +315 +00:23:30,790 --> 00:23:35,630 +الدبلوبيا أيضًا من ضمن الأشياء اللي بقدر أعرفها و + +316 +00:23:35,630 --> 00:23:40,190 +أستنتجها بالباجوليني استرياتي تجلست each lens have + +317 +00:23:40,190 --> 00:23:45,760 +fine striationsتخطيطات أو فرزات which convert a + +318 +00:23:45,760 --> 00:23:48,860 +point source of light into a line as with the + +319 +00:23:48,860 --> 00:23:52,440 +medox rod وعشان هيك بقدر استعمل ال medox rod بدل + +320 +00:23:52,440 --> 00:23:55,580 +باجوليني striated glasses بلزمني two medox rods + +321 +00:23:55,580 --> 00:23:59,560 +انشوف الباجوليني striated glasses هاي المريض حاطط + +322 +00:23:59,560 --> 00:24:02,580 +الباجوليني striated glasses أمام عينيه فيه + +323 +00:24:02,580 --> 00:24:06,700 +striation في كل عدسة ال striation هنا موجهة مثلا + +324 +00:24:06,700 --> 00:24:10,480 +على خمسة و أربعين degree وهنا على مية و خمسة و + +325 +00:24:10,480 --> 00:24:15,190 +تلاتين degree يعنيمتعامدة على هاي هاي متعامدة على + +326 +00:24:15,190 --> 00:24:18,410 +هاي طبعا لما بيكون حاطط أمام عينه الباجوليني + +327 +00:24:18,410 --> 00:24:22,030 +striated glasses ال light source أو ال point + +328 +00:24:22,030 --> 00:24:24,930 +source of light بتتحول ل line of light زي ما احنا + +329 +00:24:24,930 --> 00:24:28,830 +شايفينه هذا ال line بينشف بعين وال line العمودي + +330 +00:24:28,830 --> 00:24:32,590 +عليه بينشف بعين التانية لأن ال striation هنا + +331 +00:24:32,590 --> 00:24:36,070 +متعامدة على ال striation هنا طبعا ال line of light + +332 +00:24:36,070 --> 00:24:40,610 +بيكون عمودي على اتجاه ال striation بمعنىنفرض في + +333 +00:24:40,610 --> 00:24:44,490 +العين اليمين جاي على خمسة و أربعين ميلان + +334 +00:24:44,490 --> 00:24:48,110 +illustration التخطيطات أو الفرزات على خمسة و + +335 +00:24:48,110 --> 00:24:52,210 +أربعين هذه العين هتشوف line of light عالمية و خمسة + +336 +00:24:52,210 --> 00:24:56,050 +و تلاتين طيب لو هذه ميلة عالمية و خمسة و تلاتين + +337 +00:24:56,050 --> 00:25:00,210 +هتشوف علىخمسة واربعين ال line of light بواسطة + +338 +00:25:00,210 --> 00:25:04,090 +العين اليسار ضروري انه يكون طبعا ال illustration + +339 +00:25:04,090 --> 00:25:07,550 +هنا عمودية على ال illustration هنا عشان هذه العين + +340 +00:25:07,550 --> 00:25:11,030 +تشوف خط مائل من الضوء هيك وهذه العين خط مائل من + +341 +00:25:11,030 --> 00:25:14,610 +الضوء هيك وهكذا نقول احنا العين اليمين شافت صورة + +342 +00:25:14,610 --> 00:25:18,110 +والعين الشمال شافت صورة ممكن سيقول لأ ما هي نفس + +343 +00:25:18,110 --> 00:25:21,130 +الصورة line of light اه بس اتجاهه في الفرار بيختلف + +344 +00:25:21,130 --> 00:25:26,070 +اذا هذه صورة وهذه صورة اذا هذا dissociation test + +345 +00:25:26,640 --> 00:25:31,880 +هذه الباجولين استرايات دي glasses هذه يعني + +346 +00:25:31,880 --> 00:25:36,260 +الميالات هنا على 135 لو نحط أمام عين العين اللي + +347 +00:25:36,260 --> 00:25:41,180 +نحط أمامها هتشوف line of light جاي على 45 لأن هذه + +348 +00:25:41,180 --> 00:25:45,100 +ميلة على 135 طيب هذه العدسات التانية بتاعة + +349 +00:25:45,100 --> 00:25:48,740 +الباجولين استرايات دي glasses ميلة على 45 + +350 +00:25:48,740 --> 00:25:51,960 +الastration التخطيطات أو الفرزات هتشوف + +351 +00:25:54,170 --> 00:25:57,670 +يعني line of light عمودي على اتجاه الـ striation + +352 +00:25:57,670 --> 00:26:02,770 +فهيكون هذا ال line of light على 135 الحصيلة أن هذه + +353 +00:26:02,770 --> 00:26:07,050 +هتشوف على 45 ال line of light وهذه هتشوف على 135 + +354 +00:26:07,050 --> 00:26:10,530 +إذا هذه صورة و هذه صورة الإنسان اللي عنده + +355 +00:26:10,530 --> 00:26:17,010 +binocular single vision هيشوف crossالانسان اللي + +356 +00:26:17,010 --> 00:26:19,930 +عنده binocular single vision هيشوف cross بس قبل ما + +357 +00:26:19,930 --> 00:26:23,210 +نقول cross بنشوف الرسمة هاي هاي العين اليمين + +358 +00:26:23,210 --> 00:26:29,150 +للمريض هاي ال استرياشين ميلة على 135 هاي OD oculus + +359 +00:26:29,150 --> 00:26:34,370 +dextra على 45 لأنه ال استرياشين ميلة طبعا كل عين + +360 +00:26:34,370 --> 00:26:37,670 +بتشوف line of light عمودي على استجاه ال استرياشين + +361 +00:26:37,670 --> 00:26:43,150 +اللي أمامهاهذه الـ OS على 135 شافت الـ Oculus + +362 +00:26:43,150 --> 00:26:48,170 +Sinistra لعين الشمال لماذا شافت على 135 الـ line + +363 +00:26:48,170 --> 00:26:53,950 +of light؟ لأن ال استرايش جاية على 45 اذا المريض + +364 +00:26:53,950 --> 00:26:56,730 +لما يكون فاتع عينين تنتين المفروض يشوف two lines + +365 +00:26:56,730 --> 00:27:02,610 +بشكل across لأنه عنده fusion متقاطعين في المنتصف + +366 +00:27:02,610 --> 00:27:07,090 +بالضبط متقاطعين في المنتصف بالضبطهنا بنيجي الأن + +367 +00:27:07,090 --> 00:27:11,050 +نحكي عن الشروط بتاعة الـ Baculine Stated Glosses + +368 +00:27:11,050 --> 00:27:16,170 +ضروري جدا المريض مايعرفش سر ال test أو التفسيرات + +369 +00:27:16,170 --> 00:27:18,870 +بتاع ال results بتاعة ال test ماجيش أحكيله والله + +370 +00:27:18,870 --> 00:27:22,210 +إذا شفت الشيء الفلاني معناته أنت عندك ازدواجية + +371 +00:27:22,210 --> 00:27:25,850 +ساعته هو مثلا إذا كان مدعيا أو شيء من هذا القبيل + +372 +00:27:25,920 --> 00:27:30,080 +يعني بيكون أخد المعلومة و هيُنطق مش بالإيش اللي + +373 +00:27:30,080 --> 00:27:33,320 +شايفه و إنما بالإيش اللي هو عايزه، بالإيش اللي هو + +374 +00:27:33,320 --> 00:27:37,560 +عايزه، فبالتالي ضروري كشرط أنه المريض مايعرفش + +375 +00:27:37,560 --> 00:27:44,190 +تفسيرات ال test، هذا نقطة، النقطة التانيةأنا لازم + +376 +00:27:44,190 --> 00:27:48,030 +أعرف هل عند المريض في manifest squint ولا لأ لأنه + +377 +00:27:48,030 --> 00:27:51,610 +إذا كان في عنده manifest squint فيه تفسير وإذا كان + +378 +00:27:51,610 --> 00:27:55,610 +ortho manifest squint يعني تروبيا فيه تفسير وإذا + +379 +00:27:55,610 --> 00:28:00,190 +كان ortho أو latent squint فيه تفسير آخر يعني + +380 +00:28:00,190 --> 00:28:04,490 +الإنسان الطبيعي إذا شاف across بنقول عنده normal + +381 +00:28:04,490 --> 00:28:08,130 +binocular single vision طب إنسان عنده إيزو تروبيا + +382 +00:28:08,460 --> 00:28:13,880 +أو Exotropia أو Hypertropia أو Hypotropiaولمّا + +383 +00:28:13,880 --> 00:28:17,700 +بنقول Tropia معناته manifest سكنت حوال واضح وشاف + +384 +00:28:17,700 --> 00:28:20,960 +أيضا cross زي أو زي الإنسان الطبيعي بقول عنده + +385 +00:28:20,960 --> 00:28:24,520 +abnormal retinal correspondence يعني binocular + +386 +00:28:24,520 --> 00:28:28,500 +single vision مبني على abnormal retinal + +387 +00:28:28,500 --> 00:28:31,300 +correspondence ليش؟ لأنه عنده حوال .. لأنه عنده + +388 +00:28:31,300 --> 00:28:34,180 +حوال و ال visual direction بتاع ال corresponding + +389 +00:28:34,180 --> 00:28:37,840 +retinal points اللي هو موجود في الطبيعي مش موجود + +390 +00:28:37,840 --> 00:28:41,910 +عنده لأنه عنده Tropia ومع ذلكأدائه زي أداء الإنسان + +391 +00:28:41,910 --> 00:28:44,470 +الطبيعي في ال .. في ال test فهذا عنده abnormal + +392 +00:28:44,470 --> 00:28:50,130 +retinal correspondence طيب لو اتصورنا ان في عندنا + +393 +00:28:50,130 --> 00:28:50,570 +results + +394 +00:28:54,800 --> 00:28:58,380 +هي ال results ال possible هاي أنا عندي ال right + +395 +00:28:58,380 --> 00:29:02,440 +eye بتشوف خط ميل هيك حسب المثال في ال .. في النص + +396 +00:29:02,440 --> 00:29:05,680 +المكتوب و ال left eye بتشوف خط زي هيك إذا شاف + +397 +00:29:05,680 --> 00:29:09,740 +cross متقاطع في النص هذا normal retinal + +398 +00:29:09,740 --> 00:29:12,860 +correspondence إذا ما عندهوش squint أو abnormal + +399 +00:29:12,860 --> 00:29:17,120 +retinal correspondence إذا كان عنده squint طيب لو + +400 +00:29:17,120 --> 00:29:21,450 +شاف في نفس الواجهة خطين بس مش متقاطعينيعني مش + +401 +00:29:21,450 --> 00:29:24,890 +متقاطعين أو متقاطعين في الأطراف، يعني متقاطعين في + +402 +00:29:24,890 --> 00:29:28,490 +الأسفل أو متقاطعين في الأعلى، بس مش متقاطعين في + +403 +00:29:28,490 --> 00:29:32,670 +النص، هذا يسمى dyplopia، double vision طيب، لو شاف + +404 +00:29:32,670 --> 00:29:35,870 +الخط هذا وماشافش الخط التاني، معناته عنده right + +405 +00:29:35,870 --> 00:29:39,410 +suppression طيب، لو شاف الخط على ال right وماشافش + +406 +00:29:39,410 --> 00:29:43,310 +الخط على ال left، معناته هذا عنده left suppression + +407 +00:29:43,310 --> 00:29:48,780 +طب لو مرة شاف الخط هذاو المرة اللي بعديها بعد + +408 +00:29:48,780 --> 00:29:52,460 +بلحظة شاف الخط المائي اللي عكسه و بعدين رجع شاف + +409 +00:29:52,460 --> 00:29:55,500 +هذا و بعدين رجع هذا إذا هندي alternate suppression + +410 +00:29:55,500 --> 00:30:00,960 +alternate suppression بعض النتائج الإنسان بنقوله + +411 +00:30:00,960 --> 00:30:03,620 +إيش شايف؟ بيقول أنا شايف cross بس واحد من ال two + +412 +00:30:03,620 --> 00:30:07,540 +lines فيه defect في المصر يعني فيه gap أو منطقة مش + +413 +00:30:07,540 --> 00:30:09,900 +مضيقة في المصر هذا بيسموه central suppression + +414 +00:30:09,900 --> 00:30:13,280 +scotoma هنا عندي في ال right eye في ال right eye + +415 +00:30:13,280 --> 00:30:17,090 +الخط على ال right eye فيه central gapيعني في فرق + +416 +00:30:17,090 --> 00:30:19,730 +في المصدر، إذا هذا عنده right central suppression + +417 +00:30:19,730 --> 00:30:23,010 +scotoma يعني أنا بتوقع إن هذا المريض يكون عنده + +418 +00:30:23,010 --> 00:30:26,270 +right microtropia لأنه ال central suppression + +419 +00:30:26,270 --> 00:30:29,530 +scotoma غالبا بتكون في ال IHS عند المرضى اللي في + +420 +00:30:29,530 --> 00:30:35,270 +عندهم microtropia syndrome بقول والله إن ال right + +421 +00:30:35,270 --> 00:30:39,890 +eye فيها central suppression scotoma يعني احتمال + +422 +00:30:39,890 --> 00:30:45,720 +كبير يكون فيها right microtropia syndromeطيب، إذا + +423 +00:30:45,720 --> 00:30:48,740 +هذه ال possible results هذه ال possible results + +424 +00:30:48,740 --> 00:30:52,320 +اللي ممكنها أيضا ممكن ينعمل على ال distance و ممكن + +425 +00:30:52,320 --> 00:30:56,140 +ينعمل على ال near ممكن ينعمل على ال distance و + +426 +00:30:56,140 --> 00:30:59,360 +ممكن ينعمل على ال near بعض الناس اللي عندهم + +427 +00:30:59,360 --> 00:31:02,260 +microtropia حقيقة و متأكدين من .. من ال + +428 +00:31:02,260 --> 00:31:05,620 +microtropia بتاعتهم و جينا نعملهم ال .. بقولين + +429 +00:31:05,620 --> 00:31:10,520 +striated classes وجدنا أنه مثلا بيشوف cross عادي، + +430 +00:31:10,520 --> 00:31:15,540 +زي هيكورغم أنه متأكدين مائة بالمائة أنه عنده + +431 +00:31:15,540 --> 00:31:20,320 +microtropia syndrome ومع ذلك هو ال results .. يعني + +432 +00:31:20,320 --> 00:31:23,700 +الجواب بتاعه أن أنا شايف ال cross متقاطع في المصر + +433 +00:31:23,700 --> 00:31:27,720 +مش شايف أي gap إذا كان ماشافش الجاب مش كل الناس + +434 +00:31:27,720 --> 00:31:30,520 +اللي عندهم microtropia بيستطيعوا يميزوا الجاب لأنه + +435 +00:31:30,520 --> 00:31:34,740 +الجاب صغير جدافبالتالي طبعا الرسمة هي كام كبراء + +436 +00:31:34,740 --> 00:31:37,880 +كتير ولكن الجاب صغير جدا بعض الناس بتلاحظه اللي + +437 +00:31:37,880 --> 00:31:41,100 +عندها microtropia و بعض الناس مابتلاحظوش إذا + +438 +00:31:41,100 --> 00:31:44,820 +مالاحظوش ممكن أنا أنتقل ل test آخر اللي هو ال four + +439 +00:31:44,820 --> 00:31:48,680 +-prism test و اللي هنحكي عنه المرة القادمة ان شاء + +440 +00:31:48,680 --> 00:31:52,140 +الله تعالى .. ان شاء الله تعالى .. إذا هذا هو + +441 +00:31:52,140 --> 00:31:56,910 +dissociation testبيكتشفلي ال normal binocular + +442 +00:31:56,910 --> 00:32:00,790 +single vision وبيكتشفلي ال abnormal retinal + +443 +00:32:00,790 --> 00:32:03,590 +correspondence، بيكتشفلي ال microtropia أو ال + +444 +00:32:03,590 --> 00:32:06,230 +central suppression اسكتومة، بيكتشفلي ال + +445 +00:32:06,230 --> 00:32:09,310 +suppression سواء monocular أو alternating أو + +446 +00:32:09,310 --> 00:32:14,270 +بيكتشفلي ال diplopia إذا كانت موجودة، إذا كانت + +447 +00:32:14,270 --> 00:32:20,120 +موجودةفبالتالي ضروري جدا نعرف هذه القضية طيب ال + +448 +00:32:20,120 --> 00:32:23,460 +results بتاعة البقولين striated classes cannot be + +449 +00:32:23,460 --> 00:32:26,880 +interpreted correctly unless it is known whether + +450 +00:32:26,880 --> 00:32:30,320 +or not strabismus is present هذا شرط خاص بالفاحس + +451 +00:32:30,320 --> 00:32:34,180 +if the two streaks intersect ال streak اللي هو ال + +452 +00:32:34,180 --> 00:32:37,740 +line intersect at their centers in the form of an + +453 +00:32:37,740 --> 00:32:42,220 +oblique cross Xthe patient has binocular single + +454 +00:32:42,220 --> 00:32:46,180 +vision امتى if the eyes are straight or harmonious + +455 +00:32:46,180 --> 00:32:49,000 +abnormal retinal correspondence يعني abnormal + +456 +00:32:49,000 --> 00:32:52,240 +retinal correspondence متجانس in the presence of + +457 +00:32:52,240 --> 00:32:56,770 +manifest strabismusif the two lines are seen but + +458 +00:32:56,770 --> 00:33:00,470 +they do not form a cross يعني مش متقاطعين في النص، + +459 +00:33:00,470 --> 00:33:04,630 +بيكونوش cross، the plopia is present if only one + +460 +00:33:04,630 --> 00:33:07,110 +streak is seen, there is no simultaneous + +461 +00:33:07,110 --> 00:33:10,490 +perception and suppression is present ممكن يكون ال + +462 +00:33:10,490 --> 00:33:15,750 +suppression في one eye أو في ال other eye أو ممكن + +463 +00:33:15,750 --> 00:33:20,280 +يكون alternative in theoryليش انثياري؟ لأنه مش كل + +464 +00:33:20,280 --> 00:33:24,260 +الناس بتلاحظه if a .. if a small gap is seen in + +465 +00:33:24,260 --> 00:33:27,960 +one of the streaks a central separation scotoma as + +466 +00:33:27,960 --> 00:33:31,660 +found in microtropia is present in practice this + +467 +00:33:31,660 --> 00:33:35,900 +is often difficult to demonstrate يعني غالبا مش + +468 +00:33:35,900 --> 00:33:39,000 +كتير مرضى بيقدروا يلاحظوا الجاب هذا and the + +469 +00:33:39,000 --> 00:33:42,060 +patient describes across يعني الناس اللي عندها gap + +470 +00:33:43,020 --> 00:33:47,300 +الناس اللي عندها gap غالبا .. غالبا هذا ال gap مش + +471 +00:33:47,300 --> 00:33:51,160 +ملاحظ فبيقولك أنا شايف cross عادي شايف cross عادي + +472 +00:33:51,160 --> 00:33:54,720 +اذا in practice this is often difficult to + +473 +00:33:54,720 --> 00:33:58,120 +demonstrate يعني صعب انه المريض يعني يلاحظه and + +474 +00:33:58,120 --> 00:34:01,480 +the patient describes a cross the scotoma can be + +475 +00:34:01,480 --> 00:34:04,440 +.. ال central separation scotoma can be confirmed + +476 +00:34:04,830 --> 00:34:09,710 +with the four prism based out test زي ما هنشرحه في + +477 +00:34:09,710 --> 00:34:13,010 +المحاضرة القادمة ان شاء الله تعالى هاي ال possible + +478 +00:34:13,010 --> 00:34:16,650 +results بتاعة البقولين is related classes ويعطيكم + +479 +00:34:16,650 --> 00:34:20,110 +العافية والسلام عليكم ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/064Gnt3Exc8_raw.json b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/064Gnt3Exc8_raw.json new file mode 100644 index 0000000000000000000000000000000000000000..536db1e9275e655ee3d76c815422622afb02a955 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/064Gnt3Exc8_raw.json @@ -0,0 +1 @@ +{"segments": [{"id": 1, "seek": 1102, "start": 1.84, "end": 11.02, "text": "بسم الله الرحمن الرحيم بنواصل مع محاضرات حوال واحد واتوقفنا عند tests for sensory anomalies", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 44945, 2407, 33546, 1211, 20449, 3714, 5016, 46958, 2288, 9307, 11331, 2407, 6027, 36764, 24401, 4032, 9307, 30543, 5172, 8315, 43242, 6921, 337, 27233, 24769, 48872], "avg_logprob": -0.0648328982707527, "compression_ratio": 1.2203389830508475, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 1.84, "end": 2.14, "word": "بسم", "probability": 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"probability": 0.99365234375}, {"start": 34.53, "end": 35.05, "word": " abnormal", "probability": 0.9404296875}, {"start": 35.05, "end": 35.49, "word": " retinal", "probability": 0.959228515625}, {"start": 35.49, "end": 36.27, "word": " correspondence", "probability": 0.9326171875}, {"start": 36.27, "end": 36.67, "word": " أو", "probability": 0.9208984375}, {"start": 36.67, "end": 37.03, "word": " حتى", "probability": 0.965087890625}, {"start": 37.03, "end": 37.17, "word": " ال", "probability": 0.89794921875}, {"start": 37.17, "end": 37.47, "word": " normal", "probability": 0.85107421875}, {"start": 37.47, "end": 38.03, "word": " binocular", "probability": 0.95654296875}, {"start": 38.03, "end": 38.43, "word": " single", "probability": 0.970703125}, {"start": 38.43, "end": 38.75, "word": " vision", "probability": 0.94677734375}], "temperature": 1.0}, {"id": 3, "seek": 6470, "start": 39.37, "end": 64.71, "text": "الديبلوبيا ال suppression ال abnormal retinal correspondence والnormal binocular single vision ممكن يعني تكتشف بواسطة هذه الاختبارات أو هذه الفحوصات ال worth for dot test عبارة عن dissociation test ايش يعني dissociation test؟ اي test بيفرق بين العينتين في الرؤية", "tokens": [6027, 16254, 36150, 2407, 21292, 995, 2423, 36807, 2423, 32847, 1533, 2071, 38135, 16070, 23157, 5171, 905, 1040, 2167, 5201, 3714, 43020, 37495, 22653, 6055, 4117, 2655, 8592, 5172, 4724, 14407, 3794, 9566, 3660, 29538, 2423, 47283, 2655, 3555, 9640, 9307, 34051, 29538, 27188, 5016, 2407, 9381, 9307, 2423, 3163, 337, 5893, 1500, 6225, 3555, 9640, 3660, 18871, 44446, 399, 1500, 1975, 1829, 8592, 37495, 22653, 44446, 399, 1500, 22807, 1975, 1829, 1500, 4724, 33911, 2288, 4587, 49374, 18863, 9957, 2655, 9957, 8978, 34892, 33604, 10632], "avg_logprob": -0.15624999349144683, "compression_ratio": 1.555084745762712, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 39.37, "end": 40.29, "word": "الديبلوبيا", "probability": 0.768310546875}, {"start": 40.29, "end": 41.03, "word": " 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"text": "يعني إذا كان في Trauma عند المريض و لا مافيش Trauma عند المريض، هاي أول شرط الشرط التاني و اللي هو مهم جدا أنه المريض مايفهم طبيعة ال test قبل أداءه يعني إنسان بيجي بيقول أنا عندي .. أنا بشوف الحاجة حاجتين، عندي ازدواجية في النظر و بدي تقرير بهذا الموضوع", "tokens": [40228, 22653, 11933, 15730, 25961, 8978, 5403, 5544, 43242, 9673, 16572, 11242, 4032, 20193, 19446, 41185, 8592, 5403, 5544, 43242, 9673, 16572, 11242, 12399, 8032, 47302, 5551, 12610, 13412, 2288, 9566, 25124, 2288, 9566, 16712, 7649, 1829, 4032, 13672, 1829, 31439, 3714, 16095, 10874, 28259, 14739, 3224, 9673, 16572, 11242, 19446, 33911, 16095, 23032, 21292, 27884, 2423, 1500, 12174, 36150, 5551, 3215, 16606, 3224, 37495, 22653, 36145, 3794, 7649, 4724, 1829, 7435, 1829, 4724, 1829, 39648, 41850, 18871, 16254, 4386, 41850, 4724, 8592, 38688, 21542, 26108, 3660, 11331, 26108, 2655, 9957, 12399, 18871, 16254, 1975, 11622, 3215, 2407, 26108, 10632, 8978, 28239, 19913, 2288, 4032, 4724, 16254, 6055, 4587, 2288, 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patient wears a green lens in front of the right eye طبعا ممكن انسان يقول احنا هنا green lens جدام ال left eye ممكن .. ممكن الفلاتر تكون ممكن تغييرها بمعنى أنا ألبس المريض ل trial frame و أحطله مرة red filter هنا و مرة green filter هنا و بعدين أعكسه .. و بعدين أعكسه", "tokens": [2278, 4537, 20877, 257, 3092, 6765, 294, 1868, 295, 264, 558, 3313, 23032, 3555, 3615, 995, 3714, 43020, 16472, 3794, 7649, 7251, 39648, 1975, 5016, 8315, 34105, 3092, 6765, 10874, 3215, 10943, 2423, 1411, 3313, 3714, 43020, 4386, 3714, 43020, 27188, 1211, 9307, 2288, 6055, 30544, 3714, 43020, 6055, 17082, 1829, 13546, 11296, 4724, 2304, 3615, 1863, 7578, 41850, 5551, 46152, 3794, 9673, 16572, 11242, 5296, 7308, 3920, 4032, 5551, 5016, 9566, 43761, 3714, 25720, 2182, 6608, 34105, 4032, 3714, 25720, 3092, 6608, 34105, 4032, 39182, 9957, 5551, 3615, 4117, 3794, 3224, 4386, 4032, 39182, 9957, 5551, 3615, 4117, 3794, 3224], "avg_logprob": -0.20281862233783685, "compression_ratio": 1.652542372881356, 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شاف", "probability": 0.989501953125}, {"start": 662.43, "end": 662.77, "word": " three", "probability": 0.89453125}, {"start": 662.77, "end": 663.27, "word": " green", "probability": 0.92138671875}, {"start": 663.27, "end": 663.81, "word": " lights", "probability": 0.83984375}], "temperature": 1.0}, {"id": 29, "seek": 68303, "start": 665.53, "end": 683.03, "text": "هنا مش كتير الصورة مواضحة إن هم green بس هم green lights، three green lights معناته عندي أنا بيشوف بالعين اللي جدامها ال green filter و العين اللي جدامها ال red filter sub rest، إذا ساعتها بقول أنا هذه في عيني right sub rest", "tokens": [3224, 8315, 37893, 9122, 2655, 13546, 31767, 13063, 3660, 3714, 2407, 46958, 5016, 3660, 36145, 8032, 2304, 3092, 4724, 3794, 8032, 2304, 3092, 5811, 12399, 1045, 3092, 5811, 20449, 8315, 47395, 18871, 16254, 41850, 4724, 1829, 8592, 38688, 20666, 3615, 9957, 13672, 1829, 10874, 3215, 10943, 11296, 2423, 3092, 6608, 4032, 18863, 9957, 13672, 1829, 10874, 3215, 10943, 11296, 2423, 2182, 6608, 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lights؟ لما شوف two red قولنا في عنده right suppression لأن ال red lights أو ال red filter قدام العين الشمال، إذا العين الشمال هي اللي شغالة، معناته في عندي right suppression if three green lights are seen left suppression is present كيف أنا قررت أنه left suppression؟ لأنه ال green light", "tokens": [3555, 1863, 39648, 498, 732, 2182, 5811, 366, 1612, 558, 36807, 307, 1974, 32239, 8592, 34105, 732, 2182, 5811, 22807, 5296, 15042, 13412, 38688, 732, 2182, 12174, 12610, 8315, 8978, 43242, 3224, 558, 36807, 5296, 33456, 2423, 2182, 5811, 34051, 2423, 2182, 6608, 12174, 3215, 10943, 18863, 9957, 25124, 2304, 6027, 12399, 11933, 15730, 18863, 9957, 25124, 2304, 6027, 39896, 13672, 1829, 13412, 17082, 6027, 3660, 12399, 20449, 8315, 47395, 8978, 18871, 16254, 558, 36807, 498, 1045, 3092, 5811, 366, 1612, 1411, 36807, 307, 1974, 9122, 33911, 41850, 12174, 2288, 43500, 14739, 3224, 1411, 36807, 22807, 5296, 33456, 3224, 2423, 3092, 1442], "avg_logprob": -0.1524575294800175, 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703.04, "end": 703.48, "word": " three", "probability": 0.9345703125}, {"start": 703.48, "end": 703.96, "word": " green", "probability": 0.91552734375}, {"start": 703.96, "end": 704.34, "word": " lights", "probability": 0.8232421875}, {"start": 704.34, "end": 704.66, "word": " are", "probability": 0.96240234375}, {"start": 704.66, "end": 705.08, "word": " seen", "probability": 0.96337890625}, {"start": 705.08, "end": 706.04, "word": " left", "probability": 0.642578125}, {"start": 706.04, "end": 706.54, "word": " suppression", "probability": 0.98583984375}, {"start": 706.54, "end": 706.88, "word": " is", "probability": 0.97216796875}, {"start": 706.88, "end": 707.36, "word": " present", "probability": 0.92333984375}, {"start": 707.36, "end": 707.98, "word": " كيف", "probability": 0.9697265625}, {"start": 707.98, "end": 708.18, "word": " أنا", "probability": 0.931640625}, {"start": 708.18, "end": 708.58, "word": " قررت", "probability": 0.9845377604166666}, {"start": 708.58, "end": 708.78, "word": " أنه", "probability": 0.7039794921875}, {"start": 708.78, "end": 708.96, "word": " left", "probability": 0.9296875}, {"start": 708.96, "end": 710.68, "word": " suppression؟", "probability": 0.892578125}, {"start": 710.68, "end": 711.6, "word": " لأنه", "probability": 0.9124348958333334}, {"start": 711.6, "end": 711.84, "word": " ال", "probability": 0.76611328125}, {"start": 711.84, "end": 712.18, "word": " green", "probability": 0.95654296875}, {"start": 712.18, "end": 712.76, "word": " light", "probability": 0.90869140625}], "temperature": 1.0}, {"id": 31, "seek": 73031, "start": 713.41, "end": 730.31, "text": "هو الـ green filter الـ green lens قدام العين اليمين معناته طالما شاف الـ green dots معناته العين اليمين شغالة و العين الشمال مش شغالة لأنه ماشافش ال red إذا في عندي lift suppression طيب لو شاف five dots", "tokens": [3224, 2407, 2423, 39184, 3092, 6608, 2423, 39184, 3092, 6765, 12174, 3215, 10943, 18863, 9957, 2423, 32640, 9957, 20449, 8315, 47395, 23032, 6027, 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Dyplopia .. Dyplopia طيب لازم أسأل المريض أنه أنت شايف خمس نقاط اوصفهم هل هما في نقطتين وجنبهم تلت نقاط", "tokens": [3224, 24192, 28239, 47432, 3660, 16472, 5172, 36520, 2655, 5296, 1863, 47432, 2655, 9957, 4386, 23032, 3555, 3615, 995, 29538, 28239, 47432, 2655, 9957, 8032, 3215, 12610, 4724, 9957, 5172, 36520, 2407, 8592, 5296, 33456, 16095, 6156, 47432, 39894, 8592, 38688, 14407, 9154, 18863, 9957, 25124, 2304, 6027, 37037, 24192, 28239, 47432, 3660, 39894, 1863, 5172, 36520, 8592, 5296, 33456, 3224, 6156, 47432, 39894, 8592, 38688, 11296, 18863, 9957, 2423, 32640, 9957, 4032, 17082, 13546, 3714, 2288, 19986, 10632, 24976, 3615, 9957, 25124, 2304, 6027, 4386, 11933, 15730, 11331, 1829, 9381, 13546, 18871, 16254, 2423, 1732, 15026, 20449, 8315, 47395, 31193, 564, 22376, 4386, 31193, 564, 22376, 23032, 1829, 3555, 5296, 31377, 2304, 5551, 3794, 10721, 1211, 9673, 16572, 11242, 14739, 3224, 14739, 2655, 13412, 995, 33911, 16490, 2304, 3794, 8717, 4587, 41193, 1975, 2407, 9381, 5172, 16095, 8032, 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"end": 776.02, "word": " بينفصلوش", "probability": 0.7855631510416666}, {"start": 776.02, "end": 776.3, "word": " لأنهم", "probability": 0.6765950520833334}, {"start": 776.3, "end": 776.64, "word": " فقط", "probability": 0.971923828125}, {"start": 776.64, "end": 777.32, "word": " بتشوفوا", "probability": 0.83721923828125}, {"start": 777.32, "end": 777.4, "word": " من", "probability": 0.96044921875}, {"start": 777.4, "end": 777.62, "word": " العين", "probability": 0.94970703125}, {"start": 777.62, "end": 778.1, "word": " الشمال", "probability": 0.9248046875}, {"start": 778.1, "end": 778.86, "word": " وهذه", "probability": 0.6181640625}, {"start": 778.86, "end": 779.18, "word": " النقطة", "probability": 0.9820963541666666}, {"start": 779.18, "end": 779.78, "word": " بتنفصلش", "probability": 0.9119140625}, {"start": 779.78, "end": 780.06, "word": " لأنه", "probability": 0.8025716145833334}, {"start": 780.06, "end": 780.34, "word": " فقط", "probability": 0.976318359375}, {"start": 780.34, "end": 780.84, "word": " بتشوفها", "probability": 0.9613037109375}, {"start": 780.84, "end": 781.06, "word": " العين", "probability": 0.9912109375}, {"start": 781.06, "end": 781.54, "word": " اليمين", "probability": 0.8924153645833334}, {"start": 781.54, "end": 782.12, "word": " وغير", "probability": 0.87841796875}, {"start": 782.12, "end": 782.5, "word": " مرئية", "probability": 0.9005126953125}, {"start": 782.5, "end": 782.88, "word": " للعين", "probability": 0.9583333333333334}, {"start": 782.88, "end": 783.26, "word": " الشمال", "probability": 0.9728190104166666}, {"start": 783.26, "end": 783.36, "word": " ..", "probability": 0.72314453125}, {"start": 783.36, "end": 783.5, "word": " إذا", "probability": 0.5919189453125}, {"start": 783.5, "end": 783.92, "word": " حيصير", "probability": 0.80780029296875}, {"start": 783.92, "end": 784.26, "word": " عندي", "probability": 0.720703125}, {"start": 784.26, "end": 784.8, "word": " ال", "probability": 0.94091796875}, {"start": 784.8, "end": 785.12, "word": " five", "probability": 0.814453125}, {"start": 785.12, "end": 785.46, "word": " dots", "probability": 0.88525390625}, {"start": 785.46, "end": 786.04, "word": " معناته", "probability": 0.9632161458333334}, {"start": 786.04, "end": 786.78, "word": " Dyplopia", "probability": 0.57354736328125}, {"start": 786.78, "end": 787.7, "word": " ..", "probability": 0.6640625}, {"start": 787.7, "end": 788.18, "word": " Dyplopia", "probability": 0.84765625}, {"start": 788.18, "end": 788.44, "word": " طيب", "probability": 0.7140299479166666}, {"start": 788.44, "end": 788.84, "word": " لازم", "probability": 0.8790690104166666}, {"start": 788.84, "end": 789.26, "word": " أسأل", "probability": 0.9227294921875}, {"start": 789.26, "end": 789.8, "word": " المريض", "probability": 0.9503580729166666}, {"start": 789.8, "end": 790.18, "word": " أنه", "probability": 0.746826171875}, {"start": 790.18, "end": 790.44, "word": " أنت", "probability": 0.750244140625}, {"start": 790.44, "end": 790.88, "word": " شايف", "probability": 0.9793294270833334}, {"start": 790.88, "end": 791.28, "word": " خمس", "probability": 0.9632161458333334}, {"start": 791.28, "end": 791.84, "word": " نقاط", "probability": 0.9505208333333334}, {"start": 791.84, "end": 793.18, "word": " اوصفهم", "probability": 0.882470703125}, {"start": 793.18, "end": 793.38, "word": " هل", "probability": 0.9638671875}, {"start": 793.38, "end": 793.66, "word": " هما", "probability": 0.853759765625}, {"start": 793.66, "end": 794.0, "word": " في", "probability": 0.9775390625}, {"start": 794.0, "end": 794.68, "word": " نقطتين", "probability": 0.9385986328125}, {"start": 794.68, "end": 795.54, "word": " وجنبهم", "probability": 0.8384765625}, {"start": 795.54, "end": 796.18, "word": " تلت", "probability": 0.9397786458333334}, {"start": 796.18, "end": 796.72, "word": " نقاط", "probability": 0.9749348958333334}], "temperature": 1.0}, {"id": 35, "seek": 82484, "start": 797.26, "end": 824.84, "text": "إذا هذه horizontal diplopia أو نقطتين وفوقهم أو تحتهم تلت نقاط إذا هذه vertical diplopia vertical diplopia إذا if two red and three green lights are seen diplopia is present if the green and red lights alternate alternating suppression is present ما معنى هذا الكلام إذا كان المريض مرة بيشوف اتنين", "tokens": [28814, 15730, 29538, 12750, 11432, 22376, 34051, 8717, 47432, 2655, 9957, 4032, 5172, 30543, 16095, 34051, 6055, 33753, 16095, 6055, 1211, 2655, 8717, 4587, 41193, 11933, 15730, 29538, 9429, 11432, 22376, 9429, 11432, 22376, 11933, 15730, 498, 732, 2182, 293, 1045, 3092, 5811, 366, 1612, 11432, 22376, 307, 1974, 498, 264, 3092, 293, 2182, 5811, 18873, 40062, 36807, 307, 1974, 19446, 20449, 1863, 7578, 23758, 2423, 28820, 10943, 11933, 15730, 25961, 9673, 16572, 11242, 3714, 25720, 4724, 1829, 8592, 38688, 1975, 2655, 1863, 9957], "avg_logprob": -0.1746323494350209, "compression_ratio": 1.662280701754386, "no_speech_prob": 0.0, "words": [{"start": 797.26, "end": 797.58, "word": "إذا", "probability": 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{"start": 810.74, "end": 811.48, "word": " are", "probability": 0.947265625}, {"start": 811.48, "end": 811.88, "word": " seen", "probability": 0.92919921875}, {"start": 811.88, "end": 812.46, "word": " diplopia", "probability": 0.637939453125}, {"start": 812.46, "end": 812.72, "word": " is", "probability": 0.97021484375}, {"start": 812.72, "end": 813.22, "word": " present", "probability": 0.8994140625}, {"start": 813.22, "end": 814.1, "word": " if", "probability": 0.9140625}, {"start": 814.1, "end": 814.32, "word": " the", "probability": 0.92138671875}, {"start": 814.32, "end": 814.68, "word": " green", "probability": 0.90478515625}, {"start": 814.68, "end": 815.62, "word": " and", "probability": 0.96435546875}, {"start": 815.62, "end": 815.9, "word": " red", "probability": 0.8876953125}, {"start": 815.9, "end": 816.34, "word": " lights", "probability": 0.8408203125}, {"start": 816.34, "end": 817.28, "word": " alternate", "probability": 0.91748046875}, {"start": 817.28, "end": 818.46, 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"word": " بيشوف", "probability": 0.978759765625}, {"start": 823.42, "end": 824.84, "word": " اتنين", "probability": 0.936279296875}], "temperature": 1.0}, {"id": 36, "seek": 84150, "start": 826.72, "end": 841.5, "text": "و مرة بيشوف تلاتة و اللحظة اللي بعدها بيشوف اتنين و اللحظة اللي بعدها بيشوف تلاتة معناته عنده alternating suppression .. alternating suppression طيب لو بيشوف تلاتة وجنبهم اتنين يعني خمسة في نفس اللحظة", "tokens": [2407, 3714, 25720, 4724, 1829, 8592, 38688, 6055, 1211, 9307, 3660, 4032, 13672, 5016, 19913, 3660, 13672, 1829, 39182, 11296, 4724, 1829, 8592, 38688, 1975, 2655, 1863, 9957, 4032, 13672, 5016, 19913, 3660, 13672, 1829, 39182, 11296, 4724, 1829, 8592, 38688, 6055, 1211, 9307, 3660, 20449, 8315, 47395, 43242, 3224, 40062, 36807, 4386, 40062, 36807, 23032, 1829, 3555, 45164, 4724, 1829, 8592, 38688, 6055, 1211, 9307, 3660, 49610, 1863, 3555, 16095, 1975, 2655, 1863, 9957, 37495, 22653, 16490, 2304, 3794, 3660, 8978, 8717, 36178, 13672, 5016, 19913, 3660], 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"جنبهم مش فوجهم ولا تحتهم يعني هدولة two red lights شايفهم على الجانب إما على اليمين على الشمال عفوا أو على اليمين معناته هدى diplopia horizontal طب لو شاف three green وفجيهم أو تحتهم two red معناته هو شايف خمسة بس في عندي vertical diplopia وهيك تفسر هيك أنا قدرت أعرف إذا كان المريض عنده", "tokens": [7435, 1863, 3555, 16095, 37893, 6156, 29245, 16095, 49429, 6055, 33753, 16095, 37495, 22653, 8032, 3215, 12610, 3660, 732, 2182, 5811, 13412, 995, 33911, 16095, 15844, 25724, 7649, 3555, 11933, 15042, 15844, 2423, 32640, 9957, 15844, 25124, 2304, 6027, 6225, 5172, 14407, 34051, 15844, 2423, 32640, 9957, 20449, 8315, 47395, 8032, 3215, 7578, 11432, 22376, 12750, 23032, 3555, 45164, 13412, 31845, 1045, 3092, 4032, 5172, 7435, 1829, 16095, 34051, 6055, 33753, 16095, 732, 2182, 20449, 8315, 47395, 31439, 13412, 995, 33911, 16490, 2304, 3794, 3660, 4724, 3794, 8978, 18871, 16254, 9429, 11432, 22376, 37037, 1829, 4117, 6055, 36178, 2288, 39896, 4117, 41850, 12174, 3215, 43500, 5551, 3615, 28480, 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1382.15, "word": " classes", "probability": 0.90185546875}, {"start": 1382.15, "end": 1383.21, "word": " تكون", "probability": 0.952392578125}, {"start": 1383.21, "end": 1384.05, "word": " متوفرة", "probability": 0.9908854166666666}, {"start": 1384.05, "end": 1384.75, "word": " بينما", "probability": 0.989013671875}, {"start": 1384.75, "end": 1385.09, "word": " ال", "probability": 0.93115234375}, {"start": 1385.09, "end": 1385.37, "word": " four", "probability": 0.9521484375}, {"start": 1385.37, "end": 1385.57, "word": " dot", "probability": 0.9482421875}, {"start": 1385.57, "end": 1385.91, "word": " test", "probability": 0.9677734375}, {"start": 1385.91, "end": 1386.23, "word": " مش", "probability": 0.9931640625}, {"start": 1386.23, "end": 1386.91, "word": " متوفر", "probability": 0.9895833333333334}], "temperature": 1.0}, {"id": 59, "seek": 140036, "start": 1387.92, "end": 1400.36, "text": "طيب بقوليني striated glasses ممكن إذا مش موجودة عندي أستعمل two Maddox road، two Maddox road بيقوموا مقام اللي بقوليني striated glasses", "tokens": [9566, 1829, 3555, 4724, 39648, 9957, 1829, 3575, 770, 10812, 3714, 43020, 11933, 15730, 37893, 3714, 29245, 23328, 3660, 18871, 16254, 5551, 14851, 25957, 1211, 732, 5326, 2595, 87, 3060, 12399, 732, 5326, 2595, 87, 3060, 4724, 1829, 4587, 20498, 14407, 3714, 4587, 10943, 13672, 1829, 4724, 39648, 9957, 1829, 3575, 770, 10812], "avg_logprob": -0.18489582809033217, "compression_ratio": 1.4511278195488722, "no_speech_prob": 0.0, "words": [{"start": 1387.92, "end": 1388.28, "word": "طيب", "probability": 0.90478515625}, {"start": 1388.28, "end": 1389.4, "word": " بقوليني", "probability": 0.7508544921875}, {"start": 1389.4, "end": 1389.88, "word": " striated", "probability": 0.893798828125}, {"start": 1389.88, "end": 1390.54, "word": " glasses", "probability": 0.5537109375}, {"start": 1390.54, "end": 1391.44, "word": " ممكن", "probability": 0.949462890625}, {"start": 1391.44, "end": 1392.06, "word": " إذا", "probability": 0.876953125}, 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34051, 5701, 15346, 1513, 654, 34051, 5701, 17698, 1513, 654], "avg_logprob": -0.20002297794117646, "compression_ratio": 1.3428571428571427, "no_speech_prob": 0.0, "words": [{"start": 1688.46, "end": 1688.78, "word": "أو", "probability": 0.6337890625}, {"start": 1688.78, "end": 1689.72, "word": " Exotropia", "probability": 0.837646484375}, {"start": 1689.72, "end": 1690.04, "word": " أو", "probability": 0.9306640625}, {"start": 1690.04, "end": 1691.08, "word": " Hypertropia", "probability": 0.848388671875}, {"start": 1691.08, "end": 1691.26, "word": " أو", "probability": 0.9677734375}, {"start": 1691.26, "end": 1692.2, "word": " Hypotropia", "probability": 0.896728515625}], "temperature": 1.0}, {"id": 73, "seek": 171982, "start": 1693.46, "end": 1719.82, "text": "ولمّا بنقول Tropia معناته manifest سكنت حوال واضح وشاف أيضا cross زي أو زي الإنسان الطبيعي بقول عنده abnormal retinal correspondence يعني binocular single vision مبني على abnormal retinal correspondence ليش؟ لأنه عنده حوال .. لأنه عنده حوال و ال visual direction بتاع ال corresponding retinal points اللي هو موجود في الطبيعي مش موجود عنده لأنه عنده Tropia ومع ذلك", "tokens": [2407, 19528, 11703, 995, 44945, 39648, 43917, 654, 20449, 8315, 47395, 10067, 8608, 19452, 2655, 11331, 2407, 6027, 4032, 46958, 5016, 4032, 8592, 31845, 36632, 11242, 995, 3278, 30767, 1829, 34051, 30767, 1829, 33688, 1863, 3794, 7649, 41950, 21292, 3615, 1829, 4724, 39648, 43242, 3224, 32847, 1533, 2071, 38135, 37495, 22653, 5171, 905, 1040, 2167, 5201, 3714, 3555, 22653, 15844, 32847, 1533, 2071, 38135, 32239, 8592, 22807, 5296, 33456, 3224, 43242, 3224, 11331, 2407, 6027, 4386, 5296, 33456, 3224, 43242, 3224, 11331, 2407, 6027, 4032, 2423, 5056, 3513, 39894, 45761, 2423, 11760, 1533, 2071, 2793, 13672, 1829, 31439, 3714, 29245, 23328, 8978, 41950, 21292, 3615, 1829, 37893, 3714, 29245, 23328, 43242, 3224, 5296, 33456, 3224, 43242, 3224, 43917, 654, 4032, 2304, 3615, 29910, 23275], "avg_logprob": -0.1466250042915344, 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+1,2174 @@ +1 +00:00:01,740 --> 00:00:06,440 +بسم الله الرحمن الرحيم بنواصل محاضرات حول واحد و + +2 +00:00:06,440 --> 00:00:13,480 +المرة الماضية توقفنا عند مثال لـ muscle sequelae + +3 +00:00:13,480 --> 00:00:16,380 +كان المثال على الـ left superior oblique pulse + +4 +00:00:16,380 --> 00:00:21,820 +اليوم هناخد مثال آخر اللي هو lateral rectus pulse + +5 +00:00:21,820 --> 00:00:25,540 +في الـ right eye هاي الـ right وهي الـ left عندي + +6 +00:00:25,540 --> 00:00:28,460 +right lateral rectus pulse المنظر من أعلى، احنا + +7 +00:00:28,460 --> 00:00:33,570 +بنبص على عينين المريض من أعلى هذه العضلة فيها شلل + +8 +00:00:33,570 --> 00:00:39,870 +والشلل يعني أخد فترة طويلة يعني بمعنى ما تم شفاؤه + +9 +00:00:39,870 --> 00:00:44,630 +دلّت العضلة مشلولة فمن الـ muscle sequel اللي هتسير + +10 +00:00:44,630 --> 00:00:47,130 +أنه الـ antagonistic muscle العضلة المضادة اللي + +11 +00:00:47,130 --> 00:00:51,490 +هتسير فيها contraction وتقلص في الـ + +12 +00:00:51,490 --> 00:00:54,730 +media rectus لأنها ما بتريحش إذا عندي هنا عضلة + +13 +00:00:54,730 --> 00:00:58,190 +under acting muscle under acting يعني + +14 +00:01:01,340 --> 00:01:03,140 +نعطيلها إشارة الـ Under Action + +15 +00:01:34,350 --> 00:01:40,790 +إشارة الـ under action هي عضلة مشلولة، يعني المشكلة + +16 +00:01:40,790 --> 00:01:46,060 +بدأت من عندها، العضلة المقابلة أو الـ antagonistic + +17 +00:01:46,060 --> 00:01:49,160 +muscle اللي هي الـ media rectus في نفس العين ما + +18 +00:01:49,160 --> 00:01:52,580 +بيجيها فترات استراحة لأنه عشان تستريح لازم الـ + +19 +00:01:52,580 --> 00:01:54,740 +lateral rectus تشتغل وطبعا الـ lateral rectus + +20 +00:01:54,740 --> 00:01:59,520 +مشلولة فبالتالي بتضطر الـ media rectus على الدوام + +21 +00:01:59,520 --> 00:02:04,680 +متقلصة فبيصير فيها contracture طالما هي قوية و + +22 +00:02:04,680 --> 00:02:07,840 +متقلصة إذا كمية الـ innervation اللي بيلزمها عشان + +23 +00:02:07,840 --> 00:02:12,610 +تؤدي الشغل بتاعها قليلة، نهيج على إنه العضلة + +24 +00:02:12,610 --> 00:02:16,310 +المقابلة إليها مش متعباها في الشغل فبتسير .. بتصير + +25 +00:02:16,310 --> 00:02:20,490 +high over acting .. over acting بأقل innovation + +26 +00:02:20,490 --> 00:02:30,050 +ممكن .. بأقل innovation ممكن .. بأقل + +27 +00:02:30,050 --> 00:02:31,790 +innervation ممكن فبالتالي + +28 +00:02:38,190 --> 00:02:41,050 +overacting muscle .. overacting muscle بأقل + +29 +00:02:41,050 --> 00:02:44,330 +innervation طالما إجى لهذه العضلة اللي هي الـ media + +30 +00:02:44,330 --> 00:02:48,090 +rectus innervation قليل عشان تؤدي شغلها حسب + +31 +00:02:48,090 --> 00:02:51,750 +hearing له، لازم يجى innervation قليل للـ yoke + +32 +00:02:51,750 --> 00:02:55,130 +muscle تاعت الـ media rectus تاعت الـ right eye مين + +33 +00:02:55,130 --> 00:02:57,610 +الـ yoke muscle تاعت الـ media rectus تاعت الـ right + +34 +00:02:57,610 --> 00:03:00,990 +eye اللي هي الـ lateral rectus هنا هي عضلة طبيعية + +35 +00:03:00,990 --> 00:03:05,070 +ما فيها مشاكل ولكن إجاها أقل innervation، أقل + +36 +00:03:05,070 --> 00:03:08,450 +innervation بسبب أنها الـ yoke muscle أو الـ muscle + +37 +00:03:08,450 --> 00:03:11,670 +الفريق أو الـ muscle الـ team مع الـ .. الـ right + +38 +00:03:11,670 --> 00:03:14,890 +medial rectus فهيكون نصيبها طالما إيجي للـ media + +39 +00:03:14,890 --> 00:03:19,830 +rectus innervation قليل هيجي للـ lateral rectus في + +40 +00:03:19,830 --> 00:03:22,030 +العين الثانية في الـ left eye innervation قليل + +41 +00:03:22,030 --> 00:03:25,830 +فهتصير under acting muscle .. under acting muscle + +42 +00:03:25,830 --> 00:03:31,110 +وهيسمى inhibitional palsy .. inhibitional palsy + +43 +00:03:33,010 --> 00:03:41,730 +فهيصير عندنا inhibitional palsy في الـ .. في + +44 +00:03:41,730 --> 00:03:45,070 +الـ left lateral rectus muscle في الـ left lateral + +45 +00:03:45,070 --> 00:03:48,730 +rectus muscle إذا في عندي عضلتين اتأثروا واحدة + +46 +00:03:48,730 --> 00:03:52,550 +صارت over acting أو over action فيها عشانها + +47 +00:03:52,550 --> 00:03:56,330 +contracted muscle صار فيها contracture بسبب شلل الـ + +48 +00:03:56,330 --> 00:04:01,550 +antagonist بتاعها وعضلة صار فيها ضعف بسبب أنه + +49 +00:04:01,550 --> 00:04:04,390 +ما بيوصلها innervation لأنه الـ yoke muscle بتاعتها + +50 +00:04:04,390 --> 00:04:08,590 +الـ muscle اللي شغالة معاها كفريق الاثنين الـ right + +51 +00:04:08,590 --> 00:04:11,470 +medial rectus والـ left lateral rectus yoke muscle + +52 +00:04:11,470 --> 00:04:15,750 +في الـ left gaze في الـ left gaze فبالتالي إجاها + +53 +00:04:15,750 --> 00:04:20,130 +innervation قليل فحيصير عندي ضعف فيها وهي بهذا + +54 +00:04:20,130 --> 00:04:22,450 +بنسميها inhibitional palsy + +55 +00:04:27,520 --> 00:04:30,380 +يعني الـ lateral rectus في الـ left eye بيصير فيها + +56 +00:04:30,380 --> 00:04:40,000 +inhibitional palsy + +57 +00:04:40,000 --> 00:04:45,360 +شلل بس مش شلل حقيقي .. مش شلل حقيقي + +58 +00:04:53,860 --> 00:04:58,320 +وإنما شلل ناتج عن قلة التغذية العصبية بسبب hearing + +59 +00:04:58,320 --> 00:05:04,040 +loss لأن hearing loss أعطى الـ media rectus على + +60 +00:05:04,040 --> 00:05:08,160 +ناحية التانية اللي هي الـ yoke معاها أعطاها يعني + +61 +00:05:08,160 --> 00:05:11,660 +أقل innervation لإنه مش لازمها كتير innervation عشان + +62 +00:05:11,660 --> 00:05:14,880 +تشتغل لأنها عضلة قوية والعضلة المقابلة إلها + +63 +00:05:14,880 --> 00:05:19,990 +مشلولة، إيش اللي بيحصل مع العضلة رقم أربعة هي عند + +64 +00:05:19,990 --> 00:05:23,650 +العضلة اللي فيها الشلل الأساسي وهي عند عضلة ثالثة + +65 +00:05:23,650 --> 00:05:27,190 +فيها inhibitional palsy، palsy غير حقيقية بينما + +66 +00:05:27,190 --> 00:05:30,750 +ضعف نتيجة قلة التغذية العصبية عشان نحترم hearing + +67 +00:05:30,750 --> 00:05:34,230 +loss عشان نحترم hearing loss طيب العضلة الرابعة + +68 +00:05:34,230 --> 00:05:38,130 +اللي هي الـ left medial rectus هي طرق إيش اللي + +69 +00:05:38,130 --> 00:05:42,060 +هيصير فيها، هنفسرها من طريقين، طريق الأول شيرينجتون + +70 +00:05:42,060 --> 00:05:45,700 +لو مدام إجهت تغذية عصبية قليلة لـ lateral rectus + +71 +00:05:45,700 --> 00:05:48,980 +الصينية معناته عكسها طبعا الـ antagonistic muscles + +72 +00:05:48,980 --> 00:05:53,540 +العضلات المتضادة إذا واحدة إجهت تغذية عصبية أقل، + +73 +00:05:53,540 --> 00:05:56,140 +الثانية بيجيها تغذية عصبية أكثر، إذا واحدة إجهت + +74 +00:05:56,140 --> 00:05:59,660 +تغذية عصبية أكثر، الثانية بيجيها تغذية عصبية أقل، + +75 +00:05:59,660 --> 00:06:02,980 +فهذه هيكون اللي هي نصيب أعلى من الـ innervation و + +76 +00:06:02,980 --> 00:06:07,300 +هتصير over acting muscle هذا تفسر بطريقة hearing + +77 +00:06:07,300 --> 00:06:10,950 +.. عفوا شيرينجتون لو .. شيرينجتون لوالآن لو حبيت + +78 +00:06:10,950 --> 00:06:14,090 +أفسرها عن طريق hearing loop بنقول المريض لو حاب + +79 +00:06:14,090 --> 00:06:17,990 +يعمل fixation بالـ right eye واضح أنه عشان في شلل + +80 +00:06:17,990 --> 00:06:20,370 +في الـ lateral rectus العين جاية شوية لجوه + +81 +00:06:20,370 --> 00:06:23,970 +إيزوتروبيا، إيزوتروبيا بسبب أنه الـ media rectus + +82 +00:06:23,970 --> 00:06:27,730 +قوية والـ lateral rectus مشلولة فهتشد الـ media + +83 +00:06:27,730 --> 00:06:31,390 +rectus هتشد العين لجوه إيزوتروبيا لو شجعنا المريض + +84 +00:06:31,390 --> 00:06:35,190 +وقلنا له لازم تبطلع بعينك اليمين دوري أو شجعناه + +85 +00:06:35,190 --> 00:06:39,980 +غطينا عينه لشماله فبالتالي ساعته هو بده يحاول يعدل + +86 +00:06:39,980 --> 00:06:43,360 +عنها اليمين عشان يطلع على الـ target اللي قدامه طب + +87 +00:06:43,360 --> 00:06:47,080 +كيف هذا الأمر بده يتم؟ بده يتم أنه الـ brain هيبعت + +88 +00:06:47,080 --> 00:06:51,720 +نبضات عصبية كثيرة للـ lateral rectus عشان يحاول أنه + +89 +00:06:51,720 --> 00:06:56,010 +يشغلها عشان تعدل الآن، واحنا حكينا إنه قضية إنه يرسل + +90 +00:06:56,010 --> 00:07:00,790 +نبضات حاجة وتنفيذ النبضات هذه ممكن تنفذ بالكامل + +91 +00:07:00,790 --> 00:07:04,910 +وممكن تنفذ جزئيا وممكن ما تنفذ أبدا حسب درجة الشلل + +92 +00:07:04,910 --> 00:07:10,410 +الموجود هل هو شلل كله ولا شلل جزء بس، طالما الـ + +93 +00:07:10,410 --> 00:07:16,410 +brain بعت للـ lateral rectus هنا بعتلها innervation + +94 +00:07:16,410 --> 00:07:20,970 +كثير هيبعت نفس الكمية للـ yoke muscle بتاعتها اللي + +95 +00:07:20,970 --> 00:07:23,670 +هي الـ media rectus في الـ left eye، فبالتالي هاي + +96 +00:07:23,670 --> 00:07:26,990 +هتوصل لـ innervation كثير فهتصير over acting muscle + +97 +00:07:26,990 --> 00:07:30,710 +هي عضلة طبيعية بس حصلت على نصيب عالي من الـ + +98 +00:07:30,710 --> 00:07:36,970 +innervation فبالتالي .. فبالتالي هتصير over acting + +99 +00:07:36,970 --> 00:07:40,510 +muscle بسبب الـ increase in innervation وهذه المرة + +100 +00:07:40,510 --> 00:07:44,810 +بنكون احنا فسرناها عن طريق hearing .. hearing loop + +101 +00:07:44,810 --> 00:07:48,910 +طالما وصل لهاي hearing loop بنوص على أنه equal .. + +102 +00:07:48,910 --> 00:07:53,600 +equal and simultaneous innervation flows to the yoke + +103 +00:07:53,600 --> 00:07:59,840 +muscle فبالتالي هذه مثل آخر على شلل lateral rectus + +104 +00:07:59,840 --> 00:08:03,300 +muscle في الـ .. في الـ right eye وكيف صار عندي + +105 +00:08:03,300 --> 00:08:07,820 +muscle sequely بدأت المشكلة بعضلة انشلت ولما طول + +106 +00:08:07,820 --> 00:08:14,120 +الشلل يعني .. يعني تأثرت ثلاث عضلات في العينتين + +107 +00:08:14,120 --> 00:08:18,220 +فأصبح عندي total أربع عضلات، عضلات عينتين over + +108 +00:08:18,220 --> 00:08:21,470 +acting muscles هذه عشانها contracted وهذه عشان + +109 +00:08:21,470 --> 00:08:24,950 +إيجاه increased innervation و two under acting + +110 +00:08:24,950 --> 00:08:28,920 +muscle هذه عشان فيها شلل حقيقي وهذه فيها يعني ضعف + +111 +00:08:28,920 --> 00:08:32,300 +أو نقول شلل palsy بس inhibitional نتيجة عن الـ + +112 +00:08:32,300 --> 00:08:35,920 +inhibition أو إنه ما يجيهاش أو يجيها قليل من الـ + +113 +00:08:35,920 --> 00:08:39,120 +impulses .. قليل من الـ impulses ممكن الإنسان يقول + +114 +00:08:39,120 --> 00:08:41,420 +إيش فائدته هذا الكلام في الحياة العملية؟ هذا كلام + +115 +00:08:41,420 --> 00:08:44,980 +نظري هو يعني ماشي مفهوم بس إيش فائدته في الحياة + +116 +00:08:44,980 --> 00:08:50,260 +العملية؟ المريض لما بيجي في الـ muscles equally في + +117 +00:08:50,260 --> 00:08:53,240 +عندي two under acting muscle و two over acting + +118 +00:08:53,240 --> 00:08:58,290 +muscle الآن لما بأبحث مين اللي كان العضلة اللي بدأت + +119 +00:08:58,290 --> 00:09:01,770 +المشكلة .. مين العضلة اللي بدأت المشكلة .. هنلاقي + +120 +00:09:01,770 --> 00:09:05,130 +أنه ما بنقدرش نميز هل هي الـ right lateral rectus + +121 +00:09:05,130 --> 00:09:08,670 +ولا الـ left lateral rectus .. مش هنقدر بمجرد الفحص + +122 +00:09:08,670 --> 00:09:13,960 +الطبيعي نبين وين بدأت المشكلة وين انتهت لأنه طبيا + +123 +00:09:13,960 --> 00:09:18,020 +الـ under action عبارة عن ضعف للعضلة في تحريك العين + +124 +00:09:18,020 --> 00:09:22,060 +باتجاهها وهنا أيضا هيبين ضعف للعضلة في تحريك العين + +125 +00:09:22,060 --> 00:09:25,520 +في اتجاهها مش هتتكلم العضلة وتقولي والله أنا + +126 +00:09:25,520 --> 00:09:29,220 +inhibitional palsy أو palsy حقيقية فبالتالي ضروري + +127 +00:09:29,220 --> 00:09:34,120 +ساعتها نرجع لملف المريض ونشوف إيش مسجل فيه أو نلجأ + +128 +00:09:34,120 --> 00:09:38,520 +لبعض الفحوصات واللي هيجي يعني موعدها أو .. أو + +129 +00:09:38,520 --> 00:09:44,460 +يجي شرحها في وقته .. في وقته، الآن ننتقل للموضوع + +130 +00:09:44,460 --> 00:09:48,440 +الجديد اللي هو secondary considerations بعض + +131 +00:09:48,440 --> 00:09:54,240 +التعريفات الأساسية basic aspects بدنا نحكي عن الـ + +132 +00:09:54,240 --> 00:09:57,520 +normal binocular single vision لما بنقول الرؤية + +133 +00:09:57,520 --> 00:10:01,440 +الموحدة الـ binocular single vision الرؤية الموحدة + +134 +00:10:01,440 --> 00:10:06,260 +بواسطة عينتين، طبعا في رؤية موحدة بشكل طبيعي وفي + +135 +00:10:06,260 --> 00:10:10,060 +رؤية موحدة بس بيكون في شوية خلل موجودة وهذا + +136 +00:10:10,060 --> 00:10:13,100 +ما بنسميهوش normal بنسميه abnormal binocular single + +137 +00:10:13,100 --> 00:10:16,360 +vision احنا الآن بدنا نحكي عن الـ normal binocular + +138 +00:10:16,360 --> 00:10:20,120 +single vision عبارة عن إيش، involves يشمل the + +139 +00:10:20,120 --> 00:10:24,300 +simultaneous use of both eyes أول حاجة الإنسان + +140 +00:10:24,300 --> 00:10:26,860 +اللي عنده normal binocular single vision لازم + +141 +00:10:26,860 --> 00:10:31,120 +يستعمل العينين الاثنتين مع بعض في الرؤية لأنه لو + +142 +00:10:31,120 --> 00:10:33,760 +استعمل عين واحدة بنسميه وش binocular single + +143 +00:10:33,760 --> 00:10:37,180 +vision ساعتها بنسميه monocular single vision إذن + +144 +00:10:37,180 --> 00:10:41,720 +simultaneous use الاستعمال المتزامن of both eyes + +145 +00:10:41,720 --> 00:10:45,460 +وضروري عشان أسميه normal إنه يكون with bifoveal + +146 +00:10:45,460 --> 00:10:49,290 +fixation، أنه هو بيستعمل عين الاثنين، أنه بيستعمل + +147 +00:10:49,290 --> 00:10:52,050 +الـ fovea في العين اليمين للـ fixation، وايضا + +148 +00:10:52,050 --> 00:10:55,050 +بيستعمل الـ fovea في العين الشمال للـ fixation + +149 +00:10:55,050 --> 00:10:58,110 +طيب، لو قلنا أنه بيستعمل الـ fovea في عين، و + +150 +00:10:58,110 --> 00:11:02,090 +بيستعمل extra fovea .. foveal area .. extra foveal + +151 +00:11:02,090 --> 00:11:05,390 +area في العين الثانية، ساعتها بشيل كلمة normal، + +152 +00:11:05,390 --> 00:11:08,990 +لأن هذا يعتبر abnormal binocular single vision، + +153 +00:11:08,990 --> 00:11:13,190 +إذا with bifoveal fixations so that each eye + +154 +00:11:13,190 --> 00:11:16,550 +contributes to a common single perception of the + +155 +00:11:16,550 --> 00:11:20,870 +object of regard طب لما أنا بستعمل عيني الاثنتين و + +156 +00:11:20,870 --> 00:11:23,930 +بكون مركز بالفوفيا في اليمين والفوفيا في الشمال والـ + +157 +00:11:23,930 --> 00:11:26,530 +اثنين إيش يعني مركز فيهم؟ يعني الـ two fovea + +158 +00:11:26,530 --> 00:11:30,530 +متجهين لنفس الهدف اللي أنا بتطلع عليه سواء شمعة + +159 +00:11:30,530 --> 00:11:36,510 +قلم سيارة أي target بتطلع عليه صورة هذا الـ target + +160 +00:11:36,510 --> 00:11:41,140 +هتقع على الفوفيا في العين اليمين مع جزء حوالين + +161 +00:11:41,140 --> 00:11:44,240 +الفوفيا وهتقع الفوفيا في العين الشمال مع جزء من + +162 +00:11:44,240 --> 00:11:50,020 +الـ retina حوالين الفوفيا بهيك بقدر أنا أتأكد أنه + +163 +00:11:50,020 --> 00:11:53,660 +كل عين شاركت contributes to a common single + +164 +00:11:53,660 --> 00:11:59,160 +perception طبعا لا العينين شاركوا مع بعض في رؤية + +165 +00:11:59,160 --> 00:12:02,680 +واحدة في رؤية واحدة لأن القلم أو الشمعة أو السيارة + +166 +00:12:02,680 --> 00:12:06,320 +أو ما إلى ذلك الشيء الواحد أو الهدف الواحد أو الـ + +167 +00:12:06,320 --> 00:12:09,920 +target الواحد أنا بشوفه واحد رغم أنه صورته أو + +168 +00:12:09,920 --> 00:12:13,920 +انطبع له صورتين على الاثنين أو على شبكية الاثنين + +169 +00:12:13,920 --> 00:12:18,950 +ورغم ذلك أنا بـ .. أشوفه واحد بشكل موحد ثلاث + +170 +00:12:18,950 --> 00:12:23,130 +الأبعاد، إذا هذا يعني لإنه كل عين من العينين + +171 +00:12:23,130 --> 00:12:29,090 +شاركت في common single perception في إدراك موحد + +172 +00:12:29,090 --> 00:12:32,730 +للهدف اللي أنا بتطلع عليه أو الـ object of regard + +173 +00:12:32,730 --> 00:12:36,030 +this represents the highest form of binocular + +174 +00:12:36,030 --> 00:12:40,310 +cooperation هذه القضية تعتبر أعلى درجة من التعاون + +175 +00:12:40,310 --> 00:12:46,150 +بين العينين، بين العينين، يعني هذه أنا بستعمل عين + +176 +00:12:46,150 --> 00:12:49,430 +الاثنين عشان أطلع على هدف، الهدف هو الكتاب اللي + +177 +00:12:49,430 --> 00:12:53,110 +أنا بقرأ فيه، طبعا صورة الكتاب هتكون على الفوفيا في + +178 +00:12:53,110 --> 00:12:55,870 +العين اليمين وهتكون على الفوفيا في العين الشمال، + +179 +00:12:55,870 --> 00:13:00,610 +إذا صار عند + +201 +00:14:20,920 --> 00:14:26,030 +إذا اللي شغال نصف العين هي الـ nasal ونصف العين هي الـ + +202 +00:14:26,030 --> 00:14:30,390 +temporal هي الـ nasal .. الـ nasal retina .. ليش هم + +203 +00:14:30,390 --> 00:14:32,970 +اللي شغالين ضالوا؟ لأن أنا في عندي قطع هنا + +204 +00:14:32,970 --> 00:14:36,270 +فبالتالي الـ nasal retina هنا والـ temporal retina + +205 +00:14:36,270 --> 00:14:40,010 +هنا اللي بيودوا معلوماتهم للـ left optic tract ومن + +206 +00:14:40,010 --> 00:14:44,770 +ثم للـ left visual cortex هدول بيضالوا يستقبلوا + +207 +00:14:44,770 --> 00:14:49,190 +بينما نصف الـ field الثاني اللي هو الـ left field + +208 +00:14:49,190 --> 00:14:53,110 +اللي هو الـ right temporal retinal و الـ nasal retina + +209 +00:14:53,110 --> 00:14:55,930 +اللي هو باللون الأزرق طالما فيه قطع هنا إذا + +210 +00:14:55,930 --> 00:14:59,010 +المعلومات ما بتوصلش طالما نصف الـ field ونصف الـ field + +211 +00:14:59,010 --> 00:15:01,710 +إذا أنا عندي صار فيه خلل في الـ normal, binocular, + +212 +00:15:01,830 --> 00:15:05,970 +single, vision إذا أول حاجة لازم يكون normal + +213 +00:15:05,970 --> 00:15:11,370 +routing of visual pathways with overlapping of + +214 +00:15:11,370 --> 00:15:15,130 +visual field كل عين إلها visual field نفرض إنه .. + +215 +00:15:15,130 --> 00:15:20,550 +نفرض إنه الـ visual pathway كله سليم وهدي العين + +216 +00:15:20,550 --> 00:15:24,800 +straight بينما هذه العين موجهة بهذا الاتجاه اللي + +217 +00:15:24,800 --> 00:15:28,760 +أنا بأشر عليه بالـ mouse بالـ mouse يعني exotropic + +218 +00:15:28,760 --> 00:15:33,600 +يعني بشكل كبير هيكون الـ field بتاع العين اليمين هو + +219 +00:15:33,600 --> 00:15:37,260 +في المنطقة هذه والـ field بتاع العين الشمال في + +220 +00:15:37,260 --> 00:15:40,580 +المنطقة الأمامية فش overlapping فش تداول يعني + +221 +00:15:40,580 --> 00:15:44,560 +بمعنى أن العين اليمين بتنظر لأشياء غير اللي + +222 +00:15:44,560 --> 00:15:49,300 +بتنظرها العين الشمال وهذا طالما .. هذا طالما كل + +223 +00:15:49,300 --> 00:15:52,780 +عين بتنظر لأشياء مختلفة فبالتالي توحيدهم في صورة + +224 +00:15:52,780 --> 00:15:56,280 +واحدة مش ممكن يعني فش إمكانية للحصول على normal, + +225 +00:15:56,440 --> 00:16:00,200 +binocular, single vision إذا ضروري جدا يكون مش بس + +226 +00:16:00,200 --> 00:16:03,500 +أن الـ visual pathway سليم أيضا لازم الـ field بتاع + +227 +00:16:03,500 --> 00:16:06,590 +العين اليمين والـ field بتاع العين الشمال يكونوا + +228 +00:16:06,590 --> 00:16:09,970 +overlapped يعني داخلين على بعضهم أو بتطلعوا أو هم + +229 +00:16:09,970 --> 00:16:13,230 +في نفس المنطقة يقع يعني يعني العين اللي هي بتتطلع + +230 +00:16:13,230 --> 00:16:18,930 +على جزء من الحقل الإبصار هو نفس الجزء اللي بتتطلع + +231 +00:16:18,930 --> 00:16:21,570 +عليه العين الشمال طبعا معادة الأطراف .. معادة + +232 +00:16:21,570 --> 00:16:25,830 +الأطراف في لكل عين الطرف اللي جهتها هذا مش مشترك + +233 +00:16:25,830 --> 00:16:28,230 +مع العين الثانية إذا الـ visual field بتاع العين + +234 +00:16:28,230 --> 00:16:30,510 +اليمين والـ visual field بتاع العين الشمال ضروري + +235 +00:16:30,510 --> 00:16:34,070 +يكونوا مشتركات في معظمهم .. في معظمهم في عندي أنا + +236 +00:16:34,070 --> 00:16:38,840 +صورة هان بتوضح الأمر بشكل كويس الـ field بتاع العين + +237 +00:16:38,840 --> 00:16:43,200 +اليمنين هيهم الخط المتصل خليني أطلع على عرض مكبر + +238 +00:16:43,200 --> 00:16:51,980 +الـ field بتاع العين اليمين إذا قلنا الصورة جاية + +239 +00:16:51,980 --> 00:16:55,540 +من أعلى هتكون هذه هي العين اليمين الخط المتصل هذا + +240 +00:16:55,540 --> 00:16:58,770 +هو الـ field بتاع العين اليمين والـ field بتاع العين + +241 +00:16:58,770 --> 00:17:01,530 +الشمال حقل الإبصار بتاع العين الشمال هو الخط + +242 +00:17:01,530 --> 00:17:05,370 +المتقطع الـ dashed line الـ dashed line المنطقة high + +243 +00:17:05,370 --> 00:17:09,730 +اللي في النص واللي هي المساحة الأكبر مشتركة بين + +244 +00:17:09,730 --> 00:17:13,290 +العينين الثانية هذه المنطقة الطرفية خاصة بالعین الیمین + +245 +00:17:13,290 --> 00:17:18,350 +بسموها الـ right temporal crescent أو + +246 +00:17:18,350 --> 00:17:22,750 +monocular temporal crescent وهي خاصة بالعين الشمال + +247 +00:17:22,750 --> 00:17:26,170 +بيسموها الـ temporal crescent أو الـ left temporal + +248 +00:17:26,170 --> 00:17:29,010 +crescent أو monocular temporal crescent crescent + +249 +00:17:29,010 --> 00:17:32,490 +يعني هلال .. هلال .. منطقة هلالية أما المنطقة + +250 +00:17:32,490 --> 00:17:36,230 +الأغلب من الـ field بتاع العين اليمين متداخلة مع + +251 +00:17:36,230 --> 00:17:38,930 +المنطقة الأغلب من الـ field بتاع العين الشمال إذا + +252 +00:17:38,930 --> 00:17:42,470 +هذا شرط من شروط الـ binocular single vision أنه + +253 +00:17:42,470 --> 00:17:48,200 +يكون عندي أنا normal routing of visual pathway لازم + +254 +00:17:48,200 --> 00:17:50,780 +يكون الـ visual pathway سليم والـ field بتاع العين + +255 +00:17:50,780 --> 00:17:54,180 +اليمين متداخل مع الـ field بتاع العين الشمال عشان + +256 +00:17:54,180 --> 00:17:58,040 +يكونوا العينتين بيبصوا على نفس الأهداف أو غالبا + +257 +00:17:58,040 --> 00:18:03,600 +على نفس الأهداف وبالتالي تم توحيد صورتهم في صورة + +258 +00:18:03,600 --> 00:18:07,160 +واحدة ثاني شيء الصورة وصلت الآن للـ visual cortex + +259 +00:18:07,160 --> 00:18:09,800 +ضروري يكون في نوع خاص من الخلايا بيسموها + +260 +00:18:09,800 --> 00:18:13,060 +binocularly driving neurons in the visual cortex + +261 +00:18:13,060 --> 00:18:19,360 +الـ visual cortex اللي في الـ occipital region مختصة + +262 +00:18:19,360 --> 00:18:25,180 +بتحليل الصورة وأجزاء الصورة، هي باللون الأحمر + +263 +00:18:25,180 --> 00:18:31,420 +واللون الأزرق، الـ visual cortex هي هنا مقطع يعني للـ + +264 +00:18:31,420 --> 00:18:35,200 +visual cortex وهي ضمن الـ brain وهنا يعني شايلينها + +265 +00:18:35,200 --> 00:18:38,860 +في رسمة خارج الـ brain فبالتالي الـ visual cortex في + +266 +00:18:38,860 --> 00:18:42,420 +منها أنواع خلايا كثير بس احنا اللي بهمنا في موضوع + +267 +00:18:42,420 --> 00:18:45,400 +الـ binocular single vision ضروري تكون فيه خلايا + +268 +00:18:45,930 --> 00:18:49,210 +تستقبل من العينين يعني binocularly drive الـ + +269 +00:18:49,210 --> 00:18:52,790 +neurons يعني الـ neurons أو الخلايا العصبية اللي + +270 +00:18:52,790 --> 00:18:56,250 +بتستقبل من العينين بتستقبل معلومات من العين + +271 +00:18:56,250 --> 00:19:02,670 +الثانية لأن هذه الخلايا هي يعني موجودة عشان تستقبل من + +272 +00:19:02,670 --> 00:19:04,930 +العين اليمين ومن العين الشمال المعلومات بتاعة + +273 +00:19:04,930 --> 00:19:09,990 +الصورة وتوحدهم في صورة واحدة طبعا في .. في خلايا + +274 +00:19:09,990 --> 00:19:13,390 +أخرى بتستقبل من العين اليمين بسموها الـ right + +275 +00:19:13,390 --> 00:19:18,050 +responsive cell أو cells وفي خلايا تستقبل معلومات + +276 +00:19:18,050 --> 00:19:21,390 +فقط من العين الشمال بيسموها الـ left responsive cells + +277 +00:19:21,390 --> 00:19:24,430 +مش هذه الخلايا اللي احنا بنعنيها أو مش هذه الخلايا + +278 +00:19:24,430 --> 00:19:28,350 +المعنية بتوحيد الصورتين في صورة وإنما النوع الثالث + +279 +00:19:28,350 --> 00:19:30,950 +من الخلايا اللي هي بيسموهم binocularly driving + +280 +00:19:30,950 --> 00:19:35,800 +neurons يعني لازم يكون في طائفة من الخلايا في الـ + +281 +00:19:35,800 --> 00:19:40,040 +visual cortex تستجيب للمعلومات القادمة من العين + +282 +00:19:40,040 --> 00:19:43,940 +الثانية ثالث شيء وهو مهم جدا normal retinal أو + +283 +00:19:43,940 --> 00:19:46,760 +بالأصح نقول الـ retinocortical correspondence + +284 +00:19:46,760 --> 00:19:51,760 +resulting in cyclopean view نرجع أو نحاول نفهم إيش + +285 +00:19:51,760 --> 00:19:54,340 +يعني الـ normal retinal correspondence ونروح العرض + +286 +00:19:54,340 --> 00:19:58,070 +المكبر ونقول حاول بالصور التالية أن نفهم إيش يعني + +287 +00:19:58,070 --> 00:20:01,050 +retinal correspondence تناسق شبكي retinal + +288 +00:20:01,050 --> 00:20:04,010 +correspondence يعني تناسق شبكي إيش يعني تناسق + +289 +00:20:04,010 --> 00:20:09,450 +شبكي؟ يعني كل نقطة في شبكية العين اليمين لها ما + +290 +00:20:09,450 --> 00:20:12,970 +يماثلها في شبكية العين الشمال ما معنى لها ما + +291 +00:20:12,970 --> 00:20:17,210 +يماثلها؟ يعني في نقطة مثلا نقطة سين هنا والنقطة + +292 +00:20:17,210 --> 00:20:21,430 +سين شرطة هنا بيبصوا على نفس الجهة من الفرار يعني + +293 +00:20:21,430 --> 00:20:25,020 +هنا سين مثلا في الـ timbre الـ retinal وين بيقشر + +294 +00:20:25,020 --> 00:20:29,080 +السهم؟ وين بيقشر السهم الأزرق؟ نقطة سين والنقطة + +295 +00:20:29,080 --> 00:20:33,280 +سين شرطة ليه نقطة مماثلة أو corresponding retinal + +296 +00:20:33,280 --> 00:20:37,680 +point؟ corresponding مع سين تمام، مماثلة لسين إيش + +297 +00:20:37,680 --> 00:20:40,640 +يعني مماثلة سين برضه وين ما بيقشر السهم الأزرق؟ + +298 +00:20:40,640 --> 00:20:45,420 +يعني سين وسين شرطة بيبصوا أو بيتطلعوا على نفس + +299 +00:20:45,420 --> 00:20:49,160 +الجهة من الفرار إيش يعني برضه هذا الكلام بيعني؟ + +300 +00:20:49,160 --> 00:20:51,920 +بيعني إنه لو في هذا الفرار، في هذه المنطقة من + +301 +00:20:51,920 --> 00:21:00,030 +الفرار لو في target شمعة ووردة أي شيء هتسقط صورة + +302 +00:21:00,030 --> 00:21:03,650 +الوردة هنا وأيضا هتسقط صورة الوردة على نفس + +303 +00:21:03,650 --> 00:21:07,810 +المنطقة المماثلة وفي عندي صد وصد شرطة وفي عندي + +304 +00:21:07,810 --> 00:21:11,790 +هنا عين وعين شرطة هنلاقي إن الـ temporal retina في + +305 +00:21:11,790 --> 00:21:14,790 +الـ right eye والـ nasal retina في الـ left eye + +306 +00:21:14,790 --> 00:21:19,450 +اثنين موجهين لنفس الجهة يعني هنا الـ temporal + +307 +00:21:19,450 --> 00:21:23,310 +retina مرسومة هنا بالأزرق والـ nasal retina مرسومة + +308 +00:21:23,310 --> 00:21:28,050 +بالأزرق عشان يدللي إن هدول مناطق متماثلة كل نقطة + +309 +00:21:28,050 --> 00:21:31,310 +لها مثيلتها وكل مساحة من الشبكية لها مثيلتها + +310 +00:21:31,310 --> 00:21:35,190 +والاثنين بتطلع على نفس الجهة من الـ visual field + +311 +00:21:35,190 --> 00:21:37,930 +يعني الـ right eye الـ temporal retina بتطلع على الـ + +312 +00:21:37,930 --> 00:21:41,010 +left field هاي الـ field مرسوم على الـ left field + +313 +00:21:41,010 --> 00:21:44,090 +والـ nasal retina هنا في الـ left eye أيضا على الـ + +314 +00:21:44,090 --> 00:21:47,190 +left field يعني بمعنى آخر الـ temporal retina هنا + +315 +00:21:47,590 --> 00:21:50,870 +والـ temporal retina هنا الاثنين بيخدموا الـ left + +316 +00:21:50,870 --> 00:21:54,570 +field بتاع العينين مع بعض الـ left field طيب الـ + +317 +00:21:54,570 --> 00:21:57,370 +temporal retina في الـ left eye والـ nasal retina + +318 +00:21:57,370 --> 00:22:00,730 +في الـ right eye بيخدموا الـ right field بيخدموا الـ + +319 +00:22:00,730 --> 00:22:05,110 +right field طبعا هدول مناطق متماثلة من الشبكات + +320 +00:22:05,110 --> 00:22:10,730 +من الشبكات أيضا هنا الرسمة برضه بتوضح هي الـ field + +321 +00:22:10,730 --> 00:22:15,740 +الكلي للعينين طبعا مرسوم بشكل هو هذه الرسمة مش .. + +322 +00:22:15,740 --> 00:22:19,380 +مش .. هي رسمة تمثلية إن الـ field لأنه شكله أكثر + +323 +00:22:19,380 --> 00:22:23,160 +.. يعني أقرب للشكل البيضاوي منه للإسطواني ولكن + +324 +00:22:23,160 --> 00:22:27,020 +لتوضيح الفكرة .. لتوضيح الفكرة بنقول هاي الـ field + +325 +00:22:27,020 --> 00:22:31,700 +تعالين تان مع بعض نصف الشمال اللي ع شمالنا اللي هو + +326 +00:22:31,700 --> 00:22:35,660 +مصم باللون الأحمر من الـ field بمين .. مين بيخدم أو + +327 +00:22:35,660 --> 00:22:39,960 +مين بيستقبل منه الـ temporal retina تحت الـ right eye + +328 +00:22:39,960 --> 00:22:44,240 +والـ nasal retina تحت الـ left eye الـ temporal تحت + +329 +00:22:44,240 --> 00:22:47,460 +الـ right eye والـ nasal احنا بنطلع من فوق المريض + +330 +00:22:47,460 --> 00:22:50,340 +من فوق المريض يعني جايين للعينين من فوق فهيكون هذه + +331 +00:22:50,340 --> 00:22:54,440 +الـ right eye وهذه الـ left eye وهذه الـ left eye + +332 +00:22:54,440 --> 00:22:58,180 +فبالتالي الـ temporal مع الـ nasal بيخدموا الـ left + +333 +00:22:58,180 --> 00:23:01,680 +field والـ temporal بتاعة الـ left eye مع الـ nasal + +334 +00:23:01,680 --> 00:23:05,260 +بتاع الـ right eye موجهين وبيخدموا الـ right field + +335 +00:23:05,260 --> 00:23:07,800 +إيش يعني بيخدموا يعني بيستقبلوا معلومات منه .. + +336 +00:23:07,800 --> 00:23:11,880 +بيستقبلوا معلومات منه إيش معنى الـ temporal مع الـ + +337 +00:23:11,880 --> 00:23:16,260 +nasal والـ nasal مع الـ temporal ليش ما يقولنا + +338 +00:23:16,260 --> 00:23:19,860 +temporal و temporal و nasal و nasal؟ عشان الأسماء + +339 +00:23:19,860 --> 00:23:22,700 +متشابهة العبرة مش بالأسماء يعني لو احنا أخدنا الـ + +340 +00:23:22,700 --> 00:23:25,480 +nasal retinal في العين الثانية الـ nasal retinal في الـ + +341 +00:23:25,480 --> 00:23:28,500 +right eye موجهة لليمين والـ nasal retinal في الـ + +342 +00:23:28,500 --> 00:23:32,180 +left eye موجهة لليسار يعني موجهين عكس بعضهم بينما + +343 +00:23:32,180 --> 00:23:35,100 +هنا الـ nasal مع الـ temporal موجهين نفس الاتجاه + +344 +00:23:35,100 --> 00:23:39,140 +اللي هو الأزرق والـ temporal مع الـ nasal موجهين نفس + +345 +00:23:39,140 --> 00:23:42,320 +الاتجاه طبعا هدول بيسموهم corresponding retinal + +346 +00:23:42,320 --> 00:23:46,240 +areas و هدول بيسموهم corresponding retinal areas + +347 +00:23:46,240 --> 00:23:49,400 +بالنسبة للفوفيا اللي هي بتيجي في منطقة المنتصف + +348 +00:23:49,400 --> 00:23:53,550 +موجهة direct الـ two fovea موجهين في الـ normal + +349 +00:23:53,550 --> 00:23:56,470 +binocular single vision باتجاه الـ target اللي أنا + +350 +00:23:56,470 --> 00:24:00,170 +بتطلع عليه أو اللي بعمل fixation عليه بعمل + +351 +00:24:00,170 --> 00:24:03,570 +fixation عليه إذا ضروري يكون في عندي تناسق شبكي + +352 +00:24:03,570 --> 00:24:08,250 +هنا الصورة بشكل أوضح بكثير بشكل أوضح بكثير هاي + +353 +00:24:08,250 --> 00:24:13,670 +العينين العينين عشان احنا يعني ناخد تصور يعني أقرب + +354 +00:24:13,670 --> 00:24:17,070 +لإنه يكون ثلاثي الأبعاد بدنا ناخد هذا الجزء + +355 +00:24:17,070 --> 00:24:21,780 +المشترك من الشبكية وهذا الجزء المشترك من الشبكية + +356 +00:24:21,780 --> 00:24:25,880 +أو هنا .. هنا شبكية العين اليمين وهنا شبكية العين + +357 +00:24:25,880 --> 00:24:29,200 +الشمالية خلينا نشوف .. هاي الـ field .. هاي الـ + +358 +00:24:29,200 --> 00:24:32,840 +field الـ + +359 +00:24:32,840 --> 00:24:37,300 +field يقسم لأربع أقسام وهذا حقيقة ضروري جدا جدا + +360 +00:24:37,300 --> 00:24:42,500 +جدا نستوعبه الـ field يقسم لأربع أقسام هاي ربع + +361 +00:24:42,500 --> 00:24:49,750 +باللون الأحمر وهي ربع باللون الأخضر وهي ربع باللون + +362 +00:24:49,750 --> 00:24:53,930 +الأصفر وهي ربع باللون الـ move أو الـ beneficiary + +363 +00:24:53,930 --> 00:24:58,690 +إذا الأربع أربع بسميهم كلهم مع بعض الـ visual field + +364 +00:24:58,690 --> 00:25:03,610 +الـ visual field .. الـ visual field طبعا في معلومة + +365 +00:25:03,610 --> 00:25:08,290 +بسيطة جدا عشان الإنسان ما يتلخبطش هذا الـ field هاي + +366 +00:25:08,290 --> 00:25:12,070 +الجزء اليمين منه النصف اليمين من الـ field وهي + +367 +00:25:12,070 --> 00:25:15,210 +النصف الشمال من الـ field احنا قلنا احنا بنتطلع من + +368 +00:25:15,210 --> 00:25:20,230 +فوق احنا شايفين العينين من فوق وبالتالي بنقول هنا + +369 +00:25:20,230 --> 00:25:24,910 +الـ right field لأنه هذا أقرب للـ right eye أو على + +370 +00:25:24,910 --> 00:25:27,290 +side .. على الـ side أو على الجانب بتاع الـ right + +371 +00:25:27,290 --> 00:25:31,850 +eye وهذا الـ left half هذا الـ right half هذا النص + +372 +00:25:31,850 --> 00:25:35,170 +اليمين بتاع الـ visual field وهذا النص الشمال بتاع + +373 +00:25:35,170 --> 00:25:41,210 +الـ visual field طيب في قاعدة عشان احنا ما نتلخبطش + +374 +00:25:41,210 --> 00:25:46,230 +بنقول النص اليمين بقع على الأجزاء اليسرى من الشبكية + +375 +00:25:46,230 --> 00:25:49,670 +الأجزاء اليسرى من شبكية العين اليمين والأجزاء + +376 +00:25:49,670 --> 00:25:52,210 +اليسرى من شبكية العين الشمالية احنا قلنا هنا اليمين + +377 +00:25:52,210 + +401 +00:27:45,920 --> 00:27:51,100 +صورته بدها تسقط على عيني أو على عينية التنطينالجزء + +402 +00:27:51,100 --> 00:27:53,680 +الأعلى من ال field بيسقط على ال inferior retina + +403 +00:27:53,680 --> 00:27:57,980 +والجزء الأسفل على ال superior retina زي ما احنا + +404 +00:27:57,980 --> 00:28:02,360 +ورجينا في الرسمة هذه الجزء الأعلى من ال field طبعا + +405 +00:28:02,360 --> 00:28:05,140 +هنا احنا رسمين عين واحدة بس هاد ينطبق على عين الثانية + +406 +00:28:05,140 --> 00:28:08,440 +الجزء الأعلى من ال field بيسقط على ال inferior + +407 +00:28:08,440 --> 00:28:12,300 +retina والجزء الأعلى من ال field من حقل الإبصار + +408 +00:28:12,300 --> 00:28:16,420 +بيسقط على ال superior retina إذا الأعلى بيسقط على + +409 +00:28:16,420 --> 00:28:19,360 +ال inferior والأدنى بيسقط على ال superior retina + +410 +00:28:20,190 --> 00:28:23,690 +واليمين من ال field يمين ال field بيسقط على الشمال + +411 +00:28:23,690 --> 00:28:27,950 +وشمال ال field بيسقط على اليمين بيسقط على اليمين + +412 +00:28:27,950 --> 00:28:32,350 +لأنه مقابل لليمين .. مقابل لليمين طيب لو احنا قلنا + +413 +00:28:32,350 --> 00:28:37,190 +بدنا ناخد ربع واحد من ال field ونشوف وين بيسقط هذا + +414 +00:28:37,190 --> 00:28:40,550 +الربع اللي ملون باللون الأحمر اللي ملون باللون + +415 +00:28:40,550 --> 00:28:47,070 +الأحمر جاي بسموه left upper quadrant of the visual + +416 +00:28:47,070 --> 00:28:50,530 +field ماذا يعني left upper quadrant؟ left يعني جاي + +417 +00:28:50,530 --> 00:28:55,170 +على الشمال، ربع، left quadrant بس upper، مش .. مش + +418 +00:28:55,170 --> 00:28:59,010 +سفلي، علوي، لأن هذا السفلي، هذا السفلي اللي هو ال + +419 +00:28:59,010 --> 00:28:59,270 +move + +420 +00:29:08,210 --> 00:29:11,490 +أخدنا احنا ال left upper quadrant من ال visual + +421 +00:29:11,490 --> 00:29:15,250 +field المربع أو الربع اللي جاي على الشمال ولا فوق + +422 +00:29:15,250 --> 00:29:19,130 +من ال visual field يا طرح هيسقط وين؟ عشان أعرف + +423 +00:29:19,130 --> 00:29:22,890 +ببساطة جدا، بدي أعكس كل الكلمات ال left بتصير + +424 +00:29:22,890 --> 00:29:27,070 +right و ال upper بتصير lower، هيسقط على ال right + +425 +00:29:27,070 --> 00:29:32,890 +lower quadrant of the two retina هذه ال retina، + +426 +00:29:32,890 --> 00:29:39,430 +هذه الرسمة حسب، هذه الرسمة ال field اللي هو الحقيقة + +427 +00:29:39,430 --> 00:29:44,650 +الموجودة خارج نطاق جسمي .. خارج نطاق جسمي تمام؟ + +428 +00:29:44,650 --> 00:29:48,590 +فبالتالي هذا الجزء .. أي شيء موجود في المنطقة + +429 +00:29:48,590 --> 00:29:51,470 +الحمراء في ال field .. في الربع الأحمر من ال field + +430 +00:29:51,470 --> 00:29:55,990 +هيسقط على ال right inferior quadrant في ال .. في + +431 +00:29:55,990 --> 00:29:59,610 +ال right eye و أيضا هيسقط على ال right inferior + +432 +00:29:59,610 --> 00:30:03,490 +quadrant في ال left eye وكذا نقول هذه left eye كيف + +433 +00:30:03,490 --> 00:30:07,270 +right eye؟ ال left eye نفسها لو جسمناها لجسمين + +434 +00:30:07,270 --> 00:30:12,910 +هيكون جسم جايمين و جسم منها جاى الشمال طالما left + +435 +00:30:12,910 --> 00:30:17,010 +superior quadrant من ال field هيسقط على ال right + +436 +00:30:17,010 --> 00:30:20,690 +inferior quadrant of both retina لأن ال right + +437 +00:30:20,690 --> 00:30:24,110 +inferior quadrant هنا و ال right inferior quadrant + +438 +00:30:24,110 --> 00:30:28,660 +هنا في ال left eye الاثنين مناطق متماثلة من + +439 +00:30:28,660 --> 00:30:33,460 +الشبكيات بيبصوا على نفس الجهة على أي جهة بيبصوا + +440 +00:30:33,460 --> 00:30:37,320 +على ال left superior quadrant of the field ال + +441 +00:30:37,320 --> 00:30:41,620 +right inferior .. ال right inferior part of the + +442 +00:30:41,620 --> 00:30:45,600 +retina .. right inferior part of the retina ولما + +443 +00:30:45,600 --> 00:30:48,720 +بنحكي right inferior parts of the retina ما بنقصدش + +444 +00:30:48,720 --> 00:30:51,980 +فيها ال right eye بنقصد فيها ال both eye هنا .. + +445 +00:30:52,570 --> 00:30:57,010 +الجزء اللي عاليمين و تحت والربع اللي عاليمين و تحت + +446 +00:30:57,010 --> 00:31:00,190 +بالنسبة لكل هذا المنظر اللي هو ال retina تمام؟ + +447 +00:31:00,190 --> 00:31:03,710 +هدول الجزئين بيشتركوا ان هم بتطلعوا في الفراغ أو + +448 +00:31:03,710 --> 00:31:07,830 +مقابلين في الفراغ لل left upper quadrant of the + +449 +00:31:07,830 --> 00:31:14,250 +visual field طيب؟ إذا left superior quadrant أو + +450 +00:31:14,250 --> 00:31:18,870 +left upper quadrant مقابل لل right inferior retina + +451 +00:31:18,870 --> 00:31:24,880 +of both eyes طيب؟ هدولة طالما مناطق متماثلة من + +452 +00:31:24,880 --> 00:31:31,580 +الشبكية معناته لازم يروحوا على نفس المنطقة من ال + +453 +00:31:31,580 --> 00:31:35,440 +visual cortex هملاحظين عندي ال visual cortex في + +454 +00:31:35,440 --> 00:31:39,740 +visual cortex عاليمين وفي visual cortex على الشمال + +455 +00:31:39,740 --> 00:31:44,680 +طبعا في شق هنا بيقسم ال visual cortex ل upper part + +456 +00:31:44,680 --> 00:31:48,720 +و lower part هذه ال left و هذه ال right upper part + +457 +00:31:48,720 --> 00:31:53,720 +و lower part إذا عندي right visual cortex و left + +458 +00:31:53,720 --> 00:32:00,740 +visual cortex احنا هدولة .. هدولة اللي هم بيخدموا + +459 +00:32:00,740 --> 00:32:04,780 +.. بيخدموا ال left superior quadrant of the visual + +460 +00:32:04,780 --> 00:32:09,320 +field هنا أي target موجود هيسقط على ال right + +461 +00:32:09,320 --> 00:32:13,600 +inferior quadrant of the retina و أيضا هيسقط على + +462 +00:32:13,600 --> 00:32:16,780 +ال right inferior quadrant of the retina الـ Right + +463 +00:32:16,780 --> 00:32:19,200 +Inferior Quadrant والـ Right Inferior Quadrant + +464 +00:32:19,200 --> 00:32:25,940 +هيبعتوا معلوماتهم للـ Right Inferior Bank ضفة ضفة + +465 +00:32:25,940 --> 00:32:30,040 +Bank يعني ضفة تمام؟ هنا في شق هنا في الضفة العليا + +466 +00:32:30,040 --> 00:32:34,860 +والضفة السفلى لRight Inferior Visual Cortex Right + +467 +00:32:34,860 --> 00:32:40,100 +Inferior Visual Cortex هذا الكلام احنا نكتبه في + +468 +00:32:40,100 --> 00:32:47,290 +شريحة عشان يتضح الأمر بشكل لا لبس فيه إن شاء الله + +469 +00:32:47,290 --> 00:32:59,110 +طيب بنقول right أو عفوا آسف left superior quadrant + +470 +00:32:59,110 --> 00:33:03,130 +of + +471 +00:33:03,130 --> 00:33:11,490 +visual field since image to + +472 +00:33:12,940 --> 00:33:21,620 +right inferior quadrant of + +473 +00:33:21,620 --> 00:33:28,660 +both retina الرتينا جمع رتينات، الرتينا مفرد و رتينات + +474 +00:33:28,660 --> 00:33:59,930 +جمع to right inferior + +475 +00:34:00,030 --> 00:34:03,530 +since image to right inferior quadrant of both + +476 +00:34:03,530 --> 00:34:09,670 +retina and then to + +477 +00:34:09,670 --> 00:34:22,210 +right inferior visual cortex هنا + +478 +00:34:22,210 --> 00:34:26,510 +left superior quadrant هنعملها يعني بلون آخر + +479 +00:34:33,430 --> 00:34:36,990 +بتبعت لل right inferior quadrant في ال retina + +480 +00:34:36,990 --> 00:34:43,290 +وبدورها + +481 +00:34:43,290 --> 00:34:46,390 +بتبعت لل right inferior visual cortex right + +482 +00:34:46,390 --> 00:34:53,370 +inferior visual cortex وبالتالي left superior ببعت + +483 +00:34:53,370 --> 00:34:56,970 +لل right inferior و right inferior quadrant في ال + +484 +00:34:56,970 --> 00:34:59,850 +retina ببعت لل right inferior visual cortex + +485 +00:34:59,850 --> 00:35:05,080 +وبالتالي طبعا ما فيش خلاف طبعا هذه القضية بتوضح ليه + +486 +00:35:05,080 --> 00:35:11,860 +شغلة مهمة للغاية وإنه التناسق .. التناسق مش بين + +487 +00:35:11,860 --> 00:35:17,180 +شبكيتين العينين فقط التناسق ليس فقط بين شبكيتين + +488 +00:35:17,180 --> 00:35:21,340 +العينين وإنما أيضا نفس التوزيع اللي موجودة في ال + +489 +00:35:21,340 --> 00:35:24,840 +written up هذه المنطقة مناسبة لهذه المنطقة أو + +490 +00:35:24,840 --> 00:35:28,000 +متناسقة معاه يعني بيبصوا على نفس الجهة من ال field + +491 +00:35:28,000 --> 00:35:32,820 +.. من الفراغ و أيضا متناسب معهم هذه المنطقة من + +492 +00:35:32,820 --> 00:35:37,160 +التحليل طيب لو أخذنا هذه اللي هو left inferior + +493 +00:35:37,160 --> 00:35:41,560 +quadrant هنلاقي اللي بيبص على left inferior + +494 +00:35:41,560 --> 00:35:45,460 +quadrant هو right superior quadrant of the retina + +495 +00:35:45,460 --> 00:35:48,580 +right + +496 +00:35:48,580 --> 00:35:53,000 +superior visual cortex right يعني سيبنا من ال left + +497 +00:35:53,000 --> 00:35:56,240 +right يعني سيبنا من ال left و superior يعني سيبنا + +498 +00:35:56,240 --> 00:36:00,600 +من ال inferior فبالتالي في تناسق مش بس بين + +499 +00:36:00,600 --> 00:36:04,760 +الشبكيتين و أيضا متناسق مع الشبكية بتاعة العينين + +500 +00:36:04,760 --> 00:36:10,340 +ال visual cortex يعني منظمة أو موزعة مناطق التحليل + +501 +00:36:10,340 --> 00:36:14,440 +بما يتناسب و بما يتناسق مع مناطق الشبكية في + +502 +00:36:14,440 --> 00:36:18,020 +العينين فهذا يسمى retinocortical correspondence + +503 +00:36:18,020 --> 00:36:22,640 +إذا normal retinal أو retinocortical إذا بدنا نكون + +504 +00:36:22,640 --> 00:36:26,600 +دقيقين correspondence resulting in cyclopean + +505 +00:36:26,600 --> 00:36:31,540 +viewing رابع شيء وهو مهم جدا من شروط الـbinocular + +506 +00:36:31,540 --> 00:36:34,400 +single vision، accuracy in neuromuscular + +507 +00:36:34,400 --> 00:36:37,820 +development and coordination so that the visual + +508 +00:36:37,820 --> 00:36:41,800 +axis directed at unmaintained fixation on the + +509 +00:36:41,800 --> 00:36:45,520 +object of regard لو تصورنا أن الشروط الثلاث الأولى + +510 +00:36:45,520 --> 00:36:48,300 +موجودة ال visual field طبيعي وفي + +511 +00:36:48,300 --> 00:36:53,480 +overlapping visual field وفي عندي neurons في ال + +512 +00:36:53,480 --> 00:36:56,960 +visual cortex تستقبل من العينين و بتشتغل بشكل سليم + +513 +00:36:56,960 --> 00:37:03,000 +وفي عندي تناسق شبكي ممتاز بس المشكلة عندي طبعا + +514 +00:37:03,000 --> 00:37:07,920 +تناسق شبكي ممتاز resulting in cyclopean viewing + +515 +00:37:07,920 --> 00:37:11,180 +Cyclope يعني viewing كلمة Cyclope هذا الإنسان + +516 +00:37:11,180 --> 00:37:16,360 +الخرافي اللي في عنده عين واحدة في منتصف رأسه وطبعا + +517 +00:37:16,360 --> 00:37:18,580 +هنا المقصود فيها Cyclope يعني ال viewing أن + +518 +00:37:18,580 --> 00:37:21,960 +العينين بيشتغلوا وكأنهم عين واحدة بيحسش الإنسان + +519 +00:37:21,960 --> 00:37:25,910 +في قضية أنه في الأول اتكوّنك صورتين صورة على شبكية + +520 +00:37:25,910 --> 00:37:29,750 +اليمين و صورة على شبكية العين الشمال وبعدين تدمجهم + +521 +00:37:29,750 --> 00:37:33,350 +وهو شعر بالموضوع هذا الإنسان بمجرد ما يفتح عينه + +522 +00:37:33,350 --> 00:37:36,430 +بيحس حاله أنه شايف الصورة الواحدة واحدة وكأنه + +523 +00:37:36,430 --> 00:37:39,630 +بتطلع يعني وكأنه عينيتين تين مع بعض مش بس team + +524 +00:37:39,630 --> 00:37:44,030 +وكأنهم شيء واحد بيشتغل بتناسق كامل مائة بالمائة + +525 +00:37:44,030 --> 00:37:47,440 +بدون ما هو يشعر وبي .. بي .. بيدمجوا الصورتين في + +526 +00:37:47,440 --> 00:37:50,460 +صورة واحدة ثلاثية، الأبعاد فيها ده يسمى Cyclopean, + +527 +00:37:50,500 --> 00:37:54,240 +Unic وكأني أنا بتطلع أو أملك فقط عين واحدة مش + +528 +00:37:54,240 --> 00:37:57,900 +عينتين، من .. من كثر التناسق بين العينين، من كثر + +529 +00:37:57,900 --> 00:38:02,480 +أن شغلهم perfect مع بعض وما بتأخروش في .. عن بعضهم + +530 +00:38:02,480 --> 00:38:05,680 +البعض في الشروط لو تصورنا الثلاث شروط الأولى + +531 +00:38:05,680 --> 00:38:10,610 +موجودة وما عنديش الشرط الرابع أنه ما فيش عندي ال + +532 +00:38:10,610 --> 00:38:14,150 +neuromuscular development و التنسيق بين حركة + +533 +00:38:14,150 --> 00:38:17,390 +العضلات وبين التغذية العصبية مش موجودة بمعنى آخر + +534 +00:38:17,390 --> 00:38:21,550 +وكأنه في حوالي ساعتها هيصير عندي تختل الشروط الثلاث + +535 +00:38:21,550 --> 00:38:26,090 +الأولى بمعنى أنه هيصير اتجاه الشبكية تاعة العين + +536 +00:38:26,090 --> 00:38:29,560 +اليمين بيختلف عن اتجاه الشبكية تاعت العين الشمالي + +537 +00:38:29,560 --> 00:38:32,500 +ويصير ال binocular single vision أو ال normal + +538 +00:38:32,500 --> 00:38:36,720 +binocular single vision صعب ضروري جدا من شروط ال + +539 +00:38:36,720 --> 00:38:39,680 +binocular single vision أنه يكون التغذية العصبية + +540 +00:38:39,680 --> 00:38:44,260 +وقوة العضلات متناسقة ومتطورة بشكل طبيعي ومتناسقة + +541 +00:38:44,260 --> 00:38:48,860 +مع بعض على بعض عشان العينين يتحركوا بشكل سلس في أي + +542 +00:38:48,860 --> 00:38:52,940 +اتجاه في الفراغ وماحدش أو ما تكونش عين متأخرة عن العين + +543 +00:38:53,220 --> 00:38:57,040 +في الحركة فهذا أيضا شرط من شروط ال binocular + +544 +00:38:57,040 --> 00:39:05,360 +single vision بيضل عندي آخر شرط من الشروط اللي هو + +545 +00:39:05,360 --> 00:39:09,720 +approximately equal image size clarity and size + +546 +00:39:09,720 --> 00:39:15,040 +for both eyes وهذا حقا يعني دخل كبير في تخصص + +547 +00:39:15,040 --> 00:39:19,680 +البصريات لو فرضنا إن الشروط السابقة كلها متوفرة بس + +548 +00:39:19,680 --> 00:39:23,640 +مثلا في عندي anisometropia شديدة يعني مثلا العين M + +549 +00:39:23,640 --> 00:39:27,660 +تروب و العين الثانية مثلا minus 5 مايوب فبالتالي ال + +550 +00:39:27,660 --> 00:39:30,820 +image equality أو ال image clarity مش هتكون واضحة + +551 +00:39:30,820 --> 00:39:36,300 +في العين الثانية وحجم الصورة ممكن يكون مختلف إذا مثلا + +552 +00:39:36,300 --> 00:39:41,020 +لبس نضارات والفرق في قوة النضارات كبير ممكن يكون + +553 +00:39:41,020 --> 00:39:44,060 +حجم الصورة على شبكية العين اليمين بيختلف كتير عن + +554 +00:39:44,060 --> 00:39:47,540 +حجم الصورة على شبكية العين الشمال فبالتالي مش + +555 +00:39:47,540 --> 00:39:50,400 +دماغ لا يقبل أنصاف الحلول، دماغ بدو يكون وضوح + +556 +00:39:50,400 --> 00:39:55,190 +الصورتين في العينين متماثل أو متقارب جدا وأحجامهم + +557 +00:39:55,190 --> 00:39:58,370 +متماثلة أو متقاربة جدا عشان يقدر يدمجهم في صورة + +558 +00:39:58,370 --> 00:40:02,390 +واحدة ضروري جدا يكون approximately تقريبا equal + +559 +00:40:02,390 --> 00:40:06,410 +image clarity نفس الوضوح تقريبا وتقريبا نفس ال + +560 +00:40:06,410 --> 00:40:10,980 +size هذه الشروط الخامسة إذا توفرت عند إنسان ساعات + +561 +00:40:10,980 --> 00:40:16,080 +هذا الإنسان بيستمتع بال binocular single vision ال + +562 +00:40:16,080 --> 00:40:18,760 +normal binocular single vision وما بيعاني أبدا أن + +563 +00:40:18,760 --> 00:40:22,060 +تكون الرؤية بالنسبة له عنده موحدة وثلاثية الأبعاد + +564 +00:40:22,060 --> 00:40:25,940 +باستخدام عينتين ك team واحد وما بيعاني من أي مشاكل + +565 +00:40:25,940 --> 00:40:30,540 +طبعا ال .. الشيء الأساسي الشيء الأساسي في الخمس + +566 +00:40:30,540 --> 00:40:33,960 +شروط اللي ذكرناهم هو ال normal retinal + +567 +00:40:33,960 --> 00:40:38,420 +correspondence ضروري يكون عشان يشتغلوا الشبكية + +568 +00:40:38,420 --> 00:40:42,860 +أو العينين بصحيح بشكل صحيح أو دقيق عشان الشبكية + +569 +00:40:42,860 --> 00:40:46,020 +أو العينين يشتغلوا بشكل صحيح لازم يكون فيه تناسق + +570 +00:40:46,020 --> 00:40:49,580 +بينهم تناسق بينهم يعني كل جزء من شبكية العين + +571 +00:40:49,580 --> 00:40:54,500 +اليمين له ما يماثله أو ما يكافئه أو ما يعادله في + +572 +00:40:54,500 --> 00:40:58,610 +شبكية العين الشمالية يعني بمعنى أنه لازم كل جزء في + +573 +00:40:58,610 --> 00:41:01,690 +شبكية العين اليمين له شريك معاه في شبكية العين + +574 +00:41:01,690 --> 00:41:05,070 +الشمالي يعني بيبصوا على نفس الجهة من الفراغ عشان + +575 +00:41:05,070 --> 00:41:09,550 +يستلموا صور ال objects الموجودة في هذه الجهة من + +576 +00:41:09,550 --> 00:41:14,570 +الفراغ ضروري جدا هذه القضية binocular single + +577 +00:41:14,570 --> 00:41:18,010 +vision is based on normal retinal correspondence + +578 +00:41:18,010 --> 00:41:21,470 +يعني لو تخيلنا ال binocular single vision هرم + +579 +00:41:21,470 --> 00:41:24,710 +هيكون قاعدة الهرم هو ال normal retinal + +580 +00:41:24,710 --> 00:41:29,750 +correspondence التناسق الشبكي الطبيعي واللي + +581 +00:41:29,750 --> 00:41:33,290 +شرحناها قبل شوية في الصورة اللي عرضناها إنه مثلا + +582 +00:41:33,290 --> 00:41:37,410 +هنا ال inferior right + +601 +00:42:50,670 --> 00:42:53,930 +حاجة هنفهمها بالنسبة لعين واحدة، بعدين هنطبقها على + +602 +00:42:53,930 --> 00:42:56,430 +العينتين اللي .. اللي هو إيش اللي بدنا نفهمه؟ بدنا + +603 +00:42:56,430 --> 00:42:59,910 +نفهم الحاجة اللي بيسموها الـ visual direction و الـ + +604 +00:42:59,910 --> 00:43:02,470 +projection و هذا هنحكي عنه المرة القادمة إن شاء + +605 +00:43:02,470 --> 00:43:05,810 +الله تعالى و يعطيكم العافية والسلام عليكم ورحمة + +606 +00:43:05,810 --> 00:43:06,870 +الله وبركاته diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/08Xv7bUX5dM_raw.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/08Xv7bUX5dM_raw.srt new file mode 100644 index 0000000000000000000000000000000000000000..3c772db1a8d5008653903a606f3012b12007176e --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/08Xv7bUX5dM_raw.srt @@ -0,0 +1,2424 @@ +1 +00:00:01,740 --> 00:00:06,440 +بسم الله الرحمن الرحيم بنواصل محاضرات حوال واحد و + +2 +00:00:06,440 --> 00:00:13,480 +المرة الماضية توقفنا عند مثال ل ال muscle sequelae + +3 +00:00:13,480 --> 00:00:16,380 +كان المثال على ال left superior oblique pulse + +4 +00:00:16,380 --> 00:00:21,820 +اليوم هناخد مثال أخر اللي هو lateral rectus pulse + +5 +00:00:21,820 --> 00:00:25,540 +في ال right eye هاي ال right وهي ال left عندي + +6 +00:00:25,540 --> 00:00:28,460 +right lateral rectus pulse المنظر من أعلى، احنا + +7 +00:00:28,460 --> 00:00:33,570 +بنبص على عينين المريض من أعلىهذه العضلة فيها شلل + +8 +00:00:33,570 --> 00:00:39,870 +والشلل يعني أخد فترة طويلة يعني بمعنى ما تم شفاءه + +9 +00:00:39,870 --> 00:00:44,630 +دلت العضلة مشلولة فمن ال muscle sequel اللي هتسير + +10 +00:00:44,630 --> 00:00:47,130 +انه ال antagonistic muscle العضلة المضادة اللي + +11 +00:00:47,130 --> 00:00:51,490 +هتسير فيها contraction contraction و تقلص في ال + +12 +00:00:51,490 --> 00:00:54,730 +media rectus لأنها مابتريحش اذا عندي هنا عضلة + +13 +00:00:54,730 --> 00:00:58,190 +under acting muscle under acting يعني + +14 +00:01:01,340 --> 00:01:03,140 +نعطيلها إشارة الـ Under Action + +15 +00:01:34,350 --> 00:01:40,790 +إشارة ال under action هي عضلة مشلولة، يعني المشكلة + +16 +00:01:40,790 --> 00:01:46,060 +بدأت من عندهاالعضلة المقابلة أو ال antagonistic + +17 +00:01:46,060 --> 00:01:49,160 +muscle اللي هي ال media rectus في نفس العين ما + +18 +00:01:49,160 --> 00:01:52,580 +بيجيها فترات استراحة لأنه عشان تستريح لازم ال + +19 +00:01:52,580 --> 00:01:54,740 +lateral rectus تشتغل و طبعا ال lateral rectus + +20 +00:01:54,740 --> 00:01:59,520 +مشلولة فبالتالي بتضالها ال media rectus على الدوام + +21 +00:01:59,520 --> 00:02:04,680 +متقلصة فبيصير فيها contracture طالما هي قوية و + +22 +00:02:04,680 --> 00:02:07,840 +متقلصة إذا كمية ال innervation اللي بيلزمها عشان + +23 +00:02:07,840 --> 00:02:12,610 +تؤدي الشغل بتاعها قليلةنهيج على إنه العضلة + +24 +00:02:12,610 --> 00:02:16,310 +المقابلة إليها مش متعباها في الشغل فبتسير .. بتصير + +25 +00:02:16,310 --> 00:02:20,490 +high over acting .. over acting بأقل innovation + +26 +00:02:20,490 --> 00:02:30,050 +ممكن .. بأقل innovation ممكن .. بأقل + +27 +00:02:30,050 --> 00:02:31,790 +innovation ممكن فبالتالي + +28 +00:02:38,190 --> 00:02:41,050 +overacting muscle .. overacting muscle بأقل + +29 +00:02:41,050 --> 00:02:44,330 +innervation طالما إجى لهذه العضلة اللى هى ال media + +30 +00:02:44,330 --> 00:02:48,090 +rectus innervation قليل عشان تؤدي شغلها حسب + +31 +00:02:48,090 --> 00:02:51,750 +hearing له لازم يجى innervation قليل لل yoke + +32 +00:02:51,750 --> 00:02:55,130 +muscle تاعة ال media rectus تاعة ال right eye مين + +33 +00:02:55,130 --> 00:02:57,610 +ال yoke muscle تاعة ال media rectus تاعة ال right + +34 +00:02:57,610 --> 00:03:00,990 +eye اللى هى ال lateral rectus هنا هى عضلة طبيعية + +35 +00:03:00,990 --> 00:03:05,070 +مافيها مشاكل ولكن إجاها أقل innervationأقل + +36 +00:03:05,070 --> 00:03:08,450 +innervation بسبب أنها اليوك muscle أو ال muscle + +37 +00:03:08,450 --> 00:03:11,670 +الفريق أو ال muscle ال team مع ال .. ال right + +38 +00:03:11,670 --> 00:03:14,890 +medial rectus فهيكون نصيبها طالما إيجي لل media + +39 +00:03:14,890 --> 00:03:19,830 +rectus innervation قليل هيجي لل lateral rectus في + +40 +00:03:19,830 --> 00:03:22,030 +العين التانية في ال left eye innervation قليل + +41 +00:03:22,030 --> 00:03:25,830 +فهتصير under acting muscle .. under acting muscle + +42 +00:03:25,830 --> 00:03:31,110 +وهيسمى inhibitional palsy .. inhibitional palsy + +43 +00:03:33,010 --> 00:03:41,730 +فهيصير عندنا inhabitional policy في ال .. في + +44 +00:03:41,730 --> 00:03:45,070 +ال left lateral rectus muscle في ال left lateral + +45 +00:03:45,070 --> 00:03:48,730 +rectus muscle اذا في عندي عضلتين اتأثروا واحدة + +46 +00:03:48,730 --> 00:03:52,550 +صارت over acting او over action فيها عشانها + +47 +00:03:52,550 --> 00:03:56,330 +contracted muscle صار فيها contracture بسبب شلل ال + +48 +00:03:56,330 --> 00:04:01,550 +antagonist بتاعها و عضلة صار فيهاضعف بسبب انه + +49 +00:04:01,550 --> 00:04:04,390 +مابيوصلها innervation لأنه ال yoke muscle بتاعتها + +50 +00:04:04,390 --> 00:04:08,590 +ال muscle اللي شغالة معاها كفريق التنتين ال right + +51 +00:04:08,590 --> 00:04:11,470 +medial rectus و ال left lateral rectus يوك muscle + +52 +00:04:11,470 --> 00:04:15,750 +في ال left gaze في ال left gaze فبالتالي اجاها + +53 +00:04:15,750 --> 00:04:20,130 +innervation قليل فحيصير عندى ضعف فيها وهي بهذا + +54 +00:04:20,130 --> 00:04:22,450 +بنسمي inhibitional palsy + +55 +00:04:27,520 --> 00:04:30,380 +يعني الـ lateral rectus في الـ left eye بيصير فيها + +56 +00:04:30,380 --> 00:04:40,000 +inhibitional pulsing + +57 +00:04:40,000 --> 00:04:45,360 +شلل بس مش شلل حقيقي .. مش شلل حقيقي + +58 +00:04:53,860 --> 00:04:58,320 +وإنما شلل ناتج عن جلة التغفية العصبية بسبب hearing + +59 +00:04:58,320 --> 00:05:04,040 +loss لأنه hearing loss أعطى ال media rectus على + +60 +00:05:04,040 --> 00:05:08,160 +ناحية التانية اللي هي ال yoke معاها أعطاها يعني + +61 +00:05:08,160 --> 00:05:11,660 +أقل innovation لإنه مش لازمها كتير innovation عشان + +62 +00:05:11,660 --> 00:05:14,880 +تشتغل لإنها عضلة قوية و العضلة المقابلة إلها + +63 +00:05:14,880 --> 00:05:19,990 +مشهورةإيش اللي بيحصل مع العضلة رقم أربع هي عند + +64 +00:05:19,990 --> 00:05:23,650 +العضلة اللي فيها الشلل الأساسي وهي عند عضلة سارة + +65 +00:05:23,650 --> 00:05:27,190 +فيها inhibitional palsy، palsy غير حقيقية بينما + +66 +00:05:27,190 --> 00:05:30,750 +ضعف نتيجة قلة التخزين العصبية عشان نحترم hearing + +67 +00:05:30,750 --> 00:05:34,230 +loss عشان نحترم hearing loss طيب العضلة الرابعة + +68 +00:05:34,230 --> 00:05:38,130 +اللي هي ال left medial rectus هي طرق إيش اللي + +69 +00:05:38,130 --> 00:05:42,060 +هيصير فيها، هنفسرها من طريقينطريق الأول شيرينجتون + +70 +00:05:42,060 --> 00:05:45,700 +لو مدام إجهت تغذية عصبية قليلة لـ lateral rectal + +71 +00:05:45,700 --> 00:05:48,980 +الصينة معناته عكسها طبعا ال antagonistic muscles + +72 +00:05:48,980 --> 00:05:53,540 +العضلات المتضادة إذا واحدة إجهت تغذية عصبية أقل، + +73 +00:05:53,540 --> 00:05:56,140 +التانية بيجيها تغذية عصبية أكتر، إذا واحدة إجهت + +74 +00:05:56,140 --> 00:05:59,660 +تغذية عصبية أكتر، التانية بيجيها تغذية عصبية أقل، + +75 +00:05:59,660 --> 00:06:02,980 +فهذه هيكون اللي هي نصيب أعلى من ال innovation و + +76 +00:06:02,980 --> 00:06:07,300 +هتصير over acting muscle هذا تفسر بطريقة hearing + +77 +00:06:07,300 --> 00:06:10,950 +.. عفوا شيرينجتون لو .. شيرينجتون لوالان لو حبيت + +78 +00:06:10,950 --> 00:06:14,090 +افسرها عن طريق hearing loop بنقول المريض لو حاب + +79 +00:06:14,090 --> 00:06:17,990 +يعمل fixation بال right eye واضح انه عشان في شلل + +80 +00:06:17,990 --> 00:06:20,370 +في ال lateral rectus العين جاية شوية لجوه + +81 +00:06:20,370 --> 00:06:23,970 +ايزوتروبيا ايزوتروبيا بسبب انه ال media rectus + +82 +00:06:23,970 --> 00:06:27,730 +قوية و ال lateral rectus مشلولة فهتشد ال media + +83 +00:06:27,730 --> 00:06:31,390 +rectus هتشد العين لجوه ايزوتروبيا لو شجعنا المريض + +84 +00:06:31,390 --> 00:06:35,190 +وقلنا له لازم تبطلع بعينك اليمين دوري او شجعناه + +85 +00:06:35,190 --> 00:06:39,980 +غطيناه عينه لشمالفبالتالي ساعته هو بده يحاول يعدل + +86 +00:06:39,980 --> 00:06:43,360 +عنه اليمين عشان يطلع على ال target اللي جدامه طب + +87 +00:06:43,360 --> 00:06:47,080 +كيف هذا الأمر بده يتم؟ بده يتم أنه ال brain هيبعت + +88 +00:06:47,080 --> 00:06:51,720 +نبضات عصبية كتيرة لل lateral rectus عشان يحاول أنه + +89 +00:06:51,720 --> 00:06:56,010 +يشغلها عشان تعدل الآنواحنا حكينا إنه قضية إنه يرسل + +90 +00:06:56,010 --> 00:07:00,790 +نبضات حاجة وتنفيذ النبضات هذه ممكن تنفذ بالكامل + +91 +00:07:00,790 --> 00:07:04,910 +وممكن تنفذ جزئيا وممكن ما تنفذ أبدا حسب درجة الشلل + +92 +00:07:04,910 --> 00:07:10,410 +الموجود هل هو شلل كله ولا شلل جزء بس طالما ال + +93 +00:07:10,410 --> 00:07:16,410 +brain بعت لل lateral rectus هنا بعتلها innervation + +94 +00:07:16,410 --> 00:07:20,970 +كتير هيبعت نفس الكمية لل yoke muscle بتاعتها اللي + +95 +00:07:20,970 --> 00:07:23,670 +هي ال media rectus في ال left eyeفبالتالي هاي + +96 +00:07:23,670 --> 00:07:26,990 +هتوصل ل innovation كتير فهتصير over acting muscle + +97 +00:07:26,990 --> 00:07:30,710 +هي عضلة طبيعية بس حصلت على نصيب عالي من ال + +98 +00:07:30,710 --> 00:07:36,970 +innovation فبالتالي .. فبالتالي هتصير over acting + +99 +00:07:36,970 --> 00:07:40,510 +muscle بسبب ال increase in innovation وهذه المرة + +100 +00:07:40,510 --> 00:07:44,810 +بنكون احنا فسرناها عن طريق hearing .. hearing loop + +101 +00:07:44,810 --> 00:07:48,910 +طالما وصل لهاي hearing loop بنوص على انه equal .. + +102 +00:07:48,910 --> 00:07:53,600 +equal and simultaneous innovationflows to the yoke + +103 +00:07:53,600 --> 00:07:59,840 +muscle فبالتالي هذه مثل آخر على شلل lateral rectus + +104 +00:07:59,840 --> 00:08:03,300 +muscle في ال .. في ال right eye و كيف صار عندي + +105 +00:08:03,300 --> 00:08:07,820 +muscle sequely بدت المشكلة بعضلة انشلت و لما طول + +106 +00:08:07,820 --> 00:08:14,120 +الشلل يعني .. يعني اتأثرت تلت عضلات في العينتين + +107 +00:08:14,120 --> 00:08:18,220 +فأصبح عندي total أربع عضلات عضلات عينتين over + +108 +00:08:18,220 --> 00:08:21,470 +acting musclesهذه عشانها contracted وهذه عشان + +109 +00:08:21,470 --> 00:08:24,950 +إيجاه increased innervation و two under acting + +110 +00:08:24,950 --> 00:08:28,920 +muscle هذه عشان فيها شلل حقيقيو هذه فيها يعني ضعف + +111 +00:08:28,920 --> 00:08:32,300 +أو نقول شلل policy بس inhibitional نتجة عن ال + +112 +00:08:32,300 --> 00:08:35,920 +inhibition أو إنه مايجهاش أو يجهها قليل من ال + +113 +00:08:35,920 --> 00:08:39,120 +impulses .. قليل من ال impulses ممكن الإنسان يقول + +114 +00:08:39,120 --> 00:08:41,420 +إيش فايدته هذا الكلام في الحياة العملية؟ هذا كلام + +115 +00:08:41,420 --> 00:08:44,980 +نظري هو يعني ماشي مفهوم بس إيش فايدته في الحياة + +116 +00:08:44,980 --> 00:08:50,260 +العملية؟ المريض لما بيجي في ال muscles equally في + +117 +00:08:50,260 --> 00:08:53,240 +عندي two under acting muscle و two over acting + +118 +00:08:53,240 --> 00:08:58,290 +muscleالان لما بابحث مين اللي كان العضلة اللي بدت + +119 +00:08:58,290 --> 00:09:01,770 +المشكلة .. مين العضلة اللي بدت المشكلة .. هنلاقي + +120 +00:09:01,770 --> 00:09:05,130 +انه مابنقدرش نميز هل هي ال right lateral rectus + +121 +00:09:05,130 --> 00:09:08,670 +ولا ال left lateral rectus .. مش هنقدر بمجرد الفحص + +122 +00:09:08,670 --> 00:09:13,960 +الطبيإنه نبين وين بدأت المشكلة وين انتهت لأنه طبيا + +123 +00:09:13,960 --> 00:09:18,020 +ال under action عبارة عن ضعف للعضلة في تحريك العين + +124 +00:09:18,020 --> 00:09:22,060 +باتجاهها وهنا أيضا هيبين ضعف للعضلة في تحريك العين + +125 +00:09:22,060 --> 00:09:25,520 +في اتجاهها مش هتتكلم العضلة و تقولي والله انا + +126 +00:09:25,520 --> 00:09:29,220 +inhibitional palsy او palsy حقيقية فبالتالي ضروري + +127 +00:09:29,220 --> 00:09:34,120 +ساعتها نرجع لملف المريضونشوف إيش مسجل فيه أو نلجأ + +128 +00:09:34,120 --> 00:09:38,520 +لبعض الفحوصات و اللي هييجي يعني موعدها أو .. أو + +129 +00:09:38,520 --> 00:09:44,460 +ييجي شرحها في وقته .. في وقته الآن ننتقل للموضوع + +130 +00:09:44,460 --> 00:09:48,440 +الجديداللي هو secondary considerations بعض + +131 +00:09:48,440 --> 00:09:54,240 +التعريفات الأساسية basic aspects بدنا نحكي عن ال + +132 +00:09:54,240 --> 00:09:57,520 +normal binocular single vision لما بنقول الرؤية + +133 +00:09:57,520 --> 00:10:01,440 +الموحدة ال binocular single vision الرؤية الموحدة + +134 +00:10:01,440 --> 00:10:06,260 +بواسطة عينتينطبعا فى رؤية موحدة بشكل طبيعى و فى + +135 +00:10:06,260 --> 00:10:10,060 +رؤية موحدة بس بيكون فى شوية حوال موجودة و هذا + +136 +00:10:10,060 --> 00:10:13,100 +بنسميهوش normal بنسميه abnormal binocular single + +137 +00:10:13,100 --> 00:10:16,360 +vision احنا الآن بدنا نحكي عن ال normal binocular + +138 +00:10:16,360 --> 00:10:20,120 +single vision عبارة عن ايش involves يشملthe + +139 +00:10:20,120 --> 00:10:24,300 +simultaneous use of both eyes أول حاجة الإنسان + +140 +00:10:24,300 --> 00:10:26,860 +اللي عنده normal binocular single vision لازم + +141 +00:10:26,860 --> 00:10:31,120 +يستعمل العينتين التنتين مع بعض في الرؤية لأنه لو + +142 +00:10:31,120 --> 00:10:33,760 +استعمل عين واحدة بنسميه واش binocular single + +143 +00:10:33,760 --> 00:10:37,180 +vision ساعتها بنسميه monocular single vision إذن + +144 +00:10:37,180 --> 00:10:41,720 +simultaneous use الاستعمال المتزامن of both eyes + +145 +00:10:41,720 --> 00:10:45,460 +وضروري عشان أسميه normal إنه يكون with biphobial + +146 +00:10:45,460 --> 00:10:49,290 +fixationانه هو بيستعمل عين التنتين، انه بيستعمل + +147 +00:10:49,290 --> 00:10:52,050 +الـ fovea في العين اليمين للـ fixation، وايضا + +148 +00:10:52,050 --> 00:10:55,050 +بيستعمل الـ fovea في العين الشمال للـ fixation + +149 +00:10:55,050 --> 00:10:58,110 +طيب، لو قلنا انه بيستعمل الـ fovea في عين، و + +150 +00:10:58,110 --> 00:11:02,090 +بيستعمل extra fovea .. foveal area .. extra foveal + +151 +00:11:02,090 --> 00:11:05,390 +area في العين التانية، ساعتها بشيل كلمة normal، + +152 +00:11:05,390 --> 00:11:08,990 +لأن هذا يعتبر abnormal binocular single vision، + +153 +00:11:08,990 --> 00:11:13,190 +اذا with bifovial fixationso that each eye + +154 +00:11:13,190 --> 00:11:16,550 +contributes to a common single perception of the + +155 +00:11:16,550 --> 00:11:20,870 +object of regard طب لما أنا بستعمل عينية التنتين و + +156 +00:11:20,870 --> 00:11:23,930 +بكون مركز بالفوفيا في اليمين و الفوفيا في الشمال و + +157 +00:11:23,930 --> 00:11:26,530 +التنتين إيش يعني مركز فيهم؟ يعني ال two فوفيا + +158 +00:11:26,530 --> 00:11:30,530 +متجهين لنفس الهدف اللي أنا بتطلع عليه سواء شمعة + +159 +00:11:30,530 --> 00:11:36,510 +قلم سيارة أي target بتطلع عليه صورة هذا ال target + +160 +00:11:36,510 --> 00:11:41,140 +هتقع على الفوفيا في العين اليمين معجزء حوالين + +161 +00:11:41,140 --> 00:11:44,240 +الفوفيا و هتقع الفوفيا في العين الشمال مع جزء من + +162 +00:11:44,240 --> 00:11:50,020 +ال retina حوالين الفوفيا بهيك بقدر انا اتأكد انه + +163 +00:11:50,020 --> 00:11:53,660 +كل عين شاركت contributes to a common single + +164 +00:11:53,660 --> 00:11:59,160 +perception طبعا لا العينتين شاركوا مع بعض في رؤية + +165 +00:11:59,160 --> 00:12:02,680 +واحدة في رؤية واحدة لان الجلم او الشمعة او السيارة + +166 +00:12:02,680 --> 00:12:06,320 +او ما إلى ذلكالشيء الواحد او الهدف الواحد او ال + +167 +00:12:06,320 --> 00:12:09,920 +target الواحد انا بشوفه واحد رغم انه صورته او + +168 +00:12:09,920 --> 00:12:13,920 +انطبعله صورتين على الانتين او على شبكية الانتين + +169 +00:12:13,920 --> 00:12:18,950 +ورغم ذلك انا ب .. اشوفه واحدبشكل موحد ثلاث + +170 +00:12:18,950 --> 00:12:23,130 +الأبعاد، إذا هذا بيعني لإنه كل عين من العنتين + +171 +00:12:23,130 --> 00:12:29,090 +شاركت في common single perception في إدراك موحد + +172 +00:12:29,090 --> 00:12:32,730 +للهدف اللي أنا بتطلع عليه أو ال object of regard + +173 +00:12:32,730 --> 00:12:36,030 +this represents the highest form of binocular + +174 +00:12:36,030 --> 00:12:40,310 +cooperation هذه القضية تعتبر أعلى درجة من التعاون + +175 +00:12:40,310 --> 00:12:46,150 +بين العنتين، بين العنتين يعنيهذه أنا بستعمل عناية + +176 +00:12:46,150 --> 00:12:49,430 +التنتين عشان أطلع على هدف، الهدف هو الكتاب اللي + +177 +00:12:49,430 --> 00:12:53,110 +أنا بقرأ فيه، طبعا صورة الكتاب هتكون ع الفوفيا في + +178 +00:12:53,110 --> 00:12:55,870 +العين اليمين و هتكون ع الفوفيا في العين الشمال، + +179 +00:12:55,870 --> 00:13:00,610 +إذا صار عندي صورتين، بس هذا الشخص أو هذه الفتاة + +180 +00:13:00,610 --> 00:13:05,510 +يعني شايفة كتاب واحد، إذا الصورتين تم توحيدهم في + +181 +00:13:05,510 --> 00:13:10,520 +الدماغ و العنتين شاركوافي إحساس .. الإحساس بال + +182 +00:13:10,520 --> 00:13:14,160 +target ك target موحد .. ك target موحد و ليس ك two + +183 +00:13:14,160 --> 00:13:17,620 +targets .. و ليس ك two targets طبعا عشان نقول + +184 +00:13:17,620 --> 00:13:21,220 +normal binocular single vision هذا إله شروط .. هذا + +185 +00:13:21,220 --> 00:13:25,580 +إله شروط لابد من أنها تتوفرما هي الشروط أو الظروف + +186 +00:13:25,580 --> 00:13:29,520 +اللازمة للحصول على normal binocular single vision + +187 +00:13:29,520 --> 00:13:33,060 +يعني conditions necessary for normal binocular + +188 +00:13:33,060 --> 00:13:36,780 +single vision اول شرط normal routing of visual + +189 +00:13:36,780 --> 00:13:40,440 +pathways with overlapping visual fields يعني نيجي + +190 +00:13:40,440 --> 00:13:43,460 +نفهم هذا الشرط و نقول كالاتي لابد انه يكون عندى ال + +191 +00:13:43,460 --> 00:13:46,500 +visual pathway سليم ال routing بتاعه سليم ال + +192 +00:13:46,500 --> 00:13:50,800 +visual pathway ببدأ من العيناليمين والعل شمال ثم + +193 +00:13:50,800 --> 00:13:54,580 +ال optic nerves بعدين ال optic chiasm المحتوطة ضمن + +194 +00:13:54,580 --> 00:13:59,000 +المستطيل بعدين ال optic tractالـ right والـ left + +195 +00:13:59,000 --> 00:14:02,580 +بعدين ال lateral geniculate body بعدين ال optic + +196 +00:14:02,580 --> 00:14:06,320 +radiation عن ناحيتين بعدين وصولا لمكان التحليل + +197 +00:14:06,320 --> 00:14:09,880 +بتاع الصورة اللي هو ال visual cortex هذا الخط أو + +198 +00:14:09,880 --> 00:14:14,060 +هذا ال pathway هذا الطريق البصري إذا كان في خلل في + +199 +00:14:14,060 --> 00:14:17,060 +أي منطقة منه معناته راح ال binocular single vision + +200 +00:14:17,060 --> 00:14:20,920 +يعني لو في عندي قطع في ال right optic tract في قطع + +201 +00:14:20,920 --> 00:14:26,030 +إذااللي شغال نص العين هي ال nasal و نص العين هي ال + +202 +00:14:26,030 --> 00:14:30,390 +temporal هي ال nasal .. ال nasal retina .. ليش هم + +203 +00:14:30,390 --> 00:14:32,970 +اللي شغالين ضالوا؟ لأن أنا في عندي قطع هنا + +204 +00:14:32,970 --> 00:14:36,270 +فبالتالي ال nasal retina هنا و ال temporal retina + +205 +00:14:36,270 --> 00:14:40,010 +هنا اللي بيودوا معلوماتهم لل left optic tract و من + +206 +00:14:40,010 --> 00:14:44,770 +ثم لل left visual cortex هدول بيضالوا يستقبلوا + +207 +00:14:44,770 --> 00:14:49,190 +بينما نص ال field التاني اللي هو ال left field + +208 +00:14:49,190 --> 00:14:53,110 +اللي هو right temporal retinalift nasal retina + +209 +00:14:53,110 --> 00:14:55,930 +اللي هو باللون الأزرق طالما فيه قطع هنا إذا + +210 +00:14:55,930 --> 00:14:59,010 +المعلومات مابتوصلش طالما نص ال field و نص ال field + +211 +00:14:59,010 --> 00:15:01,710 +إذا أنا عندي صار فيه خلل في ال normal, binocular, + +212 +00:15:01,830 --> 00:15:05,970 +single, virgin إذا أول حاجة لازم يكون normal + +213 +00:15:05,970 --> 00:15:11,370 +routing of visual pathways with overlapping of + +214 +00:15:11,370 --> 00:15:15,130 +visual field كل عين إلها visual field نفرض إنه .. + +215 +00:15:15,130 --> 00:15:20,550 +نفرض إنه ال visual pathway كله سليم وهدي العين + +216 +00:15:20,550 --> 00:15:24,800 +straightبينما هذه العين موجهة بهذا الاتجاه اللي + +217 +00:15:24,800 --> 00:15:28,760 +انا بأشر عليه بال mouse بال mouse يعني exotropic + +218 +00:15:28,760 --> 00:15:33,600 +يعني بشكل كبير هيكون ال field بتاع العين اليمين هو + +219 +00:15:33,600 --> 00:15:37,260 +في المنطقة هذه و ال field بتاع العين الشمالفي + +220 +00:15:37,260 --> 00:15:40,580 +المنطقة الأمامية فش overlapping فش تداول يعني + +221 +00:15:40,580 --> 00:15:44,560 +بمعنى أن العين اليمين بتنظر لأشياء غير اللي + +222 +00:15:44,560 --> 00:15:49,300 +بتنظرها العين الشمال وهذا طالما .. هذا طالما كل + +223 +00:15:49,300 --> 00:15:52,780 +عين بتنظر لأشياء مختلفة فبالتالي توحيدهم في صورة + +224 +00:15:52,780 --> 00:15:56,280 +واحدة مش ممكن يعني فش إمكانية للحصول على normal, + +225 +00:15:56,440 --> 00:16:00,200 +binocular, single vision إذا ضروري جدا يكون مش بس + +226 +00:16:00,200 --> 00:16:03,500 +أن ال visual pathway سليم أيضا لازم ال field بتاع + +227 +00:16:03,500 --> 00:16:06,590 +العين اليمين و ال field بتاع العين الشماليكونوا + +228 +00:16:06,590 --> 00:16:09,970 +overlapped يعني دخلين على بعضهم أو بتطلعوا أو هم + +229 +00:16:09,970 --> 00:16:13,230 +في نفس المنطقة يقع يعني يعني العين اللي هي بتتطلع + +230 +00:16:13,230 --> 00:16:18,930 +على جزء من الحقل الإبصار هو نفس الجزء اللي بتتطلع + +231 +00:16:18,930 --> 00:16:21,570 +عليه العين الشمال طبعا معادة الأطراف .. معادة + +232 +00:16:21,570 --> 00:16:25,830 +الأطراف في لكل عين الطرف اللي جهتها هذا مش مشترك + +233 +00:16:25,830 --> 00:16:28,230 +مع العين التانية إذا ال visual field بتاع العين + +234 +00:16:28,230 --> 00:16:30,510 +اليمين و ال visual field بتاع العين الشمال ضروري + +235 +00:16:30,510 --> 00:16:34,070 +يكونوا مشتركات في معظمهم .. في معظمهم في عندي أنا + +236 +00:16:34,070 --> 00:16:38,840 +صورة هنابتوضح الأمر بشكل كويسي ال field بتاع العين + +237 +00:16:38,840 --> 00:16:43,200 +اليامين هيهم الخط المتصل خليني أطلع على عرض مكبر + +238 +00:16:43,200 --> 00:16:51,980 +ال field بتاع العين اليامين اذا قلنا الصورة جاية + +239 +00:16:51,980 --> 00:16:55,540 +من أعلى هتكون هذه هي العين اليامين الخط المتصل هذا + +240 +00:16:55,540 --> 00:16:58,770 +هو ال field بتاع العين اليامينوال field بتاع العين + +241 +00:16:58,770 --> 00:17:01,530 +الشمال حقل الإبصار بتاع العين الشمال هو الخط + +242 +00:17:01,530 --> 00:17:05,370 +المتقطع ال dashed line ال dashed line المنطقة high + +243 +00:17:05,370 --> 00:17:09,730 +اللي في النص و اللي هي المساحة الأكبر مشتركة بين + +244 +00:17:09,730 --> 00:17:13,290 +العين تاني هذه المنطقة الطرفية خاصة للعين اليمين + +245 +00:17:13,290 --> 00:17:18,350 +بسموها temporal crescentright temporal crescent أو + +246 +00:17:18,350 --> 00:17:22,750 +monocular temporal crescent وهي خاصة بالعين الشمال + +247 +00:17:22,750 --> 00:17:26,170 +بيسموها temporal crescent أو left temporal + +248 +00:17:26,170 --> 00:17:29,010 +crescent أو monocular temporal crescent crescent + +249 +00:17:29,010 --> 00:17:32,490 +يعني هلال .. هلال .. منطقة هلالية أما المنطقة + +250 +00:17:32,490 --> 00:17:36,230 +الأغلب من ال field بتاع العين اليمين متداخلة مع + +251 +00:17:36,230 --> 00:17:38,930 +المنطقة الأغلب من ال field بتاع العين الشمال إذا + +252 +00:17:38,930 --> 00:17:42,470 +هذا شرط من شروط ال binocular single vision أنه + +253 +00:17:42,470 --> 00:17:48,200 +يكون عندي أنا normalrouting of visual pathway لازم + +254 +00:17:48,200 --> 00:17:50,780 +يكون visual pathway سليم و ال field بتاع العين + +255 +00:17:50,780 --> 00:17:54,180 +اليامين متداخل مع ال field بتاع العين الشمال عشان + +256 +00:17:54,180 --> 00:17:58,040 +يكونوا العينتين بيبصوا على نفس الأهداف أو غالبا + +257 +00:17:58,040 --> 00:18:03,600 +على نفس الأهداف وبالتالي تم توحيد صورتهم في صورة + +258 +00:18:03,600 --> 00:18:07,160 +واحدة تاني شيء الصورة وصلت الآن لل visual cortex + +259 +00:18:07,160 --> 00:18:09,800 +ضروري يكون في نوع خاص من الخلايا بيسموها + +260 +00:18:09,800 --> 00:18:13,060 +binocularly driving neurons in the visual cortex + +261 +00:18:13,060 --> 00:18:19,360 +ال visual cortexاللي في الـ occipital region مختصة + +262 +00:18:19,360 --> 00:18:25,180 +بتحليل الصورة وأجزاء الصورة، هي باللون الأحمر + +263 +00:18:25,180 --> 00:18:31,420 +واللون الأزرق، ال visual cortexهي هنا مقطع يعني لل + +264 +00:18:31,420 --> 00:18:35,200 +visual cortex وهي ضمن ال brain وهنا يعني شايلينها + +265 +00:18:35,200 --> 00:18:38,860 +في رسمة خارج ال brain فبالتالي ال visual cortex في + +266 +00:18:38,860 --> 00:18:42,420 +منها أنواع خلايا كتير بس احنا اللي بهمنا في موضوع + +267 +00:18:42,420 --> 00:18:45,400 +ال binocular single vision ضروري تكون فيه خلايا + +268 +00:18:45,930 --> 00:18:49,210 +تستقبل من العين تاني يعني binocularly drive ال + +269 +00:18:49,210 --> 00:18:52,790 +neurons يعني ال neurons أو الخلايا العصبية اللي + +270 +00:18:52,790 --> 00:18:56,250 +بتستقبل من العين تاني بتستقبل معلومات من العين + +271 +00:18:56,250 --> 00:19:02,670 +تاني لأن هذه الخلايا هي يعني موجودة عشان تستقبل من + +272 +00:19:02,670 --> 00:19:04,930 +العين اليمين ومن العين الشمال المعلومات بتاعة + +273 +00:19:04,930 --> 00:19:09,990 +الصورة واتوحدهم في صورة واحدة طبعا في .. في خلايا + +274 +00:19:09,990 --> 00:19:13,390 +أخرى بتستقبل من العين اليمين بسموها right + +275 +00:19:13,390 --> 00:19:18,050 +responsive cell أو cellsوفي خلايا تستقبل معلومات + +276 +00:19:18,050 --> 00:19:21,390 +فقط من العين الشمال بيسموها left responsive cells + +277 +00:19:21,390 --> 00:19:24,430 +مش هذه الخلايا اللي احنا بنعنيها أو مش هذه الخلايا + +278 +00:19:24,430 --> 00:19:28,350 +المعنية بتوحيد الصورتين في صورة وانما النوع التالت + +279 +00:19:28,350 --> 00:19:30,950 +من الخلايا اللي هي بيسموهم binocularly driving + +280 +00:19:30,950 --> 00:19:35,800 +neurons يعني لازم يكون فيطائفة من الخلايا في الـ + +281 +00:19:35,800 --> 00:19:40,040 +visual cortex تستجيب للمعلومات القادمة من العين + +282 +00:19:40,040 --> 00:19:43,940 +تانية تالت شيء وهو مهم جدا normal retinal أو + +283 +00:19:43,940 --> 00:19:46,760 +بالأصحى نقول retinocortical correspondence + +284 +00:19:46,760 --> 00:19:51,760 +resulting in cyclopean view نرجع أو نحاول نفهم إيش + +285 +00:19:51,760 --> 00:19:54,340 +يعني normal retinal correspondence ونروح العرض + +286 +00:19:54,340 --> 00:19:58,070 +المكبر ونقولحاول بالصور التالية أن نفهم إيش يعني + +287 +00:19:58,070 --> 00:20:01,050 +written correspondence تناسق شبكي written + +288 +00:20:01,050 --> 00:20:04,010 +correspondence يعني تناسق شبكي إيش يعني تناسق + +289 +00:20:04,010 --> 00:20:09,450 +شبكي؟ يعني كل نقطة في شبكية العين اليمين لها ما + +290 +00:20:09,450 --> 00:20:12,970 +يماثلها في شبكية العين الشمال ما معنى لها ما + +291 +00:20:12,970 --> 00:20:17,210 +يماثلها؟ يعني في نقطة مثلا نقطة سين هنا والنقطة + +292 +00:20:17,210 --> 00:20:21,430 +سين شرطة هنا بيبصوا على نفس الجهة من الفرار يعني + +293 +00:20:21,430 --> 00:20:25,020 +هنا سين مثلا في ال timbre ال writtenوين بيقشر + +294 +00:20:25,020 --> 00:20:29,080 +السهم؟ وين بيقشر السهم الأزرق؟ نقطة سين و النقطة + +295 +00:20:29,080 --> 00:20:33,280 +سين شرطة ليه نقطة مماثلة أو corresponding retinal + +296 +00:20:33,280 --> 00:20:37,680 +point؟ corresponding مع سين تمام، مماثلة لسين إيش + +297 +00:20:37,680 --> 00:20:40,640 +يعني مماثلة سين برضه وين ما بيقشر السهم الأزرق؟ + +298 +00:20:40,640 --> 00:20:45,420 +يعني سين و سين شرطة بيبصوا أو بيتطلعوا على نفس + +299 +00:20:45,420 --> 00:20:49,160 +الجهة من الفرار إيش يعني برضه هذا الكلام بيعني؟ + +300 +00:20:49,160 --> 00:20:51,920 +بيعني إنه لو في هذا الفرار، في هذه المنطقة من + +301 +00:20:51,920 --> 00:21:00,030 +الفرارلو في target شمعة ووردة أي شيء هتسقط صورة + +302 +00:21:00,030 --> 00:21:03,650 +الوردة هنا و أيضا هتسقط صورة الوردة على نفس + +303 +00:21:03,650 --> 00:21:07,810 +المنطقة المماثلة و في عندي صد و صد شرطة و في عندي + +304 +00:21:07,810 --> 00:21:11,790 +هنا عين و عين شرطة هنلاقي ان ال temporal retina في + +305 +00:21:11,790 --> 00:21:14,790 +ال right eye و ال nasal retina في ال left eye + +306 +00:21:14,790 --> 00:21:19,450 +اتنين موجهين لنفس الجهة يعني هناالـ temporal + +307 +00:21:19,450 --> 00:21:23,310 +retina مرسومة هنا بالأزرق والـ nasal retina مرسومة + +308 +00:21:23,310 --> 00:21:28,050 +بالأزرق عشان يدللي ان هدولة مناطق متماثلة كل نقطة + +309 +00:21:28,050 --> 00:21:31,310 +لها مثيلتها وكل مساحة من الشبكية لها مثيلتها + +310 +00:21:31,310 --> 00:21:35,190 +والتنتين بتطلع على نفس الجهة من ال visual field + +311 +00:21:35,190 --> 00:21:37,930 +يعني ال right eye ال temporal retina بتطلع على ال + +312 +00:21:37,930 --> 00:21:41,010 +left field هاي ال field مرسوم على ال left field + +313 +00:21:41,010 --> 00:21:44,090 +وال nasal retina هنا في ال left eye أيضا على ال + +314 +00:21:44,090 --> 00:21:47,190 +left field يعني بمعنى أخر ال temporal retina هنا + +315 +00:21:47,590 --> 00:21:50,870 +والـ temporal retina هنا التنتين بيخدموا ال left + +316 +00:21:50,870 --> 00:21:54,570 +field بتاع العنتين مع بعض ال left field طيب ال + +317 +00:21:54,570 --> 00:21:57,370 +temporal retina في ال left eye و ال nasal retina + +318 +00:21:57,370 --> 00:22:00,730 +في ال right eye بيخدموا ال right field بيخدموا ال + +319 +00:22:00,730 --> 00:22:05,110 +right field طبعا هدولة مناطق متماثلة من الشبكيات + +320 +00:22:05,110 --> 00:22:10,730 +من الشبكيات أيضا هنا الرسمة برضه بتوضح هي ال field + +321 +00:22:10,730 --> 00:22:15,740 +الكلي للعنتين طبعا مرسوم بشكل هوهذه الرسمة مش .. + +322 +00:22:15,740 --> 00:22:19,380 +مش .. هي رسمة تمثلية أنه ال field لأنه شكله أكتر + +323 +00:22:19,380 --> 00:22:23,160 +.. يعني أقرب للشكل البيضاوي منه للإستواني ولكن + +324 +00:22:23,160 --> 00:22:27,020 +لتوضيح الفكرة .. لتوضيح الفكرة بنقول هاي ال field + +325 +00:22:27,020 --> 00:22:31,700 +تعالين تان مع بعض نص الشمال اللي ع شمالنا اللي هو + +326 +00:22:31,700 --> 00:22:35,660 +مصم باللون الأحمر من ال field بمين .. مين بيخدم أو + +327 +00:22:35,660 --> 00:22:39,960 +مين بيستقبل منه ال temporal retinaتحت ال right eye + +328 +00:22:39,960 --> 00:22:44,240 +و ال nasal retina تحت ال left eye ال temporal تحت + +329 +00:22:44,240 --> 00:22:47,460 +ال right eye و ال nasal احنا بنطلع من فوق المريض + +330 +00:22:47,460 --> 00:22:50,340 +من فوق المريض يعني جايين للعنتين من فوق فهيكون هذه + +331 +00:22:50,340 --> 00:22:54,440 +ال right eye وهذه ال left eye وهذه ال left eye + +332 +00:22:54,440 --> 00:22:58,180 +فبالتالي ال temporal مع ال nasal بيخدم ال left + +333 +00:22:58,180 --> 00:23:01,680 +fieldو ال temporal بتاعة ال left eye مع ال nasal + +334 +00:23:01,680 --> 00:23:05,260 +بتاع ال right eye موجهين و بيخدموا ال right field + +335 +00:23:05,260 --> 00:23:07,800 +إيش يعني بيخدموا يعني بيستقبلوا معلومات منه .. + +336 +00:23:07,800 --> 00:23:11,880 +بيستقبلوا معلومات منه إيش معنى ال temporal مع ال + +337 +00:23:11,880 --> 00:23:16,260 +nasal و ال nasalمع ال temporal ليش ما يقولنا + +338 +00:23:16,260 --> 00:23:19,860 +temporal و temporal و nasal و nasal؟ عشان الأسماء + +339 +00:23:19,860 --> 00:23:22,700 +متشابهة العبرة مش بالأسماء يعني لو احنا أخدنا ال + +340 +00:23:22,700 --> 00:23:25,480 +nasal written في العين تان ال nasal written في ال + +341 +00:23:25,480 --> 00:23:28,500 +right eye موجهة لليمين وال nasal written في ال + +342 +00:23:28,500 --> 00:23:32,180 +left eye موجهة للإشمال يعني موجهين عكس بعضهم بينما + +343 +00:23:32,180 --> 00:23:35,100 +هنا ال nasal مع ال temporal موجهين نفس الاتجاه + +344 +00:23:35,100 --> 00:23:39,140 +اللي هو الأزرقو ال temporal مع ال nasal موجهين نفس + +345 +00:23:39,140 --> 00:23:42,320 +الاتجاه طبعا هدولة بيسموهم corresponding retinal + +346 +00:23:42,320 --> 00:23:46,240 +areas و هدولة بيسموهم corresponding retinal areas + +347 +00:23:46,240 --> 00:23:49,400 +بالنسبة للفوفيا اللي هي بتيجي في منطقة المنتصف + +348 +00:23:49,400 --> 00:23:53,550 +موجهة directالـ two fovea موجهين في الـ normal + +349 +00:23:53,550 --> 00:23:56,470 +binocular single vision باتجاه ال target اللي أنا + +350 +00:23:56,470 --> 00:24:00,170 +بتطلع عليه أو اللي بعمل fixation عليه بعمل + +351 +00:24:00,170 --> 00:24:03,570 +fixation عليه إذا ضروري يكون في عندي تناسق شبكة + +352 +00:24:03,570 --> 00:24:08,250 +هنا الصورة بشكل أوضح بكتير بشكل أوضح بكتير هاي + +353 +00:24:08,250 --> 00:24:13,670 +العنتين العنتين عشان احنا يعني ناخد تصور يعني أقرب + +354 +00:24:13,670 --> 00:24:17,070 +لإنه يكون ثلاثي الأبعاد بدنا ناخد هذا الجزء + +355 +00:24:17,070 --> 00:24:21,780 +المشترك من الشبكيةو هذا الجزء المشترك من الشبكية + +356 +00:24:21,780 --> 00:24:25,880 +او هنا .. هنا شبكية العين اليمين وهنا شبكية العين + +357 +00:24:25,880 --> 00:24:29,200 +الشمالى خلّينا نشوف .. هاي ال field .. هاي ال + +358 +00:24:29,200 --> 00:24:32,840 +field ال + +359 +00:24:32,840 --> 00:24:37,300 +field يقسم لأربع أقسام وهذا حقيقة ضروري جدا جدا + +360 +00:24:37,300 --> 00:24:42,500 +جدا نستوعبه ال field يقسم لأربع أقسام هاي ربع + +361 +00:24:42,500 --> 00:24:49,750 +باللون الأحمر وهاي ربع باللون الأخضروهي ربع باللون + +362 +00:24:49,750 --> 00:24:53,930 +الأصفر وهي ربع باللون ال move أو ال beneficiary + +363 +00:24:53,930 --> 00:24:58,690 +إذا الأربع أربع بسميهم كلهم مع بعض ال visual field + +364 +00:24:58,690 --> 00:25:03,610 +ال visual field .. ال visual field طبعا في معلومة + +365 +00:25:03,610 --> 00:25:08,290 +بسيطة جدا عشان الإنسان ما يتلخبطش هذا ال field هاي + +366 +00:25:08,290 --> 00:25:12,070 +الجزء اليمين منه النصف اليمين من ال field وهي + +367 +00:25:12,070 --> 00:25:15,210 +النصف الشمال من ال field احنا قلنا احنا بنتطلع من + +368 +00:25:15,210 --> 00:25:20,230 +فوقاحنا شايفين العينتين من فوق وبالتالي بنقول هنا + +369 +00:25:20,230 --> 00:25:24,910 +ال right field لأنه هذا أقرب لل right eye أو على + +370 +00:25:24,910 --> 00:25:27,290 +side .. على ال side أو على الجانب بتاع ال right + +371 +00:25:27,290 --> 00:25:31,850 +eye وهذا ال left half هذا ال right half هذا النص + +372 +00:25:31,850 --> 00:25:35,170 +اليمين بتاع ال visual field وهذا النص الشمال بتاع + +373 +00:25:35,170 --> 00:25:41,210 +ال visual field طيب في قاعدة عشان احنا ما نتلخبطش + +374 +00:25:41,210 --> 00:25:46,230 +بنقول النص اليمينبقع على الأجزاء اليسرة من الشبكية + +375 +00:25:46,230 --> 00:25:49,670 +الأجزاء اليسرة من شبكية العين اليمين والأجزاء + +376 +00:25:49,670 --> 00:25:52,210 +اليسرة من شبكية العين الشمالي احنا قلنا هنا اليمين + +377 +00:25:52,210 --> 00:25:56,370 +وهنا الشمال ماشي بس هذه العين اليمين في جزء منها + +378 +00:25:56,370 --> 00:26:00,330 +لو جسمناها لجسمين هذا هيكون قسم ايمن اللي انا بقشر + +379 +00:26:00,330 --> 00:26:05,490 +عليه وهذا قسم ايصر معروف انه الجزء اليمين من ال + +380 +00:26:05,490 --> 00:26:08,450 +visual field بيجي على الأجزاء اليسرة من شبكية + +381 +00:26:08,450 --> 00:26:13,050 +العنتينوالجزء اليسار من ال visual field بيجي على + +382 +00:26:13,050 --> 00:26:17,190 +شبكية أو على النصف الأيمن اليسار بيجي على اليمين + +383 +00:26:17,190 --> 00:26:21,870 +بيسقط على اليمين واليمين بيسقط على اليسار واليمين + +384 +00:26:21,870 --> 00:26:27,430 +بيسقط على اليسار مش بس هيك الجزء الأعلى بسقط تحت + +385 +00:26:27,430 --> 00:26:34,090 +أسفل ال retina و الجزء الأسفل بسقط أو الجزء الأسفل + +386 +00:26:34,090 --> 00:26:37,090 +من ال visual field بسقط لأعلى ربما الصورة هاي + +387 +00:26:37,090 --> 00:26:43,300 +بتوضحهي انسان او هاي عين .. هاي عين بتطلع على + +388 +00:26:43,300 --> 00:26:47,620 +target اللي هو الشجرة، الآن في في الفراق أو في ال + +389 +00:26:47,620 --> 00:26:52,620 +field في مثلث بس جاي لفوق، صورته وين هتسقط؟ على ال + +390 +00:26:52,620 --> 00:26:56,980 +inferior retina، وفي عندي اشي target اللي هو الجسم + +391 +00:26:56,980 --> 00:27:01,940 +البيضاوي هذاجاي في أسفل المنظر أو في أسفل ال field + +392 +00:27:01,940 --> 00:27:06,180 +حقل الإبصار وأنا بتطلع الشجرة .. وأنا بتطلع الشجرة + +393 +00:27:06,180 --> 00:27:11,320 +موقع .. موقع الجسم البيضاوي جاي لتحت بس صورته أين + +394 +00:27:11,320 --> 00:27:14,680 +بتسقط؟ على ال superior retina .. على ال superior + +395 +00:27:14,680 --> 00:27:19,440 +retina نرجع .. بنقول عشان أعرف التوزيع بشكل بسيط + +396 +00:27:19,440 --> 00:27:26,340 +بقول كالقاتل ال field يقسم ل 4 أربعربعين علويين + +397 +00:27:26,340 --> 00:27:32,140 +يعني نص وربعين سفليين يعني أيضا نص أو ممكن أقول + +398 +00:27:32,140 --> 00:27:37,000 +ربعين عاليمين وربعين عالشمال ربعين عاليمين يعني نص + +399 +00:27:37,000 --> 00:27:41,500 +وربعين عالشمال يعني نص بيصير هيك ال visual field + +400 +00:27:41,500 --> 00:27:45,920 +مكتمل طيب، الآن هذا ال field موجود حقيقة في الفراغ + +401 +00:27:45,920 --> 00:27:51,100 +صورته بدها تسقط على عيني أو على عينية التنتينالجزء + +402 +00:27:51,100 --> 00:27:53,680 +الأعلى من ال field بيسقط على ال inferior retina + +403 +00:27:53,680 --> 00:27:57,980 +والجزء الأسفل على ال superior retina زي ما احنا + +404 +00:27:57,980 --> 00:28:02,360 +ورجينا في الرسمة هذه الجزء الأعلى من ال field طبعا + +405 +00:28:02,360 --> 00:28:05,140 +هنا احنا رسمين عين واحدة بس هاد ينطبق على عين تاني + +406 +00:28:05,140 --> 00:28:08,440 +الجزء الأعلى من ال field بيسقط على ال inferior + +407 +00:28:08,440 --> 00:28:12,300 +retina والجزء الأعلى من ال field من حقل الإبصار + +408 +00:28:12,300 --> 00:28:16,420 +بيسقط على ال superior retina إذا الأعلى بيسقط على + +409 +00:28:16,420 --> 00:28:19,360 +ال inferior والأدنى بيسقط على ال superior retina + +410 +00:28:20,190 --> 00:28:23,690 +واليمين من ال field يمين ال field بسقط على الشمال + +411 +00:28:23,690 --> 00:28:27,950 +وشمال ال field بسقط على اليمين بسقط على اليمين + +412 +00:28:27,950 --> 00:28:32,350 +لأنه مقابل لليمين .. مقابل لليمين طيب لو احنا قلنا + +413 +00:28:32,350 --> 00:28:37,190 +بدنا ناخد ربع واحد من ال field ونشوف وين بسقط هذا + +414 +00:28:37,190 --> 00:28:40,550 +الربع اللي ملون باللون الأحمر اللي ملون باللون + +415 +00:28:40,550 --> 00:28:47,070 +الأحمر جاي بسموه left upper quadrant of the visual + +416 +00:28:47,070 --> 00:28:50,530 +fieldماذا يعني left upper quadrant؟ left يعني جاي + +417 +00:28:50,530 --> 00:28:55,170 +على الشمال، ربع، left quadrant بس upper، مش .. مش + +418 +00:28:55,170 --> 00:28:59,010 +سفلي، علوي، لأن هذا السفلي، هذا السفلي اللي هو ال + +419 +00:28:59,010 --> 00:28:59,270 +move + +420 +00:29:08,210 --> 00:29:11,490 +أخدنا احنا ال left upper quadrant من ال visual + +421 +00:29:11,490 --> 00:29:15,250 +field المربع أو الربيع اللي جاي على الشمال ولا فوق + +422 +00:29:15,250 --> 00:29:19,130 +من ال visual field يا طرح هيسقط وين؟ عشان أعرف + +423 +00:29:19,130 --> 00:29:22,890 +ببساطة جدا، بدي أعكس كل الكلمات ال left بتصير + +424 +00:29:22,890 --> 00:29:27,070 +right و ال upper بتصير lower، هيسقط على ال right + +425 +00:29:27,070 --> 00:29:32,890 +lower quadrant of the two retina هذه ال retina، + +426 +00:29:32,890 --> 00:29:39,430 +هذه الرسمة حسب، هذه الرسمة ال fieldاللي هو الحقيقة + +427 +00:29:39,430 --> 00:29:44,650 +الموجودة خارج نطاق جسمي .. خارج نطاق جسمي تمام؟ + +428 +00:29:44,650 --> 00:29:48,590 +فبالتالي هذا الجزء .. أي شيء موجود في المنطقة + +429 +00:29:48,590 --> 00:29:51,470 +الحمراء في ال field .. في الربع الأحمر من ال field + +430 +00:29:51,470 --> 00:29:55,990 +هيسقط على ال right inferior quadrant في ال .. في + +431 +00:29:55,990 --> 00:29:59,610 +ال right eye و أيضا هيسقط على ال right inferior + +432 +00:29:59,610 --> 00:30:03,490 +quadrant في ال left eyeوكذا نقول هذه left eye كيف + +433 +00:30:03,490 --> 00:30:07,270 +right eye؟ ال left eye نفسها لو جسمناها لجسمين + +434 +00:30:07,270 --> 00:30:12,910 +هيكون جسم جايمين و جسم منها جاى الشمال طالما left + +435 +00:30:12,910 --> 00:30:17,010 +superior quadrant من ال field هيسقط على ال right + +436 +00:30:17,010 --> 00:30:20,690 +inferior quadrant of both retina لأن ال right + +437 +00:30:20,690 --> 00:30:24,110 +inferior quadrant هنا و ال right inferior quadrant + +438 +00:30:24,110 --> 00:30:28,660 +هنا في ال left eyeالاتنين مناطق متماثلة من + +439 +00:30:28,660 --> 00:30:33,460 +الشبكيات بيبصوا على نفس الجهة على أي جهة بيبصوا + +440 +00:30:33,460 --> 00:30:37,320 +على ال left superior quadrant of the field ال + +441 +00:30:37,320 --> 00:30:41,620 +right inferior .. ال right inferior part of the + +442 +00:30:41,620 --> 00:30:45,600 +retina .. right inferior part of the retina ولمّا + +443 +00:30:45,600 --> 00:30:48,720 +بنحكي right inferior parts of the retina مابنقصدش + +444 +00:30:48,720 --> 00:30:51,980 +فيها ال right eye بنقصد فيها ال both eye هنا .. + +445 +00:30:52,570 --> 00:30:57,010 +الجزء اللي عاليمين و تحت والربع اللي عاليمين و تحت + +446 +00:30:57,010 --> 00:31:00,190 +بالنسبة لكل هذا المنظر اللي هو ال retina تمام؟ + +447 +00:31:00,190 --> 00:31:03,710 +هدول الجزئين بيشتركوا ان هم بتطلعوا في الفراق او + +448 +00:31:03,710 --> 00:31:07,830 +مقابلين في الفراق لل left upper quadrant of the + +449 +00:31:07,830 --> 00:31:14,250 +visual field طيب؟ اذا left superior quadrant او + +450 +00:31:14,250 --> 00:31:18,870 +left upper quadrant مقابل لل right inferior retina + +451 +00:31:18,870 --> 00:31:24,880 +of both eyes طيب؟هدولة طالما مناطق متماثلة من + +452 +00:31:24,880 --> 00:31:31,580 +الشبكية معناته لازم يروحوا على نفس المنطقة من ال + +453 +00:31:31,580 --> 00:31:35,440 +visual cortex هملاحظين عندى ال visual cortex فى + +454 +00:31:35,440 --> 00:31:39,740 +visual cortex عاليمين وفى visual cortex على الشمال + +455 +00:31:39,740 --> 00:31:44,680 +طبعا فى شق هنا بيقسم ال visual cortex ل upper part + +456 +00:31:44,680 --> 00:31:48,720 +و lower part هدى ال left و هدى ال right upper part + +457 +00:31:48,720 --> 00:31:53,720 +و lower partإذا عندي right visual cortex و left + +458 +00:31:53,720 --> 00:32:00,740 +visual cortex إحنا هدولة .. هدولة اللي هم بيخدموا + +459 +00:32:00,740 --> 00:32:04,780 +.. بيخدموا ال left superior quadrant of the visual + +460 +00:32:04,780 --> 00:32:09,320 +field هنا أي target موجود حيسقط على ال right + +461 +00:32:09,320 --> 00:32:13,600 +inferior quadrant of the retina و أيضا هيسقط على + +462 +00:32:13,600 --> 00:32:16,780 +ال right inferior quadrant of the retinaالـ Right + +463 +00:32:16,780 --> 00:32:19,200 +Inferior Quadrant والـ Right Inferior Quadrant + +464 +00:32:19,200 --> 00:32:25,940 +هيبعتوا معلوماتهم للـ Right Inferior Bank ضفة ضفة + +465 +00:32:25,940 --> 00:32:30,040 +Bank يعني ضفة تمام؟ هنا في شق هنا في الضفة العليا + +466 +00:32:30,040 --> 00:32:34,860 +والضفة السفلاء لRight Inferior Visual Cortex Right + +467 +00:32:34,860 --> 00:32:40,100 +Inferior Visual Cortex هذا الكلام احنا نكتبه في + +468 +00:32:40,100 --> 00:32:47,290 +شريحةعشان يتضح الأمر بشكل لا لبسة فيه ان شاء الله + +469 +00:32:47,290 --> 00:32:59,110 +طيب بنقول right أو عفوا اسف left superior quadrant + +470 +00:32:59,110 --> 00:33:03,130 +of + +471 +00:33:03,130 --> 00:33:11,490 +visual field since image to + +472 +00:33:12,940 --> 00:33:21,620 +right inferior quadrant of + +473 +00:33:21,620 --> 00:33:28,660 +both retina ريتني جمع ريتنا، ريتنا مفرد و ريتني + +474 +00:33:28,660 --> 00:33:59,930 +جمعto right inferior + +475 +00:34:00,030 --> 00:34:03,530 +since image to right inferior quadrant of both + +476 +00:34:03,530 --> 00:34:09,670 +retina and then to + +477 +00:34:09,670 --> 00:34:22,210 +right inferior visual cortex هنا + +478 +00:34:22,210 --> 00:34:26,510 +left superior quadrant هنعملها يعني بلون آخر + +479 +00:34:33,430 --> 00:34:36,990 +بتبعت لل right inferior quadrant في ال retina + +480 +00:34:36,990 --> 00:34:43,290 +وبدورها + +481 +00:34:43,290 --> 00:34:46,390 +بتبعت لل right inferior visual cortex right + +482 +00:34:46,390 --> 00:34:53,370 +inferior visual cortex وبالتالي left superior ببعت + +483 +00:34:53,370 --> 00:34:56,970 +لل right inferior و right inferior quadrant في ال + +484 +00:34:56,970 --> 00:34:59,850 +retina ببعت لل right inferior visual cortex + +485 +00:34:59,850 --> 00:35:05,080 +وبالتالي طبعا مافيش خلافطبعا هذه القضية بتوضح ليه + +486 +00:35:05,080 --> 00:35:11,860 +شغلة مهمة للغاية وإنه التناسق .. التناسق مش بين + +487 +00:35:11,860 --> 00:35:17,180 +شبكيتين العنتين فقط التناسق ليس فقط بين شبكيتين + +488 +00:35:17,180 --> 00:35:21,340 +العنتين وإنما أيضا نفس التوزيع اللي موجودة في ال + +489 +00:35:21,340 --> 00:35:24,840 +written up هذه المنطقة مناسبة لهذه المنطقة أو + +490 +00:35:24,840 --> 00:35:28,000 +متناسقة معاه يعني بيبصوا على نفس الجهة من ال field + +491 +00:35:28,000 --> 00:35:32,820 +.. من الفرارةو أيضا متناسب معهم هذه المنطقة من + +492 +00:35:32,820 --> 00:35:37,160 +التحليل طيب لو أخدنا هذه اللي هو left inferior + +493 +00:35:37,160 --> 00:35:41,560 +quadrant هنلاقي اللي ببص على left inferior + +494 +00:35:41,560 --> 00:35:45,460 +quadrant هو right superior quadrant of the retina + +495 +00:35:45,460 --> 00:35:48,580 +right + +496 +00:35:48,580 --> 00:35:53,000 +superior visual cortex right يعني سيبنا من ال left + +497 +00:35:53,000 --> 00:35:56,240 +right يعني سيبنا من ال left و superior يعني سيبنا + +498 +00:35:56,240 --> 00:36:00,600 +من ال inferior فبالتاليفي تناسق مش بس بين + +499 +00:36:00,600 --> 00:36:04,760 +الشبكيتين و ايضا متناسق مع الشبكيتين بتاعت العنتين + +500 +00:36:04,760 --> 00:36:10,340 +ال visual cortex يعني منظمة او موزعة مناطق التحليل + +501 +00:36:10,340 --> 00:36:14,440 +بما يتناسب و بما يتناسق مع مناطق الشبكية في + +502 +00:36:14,440 --> 00:36:18,020 +العنتين فهذا يسمى retinocortical correspondence + +503 +00:36:18,020 --> 00:36:22,640 +اذا normal retinal او retinocortical اذا بدنا نكون + +504 +00:36:22,640 --> 00:36:26,600 +دقيقين correspondence resulting in cyclopean + +505 +00:36:26,600 --> 00:36:31,540 +viewingرابع شيء وهو مهم جدا من شروط الـbinocular + +506 +00:36:31,540 --> 00:36:34,400 +single vision، accuracy in neuromuscular + +507 +00:36:34,400 --> 00:36:37,820 +development and coordination so that the visual + +508 +00:36:37,820 --> 00:36:41,800 +axisdirected at unmaintained fixation on the + +509 +00:36:41,800 --> 00:36:45,520 +object of regard لو تصورنا أن الشروط التلاتة + +510 +00:36:45,520 --> 00:36:48,300 +الأولى موجودة ال visual field طبيعي وفي + +511 +00:36:48,300 --> 00:36:53,480 +overlapping visual field وفي عندي neurons في ال + +512 +00:36:53,480 --> 00:36:56,960 +visual cortex تستقبل من العنتين و بتشتغل بشكل سليم + +513 +00:36:56,960 --> 00:37:03,000 +وفي عندي تناسق شبكي ممتاز بس المشكلة عندي طبعا + +514 +00:37:03,000 --> 00:37:07,920 +تناسق شبكي ممتاز resulting in cyclopeanviewing + +515 +00:37:07,920 --> 00:37:11,180 +Cyclope يعني viewing كلمة Cyclope هذا الإنسان + +516 +00:37:11,180 --> 00:37:16,360 +الخرافي اللي في عنده عين واحدة في منتصف رأسه وطبعا + +517 +00:37:16,360 --> 00:37:18,580 +هنا المقصود فيها Cyclope يعني ال viewing أن + +518 +00:37:18,580 --> 00:37:21,960 +العنتين بيشتغلوا و كأنهم عين واحدة بيحسش الإنسان + +519 +00:37:21,960 --> 00:37:25,910 +في قضية أنه في الأول اتكوّنك صورتينصورة ع شبكية + +520 +00:37:25,910 --> 00:37:29,750 +اليمين و صورة ع شبكية العين الشمال و بعدين تمدمجهم + +521 +00:37:29,750 --> 00:37:33,350 +و هو شعر بالموضوع هذا الانسان بمجرد ما يفتح عينه + +522 +00:37:33,350 --> 00:37:36,430 +بيحس حاله انه شايف الصورة الواحدة واحدة و كأنه + +523 +00:37:36,430 --> 00:37:39,630 +بتطلع يعني كأنه عينيتين تين مع بعض مش بس team + +524 +00:37:39,630 --> 00:37:44,030 +كأنهم شيء واحد بيشتغل بتناسق كامل مائة بالمائة + +525 +00:37:44,030 --> 00:37:47,440 +بدون ما هو يشعروبي .. بي .. بيدمجلوا الصورتين في + +526 +00:37:47,440 --> 00:37:50,460 +صورة واحدة ثلاثية، الأبعاد فيها ده يسمى Cyclopean, + +527 +00:37:50,500 --> 00:37:54,240 +Unic وكأني أنا بتطلع أو أملك فقط عين واحدة مش + +528 +00:37:54,240 --> 00:37:57,900 +عينتين، من .. من كثر التناسق بين العنتين، من كثر + +529 +00:37:57,900 --> 00:38:02,480 +أن شغلهم perfect مع بعض وما بتأخروش في .. عن بعضهم + +530 +00:38:02,480 --> 00:38:05,680 +البعض في الشروط لو تصورنا التلات شروط الأولى + +531 +00:38:05,680 --> 00:38:10,610 +موجودة وماعنديش الشرط الرابعأنه مافيش عندى ال + +532 +00:38:10,610 --> 00:38:14,150 +neuromuscular development و التنسيق بين حركة + +533 +00:38:14,150 --> 00:38:17,390 +العضلات و بين التغيية العصبية مش موجودة بمعنى أخر + +534 +00:38:17,390 --> 00:38:21,550 +كأنه في حوال ساعتها هيصير عندى تختل الشروط التلاتة + +535 +00:38:21,550 --> 00:38:26,090 +الأولى بمعنى أنه هيصير اتجاه الشبكية تاعة العين + +536 +00:38:26,090 --> 00:38:29,560 +اليمينبيختلف عن اتجاه الشبكية تاعت العين الشمالي + +537 +00:38:29,560 --> 00:38:32,500 +ويصير ال binocular single vision او ال normal + +538 +00:38:32,500 --> 00:38:36,720 +binocular single vision صعب فضروري جدا من شروط ال + +539 +00:38:36,720 --> 00:38:39,680 +binocular single vision انه يكون التغيية العصبية + +540 +00:38:39,680 --> 00:38:44,260 +وقوة العضلات متناسقة ومتطورة بشكل طبيعي ومتناسقة + +541 +00:38:44,260 --> 00:38:48,860 +مع بعض على بعض عشان العينين يتحركوا بشكل سلس في اي + +542 +00:38:48,860 --> 00:38:52,940 +اتجاه في الفراق وماحدش او ماتكونش عين متأخرة عنهين + +543 +00:38:53,220 --> 00:38:57,040 +في الحركة فهذا أيضا شرط من شروط ال binocular + +544 +00:38:57,040 --> 00:39:05,360 +single vision بيضال عندى اخر شرط من الشروط اللي هو + +545 +00:39:05,360 --> 00:39:09,720 +approximately equal image size clarity and size + +546 +00:39:09,720 --> 00:39:15,040 +for both eyes وهذا حقا يعني دخل كبير في تخصص + +547 +00:39:15,040 --> 00:39:19,680 +البصرياتلو فرضنا إن الشروط السابقة كلها متوفرة بس + +548 +00:39:19,680 --> 00:39:23,640 +مثلا في عندي anisometropia شديدة يعني مثلا العين M + +549 +00:39:23,640 --> 00:39:27,660 +تروب والعين التانية مثلا minus 5 مايوب فبالتالي ال + +550 +00:39:27,660 --> 00:39:30,820 +image equality أو ال image clarity مش هتكون واضحة + +551 +00:39:30,820 --> 00:39:36,300 +في العين تانيةوحجم الصورة ممكن يكون مختلف إذا مثلا + +552 +00:39:36,300 --> 00:39:41,020 +لبس نضارات و الفرق في قوة النضارات كبير ممكن يكون + +553 +00:39:41,020 --> 00:39:44,060 +حجم الصورة على شبكية العين اليمين بختلف كتير عن + +554 +00:39:44,060 --> 00:39:47,540 +حجم الصورة على شبكية العين الشمال فبالتالي مش + +555 +00:39:47,540 --> 00:39:50,400 +ادماغ لا يقبل أنصاف الحلول، ادماغ بدو يكون وضوح + +556 +00:39:50,400 --> 00:39:55,190 +الصورتين في العينتينمتماثل أو متقارب جدا و أحجامهم + +557 +00:39:55,190 --> 00:39:58,370 +متماثلة أو متقاربة جدا عشان يقدر يدمجهم في صورة + +558 +00:39:58,370 --> 00:40:02,390 +واحدة فضروري جدا يكون approximately تقريبا equal + +559 +00:40:02,390 --> 00:40:06,410 +image clarity نفس الوضوح تقريبا وتقريبا نفس ال + +560 +00:40:06,410 --> 00:40:10,980 +size هذه الشروط الخامسة إذا توفرت عند إنسانساعات + +561 +00:40:10,980 --> 00:40:16,080 +هذا الإنسان بيستمتع بال binocular single vision ال + +562 +00:40:16,080 --> 00:40:18,760 +normal binocular single vision وما بيعاني أبدا أن + +563 +00:40:18,760 --> 00:40:22,060 +تكون الرؤية بالنسبة إله عنده موحدة وثلاثية الأبعاد + +564 +00:40:22,060 --> 00:40:25,940 +باستخدام عينتين ك team واحد وما بيعاني من أي مشاكل + +565 +00:40:25,940 --> 00:40:30,540 +طبعا ال .. الشيء الأساسيالشيء الأساسي في الخمس + +566 +00:40:30,540 --> 00:40:33,960 +شروط اللي ذكرناهم هو ال normal retinal + +567 +00:40:33,960 --> 00:40:38,420 +correspondence ضروري يكون عشان يشتغلوا الشبكيتين + +568 +00:40:38,420 --> 00:40:42,860 +أو العينين بصحيح بشكل صحيح أو دقيق عشان الشبكيتين + +569 +00:40:42,860 --> 00:40:46,020 +أو العينين يشتغلوا بشكل صحيح لازم يكون فيه تناسق + +570 +00:40:46,020 --> 00:40:49,580 +بينهم تناسق بينهم يعني كل جزء من شبكية العين + +571 +00:40:49,580 --> 00:40:54,500 +اليمين له ما يماثله او ما يكافئه او ما يعادله في + +572 +00:40:54,500 --> 00:40:58,610 +شبكية العين الشمالية يعني بمعنى انه لازم كل جزءفي + +573 +00:40:58,610 --> 00:41:01,690 +شبكية العين اليمين إله شريك معاه في شبكية العين + +574 +00:41:01,690 --> 00:41:05,070 +الشمالي يعني بيبصوا على نفس الجهة من الفرار عشان + +575 +00:41:05,070 --> 00:41:09,550 +يستلموا صور ال objects الموجودة في هذه الجهة من + +576 +00:41:09,550 --> 00:41:14,570 +الفرار فضروري جدا هذه القضيةbinocular single + +577 +00:41:14,570 --> 00:41:18,010 +vision is based on normal retinal correspondence + +578 +00:41:18,010 --> 00:41:21,470 +يعني لو تخيلنا ال binocular single vision هرم + +579 +00:41:21,470 --> 00:41:24,710 +هيكون قاعدة الهرم هو ال normal retinal + +580 +00:41:24,710 --> 00:41:29,750 +correspondence التناسق الشبكي الطبيعي و اللي + +581 +00:41:29,750 --> 00:41:33,290 +شرحناها قبل شوية في الصورة اللي عرضناها انه مثلا + +582 +00:41:33,290 --> 00:41:37,410 +هنا ال inferior right مثلا خدنا هذا مثال آخر نقول + +583 +00:41:37,410 --> 00:41:42,760 +left inferior quadrant و left inferior quadrantفي + +584 +00:41:42,760 --> 00:41:47,480 +الشبكية بخدم ال right superior left inferior بخدم + +585 +00:41:47,480 --> 00:41:50,740 +ال right superior quadrant of the visual field + +586 +00:41:50,740 --> 00:41:55,620 +يعني لو في target عندي هنا في المنطقة هاي اللي هي + +587 +00:41:55,620 --> 00:41:59,780 +right و superior quadrant of the visual field + +588 +00:41:59,780 --> 00:42:02,960 +هيسقط صورة هذا ال target على ال left inferior + +589 +00:42:02,960 --> 00:42:05,780 +quadrant of the retina وعلى ال left inferior + +590 +00:42:05,780 --> 00:42:10,810 +quadrant of the other retina هدولةمتناسقين بمعنى + +591 +00:42:10,810 --> 00:42:14,630 +بيبصوا على نفس الجهة من الفراغ وهي مرسومين بنفس + +592 +00:42:14,630 --> 00:42:18,770 +الألوان أجزاء ال retina في الشمال وفي اليمين + +593 +00:42:18,770 --> 00:42:23,010 +ومقابلهم ال visual field اللي هم بيتلقوا منه + +594 +00:42:23,010 --> 00:42:26,350 +فبالتالي أهم نقطة في ال binocular single vision + +595 +00:42:26,350 --> 00:42:29,110 +وأهم شرط في الشروط الخامسة أنه يكون في عندي normal + +596 +00:42:29,110 --> 00:42:32,570 +retinal correspondence هذا ال binocular single + +597 +00:42:32,570 --> 00:42:36,160 +vision لو صورناها هرمهيكون قاعدته هو ال normal + +598 +00:42:36,160 --> 00:42:40,220 +written correspondence و عشان نفهم هذه القاعدة هذا + +599 +00:42:40,220 --> 00:42:45,020 +بتطلب مننا ان نفهم ال unicular visual direction + +600 +00:42:45,020 --> 00:42:50,670 +and projection لازم نفهمحاجتين أو تعريفين، أول + +601 +00:42:50,670 --> 00:42:53,930 +حاجة هنفهمهم بالنسبة لعين واحدة، بعدين هنطبقهم على + +602 +00:42:53,930 --> 00:42:56,430 +العينتين اللي .. اللي هو إيش اللي بدنا نفهمه؟ بدنا + +603 +00:42:56,430 --> 00:42:59,910 +نفهم الحاجة اللي بيسموها ال visual direction و ال + +604 +00:42:59,910 --> 00:43:02,470 +projection و هذا هنحكي عنه المرة القادمة ان شاء + +605 +00:43:02,470 --> 00:43:05,810 +الله تعالى و يعطيكم العافية والسلام عليكم ورحمة + +606 +00:43:05,810 --> 00:43:06,870 +الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/0hARiudOoQ4.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/0hARiudOoQ4.srt new file mode 100644 index 0000000000000000000000000000000000000000..1be77041fe8545e31dbfd40a8f191112c5db9b52 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/0hARiudOoQ4.srt @@ -0,0 +1,855 @@ +1 +00:00:01,520 --> 00:00:05,340 +بسم الله الرحمن الرحيم، نواصل مع محاضرات حول واحد + +2 +00:00:05,340 --> 00:00:09,080 +واتوقفنا عند الـ testing in verbal children + +3 +00:00:09,080 --> 00:00:13,420 +المحاضرة السابقة كانت على الـ testing in pre-verbal + +4 +00:00:13,420 --> 00:00:16,820 +children اللي هو فحص النظر عند الأطفال ما قبل + +5 +00:00:16,820 --> 00:00:21,580 +مرحلة النطق، اليوم بدنا نفحص النظر عند الأطفال اللي + +6 +00:00:21,580 --> 00:00:27,110 +بدوا يتكلموا ونشوف كيف يتم هذا الأمر، all of the + +7 +00:00:27,110 --> 00:00:30,610 +tests described below are performed at three or + +8 +00:00:30,610 --> 00:00:34,070 +four meters، يعني الـ testات عند الـ verbal children + +9 +00:00:34,070 --> 00:00:40,710 +يتم أدائها على بعد ثلاثة إلى أربعة متر، at which ... + +10 +00:00:40,710 --> 00:00:44,110 +ليه؟ at which it is easier to obtain compliance + +11 +00:00:44,110 --> 00:00:49,290 +الطفل لما أكون أنا بعيد عنه ستة متر ممكن ما ينتبهش + +12 +00:00:49,290 --> 00:00:55,430 +إلي كتير أو ممكن يعني يلفت انتباهه لأشياء ثانية في + +13 +00:00:55,430 --> 00:00:58,530 +غرفة الفحص، فبالتالي ما بيكونش completely ... + +14 +00:00:58,530 --> 00:01:02,410 +ما بيكونش متعاون معايا على الفحص على بعد 6 متر زي + +15 +00:01:02,410 --> 00:01:07,470 +ما هيكون متعاون لو أنا اقتربت لبعد 3 أو 4 أمتار + +16 +00:01:07,470 --> 00:01:12,750 +with little or no clinical detriment، بمعنى أنه لما + +17 +00:01:12,750 --> 00:01:18,870 +أنا بجرب لـ 3 أو 4 أمتار مش كتير من ناحية طبية بتفرق + +18 +00:01:18,870 --> 00:01:24,210 +النتائج في الفحص، يعني إذا كان فيه فرق هيكون فرق + +19 +00:01:24,210 --> 00:01:28,470 +بسيط جدا أو مش موجود، It is important to note that + +20 +00:01:28,470 --> 00:01:32,710 +amblyopia can only be accurately diagnosed using a + +21 +00:01:32,710 --> 00:01:36,440 +crowded test، إذا أنا بدأ أكتشف إن في عند الطفل + +22 +00:01:36,440 --> 00:01:41,220 +amblyopia، مش لازم أستعمل single letter test أو + +23 +00:01:41,220 --> 00:01:45,620 +single picture test، يعني مش لازم أستعمل test ما فيش + +24 +00:01:45,620 --> 00:01:51,150 +فيه crowding، إنما عشان أكتشف الـ amblyopia لابد أنه + +25 +00:01:51,150 --> 00:01:55,770 +أستعمل crowded test، هذه الـ crowded test بتطلب + +26 +00:01:55,770 --> 00:02:00,470 +target recognition، يعني التعرف على الـ target مش + +27 +00:02:00,470 --> 00:02:07,650 +مجرد رؤيته فقط، and that، لجمارة test اللي هي الـ + +28 +00:02:07,650 --> 00:02:12,240 +charts اللي بتعتمد على مبدأ الـ logarithm of the + +29 +00:02:12,240 --> 00:02:16,480 +minimum angle of resolution provide the best + +30 +00:02:16,480 --> 00:02:19,700 +measure against which improvement with amblyopia + +31 +00:02:19,700 --> 00:02:24,020 +therapy can be assessed، بمعنى لما بستعمل أي من + +32 +00:02:24,020 --> 00:02:27,600 +اللجمارة charts، في عدد كبير جدا من اللجمارة + +33 +00:02:27,600 --> 00:02:31,450 +charts، أنواع كثيرة منها، كلها بتعتمد على مبدأ الـ + +34 +00:02:31,450 --> 00:02:35,030 +logarithm of the minimum angle of resolution، لما + +35 +00:02:35,030 --> 00:02:39,310 +باستعمل أي واحد منها، هذا يعتبر أفضل test ممكن + +36 +00:02:39,310 --> 00:02:44,110 +أستعمله عشان أشوف هل في تحسن في علاج الأمبيوبيا + +37 +00:02:44,110 --> 00:02:47,430 +لدى الطفل، طبعا علاج الأمبيوبيا بالـ occlusion + +38 +00:02:47,430 --> 00:02:50,710 +therapy أو بالـ penalization، ولا ما فيش تحسن + +39 +00:02:50,710 --> 00:02:54,690 +فبالتالي أفضل test أستعملها في هذا الأمر هي اللجمع + +40 +00:02:54,690 --> 00:02:59,640 +tests أو اللجمع charts، وحنشوف صور لبعضها، these are + +41 +00:02:59,640 --> 00:03:03,880 +readily available، اللي هي لجمارة شارتز يعني موجودة + +42 +00:03:03,880 --> 00:03:11,280 +ومتوفرة في الأسواق وفي الأماكن اللي بتوفرها بأشكال + +43 +00:03:11,280 --> 00:03:14,960 +مناسبة من عمر سنتين فما فوق، من عمر سنتين يعني ممكن + +44 +00:03:14,960 --> 00:03:18,680 +إنسان يسأل يقول طب أنا عايز أفحص الطفل بـ لجمارة + +45 +00:03:18,680 --> 00:03:23,440 +شارتز بس مش ملاقي لجمارة شارتز يعني لهذا الطفل لأ + +46 +00:03:23,440 --> 00:03:28,910 +بنقول من عمر سنتين فأكثر يوجد في الأسواق logmark + +47 +00:03:28,910 --> 00:03:33,690 +chart مناسبة لهذا السن فما فوق، فما فوق بالتالي + +48 +00:03:33,690 --> 00:03:38,190 +بنبدأ من عمر سنتين، كيف يفحص الطفل at age two years + +49 +00:03:38,190 --> 00:03:42,450 +most children will have sufficient language skills + +50 +00:03:42,450 --> 00:03:46,250 +to undertake a picture naming test such as the + +51 +00:03:46,250 --> 00:03:51,130 +crowded K pictures، يعني من عمر سنتين فأكثر بنلاقي + +52 +00:03:51,130 --> 00:03:56,250 +غالبية الأطفال، مش كلهم طبعا، غالبية الأطفال عندهم + +53 +00:03:56,250 --> 00:03:59,830 +ما يكفي من المهارات اللغوية، عندهم ما يكفي من + +54 +00:03:59,830 --> 00:04:04,030 +المهارات اللغوية عشان لما أعرض له picture زي الـ + +55 +00:04:04,030 --> 00:04:08,530 +crowded picture test اللي احنا سايفينه بيقدر يسميه + +56 +00:04:08,530 --> 00:04:11,310 +يعني picture naming، بيقدر يسمي هذا الـ picture، + +57 +00:04:11,310 --> 00:04:13,830 +بيقدر يقول عن هاي ساعة أو عن هاي سمكة أو عن هاي + +58 +00:04:13,830 --> 00:04:17,110 +بطة أو عن هاي سيارة، فبالتالي كتير من الأطفال + +59 +00:04:17,110 --> 00:04:21,310 +بيستطيعوا في عمر سنتين أنه يسمي الرسومات اللي هو + +60 +00:04:21,310 --> 00:04:24,820 +شايف... شايفها، وإذا ملاحظين هنا ما حكينا كيه + +61 +00:04:24,820 --> 00:04:27,980 +pictures، حكينا crowded K pictures، لأنه في كيه + +62 +00:04:27,980 --> 00:04:31,840 +pictures single test بيكون كل رسمة في صفحة لوحدها + +63 +00:04:31,840 --> 00:04:38,000 +وهذا طبعا هذا الـ test مش دقيق بالمرة، بالذات لما + +64 +00:04:38,000 --> 00:04:42,200 +أكون أنا شاكك أنه عند الطفل في amblyopia، في + +65 +00:04:42,200 --> 00:04:46,210 +amblyopia، هذا الدفتر اللي هو الـ K picture test هنا + +66 +00:04:46,210 --> 00:04:50,430 +مكتوب single crowded book، single للـ book بس في كل + +67 +00:04:50,430 --> 00:04:54,410 +صفحة في crowded pictures يعني أكتر من صورة، يعني في + +68 +00:04:54,410 --> 00:04:58,290 +عندي مثلا هنا ست صف... ست رسومات في صفحة واحدة، هذه + +69 +00:04:58,290 --> 00:05:02,950 +الصفحة عبارة عن يعني صفحة من ضمن هذا الكتاب، إذا K + +70 +00:05:02,950 --> 00:05:07,490 +picture test عبارة عن كتاب، A crowded book... + +71 +00:05:07,490 --> 00:05:11,590 +crowded book، يعني في كل شريحة منه أو في كل صفحة + +72 +00:05:11,590 --> 00:05:17,150 +منه أو في كل لوحة من لوحاته فيه طبعا crowded + +73 +00:05:17,150 --> 00:05:20,770 +pictures، بمعنى أكتر من صورة، والطفل المفروض لما + +74 +00:05:20,770 --> 00:05:25,030 +أشره على صورة إما يعمل naming يعني يقول هذه مثلا + +75 +00:05:25,030 --> 00:05:28,570 +سيارة، هذه نجمة، أو يعمل matching، كيف يعمل + +76 +00:05:28,570 --> 00:05:32,710 +matching؟ أنا بمسك الكتاب هذا و بعرض الصور و بتكون + +77 +00:05:32,710 --> 00:05:38,070 +الأم حاطة الطفل على حضنها ومعها لوحة فيها رسومات + +78 +00:05:38,070 --> 00:05:42,050 +مشابهة بس بترتيب آخر، فلمّا أنا بأشر على السيارة + +79 +00:05:42,050 --> 00:05:48,870 +المفروض الطفل يأشر على نفس الرسمة في... على اللوحة + +80 +00:05:48,870 --> 00:05:52,690 +يعني في اللوحة اللي مع الأم، في اللوحة اللي مع الأم + +81 +00:05:52,690 --> 00:05:57,530 +فبيسموها هذه matching، مطابقة للرسمة اللي أنا بأشر + +82 +00:05:57,530 --> 00:06:01,130 +عليها، ضروري يكون crowded test، ضروري يكون crowded + +83 +00:06:01,130 --> 00:06:08,470 +test، هي الـ Key picture، الـ book هذا فتحناه طبعا هي + +84 +00:06:08,470 --> 00:06:12,950 +عندي خمس رسومات، بسمهم Linear Crowded Pictures، أي + +85 +00:06:12,950 --> 00:06:17,190 +صورة، اتنين، تلاتة، أربعة، خمسة، ليه احنا يعني + +86 +00:06:17,190 --> 00:06:22,090 +بنركز على قضية الـ crowd أو الـ crowding عشان قضية + +87 +00:06:22,090 --> 00:06:26,550 +أن الحياة اللي هيعيش فيها هذا الطفل يعني لا يوجد + +88 +00:06:26,550 --> 00:06:31,050 +فيها target واحد و فقط و انتهى الأمر لأ، وإنما عدد + +89 +00:06:31,050 --> 00:06:35,950 +لانهائي من الأجسام والأشكال محيطة بالطفل في البيئة + +90 +00:06:35,950 --> 00:06:39,670 +المحيطة فيه، فبالتالي هو مطلوب منه أنه يتعرف على + +91 +00:06:39,670 --> 00:06:44,970 +الأشكال ضمن crowding... ضمن الـ crowding phenomenon + +92 +00:06:44,970 --> 00:06:47,870 +عشان نقدر نكتشف إذا فعلا في عنده amblyopia ولا + +93 +00:06:47,870 --> 00:06:53,550 +ما عندهش amblyopia، على عمر تلات سنوات، يعني كبر الطفل + +94 +00:06:53,550 --> 00:06:58,370 +كمان سنة، most children will be able to undertake + +95 +00:06:58,370 --> 00:07:02,090 +the matching of letters، الآن بده يعمل مطابقة + +96 +00:07:02,090 --> 00:07:07,950 +للأحرف، بده يكون عندنا لوحة بالأحرف ونقشر على حرف + +97 +00:07:07,950 --> 00:07:13,250 +ويكون مع الأم لوحة مشابهة بس بترتيب آخر للأحرف + +98 +00:07:13,250 --> 00:07:17,430 +ومثلا إذا حطت له على حرف الـ V أشرت أنا على حرف الـ V + +99 +00:07:17,430 --> 00:07:21,970 +المفروض هو يبحث في اللوحة اللي مع الأم ويضع يده أو + +100 +00:07:21,970 --> 00:07:26,870 +يأشر على نفس الحرف بطريقة الـ matching، إذا at age + +101 +00:07:26,870 --> 00:07:30,530 +three years most children will be able to + +102 +00:07:30,530 --> 00:07:36,230 +undertake the matching of letter optotypes as in + +103 +00:07:36,230 --> 00:07:40,390 +the Keiller Logmar or Songsten crowded test، Keiller + +104 +00:07:40,390 --> 00:07:43,630 +Logmar أو Songsten crowded test، هاي الـ Keiller + +105 +00:07:43,630 --> 00:07:50,070 +Logmar، نرجع لعرض مكبر، هذه عندي الـ book الأول الـ + +106 +00:07:50,070 --> 00:07:54,550 +chart الأول Logmark crowded test طبعا Keiller الـ + +107 +00:07:54,550 --> 00:07:58,290 +Logmark crowded test، chart two و chart three طبعا + +108 +00:07:58,290 --> 00:08:02,270 +كلهم Keiller، كل واحد فيه يعني له يعني level من + +109 +00:08:02,270 --> 00:08:07,590 +تقييم حدّة الإبصار عند الأطفال، حدّة الإبصار عند + +110 +00:08:07,590 --> 00:08:11,090 +الأطفال، هذا بالنسبة للـ Keiller الـ Songsin أيضا + +111 +00:08:11,090 --> 00:08:16,560 +نطلع على عرض مكبر، الـ Songsen في أربع booklet، أربع + +112 +00:08:16,560 --> 00:08:21,080 +كتيبات، عند الـ booklet A عبارة عن training + +113 +00:08:21,080 --> 00:08:26,340 +booklet، training booklet، الـ booklet B فيه single + +114 +00:08:26,340 --> 00:08:30,640 +letter display، وكأنه هذا الدفتر الأول للتدريب + +115 +00:08:30,640 --> 00:08:35,180 +الدفتر الثاني ما فيش فيه crowding، بنعمل على تلاتة + +116 +00:08:35,180 --> 00:08:40,940 +متر، بيقيم أو الـ pictures اللي فيه تتراوح من تمانية + +117 +00:08:40,940 --> 00:08:46,820 +من عشرة لـ minus تلاتة من عشرة log mark، يعني level + +118 +00:08:46,820 --> 00:08:51,700 +log mark level، الـ...الـ...الـ booklet C linear + +119 +00:08:51,700 --> 00:08:55,000 +display، له هذا في عندي crowding، هذا في عندي + +120 +00:08:55,000 --> 00:08:59,400 +crowding، وهنا أيضا الـ booklet D أيضا linear + +121 +00:08:59,400 --> 00:09:06,180 +display، يعني عبارة عن العديد من الأحرف... العديد من + +122 +00:09:06,180 --> 00:09:09,420 +الأحرف، زي...يعني هذه الصفحات المأخوذة...هذه + +123 +00:09:09,420 --> 00:09:12,320 +الصفحة وهذه الصفحة...هدول الصفحات اللي فيهم + +124 +00:09:12,320 --> 00:09:16,640 +crowded letters، هي عبارة عن...هنلاقيها إما في + +125 +00:09:16,640 --> 00:09:22,230 +الكتيب رقم تلاتة أو الكتيب رقم أربعة، طبعا الكتيب + +126 +00:09:22,230 --> 00:09:26,730 +رقم B تبع Songsen Logmar Test، عبارة عن single + +127 +00:09:26,730 --> 00:09:29,370 +letter، يعني عبارة عن single letter، زي ما احنا + +128 +00:09:29,370 --> 00:09:33,750 +شايفين، طبعا هذا تقييم دقيق بيكون طبعا مش الـ single + +129 +00:09:33,750 --> 00:09:37,510 +letter، وإنما هو بنعمل training للطفل، بعدين من الـ + +130 +00:09:37,510 --> 00:09:40,470 +training بينقل للـ single letter، بعدين من الـ single + +131 +00:09:40,470 --> 00:09:46,930 +letter بينقل للأدق اللي هي الـ linear display، أذن at + +132 +00:09:46,930 --> 00:09:50,310 +age three years most children will be able to + +133 +00:09:50,310 --> 00:09:54,170 +undertake the matching of letter optotypes as in + +134 +00:09:54,170 --> 00:09:58,650 +the Keiller-Logmar or Songsten crowded tests، طيب + +135 +00:09:58,650 --> 00:10:02,890 +if crowded letters، وهذا كلام غاية في الأهمية، if a + +136 +00:10:02,890 --> 00:10:06,610 +crowded letter test proves too difficult، it is + +137 +00:10:06,610 --> 00:10:10,070 +preferable to perform the crowded K picture than + +138 +00:10:10,070 --> 00:10:15,560 +to use single optotype letters، نفرض الطفل...نفرض + +139 +00:10:15,560 --> 00:10:16,100 +الطفل + +140 +00:10:18,910 --> 00:10:25,050 +تم تدريبه ثم نقل لفحصه على الكتيب رقم B في الـ Songsen + +141 +00:10:25,050 --> 00:10:28,290 +Logmar test اللي هو عبارة عن single letter + +142 +00:10:28,290 --> 00:10:32,630 +display، عبارة عن عرض لـ single letters وأدى كويس + +143 +00:10:32,630 --> 00:10:36,790 +طيب، هجينا نقلناه على الـ booklet C أو الـ booklet D + +144 +00:10:36,790 --> 00:10:41,230 +الكتيب رقم C أو D اللي بيعرض لي يعني crowded + +145 +00:10:41,230 --> 00:10:45,870 +letters ما قدرش يؤدي بالمرة عليهم، هل أكتفي وأقول + +146 +00:10:45,870 --> 00:10:48,110 +طالما عرف الـ single letter وأسجل + +147 +00:10:51,140 --> 00:10:56,960 +Log mar level اللي وصله ولا أش اعمل، طبعا لأ لأن الـ + +148 +00:10:56,960 --> 00:11:01,400 +single letter test مش دقيق، فالطفل في هذه الحالة + +149 +00:11:01,400 --> 00:11:07,040 +إذا ما استطاعش أنه يكمل بالـ crowded letter بدي أنقل + +150 +00:11:07,040 --> 00:11:11,440 +أرجع فيه سنة، هو عمره تالت سنين بس بدي أعرض له لـ + +151 +00:11:11,440 --> 00:11:18,720 +crowded K picture لـ crowded K picture test بشكل + +152 +00:11:18,720 --> 00:11:23,380 +أنه أحافظ على قضية الـ crowd حتى لو أنا اختبرته بالـ + +153 +00:11:23,380 --> 00:11:30,270 +K picture اللي يختبر لعمر سنتين، older children عدة + +154 +00:11:30,270 --> 00:11:34,570 +تلات سنوات ووصل أربع سنوات من العمر، may continue + +155 +00:11:34,570 --> 00:11:37,690 +with the crowded letter test، يعني بقدر أظل معاهم + +156 +00:11:37,690 --> 00:11:40,790 +في الـ Songsen Logmar test أو في الـ Keyler Logmar + +157 +00:11:40,790 --> 00:11:46,020 +test اللي هي crowded test بطريقة الـ naming إنه يسمي + +158 +00:11:46,020 --> 00:11:49,760 +لي اسم الحرف، على عمر أربع سنوات لازم يكون في + +159 +00:11:49,760 --> 00:11:53,740 +الغالب الأعم أنه بيسمي الحرف أو يعمل matching + +160 +00:11:53,740 --> 00:11:58,560 +للحرف، إذا كان هو مش قادر يسمي غالبا الـ matching مش + +161 +00:11:58,560 --> 00:12:03,020 +لأنه مش قادر يسمي، ولكن بعض الأطفال بيكونوا خجولين + +162 +00:12:03,020 --> 00:12:08,580 +جدا فبالتالي مش بيقدرش يسمي، بيقدر يسمي بس خجولان + +163 +00:12:08,580 --> 00:12:13,610 +فممكن احنا نعطي الأم لوحة فيها الأحرف I ونعرض له لـ + +164 +00:12:13,610 --> 00:12:19,470 +Crowded Test، وبالتالي هو يأشر على الحرف المشابه + +165 +00:12:19,470 --> 00:12:22,650 +لأن بعض الأطفال بيكونوا فعلا خجولين أنهم يتكلموا + +166 +00:12:22,650 --> 00:12:27,210 +أثناء الفحص، أو ممكن أنتقل لـ level أعلى من الـ + +167 +00:12:27,210 --> 00:12:33,270 +Keiller Logmar ومن الـ Songsen Logmar Test لـ الـ... + +168 +00:12:33,270 --> 00:12:38,270 +الـ...الـ charts بتاعة الـ adults زي الـ ETDRS chart + +169 +00:12:38,270 --> 00:12:43,890 +الـ ETDRS chart هي نوع من الـ Logmar charts، اختصار + +170 +00:12:43,890 --> 00:12:48,010 +Early Treatment of Diabetic Retinopathy Study + +171 +00:12:48,010 --> 00:12:54,180 +Early Treatment of Diabetic Retinopathy Study، هذه + +172 +00:12:54,180 --> 00:12:59,560 +الـ study أو هذه الدراسة عملت لدراسة هل يتم التدخل + +173 +00:12:59,560 --> 00:13:04,920 +المبكر لعلاج اعتلال الشبكية السكري ولا ما يتمش، فهذه + +174 +00:13:04,920 --> 00:13:09,960 +الدراسة استخدمت الـ Log-margin chart لدرجة أنه أصبح + +175 +00:13:09,960 --> 00:13:13,120 +الـ Logmar chart بيعرف باسم الدراسة هاي، يعني + +176 +00:13:13,120 --> 00:13:17,400 +أصبحت يعني الوسم بتاع الدراسة هاي يعني لحق بالـ + +177 +00:13:17,400 --> 00:13:21,580 +chart، فبالتالي لما + +201 +00:14:58,220 --> 00:15:01,240 +الأسطر .. بينما هنا في crowding .. هنا خمس حروف في + +202 +00:15:01,240 --> 00:15:05,340 +كل سطر .. مهما صغر أو كبر .. هي قضية .. قضية ثانية + +203 +00:15:05,340 --> 00:15:08,900 +.. الفرق في الحجم بين السطر والسطر الذي يليه فيه + +204 +00:15:08,900 --> 00:15:14,090 +تدرج غير منطقي وهذا تم حسابه هندسيا إذا في تدرج غير + +205 +00:15:14,090 --> 00:15:18,810 +منطقي أما هنا في عندي تدرج هندسي منطقي لوجاريتمي + +206 +00:15:18,810 --> 00:15:22,750 +فبالتالي لو شوفنا السطر الأول والثاني قداش بيفرجوا + +207 +00:15:22,750 --> 00:15:26,250 +عن بعض بالحجم مش كتير بينما هنا السطر الأول + +208 +00:15:26,250 --> 00:15:30,550 +والثاني بيفرجوا كتير جدا في الحجم هنا الفروقات بين + +209 +00:15:30,550 --> 00:15:37,690 +السطر والسطر الذي ليه طيب الآن كل حرف في ال log + +210 +00:15:37,690 --> 00:15:41,910 +-margin chart له قيمة لوجاريتمية السطر كله قيمته + +211 +00:15:41,910 --> 00:15:47,490 +لوجاريتمية واحد من عشرة كل حرف اثنين من مئة + +212 +00:15:47,490 --> 00:15:51,190 +logarithmic unit اثنين من مئة واثنين من مئة أربعة + +213 +00:15:51,190 --> 00:15:55,690 +من مئة ستة من مئة ثمانية من مئة واحد من عشرة التي + +214 +00:15:55,690 --> 00:15:59,830 +هي عشرة من مئة تمام؟ هنا واحد من عشرة logarithmic + +215 +00:15:59,830 --> 00:16:02,610 +unit وهنا واحد من عشرة logarithmic unit وهنا واحد + +216 +00:16:02,610 --> 00:16:06,050 +من عشرة logarithmic unit وهكذا .. وهكذا فبالتالي + +217 +00:16:06,050 --> 00:16:10,350 +ضروري نعرف هذه القضية فبالتالي + +218 +00:16:12,620 --> 00:16:16,220 +بنستعمل ال logarithmic units في الإشارة لل level + +219 +00:16:16,220 --> 00:16:20,220 +بتاع النظر، بينما هنا بنستعمل إما بالقدم يعني + +220 +00:16:20,220 --> 00:16:23,220 +عشرين على عشرين، عشرين على خمسة وعشرين، عشرين على + +221 +00:16:23,220 --> 00:16:27,280 +أربعين أو بنظام ال meter اللي هو ستة على ستة وستة على + +222 +00:16:27,280 --> 00:16:31,650 +اثنا عشر وستة على ثمانية عشر وهكذا وهكذا طبعا في نقطة + +223 +00:16:31,650 --> 00:16:36,750 +بدنا نروح إليها مهمة جدا أنه لما إنسان بنفحصه بال + +224 +00:16:36,750 --> 00:16:40,310 +logarithmic بال log margin chart أو logarithm of + +225 +00:16:40,310 --> 00:16:43,590 +the minimum angle of resolution وبيكون مكتوب في ال + +226 +00:16:43,590 --> 00:16:46,350 +file أنه ال vision في ال right eye مثلا صفر معناته + +227 +00:16:46,350 --> 00:16:51,670 +6 على 6 في ال log margin chart صفر معناته 6 على 6 طب + +228 +00:16:51,670 --> 00:16:55,750 +واحد صحيح معناته ستة على ستين، ليه عشرين على عشرين + +229 +00:16:55,750 --> 00:17:01,250 +أو ستة على ستين، إذا كل ما قل الرقم في اللوجاريتم الـ + +230 +00:17:01,250 --> 00:17:05,570 +chart كل ما كان النظر أفضل، كل ما كان النظر أفضل، يعني + +231 +00:17:05,570 --> 00:17:10,090 +لو في عندي minus واحد من عشرة لوجاريتم، معناته دي + +232 +00:17:10,090 --> 00:17:14,460 +عشرين على خمسة عشر أفضل من ستة على ستة فبالتالي كل + +233 +00:17:14,460 --> 00:17:18,580 +ما قل الرقم كل ما كان النظر أفضل وكل ما زاد الرقم + +234 +00:17:18,580 --> 00:17:22,580 +كل ما كان يعني low vision كل ما كان low vision أو + +235 +00:17:22,580 --> 00:17:26,520 +في decrease في ال visual acuity عند هذه النقطة + +236 +00:17:26,520 --> 00:17:30,340 +بتتوقف المحاضرة ويعطيكم العافية والسلام عليكم + +237 +00:17:30,340 --> 00:17:31,940 +ورحمة الله وبركاته diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/0hARiudOoQ4_raw.json b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/0hARiudOoQ4_raw.json new file mode 100644 index 0000000000000000000000000000000000000000..f483077cc1616298983926c67262377cdf99ece9 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/0hARiudOoQ4_raw.json @@ -0,0 +1 @@ +{"segments": [{"id": 1, "seek": 2594, "start": 1.52, "end": 25.94, "text": "بسم الله الرحمن الرحيم بنماصل مع محاضرات حوال واحد واتوقفنا عند ال testing in verbal children المحاضرة السابقة كانت على ال testing in pre-verbal children اللي هو فحص النظر عند الأطفال ما قبل مرحلة النطق اليوم بدنا نفحص النظر عند الأطفال اللي بدوا يتكلموا ونشوف كيف بيتم هدع الأمر", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 44945, 2304, 33546, 1211, 20449, 3714, 5016, 46958, 2288, 9307, 11331, 2407, 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"probability": 0.9580078125}, {"start": 88.47, "end": 89.31, "word": " amblyopia", "probability": 0.6592203776041666}, {"start": 89.31, "end": 89.65, "word": " can", "probability": 0.966796875}, {"start": 89.65, "end": 90.11, "word": " only", "probability": 0.9052734375}, {"start": 90.11, "end": 90.39, "word": " be", "probability": 0.9443359375}, {"start": 90.39, "end": 91.07, "word": " accurately", "probability": 0.94775390625}, {"start": 91.07, "end": 91.87, "word": " diagnosed", "probability": 0.88720703125}, {"start": 91.87, "end": 92.51, "word": " using", "probability": 0.93115234375}, {"start": 92.51, "end": 92.71, "word": " a", "probability": 0.9736328125}, {"start": 92.71, "end": 93.11, "word": " crowded", "probability": 0.830078125}, {"start": 93.11, "end": 93.59, "word": " test", "probability": 0.85791015625}], "temperature": 1.0}, {"id": 5, "seek": 10974, "start": 93.96, "end": 109.74, "text": "إذا أنا بدأ أكتشف إن في عند الطفل amblyopia مش لازم أستعمل single letter test أو single picture test يعني مش لازم أستعمل test مافيش فيه crowding إنما عشان أكتشف الamblyopia", "tokens": [28814, 15730, 41850, 47525, 10721, 5551, 4117, 2655, 8592, 5172, 36145, 8978, 43242, 41950, 5172, 1211, 3913, 356, 22376, 37893, 5296, 31377, 2304, 5551, 14851, 25957, 1211, 2167, 5063, 1500, 34051, 2167, 3036, 1500, 37495, 22653, 37893, 5296, 31377, 2304, 5551, 14851, 25957, 1211, 1500, 19446, 41185, 8592, 8978, 3224, 6401, 3584, 36145, 15042, 6225, 8592, 7649, 5551, 4117, 2655, 8592, 5172, 2423, 2173, 356, 22376], "avg_logprob": -0.14785448339448046, "compression_ratio": 1.5304878048780488, "no_speech_prob": 4.172325134277344e-07, "words": [{"start": 93.96, "end": 94.3, "word": "إذا", "probability": 0.877685546875}, {"start": 94.3, "end": 94.52, "word": " أنا", "probability": 0.8466796875}, {"start": 94.52, "end": 94.8, "word": " بدأ", "probability": 0.67236328125}, {"start": 94.8, "end": 95.28, "word": " أكتشف", "probability": 0.92158203125}, {"start": 95.28, "end": 95.48, 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"probability": 0.84521484375}, {"start": 389.77, "end": 389.87, "word": " و", "probability": 0.93994140625}, {"start": 389.87, "end": 390.27, "word": " انما", "probability": 0.699951171875}, {"start": 390.27, "end": 391.05, "word": " عدد", "probability": 0.98388671875}, {"start": 391.05, "end": 391.87, "word": " لانهائي", "probability": 0.8794921875}, {"start": 391.87, "end": 392.13, "word": " من", "probability": 0.99365234375}], "temperature": 1.0}, {"id": 19, "seek": 41199, "start": 392.43, "end": 411.99, "text": "الاجسام و الأشكال محيطة بالطفل في البيئة المحيطة فيه فبالتالي هو مطلوب منه أنه يتعرف على الأشكال ضمن crowding .. ضمن ال crowding phenomenon عشان نقدر نكتشف إذا فعلا في عنده amblyopia ولا ماعندهش amblyopia على عمر تلت سنوات", "tokens": [6027, 26108, 3794, 10943, 4032, 16247, 8592, 4117, 6027, 3714, 5016, 1829, 9566, 3660, 20666, 9566, 5172, 1211, 8978, 2423, 21292, 19986, 3660, 9673, 5016, 1829, 9566, 3660, 8978, 3224, 6156, 3555, 6027, 2655, 6027, 1829, 31439, 3714, 9566, 1211, 37746, 9154, 3224, 14739, 3224, 7251, 2655, 3615, 28480, 15844, 16247, 8592, 4117, 6027, 48812, 27842, 6401, 3584, 4386, 48812, 27842, 2423, 6401, 3584, 903, 268, 4726, 266, 6225, 8592, 7649, 8717, 28543, 2288, 8717, 4117, 2655, 8592, 5172, 11933, 15730, 6156, 3615, 15040, 8978, 43242, 3224, 3913, 356, 22376, 49429, 19446, 3615, 41260, 3224, 8592, 3913, 356, 22376, 15844, 6225, 29973, 6055, 1211, 2655, 8608, 1863, 2407, 9307], "avg_logprob": -0.13813919993964108, "compression_ratio": 1.6901408450704225, "no_speech_prob": 1.806020736694336e-05, "words": [{"start": 392.43, "end": 393.37, "word": "الاجسام", "probability": 0.901123046875}, {"start": 393.37, "end": 393.49, "word": " و", "probability": 0.5263671875}, {"start": 393.49, "end": 394.09, "word": " الأشكال", "probability": 0.9022216796875}, {"start": 394.09, "end": 394.69, "word": " محيطة", "probability": 0.99140625}, {"start": 394.69, "end": 395.51, "word": " بالطفل", "probability": 0.978759765625}, {"start": 395.51, "end": 395.65, "word": " في", "probability": 0.92724609375}, {"start": 395.65, "end": 395.95, "word": " البيئة", "probability": 0.937744140625}, {"start": 395.95, "end": 396.53, "word": " المحيطة", "probability": 0.991015625}, {"start": 396.53, "end": 396.79, "word": " فيه", "probability": 0.95947265625}, {"start": 396.79, "end": 397.39, "word": " فبالتالي", "probability": 0.9693196614583334}, {"start": 397.39, "end": 397.79, "word": " هو", "probability": 0.9287109375}, {"start": 397.79, "end": 398.25, "word": " مطلوب", "probability": 0.969482421875}, {"start": 398.25, "end": 398.53, "word": " منه", "probability": 0.920166015625}, {"start": 398.53, "end": 398.75, "word": " أنه", "probability": 0.702392578125}, {"start": 398.75, "end": 399.31, "word": " يتعرف", "probability": 0.9888916015625}, {"start": 399.31, "end": 399.67, "word": " على", "probability": 0.92822265625}, {"start": 399.67, "end": 401.55, "word": " الأشكال", "probability": 0.993408203125}, {"start": 401.55, "end": 401.99, "word": " ضمن", "probability": 0.989990234375}, {"start": 401.99, "end": 402.77, "word": " crowding", "probability": 0.5638427734375}, {"start": 402.77, "end": 402.89, "word": " ..", "probability": 0.32080078125}, {"start": 402.89, "end": 403.19, "word": " ضمن", "probability": 0.9716796875}, {"start": 403.19, "end": 403.47, "word": " ال", "probability": 0.8671875}, {"start": 403.47, "end": 404.13, "word": " crowding", "probability": 0.727294921875}, {"start": 404.13, "end": 404.97, "word": " phenomenon", "probability": 0.69287109375}, {"start": 404.97, "end": 405.29, "word": " عشان", "probability": 0.9833984375}, {"start": 405.29, "end": 405.61, "word": " نقدر", "probability": 0.98388671875}, {"start": 405.61, "end": 406.05, "word": " نكتشف", "probability": 0.99638671875}, {"start": 406.05, "end": 406.25, "word": " إذا", "probability": 0.918212890625}, {"start": 406.25, "end": 406.63, "word": " فعلا", "probability": 0.9148763020833334}, {"start": 406.63, "end": 406.79, "word": " في", "probability": 0.82470703125}, {"start": 406.79, "end": 407.05, "word": " عنده", "probability": 0.775390625}, {"start": 407.05, "end": 407.63, "word": " amblyopia", "probability": 0.6853841145833334}, {"start": 407.63, "end": 407.87, "word": " ولا", "probability": 0.65478515625}, {"start": 407.87, "end": 408.55, "word": " ماعندهش", "probability": 0.78837890625}, {"start": 408.55, "end": 409.87, "word": " amblyopia", "probability": 0.9052734375}, {"start": 409.87, "end": 410.63, "word": " على", "probability": 0.79150390625}, {"start": 410.63, "end": 410.95, "word": " عمر", "probability": 0.938232421875}, {"start": 410.95, "end": 411.31, "word": " تلت", "probability": 0.93408203125}, {"start": 411.31, "end": 411.99, "word": " سنوات", "probability": 0.9444580078125}], "temperature": 1.0}, {"id": 20, "seek": 43859, "start": 412.61, "end": 438.59, "text": "يعني كبر الطفل كمان سنة most children will be able to undertake the matching of letters الآن بده يعمل مطابقة للأحرف بده يكون عندنا لوحة بالأحرف ونقشر على حرف ويكون مع الأم لوحة مشابهة بس بترتيب آخر للأحرف ومثلا إذا حطتله على حرف ال V أشرت أنا على حرف ال V المفروض هو يبحث", "tokens": [40228, 22653, 9122, 26890, 41950, 5172, 1211, 9122, 2304, 7649, 8608, 1863, 3660, 881, 2227, 486, 312, 1075, 281, 37010, 264, 14324, 295, 7825, 6024, 48506, 47525, 3224, 7251, 25957, 1211, 3714, 9566, 16758, 28671, 24976, 10721, 5016, 28480, 47525, 3224, 7251, 30544, 43242, 8315, 45164, 5016, 3660, 20666, 10721, 5016, 28480, 4032, 1863, 4587, 46309, 15844, 11331, 28480, 4032, 1829, 30544, 20449, 16247, 2304, 45164, 5016, 3660, 37893, 16758, 3224, 3660, 4724, 3794, 39894, 2288, 31371, 3555, 19753, 34740, 24976, 10721, 5016, 28480, 4032, 2304, 12984, 15040, 11933, 15730, 11331, 9566, 2655, 43761, 15844, 11331, 28480, 2423, 691, 5551, 8592, 43500, 41850, 15844, 11331, 28480, 2423, 691, 9673, 5172, 32887, 11242, 31439, 7251, 49628, 12984], "avg_logprob": -0.11077724588222992, "compression_ratio": 1.6953125, "no_speech_prob": 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0.71435546875}, {"start": 418.37, "end": 419.21, "word": " the", "probability": 0.9072265625}, {"start": 419.21, "end": 419.71, "word": " matching", "probability": 0.85205078125}, {"start": 419.71, "end": 419.97, "word": " of", "probability": 0.98486328125}, {"start": 419.97, "end": 420.33, "word": " letters", "probability": 0.84619140625}, {"start": 420.33, "end": 420.75, "word": " الآن", "probability": 0.5947265625}, {"start": 420.75, "end": 421.07, "word": " بده", "probability": 0.726806640625}, {"start": 421.07, "end": 421.39, "word": " يعمل", "probability": 0.9912109375}, {"start": 421.39, "end": 422.09, "word": " مطابقة", "probability": 0.904541015625}, {"start": 422.09, "end": 422.87, "word": " للأحرف", "probability": 0.941650390625}, {"start": 422.87, "end": 423.53, "word": " بده", "probability": 0.71484375}, {"start": 423.53, "end": 423.79, "word": " يكون", "probability": 0.99169921875}, {"start": 423.79, "end": 424.21, "word": " عندنا", "probability": 0.900390625}, {"start": 424.21, "end": 424.97, "word": " لوحة", "probability": 0.9796549479166666}, {"start": 424.97, "end": 426.45, "word": " بالأحرف", "probability": 0.9774169921875}, {"start": 426.45, "end": 427.45, "word": " ونقشر", "probability": 0.7578125}, {"start": 427.45, "end": 427.63, "word": " على", "probability": 0.4921875}, {"start": 427.63, "end": 427.95, "word": " حرف", "probability": 0.98681640625}, {"start": 427.95, "end": 428.75, "word": " ويكون", "probability": 0.9503580729166666}, {"start": 428.75, "end": 428.97, "word": " مع", "probability": 0.9853515625}, {"start": 428.97, "end": 429.39, "word": " الأم", "probability": 0.97802734375}, {"start": 429.39, "end": 430.99, "word": " لوحة", "probability": 0.9866536458333334}, {"start": 430.99, "end": 431.55, "word": " مشابهة", "probability": 0.8858642578125}, {"start": 431.55, "end": 431.73, "word": " بس", "probability": 0.991455078125}, {"start": 431.73, "end": 432.31, "word": " بترتيب", "probability": 0.84423828125}, {"start": 432.31, "end": 432.63, "word": " آخر", "probability": 0.847900390625}, {"start": 432.63, "end": 433.25, "word": " للأحرف", "probability": 0.9766845703125}, {"start": 433.25, "end": 434.31, "word": " ومثلا", "probability": 0.9583740234375}, {"start": 434.31, "end": 434.55, "word": " إذا", "probability": 0.92578125}, {"start": 434.55, "end": 435.07, "word": " حطتله", "probability": 0.8260498046875}, {"start": 435.07, "end": 435.31, "word": " على", "probability": 0.93701171875}, {"start": 435.31, "end": 435.65, "word": " حرف", "probability": 0.994384765625}, {"start": 435.65, "end": 435.81, "word": " ال", "probability": 0.9677734375}, {"start": 435.81, "end": 435.91, "word": " V", "probability": 0.908203125}, {"start": 435.91, "end": 436.43, "word": " أشرت", "probability": 0.8693033854166666}, {"start": 436.43, "end": 436.63, "word": " أنا", "probability": 0.8349609375}, {"start": 436.63, "end": 436.83, "word": " على", "probability": 0.955078125}, {"start": 436.83, "end": 437.13, "word": " حرف", "probability": 0.989990234375}, {"start": 437.13, "end": 437.31, "word": " ال", "probability": 0.93115234375}, {"start": 437.31, "end": 437.43, "word": " V", "probability": 0.986328125}, {"start": 437.43, "end": 437.87, "word": " المفروض", "probability": 0.9071044921875}, {"start": 437.87, "end": 438.03, "word": " هو", "probability": 0.95361328125}, {"start": 438.03, "end": 438.59, "word": " يبحث", "probability": 0.9873046875}], "temperature": 1.0}, {"id": 21, "seek": 46587, "start": 438.87, "end": 465.87, "text": "في اللوحة اللي مع الأم ويضع يده أو يأشر على نفس الحرف بطريقة ال matching إذا at age three years most children will be able to undertake the matching of letter optotypes as in the killer logmar or songsten crowded test killer logmar أو songsten crowded test هاي ال killer logmar نرتلع على عرض مكبر", "tokens": [41185, 13672, 2407, 5016, 3660, 13672, 1829, 20449, 16247, 2304, 4032, 1829, 11242, 3615, 7251, 3215, 3224, 34051, 7251, 10721, 46309, 15844, 8717, 36178, 21542, 28480, 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"end": 441.69, "word": " يده", "probability": 0.9830729166666666}, {"start": 441.69, "end": 441.97, "word": " أو", "probability": 0.68310546875}, {"start": 441.97, "end": 442.69, "word": " يأشر", "probability": 0.763427734375}, {"start": 442.69, "end": 443.05, "word": " على", "probability": 0.921875}, {"start": 443.05, "end": 443.73, "word": " نفس", "probability": 0.9970703125}, {"start": 443.73, "end": 444.23, "word": " الحرف", "probability": 0.9921875}, {"start": 444.23, "end": 444.83, "word": " بطريقة", "probability": 0.9759521484375}, {"start": 444.83, "end": 445.05, "word": " ال", "probability": 0.9521484375}, {"start": 445.05, "end": 445.39, "word": " matching", "probability": 0.70849609375}, {"start": 445.39, "end": 445.81, "word": " إذا", "probability": 0.6134033203125}, {"start": 445.81, "end": 446.41, "word": " at", "probability": 0.748046875}, {"start": 446.41, "end": 446.87, "word": " age", "probability": 0.8203125}, {"start": 446.87, "end": 447.31, "word": " three", "probability": 0.72021484375}, {"start": 447.31, "end": 447.79, "word": " years", "probability": 0.92236328125}, {"start": 447.79, "end": 448.19, "word": " most", "probability": 0.8427734375}, {"start": 448.19, "end": 448.81, "word": " children", "probability": 0.90576171875}, {"start": 448.81, "end": 449.11, "word": " will", "probability": 0.92236328125}, {"start": 449.11, "end": 449.39, "word": " be", "probability": 0.970703125}, {"start": 449.39, "end": 449.99, "word": " able", "probability": 0.966796875}, {"start": 449.99, "end": 450.53, "word": " to", "probability": 0.966796875}, {"start": 450.53, "end": 451.09, "word": " undertake", "probability": 0.90185546875}, {"start": 451.09, "end": 451.59, "word": " the", "probability": 0.91455078125}, {"start": 451.59, "end": 452.09, "word": " matching", "probability": 0.85986328125}, {"start": 452.09, "end": 452.37, "word": " of", "probability": 0.98291015625}, {"start": 452.37, "end": 452.73, "word": " letter", "probability": 0.71435546875}, {"start": 452.73, "end": 453.65, "word": " optotypes", "probability": 0.879638671875}, {"start": 453.65, "end": 455.97, "word": " as", "probability": 0.93017578125}, {"start": 455.97, "end": 456.23, "word": " in", "probability": 0.97314453125}, {"start": 456.23, "end": 456.43, "word": " the", "probability": 0.83984375}, {"start": 456.43, "end": 456.73, "word": " killer", "probability": 0.40283203125}, {"start": 456.73, "end": 457.43, "word": " logmar", "probability": 0.5772705078125}, {"start": 457.43, "end": 458.13, "word": " or", "probability": 0.72900390625}, {"start": 458.13, "end": 458.87, "word": " songsten", "probability": 0.3487548828125}, {"start": 458.87, "end": 459.45, "word": " crowded", "probability": 0.736328125}, {"start": 459.45, "end": 459.99, "word": " test", "probability": 0.89599609375}, {"start": 459.99, "end": 460.39, "word": " killer", "probability": 0.69140625}, {"start": 460.39, "end": 461.07, "word": " logmar", "probability": 0.9580078125}, 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"end": 555.28, "word": " عن", "probability": 0.99560546875}, {"start": 555.28, "end": 555.6, "word": " ..", "probability": 0.95556640625}, {"start": 555.6, "end": 556.14, "word": " هنلاقيها", "probability": 0.9255859375}, {"start": 556.14, "end": 556.44, "word": " إما", "probability": 0.8310546875}, {"start": 556.44, "end": 556.64, "word": " في", "probability": 0.9541015625}, {"start": 556.64, "end": 557.34, "word": " الكتيب", "probability": 0.89599609375}, {"start": 557.34, "end": 557.68, "word": " رقم", "probability": 0.99267578125}, {"start": 557.68, "end": 558.26, "word": " تلاتة", "probability": 0.946533203125}, {"start": 558.26, "end": 558.52, "word": " أو", "probability": 0.9482421875}, {"start": 558.52, "end": 559.14, "word": " الكتيب", "probability": 0.9513346354166666}, {"start": 559.14, "end": 559.88, "word": " رقم", "probability": 0.9977213541666666}, {"start": 559.88, "end": 560.72, "word": " أربعة", "probability": 0.9085286458333334}], "temperature": 1.0}, {"id": 26, "seek": 58475, "start": 560.87, "end": 584.75, "text": "طبعا الكتيب رقم بي تبع Songsen Logmar Test عبارة عن single letter يعني عبارة عن single letter زي ما احنا شايفين طبعا هذا تقييم دقيق بيكون طبعا مش ال single letter وإنما هو بنعمل training للطفل بعدين من ال training بينقل لل single letter بعدين من ال single letter بينقل للأدق اللي هي ال linear display", "tokens": [9566, 3555, 3615, 995, 33251, 31371, 3555, 12602, 4587, 2304, 4724, 1829, 6055, 3555, 3615, 11862, 6748, 10824, 6209, 9279, 6225, 3555, 9640, 3660, 18871, 2167, 5063, 37495, 22653, 6225, 3555, 9640, 3660, 18871, 2167, 5063, 30767, 1829, 19446, 1975, 5016, 8315, 13412, 995, 33911, 9957, 23032, 3555, 3615, 995, 23758, 6055, 38436, 32640, 11778, 38436, 4587, 4724, 1829, 30544, 23032, 3555, 3615, 995, 37893, 2423, 2167, 5063, 4032, 28814, 1863, 15042, 31439, 44945, 25957, 1211, 3097, 24976, 9566, 5172, 1211, 39182, 9957, 9154, 2423, 3097, 4724, 9957, 4587, 1211, 24976, 2167, 5063, 39182, 9957, 9154, 2423, 2167, 5063, 4724, 9957, 4587, 1211, 24976, 10721, 3215, 4587, 13672, 1829, 39896, 2423, 8213, 4674], "avg_logprob": -0.153645831895502, "compression_ratio": 1.8680851063829786, "no_speech_prob": 4.172325134277344e-07, "words": [{"start": 560.87, "end": 561.47, "word": "طبعا", "probability": 0.956787109375}, {"start": 561.47, "end": 562.23, "word": " الكتيب", "probability": 0.8017578125}, {"start": 562.23, "end": 562.73, "word": " رقم", "probability": 0.984375}, {"start": 562.73, "end": 563.31, "word": " بي", "probability": 0.63818359375}, {"start": 563.31, "end": 563.75, "word": " تبع", "probability": 0.7538248697916666}, {"start": 563.75, "end": 564.39, "word": " Songsen", "probability": 0.1590576171875}, {"start": 564.39, "end": 564.91, "word": " Logmar", "probability": 0.5794677734375}, {"start": 564.91, "end": 565.31, "word": " Test", "probability": 0.496826171875}, {"start": 565.31, "end": 566.29, "word": " عبارة", "probability": 0.9766845703125}, {"start": 566.29, "end": 566.43, "word": " عن", 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0.932861328125}, {"start": 570.97, "end": 571.47, "word": " هذا", "probability": 0.904296875}, {"start": 571.47, "end": 571.95, "word": " تقييم", "probability": 0.9757486979166666}, {"start": 571.95, "end": 572.37, "word": " دقيق", "probability": 0.9851888020833334}, {"start": 572.37, "end": 572.79, "word": " بيكون", "probability": 0.93212890625}, {"start": 572.79, "end": 573.17, "word": " طبعا", "probability": 0.9542236328125}, {"start": 573.17, "end": 573.35, "word": " مش", "probability": 0.994140625}, {"start": 573.35, "end": 573.51, "word": " ال", "probability": 0.71728515625}, {"start": 573.51, "end": 573.75, "word": " single", "probability": 0.93896484375}, {"start": 573.75, "end": 574.15, "word": " letter", "probability": 0.9658203125}, {"start": 574.15, "end": 574.69, "word": " وإنما", "probability": 0.78863525390625}, {"start": 574.69, "end": 574.81, "word": " هو", "probability": 0.94482421875}, {"start": 574.81, "end": 575.33, "word": " بنعمل", "probability": 0.8367513020833334}, {"start": 575.33, "end": 575.79, "word": " training", "probability": 0.92919921875}, {"start": 575.79, "end": 576.49, "word": " للطفل", "probability": 0.9610595703125}, {"start": 576.49, "end": 577.23, "word": " بعدين", "probability": 0.768798828125}, {"start": 577.23, "end": 577.39, "word": " من", "probability": 0.9951171875}, {"start": 577.39, "end": 577.51, "word": " ال", "probability": 0.96337890625}, {"start": 577.51, "end": 577.91, "word": " training", "probability": 0.96240234375}, {"start": 577.91, "end": 578.63, "word": " بينقل", "probability": 0.81982421875}, {"start": 578.63, "end": 578.81, "word": " لل", "probability": 0.787109375}, {"start": 578.81, "end": 579.13, "word": " single", "probability": 0.962890625}, {"start": 579.13, "end": 579.55, "word": " letter", "probability": 0.97314453125}, {"start": 579.55, "end": 579.93, "word": " بعدين", "probability": 0.862548828125}, {"start": 579.93, "end": 580.05, "word": " من", "probability": 0.994140625}, {"start": 580.05, "end": 580.19, "word": " ال", "probability": 0.953125}, {"start": 580.19, "end": 580.47, "word": " single", "probability": 0.95654296875}, {"start": 580.47, "end": 580.81, "word": " letter", "probability": 0.9755859375}, {"start": 580.81, "end": 581.51, "word": " بينقل", "probability": 0.9249267578125}, {"start": 581.51, "end": 582.47, "word": " للأدق", "probability": 0.8167724609375}, {"start": 582.47, "end": 582.69, "word": " اللي", "probability": 0.967529296875}, {"start": 582.69, "end": 582.99, "word": " هي", "probability": 0.9169921875}, {"start": 582.99, "end": 583.29, "word": " ال", "probability": 0.94189453125}, {"start": 583.29, "end": 583.67, "word": " linear", "probability": 0.947265625}, {"start": 583.67, "end": 584.75, "word": " display", "probability": 0.9462890625}], "temperature": 1.0}, {"id": 27, "seek": 61389, "start": 586.25, "end": 613.89, "text": "أذن at age three years most children will be able to undertake the matching of letter optotypes as in the Keillor-Lagmar or Songsten crowded tests طيب if crowded letters و هذا كلام غاية في الأهمية if a crowded letter test proves too difficult it is preferable to perform the crowded key picture than to use single optotype letters نفرض الطفل", "tokens": [10721, 8848, 1863, 412, 3205, 1045, 924, 881, 2227, 486, 312, 1075, 281, 37010, 264, 14324, 295, 5063, 2427, 19477, 382, 294, 264, 3189, 373, 284, 12, 43, 559, 6209, 420, 11862, 6266, 21634, 6921, 23032, 1829, 3555, 498, 21634, 7825, 4032, 23758, 28242, 10943, 32771, 995, 10632, 8978, 16247, 16095, 10632, 498, 257, 21634, 5063, 1500, 25019, 886, 2252, 309, 307, 4382, 712, 281, 2042, 264, 21634, 2141, 3036, 813, 281, 764, 2167, 2427, 13108, 7825, 8717, 5172, 43042, 41950, 5172, 1211], "avg_logprob": -0.26469495005550836, "compression_ratio": 1.4784313725490197, "no_speech_prob": 0.0, "words": [{"start": 586.25, "end": 586.69, "word": "أذن", "probability": 0.5415852864583334}, {"start": 586.69, "end": 586.93, "word": " at", "probability": 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591.69, "end": 591.93, "word": " of", "probability": 0.98486328125}, {"start": 591.93, "end": 592.27, "word": " letter", "probability": 0.7763671875}, {"start": 592.27, "end": 593.07, "word": " optotypes", "probability": 0.908935546875}, {"start": 593.07, "end": 593.91, "word": " as", "probability": 0.9462890625}, {"start": 593.91, "end": 594.17, "word": " in", "probability": 0.9658203125}, {"start": 594.17, "end": 594.37, "word": " the", "probability": 0.833984375}, {"start": 594.37, "end": 594.79, "word": " Keillor", "probability": 0.4365234375}, {"start": 594.79, "end": 595.41, "word": "-Lagmar", "probability": 0.66583251953125}, {"start": 595.41, "end": 596.07, "word": " or", "probability": 0.79052734375}, {"start": 596.07, "end": 596.63, "word": " Songsten", "probability": 0.368896484375}, {"start": 596.63, "end": 597.21, "word": " crowded", "probability": 0.49755859375}, {"start": 597.21, "end": 597.79, "word": " tests", "probability": 0.814453125}, {"start": 597.79, "end": 598.65, "word": " طيب", "probability": 0.7967122395833334}, {"start": 598.65, "end": 599.17, "word": " if", "probability": 0.5009765625}, {"start": 599.17, "end": 599.75, "word": " crowded", "probability": 0.60009765625}, {"start": 599.75, "end": 600.11, "word": " letters", "probability": 0.83056640625}, {"start": 600.11, "end": 600.23, "word": " و", "probability": 0.3828125}, {"start": 600.23, "end": 600.37, "word": " هذا", "probability": 0.497314453125}, {"start": 600.37, "end": 600.75, "word": " كلام", "probability": 0.974609375}, {"start": 600.75, "end": 601.23, "word": " غاية", "probability": 0.7600911458333334}, {"start": 601.23, "end": 601.41, "word": " في", "probability": 0.9560546875}, {"start": 601.41, "end": 602.09, "word": " الأهمية", "probability": 0.9892578125}, {"start": 602.09, "end": 602.67, "word": " if", "probability": 0.91064453125}, {"start": 602.67, "end": 602.89, "word": " a", "probability": 0.994140625}, {"start": 602.89, "end": 603.25, "word": " crowded", "probability": 0.75927734375}, {"start": 603.25, "end": 603.65, "word": " letter", "probability": 0.82763671875}, {"start": 603.65, "end": 604.09, "word": " test", "probability": 0.94921875}, {"start": 604.09, "end": 604.59, "word": " proves", "probability": 0.92578125}, {"start": 604.59, "end": 604.95, "word": " too", "probability": 0.92529296875}, {"start": 604.95, "end": 605.61, "word": " difficult", "probability": 0.94091796875}, {"start": 605.61, "end": 606.37, "word": " it", "probability": 0.94482421875}, {"start": 606.37, "end": 606.61, "word": " is", "probability": 0.955078125}, {"start": 606.61, "end": 607.39, "word": " preferable", "probability": 0.982421875}, {"start": 607.39, "end": 607.63, "word": " to", "probability": 0.98828125}, {"start": 607.63, "end": 608.13, "word": " perform", "probability": 0.837890625}, {"start": 608.13, "end": 608.39, "word": " the", "probability": 0.92333984375}, {"start": 608.39, "end": 608.87, "word": " crowded", "probability": 0.74267578125}, {"start": 608.87, "end": 609.21, "word": " key", "probability": 0.4404296875}, {"start": 609.21, "end": 609.65, "word": " picture", "probability": 0.90673828125}, {"start": 609.65, "end": 610.07, "word": " than", "probability": 0.8994140625}, {"start": 610.07, "end": 610.31, "word": " to", "probability": 0.97265625}, {"start": 610.31, "end": 610.59, "word": " use", "probability": 0.890625}, {"start": 610.59, "end": 611.03, "word": " single", "probability": 0.94287109375}, {"start": 611.03, "end": 611.65, "word": " optotype", "probability": 0.90673828125}, {"start": 611.65, "end": 612.11, "word": " letters", "probability": 0.8603515625}, {"start": 612.11, "end": 613.21, "word": " نفرض", "probability": 0.9720052083333334}, {"start": 613.21, "end": 613.89, "word": " الطفل", "probability": 0.9772135416666666}], "temperature": 1.0}, {"id": 28, "seek": 61610, "start": 615.08, "end": 616.1, "text": "نفرض الطفل", "tokens": [1863, 5172, 43042, 41950, 5172, 1211], "avg_logprob": -0.036132813564368656, "compression_ratio": 0.6785714285714286, "no_speech_prob": 0.0, "words": [{"start": 615.08, "end": 615.56, "word": "نفرض", "probability": 0.9637044270833334}, {"start": 615.56, "end": 616.1, "word": " الطفل", "probability": 0.97216796875}], "temperature": 1.0}, {"id": 29, "seek": 64811, "start": 618.91, "end": 648.11, "text": "تم تدريبه ثم نقل لفحصه على الكتيب رقم B في ال song in logmar test اللي هو عبارة عن single letter display عبارة عن عرض ل single letters و أدى كويس طيب هجينا نقلناه على ال booklet C أو ال booklet D الكتيب رقم C أو D اللي بيعرضولي يعني crowded letters ماقدرش يؤدي بالمرة عليهم هل أكتفي و أقول طالما عرف ال single letter و أسجل", "tokens": [39237, 6055, 3215, 16572, 3555, 3224, 38637, 2304, 8717, 4587, 1211, 5296, 5172, 5016, 9381, 3224, 15844, 33251, 31371, 3555, 12602, 4587, 2304, 363, 8978, 2423, 2153, 294, 3565, 6209, 1500, 13672, 1829, 31439, 6225, 3555, 9640, 3660, 18871, 2167, 5063, 4674, 6225, 3555, 9640, 3660, 18871, 6225, 43042, 5296, 2167, 7825, 4032, 5551, 3215, 7578, 9122, 45865, 3794, 23032, 1829, 3555, 8032, 7435, 1829, 8315, 8717, 4587, 1211, 8315, 3224, 15844, 2423, 48469, 383, 34051, 2423, 48469, 413, 33251, 31371, 3555, 12602, 4587, 2304, 383, 34051, 413, 13672, 1829, 4724, 40228, 43042, 12610, 1829, 37495, 22653, 21634, 7825, 19446, 28543, 2288, 8592, 7251, 33604, 16254, 20666, 2304, 25720, 25894, 16095, 8032, 1211, 5551, 4117, 2655, 41185, 4032, 5551, 39648, 23032, 6027, 15042, 6225, 28480, 2423, 2167, 5063, 4032, 5551, 3794, 7435, 1211], "avg_logprob": -0.16802704723468467, "compression_ratio": 1.8239700374531835, "no_speech_prob": 0.0, "words": [{"start": 618.91, "end": 619.17, "word": "تم", "probability": 0.97119140625}, {"start": 619.17, "end": 619.87, "word": " تدريبه", "probability": 0.9919921875}, {"start": 619.87, "end": 620.49, "word": " ثم", "probability": 0.888671875}, {"start": 620.49, "end": 620.97, "word": " نقل", "probability": 0.9650065104166666}, {"start": 620.97, "end": 622.19, "word": " 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"word": " level", "probability": 0.8037109375}, {"start": 652.0, "end": 652.2, "word": " اللي", "probability": 0.7822265625}, {"start": 652.2, "end": 652.84, "word": " وصله", "probability": 0.78857421875}, {"start": 652.84, "end": 654.08, "word": " ولا", "probability": 0.6044921875}, {"start": 654.08, "end": 654.72, "word": " اش", "probability": 0.5458984375}, {"start": 654.72, "end": 655.18, "word": " اعمل", "probability": 0.9366861979166666}, {"start": 655.18, "end": 655.76, "word": " طبعا", "probability": 0.892333984375}, {"start": 655.76, "end": 656.06, "word": " لأ", "probability": 0.712646484375}, {"start": 656.06, "end": 656.5, "word": " لأن", "probability": 0.71923828125}, {"start": 656.5, "end": 656.96, "word": " ال", "probability": 0.7158203125}, {"start": 656.96, "end": 657.72, "word": " single", "probability": 0.87109375}, {"start": 657.72, "end": 658.12, "word": " letter", "probability": 0.923828125}, {"start": 658.12, "end": 658.52, "word": " test", "probability": 0.96044921875}, {"start": 658.52, "end": 658.82, "word": " مش", "probability": 0.9833984375}, {"start": 658.82, "end": 659.42, "word": " دقيق", "probability": 0.9881184895833334}, {"start": 659.42, "end": 660.6, "word": " فالطفل", "probability": 0.9837890625}, {"start": 660.6, "end": 660.74, "word": " في", "probability": 0.9521484375}, {"start": 660.74, "end": 660.96, "word": " هذه", "probability": 0.83544921875}, {"start": 660.96, "end": 661.4, "word": " الحالة", "probability": 0.9684244791666666}, {"start": 661.4, "end": 661.66, "word": " اذا", "probability": 0.783935546875}, {"start": 661.66, "end": 661.8, "word": " ما", "probability": 0.9462890625}, {"start": 661.8, "end": 662.48, "word": " استطاعش", "probability": 0.896728515625}, {"start": 662.48, "end": 662.72, "word": " انه", "probability": 0.890625}, {"start": 662.72, "end": 663.34, "word": " يكمل", "probability": 0.9925130208333334}, {"start": 663.34, "end": 664.02, "word": " بال", "probability": 0.931640625}, {"start": 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بدي", "probability": 0.787841796875}, {"start": 669.88, "end": 671.2, "word": " أعرضله", "probability": 0.923583984375}, {"start": 671.2, "end": 671.44, "word": " لـ", "probability": 0.571533203125}, {"start": 671.44, "end": 671.9, "word": " crowded", "probability": 0.26513671875}, {"start": 671.9, "end": 673.14, "word": " k", "probability": 0.72021484375}, {"start": 673.14, "end": 673.58, "word": " picture", "probability": 0.576171875}, {"start": 673.58, "end": 674.26, "word": " لـ", "probability": 0.4940185546875}, {"start": 674.26, "end": 674.62, "word": " crowded", "probability": 0.50390625}, {"start": 674.62, "end": 674.96, "word": " k", "probability": 0.9501953125}, {"start": 674.96, "end": 675.34, "word": " picture", "probability": 0.88623046875}, {"start": 675.34, "end": 675.86, "word": " test", "probability": 0.84912109375}, {"start": 675.86, "end": 678.72, "word": " بشكل", "probability": 0.96337890625}, {"start": 678.72, "end": 679.8, "word": " أنه", "probability": 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{"start": 683.96, "end": 684.16, "word": " اللي", "probability": 0.897216796875}, {"start": 684.16, "end": 684.62, "word": " يختبر", "probability": 0.93359375}, {"start": 684.62, "end": 685.12, "word": " لعمر", "probability": 0.9656575520833334}, {"start": 685.12, "end": 686.44, "word": " سنتين", "probability": 0.8430989583333334}, {"start": 686.44, "end": 687.96, "word": " older", "probability": 0.79296875}, {"start": 687.96, "end": 688.58, "word": " children", "probability": 0.90087890625}], "temperature": 1.0}, {"id": 32, "seek": 70277, "start": 689.87, "end": 702.77, "text": "عدة تلت سنوات ووصل أربع سنوات من العمر may continue with the crowded letter test يعني بقدر أظل معاهم في ال Songsen Logmar test أو في ال Keyler Logmar test اللي هي crowded test", "tokens": [3615, 41891, 6055, 1211, 2655, 8608, 1863, 2407, 9307, 4032, 2407, 36520, 5551, 25513, 3615, 8608, 1863, 2407, 9307, 9154, 18863, 29973, 815, 2354, 365, 264, 21634, 5063, 1500, 37495, 22653, 4724, 28543, 2288, 5551, 19913, 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789.12, "end": 807.9, "text": "إنه أصبح ال logmarg chart بيعرف باسم الدراسة هاي، يعني أصبحت يعني الوسم بتاع الدراسة هاي يعني لحق بال chart فبالتالي لما بقول E T D R S chart بفهم ضمن انه هذا logmarg ات شارت، إذا ممكن أنا الأطفال في سن أربع سنوات أكمل معهم", "tokens": [28814, 1863, 3224, 5551, 9381, 49628, 2423, 3565, 6209, 70, 6927, 4724, 40228, 28480, 4724, 32277, 2304, 32748, 23557, 3794, 3660, 8032, 47302, 12399, 37495, 22653, 5551, 9381, 3555, 33753, 37495, 22653, 2423, 2407, 38251, 39894, 45761, 32748, 23557, 3794, 3660, 8032, 47302, 37495, 22653, 5296, 5016, 4587, 20666, 6927, 6156, 3555, 6027, 2655, 6027, 1829, 5296, 15042, 4724, 39648, 462, 314, 413, 497, 318, 6927, 4724, 5172, 16095, 48812, 27842, 16472, 3224, 23758, 3565, 6209, 70, 1975, 2655, 13412, 9640, 2655, 12399, 11933, 15730, 3714, 43020, 41850, 16247, 9566, 5172, 6027, 8978, 8608, 1863, 5551, 25513, 3615, 8608, 1863, 2407, 9307, 5551, 24793, 1211, 20449, 16095], "avg_logprob": -0.1741898156426571, "compression_ratio": 1.7393364928909953, "no_speech_prob": 2.980232238769531e-07, "words": [{"start": 789.12, "end": 789.48, "word": "إنه", "probability": 0.7978515625}, {"start": 789.48, "end": 789.96, "word": " أصبح", "probability": 0.98583984375}, {"start": 789.96, "end": 790.12, "word": " ال", "probability": 0.94873046875}, {"start": 790.12, "end": 790.58, "word": " logmarg", "probability": 0.312744140625}, {"start": 790.58, "end": 790.92, "word": " chart", "probability": 0.8349609375}, {"start": 790.92, "end": 791.76, "word": " بيعرف", "probability": 0.8844401041666666}, {"start": 791.76, "end": 792.2, "word": " باسم", "probability": 0.99072265625}, {"start": 792.2, "end": 792.74, "word": " الدراسة", "probability": 0.9605712890625}, {"start": 792.74, "end": 792.94, "word": " هاي،", "probability": 0.505126953125}, {"start": 792.94, "end": 793.12, "word": " يعني", "probability": 0.96630859375}, {"start": 793.12, "end": 793.68, "word": " أصبحت", "probability": 0.9388427734375}, {"start": 793.68, "end": 794.0, "word": " يعني", "probability": 0.93896484375}, {"start": 794.0, "end": 794.86, "word": " الوسم", "probability": 0.7142740885416666}, {"start": 794.86, "end": 795.18, "word": " بتاع", "probability": 0.967529296875}, {"start": 795.18, "end": 795.7, "word": " الدراسة", "probability": 0.994140625}, {"start": 795.7, "end": 795.98, "word": " هاي", "probability": 0.833984375}, {"start": 795.98, "end": 796.6, "word": " يعني", "probability": 0.94970703125}, {"start": 796.6, "end": 797.2, "word": " لحق", "probability": 0.96923828125}, {"start": 797.2, "end": 797.4, "word": " بال", "probability": 0.974609375}, {"start": 797.4, "end": 797.8, "word": " chart", "probability": 0.82861328125}, {"start": 797.8, "end": 798.44, "word": " فبالتالي", "probability": 0.96240234375}, {"start": 798.44, "end": 798.88, "word": " لما", "probability": 0.9345703125}, {"start": 798.88, "end": 799.24, "word": " بقول", "probability": 0.98388671875}, {"start": 799.24, "end": 799.52, "word": " E", "probability": 0.27734375}, {"start": 799.52, "end": 799.66, "word": " T", "probability": 0.5810546875}, {"start": 799.66, "end": 799.86, "word": " D", "probability": 0.94189453125}, {"start": 799.86, "end": 800.12, "word": " R", "probability": 0.98828125}, {"start": 800.12, "end": 800.36, "word": " S", "probability": 0.97216796875}, {"start": 800.36, "end": 800.78, "word": " chart", "probability": 0.74462890625}, {"start": 800.78, "end": 801.26, "word": " بفهم", "probability": 0.9651692708333334}, {"start": 801.26, "end": 801.58, "word": " ضمن", "probability": 0.974365234375}, {"start": 801.58, "end": 801.92, "word": " انه", "probability": 0.5064697265625}, {"start": 801.92, "end": 802.2, "word": " هذا", "probability": 0.88623046875}, {"start": 802.2, "end": 803.2, "word": " logmarg", "probability": 0.90283203125}, {"start": 803.2, "end": 803.42, "word": " ات", "probability": 0.6829833984375}, {"start": 803.42, "end": 803.82, "word": " شارت،", "probability": 0.8291015625}, {"start": 803.82, "end": 804.08, "word": " إذا", "probability": 0.727294921875}, {"start": 804.08, "end": 804.8, "word": " ممكن", "probability": 0.99169921875}, {"start": 804.8, "end": 805.0, "word": " أنا", "probability": 0.6494140625}, {"start": 805.0, "end": 805.52, "word": " الأطفال", "probability": 0.9952392578125}, {"start": 805.52, "end": 805.7, "word": " في", "probability": 0.97509765625}, {"start": 805.7, "end": 805.92, "word": " سن", "probability": 0.9931640625}, {"start": 805.92, "end": 806.28, "word": " أربع", "probability": 0.8557942708333334}, {"start": 806.28, "end": 806.86, "word": " سنوات", "probability": 0.9398193359375}, {"start": 806.86, "end": 807.5, "word": " أكمل", "probability": 0.9586588541666666}, {"start": 807.5, "end": 807.9, "word": " معهم", "probability": 0.9560546875}], "temperature": 1.0}, {"id": 38, "seek": 82301, "start": 808.43, "end": 823.01, "text": "بالkeyler logmar test crowded test أو بالsungsen logmar test ايضا crowded test او انتقل عشان افحصهم بفحوصات الكبار اللي هي زي ال ATDRS chart may be used", "tokens": [3555, 6027, 4119, 1918, 3565, 6209, 1500, 21634, 1500, 34051, 20666, 32052, 6748, 3565, 6209, 1500, 1975, 1829, 11242, 995, 21634, 1500, 1975, 2407, 16472, 2655, 4587, 1211, 6225, 8592, 7649, 1975, 5172, 5016, 9381, 16095, 4724, 5172, 5016, 2407, 9381, 9307, 33251, 3555, 9640, 13672, 1829, 39896, 30767, 1829, 2423, 8872, 9301, 50, 6927, 815, 312, 1143], "avg_logprob": -0.2775423789428452, "compression_ratio": 1.3161290322580645, "no_speech_prob": 2.980232238769531e-07, "words": [{"start": 808.43, "end": 809.21, "word": "بالkeyler", "probability": 0.65655517578125}, {"start": 809.21, "end": 809.75, "word": " logmar", "probability": 0.524169921875}, {"start": 809.75, "end": 810.13, "word": " test", "probability": 0.7900390625}, {"start": 810.13, "end": 810.71, "word": " crowded", "probability": 0.2100830078125}, {"start": 810.71, "end": 811.29, "word": " test", "probability": 0.94091796875}, {"start": 811.29, "end": 812.05, "word": " أو", "probability": 0.8251953125}, {"start": 812.05, "end": 812.81, "word": " بالsungsen", "probability": 0.3827311197916667}, {"start": 812.81, "end": 813.35, "word": " logmar", "probability": 0.95751953125}, {"start": 813.35, "end": 813.63, "word": " test", "probability": 0.94384765625}, {"start": 813.63, "end": 814.05, "word": " ايضا", "probability": 0.8302001953125}, {"start": 814.05, "end": 814.47, "word": " crowded", "probability": 0.611328125}, {"start": 814.47, "end": 814.99, "word": " test", "probability": 0.95703125}, {"start": 814.99, "end": 815.49, "word": " او", "probability": 0.757080078125}, {"start": 815.49, "end": 816.05, "word": " انتقل", "probability": 0.890380859375}, {"start": 816.05, "end": 816.71, "word": " عشان", "probability": 0.9230143229166666}, {"start": 816.71, "end": 817.31, "word": " افحصهم", "probability": 0.883984375}, {"start": 817.31, "end": 818.01, "word": " بفحوصات", "probability": 0.9659830729166666}, {"start": 818.01, "end": 818.63, "word": " الكبار", "probability": 0.9309895833333334}, {"start": 818.63, "end": 819.17, "word": " اللي", "probability": 0.893310546875}, {"start": 819.17, "end": 819.47, "word": " هي", "probability": 0.93701171875}, {"start": 819.47, "end": 820.43, "word": " زي", "probability": 0.947021484375}, {"start": 820.43, "end": 820.55, "word": " ال", "probability": 0.92822265625}, {"start": 820.55, "end": 821.69, "word": " ATDRS", "probability": 0.7320963541666666}, {"start": 821.69, "end": 822.21, "word": " chart", "probability": 0.8349609375}, {"start": 822.21, "end": 822.49, "word": " may", "probability": 0.60400390625}, {"start": 822.49, "end": 822.69, "word": " be", "probability": 0.85009765625}, {"start": 822.69, "end": 823.01, "word": " used", "probability": 0.85302734375}], "temperature": 1.0}, {"id": 39, "seek": 84748, "start": 823.92, "end": 847.48, "text": "لغمارة شارت أو لغمارة test are in common usage and are preferable to snailing for all children at risk of ampliopia يعني لو عندى طفل عنده خطر او متوقع ان يكون فيه risk of ampliopia وعندي متوفر ال snailing acuity chart وعندي متوفر اللغمارة chart بستعمل اللغمارة chart لأنه أدق", "tokens": [1211, 17082, 2304, 9640, 3660, 13412, 9640, 2655, 34051, 5296, 17082, 2304, 9640, 3660, 1500, 366, 294, 2689, 14924, 293, 366, 4382, 712, 281, 2406, 23315, 337, 439, 2227, 412, 3148, 295, 18648, 2081, 22376, 37495, 22653, 45164, 43242, 7578, 23032, 5172, 1211, 43242, 3224, 16490, 9566, 2288, 1975, 2407, 44650, 30543, 3615, 16472, 7251, 30544, 8978, 3224, 3148, 295, 18648, 2081, 22376, 4032, 3615, 1863, 16254, 44650, 38688, 2288, 2423, 2406, 23315, 696, 21757, 6927, 4032, 3615, 1863, 16254, 44650, 38688, 2288, 13672, 17082, 2304, 9640, 3660, 6927, 4724, 14851, 25957, 1211, 13672, 17082, 2304, 9640, 3660, 6927, 5296, 33456, 3224, 5551, 3215, 4587], "avg_logprob": -0.21108490045902864, "compression_ratio": 1.7272727272727273, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 823.9200000000001, "end": 824.72, "word": "لغمارة", "probability": 0.618798828125}, {"start": 824.72, "end": 825.26, "word": " شارت", "probability": 0.8030598958333334}, {"start": 825.26, "end": 825.68, "word": " أو", "probability": 0.64453125}, {"start": 825.68, "end": 826.3, "word": " لغمارة", "probability": 0.8962890625}, {"start": 826.3, "end": 826.6, "word": " test", "probability": 0.1956787109375}, {"start": 826.6, "end": 826.88, "word": " are", "probability": 0.8134765625}, {"start": 826.88, "end": 827.12, "word": " in", "probability": 0.91162109375}, {"start": 827.12, "end": 827.46, "word": " common", "probability": 0.89404296875}, {"start": 827.46, "end": 827.88, "word": " usage", "probability": 0.9560546875}, {"start": 827.88, "end": 828.18, "word": " and", "probability": 0.91162109375}, {"start": 828.18, "end": 828.5, "word": " are", "probability": 0.9189453125}, {"start": 828.5, "end": 830.5, "word": " preferable", "probability": 0.966796875}, {"start": 830.5, "end": 831.0, "word": " to", "probability": 0.80810546875}, {"start": 831.0, "end": 831.44, "word": " snailing", "probability": 0.337158203125}, {"start": 831.44, "end": 831.72, "word": " for", "probability": 0.94970703125}, {"start": 831.72, "end": 832.1, "word": " all", "probability": 0.94580078125}, {"start": 832.1, "end": 832.68, "word": " children", "probability": 0.88134765625}, {"start": 832.68, "end": 832.96, "word": " at", "probability": 0.96923828125}, {"start": 832.96, "end": 833.28, "word": " risk", "probability": 0.939453125}, {"start": 833.28, "end": 833.52, "word": " of", "probability": 0.974609375}, {"start": 833.52, "end": 834.18, "word": " ampliopia", "probability": 0.6656087239583334}, {"start": 834.18, "end": 834.72, "word": " يعني", "probability": 0.919189453125}, {"start": 834.72, "end": 834.88, "word": " لو", "probability": 0.96630859375}, {"start": 834.88, "end": 835.24, "word": " عندى", "probability": 0.5784912109375}, {"start": 835.24, "end": 835.58, "word": " طفل", "probability": 0.9934895833333334}, {"start": 835.58, "end": 835.92, "word": " عنده", "probability": 0.9951171875}, {"start": 835.92, "end": 836.34, "word": " خطر", "probability": 0.99609375}, {"start": 836.34, "end": 836.52, "word": " او", "probability": 0.87255859375}, {"start": 836.52, "end": 837.04, "word": " متوقع", "probability": 0.9720052083333334}, {"start": 837.04, "end": 837.14, "word": " ان", "probability": 0.771484375}, {"start": 837.14, "end": 837.38, "word": " يكون", "probability": 0.92578125}, {"start": 837.38, "end": 837.62, "word": " فيه", "probability": 0.759521484375}, {"start": 837.62, "end": 837.9, "word": " risk", "probability": 0.984375}, {"start": 837.9, "end": 838.12, "word": " of", "probability": 0.98681640625}, {"start": 838.12, "end": 838.9, "word": " ampliopia", "probability": 0.7530924479166666}, {"start": 838.9, "end": 839.76, "word": " وعندي", "probability": 0.9119873046875}, {"start": 839.76, "end": 840.4, "word": " متوفر", "probability": 0.9847005208333334}, {"start": 840.4, "end": 840.52, "word": " ال", "probability": 0.2998046875}, {"start": 840.52, "end": 841.06, "word": " snailing", "probability": 0.855224609375}, {"start": 841.06, "end": 842.0, "word": " acuity", "probability": 0.856201171875}, {"start": 842.0, "end": 842.56, "word": " chart", "probability": 0.9384765625}, {"start": 842.56, "end": 843.06, "word": " وعندي", "probability": 0.9761962890625}, {"start": 843.06, "end": 843.68, "word": " متوفر", "probability": 0.9930013020833334}, {"start": 843.68, "end": 844.5, "word": " اللغمارة", "probability": 0.8137939453125}, {"start": 844.5, "end": 844.84, "word": " chart", "probability": 0.69775390625}, {"start": 844.84, "end": 845.74, "word": " بستعمل", "probability": 0.9224853515625}, {"start": 845.74, "end": 846.38, "word": " اللغمارة", "probability": 0.9767578125}, {"start": 846.38, "end": 846.64, "word": " chart", "probability": 0.76123046875}, {"start": 846.64, "end": 846.96, "word": " لأنه", "probability": 0.8447265625}, {"start": 846.96, "end": 847.48, "word": " أدق", "probability": 0.8004557291666666}], "temperature": 1.0}, {"id": 40, "seek": 87653, "start": 847.85, "end": 876.53, "text": "و بالذات بيكتشفلي ال amblyopia ومش بس بيكتشف ال amblyopia و أيضا يعني بي .. بي .. بيتبع موضوع العلاج والتطور هل في تحسن ولا مش تحسن بشكل أدق من ال Snelling's chart هنا عشان نشوف هذا Snelling's chart هذا نموذج ل Snelling's chart وهذا نموذج ل ال log married chart أول حاجة في قضية ال crowding واضح أنه في عندي في ال log married chart", "tokens": [2407, 20666, 8848, 9307, 4724, 1829, 4117, 2655, 8592, 5172, 20292, 2423, 3913, 356, 22376, 4032, 2304, 8592, 4724, 3794, 4724, 1829, 4117, 2655, 8592, 5172, 2423, 3913, 356, 22376, 4032, 36632, 11242, 995, 37495, 22653, 4724, 1829, 4386, 4724, 1829, 4386, 4724, 36081, 3555, 3615, 3714, 2407, 11242, 45367, 18863, 1211, 26108, 16070, 2655, 9566, 13063, 8032, 1211, 8978, 6055, 5016, 3794, 1863, 49429, 37893, 6055, 5016, 3794, 1863, 4724, 8592, 28820, 5551, 3215, 4587, 9154, 2423, 41336, 2669, 311, 6927, 34105, 6225, 8592, 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"word": " ورحمة", "probability": 0.982421875}, {"start": 1050.82, "end": 1051.12, "word": " الله", "probability": 0.97705078125}, {"start": 1051.12, "end": 1051.94, "word": " وبركة", "probability": 0.8609619140625}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 1051.9568125, "duration_after_vad": 1029.8331250000012} \ No newline at end of file diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/0hARiudOoQ4_raw.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/0hARiudOoQ4_raw.srt new file mode 100644 index 0000000000000000000000000000000000000000..624925acfe93e72e109758a153007c25ee729fba --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/0hARiudOoQ4_raw.srt @@ -0,0 +1,948 @@ +1 +00:00:01,520 --> 00:00:05,340 +بسم الله الرحمن الرحيم بنماصل مع محاضرات حوال واحد + +2 +00:00:05,340 --> 00:00:09,080 +واتوقفنا عند ال testing in verbal children + +3 +00:00:09,080 --> 00:00:13,420 +المحاضرة السابقة كانت على ال testing in pre-verbal + +4 +00:00:13,420 --> 00:00:16,820 +children اللي هو فحص النظر عند الأطفال ما قبل + +5 +00:00:16,820 --> 00:00:21,580 +مرحلة النطق اليوم بدنا نفحص النظر عند الأطفال اللي + +6 +00:00:21,580 --> 00:00:27,110 +بدوا يتكلموا ونشوف كيف بيتم هدع الأمرall of the + +7 +00:00:27,110 --> 00:00:30,610 +tests described below are performed at three or + +8 +00:00:30,610 --> 00:00:34,070 +four meters يعني ال testات عند ال verbal children + +9 +00:00:34,070 --> 00:00:40,710 +يتم أدائها على بعد تلاتة لاربعة متر at which .. + +10 +00:00:40,710 --> 00:00:44,110 +ليش؟ at which it is easier to obtain compliance + +11 +00:00:44,110 --> 00:00:49,290 +الطفل لما أكون أنا بعيد عنه ستة متر ممكن ما ينتبهش + +12 +00:00:49,290 --> 00:00:55,430 +إلي كتير أو ممكنيعني يلفت انتباهه لأشياء تانية في + +13 +00:00:55,430 --> 00:00:58,530 +غرفة الفحص فبالتالي مابيكونش completely .. + +14 +00:00:58,530 --> 00:01:02,410 +مابيكونش متعاون معايا على الفحص على بعد 6 متر زي + +15 +00:01:02,410 --> 00:01:07,470 +ما هيكون متعاون لو انا اقتربت لبعد 3 او 4 أمتار + +16 +00:01:07,470 --> 00:01:12,750 +with little or no clinical detriment بمعنى انه لما + +17 +00:01:12,750 --> 00:01:18,870 +انا بجرب ل3 او 4 أمتار مش كتير من ناحيةطبية بتفرج + +18 +00:01:18,870 --> 00:01:24,210 +النتائج في الفحص، يعني إذا كان فيه فرق هيكون فرق + +19 +00:01:24,210 --> 00:01:28,470 +بسيط جدا أو مش موجود It is important to note that + +20 +00:01:28,470 --> 00:01:32,710 +amblyopia can only be accurately diagnosed using a + +21 +00:01:32,710 --> 00:01:36,440 +crowded testإذا أنا بدأ أكتشف إن في عند الطفل + +22 +00:01:36,440 --> 00:01:41,220 +amblyopia مش لازم أستعمل single letter test أو + +23 +00:01:41,220 --> 00:01:45,620 +single picture test يعني مش لازم أستعمل test مافيش + +24 +00:01:45,620 --> 00:01:51,150 +فيه crowding إنما عشان أكتشف الamblyopiaلابد انه + +25 +00:01:51,150 --> 00:01:55,770 +استعمل crowded test هذه الـ crowded test بتطلب + +26 +00:01:55,770 --> 00:02:00,470 +target recognition يعني التعرف على ال target مش + +27 +00:02:00,470 --> 00:02:07,650 +مجرد رؤيته فقط and that لجمار test اللي هي ال + +28 +00:02:07,650 --> 00:02:12,240 +chartsاللي بتعتمد على مبدأ الـ logarithm of the + +29 +00:02:12,240 --> 00:02:16,480 +minimum angle of resolution provide the best + +30 +00:02:16,480 --> 00:02:19,700 +measure against which improvement with amblyopia + +31 +00:02:19,700 --> 00:02:24,020 +therapy can be assessed بمعنى لما بستعمل أي من + +32 +00:02:24,020 --> 00:02:27,600 +اللجمارة charts، في عدد كبير جدا من اللجمارة + +33 +00:02:27,600 --> 00:02:31,450 +charts، أنواع كثيرة منهاكلها بتعتمد على مبدأ ال + +34 +00:02:31,450 --> 00:02:35,030 +logarithm of the minimum angle of resolution لما + +35 +00:02:35,030 --> 00:02:39,310 +باستعمل أي واحد منها هذا يعتبر أفضل test ممكن + +36 +00:02:39,310 --> 00:02:44,110 +استعمله عشان أشوف هل في تحسن في علاج الأمبيوبيا + +37 +00:02:44,110 --> 00:02:47,430 +لدى الطفل طبعا علاج الأمبيوبيا بال occlusion + +38 +00:02:47,430 --> 00:02:50,710 +therapy أو بال penalization ولا مافيش تحسن + +39 +00:02:50,710 --> 00:02:54,690 +فبالتالي أفضل test أستعملها في هذا القمر هي اللجمع + +40 +00:02:54,690 --> 00:02:59,640 +tests أو اللجمع charts وحنشوف صور لبعضهاthese are + +41 +00:02:59,640 --> 00:03:03,880 +readily available اللي هي لجمارة شارتز يعني موجودة + +42 +00:03:03,880 --> 00:03:11,280 +ومتوفرة في الأسواق وفي الأماكن اللي بتوفرها بأشكال + +43 +00:03:11,280 --> 00:03:14,960 +مناسبة من عمر سنتين فما فوق من عمر سنتين يعني ممكن + +44 +00:03:14,960 --> 00:03:18,680 +إنسان يسأل يقول طب أنا عايز أفحص الطفل ب لجمارة + +45 +00:03:18,680 --> 00:03:23,440 +شارتز بس مش ملاقي لجمارة شارتز يعني لهذا الطفل لأ + +46 +00:03:23,440 --> 00:03:28,910 +بنقول من عمر سنتين فأكثريوجد في الأسواق logmark + +47 +00:03:28,910 --> 00:03:33,690 +chart مناسبة لهذا السن فما فوه فما فوه بالتالي + +48 +00:03:33,690 --> 00:03:38,190 +بنبدأ من عمر سنتين كيف يفحص الطفل at age two years + +49 +00:03:38,190 --> 00:03:42,450 +most children will have sufficient language skills + +50 +00:03:42,450 --> 00:03:46,250 +to undertakea picture naming test such as the + +51 +00:03:46,250 --> 00:03:51,130 +crowded k pictures يعني من عمر سنتين فأكثر بنلاقي + +52 +00:03:51,130 --> 00:03:56,250 +غالبية الأطفال مش كلهم طبعا غالبية الأطفال عندهم + +53 +00:03:56,250 --> 00:03:59,830 +ما يكفي من المهارات اللغوية عندهم ما يكفي من + +54 +00:03:59,830 --> 00:04:04,030 +المهارات اللغوية عشان لما أعرضله picture زي ال + +55 +00:04:04,030 --> 00:04:08,530 +crowded picture test اللي احنا سايفينهبيقدر يسميه + +56 +00:04:08,530 --> 00:04:11,310 +يعني picture naming، بيقدر يسمي هذا ال picture، + +57 +00:04:11,310 --> 00:04:13,830 +بيقدر يقول عن هاي ساعة أو عن هاي سمكة أو عن هاي + +58 +00:04:13,830 --> 00:04:17,110 +بطة أو عن هاي سيارة، فبالتالي كتير من الأطفال + +59 +00:04:17,110 --> 00:04:21,310 +بيستطيعوا في عمر سنتين أنه يسمي الرسومات اللي هو + +60 +00:04:21,310 --> 00:04:24,820 +شايف .. شايفهاوإذا ملاحظين هنا ماحكيناش كيه + +61 +00:04:24,820 --> 00:04:27,980 +pictures حكينا crowded كيه pictures لأنه في كيه + +62 +00:04:27,980 --> 00:04:31,840 +pictures single test بيكون كل رسمة في صفحة لوحدة + +63 +00:04:31,840 --> 00:04:38,000 +وهذا طبعا هذا ال test مش دقيق بالمرة بالذات لما + +64 +00:04:38,000 --> 00:04:42,200 +أكون أنا شاكك أنه عند الطفل في amblyopia في + +65 +00:04:42,200 --> 00:04:46,210 +amblyopia هذا الدفتراللي هو ال k picture test هنا + +66 +00:04:46,210 --> 00:04:50,430 +مكتوب single crowded book single لل book بس في كل + +67 +00:04:50,430 --> 00:04:54,410 +صفحة في crowded pictures يعني أكتر من صورة يعني في + +68 +00:04:54,410 --> 00:04:58,290 +عندي مثلا هنا ست صف .. ست رسمات في صفحة واحد هذه + +69 +00:04:58,290 --> 00:05:02,950 +الصفحة عبارة عن يعني صفحة من ضمن هذا الكتاب إذا k + +70 +00:05:02,950 --> 00:05:07,490 +picture test عبارة عن كتابA crowded book .. + +71 +00:05:07,490 --> 00:05:11,590 +crowded book يعني في كل شريحة منه أو في كل صفحة + +72 +00:05:11,590 --> 00:05:17,150 +منه أو في كل لوحة من لوحاته فيه طبعاcrowded + +73 +00:05:17,150 --> 00:05:20,770 +pictures بمعنى أكتر من صورة والطفل المفروض لما + +74 +00:05:20,770 --> 00:05:25,030 +أشره على صورة إما يعمل naming يعني يقول هذه مثلا + +75 +00:05:25,030 --> 00:05:28,570 +سيارة، هذه نجمة أو يعمل matching كيف يعمل + +76 +00:05:28,570 --> 00:05:32,710 +matching؟ أنا بمسك الكتاب هذا و بعرض الصور و بتكون + +77 +00:05:32,710 --> 00:05:38,070 +الأم حطت الطفل على حضنها و معها لوحة فيهارسومات + +78 +00:05:38,070 --> 00:05:42,050 +مشابهة بس بترتيب آخر فلمّا أنا بأشر على السيارة + +79 +00:05:42,050 --> 00:05:48,870 +المفروض الطفل يأشر على نفس الرسمة في .. على اللوحة + +80 +00:05:48,870 --> 00:05:52,690 +يعني في اللوحة اللي مع الأم في اللوحة اللي مع الأم + +81 +00:05:52,690 --> 00:05:57,530 +فبيسموها هذه matching مطابقة للرسمة اللي أنا بأشر + +82 +00:05:57,530 --> 00:06:01,130 +عليها ضروري يكون crowded test ضروري يكون crowded + +83 +00:06:01,130 --> 00:06:08,470 +test هي ال key picture ال book هذا فتحناهطبعا هي + +84 +00:06:08,470 --> 00:06:12,950 +عندي خمس رسمات بسمهم Linear Crowded Pictures أي + +85 +00:06:12,950 --> 00:06:17,190 +صورة، اتنين، تلاتة، اربعة، خمسة ليش احنا يعني + +86 +00:06:17,190 --> 00:06:22,090 +بنركز على قضية ال crowd أو ال crowding عشان قضية + +87 +00:06:22,090 --> 00:06:26,550 +ان الحياة اللي هيعيش فيها هذا الطفل يعني لا يوجد + +88 +00:06:26,550 --> 00:06:31,050 +فيها target واحد و فقط و انتهى الأمر لأ و انما عدد + +89 +00:06:31,050 --> 00:06:35,950 +لانهائي منالاجسام و الأشكال محيطة بالطفل في البيئة + +90 +00:06:35,950 --> 00:06:39,670 +المحيطة فيه فبالتالي هو مطلوب منه أنه يتعرف على + +91 +00:06:39,670 --> 00:06:44,970 +الأشكال ضمن crowding .. ضمن ال crowding phenomenon + +92 +00:06:44,970 --> 00:06:47,870 +عشان نقدر نكتشف إذا فعلا في عنده amblyopia ولا + +93 +00:06:47,870 --> 00:06:53,550 +ماعندهش amblyopia على عمر تلت سنواتيعني كبر الطفل + +94 +00:06:53,550 --> 00:06:58,370 +كمان سنة most children will be able to undertake + +95 +00:06:58,370 --> 00:07:02,090 +the matching of letters الآن بده يعمل مطابقة + +96 +00:07:02,090 --> 00:07:07,950 +للأحرف بده يكون عندنا لوحة بالأحرف ونقشر على حرف + +97 +00:07:07,950 --> 00:07:13,250 +ويكون مع الأم لوحة مشابهة بس بترتيب آخر للأحرف + +98 +00:07:13,250 --> 00:07:17,430 +ومثلا إذا حطتله على حرف ال V أشرت أنا على حرف ال V + +99 +00:07:17,430 --> 00:07:21,970 +المفروض هو يبحثفي اللوحة اللي مع الأم ويضع يده أو + +100 +00:07:21,970 --> 00:07:26,870 +يأشر على نفس الحرف بطريقة ال matching إذا at age + +101 +00:07:26,870 --> 00:07:30,530 +three years most children will be able to + +102 +00:07:30,530 --> 00:07:36,230 +undertake the matching of letter optotypes as in + +103 +00:07:36,230 --> 00:07:40,390 +the killer logmar or songsten crowded test killer + +104 +00:07:40,390 --> 00:07:43,630 +logmar أو songsten crowded test هاي ال killer + +105 +00:07:43,630 --> 00:07:50,070 +logmar نرتلع على عرض مكبرهذه عندى ال book الأول ال + +106 +00:07:50,070 --> 00:07:54,550 +chart الأول logmark crowded test طبعا killer ال + +107 +00:07:54,550 --> 00:07:58,290 +logmark crowded test chart two و chart three طبعا + +108 +00:07:58,290 --> 00:08:02,270 +كلهم killer كل واحد فيه يعني له يعني level من + +109 +00:08:02,270 --> 00:08:07,590 +تقييم حدث الإبصار عند الأطفال حدث الإبصار عند + +110 +00:08:07,590 --> 00:08:11,090 +الأطفال هذا بالنسبة لل killer ال song sin أيضا + +111 +00:08:11,090 --> 00:08:16,560 +نطلع على عرض مكبرالسونجسين في اربع booklet اربع + +112 +00:08:16,560 --> 00:08:21,080 +كتيبات عند ال booklet ايه عبارة عن training + +113 +00:08:21,080 --> 00:08:26,340 +booklet training booklet ال booklet بيه single + +114 +00:08:26,340 --> 00:08:30,640 +letter display وكأنه هذا الدفتر الاول للتدريب + +115 +00:08:30,640 --> 00:08:35,180 +الدفتر التاني مافيش فيه crowding بنعمل على تلاتة + +116 +00:08:35,180 --> 00:08:40,940 +متر بيقيم اوال pictures اللي فيه تتراوح من تمانية + +117 +00:08:40,940 --> 00:08:46,820 +من عشرة ل minus تلاتة من عشرة log mark يعني level + +118 +00:08:46,820 --> 00:08:51,700 +log mark level ال .. ال .. ال booklet C linear + +119 +00:08:51,700 --> 00:08:55,000 +display له هذا في عندي crowding هذا في عندي + +120 +00:08:55,000 --> 00:08:59,400 +crowding وهنا أيضا ال booklet D أيضا linear + +121 +00:08:59,400 --> 00:09:06,180 +display يعني عبارة عنالعديد من الأحرف .. العديد من + +122 +00:09:06,180 --> 00:09:09,420 +الأحرف زي .. يعني هذه الصفحات المأخوذة .. هذه + +123 +00:09:09,420 --> 00:09:12,320 +الصفحة و هذه الصفحة .. هدول الصفحات اللي فيهم + +124 +00:09:12,320 --> 00:09:16,640 +crowded letters هي عبارة عن .. هنلاقيها إما في + +125 +00:09:16,640 --> 00:09:22,230 +الكتيب رقم تلاتة أو الكتيب رقم أربعةطبعا الكتيب + +126 +00:09:22,230 --> 00:09:26,730 +رقم بي تبع Songsen Logmar Test عبارة عن single + +127 +00:09:26,730 --> 00:09:29,370 +letter يعني عبارة عن single letter زي ما احنا + +128 +00:09:29,370 --> 00:09:33,750 +شايفين طبعا هذا تقييم دقيق بيكون طبعا مش ال single + +129 +00:09:33,750 --> 00:09:37,510 +letter وإنما هو بنعمل training للطفل بعدين من ال + +130 +00:09:37,510 --> 00:09:40,470 +training بينقل لل single letter بعدين من ال single + +131 +00:09:40,470 --> 00:09:46,930 +letter بينقل للأدق اللي هي ال linear displayأذن at + +132 +00:09:46,930 --> 00:09:50,310 +age three years most children will be able to + +133 +00:09:50,310 --> 00:09:54,170 +undertake the matching of letter optotypes as in + +134 +00:09:54,170 --> 00:09:58,650 +the Keillor-Lagmar or Songsten crowded tests طيب + +135 +00:09:58,650 --> 00:10:02,890 +if crowded letters و هذا كلام غاية في الأهمية if a + +136 +00:10:02,890 --> 00:10:06,610 +crowded letter test proves too difficult it is + +137 +00:10:06,610 --> 00:10:10,070 +preferable to perform the crowded key picture than + +138 +00:10:10,070 --> 00:10:15,560 +to use single optotype letters نفرض الطفلنفرض + +139 +00:10:15,560 --> 00:10:16,100 +الطفل + +140 +00:10:18,910 --> 00:10:25,050 +تم تدريبه ثم نقل لفحصه على الكتيب رقم B في ال song + +141 +00:10:25,050 --> 00:10:28,290 +in logmar test اللي هو عبارة عن single letter + +142 +00:10:28,290 --> 00:10:32,630 +display عبارة عن عرض ل single letters و أدى كويس + +143 +00:10:32,630 --> 00:10:36,790 +طيب هجينا نقلناه على ال booklet C أو ال booklet D + +144 +00:10:36,790 --> 00:10:41,230 +الكتيب رقم C أو D اللي بيعرضولي يعني crowded + +145 +00:10:41,230 --> 00:10:45,870 +letters ماقدرش يؤدي بالمرة عليهم هل أكتفي و أقول + +146 +00:10:45,870 --> 00:10:48,110 +طالما عرف ال single letter و أسجل + +147 +00:10:51,140 --> 00:10:56,960 +log mar level اللي وصله ولا اش اعمل طبعا لأ لأن ال + +148 +00:10:56,960 --> 00:11:01,400 +single letter test مش دقيق فالطفل في هذه الحالة + +149 +00:11:01,400 --> 00:11:07,040 +اذا ما استطاعش انه يكمل بال crowded letterبدي أنقل + +150 +00:11:07,040 --> 00:11:11,440 +أرجع فيه سنة هو عمره تالت سنين بس بدي أعرضله لـ + +151 +00:11:11,440 --> 00:11:18,720 +crowded k picture لـ crowded k picture test بشكل + +152 +00:11:18,720 --> 00:11:23,380 +أنه أحافظ على قضية ال crowd حتى لو انا اختبرته بال + +153 +00:11:23,380 --> 00:11:30,270 +k picture اللي يختبر لعمر سنتين older childrenعدة + +154 +00:11:30,270 --> 00:11:34,570 +تلت سنوات ووصل أربع سنوات من العمر may continue + +155 +00:11:34,570 --> 00:11:37,690 +with the crowded letter test يعني بقدر أظل معاهم + +156 +00:11:37,690 --> 00:11:40,790 +في ال Songsen Logmar test أو في ال Keyler Logmar + +157 +00:11:40,790 --> 00:11:46,020 +test اللي هي crowded testبطريقة ال naming إنه يسمي + +158 +00:11:46,020 --> 00:11:49,760 +لي اسم الحرف على عمر أربع سنوات لازم يكون في + +159 +00:11:49,760 --> 00:11:53,740 +الغالب الأعام إنه بيسمي الحرف أو يعمل matching + +160 +00:11:53,740 --> 00:11:58,560 +للحرف إذا كانه مش قادر يسمي غالبا ال matching مش + +161 +00:11:58,560 --> 00:12:03,020 +لأنه مش قادر يسمي ولكن بعض الأطفال بيكونوا خجولين + +162 +00:12:03,020 --> 00:12:08,580 +جدا فبالتالي مش بيقدرش يسمي بيقدر يسمي بس خجلان + +163 +00:12:08,580 --> 00:12:13,610 +فممكن احنا نعطي الأم لوحةفيها الأحرف I ونعرضله لـ + +164 +00:12:13,610 --> 00:12:19,470 +Crowded Test وبالتالي هو يأشر على الحرف المشابه + +165 +00:12:19,470 --> 00:12:22,650 +لأن بعض الأطفال بيكونوا فعلا خجلانين أنهم يتكلموا + +166 +00:12:22,650 --> 00:12:27,210 +أثناء الفحص أو ممكن أنتقل ل level أعلى من ال + +167 +00:12:27,210 --> 00:12:33,270 +killerلغمار ومن الـ Songsen Lugmar Test لـ ال .. + +168 +00:12:33,270 --> 00:12:38,270 +ال .. ال charts بتاعة ال adults زي ال ETDRS chart + +169 +00:12:38,270 --> 00:12:43,890 +ال ETDRS chart هي نوع من ال لغمار charts اختصار + +170 +00:12:43,890 --> 00:12:48,010 +Early Treatment of Diabetic Retinopathy Study + +171 +00:12:48,010 --> 00:12:54,180 +Early Treatment of Diabetic Retinopathy Studyهذه + +172 +00:12:54,180 --> 00:12:59,560 +ال study أو هذه الدراسة عملت لدراسة هل يتم التدخل + +173 +00:12:59,560 --> 00:13:04,920 +المبكر لعلاج اعتلال الشبكية السكري ولا مايتمش فهذه + +174 +00:13:04,920 --> 00:13:09,960 +الدراسة استخدمت ال log-margin chart لدرجةإنه أصبح + +175 +00:13:09,960 --> 00:13:13,120 +ال logmarg chart بيعرف باسم الدراسة هاي، يعني + +176 +00:13:13,120 --> 00:13:17,400 +أصبحت يعني الوسم بتاع الدراسة هاي يعني لحق بال + +177 +00:13:17,400 --> 00:13:21,580 +chart فبالتالي لما بقول E T D R S chart بفهم ضمن + +178 +00:13:21,580 --> 00:13:25,700 +انه هذا logmarg ات شارت، إذا ممكن أنا الأطفال في + +179 +00:13:25,700 --> 00:13:30,130 +سن أربع سنوات أكمل معهمبالkeyler logmar test + +180 +00:13:30,130 --> 00:13:34,050 +crowded test أو بالsungsen logmar test ايضا + +181 +00:13:34,050 --> 00:13:38,630 +crowded test او انتقل عشان افحصهم بفحوصات الكبار + +182 +00:13:38,630 --> 00:13:45,260 +اللي هي زي ال ATDRS chart may be usedلغمارة شارت + +183 +00:13:45,260 --> 00:13:48,500 +أو لغمارة test are in common usage and are + +184 +00:13:48,500 --> 00:13:53,520 +preferable to snailing for all children at risk of + +185 +00:13:53,520 --> 00:13:57,140 +ampliopia يعني لو عندى طفل عنده خطر او متوقع ان + +186 +00:13:57,140 --> 00:14:01,060 +يكون فيه risk of ampliopia وعندي متوفر ال snailing + +187 +00:14:01,060 --> 00:14:05,740 +acuity chart وعندي متوفر اللغمارة chart بستعمل + +188 +00:14:05,740 --> 00:14:09,750 +اللغمارة chart لأنه أدقو بالذات بيكتشفلي ال + +189 +00:14:09,750 --> 00:14:13,750 +amblyopia ومش بس بيكتشف ال amblyopia و أيضا يعني + +190 +00:14:13,750 --> 00:14:18,610 +بي .. بي .. بيتبع موضوع العلاج والتطور هل في تحسن + +191 +00:14:18,610 --> 00:14:22,450 +ولا مش تحسن بشكل أدق من ال Snelling's chart هنا + +192 +00:14:22,450 --> 00:14:26,070 +عشان نشوف هذا Snelling's chart هذا نموذج ل + +193 +00:14:26,070 --> 00:14:30,550 +Snelling's chart وهذا نموذج ل ال log married chart + +194 +00:14:30,550 --> 00:14:35,330 +أول حاجة في قضية ال crowding واضح أنه في عندي في + +195 +00:14:35,330 --> 00:14:40,970 +ال log married chartلغماري تشارت في عندى ال + +196 +00:14:40,970 --> 00:14:45,770 +crowding موجود في كل الأسطور، طيب هنا في الأسطور + +197 +00:14:45,770 --> 00:14:49,900 +السفلة في crowdingبينما في الأسطر العليا فيش + +198 +00:14:49,900 --> 00:14:52,100 +crowding .. هنا single letter .. هنا two letters + +199 +00:14:52,100 --> 00:14:54,720 +مش هال crowding لكتير .. هنا three letters .. هأ + +200 +00:14:54,720 --> 00:14:58,220 +بدأ ل crowding .. إذا فيش crowding متكافئ في كل + +201 +00:14:58,220 --> 00:15:01,240 +الأسطر .. بينما هنا في crowding .. هنا خمس حروف في + +202 +00:15:01,240 --> 00:15:05,340 +كل سطر .. مهما صغر أو كبر .. هي قضية .. قضية تانية + +203 +00:15:05,340 --> 00:15:08,900 +.. الفرق في الحجم بين السطر والسطر اللي يليه فيه + +204 +00:15:08,900 --> 00:15:14,090 +تدرش غير منطقيوهذا تم حسابه هندسيا إذا في تدرج غير + +205 +00:15:14,090 --> 00:15:18,810 +منطقي أما هنا في عندي تدرج هندسي منطقي لغارتمي + +206 +00:15:18,810 --> 00:15:22,750 +فبالتالي لو شوفنا السطر الأول والتاني قداش بيفرجوا + +207 +00:15:22,750 --> 00:15:26,250 +عن بعض بالحجم مش كتير بينما هنا السطر الأول + +208 +00:15:26,250 --> 00:15:30,550 +والتاني بيفرجوا كتير جدا في الحجم هنا الفروقات بين + +209 +00:15:30,550 --> 00:15:37,690 +السطر والسطر التي ليها طيب الآن كل حرففي ال log + +210 +00:15:37,690 --> 00:15:41,910 +-margin chart له قيمة لغة رتمية السطر كله قيمته + +211 +00:15:41,910 --> 00:15:47,490 +لغة رتمية واحد من عشركل حرف اتنين من مية + +212 +00:15:47,490 --> 00:15:51,190 +logarithmic unit اتنين من مية و اتنين من مية اربعة + +213 +00:15:51,190 --> 00:15:55,690 +من مية ستة من مية تمانية من مية واحد من عشرة اللي + +214 +00:15:55,690 --> 00:15:59,830 +هي عشرة من مية تمام؟ هنا واحد من عشرة logarithmic + +215 +00:15:59,830 --> 00:16:02,610 +unit وهنا واحد من عشرة logarithmic unit وهنا واحد + +216 +00:16:02,610 --> 00:16:06,050 +من عشرة logarithmic unit وهكذا .. وهكذا فبالتالي + +217 +00:16:06,050 --> 00:16:10,350 +ضروري نعرف هذه القضية فبالتالي + +218 +00:16:12,620 --> 00:16:16,220 +بنستعمل ال logarithmic units في الإشارة لل level + +219 +00:16:16,220 --> 00:16:20,220 +بتاع النظر، بينما هنا بنستعمل إما بالقدم يعني + +220 +00:16:20,220 --> 00:16:23,220 +عشرين على عشرين، عشرين على خمسة وعشرين، عشرين على + +221 +00:16:23,220 --> 00:16:27,280 +اربعين أو بنظام ال meter اللي هو ستة ع ستة وستة ع + +222 +00:16:27,280 --> 00:16:31,650 +اتناش وستة ع تمانتاش و هكذا و هكذاطبعا في نقطة + +223 +00:16:31,650 --> 00:16:36,750 +بدنا نوح إليها مهمة جدا أنه لما إنسان بنفحصه بال + +224 +00:16:36,750 --> 00:16:40,310 +logarithmic بال log married chart أو logarithm of + +225 +00:16:40,310 --> 00:16:43,590 +the minimum angle of resolution وبيكون مكتوب في ال + +226 +00:16:43,590 --> 00:16:46,350 +file أنه ال vision في ال right eye مثلا صفر معناته + +227 +00:16:46,350 --> 00:16:51,670 +6 ع 6 في ال log married chart صفر معناته 6 ع 6طب + +228 +00:16:51,670 --> 00:16:55,750 +واحد صحيح معناته ستة على ستين، ليه عشرين على متين + +229 +00:16:55,750 --> 00:17:01,250 +أو ستة على ستين، إذا كل مقال الرقم في اللجمار الـ + +230 +00:17:01,250 --> 00:17:05,570 +chart كل مكان النظر أفضل، كل مكان النظر أفضل، يعني + +231 +00:17:05,570 --> 00:17:10,090 +لو في عندي minus واحد من عشرة لجمار، معناته دي + +232 +00:17:10,090 --> 00:17:14,460 +عشرين على خمساتعاش أفضل من ستة على ستةفبالتالي كل + +233 +00:17:14,460 --> 00:17:18,580 +ما قل الرقم كل ما كان النظر أفضل وكل ما زاد الرقم + +234 +00:17:18,580 --> 00:17:22,580 +كل ما كان يعني low vision كل ما كان low vision أو + +235 +00:17:22,580 --> 00:17:26,520 +في decrease في ال visual acuity عند هذه النقطة + +236 +00:17:26,520 --> 00:17:30,340 +بتتوقف المحاضرة ويعطيكم العافية والسلام عليكم + +237 +00:17:30,340 --> 00:17:31,940 +ورحمة الله وبركة + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/1h34-z56WSk_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/1h34-z56WSk_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..06a81d9ada3ac05ae914a348a24bbc0ca818e9ea --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/1h34-z56WSk_postprocess.srt @@ -0,0 +1,1956 @@ +1 +00:00:01,690 --> 00:00:05,930 +بسم الله الرحمن الرحيم بنواصل مع محاضرات حوال واحد + +2 +00:00:05,930 --> 00:00:10,370 +ووصلنا للموضوع الأخير في هذا المصاد اللي هو + +3 +00:00:10,370 --> 00:00:14,790 +refraction and phendoscopy it should be emphasized + +4 +00:00:14,790 --> 00:00:17,930 +لابد من التأكيد that dilated phendoscopy is + +5 +00:00:17,930 --> 00:00:22,040 +mandatory in the context of strabist muscleمعنى + +6 +00:00:22,040 --> 00:00:28,440 +فحص الشبكية أو فحص قاع العين يعتبر إجباري في حالة + +7 +00:00:28,440 --> 00:00:32,880 +وجود حوار ليش؟ to exclude any underlying ocular + +8 +00:00:32,880 --> 00:00:36,780 +pathology such as macular scarring, optic disc + +9 +00:00:36,780 --> 00:00:40,760 +hypoplasia or retinoplastoma في مشاكل كتيرة ممكن + +10 +00:00:40,760 --> 00:00:44,850 +تكون في ال retina وينتج عنها الحوارزي تليفات في + +11 +00:00:44,850 --> 00:00:51,130 +الماكولا، زي ضعف في تكون العصب البصري، optic disc + +12 +00:00:51,130 --> 00:00:54,850 +hypoplasia أو ورم سرطاني في الشبكية زي ال + +13 +00:00:54,850 --> 00:00:59,130 +retinoblastoma اللي هو الأشهر، طيب، نشوف بعض + +14 +00:00:59,130 --> 00:00:59,810 +المناظر + +15 +00:01:03,410 --> 00:01:07,610 +هي عندي انا ال normal fundus، هاي ال fovea، هاي ال + +16 +00:01:07,610 --> 00:01:11,650 +macula، هاي ال temporal arcades، هى ال temporal + +17 +00:01:11,650 --> 00:01:15,910 +vessels، هنا هادي normal، هنا في عندي large + +18 +00:01:15,910 --> 00:01:19,850 +macular scar، large macular scar، وفي أصغر منه + +19 +00:01:19,850 --> 00:01:24,650 +هنا، يعني جاي في ال inferior part of the macula أو + +20 +00:01:24,650 --> 00:01:28,090 +of the retina، هذا ال macular scar ممكن يخلي + +21 +00:01:28,090 --> 00:01:33,570 +المريض عنده حوال، لإنه بيحاوليوجه العين باتجاه انه + +22 +00:01:33,570 --> 00:01:37,610 +يسقط الضوء على يعني normal part of the retina، اذا + +23 +00:01:37,610 --> 00:01:41,030 +ممكن يكون عندي مشكلة في ال retina زي ال macula، ال + +24 +00:01:41,030 --> 00:01:45,390 +scarring زي ما احنا شايفينهممكن يكون عندي ورم + +25 +00:01:45,390 --> 00:01:49,350 +سرطاني اللي هو ال retinoplastoma هو أكتر يعني ورم + +26 +00:01:49,350 --> 00:01:53,270 +سرطاني منتشر عند الأطفال بالذات في السنة الأولى و + +27 +00:01:53,270 --> 00:01:57,350 +التانية من العمر، من أهم علاماته ال leukokuria ال + +28 +00:01:57,350 --> 00:02:02,670 +white pupil، leukokuria white pupil ضروري عشان هيك + +29 +00:02:02,670 --> 00:02:05,750 +نفحص أي ممكن ييجي بastravismus، هذا الطفل ممكن + +30 +00:02:05,750 --> 00:02:10,760 +ييجي بحولممكن Exotropia، Esotropia إلى آخرى، ولكن + +31 +00:02:10,760 --> 00:02:15,000 +عند فحص العين نتفاجأ بإنه في عنا يعني + +32 +00:02:15,000 --> 00:02:20,580 +Retinoplastoma أصبح الآن الأهمية تعتلى علاج و ال + +33 +00:02:20,580 --> 00:02:24,340 +management of retinoplastoma مش للحوال، و الحوال + +34 +00:02:24,340 --> 00:02:29,480 +بيتم التعامل معاه لاحقStrabismus is often + +35 +00:02:29,480 --> 00:02:33,620 +secondary to refractive error غالبا اللي حوال + +36 +00:02:33,620 --> 00:02:38,320 +غالبا و ليس دائما بيكون ناتج عن refractive error + +37 +00:02:38,320 --> 00:02:41,920 +أي نوع من refractive error حقيقة كل الأنواع + +38 +00:02:41,920 --> 00:02:45,280 +الhypermetropia الastigmatism الanisometropia + +39 +00:02:45,280 --> 00:02:49,680 +الmyopia may all be associated with strabismus + +40 +00:02:49,680 --> 00:02:53,180 +يعني كل واحد منهم ممكن يكون associated with + +41 +00:02:53,180 --> 00:02:58,390 +strabismusفبالتالي ضروري احنا عشان نعرف ال + +42 +00:02:58,390 --> 00:03:02,230 +refractive error على حقيقه لازم نعمل cycloplegia + +43 +00:03:02,230 --> 00:03:05,930 +يعني نعمل شلل في الcelliary muscle عشان ناخد ال + +44 +00:03:05,930 --> 00:03:08,590 +refractive error أو نقرأ ال refractive error بشكل + +45 +00:03:08,590 --> 00:03:12,030 +صحيح the commonest refractive error causing + +46 +00:03:12,030 --> 00:03:16,000 +strabismus is hypermetroidيعني الدراسات أثبتت أنه + +47 +00:03:16,000 --> 00:03:20,180 +ال hypermetropia هي أكتر خطأ انكساري بصري، أكتر + +48 +00:03:20,180 --> 00:03:23,620 +refractive error بيعمللي حوالي ال myopia و ال + +49 +00:03:23,620 --> 00:03:26,460 +astigmatism و ال anisometropia بيعملوا حوالي بس + +50 +00:03:26,460 --> 00:03:30,780 +بنسبة أقل من ال hypermetropiaAccurate measurement + +51 +00:03:30,780 --> 00:03:34,780 +of hypermetropia necessitate effective paralysis + +52 +00:03:34,780 --> 00:03:37,760 +of the ciliary muscle طالما الـ hypermetropia هي + +53 +00:03:37,760 --> 00:03:41,840 +أكتر نوع من الـ refractive errors بسبب الحوال لازم + +54 +00:03:41,840 --> 00:03:46,620 +المريض اللي عنده hypermetropia وحقيقة كل الأطفال + +55 +00:03:46,620 --> 00:03:50,780 +لازم نعملهم أو نعرف ال degree of refractive error + +56 +00:03:50,780 --> 00:03:54,780 +أو ال degree of hypermetropiaهذا بيخليني محتاج جدا + +57 +00:03:54,780 --> 00:03:57,940 +ان اعمل effective paralysis of the ciliary muscle + +58 +00:03:57,940 --> 00:04:01,540 +in order to neutralize the effect of accommodation + +59 +00:04:01,540 --> 00:04:05,900 +عشان ألغي ال accommodationليش بدي ألغى ال + +60 +00:04:05,900 --> 00:04:08,420 +accommodation؟ ال accommodation بيعمل masking ل + +61 +00:04:08,420 --> 00:04:11,460 +true degree of this refractive error يعني + +62 +00:04:11,460 --> 00:04:14,660 +الhypermetrogue اللي عنده hypermetrogue دي مثلا + +63 +00:04:14,660 --> 00:04:18,980 +plus 4 ممكن جابل ما أعمله cycle of legia يكون مبين + +64 +00:04:18,980 --> 00:04:23,920 +عندي plus 2 أو plus 1 أو حتى مبين يعني immature + +65 +00:04:23,920 --> 00:04:26,580 +مافيش عنده refractive error بسبب أنه ال + +66 +00:04:26,580 --> 00:04:30,750 +accommodation ألغى هذه ال plus 4أو ألغى جزء منها + +67 +00:04:30,750 --> 00:04:34,070 +يعني فبالتالي عشان أعرف كمية ال refractive error + +68 +00:04:34,070 --> 00:04:38,770 +على حقيقة و لازم أعمل Cycloblegia أكتر drug + +69 +00:04:38,770 --> 00:04:42,290 +بيستخدم لل Cycloblegia أنه اللي هو Cyclopentolate + +70 +00:04:42,960 --> 00:04:46,940 +الcycloventilate affords addict with cycloplegia + +71 +00:04:46,940 --> 00:04:51,100 +in most children يعني بينفع في معظم حالات الأطفال + +72 +00:04:51,100 --> 00:04:54,960 +أني أستخدم ال cycloventilate اللي هو عبارة عن دوة + +73 +00:04:54,960 --> 00:04:59,880 +أو قطرة بتعملي cycloplegia بت chill الcellular + +74 +00:04:59,880 --> 00:05:04,160 +muscle بتعمل relaxation للcellular muscle بتنفع في + +75 +00:05:04,160 --> 00:05:09,100 +معظم حالات الأطفالالتركيز بتاع الـ cyclopentolate، + +76 +00:05:09,100 --> 00:05:12,940 +the concentration employed is نص percent under the + +77 +00:05:12,940 --> 00:05:17,520 +age of six months and one percent thereafter إذا + +78 +00:05:17,520 --> 00:05:21,160 +كان الطفل عمره أقل من ست شهور بستخدمله تركيز نص في + +79 +00:05:21,160 --> 00:05:24,840 +المية، إذا كان عمره أكتر من ست شهور الطفل لازم + +80 +00:05:24,840 --> 00:05:28,460 +أستخدمله تركيز واحد في المية كيف أستعمل ال + +81 +00:05:28,460 --> 00:05:32,410 +cyclopentolate؟ ال cyclopentolate one droprepeated + +82 +00:05:32,410 --> 00:05:35,750 +after five minutes usually results in maximal + +83 +00:05:35,750 --> 00:05:40,450 +cycloplegia within thirty minutes يعني بنجد نقطة + +84 +00:05:40,450 --> 00:05:44,950 +في كل عين بستنى خمس دقايق برجع بنجد كمان نقطة نقطة + +85 +00:05:44,950 --> 00:05:50,250 +في كل عين فطبعا بين النقطة الأولى والتانية خمس + +86 +00:05:50,250 --> 00:05:53,890 +دقايق بعدين بنتظر نصف ساعة بعدين بعمل ال + +87 +00:05:53,890 --> 00:06:00,780 +refraction بتاع الطفل غالبا في نص ساعة بتكونالعين + +88 +00:06:00,780 --> 00:06:04,440 +أو الcelliary muscle صارت maximally relaxed + +89 +00:06:04,440 --> 00:06:07,860 +وبالتالي باخد ال refractive error أو بقرأ ال + +90 +00:06:07,860 --> 00:06:11,260 +refractive error بشكل صحيح إما باستعمال ال + +91 +00:06:11,260 --> 00:06:14,920 +retinoscopy وهو الأغلب أو إذا كان الطفل كبير شوية + +92 +00:06:14,920 --> 00:06:18,910 +ممكن أستعمل ال auto refractometerطب امتى بيرجع ال + +93 +00:06:18,910 --> 00:06:21,250 +accommodation لما أنا عملت شلل في الcelliary + +94 +00:06:21,250 --> 00:06:25,270 +muscle مؤقت بال .. بالجطرة high؟ امتى بيرجع الطفل + +95 +00:06:25,270 --> 00:06:27,970 +يعمل accommodation من جديد؟ ال recovery of + +96 +00:06:27,970 --> 00:06:31,230 +accommodation within two to three hours بس + +97 +00:06:31,230 --> 00:06:35,010 +المدرياز يستوسع البقبق within twenty four hours و + +98 +00:06:35,010 --> 00:06:38,710 +أحيانا بعض الأطفال بيستمر لتمانية و أربعين ساعة + +99 +00:06:38,710 --> 00:06:44,000 +يعني لمدة يومينthe adequacy of cycloplegia قبل ما + +100 +00:06:44,000 --> 00:06:47,920 +نحكي عن adequacy of cycloplegia بنروح للجدول هذا + +101 +00:06:47,920 --> 00:06:52,540 +هاي ال cyclopentolate هاي التركيز بتاعه بستعمل + +102 +00:06:52,540 --> 00:06:56,280 +تركيز نص في المية لغاية عمر ست شهور يعني عمره مثلا + +103 +00:06:56,280 --> 00:07:00,800 +أربع شهور خمس شهور ست شهور بستعمله نص في المية + +104 +00:07:00,800 --> 00:07:04,680 +تركيز نص في المية عشان ما يكونش أنا استعملتله + +105 +00:07:04,680 --> 00:07:10,460 +تركيز أكتر من اللازم طيبإذا كان عمره after six + +106 +00:07:10,460 --> 00:07:13,840 +months، عمره سبع شهور، تسعة شهور، سنة، سنتين، + +107 +00:07:13,840 --> 00:07:18,260 +تلاتة، بستعمله تركيز واحد في المية how to use؟ كيف + +108 +00:07:18,260 --> 00:07:22,620 +يعني أجطر؟ one drop، بعدين بستنى five minutes، + +109 +00:07:22,620 --> 00:07:27,870 +بعدين أعطي another drop، بعدين بستنى نصف ساعةالـ + +110 +00:07:27,870 --> 00:07:31,950 +maximum cycloplegia غالبية الأطفال فيه بتحدث بعد + +111 +00:07:31,950 --> 00:07:36,990 +نصف ساعة من التقطير return of accommodation الـ + +112 +00:07:36,990 --> 00:07:39,330 +accommodation بتبدأ السليري muscle تشتغل بعد + +113 +00:07:39,330 --> 00:07:44,210 +ساعتين لتلاتة return of mediasis بتوسيع بيرجع أو + +114 +00:07:44,210 --> 00:07:49,250 +بتراجع بيرجع البقبق لحجمه الطبيعي within 24 to 48 + +115 +00:07:49,250 --> 00:07:54,090 +hours هذا بالنسبة للـcyclopentelite الآن خلصنا + +116 +00:07:54,090 --> 00:07:57,520 +وعملنا واستنينا نصف ساعةبدنا نختبر هل + +117 +00:07:57,520 --> 00:08:01,540 +الـcycloplegia فعالة adequate ولا مش adequate the + +118 +00:08:01,540 --> 00:08:04,860 +adequacy of cycloplegia can be determined by + +119 +00:08:04,860 --> 00:08:07,940 +comparing retinoscopy readings with the patient + +120 +00:08:07,940 --> 00:08:11,940 +fixating for distance and thin fornia بعمل + +121 +00:08:11,940 --> 00:08:16,120 +retinoscopy للطفل على و هو مركز على distant target + +122 +00:08:16,120 --> 00:08:19,830 +زي ال visual acuity chartو بعد هيك بعيد ال + +123 +00:08:19,830 --> 00:08:23,410 +retinoscopy و هو مركز على near target .. على near + +124 +00:08:23,410 --> 00:08:26,810 +target إذا في فارق بينهم معناته لسه ال ciliary + +125 +00:08:26,810 --> 00:08:29,890 +muscle شغالة و لسه قاعد بيعمل accommodation على ال + +126 +00:08:29,890 --> 00:08:34,470 +near و عشان هيك في فارق بينهمif Cycloblegia is + +127 +00:08:34,470 --> 00:08:38,210 +adequate there will be no little or no difference + +128 +00:08:38,210 --> 00:08:42,690 +between the two retinoscopy results لما بيكون ال + +129 +00:08:42,690 --> 00:08:45,910 +.. ال Cycloblegia فعلا ماخدة مفعولها و الcelliary + +130 +00:08:45,910 --> 00:08:49,690 +muscle راخية مش هيقدر يعمل accommodation فسواء + +131 +00:08:49,690 --> 00:08:52,570 +عملتله ال retinoscopy هو بتطلع على distant target + +132 +00:08:52,570 --> 00:08:55,770 +أو على near target ال results تقريبا هتكون متقاربة + +133 +00:08:55,770 --> 00:09:00,010 +أو موحدةساعتها بعرف أنه الـcycloplegia يعني أخدت + +134 +00:09:00,010 --> 00:09:02,870 +مفعولة و بعتمد الأرقام اللي طلعت معايا في + +135 +00:09:02,870 --> 00:09:06,790 +الريتينوسكوبي if cycloplegia is incomplete لسه + +136 +00:09:06,790 --> 00:09:09,430 +الcellular muscle شغالة لسه بيعمل accommodation + +137 +00:09:09,430 --> 00:09:12,550 +there will be difference between the two readings + +138 +00:09:12,550 --> 00:09:15,470 +اللي هو الريتينوسكوبي results at distance و + +139 +00:09:15,470 --> 00:09:18,750 +الريتينوسكوبي results at near عشان هيك إيش أنا + +140 +00:09:18,750 --> 00:09:22,430 +بعمل and it may be necessary to wait another + +141 +00:09:22,430 --> 00:09:28,360 +fifteen minutesبستنى خمستاشرة جيجا زيادة أو بانجد + +142 +00:09:28,360 --> 00:09:31,780 +كمان نقطة و بستنى خمستاشرة جيجا ع بال ما النقطة + +143 +00:09:31,780 --> 00:09:36,360 +هيتبدأ نفعلها، طيب، هذه بالنسبة ليها ال adequacy + +144 +00:09:36,360 --> 00:09:40,420 +of cycloplegiaالان ال cycloventilate كتير من + +145 +00:09:40,420 --> 00:09:45,300 +الأطفال يعني بتقبلوش لإنه بيعمل يعني حرجان في سطح + +146 +00:09:45,300 --> 00:09:50,340 +العين فبالتالي عندي طريقة من طريقتين أول طريقة أنه + +147 +00:09:50,340 --> 00:09:54,220 +topical anesthesia with an agent such as topical + +148 +00:09:54,220 --> 00:09:57,860 +proxy metakain هذا عبارة عن local anesthetic مخدر + +149 +00:09:57,860 --> 00:10:04,150 +موضعي ب .. بجطر منهو باستنى شوية بعد هيك بجطر ال + +150 +00:10:04,150 --> 00:10:08,270 +cycloventilate فبيحسش الطفل بحرجان ال + +151 +00:10:08,270 --> 00:10:11,730 +cycloventilate بس بدنا نبح انه حتى ال typical حتى + +152 +00:10:11,730 --> 00:10:15,590 +المخدر الموضعى عند ما يتم تقطيره أول ما بيتم + +153 +00:10:15,590 --> 00:10:20,370 +تقطيره بيشعر الطفل بحرجان من المخدر الموضعى نفسه + +154 +00:10:20,370 --> 00:10:24,910 +بس بعد هيك ممكن اجطرله ال cycloventilate بشكل مريح + +155 +00:10:24,910 --> 00:10:29,150 +و بدون ما يشعر بحرجان ال cycloventilate + +156 +00:10:30,750 --> 00:10:34,630 +ليش أنا أحيانا بستعمل ال topical anesthesia لسبب + +157 +00:10:34,630 --> 00:10:37,850 +أنه أحيانا الطفل من حرجان ال cyclopentolate بيصير + +158 +00:10:37,850 --> 00:10:41,630 +عنده tearing، بيصير العين اتدمع كتير، فبتغسل جطرة + +159 +00:10:41,630 --> 00:10:44,210 +ال cyclopentolate أو نقطة ال cyclopentolate اللي + +160 +00:10:44,210 --> 00:10:48,910 +أنا جطرتله ياه، فمابيستفيدش منها الطفل، فنتيجة + +161 +00:10:48,910 --> 00:10:53,290 +الدموع اللي خففت ال cyclopentolate وممكن يذهب ال + +162 +00:10:53,290 --> 00:10:55,770 +cyclopentolate مع الدموع في مجرة الدموع، وما + +163 +00:10:55,770 --> 00:10:59,770 +تستفيد منه العين أو ما ي .. ما يتم عمل cycloplegia + +164 +00:11:00,180 --> 00:11:03,300 +إذا الـ topical anesthesia with an agent such as + +165 +00:11:03,300 --> 00:11:07,080 +topical proxymethicone prior to installation of + +166 +00:11:07,080 --> 00:11:10,080 +cyclobentilate يعني قبل ما أقطر ال cyclobentilate + +167 +00:11:10,080 --> 00:11:14,460 +is useful in preventing ocular irritation يعني هذا + +168 +00:11:14,460 --> 00:11:17,940 +بمنع أنه ال .. ال .. السطح الآن يتهيج بسبب ال + +169 +00:11:17,940 --> 00:11:21,280 +cyclobentilate و يصير في عندي reflex tearing، و + +170 +00:11:21,280 --> 00:11:24,310 +يصير عندي reflex tearingthus affording better + +171 +00:11:24,310 --> 00:11:27,870 +retention of cycloventilate وهذا بيخلي أن العين + +172 +00:11:27,870 --> 00:11:31,290 +تستقبل وتستوعب ال cycloventilate في ال + +173 +00:11:31,290 --> 00:11:34,950 +conjunctival ساق وبالتالي يتم امتصاصه من العين + +174 +00:11:34,950 --> 00:11:40,890 +ويعطينه effective cycloepilegia هاي قطرات ال + +175 +00:11:40,890 --> 00:11:41,910 +cycloventilate + +176 +00:11:47,990 --> 00:11:52,070 +بتيجي باسماء كتيرة زي Cyclin زي Cyclobentolate زي + +177 +00:11:52,070 --> 00:11:57,370 +Cyclogel زي Cyclobligicum في اسماء كثيرة المهم أنا + +178 +00:11:57,370 --> 00:12:01,110 +أطلع الاسم العلمي الاسم العلمي Cyclobentolate + +179 +00:12:01,110 --> 00:12:04,370 +Hydrochloride تركيز واحد في المية هنا الاسم + +180 +00:12:04,370 --> 00:12:07,810 +التجاري Cyclin بس هنا الاسم العلمي Cyclobentolate + +181 +00:12:07,810 --> 00:12:12,210 +I drops هنا Cyclogel الاسم التجاري بس لو طلعت هنا + +182 +00:12:12,210 --> 00:12:15,450 +Cyclobentolate Hydrochloride و التركيز طبعا واحد + +183 +00:12:15,450 --> 00:12:20,070 +في الميةعندي Cycloventolate + +184 +00:12:20,070 --> 00:12:24,210 +Hydrochloride نص في المية طبعا مش منتشر كتير ولكن + +185 +00:12:24,210 --> 00:12:28,600 +ممكن انا من تركيز واحد في الميةمن .. من تركيز واحد + +186 +00:12:28,600 --> 00:12:32,440 +في المية أعمل تركيز نصف في المية بإن .. يعني أسحب + +187 +00:12:32,440 --> 00:12:38,120 +من القطرة بسرنجة بالإبرة أسحب مثلا نص سانتي من هذه + +188 +00:12:38,120 --> 00:12:42,540 +القطرة و أضيف عليها نص سانتي distilled water ميه + +189 +00:12:42,540 --> 00:12:45,420 +من القطرة فبالتالي بيصير عندي تركيز يعني أخفف + +190 +00:12:45,420 --> 00:12:48,760 +بنسبة واحد لواحد فبتحول التركيز من واحد في المية + +191 +00:12:48,760 --> 00:12:53,640 +لنصف في المية بالنسبة + +192 +00:12:53,640 --> 00:12:58,610 +للاتروبيينالاتروبيين may be necessary in some + +193 +00:12:58,610 --> 00:13:02,070 +children، احنا قولنا الـ cyclopentolate اللي هو + +194 +00:13:02,070 --> 00:13:06,690 +أضعف من الأتروبيين، بينفع في المعظم من الأطفال، + +195 +00:13:06,690 --> 00:13:09,630 +الاتروبيين may be necessary in some children with + +196 +00:13:09,630 --> 00:13:13,650 +either high hypermetropia، ال high hypermetropia + +197 +00:13:14,200 --> 00:13:17,700 +بتخليني مضطر أحيانا أستعمل atropine high ممكن يكون + +198 +00:13:17,700 --> 00:13:23,900 +plus 8 plus 10 plus 15 أو أنه يكون عنده القزحية + +199 +00:13:23,900 --> 00:13:27,960 +تاعت العين يعني لونها غامق كتير heavily pigmented + +200 +00:13:27,960 --> 00:13:32,660 +iridescent نشوف مثالهذه القزحية غامجة كتير، غالبا + +201 +00:13:32,660 --> 00:13:36,640 +تستجيبش لل cycle of intolerance، هذه القزحية يعني + +202 +00:13:36,640 --> 00:13:41,300 +light iris color، يعني اللون القزحية light يعني + +203 +00:13:41,300 --> 00:13:48,340 +خفيف أو يعني اللون بتاعها فاتح، فبالتالي بتستجيب + +204 +00:13:48,340 --> 00:13:51,880 +جدا لل cycle of intolerance وما بضطر أستعمل معها + +205 +00:13:51,880 --> 00:13:55,620 +atropine، ما بضطر أستعمل معها atropine إلا في حالة + +206 +00:13:55,620 --> 00:13:59,670 +إذا كان الطفل هذا عنده high refractive errorإذا + +207 +00:13:59,670 --> 00:14:02,810 +الأتروبين بنضطرله أحيانا في الـ high-hypermetropia + +208 +00:14:02,810 --> 00:14:06,570 +أو الـ heavily pigmented irides in which + +209 +00:14:06,570 --> 00:14:09,650 +cyclopentolate may be inadequate، في هذه الحالات + +210 +00:14:09,650 --> 00:14:13,590 +ممكن الـ cyclopentolate مايكونش كافي، أتروبين may + +211 +00:14:13,590 --> 00:14:17,070 +be used as drops or ointment، يعني ممكن أستعمل + +212 +00:14:17,070 --> 00:14:23,310 +الأتروبين كمرهم للعين، هاي أتروبين صلفاتهي الاسم + +213 +00:14:23,310 --> 00:14:27,530 +التجاري atropina بينما الاسم العلمي atropine هو + +214 +00:14:27,530 --> 00:14:31,410 +طبعا I ointment للعين او tropina .. tropina هنا + +215 +00:14:31,410 --> 00:14:35,390 +atrapar الاسم التجاري بس الاسم العلمي atropine + +216 +00:14:35,390 --> 00:14:38,890 +sulfate تركيز واحد في البيت، اذا ممكن استعمله + +217 +00:14:38,890 --> 00:14:43,710 +كمرهم او ممكن استعمله كجدرة ليه ال atropine + +218 +00:14:43,710 --> 00:14:50,680 +sulfate اي زبدة atropineatrocare وفيه كمان + +219 +00:14:50,680 --> 00:14:54,460 +atrospan ففي أسماء تجارية كتيرة المهم أن الإسم + +220 +00:14:54,460 --> 00:14:57,520 +العلمي بيكون هو المادة الفعالة اللي احنا بيدناها + +221 +00:14:57,520 --> 00:15:01,580 +اللي هي الأتروبين سلفيت تركيز واحد في الميلي طيب + +222 +00:15:01,580 --> 00:15:05,520 +drops are easier for an untrained person to + +223 +00:15:05,520 --> 00:15:09,060 +install طبعا الأتروبين لازم يتم تقطيره في البيت + +224 +00:15:09,060 --> 00:15:13,600 +فبالتالي الأهل هم اللي بيجيوموا بالتقطير على مدى + +225 +00:15:13,600 --> 00:15:17,590 +تلت أيام جاب اليوم الفحصجاب اليوم الفحص يعني لو + +226 +00:15:17,590 --> 00:15:22,790 +تخيلنا أنه يوم الفحص مثلا بده يتم يوم الأثنين بده + +227 +00:15:22,790 --> 00:15:28,470 +يقطر الطفل صباحا و مساء يوم الجمعة و السبت و الأحد + +228 +00:15:28,470 --> 00:15:33,330 +ع مدى تلات أيام صباحا و مساء .. السبت صباحا و مساء + +229 +00:15:33,330 --> 00:15:38,260 +و الأحد صباحا و مساء بس بدوش يقطر يومالفحص يوم + +230 +00:15:38,260 --> 00:15:42,300 +الفحص مابدوش اي جطر و هنحكي بعد شوية ليش مابدوش اي + +231 +00:15:42,300 --> 00:15:47,900 +جطر، اذا الجطرة اسهل في الاستعمال من المرهم، مرهم + +232 +00:15:47,900 --> 00:15:51,520 +صعب انه نحطه الواحد، بس المرهم فيه ميزة، طبعا + +233 +00:15:51,520 --> 00:15:55,620 +الجطرة ميزتها انها اسهل في الاستعمالبينما المرهم + +234 +00:15:55,620 --> 00:15:59,540 +ميزته أنه بخافش من أن أكون عملت overdose، إيش يعني + +235 +00:15:59,540 --> 00:16:03,080 +عملت overdose؟ يعني أعطيت جرعة أكتر من اللازم، حتى + +236 +00:16:03,080 --> 00:16:06,780 +لو حطيت من المرهم كمية أكبر من اللازم، امتصاص + +237 +00:16:06,780 --> 00:16:10,500 +المرهم من سطح العين، من ال ocular serviceبطيق + +238 +00:16:10,500 --> 00:16:15,560 +فبالتالي بيمطص شوي شوي فبخافش أنه يصير overdose أو + +239 +00:16:15,560 --> 00:16:19,680 +أنه أخد جرعة أكتر من اللازم، بعكس القطرة، القطرة + +240 +00:16:19,680 --> 00:16:22,740 +لو أنا نقطت نقطتين أو تلاتة بدل نقطة واحدة في + +241 +00:16:22,740 --> 00:16:26,260 +المرة الواحدة، ممكن الطفل يصير عنده side effects + +242 +00:16:26,260 --> 00:16:30,380 +من الأتروبين زي حمرار في الوجه، زي سرعة نبضات في + +243 +00:16:30,380 --> 00:16:34,960 +القلب، زي تهيج وما إلى ذلك، فبالتالي صحيح أنه ميزة + +244 +00:16:34,960 --> 00:16:38,120 +القطرة أنها أسهل في الاستعمال، بالذات لما يكون + +245 +00:16:38,120 --> 00:16:41,850 +الشخص مش مدربيعني الأهل مش مدربين إنه كل يوم يعمل + +246 +00:16:41,850 --> 00:16:45,690 +.. يستعملوا القطرة بس ال .. ال .. ال .. البرهان + +247 +00:16:45,690 --> 00:16:50,230 +ميزته إنه less risk of overdose with ointment طب، + +248 +00:16:50,230 --> 00:16:54,830 +قداش التركيز؟ التركيز نص فلمية under the age of + +249 +00:16:54,830 --> 00:16:58,950 +twelve month and واحد فلمية thereafter ال maximum + +250 +00:16:58,950 --> 00:17:03,970 +cycloplegia، قلنا في ال cyclopentilate بعد خمس .. + +251 +00:17:03,970 --> 00:17:07,610 +تلاتين دقيقة، هنا بعد تلت ساعات، هنا بعد تلت ساعات + +252 +00:17:08,650 --> 00:17:11,590 +ال recovery of accommodation starts after three + +253 +00:17:11,590 --> 00:17:15,090 +days and is usually complete by ten days و أحيانا + +254 +00:17:15,090 --> 00:17:19,130 +بستمر لأربعة عشر يوم، a tribune is installed by + +255 +00:17:19,130 --> 00:17:23,390 +the parent by daily مرتين في اليوم for three days + +256 +00:17:23,900 --> 00:17:26,440 +before retinoscopy but not on the day of + +257 +00:17:26,440 --> 00:17:30,860 +administration ليش ما بجطرش الطفل يوم الفحص لأنه + +258 +00:17:30,860 --> 00:17:35,600 +غالبا الفحص بيتم صباحا و آخر نقطة أنا جطرتها بتبدأ + +259 +00:17:35,600 --> 00:17:39,240 +مفعولها بعد تلت ساعات يعني ممكن الطفل يكون انفحص و + +260 +00:17:39,240 --> 00:17:43,600 +خلص و رجع لبيته و لسه النقطة اللي نجطها في البيت + +261 +00:17:43,600 --> 00:17:47,240 +قبل ما يخرج إلى المستشفى أو إلى المركز اللي بده + +262 +00:17:47,240 --> 00:17:50,820 +يتم فيه الفحص النقطة هي بتكون زيادة فبالتالي مافيش + +263 +00:17:50,820 --> 00:17:54,780 +إلها داعي .. مافيش إلها داعينرجع هنا للجدول عشان + +264 +00:17:54,780 --> 00:17:57,920 +نذكر بالأرقام بتاعة الأطفال واللي المفروض أخصائي + +265 +00:17:57,920 --> 00:18:03,880 +البصريات يكون هذا الجدول يعني متمكن منه بشكل كويس + +266 +00:18:03,880 --> 00:18:09,280 +لأنه بده يستعمل الجطرات مع الأطفال بشكل مستمر + +267 +00:18:09,280 --> 00:18:15,080 +وبشكل دوي طيب تركيز الأطفال من نصف فلمية إذا كان + +268 +00:18:15,080 --> 00:18:20,180 +عمر الطفل سنة فأقل أكتر من سنة باستعمل تركيز واحد + +269 +00:18:20,180 --> 00:18:26,740 +في الميةالآن بالنسبة ل how to use، نقطة مرتين + +270 +00:18:26,740 --> 00:18:31,520 +يوميا لمدة تلات أيام، نقطة مرتين يوميا لمدة تلات + +271 +00:18:31,520 --> 00:18:35,970 +أيامbut not on the day of examination لأن لو + +272 +00:18:35,970 --> 00:18:40,310 +جترتله في اليوم بتاع ال examination في يوم الفحص + +273 +00:18:40,310 --> 00:18:44,930 +مش هيستفيد او .. او مش .. مش هت .. مش هتضيف اشي + +274 +00:18:44,930 --> 00:18:48,930 +بالنسبة لي ال maximum cycloplegia three hours يعني + +275 +00:18:48,930 --> 00:18:52,350 +اي نقطة عشان تاخد أثارها و تعملي cycloplegia بدها + +276 +00:18:52,350 --> 00:18:57,260 +تلت ساعات عشان توصل لها مفعولةطيب، أمتى بيرجع ال + +277 +00:18:57,260 --> 00:19:00,120 +accommodation؟ أمتى بتبدأ تتحرك ال ciliary muscle + +278 +00:19:00,120 --> 00:19:03,720 +عشان تبدأ تعمل accommodation بعد تلت أيام بالنسبة + +279 +00:19:03,720 --> 00:19:06,840 +للأتروبين؟ بينما بعد ساعتين لتلاتة بالنسبة + +280 +00:19:06,840 --> 00:19:10,560 +للcycloventilator؟ طيب، أمتى بيرجع البقبق مكانه أو + +281 +00:19:10,560 --> 00:19:14,340 +لو .. لحجمه الطبيعي من عشر أيام لاربعتاشر يوم؟ + +282 +00:19:14,340 --> 00:19:18,120 +يعني لأسبوع؟ عشان هيك بدنا نوح بالنسبة للأتروبين، + +283 +00:19:18,120 --> 00:19:22,640 +لو في عندي طفل بيدهب للمدرسةومضطر أجطر أتروبين + +284 +00:19:22,640 --> 00:19:27,100 +ممكن أنا أخلي الأتروبين تقطيره في الإجازة في + +285 +00:19:27,100 --> 00:19:30,160 +الإجازة ليش؟ لأنه بعد الأتروبين بدي أقعد من عشرة + +286 +00:19:30,160 --> 00:19:34,720 +لاربعتاشر يوم البقبق متوسع وبالتالي هيكون مغبش ولا + +287 +00:19:34,720 --> 00:19:39,700 +يستطيع مثلا الدراسة أو ما إلى ذلك فبالتالي بدي أخد + +288 +00:19:39,700 --> 00:19:43,980 +بالي من توقيت استعمال الأتروبين .. توقيت استعمال + +289 +00:19:43,980 --> 00:19:46,990 +الأتروبينthe parents should be warned to + +290 +00:19:46,990 --> 00:19:50,110 +discontinue medication if there are signs of + +291 +00:19:50,110 --> 00:19:54,370 +systemic toxicity such as flushing إذا أنا ظهرت + +292 +00:19:54,370 --> 00:19:59,370 +عندي side effects، أثار جانبية للأتروبيل أو + +293 +00:19:59,370 --> 00:20:04,290 +للـcyclopentylate و هذه الأثار الجانبية من + +294 +00:20:04,290 --> 00:20:08,490 +السمومية بتاعة ال drug زي إيش؟ زي ال flushing، + +295 +00:20:08,490 --> 00:20:15,350 +حمرار الوجه، ال fever، الحرارةالتهيج restlessness + +296 +00:20:15,350 --> 00:20:21,330 +لازم ساعتها يوقفوا القطرة و ي .. يعني يراجعوا أقرب + +297 +00:20:21,330 --> 00:20:28,310 +مركز طبي أو أقرب طبيب عيون أو مركز طوارئ لهم عساس + +298 +00:20:28,310 --> 00:20:32,310 +انه يشوفوا إيش يعملوا في الحالات هذه طيب .. الآن + +299 +00:20:32,310 --> 00:20:38,350 +عشان أخفف .. عشان أخفف الأثار الجانبية لل cycle و + +300 +00:20:38,350 --> 00:20:44,790 +ventilateولا ال atropine لازم أنا أضغط أثناء + +301 +00:20:44,790 --> 00:20:51,210 +التقطير أضغط على ال lacrimal sac مدة دقيقة و يتم + +302 +00:20:51,210 --> 00:20:54,270 +التقطير و أنا ضاغط على ال lacrimal sac يعني في شخص + +303 +00:20:54,270 --> 00:20:57,270 +لازم يحط أصابعه على ال lacrimal sac و يضغط عشان + +304 +00:20:57,270 --> 00:21:03,800 +يسكرLacrimal puncta اللي هي القنوات الدمعية + +305 +00:21:03,800 --> 00:21:08,800 +وبالتالي ممكن شخص آخر يجطر الطفل نقطة في كل عين + +306 +00:21:08,800 --> 00:21:13,500 +وبنرفع الضغط عن Lacrimal puncta بعد مرور دقيقة أو + +307 +00:21:13,500 --> 00:21:18,930 +دقيقة ونص هذا بيخلي أن العين هي اللي تمتصالجطرة + +308 +00:21:18,930 --> 00:21:22,970 +اللي جطرناها وما تنزل أي جزء منها في ال lacrimal + +309 +00:21:22,970 --> 00:21:27,510 +sac لأنه إذا نزلت في ال lacrimal sac هتمتص إلى ال + +310 +00:21:27,510 --> 00:21:31,350 +systemic circulation هتوصل لمجرة الدم .. لمجرة + +311 +00:21:31,350 --> 00:21:35,290 +الدم العام وبالتالي هتعمل side effects فضروري + +312 +00:21:35,290 --> 00:21:38,870 +pressure على ال lacrimal sac لمدة دقيقة أو دقيقة و + +313 +00:21:38,870 --> 00:21:40,530 +نص أثناء التقطير + +314 +00:21:46,310 --> 00:21:50,730 +هذا بيخفف كتير طبعا من ال side effects بتاعة ال + +315 +00:21:50,730 --> 00:21:58,790 +cycloventilate و الأترول الان change of refraction + +316 +00:21:59,030 --> 00:22:02,650 +change of refraction because refraction changes + +317 +00:22:02,650 --> 00:22:05,910 +with age it is important to check at least every + +318 +00:22:05,910 --> 00:22:09,950 +year and more frequently in smaller children يعني + +319 +00:22:09,950 --> 00:22:15,310 +كل قداش أجدر للطفل يعني كل سنة و أحيانا يعني في + +320 +00:22:15,310 --> 00:22:18,890 +أوقات أقرب من سنة يعني كل ست شهور في الأطفال + +321 +00:22:18,890 --> 00:22:24,830 +الصغار أيضاأيضا مش بس في الأطفال الصغار بجتر كل ست + +322 +00:22:24,830 --> 00:22:28,550 +شهور، أيضا إذا كان ال vision is reduced، acuity is + +323 +00:22:28,550 --> 00:22:31,110 +reduced لازم أعرف السبب، هل صار في change في ال + +324 +00:22:31,110 --> 00:22:35,410 +refraction، عشان أغير النضارة إذا لازم الأمر، at + +325 +00:22:35,410 --> 00:22:40,110 +birth most babies are hypermetropic عند الولادة + +326 +00:22:40,110 --> 00:22:43,370 +الغالبية العظمى من الأطفال بيكونوا hypermetropes + +327 +00:22:46,860 --> 00:22:49,820 +after the age of two years, there may be an + +328 +00:22:49,820 --> 00:22:52,660 +increase in hypermetropia and decrease in + +329 +00:22:52,660 --> 00:22:56,140 +astigmatism. Hypermetropia may continue to + +330 +00:22:56,140 --> 00:22:58,840 +increase، ليش احنا الكلام مركزي كتير على ال + +331 +00:22:58,840 --> 00:23:02,880 +hypermetropia؟ لأنها أكتر refractive error بتسبب + +332 +00:23:02,880 --> 00:23:08,570 +الحوارطبعا after the age of two years there may be + +333 +00:23:08,570 --> 00:23:11,590 +an increase in hypermetropia and decrease in + +334 +00:23:11,590 --> 00:23:15,050 +astigmatism الhypermetropia may continue to + +335 +00:23:15,050 --> 00:23:18,930 +increase until the age of about six years and then + +336 +00:23:18,930 --> 00:23:22,970 +between age of six and eight years levels of + +337 +00:23:22,970 --> 00:23:26,540 +subsequently decreasinguntil the early teenage + +338 +00:23:26,540 --> 00:23:30,880 +years ما معنى هذا الكلام بنشوف هذا المخطط البياني + +339 +00:23:30,880 --> 00:23:34,300 +غالبية الأطفال بيكونوا hypermetropic at birth هي + +340 +00:23:34,300 --> 00:23:38,840 +صفر سنة اليوم انولد غالبا بيكون hypermetropic و ال + +341 +00:23:38,840 --> 00:23:42,000 +hypermetropia بتاعه في الطبيعي بتتراوح بين plus + +342 +00:23:42,000 --> 00:23:47,760 +one ل plus two هذا most babies بعض الأطفال بيكون + +343 +00:23:47,760 --> 00:23:50,980 +أكتر من هيك hypermetropia قلة قليلة جدا من الأطفال + +344 +00:23:50,980 --> 00:23:54,570 +ممكن تكون myopesفبالتالي الغالبية العظمى بيكونوا + +345 +00:23:54,570 --> 00:23:58,490 +hypermetropia between plus one and plus two بعد + +346 +00:23:58,490 --> 00:24:01,470 +عمر سنتين .. بعد عمر two years بتبدأ ال + +347 +00:24:01,470 --> 00:24:06,310 +hypermetropia تزيد .. بتبدأ ال hypermetropia تزيد + +348 +00:24:06,310 --> 00:24:11,530 +لغاية عمر ست سنوات .. هذه وفد دراسات عملت على + +349 +00:24:11,530 --> 00:24:16,890 +أطفال كتير .. بعد الست سنواتlevels of يعني إيه إيش + +350 +00:24:16,890 --> 00:24:21,130 +بتوقف عند الحد طبعا من ستة لتمانية بتوقف عند الحد + +351 +00:24:21,130 --> 00:24:24,570 +اللي وصلت له يعني هنا مثلا في المثال تقريبا وصلت + +352 +00:24:24,570 --> 00:24:28,790 +عند أربع درجات و نص hypermetropia بعد سنة تمان + +353 +00:24:28,790 --> 00:24:35,140 +سنواتبتبدأ تتراجع باتجاه ال emmetropia لغاية بداية + +354 +00:24:35,140 --> 00:24:38,960 +العشرة ثانية من العمر اللي هي early teenage year + +355 +00:24:38,960 --> 00:24:42,320 +.. teenager هذا بالنسبة للhypermetropia هذا الكلام + +356 +00:24:42,320 --> 00:24:48,580 +إيش بفيدني؟ يعني أنا إنسان .. يعني أحضره والدي في + +357 +00:24:48,580 --> 00:24:51,740 +عمر أربع سنوات لجينا عنده كمية معينة من + +358 +00:24:51,740 --> 00:24:57,690 +الhypermetropia نفرض plus خمسةplus خمسة و بعد سنة + +359 +00:24:57,690 --> 00:25:01,110 +من ذلك احضره مرة تانية صار عندى plus خمسة و نص أو + +360 +00:25:01,110 --> 00:25:04,410 +plus خمسة و تلت اربعة يعني زاد نص درجة او تلت + +361 +00:25:04,410 --> 00:25:08,970 +اربعة درجة مابكونش انا جالجان لسبب هذه الزيادة + +362 +00:25:08,970 --> 00:25:13,460 +لأنه في هذا السنفي هذا السن من سن سنتين لست سنوات + +363 +00:25:13,460 --> 00:25:17,560 +هو سن زيادة في طول النظر غالبا في طول النظر غالبا + +364 +00:25:17,560 --> 00:25:21,720 +فبالتالي هذه القضية ضروري تكون واضحة أيضا في هنا + +365 +00:25:21,720 --> 00:25:25,780 +معلومة ما ننساش أنه صحيح ال hypermetropia في عمر + +366 +00:25:25,780 --> 00:25:29,820 +سنتين فأكثر بتبدأ تزيد لغاية ست سنوات بس بيصير + +367 +00:25:29,820 --> 00:25:32,700 +عندي decrease في الastigmatism decrease في + +368 +00:25:32,700 --> 00:25:37,660 +الastigmatism الآن بنيجي لنقطة المهمة when to + +369 +00:25:37,660 --> 00:25:45,020 +prescribe أمتى أوصف نضارةلأ الطفل امتى اوصف نضارة + +370 +00:25:45,020 --> 00:25:48,700 +لأ الطفل اللى عنده refractive error، امتى اوصفله + +371 +00:25:48,700 --> 00:25:52,400 +عندما يكون عنده hypermetropia، امتى اوصفله عندما + +372 +00:25:52,400 --> 00:25:55,440 +يكون عنده astigmatism، امتى اوصفله عندما يكون عنده + +373 +00:25:55,440 --> 00:25:59,300 +myopia، امتى اوصفله عندما يكون عنده hyper أو + +374 +00:25:59,300 --> 00:26:03,500 +anisometropiaالـ hypermetropia in general up to + +375 +00:26:03,500 --> 00:26:06,600 +four diopter of hypermetropia should not be + +376 +00:26:06,600 --> 00:26:10,580 +corrected in a child without squint unless they + +377 +00:26:10,580 --> 00:26:14,740 +are having problems with near vision طفل عنده أربع + +378 +00:26:14,740 --> 00:26:18,580 +ديوبتر فأقل يعني up to أربع ديوبتر عنده أربع + +379 +00:26:18,580 --> 00:26:21,560 +ديوبتر hypermetropia plus أربع plus تلاتة و نص + +380 +00:26:21,560 --> 00:26:26,520 +plus تلاتة plus اتنين و عمره أقل من أربع سنوات و + +381 +00:26:26,520 --> 00:26:31,280 +ماعندهاش squintما بوصفلهش نضارة، ليش؟ لأنه ال + +382 +00:26:31,280 --> 00:26:34,260 +accommodation بتاع العين بيقدر يتغلب على الأربعة + +383 +00:26:34,260 --> 00:26:38,300 +ديوب تار، امتى أنا بوصفله نضارة، إذا كان في عنده + +384 +00:26:38,300 --> 00:26:41,300 +مشكلة في ال near vision، إذا عنده مشكلة في ال near + +385 +00:26:41,300 --> 00:26:48,100 +visionلو عنده أربعة ديوبتر أو أكتر من أربعة ديوبتر + +386 +00:26:48,100 --> 00:26:52,380 +بس ماعندهوش squint، ماعندهو squint، ماعندهوش حوال، + +387 +00:26:52,380 --> 00:26:56,060 +عنده مثلا خمسة ديوبتر، ستة ديوبتر، بعطيه تلتين + +388 +00:26:56,060 --> 00:26:59,460 +الكمية، لو عنده انا ستة ديوبتر hypermetropia + +389 +00:26:59,460 --> 00:27:03,590 +وعينيه straightبعطيه تلتين الست ديوبتر، يعني بعطيه + +390 +00:27:03,590 --> 00:27:08,110 +أربع ديوبتر glasses، أربع ديوبتر glasses، إذا two + +391 +00:27:08,110 --> 00:27:11,690 +-thirds correction is usually given however in the + +392 +00:27:11,690 --> 00:27:15,130 +presence of esotropia, the full cyclobolic + +393 +00:27:15,130 --> 00:27:19,350 +correction should be prescribed واحد طفل عنده عمره + +394 +00:27:19,350 --> 00:27:24,590 +سنتينو عنده مثلا plus تلاتة و نص ديوبتر و عنده + +395 +00:27:24,590 --> 00:27:28,710 +إيزوتروبيا، بعطيله كل plus تلاتة و نص ديوبتر، يعني + +396 +00:27:28,710 --> 00:27:31,650 +in the presence of إيزوتروبيا، the full + +397 +00:27:31,650 --> 00:27:35,930 +cycloplegic refraction should be prescribed even + +398 +00:27:35,930 --> 00:27:40,530 +under the age of two years عشان .. عشان أريح ال + +399 +00:27:40,530 --> 00:27:43,090 +accommodation و مايتطرش أعمل accommodation لأن + +400 +00:27:43,090 --> 00:27:46,270 +الإيزوتروبيا ممكن تكون ناتجة عن ال accommodation + +401 +00:27:48,550 --> 00:27:51,830 +الان بالنسبة للastigmatism القاعدة بتاعته بسيطة + +402 +00:27:51,830 --> 00:27:56,330 +للغاية بنقول cylinder of واحد و نص ديوبتر or more + +403 +00:27:56,330 --> 00:27:59,470 +should be prescribed especially in cases of + +404 +00:27:59,470 --> 00:28:03,270 +anisometropia after the age of eighteen months + +405 +00:28:03,270 --> 00:28:08,090 +يعني eighteen months سنة و نص أي طفل عمره أكتر من + +406 +00:28:08,090 --> 00:28:12,070 +سنة و نص يعني سنة و نص فأكتر و عنده درجة و نص + +407 +00:28:12,070 --> 00:28:17,690 +ديوبتر و نص فأكتر واحد و نص في العمرفاكثر و ده + +408 +00:28:17,690 --> 00:28:22,110 +يبطر و نص في الastigmatism فأكتر لازم أوصفله درجات + +409 +00:28:22,110 --> 00:28:26,690 +الastigmatism اللي طلعت عنده بشكل نضال بالنسبة + +410 +00:28:26,690 --> 00:28:30,350 +لالmyopia .. الmyopia مرتبطة بال age .. نشوف هذا + +411 +00:28:30,350 --> 00:28:40,070 +ال jadwal بنقول .. أي طفل عمره سنتين .. سنتين .. + +412 +00:28:40,070 --> 00:28:42,270 +أعزف .. بدنا نطلع من هنا + +413 +00:28:52,290 --> 00:28:59,690 +أي طفل عمره سنتين فأقل و عنده خمسة ديوبتر أو أكثر، + +414 +00:28:59,690 --> 00:29:03,030 +يعني خمسة ديوبتر، ستة ديوبتر، سبعة ديوبتر، ميوبيا، + +415 +00:29:03,030 --> 00:29:07,260 +لازم أعطيله classesلازم أعطيله classes، طب طفل + +416 +00:29:07,260 --> 00:29:12,020 +عمره سنة و نص، أقل من سنتين، يعني within two years + +417 +00:29:12,020 --> 00:29:16,100 +of age و عنده أربع ديوبتر مايوبيا، باعطيلهش + +418 +00:29:16,100 --> 00:29:19,760 +classes، ليش؟ لأن الطفل الصغير اللي عمره سنة و نص + +419 +00:29:19,760 --> 00:29:24,160 +مش محتاج يبطلع على distant target كتيريعني بيتطلع + +420 +00:29:24,160 --> 00:29:27,640 +في ألعابه .. ألعابه جريبة منه لو عنده أربع ديوبتر + +421 +00:29:27,640 --> 00:29:32,520 +myopia هذه ال .. ال .. ال .. ال refractive error + +422 +00:29:32,520 --> 00:29:35,840 +بي .. بيعيقوش أنه يتطلع على البيئة المحيطة فيه + +423 +00:29:35,840 --> 00:29:39,840 +أكتر بيئة محيطة فيه في .. في حدود نص متر متر محتاج + +424 +00:29:39,840 --> 00:29:43,100 +يشوفها بيقدر يشوفها و عنده أربع ديوبتر إذا كان + +425 +00:29:43,100 --> 00:29:47,360 +عندي خمسة ديوبتر فأكتر لازم أعطيله اجلس طيب من عمر + +426 +00:29:47,360 --> 00:29:53,380 +سنتين لعمر أربع سنواتإذا عنده تلاتة ديوبتر أو أكتر + +427 +00:29:53,380 --> 00:29:56,700 +من الmyopia بعطيله glasses طب واحد عمره تلت سنوات + +428 +00:29:56,700 --> 00:30:00,580 +يعني جاي في ال range هذا وعنده two diopter myopia + +429 +00:30:00,580 --> 00:30:03,880 +مابلزموش glasses ليش؟ لأنه أقل من تلاتة diopter + +430 +00:30:03,880 --> 00:30:07,840 +two diopter myopia بتسمحله يجوم بكل ال activities + +431 +00:30:07,840 --> 00:30:11,480 +اللي عادة بيجوموا فيها الأطفال في هذا العمر و بدون + +432 +00:30:11,480 --> 00:30:13,800 +نضارة .. بدون نضارة .. بس لو كان عنده أكتر من + +433 +00:30:13,800 --> 00:30:18,040 +تلاتة diopter لأ لازم أعطيلهطبعا إذا كان الطفل + +434 +00:30:18,040 --> 00:30:22,120 +يعني عدى أربع سنوات من العمر بدأ بده يروح الراوطة + +435 +00:30:22,120 --> 00:30:25,580 +أقل من تلاتة دقيقة أكتر ممكن أعطي لأنه إذا بده + +436 +00:30:25,580 --> 00:30:28,320 +يروح الراوطة بيطلع الصدورة اللي هي distant target + +437 +00:30:28,320 --> 00:30:32,660 +فبالتالي لازم أنا أعطيله اجلسة، هذه القاعدة + +438 +00:30:32,660 --> 00:30:36,980 +بالنسبة للميوبيا، بالنسبة للميوبيا، الآن بالنسبة + +439 +00:30:36,980 --> 00:30:41,820 +لل anisometropiaafter the age of three years, the + +440 +00:30:41,820 --> 00:30:44,900 +full difference in refraction between the two eyes + +441 +00:30:44,900 --> 00:30:48,340 +should be prescribed if it is more than one + +442 +00:30:48,340 --> 00:30:52,640 +diopter if there is no squint then any associated + +443 +00:30:52,640 --> 00:30:56,320 +hypermetropic correction may be equally reduced + +444 +00:30:56,320 --> 00:31:00,780 +for each eye نفهم هذه القضية خلينا احنا نضيف شريحة + +445 +00:31:00,780 --> 00:31:05,280 +عشان نفهم هذه القضية انسان ما عنده مثلا squint + +446 +00:31:08,450 --> 00:31:20,810 +عنده refractive error في العين تاني أي عين بمعنى + +447 +00:31:20,810 --> 00:31:26,590 +عندي مثال طفل عمره أربع سنوات عنده خمسة ديوبتر + +448 +00:31:26,590 --> 00:31:31,120 +hypermetrobia بالعين اليمينو عنده اتنين و نص + +449 +00:31:31,120 --> 00:31:34,240 +ديوبتر في العين الشمال هايبرمتروبيا هدا بنسميه + +450 +00:31:34,240 --> 00:31:37,580 +anisometropia difference في ال refractive error + +451 +00:31:37,580 --> 00:31:41,260 +between the two eyes قررنا نعطيله نضارة لازم ال + +452 +00:31:41,260 --> 00:31:44,440 +difference هدا نلغيه كيف ياني نلغيه؟ بطريقة تالية + +453 +00:31:44,440 --> 00:31:48,540 +هاي glass is given عطينا نضارة إذا اليمين وصفناها + +454 +00:31:48,540 --> 00:31:52,260 +لها تلاتة ديوبتركداش ضال من ال refractive error + +455 +00:31:52,260 --> 00:31:56,140 +يعني انا صلحت تلاتة ديوبتر من الخمسة يعني ضال عنده + +456 +00:31:56,140 --> 00:32:00,160 +اتنين ديوبتر hypermetropia ماصلحت ال hypermetropia + +457 +00:32:00,160 --> 00:32:04,260 +كلها ضروري هنا في العين الشمال يضال اتنين ديوبتر + +458 +00:32:04,260 --> 00:32:07,800 +يعني انا من الاتنين و نص هعطيله نص عشان يضل عندى + +459 +00:32:07,800 --> 00:32:11,110 +اتنين ديوبتر هيك بكون انا كإني ألغيتالـ + +460 +00:32:11,110 --> 00:32:15,390 +anisometropia ضايل لليمين plus 2 مش مصلحات وضايل + +461 +00:32:15,390 --> 00:32:20,170 +للشمال plus 2 مش مصلحات إذاً هيك أنا عملت حساب الـ + +462 +00:32:20,170 --> 00:32:23,490 +anisometropia إني ألغيها في ال glasses ألغيها في + +463 +00:32:23,490 --> 00:32:28,430 +ال glasses إنه بصلح لكل عين بحيث إنه الفرج اللي + +464 +00:32:28,430 --> 00:32:32,010 +ضايل ما تبقى من ال uncorrected refractive error + +465 +00:32:32,010 --> 00:32:36,250 +يكون متساوي في العين تانية بعد فترة مثلا بعد فترة + +466 +00:32:36,250 --> 00:32:40,400 +سنة قررت أعمل reduction في النضارةحتى لو عملت + +467 +00:32:40,400 --> 00:32:43,140 +reduction يعني جلالت في جياس النضارة بدل plus + +468 +00:32:43,140 --> 00:32:46,660 +تلاتة اعطيته اتنين و نص جلالت هنا بدي اجلل هنا + +469 +00:32:46,660 --> 00:32:50,080 +بحيث ان اللي باقي ضال نفس الشيء يعني هنا خمسة ده + +470 +00:32:50,080 --> 00:32:53,880 +يبطر صلحنا منها اتنين و نص ضال عندى اتنين و نص مش + +471 +00:32:53,880 --> 00:32:58,700 +مسلحات uncorrected تمام هنا الاتنين و نص بدي ضال + +472 +00:32:58,700 --> 00:33:01,680 +منهم اتنين و نص اذا بقى اوصف لهبلانه بلانه يعني + +473 +00:33:01,680 --> 00:33:05,360 +نضارة قوتها صفر للعين أو عدسة قوتها صفر للعين + +474 +00:33:05,360 --> 00:33:08,560 +لشمال فبيضل ال .. ال .. ال residue و ال refractive + +475 +00:33:08,560 --> 00:33:11,180 +error اللي ضايل عندي متساوي في العينتين هيك أنا + +476 +00:33:11,180 --> 00:33:15,860 +بكون ألغيت أو عملت overcoming تغلبت على ال + +477 +00:33:15,860 --> 00:33:19,920 +anisometropia ضروري جدا ال any reduction in + +478 +00:33:19,920 --> 00:33:24,780 +refractive correction ياخد في حسابهتمام؟ if there + +479 +00:33:24,780 --> 00:33:27,700 +is no squint then any associated hypermetropic + +480 +00:33:27,700 --> 00:33:31,760 +correction may be equally reduced for each eye هنا + +481 +00:33:31,760 --> 00:33:35,100 +نزلنا نص في النضارة و هناك نزلنا نص هنا كانت + +482 +00:33:35,100 --> 00:33:41,180 +النضارة plus 3 صارت plus 2.5 يعني نزلنا نص ديوبتر + +483 +00:33:41,180 --> 00:33:46,220 +و هنا plus نص نزلنا نص ديوبتر صارت صفر إذا equally + +484 +00:33:46,220 --> 00:33:50,500 +reduced .. equally reducedالنضارة الأولى ألغيت + +485 +00:33:50,500 --> 00:33:53,300 +فيها ال anisometropia و النضارة التانية علشان أنا + +486 +00:33:53,300 --> 00:33:56,560 +نزلت بنفس الدرجة نص ديوبتر نص ديوبتر عن النضارة + +487 +00:33:56,560 --> 00:34:00,900 +الأولى، دال عندي ال anisometropia ملغية .. ملغية + +488 +00:34:00,900 --> 00:34:06,260 +هيك بتنتهي المحاضرة و بينتهي معها مسافة حوال واحد + +489 +00:34:06,260 --> 00:34:11,160 +و يعطيكم العافية والسلام عليكم ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/2GbOhM5GWj4_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/2GbOhM5GWj4_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..da147a8263f6d3ce000b59a3590af291e0827161 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/2GbOhM5GWj4_postprocess.srt @@ -0,0 +1,1432 @@ +1 +00:00:01,530 --> 00:00:04,850 +بسم الله الرحمن الرحيم بنواصل محاضرات حوال واحد + +2 +00:00:04,850 --> 00:00:08,710 +واتوقفنا عند ال motor adaptation to strabismus + +3 +00:00:08,710 --> 00:00:13,150 +عارفين إنه عندنا في sensory adaptation to + +4 +00:00:13,150 --> 00:00:16,390 +strabismus اللي هو بتلخص في ال suppression أو ال + +5 +00:00:16,390 --> 00:00:19,850 +abnormal retinal correspondence وقلنا بالنسبة لل + +6 +00:00:19,850 --> 00:00:22,110 +sensory adaptation ال suppression اللي هو negative + +7 +00:00:22,110 --> 00:00:25,310 +adaptation وال abnormal retinal correspondence + +8 +00:00:25,310 --> 00:00:29,450 +positive adaptation اليوم عندناال motor adaptation + +9 +00:00:29,450 --> 00:00:33,370 +to strabismus والمقصود فيه ال motor adaptation to + +10 +00:00:33,370 --> 00:00:40,370 +strabismus هو ال abnormal head posture الوضعية + +11 +00:00:40,370 --> 00:00:43,770 +الغير طبيعية للرأس عند المريض اللي بيكون عنده حوال + +12 +00:00:43,770 --> 00:00:47,270 +أو عند بعض المرضى اللي بيكون عندهم حوال أول حاجة + +13 +00:00:48,080 --> 00:00:52,660 +بنقول adaptation يعني بده يتأقلم أو يخلصني من + +14 +00:00:52,660 --> 00:00:56,400 +وضعية الحوار فبنقول ال motor adaptation of + +15 +00:00:56,400 --> 00:01:02,180 +strabismus أو to strabismus عفوا هو عبارة عن وضعية + +16 +00:01:02,180 --> 00:01:06,930 +معينة للرأسالهدف منها استعادة ال binocular single + +17 +00:01:06,930 --> 00:01:11,370 +vision ال binocular single vision في عدة نقاط بدنا + +18 +00:01:11,370 --> 00:01:15,870 +يعني نأكد على أهميتها جابل ما نبدأ في موضوع ال + +19 +00:01:15,870 --> 00:01:19,090 +motor adaptation to strabismus بنقول كالاتي احنا + +20 +00:01:19,090 --> 00:01:21,910 +عندنا الإنسان بيقدر يتطلع في ال nine diagnostic + +21 +00:01:21,910 --> 00:01:25,770 +positions of gaze up and right, right, down and + +22 +00:01:25,770 --> 00:01:29,800 +right هاي تلاتةup and left, left down and left هاي + +23 +00:01:29,800 --> 00:01:33,340 +كمان تلاتة ست وضعيات و straight up و straight down + +24 +00:01:33,340 --> 00:01:36,960 +هاي كمان تنتين تمانية و ال primary position تسعة + +25 +00:01:36,960 --> 00:01:41,600 +طيب من .. من الجدير بالذكر أنه بعض أنواع الحوال + +26 +00:01:41,600 --> 00:01:45,760 +بتكون ظاهرة في position و مش ظاهرة في ال position + +27 +00:01:45,760 --> 00:01:50,750 +الآخر يعني ممكنالحوال يكون ظاهر في ال right gaze و + +28 +00:01:50,750 --> 00:01:54,930 +مش ظاهر في ال left gaze وبالتالي .. و بالتالي + +29 +00:01:54,930 --> 00:01:58,990 +بيكون عنده في ال left gaze لو اطلع المريض مش ظاهر + +30 +00:01:58,990 --> 00:02:01,350 +الحوال يعني في عنده binocular single vision اللي + +31 +00:02:01,350 --> 00:02:05,220 +عندهين متزينات بينما في ال right gazeظاهر الحوال + +32 +00:02:05,220 --> 00:02:10,020 +فبيكون عنده إما dyplopia أو صدرشين فبالتالي المريض + +33 +00:02:10,020 --> 00:02:14,900 +هيضل يتطلع على الشمال طيب، معقول يمشي مثلا للأمام + +34 +00:02:14,900 --> 00:02:19,040 +و ينظر لليسار؟ لأ، هو بده ينجل للناحية اليسرى اللي + +35 +00:02:19,040 --> 00:02:22,960 +فيها مافيش فيه مشكلة فيها لأمامه فبيتخذ وضعية + +36 +00:02:22,960 --> 00:02:27,160 +للرأس معينة لو لف وجهه على الجهة اليمين عينيه + +37 +00:02:27,160 --> 00:02:30,200 +تلقائيا هيروحه على اليسار بس ساعتها اليسار هيكون + +38 +00:02:30,200 --> 00:02:34,300 +أمامهلأ، بالضبط بيشبه إنسان طبيعي واقف أمام + +39 +00:02:34,300 --> 00:02:39,460 +المرأة، بتطلع في نفسه، وفجأة لف وجهه على اليمين، + +40 +00:02:39,460 --> 00:02:43,700 +لف رأسه على اليمين وعينيه دائما على المرأة، هتلاقي + +41 +00:02:43,700 --> 00:02:48,330 +أن عيناي صحيح راحوا على الشمال، بس بالشماللازال أو + +42 +00:02:48,330 --> 00:02:53,390 +أصبح أمامه بدل ما يكون على جهته اليسرى ليش الجهة + +43 +00:02:53,390 --> 00:02:57,230 +أو ال left field عندهم أصبح أمامه لأنه في عنده + +44 +00:02:57,230 --> 00:03:00,490 +face turned to the right فالمقصود بال abnormal + +45 +00:03:00,490 --> 00:03:04,750 +head posture المقصود بال abnormal head posture أو + +46 +00:03:04,750 --> 00:03:08,410 +بين قوسين ال motor adaptation to strabismus هو إن + +47 +00:03:08,410 --> 00:03:14,670 +الإنسان اللي عنده squint بيتاخذ وضعية رأس معينةحتى + +48 +00:03:14,670 --> 00:03:19,950 +.. حتى ينقل العينتين لمكان أو لوضعية أو ل position + +49 +00:03:19,950 --> 00:03:23,590 +of gaze مافيش فيه حوال .. مافيش فيه حوال وهذا اللي + +50 +00:03:23,590 --> 00:03:27,090 +بنسميه ال motor adaptation to strabismus عند مين + +51 +00:03:27,090 --> 00:03:30,730 +بيحصل ال motor adaptation to strabismus؟ ال .. + +52 +00:03:30,730 --> 00:03:34,590 +occurs primarily in children with congenitally + +53 +00:03:34,590 --> 00:03:38,770 +abnormal eye movementsالاطفال غالبا اللي عندهم + +54 +00:03:38,770 --> 00:03:42,850 +congenital squint ممكن كتير نلاقي عندهم abnormal + +55 +00:03:42,850 --> 00:03:47,270 +head posture الهدف من ال abnormal head posture to + +56 +00:03:47,270 --> 00:03:50,430 +maintain binocular single vision عشان يحافظوا على + +57 +00:03:50,430 --> 00:03:54,030 +ال binocular single vision بمعنى انه لا إراديا .. + +58 +00:03:54,030 --> 00:03:58,790 +لا إراديا الرأس بتاع هذا الطفل بيكون ماخد وضعية + +59 +00:03:58,790 --> 00:04:03,500 +معينةالعنتين بيكونوا ماخدين وضعية أخرى معاكسة لها + +60 +00:04:03,500 --> 00:04:07,240 +لأنه عندنا قاعدة عند الإنسان الطبيعي والإنسان اللي + +61 +00:04:07,240 --> 00:04:11,680 +عنده الحوار لكل الناس لما ال head بيتحرك باتجاه + +62 +00:04:11,680 --> 00:04:15,940 +معين العنتين بتحركوا باتجاه آخر لما أرفع ال head + +63 +00:04:15,940 --> 00:04:21,130 +لفوقيعني chin up position العناية تلقائيًا بينزلوا + +64 +00:04:21,130 --> 00:04:25,130 +لتحت لما أعمل chin down position عناية تلقائيًا + +65 +00:04:25,130 --> 00:04:28,490 +بتتحركوا لفوق بشرط أن أكون مثبت عناية على ال + +66 +00:04:28,490 --> 00:04:32,150 +target اللي أنا بتطلع عليه و أحرك رأسي و أنا مثبت + +67 +00:04:32,150 --> 00:04:35,150 +عناية على ال target اللي أنا بتحرك عليه .. اللي .. + +68 +00:04:35,150 --> 00:04:39,010 +اللي بتطلع عليه بمعنى أخر أنا بتطلع على شمعة أمامي + +69 +00:04:39,010 --> 00:04:43,890 +وعملت .. خلت وجهي يلكفت لليمين بس عناية على الشمعة + +70 +00:04:44,410 --> 00:04:48,270 +عناية هيروحه للشمال وجهه التفت لليمين وعناية + +71 +00:04:48,270 --> 00:04:53,130 +التفته للشمال طبعا هذا في الوضع الطبيعي وفي وضع + +72 +00:04:53,130 --> 00:04:56,610 +الحوال بس في وضع الحوال ال abnormal head posture + +73 +00:04:56,610 --> 00:05:00,630 +يتخذ لا إراديا يعني الطفل مش قاصده .. مش قاصده + +74 +00:05:00,630 --> 00:05:04,410 +وإنما في الوضعية هذه ال binocular single vision + +75 +00:05:04,410 --> 00:05:08,270 +موجود في وضعيات تانية ممكن يكون في Diplopia أو + +76 +00:05:08,270 --> 00:05:11,870 +Subversion أو .. أو Subversion نشوف مثال برسمة + +77 +00:05:12,420 --> 00:05:17,840 +الرسمة الأعلى هذا إنسان في ال primary position + +78 +00:05:17,840 --> 00:05:22,040 +عنده right ايزوتروبيا عينه اليمين داخلة لجوه طيب + +79 +00:05:22,040 --> 00:05:26,000 +عينه اليمين داخلة لجوه السبب عنده lateral rectus + +80 +00:05:26,000 --> 00:05:29,140 +palsy شلل في ال lateral rectus بالسبب أن العصب + +81 +00:05:29,140 --> 00:05:34,460 +السادس six nerve فيه مشكلةففي paralysis أو palsy + +82 +00:05:34,460 --> 00:05:38,360 +فبالتالي ال lateral rectus ضعفت فال media rectus + +83 +00:05:38,360 --> 00:05:43,420 +شدت العين لجوة هذا الإنسان لو طلبنا منه يطلع على + +84 +00:05:43,420 --> 00:05:47,320 +اليمين يعمل upduction في ال right eye غطيناه العين + +85 +00:05:47,320 --> 00:05:52,110 +الشمالالعين اليمين لا تذهب لليمين أبدا، ليش؟ لأنه + +86 +00:05:52,110 --> 00:05:55,150 +فيها pulse في ال lateral rectus العضلة المسئولة عن + +87 +00:05:55,150 --> 00:06:01,150 +انها تنقل العين لليمين و هو في ال primary position + +88 +00:06:01,150 --> 00:06:05,650 +بيعاني من dyplopia بسبب ال aesotropia لما بتطلع + +89 +00:06:05,650 --> 00:06:08,810 +عاليمين ال dyplopia بتزيد، ليش بتزيد ال dyplopia؟ + +90 +00:06:08,810 --> 00:06:11,650 +لأن العين الشمال هتروح عاليمين باتجاه ال target + +91 +00:06:11,650 --> 00:06:14,710 +اللي حطناله إياه عاليمين و العين اليمين مش جادرة + +92 +00:06:14,710 --> 00:06:18,550 +تقع عاليمين فهتزيد زاوية الحوارالحل الأمثل لهذا + +93 +00:06:18,550 --> 00:06:24,120 +الشخص أو هذا الطفللما بيعمل right face turn هيوقلف + +94 +00:06:24,120 --> 00:06:27,680 +وجهه على اليمين العينين تلقائيا بيروحوا عكس الرأس + +95 +00:06:27,680 --> 00:06:31,200 +وهذا وضع سواء عند الإنسان اللي عنده squint أو + +96 +00:06:31,200 --> 00:06:35,580 +الإنسان الطبيعي هو بتطلع target أمامه لف وجهه على + +97 +00:06:35,580 --> 00:06:38,700 +اليمين لف وجهه على اليمين عينيتينتين راحوا على + +98 +00:06:38,700 --> 00:06:42,620 +الشمال في الوضعية هاي العينتين اتزنوا ليش؟ لأن + +99 +00:06:42,620 --> 00:06:45,680 +المسئول عن نقل العين اليمين للشمال هو ال media + +100 +00:06:45,680 --> 00:06:48,560 +rectus هنا وهي طبيعية المشكلة مش فيها المشكلة في + +101 +00:06:48,560 --> 00:06:52,270 +ال lateral rectusأيضا المسئول عن نقل العين لشمال + +102 +00:06:52,270 --> 00:06:54,670 +لا لشمال ال lateral rectus إذا ال media rectus هنا + +103 +00:06:54,670 --> 00:07:01,290 +و ال lateral rectus هنا شغلات فبالتالي ال head ذهب + +104 +00:07:02,080 --> 00:07:05,980 +إلى منطقة لا تستطيع العين أن تذهب إليها العين + +105 +00:07:05,980 --> 00:07:09,800 +اليمين لا تستطيع أن تذهب لليمين فالرأس عوّض عنها + +106 +00:07:09,800 --> 00:07:12,840 +راح لليمين عشان العين تاني يروحوا للشمال عشان + +107 +00:07:12,840 --> 00:07:16,360 +يروحوا للمنطقة اللي بيقدروا يروحوا إليها و اللي + +108 +00:07:16,360 --> 00:07:19,940 +الحوال فيها مجاسه صفر إذا في عندي قاعدة the head + +109 +00:07:19,940 --> 00:07:24,280 +turns where the eye cannot + +110 +00:07:26,610 --> 00:07:30,430 +in these children loss of abnormal head طبعا الهدف + +111 +00:07:30,430 --> 00:07:33,430 +من ال abnormal head posture زي .. يعني إيش الهدف + +112 +00:07:33,430 --> 00:07:37,330 +من هذا .. هذا يسمى abnormal head posture هذا يسمى + +113 +00:07:37,330 --> 00:07:41,310 +مش وضع طبيعي إنه يجيني الإنسان ب .. ب .. ب right + +114 +00:07:41,310 --> 00:07:43,970 +face turn هذا abnormal head posture ال head + +115 +00:07:43,970 --> 00:07:46,550 +posture الطبيعي اللي المفروض يكون في الطبيعة إنه + +116 +00:07:46,550 --> 00:07:49,810 +straight head بينما هذا abnormal head posture إيش + +117 +00:07:49,810 --> 00:07:52,910 +الهدف منه؟ الهدف منه to maintain binocular single + +118 +00:07:52,910 --> 00:07:58,590 +vision كيف؟لما اتخذ هذا ال head posture العينين + +119 +00:07:58,590 --> 00:08:02,690 +راحوا لمنطقة بيقدروا يروحوا عليها وبالتالي اتزلوا + +120 +00:08:02,690 --> 00:08:05,550 +العينين بمعنى ال corresponding retinal area اللي + +121 +00:08:05,550 --> 00:08:09,310 +صار إلها نفس ال visual direction والصورتين اتوحدوا + +122 +00:08:09,310 --> 00:08:12,210 +في صورة وبالتالي في عندي binocular single vision + +123 +00:08:12,210 --> 00:08:15,710 +في هذه الوضعية .. في هذه الوضعيةممكن إنسان يقول طب + +124 +00:08:15,710 --> 00:08:18,150 +هذا بتطلع على الشمال، هيمشي للأمام و بتطلع على + +125 +00:08:18,150 --> 00:08:21,730 +الشمال؟ لأ هو لما لف وجهه لليمين أصبح ال left + +126 +00:08:21,730 --> 00:08:26,370 +field أمامه أصبح .. أصبح ال left field أمامه أو + +127 +00:08:26,370 --> 00:08:29,970 +أصبح .. هو صحيح للشمال بس لقدام .. هو صحيح للشمال + +128 +00:08:29,970 --> 00:08:34,290 +بس لقدام وتجربة المرأة كل واحد منا بيبدأ يعني + +129 +00:08:34,290 --> 00:08:39,690 +يتأكد منها أقف أمام المرأة ثابت، راسي معتدلأركز في + +130 +00:08:39,690 --> 00:08:43,530 +صورة نفسي في المرأة، بعدين ألف وجه إلى اليمين، + +131 +00:08:43,530 --> 00:08:46,430 +هلاقي عينيا راحوا للإشمال، بس إيش؟ بتطلعوا في + +132 +00:08:46,430 --> 00:08:48,990 +المرايا، يعني للإشمال صحيح بالنسبة إلي، بالنسبة + +133 +00:08:48,990 --> 00:08:53,150 +لجسمي، بس هذا الإشمال أصبح أمامي، هذا الإشمال أصبح + +134 +00:08:53,150 --> 00:08:56,570 +أمامي، لو تكررت التجربة ولفيت وجهي على الإشمال، + +135 +00:08:56,570 --> 00:09:01,380 +عينيا هيروح إلى اليمين، عكس حركةالرأس عكس حركة + +136 +00:09:01,380 --> 00:09:04,420 +الرأس طبعا ال abnormal head posture الهدف منه + +137 +00:09:04,420 --> 00:09:07,440 +استعادة ال binocular single vision استعادة ال + +138 +00:09:07,440 --> 00:09:11,400 +binocular single vision طيب ايش اهمية ان انا الاحظ + +139 +00:09:11,400 --> 00:09:16,540 +على الطفل او المريض انه في abnormal head posture + +140 +00:09:18,240 --> 00:09:21,200 +على فكرة بعض ال adults هنا غالبا عند ال children + +141 +00:09:21,200 --> 00:09:24,340 +بتصير ال .. ال abnormal head .. head posture بس + +142 +00:09:24,340 --> 00:09:26,980 +بعض ال adults بيصير عندهم abnormal head posture + +143 +00:09:26,980 --> 00:09:31,320 +عساس يتخلص من الدبلوبيا و يستعيد ال binocular + +144 +00:09:31,320 --> 00:09:35,220 +single vision in these children loss of abnormal + +145 +00:09:35,220 --> 00:09:37,780 +head .. head posture may indicate loss of + +146 +00:09:37,780 --> 00:09:40,720 +binocular function and the need for surgical + +147 +00:09:40,720 --> 00:09:44,630 +intervention نرجع للصورة بنقول كالقادةهذا الطفل + +148 +00:09:44,630 --> 00:09:48,690 +نفرض عمره سبعة أو تمان سنوات صار عنده six nerve + +149 +00:09:48,690 --> 00:09:52,690 +palsy بال right esotropia اجان اليوم بيراجع و + +150 +00:09:52,690 --> 00:09:57,590 +فحصناه كل شيء و .. يعني سجلنا انه عنده right face + +151 +00:09:57,590 --> 00:10:00,910 +turn عشان يستعيد ال binocularity لأنه في ال left + +152 +00:10:00,910 --> 00:10:03,840 +gaze لما بيعمل right face turn في ال left gazeفي + +153 +00:10:03,840 --> 00:10:07,180 +عندى binocular single vision هذه القضية سجلناها في + +154 +00:10:07,180 --> 00:10:11,260 +ملفه بعد تلت شهور فحصناها لجينا نفس القضية بعد سنة + +155 +00:10:11,260 --> 00:10:15,420 +بعد سنتين بعد سنتين و نص مثلا لجينا الطفل جاي + +156 +00:10:15,420 --> 00:10:20,740 +بالمنظر هذابالمنظر هذا انه راسه معتدلة و مع ذلك ال + +157 +00:10:20,740 --> 00:10:24,200 +aesopropia موجودة مش اتحسنت لو اتحسنت مافي مشكلة + +158 +00:10:24,200 --> 00:10:28,600 +انه هيطبيعي انه يعدل راسه اذا اتحسنت او شفيت ال + +159 +00:10:28,600 --> 00:10:33,320 +lateral rectus bulge بس انه كان عنده aesopropia + +160 +00:10:33,320 --> 00:10:37,560 +واعتدل رأسه معناته انا بعرف ساعتها على .. على + +161 +00:10:37,560 --> 00:10:43,110 +التأكيدانه هو كان متاخذ هذه الوضعية عشان يستعيد ال + +162 +00:10:43,110 --> 00:10:46,330 +binocular single vision و بعدين عد الراسه معناته + +163 +00:10:46,330 --> 00:10:49,630 +فقد ال binocular single vision ايش يعني فقد ال + +164 +00:10:49,630 --> 00:10:52,910 +binocular single vision معناته العين هاي صار فيها + +165 +00:10:52,910 --> 00:10:56,090 +suppression الدماغ بطل استقبل منها صورة فأصبح + +166 +00:10:56,090 --> 00:11:00,050 +monocular patient ساعتها لازم يتم التدخل جراحيا + +167 +00:11:00,050 --> 00:11:05,530 +عشان نعدل العين هاي جراحياوهذا هنحكي عنه في وضع ال + +168 +00:11:05,530 --> 00:11:08,990 +surgery او .. او لما نحكي عن ال squint surgery اذا + +169 +00:11:08,990 --> 00:11:12,370 +لما ال .. الانسان بيكون او الطفل بيكون متاخذ + +170 +00:11:12,370 --> 00:11:16,630 +abnormal head posture عشان يحافظ على ال binocular + +171 +00:11:16,630 --> 00:11:21,010 +single vision ويخلي العينتين متوازينات يعني ينقلهم + +172 +00:11:21,010 --> 00:11:25,590 +.. ينقلهم لوضع مش في حوال زي ما الرسمة او زي ما + +173 +00:11:25,590 --> 00:11:29,450 +المثال ضربنا اذا كان متاخذ abnormal head posture + +174 +00:11:29,450 --> 00:11:34,370 +لفترة معينة و بعدينفجأة لجينا ال abnormal head + +175 +00:11:34,370 --> 00:11:37,570 +posture راح رغم أن الحوال موجود، يعني السبب بتاع + +176 +00:11:37,570 --> 00:11:41,210 +ال abnormal head posture موجود إلا أن الطفل عدل + +177 +00:11:41,210 --> 00:11:44,290 +راسه، معناته هذا الطفل إدماهه بدأ يعمل suppression + +178 +00:11:44,290 --> 00:11:48,010 +للصورة اللي جاية من ال squinting eye ويتحول من + +179 +00:11:48,010 --> 00:11:52,510 +binocular ل monocular visionساعتها لازم التدخل + +180 +00:11:52,510 --> 00:11:55,690 +الجراحي عشان استعادة ال binocularity ال + +181 +00:11:55,690 --> 00:11:59,210 +binocularity تشغيل العنتين مع بعضها الجراحة هذه + +182 +00:11:59,210 --> 00:12:02,550 +هتساعدني في أنه ال corresponding أن وضعية العين + +183 +00:12:02,550 --> 00:12:05,710 +العنتين تتوازن في الفرق يعني ال corresponding + +184 +00:12:05,710 --> 00:12:08,610 +retinal areas يكون لها نفس ال direction في الفرق + +185 +00:12:08,610 --> 00:12:13,630 +in these childrenloss of abnormal head posture may + +186 +00:12:13,630 --> 00:12:17,310 +indicate loss of binocular function and the need + +187 +00:12:17,310 --> 00:12:20,430 +for surgical intervention عشان نستعيد ال binocular + +188 +00:12:20,430 --> 00:12:23,990 +function طيب these patients may present in adult + +189 +00:12:23,990 --> 00:12:27,850 +life with symptoms of decompensation often unaware + +190 +00:12:27,850 --> 00:12:31,290 +of their abnormal head posture ما معنى هذا الكلام؟ + +191 +00:12:31,290 --> 00:12:35,190 +معنى هذا الكلام ممكن الطفل هذا اللي عمره سبعة أو + +192 +00:12:35,190 --> 00:12:39,740 +تمان سنوات يكبرو بعد هيك يعني يتعرض لإرهاق أو + +193 +00:12:39,740 --> 00:12:43,000 +دماغه يتعرض لتوتر أو ما شابه و يبدأ يصير + +194 +00:12:43,000 --> 00:12:46,580 +decomposition يبدأ يشكوا من أعراض ال decomposition + +195 +00:12:46,580 --> 00:12:51,660 +زي الastinopia الإرهاق البصري ال diplopia أحيانا + +196 +00:12:51,660 --> 00:12:55,640 +تمام فبيجي يشكي منها و بيكون هو نفسه مش ماخد باله + +197 +00:12:55,640 --> 00:13:01,040 +أنه طول حياتهمتاخذ وضعية معينة للرأس، كتير بنسأل + +198 +00:13:01,040 --> 00:13:04,560 +الأهالي تعين الأطفال أو حتى الناس اللي .. اللي + +199 +00:13:04,560 --> 00:13:09,520 +بلغوا سن البلوغ فأكثر وبيجوا عشان يعني عندهم يعني + +200 +00:13:09,520 --> 00:13:13,400 +مشاكل بالنسبة للحوال، بنقوله هل بتلاحظ نفسك مثلا + +201 +00:13:13,400 --> 00:13:17,030 +أنه أنت لما بتتطلى على الأمامإنه في عندنا يعني + +202 +00:13:17,030 --> 00:13:19,590 +شوية abnormal head posture أو في عندنا ياسا مثلا + +203 +00:13:19,590 --> 00:13:22,670 +بتلف وجهك على اليمين أو بتلف وجهك على الشمال أو + +204 +00:13:22,670 --> 00:13:27,550 +بتعمل شوية chin up مثلا لفوق فبالتالي أحيانا كتيرة + +205 +00:13:27,550 --> 00:13:31,110 +بيكون إجابة أنا مش مااخد بالي من هذه القضية بيكونش + +206 +00:13:31,110 --> 00:13:35,250 +لأنه هي شغل لا إرادية .. شغل لا إرادية، الرسالة من + +207 +00:13:35,250 --> 00:13:39,640 +هذه الجملة إنه لازم أنا ..كل مريض حوال .. لما ب .. + +208 +00:13:39,640 --> 00:13:42,660 +أبدأ فحصه .. قبل ما أبدأ فحصه أن أطلع عليه من + +209 +00:13:42,660 --> 00:13:46,560 +مسافة بعيدة عشان ال abnormal head posture ألاحظ + +210 +00:13:46,560 --> 00:13:51,220 +إذا موجود ولا مش موجود لأن أحيانا ال abnormal head + +211 +00:13:51,220 --> 00:13:54,360 +posture بيكون بسيط لدرجة أنه لو جاعد المريض جنبي + +212 +00:13:54,360 --> 00:13:58,340 +أو بدأت أفحص فيه ممكن ما ألاحظش يعني هذه القضية + +213 +00:13:58,340 --> 00:14:01,940 +طبعا ال abnormal head posture له يعني أهمية كبيرة + +214 +00:14:01,940 --> 00:14:07,150 +في يعني المساعدةفي التشخيص يعني احنا مابنحط تشخيص + +215 +00:14:07,150 --> 00:14:11,330 +كامل بناء مجرد على ان في عندي abnormal head + +216 +00:14:11,330 --> 00:14:16,070 +posture وانما بيساعدني في بناء الهرم التشخيصي + +217 +00:14:16,070 --> 00:14:20,930 +للمريض عشان اصل لل diagnosis او التشخيص الصحي + +218 +00:14:21,450 --> 00:14:24,450 +acquired paretic strabismus in adults may be + +219 +00:14:24,450 --> 00:14:27,430 +consciously controlled by an abnormal head posture + +220 +00:14:27,430 --> 00:14:31,290 +provided the deviation is neither too large nor + +221 +00:14:31,290 --> 00:14:36,170 +too variable with gaze يعني بعض الكباب اللي بيصير + +222 +00:14:36,170 --> 00:14:40,650 +عندهمparietic strabismus حوال شللي .. حوال شللي + +223 +00:14:40,650 --> 00:14:45,270 +مكتسب يعني ماكانش عنده كان طبيعي بيستعمل abnormal + +224 +00:14:45,270 --> 00:14:49,590 +head posture و بكون واعي أنه أنا يعني بتاخد وضعية + +225 +00:14:49,590 --> 00:14:53,650 +رأس معينة لنفسي عشان أتخلص من الإزدواجية .. عشان + +226 +00:14:53,650 --> 00:14:57,530 +أتخلص من الإزدواجية يعني بيجي المريض بيقول أنا + +227 +00:14:57,530 --> 00:15:01,550 +والله بميل راسي عاليمين أو عالشمال أو بعمل chin up + +228 +00:15:01,550 --> 00:15:07,610 +متعمدا لأن لو ماعملتش هيكيعني بإدراكي لو عدالت + +229 +00:15:07,610 --> 00:15:11,370 +راسي هسير أشوف الحاجة حاجتين طبعا هذه القضية عند + +230 +00:15:11,370 --> 00:15:15,390 +الكبار أو عند ال adults مابتسيرش دايما إلا في + +231 +00:15:15,390 --> 00:15:18,750 +حالات لما يكون ال deviation مش كبير يعني ال + +232 +00:15:18,750 --> 00:15:22,890 +deviation قليل بشوية abnormal head posture ممكن + +233 +00:15:22,890 --> 00:15:26,570 +يتسيطر عليه وأيضا ال deviation مايكونش variable + +234 +00:15:26,570 --> 00:15:30,450 +variable with gaze يعني الزاوية تحت الحوالي بتختلف + +235 +00:15:30,450 --> 00:15:37,460 +باختلافالـ gaze اللي بتطلع عليه يعني هذا الأضلت .. + +236 +00:15:37,460 --> 00:15:40,820 +هذا الأضلت الـ abnormal head posture الهدف منه + +237 +00:15:40,820 --> 00:15:44,940 +eliminates dyplopia بتخلصلي من الـ dyplopia and + +238 +00:15:44,940 --> 00:15:48,180 +helps to centralize binocular visual field كيف + +239 +00:15:48,180 --> 00:15:51,380 +يعني helps to centralize the binocular visual + +240 +00:15:51,380 --> 00:15:54,840 +field طيب لو أخدنا المثال اللي ضربناه في الأول + +241 +00:15:54,840 --> 00:15:58,840 +بنقول هذا إنسان عنده rightلاترال ريكتاس بالسي رايت + +242 +00:15:58,840 --> 00:16:02,940 +سيكس نيرف بالسي و هو بتطلع دغري و هو بتطلع دغري في + +243 +00:16:02,940 --> 00:16:06,280 +عنده دبلوبيا لأنه في إيزو تروبيا إيزو تروبيا يعني + +244 +00:16:06,280 --> 00:16:10,260 +كل عين لها أو نقاط ال corresponding retinal points + +245 +00:16:10,260 --> 00:16:13,260 +في العينتين اللي هم مش نفس ال direction بسبب + +246 +00:16:13,260 --> 00:16:15,520 +الإيزو تروبيا إذا أنه هو بتطلع في ال primary + +247 +00:16:15,520 --> 00:16:19,650 +positionفي عنده dyplopia لو هذا الشخص طلبنا منه + +248 +00:16:19,650 --> 00:16:23,390 +يطلع target على اليمين هتزيد ال dyplopia ليش؟ لأن + +249 +00:16:23,390 --> 00:16:25,830 +العين الشمال هتيجي على اليمين بينما العين اليمين + +250 +00:16:25,830 --> 00:16:28,610 +مش قادرة تيجي على اليمين فهتزيد كمية ال dyplopia + +251 +00:16:28,610 --> 00:16:32,170 +إذا في ال primary position عندي dyplopia في ال + +252 +00:16:32,170 --> 00:16:35,390 +right gaze عندي dyplopia طب لو قلنا له اطلع على ال + +253 +00:16:35,390 --> 00:16:38,570 +left gaze عن ناحية الشمال على ال left visual field + +254 +00:16:38,570 --> 00:16:42,250 +لو جسمنا ال field لتلت أجزاء ال left field وال + +255 +00:16:42,250 --> 00:16:46,020 +right field وال central fieldهيكون عنده في ال + +256 +00:16:46,020 --> 00:16:49,180 +right field فيه دبلوبيا في ال primary position أو + +257 +00:16:49,180 --> 00:16:51,960 +ال central field فيه دبلوبيا و لما يتطلع على + +258 +00:16:51,960 --> 00:16:54,420 +الشمال مافيش دبلوبيا لأنه لما بيتطلع على الشمال + +259 +00:16:54,420 --> 00:16:57,580 +بستخدم ال media rectus هنا و ال lateral rectus هنا + +260 +00:16:57,580 --> 00:17:00,240 +عشان ينجلوا العينتين على الشمال و احنا قلنا ال + +261 +00:17:00,240 --> 00:17:02,700 +media rectus هنا و ال lateral rectus هنا في حالة + +262 +00:17:02,700 --> 00:17:05,320 +ال lateral rectus بالسي في العين اليمين مالهمش + +263 +00:17:05,320 --> 00:17:08,400 +علاقة هم عضلات طبيعية فبالتالي العينتين بيجوا و + +264 +00:17:08,400 --> 00:17:11,560 +بتوازنوا في ناحية الشمال إذا ال left field مافيش + +265 +00:17:11,560 --> 00:17:15,070 +فيه دبلوبياالـ right field في دبلوبيا وال central + +266 +00:17:15,070 --> 00:17:19,870 +field في دبلوبيا يعني لو حد سألنا واحد عنده right + +267 +00:17:19,870 --> 00:17:24,050 +esotropia بسبب lateral rectus pulsae وين ال field + +268 +00:17:24,050 --> 00:17:27,070 +of binocular single pigeon يعني وين الجزء من ال + +269 +00:17:27,070 --> 00:17:30,570 +field اللي بيكون فيه يستمتع أو الحاجات ما بتبدأ + +270 +00:17:30,570 --> 00:17:35,110 +لتبدو لهذا المريض مزجوجة هنقول في ال left field في + +271 +00:17:35,110 --> 00:17:37,830 +هذا المثال في ال left fieldطب ال left field مش + +272 +00:17:37,830 --> 00:17:40,450 +معجول أنا أظل أطلع على الشمال، أنا بدي أجيب ال + +273 +00:17:40,450 --> 00:17:44,290 +left field أمامي، أعمله centralization، يعني أخليه + +274 +00:17:44,290 --> 00:17:48,210 +بدل ما هو left field، أخليه أمامي، ساعتها لأيراديا + +275 +00:17:48,210 --> 00:17:53,210 +المريض بيتاخذ right face turn عشان عينيه يروحوا + +276 +00:17:53,210 --> 00:17:56,330 +على الشمال، بس الشمال في هذه الوضعية أصبح أمامه، + +277 +00:17:56,330 --> 00:18:01,170 +إذاThe abnormal head posture eliminates diplopia + +278 +00:18:01,170 --> 00:18:06,630 +and helps to centralize the binocular visual field + +279 +00:18:06,630 --> 00:18:09,690 +The patient will turn the head into the direction + +280 +00:18:09,690 --> 00:18:13,890 +of the field of action of the weak muscle قاعدة + +281 +00:18:13,890 --> 00:18:18,410 +قاعدة بتساعدني كتير في فهم حاجات كتيرعشان أعرف وين + +282 +00:18:18,410 --> 00:18:21,270 +ال head المفروض يروح .. عشان أعرف وين ال head + +283 +00:18:21,270 --> 00:18:24,870 +المفروض يروح .. بشوف وين العضلة أو وين العين ومش + +284 +00:18:24,870 --> 00:18:27,970 +قادرة تروح وين .. وين الاتجاه اللي إحدى العينتين + +285 +00:18:27,970 --> 00:18:31,210 +مش قادرة تروح فيه .. احنا لو جينا مسكنا ال left + +286 +00:18:31,210 --> 00:18:33,670 +eye بتروح في جميع الاتجاهات .. مافيش فيها أي مشكلة + +287 +00:18:33,670 --> 00:18:36,750 +ال right eye في عندها مشكلة في ال right gaze .. مش + +288 +00:18:36,750 --> 00:18:40,490 +قادرة تروح على ال right .. ال head بيروح بالنيابة + +289 +00:18:40,490 --> 00:18:43,730 +عنهالأنه .. لأنه ال head لما بيروح على المكان اللي + +290 +00:18:43,730 --> 00:18:46,610 +مش قادر تروح عليه العين، في هذه الحالة on right، + +291 +00:18:46,610 --> 00:18:49,830 +الهنتين تلقائيا هينتقلوا على الشمال، الهنتين + +292 +00:18:49,830 --> 00:18:52,890 +تلقائيا هينتقلوا على الشمال، the patient will turn + +293 +00:18:52,890 --> 00:18:56,630 +the head into the direction of the field of action + +294 +00:18:56,630 --> 00:18:59,800 +of the weak muscle، عند ال weak muscleهي ال + +295 +00:18:59,800 --> 00:19:03,140 +lateral rectus وين ال field of action؟ وين حقل + +296 +00:19:03,140 --> 00:19:06,020 +العمل بتاعها؟ وين .. وين اتجاه العمل بتاعها؟ بتجاه + +297 +00:19:06,020 --> 00:19:10,120 +اليمين إذاً هيروح ال head باتجاه اليمين إذاً into + +298 +00:19:10,120 --> 00:19:13,180 +the field of action of the weak muscle so that the + +299 +00:19:13,180 --> 00:19:16,600 +eyes are then automatically turned to the opposite + +300 +00:19:16,600 --> 00:19:20,000 +direction وهذا بيصير عند الناس الطبيعيين وعند + +301 +00:19:20,000 --> 00:19:23,620 +الناس اللي عندهم حوال انه لما ال head بتحرك باتجاه + +302 +00:19:23,620 --> 00:19:28,250 +automatically العنتين بيروحواعكس هذا الاتجاه ال + +303 +00:19:28,250 --> 00:19:32,810 +head و العينتين بتحركوا عكس بعضهم البعض and as far + +304 +00:19:32,810 --> 00:19:36,710 +as possible away from its field of action بمعنى + +305 +00:19:36,710 --> 00:19:40,430 +أخر لما العنتين راحوا على الشمال يعني كأنه العين + +306 +00:19:40,430 --> 00:19:44,670 +اليمين هربت من منطقة عمل وتشغيل ال lateral rectus + +307 +00:19:44,670 --> 00:19:49,690 +راحت لمنطقة عمل ال medial rectus وهذا بيقودنا + +308 +00:19:49,690 --> 00:19:53,010 +لقاعدة في هذا الموضوع في مجال ال abnormal head + +309 +00:19:53,010 --> 00:19:59,200 +posturethe head will turn where the eye cannot + +310 +00:19:59,200 --> 00:20:04,600 +يذهب الرأس .. يذهب رأس المريض إلى حيث لا تستطيع + +311 +00:20:04,600 --> 00:20:10,580 +العين إلى حيث لا تستطيع عين المريض طبعا ال + +312 +00:20:10,580 --> 00:20:14,000 +abnormal head posture ال abnormal head posture + +313 +00:20:14,000 --> 00:20:16,580 +ممكن يكون face turned زي ما احنا شايفين هنا face + +314 +00:20:16,580 --> 00:20:19,540 +turned to the right ممكن يكون to the left العكس + +315 +00:20:19,540 --> 00:20:25,200 +chin down chin down head tiltهذه المناظر مثلا هي + +316 +00:20:25,200 --> 00:20:27,340 +head tilted to the right .. head tilted to the + +317 +00:20:27,340 --> 00:20:30,180 +right .. head tilted to the right .. هنا straight + +318 +00:20:30,180 --> 00:20:32,760 +head بس هنا head في عندي ال .. ال head tilted to + +319 +00:20:32,760 --> 00:20:35,960 +the right فالعنتين زي ما انتوا شايفين tilted to + +320 +00:20:35,960 --> 00:20:39,000 +the left .. هاي هتعمل intuition عكس .. عكس اتجاه + +321 +00:20:39,000 --> 00:20:41,920 +ميالان الرأس .. ميالان الرأس بهذا الاتجاه .. + +322 +00:20:41,920 --> 00:20:44,420 +فالعنت .. باتجاه اليمين head tilted to the right + +323 +00:20:44,420 --> 00:20:49,480 +.. right head tilted .. هنا العنتينبلفوا عكس لفة + +324 +00:20:49,480 --> 00:20:52,800 +الرأس، هنا هتعمل ال right eye in torsion وال left + +325 +00:20:52,800 --> 00:20:57,500 +eye هتعمل extortion، ايضا هنا نماذج بتوضح قضية ال + +326 +00:20:57,500 --> 00:21:00,500 +abnormal head posture، هنا straight head، هنا head + +327 +00:21:00,500 --> 00:21:06,380 +tilt، head tilt to thereto the left فالعينتين + +328 +00:21:06,380 --> 00:21:08,900 +بيعملوا tilting to the right العين اليمين بتعمل + +329 +00:21:08,900 --> 00:21:13,200 +extortion والعين الشمالي بتعمل intortion بتعمل + +330 +00:21:13,200 --> 00:21:18,960 +intortion هنا نفس القضية هنا بتعمل extortion وهنا + +331 +00:21:18,960 --> 00:21:23,180 +بتعمل intortion وحنحكي ليش هذا الكلام ليش ال + +332 +00:21:23,180 --> 00:21:26,540 +abnormal head posture بيصير ايضا هنا نماذج هذا + +333 +00:21:26,540 --> 00:21:29,960 +head tilt to the right هذا head tilt to the right + +334 +00:21:29,960 --> 00:21:34,180 +هذا head tilt to the leftكلها abnormal head + +335 +00:21:34,180 --> 00:21:39,920 +posture هذا face turned to the right هنا chin up + +336 +00:21:39,920 --> 00:21:43,660 +هنا chin down هنا head tilted to the right هنا + +337 +00:21:43,660 --> 00:21:47,440 +الفرق شوفوا بين ال face turned ال face turned to + +338 +00:21:47,440 --> 00:21:50,340 +the right و ال head tilted to the right في ال face + +339 +00:21:50,340 --> 00:21:55,870 +turnedفي ال fast turn إحدى الأذنين بتكون مش موجودة + +340 +00:21:55,870 --> 00:21:59,670 +في الصورة أو تقريبا مختفية مش مبينة هنا إحدى + +341 +00:21:59,670 --> 00:22:02,690 +الأذنين بتكون أعلى من الأذن التاني يعني هنا head + +342 +00:22:02,690 --> 00:22:05,910 +tilt to the right شايفين الأذن اليسرى أعلى في + +343 +00:22:05,910 --> 00:22:09,970 +الصورة من الأذن اليمنى هنا ال .. دانه الشمال مش + +344 +00:22:09,970 --> 00:22:13,570 +مبينة عنده left fast turn left fast turn من الأذن + +345 +00:22:13,570 --> 00:22:17,050 +اليمين مبينةهذه الـ abnormal head posture اللي هو + +346 +00:22:17,050 --> 00:22:20,090 +عبارة عن الـ chin up position chin up position + +347 +00:22:20,090 --> 00:22:23,890 +يعني رافع رأسه لفوق أو رافع ال chin اللي هو الذقن + +348 +00:22:23,890 --> 00:22:28,330 +إلى الأعلى إذا an abnormal head posture is + +349 +00:22:28,330 --> 00:22:31,090 +analyzed in terms of the following three + +350 +00:22:31,090 --> 00:22:34,030 +components إما بيكون عندي face turned to right or + +351 +00:22:34,030 --> 00:22:38,120 +leftأو بيكون عندي head tilt to right or left أو + +352 +00:22:38,120 --> 00:22:41,980 +عندي chin elevation or depression أو combination + +353 +00:22:41,980 --> 00:22:45,200 +خلطة من هذه الأشياء يعني ممكن مريض يجيني ب face + +354 +00:22:45,200 --> 00:22:48,860 +turn to the right مع head tilt to the left و مع + +355 +00:22:48,860 --> 00:22:52,060 +chin مثلا depression يعني .. و هذا الكلام هناخده + +356 +00:22:52,060 --> 00:22:55,220 +بتفصيله ان شاء الله تعالى في المحاضرة القادمة و + +357 +00:22:55,220 --> 00:22:58,740 +هنبدأ بال face turn و يعطيكم العافية والسلام عليكم + +358 +00:22:58,740 --> 00:23:00,540 +ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/3bJja81w4MA_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/3bJja81w4MA_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..ca9196179efdbf6c1ef27a2d20302d4251624108 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/3bJja81w4MA_postprocess.srt @@ -0,0 +1,2280 @@ +1 +00:00:01,770 --> 00:00:06,350 +بسم الله الرحمن الرحيم بنكمل مع محاضرات حوال واحد + +2 +00:00:06,350 --> 00:00:09,050 +وصلنا لموضوع غاية في الأهمية اللي هو ال cover + +3 +00:00:09,050 --> 00:00:16,530 +tests وهذه سلسلة من الفحوصات لتقييم قيمة الحوال و + +4 +00:00:16,530 --> 00:00:21,110 +نوعه وهي حقيقة الأدق في كل الفحوصات الموجودة + +5 +00:00:21,110 --> 00:00:24,990 +حاليا، اذا the cover test comprises a series of + +6 +00:00:24,990 --> 00:00:28,480 +simple testsيعني هو عبارة عن سلسلة من الفحوصات + +7 +00:00:28,480 --> 00:00:32,500 +البسيطة بس المهم إجراءها بدقة which are essential + +8 +00:00:32,500 --> 00:00:37,140 +to diagnosis of strabismus in all its forms يعني + +9 +00:00:37,140 --> 00:00:41,900 +هذه الفحوصات أو سلسلة الفحوصات تعتبر أساسية لتشخيص + +10 +00:00:41,900 --> 00:00:46,720 +الحوال بجميع أنواعه .. بجميع أنواعهallow the + +11 +00:00:46,720 --> 00:00:49,720 +examiner to differentiate manifests from a latent + +12 +00:00:49,720 --> 00:00:54,020 +school يعني بواسطة هذه الفحوصات ممكن افرق بين + +13 +00:00:54,020 --> 00:00:59,850 +الحول الظاهر Latropia من الحول الخفي الفوريهذه + +14 +00:00:59,850 --> 00:01:03,530 +نقطة تاني إشي بتمكنني هذه الفحوصات to detect the + +15 +00:01:03,530 --> 00:01:08,730 +direction يعني هل هو ايزو تروبيا او ايزو فوريا + +16 +00:01:08,730 --> 00:01:12,430 +ايزو ولا اكزو ولا hyper ولا hypo يعني بتحدد لاتجاه + +17 +00:01:12,430 --> 00:01:16,950 +الحوار تالت شي approximate size of deviation يعني + +18 +00:01:16,950 --> 00:01:21,010 +هذي بتجيسلي كمية الحوار يعني جديش ال size بتاعه + +19 +00:01:21,010 --> 00:01:23,870 +يعني هل هو تلاتين prism اربعين prism عشرة prism + +20 +00:01:23,870 --> 00:01:29,560 +خمسة prism جد ما يكون بتقييملي أيامأيضًا to assess + +21 +00:01:29,560 --> 00:01:32,780 +the degree of any control، يعني هل .. هل أنا لو + +22 +00:01:32,780 --> 00:01:36,740 +عملت dissociation between the two eyes، الفوريا + +23 +00:01:36,740 --> 00:01:40,740 +بتتحول لتروبيا، لو اتحولت لتروبيا، جديش ال brain + +24 +00:01:40,740 --> 00:01:44,240 +بيقدر يستعيد لو أنا شيلت ال dissociation أو شيلت + +25 +00:01:44,240 --> 00:01:47,920 +ال cover عن عين من العينتين، يعني هذه بتعمل + +26 +00:01:47,920 --> 00:01:52,160 +assessment أو تقييم لجديش الدماغ متحكم في موضوع + +27 +00:01:52,160 --> 00:01:56,400 +الحوال ومسيطر عليهand to gain an indication of + +28 +00:01:56,400 --> 00:02:02,740 +amblyopia يعني ممكن تعطيني .. او .. او يعني تعطيني + +29 +00:02:02,740 --> 00:02:07,480 +فكرة اذا كان في عين من العينتين في amblyopia أهم + +30 +00:02:07,480 --> 00:02:11,380 +نقطة في سلسلة ال cover tests ان هذه ال testات كلها + +31 +00:02:11,380 --> 00:02:15,410 +بتعتمد على ال patients ability to fix itإذا ال + +32 +00:02:15,410 --> 00:02:19,550 +patient مش قادر يعمل fixation لسبب أو لآخر، معناته + +33 +00:02:19,550 --> 00:02:24,290 +إجراء هذه الفحوصات بيكون useless أو يعني مش مفيد، + +34 +00:02:24,290 --> 00:02:27,690 +لازم المريض يكون بيقدر يعمل fixation على ال target + +35 +00:02:27,690 --> 00:02:32,090 +اللي أنا بورجيله إياه أو بعرضله إياه، they are + +36 +00:02:32,090 --> 00:02:35,070 +performed for near and distance fixation يعني أنا + +37 +00:02:35,070 --> 00:02:39,100 +هذه الفحوصاتسلسلة ال cover test بعملها على ال + +38 +00:02:39,100 --> 00:02:41,520 +near، ال target بيكون على ال near، وأيضا بعملها + +39 +00:02:41,520 --> 00:02:44,960 +على ال distance، لما المريض بيكون معانا الدارة، + +40 +00:02:44,960 --> 00:02:47,860 +بعملها على ال near وعلى ال distance، بال glasses و + +41 +00:02:47,860 --> 00:02:50,680 +بدون glasses، with and without spectacle + +42 +00:02:50,680 --> 00:02:55,020 +correctionأيضًا لما يكون المريض متاخد head posture + +43 +00:02:55,020 --> 00:02:58,100 +compensatory head posture معين يعني ميّل راسه أو + +44 +00:02:58,100 --> 00:03:01,740 +وجهه أو في عنده chin up or down ممكن أجيسه في + +45 +00:03:01,740 --> 00:03:05,640 +الوضعية اللي هو عليها قبل ما أعمل straightening + +46 +00:03:05,640 --> 00:03:08,940 +للhead وأجيسله في وضع ال straight head position + +47 +00:03:10,550 --> 00:03:13,690 +المطلوب من ال patient أن يكون فيه اندى reasonable + +48 +00:03:13,690 --> 00:03:17,170 +attention and cooperation أنه ينتبه لل target + +49 +00:03:17,170 --> 00:03:22,390 +وينتبه للفحص وأنه يتعاون مع الفحص أو أثناء أداء + +50 +00:03:22,390 --> 00:03:26,010 +الفحص reasonable attention and cooperation are + +51 +00:03:26,010 --> 00:03:29,410 +required but it is possible to perform essential + +52 +00:03:29,410 --> 00:03:33,710 +tests in most patients regardless of age يعني بقدر + +53 +00:03:33,710 --> 00:03:37,830 +أعمل cover test من سن صغير كتير بس بدنا يكون الطفل + +54 +00:03:37,830 --> 00:03:43,770 +شوية متعاونو منتبه لل target اللي انا باعرضله ايه + +55 +00:03:43,770 --> 00:03:48,030 +.. لل target اللي انا باعرضله ايه نبدأ مع هذه + +56 +00:03:48,030 --> 00:03:51,530 +السلسلة من الفحوصات ال cover and uncover test هي + +57 +00:03:51,530 --> 00:03:55,070 +حقيقة عبارة عن اختبارين اول اختبار اللي هو ال + +58 +00:03:55,070 --> 00:03:58,410 +cover test و تاني اختبار ال uncover test بس + +59 +00:03:58,410 --> 00:04:03,670 +بيتساووا ورا بعضهم البعض او بيعتبر اختبار يقسم + +60 +00:04:03,670 --> 00:04:09,850 +لجزئينconsists of two parts ال cover test to + +61 +00:04:09,850 --> 00:04:13,830 +detect heterotropia ال cover test عشان يحددلي + +62 +00:04:13,830 --> 00:04:17,470 +الحول الظاهر لتروبيا to detect heterotropia او + +63 +00:04:17,470 --> 00:04:22,110 +اختصارا اتروبيا يعني الهدف من ال cover test اني + +64 +00:04:22,110 --> 00:04:27,470 +احدد لتروبيا it is helpful to begin the near test + +65 +00:04:27,470 --> 00:04:30,910 +using a light to observe the corneal reflection + +66 +00:04:30,910 --> 00:04:33,470 +بجيب الضوء البنتورش + +67 +00:04:36,750 --> 00:04:40,790 +it is helpful to begin the near test using a light + +68 +00:04:40,790 --> 00:04:45,750 +to observe the corneal reflection يعني بستخدم ال + +69 +00:04:45,750 --> 00:04:49,990 +pin torch على ال near عشان أشوف ال corneal reflex + +70 +00:04:49,990 --> 00:04:55,470 +ومنه أخمن في الأول قبل ما أبدأ cover test في أي + +71 +00:04:55,470 --> 00:04:58,970 +عين الحوال موجود نفرض أنه مثلا في العين الشمال + +72 +00:04:58,970 --> 00:05:02,050 +ببدأ بعمل cover للعين اليمين عشان أتأكد أنه في + +73 +00:05:02,050 --> 00:05:07,590 +العين الشمالto observe corneal reflections and to + +74 +00:05:07,590 --> 00:05:12,470 +assess the fixation in the deviating eye it should + +75 +00:05:12,470 --> 00:05:15,590 +then be repeated for near using an accommodative + +76 +00:05:15,590 --> 00:05:19,450 +target for and for distance aspects يعني أول شيء + +77 +00:05:19,450 --> 00:05:23,250 +بستخدم الضوء على النيا بخمن مين العين اللي فيها + +78 +00:05:23,250 --> 00:05:26,790 +لتروبيا حسب الضوء أو ال corneal light reflex وين + +79 +00:05:26,790 --> 00:05:29,930 +منحرف إذا كان منحرف للخارج معناته في عندي إيزو + +80 +00:05:29,930 --> 00:05:34,700 +تروبيا منحرف للداخل في إكزو تروبيا و هكذابابدأ .. + +81 +00:05:34,700 --> 00:05:38,980 +بضلي أستعمل الضوء، بابدأ بغطي العين السليمة و بشوف + +82 +00:05:38,980 --> 00:05:42,740 +إذا كان ال fixation .. العين ال .. إيش وضع ال + +83 +00:05:42,740 --> 00:05:45,400 +fixation في ال deviating eye؟ هل .. هل لما أغطي + +84 +00:05:45,400 --> 00:05:47,860 +العين السليمة بتاخد fixation ولا مابتاخدش + +85 +00:05:47,860 --> 00:05:52,830 +fixation؟أذا مبدأيا بستعمل الضوء بعد هيك بدي أعيد + +86 +00:05:52,830 --> 00:05:55,910 +قياس ال near و ال distance ب accommodative target + +87 +00:05:55,910 --> 00:05:59,790 +accommodative target يعني target بده تركيز و بده + +88 +00:05:59,790 --> 00:06:04,630 +يتعرف عليه أو يحلله في دماغه يعني بدي يشوفه كصورة + +89 +00:06:04,630 --> 00:06:07,290 +هذه accommodative targets هذه accommodative + +90 +00:06:07,290 --> 00:06:11,850 +targets طبعا for near و ال distance طبعا ممكن + +91 +00:06:11,850 --> 00:06:16,020 +أستخدمالـ visual acuity it's chart أخليه يركز على + +92 +00:06:16,020 --> 00:06:20,840 +حرف من الأحرف فيه the patient fixates a straight + +93 +00:06:20,840 --> 00:06:25,760 +ahead target if right deviation is suspected the + +94 +00:06:25,760 --> 00:06:29,740 +examiner covers the fixing left eye and notes any + +95 +00:06:29,740 --> 00:06:34,440 +movement of the right eye to take up fixation طيب + +96 +00:06:34,440 --> 00:06:38,340 +احنا متوقعين ان في عندي حول في العين اليمين بروح + +97 +00:06:38,340 --> 00:06:44,470 +بعمل cover للعين الشمال ال fixating eyeطالما + +98 +00:06:44,470 --> 00:06:47,230 +اليمين احنا متوقعين انه فيها انحراف أو يظهر عليها + +99 +00:06:47,230 --> 00:06:50,270 +انه فيها انحراف بنروح مغطين الشمال عاملين لها + +100 +00:06:50,270 --> 00:06:54,550 +cover فساعتها بنشوف تصرف العين اليمين كيف عدلت + +101 +00:06:54,550 --> 00:06:57,290 +معناته في deviation، ضالت زي ما هي معناته ممكن + +102 +00:06:57,290 --> 00:07:01,150 +يكون مافيش deviation عدلت يعني اتحركت عشان تاخد ال + +103 +00:07:01,150 --> 00:07:05,030 +fixation أو عشان يعني يعني تقوم بواجب ال fixation + +104 +00:07:05,030 --> 00:07:08,490 +لأنه اتغطت العين الشمال طب لو مااتحركتش بالمرة + +105 +00:07:08,490 --> 00:07:12,330 +معناته هذا الكلام بيكون عندي no movement indicates + +106 +00:07:12,330 --> 00:07:17,500 +orthotopiaاو ممكن indicates left heterotropic + +107 +00:07:17,500 --> 00:07:20,860 +انشوف هذا الكلام اللي احنا حكيناه بال simulation + +108 +00:07:20,860 --> 00:07:24,400 +بال simulation هاي انا عندي target وهي عندي ال + +109 +00:07:24,400 --> 00:07:28,860 +cover ال prism لسه ما اجه وقته ال prism لسه ما اجه + +110 +00:07:28,860 --> 00:07:33,480 +وقته هذا + +111 +00:07:33,480 --> 00:07:36,620 +ال prism بنزيحه جانبا ما اجه وقته + +112 +00:07:44,060 --> 00:07:46,920 +الـ target هذا المفروض المريض يعمل عليه fixation + +113 +00:07:46,920 --> 00:07:51,620 +اتأكد انه متبع ال target بعينيه تنتين اذا هو بتبع + +114 +00:07:51,620 --> 00:07:54,740 +ال target معايا بعينيه تنتين نفرض هذا ال target + +115 +00:07:54,740 --> 00:07:58,540 +على ال near والان انا متوقع انه في حوال في العين + +116 +00:07:58,540 --> 00:08:02,260 +اليمين في حوال في العين اليمين بدنا نروح نغطي + +117 +00:08:02,260 --> 00:08:05,220 +العين الشمال هي ال cover هي عملنا cover العين + +118 +00:08:05,220 --> 00:08:08,260 +اليمين ماتحركتش لما عملنا ال cover هي مرة تانية + +119 +00:08:08,260 --> 00:08:13,060 +عملنا coverما اتحركت العين اليمين، عملنا cover ما + +120 +00:08:13,060 --> 00:08:16,180 +اتحركت، إيش هذا بيعني؟ إن العين اليمين ما فيها + +121 +00:08:16,180 --> 00:08:19,660 +Tropia، ما فيها حوال ظاهر، طيب، هذا ال scenario + +122 +00:08:19,660 --> 00:08:23,820 +نفسه إنه ما اتحركتش العين اليمين، ممكن يكون الحوال + +123 +00:08:23,820 --> 00:08:29,460 +موجود في العين الشمال، هنشوف مثال على ذلكهذه في + +124 +00:08:29,460 --> 00:08:34,100 +عندي حول في العين الشمالية بس انا ظننت او المريض + +125 +00:08:34,100 --> 00:08:38,960 +كنت بتطلع عليه من زاوية معينة فممكن المريض بتطلع + +126 +00:08:38,960 --> 00:08:42,420 +لليمين شوية لليمين شوية فبين ان العين الشمالية هي + +127 +00:08:42,420 --> 00:08:49,320 +straight هاي عندنا exotropia في الشمال هنا + +128 +00:08:49,320 --> 00:08:52,360 +نبين العين الشمال هي ال straight و العين اليمين هي + +129 +00:08:52,360 --> 00:08:55,020 +اللي نبين طالع على برة بس لأن الطال يتجاى على + +130 +00:08:55,020 --> 00:08:59,690 +يمينه طيب .. الآنروحت عملت cover للعين الشمال ما + +131 +00:08:59,690 --> 00:09:03,230 +اتحركتش العين اليمين روحت عملت cover للعين الشمال + +132 +00:09:03,230 --> 00:09:05,590 +ما اتحركتش العين اليمين كمان مرة cover للعين + +133 +00:09:05,590 --> 00:09:09,650 +الشمال ما اتحركت العين اليمين اذا ممكن العين .. + +134 +00:09:09,650 --> 00:09:13,630 +يعني اقول orthotropia هنا او ممكن يكون عندي tropia + +135 +00:09:13,630 --> 00:09:17,470 +في العين التانية يعني no movement indicates + +136 +00:09:17,470 --> 00:09:20,850 +orthotropia بالنسبة للعين اليمين او left + +137 +00:09:20,850 --> 00:09:25,750 +heterotropia بس انا لسه ما فحصت left heterotropia + +138 +00:09:25,750 --> 00:09:30,070 +طيبالان خلصنا ال cover تاع ال left eye بنيجي نعمل + +139 +00:09:30,070 --> 00:09:34,870 +cover لل right eye و مجرد ما عملت cover لل right + +140 +00:09:34,870 --> 00:09:39,590 +eye العين الشمال عملت fixation اتحركت باتجاه ال + +141 +00:09:39,590 --> 00:09:43,750 +adduction هي ما عملت adduction بس هي كانت لبراهى + +142 +00:09:43,750 --> 00:09:48,710 +كانت لبرا والعين اليمين fixating لما انا غطيت + +143 +00:09:48,710 --> 00:09:52,830 +اليمين عدلت عشان تاخد fixation اتجاه التعديل + +144 +00:09:52,830 --> 00:09:57,090 +بتاعها من برا لجوا او باتجاه ال adoption نقول عملت + +145 +00:09:57,090 --> 00:10:00,770 +adoption عملت adoption من ال out ل ال straight + +146 +00:10:00,770 --> 00:10:04,530 +ahead هذا اتجاه ال adoption تمام ساعتها بقول عندي + +147 +00:10:04,530 --> 00:10:09,550 +exotropia عندي exotropia نشوف مثال آخر + +148 +00:10:15,600 --> 00:10:19,480 +هي العين الشمال في وضعية معينة لما عملت cover + +149 +00:10:19,480 --> 00:10:24,020 +لليمين اتحركت لبرا هي اتحركت مش لبرا على الآخر هي + +150 +00:10:24,020 --> 00:10:27,100 +اتحركت من ال end position عملت abduction لل + +151 +00:10:27,100 --> 00:10:29,820 +straight head position يعني معناته عندي ايزو + +152 +00:10:29,820 --> 00:10:35,540 +اتروبيا عندي ايزو اتروبيا طيب مرة تانية بمجرد ما + +153 +00:10:35,540 --> 00:10:39,560 +احط ال cover ال cover بكشف ال اتروبيا هاي cover + +154 +00:10:39,560 --> 00:10:43,820 +اتحركت العين طيب الآن + +155 +00:11:02,120 --> 00:11:05,420 +خلّينا هذا الكلام نطبخه على ال right eye لأنه ممكن + +156 +00:11:05,420 --> 00:11:08,740 +نحاول نكون هنا و ممكن نكون هنا، نقول كالآت، مجرد + +157 +00:11:08,740 --> 00:11:12,640 +ما قطّينا ال fixating eye، نزلت العين، كانت فوق و + +158 +00:11:12,640 --> 00:11:15,800 +نزلت لل straight head، نزلت لل straight head، إذاً + +159 +00:11:15,800 --> 00:11:22,260 +هذه hypertropia، مرة تانية، hypertropia، + +160 +00:11:22,260 --> 00:11:23,800 +hypertropia + +161 +00:11:26,170 --> 00:11:28,770 +ممكن إنسان يقول أنا ملاحظ هنا أنه لما نزلت هذه + +162 +00:11:28,770 --> 00:11:31,590 +العين، هذه العين نزلت بزيادة، مثل اللي .. مظبوط، + +163 +00:11:31,590 --> 00:11:33,990 +حسب hearing loop، حسب hearing loop، إذا + +164 +00:11:33,990 --> 00:11:43,850 +Hypertropia، طيب + +165 +00:11:43,850 --> 00:11:48,810 +Right Hypertropia، مجرد ما أعمل cover لل left eye + +166 +00:11:49,790 --> 00:11:53,930 +الـ right eye بتستعيد الـ fixation بتطلع من تحت لل + +167 +00:11:53,930 --> 00:11:57,790 +primary position يعني هي كانت في وضع town، معناته + +168 +00:11:57,790 --> 00:12:02,030 +hypotropia، اذا right hypotropia، اذا ملاحظين حسب + +169 +00:12:02,030 --> 00:12:05,990 +ال hearing low خلف ال cover، هاد ال cover معتب، بس + +170 +00:12:05,990 --> 00:12:08,930 +خلف ال cover العين الشمال هتطلع حسب hearing low، + +171 +00:12:08,930 --> 00:12:14,540 +حسب hearing lowفبالتالي هذه القضية بدأت تكون واضحة + +172 +00:12:14,540 --> 00:12:17,380 +.. بدأت تكون واضحة .. اذا لتروبيا بفحصها بال cover + +173 +00:12:17,380 --> 00:12:21,100 +test هنا لما عملنا cover لل left eye مافيش فيها + +174 +00:12:21,100 --> 00:12:24,700 +تروبيا فبالتالي مش هتتحرك بالمرة بينما ال right + +175 +00:12:24,700 --> 00:12:28,620 +eye فيها تروبيا اول ما بغطي ال left eye اذا في ال + +176 +00:12:28,620 --> 00:12:32,680 +.. كيف اكشف لتروبيا بعمل cover لل other eye كيف + +177 +00:12:32,680 --> 00:12:36,660 +اكشف لتروبيا في عين معينة بعمل cover للعين التانية + +178 +00:12:36,660 --> 00:12:40,380 +فبيبين اذا كان في تروبيا عندى ولا مافيش تروبيا + +179 +00:12:40,380 --> 00:12:51,220 +عندىإذا هذا بالنسبة لها موضوع التروبيا إذا + +180 +00:12:51,220 --> 00:12:55,520 +no movement إما بيكون عندي orthotropia أو left + +181 +00:12:55,520 --> 00:13:00,550 +heterotropia في المثال ابتعدadduction of the right + +182 +00:13:00,550 --> 00:13:04,470 +eye to take up fixation indicates exotropia لو + +183 +00:13:04,470 --> 00:13:08,230 +كانت العين لبرا وغطيت العين ال fixating العين اللي + +184 +00:13:08,230 --> 00:13:11,610 +كانت لبرا عدلت لجوة لل primary position معناته بجت + +185 +00:13:11,610 --> 00:13:15,650 +في وضع exotropia طب لو كانت لجوة وعملت abduction + +186 +00:13:15,650 --> 00:13:19,490 +indicates esotropia downward movement indicates + +187 +00:13:19,490 --> 00:13:24,150 +hyperotropia and upward movement hypotropia the + +188 +00:13:24,150 --> 00:13:27,050 +test is repeated on the opposite eye يعني بعمل + +189 +00:13:27,820 --> 00:13:33,940 +cover العين مافيش Tropia هنا طيب بروح للعين + +190 +00:13:33,940 --> 00:13:38,900 +التانية هي مرة مرتين هو مرتين بيكفي ممكن تلاتة + +191 +00:13:38,900 --> 00:13:42,300 +ممكن اربع عشان اتأكد ان المريض بتطلع على ال target + +192 +00:13:43,280 --> 00:13:46,300 +مافيش أي movement لما عملت cover هنا مافيش + +193 +00:13:46,300 --> 00:13:48,780 +movement و لما عملت cover هنا مافيش movement + +194 +00:13:48,780 --> 00:13:52,920 +معناته هذا orthotropic patient معناته مريض مافيش + +195 +00:13:52,920 --> 00:13:57,960 +عنده حوالظهر .. مافيش عنده حوالظهر لو في عندي غطيت + +196 +00:13:57,960 --> 00:14:01,140 +عين و العين التانية اتحركت حسب اتجاه الحركة من جوا + +197 +00:14:01,140 --> 00:14:04,710 +ل primary position معناته كانت ISOمن برة لل + +198 +00:14:04,710 --> 00:14:08,310 +primary position معناته كانت exo من فوق لل primary + +199 +00:14:08,310 --> 00:14:12,350 +position معناته كانت hypertropia من .. من أسفل لل + +200 +00:14:12,350 --> 00:14:15,210 +primary position معناته كانت hypotropia إذا + +201 +00:14:15,210 --> 00:14:19,030 +ملاحظين كل ألفازنا بتنتهي بكلمة tropia يعني حوال + +202 +00:14:19,030 --> 00:14:23,410 +ظاهر .. حوال ظاهر طبعا بتكرر ال cover لالعينتين ال + +203 +00:14:23,410 --> 00:14:29,850 +cover لالعينتين نيجي لل uncover test .. لل uncover + +204 +00:14:29,850 --> 00:14:35,890 +testالـ uncover test to detect heterophobia الـ + +205 +00:14:35,890 --> 00:14:42,950 +cover .. ال cover test عشان يكشف ليه التروبيا + +206 +00:14:42,950 --> 00:14:47,010 +الحوالي الظاهر to detect heterotropia أما ال + +207 +00:14:47,010 --> 00:14:53,850 +uncover test to detect heterophobia should be + +208 +00:14:53,850 --> 00:14:57,380 +performed both for nearباستعمال accommodative + +209 +00:14:57,380 --> 00:15:01,700 +target and for distance أيضًا باستعمال target من + +210 +00:15:01,700 --> 00:15:04,900 +ال visual acuity chart بالطريقة التالية the + +211 +00:15:04,900 --> 00:15:07,780 +patient fixates a straight ahead distant target + +212 +00:15:07,780 --> 00:15:11,820 +the examiner covers the left eye and after two to + +213 +00:15:11,820 --> 00:15:16,600 +three seconds removes the cover no movement + +214 +00:15:16,600 --> 00:15:22,940 +indicates orthophoria أول + +215 +00:15:22,940 --> 00:15:24,540 +شيء بدنا نسأله لأنفسنا + +216 +00:15:27,820 --> 00:15:31,780 +ليش أنا بفحص الفوريا؟ أو المريض اللي عنده فوريا + +217 +00:15:31,780 --> 00:15:39,040 +إيش الوضع اللي بيجيني فيه؟ + +218 +00:15:39,040 --> 00:15:43,460 +الجواب هاي + +219 +00:15:43,460 --> 00:15:48,860 +عندي مثلا exofuria لل right eye خمسة و خمسين + +220 +00:15:48,860 --> 00:15:52,580 +prison هاي المريض وضعيته straight ليش؟ لأنها فوريا + +221 +00:15:52,580 --> 00:15:55,160 +حوال غير ضايع بس لو قلنا Tropia + +222 +00:16:02,300 --> 00:16:08,120 +الحوال ظاهر زي ما احنا ملاحظين نتروبيا حوال ظاهر + +223 +00:16:08,120 --> 00:16:12,280 +حتى لو كان خفيف برضه بيكون ظاهر الفوريا + +224 +00:16:14,850 --> 00:16:19,530 +هيوصلنا خمسة و خمسين بريزم ايزوفوريا ايزوفوريا في + +225 +00:16:19,530 --> 00:16:23,590 +ال right eye و مع ذلك العينين straight لما بلاجي + +226 +00:16:23,590 --> 00:16:26,950 +انه ال cover test .. ال cover test ماطلعش معاه + +227 +00:16:26,950 --> 00:16:31,290 +تروبيا مفروض انا افحص الفوريا فبالتالي انا بفحص + +228 +00:16:31,290 --> 00:16:35,130 +بال cover test لتروبيا و ال uncovered test بفحص + +229 +00:16:35,130 --> 00:16:40,870 +الفوريا بروح هنا بغطي عين و بستنى شوية مرة تانية + +230 +00:16:42,460 --> 00:16:46,640 +المريض جاي بعينين straight and thin، طب ليه جاي؟ + +231 +00:16:46,640 --> 00:16:49,820 +جاي لأنه مشكلة من أعراض، euphoria ممكن تسبب أعراض، + +232 +00:16:49,820 --> 00:16:53,240 +أستينوبيا، إرهاب بصري، أحيانا diplopia، أحيانا + +233 +00:16:53,240 --> 00:16:57,180 +headache وما إلى ذلك، أحيانا blurring of vision + +234 +00:16:57,180 --> 00:17:02,330 +وما إلى ذلكال uncover test انا لما عملت ال cover + +235 +00:17:02,330 --> 00:17:06,730 +كنت بتطلع العين التانية المكشوفة وانا بعمل ال + +236 +00:17:06,730 --> 00:17:10,030 +uncover بده اطلع العين اللي غطيتها .. بده اطلع + +237 +00:17:10,030 --> 00:17:16,280 +العين اللي غطيتها .. الآن بنغطياحدة لعينتين هنا + +238 +00:17:16,280 --> 00:17:20,280 +غطينا ال right eye و بنستنى ثانية ثانيتين تلاتة او + +239 +00:17:20,280 --> 00:17:24,080 +اكتر ثلاث ثواني او اكتر بعدين نرفع الغطا اول ما + +240 +00:17:24,080 --> 00:17:27,360 +بنرفع الغطا بنشوف وين كانت العين و كيف عدلت هنا + +241 +00:17:27,360 --> 00:17:30,840 +كانت في وضع ال M و عدلت لل primary position اذا + +242 +00:17:30,840 --> 00:17:37,220 +هذه isophoria بقولش isotropia ال isotropia هي + +243 +00:17:37,220 --> 00:17:40,940 +واضحة عندي هي ال isotropia قبل ما اغطي باكتشفها + +244 +00:17:40,940 --> 00:17:45,020 +بال coverبتاع العين التانية cover بتاع العين + +245 +00:17:45,020 --> 00:17:49,340 +التانية بس انا بحكي الان عن ال for ya مش عن ال + +246 +00:17:49,340 --> 00:17:52,200 +etrobia عن ال for ya مش عن ال etrobia اللي هي + +247 +00:17:52,200 --> 00:17:56,440 +الحوال الخفي الحوال الخفي ضروري جدا اتمكن من ان + +248 +00:17:56,440 --> 00:18:06,440 +انا افحص الحوال الظاهر والحوال الخفي هيحطينا + +249 +00:18:06,440 --> 00:18:11,040 +ال cover واحد اتنين بعد ثانيتين ليش لما انا حطيت + +250 +00:18:11,040 --> 00:18:15,290 +ال coverأغلقت الصورة .. صورة ال target أمام العين + +251 +00:18:15,290 --> 00:18:19,810 +هذه عملت dissociation لل two eye ال brain بسلم من + +252 +00:18:19,810 --> 00:18:23,710 +العين الشمال صورة و بستمش من العين اليمين فظهر + +253 +00:18:23,710 --> 00:18:28,450 +الحول ال fusion .. ال fusion صارله block .. صارله + +254 +00:18:28,450 --> 00:18:31,590 +ال block ال fusion اللي هو دمش صورتين في صورة اللي + +255 +00:18:31,590 --> 00:18:35,290 +هو ال sensory fusion بيتمش إلا إذا في عندي صورتين + +256 +00:18:35,290 --> 00:18:39,530 +طب أنا ..غطيت عين وطولت وانا مغطي قعدت ثانيتين + +257 +00:18:39,530 --> 00:18:43,930 +تلاتة فبالتالي انكسر ال fusion لما بكسر ال fusion + +258 +00:18:43,930 --> 00:18:48,090 +الحوال الخفي بيظهر لأن الحوال الخفي اللي هو + +259 +00:18:48,090 --> 00:18:53,270 +الphoria ليش خفي؟ لأن ال fusion mechanism في ال + +260 +00:18:53,270 --> 00:18:56,930 +brain هو اللي مخليه خفي هو اللي متحكم في عضلات + +261 +00:18:56,930 --> 00:19:00,330 +العين ومخليه خفي عبر ال motor fusion أو ال + +262 +00:19:00,330 --> 00:19:06,710 +fusional virgins لان بغطي وبصبرتحت الغطاء العين + +263 +00:19:06,710 --> 00:19:12,290 +زيادة لجوة أول ما برفع بقيم سرعة رجوعها .. سرعة + +264 +00:19:12,290 --> 00:19:16,190 +رجوعها ل .. ال straight head position .. سرعة + +265 +00:19:16,190 --> 00:19:20,290 +استعادة ال binocularity هذا بتديني فكرة قداش ال + +266 +00:19:20,290 --> 00:19:24,490 +brain متحكم أو عامل control على ال latent squint + +267 +00:19:24,490 --> 00:19:28,030 +طيب لو أنا عند ال latent squint في الاتجاه التاني + +268 +00:19:28,860 --> 00:19:31,740 +أيضا هيجيني ب straight دائما الفوريا مهما كانت + +269 +00:19:31,740 --> 00:19:35,680 +تجاهها و مهما كانت كميتها المريض بيجي ب straight + +270 +00:19:35,680 --> 00:19:42,140 +eyes و عشان هيك سميناها فوريا بعد ثانيتين تلاتة + +271 +00:19:42,140 --> 00:19:47,260 +أصبح عندي exofuria كيف عرفت؟ لما عملت uncover + +272 +00:19:47,260 --> 00:19:58,020 +اتعدلت من برا لل primary position exofuria طيب + +273 +00:20:06,290 --> 00:20:15,810 +هذه تروبيا هاي بارفوريا بعد + +274 +00:20:15,810 --> 00:20:18,990 +ما عملت الغطاء و استنيت ثانيتين او تلاتة هاي + +275 +00:20:18,990 --> 00:20:26,750 +بارفوريا عدلت لل primary position نزلت جاب للفحص + +276 +00:20:26,750 --> 00:20:31,590 +وبعد الفحص straight ice هاي جاب للفحص هاي فحصنا + +277 +00:20:33,050 --> 00:20:36,910 +hyperphoria رفعنا الغطاء رجع straight .. رجع + +278 +00:20:36,910 --> 00:20:40,850 +straight الفوريا بعد الفحص برجع straight ما لم يكن + +279 +00:20:40,850 --> 00:20:49,550 +ال fusion ضعيف أو ال control ضعيف hypophoria + +280 +00:20:49,550 --> 00:20:58,930 +.. hypophoria رجع straight hypophoria رجع straight + +281 +00:21:00,000 --> 00:21:07,620 +الدليل على أن أفوريا ها مافيش أي حركة فبالتالي هنا + +282 +00:21:07,620 --> 00:21:12,380 +في عندي hypophoria بال right eye فبالتالي هذه + +283 +00:21:12,380 --> 00:21:16,140 +بالنسبة لل uncovered test إذا the patient fixates + +284 +00:21:16,140 --> 00:21:19,580 +a straight ahead target دائما هنلاقي مطلوب من ال + +285 +00:21:19,580 --> 00:21:23,180 +patient إنه يعمل fixationthe patient fixates في + +286 +00:21:23,180 --> 00:21:27,020 +حالة ال cover test عشان أحدد التروبيا وفي حالة + +287 +00:21:27,020 --> 00:21:29,480 +الphoria أيضا في حالة ال uncovered test the + +288 +00:21:29,480 --> 00:21:33,180 +patient fixates هستريت أهد distant target وأيضا + +289 +00:21:33,180 --> 00:21:36,940 +بعيد على النيا طيب no movement لو مافيش أي حركة + +290 +00:21:36,940 --> 00:21:40,140 +معناته في orthophobia يعني هذا المريض لا عنده + +291 +00:21:40,140 --> 00:21:43,840 +تروبيا ولا عنده فوريا الآن ضروري جدا أن يعرف أن + +292 +00:21:43,840 --> 00:21:48,820 +معظم البشر عندها شوية فوريا بالذات على النيا + +293 +00:21:48,820 --> 00:21:55,110 +although a keen observerيعني الملاحظ .. الملاحظات + +294 +00:21:55,110 --> 00:21:58,390 +دقيقة will frequently detect very slight latent + +295 +00:21:58,390 --> 00:22:03,650 +deviation in most normal individuals as very few + +296 +00:22:03,650 --> 00:22:08,650 +people are truly orthophoric particularly on near + +297 +00:22:08,650 --> 00:22:11,810 +fixation .. particularly on near fixation + +298 +00:22:16,260 --> 00:22:20,460 +إذا no movement indicates orthophoria although a + +299 +00:22:20,460 --> 00:22:23,840 +keen observer will frequently detect very slight + +300 +00:22:23,840 --> 00:22:27,740 +latent deviation in most طبعا very slight كميته + +301 +00:22:27,740 --> 00:22:32,580 +قليلة جدا in most normal individuals as very few + +302 +00:22:32,580 --> 00:22:37,000 +people are truly orthophoricparticularly for near + +303 +00:22:37,000 --> 00:22:41,560 +fixation اكتير من الناس على ال near fixation نفرض + +304 +00:22:41,560 --> 00:22:44,700 +هذا ال target محطوط على ال near بيكون عنده slight + +305 +00:22:44,700 --> 00:22:50,700 +phoria slight phoria وغالبا بتكون exophoria غالبا + +306 +00:22:50,700 --> 00:22:55,100 +بتكون exophoria very slight + +307 +00:23:00,090 --> 00:23:04,870 +غالبية البشر طبعا ممكن يكون esophoria بس غالبية + +308 +00:23:04,870 --> 00:23:09,330 +بيكونوا غالبا exophoric at near بس الكمية بتكون + +309 +00:23:09,330 --> 00:23:12,410 +ضئيلة للغاية، ضئيلة للغاية عشان انا كنت بدها + +310 +00:23:12,410 --> 00:23:17,470 +ملاحظة عشان نلاحظ كيف صار dissociation لان حرفة + +311 +00:23:17,470 --> 00:23:22,270 +under the coverلما رفعنا ال cover استعادت ال + +312 +00:23:22,270 --> 00:23:26,130 +fixation استعادت ال fixation فهذا الكلام ضروري جدا + +313 +00:23:26,130 --> 00:23:29,370 +ناخد بالناه منه قلة قليلة جدا اللي ماعندهم مش اي + +314 +00:23:29,370 --> 00:23:33,810 +نوع من ال fold if the left eye had deviated under + +315 +00:23:33,810 --> 00:23:37,470 +the cover a refixation movement recovery to + +316 +00:23:37,470 --> 00:23:40,670 +binocular single vision is observed on being + +317 +00:23:40,670 --> 00:23:44,230 +uncovered عشان هيك بيسموه uncovered test بدي ألاحظ + +318 +00:23:44,230 --> 00:23:48,040 +العين ساعت ما أرفع ال cover أعمل uncoveredللعين + +319 +00:23:48,040 --> 00:23:51,980 +adoption nasal recovery indicates exophoria يعني + +320 +00:23:51,980 --> 00:23:54,740 +العين لما رفعنا الغطا عملت adoption باتجاه ال + +321 +00:23:54,740 --> 00:23:57,500 +primary position اللي معناته كانت لبرا and + +322 +00:23:57,500 --> 00:24:01,320 +abduction كانت لجوة وعملت abduction indicates + +323 +00:24:01,320 --> 00:24:06,520 +exophoria upward or downward movement indicates + +324 +00:24:06,520 --> 00:24:09,520 +vertical phoria لو العين نزلت ل primary position + +325 +00:24:09,520 --> 00:24:13,340 +معناته كانت فوق معناته hyperphoria لو العين طلعت + +326 +00:24:13,340 --> 00:24:17,240 +upward movement من ال downللـ primary position + +327 +00:24:17,240 --> 00:24:21,000 +طبعا لما كانت under the cover هذا معناته hypphoria + +328 +00:24:21,000 --> 00:24:27,780 +مهم جدا after the cover is removed the examiner + +329 +00:24:27,780 --> 00:24:31,800 +notes the speed and smoothness of recovery جداش + +330 +00:24:31,800 --> 00:24:34,760 +السرعة اللي استعادت فيها العين ال straight head + +331 +00:24:34,760 --> 00:24:40,060 +position و جداش يعني الانسيابية في هذا الموضوع as + +332 +00:24:40,060 --> 00:24:43,000 +evidence of strength of motor fusion كل مكان + +333 +00:24:43,000 --> 00:24:51,200 +استعادة أسرعكل ما كان الاستعادة أسرع هاي + +334 +00:24:51,200 --> 00:24:54,240 +احنا حطينا ال cover لان ساعات ما نرفع ال cover + +335 +00:24:54,240 --> 00:24:57,400 +جديش السرعة و ال انسيابية اللي بتستعيد فيها ال + +336 +00:24:57,400 --> 00:25:03,800 +binocularity فورا استعادت في ناس بيكون بيقعد فترة + +337 +00:25:03,800 --> 00:25:09,000 +او بده يرمش عشان يستعيد وضع العين السليم وهذا + +338 +00:25:09,000 --> 00:25:14,150 +بيكون مثلا motor fusion عنده ضعيف اما هناالان + +339 +00:25:14,150 --> 00:25:18,690 +اكزوفوريا رفعنا الغطاء على السريع فورا بمجرد ما + +340 +00:25:18,690 --> 00:25:22,870 +رفعنا الغطاء صارت العنتين straight إذا هذا + +341 +00:25:22,870 --> 00:25:27,290 +indication أو evidence لل strength of motor fusion + +342 +00:25:27,290 --> 00:25:31,650 +كل ما كان أسرع و أكتر انسيابية كل ما كان في عندي + +343 +00:25:31,650 --> 00:25:35,810 +ال motor fusion أقوى ال motor fusion أقوى طبعا ال + +344 +00:25:35,810 --> 00:25:38,770 +uncovered test بنعيده للعين التانية إذا عملناه + +345 +00:25:38,770 --> 00:25:45,180 +لليمين في البداية بنعيده للشمال بعد ذلكنجي للـ + +346 +00:25:45,180 --> 00:25:50,820 +Alternate Cover Test Alternate Cover Test بيفحصل + +347 +00:25:50,820 --> 00:25:53,420 +الـ Total Deviation الـ Total Deviation اللي هو + +348 +00:25:53,420 --> 00:25:57,000 +الترابيا زائد الفوريا الترابيا زائد الفوريا بعض + +349 +00:25:57,000 --> 00:26:00,280 +الناس يكون عنده ترابيا مع شوية فوريا يعني مثلا + +350 +00:26:00,280 --> 00:26:07,140 +نشوف المثال هذا نقول عندنا ترابيا مثلا اكزو ترابيا + +351 +00:26:07,140 --> 00:26:10,880 +عشتين برزم في نفس الوقت + +352 +00:26:13,580 --> 00:26:20,720 +Exophoria عشرة ابرزة الان بال cover انا بفحص + +353 +00:26:20,720 --> 00:26:23,800 +التروبيا + +354 +00:26:23,800 --> 00:26:33,400 +بال uncover بفحص الفوريا بال alternate cover بفحص + +355 +00:26:33,400 --> 00:26:36,880 +ال total deviation ال total deviation كيف بعمل ال + +356 +00:26:36,880 --> 00:26:39,120 +alternate cover؟ بغطي عين + +357 +00:26:42,890 --> 00:26:48,450 +و بصبر عدة .. يعني several seconds، يعني ثواني + +358 +00:26:48,450 --> 00:26:52,370 +عديدة عشان أكسر ال fusion أو أعمل dissociation + +359 +00:26:52,370 --> 00:26:56,350 +between the two eyes، بعدين بروح بنجل ثانيتين، + +360 +00:26:56,350 --> 00:26:59,790 +بعدين بعاوت ثانيتين، بعدين بعاوت ثانيتين، عشان هيك + +361 +00:26:59,790 --> 00:27:05,690 +اسمه alternate cover، و بعدين بشوف جديش استعاد + +362 +00:27:05,690 --> 00:27:10,110 +الوضع ما قبل الفحص، إذا عنده tropia و عنده phoria + +363 +00:27:13,670 --> 00:27:16,730 +بعمل alternate cover، بعمل dissociation لل two + +364 +00:27:16,730 --> 00:27:19,950 +eyes، dissociation لأنه مابسمحش ال cover هذا + +365 +00:27:19,950 --> 00:27:24,390 +المتنقل لـ brain أنه يسلم صورتين مع بعض في أن + +366 +00:27:24,390 --> 00:27:27,310 +واحد، يا بيسلم من اليمين يا بالإشمال، لأنه إذا + +367 +00:27:27,310 --> 00:27:30,690 +استلم من اليمين صورة، معناته الإشمال مغطى يعني، + +368 +00:27:30,690 --> 00:27:33,290 +إذا استلم من الإشمال، معناته اليمين مغطى، فهذا + +369 +00:27:33,290 --> 00:27:40,010 +dissociation testبعدين بقى ارفع شوف كده اش وجد + +370 +00:27:40,010 --> 00:27:43,590 +عشان يستعيد وضع ما قبل الفحص كده اش وجد عشان + +371 +00:27:43,590 --> 00:27:46,970 +يستعيد وضع ما قبل الفحص اذا ال alternate cover + +372 +00:27:46,970 --> 00:27:50,310 +test is a dissociation test which reveals the + +373 +00:27:50,310 --> 00:27:54,030 +total deviation when fusion is suspended لما بوقف + +374 +00:27:54,030 --> 00:27:57,110 +عملية ال fusion كيف بدي اوقفها؟ ليه ده مش صورتين + +375 +00:27:57,110 --> 00:28:01,450 +في صورة؟ ان امنع صورة تصل ل brain عبر ال retina + +376 +00:28:01,450 --> 00:28:05,230 +يعني بغطي مرة highبتضال التانية شغالة، بغطي + +377 +00:28:05,230 --> 00:28:07,870 +التانية، بتضال الأولى شغالة، دايما بيصل ال brain + +378 +00:28:07,870 --> 00:28:11,490 +one image it should be performed after the cover + +379 +00:28:11,490 --> 00:28:15,810 +and uncovered testطيب كيف بنعمله؟ the right eye is + +380 +00:28:15,810 --> 00:28:18,830 +covered for several seconds the occluder is + +381 +00:28:18,830 --> 00:28:21,330 +quickly shifted to the opposite eye for two + +382 +00:28:21,330 --> 00:28:24,430 +seconds then back and forth مرة هنا و مرة هنا + +383 +00:28:24,430 --> 00:28:27,710 +several times after the cover is removed the + +384 +00:28:27,710 --> 00:28:31,210 +examiner notes the speed and smoothness of + +385 +00:28:31,210 --> 00:28:33,650 +recovery as the eyes return to their + +386 +00:28:33,650 --> 00:28:40,820 +predissociated state يعني هاي بدينا خطينالعدد + +387 +00:28:40,820 --> 00:28:44,520 +ثواني .. ثواني عديدة ممكن في الفترة هاي إذا كانوا + +388 +00:28:44,520 --> 00:28:48,140 +طفل يعني نتكلم معاه يعني مثلا عمره ست سنوات .. سبع + +389 +00:28:48,140 --> 00:28:52,400 +سنوات يعني ممكن نتكلم معاه عشان يعني نلفت انتباهه + +390 +00:28:52,400 --> 00:28:56,140 +أو .. أو نخلي موضوع ال dissociation أكتر يعني + +391 +00:28:56,140 --> 00:29:00,040 +ينتبه لشيء تاني غير .. يعني هو مركز في ال target + +392 +00:29:00,040 --> 00:29:04,120 +بس احنا يعني بن .. بنحاول يعني نلفت انتباهه و + +393 +00:29:04,120 --> 00:29:07,660 +نتكلم معاه إنه في أي صفر و كده و كده بس المهم .. + +394 +00:29:07,660 --> 00:29:11,160 +المهم إنه مايتطلعش فينا يظل بتطلعبال target الان + +395 +00:29:11,160 --> 00:29:17,040 +عدة seconds مضوا ببدأ اثنين ثانيتين ثانيتين + +396 +00:29:17,040 --> 00:29:21,720 +ثانيتين ثانيتين عدة مرات بعدين برفع ال cover بتاعي + +397 +00:29:21,720 --> 00:29:26,300 +عشان اشوف قداش سرعة العودة لما قبل ال alternate + +398 +00:29:26,300 --> 00:29:32,240 +cover هنا عاد بسرعة هو صحيح drop ya بس في كمان for + +399 +00:29:32,240 --> 00:29:37,650 +ya ال for ya ليه هاي؟بعد ما عملت ال alternate + +400 +00:29:37,650 --> 00:29:42,190 +cover رجعت ل brain عنده قدرة يتحكم هو كمية الحوار + +401 +00:29:42,190 --> 00:29:46,570 +الكلية تلاتين Prism Exo منهم ترابيا عشرين Prism + +402 +00:29:46,570 --> 00:29:50,210 +وعشرة Prism فوريا هذه الفوريا فوريا لأن ال brain + +403 +00:29:50,210 --> 00:29:53,430 +متغلب عليها لأن بعد ما عملت ال alternate cover + +404 +00:29:53,430 --> 00:29:57,430 +وشلت + +405 +00:29:57,930 --> 00:30:01,310 +الفوريا اللى كانت ظاهرة بال alternate cover اتغلب + +406 +00:30:01,310 --> 00:30:04,210 +عليها الدماغ وضلت لتروبيا اللى أنا مش قادر اتغلب + +407 +00:30:04,210 --> 00:30:07,790 +عليها الدماغ، اذا هذا بالنسبة لل alternate cover + +408 +00:30:07,790 --> 00:30:13,850 +test كيف اجرى a patient with a well compensated + +409 +00:30:13,850 --> 00:30:18,350 +heterofuria will have straight eyes before and + +410 +00:30:18,350 --> 00:30:23,520 +after the test has been performedwhereas a patient + +411 +00:30:23,520 --> 00:30:26,480 +with poor control may decompensate to manifest + +412 +00:30:26,480 --> 00:30:31,420 +deviation انشوف المثال اللي هم بيحكوا عليه، بنقول + +413 +00:30:31,420 --> 00:30:38,080 +كالقادة هاي + +414 +00:30:38,080 --> 00:30:43,580 +أنا عندي euphoria، بس well compensated several + +415 +00:30:43,580 --> 00:30:44,220 +seconds + +416 +00:30:51,860 --> 00:30:55,620 +Alternate cover بعدين رح تترفع ع السريع Straight + +417 +00:30:55,620 --> 00:30:59,420 +eyes before the test and straight eyes after the + +418 +00:30:59,420 --> 00:31:03,600 +test بينما بعض الناس اللي عندهم poor compensation + +419 +00:31:03,600 --> 00:31:07,560 +أو poor control هذه الفورية ممكن تصير ترابية بعد + +420 +00:31:07,560 --> 00:31:10,740 +ال test يعني بعد ال test كان قبل ال test زي هيك + +421 +00:31:10,740 --> 00:31:16,770 +وبعد ال test أصبحبالوضعية هذه ماقدرش اعدل، ماقدرش + +422 +00:31:16,770 --> 00:31:20,730 +اعدل معناته ال .. ال control عنده او ال fusion is + +423 +00:31:20,730 --> 00:31:25,510 +poor فمش قادر يتحكم في ال fourية اللي انها جلبت + +424 +00:31:25,510 --> 00:31:29,350 +لتروبيا، يعني decompensate هو a manifest deviation + +425 +00:31:31,200 --> 00:31:34,160 +أخر حاجة في السلسلة بتاعة ال cover tests اللي هي + +426 +00:31:34,160 --> 00:31:37,220 +ال prism cover test أو ال alternative prism cover + +427 +00:31:37,220 --> 00:31:41,380 +test majors the angle of deviation on near or + +428 +00:31:41,380 --> 00:31:45,200 +distance fixation and in any gaze position يعني في + +429 +00:31:45,200 --> 00:31:48,360 +ال nine diagnostic position ممكن أجيس يعني أنا + +430 +00:31:48,360 --> 00:31:52,380 +ممكن أ guessباستعمال ال alternate cover test اللي + +431 +00:31:52,380 --> 00:31:57,000 +شرحناها قبل شوية مع استخدام ال prison و في .. ع ال + +432 +00:31:57,000 --> 00:32:00,780 +distance عنيا ممكن في ال up case أجيس الحول و في + +433 +00:32:00,780 --> 00:32:07,540 +ال down case أجيس الحول و down and left .. left up + +434 +00:32:07,540 --> 00:32:15,690 +and left .. up up and right .. rightdown and right + +435 +00:32:15,690 --> 00:32:19,330 +و down فبالتاني ممكن اجيسه في ال nine diagnostic + +436 +00:32:19,330 --> 00:32:22,390 +positions of gaze ايضا ممكن اجيسه في ال nine + +437 +00:32:22,390 --> 00:32:25,630 +diagnostic positions of gaze بدون نضارة و مع نضارة + +438 +00:32:25,630 --> 00:32:30,170 +هو ده الفحص المتكامل و الفحص السليم و بالذات لما + +439 +00:32:30,170 --> 00:32:34,110 +يكون المريض عندى لسه اول مرة انا بالتقي فيه و بدى + +440 +00:32:34,110 --> 00:32:37,950 +اعرف القياسات بتاعة الحوار كيف بنعمل ال prism + +441 +00:32:37,950 --> 00:32:41,750 +cover test عشان نقيس زاوية الحوار طبعا هنا عندى + +442 +00:32:52,720 --> 00:33:00,800 +بنفرض عندي هنا right exotropia مقدارها 25 بريسم + +443 +00:33:00,800 --> 00:33:06,820 +الان احنا بنبدأ من البريسم القليل اول حاجة اي + +444 +00:33:06,820 --> 00:33:09,800 +نتجاه اللي حول للخارج اذا ال apex بتاعة البريسم + +445 +00:33:09,800 --> 00:33:13,420 +بده تكون للخارج ال apex بتاعة البريسم بده تكون + +446 +00:33:13,420 --> 00:33:19,280 +للخارجطيب، هاي نقطة، النقطة التانية إذا طالما ال + +447 +00:33:19,280 --> 00:33:23,600 +apex هتكون للخارج معناته ال base in دائما احنا + +448 +00:33:23,600 --> 00:33:27,180 +بنسمي ال prism بال base بال base بتاعنا، إذا base + +449 +00:33:27,180 --> 00:33:30,900 +in ال prism الآن أهم نقطة، هل ضروري جدا لازم انا + +450 +00:33:30,900 --> 00:33:33,620 +أحطه أمام العين اللي فيها ال deviation؟ لأ، ممكن + +451 +00:33:33,620 --> 00:33:37,780 +أعمل .. أعمله أمام العين اللي فيها ال deviation أو + +452 +00:33:37,780 --> 00:33:41,960 +أعمله أمام العين اللي فيها اللي هي ال fixating eye + +453 +00:33:41,960 --> 00:33:46,720 +بس ضروري طالما x يكون base inطالما exo يكون base + +454 +00:33:46,720 --> 00:33:52,100 +in تمام فبالتالي في ال exotropia بدأ أحطه base in + +455 +00:33:52,100 --> 00:33:55,500 +طيب، هنشوف مرة هنا و نشوف مرة هنا و نشوف هل بنفع + +456 +00:33:55,500 --> 00:33:58,840 +ولا بنفعش، احنا بنقول انه بينفع، بنقول كالقادي، هي + +457 +00:33:58,840 --> 00:34:04,000 +حطينا ال prism و بدنا عمل alternate cover، لسه + +458 +00:34:04,000 --> 00:34:09,920 +العين بتتحرك، بدأ أزود قيمة ال prism العين لازالت + +459 +00:34:09,920 --> 00:34:16,150 +بتتحرك، معناته بدأ أزود قيمة ال prismالعين بتتحرك + +460 +00:34:16,150 --> 00:34:21,130 +بس الحركة بدأت تتخفف الحركة بدأت تتخفف بدأ أزود + +461 +00:34:21,130 --> 00:34:24,650 +قيمة ال Prism كمان وأعمل alternate cover ضروري + +462 +00:34:24,650 --> 00:34:28,750 +المريض يكون بتطلع على ال target الآن بدأ أزود قيمة + +463 +00:34:28,750 --> 00:34:33,970 +ال Prism كمان ونشوف كيف no movement no movement + +464 +00:34:33,970 --> 00:34:39,350 +معناته أنا عملت neutralization لل Esquint إذا قيمة + +465 +00:34:39,350 --> 00:34:42,890 +هذا لل Esquint خمسة وعشرين Prism ديوبتر right + +466 +00:34:42,890 --> 00:34:47,930 +exotropiaهل بنفع انا لو حطيت ال prism base in قدام + +467 +00:34:47,930 --> 00:34:51,610 +ال right eye، ال left eye عفوا، اللي هي العين + +468 +00:34:51,610 --> 00:34:56,090 +التانية، بنقول نعم، بنفع، بس ضروري يكون base in، + +469 +00:34:56,090 --> 00:34:59,430 +base in، هاي ال base in، نشوف ال alternate cover + +470 +00:34:59,430 --> 00:35:04,930 +أو ال alternate prism cover، لسه في movement، طيب، + +471 +00:35:04,930 --> 00:35:10,880 +بنزود قيمة ال prism؟بنكمل ضروري المريض يكون بتطلع + +472 +00:35:10,880 --> 00:35:15,640 +على ال target alternate cover بمسك بإيدي ال prism + +473 +00:35:15,640 --> 00:35:19,860 +بالإيدي التانية ال cover لسه في movement بدنا نزود + +474 +00:35:19,860 --> 00:35:26,920 +الان نشوف عفوا بدنا + +475 +00:35:26,920 --> 00:35:34,590 +نمسك احنا الان مافيش اي movementهذه بيسموها + +476 +00:35:34,590 --> 00:35:38,270 +neutralization point يعني النقطة اللي عندها الحوال + +477 +00:35:38,270 --> 00:35:43,190 +اعملتله neutralization بواسطة ال prism بقوة معينة + +478 +00:35:43,190 --> 00:35:48,010 +اذا based in prism خمسة و عشرين prism ضيوف بعض + +479 +00:35:48,010 --> 00:35:51,310 +المدارس الطبية بتنصح انه عشان اتأكد انه فعلا خمسة + +480 +00:35:51,310 --> 00:35:55,470 +و عشرين خليني ازود المفروض الحركة تعكس شايفين + +481 +00:35:55,470 --> 00:36:00,980 +الحركة هنا لما كان الأقلكانت من برا لجوه لما بشيل + +482 +00:36:00,980 --> 00:36:05,460 +الغطة العين بتعدل من برا لجوه لما بشيل الغطة عفوا + +483 +00:36:05,460 --> 00:36:10,160 +احنا نشيل ال prism لما بشيل الغطة العين بتعدل من + +484 +00:36:10,160 --> 00:36:13,800 +برا لجوه من برا لجوه نتطلع العين اللي انا بشيل + +485 +00:36:13,800 --> 00:36:18,040 +عنها الغطة بتعدل من برا لجوه طيب الان ازود قيمة ال + +486 +00:36:18,040 --> 00:36:24,260 +prism عن 25 عشان نشوف ان الحركة هتجلب ولا لأ أصبحت + +487 +00:36:24,260 --> 00:36:25,120 +من جوه لبرا + +488 +00:36:28,160 --> 00:36:31,960 +أصبحت من جوه لبره إذا أنا عديت القيمة بتاعة الحوال + +489 +00:36:31,960 --> 00:36:35,740 +بسموها point of reversal لما تجلب الحركة كانت من + +490 +00:36:35,740 --> 00:36:39,540 +برا لجوه صارت من جوه لبره أو كانت من جوه لبره صارت + +491 +00:36:39,540 --> 00:36:42,780 +من برا لجوه إذا هذه ال point of reversal لأ برجع + +492 +00:36:42,780 --> 00:36:46,360 +عنها شوية بنزل قيمة ال prism لما يصير عندي مرة + +493 +00:36:46,360 --> 00:36:52,240 +تانية no movement هذا مثال على ال exotropia طيب + +494 +00:36:52,240 --> 00:36:55,460 +الآن أنا بدي أشوف مثال على الisotropia + +495 +00:37:01,560 --> 00:37:07,440 +وخلّيه ل left eye left esotropia عشرين ابرزه أول + +496 +00:37:07,440 --> 00:37:11,280 +حاجة بعمل ال alternate cover esotropia العين اللي + +497 +00:37:11,280 --> 00:37:14,220 +برفع اللي برفع لازم ألاحظ اللي برفع عنها ال cover + +498 +00:37:14,220 --> 00:37:17,860 +هاي ال right eye رفعنا عنها اتحركت من جوا لبرا + +499 +00:37:17,860 --> 00:37:24,880 +معناته esotropia عندي هنا left esotropia هاي ال + +500 +00:37:24,880 --> 00:37:29,210 +cover testهي كمان مرة ال cover test left esotropia + +501 +00:37:29,210 --> 00:37:33,330 +طيب نشوف هنا مافيش tropia في ال right eye ال + +502 +00:37:33,330 --> 00:37:37,710 +alternate cover لازم أعمله طالما esotropia لازم + +503 +00:37:37,710 --> 00:37:41,410 +يكون هندي base أوت ال prism لان اتجاه الحوالة + +504 +00:37:41,410 --> 00:37:45,610 +الداخل سواء استعملت ال prism هنا أو استعملته هنا + +505 +00:37:45,610 --> 00:37:49,930 +طيب نبدأ بprism قوته صغيرة خمسة prism ونعمل ال + +506 +00:37:49,930 --> 00:37:50,730 +alternate cover + +507 +00:37:55,070 --> 00:38:02,330 +لسه فى movement بزود قيمة ال prison لسه + +508 +00:38:02,330 --> 00:38:06,710 +العين جوا و بتطلع لبرا لإن لم أبدأ أرفع الغطاء عن + +509 +00:38:06,710 --> 00:38:09,170 +العين اليمين بنلاحظ العين اليمين إيه أشهر جت بدأ + +510 +00:38:09,170 --> 00:38:12,410 +أرفع عينها الغطاة هتلاحظها أنه طلعت من برا لل + +511 +00:38:12,410 --> 00:38:18,130 +primary position فلسه معناته ال ISO موجودة هى + +512 +00:38:18,130 --> 00:38:21,190 +زودنا الحركة جاعدة بتخ... عفوا ناسف + +513 +00:38:27,420 --> 00:38:38,400 +لسة لازال عندي إيزو تروبيا الان برضه فش + +514 +00:38:38,400 --> 00:38:44,060 +movement فش movement إذا الان + +515 +00:38:44,060 --> 00:38:47,960 +هذا ال prism قوته مكافئة إذا عندي left إيزو تروبيا + +516 +00:38:47,960 --> 00:38:57,560 +عشرين ال prism انزود شوية أصبحت الحركة معاكسةأصبحت + +517 +00:38:57,560 --> 00:39:01,200 +من برا لجوه بعد ما كانت من جوه لبرا لأن ده أرفع عن + +518 +00:39:01,200 --> 00:39:04,680 +العين اليمين هتتحرك من برا لجوه العين اليمين بمجرد + +519 +00:39:04,680 --> 00:39:09,460 +ما نرفع عنها هتتحرك من برا لجوه العين الشمالة ما + +520 +00:39:09,460 --> 00:39:12,400 +نرفع عنها من برا لجوه أصلا جالبات صارت اكزو بدل ما + +521 +00:39:12,400 --> 00:39:16,940 +هي ايزو فبرجع هذه .. هذه النقطة اللي احنا عكست + +522 +00:39:16,940 --> 00:39:22,780 +الحركة بسموها ال point of reversing فأرجع عنها + +523 +00:39:22,780 --> 00:39:30,650 +درجة خمسة برزينمافيش أي movement إذا عندي left + +524 +00:39:30,650 --> 00:39:47,770 +إكزوتروبيا عشرين إبرزة نيجي لمثال تالت هاي + +525 +00:39:47,770 --> 00:39:53,950 +عندي left hypotropia .. hypotropia بال cover test + +526 +00:39:53,950 --> 00:39:59,540 +hypotropiaفى ال left eye فى ال left eye طيب هنا + +527 +00:39:59,540 --> 00:40:02,120 +عملنا cover مافيش فى ال right eye ولا حاجة طيب + +528 +00:40:02,120 --> 00:40:08,080 +الآن بدى استعمل .. بدى استعمل Librasium هنا بدنا + +529 +00:40:08,080 --> 00:40:12,920 +ننتبه لشيء ضرورى جدا جدا جدا فى ال vertical squint + +530 +00:40:12,920 --> 00:40:17,080 +ضرورى نعرف إذا كان high hypo معناته هادي hyper إذا + +531 +00:40:17,080 --> 00:40:21,260 +كان هادي hypohypo بالنسبة لمن؟ بالنسبة لل right + +532 +00:40:21,260 --> 00:40:24,680 +eye معناته ال right eye أعلى منها يعني hyper + +533 +00:40:24,680 --> 00:40:27,580 +بالنسبة إليها فبالتالي هنا ال prism بده يكون base + +534 +00:40:27,580 --> 00:40:35,960 +up لأنه اتجاه الحوال .. اتجاه الحوال الأسفل طيب أو + +535 +00:40:35,960 --> 00:40:38,720 +إذا بده أستعمله هنا بده أستعمله base down لأن + +536 +00:40:38,720 --> 00:40:42,820 +اتجاه الحوال الأعلى لأن هذه hyper بالنسبة للعين + +537 +00:40:42,820 --> 00:40:48,340 +التانية إذا بده أعادل الحوال ب highلازم اعدله + +538 +00:40:48,340 --> 00:40:53,860 +بprism .. بprism based down بينما هنا لازم اعدله + +539 +00:40:53,860 --> 00:41:01,320 +بprism based up طيب نيجي احنا نعمل ال alternate + +540 +00:41:01,320 --> 00:41:04,680 +cover test او ال prism cover test لسه لما بغطي + +541 +00:41:04,680 --> 00:41:08,140 +العين اليمين العين الشمالي بتطلع لفوق ال alternate + +542 +00:41:08,140 --> 00:41:12,240 +cover لسه في movement بزود قيمة لprism + +543 +00:41:17,740 --> 00:41:21,600 +الـ movement صارت أقل بس لسه موجودة لما ب .. بارفع + +544 +00:41:21,600 --> 00:41:25,320 +عن ال .. الشمال بتطلع لفوق يعني hypo لما بارفع على + +545 +00:41:25,320 --> 00:41:29,160 +اليمين بتنزل لتحت يعني hyper تمام؟ بنزود القيمة + +546 +00:41:29,160 --> 00:41:35,500 +كمان عفوا مافيش + +547 +00:41:35,500 --> 00:41:39,740 +أي movement مافيش أي movement فبالتالي بدي أعدي + +548 +00:41:39,740 --> 00:41:43,540 +قيمة ال neutralizationأصبح .. أصبحت العين اليمين + +549 +00:41:43,540 --> 00:41:46,400 +كإنها hypo لإن أنا لما بشيل عنها ال cover وبنجل + +550 +00:41:46,400 --> 00:41:49,860 +للعين التانية تطلع من تحت لفوق نلاحظ تاني العين + +551 +00:41:49,860 --> 00:41:53,940 +اليمين أول + +552 +00:41:53,940 --> 00:41:57,760 +ما برفع عن اليمين طلعت لفوق لل primary position + +553 +00:41:57,760 --> 00:42:01,500 +معناته صارت hypo جلبت ل hypo هذه اللي هي hypo + +554 +00:42:01,500 --> 00:42:04,940 +أساسا أول ما برفع عنها ال cover بتنزل لتحت معناته + +555 +00:42:04,940 --> 00:42:08,140 +أنا معالجها ب prism أعلى من اللازم point of + +556 +00:42:08,140 --> 00:42:08,800 +reversing + +557 +00:42:13,000 --> 00:42:16,300 +مافي اي مشكلة ممكن ساني يقول طيب بدنا نجرب احنا + +558 +00:42:16,300 --> 00:42:23,960 +على العين اليمين نحط base down ونشوف + +559 +00:42:23,960 --> 00:42:30,900 +كيف الأمر بيصير نقول كالقادم هي base down لسه في + +560 +00:42:30,900 --> 00:42:34,840 +movement لسه ال left eye hyper و ال right eye + +561 +00:42:34,840 --> 00:42:40,840 +hyper طيب بنزود قيمة ال prism لسه + +562 +00:42:40,840 --> 00:42:45,460 +في movement بس بدأ تتخلبنزود movement او بنزود + +563 +00:42:45,460 --> 00:42:50,100 +قيمة الprism مافيش عندي movement اذا هنا عشرين + +564 +00:42:50,100 --> 00:42:55,160 +prism left hyper او بقول عشرين prism right hyper + +565 +00:42:55,160 --> 00:42:59,620 +او عشرين prism right hyper واتنين مكافئين لبعض + +566 +00:42:59,620 --> 00:43:06,420 +يمكن اعتبارهم هذا ال alternative prism cover test + +567 +00:43:06,420 --> 00:43:11,830 +وهدي ال point of reversal اللي حكينابسجل هذا + +568 +00:43:11,830 --> 00:43:16,830 +الكلام في ملف المريض وهيك بيكون انتهت اللي هو + +569 +00:43:16,830 --> 00:43:22,210 +سلسلة ال cover tests بيعطيكم العافية والسلام عليكم + +570 +00:43:22,210 --> 00:43:23,950 +ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/3j78bCtcI-U_raw.json b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/3j78bCtcI-U_raw.json new file mode 100644 index 0000000000000000000000000000000000000000..2014381266ba76de1e1e22a0225c3c74cc04510c --- 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for the angle of squint compensates for the angle of squint بمعنى بيعوض عن زاوية الحوار كيف؟ نشوف الرسمة هاي اللي بتبين بهذه القضية بشكل مبسط للغاية", "tokens": [9381, 13063, 3660, 12399, 8978, 20328, 13063, 3660, 3714, 46456, 46538, 3660, 18871, 31767, 13063, 3660, 13672, 1829, 8978, 16247, 1863, 3555, 37746, 3660, 16712, 7649, 10632, 11933, 15730, 2423, 39184, 26155, 5747, 5317, 418, 6225, 3555, 9640, 3660, 18871, 324, 564, 10466, 40216, 4302, 6024, 118, 43042, 9154, 2423, 39184, 26155, 5747, 5317, 418, 14739, 3224, 11598, 1024, 337, 264, 5802, 295, 2339, 686, 11598, 1024, 337, 264, 5802, 295, 2339, 686, 4724, 2304, 3615, 1863, 7578, 4724, 40228, 2407, 11242, 18871, 30767, 995, 2407, 10632, 21542, 2407, 9640, 9122, 33911, 22807, 8717, 8592, 38688, 34892, 38251, 3660, 8032, 47302, 13672, 1829, 39894, 3555, 9957, 39627, 24192, 25062, 11242, 10632, 4724, 8592, 28820, 3714, 3555, 3794, 9566, 24976, 17082, 995, 10632], "avg_logprob": -0.16069614063433516, "compression_ratio": 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الأنبوبة هنا و في نهاية الأنبوبة هنا لما عملنا .. حركنا الأنبوبة هاي لبرا .. حركناها لبرا يعني صار عندي أنه بالظبط الصورة عجبالي ال fovea في العين ال squinting حتى لو انها squinting و كأنه حركة الأنبوبة يعني ألغت", "tokens": [40228, 22653, 31767, 13063, 3660, 8032, 2655, 30544, 8978, 8717, 11296, 10632, 16247, 1863, 3555, 37746, 3660, 34105, 4032, 8978, 8717, 11296, 10632, 16247, 1863, 3555, 37746, 3660, 34105, 5296, 15042, 6225, 42213, 8315, 4386, 11331, 31747, 8315, 16247, 1863, 3555, 37746, 3660, 8032, 47302, 5296, 3555, 23557, 4386, 11331, 31747, 8315, 11296, 5296, 3555, 23557, 37495, 22653, 20328, 9640, 18871, 16254, 14739, 3224, 20666, 19913, 3555, 9566, 31767, 13063, 3660, 6225, 7435, 3555, 6027, 1829, 2423, 283, 1682, 64, 8978, 18863, 9957, 2423, 2339, 686, 278, 11331, 49975, 45164, 16472, 11296, 2339, 686, 278, 4032, 9122, 33456, 3224, 11331, 31747, 3660, 16247, 1863, 3555, 37746, 3660, 37495, 22653, 5551, 1211, 17082, 2655], "avg_logprob": -0.13802083830038706, 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squint and allows stimuli to be presented to both eyes simultaneously يعني بسمح ليه لما انا اعوض عن زاوية الحوال ان ال stimulus اللي هي الصور او ال stimuli اللي هي الصور to be presented to both eyes simultaneously", "tokens": [2994, 264, 5802, 295, 2339, 686, 293, 4045, 47752, 281, 312, 8212, 281, 1293, 2575, 16561, 37495, 22653, 4724, 38251, 5016, 32239, 3224, 5296, 15042, 1975, 8315, 1975, 3615, 2407, 11242, 18871, 30767, 995, 2407, 10632, 21542, 2407, 6027, 16472, 2423, 21366, 13672, 1829, 39896, 31767, 13063, 1975, 2407, 2423, 47752, 13672, 1829, 39896, 31767, 13063, 281, 312, 8212, 281, 1293, 2575, 16561], "avg_logprob": -0.16809082450345159, "compression_ratio": 1.7710843373493976, "no_speech_prob": 2.980232238769531e-07, "words": [{"start": 584.67, "end": 584.93, "word": "for", "probability": 0.853515625}, {"start": 584.93, "end": 585.13, "word": " the", "probability": 0.943359375}, {"start": 585.13, "end": 585.57, "word": " angle", "probability": 0.89404296875}, {"start": 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يعني", "probability": 0.81787109375}, {"start": 592.29, "end": 592.71, "word": " بسمح", "probability": 0.9573567708333334}, {"start": 592.71, "end": 592.95, "word": " ليه", "probability": 0.920166015625}, {"start": 592.95, "end": 593.21, "word": " لما", "probability": 0.92626953125}, {"start": 593.21, "end": 593.43, "word": " انا", "probability": 0.7188720703125}, {"start": 593.43, "end": 593.87, "word": " اعوض", "probability": 0.75323486328125}, {"start": 593.87, "end": 594.05, "word": " عن", "probability": 0.974609375}, {"start": 594.05, "end": 594.37, "word": " زاوية", "probability": 0.71624755859375}, {"start": 594.37, "end": 594.81, "word": " الحوال", "probability": 0.7604166666666666}, {"start": 594.81, "end": 595.03, "word": " ان", "probability": 0.77685546875}, {"start": 595.03, "end": 595.57, "word": " ال", "probability": 0.7060546875}, {"start": 595.57, "end": 596.17, "word": " stimulus", "probability": 0.95166015625}, {"start": 596.17, "end": 596.39, "word": " اللي", "probability": 0.951904296875}, {"start": 596.39, "end": 596.49, "word": " هي", "probability": 0.8955078125}, {"start": 596.49, "end": 596.97, "word": " الصور", "probability": 0.992919921875}, {"start": 596.97, "end": 597.45, "word": " او", "probability": 0.79150390625}, {"start": 597.45, "end": 597.55, "word": " ال", "probability": 0.91162109375}, {"start": 597.55, "end": 597.97, "word": " stimuli", "probability": 0.96337890625}, {"start": 597.97, "end": 598.25, "word": " اللي", "probability": 0.98046875}, {"start": 598.25, "end": 598.33, "word": " هي", "probability": 0.92431640625}, {"start": 598.33, "end": 598.75, "word": " الصور", "probability": 0.98876953125}, {"start": 598.75, "end": 599.17, "word": " to", "probability": 0.94580078125}, {"start": 599.17, "end": 599.37, "word": " be", "probability": 0.9619140625}, {"start": 599.37, "end": 599.93, "word": " presented", "probability": 0.841796875}, {"start": 599.93, "end": 600.19, "word": " to", "probability": 0.984375}, {"start": 600.19, "end": 600.41, "word": " both", "probability": 0.91064453125}, {"start": 600.41, "end": 600.85, "word": " eyes", "probability": 0.8623046875}, {"start": 600.85, "end": 603.47, "word": " simultaneously", "probability": 0.88037109375}], "temperature": 1.0}, {"id": 21, "seek": 61991, "start": 604.02, "end": 619.92, "text": "it can thus و هكذا be used to investigate the potential for binocular function لو أنا عوضت عن زاوية الحوال، هل هيرجع العنتين يشتغلوا ك team ولا لأ؟ in the presence طبعا of manifest squint، هعوض عن ال manifest squint", "tokens": [270, 393, 8807, 4032, 8032, 4117, 15730, 312, 1143, 281, 15013, 264, 3995, 337, 5171, 905, 1040, 2445, 45164, 41850, 6225, 2407, 11242, 2655, 18871, 30767, 995, 2407, 10632, 21542, 2407, 6027, 12399, 8032, 1211, 39896, 47341, 3615, 18863, 29399, 9957, 7251, 8592, 2655, 17082, 1211, 14407, 9122, 1469, 49429, 5296, 10721, 22807, 294, 264, 6814, 23032, 3555, 3615, 995, 295, 10067, 2339, 686, 12399, 8032, 3615, 2407, 11242, 18871, 2423, 10067, 2339, 686], "avg_logprob": -0.15395833253860475, "compression_ratio": 1.3990147783251232, "no_speech_prob": 0.0005426406860351562, "words": [{"start": 604.02, "end": 604.48, "word": "it", "probability": 0.49755859375}, {"start": 604.48, "end": 604.84, "word": " can", "probability": 0.87158203125}, {"start": 604.84, "end": 605.14, "word": " thus", "probability": 0.9072265625}, {"start": 605.14, "end": 605.26, "word": " و", "probability": 0.740234375}, {"start": 605.26, "end": 605.82, "word": " هكذا", "probability": 0.9124348958333334}, {"start": 605.82, "end": 606.2, "word": " be", "probability": 0.77587890625}, {"start": 606.2, "end": 606.56, "word": " used", "probability": 0.93115234375}, {"start": 606.56, "end": 606.76, "word": " to", "probability": 0.98193359375}, {"start": 606.76, "end": 607.62, "word": " investigate", "probability": 0.94482421875}, {"start": 607.62, "end": 608.1, "word": " the", "probability": 0.89501953125}, {"start": 608.1, "end": 608.64, "word": " potential", "probability": 0.94677734375}, {"start": 608.64, "end": 608.92, "word": " for", "probability": 0.9482421875}, {"start": 608.92, "end": 609.54, "word": " binocular", "probability": 0.9298502604166666}, {"start": 609.54, "end": 610.04, "word": " function", "probability": 0.97412109375}, {"start": 610.04, "end": 610.46, "word": " لو", "probability": 0.6044921875}, {"start": 610.46, "end": 610.74, "word": " أنا", "probability": 0.71630859375}, {"start": 610.74, "end": 611.08, "word": " عوضت", "probability": 0.8934326171875}, {"start": 611.08, "end": 611.22, "word": " عن", "probability": 0.98828125}, {"start": 611.22, "end": 611.54, "word": " زاوية", "probability": 0.9163818359375}, {"start": 611.54, "end": 612.0, "word": " الحوال،", "probability": 0.7672119140625}, {"start": 612.0, "end": 612.22, "word": " هل", "probability": 0.992431640625}, {"start": 612.22, "end": 612.76, "word": " هيرجع", "probability": 0.9249674479166666}, {"start": 612.76, "end": 613.42, "word": " العنتين", "probability": 0.6017252604166666}, {"start": 613.42, "end": 614.4, "word": " يشتغلوا", "probability": 0.992919921875}, {"start": 614.4, "end": 614.56, "word": " ك", "probability": 0.9921875}, {"start": 614.56, "end": 614.78, "word": " team", "probability": 0.9658203125}, {"start": 614.78, "end": 614.94, "word": " ولا", "probability": 0.875}, {"start": 614.94, "end": 615.68, "word": " لأ؟", "probability": 0.87060546875}, {"start": 615.68, "end": 615.86, "word": " in", "probability": 0.72998046875}, {"start": 615.86, "end": 616.0, "word": " the", "probability": 0.9384765625}, {"start": 616.0, "end": 616.34, "word": " presence", "probability": 0.95556640625}, {"start": 616.34, "end": 616.78, "word": " طبعا", "probability": 0.9764404296875}, {"start": 616.78, "end": 616.98, "word": " of", "probability": 0.970703125}, {"start": 616.98, "end": 617.5, "word": " manifest", "probability": 0.8583984375}, {"start": 617.5, "end": 618.1, "word": " squint،", "probability": 0.7412109375}, {"start": 618.1, "end": 618.58, "word": " هعوض", "probability": 0.8577880859375}, {"start": 618.58, "end": 618.76, "word": " عن", "probability": 0.99609375}, {"start": 618.76, "end": 618.88, "word": " ال", "probability": 0.80029296875}, {"start": 618.88, "end": 619.2, "word": " manifest", "probability": 0.87255859375}, {"start": 619.2, "end": 619.92, "word": " squint", "probability": 0.9736328125}], "temperature": 1.0}, {"id": 22, "seek": 63973, "start": 621.15, "end": 639.73, "text": "الـ latent squint ليش مابعودش عليه لأنه latent الانين بيكونوا في الوضع الطبيعي في ال latent squint بيكونوا straight and is of particular value in testing young children طبعا الصور اللي .. اللي .. اللي هنعرضها بعد شوية هتبين أن هذا الـ synaptic form ممكن أستعمله للأطفال", "tokens": [6027, 39184, 48994, 2339, 686, 32239, 8592, 3714, 16758, 3615, 23328, 8592, 47356, 5296, 33456, 3224, 48994, 2423, 7649, 9957, 4724, 1829, 30544, 14407, 8978, 2423, 2407, 11242, 3615, 41950, 21292, 3615, 1829, 8978, 2423, 48994, 2339, 686, 4724, 1829, 30544, 14407, 2997, 293, 307, 295, 1729, 2158, 294, 4997, 2037, 2227, 23032, 3555, 3615, 995, 31767, 13063, 13672, 1829, 4386, 13672, 1829, 4386, 13672, 1829, 8032, 1863, 3615, 43042, 11296, 39182, 13412, 2407, 10632, 8032, 2655, 3555, 9957, 14739, 23758, 2423, 39184, 5451, 2796, 299, 1254, 3714, 43020, 5551, 14851, 25957, 43761, 24976, 10721, 9566, 5172, 6027], "avg_logprob": -0.22206438761768918, "compression_ratio": 1.6213991769547325, "no_speech_prob": 1.0132789611816406e-06, "words": [{"start": 621.15, "end": 621.45, "word": "الـ", "probability": 0.501708984375}, {"start": 621.45, "end": 621.65, "word": " latent", "probability": 0.89306640625}, {"start": 621.65, "end": 622.15, "word": " squint", "probability": 0.614501953125}, {"start": 622.15, "end": 622.37, "word": " ليش", "probability": 0.7978515625}, {"start": 622.37, "end": 622.93, "word": " مابعودش", "probability": 0.873046875}, {"start": 622.93, "end": 623.15, "word": " عليه", "probability": 0.921875}, {"start": 623.15, "end": 623.49, "word": " لأنه", "probability": 0.741455078125}, {"start": 623.49, "end": 623.85, "word": " latent", "probability": 0.98974609375}, {"start": 623.85, "end": 624.37, "word": " الانين", "probability": 0.5040690104166666}, {"start": 624.37, "end": 624.89, "word": " بيكونوا", "probability": 0.9490966796875}, {"start": 624.89, "end": 624.99, "word": " في", "probability": 0.96240234375}, {"start": 624.99, "end": 625.31, "word": " الوضع", "probability": 0.98828125}, {"start": 625.31, "end": 625.85, "word": " الطبيعي", "probability": 0.98388671875}, {"start": 625.85, "end": 626.03, "word": " في", "probability": 0.56298828125}, {"start": 626.03, "end": 626.09, "word": " ال", "probability": 0.93115234375}, {"start": 626.09, "end": 626.37, "word": " latent", "probability": 0.7890625}, {"start": 626.37, "end": 626.83, "word": " squint", "probability": 0.927978515625}, {"start": 626.83, "end": 627.23, "word": " بيكونوا", "probability": 0.9580078125}, {"start": 627.23, "end": 627.61, "word": " straight", "probability": 0.87890625}, {"start": 627.61, "end": 628.29, "word": " and", "probability": 0.80322265625}, {"start": 628.29, "end": 628.55, "word": " is", "probability": 0.8935546875}, {"start": 628.55, "end": 628.75, "word": " of", "probability": 0.97216796875}, {"start": 628.75, "end": 629.39, "word": " particular", "probability": 0.92236328125}, {"start": 629.39, "end": 630.07, "word": " value", "probability": 0.583984375}, {"start": 630.07, "end": 631.17, "word": " in", "probability": 0.646484375}, {"start": 631.17, "end": 631.63, "word": " testing", "probability": 0.888671875}, {"start": 631.63, "end": 631.91, "word": " young", "probability": 0.927734375}, {"start": 631.91, "end": 632.41, "word": " children", "probability": 0.90380859375}, {"start": 632.41, "end": 633.11, "word": " طبعا", "probability": 0.9295654296875}, {"start": 633.11, "end": 633.51, "word": " الصور", "probability": 0.912841796875}, {"start": 633.51, "end": 633.77, "word": " اللي", "probability": 0.943115234375}, {"start": 633.77, "end": 633.77, "word": " ..", "probability": 0.7001953125}, {"start": 633.77, "end": 634.35, "word": " اللي", "probability": 0.959228515625}, {"start": 634.35, "end": 634.35, "word": " ..", "probability": 0.9404296875}, {"start": 634.35, "end": 634.71, "word": " اللي", "probability": 0.942138671875}, {"start": 634.71, "end": 636.03, "word": " هنعرضها", "probability": 0.720263671875}, {"start": 636.03, "end": 636.27, "word": " بعد", "probability": 0.85107421875}, {"start": 636.27, "end": 636.71, "word": " شوية", "probability": 0.8499348958333334}, {"start": 636.71, "end": 637.31, "word": " هتبين", "probability": 0.9427490234375}, {"start": 637.31, "end": 637.49, "word": " أن", "probability": 0.4873046875}, {"start": 637.49, "end": 637.75, "word": " هذا", "probability": 0.732421875}, {"start": 637.75, "end": 637.93, "word": " الـ", "probability": 0.5078125}, {"start": 637.93, "end": 638.23, "word": " synaptic", "probability": 0.4886067708333333}, {"start": 638.23, "end": 638.37, "word": " form", "probability": 0.7265625}, {"start": 638.37, "end": 638.53, "word": " ممكن", "probability": 0.968505859375}, {"start": 638.53, "end": 639.09, "word": " أستعمله", "probability": 0.816162109375}, {"start": 639.09, "end": 639.73, "word": " للأطفال", "probability": 0.96123046875}], "temperature": 1.0}, {"id": 23, "seek": 66133, "start": 640.13, "end": 661.33, "text": "و ممكن إذا كان الطفل متعاون من عمر تلت سنين أبدأ يعني أستعمل أو أفحص للطفل على جهاز sign up to four و الطفل هيشوف أنه الفحص على sign up to four enjoyable لأنه الصور يعني very interesting it can also detect suppression كيف يعني detect suppression؟ يعني إنسان حطنا له صورتين", "tokens": [2407, 3714, 43020, 11933, 15730, 25961, 41950, 5172, 1211, 44650, 3615, 995, 11536, 9154, 6225, 29973, 6055, 1211, 2655, 8608, 1863, 9957, 5551, 44510, 10721, 37495, 22653, 5551, 14851, 25957, 1211, 34051, 5551, 5172, 5016, 9381, 24976, 9566, 5172, 1211, 15844, 10874, 3224, 31377, 1465, 493, 281, 1451, 4032, 41950, 5172, 1211, 39896, 8592, 38688, 14739, 3224, 27188, 5016, 9381, 15844, 1465, 493, 281, 1451, 20305, 5296, 33456, 3224, 31767, 13063, 37495, 22653, 588, 1880, 309, 393, 611, 5531, 36807, 9122, 33911, 37495, 22653, 5531, 36807, 22807, 37495, 22653, 36145, 3794, 7649, 11331, 9566, 8315, 46740, 20328, 13063, 2655, 9957], "avg_logprob": -0.14240408297812585, "compression_ratio": 1.6611570247933884, "no_speech_prob": 2.86102294921875e-06, "words": [{"start": 640.13, "end": 640.43, "word": "و", "probability": 0.90966796875}, {"start": 640.43, "end": 641.13, "word": " ممكن", "probability": 0.9189453125}, {"start": 641.13, "end": 641.57, "word": " إذا", "probability": 0.870361328125}, {"start": 641.57, "end": 641.75, "word": " كان", "probability": 0.99560546875}, {"start": 641.75, "end": 642.07, "word": " الطفل", "probability": 0.9807942708333334}, {"start": 642.07, "end": 642.59, "word": " متعاون", "probability": 0.8900146484375}, {"start": 642.59, "end": 642.75, "word": " من", "probability": 0.9951171875}, {"start": 642.75, "end": 643.03, "word": " عمر", "probability": 0.96630859375}, {"start": 643.03, "end": 643.39, "word": " تلت", "probability": 0.876953125}, {"start": 643.39, "end": 643.77, "word": " سنين", "probability": 0.98681640625}, {"start": 643.77, "end": 644.33, "word": " أبدأ", "probability": 0.8758138020833334}, {"start": 644.33, "end": 644.71, "word": " يعني", "probability": 0.73876953125}, {"start": 644.71, "end": 645.45, "word": " أستعمل", "probability": 0.9560546875}, {"start": 645.45, "end": 645.67, "word": " أو", "probability": 0.9228515625}, {"start": 645.67, "end": 646.07, "word": " أفحص", "probability": 0.875244140625}, {"start": 646.07, "end": 646.65, "word": " للطفل", "probability": 0.874267578125}, {"start": 646.65, "end": 646.85, "word": " على", "probability": 0.9140625}, {"start": 646.85, "end": 647.21, "word": " جهاز", "probability": 0.9793294270833334}, {"start": 647.21, "end": 647.47, "word": " sign", "probability": 0.2030029296875}, {"start": 647.47, "end": 647.61, "word": " up", "probability": 0.73046875}, {"start": 647.61, "end": 647.77, "word": " to", "probability": 0.9541015625}, {"start": 647.77, "end": 648.01, "word": " four", "probability": 0.6875}, {"start": 648.01, "end": 648.65, "word": " و", "probability": 0.880859375}, {"start": 648.65, "end": 649.11, "word": " الطفل", "probability": 0.9168294270833334}, {"start": 649.11, "end": 649.57, "word": " هيشوف", "probability": 0.9020182291666666}, {"start": 649.57, "end": 649.97, "word": " أنه", "probability": 0.7225341796875}, {"start": 649.97, "end": 650.41, "word": " الفحص", "probability": 0.9666341145833334}, {"start": 650.41, "end": 650.55, "word": " على", "probability": 0.6005859375}, {"start": 650.55, "end": 650.71, "word": " sign", "probability": 0.6708984375}, {"start": 650.71, "end": 650.87, "word": " up", "probability": 0.9541015625}, {"start": 650.87, "end": 650.99, "word": " to", 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misalignment اللي هو الـ squant simultaneously يعني في نفس الوقت and is valuable in determining surgical approach by assessing the different contributions and cardinal positions of cases ممكن يساعدني في أخذ القرار الجراحي إذا المريض محتاج جراحة ليش؟ لأنه ممكن أنا أجيس الحوال في nine diagnostic positions", "tokens": [2407, 6027, 39184, 3930, 82, 1966, 3346, 304, 41134, 13672, 1829, 31439, 2423, 39184, 2339, 394, 16561, 37495, 22653, 8978, 8717, 36178, 2423, 30543, 2655, 293, 307, 8263, 294, 23751, 26646, 3109, 538, 34348, 264, 819, 15725, 293, 2920, 2071, 8432, 295, 3331, 3714, 43020, 7251, 3794, 995, 22488, 22653, 8978, 5551, 9778, 8848, 25062, 2288, 9640, 25724, 23557, 5016, 1829, 11933, 15730, 9673, 16572, 11242, 3714, 33753, 26108, 10874, 23557, 5016, 3660, 32239, 8592, 22807, 5296, 33456, 3224, 3714, 43020, 41850, 5551, 7435, 1829, 3794, 21542, 2407, 6027, 8978, 4949, 27897, 8432], "avg_logprob": -0.2024601049562718, "compression_ratio": 1.530909090909091, "no_speech_prob": 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1562.72, "word": " contributions", "probability": 0.90478515625}, {"start": 1562.72, "end": 1562.98, "word": " and", "probability": 0.68310546875}, {"start": 1562.98, "end": 1563.4, "word": " cardinal", "probability": 0.86962890625}, {"start": 1563.4, "end": 1564.14, "word": " positions", "probability": 0.89599609375}, {"start": 1564.14, "end": 1564.4, "word": " of", "probability": 0.9609375}, {"start": 1564.4, "end": 1564.6, "word": " cases", "probability": 0.26123046875}, {"start": 1564.6, "end": 1565.16, "word": " ممكن", "probability": 0.904052734375}, {"start": 1565.16, "end": 1565.66, "word": " يساعدني", "probability": 0.98583984375}, {"start": 1565.66, "end": 1565.82, "word": " في", "probability": 0.9580078125}, {"start": 1565.82, "end": 1566.18, "word": " أخذ", "probability": 0.8850911458333334}, {"start": 1566.18, "end": 1566.66, "word": " القرار", "probability": 0.9876302083333334}, {"start": 1566.66, "end": 1567.28, "word": " الجراحي", "probability": 0.9737548828125}, 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0.271728515625}, {"start": 1572.18, "end": 1572.82, "word": " diagnostic", "probability": 0.8408203125}, {"start": 1572.82, "end": 1573.54, "word": " positions", "probability": 0.921875}], "temperature": 1.0}, {"id": 63, "seek": 159706, "start": 1573.78, "end": 1597.06, "text": "في الـ nine diagnostic positions ونشوف كل position كداش كمية الحوال وين بكتر وين بجل ومين العضلة المسؤولة عن هذه القضية، إذا فيه إله استخدامات كتيرة وممكن اعتباره عيادة حوال متنقلة، عيادة حوال متنقلة إذا جازة التعبير، إذا جازة التعبير، الآن نيجي نستخدم الـ synaptophore", "tokens": [41185, 2423, 39184, 4949, 27897, 8432, 4032, 1863, 8592, 38688, 28242, 2535, 9122, 3215, 33599, 9122, 2304, 10632, 21542, 2407, 6027, 4032, 9957, 4724, 4117, 2655, 2288, 4032, 9957, 4724, 7435, 1211, 4032, 2304, 9957, 18863, 11242, 37977, 9673, 3794, 33604, 12610, 3660, 18871, 29538, 25062, 11242, 10632, 12399, 11933, 15730, 8978, 3224, 11933, 43761, 44713, 9778, 3215, 10943, 9307, 9122, 2655, 48923, 4032, 2304, 43020, 1975, 34268, 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{"start": 1594.26, "end": 1594.6, "word": " نيجي", "probability": 0.9619140625}, {"start": 1594.6, "end": 1595.38, "word": " نستخدم", "probability": 0.9912109375}, {"start": 1595.38, "end": 1596.22, "word": " الـ", "probability": 0.5836181640625}, {"start": 1596.22, "end": 1597.06, "word": " synaptophore", "probability": 0.603668212890625}], "temperature": 1.0}, {"id": 64, "seek": 162697, "start": 1598.11, "end": 1626.97, "text": "مع بعضنا البعض ونشوف كيف احنا بدنا نستخدمه في عندنا اول حاجة بد اعرف المريض عنده binocular single vision و لا ما عنده binocular single vision binocular single vision is graded on the synaptic four as follows انا لما باختبر ال binocular single vision احنا قولنا ال binocular single vision عبارة عن حرم بيبدأ من ال simultaneous perception بيبدأ من ال simultaneous perception", "tokens": [2304, 3615, 45030, 11242, 8315, 29739, 3615, 11242, 4032, 1863, 8592, 38688, 9122, 33911, 1975, 5016, 8315, 47525, 8315, 8717, 14851, 9778, 40448, 3224, 8978, 43242, 8315, 1975, 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perception", "probability": 0.88232421875}], "temperature": 1.0}, {"id": 65, "seek": 164943, "start": 1627.51, "end": 1649.43, "text": "إذا كان المريض ماعندهش simultaneous perception فاش معناته عنده binocular single beginning، إيش يعني simultaneous perception؟ إنه الإلتقاط المتزامن لصورتين بواسطة العينتين، لو مافيش التقاط متزامن، عين التقطت صورة والعين التانية ما التقطت الصورة، يعني فيها separation، الدماغ ما تقبل منها أي صورة", "tokens": [28814, 15730, 25961, 9673, 16572, 11242, 19446, 3615, 41260, 3224, 8592, 46218, 12860, 6156, 33599, 20449, 8315, 47395, 43242, 3224, 5171, 905, 1040, 2167, 2863, 12399, 11933, 1829, 8592, 37495, 22653, 46218, 12860, 22807, 36145, 3224, 33688, 1211, 2655, 4587, 41193, 9673, 2655, 11622, 10943, 1863, 5296, 9381, 13063, 2655, 9957, 4724, 14407, 3794, 9566, 3660, 18863, 9957, 2655, 9957, 12399, 45164, 19446, 41185, 8592, 16712, 4587, 41193, 44650, 11622, 10943, 1863, 12399, 6225, 9957, 16712, 47432, 2655, 20328, 13063, 3660, 16070, 3615, 9957, 16712, 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هنا ال garage أكبر من السيارة، هنا بيت العنكبوت أكبر من العنكبوت نفسه كصورة", "tokens": [6027, 148, 48506, 8608, 10721, 1211, 14407, 18863, 19528, 16606, 14739, 36178, 16095, 6225, 8592, 7649, 7251, 1863, 8592, 7435, 3615, 27188, 5016, 9381, 12399, 34105, 2423, 732, 9788, 12399, 23758, 2423, 4137, 5551, 4117, 26890, 9154, 2423, 4137, 23758, 12399, 31767, 13063, 3660, 5551, 4117, 26890, 11331, 7435, 2304, 11296, 12399, 34105, 25062, 5172, 9381, 5551, 4117, 26890, 9154, 18863, 9381, 5172, 13063, 12399, 34105, 25062, 5172, 9381, 5551, 4117, 26890, 9154, 16247, 3794, 3215, 12399, 34105, 2423, 14400, 5551, 4117, 26890, 9154, 21136, 1829, 9640, 3660, 12399, 34105, 4724, 36081, 18863, 1863, 4117, 3555, 35473, 5551, 4117, 26890, 9154, 18863, 1863, 4117, 3555, 35473, 8717, 36178, 3224, 9122, 9381, 13063, 3660], "avg_logprob": -0.08168859734085568, "compression_ratio": 2.1770833333333335, "no_speech_prob": 1.0132789611816406e-06, "words": [{"start": 2221.3, "end": 2221.62, "word": "الآن", 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ال", "probability": 0.970703125}, {"start": 2227.28, "end": 2227.58, "word": " slide", "probability": 0.98876953125}, {"start": 2227.58, "end": 2228.04, "word": " أكبر", "probability": 0.9505208333333334}, {"start": 2228.04, "end": 2228.28, "word": " من", "probability": 0.994140625}, {"start": 2228.28, "end": 2228.4, "word": " ال", "probability": 0.7490234375}, {"start": 2228.4, "end": 2228.68, "word": " slide", "probability": 0.990234375}, {"start": 2228.68, "end": 2229.08, "word": " هذا،", "probability": 0.88720703125}, {"start": 2229.08, "end": 2229.52, "word": " الصورة", "probability": 0.984375}, {"start": 2229.52, "end": 2229.86, "word": " أكبر", "probability": 0.9768880208333334}, {"start": 2229.86, "end": 2230.8, "word": " حجمها،", "probability": 0.9076171875}, {"start": 2230.8, "end": 2230.98, "word": " هنا", "probability": 0.98974609375}, {"start": 2230.98, "end": 2231.58, "word": " القفص", "probability": 0.9694010416666666}, {"start": 2231.58, "end": 2232.78, "word": " أكبر", 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"probability": 0.998046875}, {"start": 2237.42, "end": 2238.66, "word": " السيارة،", "probability": 0.9822265625}, {"start": 2238.66, "end": 2238.92, "word": " هنا", "probability": 0.99267578125}, {"start": 2238.92, "end": 2239.62, "word": " بيت", "probability": 0.8876953125}, {"start": 2239.62, "end": 2240.18, "word": " العنكبوت", "probability": 0.9671875}, {"start": 2240.18, "end": 2240.54, "word": " أكبر", "probability": 0.986328125}, {"start": 2240.54, "end": 2240.66, "word": " من", "probability": 0.99609375}, {"start": 2240.66, "end": 2241.22, "word": " العنكبوت", "probability": 0.99482421875}, {"start": 2241.22, "end": 2241.56, "word": " نفسه", "probability": 0.9943033854166666}, {"start": 2241.56, "end": 2242.04, "word": " كصورة", "probability": 0.9541015625}], "temperature": 1.0}, {"id": 92, "seek": 226752, "start": 2243.26, "end": 2267.52, "text": "فبالتالي ينصح أنه أحط الصورة الأصغر اللي هي هتيجي على الفوفيا أحطها قدام ال fixating eye العين ال straight العين اللي بيركز فيها 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b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/557oeUaWOTI.srt @@ -0,0 +1,1210 @@ +1 +00:00:01,740 --> 00:00:05,520 +بسم الله الرحمن الرحيم بنواصل مع الـ motor + +2 +00:00:05,520 --> 00:00:08,120 +adaptation to strabismus والـ compensatory head + +3 +00:00:08,120 --> 00:00:11,740 +posture أخذنا أمثلة المرة الماضية على هذا الموضوع و + +4 +00:00:11,740 --> 00:00:16,560 +بنستكمل اليوم بعض الأمثلة الأخرى حتى تترسخ القضية + +5 +00:00:16,560 --> 00:00:20,480 +في أذهاننا وبنقول ضروري الإنسان عشان يعرف الـ + +6 +00:00:20,480 --> 00:00:23,760 +compensatory head posture للبسي في أي من الـ + +7 +00:00:23,760 --> 00:00:27,880 +extraocular muscles لابد إنه يكون عارف الـ function + +8 +00:00:27,880 --> 00:00:32,580 +بتاعة كل extraocular muscle بشكل دقيق ويعرف الـ + +9 +00:00:32,580 --> 00:00:36,640 +testing position بتاعه، هنبدأ مع الـ right inferior + +10 +00:00:36,640 --> 00:00:39,710 +rectus palsyالـ inferior rectus في الـ right eye + +11 +00:00:39,710 --> 00:00:43,550 +صار فيها شلل يترى إيش هو الـ compensatory head + +12 +00:00:43,550 --> 00:00:48,770 +posture اللي هيتخذه هذا الشخص أو المريض اللي عنده + +13 +00:00:48,770 --> 00:00:52,050 +right inferior rectus palsy الـ inferior rectus + +14 +00:00:52,050 --> 00:00:55,070 +الـ functions بتاعتها depression والـ primary + +15 +00:00:55,070 --> 00:00:58,550 +function الـ secondary extortion والـ tertiary + +16 +00:00:58,550 --> 00:01:02,430 +function ليه الـ adduction بتختبر الـ inferior rectus + +17 +00:01:02,430 --> 00:01:08,710 +في الـ down and out position إذا .. إذا صار في ضعف + +18 +00:01:08,710 --> 00:01:12,270 +في الـ inferior rectus في الـ right eye فلابد إنها الـ + +19 +00:01:12,270 --> 00:01:16,090 +right eye تهرب من وضعية الـ out ومن وضعية الـ down + +20 +00:01:16,090 --> 00:01:19,910 +ومن إن هيصير فيها extortion ليش بدها تهرب من + +21 +00:01:19,910 --> 00:01:23,610 +هدولة التلت أشياء؟ لأنه مش قادرة تعملهم بسبب إن + +22 +00:01:23,610 --> 00:01:28,710 +اللي بيعملهم هو الـ inferior rectus وبالتالي طالما + +23 +00:01:28,710 --> 00:01:32,830 +الـ inferior rectus ضعيف فهيظهر عيب العين اليمين أو + +24 +00:01:32,830 --> 00:01:36,620 +هيزيد الحول في وضعية الـ out وفي وضعية الـ down ولو + +25 +00:01:36,620 --> 00:01:40,600 +اضطرت العين الييمين هتعمل extortion فهنشوف كيف الـ + +26 +00:01:40,600 --> 00:01:45,540 +.. ال .. ال head هيتحرك بحيث انه يبعد العين عن + +27 +00:01:45,540 --> 00:01:49,680 +هدول التلت وضعية بدنا نشوف الـ face turned كيف بده + +28 +00:01:49,680 --> 00:01:55,660 +يصير بدنا + +29 +00:01:55,660 --> 00:02:00,500 +نشوف الـ head tilted كيف + +30 +00:02:00,500 --> 00:02:06,480 +بده يصير أو بدنا نشوف الـ chin هل هو هيكون في الـ up + +31 +00:02:06,480 --> 00:02:08,760 +position ولا في الـ down position .. في الـ up + +32 +00:02:08,760 --> 00:02:12,080 +position ولا في الـ down position نشوف الـ face turn + +33 +00:02:12,080 --> 00:02:16,300 +.. الـ face turn بدنا يسي .. يعني هيحدث عنا face + +34 +00:02:16,300 --> 00:02:19,720 +turn بحيث أنه العين ماتروحش out بالعكس أنها تروح + +35 +00:02:19,720 --> 00:02:21,700 +in .. نشوف الصورة إيش بتقول + +36 +00:02:24,920 --> 00:02:27,880 +هي عندي left face turn وهي عندي right face turn + +37 +00:02:27,880 --> 00:02:31,780 +اللي عنده inferior rectus palsy مفروض يختار واحد + +38 +00:02:31,780 --> 00:02:34,540 +منهم أو مفروض يصير معاه واحد منهم بحيث ان العين + +39 +00:02:34,540 --> 00:02:37,860 +اليمين تشرد من وضع الـ out لاحظين هنا العين اليمين + +40 +00:02:37,860 --> 00:02:41,000 +في الـ in position بينما هنا العين اليمين في الـ out + +41 +00:02:41,000 --> 00:02:44,560 +position إذا هذا .. إذا هذا الـ face turn هو الأنسب + +42 +00:02:44,560 --> 00:02:49,400 +هو الأنسب إذا right face turn right face turn سجل + +43 +00:02:49,400 --> 00:02:55,590 +هذا الكلام نقول الـ face turn to the right طيب الـ + +44 +00:02:55,590 --> 00:02:59,610 +head tilt هيهرب .. هيهرب العين من الـ extortion + +45 +00:02:59,610 --> 00:03:04,850 +يعني المريض هيتخذ head tilt معين أيضا عشان العين + +46 +00:03:04,850 --> 00:03:08,690 +اليمين ماتروحش في .. في .. في .. في حالة extortion + +47 +00:03:08,690 --> 00:03:12,610 +وإنما تكون في حالة intortion .. intortion إيش + +48 +00:03:12,610 --> 00:03:16,130 +اللي بيوفرليها هذا الكلام؟ بالرسمة بتبين .. بنقول + +49 +00:03:16,130 --> 00:03:20,190 +هي العين اليمين لو صار lift tilt .. لو صار lift + +50 +00:03:20,190 --> 00:03:23,450 +tilt العين اليمين هتعمل extortion، هذا مش مناسب + +51 +00:03:23,450 --> 00:03:29,270 +لهالو صار right tilt العين اليمين هتعمل in torsion + +52 +00:03:29,270 --> 00:03:33,730 +وهذا مناسب لإذا right sided head tilt right sided + +53 +00:03:33,730 --> 00:03:39,610 +head tilt أيضا الـ head tilt على الـ right الـ head + +54 +00:03:39,610 --> 00:03:49,390 +tilt على الـ right الآن بيضال + +55 +00:03:49,390 --> 00:03:54,760 +قضية الـ chin هل هو هيكون up ولا downالـ chin بدي + +56 +00:03:54,760 --> 00:03:58,280 +يكون بحيث أنه نشرد من وضعية الـ down بالنسبة للـ + +57 +00:03:58,280 --> 00:04:02,100 +right eye شوف فادر القضية كيف هتحدث + +58 +00:04:05,090 --> 00:04:08,970 +لو صار chin up العينين هييجوا down وهذا مش مناسب + +59 +00:04:08,970 --> 00:04:11,370 +لأن العين اليمين مش مناسب اللي احنا هديجي down + +60 +00:04:11,370 --> 00:04:14,670 +بينما في الـ chin down position العينين هيطلعوا + +61 +00:04:14,670 --> 00:04:18,250 +لفوق وبالتالي هيبعدوا عن منطقات الـ down position + +62 +00:04:18,250 --> 00:04:21,290 +إذا الـ chin down position هو اللي بيوفرلي هذه + +63 +00:04:21,290 --> 00:04:25,390 +القضية هو اللي بيوفرلي هذه القضية إذا الـ chin down + +64 +00:04:25,390 --> 00:04:32,090 +إذا + +65 +00:04:32,090 --> 00:04:36,060 +الشخص اللي عنده right inferior rectus palsy + +66 +00:04:36,060 --> 00:04:40,200 +الكمبينساتوري head posture عنده right face turn + +67 +00:04:40,200 --> 00:04:43,640 +right head tilt chin down position هياخدهم مع بعض + +68 +00:04:43,640 --> 00:04:48,520 +كلهم في نفس الوقت فبالتالي هيكون بعيدة العين تماما + +69 +00:04:48,520 --> 00:04:53,060 +عن المنطقة اللي تختبر فيها الـ inferior rectus وهيك + +70 +00:04:53,060 --> 00:04:56,000 +احنا بيكون عرفنا ايش الكمبينساتوري head posture + +71 +00:04:56,000 --> 00:04:58,500 +بتاع الـ inferior rectus palsy + +72 +00:05:01,100 --> 00:05:05,640 +الآن في .. قبل ما ننتقل للمثال التالي، بنقول .. + +73 +00:05:05,640 --> 00:05:09,800 +نفرض إنسان إحنا متأكدين تماما إنه في عنده right + +74 +00:05:09,800 --> 00:05:13,920 +inferior rectus palsy، بعدة فحوصات هييجي ذكرها في + +75 +00:05:13,920 --> 00:05:17,640 +موعدها، متأكدين بنسبة مائة بالمائة إنه في عندي + +76 +00:05:17,640 --> 00:05:21,700 +right inferior rectus palsy، ومفروض يعمل head tilt + +77 +00:05:21,700 --> 00:05:26,500 +to the right لجناع عامل head tilt to the left عكس + +78 +00:05:26,500 --> 00:05:31,200 +ما هو متوقع، ساعتها .. ساعتها بنسمي هذا الـ head + +79 +00:05:31,200 --> 00:05:35,060 +posture مش compensatory وانما paradoxical head + +80 +00:05:35,060 --> 00:05:39,840 +posture يعني head posture خلف خلاف أو غير متوقع، + +81 +00:05:39,840 --> 00:05:43,340 +المفروض يميل رأسه على اليمين راح يميله على الشمال + +82 +00:05:43,340 --> 00:05:46,740 +رغم انه عنده right inferior rectus palsy، إذا هذا + +83 +00:05:46,740 --> 00:05:50,680 +paradoxical head posture، امتى بيحدث؟ بيحدث إذا .. + +84 +00:05:50,680 --> 00:05:54,900 +إذا الـ compensatory head posture المتوقع ما .. + +85 +00:05:54,900 --> 00:05:59,240 +يعني لم يفي بالغرض، لم يفي بالغرض، الغرض هو تقريب + +86 +00:05:59,240 --> 00:06:02,480 +الصورتين لأقرب مسافة ممكن من بعضهم عشان يتم الـ + +87 +00:06:02,480 --> 00:06:05,920 +fusion واستعاد الـ binocular single vision إذا ما + +88 +00:06:05,920 --> 00:06:10,120 +جدرش الدماغ يعمل fusion وظل الصورتين صورتين بالـ + +89 +00:06:10,120 --> 00:06:13,640 +compensatory head posture ساعتها الـ head هيروح + +90 +00:06:13,640 --> 00:06:17,400 +تلقائيا للناحية العكسية اللي هي المخالفة للمتوقع + +91 +00:06:17,400 --> 00:06:21,300 +اللي مش طبيعي أنه يروح عليها .. اللي مش طبيعي أنه + +92 +00:06:21,300 --> 00:06:24,820 +يروح عليها عشان يعمل maximum separation between + +93 +00:06:24,820 --> 00:06:28,820 +the two images فيسهل أنه يعمل separation لـ one of + +94 +00:06:28,820 --> 00:06:31,680 +the two images إذا في عندي compensatory head + +95 +00:06:31,680 --> 00:06:35,340 +posture هذا مرتبط بالـ function والـ testing + +96 +00:06:35,340 --> 00:06:40,140 +position بتاع العضلة وفي عندي paradoxical head + +97 +00:06:40,140 --> 00:06:47,060 +posture اللي هو خلف خلاف أو عكس المتوقع عكس الـ + +98 +00:06:47,060 --> 00:06:51,940 +compensatory بالذات في الـ head tilt الهدف منه انه + +99 +00:06:51,940 --> 00:06:55,360 +طالما الـ diploma ما حلتش مشكلتها بالـ compensatory + +100 +00:06:55,360 --> 00:07:00,710 +head posture بيروح الـ head عن ناحية الغير متوقعة .. + +101 +00:07:00,710 --> 00:07:04,670 +عن ناحية .. عن ناحية العكسية عشان الـ diploma يعني + +102 +00:07:04,670 --> 00:07:08,770 +بدل ما تقتربوا الصورتين من بعض ويتوحدوا مش جادرين + +103 +00:07:08,770 --> 00:07:13,110 +ينوحدهم اه .. إذا بنعمل maximum separation فيهم + +104 +00:07:13,110 --> 00:07:17,050 +عشان يسهل انه يعمل separation في one image عشان + +105 +00:07:17,050 --> 00:07:20,030 +يسهل انه يعمل .. انه يعمل separation في one image + +106 +00:07:20,030 --> 00:07:26,840 +وهذا يسمى paradoxical head posture المثال التالي، + +107 +00:07:26,840 --> 00:07:32,240 +right superior rectus palsy أول حاجة بنستفكر ايش + +108 +00:07:32,240 --> 00:07:38,360 +الـ superior rectus بتعمل elevation and + +109 +00:07:38,360 --> 00:07:42,820 +adduction + +110 +00:07:43,930 --> 00:07:47,130 +بدون معرفة الـ function بتاعة superior rectus أو + +111 +00:07:47,130 --> 00:07:51,570 +أي extraocular muscle بيكون الكلام يعني بلا فائدة + +112 +00:07:51,570 --> 00:07:54,910 +وبيكون الإنسان مستنتج الـ compensatory head posture + +113 +00:07:54,910 --> 00:08:03,710 +بيكون مش صعب يعني شبه مستحيل up and out هذه منطقة + +114 +00:08:03,710 --> 00:08:08,560 +اختبار الـ superior rectus muscle اللي هي up and out + +115 +00:08:08,560 --> 00:08:13,180 +الآن طالما في ضعف الـ superior rectus muscle معناته + +116 +00:08:13,180 --> 00:08:17,920 +العين لازم تشرد من + +117 +00:08:17,920 --> 00:08:25,520 +وضعية الـ intortion هذه + +118 +00:08:25,520 --> 00:08:28,800 +الوضعية ممنوع العين تضلها فيها + +119 +00:08:32,340 --> 00:08:35,780 +الـ out position برضه لازم تشرد منه، يعني العين + +120 +00:08:35,780 --> 00:08:41,020 +اليمين لازم تشرد من الـ out position ومن الـ up + +121 +00:08:41,020 --> 00:08:46,180 +position العين اليمين لا يفضل إلاها، لا يستحب + +122 +00:08:46,180 --> 00:08:51,600 +إلاها، الدماغ هيهربها من الـ up ومن الـ out ومن الـ + +123 +00:08:51,600 --> 00:08:52,000 +intortion + +124 +00:08:54,670 --> 00:08:58,330 +هدولة التلات وضعيات اللي بيشير إليهم أسهم العين + +125 +00:08:58,330 --> 00:09:01,290 +اليمين لازم تهرب منها إذا الـ head posture بدي يوفر + +126 +00:09:01,290 --> 00:09:04,990 +إن العين اليمين بدل ما تيجي out تيجي in بدل ما + +127 +00:09:04,990 --> 00:09:08,230 +تيجي up تيجي down بدل ما تعمل intortion تعمل + +128 +00:09:08,230 --> 00:09:14,890 +extortion نشوف الجدول إيش بده يصير فيه عناه + +129 +00:09:14,890 --> 00:09:19,050 +بالنسبة + +130 +00:09:19,050 --> 00:09:20,810 +لـ الـ face turned + +131 +00:09:31,840 --> 00:09:39,160 +وبالنسبة للـ head tilt وبالنسبة + +132 +00:09:39,160 --> 00:09:44,900 +لـ الـ chin هل هيكون اندي up ولا down نبدأ بالـ face + +133 +00:09:44,900 --> 00:09:48,780 +tilt العين اليمين طالما العضلة الموجودة اللي فيها + +134 +00:09:48,780 --> 00:09:51,120 +الشلل موجودة في العين اليمين إذا العين اليمين لازم + +135 +00:09:51,120 --> 00:09:54,860 +تهرب من الـ out position يعني بمعنى آخر الـ head بده + +136 +00:09:54,860 --> 00:09:59,460 +يسير في وضعية حيث العين تيجي in مش out تيجي in مش + +137 +00:09:59,460 --> 00:10:06,390 +out نشوف الرسمة كيف العين الييمين ده تيجي in؟ العين + +138 +00:10:06,390 --> 00:10:10,090 +الييمين تيجي in بالـ right face turn لأن الـ left + +139 +00:10:10,090 --> 00:10:12,750 +face turn هيخلق العين الييمين تيجي out وهذا مش + +140 +00:10:12,750 --> 00:10:16,630 +مناسب أبدا، هنيجي في منطقة اختبار superior rectus + +141 +00:10:16,630 --> 00:10:19,970 +وهذا مش مناسب للمريض، إذا right face turn right + +142 +00:10:19,970 --> 00:10:27,370 +face turn طيب + +143 +00:10:28,960 --> 00:10:31,760 +بالنسبة للـ head tilt ممنوع العين اليمين تعمل + +144 +00:10:31,760 --> 00:10:36,320 +intortion ممنوع العين اليمين تعمل intortion وإنما + +145 +00:10:36,320 --> 00:10:40,280 +يفضل إلها تماما إنها تعمل extortion بعيدا عن الـ + +146 +00:10:40,280 --> 00:10:43,040 +intortion لأنه في ضعف في واحدة من الـ interior + +147 +00:10:43,040 --> 00:10:46,160 +muscles اللي هي الـ superior rectus إذا العين + +148 +00:10:46,160 --> 00:10:49,600 +اليمين بدلاش هي تعمل intortion ده هي تعمل + +149 +00:10:49,600 --> 00:10:53,620 +extortion هي تعمل extortion في وضعية الـ right tilt + +150 +00:10:53,620 --> 00:10:56,750 +العين اليمين هي تعمل intortion وهذا مش مناسب في + +151 +00:10:56,750 --> 00:11:02,430 +وضعية الـ left tilt، العين اليمين هتعمل extortion، + +152 +00:11:02,430 --> 00:11:09,910 +إذا الـ left side التيلت هو الأنسب إليها + +153 +00:11:09,910 --> 00:11:15,250 +الـ left side التيلت ساعتها هتعمل extortion العين + +154 +00:11:15,250 --> 00:11:23,700 +اليميني طيب، تالت شيء الـ chin هيكون بحيث أنه نهرب + +155 +00:11:23,700 --> 00:11:28,820 +من الـ up position من الـ up position لأنه العين مش + +156 +00:11:28,820 --> 00:11:33,180 +قادرة تعمل up عشان نهرب من الـ up position الـ chin + +157 +00:11:33,180 --> 00:11:36,240 +هيروح up فالعينين هينزلوا down فالعينين هينزلوا + +158 +00:11:36,240 --> 00:11:43,050 +down إذا الـ chin up position هيكون هو الأسلم أو هو + +159 +00:11:43,050 --> 00:11:46,670 +اللي .. اللي هيتاخده المرض .. اللي هيتاخده المرضى + +160 +00:11:46,670 --> 00:11:49,750 +هيك بتنتهي المسألة اللي هي right superior rectus + +161 +00:11:49,750 --> 00:11:55,110 +palsy هيكون عندي right face turn left tilt و chin + +162 +00:11:55,110 --> 00:12:01,570 +up right face turn left head tilt و chin up نأخذ + +163 +00:12:01,570 --> 00:12:05,930 +المثال اللي بعده، هذا المثال سهل جدا اللي بيحكي عن + +164 +00:12:05,930 --> 00:12:10,330 +الـ left medial rectus palsy الـ media rectus + +165 +00:12:10,330 --> 00:12:14,770 +الـ function تعتها adduction فقط، مافي أي secondary أو + +166 +00:12:14,770 --> 00:12:20,530 +tertiary action وتختبر + +167 +00:12:20,530 --> 00:12:25,910 +في الـ in position هي + +168 +00:12:25,910 --> 00:12:34,340 +هتهرب من وضعية الـ in الدماغ أو الـ head هيهربها من + +169 +00:12:34,340 --> 00:12:37,520 +وضعية الـ in يعني المفروض الـ left eye عشان في عندي + +170 +00:12:37,520 --> 00:12:41,180 +ضعف في الـ medial rectus المفروض الـ left eye ماتروحش + +171 +00:12:41,180 --> 00:12:44,860 +في الـ adduction ماتروحش في الـ in position تروح في + +172 +00:12:44,860 --> 00:12:49,960 +الـ out تروح في الـ out كيف هذا الكلام هيحصل بس الـ + +173 +00:12:49,960 --> 00:12:53,440 +face turn هو اللي هيحل المشكلة طيب لو عمل left + +174 +00:12:53,440 --> 00:12:56,540 +face turn هتيجي الـ left eye في الـ in position مش + +175 +00:12:56,540 --> 00:13:01,460 +مناسب لو عمل right right face turn الآن الشمال + +176 +00:13:01,460 --> 00:13:05,880 +هتروح out وهذا بعيدا عن الان اللي هو فيه ضعف بسبب + +177 +00:13:05,880 --> 00:13:09,400 +أنه في left medial rectus palsy إذا right face turn + +178 +00:13:09,400 --> 00:13:17,020 +هذا هو الجواب right face turn هذا هو الجواب وهيك + +179 +00:13:17,020 --> 00:13:24,020 +بتنتهي المسألة أو المثال التاني right face turn أي + +180 +00:13:24,020 --> 00:13:26,300 +حد عنده left medial rectus palsy + +181 +00:13:29,000 --> 00:13:35,100 +right face turn فهذا + +182 +00:13:35,100 --> 00:13:40,200 +هو الجواب ببساطة لن يكون هناك لا chin up ولا down و + +183 +00:13:40,200 --> + +201 +00:15:26,180 --> 00:15:30,460 +إلى وضعية بحيث العين بدل ما تكون up تكون down، بدل + +202 +00:15:30,460 --> 00:15:33,540 +ما تكون in تكون out، بدل ما تعمل extortion تعمل + +203 +00:15:33,540 --> 00:15:36,840 +intortion، ندرج الجدول بتاعنا + +204 +00:15:51,170 --> 00:15:56,570 +الـ Face Turn هيكون لوين والـ + +205 +00:15:56,570 --> 00:16:07,410 +Head Tilt هيكون لوين والـ + +206 +00:16:07,410 --> 00:16:12,710 +Chin هيتجه للأعلى و للأسفل هذا اللي هنشوفه مع بعض + +207 +00:16:14,410 --> 00:16:18,690 +الآن نجي لل face turn نشوف وين بالظبط هيكون ال + +208 +00:16:18,690 --> 00:16:22,210 +face turn هيكون بحيث انه نشرط من وضعية ال in يعني + +209 +00:16:22,210 --> 00:16:25,330 +ال left eye بده تكون في وضعية ال out أنسب إلى .. + +210 +00:16:25,330 --> 00:16:27,550 +أنسب إلى .. نروح على الصورة + +211 +00:16:31,220 --> 00:16:34,200 +الـ left eye لو فيه left face turn ال left eye + +212 +00:16:34,200 --> 00:16:37,940 +هتروح in و هذا مش مناسب إليها أما المناسب إليها + +213 +00:16:37,940 --> 00:16:41,840 +أنه الوجه يتجه إلى اليمين right face turn ساعتها + +214 +00:16:41,840 --> 00:16:45,520 +ال left eye هتروح out إذا ال right face turn right + +215 +00:16:45,520 --> 00:16:57,580 +face turn right + +216 +00:16:57,580 --> 00:17:03,710 +face turn طيب ال head tilt هيشرد للعين الشمال من + +217 +00:17:03,710 --> 00:17:06,570 +قضية ال extortion يعني العين الشمال المفروض تعمل + +218 +00:17:06,570 --> 00:17:12,470 +intortion كيف بتعمل intortion للعين الشمال؟ العين + +219 +00:17:12,470 --> 00:17:16,350 +الشمال في ال right-sided head tilt هتعمل extortion + +220 +00:17:16,350 --> 00:17:21,270 +مش مناسب لأن في الربليك فيها palsy في ال left + +221 +00:17:21,270 --> 00:17:26,210 +-sided tilt لما يعمل left-sided tilt هتعمل العين + +222 +00:17:26,210 --> 00:17:29,990 +لشمال in torsion بعيدا عن الاكستورشن، تهرب من + +223 +00:17:29,990 --> 00:17:33,070 +الاكستورشن، إذا هذا هو الوضع المناسب، إذا left + +224 +00:17:33,070 --> 00:17:39,590 +-sided tilt، left-sided tilt إذا + +225 +00:17:39,590 --> 00:17:45,130 +الـ head tilt to the left الـ chin، ال position + +226 +00:17:45,130 --> 00:17:48,590 +بتاع ال chin، بده يهرب العين لشمال من وضعية ال up + +227 +00:17:48,590 --> 00:17:52,430 +و يحطها في وضعية ال down، إذا العين لشمال أنسبلها + +228 +00:17:52,430 --> 00:17:59,050 +أن تكون down هنسابي لإنها تكون down هنا العين + +229 +00:17:59,050 --> 00:18:03,230 +الشمال up مش مناسب، هنا العين الشمال down مناسب، + +230 +00:18:03,230 --> 00:18:15,490 +لذلك chin up position كتبنا + +231 +00:18:15,490 --> 00:18:21,970 +chin، هنكتب up إذا الـ chin دي بيكون up إذا المريض + +232 +00:18:21,970 --> 00:18:26,450 +اللي عنده left inferior oblique palsy هيكون عنده + +233 +00:18:26,450 --> 00:18:31,990 +right face turn left head tilt و chin up position + +234 +00:18:31,990 --> 00:18:36,810 +و chin up position فهيجيني بهذا ال compensatory + +235 +00:18:36,810 --> 00:18:41,630 +head posture إذا في إنسان عنده left inferior + +236 +00:18:41,630 --> 00:18:45,450 +oblique palsy و متأكدين منه تماما من التشخيص و + +237 +00:18:45,450 --> 00:18:49,460 +إجاني ب head tilt to the right معناتها هذا مش + +238 +00:18:49,460 --> 00:18:54,080 +compensatory هذا paradoxical لأن في هذه العضلة + +239 +00:18:54,080 --> 00:18:57,800 +إذا فيها شلل في العين الشمال left inferior oblique + +240 +00:18:57,800 --> 00:19:00,400 +palsy ال head tilt ال compensatory المفروض يكون + +241 +00:19:00,400 --> 00:19:04,700 +left مش right left مش right هيك بيكون خلص المثال + +242 +00:19:04,700 --> 00:19:12,000 +التالي بيضل عندنا مثال آخر right lateral rectus + +243 +00:19:12,000 --> 00:19:15,280 +palsy right lateral rectus palsy ال lateral rectus + +244 +00:19:15,280 --> 00:19:16,360 +بتعمل abduction + +245 +00:19:21,200 --> 00:19:25,700 +وتختبر في الـ out position مالهاش secondary ولا + +246 +00:19:25,700 --> 00:19:29,360 +tertiary action ماعلها secondary ولا tertiary + +247 +00:19:29,360 --> 00:19:34,360 +action وبالتالي + +248 +00:19:34,360 --> 00:19:41,420 +بالتالي + +249 +00:19:41,420 --> 00:19:44,700 +تهرب من ال abduction أو تهرب من ال out position + +250 +00:19:44,700 --> 00:19:49,980 +تيجي في ال in نفس الأشياء فبالتالي ال face turn + +251 +00:19:51,090 --> 00:19:54,990 +اللي هيهربلي ال right eye من إنها تكون في وضعية ال + +252 +00:19:54,990 --> 00:19:57,750 +out يعني ال right eye أنسبلها في حالة ال lateral + +253 +00:19:57,750 --> 00:20:02,530 +rectus palsy إنها تكون في وضعية ال in في وضعية ال + +254 +00:20:02,530 --> 00:20:07,530 +in مش في وضعية ال out ال first term هيكون هي ال + +255 +00:20:07,530 --> 00:20:10,670 +right eye في وضعية ال in إذن ال right face turn هو + +256 +00:20:10,670 --> 00:20:13,750 +ال answer ال left face turn مش مناسب بحالة ال + +257 +00:20:13,750 --> 00:20:16,630 +lateral rectus palsy بتاعة ال right eye لأنه + +258 +00:20:16,630 --> 00:20:19,870 +ساعتها ال right eye هتضطر تيجي في وضعية ال out وهي + +259 +00:20:19,870 --> 00:20:24,150 +مش قادرة تيجي في وضعية ال out فهيزيد كمية الحول أو + +260 +00:20:24,150 --> 00:20:27,790 +هيكشف عيب ال lateral rectus فبالتالي ال right face + +261 +00:20:27,790 --> 00:20:30,510 +turn هو ال face turn أو ال compensatory head + +262 +00:20:30,510 --> 00:20:33,750 +posture الطبيعي ال compensatory head posture + +263 +00:20:33,750 --> 00:20:35,410 +الطبيعي إنه هيكون عنده + +264 +00:20:40,560 --> 00:20:48,580 +right face turn هذا هو الكمبنساتوري head posture + +265 +00:20:48,580 --> 00:20:55,040 +بتاع ال right lateral rectus palsy الأن بقى الأخر + +266 +00:20:55,040 --> 00:20:59,340 +شيء في هذه المحاضرة بتاعة الأمثلة بنقول بدنا نلاحظ + +267 +00:20:59,340 --> 00:21:01,280 +على بعض الأمثلة اللي احنا أخدناها + +268 +00:21:04,900 --> 00:21:13,040 +مثلا عندي ال left superior oblique palsy أخدناها + +269 +00:21:13,040 --> 00:21:17,780 +و ال right inferior rectus palsy احنا ال right + +270 +00:21:17,780 --> 00:21:20,400 +inferior rectus palsy أخدناها المرة الماضية، ال left + +271 +00:21:20,400 --> 00:21:23,820 +superior oblique palsy أخدناها المرة الماضية، + +272 +00:21:23,820 --> 00:21:28,840 +أخدناها المرة الماضية، نشوف، نقارن بين ال left + +273 +00:21:28,840 --> 00:21:32,100 +superior oblique palsy، ال compensatory head + +274 +00:21:32,100 --> 00:21:37,250 +posture تاعها، و ال right inferior rectus palsy الـ + +275 +00:21:37,250 --> 00:21:40,610 +compensatory head posture بتاعها، اذا ملاحظين، + +276 +00:21:40,610 --> 00:21:43,250 +face turned right, head turned right, chin down + +277 +00:21:43,250 --> 00:21:47,090 +هنا، face turned right, head turned right, chin + +278 +00:21:47,090 --> 00:21:50,330 +down، هما نفس الـ compensatory head posture، هذه + +279 +00:21:50,330 --> 00:21:55,970 +نقطة، ايضا بدنا نلاحظ ال right superior rectus مع + +280 +00:21:55,970 --> 00:22:00,050 +ال left inferior oblique palsy الـ Right Superior + +281 +00:22:00,050 --> 00:22:05,910 +Rectus Palsy الـ Face Turn و الـ Head Turn و الـ + +282 +00:22:05,910 --> 00:22:12,630 +Chin Right Left Up Right Left Up و هنا أيضًا في + +283 +00:22:12,630 --> 00:22:15,530 +الـ Left Inferior Rectus Palsy الـ Right Left Up + +284 +00:22:15,530 --> 00:22:19,650 +ثالث شيء بدنا نلاحظه الـ Right Lateral Rectus + +285 +00:22:19,650 --> 00:22:23,730 +Palsy و الـ Left Medial Rectus Palsy هذه Right + +286 +00:22:23,730 --> 00:22:29,140 +Face Turn وها دي Right Face Turn ايش السر في هذا؟ السر + +287 +00:22:29,140 --> 00:22:33,680 +في هذا أو النتيجة في التشابه إن هدولة yoke muscles + +288 +00:22:33,680 --> 00:22:37,540 +البالسي بتاعة ال yoke muscles بتحدث نفس ال + +289 +00:22:37,540 --> 00:22:41,520 +compensatory head posture يعني لو جينا مرة تانية + +290 +00:22:41,520 --> 00:22:49,160 +نقول كالقاعدة left + +291 +00:22:49,160 --> 00:22:53,400 +superior oblique مين ال yoke بتاعها؟ ال right + +292 +00:22:53,400 --> 00:22:58,070 +inferior rectus الـ right inferior rectus والـ left + +293 +00:22:58,070 --> 00:23:03,450 +superior oblique هما yoke muscles هما التنتين مع + +294 +00:23:03,450 --> 00:23:09,670 +بعض بيشتغلوا في اللي هو ال right inferior rectus + +295 +00:23:09,670 --> 00:23:13,590 +وال left superior oblique في ال right and down + +296 +00:23:13,590 --> 00:23:16,770 +position right and down position dextro depression + +297 +00:23:16,770 --> 00:23:19,950 +في ال dextro depression هدولة yoke muscles لما + +298 +00:23:19,950 --> 00:23:24,470 +بيصير بلسي في ال right inferior rectus أو بلسي + +299 +00:23:28,230 --> 00:23:31,230 +في الـ left superior oblique الكمبنساتوري head + +300 +00:23:31,230 --> 00:23:33,950 +posture بتاع اليوك muscles بتاع البلسي بتاع اليوك + +301 +00:23:33,950 --> 00:23:37,350 +muscles هو نفس الكمبنساتوري head posture هاي عندي + +302 +00:23:37,350 --> 00:23:41,970 +right face turn، right head tilt، chin down في + +303 +00:23:41,970 --> 00:23:45,170 +اليوك بتاعتها لو صار فيها بلسي، right face turn، + +304 +00:23:45,170 --> 00:23:51,770 +right head tilt، chin down طيب الـ left medial + +305 +00:23:51,770 --> 00:23:56,030 +تصميم اليوك بتاعتها الـ Right Lateral Rectus الـ + +306 +00:23:56,030 --> 00:23:58,530 +Right Lateral Rectus البالسي بتاعتها بتحدث Right + +307 +00:23:58,530 --> 00:24:02,370 +Face Turn والـ Left Medial Rectus اليوك بتاعة الـ + +308 +00:24:02,370 --> 00:24:04,650 +Lateral Rectus بتاعة الـ Right Eye برضه بتحدث + +309 +00:24:04,650 --> 00:24:09,710 +Right Face Turn إذا وها كذا لو استنتجنا .. لو + +310 +00:24:09,710 --> 00:24:13,470 +استنتجنا البالسي بتاعة أي يوك muscles هتكون نفس + +311 +00:24:13,470 --> 00:24:19,150 +الكمبينساتوريهيدبوستشر تمام؟ إذا الجملة اللي هننهي + +312 +00:24:19,150 --> 00:24:32,330 +فيها المحاضرة بنقول palsy of yoke muscles induce + +313 +00:24:32,330 --> 00:24:39,910 +.. induce the + +314 +00:24:39,910 --> 00:24:47,470 +same compensatory head + +315 +00:24:47,470 --> 00:24:47,990 +posture + +316 +00:24:50,970 --> 00:24:53,610 +بنحكي على ال compensatory مش على ال paradoxical، + +317 +00:24:53,610 --> 00:24:57,290 +إذا palsy of yoke muscles induce the same + +318 +00:24:57,290 --> 00:25:00,550 +compensatory head posture، the same compensatory + +319 +00:25:00,550 --> 00:25:03,910 +head posture، وعلى هذا بننهي المحاضرة ويعطيكم + +320 +00:25:03,910 --> 00:25:07,130 +العافية والسلام عليكم ورحمة الله وبركاته diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/557oeUaWOTI_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/557oeUaWOTI_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..7c810e749ff2a71f90f66c500ae1297b8e2821d1 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/557oeUaWOTI_postprocess.srt @@ -0,0 +1,1280 @@ +1 +00:00:01,740 --> 00:00:05,520 +بسم الله الرحمن الرحيم بنواصل مع ال motor + +2 +00:00:05,520 --> 00:00:08,120 +adaptation to strabismus و ال compensatory head + +3 +00:00:08,120 --> 00:00:11,740 +posture خدنا أمثلة المرة الماضية على هذا الموضوع و + +4 +00:00:11,740 --> 00:00:16,560 +بنستكمل اليوم بعض الأمثلة الأخرى حتى تترسخ القضية + +5 +00:00:16,560 --> 00:00:20,480 +في أذهانناوبنقول ضروري الإنسان عشان يعرف ال + +6 +00:00:20,480 --> 00:00:23,760 +compensatory head posture لبالسي في أي من ال + +7 +00:00:23,760 --> 00:00:27,880 +extraocular muscles لابد إنه يكون عارف ال function + +8 +00:00:27,880 --> 00:00:32,580 +بتاعة كل extraocular muscle بشكل دقيق ويعرف ال + +9 +00:00:32,580 --> 00:00:36,640 +testing position بتاعه، هنبدأ مع ال right inferior + +10 +00:00:36,640 --> 00:00:39,710 +rectus pulseالـ inferior rectus في الـ right eye + +11 +00:00:39,710 --> 00:00:43,550 +صار فيها شلال يترى إيش هو الـ compensatory head + +12 +00:00:43,550 --> 00:00:48,770 +posture اللي هيتخذه هذا الشخص أو المريض اللي عنده + +13 +00:00:48,770 --> 00:00:52,050 +right inferior rectus policy الـ inferior rectus + +14 +00:00:52,050 --> 00:00:55,070 +ال functions بتاعتها depression الولي primary + +15 +00:00:55,070 --> 00:00:58,550 +function الsecondary extortion وال tertiary + +16 +00:00:58,550 --> 00:01:02,430 +function ليه الadduction بتختبر ال inferior rectus + +17 +00:01:02,430 --> 00:01:08,710 +في ال down and out positionإذا .. إذا صار في ضعف + +18 +00:01:08,710 --> 00:01:12,270 +في ال inferior rectus في ال right eye فلبد إنها ال + +19 +00:01:12,270 --> 00:01:16,090 +right eye تهرب من وضعية ال out و من وضعية ال down + +20 +00:01:16,090 --> 00:01:19,910 +و من إن هيصير فيها extortion ليش بدها تهرب من + +21 +00:01:19,910 --> 00:01:23,610 +هدولة التلت أشياء؟ لأنه مش قادرة تعملهم بسبب إن + +22 +00:01:23,610 --> 00:01:28,710 +اللي بيعملهم هو ال inferior rectus وبالتالي طالما + +23 +00:01:28,710 --> 00:01:32,830 +ال inferior rectus ضعيف فهيظهر عيب العين اليمين أو + +24 +00:01:32,830 --> 00:01:36,620 +هيزيد الحولفي وضعية ال out و في وضعية ال down و لو + +25 +00:01:36,620 --> 00:01:40,600 +اضطرت العين الي امين هتعمل extortion فهنشوف كيف ال + +26 +00:01:40,600 --> 00:01:45,540 +.. ال .. ال head هيتحرك بحيث انه يبعد العين عن + +27 +00:01:45,540 --> 00:01:49,680 +هدول التلت وضعية بدنا نشوف ال face turned كيف بده + +28 +00:01:49,680 --> 00:01:55,660 +يصير بدنا + +29 +00:01:55,660 --> 00:02:00,500 +نشوف ال head tilted كيف + +30 +00:02:00,500 --> 00:02:06,480 +بده يصيرأو بدنا نشوف ال chin هل هو هيكون في ال up + +31 +00:02:06,480 --> 00:02:08,760 +position ولا في ال down position .. في ال up + +32 +00:02:08,760 --> 00:02:12,080 +position ولا في ال down position نشوف ال face turn + +33 +00:02:12,080 --> 00:02:16,300 +.. ال face turn بدنا يسي .. يعني هيحدث عنا face + +34 +00:02:16,300 --> 00:02:19,720 +turn بحيث أنه العين ماتروحش out بالعكس أنها تروح + +35 +00:02:19,720 --> 00:02:21,700 +in .. نشوف الصورة إيش بتقول + +36 +00:02:24,920 --> 00:02:27,880 +هي عندي left face turn وهي عندي right face turn + +37 +00:02:27,880 --> 00:02:31,780 +اللي عنده inferior rectus palsy مفروض يختار واحد + +38 +00:02:31,780 --> 00:02:34,540 +منهم او مفروض يصير معاه واحد منهم بحيث ان العين + +39 +00:02:34,540 --> 00:02:37,860 +اليمين تشرد من وضع ال out لاحظين هنا العين اليمين + +40 +00:02:37,860 --> 00:02:41,000 +في ال in position بينما هنا العين اليمين في ال out + +41 +00:02:41,000 --> 00:02:44,560 +position إذا هذا .. إذا هذا ال face turn هو الأنسب + +42 +00:02:44,560 --> 00:02:49,400 +هو الأنسب إذا right face turn right face turn سجل + +43 +00:02:49,400 --> 00:02:55,590 +هذا الكلام نقول ال face turn to the rightطيب ال + +44 +00:02:55,590 --> 00:02:59,610 +head tilt هيهرب .. هيهرب العين من ال extortion + +45 +00:02:59,610 --> 00:03:04,850 +يعني المريض هيتخذ head tilt معين أيضا عشان العين + +46 +00:03:04,850 --> 00:03:08,690 +اليمين ماتروحش في .. في .. في .. في حالة extortion + +47 +00:03:08,690 --> 00:03:12,610 +و أنما تكون في حالة intortion .. intortion إيش + +48 +00:03:12,610 --> 00:03:16,130 +اللي بوفرليها هذا الكلام؟ بالرسمة بتبين .. بنقول + +49 +00:03:16,130 --> 00:03:20,190 +هي العين اليمين لو صار lift tilt .. لو صار lift + +50 +00:03:20,190 --> 00:03:23,450 +tilt العين اليمين هتعمل extortion، هذا مش مناسب + +51 +00:03:23,450 --> 00:03:29,270 +لهالو صار right tilt العين اليمين هتعمل in torsion + +52 +00:03:29,270 --> 00:03:33,730 +وهذا مناسب لإذا right sided head tilt right sided + +53 +00:03:33,730 --> 00:03:39,610 +head tilt أيضا ال head tilt على ال right ال head + +54 +00:03:39,610 --> 00:03:49,390 +tilt على ال right الآن بيضال + +55 +00:03:49,390 --> 00:03:54,760 +قضية ال chin هل هو هيكون up ولا downالـ chin بدي + +56 +00:03:54,760 --> 00:03:58,280 +يكون بحيث أنه نشرد من وضعية ال down بالنسبة لل + +57 +00:03:58,280 --> 00:04:02,100 +right eye شوف فادر القضية كيف هتحدث + +58 +00:04:05,090 --> 00:04:08,970 +لو صار chin up العينين هييجوا down وهذا مش مناسب + +59 +00:04:08,970 --> 00:04:11,370 +لأن العين اليمين مش مناسب اللي احنا هديجي down + +60 +00:04:11,370 --> 00:04:14,670 +بينما في ال chin down position العينين هيطلعوا + +61 +00:04:14,670 --> 00:04:18,250 +لفوق وبالتالي هيبعدوا عن منطقات ال down position + +62 +00:04:18,250 --> 00:04:21,290 +إذا ال chin down position هو اللي بيوفرلي هذه + +63 +00:04:21,290 --> 00:04:25,390 +القضية هو اللي بيوفرلي هذه القضية إذا ال chin down + +64 +00:04:25,390 --> 00:04:32,090 +إذا + +65 +00:04:32,090 --> 00:04:36,060 +الشخص اللي عندهright inferior rectus palsy + +66 +00:04:36,060 --> 00:04:40,200 +الكمبينساتوري head posture عنده right face turn + +67 +00:04:40,200 --> 00:04:43,640 +right head tilt chin down position هياخدهم مع بعض + +68 +00:04:43,640 --> 00:04:48,520 +كلهم في نفس الوقت فبالتالي هيكون بعيدة العين تماما + +69 +00:04:48,520 --> 00:04:53,060 +عن المنطقة اللي تختبر فيها ال inferior rectus وهيك + +70 +00:04:53,060 --> 00:04:56,000 +احنا بيكون عرفنا ايش الكمبينساتوري head posture + +71 +00:04:56,000 --> 00:04:58,500 +بتاع ال inferior rectus palsy + +72 +00:05:01,100 --> 00:05:05,640 +الآن في .. قبل ما ننتقل للمثال التالي، بنقول .. + +73 +00:05:05,640 --> 00:05:09,800 +نفرض إنسان إحنا متأكدين تماما إنه في عنده right + +74 +00:05:09,800 --> 00:05:13,920 +inferior rectus palsy، بعدة فحوصات هييجي ذكرها في + +75 +00:05:13,920 --> 00:05:17,640 +موعدها، متأكدين بنسبة مائة بالمائة إنه في عندي + +76 +00:05:17,640 --> 00:05:21,700 +right inferior rectus palsy، ومفروض يعمل head tilt + +77 +00:05:21,700 --> 00:05:26,500 +to the rightلجناع عامل head tilt to the left عكس + +78 +00:05:26,500 --> 00:05:31,200 +ما هو متوقع، ساعتها .. ساعتها بنسمي هذا ال head + +79 +00:05:31,200 --> 00:05:35,060 +posture مش compensatory وانما paradoxical head + +80 +00:05:35,060 --> 00:05:39,840 +posture يعني head posture خلف خلاف أو غير متوقع، + +81 +00:05:39,840 --> 00:05:43,340 +المفروض يميل رأسه على اليمينراح يميله على الشمال + +82 +00:05:43,340 --> 00:05:46,740 +رغم انه عنده right inferior rectus palsy، اذا هذا + +83 +00:05:46,740 --> 00:05:50,680 +paradoxical head posture، امتى بيحدث؟ بيحدث اذا .. + +84 +00:05:50,680 --> 00:05:54,900 +اذا ال compensatory head posture المتوقع ما .. + +85 +00:05:54,900 --> 00:05:59,240 +يعني لم يفي بالغرض، لم يفي بالغرض، الغرض هو تقريب + +86 +00:05:59,240 --> 00:06:02,480 +الصورتين لأقرب مسافة ممكن من بعضهم عشان يتم ال + +87 +00:06:02,480 --> 00:06:05,920 +fusion واستعاد الbinocular single visionإذا ما + +88 +00:06:05,920 --> 00:06:10,120 +جدرش الدماغ يعمل fusion وضل الصورتين صورتين بال + +89 +00:06:10,120 --> 00:06:13,640 +compensatory head posture ساعتها ال head هيروح + +90 +00:06:13,640 --> 00:06:17,400 +تلقائيا للناحية العكسية اللي هي المخالفة للمتوقع + +91 +00:06:17,400 --> 00:06:21,300 +اللي مش طبيعي أنه يروح عليها .. اللي مش طبيعي أنه + +92 +00:06:21,300 --> 00:06:24,820 +يروح عليها عشان يعمل maximum separation between + +93 +00:06:24,820 --> 00:06:28,820 +the two images فيسهل أنه يعمل separation ل one of + +94 +00:06:28,820 --> 00:06:31,680 +the two images إذا في عندي compensatory head + +95 +00:06:31,680 --> 00:06:35,340 +postureهذا مرتبط بال function و ال testing + +96 +00:06:35,340 --> 00:06:40,140 +position بتاع العضلة و في عندي paradoxical head + +97 +00:06:40,140 --> 00:06:47,060 +posture اللي هو خلف خلاف أو عكس المتوقع عكس ال + +98 +00:06:47,060 --> 00:06:51,940 +compensatory بالذات في ال head tilt الهدف منه انه + +99 +00:06:51,940 --> 00:06:55,360 +طالما ال diploma ما حلتش مشكلتها بال compensatory + +100 +00:06:55,360 --> 00:07:00,710 +head postureبيروح ال head عن ناحية الغير متوقعة .. + +101 +00:07:00,710 --> 00:07:04,670 +عن ناحية .. عن ناحية العكسية عشان ال diploma يعني + +102 +00:07:04,670 --> 00:07:08,770 +بدل ما تقتربوا الصورتين من بعض ويتوحدوا مش جادرين + +103 +00:07:08,770 --> 00:07:13,110 +ينوحدهم اه .. اذا بنعمل maximum separation فيهم + +104 +00:07:13,110 --> 00:07:17,050 +عشان يسهل انه يعمل separation في one image عشان + +105 +00:07:17,050 --> 00:07:20,030 +يسهل انه يعمل .. انه يعمل separation في one image + +106 +00:07:20,030 --> 00:07:26,840 +وهذا يسمى paradoxical head postureالمثال التالي، + +107 +00:07:26,840 --> 00:07:32,240 +write superior rectus pulsae اول حاجة بنستفكر ايش + +108 +00:07:32,240 --> 00:07:38,360 +ال superior rectus بتعمل elevation and + +109 +00:07:38,360 --> 00:07:42,820 +adduction + +110 +00:07:43,930 --> 00:07:47,130 +بدون معرفة الـ function بتاعة superior rectus أو + +111 +00:07:47,130 --> 00:07:51,570 +أي extraocular muscle بيكون الكلام يعني بلا فائدة + +112 +00:07:51,570 --> 00:07:54,910 +وبيكون الإنسان مستنتج ال compensatory head posture + +113 +00:07:54,910 --> 00:08:03,710 +بيكون مش صعب يعني شبه مستحيل up and out هذه منطقة + +114 +00:08:03,710 --> 00:08:08,560 +اختبار ال superior rectus muscleاللي هي up and out + +115 +00:08:08,560 --> 00:08:13,180 +الان طالما في ضعف ال superior rectus muscle معناته + +116 +00:08:13,180 --> 00:08:17,920 +العين لازم تشرد من + +117 +00:08:17,920 --> 00:08:25,520 +وضعية ال intortion هذه + +118 +00:08:25,520 --> 00:08:28,800 +الوضعية ممنوع العين تضلها فيها + +119 +00:08:32,340 --> 00:08:35,780 +الـ out position برضه لازم تشرد منه، يعني العين + +120 +00:08:35,780 --> 00:08:41,020 +اليمين لازم تشرد من ال out position و من ال up + +121 +00:08:41,020 --> 00:08:46,180 +position العين اليمين لا يفضل إلاها، لا يستحب + +122 +00:08:46,180 --> 00:08:51,600 +إلاها، الدماغ هيهربها من ال up و من ال out و من ال + +123 +00:08:51,600 --> 00:08:52,000 +intuition + +124 +00:08:54,670 --> 00:08:58,330 +هدولة التلات وضعيات اللي بيشير إليهم أسهم العين + +125 +00:08:58,330 --> 00:09:01,290 +اليمين لازم تهرب منها إذا ال head posture بدي يوفر + +126 +00:09:01,290 --> 00:09:04,990 +إن العين اليمين بدل ما تيجي out تيجي in بدل ما + +127 +00:09:04,990 --> 00:09:08,230 +تيجي up تيجي down بدل ما تعمل intortion تعمل + +128 +00:09:08,230 --> 00:09:14,890 +extortion نشوف الجدول إيش بده يصير فيه عناه + +129 +00:09:14,890 --> 00:09:19,050 +بالنسبة + +130 +00:09:19,050 --> 00:09:20,810 +ل ال face turned + +131 +00:09:31,840 --> 00:09:39,160 +و بالنسبة لل head tilt و بالنسبة + +132 +00:09:39,160 --> 00:09:44,900 +لل chin هل هيكون اندي up ولا down نبدأ بال face + +133 +00:09:44,900 --> 00:09:48,780 +tilt العين اليمين طالما العضلة الموجودة اللي فيها + +134 +00:09:48,780 --> 00:09:51,120 +الشلل موجودة في العين اليمين إذا العين اليمين لازم + +135 +00:09:51,120 --> 00:09:54,860 +تهرب من ال out position يعني بمعنى أخر ال head بده + +136 +00:09:54,860 --> 00:09:59,460 +يسير في وضعية حيث العين تيجي in مش out تيجي in مش + +137 +00:09:59,460 --> 00:10:06,390 +out نشوف الرسمةكيف العين اليامين ده تيجي in؟ العين + +138 +00:10:06,390 --> 00:10:10,090 +اليامين تيجي in بال right face turn لأن ال left + +139 +00:10:10,090 --> 00:10:12,750 +face turn هيخلق العين اليامين تيجي out وهذا مش + +140 +00:10:12,750 --> 00:10:16,630 +مناسب أبدا، هنيجي في منطقة اختبار superior rectus + +141 +00:10:16,630 --> 00:10:19,970 +وهذا مش مناسب للمريض، إذا right face turn right + +142 +00:10:19,970 --> 00:10:27,370 +face turn طيب + +143 +00:10:28,960 --> 00:10:31,760 +بالنسبة لل head tilt ممنوع العين اليمين تعمل + +144 +00:10:31,760 --> 00:10:36,320 +intortion ممنوع العين اليمين تعمل intortion وإنما + +145 +00:10:36,320 --> 00:10:40,280 +يفضل إلها تماما إنها تعمل extortion بعيدا عن ال + +146 +00:10:40,280 --> 00:10:43,040 +intortion لأنه في ضعف في واحدة من ال interior + +147 +00:10:43,040 --> 00:10:46,160 +muscles اللي هي ال superior rectus إذا العين + +148 +00:10:46,160 --> 00:10:49,600 +اليمين بدلاش هي تعمل intortion ده هي تعمل + +149 +00:10:49,600 --> 00:10:53,620 +extortion هي تعمل extortion في وضعية ال right tilt + +150 +00:10:53,620 --> 00:10:56,750 +العين اليمين هي تعمل intortion وهذا مش مناسبفي + +151 +00:10:56,750 --> 00:11:02,430 +وضعية الـ left tilt، العين اليمين هتعمل extortion، + +152 +00:11:02,430 --> 00:11:09,910 +إذا الـ left side التلت هو الأنسب إليها + +153 +00:11:09,910 --> 00:11:15,250 +ال left side التلت ساعتها هتعمل extortion العين + +154 +00:11:15,250 --> 00:11:23,700 +اليميني طيب، تالت شيء ال chinهيكون بحيث أنه نهرب + +155 +00:11:23,700 --> 00:11:28,820 +من ال up position من ال up position لأنه العين مش + +156 +00:11:28,820 --> 00:11:33,180 +جادرة تعمل up عشان نهرب من ال up position ال chin + +157 +00:11:33,180 --> 00:11:36,240 +هيروح up فالعينين هينزلوا down فالعينين هينزلوا + +158 +00:11:36,240 --> 00:11:43,050 +down إذا ال chin up positionهيكون هو الأسلم أو هو + +159 +00:11:43,050 --> 00:11:46,670 +اللي .. اللي هيتاخده المرض .. اللي هيتاخده المرض + +160 +00:11:46,670 --> 00:11:49,750 +هيك بتنتهي المسألة اللي هي right superior rectus + +161 +00:11:49,750 --> 00:11:55,110 +bulce هيكون عندي right face tear left tilt و chin + +162 +00:11:55,110 --> 00:12:01,570 +up right face tear left head tilt و chin up ناخد + +163 +00:12:01,570 --> 00:12:05,930 +المثل اللي بعده، هذا المثل سهل جدا اللي بيحكي عن + +164 +00:12:05,930 --> 00:12:10,330 +ال left medial rectus bulceالـ media rectus + +165 +00:12:10,330 --> 00:12:14,770 +الفنكشن تعتها adoption فقط، مافي اي secondary او + +166 +00:12:14,770 --> 00:12:20,530 +tertiary action وتختبر + +167 +00:12:20,530 --> 00:12:25,910 +في ال in position هي + +168 +00:12:25,910 --> 00:12:34,340 +هتهرب من وضعية ال inالدماج او ال head هيهربها من + +169 +00:12:34,340 --> 00:12:37,520 +مضاية ال in يعني المفروض ال left eye عشان في عندي + +170 +00:12:37,520 --> 00:12:41,180 +ضعف في ال media rectus المفروض ال left eye ماتروحش + +171 +00:12:41,180 --> 00:12:44,860 +في ال adduction ماتروحش في ال in position اتروح في + +172 +00:12:44,860 --> 00:12:49,960 +ال out اتروح في ال out كيف هذا الكلام هيحصل بس ال + +173 +00:12:49,960 --> 00:12:53,440 +face turn هو اللي هيحل المشكلة طيب لو عمل left + +174 +00:12:53,440 --> 00:12:56,540 +face turn هتيجي ال left eye في ال in position مش + +175 +00:12:56,540 --> 00:13:01,460 +مناسب لو عمل rightright face term الان الشمال + +176 +00:13:01,460 --> 00:13:05,880 +هتروح out وهذا بعيدا عن الان اللي هو فيه ضعف بسبب + +177 +00:13:05,880 --> 00:13:09,400 +انه في left media recta sparse اذا right face term + +178 +00:13:09,400 --> 00:13:17,020 +هذا هو الجواب right face term هذا هو الجواب وهيك + +179 +00:13:17,020 --> 00:13:24,020 +بتنتهي المسألة او المثال التاني right face term اي + +180 +00:13:24,020 --> 00:13:26,300 +حد عنده left media recta sparse + +181 +00:13:29,000 --> 00:13:35,100 +right face turn فهذا + +182 +00:13:35,100 --> 00:13:40,200 +هو الجواب ببساطة لن يكون هناك لاتشن up ولا down و + +183 +00:13:40,200 --> 00:13:43,940 +لن يكون هناك tilt لأن لا فيه torsional function + +184 +00:13:43,940 --> 00:13:47,800 +للmedial rectus ولا فيه vertical function للmedial + +185 +00:13:47,800 --> 00:13:52,040 +rectus فبالتالي هذه القضية بدأت تكون واضحة left + +186 +00:13:52,040 --> 00:13:56,300 +inferior oblique palsy left inferior oblique palsy + +187 +00:13:57,830 --> 00:14:01,270 +أول حاجة نستذكر ايش ال function بتاعة ال .. طبعا + +188 +00:14:01,270 --> 00:14:04,910 +هذه العضلة المشلولة ال inferior oblique بتعمل + +189 +00:14:04,910 --> 00:14:10,690 +extortion ايضا + +190 +00:14:10,690 --> 00:14:16,190 +بتعمل elevation ايضا + +191 +00:14:16,190 --> 00:14:22,110 +بتعمل abduction testing position بتاع ال inferior + +192 +00:14:22,110 --> 00:14:41,710 +oblique muscle up and in او in and inand up + +193 +00:14:41,710 --> 00:14:49,890 +المفروض + +194 +00:14:49,890 --> 00:14:51,850 +الآن الشمال تهرب + +195 +00:14:54,370 --> 00:14:57,330 +من ال up position يعني تروح down العين الشمال + +196 +00:14:57,330 --> 00:15:01,850 +المفروض العين الشمال تهرب من ال in position يعني + +197 +00:15:01,850 --> 00:15:08,030 +تروح out المفروض + +198 +00:15:08,030 --> 00:15:17,750 +العين الشمال مايصيرش فيها extortion هدولة + +199 +00:15:17,750 --> 00:15:22,260 +التلات شغلات مفروض ما تعملهمش العين الشمالفدماغ + +200 +00:15:22,260 --> 00:15:26,180 +هيهرب العين الشمال من هذه الأوضاع التلاتة، هيذهب + +201 +00:15:26,180 --> 00:15:30,460 +إلى وضعية بحيث العين بدل ما تكون up تكون down، بدل + +202 +00:15:30,460 --> 00:15:33,540 +ما تكون in تكون out، بدل ما تعمل extortion تعمل + +203 +00:15:33,540 --> 00:15:36,840 +intortion، ندرج الجدول بتاعنا + +204 +00:15:51,170 --> 00:15:56,570 +الـ FaceTair هيكون لوين والـ + +205 +00:15:56,570 --> 00:16:07,410 +HeadTilt هيكون لوين والـ + +206 +00:16:07,410 --> 00:16:12,710 +Chin هيتجه للأعلى و للأسفل هذا اللي هنشوفه مع بعض + +207 +00:16:14,410 --> 00:16:18,690 +الان نجي لل face turn نشوف وين بالظبط هيكون ال + +208 +00:16:18,690 --> 00:16:22,210 +face turn هيكون بحيث انه نشرط من وضعية ال in يعني + +209 +00:16:22,210 --> 00:16:25,330 +ال left eye بده تكون في وضعية ال out أنسب إلى .. + +210 +00:16:25,330 --> 00:16:27,550 +أنسب إلى .. نروح على الصورة + +211 +00:16:31,220 --> 00:16:34,200 +الـ left eye لو فيه فيه left face turn ال left eye + +212 +00:16:34,200 --> 00:16:37,940 +هتروح in و هذا مش مناسب إليها أما المناسب إليها + +213 +00:16:37,940 --> 00:16:41,840 +أنه الوجه يتجه إلى اليمين right face turn ساعتها + +214 +00:16:41,840 --> 00:16:45,520 +ال left eye هتروح out إذا ال right face turn right + +215 +00:16:45,520 --> 00:16:57,580 +face turn right + +216 +00:16:57,580 --> 00:17:03,710 +face turn طيب ال head tiltهيشرد للعين الشمال من + +217 +00:17:03,710 --> 00:17:06,570 +قضية ال extortion يعني العين الشمال المفروض تعمل + +218 +00:17:06,570 --> 00:17:12,470 +intortion كيف بتعمل intortion للعين الشمال؟ العين + +219 +00:17:12,470 --> 00:17:16,350 +الشمال في ال right-sided head tilt هتعمل extortion + +220 +00:17:16,350 --> 00:17:21,270 +مش مناسب لأن في الربليك فيها palsy في ال left + +221 +00:17:21,270 --> 00:17:26,210 +-sided tilt لما يعمل left-sided tiltهتعمل العين + +222 +00:17:26,210 --> 00:17:29,990 +لشمال in torsion بعيدا عن الاكستورشن، تهرب من + +223 +00:17:29,990 --> 00:17:33,070 +الاكستورشن، إذا هذا هو الوضع المناسب، إذا left + +224 +00:17:33,070 --> 00:17:39,590 +-sided tilt، left-sided tilt إذا + +225 +00:17:39,590 --> 00:17:45,130 +الـ head tilt to the left الـ chin، ال position + +226 +00:17:45,130 --> 00:17:48,590 +بتاع ال chin، بده يهرب العين لشمال من وضعية ال up + +227 +00:17:48,590 --> 00:17:52,430 +و يحطها في وضعية ال down، إذا العين لشمال أنسبلها + +228 +00:17:52,430 --> 00:17:59,050 +أن تكون downهنسابي لإنها تكون down هنا العين + +229 +00:17:59,050 --> 00:18:03,230 +الشمال up مش مناسب، هنا العين الشمال down مناسب، + +230 +00:18:03,230 --> 00:18:15,490 +لذن chin up position كتبنا + +231 +00:18:15,490 --> 00:18:21,970 +chin، هنكتب upإذا الـ chin دي بيكون up إذا المريض + +232 +00:18:21,970 --> 00:18:26,450 +اللي عنده left inferior oblique palsy هيكون عنده + +233 +00:18:26,450 --> 00:18:31,990 +right face turn left head tilt و chin up position + +234 +00:18:31,990 --> 00:18:36,810 +و chin up position فهيجيني بهذا ال compensatory + +235 +00:18:36,810 --> 00:18:41,630 +head posture إذا في إنسان عنده left inferior + +236 +00:18:41,630 --> 00:18:45,450 +oblique palsy و متأكدين منه تماما من التشخيص و + +237 +00:18:45,450 --> 00:18:49,460 +إجاني ب head tilt to the rightمعناته هذا مش + +238 +00:18:49,460 --> 00:18:54,080 +compensatory هذا paradoxical لأنه في هذه العضلة + +239 +00:18:54,080 --> 00:18:57,800 +إذا فيها شلل في العين الشمال left inferior oblique + +240 +00:18:57,800 --> 00:19:00,400 +palsy ال hit tilt ال compensatory المفروض يكون + +241 +00:19:00,400 --> 00:19:04,700 +left مش right left مش right هيك بيكون خلص المثال + +242 +00:19:04,700 --> 00:19:12,000 +التالي بيضل عندنا مثال آخر right lateral rectus + +243 +00:19:12,000 --> 00:19:15,280 +palsy right lateral rectus palsy ال lateral rectus + +244 +00:19:15,280 --> 00:19:16,360 +بتعمل abduction + +245 +00:19:21,200 --> 00:19:25,700 +وتختبر في الـ out position مالهاش secondary ولا + +246 +00:19:25,700 --> 00:19:29,360 +tertiary action ماعلها secondary ولا tertiary + +247 +00:19:29,360 --> 00:19:34,360 +action وبالتالي + +248 +00:19:34,360 --> 00:19:41,420 +بدا + +249 +00:19:41,420 --> 00:19:44,700 +تهرب من ال abduction أو تهرب من ال out position + +250 +00:19:44,700 --> 00:19:49,980 +تيجي في ال in نفس الأشياء فبالتالي ال face turn + +251 +00:19:51,090 --> 00:19:54,990 +اللي هيهربلي ال right eye من إنها تكون في وضعية ال + +252 +00:19:54,990 --> 00:19:57,750 +out يعني ال right eye أنسبلها في حالة ال lateral + +253 +00:19:57,750 --> 00:20:02,530 +rectus palsy إنها تكون في وضعية ال in في وضعية ال + +254 +00:20:02,530 --> 00:20:07,530 +in مش في وضعية ال out ال first term هيكونهي ال + +255 +00:20:07,530 --> 00:20:10,670 +right eye في وضعية ال in إذن ال right face turn هو + +256 +00:20:10,670 --> 00:20:13,750 +ال answer ال left face turn مش مناسب بحالة ال + +257 +00:20:13,750 --> 00:20:16,630 +lateral rectus pulse بتاعة ال right eye لأنه + +258 +00:20:16,630 --> 00:20:19,870 +ساعتها ال right eye هتضطر تيجي في وضعية ال out وهي + +259 +00:20:19,870 --> 00:20:24,150 +مش قادرة تيجي في وضعية ال out فهيزيد كمية الحول أو + +260 +00:20:24,150 --> 00:20:27,790 +هيكشف عيب ال lateral rectus فبالتالي ال right face + +261 +00:20:27,790 --> 00:20:30,510 +turn هو ال face turn أو ال compensatory head + +262 +00:20:30,510 --> 00:20:33,750 +posture الطبيعي ال compensatory head posture + +263 +00:20:33,750 --> 00:20:35,410 +الطبيعي إنه هيكون عنده + +264 +00:20:40,560 --> 00:20:48,580 +right face tip هذا هو الكمبنساتوري head posture + +265 +00:20:48,580 --> 00:20:55,040 +بتاع ال right lateral rectus pulse الأن بقى الأخر + +266 +00:20:55,040 --> 00:20:59,340 +شئ في هذه المحاضرة بتاعة الأمثلة بنقول بدنا نلاحظ + +267 +00:20:59,340 --> 00:21:01,280 +على بعض الأمثلة اللي احنا أخدناها + +268 +00:21:04,900 --> 00:21:13,040 +مثلا عندي ال left superior oblique pulsae أخدناها + +269 +00:21:13,040 --> 00:21:17,780 +و ال right inferior rectus pulsaeاحنا ال right + +270 +00:21:17,780 --> 00:21:20,400 +inferior rectus palsy أخدناها المرة high، ال left + +271 +00:21:20,400 --> 00:21:23,820 +superior oblique palsy أخدناها المرة الماضية، + +272 +00:21:23,820 --> 00:21:28,840 +أخدناها المرة الماضية، نشوف، نقارن بين ال left + +273 +00:21:28,840 --> 00:21:32,100 +superior oblique palsy، ال compensatory head + +274 +00:21:32,100 --> 00:21:37,250 +posture تاعها، و ال right inferior rectus palsyالـ + +275 +00:21:37,250 --> 00:21:40,610 +compensatory head posture بتاعها، اذا ملاحظين، + +276 +00:21:40,610 --> 00:21:43,250 +face turned right, head turned right, chin down + +277 +00:21:43,250 --> 00:21:47,090 +هنا، face turned right, head turned right, chin + +278 +00:21:47,090 --> 00:21:50,330 +down، هما نفس الـ compensatory head posture، هذه + +279 +00:21:50,330 --> 00:21:55,970 +نقطة، ايضا بدنا نلاحظ ال right superior rectus مع + +280 +00:21:55,970 --> 00:22:00,050 +ال left inferior oblique pulseالـ Right Superior + +281 +00:22:00,050 --> 00:22:05,910 +Rectus Bulce الـ Face Turn و الـ Head Turn و الـ + +282 +00:22:05,910 --> 00:22:12,630 +Chin Right Left Up Right Left Up و هنا أيضًا في + +283 +00:22:12,630 --> 00:22:15,530 +الـ Left Inferior Rectus Bulce الـ Right Left Up + +284 +00:22:15,530 --> 00:22:19,650 +تالت شيء بدنا نلاحظه الـ Right Lateral Rectus + +285 +00:22:19,650 --> 00:22:23,730 +Bulce و الـ Left Medial Rectus Bulce هذه Right + +286 +00:22:23,730 --> 00:22:29,140 +Face Turnوها دي right fester إيش السر في هذا؟ السر + +287 +00:22:29,140 --> 00:22:33,680 +في هذا أو النتيجة في التشابه إن هدولة yoke muscles + +288 +00:22:33,680 --> 00:22:37,540 +البالسي بتاعة ال yoke muscles بتحدث نفس ال + +289 +00:22:37,540 --> 00:22:41,520 +compensatory head posture يعني لو جينا مرة تانية + +290 +00:22:41,520 --> 00:22:49,160 +نقول كالقاعدة left + +291 +00:22:49,160 --> 00:22:53,400 +superior oblique مين ال yoke بتاعها؟ ال right + +292 +00:22:53,400 --> 00:22:58,070 +inferior rectusالـ right inferior rectus والـ left + +293 +00:22:58,070 --> 00:23:03,450 +superior oblique هما yoke muscles هما التنتين مع + +294 +00:23:03,450 --> 00:23:09,670 +بعض بيشتغلوا في اللي هو ال right inferior rectus + +295 +00:23:09,670 --> 00:23:13,590 +وال left superior oblique في ال right and down + +296 +00:23:13,590 --> 00:23:16,770 +position right and down position dextro depression + +297 +00:23:16,770 --> 00:23:19,950 +في ال dextro depression هدولة yoke muscles لما + +298 +00:23:19,950 --> 00:23:24,470 +بيصير بلسي في ال right inferior rectus أو بلسي + +299 +00:23:28,230 --> 00:23:31,230 +في الـ left superior oblique الكمبنساتوري head + +300 +00:23:31,230 --> 00:23:33,950 +posture بتاع اليوك muscles بتاع البلسي بتاع اليوك + +301 +00:23:33,950 --> 00:23:37,350 +muscles هو نفس الكمبنساتوري head posture هاي عندي + +302 +00:23:37,350 --> 00:23:41,970 +right fist turn، right head tilt، chin down في + +303 +00:23:41,970 --> 00:23:45,170 +اليوك بتاعتها لو صار فيها بلسي، right fist turn، + +304 +00:23:45,170 --> 00:23:51,770 +right head tilt، chin down طيب الـ left mediaric + +305 +00:23:51,770 --> 00:23:56,030 +تصميم اليوك بتاعتهاالـ Right Lateral Rectus الـ + +306 +00:23:56,030 --> 00:23:58,530 +Right Lateral Rectus البالسي بتاعتها بتحدث Right + +307 +00:23:58,530 --> 00:24:02,370 +Face Tier والـ Left Medial Rectus اليوك بتاعة الـ + +308 +00:24:02,370 --> 00:24:04,650 +Lateral Rectus بتاعة الـ Right Eye برضه بتحدث + +309 +00:24:04,650 --> 00:24:09,710 +Right Face Tier إذا وها كذا لو استنتجنا .. لو + +310 +00:24:09,710 --> 00:24:13,470 +استنتجنا البالسي بتاعة أي يوك muscles هتكون نفس + +311 +00:24:13,470 --> 00:24:19,150 +الكمبينساتوريهيدبوستشر تمام؟ إذا الجملة اللي هننهي + +312 +00:24:19,150 --> 00:24:32,330 +فيها المحاضرة بنقول بالسيof yoke muscles induce + +313 +00:24:32,330 --> 00:24:39,910 +.. induce the + +314 +00:24:39,910 --> 00:24:47,470 +same compensatory head + +315 +00:24:47,470 --> 00:24:47,990 +posture + +316 +00:24:50,970 --> 00:24:53,610 +بنحكي على ال compensatory مش على ال paradoxical، + +317 +00:24:53,610 --> 00:24:57,290 +إذا policy of your muscles induce the same + +318 +00:24:57,290 --> 00:25:00,550 +compensatory head posture، the same compensatory + +319 +00:25:00,550 --> 00:25:03,910 +head posture، وعلى هذا بننهي المحاضرة ويعطيكم + +320 +00:25:03,910 --> 00:25:07,130 +العافية والسلام عليكم ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/557oeUaWOTI_raw.json b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/557oeUaWOTI_raw.json new file mode 100644 index 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298.5, "text": "right inferior rectus palsy الكمبينساتوري head posture عنده right face turn right head tilt chin down position هياخدهم مع بعض كلهم في نفس الوقت فبالتالي هيكون بعيدة العين تماما عن المنطقة اللي تختبر فيها ال inferior rectus وهيك احنا بيكون عرفنا ايش الكمبينساتوري head posture بتاع ال inferior rectus palsy", "tokens": [1938, 24249, 11048, 301, 3984, 3187, 2423, 24793, 3555, 9957, 3794, 9307, 13063, 1829, 1378, 18502, 43242, 3224, 558, 1851, 1261, 558, 1378, 18446, 14210, 760, 2535, 39896, 47283, 3215, 16095, 20449, 45030, 11242, 28242, 16095, 8978, 8717, 36178, 2423, 30543, 2655, 6156, 3555, 6027, 2655, 6027, 1829, 39896, 30544, 45030, 25708, 3660, 18863, 9957, 46811, 10943, 995, 18871, 9673, 1863, 9566, 28671, 13672, 1829, 6055, 46456, 26890, 8978, 11296, 2423, 24249, 11048, 301, 37037, 1829, 4117, 1975, 5016, 8315, 4724, 1829, 30544, 6225, 28480, 8315, 1975, 1829, 8592, 2423, 24793, 3555, 9957, 3794, 9307, 13063, 1829, 1378, 18502, 39894, 45761, 2423, 24249, 11048, 301, 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{"start": 789.88, "end": 790.38, "word": " الجواب", "probability": 0.9602864583333334}, {"start": 790.38, "end": 790.7, "word": " right", "probability": 0.26904296875}, {"start": 790.7, "end": 791.04, "word": " face", "probability": 0.82861328125}, {"start": 791.04, "end": 791.4, "word": " term", "probability": 0.9560546875}, {"start": 791.4, "end": 792.06, "word": " هذا", "probability": 0.8671875}, {"start": 792.06, "end": 792.26, "word": " هو", "probability": 0.98486328125}, {"start": 792.26, "end": 793.96, "word": " الجواب", "probability": 0.9816080729166666}, {"start": 793.96, "end": 797.02, "word": " وهيك", "probability": 0.7960611979166666}, {"start": 797.02, "end": 797.6, "word": " بتنتهي", "probability": 0.7801513671875}, {"start": 797.6, "end": 798.24, "word": " المسألة", "probability": 0.9432373046875}, {"start": 798.24, "end": 798.4, "word": " او", "probability": 0.77294921875}, {"start": 798.4, "end": 798.88, "word": " المثال", "probability": 0.9588216145833334}, {"start": 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يكون هناك لاتشن up ولا down و لن يكون هناك tilt لأن لا فيه torsional function للmedial rectus ولا فيه vertical function للmedial rectus فبالتالي هذه القضية بدأت تكون واضحة left inferior oblique palsy left inferior oblique palsy", "tokens": [1938, 1851, 1261, 6156, 3224, 15730, 31439, 25724, 14407, 3555, 4724, 3555, 3794, 41193, 3660, 5296, 1863, 7251, 30544, 34105, 4117, 5296, 9307, 8592, 1863, 493, 49429, 760, 4032, 5296, 1863, 7251, 30544, 34105, 4117, 18446, 5296, 33456, 20193, 8978, 3224, 3930, 82, 1966, 2445, 24976, 1912, 831, 11048, 301, 49429, 8978, 3224, 9429, 2445, 24976, 1912, 831, 11048, 301, 6156, 3555, 6027, 2655, 6027, 1829, 29538, 25062, 11242, 10632, 47525, 10721, 2655, 6055, 30544, 4032, 46958, 5016, 3660, 1411, 24249, 23740, 1925, 43806, 88, 1411, 24249, 23740, 1925, 43806, 88], "avg_logprob": -0.2393002749785133, "compression_ratio": 1.704225352112676, "no_speech_prob": 1.0907649993896484e-05, "words": [{"start": 809.0, "end": 809.5, "word": "right", "probability": 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0000000000000000000000000000000000000000..75c8a03402d6676e52b5ff6f6c9f14996b4051f1 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/62lQclcJPl0_raw.srt @@ -0,0 +1,940 @@ +1 +00:00:01,850 --> 00:00:05,850 +بسم الله الرحمن الرحيم بنستكمل مع المحاضرة الرابعة + +2 +00:00:05,850 --> 00:00:12,050 +من محاضرات حوال واحد و .. أو حوال ألف و بنذكر بآخر + +3 +00:00:12,050 --> 00:00:17,170 +محاضرة حينها أنه طبيعة حركة العين في جمع الاتجاه + +4 +00:00:17,170 --> 00:00:20,330 +هي طبيعة دورانية يعني العين بتدور حوالين مركز + +5 +00:00:20,330 --> 00:00:24,700 +دورانهذا مركز الدوران ثابت وإنما العين بتدور + +6 +00:00:24,700 --> 00:00:28,080 +حواليه، يعني ممكن القرانية تطلع و الجزء الخلفي من + +7 +00:00:28,080 --> 00:00:33,080 +العين ينزل بينما المركز دا الدوران ثابت فيسموه sub + +8 +00:00:33,080 --> 00:00:37,760 +reduction أو elevation يعني ارتفاع للعين طبعا احنا + +9 +00:00:37,760 --> 00:00:40,740 +لما بيقول ارتفاع او انخفاض او adoption او + +10 +00:00:40,740 --> 00:00:43,640 +abduction العبرة بما يظهر لنا من العين الجزء + +11 +00:00:43,640 --> 00:00:47,320 +الظاهر من العين هو اللي معتبر في هذه الحركات بمعنى + +12 +00:00:47,320 --> 00:00:51,820 +احنا ما بنشوف الجزء الخالفيلما بنشوف الجزء الأمامي + +13 +00:00:51,820 --> 00:00:54,200 +اللي هو القرن يطلع إلى فوق معناته هذا elevation + +14 +00:00:54,200 --> 00:00:58,120 +طبعا منطقي لما يكون جسم كراوي وجزء الأمامي يطلع + +15 +00:00:58,120 --> 00:01:01,840 +إلى فوق أن جزء الخلف يكون نزل لتحت عشان يظل مركز + +16 +00:01:01,840 --> 00:01:04,700 +الدوران ثابت لأن لو الجزءين طلعوا إلى فوق معناته + +17 +00:01:04,700 --> 00:01:09,520 +هذه صارت حركة إزاحية وليست حركة دورانية وليست حركة + +18 +00:01:09,520 --> 00:01:16,010 +دورانية وأيضا بنذكر أنهالعين بتدور حوال تلت محاور + +19 +00:01:16,010 --> 00:01:19,830 +ال elevation و ال depression حوالين المحور X ال + +20 +00:01:19,830 --> 00:01:23,710 +abduction و ال abduction حوالين المحور Z و ال + +21 +00:01:23,710 --> 00:01:28,890 +wheel rotation يعني حركة العجلة أو حركة البرغي + +22 +00:01:28,890 --> 00:01:33,230 +بالظبط زي ما بيفوت البرغي في الخشب او in torsion + +23 +00:01:33,230 --> 00:01:36,570 +باتجاه الأنف ان ال superior limbus الساعة 12 في ال + +24 +00:01:36,570 --> 00:01:39,930 +limbus تتحرك ناحية الأنف نفرض الأنف في المنطقة I + +25 +00:01:39,930 --> 00:01:43,180 +وهذه ال right eyeأو أن الساعة اتناش في ال limbus + +26 +00:01:43,180 --> 00:01:45,740 +أعلى ال limbus ال limbus اللي هو منطقة التقاء + +27 +00:01:45,740 --> 00:01:50,500 +القرنية مع ال sclera أن الساعة اتناش في ال limbus + +28 +00:01:50,500 --> 00:01:53,720 +تتحرك temporally بعيدا عن القنف بيسموها extortion + +29 +00:01:53,720 --> 00:02:00,880 +نازلي قريبا من القنف بيسموها intortion طبعا حوالين + +30 +00:02:00,880 --> 00:02:05,040 +المحور Y اللي هو المحور الأمامي الخلفي المحور + +31 +00:02:05,040 --> 00:02:10,950 +الأمامي الخلفيالآن في إنسان يعني بيتصعب .. بيتصعب + +32 +00:02:10,950 --> 00:02:15,930 +أنه يفرق بين ال adduction و ال intortion ال + +33 +00:02:15,930 --> 00:02:20,570 +adduction زي ما شايفينه هو أن العين نفسها تدور + +34 +00:02:20,570 --> 00:02:24,630 +لجوة معناته الجزء الخلفي من العين هيروح لبرا .. + +35 +00:02:24,630 --> 00:02:30,390 +الجزء الخلفي من العين هيروح لبرا و مقدمة العين + +36 +00:02:30,390 --> 00:02:33,180 +اللي هي ال corner هتروح لجوة باتجاه العنفهذا + +37 +00:02:33,180 --> 00:02:38,280 +adoption بنسميه، بينما ال-intuition الساعة اتناشر + +38 +00:02:38,280 --> 00:02:42,040 +والعين واقفة في مكانها، اتلف بشكل برغي، بالظبط + +39 +00:02:42,040 --> 00:02:45,480 +حوالين المحور الأمامي الخالفي اللي هو بينطلق من + +40 +00:02:45,480 --> 00:02:49,100 +عندنا لنحيط الصورةوبختارق ناحية ال optic nerve + +41 +00:02:49,100 --> 00:02:53,400 +يعني هذا محور أمامي خلفي اللي عين بتلف entorsion + +42 +00:02:53,400 --> 00:02:57,640 +يعني أن الساعة 12 في الليمبس بتيجي بهذا الاتجاه مش + +43 +00:02:57,640 --> 00:03:00,920 +اللي عين كلها بتروح نازلي زي ما أنتوا شايفين هذا + +44 +00:03:00,920 --> 00:03:04,780 +adoption وهذا entorsionممكن الإنسان يقول ال + +45 +00:03:04,780 --> 00:03:07,760 +intortion بنشوفوش، و هذا كلام سليم، هذا احنا ما + +46 +00:03:07,760 --> 00:03:11,080 +بنشوفه إلا في بعض الحالات المرضية، بس هو موجود + +47 +00:03:11,080 --> 00:03:16,000 +جميع .. عندنا جميعا و وظيفته هو و ال extortion أنه + +48 +00:03:16,000 --> 00:03:19,420 +يعمل و ردود الأفعال التصحيحية بمعنى ال writing + +49 +00:03:19,420 --> 00:03:23,620 +reflexes، بمعنى هذا أنه لما إنسان بتميل راسه شمال + +50 +00:03:23,620 --> 00:03:27,790 +أو يمينبيظل الصورة اللي بتطلع عليها أو الأجسام + +51 +00:03:27,790 --> 00:03:30,970 +اللي بتطلع عليها بتظل ثابتة، بتميلش معاه لأن + +52 +00:03:30,970 --> 00:03:35,210 +العنتين بيميلوا عكس ميلان الراس، واحدة بتعمل + +53 +00:03:35,210 --> 00:03:41,140 +intortion وواحدة بتعمل extortionهنا العين الشمال + +54 +00:03:41,140 --> 00:03:44,900 +عاملة intortion والعين اليمين عاملة extortion ال + +55 +00:03:44,900 --> 00:03:47,680 +superior limbus أو الساعة اتناش من ال limbus لو + +56 +00:03:47,680 --> 00:03:52,780 +تخيلنا ال limbus زي هذه الدائرة الكورنية تمام ساعة + +57 +00:03:52,780 --> 00:03:56,500 +وجسمناها هتيجي الساعة اتناش هناساعة تلاتة هنا، + +58 +00:03:56,500 --> 00:03:59,700 +الساعة ستة هنا، الساعة تسعة هنا لما الساعة اتناشة + +59 +00:03:59,700 --> 00:04:03,580 +تروح بعيدا عن القنف، تلف بعيدا عن القنف باتجاه + +60 +00:04:03,580 --> 00:04:07,580 +السهم A، هذا extortion لما الساعة اتناشة تلف قريبا + +61 +00:04:07,580 --> 00:04:12,120 +من القنف، هذا يسموه intortion طبعا لما الرأس بيلف + +62 +00:04:12,120 --> 00:04:17,160 +للشمال ككل أو بيميل للشمال، العنتين بيميلوا لليمين + +63 +00:04:17,160 --> 00:04:22,900 +عكس اتجاه ميالان الرأس حتى يحافظ على موقع الصورة + +64 +00:04:22,900 --> 00:04:26,870 +على الشبكيةوماتميلش صورة الأجسام لأن هذا بيصير + +65 +00:04:26,870 --> 00:04:29,770 +مزعج في الحياة العملية للإنسان إنه كل ما بده يميل + +66 +00:04:29,770 --> 00:04:33,230 +رأسه بده يشعر إن الأجسام اللي بتطلع عليها مالت + +67 +00:04:33,230 --> 00:04:37,770 +معاه بنفس الاتجاه إذا ال adoption إن العين نفسها + +68 +00:04:37,770 --> 00:04:42,210 +بتدخل ككل ناحية الأنف ال intortion إن العين بتلف + +69 +00:04:42,210 --> 00:04:46,170 +في مكانها بشكل لفة البرغي بس الساعة اتناش هتروح + +70 +00:04:46,170 --> 00:04:55,380 +باتجاه ال nose مش باتجاهيعني بعيدا عن الانف لأن في + +71 +00:04:55,380 --> 00:05:00,200 +ناس برضه بيتلخبط بين ال abduction و ال extortion + +72 +00:05:00,200 --> 00:05:04,800 +ال abduction العين كلها تروح out بعيدا عن الانف ال + +73 +00:05:04,800 --> 00:05:08,280 +extortion انه تلف في مكانها ال superior limb بس + +74 +00:05:08,280 --> 00:05:13,400 +يلف لبرا بس العين شايفين ما راحت out إذن بشكل .. + +75 +00:05:13,430 --> 00:05:19,330 +لفت البرغي أو حركة البرغي سواء ال intortion أو ال + +76 +00:05:19,330 --> 00:05:22,510 +extortion إذا ال extortion مش لازم نلخبطه مع ال + +77 +00:05:22,510 --> 00:05:27,830 +abduction و ال intortion مش لازم نلخبطه مع ال + +78 +00:05:27,830 --> 00:05:33,190 +adduction .. ال adduction احنا توقفنا عند ال + +79 +00:05:33,190 --> 00:05:37,150 +horizontal rectus muscles بدنا نتعرف عليهم و نشوف + +80 +00:05:37,150 --> 00:05:43,450 +إيش وظائفهم و هل في بالإضافة ل ..الوظيفة الرئيسية + +81 +00:05:43,450 --> 00:05:46,590 +أو ال primary action هل في subsidiary action وظائف + +82 +00:05:46,590 --> 00:05:49,410 +أخرى بتقوم فيها هذه العضلات ولا لأ؟ طبعا ال + +83 +00:05:49,410 --> 00:05:52,870 +horizontal muscle لإنه two horizontal muscles اللي + +84 +00:05:52,870 --> 00:05:56,070 +هي ال media rectus muscle و ال lateral rectus + +85 +00:05:56,070 --> 00:06:02,030 +muscle when the eye is in the primary position the + +86 +00:06:02,030 --> 00:06:06,170 +horizontal recti are purely horizontal movers on + +87 +00:06:06,170 --> 00:06:10,210 +the vertical z axis and have only primary action + +88 +00:06:12,610 --> 00:06:15,690 +العضلتين ال media rectus و ال lateral rectus في كل + +89 +00:06:15,690 --> 00:06:20,370 +عين هتحرك العين حوالين المحور العمودي Z ال media + +90 +00:06:20,370 --> 00:06:23,590 +rectus هتعمل abduction و ال lateral rectus عكسها + +91 +00:06:23,590 --> 00:06:27,670 +هتعمل abduction هذا يسمى ال primary action ل ال + +92 +00:06:27,670 --> 00:06:30,190 +media rectus اللي هو ال abduction و ال lateral + +93 +00:06:30,190 --> 00:06:33,990 +rectus ال primary action اللي هي ال abduction + +94 +00:06:33,990 --> 00:06:37,510 +مافيش أي secondary action لأي من العضلتين يعني كل + +95 +00:06:37,510 --> 00:06:40,400 +واحدة منهم بس اللي هي primary actionالـ + +96 +00:06:40,400 --> 00:06:44,340 +Mediaryctus originates at the annulus of زن حنعرف + +97 +00:06:44,340 --> 00:06:48,520 +إيش annulus of زن at the orbital apex and inserts + +98 +00:06:48,520 --> 00:06:52,920 +خمسة و نص ملي متر behind the nasal limb its sole + +99 +00:06:52,920 --> 00:06:59,380 +primary action is adduction إذا المحجر + +100 +00:06:59,380 --> 00:07:04,140 +العين اللي هو التجويف العظمىالتجويف العظمى اللى + +101 +00:07:04,140 --> 00:07:09,540 +جاعدة فى العين وموجود فى حوالين العين العضلات هذا + +102 +00:07:09,540 --> 00:07:14,200 +المحجر العظمى شكله هرمى الشكل بحيث انه قاعدة الهرم + +103 +00:07:14,200 --> 00:07:19,880 +فى فوهة المحجر هنا يعني على السطل وقمة الهرم لجوا + +104 +00:07:19,880 --> 00:07:23,040 +على الآخر عند ال optic nerve اللى أنا بأشير عليه + +105 +00:07:23,040 --> 00:07:30,010 +هذا المحجر العظمى ملتسق بالعظم جوا جوا حوالينالـ + +106 +00:07:30,010 --> 00:07:33,230 +Optical Canal و الـ Superior Orbital Fissure في + +107 +00:07:33,230 --> 00:07:38,070 +قمة الهرم هذا العظمى ملتصق فيه نوع من اللسيج اللي + +108 +00:07:38,070 --> 00:07:43,750 +في الشديد القوة و ملتصق فيه بشكل يعني كثيف و قوي + +109 +00:07:43,750 --> 00:07:49,400 +جدا و بشكل حلقة او زي الخاتم نسموه Annulusof zin + +110 +00:07:49,400 --> 00:07:52,580 +على اسم العالم اللي وصفه إذا هذا هو اللي أنا بأشر + +111 +00:07:52,580 --> 00:07:56,260 +عليه اللي هو لونه أبيض هو ال annulus of zin + +112 +00:07:56,260 --> 00:07:59,360 +annulus of zin عبارة عن نوع من النسيج الضامن + +113 +00:07:59,360 --> 00:08:04,700 +الليفي اللي هو نسيج تليفي شديد القوة متماسك بشكل + +114 +00:08:04,700 --> 00:08:09,480 +حلقة وملتصق بالعضن التصاق شديد منه بتنشأ ال four + +115 +00:08:09,480 --> 00:08:13,800 +rectus muscles بتنشأ العضلات الأربعة المستقيمة ال + +116 +00:08:13,800 --> 00:08:18,640 +media rectusالنوز هنا طبعا ال media rectus وال + +117 +00:08:18,640 --> 00:08:22,520 +lateral rectus بتنشأ منه أيضا ال inferior rectus + +118 +00:08:22,520 --> 00:08:25,960 +اللي أنا بقشر عنها وال superior rectus اللي أنا + +119 +00:08:25,960 --> 00:08:31,890 +أيضا بقشر عليها الآنال media rectus اللي هنحكي + +120 +00:08:31,890 --> 00:08:35,490 +عنها بتنشأ من ال nasal part من الجزء ال nasal اللي + +121 +00:08:35,490 --> 00:08:40,050 +أقرب لل nose من ال annulus of zen ال superior + +122 +00:08:40,050 --> 00:08:43,010 +rectus من ال superior part ال inferior rectus من + +123 +00:08:43,010 --> 00:08:45,930 +ال inferior part و ال lateral rectus من ال + +124 +00:08:45,930 --> 00:08:49,650 +temporal أو ال lateral part of the annulus of zen + +125 +00:08:49,650 --> 00:08:54,310 +إذا منشأ ال four rectus muscles من ال annulus of + +126 +00:08:54,310 --> 00:08:58,150 +zen طبعا العضلة اللي هنحكي عليها ال media rectus + +127 +00:08:58,150 --> 00:09:03,660 +بتنشأمن ال nasal part of the annulus of زن وبتمشي + +128 +00:09:03,660 --> 00:09:10,390 +للأمام لغاية ما تصللغاية ما اتصلت للمكان اللي فيه + +129 +00:09:10,390 --> 00:09:14,050 +بيصير لها insertion أو تثبيت على سطح الاسكليرة هذا + +130 +00:09:14,050 --> 00:09:17,670 +المكان بيبعد عن ال limbus بيبعد عن ال limbus + +131 +00:09:17,670 --> 00:09:21,410 +تقريبا وفق الدراسات خمسة و نص millimeters ال + +132 +00:09:21,410 --> 00:09:24,230 +limbus اللي هو مكان التقاء القرانية في الاسكليرة + +133 +00:09:24,230 --> 00:09:28,570 +اللي هي المنطقة هذه كلهيتها .. تمام؟ هذه كلهيتها + +134 +00:09:28,570 --> 00:09:33,520 +اللي هي منطقة أو الحد الفاصل بين الاسكليرةو بين + +135 +00:09:33,520 --> 00:09:37,020 +الكورنيا و بين الكورنيا طب ليش انسان يقول طب ال 5 + +136 +00:09:37,020 --> 00:09:40,100 +.5 ميلي متر هذي ايش بتفيدنا يعني في ناس أقرب في + +137 +00:09:40,100 --> 00:09:44,120 +ناس أبعد المتوسط تقريبا وثق دراسات ان ال insertion + +138 +00:09:44,120 --> 00:09:48,580 +او مكان التثبيت تاع ال media rectus 5.5 ميلي متر + +139 +00:09:48,580 --> 00:09:52,920 +طبعا هذا مفيد من ناحية جراحية في حالة إجراء جراحة + +140 +00:09:52,920 --> 00:09:56,180 +جراحة اتحاول و بدنا نشتغل على ال media rectus + +141 +00:09:56,180 --> 00:10:01,180 +muscle ساعتها احنا بنعرفأو بنتوقع أن مكانها على + +142 +00:10:01,180 --> 00:10:06,980 +بعد خمسة و نص مليمتر فبيكون مكان الجروح اللي بنفتح + +143 +00:10:06,980 --> 00:10:13,130 +فيه عشان ..في ال conjunctiva عشان يعني نوصل للمصل + +144 +00:10:13,130 --> 00:10:17,890 +بيكون مكان صحيح لأننا بنعرف مكان ال insertion بتاع + +145 +00:10:17,890 --> 00:10:21,430 +ال media rectus muscle هذه صورة متكاملة هنا بدأت + +146 +00:10:21,430 --> 00:10:24,570 +ال media rectus من الannulus of zin من ال nasal + +147 +00:10:24,570 --> 00:10:29,210 +part بتاعه ومشيت للأمام لغاية ما وصلت لمكان ال + +148 +00:10:29,210 --> 00:10:32,110 +insertion واحنا قلنا مكان ال insertion بيبعد عن ال + +149 +00:10:32,110 --> 00:10:37,130 +limbus خمسة و نص ملي متر خمسة و نص ملي متر + +150 +00:10:41,930 --> 00:10:45,750 +طبعا هاد ال lateral rectus muscle .. هنقول ليش هاد + +151 +00:10:45,750 --> 00:10:49,340 +ال lateral rectus muscleالـ lateral rectus muscle + +152 +00:10:49,340 --> 00:10:54,780 +originates at the annulus of zin and inserts 6 و 9 + +153 +00:10:54,780 --> 00:10:58,780 +من 10 مليامتر طبعاً بدنا نقول أن الوظيفة الوحيدة + +154 +00:10:58,780 --> 00:11:02,000 +لل media rectus أو ال primary action إلها is + +155 +00:11:02,000 --> 00:11:05,800 +abduction و الوظيفة الوحيدة لل lateral rectus هي + +156 +00:11:05,800 --> 00:11:09,730 +ال abduction مافيش إلهم أي وظائف ثانويةإذا ال + +157 +00:11:09,730 --> 00:11:13,590 +lateral rectus originates at the annulus of زن and + +158 +00:11:13,590 --> 00:11:18,370 +inserts ستة وتسعة من عشرة millimeter من ال limbus + +159 +00:11:18,370 --> 00:11:22,310 +يعني ال lateral rectus ممكن سان يقول طب كيف أعرفت + +160 +00:11:22,310 --> 00:11:24,890 +أن هذه ال lateral rectus؟ يمكن هذه ال media rectus + +161 +00:11:24,990 --> 00:11:27,970 +لأن ال nose بعيد عني، أنا .. عن ناحية تانية، أنا + +162 +00:11:27,970 --> 00:11:32,090 +من الجانب .. بتطلع من الجانب .. تاع ال lateral + +163 +00:11:32,090 --> 00:11:35,570 +rectus، هذه النقطة طب لو ال nose هنا مش مرسوم، + +164 +00:11:35,570 --> 00:11:38,910 +طبعا ال oblique ال inferior oblique muscle بتمر + +165 +00:11:38,910 --> 00:11:41,550 +تحت ال medial rectus .. تحت ال lateral rectus + +166 +00:11:41,550 --> 00:11:44,830 +عفوا، مابتمرش تحت ال medial rectus يعني ال + +167 +00:11:44,830 --> 00:11:47,550 +inferior oblique اللي أنا بأشر عليها و هنحكي عنها + +168 +00:11:47,550 --> 00:11:52,400 +في حينه بتمر تحت ال lateral rectus muscleالـ + +169 +00:11:52,400 --> 00:11:55,380 +lateral rectus muscle بتبدأ من الـ annulus of zin + +170 +00:11:55,380 --> 00:11:59,880 +هي اللي بالشكل الأبيض هنا اللي هو الحلقة هي اللي + +171 +00:11:59,880 --> 00:12:02,880 +بتنشأ منها ال forectus muscle بتنشأ من ال temporal + +172 +00:12:02,880 --> 00:12:07,480 +part of annulus of zin تمشي للأمام لغاية ما تتثبت + +173 +00:12:07,480 --> 00:12:11,520 +على ال sclera بتبعد في تثبيتها عن ال sclera في + +174 +00:12:11,520 --> 00:12:15,820 +المتوسط تقريبا 6 أو 9 من 10 ملي متر وقولنا هذه + +175 +00:12:15,820 --> 00:12:20,930 +الأرقامعساس انه في حال إجراء الجراحة يعرف الإنسان + +176 +00:12:20,930 --> 00:12:25,190 +أو الجراح بتاع العيون وين بده يعمل اللي هو ال + +177 +00:12:25,190 --> 00:12:28,710 +insigen أو الفتحة اللي يوصل منها لل muscle .. اللي + +178 +00:12:28,710 --> 00:12:34,060 +يوصل منها للمuscleطبعا تتثبت على بعد ستة وتسعة من + +179 +00:12:34,060 --> 00:12:37,580 +عشرة millimeter behind the temporal limbus its + +180 +00:12:37,580 --> 00:12:41,300 +sole primary action is abduction .. is abduction + +181 +00:12:41,300 --> 00:12:45,040 +.. إذا ال media rectus بتعمل abduction و ال + +182 +00:12:45,040 --> 00:12:49,260 +lateral rectus بتعمل abduction .. بتعمل abduction + +183 +00:12:49,260 --> 00:12:54,240 +الآن بالنسبة لل vertical rectus muscle في نقطة بدي + +184 +00:12:54,240 --> 00:12:59,980 +أقولها .. هذه النقطة أنه .. إيش معناه .. إيش معناه + +185 +00:13:00,230 --> 00:13:03,950 +ال media rectus وال lateral rectus muscle أو + +186 +00:13:03,950 --> 00:13:09,970 +muscles اللهم بس primary action طبعا لأن ال axis + +187 +00:13:09,970 --> 00:13:15,590 +بتاعهم موازي لل axis بتاع العين الموازي لل axis + +188 +00:13:15,590 --> 00:13:21,370 +بتاع العين يعني يعني كأنه منطبق على ال axis بتاع + +189 +00:13:21,370 --> 00:13:25,230 +العين يعني كأنه منطبق على ال axis بتاع العين أي + +190 +00:13:25,230 --> 00:13:30,580 +عضلة .. أي عضلة ال axis بتاعها موازيةلأكسس تاع + +191 +00:13:30,580 --> 00:13:34,400 +العين بيكون إلها action واحد فقط .. action واحد + +192 +00:13:34,400 --> 00:13:38,720 +فقط .. أي عضلة محورها يختلف عن محور العين يعني + +193 +00:13:38,720 --> 00:13:42,820 +بينهم زاوية هيكون في عين دي أنا أكتر من action .. + +194 +00:13:42,820 --> 00:13:46,480 +أكتر من action .. هذه قاعدة بنعيدها مرة تانية .. + +195 +00:13:46,480 --> 00:13:51,200 +لما محور العضلة ومحور العين يكونوا متوازيات ساعتها + +196 +00:13:51,200 --> 00:13:58,570 +العضلة إلها action واحد .. لما ..محور العضلة ومحور + +197 +00:13:58,570 --> 00:14:03,010 +العين يكونوا مش متوازيات ساعتها إلها أكتر من أكتر + +198 +00:14:03,010 --> 00:14:06,070 +نضرب مثال، هاي أنا عندي محور العين، أنا هأشر عليه + +199 +00:14:06,070 --> 00:14:10,190 +ومش مرسوم، هذا المحور اللي هو مثلا محور العين ال + +200 +00:14:10,190 --> 00:14:15,530 +axis of the eye ال axis of the eye ومثلا هاي ال + +201 +00:14:15,530 --> 00:14:19,570 +inferior oblique muscle هل هما متوازين؟ طبعا لأ، + +202 +00:14:19,570 --> 00:14:22,330 +يعني في بينهم زاوية وزاوية كبيرة، يعني هاي محور + +203 +00:14:22,330 --> 00:14:26,500 +عضلة ال inferior oblique ماشي بالشكل هذاوهي محور + +204 +00:14:26,500 --> 00:14:30,400 +العين ماشي بالشكل هذا .. يعني مابناش نقول متعامدين + +205 +00:14:30,400 --> 00:14:34,420 +ولكن بينهم زاوية كبيرة .. بينهم زاوية كبيرة طالما + +206 +00:14:34,420 --> 00:14:37,040 +في بينهم زاوية كبيرة معناته ال inferior oblique + +207 +00:14:37,040 --> 00:14:40,980 +muscle لها أكثر من action .. لها أكثر من action .. + +208 +00:14:40,980 --> 00:14:46,910 +فهذا الكلامضروري احنا نستوعبه مثال آخر، هذه العضلة + +209 +00:14:46,910 --> 00:14:51,070 +الفوجانية على الآخر اللي بتلف عبر البكرة هاي اللي + +210 +00:14:51,070 --> 00:14:54,090 +بيسموها الاتروكليا، هذه ال superior oblique muscle + +211 +00:14:54,090 --> 00:14:59,010 +و بتيجي تتحول ل tendon، تتحول لرباط، و هذا الرباط + +212 +00:14:59,010 --> 00:15:01,850 +بنزل تحت ال superior rectus muscle، هاي ال + +213 +00:15:01,850 --> 00:15:04,900 +superior rectusو كنت ساني أقول طب و إيش هذه + +214 +00:15:04,900 --> 00:15:08,000 +العضلة؟ هذه العضلة ال elevator بالpebre superioris + +215 +00:15:08,000 --> 00:15:11,520 +العضلة اللي بترفع الجفن ال superior oblique مصلحة + +216 +00:15:11,520 --> 00:15:16,920 +.. نمشي معاها .. نمشي معاها دخلت في الأتروكليا + +217 +00:15:16,920 --> 00:15:23,340 +تحولت لتندون و دخلت في الأتروكليا و مشيت مع .. صار + +218 +00:15:23,340 --> 00:15:27,380 +لأ insertion يعني اتجاه ال axis بتاعها هيكممكن + +219 +00:15:27,380 --> 00:15:30,420 +ساينجول اتجاه ال axis بتاعها هيك لأ اتجاه ال axis + +220 +00:15:30,420 --> 00:15:35,640 +بتاعها باتجاه الهتروكلية طبعا هذا مش منطبق او مش + +221 +00:15:35,640 --> 00:15:38,660 +موازي لمحور العين هاي محور العين هاي ال axis بتاعه + +222 +00:15:38,660 --> 00:15:42,080 +وهاي ال axis بتاع ال superior oblique muscle طالما + +223 +00:15:42,080 --> 00:15:45,500 +ال axis بتاع ال superior oblique و ال axis بتاع + +224 +00:15:45,500 --> 00:15:52,920 +العين مش متوازين معناته في اكثر من action لهذه ال + +225 +00:15:52,920 --> 00:15:57,460 +muscle اذا نلخص القاعدة نقول اي عضلةال axis بتاع + +226 +00:15:57,460 --> 00:16:01,520 +العضلة موازي لل axis بتاع العين، إذا هذه العضلة + +227 +00:16:01,520 --> 00:16:06,020 +إلها action واحد، إذا كان ال axis بتاع العضلة مش + +228 +00:16:06,020 --> 00:16:10,780 +موازي لل axis بتاع العين، هذه إلها أكتر من action + +229 +00:16:10,780 --> 00:16:13,420 +.. إلها أكتر من action .. إلها ال primary action + +230 +00:16:13,420 --> 00:16:17,200 +وال secondary action .. ال primary action وال + +231 +00:16:17,200 --> 00:16:24,260 +secondary actionطبعا بنانيجي نحكي عن ال vertical + +232 +00:16:24,260 --> 00:16:28,760 +rectus muscles و هذا هنأجله ان شاء الله تعالى + +233 +00:16:28,760 --> 00:16:33,380 +للمحاضرة التالتة أو التالية عفواً اللي المحاضرة + +234 +00:16:33,380 --> 00:16:36,940 +رقم خمسة هتكون و يعطيكم العافية والسلام عليكم + +235 +00:16:36,940 --> 00:16:38,320 +ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/9pjuQ2z4mJ0_raw.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/9pjuQ2z4mJ0_raw.srt new file mode 100644 index 0000000000000000000000000000000000000000..2419d280bba01df2729c8758fc2d1f23c0c81c8b --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/9pjuQ2z4mJ0_raw.srt @@ -0,0 +1,1736 @@ +1 +00:00:01,670 --> 00:00:05,350 +بسم الله الرحمن الرحيم بنواصل محاضرات حوال واحد + +2 +00:00:05,350 --> 00:00:10,010 +ووصلنا ل ال clinical evaluation of strabismus يعني + +3 +00:00:10,010 --> 00:00:16,370 +التقييم الطبي لمرض الحوال وفي أشياء ضروري جدا + +4 +00:00:16,370 --> 00:00:22,270 +نعرفها حين نبدأ في تقييم المريض طبعا أول حاجة بدنا + +5 +00:00:22,270 --> 00:00:26,330 +نقييمها عند المريض هي ال historyقصة المرض و تاريخ + +6 +00:00:26,330 --> 00:00:30,810 +المرض ال history ضروري في موضوع الحول جدا .. جدا + +7 +00:00:30,810 --> 00:00:35,990 +.. جدا و مش بس في موضوع الحول في أي مرض طبي بيبدأ + +8 +00:00:35,990 --> 00:00:42,550 +المختص أو الكادر الطبي سواء طبيب أو أخصاء بصريات + +9 +00:00:42,550 --> 00:00:46,610 +أو أي مختص في أي مجال من المجالات الطبية بيبدأ + +10 +00:00:46,610 --> 00:00:51,610 +ياخد قصة المرضسواء من المريض نفسه أو إذا كان + +11 +00:00:51,610 --> 00:00:56,650 +المريض صغير أو طفل بي .. بيسأل .. بيسأل الأهل عن + +12 +00:00:56,650 --> 00:01:01,910 +قصة المرض كيف بدأت و كيف اتطورت و هل مثلا ..يعني + +13 +00:01:01,910 --> 00:01:09,290 +.. يعني ذهب للفحص من قبل و ما إلى ذلك طبعا ال + +14 +00:01:09,290 --> 00:01:14,750 +history عندنا هنا مقسم لأقسام ضروري جدا أخصائي + +15 +00:01:14,750 --> 00:01:18,310 +البصريات يبدأ بالسؤال عنه أول شيء بدأ نسأل عنه في + +16 +00:01:18,310 --> 00:01:22,190 +ال history اللي هو ال age of onset متى بدأ الحول + +17 +00:01:22,190 --> 00:01:28,150 +ضروري جدا نعرف متى بدأ الحول مثال طفل عمره خمس + +18 +00:01:28,150 --> 00:01:34,370 +سنين يعني ..احضروا والده او والدته على مركز ال .. + +19 +00:01:34,370 --> 00:01:40,950 +العيون او المركز الطبي مثلا او المستشفى عشان يفحص + +20 +00:01:40,950 --> 00:01:44,730 +ليس معناه انه عمره خمس سنين ان القضية بدأت عنده + +21 +00:01:44,730 --> 00:01:48,790 +على عمر خمس سنين او قبل شهر او شهرين من ال history + +22 +00:01:48,790 --> 00:01:53,120 +ممكن نعرف مثلالمّا نسأل عن متى بدأ الحوال ممكن + +23 +00:01:53,120 --> 00:01:57,040 +تكون الإجابة أنه من عمر سنة أو ست شهور أو حتى من + +24 +00:01:57,040 --> 00:02:01,280 +الولادة فضروري جدا نسأل متى بدأ الحوال اللي هو age + +25 +00:02:01,280 --> 00:02:04,700 +of onset ليش؟ لأنه بيعطينا .. can give an + +26 +00:02:04,700 --> 00:02:08,460 +indicationas to the etiology of a student ممكن + +27 +00:02:08,460 --> 00:02:12,760 +السن اللي بدأ فيه الحوال عند الطفل يعني يعطيني + +28 +00:02:12,760 --> 00:02:17,040 +فكرة .. فكرة عن السبب بتاع الحوال في قاعدة في .. + +29 +00:02:17,040 --> 00:02:20,040 +في هذا الموضوع ان the earlier the onset the more + +30 +00:02:20,040 --> 00:02:23,640 +likely the need for surgical correction the later + +31 +00:02:23,640 --> 00:02:26,380 +the onset the greater the likelihood of an + +32 +00:02:26,380 --> 00:02:29,920 +accommodative component mostly arising between + +33 +00:02:29,920 --> 00:02:34,290 +تمانتاش و ستة و تلاتين شهر ماعنى القاعدةالقاعدة هي + +34 +00:02:34,290 --> 00:02:39,450 +بتقول أنه كل ما كان الحوال ظهر في مرحلة مبكرة جدا + +35 +00:02:39,450 --> 00:02:44,850 +من العمور، كل ما كنا احنا محتاجينانه نتدخل جراحيا + +36 +00:02:44,850 --> 00:02:49,510 +لتصحيح الحول يعني عملية حول وكل ما كان ظهور الحول + +37 +00:02:49,510 --> 00:02:54,710 +متأخر نوعا ما في عمر بين سنة و نص لتالت سنين أو + +38 +00:02:54,710 --> 00:02:59,110 +حتى بعد ذلك ساعتها احنا ممكن نبدأ نفكر في موضوع + +39 +00:02:59,110 --> 00:03:04,450 +انه سبب الحول هو accommodation وما يتعلق بال + +40 +00:03:04,450 --> 00:03:07,930 +accommodation من convergence وما إلى ذلك ما السبب + +41 +00:03:07,930 --> 00:03:10,870 +في هذه القاعدة؟ يعني ليش العلماء حطوا هذه القاعدة + +42 +00:03:12,020 --> 00:03:15,560 +العلماء حطوا هذه القاعدة بناء على دراسات كتيرة على + +43 +00:03:15,560 --> 00:03:21,900 +عدد يعني كبير جدا من الأطفال واستنتجوا هذه القاعدة + +44 +00:03:21,900 --> 00:03:26,780 +اللي هي استنتاج منطقي يعني طفل مثلا لو سألنا أهله + +45 +00:03:26,780 --> 00:03:32,120 +متى بدأ عنده الحوال كانت الإجابة أنه احنا بدأنا + +46 +00:03:32,120 --> 00:03:35,940 +نلاحظ عليه الحوال في عمر تلت شهور أو أربع شهور أو + +47 +00:03:35,940 --> 00:03:40,000 +خمس شهور بنسأل نفسنا السؤال يا ترى اللي عمره خمس + +48 +00:03:40,000 --> 00:03:45,650 +شهور أو ست شهورمحتاج يعمل accommodation ولا مش + +49 +00:03:45,650 --> 00:03:48,630 +محتاج يعمل accommodation؟ الحقيقة أنه حاجته لل + +50 +00:03:48,630 --> 00:03:52,550 +accommodation قليلة جدا لأنه في العمر المبكر جدا + +51 +00:03:52,550 --> 00:03:55,870 +.. في العمر المبكر جدا الطفل لا بيقرأ ولا بيكتب + +52 +00:03:55,870 --> 00:03:59,630 +ولا حتى بيدقق في الألعاب أو كده الأشياء أو ال + +53 +00:03:59,630 --> 00:04:02,590 +targets اللي بتطلع عليها اللي هي أوجه الناس + +54 +00:04:02,590 --> 00:04:06,990 +المحيطة في وجه والده و والدته أخو لي أكبر منه أخته + +55 +00:04:06,990 --> 00:04:10,290 +لي أكبر منهفبالتالي هذه ال targets .. ال targets + +56 +00:04:10,290 --> 00:04:13,430 +اللي بتطلع عليها تعتبر كبيرة نوعا ما و بدهاش + +57 +00:04:13,430 --> 00:04:16,930 +accommodation فبالتالي إذا لجينا في هذا السن حوال + +58 +00:04:16,930 --> 00:04:21,570 +غالبا هذا السن وجود الحوال فيه غالبا .. بنقولش + +59 +00:04:21,570 --> 00:04:24,650 +مائة بالمائة ولكن غالبا بيعطينا فكرة أن هذا الحوال + +60 +00:04:24,650 --> 00:04:28,350 +بحتاج تدخل جراحي لأنه ليس له غالبا علاقة بال + +61 +00:04:28,350 --> 00:04:32,290 +accommodation طبعا في نقطة قبل ما نتحرك بنقول أنه + +62 +00:04:32,290 --> 00:04:36,750 +ال history ما بعطينيش تشخيصال history أنا بستخدمه + +63 +00:04:36,750 --> 00:04:41,290 +و باستعين فيه عشان أضيفه للفحوصات اللي بعدين + +64 +00:04:41,290 --> 00:04:46,830 +هعملها و أصل للتشخيص بالشكل علمي سليم، يعني أما ال + +65 +00:04:46,830 --> 00:04:50,030 +.. ال history ضروري جدا صحيح بس هو هيعطيني فكرة + +66 +00:04:50,030 --> 00:04:55,110 +أنا وين .. يعني او وين الاتجاه اللي الفحوصات لازم + +67 +00:04:55,110 --> 00:04:59,990 +يعني تجري فيه، اذا the earlier the onsetthe more + +68 +00:04:59,990 --> 00:05:03,550 +likely the need for surgical correction طيب الان + +69 +00:05:03,550 --> 00:05:06,990 +نص الاخر من القاعدة اللي .. اللي حكينا عنها انه + +70 +00:05:06,990 --> 00:05:10,110 +the later the onset كل مكان ظهور الحوال متأخر + +71 +00:05:10,110 --> 00:05:15,750 +قليلا يعني بعد عمر السنة و نص أو التلت سنوات اللي + +72 +00:05:15,750 --> 00:05:20,250 +هو من 18 ل 36 شهرو أحيانا بتأخر أكتر على عمر أربع + +73 +00:05:20,250 --> 00:05:23,770 +سنوات و خمس سنوات، معناته أنا بدأ أبدأ أفكر في ال + +74 +00:05:23,770 --> 00:05:27,130 +accommodation أن هو السبب في أنه نشأ الحوال عند + +75 +00:05:27,130 --> 00:05:31,110 +هذا الطفل، ليش؟ لأنه الحوال في .. إذا نشأ في عمر + +76 +00:05:31,110 --> 00:05:35,760 +سنة و نص فما فوق فأكترمعناته الطفل بدأ يلعب في + +77 +00:05:35,760 --> 00:05:39,580 +الألعاب، بدأ يحصل على ألعاب صغيرة، دخل الروضة على + +78 +00:05:39,580 --> 00:05:42,660 +عمر مثلا أربع سنوات، لاحظوا أنه بدأ الحاول عنده، + +79 +00:05:42,660 --> 00:05:46,260 +بدأ يكتب، بدأ يتعلم الكتابة، بدأ .. لازم أنه يدقق + +80 +00:05:46,260 --> 00:05:50,180 +في أشياء أو كلمات أصغر حجمها من حجم ال targets + +81 +00:05:50,180 --> 00:05:55,070 +اللي كان يدقق فيهاقبل ذلك، اذا لما انا بيكون + +82 +00:05:55,070 --> 00:06:00,170 +السؤال متى بدأ الحوار عند الطفل وبيكون الجواب انه + +83 +00:06:00,170 --> 00:06:05,190 +مبكر جدا معناته انا اتجاهي .. اتجاه التفكير بتاعي + +84 +00:06:05,190 --> 00:06:08,330 +و هذا ليس قرار نهائي، اتجاه التفكير هيروح باتجاه + +85 +00:06:08,330 --> 00:06:12,810 +ان هذا الطفل ربما يحتاج تدخل جراحهأما إذا كانت + +86 +00:06:12,810 --> 00:06:16,250 +الإجابة إنه لأ في عمر ثلاث سنوات أو أربع سنوات، آه + +87 +00:06:16,250 --> 00:06:18,810 +رب .. ليش .. ليش ما ظهرش قبل هيك؟ آه لأنه مثلا + +88 +00:06:18,810 --> 00:06:22,210 +اتحق في الروضة أو بدأ يدقق في الألعاب أو شيء من + +89 +00:06:22,210 --> 00:06:24,930 +هذا .. أو بدأ يستعمل الجوال، حتى الأطفال الآن بت + +90 +00:06:24,930 --> 00:06:27,970 +.. بتستعمل اللي هو ال mobile أو شيء من هذا القبيل، + +91 +00:06:27,970 --> 00:06:34,480 +فبالتاليببدأ أفكر إنما ربما .. ربما تكون القضية .. + +92 +00:06:34,480 --> 00:06:38,300 +قضية accommodation هذه نقطة النقطة التانية في ال + +93 +00:06:38,300 --> 00:06:41,900 +history the longer the duration of squint in early + +94 +00:06:41,900 --> 00:06:45,780 +childhood the greater the risk of ampliopia unless + +95 +00:06:45,780 --> 00:06:50,160 +fixation is freely alternating طبعا ممكن إنسان + +96 +00:06:50,160 --> 00:06:55,520 +يجيب ابنه أو بنته عمره مثلا ست أو سبع سنوات السؤال + +97 +00:06:55,520 --> 00:07:00,890 +لما بيطرح متى بدأ الحوالفجال على عمر سنة، الآن + +98 +00:07:00,890 --> 00:07:03,890 +الطفل أو الطفلة عمره ست أو سبع سنوات، يعني الحوال + +99 +00:07:03,890 --> 00:07:08,150 +إله خمس سنين أو ست سنين عند الطفل، الطفل الآن عمره + +100 +00:07:08,150 --> 00:07:11,670 +سبع سنوات من عمر السنة بدأ عنده الحوال، معناته أنا + +101 +00:07:11,670 --> 00:07:16,390 +بسير عندي الفكر، أيضا بسير أفكر في قضية هل الطفل + +102 +00:07:16,390 --> 00:07:19,810 +عنده كسل ولا لأ، لأن مدة الحوال طويلة، اذا the + +103 +00:07:19,810 --> 00:07:23,310 +longer the duration of squint in early childhood, + +104 +00:07:23,830 --> 00:07:27,690 +the greater the risk of amblyopiaما لم .. ما لم في + +105 +00:07:27,690 --> 00:07:32,650 +الفحص يثبت عندي انه ال fixation alternating يعني + +106 +00:07:32,650 --> 00:07:36,470 +عين اليمين بتعمل fixation لفترة و العين الشمال + +107 +00:07:36,470 --> 00:07:38,890 +بيكون .. الشمال بيكون فيها ال squint بعدين + +108 +00:07:38,890 --> 00:07:43,650 +بتبادلوا تصير الشمال هي ال fixating و اليمين بتصير + +109 +00:07:43,650 --> 00:07:46,570 +squinting فبالتالي اذا في عندي alternating + +110 +00:07:46,570 --> 00:07:54,370 +fixation بصورة مريحة ساعتها بيكون عندي انا ..يعني + +111 +00:07:54,370 --> 00:07:58,750 +مابخافش من موضوع ال amblyopia طيب، الآن بنيجي + +112 +00:07:58,750 --> 00:08:03,970 +لنقطة أنه أحيانا بنسأل الأهل أمتى بدل حوالي بيكون + +113 +00:08:03,970 --> 00:08:08,590 +الإجابة مش واضحة ومحددة، مش واضحة ومحددة أو فيها + +114 +00:08:08,590 --> 00:08:13,790 +يعني عدم دقة في التحديد، ساعتها أنا بطلب من الأهل + +115 +00:08:13,790 --> 00:08:18,960 +إحضار صورphotography لطفل من مراحل عمرية مختلفة من + +116 +00:08:18,960 --> 00:08:23,320 +بداية حياته لغاية السن اللي هو إجاني فيه ليش؟ لأن + +117 +00:08:23,320 --> 00:08:27,460 +inspection of previous photographs may be useful + +118 +00:08:27,460 --> 00:08:31,720 +for the documentation of strabismus أو ال abnormal + +119 +00:08:31,720 --> 00:08:35,580 +head posture لما أطلع على صور قديمة .. لما أطلع + +120 +00:08:35,580 --> 00:08:41,600 +على صور قديمةبتفيدني في اني احدد ايش نوع الحوال + +121 +00:08:41,600 --> 00:08:44,760 +اللي كان موجود و من اي سن بدأ .. ايش نوع الحوال + +122 +00:08:44,760 --> 00:08:48,340 +اللي كان موجود و من اي سنة و ايضا بتفيدني الصور + +123 +00:08:48,340 --> 00:08:52,000 +القديمة في انها تحددلي اذا كان في abnormal head + +124 +00:08:52,000 --> 00:08:55,940 +posture ولا لا مثال على ذلك، انسان اجا عندنا عنده + +125 +00:08:55,940 --> 00:08:59,780 +exotropia .. exotropia حوال وحش يعني العين بتحرف + +126 +00:08:59,780 --> 00:09:07,360 +للخارج و أثناء ما كنا ناخد ال historyهل عملت + +127 +00:09:07,360 --> 00:09:10,840 +عمليات قبل ذلك؟ نعم عملت عمليات طب وين تقرير + +128 +00:09:10,840 --> 00:09:14,840 +العملية؟ مش موجود، ضايع العملية من عدة سنوات وانا + +129 +00:09:14,840 --> 00:09:18,660 +ما .. يعني ماحتفظتش بأوراق أو ضاعت الأوراق إلى + +130 +00:09:18,660 --> 00:09:22,880 +آخرين طيب، الآن السؤال هو عنده الآن Exotropia عمره + +131 +00:09:22,880 --> 00:09:27,320 +مثلا خمستاش أو عشرين سنة وعنده Exotropia وعامل + +132 +00:09:27,320 --> 00:09:31,140 +عملية هو متذكر تماما أنه تم و هو صغير له إجراء + +133 +00:09:31,140 --> 00:09:36,700 +عملية حول طيب، هل هي مثلا كانت Esotropiaوصار over + +134 +00:09:36,700 --> 00:09:40,160 +correction بالعملية الأولى فجلبت exotropia يعني + +135 +00:09:40,160 --> 00:09:44,440 +كان الحوال أنسى للداخل exotropia وصار over + +136 +00:09:44,440 --> 00:09:49,420 +correction يعني اترخت العضلات بزيادة واتحولت ل + +137 +00:09:49,420 --> 00:09:54,900 +exotropia ولا كان exotropia كمية كبيرة وكان تصحيح + +138 +00:09:54,900 --> 00:10:00,760 +جزء منها وظل يعني جزء تبقى من ال exotropia فأحيانا + +139 +00:10:00,760 --> 00:10:06,830 +ال old photo ال old photoبتساعد كتير في هذه القضية + +140 +00:10:06,830 --> 00:10:13,210 +يعني .. يعني في إحدى المرات تم عرض مريض على طبيب + +141 +00:10:13,210 --> 00:10:19,750 +عيون و المريض هذا عنده فعلا exotropia و كان المريض + +142 +00:10:19,750 --> 00:10:24,470 +يعني ..مش متذكر اتجاه الحوال .. بالنظر للصور في .. + +143 +00:10:24,470 --> 00:10:28,650 +في .. صوره في الطفولة احدها تقريبا خمس او ست صور + +144 +00:10:28,650 --> 00:10:32,890 +تم اكتشاف ان هذه كانت ايزوتروبيا يعني عينه كانت + +145 +00:10:32,890 --> 00:10:38,710 +تحرف للداخل وبعد العملية اللي أجراها في سن الطفولة + +146 +00:10:38,920 --> 00:10:43,760 +يعني تحولت من إيزو تروبيا لإكزو تروبيا فبالتالي تم + +147 +00:10:43,760 --> 00:10:47,400 +معرفة إيش العملية السابقة فال inspection of + +148 +00:10:47,400 --> 00:10:52,360 +previous photographs ممكن يكون يعني useful كتير في + +149 +00:10:52,360 --> 00:10:57,920 +أنه يعرفني نوع الحول وحتى أحيانا أقترب من السن + +150 +00:10:57,920 --> 00:11:02,380 +اللي بدأ فيه الحول حسب السن المتوقع من الصورة اللي + +151 +00:11:02,380 --> 00:11:06,360 +تم إحضارهاأيضا بعرفني إذا كان في abnormal head + +152 +00:11:06,360 --> 00:11:10,000 +posture ولا مافيش abnormal head posture تاني إشي + +153 +00:11:10,000 --> 00:11:14,540 +لازم أسأل المريض عنه اللي هي هل في أعراض للحوال + +154 +00:11:14,540 --> 00:11:19,060 +غير العرض الجمالي، غير العرض الجمالي، هل في + +155 +00:11:19,060 --> 00:11:23,740 +symptoms ولا لا، حقيقة ال symptoms الحوال عموما + +156 +00:11:23,740 --> 00:11:27,510 +مالوش symptomsيعني لا في ألم ولا في شيء من هذا + +157 +00:11:27,510 --> 00:11:31,970 +القبيل ولكن في نوعين من الحوال .. نوعين من الحوال + +158 +00:11:31,970 --> 00:11:36,450 +بيكون معهم في أعراض إيش هم النوعين؟ أول حاجة + +159 +00:11:36,450 --> 00:11:40,750 +decomposition of a pre-existing heterophoria يعني + +160 +00:11:40,750 --> 00:11:44,850 +في حوال خفي بدأ يصيرله decomposition بدأ يعني + +161 +00:11:44,850 --> 00:11:48,630 +ينهار ويتحول لحوال غير .. إذا decompensating + +162 +00:11:48,630 --> 00:11:55,280 +heterophoria أو .. أو ..recently acquired parotic + +163 +00:11:55,280 --> 00:12:01,040 +او paralytic condition اما حاول شللي ايجي فجأةيعني + +164 +00:12:01,040 --> 00:12:05,940 +حديث الظهور حول شللي حديث الظهور أو فوريا موجودة + +165 +00:12:05,940 --> 00:12:09,780 +من زمان بس بدأ يصير لها decomposition في هدول + +166 +00:12:09,780 --> 00:12:13,620 +الحالتين أو هدول النوعين من الحول بتبدأ تظهر + +167 +00:12:13,620 --> 00:12:18,800 +الأعراض .. بتبدأ تظهر الأعراض في قضية الفوريا لما + +168 +00:12:18,800 --> 00:12:23,850 +يصير لها decomposition بيكون عندي discomfortocular + +169 +00:12:23,850 --> 00:12:27,050 +discomfort العين مش مرتاحة مش قادرة تركز في إشي + +170 +00:12:27,050 --> 00:12:32,370 +blurring غباش و أحيانا ديبلوبيا إزدواجية في النظر + +171 +00:12:32,370 --> 00:12:36,830 +في النوع الأول في ال decomposition في ال .. ال .. + +172 +00:12:36,830 --> 00:12:40,710 +ال foria decomposition بيكون ال .. ال .. ال onset + +173 +00:12:40,710 --> 00:12:44,690 +indeterminate بيقدرش المريض يحددلي أمتى بتظهر + +174 +00:12:44,690 --> 00:12:48,310 +الأعراض و أمتى بتختفي بيجي مش كأنا أحيانا لما بقرأ + +175 +00:12:49,300 --> 00:12:52,380 +بيصير عندي ازدواجية في النظر و أحيانا بيصير عندي + +176 +00:12:52,380 --> 00:12:55,480 +غباش، أحيانا بحس أن عيني مش مرتاحة و هي بتقرأ، في + +177 +00:12:55,480 --> 00:12:59,400 +.. في إشي يعني بيشد على عيني، بنقوله طب إمتى + +178 +00:12:59,400 --> 00:13:03,020 +بالضبط؟ يعني بعد عشر دقائق من بدء القراءة أو بعد + +179 +00:13:03,020 --> 00:13:07,350 +عشر دقائق من ..يعني النظر في الجوال او مشابه + +180 +00:13:07,350 --> 00:13:10,910 +بيقدرش يحدد لبوه أحيانا مثلا بعد عشر دقائق أحيان + +181 +00:13:10,910 --> 00:13:14,850 +بقرأ نص ساعة بيكون الوضع كويس أحيانا بقرأ اتجيجة + +182 +00:13:14,850 --> 00:13:18,510 +ما .. يعني ما .. مافيش indeterminate onset and + +183 +00:13:18,510 --> 00:13:21,970 +duration يعني لا بيقدر يحدد امتى بتبدأ هذه الأعراض + +184 +00:13:21,970 --> 00:13:26,350 +ولا جداش بتستمر بينما في ال acquired paralytic او + +185 +00:13:26,350 --> 00:13:30,960 +paralytic squintيعني الحول الشللي طبعا عشان .. + +186 +00:13:30,960 --> 00:13:34,880 +عشان ما .. مانحتارش ال paralysis complete شلل + +187 +00:13:34,880 --> 00:13:39,260 +complete أما ال paralysis شلل جزئي، إذا parotic و + +188 +00:13:39,260 --> 00:13:42,820 +paralytic، parotic من .. من paralysis، paralysis + +189 +00:13:42,820 --> 00:13:48,340 +اللي هو حول جزئي أو شلل جزئي في العضلة، ما ينما + +190 +00:13:48,340 --> 00:13:53,460 +paralysis حول كامل، يعني complete شلل complete أو + +191 +00:13:53,460 --> 00:13:57,360 +شلل كامل في العضلةبينما في ال acquired condition + +192 +00:13:57,360 --> 00:14:00,380 +اللي هو ال paralysis أو ال paresis with sudden + +193 +00:14:00,380 --> 00:14:05,300 +onset of diplopia بيضل .. يعني بيقدر يحدد و يقول + +194 +00:14:05,300 --> 00:14:11,080 +مثلا أنا اتعرضت لحادث سير بعد ما ..استضمت فيا + +195 +00:14:11,080 --> 00:14:18,880 +السيارة او المركبة وقعت على الأرض اعتدلب فبديت + +196 +00:14:18,880 --> 00:14:22,040 +اشوف الشغل اللي هتنتل يعني بيقدر يحدد بالضبط + +197 +00:14:22,040 --> 00:14:25,520 +اللحظة اللي صار معاه القضية هاي بعكس + +198 +00:14:25,600 --> 00:14:29,940 +الـdecompensating phoria قضية الـ discomfort + +199 +00:14:29,940 --> 00:14:33,560 +والـpluring والديبلوبيا ما بيقدرش يحدد امت بده + +200 +00:14:33,560 --> 00:14:39,180 +وجداش يستمروا معاه الـtype of diplopia لا يكفي انه + +201 +00:14:39,180 --> 00:14:43,220 +اسأل اذا كان المريض شك من ديبلوبيا لازم اسأله اكمل + +202 +00:14:43,220 --> 00:14:46,860 +في السؤال في ال history طبعا هل الديبلوبيا + +203 +00:14:46,860 --> 00:14:50,490 +horizontal؟والا هل الديبلوبيا cyclo-vertical عشان + +204 +00:14:50,490 --> 00:14:55,090 +ابدأ تفكيري اوجهه باتجاه اي من العضلات هل هي ال + +205 +00:14:55,090 --> 00:14:58,890 +horizontal muscles ولا ال cyclo-vertical او ال + +206 +00:14:58,890 --> 00:15:02,170 +vertically acting muscles طبعا the type of + +207 +00:15:02,170 --> 00:15:05,000 +diplopia should beestablished should be + +208 +00:15:05,000 --> 00:15:09,620 +established أيضا مش بس هيك ال direction of gaze in + +209 +00:15:09,620 --> 00:15:14,000 +which it predominates whether any binocular single + +210 +00:15:14,000 --> 00:15:17,260 +vision is retained يعني ضروري كمان اسأله هل + +211 +00:15:17,260 --> 00:15:21,560 +الدبلوبيا بتزيد في اتجاه معين مثلا في ال right sex + +212 +00:15:21,560 --> 00:15:24,540 +nerve palsy لما المريض يتطلع على ال right هتزيد + +213 +00:15:24,540 --> 00:15:28,240 +الدبلوبيالما المريض يتطلع على ال right في حالة ال + +214 +00:15:28,240 --> 00:15:31,680 +right six nerve pulse هتزيد الدبلوبيا و ايه بدأ + +215 +00:15:31,680 --> 00:15:35,680 +اسأله هل لو انت اتطلعت باتجاه معين بتلاحظ ان + +216 +00:15:35,680 --> 00:15:38,640 +الدبلوبيا راحت ايش يعني الدبلوبيا راحت يعني تم + +217 +00:15:38,640 --> 00:15:42,280 +استعادة ال binocular single vision ايضا في نفس + +218 +00:15:42,280 --> 00:15:45,220 +المثال اللي ضربناه قبل شوية right six nerve pulse + +219 +00:15:45,220 --> 00:15:49,420 +غالبا لما المريض بيتطلع على الشمال بيكون عنده + +220 +00:15:49,420 --> 00:15:53,660 +الدبلوبيا مافيش مش موجودة لأنه بيبعد عن منطقة عمل + +221 +00:15:53,660 --> 00:15:59,310 +ال paralytic musclein adults وهنا سؤال مهم جدا + +222 +00:15:59,310 --> 00:16:02,670 +ضروري أسأله للمريض لما المريض الحاول بيكون مش طفل + +223 +00:16:02,670 --> 00:16:06,410 +بيكون adult it is very important to determine + +224 +00:16:06,410 --> 00:16:10,950 +exactly what problems the squint is causing as a + +225 +00:16:10,950 --> 00:16:15,540 +basis for decisions about treatmentلازم أسأل + +226 +00:16:15,540 --> 00:16:19,440 +المريض ليش أو إيش المشكلة اللي مسببلك إياها + +227 +00:16:19,440 --> 00:16:23,300 +الحوار، هل هي يعني ممكن ييجي يشكي من أعرض، يقول + +228 +00:16:23,300 --> 00:16:27,360 +أنا عينيا يعني تعبانين أو مثلا بقاش عرض غباش أو + +229 +00:16:27,360 --> 00:16:32,000 +عيني بتقلمني، بتكونش هي ألم بمعنى ألم ولكن هو يعني + +230 +00:16:32,000 --> 00:16:36,560 +في خجل عند هذا المريضانه يحكي ان هو يعني المنظر + +231 +00:16:36,560 --> 00:16:40,400 +الجمالي للحوال مش عاجبه فبالتالي هو مش قادر يصرح + +232 +00:16:40,400 --> 00:16:45,720 +في هذا القضية ضروري انا يعني اجي بسؤال لطيف للمريض + +233 +00:16:45,720 --> 00:16:49,500 +و اقوله اذا كان ان الحوالة ده مزعجك من ناحية + +234 +00:16:49,500 --> 00:16:55,330 +جماليةهنلاقي غالبا الإجابة انه نعم و طبعا هو طبعا + +235 +00:16:55,330 --> 00:16:59,250 +بيكون مش .. او .. او يعني في قليل من الخجل انه + +236 +00:16:59,250 --> 00:17:03,850 +يعني .. يعني يعبر عن انه رغبته في تحسين ال .. ال + +237 +00:17:03,850 --> 00:17:08,510 +.. المنظر الجمالي للهنتين بأكتر من قضية انه في + +238 +00:17:08,510 --> 00:17:13,750 +ocular discomfort او ما شابه it is un .. it is not + +239 +00:17:13,750 --> 00:17:17,850 +unusualfor patients to present with spurious + +240 +00:17:17,850 --> 00:17:21,030 +symptoms which mask embarrassment over a + +241 +00:17:21,030 --> 00:17:25,630 +cosmetically noticable scoundrel يعني ليس نادرا .. + +242 +00:17:25,630 --> 00:17:30,730 +ليس نادرا يعني بحدث كتير أن المريض بيجي و ببدأ + +243 +00:17:30,730 --> 00:17:36,930 +يحكي في أعراض هذه الأعراض بيخفي تحتها رغبته في أنه + +244 +00:17:36,930 --> 00:17:44,160 +يتخلص منال .. ال squint اللي مسببله مشكلة جمالية + +245 +00:17:44,160 --> 00:17:48,260 +فضروري انا اكون بسؤال لطيف اني اسأل عن هذا الموضوع + +246 +00:17:48,260 --> 00:17:53,700 +عساس ايضا من حق المريض انه يحصل على الشكل الجمالي + +247 +00:17:53,700 --> 00:17:59,960 +سواء بعملية جراحية او ..ب .. ب .. بشيء آخر يعني + +248 +00:17:59,960 --> 00:18:04,360 +مثلا عدسات لاصقة أو ما شابه و هذا احنا نحكي عنه في + +249 +00:18:04,360 --> 00:18:07,920 +موضوع العلاج للسكوينت في النضارات و العدسات + +250 +00:18:07,920 --> 00:18:11,740 +اللاصقة و العمليات الجراحية و المنشير و ما إلى ذلك + +251 +00:18:11,740 --> 00:18:15,280 +فبالتالي ضروري اسأل عن هذه القضية تالت شيء بدي + +252 +00:18:15,280 --> 00:18:19,260 +اسأل عنه ال variability ال variability اللي هي + +253 +00:18:19,260 --> 00:18:23,300 +التغير بتاع الحواك ال significant لأن في عند حشتي + +254 +00:18:24,330 --> 00:18:27,770 +في عندي intermittent strabismus وفي عندي + +255 +00:18:27,770 --> 00:18:31,270 +alternating strabismus يعترى إيش ال intermittent + +256 +00:18:31,270 --> 00:18:35,950 +strabismus وإيش ال alternating وكيف أميز بينهم هاي + +257 +00:18:35,950 --> 00:18:39,930 +أنا عندي المنظر العلوي هنا نطلع على عرض مكبر + +258 +00:18:39,930 --> 00:18:45,890 +المنظر العلوي هذا بيسموه intermittent exotropia + +259 +00:18:45,890 --> 00:18:49,750 +إذا ملاحظين هنا العينين straight تماما مافيش أي + +260 +00:18:49,750 --> 00:18:54,830 +حولفي لحظات معينة من النهار بتلاقي إحدى العينتين + +261 +00:18:54,830 --> 00:18:58,030 +حرفة يا إما الشمال زي المنظر هذا ما بيغضب هذه + +262 +00:18:58,030 --> 00:19:02,590 +fixating وهذه الآن فيها exotropia بعد شوية المريض + +263 +00:19:02,590 --> 00:19:06,470 +انتبه عدل عينيه هذا بيسموه intermittent حوال متقطع + +264 +00:19:06,470 --> 00:19:11,200 +حوال متقطع والغالبية العظمى من النهاربتكون عينيه + +265 +00:19:11,200 --> 00:19:14,060 +معتدلة يعني فيش حوار .. يعني فيه binocular single + +266 +00:19:14,060 --> 00:19:17,960 +vision هذه القضية بسميها intermittent squint .. + +267 +00:19:17,960 --> 00:19:21,500 +intermittent squint الان في عندي حاجة اسمها + +268 +00:19:21,500 --> 00:19:25,360 +alternating squint .. alternating تبادل يعني + +269 +00:19:25,360 --> 00:19:29,600 +هالجيت المنظر التاني العين اليمين عاملة fixation + +270 +00:19:29,600 --> 00:19:34,170 +والعين الشمال داخلة إيزوتروبيابعد فترة من الزمن في + +271 +00:19:34,170 --> 00:19:38,650 +.. في نفس اليوم بنلاقي العين الشمال عاملة fixation + +272 +00:19:38,650 --> 00:19:42,410 +والعين اليمين داخلة لجوة هذا بيسموه alternating + +273 +00:19:42,410 --> 00:19:46,210 +strabismus الان في انسان ممكن يسأل سؤال طب هل ممكن + +274 +00:19:46,210 --> 00:19:49,230 +ال intermittent strabismus يكون في نفس الوجه + +275 +00:19:49,230 --> 00:19:54,460 +alternating؟ يعني هاي العينين التنتين straightبعد + +276 +00:19:54,460 --> 00:20:01,320 +فترة صرح او ركز في شيء او يعني نعس او كده بدت يظهر + +277 +00:20:01,320 --> 00:20:05,340 +الحوال على العين الشمال بعديك انتبه عدا العينية + +278 +00:20:05,340 --> 00:20:10,200 +ممكن المرة اللي بعديها تكون العين الشمال fixating + +279 +00:20:10,200 --> 00:20:12,500 +والعين اليمين فيها exo اه نعم ممكن يكون + +280 +00:20:12,500 --> 00:20:16,320 +intermittent وفي نفس الوجد alternating بس ضروري + +281 +00:20:16,320 --> 00:20:19,680 +نفهم ايش الفرق بين كلمة intermittent يعني متقطع + +282 +00:20:19,680 --> 00:20:26,300 +يعني لمابيروح الحوال العينين بيعدلوا هنا constant + +283 +00:20:26,300 --> 00:20:30,100 +squint بس alternating constant squint alternating + +284 +00:20:30,100 --> 00:20:33,260 +يعني أنه دائما الحوال موجود بس في إحدى العين تان + +285 +00:20:33,260 --> 00:20:38,720 +مرة بيحول لشمال و بيعدل ليمين و مرة بيعدل لشمال و + +286 +00:20:38,720 --> 00:20:42,660 +بيحول ليمين بس طول النهار في حوال سواء في high أو + +287 +00:20:42,660 --> 00:20:47,790 +في high أما هنا لأ هناغالبية العظمة من النهار + +288 +00:20:47,790 --> 00:20:51,430 +بيكون عيني عدلات، يعني binocular single vision، + +289 +00:20:51,430 --> 00:20:56,150 +لما بيصرح أو بينعس أو بيصفن في شيء، بنلاقي إحدى + +290 +00:20:56,150 --> 00:21:00,190 +العنتين ممكن تكون دائما تظهر في الشمال أو .. أو .. + +291 +00:21:00,190 --> 00:21:02,710 +و دائما تظهر في اليمين أو مرة بيظهر في الشمال، + +292 +00:21:02,710 --> 00:21:05,510 +يعني ممكن يكون intermittent و في نفس الوجد + +293 +00:21:05,820 --> 00:21:08,860 +alternating إذا نرجع لل variability بنقول is + +294 +00:21:08,860 --> 00:21:12,160 +significant because intermittent strabismus + +295 +00:21:12,160 --> 00:21:16,040 +indicates some degree of binocularity لما أنا في + +296 +00:21:16,040 --> 00:21:20,140 +ال history بسأل الأهل بقولهم كيف الحوال بيضرع انهم + +297 +00:21:20,140 --> 00:21:23,760 +بقولوله والله بيكون الإجابة انه والله غالبية + +298 +00:21:23,760 --> 00:21:30,060 +النهار عينيهعدلات مافيش حوال و ثواني قليلة جدا لما + +299 +00:21:30,060 --> 00:21:35,300 +بيركز في التلفزيون أو بيصرح أو بينعس بلاحظ لعدد + +300 +00:21:35,300 --> 00:21:38,500 +ثواني إحدى العين تان حرفته رجعت لما أنا باخد + +301 +00:21:38,500 --> 00:21:42,660 +معلومة منهم أن غالبيا العظمة من وقت النهار عينيا + +302 +00:21:42,660 --> 00:21:46,780 +عدلات معناتهمعناته تماما هذا عنده binocular single + +303 +00:21:46,780 --> 00:21:50,260 +vision ممتاز جدا الثواني البسيطة اللى بتحرف فيها + +304 +00:21:50,260 --> 00:21:53,620 +العين لن تؤثر أبدا على موضوع ال binocular single + +305 +00:21:53,620 --> 00:21:58,910 +vision أو تضعف منه فبالتاليبأكون أخدت فكرة أنه في + +306 +00:21:58,910 --> 00:22:02,970 +عيني some degree of binocularity هذه نقطة طيب لما + +307 +00:22:02,970 --> 00:22:07,370 +بنسأل مرة تانية في .. في مريض تاني بنقول الحوال + +308 +00:22:07,370 --> 00:22:10,090 +كيف أنتوا بتشوفوه نقوله والله احنا بنشوفه مرة في + +309 +00:22:10,090 --> 00:22:12,950 +العين الشمال ومرة في العين اليمين يعني مرة العين + +310 +00:22:12,950 --> 00:22:15,870 +اليمين بتكون عدلة والشمال فيها الحوال ومرة العين + +311 +00:22:15,870 --> 00:22:19,910 +الشمال .. الشمال عدلة وال .. واليمين فيها الحوال + +312 +00:22:19,910 --> 00:22:22,950 +هذا إيش بيفيدني أنا من ناحية history؟an + +313 +00:22:22,950 --> 00:22:26,590 +alternating deviation suggests symmetrical visual + +314 +00:22:26,590 --> 00:22:30,310 +acuity in both eye بنقولش ستة ع ستة في ال both eye + +315 +00:22:30,310 --> 00:22:36,820 +بنقول غالبا غالباال vision عندهم equal بالتالي + +316 +00:22:36,820 --> 00:22:40,520 +الدماغ مرة بيستقبل من هاي فبتصير هي اللي معتادلة و + +317 +00:22:40,520 --> 00:22:44,300 +بتحول هاي و مرة بيستقبل من هاي لو لأن الصورتين + +318 +00:22:44,300 --> 00:22:47,760 +واضحة في صورة العين اليمين و صورة العين الشمال + +319 +00:22:47,760 --> 00:22:51,860 +تقريبا نفس الوضوح يعني تقريبا نفس ال vision كان لل + +320 +00:22:51,860 --> 00:22:55,680 +brain اعتمد على العين الأوضح و صار عندى monocular + +321 +00:22:55,680 --> 00:23:00,210 +squint إذا ال alternating squintال alternating + +322 +00:23:00,210 --> 00:23:05,670 +squint بيعنيلي symmetrical visual acuity in both + +323 +00:23:05,670 --> 00:23:09,470 +eyes الآن بدنا نعرض فيديو عن ال alternating إيزو + +324 +00:23:09,470 --> 00:23:15,350 +تروبيا ونشوف كيف هذا الفيديو دي ايه دي role .. هاي + +325 +00:23:15,350 --> 00:23:20,030 +عندي right إيزو تروبيا الآن خليني بس هذا right + +326 +00:23:20,030 --> 00:23:26,730 +إيزو تروبيا الآن نشوف كيف هتجلب left إيزو تروبيا + +327 +00:23:26,730 --> 00:23:27,490 +بعد شوية + +328 +00:23:32,960 --> 00:23:37,520 +الان عمل cover test الان اصبحت left esotropia اذا + +329 +00:23:37,520 --> 00:23:42,800 +هدا alternating squint left + +330 +00:23:42,800 --> 00:23:49,560 +esotropia اذا + +331 +00:23:49,560 --> 00:23:56,680 +مرة right esotropia و مرة left esotropia طبعا + +332 +00:23:56,680 --> 00:24:01,220 +هو بدأ الفحص احنا بس تبهمنا الانالان right + +333 +00:24:01,220 --> 00:24:05,520 +esotropia مرة تانية انا بعرض الجزء اللي بهمنا هاي + +334 +00:24:05,520 --> 00:24:11,880 +right esotropia والعين الشمال fixating هاي اللي + +335 +00:24:11,880 --> 00:24:16,720 +لحظة قبل شوية اتحولت ل left eso لان هيساعده انه + +336 +00:24:16,720 --> 00:24:21,820 +يعمل fixation بال .. بال right eye أصبحت left + +337 +00:24:21,820 --> 00:24:24,300 +esotropia left esotropia + +338 +00:24:29,680 --> 00:24:34,340 +إذا هذا ال alternating esquent أيضا من ضمن الأشياء + +339 +00:24:34,340 --> 00:24:38,160 +اللي لازم أسأل عنها اللي هي ال general health ال + +340 +00:24:38,160 --> 00:24:39,100 +general health + +341 +00:24:43,160 --> 00:24:47,000 +ال general health اللي هي all developmental + +342 +00:24:47,000 --> 00:24:51,880 +problems are significant غالبا لما بتكون ال .. ال + +343 +00:24:51,880 --> 00:24:56,240 +general health تعبانة عند الطفل أو في عنده مشاكل + +344 +00:24:56,240 --> 00:25:01,360 +في النمو بيكون عنده فرصة نشوء حول عنده أعلى من + +345 +00:25:01,360 --> 00:25:05,580 +غيره عملوا دراسات فوجدوا أن الأطفال اللي عندهم شلل + +346 +00:25:05,580 --> 00:25:09,750 +دماغي cerebral palsyhave an increased incidence of + +347 +00:25:09,750 --> 00:25:12,790 +strabismus طبعا ال general health بتأثر على ال + +348 +00:25:12,790 --> 00:25:15,790 +brain بتضعف من قدرته على التحكم في عضلات العين + +349 +00:25:15,790 --> 00:25:19,810 +وبالتالي بيصير فرصة نشوء حوال أكتر ضروري أسأل إذا + +350 +00:25:19,810 --> 00:25:23,550 +كان فيه اندوشال الدماغي أو هل بيعاني من أي مرض من + +351 +00:25:23,550 --> 00:25:26,150 +الأمراض اللي بتصيب الأطفال + +352 +00:25:28,700 --> 00:25:32,200 +in older patients poor health and stress may cause + +353 +00:25:32,200 --> 00:25:35,980 +decompensation and in acquired paresis patients + +354 +00:25:35,980 --> 00:25:40,320 +may report association with or causal factors such + +355 +00:25:40,320 --> 00:25:43,780 +as trauma, neurological disease or diabetes طبعا + +356 +00:25:43,780 --> 00:25:48,380 +في المرضى اللي هم البالقين ال poor health و ال + +357 +00:25:48,380 --> 00:25:51,780 +stress ال stress يعني بقعد على الجوال مثلا ست سبعة + +358 +00:25:51,780 --> 00:25:56,700 +ساعات تمان ساعاتأو بيصهر كتير أو بتعرض لضغوطات + +359 +00:25:56,700 --> 00:26:00,840 +نفسية كتير ممكن تعمل decompensation عند هذا المريض + +360 +00:26:00,840 --> 00:26:04,620 +وتحول الفوريا لتروبيا .. و تحول الفوريا لتروبيا + +361 +00:26:04,620 --> 00:26:08,760 +بالنسبة لل acquired paresis ال patient اللي هو في + +362 +00:26:08,760 --> 00:26:13,020 +حالة الحوال الشلليال patients ممكن يعني يتذكرلي + +363 +00:26:13,020 --> 00:26:16,860 +بالضبط إيش السبب في هذا الحوار هل اتعرض ل trauma؟ + +364 +00:26:16,860 --> 00:26:21,880 +هل في عنده أمراض عصبية مثلا في الدماغ أو ما شابه + +365 +00:26:21,880 --> 00:26:25,980 +نزيف في الدماغ أو ورم أو شيء من هذا القبيل أو بعض + +366 +00:26:25,980 --> 00:26:29,960 +الأمراض المزمنة زي مرض السكري زي مرض السكري ضروري + +367 +00:26:29,960 --> 00:26:35,520 +أن أسأل إذا كان في trauma أو اتعرض لشيء معين أو هل + +368 +00:26:35,520 --> 00:26:40,280 +بيعاني من .. من أي مرض من الأمراضخامس شئ بدي أسأل + +369 +00:26:40,280 --> 00:26:44,820 +عنه ال birth history اللي هي فترة الحمل فترة الحمل + +370 +00:26:44,820 --> 00:26:49,220 +period of gestation ال birth weight ضروري جدا أسأل + +371 +00:26:49,220 --> 00:26:53,020 +عن الوزن عند الولادة لأن الوزن القليل جدا ممكن + +372 +00:26:53,020 --> 00:26:58,740 +يكون برضه مصاحب بعدم نضوج أو اكتمال في النمو ومن + +373 +00:26:58,740 --> 00:27:01,540 +ضمن الأشياء اللي ممكن ما تكونش اكتملت في النمو + +374 +00:27:01,540 --> 00:27:05,800 +أيضا اللي هي الشبكية وممكن هذا بالنهاية يؤدي لنشوء + +375 +00:27:05,800 --> 00:27:10,760 +الحوارand any problems in utero أو أي مشاكل حدثت + +376 +00:27:10,760 --> 00:27:15,040 +داخل الرحم أثناء فترة الحمل أيضًا أي مشاكل حدثت في + +377 +00:27:15,040 --> 00:27:18,640 +ال delivery في الولادة أو في ال neonatal period في + +378 +00:27:18,640 --> 00:27:22,660 +الشهر الأول من بعد الولادة من بعد الولادة ضروري + +379 +00:27:22,660 --> 00:27:27,720 +أسأل عن هذه الأشياء لأن كتير من الأشياء هذه أو + +380 +00:27:27,720 --> 00:27:31,590 +الأشياء هذه ممكن تؤدي إلى أنواع معينةمن الحاول + +381 +00:27:31,590 --> 00:27:35,770 +فضروري أني أنا أسأل عنها و أسجلها في ملاف المريض + +382 +00:27:35,770 --> 00:27:39,870 +سادس شئ بدي أسأل عنه ال family history مهم للغاية + +383 +00:27:39,870 --> 00:27:43,630 +ال family history أني أسأل عنه is important + +384 +00:27:43,630 --> 00:27:47,290 +because strabismus is frequently familial although + +385 +00:27:47,290 --> 00:27:51,440 +there is no definitive inheritance patternلأ غالبا + +386 +00:27:51,440 --> 00:27:56,140 +الحوال ممكن يكون منتشر في .. في عائلات بشكل كبير + +387 +00:27:56,140 --> 00:28:02,440 +بس مافيش يعني طريقة توريث محددة لسه الآن مااكتشفش + +388 +00:28:02,440 --> 00:28:07,160 +العلم ما هي الطريقة التي يورث بيهاالحوال بس هو + +389 +00:28:07,160 --> 00:28:11,100 +ممكن يكون منتشر في عائلات معينة وأنواع معينة في + +390 +00:28:11,100 --> 00:28:17,160 +الحوال فضروري أسأل هل مثلا الطفل اللي إجا عشان + +391 +00:28:17,160 --> 00:28:21,620 +يفحص هل مثلا أخوه أو أخته أو والده أو ولدته أو أحد + +392 +00:28:21,620 --> 00:28:26,480 +الأقرباء من الدرجة الأولى أو ما شابه هل بيعاني من + +393 +00:28:26,480 --> 00:28:32,120 +حوال وما هي وسائل العلاج اللي اتبعت مع هذا القريب + +394 +00:28:33,130 --> 00:28:36,550 +it is also important to know what therapy was + +395 +00:28:36,550 --> 00:28:40,870 +necessary in other family members مثال بنقول طفل + +396 +00:28:40,870 --> 00:28:45,630 +صغير عمره أربع سنوات إجاب إيزوتروبيا .. إيزوتروبيا + +397 +00:28:45,630 --> 00:28:51,850 +أثناء أخذ ال history الأهل لما سألناهم هل فيه إله + +398 +00:28:51,850 --> 00:28:56,170 +أحد الأقارب مثلا بيعاني من نفس القضيةكان الجواب + +399 +00:28:56,170 --> 00:29:01,190 +مثلا انه أخولي أكبر منه كان عنده نفس المشكلة ولبس + +400 +00:29:01,190 --> 00:29:04,670 +نضارة لطول النظر وعينيه اعتدله بالنضارة غالبا .. + +401 +00:29:04,670 --> 00:29:09,090 +غالبا يعني في تسعة و تسعين في المية او اكتر من ال + +402 +00:29:09,090 --> 00:29:13,430 +.. ال .. ال ..الحالات إذا الأخو لزمه نضارة واعتدله + +403 +00:29:13,430 --> 00:29:16,830 +عينيه بالنضارة غالبا نفس وسيلة العلاج هتكون هي + +404 +00:29:16,830 --> 00:29:21,350 +اللازمة للطفل طبعا احنا بنبنيش على ال history + +405 +00:29:21,350 --> 00:29:25,770 +لحاله بس احنا بيصير تفكيرنا او في .. في عقلنا + +406 +00:29:25,770 --> 00:29:29,890 +الباطن تدور فكرة ان طالما الأخو عنده accommodative + +407 +00:29:29,890 --> 00:29:34,150 +esotropia و لزمه نضارات معناته هذا الطفل اللي جاي + +408 +00:29:34,150 --> 00:29:39,520 +الآنغالبا حالته بتشبه حالة أخوه، يعني في الغالب + +409 +00:29:39,520 --> 00:29:43,780 +الأعام من الأحيان آخر شئ احنا هنسأل عنه اللي هو ال + +410 +00:29:43,780 --> 00:29:47,540 +previous ocular history عند نفس المريض هل مثلا + +411 +00:29:47,540 --> 00:29:53,460 +المريض ذهب؟ هل ذهب ل .. يعني أخصائي آخر أو طبيب + +412 +00:29:53,460 --> 00:29:58,420 +عيون آخر؟ هل وصفله نضارات؟ هل أجراله عملية؟ هل طلب + +413 +00:29:58,420 --> 00:30:01,480 +منه أنه يغطي عين عشان ينشط العين التاني؟ هل يعني + +414 +00:30:01,480 --> 00:30:05,960 +عنده كسل؟غالبا بيكون التشخيص غالبا في الغالب + +415 +00:30:05,960 --> 00:30:09,580 +الأعام من الأحيان بيكون التشخيص صحيح بس الأهل + +416 +00:30:09,580 --> 00:30:13,480 +حابين مثلا مزيد من الإطمئنان أو حابين يشوفوا other + +417 +00:30:13,480 --> 00:30:17,640 +option يعني خيار آخر غير الخيار اللي تم إعطاهم له، + +418 +00:30:17,640 --> 00:30:21,480 +إذا previous ocular history including prescription + +419 +00:30:22,210 --> 00:30:25,610 +يعني .. يعني هل تم وصف نضارات and compliance؟ هل + +420 +00:30:25,610 --> 00:30:29,590 +الطفل اتعاون مع النضارة؟ جبل النضارة ليه ال + +421 +00:30:29,590 --> 00:30:32,890 +spectacles؟ أو تقبل ال occlusion؟ ال occlusion إذا + +422 +00:30:32,890 --> 00:30:38,330 +حكولي مثلا إحنا روحنا مركز زين مثلا قبل ذلك و طلب + +423 +00:30:38,330 --> 00:30:41,630 +منا أنه نبطي ع السريع أنا بيصير تدور عندي فكرة + +424 +00:30:41,630 --> 00:30:44,670 +فعلا الطفل ممكن يكون عنده amblyopia في إحدى + +425 +00:30:44,670 --> 00:30:47,890 +العينتين أو في العينتين التنتين هل مثلا عمل + +426 +00:30:47,890 --> 00:30:52,300 +previous surgery؟ هل مثلا لبس بريزمات؟مع النضارات + +427 +00:30:52,300 --> 00:30:56,060 +it is important for future treatment options and + +428 +00:30:56,060 --> 00:31:00,100 +prognosis كل هذا بيساعدني في اتخاذ القرار السليم + +429 +00:31:00,100 --> 00:31:03,240 +.. في اتخاذ القرار السليم لما بخلص أخذ ال history + +430 +00:31:03,240 --> 00:31:07,000 +و تسجيله في ملف المريض ببدأ في الخطوة التانية اللي + +431 +00:31:07,000 --> 00:31:11,540 +هي فحص المريض و هنبدأ الفحص المرة القادمة ان شاء + +432 +00:31:11,540 --> 00:31:15,140 +الله في المحاضرة الجاية بأول شيء بيفحص وهو ال + +433 +00:31:15,140 --> 00:31:19,040 +visual acuity أو حدة الإبصاروعند هنا بنتوقف يعطيكم + +434 +00:31:19,040 --> 00:31:22,060 +العافية والسلام عليكم ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/BpinpqwQLkE_raw.json b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/BpinpqwQLkE_raw.json new file mode 100644 index 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{"start": 319.99, "end": 320.49, "word": " تعتبر", "probability": 0.9451497395833334}, {"start": 320.49, "end": 321.05, "word": " amblyopia", "probability": 0.795654296875}, {"start": 321.05, "end": 321.51, "word": " بسيطة", "probability": 0.99169921875}, {"start": 321.51, "end": 321.63, "word": " ال", "probability": 0.865234375}, {"start": 321.63, "end": 321.91, "word": " vision", "probability": 0.94091796875}, {"start": 321.91, "end": 322.21, "word": " فيها", "probability": 0.989501953125}, {"start": 322.21, "end": 322.45, "word": " مش", "probability": 0.984375}, {"start": 322.45, "end": 322.83, "word": " كتير", "probability": 0.9679361979166666}, {"start": 322.83, "end": 323.51, "word": " متراجع", "probability": 0.9315185546875}, {"start": 323.51, "end": 324.11, "word": " يعني", "probability": 0.829345703125}, {"start": 324.11, "end": 324.95, "word": " ينقصه", "probability": 0.95986328125}, {"start": 324.95, "end": 325.13, "word": " two", "probability": 0.8876953125}, {"start": 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الأمبيوبيا بمعنى + +3 +00:00:28,400 --> 00:00:33,650 +آخرالمرحلة اللى ممكن اعالج فيها ال amblyopia لما + +4 +00:00:33,650 --> 00:00:38,490 +تكون نوعها astrapismic amblyopia بتمتد لغاية سبعة + +5 +00:00:38,490 --> 00:00:43,470 +لتمان سنوات من عمر الطفلإذا في حالة ما يكون عندى + +6 +00:00:43,470 --> 00:00:46,710 +فيه Strabismic Ampliopia بقدر أعالج ال Ampliopia + +7 +00:00:46,710 --> 00:00:50,410 +ناتجة عن ال Strabismus لغاية 8 سنوات من العمر + +8 +00:00:50,410 --> 00:00:55,070 +غالبا بعد هيك بيكون العلاج غالبا غير فعال بالنسبة + +9 +00:00:55,070 --> 00:00:58,370 +لل Anisometropic Ampliopia الفترة اللى بقدر فيها + +10 +00:00:58,370 --> 00:01:02,490 +أعالج ال Ampliopia أو الكسل بتكون longer يعني + +11 +00:01:02,490 --> 00:01:05,950 +لبداية العشرة التانية من العمر يعني 11-12 سنة + +12 +00:01:06,480 --> 00:01:10,260 +فبالتالي في معايا فرصة أكبر، في معايا فرصة أكبر، + +13 +00:01:10,260 --> 00:01:13,940 +بس القاعدة العامة لعلاج أي نوع من أنواع ال + +14 +00:01:13,940 --> 00:01:18,660 +amblyopia كل ما بديت مبكرا أكتر كل ما كان النتائج + +15 +00:01:18,660 --> 00:01:22,420 +أفضل بالغالب، النتائج أفضل بالغالب، طيب، الآن + +16 +00:01:22,420 --> 00:01:25,620 +السؤال بيطرح نفسه ليش ال anisometropic amblyopia + +17 +00:01:25,620 --> 00:01:29,920 +معاها واجت أطول أنه تتعالج من الastrapismic + +18 +00:01:29,920 --> 00:01:32,960 +amblyopiaلأنه غالبا في الastrapismic ampliopia + +19 +00:01:32,960 --> 00:01:35,360 +بيكون عندي monocular suppression و ال brain بس + +20 +00:01:35,360 --> 00:01:38,480 +بيسلم من عين واحدة الصورة بينما في ال + +21 +00:01:38,480 --> 00:01:42,360 +anisometropic ampliopia بيكون يعني في شوية + +22 +00:01:42,360 --> 00:01:45,980 +binocular function بتكون موجودة و هذا بيخلي أنه + +23 +00:01:45,980 --> 00:01:49,800 +العين ال ampliobic مش .. مش ساكنة بتاتا و إنما + +24 +00:01:49,800 --> 00:01:53,640 +أحيانا بي .. بيصيرلها فرص إنها تعمل و تستقبل + +25 +00:01:53,640 --> 00:01:57,670 +الصورة و ترسلها لدمعالأن ما هي وسائل العلاج اللي + +26 +00:01:57,670 --> 00:02:01,410 +إحنا بنحكي عنها بالنسبة لل .. للـ Ampliopia؟ أول + +27 +00:02:01,410 --> 00:02:05,230 +وسيلة علاج وأهم وسيلة علاج وأكثر وسيلة علاج فعالة + +28 +00:02:05,230 --> 00:02:09,380 +هي الـ Occlusion of the normal eyeocclusion of the + +29 +00:02:09,380 --> 00:02:12,500 +normal eye يعني تغطية العين السليمة ليش؟ to + +30 +00:02:12,500 --> 00:02:15,640 +encourage use of the amblyobic eye عشان نشجع + +31 +00:02:15,640 --> 00:02:20,560 +استخدام العين الكسولة بمعنى آخر لما بيصير + +32 +00:02:20,560 --> 00:02:24,300 +occlusion لل normal eye ال brain ما .. مافيش أمامه + +33 +00:02:24,300 --> 00:02:27,260 +إلا إنه يسلم صورة من العين ال amblyobic لأنه العين + +34 +00:02:27,260 --> 00:02:31,310 +التانية اللي هي normal مغطيةطبعا هذه ال occlusion + +35 +00:02:31,310 --> 00:02:34,110 +of the normal eye is the most effective treatment + +36 +00:02:34,110 --> 00:02:39,010 +في وسائل علاج كتير و بالذات في برامج و softwares + +37 +00:02:39,010 --> 00:02:43,750 +على الكمبيوتر لتمارين بصرية كثيرة ولكن أكثر علاج + +38 +00:02:43,750 --> 00:02:47,090 +فعال هو ال occlusion of the normal eye + +39 +00:02:50,030 --> 00:02:54,450 +طيب، الآن نظام التغضية، يعني قداش أغطي في اليوم، + +40 +00:02:54,450 --> 00:02:58,330 +هل هو full-time ولا part-time؟ هل أغطي طول النهار + +41 +00:02:58,330 --> 00:03:03,110 +ولا أغطي جزء من النهار؟ هذا بيعتمد على ال age of + +42 +00:03:03,110 --> 00:03:06,570 +the patient، عمر الطفلand the density of + +43 +00:03:06,570 --> 00:03:09,310 +amblyopia، شدة الامبليوبيا، يعني بعتمد على عمر + +44 +00:03:09,310 --> 00:03:13,030 +الطفل وعلى شدة الامبليوبيا، the younger the + +45 +00:03:13,030 --> 00:03:15,670 +patient the more rapid improvement، كل ما كان + +46 +00:03:15,670 --> 00:03:21,170 +الطفل أصغر استجابته للعلاج ولتنشيط العين الكسولة، + +47 +00:03:21,170 --> 00:03:25,090 +اللي هي ال amblyobic eye بيكون أسرع، كقاعدة عامة + +48 +00:03:25,090 --> 00:03:29,210 +طبعا، ولها استثناء، ولها استثناء although the + +49 +00:03:29,210 --> 00:03:32,470 +greater the risk of inducing amblyopia in the + +50 +00:03:32,470 --> 00:03:36,940 +normal eyeبنقول كالاتي احنا ممكن نغطي للطفل الصغير + +51 +00:03:36,940 --> 00:03:41,560 +نغطيله عينه السليمة عشان نشط العين الكسولة وكل ما + +52 +00:03:41,560 --> 00:03:46,120 +كان سنه أصغر كل ما كان أسرع استجابته للتنشيط بس + +53 +00:03:46,120 --> 00:03:50,560 +برضه بيكون كل ما سنه أصغر في خطر ان انا احدثله + +54 +00:03:50,560 --> 00:03:53,660 +amblyopia في العين السليمة بواسطة التغطية + +55 +00:03:53,660 --> 00:03:58,240 +المتواصلة بواسطة التغطية المتواصلة فبالتالي بدي + +56 +00:03:58,240 --> 00:04:02,460 +اخد بالي من قضية انه في عنده risk في الطفل الصغير + +57 +00:04:03,070 --> 00:04:06,190 +ال .. ال .. ال younger child انه في عندي greater + +58 +00:04:06,190 --> 00:04:09,630 +risk of inducing ampliobia in the normal eye بسبب + +59 +00:04:09,630 --> 00:04:15,240 +التغطية نفسها، بسبب ال occlusion therapy itselfit + +60 +00:04:15,240 --> 00:04:18,440 +is therefore very important to monitor visual + +61 +00:04:18,440 --> 00:04:22,700 +acuity regularly in both eye during treatment ما + +62 +00:04:22,700 --> 00:04:26,980 +بنفع أنا في ال follow-up visits في زيارات المراجعة + +63 +00:04:26,980 --> 00:04:30,460 +على الطفل أفحص النظر فقط في العين اللي فيها كسل + +64 +00:04:30,460 --> 00:04:34,660 +عشان أشوف اتحسن ولا لا أيضا ضروري أفحص النظر في + +65 +00:04:34,660 --> 00:04:39,860 +العين ال normal الطبيعي عشان أشوف هلتأثرت بالتغطية + +66 +00:04:39,860 --> 00:04:43,480 +هل ال 6 ساعات أو ال 8 ساعات اللي أنا طلبت من الأهل + +67 +00:04:43,480 --> 00:04:46,480 +انهم يغطوا فيها ال normal eye أثروا على ال normal + +68 +00:04:46,480 --> 00:04:51,280 +eye وخلوها ampliobic فضروري جدا الموازنة أو فحص + +69 +00:04:51,280 --> 00:04:54,520 +النظر في العنتين العين اللي فيها ampliopia والعين + +70 +00:04:54,520 --> 00:04:58,020 +ال normal اللي عملناها occlusion the better visual + +71 +00:04:58,020 --> 00:05:01,480 +acuity at the start of occlusion the shorter the + +72 +00:05:01,480 --> 00:05:04,800 +duration required although there is wide variation + +73 +00:05:04,800 --> 00:05:09,970 +between patients نفرضإنه إنسان عنده العين اليمين 6 + +74 +00:05:09,970 --> 00:05:14,810 +على 6 والعين الشمال مثلا 6 على 12 ال best + +75 +00:05:14,810 --> 00:05:17,650 +correction 6 على 12 is an amblyopia في العين + +76 +00:05:17,650 --> 00:05:21,630 +الشمال هذه ال amblyopia تعتبر amblyopia بسيطة ال + +77 +00:05:21,630 --> 00:05:25,610 +vision فيها مش كتير متراجع يعني ينقصه two lines + +78 +00:05:25,610 --> 00:05:30,710 +عشان يوصل لل 6 على 6طفل تاني عنده في اليمين 6 على + +79 +00:05:30,710 --> 00:05:35,350 +6 مثلا و في الشمال 66 هنا التراجع كبير كل ما كان + +80 +00:05:35,350 --> 00:05:38,590 +ال visual acuity في ال .. ال visual acuity في ال + +81 +00:05:38,590 --> 00:05:42,970 +.. في ال amblyobic eye عند ما نبدأ تغطية كل ما كان + +82 +00:05:42,970 --> 00:05:47,910 +أحسن كل ما كانت better كل ما كانتالمدة اللى بدنا + +83 +00:05:47,910 --> 00:05:52,350 +نغطي فيها بتكون shorter the shorter the duration + +84 +00:05:52,350 --> 00:05:56,250 +required يعني ممكن يلزمنا مثلا شهرين تلاتة ست شهور + +85 +00:05:56,250 --> 00:06:01,090 +بالكثير وكل ما كان النظر أسوأ كل ما لازمنا يعني + +86 +00:06:01,090 --> 00:06:05,690 +فترة أطول من التغطية عشان نوصل للنتيجة المرجوةبس + +87 +00:06:05,690 --> 00:06:09,750 +هذه القاعدة إلها استثناءات كتيرة لأنه في variation + +88 +00:06:09,750 --> 00:06:12,710 +between patients ممكن الإنسان يكون 6 ع 60 في ال + +89 +00:06:12,710 --> 00:06:17,790 +amblyobic eye وفي ظرف 3،4 أسابيع يصير 6 ع 6 وإنسان + +90 +00:06:17,790 --> 00:06:22,450 +6 ع 12 في الamblyobic eye ويقعد شهور طويلة ويظل 6 + +91 +00:06:22,450 --> 00:06:26,050 +ع 12 مايتحسنش فهذا في variation في اختلاف بين + +92 +00:06:26,050 --> 00:06:30,590 +المرضى واستجابتهم لعلاج ال amblyopia بواسطة ال + +93 +00:06:30,590 --> 00:06:34,460 +occlusion بواسطة ال occlusionif there has been no + +94 +00:06:34,460 --> 00:06:38,000 +improvement after six months of effective + +95 +00:06:38,000 --> 00:06:41,740 +occlusion, further treatment is unlikely to be + +96 +00:06:41,740 --> 00:06:46,860 +fruitful إذا احنا ماضينا مع الطفل واستمرنا مع + +97 +00:06:46,860 --> 00:06:50,720 +الطفل ست شهور كاملة من ال effective occlusion, + +98 +00:06:51,240 --> 00:06:54,640 +further treatment is unlikely to be fruitful وما + +99 +00:06:54,640 --> 00:06:59,130 +اتحسنش معناته مش هيتحسنمعناته مش هيتحسن يعني + +100 +00:06:59,130 --> 00:07:02,810 +نغطينا العين السليمة لمدة 6 شهور وعدد ساعات كافية + +101 +00:07:03,780 --> 00:07:06,480 +عدد ساعات كافية، غطينا العين السليمة، مثلا، 6 + +102 +00:07:06,480 --> 00:07:11,020 +ساعات، 8 ساعات، 10 ساعات، ومع ذلك ما اتحسنش، + +103 +00:07:11,020 --> 00:07:14,860 +معناته مش هيتحسن غالبا، إذا مروا 6 شهور بدون I، + +104 +00:07:14,860 --> 00:07:19,120 +اتحسن، و ساعتها هتكون النظر استقر على هادي، على + +105 +00:07:19,120 --> 00:07:22,400 +الكمية اللي هو أصلا موجود عليها، على الكمية اللي + +106 +00:07:22,400 --> 00:07:26,960 +هو موجود عليها طيب، هنا في نقطة أو كلمة ضروري جدا + +107 +00:07:26,960 --> 00:07:30,700 +ان انت باهقلها، و أنا حاول حقيقة أحط تحتها خط + +108 +00:07:34,540 --> 00:07:37,960 +ليش ان انت بيقلها؟ في حاجة اسمها occlusion وفي + +109 +00:07:37,960 --> 00:07:43,320 +حاجة اسمها effective occlusion occlusion بغطي عين + +110 +00:07:43,320 --> 00:07:49,020 +الطفل و بتركه بيخرج الطفل يلعب معناته بمجرد ما + +111 +00:07:49,020 --> 00:07:52,640 +يخرج من البيت للعب أو يروح الروضة او ما إلى ذلك + +112 +00:07:52,640 --> 00:07:57,240 +ممكن يرفع الغطاة هذا مش occlusion اذا انا يعني + +113 +00:07:57,240 --> 00:08:03,650 +بحكي ل ..أخصاء البصريات في المراجعة أو لطبيب + +114 +00:08:03,650 --> 00:08:06,290 +العيون في المراجعة أنا والله كنت أغطي لإبني أو + +115 +00:08:06,290 --> 00:08:11,710 +لبنتي ولكن للأسف هذا مش effective occlusion هذه + +116 +00:08:11,710 --> 00:08:17,650 +نقطة النقطة التانية أنا غطيت للطفل والطفل نعس ونام + +117 +00:08:17,650 --> 00:08:23,250 +طيب و هو نايم طبعاكأنه مش مغطى لأنه أغلق عينيه + +118 +00:08:23,250 --> 00:08:26,490 +التنتين و هو منايم فسواء انا حطيت الغطاء او محطتهش + +119 +00:08:26,490 --> 00:08:30,790 +هو أغلق العين السليمة اللى محطوط عليها batch و + +120 +00:08:30,790 --> 00:08:33,810 +أغلق العين اللى فيها amblyopia و بده نشطها لأنه + +121 +00:08:33,810 --> 00:08:37,630 +نايم طبعا طالما نام اذا انسكر عينيه التنتين و + +122 +00:08:37,630 --> 00:08:42,150 +أغلقهم فبالتالي هذا مش effective occlusion تالت شئ + +123 +00:08:42,150 --> 00:08:45,910 +انا طلبت occlusion ست ساعات على ال follow up بعد + +124 +00:08:45,910 --> 00:08:49,810 +شهر زمان اجوا الاهل بيقول والله احنا غطينا طب قداش + +125 +00:08:49,810 --> 00:08:55,270 +غطيتهغطينا ساعتين اذا مش المطلوب ولا نص المطلوب + +126 +00:08:55,270 --> 00:08:59,690 +فبالتالي ضروري جدا اتأكد قبل ما اقرر ان هذا الطفل + +127 +00:08:59,690 --> 00:09:04,150 +ال amblyopia مش هتتحسن ضروري اتأكد ان الاهل عملوا + +128 +00:09:04,150 --> 00:09:08,990 +effective occlusion وللأسف الشديدفي حالات كثيرة + +129 +00:09:08,990 --> 00:09:12,710 +تفوق ال 80 أو ال 90% من حالات الأمبيوبيا بيكون + +130 +00:09:12,710 --> 00:09:18,110 +تنفيذ الoclusion مش سليم 100% زي ما هو مطلوب، زي + +131 +00:09:18,110 --> 00:09:22,590 +ما هو مطلوب، وعشان هيك أكبر سبب وأهم سبب للفشل في + +132 +00:09:22,590 --> 00:09:26,510 +علاج الأمبيوبيا هو ال poor compliance، عدم التعاون + +133 +00:09:26,510 --> 00:09:30,420 +طبعا اللي غير مقصودالطفل صار يبكي لأنه النظر عنده + +134 +00:09:30,420 --> 00:09:34,580 +في ال amblyobic eye رديق جدا، ستة ع ستين أو تلاتة + +135 +00:09:34,580 --> 00:09:38,980 +ع ستين وغطيناله العين السليمة اللي بتشوف ستة ع ستة + +136 +00:09:38,980 --> 00:09:43,480 +صار يبكي، الأهل أخذتهم العاطف على موضوع بكاء الطفل + +137 +00:09:43,480 --> 00:09:46,860 +فراحوا رفعوا الغطا، مطلوب يغطي ست ساعات أو تمان + +138 +00:09:46,860 --> 00:09:50,980 +ساعاتما غطاش إلا نص ساعة أو ربع ساعة بالعافية + +139 +00:09:50,980 --> 00:09:57,920 +فبالتالي هذا poor compliance من .. قبل الأهل في + +140 +00:09:57,920 --> 00:10:01,320 +شأن ال occlusion of the normal eye إذا ال poor + +141 +00:10:01,320 --> 00:10:04,960 +compliance is the single greatest barrier هو + +142 +00:10:04,960 --> 00:10:09,860 +الحاجز الوحيد و المهم و ال .. و الأكثر أهمية + +143 +00:10:09,860 --> 00:10:14,160 +الحاجز الأعظم اللي بيحول دون .. دون أنه يصير في + +144 +00:10:14,160 --> 00:10:18,120 +improvementو لازم احنا نعمله monitoring احنا + +145 +00:10:18,120 --> 00:10:22,300 +كاخصائيين بصريات لازم احنا نعمله monitoring بمعنى + +146 +00:10:22,300 --> 00:10:25,820 +لازم نراقبه كيف نراقبه؟ هل نقعد مع الطفل في بيته؟ + +147 +00:10:25,820 --> 00:10:29,540 +طبعا لا لازم نسأل الأهل بالتفصيل عن موضوع الغطاء + +148 +00:10:29,540 --> 00:10:34,080 +هل غطى؟ اه نعم غطى طب كل يوم غطى؟ ممكن يكون + +149 +00:10:34,080 --> 00:10:38,220 +الإجابة نعم او لايعني يوم كنا نريحه يوم كذا، قلو + +150 +00:10:38,220 --> 00:10:42,060 +أسبوع بيغطيش، قلو أسبوعين بيغطيش، التزم فترة بعدين + +151 +00:10:42,060 --> 00:10:48,160 +بطل، طيب لما بيغطي، هل احنا الطفل تحت عيوننا، يعني + +152 +00:10:48,160 --> 00:10:51,500 +احنا مراقبينه، يعني بتفرج مثلا على التلفزيون أو + +153 +00:10:51,500 --> 00:10:55,420 +بيشاهد الجوال أو بيرسم أو بيلون أو ما إلى ذلك، ولا + +154 +00:10:55,420 --> 00:10:59,360 +احنا مجرد غطيناله عينه وقولناله يعني اذهب إلعب + +155 +00:10:59,360 --> 00:11:02,660 +يعني و بترجع بعد ساعة أو ساعتين عشان اريحك من + +156 +00:11:02,660 --> 00:11:06,910 +الغطأهذا كله الكلام ضروري جدا احنا نستفسر عنه لأنه + +157 +00:11:06,910 --> 00:11:10,410 +بي .. بيعطينا صورة .. بيعطينا صورة هل فعلا في + +158 +00:11:10,410 --> 00:11:13,610 +effective occlusion ولا مافيش effective occlusion + +159 +00:11:13,610 --> 00:11:18,370 +Ampliobia treatment benefits from time spent at + +160 +00:11:18,370 --> 00:11:21,270 +the outset on communication of the rational and + +161 +00:11:21,270 --> 00:11:25,660 +difficulties involvedالآن عملوا دراسة .. عملوا + +162 +00:11:25,660 --> 00:11:30,000 +دراسة في الغرب، يعني لو أنا جبت مجموعة من الناس + +163 +00:11:30,000 --> 00:11:35,580 +أطفالهم عندها Ampliobia ومجموعة أخرى من الناسبرضه + +164 +00:11:35,580 --> 00:11:38,980 +أطفالهم عندهم Ampliobia، المجموعة الأولى جلعت مع + +165 +00:11:38,980 --> 00:11:42,740 +.. مع .. مع الأهل، مع الأب و الأم و فهمتهم بشكل + +166 +00:11:42,740 --> 00:11:46,060 +تفصيلي إيش هو الكسل البصري و إيش م .. المخاطر + +167 +00:11:46,060 --> 00:11:49,140 +بتاعته و إيش المضار بتاعته و كيف علاجه و ليش + +168 +00:11:49,140 --> 00:11:52,580 +العلاج صعب لإن إحنا بنغط العين السليمة و الطفل + +169 +00:11:52,580 --> 00:11:56,900 +هيعاني فترة قبل ما تنشط العينهيشعر أن الرؤية مغبشة + +170 +00:11:56,900 --> 00:12:02,080 +وإلى آخرين وضربنا لهم أمثلة مثلا على سبيل المثال + +171 +00:12:02,080 --> 00:12:06,280 +قضية علاج ال ambliopia بتغطية العين السليمة الصعبة + +172 +00:12:06,280 --> 00:12:09,860 +بالنسبة للطفل و بالضبط هذا بيشبه لما يكون مثلا + +173 +00:12:09,860 --> 00:12:13,760 +الطفل عنده اتهاب في اللوزتين أو في الحلق و بنعطيله + +174 +00:12:13,760 --> 00:12:18,420 +مضاد حيوي مر نجبره على شرب المضاد الحيوي المر لأن + +175 +00:12:18,420 --> 00:12:22,780 +هذا فيه الفائدة بالنسبة له رغم معارضة الطفل ل .. + +176 +00:12:23,640 --> 00:12:26,740 +يعني تناول الشراب بتاع المضاد الحاوي لإن طعمه فيه + +177 +00:12:26,740 --> 00:12:30,400 +مرار أو ما شابه، لكن الأهل بيجبروا لإن فيه مصلحته، + +178 +00:12:30,400 --> 00:12:34,400 +أيضا علاج ال ampliopia يعني ضروري جدا نفهم الأهل + +179 +00:12:34,400 --> 00:12:39,920 +التفاصيل و .. و نشرح شرح مستفيد عن هذا الموضوع، + +180 +00:12:39,920 --> 00:12:43,040 +المجموعة الأولى شرحناها بشكل كويس، هي كانت الدراسة + +181 +00:12:43,040 --> 00:12:47,640 +عن عملاتو المجموعة التانية بس طلبنا منهم أنه غطي + +182 +00:12:47,640 --> 00:12:51,440 +لإبنك مثلا ست ساعات أو أربع ساعات أو تمان ساعات و + +183 +00:12:51,440 --> 00:12:55,460 +بترجعنا بعد شهر وجدوا .. وجدوا أن المجموعة الأولى + +184 +00:12:55,460 --> 00:13:00,360 +أطفالهم حققت نتائج أفضل لأن الأهل فهموا مشكلة ال + +185 +00:13:00,360 --> 00:13:04,220 +amblyopia و الكسل البصري و مخاطره بشكل أفضل و + +186 +00:13:04,220 --> 00:13:07,950 +فهموا جديش الصعوبات و التحدياتفي موضوع إن أنا أظلم + +187 +00:13:07,950 --> 00:13:11,430 +راقب الطفل و أظلم تابع الطفل و أظلم و أغطي عين + +188 +00:13:11,430 --> 00:13:15,110 +الطفل و أخل الطفل أثناء تغطية العين السليمة يمارس + +189 +00:13:15,110 --> 00:13:18,350 +نشاط بصري زي الكتابة و الرسم و التلوين و مشاهدة + +190 +00:13:18,350 --> 00:13:23,010 +التلفاز و ما إلى ذلك و تركيب المكعبات و الألعاب + +191 +00:13:23,010 --> 00:13:27,770 +المشابهة عشان ينشط العين بتاعته فبالتالي الـ + +192 +00:13:27,770 --> 00:13:31,920 +Ampliopia Treatmentbenefits from time spent يعني + +193 +00:13:31,920 --> 00:13:35,320 +بيستفيد الطفل في علاج ال amblyopia إذا أنا .. إذا + +194 +00:13:35,320 --> 00:13:39,620 +أنا يعني عملت أو .. أو أنفقت جزء من وقتي أنا + +195 +00:13:39,620 --> 00:13:43,580 +كأخصائي بصريات أو كطبيب عيون في البداية على + +196 +00:13:43,580 --> 00:13:48,820 +التواصل مع الأهل على الأهداف والصعوبات اللي احنا + +197 +00:13:49,080 --> 00:13:52,520 +الاهداف من التغطية، إيش الهدف؟ يعني إحنا ليش بنغطي + +198 +00:13:52,520 --> 00:13:57,420 +عين الطفل؟ يعني إحنا بدنا نشط العين الكسولة وإيش + +199 +00:13:57,420 --> 00:14:00,260 +الصعوبات في تنشيط العين الكسولة لما نغطي العين + +200 +00:14:00,260 --> 00:14:03,500 +لهدا وإن الطفل هيشعر بتغبيش وهيدايق و بالذات لما + +201 +00:14:03,500 --> 00:14:08,060 +تكون ال amblyopia شديدة، فضروري جدايعني إذا تم + +202 +00:14:08,060 --> 00:14:10,820 +التشخيص .. تم وضع التشخيص لأي طفل إنه عنده + +203 +00:14:10,820 --> 00:14:15,780 +amblyopia ضروري للغاية يكون فيه مدة زمانية كافية + +204 +00:14:15,780 --> 00:14:20,020 +لشرح هذه القضية حتى لو استفرق الأمر في الشرح من + +205 +00:14:20,020 --> 00:14:24,620 +ربع الساعة لنص ساعة لشرح التفاصيل كلها و التأكيد + +206 +00:14:24,620 --> 00:14:28,420 +على أهمية موضوع التخطيه .. على أهمية موضوع التخطيه + +207 +00:14:28,420 --> 00:14:33,950 +طبعاوسائل التغطية العادية موجودة اللي هي ال eye + +208 +00:14:33,950 --> 00:14:38,090 +patch .. ال eye patch وفي وسائل مشجع للطفل، يعني + +209 +00:14:38,090 --> 00:14:42,530 +تحويل العملية التغطية بشكل لعبة أو بشكل .. يعني + +210 +00:14:42,530 --> 00:14:45,330 +هنا عاملينها بشكل mask، هنا العين اليمين مغطية، + +211 +00:14:45,330 --> 00:14:49,040 +معناته العين اليمين هي السليمةوالشمال يعني مفتوح + +212 +00:14:49,040 --> 00:14:52,880 +ال .. ال .. ال .. المجال أمامها لتبصر لأنها فيها + +213 +00:14:52,880 --> 00:14:57,080 +amblyopia حتى يتم تنشيطها الطفل بيلاقي هذه الأشياء + +214 +00:14:57,080 --> 00:15:02,360 +enjoyable و ممتعة و ممكن حتى يعني ما يمتقد من + +215 +00:15:02,360 --> 00:15:06,660 +الأطفال الآخرين في الروضة أو في المدرسة أنه مغطي + +216 +00:15:06,660 --> 00:15:10,560 +عينه أو .. أو شيء بالعكس هذه ممكن يعني تعتبر يعني + +217 +00:15:10,560 --> 00:15:14,590 +زي لعبة يتميز فيها عنباقي الأطفال وصناعتها أصلا + +218 +00:15:14,590 --> 00:15:17,470 +وتلوينها حتى ممكن يتم في .. في .. في البيت أو + +219 +00:15:17,470 --> 00:15:24,470 +بطريقة منزلية أيضا الألوان والرسومات على ال eye + +220 +00:15:24,470 --> 00:15:28,150 +patch بتساعد الطفل في قبول ال eye patch لأنه ممكن + +221 +00:15:28,150 --> 00:15:33,710 +يشعر بنفسه أنه مميز يعني نوعا ما أو حاطت شيء مميز + +222 +00:15:33,710 --> 00:15:37,130 +على عينه من ضمن الأشياء اللي بتشجع في قضية قبول + +223 +00:15:37,130 --> 00:15:40,510 +الطفل لل occlusion أنه زي احنا .. زي ما احنا + +224 +00:15:40,510 --> 00:15:45,750 +ملاحظين هناعملنا له occlusion للطفلة لل right eye + +225 +00:15:45,750 --> 00:15:48,110 +لأنها ال normal معناته في عندها amblyopia في ال + +226 +00:15:48,110 --> 00:15:54,110 +left eye و خلينا الطفلة أيضا تعمل نفس القضية و + +227 +00:15:54,110 --> 00:15:58,710 +تعالج الكسل بالنسبة للعبتها أو العروسة اللي معها + +228 +00:15:58,710 --> 00:16:01,390 +طبعا هذا الطفل ممكن يستمتع جدا بهذه القضية و + +229 +00:16:01,390 --> 00:16:06,500 +مايحسش بالوقتهذا قضية انه مجرد انغطي للطفل و نقوله + +230 +00:16:06,500 --> 00:16:10,180 +بعد 6 ساعات بدنا نفكرلك الانسان كبير السن البالغ + +231 +00:16:10,180 --> 00:16:13,620 +ال adult ممكن يتضايق من الغطاء اذا استمر على عينه + +232 +00:16:13,620 --> 00:16:17,820 +ربع ساعة او نص ساعة رغم انه يعني واعي و مدرك + +233 +00:16:17,820 --> 00:16:23,060 +لأهداف من التغطية بينما الطفل بيكون اقل واعي بهذه + +234 +00:16:23,060 --> 00:16:26,880 +القضية فقبوله بيكون اقل فبالتالي ضروري جدا احنا + +235 +00:16:33,730 --> 00:16:39,050 +فضروري جدا احنا يكون عندنا يعني وسيلة لتقبل الطفل + +236 +00:16:39,050 --> 00:16:44,390 +هذه القضية ايضا من ضمن الأشياء ممكن يكون الطفل + +237 +00:16:44,390 --> 00:16:48,630 +المصاب بالكسل البصري وطفل اخر غير مصاب يعني اخو او + +238 +00:16:48,630 --> 00:16:53,970 +اخته الى اخره بيكون group patching بمعنى عشان نشجع + +239 +00:16:53,970 --> 00:16:57,950 +الطفل انه يقبل ال patch بنلاقي فرد اخر من العيلة + +240 +00:16:57,950 --> 00:17:01,630 +تطوع انه يغطي عينه عساس انه يفهموا ان هذه القضية + +241 +00:17:01,830 --> 00:17:06,130 +ليست صعبة و أحيانا أفراد العائلة طبعا و هذا ربما + +242 +00:17:06,130 --> 00:17:12,750 +يحتاج إلى يعني .. يعني .. مصروف أو .. أو انفاق + +243 +00:17:12,750 --> 00:17:16,930 +اقتصادي أكتر شوية على موضوع ال I-Bad ربما يتأثى + +244 +00:17:16,930 --> 00:17:21,130 +للجميع بس أحيانا بيكون هذا وسيلة من الوسائل اللي + +245 +00:17:21,130 --> 00:17:26,830 +ممكن تشجع الطفل على قبول قضية ال inclusion ل ال + +246 +00:17:26,830 --> 00:17:32,860 +normal Iالآن بالنسبة لل Eclosion حكينا عنه الوسيلة + +247 +00:17:32,860 --> 00:17:38,320 +التانية من الوسائل بيسموها ال penalization التغبيش + +248 +00:17:38,320 --> 00:17:41,540 +أو ال fogging penalization in which vision in the + +249 +00:17:41,540 --> 00:17:46,000 +normal eye is blurred with ais an alternative + +250 +00:17:46,000 --> 00:17:49,340 +method وبدنا نركز على إنه هي طريقة بديلة وليس + +251 +00:17:49,340 --> 00:17:54,340 +طريقة أساسية الطريقة الأساسية والطريقة الأفضل هي + +252 +00:17:54,340 --> 00:17:58,240 +ال occlusion اللي حكينا عنها قبل شوية it is best + +253 +00:17:58,240 --> 00:18:01,520 +in the treatment of relatively mild amblyopia + +254 +00:18:01,520 --> 00:18:04,820 +العين اللي فيها amblyopia المفروض النظر يكون فيها + +255 +00:18:04,820 --> 00:18:11,200 +6 على 24 أو أفضل يعني 6 ع 18 6 ع 12 بتنفعش في حالة + +256 +00:18:11,200 --> 00:18:14,120 +ال penalization تغبيش النظر في العين ال normal + +257 +00:18:14,390 --> 00:18:18,610 +تغبيش مش occlusion في العين ال normal بده يكون + +258 +00:18:18,610 --> 00:18:23,210 +نغبش النظر في العين ال normal بحيث يصبح النظر في + +259 +00:18:23,210 --> 00:18:27,090 +ال normal eye أسوأ من ال amblyobic eye إذا في حالة + +260 +00:18:27,090 --> 00:18:31,130 +ال severe amblyopia مابنفعش نضرب مثال على ذلك هاي + +261 +00:18:31,130 --> 00:18:35,310 +إنسان عنده ال left eye هي ال normal eye و عنده ال + +262 +00:18:35,310 --> 00:18:40,320 +right eye ال right eyeهي ال amblyobic eye فغبشناله + +263 +00:18:40,320 --> 00:18:45,240 +الرؤية بواسطة جطرة الأتروبيل عساس انه النظر يصير + +264 +00:18:45,240 --> 00:18:48,460 +هنا مغبش اكتر من هنا بمعنى ال amblyobic eye تصير + +265 +00:18:48,460 --> 00:18:53,460 +اوضح بمعنى اخر الان نفرض انه مع التغبيش النظر صار + +266 +00:18:53,460 --> 00:18:57,220 +6 على + +267 +00:18:57,220 --> 00:19:03,340 +24بعد ما غباشنا معروف أنه لما بتوسع ال pupil .. + +268 +00:19:03,340 --> 00:19:06,380 +لما بتوسع ال pupil اللي اللي بيصير غباش في الرؤية + +269 +00:19:06,380 --> 00:19:11,280 +و النظر إذا كان 6 ع 6 ممكن يهبط يصير 6 ع 18 أو 6 ع + +270 +00:19:11,280 --> 00:19:17,920 +24 طيب ال amblyobic eye نفرت عند هذا المريض ال + +271 +00:19:17,920 --> 00:19:25,390 +amblyobic eye بتشوف 6على 12 اذا لما انا غبشت في ال + +272 +00:19:25,390 --> 00:19:29,770 +normal I و أصبحت ال normal I تشوف 6 ع 24 أصبحت ال + +273 +00:19:29,770 --> 00:19:33,270 +amblyobic I بالنسبة للإبراهيم نظرها أوضح فساعتها + +274 +00:19:33,270 --> 00:19:37,370 +هيستفيد من قضية ال penalization او التغبيش طيب لو + +275 +00:19:37,370 --> 00:19:42,530 +بالاساس .. لو بالاساس انا عندي ال amblyopia severe + +276 +00:19:42,530 --> 00:19:49,820 +66 ال best correction 6 على 60ساعتها ما أفكر بتاتا + +277 +00:19:49,820 --> 00:19:52,960 +في استعمال الوسيلة البديلة اللي هي ال penalization + +278 +00:19:52,960 --> 00:19:57,260 +ليش؟ لأنه لما بغبش ال normal eye بال أتروبين بجطر + +279 +00:19:57,260 --> 00:20:00,740 +أتروبين و بتوسع البقبوك و بتصير غباش و بتصير النظر + +280 +00:20:00,740 --> 00:20:05,760 +6 ع 24 لسه ال normal eye أفضل في النظرمن ال + +281 +00:20:05,760 --> 00:20:09,340 +amblyobic eye فبالتالي هيضل ال brain رغم أنها بدأت + +282 +00:20:09,340 --> 00:20:12,720 +تغبش هيضل ال brain يستجبل منها لأن نظرها لسه أفضل + +283 +00:20:12,720 --> 00:20:16,160 +من نظر ال amblyobic eye إذا ال penalization بنفع + +284 +00:20:16,160 --> 00:20:19,340 +في ال mild amblyopia بنفعش في ال severe amblyopia + +285 +00:20:19,340 --> 00:20:25,660 +يعني ضروري جدا ان يعني .. يعني نفهم هذه القضية + +286 +00:20:25,660 --> 00:20:30,330 +مابنفعش إنسانعنده ستة ع ستين أو counting finger + +287 +00:20:30,330 --> 00:20:33,110 +مثلا اتنين متر او تلاتة متر في ال amblyobic eye + +288 +00:20:33,110 --> 00:20:37,070 +هذا ال best correction عنده اروح انا اوصفله + +289 +00:20:37,070 --> 00:20:39,830 +atropine لل normal eye اللي بيكون حدث اذا انا + +290 +00:20:39,830 --> 00:20:43,950 +وصفتله atropine بس انا ازعجته بانه خليت النظر في + +291 +00:20:43,950 --> 00:20:47,690 +العين السليمة اللي هي ستة ع ستة خليته يغبشوبالتالي + +292 +00:20:47,690 --> 00:20:50,450 +ما فى الـ 2 مش هيتنشط النظر فى العين ال .. ال + +293 +00:20:50,450 --> 00:20:53,710 +amblyobic لأن النظر فيها very poor و هيضل ال brain + +294 +00:20:53,710 --> 00:20:56,970 +يستجبل من العين السليم بس بيكون أنا أزعجت الطفل مش + +295 +00:20:56,970 --> 00:21:00,810 +أكتر امتى أنا بوصف ال penalization اللى هى قضيتى + +296 +00:21:00,810 --> 00:21:05,070 +ان اوصف atropine لل normal eye لما بيكون عندى mild + +297 +00:21:05,070 --> 00:21:07,990 +amblyopia فى الamblyobic eye يعنى ال decreased او + +298 +00:21:07,990 --> 00:21:12,450 +ال best correction بيوصل ل 6.12 6.18 طيب نفرض + +299 +00:21:12,450 --> 00:21:19,160 +انسان عنده6 ع 12 أو 6 ع 18 في ال amblyobic eye ال + +300 +00:21:19,160 --> 00:21:23,000 +best correction و يقبل ال occlusion بيقبل ال + +301 +00:21:23,000 --> 00:21:26,820 +occlusion ساعتها احنا مش ضرور نروح لل أتروبيل طبعا + +302 +00:21:26,820 --> 00:21:31,260 +ال occlusion هو ال .. ال .. ال treatment الأهم أو + +303 +00:21:31,260 --> 00:21:36,220 +الطريقة المفلة لهذا طب امتى انا بلجأ لهللأطربيين + +304 +00:21:36,220 --> 00:21:39,440 +لل penalization امتى انا بلجأ للأطربيين لل + +305 +00:21:39,440 --> 00:21:42,900 +penalization في حالة مثلا ما يكون حساسية مفرطة في + +306 +00:21:42,900 --> 00:21:47,020 +الجلب مش قادر احط ال eye patch بتاتا او يكون مثلا + +307 +00:21:47,020 --> 00:21:51,770 +الطفل mentally retarded في عنده يعنيمرض عقلي أو + +308 +00:21:51,770 --> 00:21:56,170 +يعني حالة من التخلف العقلي مش جادرين احنا نحكم + +309 +00:21:56,170 --> 00:22:00,490 +موضوع ال badge فبالتالي الأتروبين بيشكل حاجة بدنا + +310 +00:22:00,490 --> 00:22:04,250 +نضلنا نأكد على موضوع أنه هذه alternative method + +311 +00:22:04,250 --> 00:22:07,470 +alternative method و بتفيد في حالة ال mild + +312 +00:22:07,470 --> 00:22:10,390 +-amblyopia it is best in the treatment of + +313 +00:22:10,390 --> 00:22:15,130 +relatively mild-amblyopia اللي هي 6 على 24 orbiter + +314 +00:22:15,740 --> 00:22:19,560 +in association with hypermetropia طيب بنرجع بنأكد + +315 +00:22:19,560 --> 00:22:22,820 +و بنقول conventional occlusion التغطية المعتادة + +316 +00:22:22,820 --> 00:22:26,940 +اللي اتحدتنا عنها كأنها بصفتها الوسيلة الأفضل is + +317 +00:22:26,940 --> 00:22:30,280 +likely to produce a quicker response than atropine + +318 +00:22:30,280 --> 00:22:34,540 +الاستجابة لل occlusion therapy بيكون أسرع من + +319 +00:22:34,540 --> 00:22:38,180 +الاستجابة لل atropine which is generally used when + +320 +00:22:38,180 --> 00:22:41,380 +compliance with occlusion is poorامت احنا بنستعمل + +321 +00:22:41,380 --> 00:22:43,720 +ال .. ال .. ال atropine لما بكون عنده ال + +322 +00:22:43,720 --> 00:22:47,280 +compliance مع ال eclosion pore يعني مافيش تعاون + +323 +00:22:47,280 --> 00:22:51,000 +أبدا زي ما حكينا إنسان عنده تحسس شديد جدا من موضوع + +324 +00:22:51,000 --> 00:22:55,600 +ال eye patch اللاسق بتاع ال eye patch أو عنده تخلف + +325 +00:22:55,600 --> 00:22:59,960 +عقلي أو ما شبه .. او ما شبه فبالتالي ضروري نستعمل + +326 +00:22:59,960 --> 00:23:02,360 +ال atropine بس بده يكون برضه النظر عنده في ال + +327 +00:23:02,360 --> 00:23:07,900 +amblyobic eye مش .. مش كتير متردى و انما عنده mild + +328 +00:23:07,900 --> 00:23:12,920 +amblyomild amblyopia بجطر طبعا القطرة بتقطر للعين + +329 +00:23:12,920 --> 00:23:19,120 +السليمة عشان نشط ال amblyopic eye طيب هنا في وسيلة + +330 +00:23:19,120 --> 00:23:23,380 +للعلاج خلينا نطلع للتكبير عساس نشرحها بنقول + +331 +00:23:23,380 --> 00:23:28,360 +كالقاتل هذه الوسيلة عبارة عن fogging optical + +332 +00:23:28,360 --> 00:23:32,620 +penalization fogging هنا إذا ملاحظين معايا الشريط + +333 +00:23:32,620 --> 00:23:37,270 +اللاسق هذاالشريط اللاسق جاي أمام النضارة عشان يعمل + +334 +00:23:37,270 --> 00:23:42,110 +غبش في العين السليمة لتنشيط العين اللي فيها كسل + +335 +00:23:42,110 --> 00:23:45,950 +امتى انا بستعمل ال fogging بالشكل هذا لما يكون في + +336 +00:23:45,950 --> 00:23:49,550 +عندي nystagmus ال nystagmus لو حطيت occlusion كامل + +337 +00:23:49,550 --> 00:23:53,310 +طبيعي زي ما احنا متعودين ال occlusion هذا بيزيد ال + +338 +00:23:53,310 --> 00:23:56,470 +nystagmus أحيانا بيكون عندي latent nystagmus لما + +339 +00:23:56,470 --> 00:24:00,550 +بغطي عين بالذات في العين المفتوحةLatent nystagmus + +340 +00:24:00,550 --> 00:24:04,110 +لما بغطي عين لو غطيتها تغطية كاملة بيزيد ال + +341 +00:24:04,110 --> 00:24:08,550 +nystagmus فبالتالي مش هيتحسن ال vision مش هيكون + +342 +00:24:08,550 --> 00:24:11,730 +أفضل فبالتالي بعمل fogging هي هنا الشريط اللاصق + +343 +00:24:11,730 --> 00:24:16,980 +الشفاف إذا ملاحظين الحفة بتاعتهأو ممكن اعمل + +344 +00:24:16,980 --> 00:24:45,700 +الطريقة هي ان نفس العدسة تكون fogged + +345 +00:24:45,810 --> 00:24:53,730 +بتستجيبش ممكن احنا هذا ال nylon الرقيق ممكن نلف + +346 +00:24:53,730 --> 00:24:56,970 +لفتين او تلاتة حوالين العدسة بتاعة العين اللي بده + +347 +00:24:56,970 --> 00:25:00,390 +اغطيها بده اقطي العين اليمين و عنده nystagmus او + +348 +00:25:00,390 --> 00:25:04,950 +latent nystagmus بخلي الاهلي يلفوا لفتين او تلاتة + +349 +00:25:04,950 --> 00:25:10,270 +هذا يعني .. يعني بالتثق بنفسه وسهل الإزالة تمام + +350 +00:25:10,270 --> 00:25:15,350 +بخليه يغطي العدسةاللي فيها أو اللي جدام ال normal + +351 +00:25:15,350 --> 00:25:19,530 +eye أو اللي جدام العين اللي فيها النظر أفضل عشان + +352 +00:25:19,530 --> 00:25:23,670 +اتنشط العين التانية تلت أربع لفات فبالتالي بيصير + +353 +00:25:23,670 --> 00:25:28,290 +عندي المنظر مغبش وبالتالي ممكن أستعمل هذا النيلون + +354 +00:25:28,290 --> 00:25:34,190 +الرقيق أمام العدسة اللي بده أغطي العين بتاعتها + +355 +00:25:34,190 --> 00:25:39,870 +الان it is essential to examine the fungi to + +356 +00:25:39,870 --> 00:25:44,060 +diagnose any visibleorganic disease prior to + +357 +00:25:44,060 --> 00:25:47,260 +convincing treatment for amblyopia الفندس + +358 +00:25:47,260 --> 00:25:52,380 +examination ضروري يكون سابق لقرار التفطية لأنه إذا + +359 +00:25:52,380 --> 00:25:56,160 +أنا بدأ أقرر أن أعمل occlusionأو أعالج ال + +360 +00:25:56,160 --> 00:25:59,980 +amblyopia معناته هذا العلاج هيستمر أسابيع و ربما + +361 +00:25:59,980 --> 00:26:04,360 +أشهر عديدة فبالتالي قبل ما ناخد القرار لأن هذا + +362 +00:26:04,360 --> 00:26:07,780 +القرار هيكون مرهق للطفل لازم نكون متأكدين ان + +363 +00:26:07,780 --> 00:26:11,480 +الفندس سليم ال retina سليمة ال optic nerve سليم و + +364 +00:26:11,480 --> 00:26:15,560 +مافيش عندي أي organic disease قبل ما أاخد القرار + +365 +00:26:15,560 --> 00:26:19,660 +بالتغطية organic disease and amblyopia may coexist + +366 +00:26:20,540 --> 00:26:24,080 +and a trial of patching may still be indicated in + +367 +00:26:24,080 --> 00:26:27,680 +the presence of organic disease حقيقة أحيانا بيكون + +368 +00:26:27,680 --> 00:26:30,220 +في عندي organic disease وفيه في نفس الوجد + +369 +00:26:30,220 --> 00:26:35,780 +amblyopia وصارت حالات كتيرة انه في organic disease + +370 +00:26:35,780 --> 00:26:40,880 +والنظر كان سيء جدا وفي amblyopia ومع التغطية النظر + +371 +00:26:40,880 --> 00:26:45,160 +اتحسن بشكل جوهري ماوصل ل 6 ع 6 يعني نفرض ان النظر + +372 +00:26:45,160 --> 00:26:52,290 +بكان 63وصار 6 ع 18 طبعا أفضل بكثير ال 6 ع 18 من ال + +373 +00:26:52,290 --> 00:26:55,890 +3 ع 60 طب ليش ماوصل ل 6 ع 6 بسبب ال organic + +374 +00:26:55,890 --> 00:26:58,330 +disease؟ إذا ممكن ال organic disease و ال + +375 +00:26:58,330 --> 00:27:02,170 +amblyopia يكونوا مترافقين في نفس العين يعني في في + +376 +00:27:02,170 --> 00:27:04,950 +العين amblyopia و في في نفس الوجهة organic disease + +377 +00:27:04,950 --> 00:27:09,050 +يعني ال trial محاولة التغطية may still be + +378 +00:27:09,050 --> 00:27:12,310 +indicated in the presence of organic diseaseIf + +379 +00:27:12,310 --> 00:27:14,650 +acuity does not respond to treatment, + +380 +00:27:14,910 --> 00:27:18,230 +investigations such as electrophysiology or + +381 +00:27:18,230 --> 00:27:21,470 +imaging should be considered إذا الأهل اتبعوا + +382 +00:27:21,470 --> 00:27:26,090 +النظام كما يجب واتعاونوا تماما ونفذوا الخطة + +383 +00:27:26,090 --> 00:27:29,470 +العلاجية من تغطية العين السليمة وبعدد الساعات + +384 +00:27:29,470 --> 00:27:34,350 +المطلوب ورغم ذلك مافيش تحسن بالمرة ممكن احنا نعمل + +385 +00:27:34,350 --> 00:27:37,840 +بعض الفحوصاتزي ال electro-retinography زي ال + +386 +00:27:37,840 --> 00:27:41,640 +electro .. زي ال visually evoked potential و ال + +387 +00:27:41,640 --> 00:27:46,100 +electro-retinography و ال electro-oculography عشان + +388 +00:27:46,100 --> 00:27:49,380 +نشوف هل في عندي مشاكل مش ظاهرة في ال fundus + +389 +00:27:49,380 --> 00:27:52,680 +examination؟ هل في عندي مشاكل في العصب البصري؟ هل + +390 +00:27:52,680 --> 00:27:56,500 +في عندي مشاكل في ال retina؟ مش .. مش .. مش ظاهرة + +391 +00:27:56,500 --> 00:28:00,340 +clinically؟ عشان نتأكد هل في إمكانية أنكمل العلاج + +392 +00:28:00,340 --> 00:28:05,040 +و لا نتوقف عن العلاج إذا في عندى وسيلتين رئيسيات + +393 +00:28:05,040 --> 00:28:07,780 +الوسيلة الأولى هي الأهم و الأفضل و الأقوى في + +394 +00:28:07,780 --> 00:28:10,320 +العلاج اللى هى ال occlusion و الوسيلة التانية + +395 +00:28:10,320 --> 00:28:12,900 +البديلة اللى هى ال penalization إما + +396 +00:28:12,900 --> 00:28:16,440 +pharmacological penalization بواسطة الأترابين أو + +397 +00:28:16,440 --> 00:28:20,300 +optical penalization بواسطة التغبيش اللى إحنا + +398 +00:28:20,300 --> 00:28:25,060 +شايفينه بيسموه optical penalization وبالتالي هذا + +399 +00:28:25,060 --> 00:28:29,370 +هو علاج الamblyopia بنتوقف عند هذه النقطةويعطيكم + +400 +00:28:29,370 --> 00:28:32,210 +العافية والسلام عليكم ورحمة الله وبركة + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/EoYz7ewce0Y_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/EoYz7ewce0Y_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..6664e14d9d2882f621e0ff0c5f250fe52526b5d8 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/EoYz7ewce0Y_postprocess.srt @@ -0,0 +1,1588 @@ +1 +00:00:01,530 --> 00:00:06,450 +بسم الله الرحمن الرحيم بنواصل مع محاضرات حوال واحد + +2 +00:00:06,450 --> 00:00:11,750 +واتوقفنا عند قوانين حركة العين اللي هي laws of + +3 +00:00:11,750 --> 00:00:18,250 +ocular motility طبعا في قوانين للطريقة اللي بتتحرك + +4 +00:00:18,250 --> 00:00:22,810 +فيها العنتين بس قبل ما نتعرف على هذه القوانين لابد + +5 +00:00:22,810 --> 00:00:27,830 +من بعض التعريفات البسيطة أول تعريف اللي هو agonist + +6 +00:00:27,830 --> 00:00:34,190 +-antagonistagonist مقصود فيها العضلة المحركة للعين + +7 +00:00:34,190 --> 00:00:39,210 +باتجاه معين ال antagonist العضلة المضادة إليها + +8 +00:00:39,210 --> 00:00:43,110 +يعني في عضلتين عضلة بتحرك العين في اتجاه معين هذا + +9 +00:00:43,110 --> 00:00:46,670 +الاتجاه اللي الإنسان بيرغب أنه ينظر إليه فيه هدف + +10 +00:00:46,670 --> 00:00:52,570 +بيطلع عليه ال antagonist عضلة معاكسة للعضلة اللي + +11 +00:00:52,570 --> 00:00:56,850 +بنسميها ال agonistis an agonist، antagonist تعرف + +12 +00:00:56,850 --> 00:01:00,550 +علي إنها are muscles of the same eye ضروري نفهم + +13 +00:01:00,550 --> 00:01:06,350 +إنه العضلة اللي هطلق عليها كلمة أو تعريف agonist و + +14 +00:01:06,350 --> 00:01:10,670 +العضلة المضادة إلها التنتين موجودات في نفس العين + +15 +00:01:10,670 --> 00:01:14,510 +are muscles of the same eye that move the eye in + +16 +00:01:14,510 --> 00:01:18,900 +opposite directionsThe agonist is the primary + +17 +00:01:18,900 --> 00:01:21,980 +muscle moving the eye in a given direction.إذن الـ + +18 +00:01:21,980 --> 00:01:25,280 +agonist مين هي؟ هي العضلة اللي بتحرك العين في + +19 +00:01:25,280 --> 00:01:29,620 +اتجاه معين The antagonist acts in opposite + +20 +00:01:29,620 --> 00:01:33,480 +direction to the agonist ال antagonist هي عضلة + +21 +00:01:33,480 --> 00:01:38,360 +موجودة في نفس العين بس بتشتغل عكس شغل ال agonist + +22 +00:01:38,360 --> 00:01:42,720 +في اتجاه معاكس للاتجاه اللي بتشتغل فيه ال agonist + +23 +00:01:43,410 --> 00:01:46,910 +مثال the right lateral rectus is the antagonist to + +24 +00:01:46,910 --> 00:01:50,330 +the right medial rectus the right lateral rectus + +25 +00:01:50,330 --> 00:01:55,350 +is the agonist to the antagonist عفوا to the right + +26 +00:01:55,350 --> 00:01:59,890 +medial rectus الان ممكن سان يسأل طب يا ترى أي عضلة + +27 +00:01:59,890 --> 00:02:03,610 +هسميها ال agonist و أي عضلة هسميها ال antagonist + +28 +00:02:03,610 --> 00:02:08,370 +هذا بيرتبط بالعين و مين ده تتطلع والله إذا العين + +29 +00:02:08,370 --> 00:02:13,130 +ده تتطلع في وضع ال adductionفي وضع ال adoption مين + +30 +00:02:13,130 --> 00:02:15,870 +المسئول عن انه يشد الين في وضع ال adoption ال + +31 +00:02:15,870 --> 00:02:19,270 +media rectusإذن ال media rectus في هذه الحالة هي + +32 +00:02:19,270 --> 00:02:23,630 +هتمثل دور ال agonist وفي نفس الوقت مين العضلة + +33 +00:02:23,630 --> 00:02:26,550 +المعاكسة لل media rectus اللي هي العضلة المقابلة + +34 +00:02:26,550 --> 00:02:29,950 +ال lateral rectus إذن لما العين بدأت تروح في اتجاه + +35 +00:02:29,950 --> 00:02:33,970 +ال adduction في اتجاه ال adduction اللي هيمثل دور + +36 +00:02:33,970 --> 00:02:38,050 +ال agonist هو ال media rectus واللي ما هيمثل دور + +37 +00:02:38,050 --> 00:02:41,750 +ال antagonist هو ال lateral rectus مثال آخر لو + +38 +00:02:41,750 --> 00:02:44,870 +احنا حبينا العين تطلع على برا يعني بمعنى أنها تروح + +39 +00:02:44,870 --> 00:02:49,270 +في وضع ال abductionالأدوار بتتم تبادلها يعني هذه + +40 +00:02:49,270 --> 00:02:52,810 +العضلات ال lateral rectus بتصبح هي ال agonist وال + +41 +00:02:52,810 --> 00:02:56,870 +media rectus هي اللي بتصبح ال antagonist ليش؟ لأن + +42 +00:02:56,870 --> 00:03:00,050 +ال lateral rectus هي المسئولة انها تود العين و تشد + +43 +00:03:00,050 --> 00:03:03,610 +العين في الهدف اللي الإنسان عايز أو العين عايزة + +44 +00:03:03,610 --> 00:03:07,570 +تطلع عليه فبالتالي دور ال agonist و دور ال + +45 +00:03:07,570 --> 00:03:12,070 +antagonist مش ثابت لعضلة معينة بذاتها حسب اتجاه + +46 +00:03:12,070 --> 00:03:17,350 +النظرالعضلة اللى بتحرك العين فى اتجاه النظر أو فى + +47 +00:03:17,350 --> 00:03:20,610 +اتجاه الهدف اللى بدى يتطلى عليه الإنسان هذه العضلة + +48 +00:03:20,610 --> 00:03:24,350 +هي ال agonist والعضلة المقابلة لها اللى بتشد فى + +49 +00:03:24,350 --> 00:03:28,130 +اتجاه العكس هي ال antagonist مثال آخر بنقول لو + +50 +00:03:28,130 --> 00:03:32,170 +الإنسان حاب يتطلى على فوق ال superior rectus طبعا + +51 +00:03:32,170 --> 00:03:35,570 +برا و فوق out and up ال superior rectus هى ال + +52 +00:03:35,570 --> 00:03:39,250 +agonist فى نفس الوقت ال inferior rectus هى ال + +53 +00:03:39,250 --> 00:03:44,390 +antagonist هى ال antagonist طيبلو حاب يطلع out and + +54 +00:03:44,390 --> 00:03:47,690 +down .. out and down ال inferior rectus هي اللي + +55 +00:03:47,690 --> 00:03:51,070 +بتصير ال agonist وال superior rectus هي ال + +56 +00:03:51,070 --> 00:03:56,110 +antagonist طيب لو حاب يطلع in and up مين المسئول + +57 +00:03:56,110 --> 00:03:59,540 +عن رفع العين في ال in and up؟ال inferior oblique + +58 +00:03:59,540 --> 00:04:02,240 +muscle ال inferior oblique muscle ساعتها هي ال + +59 +00:04:02,240 --> 00:04:05,180 +agonist وال superior oblique اللي هي العضلة + +60 +00:04:05,180 --> 00:04:10,860 +المقابلة هي ال antagonist و لو حاب يطلع in and + +61 +00:04:10,860 --> 00:04:14,440 +down لا جوا ولا تحت ال superior oblique هي ال + +62 +00:04:14,440 --> 00:04:17,960 +agonist و ال inferior oblique اللي هي العضلة + +63 +00:04:17,960 --> 00:04:21,820 +المقابلة إليها هي ال antagonist إذا كل عضلة ممكن + +64 +00:04:21,820 --> 00:04:27,430 +تمثل دور ال agonistو العضلة المضادة إليها ال + +65 +00:04:27,430 --> 00:04:31,850 +antagonist أو يتعاكسوا الأدوار أو يتعاكسوا الأدوار + +66 +00:04:31,850 --> 00:04:36,730 +إذا ال agonist و ال antagonist هما عبارة عن عضلتين + +67 +00:04:36,730 --> 00:04:42,050 +في نفس العين بيشتغلوا عكس بعض ال agonist بتحرك في + +68 +00:04:42,050 --> 00:04:47,690 +الاتجاه المراد للنظر و ال antagonistبتقاوم هذه + +69 +00:04:47,690 --> 00:04:51,790 +الحركة اذا are muscles of the same eye that move + +70 +00:04:51,790 --> 00:04:55,610 +the eye in opposite direction .. directions the + +71 +00:04:55,610 --> 00:04:59,090 +agonist ايش هو ال agonist تعريفه is the primary + +72 +00:04:59,090 --> 00:05:02,530 +muscle moving the eye in a given direction هي + +73 +00:05:02,530 --> 00:05:06,290 +العضلة الرئيسية اللي بتحرك العين في اتجاه معين هذا + +74 +00:05:06,290 --> 00:05:10,710 +الاتجاه الإنسان عايز يتطلع عليه the antagonist + +75 +00:05:10,710 --> 00:05:14,310 +acts in opposite direction to the agonistالـ + +76 +00:05:14,310 --> 00:05:18,170 +antagonist acts in opposite direction to the + +77 +00:05:18,170 --> 00:05:23,810 +agonist نيجي للتعريف التاني are ال synergists + +78 +00:05:23,810 --> 00:05:28,350 +العضلات المتساعدة هنا عضلات متضادة agonist و + +79 +00:05:28,350 --> 00:05:32,710 +antagonist ال synergists are muscles of the same + +80 +00:05:32,710 --> 00:05:37,170 +eye أيضا هدول عضلتين موجودين في نفس العين موجودين + +81 +00:05:37,170 --> 00:05:40,690 +في نفس العينthat move the eye in the same + +82 +00:05:40,690 --> 00:05:45,050 +direction بتعاونوا عشان يخلوا العين تتحرك في نفس + +83 +00:05:45,050 --> 00:05:50,290 +الاتجاه عضلات متساعدة مع بعضها البعض زي إيش؟ زي ال + +84 +00:05:50,290 --> 00:05:53,650 +superior rectus و ال inferior oblique في ال + +85 +00:05:53,650 --> 00:05:57,390 +straight up position .. في ال straight up .. نروح + +86 +00:05:57,390 --> 00:06:01,250 +لصورة في ال straight upفي ال straight up .. + +87 +00:06:01,250 --> 00:06:05,310 +straight up في نفس العين .. في نفس العين ال + +88 +00:06:05,310 --> 00:06:08,010 +superior rectus مع ال inferior oblique اتشاركوا في + +89 +00:06:08,010 --> 00:06:11,610 +رفع العين superior rectus مع ال inferior oblique + +90 +00:06:11,610 --> 00:06:15,250 +بينما لما بتكون العين up and right مثلا فقط هنا ال + +91 +00:06:15,250 --> 00:06:18,430 +superior rectus لحالها لأنها هتكون up and out و + +92 +00:06:18,430 --> 00:06:22,350 +فقط هنا ال inferior oblique لحالها لأنها in and up + +93 +00:06:22,350 --> 00:06:27,840 +أمافي ال straight up عضلتين مع بعض بيساعدوا بعض في + +94 +00:06:27,840 --> 00:06:31,780 +الرفع هدول العضلتين في هذه الحالة بسميهم synergist + +95 +00:06:31,780 --> 00:06:35,620 +synergistic muscles synergistic muscles يعني عضلات + +96 +00:06:35,620 --> 00:06:39,840 +متساعدة أو متعاون في ال straight down نفس القضية + +97 +00:06:39,840 --> 00:06:43,900 +ال inferior rectus والسبين والقبليكيعني عضلتين في + +98 +00:06:43,900 --> 00:06:47,900 +نفس العين بيساعدوا بعضهم البعض .. بيساعدوا بعضهم + +99 +00:06:47,900 --> 00:06:51,740 +البعض على .. يعني تنزيل العين straight down + +100 +00:06:51,740 --> 00:06:55,680 +فبالتالي بيكونوا synergistic muscle لما بنقول مثلا + +101 +00:06:55,680 --> 00:06:59,160 +down and lift .. down and lift هتكون هنا فقط ال + +102 +00:06:59,160 --> 00:07:03,320 +philorectas عضلة واحدة لأنها out and down و فقط + +103 +00:07:03,320 --> 00:07:06,440 +هنا ال superior oblique لأنها in and outdown + +104 +00:07:06,440 --> 00:07:10,900 +فبالتالي ال .. ال .. ال synergism أو التعاون بيبين + +105 +00:07:10,900 --> 00:07:14,320 +في ال straight up و في ال straight down position + +106 +00:07:14,320 --> 00:07:19,720 +example طبعا the right superior rectus and the + +107 +00:07:19,720 --> 00:07:22,540 +right inferior right و right يعني في نفس العين + +108 +00:07:22,540 --> 00:07:25,240 +superior rectus و inferior oblique act + +109 +00:07:25,240 --> 00:07:30,410 +synergistically بي .. بي .. بيشتغلوا بشكل تعاونيin + +110 +00:07:30,410 --> 00:07:33,150 +elevation .. in elevation .. إذا الأن مر عنا + +111 +00:07:33,150 --> 00:07:36,370 +تعريفين .. تعريف الأول ال agonist و ال antagonist + +112 +00:07:36,370 --> 00:07:41,310 +عضلات متضادة في نفس العين عضلات متضادة فينا .. إيش + +113 +00:07:41,310 --> 00:07:44,270 +يعني متضادة يعني إيه لهم اتجاه عمل متعكس .. + +114 +00:07:44,270 --> 00:07:47,550 +abduction عكس ال abduction elevation عكس ال + +115 +00:07:47,550 --> 00:07:50,840 +depression و هكذافبالتالي ال agonist و ال + +116 +00:07:50,840 --> 00:07:55,260 +antagonist عضلتين في نفس العين بيشتغلوا عكس بعض ال + +117 +00:07:55,260 --> 00:07:59,940 +synergists عضلتين في نفس العين بيشتغلوا و + +118 +00:07:59,940 --> 00:08:04,360 +بيتعاملوا مع بعض عشان نقل العين في اتجاه معين + +119 +00:08:04,360 --> 00:08:09,730 +بيضال تالي التعريف ال yoke musclesالـ Yoke muscle + +120 +00:08:09,730 --> 00:08:14,030 +إلهة اسم تاني Contralateral synergist عضلات + +121 +00:08:14,030 --> 00:08:17,870 +متعاونة بس إيش يعني Contralateral كل واحدة منهم في + +122 +00:08:17,870 --> 00:08:23,390 +عين يعني في في كل عين عضلة وفي إلها رفيقتها من + +123 +00:08:23,390 --> 00:08:27,510 +العضلات من العين الأخرى إيش يعني رفيقتها يعني اللي + +124 +00:08:27,510 --> 00:08:31,130 +هو Contralateral synergist يعني اللي بتعاونها في + +125 +00:08:31,130 --> 00:08:35,310 +نقل العين التانية على نفس الاتجاه على نفس الاتجاه + +126 +00:08:35,310 --> 00:08:40,390 +our pairs عبارة عن زوج من العضلاتone in each eye + +127 +00:08:40,390 --> 00:08:48,290 +that produce conjugate ocular movement يعني عضلتين + +128 +00:08:48,290 --> 00:08:51,230 +عضلة في كل عين هدول العضلتين العضلة في العين + +129 +00:08:51,230 --> 00:08:53,990 +الأولى والعضلة في العين التانية بيشتغلوا ك team + +130 +00:08:53,990 --> 00:08:58,110 +ايش يعني بيشتغلوا ك team كفريق عمل يعني بيحركوا + +131 +00:08:58,110 --> 00:09:03,430 +العينتين باتجاه موحد باتجاه موحد مثال على ذلك left + +132 +00:09:03,430 --> 00:09:07,770 +superior oblique وال right inferior rectusleft + +133 +00:09:07,770 --> 00:09:12,830 +superior oblique left superior oblique هي left eye + +134 +00:09:12,830 --> 00:09:16,730 +superior oblique وال right inferior rectus في ال + +135 +00:09:16,730 --> 00:09:20,250 +right and down position هذا الإنسان هذا الإنسان + +136 +00:09:20,250 --> 00:09:25,010 +بتطلع لل right و down يعني لليمين و أسفل طيب لما + +137 +00:09:25,010 --> 00:09:28,650 +بتطلع لليمين و أسفل مين اللي مسئول عن نقل العين + +138 +00:09:28,650 --> 00:09:32,750 +اليمين out and down ال inferior rectus لأن هذا + +139 +00:09:32,750 --> 00:09:36,780 +مكان اختبارها وهذا المكان اللي هي بتكونpure + +140 +00:09:36,780 --> 00:09:39,920 +depression طيب العين الشمال مين اللي مسئول عن + +141 +00:09:39,920 --> 00:09:43,720 +نقلها لل in and down position in and down ال + +142 +00:09:43,720 --> 00:09:46,760 +superior obliqueإذا ال inferior rectus في ال right + +143 +00:09:46,760 --> 00:09:50,340 +eye و ال superior oblique في ال left eye تعاونوا + +144 +00:09:50,340 --> 00:09:53,540 +في ال right and down position إذا هدولة yoke + +145 +00:09:53,540 --> 00:09:57,360 +muscles لما بنقول dextroversion .. dextroversion + +146 +00:09:57,360 --> 00:10:00,640 +هيكون عندي ال lateral rectus في ال right eye و ال + +147 +00:10:00,640 --> 00:10:04,220 +medial rectus في ال left eye عبارة عن yoke muscles + +148 +00:10:04,220 --> 00:10:08,760 +يعني بتعاون و هم عضلة في كل عينبيتشتغلوا في نفس + +149 +00:10:08,760 --> 00:10:12,100 +الاتجاه بنقلوا العينتين لل right .. بنقلوا + +150 +00:10:12,100 --> 00:10:15,360 +العينتين لل right في ال .. ال .. ال right and up + +151 +00:10:15,360 --> 00:10:18,780 +.. right and up .. dextro elevation يعني ال + +152 +00:10:18,780 --> 00:10:21,380 +superior rectus في ال .. في ال right eye و ال + +153 +00:10:21,380 --> 00:10:25,840 +inferior oblique في ال left eye الآن في ال levo + +154 +00:10:25,840 --> 00:10:28,780 +elevation .. ال inferior oblique في ال right eye + +155 +00:10:29,000 --> 00:10:32,860 +وال superior rectus في ال left eye يعتبر يوك مسلز + +156 +00:10:32,860 --> 00:10:37,680 +في ال level virgin ال media rectus بتاع العين + +157 +00:10:37,680 --> 00:10:40,960 +اليمين و ال lateral rectus بتاع العين الشمال برضه + +158 +00:10:40,960 --> 00:10:44,940 +يوك مسلز ليش؟ لأن هم التنتين اشتغلوا ك team عضلة + +159 +00:10:44,940 --> 00:10:49,620 +في كل عين بس التنتين نجلوا العينتين في اتجاه اللي + +160 +00:10:49,620 --> 00:10:54,880 +هو الشمال او في اتجاه واحد في اتجاه واحد left and + +161 +00:10:54,880 --> 00:10:58,850 +down dextro depression ال superior obliqueفي ال + +162 +00:10:58,850 --> 00:11:01,310 +right eye و ال inferior rectus ممكن انسان يقول ليش + +163 +00:11:01,310 --> 00:11:03,790 +superior oblique لأنها in and down هذه منطقة + +164 +00:11:03,790 --> 00:11:07,130 +اختبار ال superior oblique muscle و هنا ليش ال + +165 +00:11:07,130 --> 00:11:12,950 +inferior rectus لأنه out and down فبالتالي هذه + +166 +00:11:12,950 --> 00:11:15,410 +منطقة اختبار ال inferior rectus muscle إذا ال + +167 +00:11:15,410 --> 00:11:18,790 +superior oblique في ال right eye و ال inferior + +168 +00:11:18,790 --> 00:11:23,790 +rectus في ال left eye are yoke muscles فبالتالي + +169 +00:11:23,790 --> 00:11:28,030 +هدول العضلات يسمى yoke muscles + +170 +00:11:30,270 --> 00:11:35,090 +هي هنا أيضًا مثال آخر right and up ليها .. هنا + +171 +00:11:35,090 --> 00:11:38,170 +هتكون العين طلعت لبرة و لفوق فال superior rectus + +172 +00:11:38,170 --> 00:11:41,730 +هي المسؤولة، هنا دخلت لجوة و لفوق، ال inferior + +173 +00:11:41,730 --> 00:11:45,830 +oblique هي المسؤولة، فبالتالي ال superior rectus + +174 +00:11:45,830 --> 00:11:48,170 +في ال right eye و ال inferior oblique في ال left + +175 +00:11:48,170 --> 00:11:52,360 +eye are yoke musclesلو الإنسان هذا بيتطلع لليمين، + +176 +00:11:52,360 --> 00:11:55,880 +عينيته تنتين هيروح و مرة واحدة لليمين مع بعض بشكل + +177 +00:11:55,880 --> 00:12:00,980 +يعني موحد و في نفس اللحظة و بنفس الدرجة فال + +178 +00:12:00,980 --> 00:12:04,560 +lateral rectus في ال right eye و ال medial rectus + +179 +00:12:04,560 --> 00:12:07,900 +في ال left eye هدولة يوك muscles في المنظر هذا + +180 +00:12:07,900 --> 00:12:10,620 +dextro depression ال inferior rectus في ال right + +181 +00:12:10,620 --> 00:12:14,530 +eye و ال superior obliqueهم يوك muscles .. هم يوك + +182 +00:12:14,530 --> 00:12:17,890 +muscles فبالتالي هذه القضية بدها تكون ان شاء الله + +183 +00:12:17,890 --> 00:12:22,930 +واضحة .. بدها تكون ان شاء الله واضحة طيب عشان نحكي + +184 +00:12:22,930 --> 00:12:27,230 +نقطة ان هدولة Contralateral synergist أو يوك + +185 +00:12:27,230 --> 00:12:30,870 +muscles عبارة عن pairs of muscles زوج من العضلات + +186 +00:12:30,870 --> 00:12:35,610 +أو أزواج من العضلات عضلة في كل عين that produce + +187 +00:12:35,610 --> 00:12:39,810 +conjugate ocular movement لو رجعنا نتذكر إيش هي ال + +188 +00:12:39,810 --> 00:12:43,260 +conjugate ocular movement هي ال virginهي ال virgin + +189 +00:12:43,260 --> 00:12:47,360 +movement و واضح انه هذه الكلام .. هذه كلها virgin + +190 +00:12:47,360 --> 00:12:51,160 +movements binocular simultaneous conjugate + +191 +00:12:51,160 --> 00:12:55,880 +binocular العينين التنتين مفتحات simultaneous في + +192 +00:12:55,880 --> 00:12:59,420 +نفس اللحظة بالتم الحركة conjugate يعني في نفس + +193 +00:12:59,420 --> 00:13:02,740 +الاتجاه .. في نفس الاتجاه يعني المسئول عن ال + +194 +00:13:02,740 --> 00:13:06,580 +virgins .. المسئول عن ال virgins هم اليوك muscles + +195 +00:13:06,580 --> 00:13:10,220 +في العينين .. هم اليوك muscles في العينين + +196 +00:13:12,520 --> 00:13:17,960 +نجي للقانون الأول من قوانين حركة العين اللي بيسموه + +197 +00:13:17,960 --> 00:13:21,840 +Sherrington law of reciprocal innervation أو + +198 +00:13:21,840 --> 00:13:25,640 +inhibition Sherrington law للتغفية العصبية + +199 +00:13:25,640 --> 00:13:29,240 +المتعاكسة يعني اللي بيصير فيها inhibition يعني + +200 +00:13:29,240 --> 00:13:34,680 +اللي بيصير فيها تثبيض ينص على .. ينص على increased + +201 +00:13:34,680 --> 00:13:41,260 +innervation to an extraocular muscleعلى سبيل + +202 +00:13:41,260 --> 00:13:45,820 +المثال right medial rectus is accompanied يصاحب + +203 +00:13:45,820 --> 00:13:51,640 +ويرافق by reciprocal decreased in innovation to + +204 +00:13:51,640 --> 00:13:55,700 +its antagonist زي ال right lateral rectus يعني + +205 +00:13:55,700 --> 00:14:02,680 +زيادة التغذية العصبية زيادة التغذية العصبية لعضلة + +206 +00:14:02,680 --> 00:14:08,760 +ما لل agonistزيادة التغذية العصبية للعضل ال + +207 +00:14:08,760 --> 00:14:12,320 +agonist احنا بنحكي المثال ان ال agonist بنعتبره هو + +208 +00:14:12,320 --> 00:14:16,340 +ال media rectus هذه العين عايزة تروح لل adoption + +209 +00:14:16,340 --> 00:14:20,400 +ناحية النوز يعني عايزة تروح لل adoption إذا ال + +210 +00:14:20,400 --> 00:14:23,280 +agonist هو ال media rectus وال antagonist هو ال + +211 +00:14:23,280 --> 00:14:27,140 +lateral rectus قانون شيرنجتون للتغذية العصبية + +212 +00:14:27,140 --> 00:14:33,100 +المتعاكسة بيقول زيادة التغذية العصبية لل agonist + +213 +00:14:33,100 --> 00:14:39,840 +يصاحببتثبيت ال antagonist أو بقلة التغذية العصبية + +214 +00:14:39,840 --> 00:14:45,500 +لل antagonist عشان نفهم هذا الكلام أول حاجة بدنا + +215 +00:14:45,500 --> 00:14:50,780 +نعرفها و أهم حاجة بدنا نعرفها ان قوانين حركة العين + +216 +00:14:50,780 --> 00:14:55,240 +ال laws of ocular motility تتكلم عن التغذية + +217 +00:14:55,240 --> 00:15:01,070 +العصبيةعن ال innovation وليس عن ال movement وهذه + +218 +00:15:01,070 --> 00:15:05,770 +موضوع أو جملة مهمة للغاية أنه نفهمها تماما تماما + +219 +00:15:05,770 --> 00:15:10,330 +تماما لما بنقول laws of ocular motility احنا الآن + +220 +00:15:10,330 --> 00:15:13,330 +بدأنا نتكلم عن القانون الأول اللي هو قانون + +221 +00:15:13,330 --> 00:15:17,990 +Sherrington أو Sherrington law بيتكلم عن التغذية + +222 +00:15:17,990 --> 00:15:24,450 +العصبيةوبيحكي إنه لما بيزيد التغذية العصبية لعضلة + +223 +00:15:24,450 --> 00:15:27,890 +ال agonist اللي احنا ضربنا مثال عليها الآن ال + +224 +00:15:27,890 --> 00:15:32,190 +media rectus لابد إنه في نفس اللحظة يقل التغذية + +225 +00:15:32,190 --> 00:15:37,510 +العصبية لل antagonist ليش؟ لأنه لو دال في تغذية + +226 +00:15:37,510 --> 00:15:43,070 +عصبية أو innervation لتنتين بنفس القدرساعتها العين + +227 +00:15:43,070 --> 00:15:45,810 +عشان تروح عاليمين بدها تصير contraction في ال + +228 +00:15:45,810 --> 00:15:49,270 +media rectus muscle عشان تروح باتجاه ال adduction + +229 +00:15:49,270 --> 00:15:53,270 +طيب في نفس الوقت أنه في جاي تبغية عصبية لل lateral + +230 +00:15:53,270 --> 00:15:56,570 +rectus فال lateral rectus عاملة أيضا contraction + +231 +00:15:56,570 --> 00:16:00,010 +يعني مش راخية فبالتالي العين مش هتقدر تيجي في وضع + +232 +00:16:00,010 --> 00:16:03,330 +ال adduction لأن ال media rectus بتشد وال lateral + +233 +00:16:03,330 --> 00:16:07,170 +rectus بتشد عكسها ضروري جدا عشان العين يصير لها + +234 +00:16:07,170 --> 00:16:12,150 +rotation rotation حول محور الدوران بتاعهاحاول محور + +235 +00:16:12,150 --> 00:16:16,470 +الدوران بتاعها لابد انه اذا عضلة اجاها innervation + +236 +00:16:16,470 --> 00:16:21,370 +اجاها innervation عشان تنقبط لازم ييجي تثبيت + +237 +00:16:21,370 --> 00:16:26,690 +وتقليل من الترثية العصبية ل ال antagonist بتاعها + +238 +00:16:26,690 --> 00:16:31,030 +عشان ترخي وبالتالي تقدر العضلة تدور يعني بدها تشد + +239 +00:16:31,030 --> 00:16:33,970 +عضلة و بدها ترخي اللي عاجبالها بدها تشد عضلة و + +240 +00:16:33,970 --> 00:16:39,230 +بدها ترخي اللي عاجبالها فبالتالي يا نص القانون .. + +241 +00:16:39,230 --> 00:16:46,530 +يا نص القانونstates that increased contraction لأ + +242 +00:16:46,530 --> 00:16:51,350 +innervation بيتكلم عن ال innervation increased + +243 +00:16:51,350 --> 00:16:56,670 +innervation to an extraocular muscle مثال ال right + +244 +00:16:56,670 --> 00:17:02,970 +medial rectus is accompanied يرافق في نفس اللحظة + +245 +00:17:02,970 --> 00:17:07,620 +by reciprocal reciprocal عكسي أو خلف خلاف يعنيby + +246 +00:17:07,620 --> 00:17:10,880 +reciprocal decrease in innovation to its + +247 +00:17:10,880 --> 00:17:14,260 +antagonist اللي هي إذا كان احنا قلنا ال agonist ال + +248 +00:17:14,260 --> 00:17:17,320 +right medial rectus هتكون ال antagonist بتاعتها ال + +249 +00:17:17,320 --> 00:17:20,520 +right lateral rectus طيب ممكن الإنسان يقول يعني + +250 +00:17:20,520 --> 00:17:22,820 +هذا دايما بحدث مع ال medial rectus و ال lateral + +251 +00:17:22,820 --> 00:17:27,340 +rectus هذا حسب الحاجة للنظر بأي اتجاه لو قلنا + +252 +00:17:27,940 --> 00:17:30,560 +الإنسان هذا أو هذه العين ده تروح في وضع ال + +253 +00:17:30,560 --> 00:17:33,440 +abduction مين اللي بيجيب العين في وضع ال + +254 +00:17:33,440 --> 00:17:37,200 +abduction؟ ال lateral rectus إذا ال brain هيبعت + +255 +00:17:37,200 --> 00:17:41,320 +innervation أكتر لل lateral rectus وفي نفس الوقت + +256 +00:17:41,320 --> 00:17:44,740 +ال medial rectus أصبح دورها ال antagonist فبيصير + +257 +00:17:44,740 --> 00:17:48,080 +لها decrease في ال innervation طيب لو هذه العين ده + +258 +00:17:48,080 --> 00:17:51,620 +تروح up and out ال superior rectus بيجيها + +259 +00:17:51,620 --> 00:17:55,390 +increased innervationوفي نفس اللحظة لازم ترخي اللي + +260 +00:17:55,390 --> 00:17:58,790 +عاجبالها لأنه مابنفع أن عضلة يجيها تغذية عصبية + +261 +00:17:58,790 --> 00:18:02,850 +عشان تعمل contraction ويجي في نفس اللحظة تغذية + +262 +00:18:02,850 --> 00:18:07,190 +عصبية مماثلة لل antagonistic muscle لأنه لو هتبدأ + +263 +00:18:07,190 --> 00:18:10,210 +تعمل contraction و العضلة المضادة ال antagonistic + +264 +00:18:10,210 --> 00:18:14,220 +muscle بتعمل contractionساعتها التنير هيصير فيهم + +265 +00:18:14,220 --> 00:18:17,680 +contraction و الحركة باتجاه معين هتصبح مش ممكنة + +266 +00:18:17,680 --> 00:18:22,940 +لازم عشان يتصير الحركة ممكنة في اتجاه معين من + +267 +00:18:22,940 --> 00:18:26,100 +الاتجاهات لازم العضلة المعنية يصير اللي هي + +268 +00:18:26,100 --> 00:18:28,640 +increased innervation يعني إيش العضلة المعنية؟ + +269 +00:18:28,640 --> 00:18:31,840 +يعني اللي بتشتغل على هذا الخط أو في هذا الاتجاه + +270 +00:18:31,840 --> 00:18:35,100 +يجي لها increased innervation و العضلة المضادة + +271 +00:18:35,100 --> 00:18:38,920 +اللي هي ال antagonistic muscle فلازم يجيها + +272 +00:18:38,920 --> 00:18:42,130 +inhibitionInhibition يعني decreased innervation + +273 +00:18:42,130 --> 00:18:46,270 +فلو قلنا ال superior oblique بده يجيها increased + +274 +00:18:46,270 --> 00:18:51,130 +innervation عشان ال down and in movement ساعتها ال + +275 +00:18:51,130 --> 00:18:53,990 +inferior oblique لازم يجيها inhibition لأنها عضلة + +276 +00:18:53,990 --> 00:18:57,450 +معاكسة لل superior oblique إذا increased + +277 +00:18:57,450 --> 00:19:01,530 +innervation بنعود بنأكد أنه القوانين الحركة بتحكي + +278 +00:19:01,530 --> 00:19:05,200 +عن ال innervation بتحكي عن ال innervationممكن + +279 +00:19:05,200 --> 00:19:08,080 +إنسان يقول طب يعني إيش الفرق؟ سواء حكينا + +280 +00:19:08,080 --> 00:19:12,480 +innovation أو حكينا movement لأ، ليس شرطا إنه إذا + +281 +00:19:12,480 --> 00:19:18,060 +ال innovation نزل للعضلة إنها تنفذ العضلة ليس شرطا + +282 +00:19:18,060 --> 00:19:21,120 +إنه ال innovation .. ال innovation عبارة عن + +283 +00:19:21,120 --> 00:19:25,940 +impulses .. impulses نبضات عصبية بتنزل أو أوامر + +284 +00:19:25,940 --> 00:19:30,660 +عصبية بتنزل من الدماغ لعضلات العين ممكن عضلة العين + +285 +00:19:30,660 --> 00:19:35,680 +تنفذ هذا ال orderو ممكن ما تنفذوش و هذا هيتضح معنى + +286 +00:19:35,680 --> 00:19:39,000 +في المحاضرات التالية إيش معناة innovation و إيش + +287 +00:19:39,000 --> 00:19:43,620 +معناة إنه ينفذ أو لا ينفذ .. إنه ينفذ أو لا ينفذ + +288 +00:19:43,620 --> 00:19:50,740 +بس بدنا نقول شغلة إنه القوانين بنأكد مرة تالتة و + +289 +00:19:50,740 --> 00:19:54,640 +رابعة إنه بتتكلم عن ال innovation و لا تتكلم عن ال + +290 +00:19:54,640 --> 00:19:58,080 +movement أو عن ال contraction يعني بتتكلم عن + +291 +00:19:58,080 --> 00:20:02,660 +التغذية العصبيةthis means that when the medial + +292 +00:20:02,660 --> 00:20:06,200 +rectus contracts لأن هذا بعد ما تم ال innovation + +293 +00:20:06,200 --> 00:20:10,060 +الخطوة التالية تبدأ العضلة اللي إجهها ال + +294 +00:20:10,060 --> 00:20:14,140 +innovation تعمل contraction و اللي ما إجهاش أو + +295 +00:20:14,140 --> 00:20:17,060 +اللي .. اللي .. اللي صار لها inhibition بتعمل + +296 +00:20:17,060 --> 00:20:21,080 +relaxation .. بتعمل relaxation this means that + +297 +00:20:21,080 --> 00:20:23,780 +when the medial rectus contracts the lateral + +298 +00:20:23,780 --> 00:20:27,840 +rectus automatically relaxes and vice versa و + +299 +00:20:27,840 --> 00:20:31,500 +العكس بالعكس لو العين بدهاتروح في وضع ال abduction + +300 +00:20:31,500 --> 00:20:35,560 +ساعتها هييجي innervation لل lateral rectus وييجي + +301 +00:20:35,560 --> 00:20:39,420 +inhibition لل medial rectus فبعد هذه الخطوة بعد + +302 +00:20:39,420 --> 00:20:42,360 +خطوة ال innervation هتبدأ ال lateral rectus تعمل + +303 +00:20:42,360 --> 00:20:45,680 +contraction و ال medial rectus تعمل relaxation + +304 +00:20:45,680 --> 00:20:52,280 +عشان تتم الحركة بشكل يعني سلسوة بدون أي مشكلة طبعا + +305 +00:20:52,280 --> 00:20:55,600 +sharington law applies to both virgins and + +306 +00:20:55,600 --> 00:21:01,840 +virginses وبنضيفلهم أيضاand ductions طيب يعني إيش + +307 +00:21:01,840 --> 00:21:06,100 +يعني أنه يطبق على جميع أنواع الحركات سواء ductions + +308 +00:21:06,100 --> 00:21:11,820 +أو virgins أو virgins دكشن أو virgins أو virgins + +309 +00:21:11,820 --> 00:21:16,320 +هذا القانون اللي هو sharrington law بنعيد نصه نصه + +310 +00:21:16,320 --> 00:21:19,820 +بيبدأ من عند كلمة increased innervation to an + +311 +00:21:19,820 --> 00:21:24,190 +extraocular muscleis accompanied by reciprocal + +312 +00:21:24,190 --> 00:21:28,490 +decrease in innovation to its antagonist خلص نص + +313 +00:21:28,490 --> 00:21:32,750 +القانون .. خلص نص القانون الآن القانون التاني هي + +314 +00:21:32,750 --> 00:21:36,710 +احنا عندنا رسمه بتوضح طبعا النبضات العصبية ممثلة + +315 +00:21:36,710 --> 00:21:40,310 +هنا بشرتات او شحتات هي احنا عندنا مثلا ال media + +316 +00:21:40,310 --> 00:21:43,290 +rectus muscle وهي عندنا ال lateral rectus muscle + +317 +00:21:43,290 --> 00:21:46,780 +والعين بدها تروح في وضع ال adductionطبعا كلام ال + +318 +00:21:46,780 --> 00:21:50,400 +innovation بيتم قبل أو سابق لموضوع ال contraction + +319 +00:21:50,400 --> 00:21:54,220 +أول اشي بيجي ال innovation بعدك العضلة بيصير فيها + +320 +00:21:54,220 --> 00:21:58,160 +contraction طبعا هنا الرسمة يعني بتوضح اجهتين ال + +321 +00:21:58,160 --> 00:22:01,240 +innovation و ال contraction بدليل ان العين راحت في + +322 +00:22:01,240 --> 00:22:05,520 +اتجاه ال adduction هنا ال noseفبالتالي عدد الشحتات + +323 +00:22:05,520 --> 00:22:08,880 +أو عدد النبضات العصبية هي ال innovation .. هي ال + +324 +00:22:08,880 --> 00:22:12,680 +innovation الواصل ل .. طبعا هذا simulation لل + +325 +00:22:12,680 --> 00:22:16,880 +innovation الواصل ل ال media rectus كتير و في نفس + +326 +00:22:16,880 --> 00:22:21,080 +اللحظةاللي واصل لل lateral rectus جليل جدا إذا ما + +327 +00:22:21,080 --> 00:22:24,540 +قولن بالواصل يعني فبالتالي هنا النبضات كتيرة و هنا + +328 +00:22:24,540 --> 00:22:28,780 +خفت النبضات بشكل كبير جدا عشان تعمل ال lateral + +329 +00:22:28,780 --> 00:22:33,300 +rectus relaxation و تعمل ال medial rectus + +330 +00:22:33,300 --> 00:22:37,260 +contraction فالعين تتحرك باتجاه ال adduction .. ال + +331 +00:22:37,260 --> 00:22:41,400 +adduction طيب نيجي للقانون التاني و الأخير من + +332 +00:22:41,400 --> 00:22:45,970 +قوانين حركة العين اللي هو ال hearing lawاحنا خلصنا + +333 +00:22:45,970 --> 00:22:49,810 +الـ Sherrington law و الآن بنحكي عن ال hearing law + +334 +00:22:49,810 --> 00:22:54,590 +of equal innervation .. of equal innervation اذا + +335 +00:22:54,590 --> 00:22:59,650 +.. اذا بنقول في ال hearing law نصه states that + +336 +00:22:59,650 --> 00:23:03,930 +equal states that during .. من عند كلمة during + +337 +00:23:03,930 --> 00:23:09,110 +هيبدأ .. during any conjugate I movement equal and + +338 +00:23:09,110 --> 00:23:13,030 +simultaneous innervationflows to the yoke muscles + +339 +00:23:13,030 --> 00:23:17,850 +خلص نص القانون، اذا بينص على انه during any + +340 +00:23:17,850 --> 00:23:21,930 +conjugate I movement equal and simultaneous + +341 +00:23:21,930 --> 00:23:26,150 +innervation flows to the yoke muscles اول مقطة + +342 +00:23:26,150 --> 00:23:31,070 +بدنا نحكيها، هذا القانون بيحكي ان خلال ال + +343 +00:23:31,070 --> 00:23:34,550 +conjugate I movements، ايش هي ال conjugate I + +344 +00:23:34,550 --> 00:23:37,810 +movements؟اللي هي ال virgin .. اللي هي ال virgin + +345 +00:23:37,810 --> 00:23:42,710 +لما .. بنتذكر تعريف ال virgin هي binocular + +346 +00:23:42,710 --> 00:23:47,730 +simultaneous conjugate .. conjugate ocular + +347 +00:23:47,730 --> 00:23:52,810 +motility فبالتالي .. يعني during virgin .. during + +348 +00:23:52,810 --> 00:23:57,030 +virgin movements أو during conjugate eye movements + +349 +00:23:57,030 --> 00:24:03,030 +equal متساوي and simultaneous innervation بيحكي + +350 +00:24:03,030 --> 00:24:06,710 +أيضا عن ال innervationflows to the yoke muscle + +351 +00:24:06,710 --> 00:24:09,950 +احنا بنذكر احنا قبل شوية أخدنا تعريف ال yoke + +352 +00:24:09,950 --> 00:24:13,070 +muscle قولنا هاي أمثلة على ال yoke muscle superior + +353 +00:24:13,070 --> 00:24:17,140 +rectus و inferior obliqueup and right العنتين + +354 +00:24:17,140 --> 00:24:20,700 +رايحين up and right هذا conjugate eye movement في + +355 +00:24:20,700 --> 00:24:24,200 +هذه اللحظة في المنظر هذا بيصل innervation لل + +356 +00:24:24,200 --> 00:24:28,400 +superior rectus ونفس كمية ال innervation وفي نفس + +357 +00:24:28,400 --> 00:24:32,080 +اللحظة نفس الكمية وفي نفس اللحظة بتصل لل inferior + +358 +00:24:32,080 --> 00:24:35,440 +oblique في ال left eye لأنهم yoke muscle ومسؤولين + +359 +00:24:35,440 --> 00:24:40,820 +عن نقل العنتين لهذا الموقع من النظر لهذا الموقع من + +360 +00:24:40,820 --> 00:24:45,280 +النظرأيضًا لما الإنسان بيتطلع على اليمين بنقول ال + +361 +00:24:45,280 --> 00:24:47,860 +lateral rectus في ال right eye و ال medial rectus + +362 +00:24:47,860 --> 00:24:51,580 +في ال left eye بيصلهم equal and simultaneous + +363 +00:24:51,580 --> 00:24:55,860 +بيصلهم نفس الكمية من التغذية العصبية و في نفس + +364 +00:24:55,860 --> 00:25:00,140 +اللحظة مش بيصل نفس الكمية بس في أوقات مختلفة يعني + +365 +00:25:00,140 --> 00:25:03,640 +بيصل ال lateral rectus هناوبعد دقيقة او دقيقتين + +366 +00:25:03,640 --> 00:25:07,240 +بيصل ال media rectus ان لأ في نفس اللحظة بيصل لأنه + +367 +00:25:07,240 --> 00:25:11,200 +لو في تأخير في وصول ال innervation لعضلة عن عضلة + +368 +00:25:11,200 --> 00:25:14,220 +بنلاقي مثلا ال lateral rectus اتحركت لليمين ولسه + +369 +00:25:14,220 --> 00:25:19,040 +ال media rectus ثابتة في مكانها والسبب انه ماوصلها + +370 +00:25:19,040 --> 00:25:22,380 +innervation فهذا الكلام مابيصيرش في الوضع الطبيعي + +371 +00:25:22,380 --> 00:25:28,110 +وانماحسب hearing law بينص على انه equal and + +372 +00:25:28,110 --> 00:25:32,510 +simultaneous innervation flows to the yoke muscles + +373 +00:25:32,510 --> 00:25:40,030 +فبالتالي هذا الكلام بيكون واضح الان بالنسبة ل ال + +374 +00:25:40,030 --> 00:25:43,170 +dextro depression inferior rectus في ال right eye + +375 +00:25:43,170 --> 00:25:46,570 +و ال superior oblique في ال left eye بيصلهم ايضا + +376 +00:25:46,570 --> 00:25:51,910 +equal and simultaneous innervationلو جينا نقعد هنا + +377 +00:25:51,910 --> 00:25:56,870 +مثلا level elevation up and leftال superior rectus + +378 +00:25:56,870 --> 00:25:59,610 +في ال left eye و ال inferior oblique في ال right + +379 +00:25:59,610 --> 00:26:03,750 +eye بيصلهم equal and simultaneous ضروري يكون equal + +380 +00:26:03,750 --> 00:26:08,510 +و ضروري يكون simultaneous innovation بيصل هدول + +381 +00:26:08,510 --> 00:26:12,490 +اليوك ناصل عشان يقدروا يحركوا العنتين في نفس + +382 +00:26:12,490 --> 00:26:17,970 +اللحظة وبنفس الاتجاه وبنفس القدر بنفس القدر + +383 +00:26:17,970 --> 00:26:23,350 +فبالتالي هذا نص اللي هو hearing low hearing low + +384 +00:26:23,350 --> 00:26:28,770 +بنقولduring any conjugate I movements equal and + +385 +00:26:28,770 --> 00:26:32,470 +simultaneous innerversion flows to the yoke muscle + +386 +00:26:32,470 --> 00:26:37,170 +طيب فبالتالي احنا زي ما قلنا .. احنا قلنا + +387 +00:26:37,170 --> 00:26:41,410 +Sherrington له معنى .. معنى بكل أنواع الحركة و + +388 +00:26:41,410 --> 00:26:44,650 +يطبق على جميع أنواع الحركة على ال virgins و ال + +389 +00:26:44,650 --> 00:26:48,630 +virginses و ال ductions هنا بيطبق ال herring فقط + +390 +00:26:48,630 --> 00:26:52,960 +على ال virgins فقط على ال virginsequal and + +391 +00:26:52,960 --> 00:26:57,920 +simultaneous innervation flows to the yoke muscles + +392 +00:26:57,920 --> 00:27:01,260 +.. to the yoke muscles عند هذه النقطة هنتوقف ان + +393 +00:27:01,260 --> 00:27:05,180 +شاء الله و نشوف ايش أثر hearing low .. hearing low + +394 +00:27:05,180 --> 00:27:09,660 +بالذات في حالة الحوال الشدلي الbaritic squint و + +395 +00:27:09,660 --> 00:27:13,620 +نتوقف عند هذه النقطة و بنكمل المرة القادمة ان شاء + +396 +00:27:13,620 --> 00:27:16,300 +الله تعالى و يعطيكم العافية والسلام عليكم ورحمة + +397 +00:27:16,300 --> 00:27:17,620 +الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Eow1zunSMNY.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Eow1zunSMNY.srt new file mode 100644 index 0000000000000000000000000000000000000000..565b660ecf8263d0dba3869c348b8c5b753ec0d7 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Eow1zunSMNY.srt @@ -0,0 +1,1531 @@ +1 +00:00:03,200 --> 00:00:07,580 +بسم الله الرحمن الرحيم هذه الـ .. أو هذا الفيديو + +2 +00:00:07,580 --> 00:00:12,800 +مراجعة للنسخة الأولى والثانية من الامتحان النصفي + +3 +00:00:12,800 --> 00:00:17,040 +في الرؤية الموحدة والحَوَل نبدأ بِعون الله نشوف + +4 +00:00:17,040 --> 00:00:21,200 +النسخة الأولى للامتحان النصفي suppression occurs + +5 +00:00:21,200 --> 00:00:24,920 +only as a result of squint طبعًا غلط ممكن يكون as a + +6 +00:00:24,920 --> 00:00:27,960 +result of anisometropia لأن في حالة الانيزومتروبيا + +7 +00:00:28,520 --> 00:00:33,040 +الـ more ametropic eye ممكن تكون الصورة فيها مش واضحة + +8 +00:00:33,040 --> 00:00:39,300 +كويس وبالتالي .. وبالتالي بيكون أن الصورة مش + +9 +00:00:39,300 --> 00:00:41,720 +واضحة اللي هيقبلها الـ brain فبيعملها suppression + +10 +00:00:41,720 --> 00:00:48,170 +يعني مش بس في الاسكونة السؤال الثاني yoke muscles + +11 +00:00:48,170 --> 00:00:51,510 +in dextro depression، dextro depression يعني right + +12 +00:00:51,510 --> 00:00:54,890 +and down، مين اللي بيجيب العين اليمين right and + +13 +00:00:54,890 --> 00:00:57,710 +down؟ الـ inferior rectus، والـ yoke muscle في + +14 +00:00:57,710 --> 00:01:00,710 +الشمال، اللي هي الـ superior oblique، إذا right + +15 +00:01:00,710 --> 00:01:07,510 +inferior rectus and left superior oblique، هذه هي + +16 +00:01:07,510 --> 00:01:11,470 +الجواب الصحيح في dextro depression، في الـ dextro + +17 +00:01:11,470 --> 00:01:16,000 +depression، السؤال اللي بعده هذا سؤال very + +18 +00:01:16,000 --> 00:01:19,180 +interesting بعض الأسئلة على فكرة عليها أكثر من + +19 +00:01:19,180 --> 00:01:25,920 +علامة يعني ممكن هذا السؤال يكون علي علامتين drag + +20 +00:01:25,920 --> 00:01:28,540 +and drop into the image the correct type of + +21 +00:01:28,540 --> 00:01:32,120 +fusional vergences that these glasses stimulate + +22 +00:01:32,120 --> 00:01:37,080 +put in appropriate choice in the upper box طيب + +23 +00:01:37,080 --> 00:01:42,890 +بنقول كالتالي هذا البرزم بيز أوت وهذا البرزم بيز + +24 +00:01:42,890 --> 00:01:46,330 +أوت واضح أن المنطقة هي الـ base بتاعة البرزم وهي الـ + +25 +00:01:46,330 --> 00:01:49,090 +base بتاعة البرزم لما بيكون بيز أوت بيز أوت + +26 +00:02:09,940 --> 00:02:14,200 +سأحط refusional convergence كجواب وكلّه في الـ right + +27 +00:02:14,200 --> 00:02:18,820 +in the right upper box أو أني أتركه كما هو أو + +28 +00:02:18,820 --> 00:02:23,260 +أن أتركه كما هو يعني هنا خلاص هو الجواب الصحيح + +29 +00:02:23,260 --> 00:02:27,280 +refusional convergence refusional convergence + +30 +00:02:27,280 --> 00:02:29,520 +انتقل للسؤال اللي بعده + +31 +00:02:35,650 --> 00:02:39,170 +vertical recti are adductors الـ vertical recti اللي + +32 +00:02:39,170 --> 00:02:41,970 +هي superior rectus والـ inferior rectus muscles هذا + +33 +00:02:41,970 --> 00:02:45,810 +true من ضمن الـ actions بتاعتهم الـ adduction وقلنا + +34 +00:02:45,810 --> 00:02:49,840 +الـ function ضروري يكون الإنسان متقنها تمامًا الآن + +35 +00:02:49,840 --> 00:02:53,120 +سؤال matching prevents the sensation of diplopia + +36 +00:02:53,120 --> 00:02:56,440 +إيش اللي بيمنع الـ sensation of diplopia؟ هل هو الـ + +37 +00:02:56,440 --> 00:02:58,620 +central suppression ولا الـ alternating suppression + +38 +00:02:58,620 --> 00:03:00,400 +ولا الـ peripheral suppression ولا الـ abnormal + +39 +00:03:00,400 --> 00:03:02,840 +retinal correspondence ولا الـ confusion ولا الـ + +40 +00:03:02,840 --> 00:03:05,440 +monocular suppression طبعًا الـ peripheral + +41 +00:03:05,440 --> 00:03:08,960 +suppression بيمنع الـ diplopia في الـ small angle + +42 +00:03:08,960 --> 00:03:12,730 +strabismus بيصير عندي abnormal retinal + +43 +00:03:12,730 --> 00:03:15,670 +correspondence من ضمن شروط الـ abnormal retinal + +44 +00:03:15,670 --> 00:03:19,750 +correspondence تكون زاوية الحول صغيرة two targets + +45 +00:03:19,750 --> 00:03:23,230 +stimulating the fovea هذا confusion .. هذا + +46 +00:03:23,230 --> 00:03:27,950 +confusion can cause amblyopia .. إيش في الأشياء + +47 +00:03:27,950 --> 00:03:30,530 +الموجودة عندي can cause amblyopia؟ الـ monocular + +48 +00:03:30,530 --> 00:03:33,370 +suppression لأن الـ alternating suppression ما + +49 +00:03:33,370 --> 00:03:38,600 +بيسبب amblyopia .. ما بيسبب amblyopia on abduction + +50 +00:03:38,600 --> 00:03:42,400 +لما العين تيجي في الـ abduction it becomes only + +51 +00:03:42,400 --> 00:03:45,600 +extortible طبعًا الـ inferior oblique لأنه في الـ + +52 +00:03:45,600 --> 00:03:48,820 +abduction الـ superior rectus elevator والـ + +53 +00:03:48,820 --> 00:03:51,940 +inferior oblique extortible inferior oblique هي في + +54 +00:03:51,940 --> 00:03:55,520 +الـ abduction في الـ abduction المحور بتاعها بتعامل + +55 +00:03:55,520 --> 00:03:59,360 +على محور العين وهي جاية من أسفل فتعمل extortion + +56 +00:03:59,360 --> 00:04:05,520 +only هتعمل extortion only طيب confusion results + +57 +00:04:05,520 --> 00:04:08,620 +from two different targets stimulating + +58 +00:04:08,620 --> 00:04:12,380 +corresponding retinal areas هنا لو شيلنا الـ + +59 +00:04:12,380 --> 00:04:15,060 +corresponding retinal areas وحطينا بدلها phobia + +60 +00:04:15,060 --> 00:04:18,120 +ما هي الـ phobia مع الـ phobia corresponding retinal + +61 +00:04:18,120 --> 00:04:21,360 +areas فالإجابة صحيحة two targets two different + +62 +00:04:21,360 --> 00:04:24,560 +targets stimulating corresponding retinal areas + +63 +00:04:24,560 --> 00:04:28,240 +وبالتالي بيعملولي confusion لأنه هيتم توحيد أشياء + +64 +00:04:28,240 --> 00:04:32,440 +مختلفة مع بعضها البعض conditions necessary for + +65 +00:04:32,440 --> 00:04:35,520 +normal binocular single vision include all of the + +66 +00:04:35,520 --> 00:04:40,030 +following except select one طبعًا accurate + +67 +00:04:40,030 --> 00:04:43,090 +neuromuscular development شرط عشان الـ binocular + +68 +00:04:43,090 --> 00:04:46,130 +single vision and coordination so that the visual + +69 +00:04:46,130 --> 00:04:49,890 +axis directed at and maintain fixation on the + +70 +00:04:49,890 --> 00:04:52,990 +object of regard طبعًا صحيح لازم يكون في عندي + +71 +00:04:52,990 --> 00:04:55,730 +normal retinal أو retinocortical correspondence + +72 +00:04:55,730 --> 00:05:00,170 +resulting in cyclopean viewing أيضًا الـ visual + +73 +00:05:00,170 --> 00:05:03,070 +pathway لازم يكون طبيعي normal routing of visual + +74 +00:05:03,070 --> 00:05:07,040 +pathways with overlapping of visual field مين اللي + +75 +00:05:07,040 --> 00:05:09,780 +مش شرط أنّه monocularly driving neurons in the + +76 +00:05:09,780 --> 00:05:12,900 +visual cortex لأنها ما لهاش علاقة في الـ binocular + +77 +00:05:12,900 --> 00:05:16,040 +single vision، مين اللي له علاقة الـ binocularly + +78 +00:05:16,040 --> 00:05:19,700 +driving neurons، إذا هذه هي الاستثناء، هذه هي + +79 +00:05:19,700 --> 00:05:24,840 +الاستثناء السؤال اللي بعده stereopsis is a + +80 +00:05:24,840 --> 00:05:28,340 +binocular function كلام صحيح مائة بالمائة وقلنا + +81 +00:05:28,340 --> 00:05:30,560 +فيه فارق بين الـ stereopsis اللي هو binocular + +82 +00:05:30,560 --> 00:05:33,760 +function والـ depth perception اللي هو ممكن أنا + +83 +00:05:33,760 --> 00:05:38,540 +يعني أحصل عليه بواسطة عين واحدة وقلنا تجربة أقلام + +84 +00:05:38,540 --> 00:05:42,740 +الرصاص يعني قلمين رصاص أحاول أحط سن القلم على سن + +85 +00:05:42,740 --> 00:05:48,090 +القلم بعينيّ الاثنتين يكون الحكم صحيح، بينما بعين + +86 +00:05:48,090 --> 00:05:51,970 +واحدة لما أغلق الثانية، غالبًا سأخطئ ومش هقدر أحط + +87 +00:05:51,970 --> 00:05:55,770 +سن القلم على سن القلم من أول مرة فالـ stereopsis + +88 +00:05:55,770 --> 00:05:59,270 +binocular function superior muscles اللي هي + +89 +00:05:59,270 --> 00:06:02,250 +superior rectus والـ superior oblique are in + +90 +00:06:02,250 --> 00:06:08,230 +twins طبعًا هذا كلام صحيح شايفين أنّه بدون الـ + +91 +00:06:08,230 --> 00:06:10,550 +function بتاعة الـ extraocular muscles كل شيء صعب + +92 +00:06:10,550 --> 00:06:16,130 +حيصير طبعًا سؤال زي اللي فات .. زي اللي فات سؤال + +93 +00:06:16,130 --> 00:06:20,770 +يعني مش مفروض يتعامل معه ثانيتين drag and drop + +94 +00:06:20,770 --> 00:06:23,550 +into the image the correct type of diplopia هنا + +95 +00:06:23,550 --> 00:06:28,290 +فيه diplopia هل هي vertical؟ يعني الصورتين فوق + +96 +00:06:28,290 --> 00:06:33,450 +بعض؟ طبعًا لا هل هي torsional؟ يعني صورة مائلة + +97 +00:06:33,450 --> 00:06:36,730 +بالنسبة للثانية؟ طبعًا لا هل هي horizontal؟ طبعًا + +98 +00:06:36,730 --> 00:06:40,350 +horizontal يعني سؤال زي هذا سهل جدًا عليه علامتين + +99 +00:06:40,610 --> 00:06:45,770 +ممكن الإنسان يعني بي .. أو .. أو يعني يتحصر أنّه + +100 +00:06:45,770 --> 00:06:50,590 +يفقد مثل هذه العلوم هذه in left eye which muscle + +101 +00:06:50,590 --> 00:06:55,430 +must relax on contraction of the right superior + +102 +00:06:55,430 --> 00:06:58,370 +rectus muscle in normal binocular single vision + +103 +00:06:58,370 --> 00:07:02,290 +patient أو .. أو person طيب لما يكون في عندي + +104 +00:07:02,290 --> 00:07:06,360 +normal binocular single vision person ومفتح عين + +105 +00:07:06,360 --> 00:07:09,780 +الاثنتين ويصير contraction في الـ right superior + +106 +00:07:09,780 --> 00:07:13,360 +rectus، معناته لازم يصير contraction في الـ yoke + +107 +00:07:13,360 --> 00:07:16,140 +muscle بتاعتها في العين الشمالية، مين الـ yoke + +108 +00:07:16,140 --> 00:07:20,230 +muscle مع الـ right superior rectus؟ اللي هي الـ left + +109 +00:07:20,230 --> 00:07:23,830 +inferior oblique طيب الـ left inferior oblique بما + +110 +00:07:23,830 --> 00:07:27,190 +أنها الـ yoke بتاعة الـ right superior rectus معناته + +111 +00:07:27,190 --> 00:07:30,170 +حيصير فيها أيضًا contraction لأن حسب Hering law + +112 +00:07:30,170 --> 00:07:34,290 +إذا أجا innervation لعضلة وعملت contraction لازم + +113 +00:07:34,290 --> 00:07:38,210 +يكون برده أجا innervation مساوي لعضلة yoke معاها + +114 +00:07:38,210 --> 00:07:40,710 +اللي هي هنا الـ right superior rectus والـ left + +115 +00:07:40,710 --> 00:07:42,650 +inferior oblique هيجيها نفس الكمية من الـ + +116 +00:07:42,650 --> 00:07:47,320 +innervation فتصير Contracted طيب بتعمل contraction + +117 +00:07:47,320 --> 00:07:49,980 +مين اللي .. اللي لازم يريح يصير له الـ relaxation؟ + +118 +00:07:49,980 --> 00:07:52,860 +الـ antagonist بتاع .. الـ antagonist بتاع الـ left + +119 +00:07:52,860 --> 00:07:56,800 +inferior oblique .. بتاع الـ left inferior oblique + +120 +00:07:56,800 --> 00:07:59,500 +هو الـ left superior oblique muscle .. الـ left + +121 +00:07:59,500 --> 00:08:02,180 +superior oblique muscle هي الـ antagonist بتاع الـ + +122 +00:08:02,180 --> 00:08:05,330 +left inferior oblique طالما الـ left inferior + +123 +00:08:05,330 --> 00:08:07,690 +oblique أجهها innervation كثير عشان تعمل + +124 +00:08:07,690 --> 00:08:10,110 +contraction عشان هي الـ yoke بتاعة الـ superior + +125 +00:08:10,110 --> 00:08:13,250 +rectus في الـ right eye، معناته اللي لازم يصير له + +126 +00:08:13,250 --> 00:08:16,770 +فيه relaxation حسب Sherrington law اللي هي left + +127 +00:08:16,770 --> 00:08:21,830 +superior oblique أيضًا لازم أعرف الـ agonist والـ + +128 +00:08:21,830 --> 00:08:24,130 +antagonist والـ synergist والـ yoke muscle + +129 +00:08:24,130 --> 00:08:28,090 +fusional divergence amplitudes are larger at + +130 +00:08:28,090 --> 00:08:32,310 +distance than at near طبعًا اللي بيرجع للأرقام لأ + +131 +00:08:32,310 --> 00:08:36,250 +هي larger at near تقريبًا من اثنتي عشرة إلى أربع عشرة prism + +132 +00:08:36,250 --> 00:08:39,770 +diopters than at distance تقريبًا من ستة إلى ثمانية prism إذا + +133 +00:08:39,770 --> 00:08:45,450 +هذا false واضح أن الأسئلة ما بتاخدش وقت كثير، يعني + +134 +00:08:45,450 --> 00:08:48,450 +المفروض مع الطالب، ما بنأش نقول مع الدكتور، تأخذ + +135 +00:08:48,450 --> 00:08:52,290 +من ثلاثين إلى أربعين ثانية كل سؤال By nasal image + +136 +00:08:52,290 --> 00:08:56,010 +disparity stimulate fusional divergence، كلام صحيح + +137 +00:08:56,010 --> 00:09:00,070 +مائة في المائة، لأن الفوفيا هتروح نازلة، والفوفيا + +138 +00:09:00,070 --> 00:09:03,690 +هتروح نازلة، فمن الأمام هيعمل divergence، إذا الـ + +139 +00:09:03,690 --> 00:09:07,190 +by nasal image disparity stimulates fusional + +140 +00:09:07,190 --> 00:09:11,870 +divergence، سؤال سهل ومباشر depressor of the left + +141 +00:09:11,870 --> 00:09:16,130 +eye in right gaze الـ left eye في الـ right gaze + +142 +00:09:16,130 --> 00:09:20,670 +بتصير in تدخل لداخل لما العينين بتطلعوا لليمين + +143 +00:09:20,670 --> 00:09:24,190 +معناته الـ left eye دخلت لداخل مين اللي بيعمل + +144 +00:09:24,190 --> 00:09:27,790 +depression؟ depressor of the left eye in right + +145 +00:09:27,790 --> 00:09:32,410 +gaze العين الشمال بتكون دخلت لداخل في الـ right gaze + +146 +00:09:32,410 --> 00:09:34,770 +طب مين بيعملها في الـ in position؟ مين بيعملها + +147 +00:09:34,770 --> 00:09:38,030 +down؟ الـ superior oblique الـ superior oblique is + +148 +00:09:38,030 --> 00:09:39,770 +on the left superior oblique muscle + +149 +00:09:44,230 --> 00:09:47,510 +Hering law can be applied to vergences is false + +150 +00:09:47,510 --> 00:09:51,890 +اللي بيرجع لتعريف Hering law هيقول during + +151 +00:09:51,890 --> 00:09:56,250 +conjugate eye .. أول كلمة فيه during conjugate eye + +152 +00:09:56,250 --> 00:09:59,930 +movements إيش هي الـ conjugate eye movements؟ الـ + +153 +00:09:59,930 --> 00:10:04,850 +vergences .. الـ vergences مش الـ versions إذا هو بنطبق على + +154 +00:10:04,850 --> 00:10:08,790 +الـ vergences facultative + +155 +00:10:08,790 --> 00:10:13,440 +suppression frequently leads to amblyopia خطأ الـ + +156 +00:10:13,440 --> 00:10:16,880 +obligatory suppression هو اللي عادة بيؤدي + +157 +00:10:16,880 --> 00:10:19,520 +للامبليوبيا facultative suppression لأنّه أحيانًا + +158 +00:10:19,520 --> 00:10:22,740 +بيكون موجود وأحيانًا مش موجود يعني إيش أحيانًا مش + +159 +00:10:22,740 --> 00:10:27,240 +موجود يعني في binocular single vision فمش هيؤدي + +160 +00:10:27,240 --> 00:10:34,980 +للامبليوبيا طيب right lateral rectus palsy leads to + +161 +00:10:34,980 --> 00:10:39,660 +contracture of the عندي lateral rectus في الـ right + +162 +00:10:39,660 --> 00:10:43,760 +eye صار فيها pulse مع مرور المدّة العضل اللي بيصير + +163 +00:10:43,760 --> 00:10:47,160 +فيها contraction اللي هي الـ medial rectus في الـ + +164 +00:10:47,160 --> 00:10:50,760 +right eye right medial rectus مصرية هذه السؤال يعني + +165 +00:10:50,760 --> 00:10:51,840 +غاية في السهولة + +166 +00:10:54,610 --> 00:10:58,510 +All objects on the horopter are seen singly and + +167 +00:10:58,510 --> 00:11:02,430 +stereoscopically، false، are seen singly، صحيح، + +168 +00:11:02,430 --> 00:11:05,690 +ولكن مش stereoscopically، in three dimensions، in + +169 +00:11:05,690 --> 00:11:08,990 +two dimensions، نرجع للهوربتر، راح نلاقي أنّه طبعًا + +170 +00:11:08,990 --> 00:11:14,130 +كل الـ objects اللي تقع على الـ horopter، بي .. بتُرى + +171 +00:11:14,130 --> 00:11:16,510 +singly and in two dimensions + +172 +00:11:20,450 --> 00:11:23,830 +extends from the posterior pole to the anterior + +173 +00:11:23,830 --> 00:11:29,030 +pole of the eye to infinity الـ anatomical axis هذا + +174 +00:11:29,030 --> 00:11:34,050 +تعريف مباشر which + +175 +00:11:34,050 --> 00:11:37,530 +muscle will go into inhibitional palsy if there + +176 +00:11:37,530 --> 00:11:43,910 +was longstanding left superior rectus palsy بنقول + +177 +00:11:43,910 --> 00:11:46,950 +left superior rectus إلها فترة طويلة الـ left + +178 +00:11:47,600 --> 00:11:51,140 +superior rectus إلى فترة طويلة مشلولة العضل + +179 +00:11:51,140 --> 00:11:53,460 +الانتاجونيست بتاعتها اللي هي الـ left inferior + +180 +00:11:53,460 --> 00:11:57,500 +rectus هتصير contracted وحيلزمها innervation أقل + +181 +00:11:57,500 --> 00:12:02,380 +هي over acting muscle الـ left inferior rectus ولكن + +182 +00:12:02,380 --> 00:12:06,360 +بـ innervation أقل بتعطي شغل كثير لأن اللي عاجبالها + +183 +00:12:06,360 --> 00:12:13,130 +يعني مشلول إذا طالما الـ left inferior rectus صارت + +184 +00:12:13,130 --> 00:12:17,070 +شغالة وقوية وبـ innervation قليل حسب Hering law + +185 +00:12:17,070 --> 00:12:21,910 +من الـ yoke بتاع الـ left inferior rectus الـ yoke بتاع الـ left + +186 +00:12:21,910 --> 00:12:25,110 +inferior rectus الـ right superior oblique فهتدخل + +187 +00:12:25,110 --> 00:12:28,950 +في innervation أقل وهي عضلة طبيعية عضلة طبيعية + +188 +00:12:28,950 --> 00:12:31,730 +بت + +201 +00:13:18,930 --> 00:13:22,190 +convergence insufficiency وهذا كلام صحيح وهذا + +202 +00:13:22,190 --> 00:13:25,850 +مأخوذ من .. يعني بشكل .. بالكلمة .. بالحرف من + +203 +00:13:25,850 --> 00:13:26,690 +الملزمة + +204 +00:13:29,410 --> 00:13:32,590 +up and out position is a diagnostic but not + +205 +00:13:32,590 --> 00:13:36,070 +a cardinal position of gaze لأ هو diagnostic و + +206 +00:13:36,070 --> 00:13:40,150 +cardinal في نفس الوقت ال up and out diagnostic و + +207 +00:13:40,150 --> 00:13:46,390 +cardinal إذا الإجابة خطأ طيب + +208 +00:13:46,840 --> 00:13:50,580 +Which kind of ocular movements occurs around the Z + +209 +00:13:50,580 --> 00:13:53,900 +-axis؟ Z-axis الـ vertical axis بما أن ال vertical + +210 +00:13:53,900 --> 00:13:57,740 +axis إذا ال adduction و ال abduction هما اللي + +211 +00:13:57,740 --> 00:14:04,260 +بيحصلوا حوالين Z-axis هيك خلصنا النموذج الأول بدنا + +212 +00:14:04,260 --> 00:14:06,360 +نروح للنموذج الثاني + +213 +00:14:10,920 --> 00:14:17,000 +أخد 16 دقيقة من 30 يعني نصف الوجد تقريبا مع الشرح و + +214 +00:14:17,000 --> 00:14:34,920 +التفصيل طيب + +215 +00:14:34,920 --> 00:14:36,980 +.. الآن نرجع للنسخة الثانية + +216 +00:14:42,850 --> 00:14:50,530 +امتحان نصفي النسخة الثانية بسم + +217 +00:14:50,530 --> 00:14:54,850 +الله the yoke + +218 +00:14:54,850 --> 00:14:59,110 +muscles in left up position left up .. left up + +219 +00:14:59,110 --> 00:15:02,850 +يعني ال left superior rectus و ال right inferior + +220 +00:15:02,850 --> 00:15:08,810 +oblique السؤال اللي بعده All objects in the + +221 +00:15:08,810 --> 00:15:11,690 +horopter are seen singly and stereoscopically قبل + +222 +00:15:11,690 --> 00:15:17,310 +شوية حلناها، طبعا خطأ are seen in two dimensions + +223 +00:15:17,310 --> 00:15:20,890 +negative + +224 +00:15:20,890 --> 00:15:26,610 +angle kappa will result in negative angle kappa will + +225 +00:15:26,610 --> 00:15:30,050 +result in temporal displacement of the corneal + +226 +00:15:30,050 --> 00:15:36,450 +light reflex لأنها هتعمل simulation لإيزو تروبيا + +227 +00:15:39,360 --> 00:15:42,360 +The optimal position for testing inferior rectus + +228 +00:15:42,360 --> 00:15:47,240 +muscle is when its axis is coincident with the + +229 +00:15:47,240 --> 00:15:52,040 +visual axis its axis is perpendicular to the + +230 +00:15:52,040 --> 00:15:55,760 +visual axis its axis is coincident with the + +231 +00:15:55,760 --> 00:16:00,200 +orbital axis in adduction طبعا لما ال axis بتاع ال + +232 +00:16:00,200 --> 00:16:03,900 +inferior rectus يصير coincident متفق مع ال visual + +233 +00:16:03,900 --> 00:16:09,030 +axis أو ال axis of the eye if the angle between + +234 +00:16:09,030 --> 00:16:12,390 +anatomical and visual axis is large and the + +235 +00:16:12,390 --> 00:16:17,210 +posterior pole is temporal temporal to the fovea + +236 +00:16:17,210 --> 00:16:21,230 +يعني الفوفيا نازل إله نازل يعني negative then + +237 +00:16:21,230 --> 00:16:26,170 +angle kappa is negative كلام صحيح هنا إيه؟ بنقول + +238 +00:16:26,170 --> 00:16:29,030 +إذا ال angle بين ال anatomical axis و ال visual + +239 +00:16:29,030 --> 00:16:35,290 +axis اللي هي سمناها angle kappa كبيرة بس ال + +240 +00:16:35,290 --> 00:16:38,590 +posterior pole جاي temporal للفوفيا أو الفوفيا + +241 +00:16:38,590 --> 00:16:44,890 +جاية nasal .. nasal بالنسبة ل .. ال posterior pole + +242 +00:16:44,890 --> 00:16:48,110 +فبالتالي angle kappa .. قولنا nasal، negative + +243 +00:16:48,110 --> 00:16:52,190 +الفوفيا nasal، negative فبالتالي angle kappa is + +244 +00:16:52,190 --> 00:16:58,330 +negative، كلام سليم طيب the main extorter of the + +245 +00:16:58,330 --> 00:17:01,230 +eye و احنا مغمضين ال inferior oblique هي ال + +246 +00:17:01,230 --> 00:17:04,490 +extorter الرئيسي صحيح ال inferior rectus تعمل + +247 +00:17:04,490 --> 00:17:07,750 +extortion بس الوظيفة الأساسية لل inferior rectus + +248 +00:17:07,750 --> 00:17:10,870 +ال depression بينما ال inferior oblique الوظيفة + +249 +00:17:10,870 --> 00:17:15,670 +الرئيسية لها ال extortion ال + +250 +00:17:15,670 --> 00:17:19,010 +normal binocular single vision visual direction of + +251 +00:17:19,010 --> 00:17:22,670 +the right fovea is the same as the principal + +252 +00:17:22,670 --> 00:17:27,000 +visual direction of the left eye الـ visual + +253 +00:17:27,000 --> 00:17:30,040 +direction of the right fovea هو نفس الـ visual + +254 +00:17:30,040 --> 00:17:33,360 +direction بتاع لبرنز طبعا في ال right هنا في ال + +255 +00:17:33,360 --> 00:17:36,460 +right ال right fovea اتجاهها في الفرق هو نفس + +256 +00:17:36,460 --> 00:17:41,260 +الاتجاه الرئيسي أو ال visual direction ال principal + +257 +00:17:41,260 --> 00:17:44,740 +بتاع ال left eye ما هو في ال normal binocular + +258 +00:17:44,740 --> 00:17:47,920 +single vision ال principal visual direction بتاع + +259 +00:17:47,920 --> 00:17:50,300 +ال left eye هو ال visual direction بتاع ال fovea + +260 +00:17:50,300 --> 00:17:53,040 +وكأنه بيقوللي هو ال visual direction بتاع ال right + +261 +00:17:53,040 --> 00:17:55,220 +fovea هو نفس ال visual direction بتاع ال left + +262 +00:17:55,220 --> 00:17:57,440 +fovea وهذا كلام صحيح + +263 +00:18:02,140 --> 00:18:05,540 +controlled downward displacement of one eye + +264 +00:18:05,540 --> 00:18:09,360 +relative to the other eye is termed hypotropia خطأ + +265 +00:18:09,360 --> 00:18:13,280 +ليش خطأ؟ لو شيلنا كلمة controlled و بدناها من عند + +266 +00:18:13,280 --> 00:18:17,020 +downward كان بيكون صح الجواب لما بتكون عين منخفضة + +267 +00:18:17,020 --> 00:18:20,260 +بشكل واضح بس كلمة controlled يعني الدماغ متحكم فيه + +268 +00:18:20,260 --> 00:18:24,260 +يعني مش ظاهر للعيان بتسمى hypophoria إذا كانوا + +269 +00:18:24,260 --> 00:18:27,140 +controlled الصحيح أنه بتسمى hypophoria مش + +270 +00:18:27,140 --> 00:18:28,100 +hypotropia + +271 +00:18:31,290 --> 00:18:36,150 +vertical recti are adductors وهذا كلام صحيح مر + +272 +00:18:36,150 --> 00:18:40,700 +السؤال ده في النسخة الأولى in comparison with + +273 +00:18:40,700 --> 00:18:44,880 +horizontal fusional divergences vertical fusional + +274 +00:18:44,880 --> 00:18:48,360 +divergences are equal ولا larger ولا smaller ولا + +275 +00:18:48,360 --> 00:18:52,100 +all choices are wrong طبعا smaller ال vertical + +276 +00:18:52,100 --> 00:18:54,720 +fusional divergences ال vertical fusional + +277 +00:18:54,720 --> 00:18:58,160 +divergences من اتنين لتلاتة prism بينما ال + +278 +00:18:58,160 --> 00:19:00,500 +horizontal fusional divergences ايش هي ال + +279 +00:19:00,500 --> 00:19:03,060 +horizontal fusional divergences اللي هو ال + +280 +00:19:03,060 --> 00:19:05,420 +fusional convergence و ال fusional divergence + +281 +00:19:05,860 --> 00:19:09,120 +أرقامها أعلى من ذلك بكثير، إذا ال horizontal + +282 +00:19:09,120 --> 00:19:12,900 +fusional vergence أكبر بكثير من ال vertical + +283 +00:19:12,900 --> 00:19:16,560 +فبالتالي ال vertical تعتبر smaller than in + +284 +00:19:16,560 --> 00:19:19,680 +comparison .. in comparison لما نقارنها في ال + +285 +00:19:19,680 --> 00:19:23,540 +horizontal fusional vergence ال vertical fusional + +286 +00:19:23,540 --> 00:19:29,860 +vergence are smaller are smaller on + +287 +00:19:29,860 --> 00:19:33,830 +head tilt to the right هل بيصير extortion في + +288 +00:19:33,830 --> 00:19:37,930 +العنتين؟ لأ هل بيصير intortion في العنتين؟ لأ طيب + +289 +00:19:37,930 --> 00:19:40,610 +ال head tilt to the right .. to the right عفوا في + +290 +00:19:40,610 --> 00:19:44,810 +الاتجاه هذا العنتين بيلفوا عكسه بحيث انه ال right + +291 +00:19:44,810 --> 00:19:48,470 +eye بتعمل intortion و ال left eye بتعمل extortion + +292 +00:19:48,470 --> 00:19:53,690 +يعني هذا هو الجواب الصحيح + +293 +00:19:53,690 --> 00:19:58,390 +depression of the left eye in right gaze في ال + +294 +00:19:58,390 --> 00:20:02,620 +right gaze هذا السؤال مر في ال right gaze الـ left + +295 +00:20:02,620 --> 00:20:06,120 +eye بتصير لجوا ناحية الأنف مين اللي بنزلها و هي + +296 +00:20:06,120 --> 00:20:10,540 +فين ال superior oblique ال left superior oblique + +297 +00:20:10,540 --> 00:20:16,600 +هذا سؤال كان في النسخة الأولى موجود طيب right + +298 +00:20:16,600 --> 00:20:20,600 +lateral rectus palsy leads to contracture of the + +299 +00:20:20,600 --> 00:20:26,480 +right medial rectus الانتاجونيست بتاعتها هذا في + +300 +00:20:26,480 --> 00:20:31,510 +المصل سكويلي مشروع باستفادة extortion is movement + +301 +00:20:31,510 --> 00:20:34,890 +of the inferior limbus nasally، معناته ال superior + +302 +00:20:34,890 --> 00:20:38,290 +rectus هيروح temporally، معناته الكلام صحيح، هذا + +303 +00:20:38,290 --> 00:20:43,720 +ال extortion، العكس هيكون ال intortion طيب + +304 +00:20:43,720 --> 00:20:47,680 +orthoptic exercises can be helpful in the case of + +305 +00:20:47,680 --> 00:20:50,160 +convergence insufficiency ده سؤال مكرر بين + +306 +00:20:50,160 --> 00:20:53,680 +النسختين كلام صحيح ممكن تفيد ال orthoptic + +307 +00:20:53,680 --> 00:20:57,620 +exercises the left inferior oblique will go into + +308 +00:20:57,620 --> 00:21:01,780 +inhibitional palsy in long standing right superior + +309 +00:21:01,780 --> 00:21:07,680 +rectus palsy ال left inferior obliquewill go to + +310 +00:21:07,680 --> 00:21:11,940 +inhibitional palsy in long standing right superior + +311 +00:21:11,940 --> 00:21:16,080 +rectus palsy، إذا عندي right superior rectus palsy + +312 +00:21:16,080 --> 00:21:21,620 +طولت، صارت long standing، هذه ال superior rectus + +313 +00:21:21,620 --> 00:21:28,980 +palsy العضلة ضعيفة، طيبعشان تشتغل هذه العضلة، عشان + +314 +00:21:28,980 --> 00:21:33,040 +تشتغل هذه العضلة لازمها innervation كتير، فإذا + +315 +00:21:33,040 --> 00:21:37,280 +أجالها innervation كتير عشان تشتغل و تعدل وضع + +316 +00:21:37,280 --> 00:21:39,940 +العين من ال down gaze، من ال hypotropic، يعني أنه + +317 +00:21:39,940 --> 00:21:43,120 +في حالة ال right superior rectus palsy عندي شلل في + +318 +00:21:43,120 --> 00:21:46,440 +ال right superior rectus، العين هتكون hypotropic، + +319 +00:21:46,440 --> 00:21:50,100 +hypotropic لأن ال inferior rectus هتكون أقوى و + +320 +00:21:50,100 --> 00:21:54,870 +هتشد العين لتحت، ال right eye طيب عندي طلبنا من + +321 +00:21:54,870 --> 00:21:58,630 +المريض يعمل fixation بال right eye لازم ييجي لل + +322 +00:21:58,630 --> 00:22:00,830 +superior rectus في ال right eye اللي فيها palsy + +323 +00:22:00,830 --> 00:22:04,210 +increased innervation طب إجاهة increased + +324 +00:22:04,210 --> 00:22:07,870 +innervation معناته اليوك بتاعتها في العين التانية + +325 +00:22:07,870 --> 00:22:10,690 +اللي هي left inferior oblique هيجيها increased + +326 +00:22:10,690 --> 00:22:13,830 +innervation عضلة طبيعية إجاهة increased + +327 +00:22:13,830 --> 00:22:16,690 +innervation بصيرش فيها inhibitional palsy يوانها + +328 +00:22:16,690 --> 00:22:20,610 +بتصير over acting .. بتسكير over acting إذا الجواب + +329 +00:22:20,610 --> 00:22:24,360 +غلط .. إذا الجواب غلطف هذا ال muscles equally اللي + +330 +00:22:24,360 --> 00:22:28,220 +شرحناه باستفادة و اللي قلنا لازم الإنسان يتقنه و + +331 +00:22:28,220 --> 00:22:32,480 +يرجع لمحاضراته و يكررها عدة مرات by temporal image + +332 +00:22:32,480 --> 00:22:36,540 +disparity stimulates fusional divergence غلط ال by + +333 +00:22:36,540 --> 00:22:39,740 +temporal image disparity stimulates fusional + +334 +00:22:39,740 --> 00:22:45,420 +convergence إذا غلط طيب + +335 +00:22:45,420 --> 00:22:50,990 +the superior oblique muscle inserts in the superior + +336 +00:22:50,990 --> 00:22:53,470 +and anterior لحد ما ألاقي كلمة anterior لأ + +337 +00:22:53,470 --> 00:22:57,150 +inferior لأ superior and oblique لأ مابتظبطش + +338 +00:22:57,150 --> 00:23:01,990 +superior posterior temporal quadrant طبعا مش في ال + +339 +00:23:01,990 --> 00:23:04,650 +nasal quadrant في ال temporal superior posterior + +340 +00:23:04,650 --> 00:23:12,610 +temporal quadrant هذا ال insertion بتاع ال + +341 +00:23:12,610 --> 00:23:15,930 +superior oblique muscle الآن سؤال drag and drop + +342 +00:23:15,930 --> 00:23:22,610 +عندي target اللي هو المربع الأزرق جايع على الفوفيا، و + +343 +00:23:22,610 --> 00:23:25,770 +different target جايع على الفوفيا، two different + +344 +00:23:25,770 --> 00:23:29,310 +targets stimulating corresponding retinal area، + +345 +00:23:29,310 --> 00:23:33,710 +إيه الشيء ده بيسميه؟ بسميه confusion، هذا السؤال + +346 +00:23:33,710 --> 00:23:38,630 +ممكن يكون عليه علامتين، ممكن يكون عليه علامتين في + +347 +00:23:38,630 --> 00:23:45,000 +المحضر بس لا أكتر ولا أقل، يعني ما استغرقش ثانيتين + +348 +00:23:45,000 --> 00:23:49,360 +Stereopsis is a binocular function، الكلام صحيح، هذا + +349 +00:23:49,360 --> 00:23:55,560 +سؤال مكرر tested + +350 +00:23:55,560 --> 00:23:58,720 +by occluding the other eye، إيش الحاجة اللي إحنا + +351 +00:23:58,720 --> 00:24:02,860 +بنختبرها؟ هل هي ال infraduction؟ هل هي ال + +352 +00:24:02,860 --> 00:24:05,780 +divergence؟ هل هي ال dextrodepression أو ال level + +353 +00:24:05,780 --> 00:24:09,470 +elevation؟ هذا ال divergence و ال dextro depression + +354 +00:24:09,470 --> 00:24:12,370 +و ال elevation لازم العين التانية يكونوا مفتوحين لأن + +355 +00:24:12,370 --> 00:24:16,190 +هذا نوع من ال vergences هذا نوع من ال vergences و + +356 +00:24:16,190 --> 00:24:19,630 +هذا نوع من ال vergences هذا اللي هو ال infraduction + +357 +00:24:19,630 --> 00:24:23,110 +لازم نغطي عين و نقول العين التانية تطلع عينها لتحت + +358 +00:24:23,110 --> 00:24:26,210 +إذا هذا نوع من الدكشن إذا هو tested by occluding + +359 +00:24:26,210 --> 00:24:31,170 +the other eye تمام، + +360 +00:24:31,170 --> 00:24:34,810 +عندي diplopia which type of diplopia هل هي + +361 +00:24:34,810 --> 00:24:39,290 +vertical؟ طبعا لأ هل هي torsional يعني صورة ال .. + +362 +00:24:39,290 --> 00:24:43,150 +ال mug يعني مائلة؟ لأ هي هذه horizontal diplopia + +363 +00:24:43,150 --> 00:24:47,190 +بسيطة جدا جدا مافيها أي مشكلة هيك أخلص السؤال يعني + +364 +00:24:47,190 --> 00:24:51,630 +هذا سؤال يعني nothing يعني which of the following + +365 +00:24:51,630 --> 00:24:54,790 +is not a condition for the development of abnormal + +366 +00:24:54,790 --> 00:24:57,210 +retinal correspondence؟ قلنا شروط ال abnormal + +367 +00:24:57,210 --> 00:25:01,510 +retinal correspondence تلاتة long period ثاني حاجة + +368 +00:25:01,510 --> 00:25:05,590 +small angle, stable angle و long period، التلات + +369 +00:25:05,590 --> 00:25:08,950 +شروط، طيب small angle اه من ضمن الشروط، stable + +370 +00:25:08,950 --> 00:25:12,290 +angle من ضمن الشروط، chronic long standing squint + +371 +00:25:12,290 --> 00:25:15,170 +نعم من ضمن الشروط، short period after the + +372 +00:25:15,170 --> 00:25:17,550 +development of squint يعني مافيش حد بيصير معاه + +373 +00:25:17,550 --> 00:25:19,370 +squint وبعد أسبوع بيصير abnormal retinal + +374 +00:25:19,370 --> 00:25:22,470 +correspondence، إذا هذه الوحيدة ليست condition + +375 +00:25:22,470 --> 00:25:26,050 +ليست شرطا من شروط ال abnormal retinal + +376 +00:25:26,050 --> 00:25:27,010 +correspondence + +377 +00:25:29,160 --> 00:25:32,480 +Fusional convergence amplitudes at near are larger + +378 +00:25:32,480 --> 00:25:35,720 +than at distance يعني ال fusional convergence ع ال + +379 +00:25:35,720 --> 00:25:39,260 +near أكتر من ال fusional convergence ع ال distance + +380 +00:25:39,260 --> 00:25:45,000 +و ده كلام صحيح The + +381 +00:25:45,000 --> 00:25:49,300 +main elevator of the eye in abduction is superior + +382 +00:25:49,300 --> 00:25:52,680 +rectus في ال up and out abduction يعني out + +383 +00:25:52,680 --> 00:25:55,620 +فبالتالي اللي بيرفع العين من ال out هو ال superior + +384 +00:25:55,620 --> 00:26:01,120 +rectus هو ال main elevator طيب، هنا عندي نظارة + +385 +00:26:01,120 --> 00:26:07,600 +based in prism، واضح القاعدة بتاعة البرزم هي خميلة و + +386 +00:26:07,600 --> 00:26:11,840 +ال Apex عنده لبرا و هنا base in prism لو هذا + +387 +00:26:11,840 --> 00:26:16,960 +الإنسان لبس هذه النظارة الأشعة هتنحرف باتجاه ال + +388 +00:26:16,960 --> 00:26:20,560 +base يعني باتجاه ال nasal retina هنا و نفس الأشعة + +389 +00:26:20,560 --> 00:26:23,120 +اللي جاية من نفس ال target هتنحرف باتجاه ال nasal + +390 +00:26:23,120 --> 00:26:26,520 +retina nasal مع nasal + +401 +00:27:12,140 --> 00:27:16,560 +الإنسان يكون متأكد جدا من ال function بتاعة اللي + +402 +00:27:16,560 --> 00:27:19,800 +هي الـ extraocular muscles والـ testing position و + +403 +00:27:19,800 --> 00:27:22,540 +مكان الـ insertion و مكان الـ origin + +404 +00:27:28,670 --> 00:27:35,330 +هذه الإجابات وبالتالي انتهى المراجعة على النسختين + +405 +00:27:35,330 --> 00:27:39,370 +ويعطيكم العافية والسلام عليكم ورحمة الله وبركاته diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Eow1zunSMNY_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Eow1zunSMNY_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..f16f52947ecec6667025db1fa38d116691693e25 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Eow1zunSMNY_postprocess.srt @@ -0,0 +1,1620 @@ +1 +00:00:03,200 --> 00:00:07,580 +بسم الله الرحمن الرحيم هذه ال .. او هذا الفيديو + +2 +00:00:07,580 --> 00:00:12,800 +مراجعة للنسخة الأولى والتانية من الامتحان النصفي + +3 +00:00:12,800 --> 00:00:17,040 +في الرؤية الموحدة والحوال نبدأ على برج الله نشوف + +4 +00:00:17,040 --> 00:00:21,200 +النسخة الأولى للامتحان النصفي suppression occurs + +5 +00:00:21,200 --> 00:00:24,920 +only as a result of squint طبعا غلط ممكن يكون as a + +6 +00:00:24,920 --> 00:00:27,960 +result of anisometropia لأن في حالة الانيزومتروبيا + +7 +00:00:28,520 --> 00:00:33,040 +ال more ametropic I ممكن تكون الصورة فيها مش واضحة + +8 +00:00:33,040 --> 00:00:39,300 +كويس و بالتالي .. و بالتالي بيكون أن الصورة مش + +9 +00:00:39,300 --> 00:00:41,720 +واضحة اللي هيقبلها ال brain فبيعملها suppression + +10 +00:00:41,720 --> 00:00:48,170 +يعني مش بس في الاسكونة السؤال التانيyoke muscles + +11 +00:00:48,170 --> 00:00:51,510 +in dextro depression، dextro depression يعني right + +12 +00:00:51,510 --> 00:00:54,890 +and down، مين اللي بيجيب العين اليمين right and + +13 +00:00:54,890 --> 00:00:57,710 +down؟ ال inferior rectus، وال yoke muscle في + +14 +00:00:57,710 --> 00:01:00,710 +الشمال، اللي هي ال superior oblique، اذا right + +15 +00:01:00,710 --> 00:01:07,510 +inferior rectus and left superior oblique، هذه هي + +16 +00:01:07,510 --> 00:01:11,470 +الجواب الصح في dextro depression، في ال dextro + +17 +00:01:11,470 --> 00:01:16,000 +depression، السؤال اللي بعدههذا سؤال very + +18 +00:01:16,000 --> 00:01:19,180 +interesting بعض الأسئلة على فكرة عليها أكتر من + +19 +00:01:19,180 --> 00:01:25,920 +علامة يعني ممكن هذا السؤال يكون علي علامتين drag + +20 +00:01:25,920 --> 00:01:28,540 +and drop into the image the correct type of + +21 +00:01:28,540 --> 00:01:32,120 +fusional virgences that these glasses stimulate + +22 +00:01:32,120 --> 00:01:37,080 +put in appropriate choice in the upper box طيب + +23 +00:01:37,080 --> 00:01:42,890 +بنقول كالقاتلهذا البرزم بيز اوت وهذا البرزم بيز + +24 +00:01:42,890 --> 00:01:46,330 +اوت واضح ان المنطقة هي ال base بتاعة البرزم وهي ال + +25 +00:01:46,330 --> 00:01:49,090 +base بتاعة البرزم لما بيكون بيز اوت بيز اوت + +26 +00:02:09,940 --> 00:02:14,200 +هحط refusional convergence كجواب و كله في ال right + +27 +00:02:14,200 --> 00:02:18,820 +in the right upper box او اني اسيبه زي ما هو او + +28 +00:02:18,820 --> 00:02:23,260 +اني اسيبه زي ما هو يعني هنا خلاص هو الجواب الصحيح + +29 +00:02:23,260 --> 00:02:27,280 +refusional convergence refusional convergence + +30 +00:02:27,280 --> 00:02:29,520 +انتقل للسؤال اللي بعده + +31 +00:02:35,650 --> 00:02:39,170 +vertical recti are adductors الvertical recti اللي + +32 +00:02:39,170 --> 00:02:41,970 +هي superior rectus والinferior rectus muscles هذا + +33 +00:02:41,970 --> 00:02:45,810 +true من ضمن ال actions بتاعتهم ال adduction وقلنا + +34 +00:02:45,810 --> 00:02:49,840 +ال function ضروري يكون الإنسان متقنها تماماالان + +35 +00:02:49,840 --> 00:02:53,120 +سؤال matching prevents the sensation of diplopia + +36 +00:02:53,120 --> 00:02:56,440 +إيش اللي بمنع ال sensation of diplopia؟ هل هو ال + +37 +00:02:56,440 --> 00:02:58,620 +central suppression ولا ال alternating suppression + +38 +00:02:58,620 --> 00:03:00,400 +ولا ال peripheral suppression ولا ال abnormal + +39 +00:03:00,400 --> 00:03:02,840 +retinal correspondence ولا ال confusion ولا ال + +40 +00:03:02,840 --> 00:03:05,440 +monocular suppression طبعا ال peripheral + +41 +00:03:05,440 --> 00:03:08,960 +suppression بمنع ال diplopia في ال small angle + +42 +00:03:08,960 --> 00:03:12,730 +strabismusبيصير عندى abnormal retinal + +43 +00:03:12,730 --> 00:03:15,670 +correspondence من ضمن شروط ال abnormal retinal + +44 +00:03:15,670 --> 00:03:19,750 +correspondence تكون زاوية الحوال صغيرة two targets + +45 +00:03:19,750 --> 00:03:23,230 +stimulating the fovea هذا confusion .. هذا + +46 +00:03:23,230 --> 00:03:27,950 +confusion can cause amblyopia .. إيش في الأشياء + +47 +00:03:27,950 --> 00:03:30,530 +الموجودة عندى can cause amblyopia؟ ال monocular + +48 +00:03:30,530 --> 00:03:33,370 +suppression لأن ال alternating suppression ما + +49 +00:03:33,370 --> 00:03:38,600 +بيسبب amblyopia .. ما بيسبب amblyopiaon abduction + +50 +00:03:38,600 --> 00:03:42,400 +لما العين تيجي في ال abduction it becomes only + +51 +00:03:42,400 --> 00:03:45,600 +extortable طبعا ال inferior oblique لأنه في ال + +52 +00:03:45,600 --> 00:03:48,820 +abduction ال superior rectus elevator و ال + +53 +00:03:48,820 --> 00:03:51,940 +inferior oblique extortable inferior oblique هي في + +54 +00:03:51,940 --> 00:03:55,520 +ال abduction في ال abduction المحور بتاعها بتعامل + +55 +00:03:55,520 --> 00:03:59,360 +على محور العين و هي جاية من أسل فهتعمل extortion + +56 +00:03:59,360 --> 00:04:05,520 +only هتعمل extortion onlyطيب confusion results + +57 +00:04:05,520 --> 00:04:08,620 +from two different targets stimulating + +58 +00:04:08,620 --> 00:04:12,380 +corresponding retinal areas هنا لو شيلنا ال + +59 +00:04:12,380 --> 00:04:15,060 +corresponding retinal areas و حطينا بدلها phobia + +60 +00:04:15,060 --> 00:04:18,120 +ما هي ال phobia مع ال phobia corresponding retinal + +61 +00:04:18,120 --> 00:04:21,360 +areas فالإجابة صحيحةtwo targets two different + +62 +00:04:21,360 --> 00:04:24,560 +targets stimulating corresponding retinal areas + +63 +00:04:24,560 --> 00:04:28,240 +وبالتالي بيعملولي confusion لأنه هيتم توحيد أشياء + +64 +00:04:28,240 --> 00:04:32,440 +مختلفة مع بعضها البعض conditions necessary for + +65 +00:04:32,440 --> 00:04:35,520 +normal binocular single vision include all of the + +66 +00:04:35,520 --> 00:04:40,030 +following except select oneطبعا accurate + +67 +00:04:40,030 --> 00:04:43,090 +neuromuscular development شرط عشان ال binocular + +68 +00:04:43,090 --> 00:04:46,130 +single vision and coordination so that the visual + +69 +00:04:46,130 --> 00:04:49,890 +axis directed at and maintain fixation on the + +70 +00:04:49,890 --> 00:04:52,990 +object of regard طبعا صحيح لازم يكون في عندي + +71 +00:04:52,990 --> 00:04:55,730 +normal retinal او retinocortical correspondence + +72 +00:04:55,730 --> 00:05:00,170 +resulting in cyclopean viewing ايضا ال visual + +73 +00:05:00,170 --> 00:05:03,070 +pathway لازم يكون طبيعي normal routing of visual + +74 +00:05:03,070 --> 00:05:07,040 +pathways with overlapping of visual fieldمين اللي + +75 +00:05:07,040 --> 00:05:09,780 +مش شرط انه monocularly driving neurons in the + +76 +00:05:09,780 --> 00:05:12,900 +visual cortex لانها مالاش علاقة في ال binocular + +77 +00:05:12,900 --> 00:05:16,040 +single vision، مين اللي له علاقة ال binocularly + +78 +00:05:16,040 --> 00:05:19,700 +driving neurons، اذا هذه هي الاستثناء، هذه هي + +79 +00:05:19,700 --> 00:05:24,840 +الاستثناءالسؤال اللي بعده stereopsis is a + +80 +00:05:24,840 --> 00:05:28,340 +binocular function كلام صحيح مائة بالمائة وقلنا + +81 +00:05:28,340 --> 00:05:30,560 +فيه فارق بين ال stereopsis اللي هو binocular + +82 +00:05:30,560 --> 00:05:33,760 +function و ال depth perception اللي هو ممكن انا + +83 +00:05:33,760 --> 00:05:38,540 +يعني احصل عليه بواسطة عين واحدة وقلنا تجربة أقلام + +84 +00:05:38,540 --> 00:05:42,740 +الرصاص يعني قلمين رصاص احاول احط سن الجلم على سن + +85 +00:05:42,740 --> 00:05:48,090 +الجلم بعينية تنتينهيكون الحكم صحيح، بينما بعين + +86 +00:05:48,090 --> 00:05:51,970 +واحدة لما أغمض التانية، غالبا هأخطئ ومش هقدر أحط + +87 +00:05:51,970 --> 00:05:55,770 +سن الجلم على سن الجلم من أول مرة فالstereopsis + +88 +00:05:55,770 --> 00:05:59,270 +binocular function superior muscles اللي هي + +89 +00:05:59,270 --> 00:06:02,250 +superior rectus وال superior oblique are in + +90 +00:06:02,250 --> 00:06:08,230 +twitters طبعا هذا كلام صحيح شايفين أنه بدون ال + +91 +00:06:08,230 --> 00:06:10,550 +function بتاعة الextraocular muscles كل إشي صعب + +92 +00:06:10,550 --> 00:06:16,130 +هيصيرطبعا سؤال زي اللي فات .. زي اللي فات سؤال + +93 +00:06:16,130 --> 00:06:20,770 +يعني مش مفروض يتصرف معاه ثانيتين drag and drop + +94 +00:06:20,770 --> 00:06:23,550 +into the image the correct type of diplopia هنا + +95 +00:06:23,550 --> 00:06:28,290 +فيه diplopia هل هي vertical؟ يعني الصورتين فوق + +96 +00:06:28,290 --> 00:06:33,450 +بعض؟ طبعا لأ هل هي torsional؟ يعني صورة ميلة + +97 +00:06:33,450 --> 00:06:36,730 +بالنسبة للتانية؟ طبعا لأ هل هي horizontal؟ طبعا + +98 +00:06:36,730 --> 00:06:40,350 +horizontal يعني سؤال زي هذا سهل جدا عليه علامتين + +99 +00:06:40,610 --> 00:06:45,770 +ممكن الإنسان يعني بي .. او .. او يعني يتحصر إنه + +100 +00:06:45,770 --> 00:06:50,590 +يفقد مثل هذه العالم هذه in left eye which muscle + +101 +00:06:50,590 --> 00:06:55,430 +must relax on contraction of the right superior + +102 +00:06:55,430 --> 00:06:58,370 +rectus muscle in normal binocular single vision + +103 +00:06:58,370 --> 00:07:02,290 +patient أو .. أو person طيب لما يكون في عندي + +104 +00:07:02,290 --> 00:07:06,360 +normal binocular single vision personومفتح عين + +105 +00:07:06,360 --> 00:07:09,780 +التنتين ويصير contraction في ال right superior + +106 +00:07:09,780 --> 00:07:13,360 +rectus، معناته لازم يصير contraction في ال yoke + +107 +00:07:13,360 --> 00:07:16,140 +muscle بتاعتها في العين الشمالية، مين ال yoke + +108 +00:07:16,140 --> 00:07:20,230 +muscle مع ال right superior rectus؟اللي هي ال left + +109 +00:07:20,230 --> 00:07:23,830 +inferior oblique طيب ال left inferior oblique بما + +110 +00:07:23,830 --> 00:07:27,190 +إنها ال يوك بتاعة ال right superior rectus معناته + +111 +00:07:27,190 --> 00:07:30,170 +هيصير فيها أيضا contraction لأنه حسب hearing law + +112 +00:07:30,170 --> 00:07:34,290 +إذا إجا innervation لعضلة وعملت contraction لازم + +113 +00:07:34,290 --> 00:07:38,210 +يكون برضه إجا innervation مساوي لعضلة يوك معاها + +114 +00:07:38,210 --> 00:07:40,710 +اللي هي هنا ال right superior rectus و ال left + +115 +00:07:40,710 --> 00:07:42,650 +inferior oblique هيجيها نفس الكمية من ال + +116 +00:07:42,650 --> 00:07:47,320 +innervation فهتصيرContracted طيب بتعمل contraction + +117 +00:07:47,320 --> 00:07:49,980 +مين اللي .. اللي لازم يريح يصير له ال relaxation؟ + +118 +00:07:49,980 --> 00:07:52,860 +ال antagonist بتاع .. ال antagonist بتاع ال left + +119 +00:07:52,860 --> 00:07:56,800 +inferior oblique .. بتاع ال left inferior oblique + +120 +00:07:56,800 --> 00:07:59,500 +هو ال left superior oblique muscle .. ال left + +121 +00:07:59,500 --> 00:08:02,180 +superior oblique muscle هي ال antagonist بتاع ال + +122 +00:08:02,180 --> 00:08:05,330 +left inferior obliqueطالما ال left inferior + +123 +00:08:05,330 --> 00:08:07,690 +oblique اجهها innervation كتير عشان تعمل + +124 +00:08:07,690 --> 00:08:10,110 +contraction عشان هي ال yoke بتاعة ال superior + +125 +00:08:10,110 --> 00:08:13,250 +rectus في ال right eye، معناته اللي لازم يصيرله + +126 +00:08:13,250 --> 00:08:16,770 +فيه relaxation حسب Sherrington law اللي هي left + +127 +00:08:16,770 --> 00:08:21,830 +superior obliqueأيضا لازم أعرف ال agonist و ال + +128 +00:08:21,830 --> 00:08:24,130 +antagonist و ال synergist و ال yoke muscle + +129 +00:08:24,130 --> 00:08:28,090 +effusional divergence amplitudes are larger at + +130 +00:08:28,090 --> 00:08:32,310 +distance than at near طبعا اللي بيرجع للأرقام لأ + +131 +00:08:32,310 --> 00:08:36,250 +هي larger at near تقريبا من اتناش لاربعتاشر prism + +132 +00:08:36,250 --> 00:08:39,770 +than at distance تقريبا من ستة لتمانية prism إذا + +133 +00:08:39,770 --> 00:08:45,450 +هذا falseواضح أن الأسئلة مابتاخدش وقت كثير، يعني + +134 +00:08:45,450 --> 00:08:48,450 +المفروض مع الطالب، مابناشي نقول مع الدكتور، تاخد + +135 +00:08:48,450 --> 00:08:52,290 +من تلاتين لاربعين ثانية كل سؤال By nasal image + +136 +00:08:52,290 --> 00:08:56,010 +disparity stimulate fusional divergence، كلام صحيح + +137 +00:08:56,010 --> 00:09:00,070 +مية في المية، لأنه الفوفيا هتروح نازلي، و الفوفيا + +138 +00:09:00,070 --> 00:09:03,690 +هتروح نازلي، فمن الأمام هيعمل divergence، إذا ال + +139 +00:09:03,690 --> 00:09:07,190 +by nasal image disparity stimulates fusional + +140 +00:09:07,190 --> 00:09:11,870 +divergence، سؤال سهل ومباشرdepressor of the left + +141 +00:09:11,870 --> 00:09:16,130 +eye in right gaze الـ left eye في ال right gaze + +142 +00:09:16,130 --> 00:09:20,670 +بتصير in تدخل لجوه لما العينين بتطلعوا لليمين + +143 +00:09:20,670 --> 00:09:24,190 +معناته ال left eye دخلت لجوه مين اللي بيعمل + +144 +00:09:24,190 --> 00:09:27,790 +depression؟ depressor of the left eye in right + +145 +00:09:27,790 --> 00:09:32,410 +gaze العين الشمال بتكون دخلت لجوه في ال right gaze + +146 +00:09:32,410 --> 00:09:34,770 +طب مين بيعملها في ال in position؟ مين بيعملها + +147 +00:09:34,770 --> 00:09:38,030 +down؟ ال superior oblique ال superior oblique is + +148 +00:09:38,030 --> 00:09:39,770 +on the left superior oblique muscle + +149 +00:09:44,230 --> 00:09:47,510 +hearing law can be applied to virgins is false + +150 +00:09:47,510 --> 00:09:51,890 +اللي برجع لتعريف hearing law هيقول during + +151 +00:09:51,890 --> 00:09:56,250 +conjugate I .. أول كلمة فيه during conjugate I + +152 +00:09:56,250 --> 00:09:59,930 +movements إيش هي ال conjugate I movements؟ ال + +153 +00:09:59,930 --> 00:10:04,850 +virgins .. ال virgins مش ال virgins إذا هو بنطبق ع + +154 +00:10:04,850 --> 00:10:08,790 +ال virgins facultative + +155 +00:10:08,790 --> 00:10:13,440 +suppression frequently leads to amblyopia خطأال + +156 +00:10:13,440 --> 00:10:16,880 +obligatory suppression هو اللي عادة بيأدي + +157 +00:10:16,880 --> 00:10:19,520 +لامبليوبيا facultative suppression لأنه أحيانا + +158 +00:10:19,520 --> 00:10:22,740 +بيكون موجود و أحيانا مش موجود يعني إيش أحيانا مش + +159 +00:10:22,740 --> 00:10:27,240 +موجود يعني في binocular single vision فمش هيأدي + +160 +00:10:27,240 --> 00:10:34,980 +لامبليوبيا طيب right lateral rectusbalcy leads to + +161 +00:10:34,980 --> 00:10:39,660 +contracture of theعندي lateral rectus في ال right + +162 +00:10:39,660 --> 00:10:43,760 +eye صار فيها pulse مع مرور المدمن العضل اللي بيصير + +163 +00:10:43,760 --> 00:10:47,160 +فيها contraction اللي هي ال media rectus في ال + +164 +00:10:47,160 --> 00:10:50,760 +right eye right media rectus مصرية هذه السؤال يعني + +165 +00:10:50,760 --> 00:10:51,840 +غاية في السوق + +166 +00:10:54,610 --> 00:10:58,510 +All objects on the horopter are seen singly and + +167 +00:10:58,510 --> 00:11:02,430 +stereoscopically، false، are seen singly، صحيح، + +168 +00:11:02,430 --> 00:11:05,690 +ولكن مش stereoscopically، in three dimensions، in + +169 +00:11:05,690 --> 00:11:08,990 +two dimensions، نرجع للهوربتر، راح نلاقي إنه طبعا + +170 +00:11:08,990 --> 00:11:14,130 +كل ال objects اللي تقع الهوربتر، بي .. بتنشف + +171 +00:11:14,130 --> 00:11:16,510 +single and in two dimensions + +172 +00:11:20,450 --> 00:11:23,830 +extends from the posterior pool to the anterior + +173 +00:11:23,830 --> 00:11:29,030 +pool of the eye to infinity ال Anatomical axis هذا + +174 +00:11:29,030 --> 00:11:34,050 +تعريف مباشر which + +175 +00:11:34,050 --> 00:11:37,530 +muscle will go into inhibitional palsy if there + +176 +00:11:37,530 --> 00:11:43,910 +was longstanding left superior rectus palsy بنقول + +177 +00:11:43,910 --> 00:11:46,950 +left superior rectus إلها فترة طويلة ال left + +178 +00:11:47,600 --> 00:11:51,140 +subperior rectus إلى فترة طويلة مشلولة العضل + +179 +00:11:51,140 --> 00:11:53,460 +الانتاجونيست بتاعتها اللي هي ال left inferior + +180 +00:11:53,460 --> 00:11:57,500 +rectus هتصير contracted وحيلزمها innervation أقل + +181 +00:11:57,500 --> 00:12:02,380 +هي over acting muscle ال left inferior rectus ولكن + +182 +00:12:02,380 --> 00:12:06,360 +ب innervation أقل بتعطي شغل كتير لأن اللي عاجبالها + +183 +00:12:06,360 --> 00:12:13,130 +يعني مشلول اذا طالما ال left inferior rectusصارت + +184 +00:12:13,130 --> 00:12:17,070 +شغالة و قوية و ب innervation قليل حسب hearing blow + +185 +00:12:17,070 --> 00:12:21,910 +من اليوكتع ال left inferior rectus اليوكتع ال left + +186 +00:12:21,910 --> 00:12:25,110 +inferior rectus ال right superior oblique فهتدخل + +187 +00:12:25,110 --> 00:12:28,950 +في innervation أقل و هي عضلة طبيعية عضلة طبيعية + +188 +00:12:28,950 --> 00:12:31,730 +بتجيها innervation أقل بتصير inhibitional palsy + +189 +00:12:31,730 --> 00:12:34,590 +إذا ال right superior oblique muscle ال right + +190 +00:12:34,590 --> 00:12:39,700 +superior oblique muscle هي الجواب الصحيو هذا في + +191 +00:12:39,700 --> 00:12:42,580 +المصر السيكويلي اللي ضروري احنا او احنا شرحناها + +192 +00:12:42,580 --> 00:12:48,380 +بشكل يعني مستفيد obliques are inserted behind the + +193 +00:12:48,380 --> 00:12:52,900 +equator صح in the nasal quadrants لأ في ال + +194 +00:12:52,900 --> 00:12:57,200 +temporal quadrants ال superior oblique في ال + +195 +00:12:57,200 --> 00:13:00,160 +posterior يعني behind the equator superior + +196 +00:13:00,160 --> 00:13:03,440 +temporal quadrant و ال inferior oblique في ال + +197 +00:13:04,210 --> 00:13:08,550 +posterior behind the equator inferior temporal .. + +198 +00:13:08,550 --> 00:13:12,490 +التنين في ال temporal quadrant إذا الجواب غلط + +199 +00:13:12,490 --> 00:13:15,950 +Orthoptic + +200 +00:13:15,950 --> 00:13:18,930 +exercises can be helpful in the case of + +201 +00:13:18,930 --> 00:13:22,190 +convergence insufficiency وهذا كلام صحيح وهذا + +202 +00:13:22,190 --> 00:13:25,850 +مأخوذ من .. يعني بشكل .. بالكلمة .. بالحرف من + +203 +00:13:25,850 --> 00:13:26,690 +الملزمة + +204 +00:13:29,410 --> 00:13:32,590 +up and out position is a diagnostic but not + +205 +00:13:32,590 --> 00:13:36,070 +cardinal position of gaze لأ هو diagnostic و + +206 +00:13:36,070 --> 00:13:40,150 +cardinal في نفس الوقت ال up and out diagnostic و + +207 +00:13:40,150 --> 00:13:46,390 +cardinal إذا الإجابة خطأ طيب + +208 +00:13:46,840 --> 00:13:50,580 +Which kind of ocular movements occurs around Z + +209 +00:13:50,580 --> 00:13:53,900 +-axis؟ Z-axis الـ vertical axis بما أن ال vertical + +210 +00:13:53,900 --> 00:13:57,740 +axis إذا ال adduction و ال abduction هما اللي + +211 +00:13:57,740 --> 00:14:04,260 +بيحصلوا حوالين Z-axis هيك خلصنا النموذج الأول بدنا + +212 +00:14:04,260 --> 00:14:06,360 +نروح للنموذج التاني + +213 +00:14:10,920 --> 00:14:17,000 +أخد 16 دقيقة من 30 يعني نص الوجد تقريبا مع الشرح و + +214 +00:14:17,000 --> 00:14:34,920 +التفصيل طيب + +215 +00:14:34,920 --> 00:14:36,980 +.. الآن نرجع للنسخة التانية + +216 +00:14:42,850 --> 00:14:50,530 +امتحان نصفي النسخة التانية بسم + +217 +00:14:50,530 --> 00:14:54,850 +الله yoke + +218 +00:14:54,850 --> 00:14:59,110 +muscles in left up position left up .. left up + +219 +00:14:59,110 --> 00:15:02,850 +يعني ال left superior rectus و ال right inferior + +220 +00:15:02,850 --> 00:15:08,810 +oblique السؤال اللي بعدهAll objects in the + +221 +00:15:08,810 --> 00:15:11,690 +horopter are seen singly and stereoscopically قبل + +222 +00:15:11,690 --> 00:15:17,310 +شوية حلناها، طبعا خطأ are seen in two dimensions + +223 +00:15:17,310 --> 00:15:20,890 +نجатив + +224 +00:15:20,890 --> 00:15:26,610 +أنجل كبّا will result in نجاتف أنجل كبّا will + +225 +00:15:26,610 --> 00:15:30,050 +result in temporal displacement of the corneal + +226 +00:15:30,050 --> 00:15:36,450 +light reflex لأنها هتعمل simulation لإيزو تروبيا + +227 +00:15:39,360 --> 00:15:42,360 +The optimal position for testing inferior rectus + +228 +00:15:42,360 --> 00:15:47,240 +muscle is when Its axis is coincident with the + +229 +00:15:47,240 --> 00:15:52,040 +visual axis Its axis is perpendicular to the + +230 +00:15:52,040 --> 00:15:55,760 +visual axis Its axis is coincident with the + +231 +00:15:55,760 --> 00:16:00,200 +orbital axis in adduction طبعا لما ال axis بتاع ال + +232 +00:16:00,200 --> 00:16:03,900 +inferior rectus يصير coincident متفق مع ال visual + +233 +00:16:03,900 --> 00:16:09,030 +axis أو ال axis of the eyeif the angle between + +234 +00:16:09,030 --> 00:16:12,390 +anatomical and visual axis is large and the + +235 +00:16:12,390 --> 00:16:17,210 +posterior pole is temporal temporal to the fovea + +236 +00:16:17,210 --> 00:16:21,230 +يعني الفوفيا نازل إله نازل يعني negative then + +237 +00:16:21,230 --> 00:16:26,170 +angle كبّه is negative كلام صحيح هنا إيه؟ بنقول + +238 +00:16:26,170 --> 00:16:29,030 +إذا ال angle بين ال anatomical axis و ال visual + +239 +00:16:29,030 --> 00:16:35,290 +axis اللي هي سمناها angle كبّه كبيرةبس ال + +240 +00:16:35,290 --> 00:16:38,590 +posterior pole جاي temporal للفوفيا أو الفوفيا + +241 +00:16:38,590 --> 00:16:44,890 +جاية nasal .. nasal بالنسبة ل .. ال posterior pole + +242 +00:16:44,890 --> 00:16:48,110 +فبالتالي angle kappa .. قولنا nasal، negative + +243 +00:16:48,110 --> 00:16:52,190 +الفوفيا nasal، negative فبالتالي angle kappa is + +244 +00:16:52,190 --> 00:16:58,330 +negative، كلام سليمطيب the main extorter of the + +245 +00:16:58,330 --> 00:17:01,230 +eye و احنا مغمضين ال inferior oblique هي ال + +246 +00:17:01,230 --> 00:17:04,490 +extorter الرئيسي صحيح ال inferior rectus تعمل + +247 +00:17:04,490 --> 00:17:07,750 +extortion بس الوظيفة الأساسية لل inferior rectus + +248 +00:17:07,750 --> 00:17:10,870 +ال depression بينما ال inferior oblique الوظيفة + +249 +00:17:10,870 --> 00:17:15,670 +الرئيسية لها ال extortion ال + +250 +00:17:15,670 --> 00:17:19,010 +normal binocular single vision visual direction of + +251 +00:17:19,010 --> 00:17:22,670 +the right fovea is the same as the principal + +252 +00:17:22,670 --> 00:17:27,000 +visual direction of the left eyeالـ visual + +253 +00:17:27,000 --> 00:17:30,040 +direction of the right fovea هو نفس الـ visual + +254 +00:17:30,040 --> 00:17:33,360 +direction بتاع لبرنز طبعا في ال right هنا في ال + +255 +00:17:33,360 --> 00:17:36,460 +right ال right fovea اتجاهها في الفرق هو نفس + +256 +00:17:36,460 --> 00:17:41,260 +الاتجاه الرئيسيأو ال visual direction ال principal + +257 +00:17:41,260 --> 00:17:44,740 +بتاع ال left eye ما هو في ال normal binocular + +258 +00:17:44,740 --> 00:17:47,920 +single vision ال principal visual direction بتاع + +259 +00:17:47,920 --> 00:17:50,300 +ال left eye هو ال visual direction بتاع ال fovea + +260 +00:17:50,300 --> 00:17:53,040 +وكأنه بيقوللي هو ال visual direction بتاع ال right + +261 +00:17:53,040 --> 00:17:55,220 +fovea هو نفس ال visual direction بتاع ال left + +262 +00:17:55,220 --> 00:17:57,440 +fovea وهذا كلام صحيح + +263 +00:18:02,140 --> 00:18:05,540 +controlled downward displacement of one eye + +264 +00:18:05,540 --> 00:18:09,360 +relative to the other eye is termed hypotropia خطأ + +265 +00:18:09,360 --> 00:18:13,280 +ليش خطأ؟ لو شيلنا كلمة controlled و بدناها من عند + +266 +00:18:13,280 --> 00:18:17,020 +downward كان بيكون صح الجواب لما بتكون عين منخفضة + +267 +00:18:17,020 --> 00:18:20,260 +بشكل واضح بس كلمة controlled يعني الدماغ متحكم فيه + +268 +00:18:20,260 --> 00:18:24,260 +يعني مش ظاهر للعيان بتسمى hypophoria إذا كانوا + +269 +00:18:24,260 --> 00:18:27,140 +controlled الصحيح أنه بتسمى hypophoria مش + +270 +00:18:27,140 --> 00:18:28,100 +hypotropia + +271 +00:18:31,290 --> 00:18:36,150 +vertical recti are adductors وهذا كلام صحيح مر + +272 +00:18:36,150 --> 00:18:40,700 +السؤال ده في النسخة الأولىin comparison with + +273 +00:18:40,700 --> 00:18:44,880 +horizontal fusional divergences vertical fusional + +274 +00:18:44,880 --> 00:18:48,360 +divergences are equal ولا larger ولا smaller ولا + +275 +00:18:48,360 --> 00:18:52,100 +all choices are wrong طبعا smaller ال vertical + +276 +00:18:52,100 --> 00:18:54,720 +fusional divergences ال vertical fusional + +277 +00:18:54,720 --> 00:18:58,160 +divergences من اتنين لتلاتة prism بينما ال + +278 +00:18:58,160 --> 00:19:00,500 +horizontal fusional divergences ايش هي ال + +279 +00:19:00,500 --> 00:19:03,060 +horizontal fusional divergences اللي هو ال + +280 +00:19:03,060 --> 00:19:05,420 +fusional convergence و ال fusional divergence + +281 +00:19:05,860 --> 00:19:09,120 +أرقامها أعلى من ذلك بكثير، إذا ال horizontal + +282 +00:19:09,120 --> 00:19:12,900 +fusional vergence أكبر بكثير من ال vertical + +283 +00:19:12,900 --> 00:19:16,560 +فبالتالي ال vertical تعتبر smaller than in + +284 +00:19:16,560 --> 00:19:19,680 +comparison .. in comparison لما نقارنها في ال + +285 +00:19:19,680 --> 00:19:23,540 +horizontal fusional vergence ال vertical fusional + +286 +00:19:23,540 --> 00:19:29,860 +vergence are smaller are smaller on + +287 +00:19:29,860 --> 00:19:33,830 +head tilt to the rightهل بيصير extortion في + +288 +00:19:33,830 --> 00:19:37,930 +العنتين؟ لأ هل بيصير intortion في العنتين؟ لأ طيب + +289 +00:19:37,930 --> 00:19:40,610 +ال head tilt to the right .. to the right عفوا في + +290 +00:19:40,610 --> 00:19:44,810 +الاتجاه هذا العنتين بيلفوا عكسه بحيث انه ال right + +291 +00:19:44,810 --> 00:19:48,470 +eye بتعمل intortion و ال left eye بتعمل extortion + +292 +00:19:48,470 --> 00:19:53,690 +يعني هذا هو الجواب الصحيح + +293 +00:19:53,690 --> 00:19:58,390 +depressure of the left eye in right gaze في ال + +294 +00:19:58,390 --> 00:20:02,620 +right gaze هذا السؤال مر في ال right gazeالـ left + +295 +00:20:02,620 --> 00:20:06,120 +eye بتصير لجوا ناحية الأنف مين اللي بنزلها و هي + +296 +00:20:06,120 --> 00:20:10,540 +اين ال superior oblique ال left superior oblique + +297 +00:20:10,540 --> 00:20:16,600 +هذا سؤال كان في النسخة الأولى موجود طيب right + +298 +00:20:16,600 --> 00:20:20,600 +lateral rectus palsy leads to contracture of the + +299 +00:20:20,600 --> 00:20:26,480 +right medial rectus الانتاجونيست بتاعتها هذا في + +300 +00:20:26,480 --> 00:20:31,510 +المصل سكويلي مشروع باستفادةextortion is movement + +301 +00:20:31,510 --> 00:20:34,890 +of the inferior limbus nasally، معناته ال superior + +302 +00:20:34,890 --> 00:20:38,290 +rectus هيروح temporally، معناته الكلام صحيح، هذا + +303 +00:20:38,290 --> 00:20:43,720 +ال extortion، العكس هيكون ال intortionطيب + +304 +00:20:43,720 --> 00:20:47,680 +orthoptic exercises can be helpful in the case of + +305 +00:20:47,680 --> 00:20:50,160 +convergence insufficiency ده سؤال مكرر بين + +306 +00:20:50,160 --> 00:20:53,680 +النسختين كلام صحيح ممكن تفيد ال orthoptic + +307 +00:20:53,680 --> 00:20:57,620 +exercises the left inferior oblique will go into + +308 +00:20:57,620 --> 00:21:01,780 +inhibitional palsy in long standing right superior + +309 +00:21:01,780 --> 00:21:07,680 +rectus palsy ال left inferior obliquewill go to + +310 +00:21:07,680 --> 00:21:11,940 +inhibitional palsy in long standing right superior + +311 +00:21:11,940 --> 00:21:16,080 +rectus palsy، إذا عندي right superior rectus palsy + +312 +00:21:16,080 --> 00:21:21,620 +طولت، صارت long standing، هذه ال superior rectus + +313 +00:21:21,620 --> 00:21:28,980 +palsy العضلة ضعيفة، طيبعشان تشتغل هذه العضلة، عشان + +314 +00:21:28,980 --> 00:21:33,040 +تشتغل هذه العضلة لازمها innervation كتير، فإذا + +315 +00:21:33,040 --> 00:21:37,280 +إجالها innervation كتير عشان تشتغل و تعدل وضع + +316 +00:21:37,280 --> 00:21:39,940 +العين من ال down gaze، من ال hypotropic، يعني أنه + +317 +00:21:39,940 --> 00:21:43,120 +في حالة ال right superior rectus pulse عندي شلل في + +318 +00:21:43,120 --> 00:21:46,440 +ال right superior rectus، العين هتكون hypotropic، + +319 +00:21:46,440 --> 00:21:50,100 +hypotropic لأن ال inferior rectus هتكون أقوى و + +320 +00:21:50,100 --> 00:21:54,870 +هتشد العين لتحت، ال right eyeطيب عندي طلبنا من + +321 +00:21:54,870 --> 00:21:58,630 +المريض يعمل fixation بال right eye لازم ييجي لل + +322 +00:21:58,630 --> 00:22:00,830 +superior rectus في ال right eye اللي فيها pulse + +323 +00:22:00,830 --> 00:22:04,210 +increased innervationطب إجاهة increased + +324 +00:22:04,210 --> 00:22:07,870 +innervation معناته اليوك بتاعتها في العين التانية + +325 +00:22:07,870 --> 00:22:10,690 +اللي هي left inferior oblique هيجيها increased + +326 +00:22:10,690 --> 00:22:13,830 +innervation عضلة طبيعية إجاهة increased + +327 +00:22:13,830 --> 00:22:16,690 +innervation بصيرش فيها inhibitional pulse يوانها + +328 +00:22:16,690 --> 00:22:20,610 +بتصير over acting .. بتسكير over acting إذا الجواب + +329 +00:22:20,610 --> 00:22:24,360 +غلط .. إذا الجواب غلطفهذا ال muscles equally اللي + +330 +00:22:24,360 --> 00:22:28,220 +شرحناه باستفادة و اللي قلنا لازم الإنسان يتقنه و + +331 +00:22:28,220 --> 00:22:32,480 +يرجع لمحاضراته و يكررها عدة مرات by temporal image + +332 +00:22:32,480 --> 00:22:36,540 +disparity stimulates fusional divergence غلط ال by + +333 +00:22:36,540 --> 00:22:39,740 +temporal image disparity stimulates fusional + +334 +00:22:39,740 --> 00:22:45,420 +convergence إذا غلط طيب + +335 +00:22:45,420 --> 00:22:50,990 +the superior oblique muscle inserts in thesuperior + +336 +00:22:50,990 --> 00:22:53,470 +and anterior لحد ما ألاقي كلمة anterior لأ + +337 +00:22:53,470 --> 00:22:57,150 +inferior لأ superior and oblique لأ مابتظبطش + +338 +00:22:57,150 --> 00:23:01,990 +superior posterior temporal quadrant طبعا مش في ال + +339 +00:23:01,990 --> 00:23:04,650 +nasal quadrant في ال temporal superior posterior + +340 +00:23:04,650 --> 00:23:12,610 +temporal quadrant هذا ال insertion بتاع ال + +341 +00:23:12,610 --> 00:23:15,930 +superior oblique muscle الآن سؤال drag and drop + +342 +00:23:15,930 --> 00:23:22,610 +عندي target اللي هو المربع الأزرقجايعالفوفيا، و + +343 +00:23:22,610 --> 00:23:25,770 +different target جايعالفوفيا، two different + +344 +00:23:25,770 --> 00:23:29,310 +targets stimulating corresponding retinal area، + +345 +00:23:29,310 --> 00:23:33,710 +إيه الشيء ده بيسميه؟ بسميه confusion، هذا السؤال + +346 +00:23:33,710 --> 00:23:38,630 +ممكن يكون عليه علامتين، ممكن يكون عليه علامتين في + +347 +00:23:38,630 --> 00:23:45,000 +المحصربس لا أكتر ولا أقل، يعني ما استغرقش ثانيتين + +348 +00:23:45,000 --> 00:23:49,360 +Stereopsis is binocular function، الكلام صحيح، هذا + +349 +00:23:49,360 --> 00:23:55,560 +سؤال مكرر Tested + +350 +00:23:55,560 --> 00:23:58,720 +by occluding the other eye، إيش الحاجة اللي إحنا + +351 +00:23:58,720 --> 00:24:02,860 +بنختبرها؟ هل هي ال infraduction؟ هل هي ال + +352 +00:24:02,860 --> 00:24:05,780 +divergence؟ هل هي ال dextrodepression أو ال level + +353 +00:24:05,780 --> 00:24:09,470 +elevation؟هذا ال divergence و ال dextro depression + +354 +00:24:09,470 --> 00:24:12,370 +و ال elevation لازم العين تانية يكونوا مفتوحين لأن + +355 +00:24:12,370 --> 00:24:16,190 +هذا نوع من ال virgences هذا نوع من ال virgins و + +356 +00:24:16,190 --> 00:24:19,630 +هذا نوع من ال virgins هذا اللي هو ال infraduction + +357 +00:24:19,630 --> 00:24:23,110 +لازم نغطي عين و نقول العين التانية تطلع عينها لتحت + +358 +00:24:23,110 --> 00:24:26,210 +إذا هذا نوع من الدكشن إذا هو tested by occluding + +359 +00:24:26,210 --> 00:24:31,170 +the other eye تمام، + +360 +00:24:31,170 --> 00:24:34,810 +عندي dyplopiawhich type of diplopia هل هي + +361 +00:24:34,810 --> 00:24:39,290 +vertical؟ طبعا لأ هل هي torsional يعني صورة ال .. + +362 +00:24:39,290 --> 00:24:43,150 +ال mug يعني مائلة؟ لأ هي هذه horizontal diplopia + +363 +00:24:43,150 --> 00:24:47,190 +بسيطة جدا جدا مافيها أي مشكلة هيك أخلص السؤال يعني + +364 +00:24:47,190 --> 00:24:51,630 +هذا سؤال يعني nothing يعني which of the following + +365 +00:24:51,630 --> 00:24:54,790 +is not a condition for the development of abnormal + +366 +00:24:54,790 --> 00:24:57,210 +retinal correspondence؟ قلنا شروط ال abnormal + +367 +00:24:57,210 --> 00:25:01,510 +retinal correspondence تلاتة long periodتاني حاجة + +368 +00:25:01,510 --> 00:25:05,590 +small angle, stable angle و long period، التلات + +369 +00:25:05,590 --> 00:25:08,950 +شروع، طيب small angle اه من ضمن الشروط، stable + +370 +00:25:08,950 --> 00:25:12,290 +angle من ضمن الشروط، chronic long standing squint + +371 +00:25:12,290 --> 00:25:15,170 +نعم من ضمن الشروط، short period after the + +372 +00:25:15,170 --> 00:25:17,550 +development of squint يعني مافيش حد بيصير معاه + +373 +00:25:17,550 --> 00:25:19,370 +squint وبعد أسبوع بيصير abnormal retinal + +374 +00:25:19,370 --> 00:25:22,470 +correspondence، إذا هذه الوحيدة ليست condition + +375 +00:25:22,470 --> 00:25:26,050 +ليست شرطا من شروط ال abnormal retinal + +376 +00:25:26,050 --> 00:25:27,010 +correspondence + +377 +00:25:29,160 --> 00:25:32,480 +Fusional convergence amplitudes at near are larger + +378 +00:25:32,480 --> 00:25:35,720 +than at distance يعني ال fusional convergence ع ال + +379 +00:25:35,720 --> 00:25:39,260 +near أكتر من ال fusional convergence ع ال distance + +380 +00:25:39,260 --> 00:25:45,000 +و ده كلام صحيح The + +381 +00:25:45,000 --> 00:25:49,300 +main elevator of the eye in abduction is superior + +382 +00:25:49,300 --> 00:25:52,680 +rectus في ال up and out abduction يعني out + +383 +00:25:52,680 --> 00:25:55,620 +فبالتالي اللي بيرفع العين من ال out هو ال superior + +384 +00:25:55,620 --> 00:26:01,120 +rectus هو ال main elevatorطيب، هنا عندي نضارة + +385 +00:26:01,120 --> 00:26:07,600 +based in برزم، واضح القاعدة بتاعة البرزم هي خميلةو + +386 +00:26:07,600 --> 00:26:11,840 +ال Apex عنده لبرا و هنا base in prism لو هذا + +387 +00:26:11,840 --> 00:26:16,960 +الإنسان لبس هذه النضارة الأشعة هتنحرف باتجاه ال + +388 +00:26:16,960 --> 00:26:20,560 +base يعني باتجاه ال nasal retina هنا و نفس الأشعة + +389 +00:26:20,560 --> 00:26:23,120 +اللي جاية من نفس ال target هتنحرف باتجاه ال nasal + +390 +00:26:23,120 --> 00:26:26,520 +retina nasal مع nasal إذا by nasal image disparity + +391 +00:26:26,520 --> 00:26:29,800 +فهيعمل stimulation لل effusional divergence + +392 +00:26:29,800 --> 00:26:36,180 +effusional divergence هذه السؤاليعني مش صعب بالمرة + +393 +00:26:36,180 --> 00:26:42,300 +و بالعكس يعني مباشر يعتبر واضح من النضارة أنها مش + +394 +00:26:42,300 --> 00:26:45,440 +نضارة طبعا، هدا prison، هدا prison واضح جدا و في + +395 +00:26:45,440 --> 00:26:48,360 +ميل من .. من ناحية ال nasal side .. من ناحية ال + +396 +00:26:48,360 --> 00:26:51,940 +nasal side طبعا سؤال زي هذا عليه أكتر من عالم، + +397 +00:26:51,940 --> 00:26:53,180 +عليه أكتر من عالم + +398 +00:26:58,260 --> 00:27:01,840 +Inferior oblique muscle inserts in الانفيريور + +399 +00:27:01,840 --> 00:27:07,460 +أوبليك في الانفيريور بوستيريور تمبرال اكوادرات + +400 +00:27:07,460 --> 00:27:12,140 +انفيريور بوستيريور تمبرال مش نازل اكوادرات لازم + +401 +00:27:12,140 --> 00:27:16,560 +الانسان يكون متأكد جدا من ال function بتاعة اللي + +402 +00:27:16,560 --> 00:27:19,800 +هي ال extraocular muscles و ال testing position و + +403 +00:27:19,800 --> 00:27:22,540 +مكان ال insertion و مكان ال origin + +404 +00:27:28,670 --> 00:27:35,330 +هذه الإجابات وبالتالي انتهى المراجعة على النسختين + +405 +00:27:35,330 --> 00:27:39,370 +ويعطيكم العافية والسلام عليكم ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Eow1zunSMNY_raw.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Eow1zunSMNY_raw.srt new file mode 100644 index 0000000000000000000000000000000000000000..f16f52947ecec6667025db1fa38d116691693e25 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Eow1zunSMNY_raw.srt @@ -0,0 +1,1620 @@ +1 +00:00:03,200 --> 00:00:07,580 +بسم الله الرحمن الرحيم هذه ال .. او هذا الفيديو + +2 +00:00:07,580 --> 00:00:12,800 +مراجعة للنسخة الأولى والتانية من الامتحان النصفي + +3 +00:00:12,800 --> 00:00:17,040 +في الرؤية الموحدة والحوال نبدأ على برج الله نشوف + +4 +00:00:17,040 --> 00:00:21,200 +النسخة الأولى للامتحان النصفي suppression occurs + +5 +00:00:21,200 --> 00:00:24,920 +only as a result of squint طبعا غلط ممكن يكون as a + +6 +00:00:24,920 --> 00:00:27,960 +result of anisometropia لأن في حالة الانيزومتروبيا + +7 +00:00:28,520 --> 00:00:33,040 +ال more ametropic I ممكن تكون الصورة فيها مش واضحة + +8 +00:00:33,040 --> 00:00:39,300 +كويس و بالتالي .. و بالتالي بيكون أن الصورة مش + +9 +00:00:39,300 --> 00:00:41,720 +واضحة اللي هيقبلها ال brain فبيعملها suppression + +10 +00:00:41,720 --> 00:00:48,170 +يعني مش بس في الاسكونة السؤال التانيyoke muscles + +11 +00:00:48,170 --> 00:00:51,510 +in dextro depression، dextro depression يعني right + +12 +00:00:51,510 --> 00:00:54,890 +and down، مين اللي بيجيب العين اليمين right and + +13 +00:00:54,890 --> 00:00:57,710 +down؟ ال inferior rectus، وال yoke muscle في + +14 +00:00:57,710 --> 00:01:00,710 +الشمال، اللي هي ال superior oblique، اذا right + +15 +00:01:00,710 --> 00:01:07,510 +inferior rectus and left superior oblique، هذه هي + +16 +00:01:07,510 --> 00:01:11,470 +الجواب الصح في dextro depression، في ال dextro + +17 +00:01:11,470 --> 00:01:16,000 +depression، السؤال اللي بعدههذا سؤال very + +18 +00:01:16,000 --> 00:01:19,180 +interesting بعض الأسئلة على فكرة عليها أكتر من + +19 +00:01:19,180 --> 00:01:25,920 +علامة يعني ممكن هذا السؤال يكون علي علامتين drag + +20 +00:01:25,920 --> 00:01:28,540 +and drop into the image the correct type of + +21 +00:01:28,540 --> 00:01:32,120 +fusional virgences that these glasses stimulate + +22 +00:01:32,120 --> 00:01:37,080 +put in appropriate choice in the upper box طيب + +23 +00:01:37,080 --> 00:01:42,890 +بنقول كالقاتلهذا البرزم بيز اوت وهذا البرزم بيز + +24 +00:01:42,890 --> 00:01:46,330 +اوت واضح ان المنطقة هي ال base بتاعة البرزم وهي ال + +25 +00:01:46,330 --> 00:01:49,090 +base بتاعة البرزم لما بيكون بيز اوت بيز اوت + +26 +00:02:09,940 --> 00:02:14,200 +هحط refusional convergence كجواب و كله في ال right + +27 +00:02:14,200 --> 00:02:18,820 +in the right upper box او اني اسيبه زي ما هو او + +28 +00:02:18,820 --> 00:02:23,260 +اني اسيبه زي ما هو يعني هنا خلاص هو الجواب الصحيح + +29 +00:02:23,260 --> 00:02:27,280 +refusional convergence refusional convergence + +30 +00:02:27,280 --> 00:02:29,520 +انتقل للسؤال اللي بعده + +31 +00:02:35,650 --> 00:02:39,170 +vertical recti are adductors الvertical recti اللي + +32 +00:02:39,170 --> 00:02:41,970 +هي superior rectus والinferior rectus muscles هذا + +33 +00:02:41,970 --> 00:02:45,810 +true من ضمن ال actions بتاعتهم ال adduction وقلنا + +34 +00:02:45,810 --> 00:02:49,840 +ال function ضروري يكون الإنسان متقنها تماماالان + +35 +00:02:49,840 --> 00:02:53,120 +سؤال matching prevents the sensation of diplopia + +36 +00:02:53,120 --> 00:02:56,440 +إيش اللي بمنع ال sensation of diplopia؟ هل هو ال + +37 +00:02:56,440 --> 00:02:58,620 +central suppression ولا ال alternating suppression + +38 +00:02:58,620 --> 00:03:00,400 +ولا ال peripheral suppression ولا ال abnormal + +39 +00:03:00,400 --> 00:03:02,840 +retinal correspondence ولا ال confusion ولا ال + +40 +00:03:02,840 --> 00:03:05,440 +monocular suppression طبعا ال peripheral + +41 +00:03:05,440 --> 00:03:08,960 +suppression بمنع ال diplopia في ال small angle + +42 +00:03:08,960 --> 00:03:12,730 +strabismusبيصير عندى abnormal retinal + +43 +00:03:12,730 --> 00:03:15,670 +correspondence من ضمن شروط ال abnormal retinal + +44 +00:03:15,670 --> 00:03:19,750 +correspondence تكون زاوية الحوال صغيرة two targets + +45 +00:03:19,750 --> 00:03:23,230 +stimulating the fovea هذا confusion .. هذا + +46 +00:03:23,230 --> 00:03:27,950 +confusion can cause amblyopia .. إيش في الأشياء + +47 +00:03:27,950 --> 00:03:30,530 +الموجودة عندى can cause amblyopia؟ ال monocular + +48 +00:03:30,530 --> 00:03:33,370 +suppression لأن ال alternating suppression ما + +49 +00:03:33,370 --> 00:03:38,600 +بيسبب amblyopia .. ما بيسبب amblyopiaon abduction + +50 +00:03:38,600 --> 00:03:42,400 +لما العين تيجي في ال abduction it becomes only + +51 +00:03:42,400 --> 00:03:45,600 +extortable طبعا ال inferior oblique لأنه في ال + +52 +00:03:45,600 --> 00:03:48,820 +abduction ال superior rectus elevator و ال + +53 +00:03:48,820 --> 00:03:51,940 +inferior oblique extortable inferior oblique هي في + +54 +00:03:51,940 --> 00:03:55,520 +ال abduction في ال abduction المحور بتاعها بتعامل + +55 +00:03:55,520 --> 00:03:59,360 +على محور العين و هي جاية من أسل فهتعمل extortion + +56 +00:03:59,360 --> 00:04:05,520 +only هتعمل extortion onlyطيب confusion results + +57 +00:04:05,520 --> 00:04:08,620 +from two different targets stimulating + +58 +00:04:08,620 --> 00:04:12,380 +corresponding retinal areas هنا لو شيلنا ال + +59 +00:04:12,380 --> 00:04:15,060 +corresponding retinal areas و حطينا بدلها phobia + +60 +00:04:15,060 --> 00:04:18,120 +ما هي ال phobia مع ال phobia corresponding retinal + +61 +00:04:18,120 --> 00:04:21,360 +areas فالإجابة صحيحةtwo targets two different + +62 +00:04:21,360 --> 00:04:24,560 +targets stimulating corresponding retinal areas + +63 +00:04:24,560 --> 00:04:28,240 +وبالتالي بيعملولي confusion لأنه هيتم توحيد أشياء + +64 +00:04:28,240 --> 00:04:32,440 +مختلفة مع بعضها البعض conditions necessary for + +65 +00:04:32,440 --> 00:04:35,520 +normal binocular single vision include all of the + +66 +00:04:35,520 --> 00:04:40,030 +following except select oneطبعا accurate + +67 +00:04:40,030 --> 00:04:43,090 +neuromuscular development شرط عشان ال binocular + +68 +00:04:43,090 --> 00:04:46,130 +single vision and coordination so that the visual + +69 +00:04:46,130 --> 00:04:49,890 +axis directed at and maintain fixation on the + +70 +00:04:49,890 --> 00:04:52,990 +object of regard طبعا صحيح لازم يكون في عندي + +71 +00:04:52,990 --> 00:04:55,730 +normal retinal او retinocortical correspondence + +72 +00:04:55,730 --> 00:05:00,170 +resulting in cyclopean viewing ايضا ال visual + +73 +00:05:00,170 --> 00:05:03,070 +pathway لازم يكون طبيعي normal routing of visual + +74 +00:05:03,070 --> 00:05:07,040 +pathways with overlapping of visual fieldمين اللي + +75 +00:05:07,040 --> 00:05:09,780 +مش شرط انه monocularly driving neurons in the + +76 +00:05:09,780 --> 00:05:12,900 +visual cortex لانها مالاش علاقة في ال binocular + +77 +00:05:12,900 --> 00:05:16,040 +single vision، مين اللي له علاقة ال binocularly + +78 +00:05:16,040 --> 00:05:19,700 +driving neurons، اذا هذه هي الاستثناء، هذه هي + +79 +00:05:19,700 --> 00:05:24,840 +الاستثناءالسؤال اللي بعده stereopsis is a + +80 +00:05:24,840 --> 00:05:28,340 +binocular function كلام صحيح مائة بالمائة وقلنا + +81 +00:05:28,340 --> 00:05:30,560 +فيه فارق بين ال stereopsis اللي هو binocular + +82 +00:05:30,560 --> 00:05:33,760 +function و ال depth perception اللي هو ممكن انا + +83 +00:05:33,760 --> 00:05:38,540 +يعني احصل عليه بواسطة عين واحدة وقلنا تجربة أقلام + +84 +00:05:38,540 --> 00:05:42,740 +الرصاص يعني قلمين رصاص احاول احط سن الجلم على سن + +85 +00:05:42,740 --> 00:05:48,090 +الجلم بعينية تنتينهيكون الحكم صحيح، بينما بعين + +86 +00:05:48,090 --> 00:05:51,970 +واحدة لما أغمض التانية، غالبا هأخطئ ومش هقدر أحط + +87 +00:05:51,970 --> 00:05:55,770 +سن الجلم على سن الجلم من أول مرة فالstereopsis + +88 +00:05:55,770 --> 00:05:59,270 +binocular function superior muscles اللي هي + +89 +00:05:59,270 --> 00:06:02,250 +superior rectus وال superior oblique are in + +90 +00:06:02,250 --> 00:06:08,230 +twitters طبعا هذا كلام صحيح شايفين أنه بدون ال + +91 +00:06:08,230 --> 00:06:10,550 +function بتاعة الextraocular muscles كل إشي صعب + +92 +00:06:10,550 --> 00:06:16,130 +هيصيرطبعا سؤال زي اللي فات .. زي اللي فات سؤال + +93 +00:06:16,130 --> 00:06:20,770 +يعني مش مفروض يتصرف معاه ثانيتين drag and drop + +94 +00:06:20,770 --> 00:06:23,550 +into the image the correct type of diplopia هنا + +95 +00:06:23,550 --> 00:06:28,290 +فيه diplopia هل هي vertical؟ يعني الصورتين فوق + +96 +00:06:28,290 --> 00:06:33,450 +بعض؟ طبعا لأ هل هي torsional؟ يعني صورة ميلة + +97 +00:06:33,450 --> 00:06:36,730 +بالنسبة للتانية؟ طبعا لأ هل هي horizontal؟ طبعا + +98 +00:06:36,730 --> 00:06:40,350 +horizontal يعني سؤال زي هذا سهل جدا عليه علامتين + +99 +00:06:40,610 --> 00:06:45,770 +ممكن الإنسان يعني بي .. او .. او يعني يتحصر إنه + +100 +00:06:45,770 --> 00:06:50,590 +يفقد مثل هذه العالم هذه in left eye which muscle + +101 +00:06:50,590 --> 00:06:55,430 +must relax on contraction of the right superior + +102 +00:06:55,430 --> 00:06:58,370 +rectus muscle in normal binocular single vision + +103 +00:06:58,370 --> 00:07:02,290 +patient أو .. أو person طيب لما يكون في عندي + +104 +00:07:02,290 --> 00:07:06,360 +normal binocular single vision personومفتح عين + +105 +00:07:06,360 --> 00:07:09,780 +التنتين ويصير contraction في ال right superior + +106 +00:07:09,780 --> 00:07:13,360 +rectus، معناته لازم يصير contraction في ال yoke + +107 +00:07:13,360 --> 00:07:16,140 +muscle بتاعتها في العين الشمالية، مين ال yoke + +108 +00:07:16,140 --> 00:07:20,230 +muscle مع ال right superior rectus؟اللي هي ال left + +109 +00:07:20,230 --> 00:07:23,830 +inferior oblique طيب ال left inferior oblique بما + +110 +00:07:23,830 --> 00:07:27,190 +إنها ال يوك بتاعة ال right superior rectus معناته + +111 +00:07:27,190 --> 00:07:30,170 +هيصير فيها أيضا contraction لأنه حسب hearing law + +112 +00:07:30,170 --> 00:07:34,290 +إذا إجا innervation لعضلة وعملت contraction لازم + +113 +00:07:34,290 --> 00:07:38,210 +يكون برضه إجا innervation مساوي لعضلة يوك معاها + +114 +00:07:38,210 --> 00:07:40,710 +اللي هي هنا ال right superior rectus و ال left + +115 +00:07:40,710 --> 00:07:42,650 +inferior oblique هيجيها نفس الكمية من ال + +116 +00:07:42,650 --> 00:07:47,320 +innervation فهتصيرContracted طيب بتعمل contraction + +117 +00:07:47,320 --> 00:07:49,980 +مين اللي .. اللي لازم يريح يصير له ال relaxation؟ + +118 +00:07:49,980 --> 00:07:52,860 +ال antagonist بتاع .. ال antagonist بتاع ال left + +119 +00:07:52,860 --> 00:07:56,800 +inferior oblique .. بتاع ال left inferior oblique + +120 +00:07:56,800 --> 00:07:59,500 +هو ال left superior oblique muscle .. ال left + +121 +00:07:59,500 --> 00:08:02,180 +superior oblique muscle هي ال antagonist بتاع ال + +122 +00:08:02,180 --> 00:08:05,330 +left inferior obliqueطالما ال left inferior + +123 +00:08:05,330 --> 00:08:07,690 +oblique اجهها innervation كتير عشان تعمل + +124 +00:08:07,690 --> 00:08:10,110 +contraction عشان هي ال yoke بتاعة ال superior + +125 +00:08:10,110 --> 00:08:13,250 +rectus في ال right eye، معناته اللي لازم يصيرله + +126 +00:08:13,250 --> 00:08:16,770 +فيه relaxation حسب Sherrington law اللي هي left + +127 +00:08:16,770 --> 00:08:21,830 +superior obliqueأيضا لازم أعرف ال agonist و ال + +128 +00:08:21,830 --> 00:08:24,130 +antagonist و ال synergist و ال yoke muscle + +129 +00:08:24,130 --> 00:08:28,090 +effusional divergence amplitudes are larger at + +130 +00:08:28,090 --> 00:08:32,310 +distance than at near طبعا اللي بيرجع للأرقام لأ + +131 +00:08:32,310 --> 00:08:36,250 +هي larger at near تقريبا من اتناش لاربعتاشر prism + +132 +00:08:36,250 --> 00:08:39,770 +than at distance تقريبا من ستة لتمانية prism إذا + +133 +00:08:39,770 --> 00:08:45,450 +هذا falseواضح أن الأسئلة مابتاخدش وقت كثير، يعني + +134 +00:08:45,450 --> 00:08:48,450 +المفروض مع الطالب، مابناشي نقول مع الدكتور، تاخد + +135 +00:08:48,450 --> 00:08:52,290 +من تلاتين لاربعين ثانية كل سؤال By nasal image + +136 +00:08:52,290 --> 00:08:56,010 +disparity stimulate fusional divergence، كلام صحيح + +137 +00:08:56,010 --> 00:09:00,070 +مية في المية، لأنه الفوفيا هتروح نازلي، و الفوفيا + +138 +00:09:00,070 --> 00:09:03,690 +هتروح نازلي، فمن الأمام هيعمل divergence، إذا ال + +139 +00:09:03,690 --> 00:09:07,190 +by nasal image disparity stimulates fusional + +140 +00:09:07,190 --> 00:09:11,870 +divergence، سؤال سهل ومباشرdepressor of the left + +141 +00:09:11,870 --> 00:09:16,130 +eye in right gaze الـ left eye في ال right gaze + +142 +00:09:16,130 --> 00:09:20,670 +بتصير in تدخل لجوه لما العينين بتطلعوا لليمين + +143 +00:09:20,670 --> 00:09:24,190 +معناته ال left eye دخلت لجوه مين اللي بيعمل + +144 +00:09:24,190 --> 00:09:27,790 +depression؟ depressor of the left eye in right + +145 +00:09:27,790 --> 00:09:32,410 +gaze العين الشمال بتكون دخلت لجوه في ال right gaze + +146 +00:09:32,410 --> 00:09:34,770 +طب مين بيعملها في ال in position؟ مين بيعملها + +147 +00:09:34,770 --> 00:09:38,030 +down؟ ال superior oblique ال superior oblique is + +148 +00:09:38,030 --> 00:09:39,770 +on the left superior oblique muscle + +149 +00:09:44,230 --> 00:09:47,510 +hearing law can be applied to virgins is false + +150 +00:09:47,510 --> 00:09:51,890 +اللي برجع لتعريف hearing law هيقول during + +151 +00:09:51,890 --> 00:09:56,250 +conjugate I .. أول كلمة فيه during conjugate I + +152 +00:09:56,250 --> 00:09:59,930 +movements إيش هي ال conjugate I movements؟ ال + +153 +00:09:59,930 --> 00:10:04,850 +virgins .. ال virgins مش ال virgins إذا هو بنطبق ع + +154 +00:10:04,850 --> 00:10:08,790 +ال virgins facultative + +155 +00:10:08,790 --> 00:10:13,440 +suppression frequently leads to amblyopia خطأال + +156 +00:10:13,440 --> 00:10:16,880 +obligatory suppression هو اللي عادة بيأدي + +157 +00:10:16,880 --> 00:10:19,520 +لامبليوبيا facultative suppression لأنه أحيانا + +158 +00:10:19,520 --> 00:10:22,740 +بيكون موجود و أحيانا مش موجود يعني إيش أحيانا مش + +159 +00:10:22,740 --> 00:10:27,240 +موجود يعني في binocular single vision فمش هيأدي + +160 +00:10:27,240 --> 00:10:34,980 +لامبليوبيا طيب right lateral rectusbalcy leads to + +161 +00:10:34,980 --> 00:10:39,660 +contracture of theعندي lateral rectus في ال right + +162 +00:10:39,660 --> 00:10:43,760 +eye صار فيها pulse مع مرور المدمن العضل اللي بيصير + +163 +00:10:43,760 --> 00:10:47,160 +فيها contraction اللي هي ال media rectus في ال + +164 +00:10:47,160 --> 00:10:50,760 +right eye right media rectus مصرية هذه السؤال يعني + +165 +00:10:50,760 --> 00:10:51,840 +غاية في السوق + +166 +00:10:54,610 --> 00:10:58,510 +All objects on the horopter are seen singly and + +167 +00:10:58,510 --> 00:11:02,430 +stereoscopically، false، are seen singly، صحيح، + +168 +00:11:02,430 --> 00:11:05,690 +ولكن مش stereoscopically، in three dimensions، in + +169 +00:11:05,690 --> 00:11:08,990 +two dimensions، نرجع للهوربتر، راح نلاقي إنه طبعا + +170 +00:11:08,990 --> 00:11:14,130 +كل ال objects اللي تقع الهوربتر، بي .. بتنشف + +171 +00:11:14,130 --> 00:11:16,510 +single and in two dimensions + +172 +00:11:20,450 --> 00:11:23,830 +extends from the posterior pool to the anterior + +173 +00:11:23,830 --> 00:11:29,030 +pool of the eye to infinity ال Anatomical axis هذا + +174 +00:11:29,030 --> 00:11:34,050 +تعريف مباشر which + +175 +00:11:34,050 --> 00:11:37,530 +muscle will go into inhibitional palsy if there + +176 +00:11:37,530 --> 00:11:43,910 +was longstanding left superior rectus palsy بنقول + +177 +00:11:43,910 --> 00:11:46,950 +left superior rectus إلها فترة طويلة ال left + +178 +00:11:47,600 --> 00:11:51,140 +subperior rectus إلى فترة طويلة مشلولة العضل + +179 +00:11:51,140 --> 00:11:53,460 +الانتاجونيست بتاعتها اللي هي ال left inferior + +180 +00:11:53,460 --> 00:11:57,500 +rectus هتصير contracted وحيلزمها innervation أقل + +181 +00:11:57,500 --> 00:12:02,380 +هي over acting muscle ال left inferior rectus ولكن + +182 +00:12:02,380 --> 00:12:06,360 +ب innervation أقل بتعطي شغل كتير لأن اللي عاجبالها + +183 +00:12:06,360 --> 00:12:13,130 +يعني مشلول اذا طالما ال left inferior rectusصارت + +184 +00:12:13,130 --> 00:12:17,070 +شغالة و قوية و ب innervation قليل حسب hearing blow + +185 +00:12:17,070 --> 00:12:21,910 +من اليوكتع ال left inferior rectus اليوكتع ال left + +186 +00:12:21,910 --> 00:12:25,110 +inferior rectus ال right superior oblique فهتدخل + +187 +00:12:25,110 --> 00:12:28,950 +في innervation أقل و هي عضلة طبيعية عضلة طبيعية + +188 +00:12:28,950 --> 00:12:31,730 +بتجيها innervation أقل بتصير inhibitional palsy + +189 +00:12:31,730 --> 00:12:34,590 +إذا ال right superior oblique muscle ال right + +190 +00:12:34,590 --> 00:12:39,700 +superior oblique muscle هي الجواب الصحيو هذا في + +191 +00:12:39,700 --> 00:12:42,580 +المصر السيكويلي اللي ضروري احنا او احنا شرحناها + +192 +00:12:42,580 --> 00:12:48,380 +بشكل يعني مستفيد obliques are inserted behind the + +193 +00:12:48,380 --> 00:12:52,900 +equator صح in the nasal quadrants لأ في ال + +194 +00:12:52,900 --> 00:12:57,200 +temporal quadrants ال superior oblique في ال + +195 +00:12:57,200 --> 00:13:00,160 +posterior يعني behind the equator superior + +196 +00:13:00,160 --> 00:13:03,440 +temporal quadrant و ال inferior oblique في ال + +197 +00:13:04,210 --> 00:13:08,550 +posterior behind the equator inferior temporal .. + +198 +00:13:08,550 --> 00:13:12,490 +التنين في ال temporal quadrant إذا الجواب غلط + +199 +00:13:12,490 --> 00:13:15,950 +Orthoptic + +200 +00:13:15,950 --> 00:13:18,930 +exercises can be helpful in the case of + +201 +00:13:18,930 --> 00:13:22,190 +convergence insufficiency وهذا كلام صحيح وهذا + +202 +00:13:22,190 --> 00:13:25,850 +مأخوذ من .. يعني بشكل .. بالكلمة .. بالحرف من + +203 +00:13:25,850 --> 00:13:26,690 +الملزمة + +204 +00:13:29,410 --> 00:13:32,590 +up and out position is a diagnostic but not + +205 +00:13:32,590 --> 00:13:36,070 +cardinal position of gaze لأ هو diagnostic و + +206 +00:13:36,070 --> 00:13:40,150 +cardinal في نفس الوقت ال up and out diagnostic و + +207 +00:13:40,150 --> 00:13:46,390 +cardinal إذا الإجابة خطأ طيب + +208 +00:13:46,840 --> 00:13:50,580 +Which kind of ocular movements occurs around Z + +209 +00:13:50,580 --> 00:13:53,900 +-axis؟ Z-axis الـ vertical axis بما أن ال vertical + +210 +00:13:53,900 --> 00:13:57,740 +axis إذا ال adduction و ال abduction هما اللي + +211 +00:13:57,740 --> 00:14:04,260 +بيحصلوا حوالين Z-axis هيك خلصنا النموذج الأول بدنا + +212 +00:14:04,260 --> 00:14:06,360 +نروح للنموذج التاني + +213 +00:14:10,920 --> 00:14:17,000 +أخد 16 دقيقة من 30 يعني نص الوجد تقريبا مع الشرح و + +214 +00:14:17,000 --> 00:14:34,920 +التفصيل طيب + +215 +00:14:34,920 --> 00:14:36,980 +.. الآن نرجع للنسخة التانية + +216 +00:14:42,850 --> 00:14:50,530 +امتحان نصفي النسخة التانية بسم + +217 +00:14:50,530 --> 00:14:54,850 +الله yoke + +218 +00:14:54,850 --> 00:14:59,110 +muscles in left up position left up .. left up + +219 +00:14:59,110 --> 00:15:02,850 +يعني ال left superior rectus و ال right inferior + +220 +00:15:02,850 --> 00:15:08,810 +oblique السؤال اللي بعدهAll objects in the + +221 +00:15:08,810 --> 00:15:11,690 +horopter are seen singly and stereoscopically قبل + +222 +00:15:11,690 --> 00:15:17,310 +شوية حلناها، طبعا خطأ are seen in two dimensions + +223 +00:15:17,310 --> 00:15:20,890 +نجатив + +224 +00:15:20,890 --> 00:15:26,610 +أنجل كبّا will result in نجاتف أنجل كبّا will + +225 +00:15:26,610 --> 00:15:30,050 +result in temporal displacement of the corneal + +226 +00:15:30,050 --> 00:15:36,450 +light reflex لأنها هتعمل simulation لإيزو تروبيا + +227 +00:15:39,360 --> 00:15:42,360 +The optimal position for testing inferior rectus + +228 +00:15:42,360 --> 00:15:47,240 +muscle is when Its axis is coincident with the + +229 +00:15:47,240 --> 00:15:52,040 +visual axis Its axis is perpendicular to the + +230 +00:15:52,040 --> 00:15:55,760 +visual axis Its axis is coincident with the + +231 +00:15:55,760 --> 00:16:00,200 +orbital axis in adduction طبعا لما ال axis بتاع ال + +232 +00:16:00,200 --> 00:16:03,900 +inferior rectus يصير coincident متفق مع ال visual + +233 +00:16:03,900 --> 00:16:09,030 +axis أو ال axis of the eyeif the angle between + +234 +00:16:09,030 --> 00:16:12,390 +anatomical and visual axis is large and the + +235 +00:16:12,390 --> 00:16:17,210 +posterior pole is temporal temporal to the fovea + +236 +00:16:17,210 --> 00:16:21,230 +يعني الفوفيا نازل إله نازل يعني negative then + +237 +00:16:21,230 --> 00:16:26,170 +angle كبّه is negative كلام صحيح هنا إيه؟ بنقول + +238 +00:16:26,170 --> 00:16:29,030 +إذا ال angle بين ال anatomical axis و ال visual + +239 +00:16:29,030 --> 00:16:35,290 +axis اللي هي سمناها angle كبّه كبيرةبس ال + +240 +00:16:35,290 --> 00:16:38,590 +posterior pole جاي temporal للفوفيا أو الفوفيا + +241 +00:16:38,590 --> 00:16:44,890 +جاية nasal .. nasal بالنسبة ل .. ال posterior pole + +242 +00:16:44,890 --> 00:16:48,110 +فبالتالي angle kappa .. قولنا nasal، negative + +243 +00:16:48,110 --> 00:16:52,190 +الفوفيا nasal، negative فبالتالي angle kappa is + +244 +00:16:52,190 --> 00:16:58,330 +negative، كلام سليمطيب the main extorter of the + +245 +00:16:58,330 --> 00:17:01,230 +eye و احنا مغمضين ال inferior oblique هي ال + +246 +00:17:01,230 --> 00:17:04,490 +extorter الرئيسي صحيح ال inferior rectus تعمل + +247 +00:17:04,490 --> 00:17:07,750 +extortion بس الوظيفة الأساسية لل inferior rectus + +248 +00:17:07,750 --> 00:17:10,870 +ال depression بينما ال inferior oblique الوظيفة + +249 +00:17:10,870 --> 00:17:15,670 +الرئيسية لها ال extortion ال + +250 +00:17:15,670 --> 00:17:19,010 +normal binocular single vision visual direction of + +251 +00:17:19,010 --> 00:17:22,670 +the right fovea is the same as the principal + +252 +00:17:22,670 --> 00:17:27,000 +visual direction of the left eyeالـ visual + +253 +00:17:27,000 --> 00:17:30,040 +direction of the right fovea هو نفس الـ visual + +254 +00:17:30,040 --> 00:17:33,360 +direction بتاع لبرنز طبعا في ال right هنا في ال + +255 +00:17:33,360 --> 00:17:36,460 +right ال right fovea اتجاهها في الفرق هو نفس + +256 +00:17:36,460 --> 00:17:41,260 +الاتجاه الرئيسيأو ال visual direction ال principal + +257 +00:17:41,260 --> 00:17:44,740 +بتاع ال left eye ما هو في ال normal binocular + +258 +00:17:44,740 --> 00:17:47,920 +single vision ال principal visual direction بتاع + +259 +00:17:47,920 --> 00:17:50,300 +ال left eye هو ال visual direction بتاع ال fovea + +260 +00:17:50,300 --> 00:17:53,040 +وكأنه بيقوللي هو ال visual direction بتاع ال right + +261 +00:17:53,040 --> 00:17:55,220 +fovea هو نفس ال visual direction بتاع ال left + +262 +00:17:55,220 --> 00:17:57,440 +fovea وهذا كلام صحيح + +263 +00:18:02,140 --> 00:18:05,540 +controlled downward displacement of one eye + +264 +00:18:05,540 --> 00:18:09,360 +relative to the other eye is termed hypotropia خطأ + +265 +00:18:09,360 --> 00:18:13,280 +ليش خطأ؟ لو شيلنا كلمة controlled و بدناها من عند + +266 +00:18:13,280 --> 00:18:17,020 +downward كان بيكون صح الجواب لما بتكون عين منخفضة + +267 +00:18:17,020 --> 00:18:20,260 +بشكل واضح بس كلمة controlled يعني الدماغ متحكم فيه + +268 +00:18:20,260 --> 00:18:24,260 +يعني مش ظاهر للعيان بتسمى hypophoria إذا كانوا + +269 +00:18:24,260 --> 00:18:27,140 +controlled الصحيح أنه بتسمى hypophoria مش + +270 +00:18:27,140 --> 00:18:28,100 +hypotropia + +271 +00:18:31,290 --> 00:18:36,150 +vertical recti are adductors وهذا كلام صحيح مر + +272 +00:18:36,150 --> 00:18:40,700 +السؤال ده في النسخة الأولىin comparison with + +273 +00:18:40,700 --> 00:18:44,880 +horizontal fusional divergences vertical fusional + +274 +00:18:44,880 --> 00:18:48,360 +divergences are equal ولا larger ولا smaller ولا + +275 +00:18:48,360 --> 00:18:52,100 +all choices are wrong طبعا smaller ال vertical + +276 +00:18:52,100 --> 00:18:54,720 +fusional divergences ال vertical fusional + +277 +00:18:54,720 --> 00:18:58,160 +divergences من اتنين لتلاتة prism بينما ال + +278 +00:18:58,160 --> 00:19:00,500 +horizontal fusional divergences ايش هي ال + +279 +00:19:00,500 --> 00:19:03,060 +horizontal fusional divergences اللي هو ال + +280 +00:19:03,060 --> 00:19:05,420 +fusional convergence و ال fusional divergence + +281 +00:19:05,860 --> 00:19:09,120 +أرقامها أعلى من ذلك بكثير، إذا ال horizontal + +282 +00:19:09,120 --> 00:19:12,900 +fusional vergence أكبر بكثير من ال vertical + +283 +00:19:12,900 --> 00:19:16,560 +فبالتالي ال vertical تعتبر smaller than in + +284 +00:19:16,560 --> 00:19:19,680 +comparison .. in comparison لما نقارنها في ال + +285 +00:19:19,680 --> 00:19:23,540 +horizontal fusional vergence ال vertical fusional + +286 +00:19:23,540 --> 00:19:29,860 +vergence are smaller are smaller on + +287 +00:19:29,860 --> 00:19:33,830 +head tilt to the rightهل بيصير extortion في + +288 +00:19:33,830 --> 00:19:37,930 +العنتين؟ لأ هل بيصير intortion في العنتين؟ لأ طيب + +289 +00:19:37,930 --> 00:19:40,610 +ال head tilt to the right .. to the right عفوا في + +290 +00:19:40,610 --> 00:19:44,810 +الاتجاه هذا العنتين بيلفوا عكسه بحيث انه ال right + +291 +00:19:44,810 --> 00:19:48,470 +eye بتعمل intortion و ال left eye بتعمل extortion + +292 +00:19:48,470 --> 00:19:53,690 +يعني هذا هو الجواب الصحيح + +293 +00:19:53,690 --> 00:19:58,390 +depressure of the left eye in right gaze في ال + +294 +00:19:58,390 --> 00:20:02,620 +right gaze هذا السؤال مر في ال right gazeالـ left + +295 +00:20:02,620 --> 00:20:06,120 +eye بتصير لجوا ناحية الأنف مين اللي بنزلها و هي + +296 +00:20:06,120 --> 00:20:10,540 +اين ال superior oblique ال left superior oblique + +297 +00:20:10,540 --> 00:20:16,600 +هذا سؤال كان في النسخة الأولى موجود طيب right + +298 +00:20:16,600 --> 00:20:20,600 +lateral rectus palsy leads to contracture of the + +299 +00:20:20,600 --> 00:20:26,480 +right medial rectus الانتاجونيست بتاعتها هذا في + +300 +00:20:26,480 --> 00:20:31,510 +المصل سكويلي مشروع باستفادةextortion is movement + +301 +00:20:31,510 --> 00:20:34,890 +of the inferior limbus nasally، معناته ال superior + +302 +00:20:34,890 --> 00:20:38,290 +rectus هيروح temporally، معناته الكلام صحيح، هذا + +303 +00:20:38,290 --> 00:20:43,720 +ال extortion، العكس هيكون ال intortionطيب + +304 +00:20:43,720 --> 00:20:47,680 +orthoptic exercises can be helpful in the case of + +305 +00:20:47,680 --> 00:20:50,160 +convergence insufficiency ده سؤال مكرر بين + +306 +00:20:50,160 --> 00:20:53,680 +النسختين كلام صحيح ممكن تفيد ال orthoptic + +307 +00:20:53,680 --> 00:20:57,620 +exercises the left inferior oblique will go into + +308 +00:20:57,620 --> 00:21:01,780 +inhibitional palsy in long standing right superior + +309 +00:21:01,780 --> 00:21:07,680 +rectus palsy ال left inferior obliquewill go to + +310 +00:21:07,680 --> 00:21:11,940 +inhibitional palsy in long standing right superior + +311 +00:21:11,940 --> 00:21:16,080 +rectus palsy، إذا عندي right superior rectus palsy + +312 +00:21:16,080 --> 00:21:21,620 +طولت، صارت long standing، هذه ال superior rectus + +313 +00:21:21,620 --> 00:21:28,980 +palsy العضلة ضعيفة، طيبعشان تشتغل هذه العضلة، عشان + +314 +00:21:28,980 --> 00:21:33,040 +تشتغل هذه العضلة لازمها innervation كتير، فإذا + +315 +00:21:33,040 --> 00:21:37,280 +إجالها innervation كتير عشان تشتغل و تعدل وضع + +316 +00:21:37,280 --> 00:21:39,940 +العين من ال down gaze، من ال hypotropic، يعني أنه + +317 +00:21:39,940 --> 00:21:43,120 +في حالة ال right superior rectus pulse عندي شلل في + +318 +00:21:43,120 --> 00:21:46,440 +ال right superior rectus، العين هتكون hypotropic، + +319 +00:21:46,440 --> 00:21:50,100 +hypotropic لأن ال inferior rectus هتكون أقوى و + +320 +00:21:50,100 --> 00:21:54,870 +هتشد العين لتحت، ال right eyeطيب عندي طلبنا من + +321 +00:21:54,870 --> 00:21:58,630 +المريض يعمل fixation بال right eye لازم ييجي لل + +322 +00:21:58,630 --> 00:22:00,830 +superior rectus في ال right eye اللي فيها pulse + +323 +00:22:00,830 --> 00:22:04,210 +increased innervationطب إجاهة increased + +324 +00:22:04,210 --> 00:22:07,870 +innervation معناته اليوك بتاعتها في العين التانية + +325 +00:22:07,870 --> 00:22:10,690 +اللي هي left inferior oblique هيجيها increased + +326 +00:22:10,690 --> 00:22:13,830 +innervation عضلة طبيعية إجاهة increased + +327 +00:22:13,830 --> 00:22:16,690 +innervation بصيرش فيها inhibitional pulse يوانها + +328 +00:22:16,690 --> 00:22:20,610 +بتصير over acting .. بتسكير over acting إذا الجواب + +329 +00:22:20,610 --> 00:22:24,360 +غلط .. إذا الجواب غلطفهذا ال muscles equally اللي + +330 +00:22:24,360 --> 00:22:28,220 +شرحناه باستفادة و اللي قلنا لازم الإنسان يتقنه و + +331 +00:22:28,220 --> 00:22:32,480 +يرجع لمحاضراته و يكررها عدة مرات by temporal image + +332 +00:22:32,480 --> 00:22:36,540 +disparity stimulates fusional divergence غلط ال by + +333 +00:22:36,540 --> 00:22:39,740 +temporal image disparity stimulates fusional + +334 +00:22:39,740 --> 00:22:45,420 +convergence إذا غلط طيب + +335 +00:22:45,420 --> 00:22:50,990 +the superior oblique muscle inserts in thesuperior + +336 +00:22:50,990 --> 00:22:53,470 +and anterior لحد ما ألاقي كلمة anterior لأ + +337 +00:22:53,470 --> 00:22:57,150 +inferior لأ superior and oblique لأ مابتظبطش + +338 +00:22:57,150 --> 00:23:01,990 +superior posterior temporal quadrant طبعا مش في ال + +339 +00:23:01,990 --> 00:23:04,650 +nasal quadrant في ال temporal superior posterior + +340 +00:23:04,650 --> 00:23:12,610 +temporal quadrant هذا ال insertion بتاع ال + +341 +00:23:12,610 --> 00:23:15,930 +superior oblique muscle الآن سؤال drag and drop + +342 +00:23:15,930 --> 00:23:22,610 +عندي target اللي هو المربع الأزرقجايعالفوفيا، و + +343 +00:23:22,610 --> 00:23:25,770 +different target جايعالفوفيا، two different + +344 +00:23:25,770 --> 00:23:29,310 +targets stimulating corresponding retinal area، + +345 +00:23:29,310 --> 00:23:33,710 +إيه الشيء ده بيسميه؟ بسميه confusion، هذا السؤال + +346 +00:23:33,710 --> 00:23:38,630 +ممكن يكون عليه علامتين، ممكن يكون عليه علامتين في + +347 +00:23:38,630 --> 00:23:45,000 +المحصربس لا أكتر ولا أقل، يعني ما استغرقش ثانيتين + +348 +00:23:45,000 --> 00:23:49,360 +Stereopsis is binocular function، الكلام صحيح، هذا + +349 +00:23:49,360 --> 00:23:55,560 +سؤال مكرر Tested + +350 +00:23:55,560 --> 00:23:58,720 +by occluding the other eye، إيش الحاجة اللي إحنا + +351 +00:23:58,720 --> 00:24:02,860 +بنختبرها؟ هل هي ال infraduction؟ هل هي ال + +352 +00:24:02,860 --> 00:24:05,780 +divergence؟ هل هي ال dextrodepression أو ال level + +353 +00:24:05,780 --> 00:24:09,470 +elevation؟هذا ال divergence و ال dextro depression + +354 +00:24:09,470 --> 00:24:12,370 +و ال elevation لازم العين تانية يكونوا مفتوحين لأن + +355 +00:24:12,370 --> 00:24:16,190 +هذا نوع من ال virgences هذا نوع من ال virgins و + +356 +00:24:16,190 --> 00:24:19,630 +هذا نوع من ال virgins هذا اللي هو ال infraduction + +357 +00:24:19,630 --> 00:24:23,110 +لازم نغطي عين و نقول العين التانية تطلع عينها لتحت + +358 +00:24:23,110 --> 00:24:26,210 +إذا هذا نوع من الدكشن إذا هو tested by occluding + +359 +00:24:26,210 --> 00:24:31,170 +the other eye تمام، + +360 +00:24:31,170 --> 00:24:34,810 +عندي dyplopiawhich type of diplopia هل هي + +361 +00:24:34,810 --> 00:24:39,290 +vertical؟ طبعا لأ هل هي torsional يعني صورة ال .. + +362 +00:24:39,290 --> 00:24:43,150 +ال mug يعني مائلة؟ لأ هي هذه horizontal diplopia + +363 +00:24:43,150 --> 00:24:47,190 +بسيطة جدا جدا مافيها أي مشكلة هيك أخلص السؤال يعني + +364 +00:24:47,190 --> 00:24:51,630 +هذا سؤال يعني nothing يعني which of the following + +365 +00:24:51,630 --> 00:24:54,790 +is not a condition for the development of abnormal + +366 +00:24:54,790 --> 00:24:57,210 +retinal correspondence؟ قلنا شروط ال abnormal + +367 +00:24:57,210 --> 00:25:01,510 +retinal correspondence تلاتة long periodتاني حاجة + +368 +00:25:01,510 --> 00:25:05,590 +small angle, stable angle و long period، التلات + +369 +00:25:05,590 --> 00:25:08,950 +شروع، طيب small angle اه من ضمن الشروط، stable + +370 +00:25:08,950 --> 00:25:12,290 +angle من ضمن الشروط، chronic long standing squint + +371 +00:25:12,290 --> 00:25:15,170 +نعم من ضمن الشروط، short period after the + +372 +00:25:15,170 --> 00:25:17,550 +development of squint يعني مافيش حد بيصير معاه + +373 +00:25:17,550 --> 00:25:19,370 +squint وبعد أسبوع بيصير abnormal retinal + +374 +00:25:19,370 --> 00:25:22,470 +correspondence، إذا هذه الوحيدة ليست condition + +375 +00:25:22,470 --> 00:25:26,050 +ليست شرطا من شروط ال abnormal retinal + +376 +00:25:26,050 --> 00:25:27,010 +correspondence + +377 +00:25:29,160 --> 00:25:32,480 +Fusional convergence amplitudes at near are larger + +378 +00:25:32,480 --> 00:25:35,720 +than at distance يعني ال fusional convergence ع ال + +379 +00:25:35,720 --> 00:25:39,260 +near أكتر من ال fusional convergence ع ال distance + +380 +00:25:39,260 --> 00:25:45,000 +و ده كلام صحيح The + +381 +00:25:45,000 --> 00:25:49,300 +main elevator of the eye in abduction is superior + +382 +00:25:49,300 --> 00:25:52,680 +rectus في ال up and out abduction يعني out + +383 +00:25:52,680 --> 00:25:55,620 +فبالتالي اللي بيرفع العين من ال out هو ال superior + +384 +00:25:55,620 --> 00:26:01,120 +rectus هو ال main elevatorطيب، هنا عندي نضارة + +385 +00:26:01,120 --> 00:26:07,600 +based in برزم، واضح القاعدة بتاعة البرزم هي خميلةو + +386 +00:26:07,600 --> 00:26:11,840 +ال Apex عنده لبرا و هنا base in prism لو هذا + +387 +00:26:11,840 --> 00:26:16,960 +الإنسان لبس هذه النضارة الأشعة هتنحرف باتجاه ال + +388 +00:26:16,960 --> 00:26:20,560 +base يعني باتجاه ال nasal retina هنا و نفس الأشعة + +389 +00:26:20,560 --> 00:26:23,120 +اللي جاية من نفس ال target هتنحرف باتجاه ال nasal + +390 +00:26:23,120 --> 00:26:26,520 +retina nasal مع nasal إذا by nasal image disparity + +391 +00:26:26,520 --> 00:26:29,800 +فهيعمل stimulation لل effusional divergence + +392 +00:26:29,800 --> 00:26:36,180 +effusional divergence هذه السؤاليعني مش صعب بالمرة + +393 +00:26:36,180 --> 00:26:42,300 +و بالعكس يعني مباشر يعتبر واضح من النضارة أنها مش + +394 +00:26:42,300 --> 00:26:45,440 +نضارة طبعا، هدا prison، هدا prison واضح جدا و في + +395 +00:26:45,440 --> 00:26:48,360 +ميل من .. من ناحية ال nasal side .. من ناحية ال + +396 +00:26:48,360 --> 00:26:51,940 +nasal side طبعا سؤال زي هذا عليه أكتر من عالم، + +397 +00:26:51,940 --> 00:26:53,180 +عليه أكتر من عالم + +398 +00:26:58,260 --> 00:27:01,840 +Inferior oblique muscle inserts in الانفيريور + +399 +00:27:01,840 --> 00:27:07,460 +أوبليك في الانفيريور بوستيريور تمبرال اكوادرات + +400 +00:27:07,460 --> 00:27:12,140 +انفيريور بوستيريور تمبرال مش نازل اكوادرات لازم + +401 +00:27:12,140 --> 00:27:16,560 +الانسان يكون متأكد جدا من ال function بتاعة اللي + +402 +00:27:16,560 --> 00:27:19,800 +هي ال extraocular muscles و ال testing position و + +403 +00:27:19,800 --> 00:27:22,540 +مكان ال insertion و مكان ال origin + +404 +00:27:28,670 --> 00:27:35,330 +هذه الإجابات وبالتالي انتهى المراجعة على النسختين + +405 +00:27:35,330 --> 00:27:39,370 +ويعطيكم العافية والسلام عليكم ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/GL_2ut21Bds_raw.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/GL_2ut21Bds_raw.srt new file mode 100644 index 0000000000000000000000000000000000000000..57fbb71215e5fc0f74a48304745645c1a6b63566 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/GL_2ut21Bds_raw.srt @@ -0,0 +1,1124 @@ +1 +00:00:01,380 --> 00:00:05,800 +بسم الله الرحمن الرحيم نستكمل محاضرات حوال واحد + +2 +00:00:05,800 --> 00:00:09,980 +ووصلنا لل inferior oblique muscle اللى هى اخر عضلة + +3 +00:00:09,980 --> 00:00:14,240 +فى العضلات الستة ال extraocular muscles ال + +4 +00:00:14,240 --> 00:00:18,100 +inferior oblique حقيقة فى الها بعض الخصائص اللى + +5 +00:00:18,100 --> 00:00:24,570 +بتميزها عن باقي العضلاتoriginates from a small + +6 +00:00:24,570 --> 00:00:28,570 +depression just behind the orbital rim lateral to + +7 +00:00:28,570 --> 00:00:33,050 +the lacrimal sac يعني هي بتبدأ مش من عمق ال orbit + +8 +00:00:33,050 --> 00:00:37,750 +من عمق محجر العين وإنما بتبدأ من الجزء الأمامي من + +9 +00:00:37,750 --> 00:00:42,510 +محجر العين يعني في depression خفيف أو جورة خفيفة + +10 +00:00:42,810 --> 00:00:48,210 +جنب ال lacrimal sac أو lateral لل lacrimal sac + +11 +00:00:48,210 --> 00:00:53,170 +طبعا عند ال orbital rim عند حافة ال orbit يعني عند + +12 +00:00:53,170 --> 00:00:58,950 +الحافة الخارجية لل orbit و بتروح او بتذهب هذه + +13 +00:00:58,950 --> 00:01:03,030 +العضلة للخلف، اذا هي العضلة الوحيدة اللي بتبدأ من + +14 +00:01:03,030 --> 00:01:06,610 +ال anterior orbit مش من ال posterior orbitباقية + +15 +00:01:06,610 --> 00:01:10,330 +العضلات بيبدأوا من ال .. إيش؟ ال posterior orbit، + +16 +00:01:10,330 --> 00:01:14,870 +نشوف المنظر هذا، بنقول هاي عندي ال media rectus، + +17 +00:01:14,870 --> 00:01:17,950 +هاي عندي ال inferior rectus، هاي عندي ال lateral + +18 +00:01:17,950 --> 00:01:21,610 +rectus و هاي عندي ال superior rectus، ممكن الإنسان + +19 +00:01:21,610 --> 00:01:24,230 +يسأل إيش هاي العضلة، هذه العضلة ال elevator + +20 +00:01:24,230 --> 00:01:28,190 +بالbipary superioris، العضلة الرافعة للجفن و هذه + +21 +00:01:28,190 --> 00:01:32,450 +ملاش علاقة في تحريك العين لأنها بتذهب للجفن وإنما + +22 +00:01:32,450 --> 00:01:37,180 +يعني لا ت .. تساهم في تحريك العينأيضًا ال superior + +23 +00:01:37,180 --> 00:01:40,420 +oblique muscle أيضًا بتبدأ من عمق ال orbit الأربعة + +24 +00:01:40,420 --> 00:01:44,660 +دول ال rectus muscles بيبدأوا من ال annulus of zin + +25 +00:01:44,660 --> 00:01:49,820 +في عمق ال orbit و ال superior oblique muscle بتبدأ + +26 +00:01:49,820 --> 00:01:53,760 +above the optic canalبرضه في عمق ال orbit .. في + +27 +00:01:53,760 --> 00:01:57,420 +عمق ال orbit .. اذا كله بيبدأ من الجزء الخلفي + +28 +00:01:57,420 --> 00:02:01,140 +العميق جدا في ال orbit بينما ال inferior oblique + +29 +00:02:01,140 --> 00:02:04,580 +بتبدأ .. هاي ال lacrimal sac هنا .. ال lacrimal + +30 +00:02:04,580 --> 00:02:08,720 +sac هنا هي بتبدأ من جورة جنب ال lacrimal sac جاية + +31 +00:02:08,720 --> 00:02:12,740 +lateral to the lacrimal sac و بتمشي لورا لغاية ما + +32 +00:02:12,740 --> 00:02:19,260 +توصل لنهايتها في ال inferiorالـ inferior posterior + +33 +00:02:19,260 --> 00:02:22,780 +temporal equadrant في ال inferior posterior + +34 +00:02:22,780 --> 00:02:28,620 +temporal equadrant اذا اول خاصية من خصائص ال + +35 +00:02:28,620 --> 00:02:33,420 +inferior oblique muscle انها بتبدأ .. بتبدأ من ال + +36 +00:02:33,420 --> 00:02:37,140 +anterior orbit lateral to the lacrimal saddle + +37 +00:02:37,140 --> 00:02:41,480 +lateral to the lacrimal saddle تمام فبالتالي هذه + +38 +00:02:41,480 --> 00:02:47,320 +القضية بدها تكون واضحةit passes backward and + +39 +00:02:47,320 --> 00:02:50,760 +laterally to insert into the posterior lower + +40 +00:02:50,760 --> 00:02:54,920 +temporal quadrant of the globe close to the macula + +41 +00:02:54,920 --> 00:02:59,580 +يعني هي بتروح للخلف تذهب العضلة للخلف و بتذهب + +42 +00:02:59,580 --> 00:03:03,320 +laterally يعني هي بتبدأ medial و بتذهب lateralتبدأ + +43 +00:03:03,320 --> 00:03:07,440 +medial تذهب lateral و مع ذهبها lateral بتروح لورا + +44 +00:03:07,440 --> 00:03:11,120 +.. بتروح لورا و بيصير لها insertion في ال + +45 +00:03:11,120 --> 00:03:16,080 +posterior lower temporal equadrant هذا الجزء nasal + +46 +00:03:16,080 --> 00:03:20,050 +و هذا الجزء temporalهي بتتثبت في الجزء ال temporal + +47 +00:03:20,050 --> 00:03:24,850 +فوق ولا تحت؟ لأ تحت بتتثبت، اذا temporal lower و + +48 +00:03:24,850 --> 00:03:28,570 +هل هي بتتثبت في الأمام ولا خلف ال equator؟ طبعا + +49 +00:03:28,570 --> 00:03:33,070 +خلف ال equator فبنقول posterior lower temporal + +50 +00:03:33,070 --> 00:03:37,150 +equadrant طبعا الميزة التانية فيها غير انها بتبدأ + +51 +00:03:37,150 --> 00:03:39,730 +من ال anterior orbit هي الوحيدة اللي بتبدأ من ال + +52 +00:03:39,730 --> 00:03:45,200 +anterior orbitإنها مكان تثبيتها قريب جدا من + +53 +00:03:45,200 --> 00:03:48,300 +الماكولا، الماكولا هتكون من جوا وال inferral + +54 +00:03:48,300 --> 00:03:51,040 +oblique من برا، من برا على ال sclera مثبتة ال + +55 +00:03:51,040 --> 00:03:54,600 +inferral oblique وعجبالها من جوا قريبة جدا منها + +56 +00:03:54,600 --> 00:03:59,040 +بتكون الماكولا أو ال fovea يعني بعض الدراسات بتقول + +57 +00:03:59,040 --> 00:04:03,210 +أن ال fovea بعيدة عنال inferior oblique عن مكان ال + +58 +00:04:03,210 --> 00:04:05,630 +insertion أو التثبيت بتاع ال inferior oblique + +59 +00:04:05,630 --> 00:04:09,710 +بمقدار تقريبا اتنين مليام هذا الكلام له فايدة + +60 +00:04:09,710 --> 00:04:13,350 +عملية شديدة الأهمية ان اللي بدي يشتغل جراحة على ال + +61 +00:04:13,350 --> 00:04:18,490 +inferior oblique بده يكون جراح delicate يعني عنده + +62 +00:04:18,490 --> 00:04:26,780 +يعنييعني مهارة عالية و عنده يعني حس مرهف في العمل + +63 +00:04:26,780 --> 00:04:31,080 +الجراحي عشان مايأذيش ال macula أثناء العمل على ال + +64 +00:04:31,080 --> 00:04:34,540 +inferior oblique muscle على ال inferior oblique + +65 +00:04:34,540 --> 00:04:41,040 +muscle فبالتالي هدول الخاصيتين يعني هم يعني خصت في + +66 +00:04:41,040 --> 00:04:44,880 +ال .. ال inferior oblique muscleالان نيجي لل + +67 +00:04:44,880 --> 00:04:48,920 +actions بتاعة ال .. ال .. ال .. ال inferior + +68 +00:04:48,920 --> 00:04:52,640 +oblique ال primary action is extortion ال + +69 +00:04:52,640 --> 00:04:56,620 +secondary actions are elevation and abduction بدنا + +70 +00:04:56,620 --> 00:05:01,000 +نفهم كيف ال extortion، كيف ال elevation و كيف ال + +71 +00:05:01,000 --> 00:05:04,960 +abduction و كيف ال abduction بننتقل للرسومات + +72 +00:05:04,960 --> 00:05:10,850 +التوضيحية اللي بتساعدني في هذا المجالزي ما احنا + +73 +00:05:10,850 --> 00:05:15,170 +عارفين كل العضلات بتبدأ من العمق بتاع ال orbit من + +74 +00:05:15,170 --> 00:05:20,450 +ال .. ال .. ال deep orbit من ال posterior orbit + +75 +00:05:20,450 --> 00:05:23,210 +معادة ال inferior oblique muscle زي ما احنا شايفين + +76 +00:05:23,210 --> 00:05:28,030 +بتبدأ من ال anterior part of the orbit و بتتسبت في + +77 +00:05:28,030 --> 00:05:33,430 +ال posterior .. في ال posterior temporal lower + +78 +00:05:33,430 --> 00:05:37,470 +quadrant طبعا هنا الرسمة مش كتير موفقة ولكن رسمة + +79 +00:05:37,470 --> 00:05:42,600 +توضيحيةهي هنا عندنا ال four rectus muscles ال + +80 +00:05:42,600 --> 00:05:45,800 +lateral rectus ال superior rectus اللي تحتها ال + +81 +00:05:45,800 --> 00:05:49,680 +inferior rectus ال medial rectus كلها طبعا خيالات + +82 +00:05:49,680 --> 00:05:52,760 +و هنا ال superior oblique كلها .. كل هذه العضلات + +83 +00:05:52,760 --> 00:05:55,820 +بتبدأ من ال posterior orbit مع ده ال inferior + +84 +00:05:55,820 --> 00:05:59,320 +oblique اللي أنا بأشر عليها بتبدأ من ال anterior + +85 +00:05:59,320 --> 00:06:03,630 +orbit عند ال orbital rim عند حافة ال orbitLateral + +86 +00:06:03,630 --> 00:06:07,330 +to lacrimal sac يعني موقع ال lacrimal sac هنا طبعا + +87 +00:06:07,330 --> 00:06:10,630 +و هي من الأرضية تاعت ال orbit من ال floor من ال + +88 +00:06:10,630 --> 00:06:13,530 +orbit ال floor بتبدأ ال inferior oblique muscle و + +89 +00:06:13,530 --> 00:06:18,630 +بتروح temporal و لورق يعني temporal and backward + +90 +00:06:18,630 --> 00:06:23,540 +لغاية ما تتثبتأسفل العين بالظبط ع جبال تقريبا ال + +91 +00:06:23,540 --> 00:06:27,160 +superior oblique insertion بس من الأسفل .. من + +92 +00:06:27,160 --> 00:06:31,840 +الأسفل .. اذا هذا يعني توضيح بالنسبة لمنشأ ومنتهى + +93 +00:06:31,840 --> 00:06:35,220 +ال inferior oblique muscle طبعا ال inferior + +94 +00:06:35,220 --> 00:06:39,040 +oblique muscle بتعمل + +95 +00:06:40,530 --> 00:06:42,670 +هذه ال superior oblique الآن نجي لل inferior + +96 +00:06:42,670 --> 00:06:45,350 +oblique ال inferior oblique muscle بتعمل مع ال + +97 +00:06:45,350 --> 00:06:50,650 +axis of the eye 51 degree يعني هاي ال axis بتاع ال + +98 +00:06:50,650 --> 00:06:54,190 +inferior oblique نحاول نوضحه + +99 +00:07:11,310 --> 00:07:16,710 +هي ال axis بتاع ال inferior oblique muscle اللي هو + +100 +00:07:16,710 --> 00:07:21,910 +مرسوم خليني أكبره شوية عشان يوضحهذا السهم + +101 +00:07:21,910 --> 00:07:25,430 +البرتقالي هذا السهم البرتقالي هو ال axis بتاع + +102 +00:07:25,430 --> 00:07:30,510 +العضلة وهي ال axis بتاع العين في بينهم زاوية واحد + +103 +00:07:30,510 --> 00:07:34,030 +وخمسين degree طبعا العضلة جاية من الأسفل جاية من + +104 +00:07:34,030 --> 00:07:38,670 +الأسفل طبعا زي ما انها العضلة او المحور بتاع + +105 +00:07:38,670 --> 00:07:41,750 +العضلة بيعمل واحد وخمسين degree مع ال visual axis + +106 +00:07:41,750 --> 00:07:46,210 +ساعتها هو هيعمل تسعة و تلاتين degree مع ال axis + +107 +00:07:46,210 --> 00:07:50,800 +العمودي على العينإذا لما بنحلل القوة لو فرضنا أنه + +108 +00:07:50,800 --> 00:07:53,840 +ال inferior oblique muscle بتشد بقوة 100 نيوتن + +109 +00:07:53,840 --> 00:07:58,260 +وحللنا ال 100 نيوتن للإحداثيات اللي اتفقنا عليها + +110 +00:07:58,260 --> 00:08:02,660 +الإحداثيين أول شيء هيكونوا متعامدين واحد متفق مع + +111 +00:08:02,660 --> 00:08:06,280 +ال visual axis والتاني عمودي على ال visual axis بس + +112 +00:08:06,280 --> 00:08:09,480 +هدول الإحداثيين هيكونوا من أسفل العين جايين لسبب + +113 +00:08:09,480 --> 00:08:14,090 +أن العضلة جاية أسفل العينالعضلة جاية أسفل العين + +114 +00:08:14,090 --> 00:08:18,510 +طيب الآن القوة اللي هتاخد نصيب الأسد هي المحور + +115 +00:08:18,510 --> 00:08:22,270 +الأقرب لمحور ال inferior oblique يعني المحور + +116 +00:08:22,270 --> 00:08:26,810 +العمودي هو اللي هياخد نصيب الأسد اذا هذه القوة او + +117 +00:08:26,810 --> 00:08:31,690 +هذه القوة احدى القواتين المكافئتين هتاخد نصيب + +118 +00:08:31,690 --> 00:08:36,170 +الأسدهتشد العين بشكل عمودي، العين هو جسم شبه + +119 +00:08:36,170 --> 00:08:41,590 +كراوي، هتنشد من الأسفل .. من الأسفل فهيكون الحركة + +120 +00:08:41,590 --> 00:08:47,290 +دورانية .. دورانية بشكل البرغي، ساعتها هي هتشد + +121 +00:08:47,290 --> 00:08:50,750 +الساعة ستة من ال limbus لجوا، معناته الساعة اتناشر + +122 +00:08:50,750 --> 00:08:54,250 +من ال limbus هتطلع لبرا وهذا يسمى extortion، اذا + +123 +00:08:54,250 --> 00:08:59,450 +ال primary action .. ال primary actionال inferral + +124 +00:08:59,450 --> 00:09:02,730 +oblique extortion ليش extortion لأن ال inferral + +125 +00:09:02,730 --> 00:09:05,990 +oblique جاية من أسفل هذه النقطة النقطة التانية هي + +126 +00:09:05,990 --> 00:09:10,290 +أقرب للمحور العمودي على العين فلو تخيلنا أنه في + +127 +00:09:10,290 --> 00:09:14,690 +قوة بتشد بشكل عمودي من أسفل العين فساعتها الساعة + +128 +00:09:14,690 --> 00:09:18,410 +ستة في ال limbus اللي مش مبينة لنا في الرسم هتنشد + +129 +00:09:18,410 --> 00:09:22,330 +نيزلي نيزلي بهذا الاتجاه حسب اتجاه المحور هذا + +130 +00:09:22,530 --> 00:09:26,350 +فبالتالي طالما الساعة 6 انشدت بالاتجاه النازل + +131 +00:09:26,350 --> 00:09:29,630 +الساعة 12 هتروح بالاتجاه ال temporal وهذا يسمى + +132 +00:09:29,630 --> 00:09:33,810 +extortion إذا ال primary action بتاع ال inferior + +133 +00:09:33,810 --> 00:09:37,210 +oblique muscle هو extortion ال secondary action + +134 +00:09:37,210 --> 00:09:40,770 +بنفهمه لما نفهم القوة التانية من القوتين + +135 +00:09:40,770 --> 00:09:44,410 +المكافئتين لل inferior oblique muscle القوة + +136 +00:09:44,410 --> 00:09:47,730 +التانية متطافقة مع ال visual axis وجاية من الأسفل + +137 +00:09:48,180 --> 00:09:51,360 +جاية من الأسفل إذا لما تشتب هذا الاتجاه من هذه + +138 +00:09:51,360 --> 00:09:55,320 +النقطة لخلف ال equator هتعمل depression بس + +139 +00:09:55,320 --> 00:09:58,740 +depression لأي جزء من العين للجزء الخلفي من العين + +140 +00:09:58,740 --> 00:10:02,980 +فلما بيصير depression للجزء الخلفي من العين ساعتها + +141 +00:10:02,980 --> 00:10:07,220 +الجزء الأمامي بيرتفع للأعلى لما أنا بنزل الجزء + +142 +00:10:07,220 --> 00:10:11,240 +الخلفي من الكرة الجزء الأمامي من الكرة بيطلع لفوق + +143 +00:10:11,240 --> 00:10:15,370 +إذا ال secondary action هو إيش؟elevation إذا عندي + +144 +00:10:15,370 --> 00:10:18,730 +extortion و elevation و بال simulation ان شاء الله + +145 +00:10:18,730 --> 00:10:24,750 +تعالى بيتضح هذا الكلام بشكل أفضل بكتير من الشرح + +146 +00:10:24,750 --> 00:10:29,530 +النظري بس الشرح النظري هيعطينا فكرة ولو يعني بنسبة + +147 +00:10:29,530 --> 00:10:34,290 +معين .. ولو بنسبة معينةالان ال tertiary action كيف + +148 +00:10:34,290 --> 00:10:38,150 +نفهم و كيف صار انه ال origin بتاع ال inferior + +149 +00:10:38,150 --> 00:10:41,630 +oblique مثبت في العضم ال insertion بتاع ال + +150 +00:10:41,630 --> 00:10:44,910 +inferior oblique مثبت في كرة العين لما بتصير + +151 +00:10:44,910 --> 00:10:50,010 +contraction للعضلة بتقصر ف ال insertion باتجاه ال + +152 +00:10:50,010 --> 00:10:53,530 +origin بنشد ال insertion باتجاه ال origin يعني ال + +153 +00:10:53,530 --> 00:10:56,770 +back of the eye ال back of the eye هيروح medially + +154 +00:10:56,770 --> 00:11:00,770 +فال anterior part هيروح temporally او في وضع ال + +155 +00:11:00,770 --> 00:11:05,010 +abduction اذاالـ tertiary action هو abduction بسبب + +156 +00:11:05,010 --> 00:11:08,990 +قصر العضلة أثناء انقباضها لما بتقصر بتشد الجزء + +157 +00:11:08,990 --> 00:11:12,710 +الخلفي من العين ناحيتها .. ناحيت مبدأها الجزء + +158 +00:11:12,710 --> 00:11:16,350 +الخلفي من العين جاي temporal و الجزء أو عفوا ال + +159 +00:11:16,350 --> 00:11:19,170 +insertion بتاعها جاي temporal و ال origin جاي + +160 +00:11:19,170 --> 00:11:22,910 +medial فبنشد ال insertion medialطب ال insertion في + +161 +00:11:22,910 --> 00:11:25,470 +ال back of the eye إذا ال back of the eye بنشد + +162 +00:11:25,470 --> 00:11:28,270 +medial و ال anterior part of the eye بيروح + +163 +00:11:28,270 --> 00:11:31,690 +temporal بمعنى abduction إذا ال inferior oblique + +164 +00:11:31,690 --> 00:11:36,630 +muscle بتعمل extortion و elevation و abduction و + +165 +00:11:36,630 --> 00:11:40,520 +abductionفبالتالي هذه القضية بدأت تكون عندى واضحة + +166 +00:11:40,520 --> 00:11:46,200 +إذا extortion لأنه لما بنحلل قوة ال inferior + +167 +00:11:46,200 --> 00:11:50,280 +oblique اللى جاية كعضلة من الأسفل و عاملة 51 + +168 +00:11:50,280 --> 00:11:55,040 +degree مع المحور تعي العين لما بنحللها لقوة على + +169 +00:11:55,040 --> 00:12:00,240 +الإحداثيات المتفق عليها لأنها طبعا مش متفقة هي مع + +170 +00:12:00,240 --> 00:12:03,480 +محور العين فطالما في بينها و بين محور العين زاوية + +171 +00:12:03,480 --> 00:12:07,080 +إذا هي إلها أكثر من actionعشان نفهم ال actions + +172 +00:12:07,080 --> 00:12:11,280 +بتاعتها، وهذا كلام يعني احنا بنكرره للإفادة، بنقول + +173 +00:12:11,280 --> 00:12:16,180 +بنحلل القوة تاعت العضلة لقوتين متعامدات، واحدة + +174 +00:12:16,180 --> 00:12:20,520 +منهم متفقة مع ال axis of the eye والتانية متعامدة + +175 +00:12:20,520 --> 00:12:23,500 +على ال axis of the eyeطبعا هنشيل ال inferior + +176 +00:12:23,500 --> 00:12:27,080 +oblique و نتخيل أنه في عضلتين جايين من أسفل ضروري + +177 +00:12:27,080 --> 00:12:30,280 +جدا نقول أنهم جايين من أسفل لأنه هي العضلة جاية من + +178 +00:12:30,280 --> 00:12:34,500 +أسفل يعني كل المنظر هيكون من أسفل رغم أنه إحنا في + +179 +00:12:34,500 --> 00:12:37,180 +المنظر هذا قاعدين بنبص على العين أو بنبطلع على + +180 +00:12:37,180 --> 00:12:42,690 +العين من أعلى شيلنا العضلة هايأو شيلنا القوة high + +181 +00:12:42,690 --> 00:12:46,650 +و حطينا بدلها قوتين من أسفل واحدة متعامدة على ال + +182 +00:12:46,650 --> 00:12:50,250 +axis of the I و واحدة منطبقة على ال axis of the I + +183 +00:12:50,250 --> 00:12:54,690 +يترى مين من القوتين بيكون أكبر و ليش؟ بنقول القوة + +184 +00:12:54,690 --> 00:12:59,010 +المتعامدة القوة المتعامدة هي الأكبر ليش؟ لأن محور + +185 +00:12:59,010 --> 00:13:02,070 +ال inferior oblique أقرب إلها ففي تحليل القوة + +186 +00:13:02,070 --> 00:13:05,930 +هتنال نصيب الأسد أو هتنال نصيب أكبر من القوة + +187 +00:13:05,930 --> 00:13:09,440 +التانيةطالما هي القوة الأقوى أو هي القوة الأكبر + +188 +00:13:09,440 --> 00:13:14,540 +إذا ال primary action هو مرتبط فيها لما عضلة بتشد + +189 +00:13:14,540 --> 00:13:18,400 +بهذا الاتجاه من أسفل العين الساعة ستة من ال limbus + +190 +00:13:18,400 --> 00:13:21,940 +هتتحرك باتجاه ال nose .. باتجاه الشد والساعة اتناش + +191 +00:13:21,940 --> 00:13:26,840 +بعيدا عن ال nose يعني حركة البرغي هتكون بشكل + +192 +00:13:26,840 --> 00:13:32,260 +extortion .. بشكل extortionوبالتالي ال primary + +193 +00:13:32,260 --> 00:13:37,140 +action extortion العضلة التانية اللي هي من + +194 +00:13:37,140 --> 00:13:40,420 +العضلتين المكافئات لل inferior oblique أيضا جاية + +195 +00:13:40,420 --> 00:13:46,960 +من أسفل ومكان التثبيت تاعها خلف ال equator إذا هي + +196 +00:13:46,960 --> 00:13:50,100 +هتعمل depression لانها جاية من أسفل بس هتعمل + +197 +00:13:50,100 --> 00:13:53,700 +depression لل back of the eye لل back of the eye + +198 +00:13:53,700 --> 00:13:56,980 +فبالتالي هذا الجزء لما يصير له depression الجزء + +199 +00:13:56,980 --> 00:13:59,980 +الأمامي من العين بيرتفع اللي احنا قلنا العبرة + +200 +00:14:00,410 --> 00:14:04,170 +بالجزء الأمامي اذا ال secondary action عبارة عن + +201 +00:14:04,170 --> 00:14:08,830 +elevation ال tertiary action ناشئ عن انقباض العضلة + +202 +00:14:08,830 --> 00:14:13,950 +و قصارها فلما بتقصر بينشد ال insertion باتجاه ال + +203 +00:14:13,950 --> 00:14:18,230 +origin طيب ال insertion باتجاه ال origin معناته ال + +204 +00:14:18,230 --> 00:14:22,970 +insertion بيروح باتجاه ال nasal باتجاه ال + +205 +00:14:22,970 --> 00:14:26,290 +adduction فال anterior part of the eye بيسيرله + +206 +00:14:26,500 --> 00:14:29,340 +abduction وهذا ال reaction الترشيهية بتاع + +207 +00:14:29,340 --> 00:14:33,640 +الانفريوريوبليك مسل الان لو احنا طلعنا من العرض + +208 +00:14:33,640 --> 00:14:37,880 +عشان نشوف امتى احنا او كيف احنا هنختبر ال inferior + +209 +00:14:37,880 --> 00:14:43,660 +oblique muscle يعني كيف احنا هيتم اختبارها بنقول + +210 +00:14:43,660 --> 00:14:49,340 +كالقاتى يا ترى عشان اختبر ال inferior oblique + +211 +00:14:49,340 --> 00:14:54,970 +muscleهختبر ال extortion ولا ال elevation ولا ال + +212 +00:14:54,970 --> 00:14:58,330 +abduction ال extortion اللي هو ال primary action + +213 +00:14:58,330 --> 00:15:01,230 +لل inferior oblique مش هقدر اختبره لأنه لا يرى + +214 +00:15:01,230 --> 00:15:07,230 +بالعين المجردة ال abduction .. ال abduction ماقدرش + +215 +00:15:07,230 --> 00:15:10,370 +اختبره لسبب انه في عندي abductor اللي هو ال + +216 +00:15:10,370 --> 00:15:13,650 +lateral rectus muscleالـ lateral rectus muscle هي + +217 +00:15:13,650 --> 00:15:19,990 +abductor فبالتالي مش هقدر أحيدها و أصفر شغلها إذا + +218 +00:15:19,990 --> 00:15:22,490 +مابضلش عندي من ال functions بتاعة ال inferior + +219 +00:15:22,490 --> 00:15:26,790 +oblique إلا أني أختبر ال elevation .. ال elevation + +220 +00:15:26,790 --> 00:15:30,550 +طيب أنا لما بختبر ال elevation .. لما بختبر ال + +221 +00:15:30,550 --> 00:15:36,050 +elevationمفروض انه اختبر ال elevation و ألغي ال + +222 +00:15:36,050 --> 00:15:40,150 +other elevator .. ألغي ال other elevator فبالتالي + +223 +00:15:40,150 --> 00:15:44,870 +هذه القضية يعني ضرورى تكون بالنسبة لنا واضحة جدا + +224 +00:15:44,870 --> 00:15:50,430 +فبنقول احنا كالقادة .. لما انا بتطلع الرسمة رقم + +225 +00:15:50,430 --> 00:15:55,330 +اتنينوالرسمة رقم تمانية و الرسمة رقم تمانية في + +226 +00:15:55,330 --> 00:15:58,310 +الرسمة رقم اتنين مرسومة ال superior rectus muscle + +227 +00:15:58,310 --> 00:16:02,050 +وفي الرسمة رقم تمانية مرسومة ال inferior oblique + +228 +00:16:02,050 --> 00:16:06,350 +muscle جاية من الأسفل هدول الاتنين هم ال elevator + +229 +00:16:06,350 --> 00:16:10,670 +تعيين العين لما العين بتروح في وضع ال adduction ال + +230 +00:16:10,670 --> 00:16:16,250 +adduction محورها ومحور ال inferior oblique بيتفقوا + +231 +00:16:16,250 --> 00:16:19,520 +تماما و بتصير ال inferior obliqueفي وضع ال + +232 +00:16:19,520 --> 00:16:22,940 +adduction الوضع هذا اللي احنا شايفينه بتصير ال + +233 +00:16:22,940 --> 00:16:26,940 +inferior oblique للأسف مش مرسومة هنا ولكن في وضع + +234 +00:16:26,940 --> 00:16:30,080 +ال adduction بتصير ال inferior oblique pure + +235 +00:16:30,080 --> 00:16:34,460 +elevator فقط elevator بتعمل elevation للعين بسبب + +236 +00:16:34,460 --> 00:16:38,040 +انها بتعمل depression لل back of the eye وساعتها + +237 +00:16:38,040 --> 00:16:41,580 +ال anterior part بيصير له elevation اذا في وضع ال + +238 +00:16:41,580 --> 00:16:44,740 +adduction لما العين بتخش لجواساعتها ال inferior + +239 +00:16:44,740 --> 00:16:48,420 +oblique ممكن تشتغل لحالها ك elevator ليش لحالها؟ + +240 +00:16:48,420 --> 00:16:51,460 +ليش ما ال superior rectus muscle تشتغل معاها ك + +241 +00:16:51,460 --> 00:16:55,900 +elevator؟ بنقول في وضع ال adduction وضع بيتعامد في + +242 +00:16:55,900 --> 00:16:59,740 +ال superior rectus muscle مع ال axis of the eye + +243 +00:16:59,740 --> 00:17:03,180 +وساعتها ال superior rectus بتكون فقط in order فقط + +244 +00:17:03,180 --> 00:17:07,500 +in order بعكس هذا الوضع في ال abduction في ال + +245 +00:17:07,500 --> 00:17:11,930 +abduction بتكون ال superior rectus elevatorو ال + +246 +00:17:11,930 --> 00:17:15,430 +inferior oblique extorter و ال inferior oblique + +247 +00:17:15,430 --> 00:17:19,790 +extorter حنعمل أو حنحاول نعمل simulation توضح + +248 +00:17:19,790 --> 00:17:23,590 +أزواج من العضلات اللي بتتشارك في قضية ال elevation + +249 +00:17:23,590 --> 00:17:26,830 +أو تتشارك في قضية ال depression زي ال superior + +250 +00:17:26,830 --> 00:17:29,150 +oblique و ال inferior rectus بتشاركوا في ال + +251 +00:17:29,150 --> 00:17:32,370 +depression و زي ال superior rectus .. superior + +252 +00:17:32,370 --> 00:17:34,610 +rectus و ال inferior oblique بتشاركوا في ال + +253 +00:17:34,610 --> 00:17:39,800 +elevationو هنشوف في أي من الأوضاع أنسب لكل عضلة من + +254 +00:17:39,800 --> 00:17:43,600 +العضلات وهذا بال simulation هيكون أوضح ان شاء الله + +255 +00:17:43,600 --> 00:17:47,280 +تعالى اذا انا باختبر ال inferior oblique في وضع ال + +256 +00:17:47,280 --> 00:17:52,020 +in and up position in and up position هذا الوضع + +257 +00:17:52,020 --> 00:18:01,230 +اللي مناسبلهذه العضلة بنلخص الكلام يعني بشكل يعني + +258 +00:18:01,230 --> 00:18:06,130 +واضح بنقول كالقاعدى ان ال superior rectus muscle + +259 +00:18:08,820 --> 00:18:12,040 +أفضل شيء أني أختبرها في وضع ال abduction لأنه + +260 +00:18:12,040 --> 00:18:16,080 +المحور تاعه .. محور العين بتتفق بينما ال inferior + +261 +00:18:16,080 --> 00:18:18,700 +oblique و اللي هي مش مرسومة عندي .. أنا هنا مرسوم + +262 +00:18:18,700 --> 00:18:21,140 +عندي ال superior oblique بس ال inferior oblique + +263 +00:18:21,140 --> 00:18:24,400 +محورها .. يعني زي محور ال superior oblique بس جاية + +264 +00:18:24,400 --> 00:18:27,880 +من التحت ساعتها في ال adduction .. في ال adduction + +265 +00:18:27,880 --> 00:18:32,260 +بتتفق محور ال inferior obliqueمع محور العين .. مع + +266 +00:18:32,260 --> 00:18:36,120 +محور العين فبالتالي هذه القضية بدها تكون واضحة .. + +267 +00:18:36,120 --> 00:18:39,900 +اذا انا باختبر .. انا باختبر ال superior rectus + +268 +00:18:39,900 --> 00:18:44,380 +muscle في ال out and up هي out and up position + +269 +00:18:44,380 --> 00:18:49,660 +superior rectus muscle لما بقولin and up inferior + +270 +00:18:49,660 --> 00:18:53,820 +oblique muscle inferior oblique muscle فهذه القضية + +271 +00:18:53,820 --> 00:18:57,120 +بدها تكون عندنا يعني ان شاء الله واضحة و هتبين ان + +272 +00:18:57,120 --> 00:19:02,020 +شاء الله تعالى مع ال simulation بإذن الله تعالى + +273 +00:19:02,020 --> 00:19:05,580 +when the globe is abducted واحد وخمسين degree the + +274 +00:19:05,580 --> 00:19:09,390 +inferior oblique acts only as an elevatorفي ال + +275 +00:19:09,390 --> 00:19:12,450 +abduction ال inferior oblique بتشتغل فقط ك + +276 +00:19:12,450 --> 00:19:17,030 +elevator لأن محورها بيتفق مع محور العين when the + +277 +00:19:17,030 --> 00:19:20,770 +eye is abducted تسعة و تلاتين degree its main + +278 +00:19:20,770 --> 00:19:25,530 +action is extortion لأنها جاية من تحت و متعامدة في + +279 +00:19:25,530 --> 00:19:30,530 +وضع ال abduction على ال axis تع العين هنتوقف عند + +280 +00:19:30,530 --> 00:19:34,170 +ال muscle pulis كموضوع جديد و يعطيكم العافية + +281 +00:19:34,170 --> 00:19:37,050 +والسلام عليكم ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/HjOQmj-dMSA_raw.json b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/HjOQmj-dMSA_raw.json new file mode 100644 index 0000000000000000000000000000000000000000..bb1b6af8a2c178311965d094c340d10d706bd566 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/HjOQmj-dMSA_raw.json @@ -0,0 +1 @@ +{"segments": [{"id": 1, "seek": 736, "start": 2.14, "end": 7.36, "text": "بسم الله الرحمن الرحيم اليوم عاملين simulation مبسط عشان يفهمنا", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 45595, 20498, 6225, 10943, 1211, 9957, 16575, 3714, 3555, 3794, 9566, 6225, 8592, 7649, 7251, 5172, 16095, 8315], "avg_logprob": -0.05116489835615669, "compression_ratio": 1.2588235294117647, "no_speech_prob": 3.814697265625e-06, "words": [{"start": 2.14, "end": 2.42, "word": "بسم", "probability": 0.912841796875}, {"start": 2.42, "end": 2.58, "word": " الله", "probability": 0.9638671875}, {"start": 2.58, "end": 2.96, "word": " الرحمن", "probability": 0.98291015625}, {"start": 2.96, "end": 3.54, "word": " الرحيم", "probability": 0.9939778645833334}, {"start": 3.54, "end": 4.92, "word": " اليوم", 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كراوي أو شبه كراوي أو بيضاوي أو استواني بيكون الفعل دوران، دوران البرغي، بالظبط كأنه برغي قاعد بيدور", "tokens": [4587, 2407, 3660, 6225, 2304, 23328, 10632, 15844, 10874, 38251, 9122, 23557, 45865, 34051, 13412, 3555, 3224, 9122, 23557, 45865, 34051, 4724, 1829, 11242, 995, 45865, 34051, 44713, 2407, 7649, 1829, 4724, 1829, 30544, 27188, 30241, 11778, 13063, 7649, 12399, 11778, 13063, 7649, 2423, 26890, 17082, 1829, 12399, 20666, 19913, 3555, 9566, 9122, 33456, 3224, 4724, 2288, 17082, 1829, 12174, 995, 22488, 4724, 25708, 13063], "avg_logprob": -0.13281249300096976, "compression_ratio": 1.682170542635659, "no_speech_prob": 1.7881393432617188e-07, "words": [{"start": 136.48, "end": 136.94, "word": "قوة", "probability": 0.7763671875}, {"start": 136.94, "end": 137.54, "word": " عمودية", "probability": 0.888916015625}, {"start": 137.54, "end": 138.18, "word": " على", "probability": 0.8486328125}, {"start": 138.18, "end": 139.0, "word": " جسم", "probability": 0.986083984375}, {"start": 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"end": 144.24, "word": " البرغي،", "probability": 0.806103515625}, {"start": 144.24, "end": 144.54, "word": " بالظبط", "probability": 0.9798583984375}, {"start": 144.54, "end": 144.94, "word": " كأنه", "probability": 0.9085286458333334}, {"start": 144.94, "end": 145.28, "word": " برغي", "probability": 0.9658203125}, {"start": 145.28, "end": 145.66, "word": " قاعد", "probability": 0.9220377604166666}, {"start": 145.66, "end": 146.28, "word": " بيدور", "probability": 0.9775390625}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 149.8151875, "duration_after_vad": 144.08312499999994} \ No newline at end of file diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/HnKcNdu6YbE_raw.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/HnKcNdu6YbE_raw.srt new file mode 100644 index 0000000000000000000000000000000000000000..578d768f8fe2ba528732a061aedcf2e33390b07a --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/HnKcNdu6YbE_raw.srt @@ -0,0 +1,1116 @@ +1 +00:00:01,640 --> 00:00:08,240 +بسم الله الرحمن الرحيم نستكمل مع ال inferior + +2 +00:00:08,240 --> 00:00:12,080 +rectus muscle المرة الماضية شرحنا superior rectus + +3 +00:00:12,080 --> 00:00:15,680 +muscle و حكينا أنه ال actions بتاعتهاإبارة عن + +4 +00:00:15,680 --> 00:00:21,640 +elevation وinversion وadduction وإنها بتعمل زاوية + +5 +00:00:21,640 --> 00:00:24,540 +لما تكون العين في ال primary position بتعمل زاوية + +6 +00:00:24,540 --> 00:00:28,100 +تلاتة وعشرين degree مع ال visual axis أو ال axis + +7 +00:00:28,100 --> 00:00:31,420 +of the eye وإنه عشان نختبر ال superior rectus + +8 +00:00:31,420 --> 00:00:35,300 +muscle لازم العين تكون في وضع ال adduction في وضع + +9 +00:00:35,300 --> 00:00:41,000 +عفوا ال abduction في وضع ال abductionبنقول العين + +10 +00:00:41,000 --> 00:00:44,020 +في وضع ال abduction لما العين بروح في وضع ال + +11 +00:00:44,020 --> 00:00:49,100 +abduction زي الرسمة هي ما بتوضح ساعتها ال superior + +12 +00:00:49,100 --> 00:00:53,280 +rectus muscle بيتفق محورها مع محور العين مع ال + +13 +00:00:53,280 --> 00:00:58,100 +visual axis و بتصير pure elevator يعني بيضل action + +14 +00:00:58,100 --> 00:01:04,120 +واحد لها يعني نقي ل .. ل .. لأفعال غيره اللي هو ال + +15 +00:01:04,120 --> 00:01:07,020 +action بتاع ال elevation في هذه الوضع وضع ال + +16 +00:01:07,020 --> 00:01:10,320 +abductionبتكون ال other elevator اللي هي جاية من + +17 +00:01:10,320 --> 00:01:13,180 +أسفل العين اللي هي ال inferior oblique متعامدة و + +18 +00:01:13,180 --> 00:01:17,560 +لن تستطيع أن تساهم في رفع العين، اذا انا باختبر ال + +19 +00:01:17,560 --> 00:01:21,340 +superior rectus muscle في ال up and out position + +20 +00:01:21,340 --> 00:01:25,880 +out out يعني العين طلعت abduction عشان نخلي محور + +21 +00:01:25,880 --> 00:01:30,660 +العضلة متفق مع محورالعين وفي نفس الوقت نخلي ال + +22 +00:01:30,660 --> 00:01:35,220 +inferior oblique متعامدة أي لا تستطيع أن تساهم في + +23 +00:01:35,220 --> 00:01:38,760 +ال elevation إذا ال superior rectus تختبر في ال + +24 +00:01:38,760 --> 00:01:43,100 +out and up position out عشان يتفق محورها وبعدين هى + +25 +00:01:43,100 --> 00:01:47,500 +بترفع العين لل up position out and up ماذا يحدث لو + +26 +00:01:47,500 --> 00:01:50,540 +أن ال superior rectus muscle أو العين صارت في وضع + +27 +00:01:50,540 --> 00:01:51,540 +ال adduction + +28 +00:01:54,110 --> 00:01:56,970 +في وضع ال adoption بيصير ال axis بتاع ال superior + +29 +00:01:56,970 --> 00:02:00,950 +rectus muscle متعامد على ال axis بتاع العين و + +30 +00:02:00,950 --> 00:02:03,790 +ساعتها ال superior rectus muscle بتكون فقط + +31 +00:02:03,790 --> 00:02:08,110 +entorter .. entorter بنقول احنا اي جسم بيضاوي او + +32 +00:02:08,110 --> 00:02:14,790 +كروي او استواني لو اجته قوة متعامدة بيكون الفعل + +33 +00:02:14,790 --> 00:02:19,430 +بتاعه فعل البرغي او اللي هو الفعل الدوراني اللي هو + +34 +00:02:19,430 --> 00:02:23,030 +ال entortionأو ال extortion, extortion إذا كان + +35 +00:02:23,030 --> 00:02:27,190 +الساعة 12 اتحركت باتجاه ال nose أو extortion إذا + +36 +00:02:27,190 --> 00:02:31,890 +الساعة 12 من الليمباص اتحركت بعيدا عن ال nose هذا + +37 +00:02:31,890 --> 00:02:36,520 +استكمالا لموضوع superior rectus muscleالان بدنا + +38 +00:02:36,520 --> 00:02:39,580 +نحكي عن ال inferior rectus muscle ال inferior + +39 +00:02:39,580 --> 00:02:43,240 +rectus muscle originates at the lower part of the + +40 +00:02:43,240 --> 00:02:46,680 +annulus of zin at the lower part of the annulus of + +41 +00:02:46,680 --> 00:02:52,780 +zin and inserts 6.5 mm behind the inferior limbus + +42 +00:02:52,780 --> 00:02:56,620 +behind the inferior limbus نحاول نشوف صورة توضح + +43 +00:02:56,620 --> 00:02:57,500 +هذه القضية + +44 +00:03:01,050 --> 00:03:05,110 +هي ال annulus of zin، هى annulus of zin، قلنا من + +45 +00:03:05,110 --> 00:03:08,230 +ال media part بتاعه بتنشأ ال media rectus، من ال + +46 +00:03:08,230 --> 00:03:11,650 +lateral part بتاعه بتنشأ ال lateral rectus، من ال + +47 +00:03:11,650 --> 00:03:15,270 +superior part بتنشأ ال superior rectus، ومن ال + +48 +00:03:15,270 --> 00:03:19,070 +inferior part of annulus of zinبتيجي ال inferior + +49 +00:03:19,070 --> 00:03:24,010 +rectus muscle بتضلها ماشية لغاية ما تتثبت أو يصير + +50 +00:03:24,010 --> 00:03:28,470 +لها insertion بعيدا عن ال inferior limbus بمقدار 6 + +51 +00:03:28,470 --> 00:03:33,170 +.5 ميلي متر وقولنا هذه الأرقام مهمة للي بيجروا + +52 +00:03:33,170 --> 00:03:38,470 +جراحة الحوال اللي بيجروا جراحة الحوال وبالتالي كل + +53 +00:03:38,470 --> 00:03:41,150 +ال four rectus muscles ال four rectus muscles + +54 +00:03:41,150 --> 00:03:44,980 +بتنشأ من الannulusof zinc اللي هو عبارة عن نسيج + +55 +00:03:44,980 --> 00:03:50,860 +ليفي قوي جداً adherent ملتسق بالعظم عند قمة ال + +56 +00:03:50,860 --> 00:03:54,860 +orbit يعني في أعمق منطقة من ال orbit حوالين ال + +57 +00:03:54,860 --> 00:03:59,160 +optic nerve حوالين ال optic nerve وبالتالي من ال + +58 +00:03:59,160 --> 00:04:02,560 +inferior part of annulus of zinc تنشأ ال inferior + +59 +00:04:02,560 --> 00:04:07,300 +rectus muscleoriginates at the lower part of the + +60 +00:04:07,300 --> 00:04:12,080 +annulus of zinc and inserts 6.5 mm behind the + +61 +00:04:12,080 --> 00:04:17,100 +inferior limbus الان عشان نعرف إيش ال actions + +62 +00:04:17,100 --> 00:04:21,740 +بتاعة ال inferior rectus muscle نحاول ننتقل للصورة + +63 +00:04:21,740 --> 00:04:29,240 +نحاول ننتقل للصورة اللي بتوضح هذه القضية هاي + +64 +00:04:29,240 --> 00:04:33,000 +هنا منظر يعني طبعا باهت لل inferior rectus لإنها + +65 +00:04:33,000 --> 00:04:36,780 +جاية من الأسفلبس في مناظر أوضح هذه ال superior + +66 +00:04:36,780 --> 00:04:40,320 +rectus muscle هنا أوضح منظر يعني ممكن نلاقيه هنا + +67 +00:04:40,320 --> 00:04:44,100 +ال inferior rectus muscle نشأت من ال inferior part + +68 +00:04:44,100 --> 00:04:49,280 +of annulus of زن مشت للأمام تحت العين طبعا لأنها + +69 +00:04:49,280 --> 00:04:53,200 +inferior جاين بالنسبة للعين لغاية ما تتثبت على بعد + +70 +00:04:53,200 --> 00:04:58,620 +6.5 ميلي متر من الlimbus ال axis بتاع العضلة ال + +71 +00:04:58,620 --> 00:05:03,340 +axis بتاع العضلة بعمل زاوية مع ال visual axis 23 + +72 +00:05:03,340 --> 00:05:09,640 +degreeوبيعمل زاوية مع المحور العمودي على العين 67 + +73 +00:05:09,640 --> 00:05:14,500 +degree إذا لما ال .. ال inferior rectus بدها تشد + +74 +00:05:14,500 --> 00:05:19,500 +.. بدها تشد هيكون لها أكثر من axis بسبب عدم اتفاق + +75 +00:05:19,500 --> 00:05:23,680 +محورها .. هيكون لها أكتر من action عفوابسبب عدم + +76 +00:05:23,680 --> 00:05:28,580 +اتفاق محورها مع محور العين بنقول كالاتي هي هتشد + +77 +00:05:28,580 --> 00:05:31,500 +احنا هن .. ال .. القوة اللي هتشد فيها ال media + +78 +00:05:31,500 --> 00:05:35,160 +rectus عفواً ال inferior rectus آسف القوة اللي + +79 +00:05:35,160 --> 00:05:38,920 +هتشد فيها ال inferior rectus هنستبدلها بقوتين من + +80 +00:05:38,920 --> 00:05:43,780 +مبدأ تحليل القوة عشان نعرف ال actions بتاعة ال + +81 +00:05:43,780 --> 00:05:48,060 +inferior rectus في قوة متفقة مع محور العين وفي قوة + +82 +00:05:48,060 --> 00:05:52,620 +هتكون عموديها دي أولا القوتين بيسدواأو بيمثله أو + +83 +00:05:52,620 --> 00:05:58,260 +بيكافئه قوة ال inferior rectus يعني هنشيلها ونحط + +84 +00:05:58,260 --> 00:06:01,860 +كأنه في عندى عضلتين طبعا ضرورى جدا نفهم أن هدولة + +85 +00:06:01,860 --> 00:06:05,440 +العضلتين المتعمدات واحدة منهم متفقة مع ال axis + +86 +00:06:05,440 --> 00:06:08,900 +بتاع العين وواحدة منهم متعمدة على ال axis بتاع + +87 +00:06:08,900 --> 00:06:11,980 +العين بس ضرورى نقطة ماننساش أن هدولة جايين مش من + +88 +00:06:11,980 --> 00:06:16,490 +فوقهدولة العضلتين أو القوتين المكافئات جايين من + +89 +00:06:16,490 --> 00:06:21,310 +أسفل العين طبعا الرسم جاي من فوق معادا ال inferior + +90 +00:06:21,310 --> 00:06:24,850 +rectus مرسومة من تحت طبعا اللي تمكننا منه أنه نرسم + +91 +00:06:24,850 --> 00:06:29,330 +الأسهم من فوق لأنه المنظر هذا منظر علويالان هيكون + +92 +00:06:29,330 --> 00:06:33,450 +نصيب القوة الأكبر هو نصيب القوة الأقرب لل inferior + +93 +00:06:33,450 --> 00:06:38,450 +rectus بمعنى أن العضلة أحد العضلات المكافئة أو + +94 +00:06:38,450 --> 00:06:42,250 +القوة المكافئة لقوة ال inferior rectus هتكون متفقة + +95 +00:06:42,250 --> 00:06:46,650 +مع محور العين وجاية من أسفل وجاية من أسفل والتانية + +96 +00:06:46,650 --> 00:06:51,170 +عمودية على محور العين وجاية من أسفل وجاية من أسفل + +97 +00:06:51,170 --> 00:06:56,170 +فبالتالي نصيب الأسد هيكون للقوة المتفقة لأنها هي + +98 +00:06:56,170 --> 00:07:01,750 +القوة الأقربلا ال inferior rectusفحيكون ال primary + +99 +00:07:01,750 --> 00:07:04,270 +action بتاع ال inferior rectus طالما جاية من تحت + +100 +00:07:04,270 --> 00:07:08,630 +depression depression يعني إنها بتنزل العين للأسفل + +101 +00:07:08,630 --> 00:07:13,270 +ال secondary action ال secondary action طالما إنه + +102 +00:07:13,270 --> 00:07:17,070 +هادي عضلة عمودية أو قوة مكافئة عمودية وجاية من + +103 +00:07:17,070 --> 00:07:21,890 +أسفل هتشد الساعة 6 ناحية ال limbus هتشد .. عفوا .. + +104 +00:07:21,890 --> 00:07:25,670 +ناحية ال nose هتشد الساعة 6 في ال limbus الساعة 6 + +105 +00:07:25,670 --> 00:07:28,310 +في ال limbus طالما جاية من أسفل هتنشد باتجاه ال + +106 +00:07:28,310 --> 00:07:32,300 +nose معناته الساعة 12هتبعد عن ال nose وهذا يسمى + +107 +00:07:32,300 --> 00:07:35,960 +extortion إذا ال primary action depression ال + +108 +00:07:35,960 --> 00:07:41,240 +secondary action extortion بنعيد عشان يعني نبسط + +109 +00:07:41,240 --> 00:07:44,400 +الموضوع ويه ماينساش الإنسان بنقول ال inferior + +110 +00:07:44,400 --> 00:07:49,660 +rectus muscle بتعمل زاوية مع محور العين 23 degree + +111 +00:07:49,660 --> 00:07:54,240 +إذا طالما مش موازية لمحور العين ومش منطبقة على + +112 +00:07:54,240 --> 00:07:57,830 +محور العين إذا إلها أكتر من actionالان من مبدأ + +113 +00:07:57,830 --> 00:08:00,570 +تحليل القوة هنشيل ال inferior rectus muscle اللي + +114 +00:08:00,570 --> 00:08:05,650 +هي جاية من أسفل العين ونعود عنها بعضلتين مكافئتين + +115 +00:08:05,650 --> 00:08:09,470 +أو قوتين مكافئتين التنتين هيكونوا أيضا جايين من + +116 +00:08:09,470 --> 00:08:13,410 +أسفل العين إحدى القوة أو إحدى العضلات المكافئة + +117 +00:08:13,410 --> 00:08:18,390 +هتكون متفقة مع محور العين و جاية من أسفل ولها نصيب + +118 +00:08:18,390 --> 00:08:21,730 +الأسد لأنها أقرب لل media rectusهيكون ال primary + +119 +00:08:21,730 --> 00:08:25,890 +action depression العضلة التانية المكافئة لقوة ال + +120 +00:08:25,890 --> 00:08:28,910 +media rectus هدولا التنتين مكافئات لقوة ال media + +121 +00:08:28,910 --> 00:08:32,250 +rectus .. ال .. آسف .. آسف ال inferior rectus + +122 +00:08:32,250 --> 00:08:35,810 +هدولا القوتين مكافئات لقوة ال inferior rectus + +123 +00:08:35,810 --> 00:08:40,230 +فبالتالي .. بالتالي هيكون نصيب الأسد للقوة اللي .. + +124 +00:08:40,230 --> 00:08:43,030 +اللي .. اللي متفقة مع محور العين و هيكون ال + +125 +00:08:43,030 --> 00:08:46,640 +primary action depression طالما جاية من أسفةأيضا + +126 +00:08:46,640 --> 00:08:50,280 +عندي القوة التانية المكافئة جاية من أسفل بس عمودية + +127 +00:08:50,280 --> 00:08:53,940 +على محور العين فهتعمل extortion ممكن إنسان يقول طب + +128 +00:08:53,940 --> 00:08:58,120 +ليش ما هى بتعمل extortion هذه القوة لما بتشتغل على + +129 +00:08:58,120 --> 00:09:01,920 +المحور هذا بتشد الساعة 6 لإن أنا جاية من أسفل بتشد + +130 +00:09:01,920 --> 00:09:06,460 +الساعة 6 من ال limbus باتجاه النوز وطبعا ال limbus + +131 +00:09:06,460 --> 00:09:09,900 +لأنه دائرة طالما الساعة 6 انشدت باتجاه النوز + +132 +00:09:09,900 --> 00:09:14,120 +معناته الساعة 12 هتنشد بعيدا عن النوز وهذا يسمى + +133 +00:09:14,120 --> 00:09:18,540 +extortionلو احنا أخدنا الصورة هاي لتوضيح الفكرة + +134 +00:09:18,540 --> 00:09:22,640 +بنقول هي الساعة ستة في ال limbusهي الساعة 6 في ال + +135 +00:09:22,640 --> 00:09:25,720 +limbus وهي الساعة 12 في ال limbus احنا عوضنا + +136 +00:09:25,720 --> 00:09:29,120 +بقوتين القوة الأولى متفقة مع محور العين هتعمل + +137 +00:09:29,120 --> 00:09:32,360 +depression و القوة التانية جاية من أسفل و عمودي + +138 +00:09:32,360 --> 00:09:37,280 +على محور العين هتعمل ان الساعة 6 تنشد باتجاه النذ + +139 +00:09:37,280 --> 00:09:41,660 +هاي عظم النذ النذ ساعتها الساعة 12 هتلف للخارج اذا + +140 +00:09:41,660 --> 00:09:44,440 +هيكون عندى extortion اذا ال primary action + +141 +00:09:44,440 --> 00:09:49,140 +depressionو ال secondary action extortion و ال + +142 +00:09:49,140 --> 00:09:52,860 +secondary action extortion هنحاول نعمل simulation + +143 +00:09:52,860 --> 00:09:55,480 +لل superior rectus ان شاء الله و لل inferior + +144 +00:09:55,480 --> 00:09:58,980 +rectus عشان نوضح هذه ال actions بواسطة ال + +145 +00:09:58,980 --> 00:10:02,800 +simulation قريبا ان شاء الله تعالى ال anus ال + +146 +00:10:02,800 --> 00:10:06,340 +tertiary action تالت action احنا قولنا ال origin + +147 +00:10:06,340 --> 00:10:10,560 +من عند الannulus of zin و ال insertion بعيدا عن ال + +148 +00:10:10,560 --> 00:10:15,520 +limbus بمقدار 6.5 mm طبعا كله من أسفل كله من أسفل + +149 +00:10:15,720 --> 00:10:21,240 +الان لما بتقصر العضلة لما بتتقلص العضلة و بيصير + +150 +00:10:21,240 --> 00:10:25,120 +فيها انقباض بتقصر فال insertion بتجاه ال origin + +151 +00:10:25,120 --> 00:10:28,700 +بنشد ال insertion بتجاه ال origin بنشد لأن ال + +152 +00:10:28,700 --> 00:10:33,430 +origin ثابت لا يتغير فبالتاليتنشد باتجاهه لأن ال + +153 +00:10:33,430 --> 00:10:38,970 +origin مبدأ العضلة جاي medial أو nasal بالنسبة لإن + +154 +00:10:38,970 --> 00:10:42,670 +ال insertion ساعتها كل العين هتتحرك شوية صغيرة + +155 +00:10:42,670 --> 00:10:46,630 +وتجرب من ال adduction تجرب من ال adduction + +156 +00:10:46,630 --> 00:10:49,620 +فبالتالي tertiary actionadduction اللي اللي العين + +157 +00:10:49,620 --> 00:10:53,360 +هتعمل شوية adoption بسيطة ممكن انسان تخيل ان ال + +158 +00:10:53,360 --> 00:10:57,560 +adoption اللي بتعمله ال inferior rectus هو يعني + +159 +00:10:57,560 --> 00:11:02,340 +كبير لأ هو صغير جدا لأ أكاد يذكر إذا ما قورن بال + +160 +00:11:02,340 --> 00:11:05,260 +adoption بتاع ال media rectus اللي أنا قاعد بأشر + +161 +00:11:05,260 --> 00:11:09,140 +عليها طبعا ال main adductor of the eye is media + +162 +00:11:09,140 --> 00:11:12,540 +rectus أما ال superior rectus و ال inferior rectus + +163 +00:11:12,540 --> 00:11:16,790 +superior rectusوالـ inferior rectus بيعملوا + +164 +00:11:16,790 --> 00:11:21,970 +adoption خفيف جدا .. خفيف جدا بسبب أن ال origin + +165 +00:11:21,970 --> 00:11:25,830 +بتاعهم جاي medial مقارنة مع ال insertion ولمّا + +166 +00:11:25,830 --> 00:11:30,070 +بيقصروا العين ككل بتتحرك شوية صغيرة very slight + +167 +00:11:30,070 --> 00:11:35,530 +adoption بتعمل طبعا هذا لا يلاحظ مقارنة مع اللي هو + +168 +00:11:35,530 --> 00:11:38,690 +ال adoption اللي بتعمل ليا ال medial rectus muscle + +169 +00:11:38,690 --> 00:11:41,770 +إذا نلخص ال actions بتاعة ال inferior rectus + +170 +00:11:41,770 --> 00:11:45,690 +muscle بنقول depressionextortion و adoption + +171 +00:11:45,690 --> 00:11:52,010 +depression و extortion و adoption طبعا هي بتتفق مع + +172 +00:11:52,010 --> 00:11:56,130 +ال superior rectus في ال adoption بينما بتختلف في + +173 +00:11:56,130 --> 00:11:59,850 +موضوع ال vertical action و ال torsional action ال + +174 +00:11:59,850 --> 00:12:02,350 +superior rectus بتعمل elevation و ال inferior + +175 +00:12:02,350 --> 00:12:06,390 +rectus بتعمل depression ال superior rectus بتعملin + +176 +00:12:06,390 --> 00:12:09,990 +torsion بينما ال inferior rectus بتعمل extortion + +177 +00:12:09,990 --> 00:12:16,030 +بسبب أن واحدة جاية من فوق فهتشد الساعة 12 لجوه و + +178 +00:12:16,030 --> 00:12:19,590 +هيكون in torsion و واحدة جاية من تحت هتشد الساعة 6 + +179 +00:12:19,590 --> 00:12:23,170 +لجوه وبالتالي الساعة 12 هتروح لبرا و هيكون عندي + +180 +00:12:23,170 --> 00:12:24,270 +extortion + +181 +00:12:27,130 --> 00:12:33,670 +الكلام هذا ممتاز والان بدنا نختبر الوظيفة بتاعت ال + +182 +00:12:33,670 --> 00:12:36,790 +inferior rectus muscle عشان نشوف هل ال inferior + +183 +00:12:36,790 --> 00:12:41,410 +rectus muscle شغالة ولا مش شغالة يترى في أي وضعبس + +184 +00:12:41,410 --> 00:12:44,950 +قبل ما اقول في أي وضع بدنا نشوف طبعا احنا متفقين + +185 +00:12:44,950 --> 00:12:48,570 +ان اختبار اي واحدة من الوظائف التلاتة لل inferior + +186 +00:12:48,570 --> 00:12:52,290 +rectus بيكفي عشان اخد فكرة عن ال inferior rectus + +187 +00:12:52,290 --> 00:12:56,330 +هل هي شغالة كويس ولا مش شغالة كويس لأنه الضعف لما + +188 +00:12:56,330 --> 00:12:59,670 +بيصيب عضلة ما ما بيصيب وظيفة وبيترك وظيفة يعني + +189 +00:12:59,670 --> 00:13:03,310 +بيأثر على ال depression و بيخل ال extortion طبيعي + +190 +00:13:03,310 --> 00:13:06,480 +مثلالما بتتأثر العضلة أو بتضعف العضلة بتضعف + +191 +00:13:06,480 --> 00:13:09,640 +وظائفها مع بعض و لما بتجوى العضلة أو بيصير فيها + +192 +00:13:09,640 --> 00:13:12,980 +over action بتجوى وظائفها مع بعض طبعا لو احنا + +193 +00:13:12,980 --> 00:13:18,020 +حابين نختبر ال extortionأو نتخذ هو يعني دليل إلنا + +194 +00:13:18,020 --> 00:13:20,800 +على ال function بتاعة ال .. ال inferior rectus + +195 +00:13:20,800 --> 00:13:23,540 +muscle مش هينفع لأنه ما بنقدرش نشوف ال extortion + +196 +00:13:23,540 --> 00:13:27,460 +في الوضع الطبيعي لو حابين أخد ال adduction برضه مش + +197 +00:13:27,460 --> 00:13:32,160 +هينفع لأنه مش هقدر أعمل تحييد .. تحييد ل ال main + +198 +00:13:32,160 --> 00:13:35,320 +adductor of the eye اللي هو ال media rectus muscle + +199 +00:13:35,320 --> 00:13:37,760 +ال media rectus muscle ماقدرش أقولها توقف يعني + +200 +00:13:37,760 --> 00:13:41,760 +مافيش position تتطلع عليه العين و هذا ال position + +201 +00:13:41,760 --> 00:13:45,020 +يخلي قوة ال media rectus صفر أو لا تساهم في ال + +202 +00:13:45,020 --> 00:13:51,650 +adductionإذا هذا بنشافش وهذا لا يمكن إنه نحيد ال + +203 +00:13:51,650 --> 00:13:54,950 +media rectus فبيضل عشان أختبر ال inferior rectus + +204 +00:13:54,950 --> 00:13:58,970 +muscle لازم أركز على موضوع ال depression لازم أركز + +205 +00:13:58,970 --> 00:14:02,170 +على موضوع ال depression الآن موضوع ال depression + +206 +00:14:02,170 --> 00:14:05,890 +.. موضوع ال depression في عندي كذا depressor في + +207 +00:14:05,890 --> 00:14:09,060 +العين في عندي ال inferior rectus اللي أنا ..رسمها + +208 +00:14:09,060 --> 00:14:11,900 +هاي اللي جاية من تحت العين أو ال simulation هذا + +209 +00:14:11,900 --> 00:14:15,540 +هذه ال inferior rectus بتعمل depression و أيضا ال + +210 +00:14:15,540 --> 00:14:18,740 +superior oblique muscle اللي أنا قاعد بقشر عليها + +211 +00:14:18,740 --> 00:14:23,140 +أيضا بتعمل depression أيضا بتعمل depression لو + +212 +00:14:23,140 --> 00:14:27,200 +العين اتحركت في وضع ال abduction يعني العين طلعت + +213 +00:14:27,200 --> 00:14:31,390 +لبراساعتها محور الـ inferior rectus muscle هيتفق + +214 +00:14:31,390 --> 00:14:35,670 +مع محور العين الـ inferior rectus muscle والعين + +215 +00:14:35,670 --> 00:14:39,690 +هيصير اللهم نفس الخط أو نفس المحاول لما بتطلع + +216 +00:14:39,690 --> 00:14:43,410 +العين لبرا في نفس اللحظة اللي اتفق فيها محور ال + +217 +00:14:43,410 --> 00:14:47,050 +inferior rectus muscleمع محور العين نتيجة ان العين + +218 +00:14:47,050 --> 00:14:51,750 +طلعت في وضع ال abduction بيتعامد في نفس اللحظة وضع + +219 +00:14:51,750 --> 00:14:54,050 +ال superior oblique muscle اللي هي ال other + +220 +00:14:54,050 --> 00:14:58,090 +depressor وبتصير فقط in torture فقط in torture + +221 +00:14:58,090 --> 00:15:01,710 +يعني لن تساهم في ال depression اذا انا بختبر ال + +222 +00:15:01,710 --> 00:15:05,550 +inferior rectus muscle في وضع ال abduction out and + +223 +00:15:05,550 --> 00:15:11,490 +down out and down وبالتالي ساعتهاهيكون عنده ال + +224 +00:15:11,490 --> 00:15:14,650 +other depressor of the eye ما بيساهم في ال + +225 +00:15:14,650 --> 00:15:18,930 +depression لأنه متعمد على محور العين نحاول نشوف + +226 +00:15:18,930 --> 00:15:22,850 +هذا بالصور اللي توضح هذه الفكرة + +227 +00:15:38,200 --> 00:15:41,360 +هي العين في وضع ال abduction .. هي العين في وضع ال + +228 +00:15:41,360 --> 00:15:45,140 +abduction واضح أنه ال superior oblique .. ال + +229 +00:15:45,140 --> 00:15:49,240 +superior oblique muscle .. المحور بتاعها متعامد + +230 +00:15:49,240 --> 00:15:52,540 +على محور العين .. متعامد على محور العين في وضع ال + +231 +00:15:52,540 --> 00:15:56,200 +abduction .. في نفس اللحظة في وضع ال abduction .. + +232 +00:15:56,200 --> 00:16:00,730 +في وضع ال abductionال inferior rectus muscle .. ال + +233 +00:16:00,730 --> 00:16:03,010 +inferior rectus .. هذه ال inferior rectus وهنا ال + +234 +00:16:03,010 --> 00:16:05,310 +superior rectus .. هنا ال superior rectus ال + +235 +00:16:05,310 --> 00:16:08,230 +inferior rectus muscle اللي جاية من أسفل العين في + +236 +00:16:08,230 --> 00:16:12,170 +وضع ال abduction .. في وضع ال abduction اتفق + +237 +00:16:12,170 --> 00:16:16,150 +محورها مع محور العين و ساعتها هي هتعمل depression + +238 +00:16:16,150 --> 00:16:20,350 +بينما ال superior oblique تعامد محورها مع محور + +239 +00:16:20,350 --> 00:16:22,610 +العين .. هاي محور ال superior oblique أنا بقشر + +240 +00:16:22,610 --> 00:16:28,120 +عليه .. و هاي محور العينو التالي ساعتها ال + +241 +00:16:28,120 --> 00:16:31,680 +superior oblique هتكون فقط in torture .. فقط in + +242 +00:16:31,680 --> 00:16:35,220 +torture يعني لا تساهم في ال depression .. بينما ال + +243 +00:16:35,220 --> 00:16:39,280 +inferior rectus muscle هتكون هي ال depressor .. هي + +244 +00:16:39,280 --> 00:16:42,920 +ال depressor .. إذا أنا بختبر ال inferior rectus + +245 +00:16:42,920 --> 00:16:48,180 +muscle في ال out and down position .. outعشان + +246 +00:16:48,180 --> 00:16:52,520 +محورها هيتفق مع محور العين و ساعتها هى هتقدر تعمل + +247 +00:16:52,520 --> 00:16:58,020 +depression فهيصير عينلى out and down هذا هو الموقع + +248 +00:16:58,020 --> 00:17:01,200 +اللى انا باختبر فيه ال inferior rectus muscle + +249 +00:17:01,200 --> 00:17:04,060 +inferior .. او عفوا ال inferior rectus muscle + +250 +00:17:04,060 --> 00:17:07,640 +inferior rectus originates at the lower part of + +251 +00:17:07,640 --> 00:17:12,460 +the annulus of zin and inserts 6.5 mm behind the + +252 +00:17:12,460 --> 00:17:15,800 +inferior limbus the primary action is depression + +253 +00:17:16,220 --> 00:17:21,320 +secondary actions are extortion and abduction لما + +254 +00:17:21,320 --> 00:17:25,340 +يصير abduction .. abduction في العين .. abduction + +255 +00:17:25,340 --> 00:17:29,500 +تلاتة و عشرين degree ساعتها ال .. ال inferior + +256 +00:17:29,500 --> 00:17:35,140 +rectus muscle acts purely as depressoras depressor + +257 +00:17:35,140 --> 00:17:38,280 +as for the superior rectus this is the optimal + +258 +00:17:38,280 --> 00:17:41,220 +position of the globe for testing the function of + +259 +00:17:41,220 --> 00:17:45,640 +the inferior rectus muscle اذا كان صار abduction + +260 +00:17:45,640 --> 00:17:50,680 +abduction 67 degree ال inferior rectus بتشتغل فقط + +261 +00:17:50,680 --> 00:17:55,860 +كextruder اللي هي عكس اللي احنا قلناه احنا في وضع + +262 +00:17:55,860 --> 00:17:59,420 +ال abduction في وضع ال abduction ال inferior + +263 +00:17:59,420 --> 00:18:05,210 +rectusبتشتغل ك Depressor بينما في وضعية ال + +264 +00:18:05,210 --> 00:18:08,570 +adduction .. في وضعية ال adduction ال inferior + +265 +00:18:08,570 --> 00:18:11,670 +rectus اللي .. اللي مش مرسومة هنا .. هنا مرسوم ال + +266 +00:18:11,670 --> 00:18:14,590 +superior oblique في ال .. في ال adduction .. في ال + +267 +00:18:14,590 --> 00:18:18,910 +adduction ال inferior rectus بتكون in torte هاي + +268 +00:18:18,910 --> 00:18:22,150 +رقم تلاتة رسمة رقم تلاتة العين راحت في وضع ال + +269 +00:18:22,150 --> 00:18:27,210 +adduction بيتعامد محور ال inferior rectus مع محور + +270 +00:18:27,210 --> 00:18:32,140 +العين و بتصير فقط extortتلخيصا للكلام ال vertical + +271 +00:18:32,140 --> 00:18:35,320 +recti ال superior rectus وال inferior rectus + +272 +00:18:35,320 --> 00:18:39,820 +بختبرهم في وضع ال abduction بينما ال obliques وهذا + +273 +00:18:39,820 --> 00:18:43,740 +هنحكي عنه يختبروا في وضع ال abduction وهذا ان شاء + +274 +00:18:43,740 --> 00:18:48,700 +الله تعالى ليس فقط بال simulation ايضا بالنموذج + +275 +00:18:48,700 --> 00:18:52,180 +العملي اللي بنحاول بناءه ان شاء الله تعالى هتتضح + +276 +00:18:52,180 --> 00:18:57,210 +الأمور بشكل أفضل بكثير هنتوقف عندهذه النقطة و + +277 +00:18:57,210 --> 00:19:01,370 +المرة القادمة ان شاء الله يتعالى هنبدأ مع ال + +278 +00:19:01,370 --> 00:19:08,930 +spiral of telox و + +279 +00:19:08,930 --> 00:19:10,370 +يعطيكم العافية + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/I-j76JXQmsQ_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/I-j76JXQmsQ_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..c9354a003c311cddcb4d00202df96ed5f4c4f72e --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/I-j76JXQmsQ_postprocess.srt @@ -0,0 +1,1640 @@ +1 +00:00:01,350 --> 00:00:05,270 +بسم الله الرحمن الرحيم بنواصل مع محاضرات حوال واحد + +2 +00:00:05,270 --> 00:00:12,730 +واتوقفنا عند محاضرة ال visual acuity و هذا موضوع + +3 +00:00:12,730 --> 00:00:17,810 +حقيقة غاية في الأهمية و أهميته بتنبع من .. يعني + +4 +00:00:17,810 --> 00:00:24,150 +كتير لا توجد رغبة أحيانا عند الكوادر الطبية في + +5 +00:00:24,150 --> 00:00:30,070 +التعامل مع الأطفالو تقييم حدث الإبصار عندهم لإنه + +6 +00:00:30,070 --> 00:00:35,070 +فيها نوعا ما صعوبة و الطفل غالبا بيكون غير متعاون + +7 +00:00:35,070 --> 00:00:40,420 +إلا إنه باتباع بعض الفحوصاتاللي هنسردها في + +8 +00:00:40,420 --> 00:00:44,640 +المحاطرة هناجي أنه الأمر ليس بالصعوبة الشديدة + +9 +00:00:44,640 --> 00:00:52,860 +وإنما يعني شيء ممكن أدائه وبإتقان أيضا أول شيء + +10 +00:00:52,860 --> 00:00:58,340 +لازم نفرج بين حاجة بنسميها qualitative assessment + +11 +00:00:58,340 --> 00:01:02,860 +of visual behavior و quantitative assessment of + +12 +00:01:02,860 --> 00:01:06,700 +visual acuity quantitative assessment of visual + +13 +00:01:06,700 --> 00:01:12,150 +acuity التقييم الكمالكم لحدة الإبصار يعني لازم في + +14 +00:01:12,150 --> 00:01:16,490 +نهاية هذا التقييم أو هذا ال test اقول 6 ع جديش او + +15 +00:01:16,490 --> 00:01:21,130 +جديش من عشرة او باللغة باللغ مارت شارت جديش تساوي + +16 +00:01:21,130 --> 00:01:25,130 +حدة الإبصار يعني في عندي كام بدي انا ابينه في ملف + +17 +00:01:25,130 --> 00:01:29,090 +المريض و احكي مثلا المريض بيشوف 6 على 12 هذا يسمى + +18 +00:01:29,090 --> 00:01:33,590 +quantitative assessment of visual acuity يعني في + +19 +00:01:33,590 --> 00:01:39,160 +نهاية ال test او اي test من التستات الليبتندرج تحت + +20 +00:01:39,160 --> 00:01:44,060 +هذه ال .. تحت هذا العنوان لازم في نهايته أعطي كام + +21 +00:01:44,060 --> 00:01:48,620 +أو أعطي قيمة لل visual acuity في عندي مجموعة من + +22 +00:01:48,620 --> 00:01:53,300 +الفحوصات ب .. بنهاية الفحص ما بعطي أنا كام وإنما + +23 +00:01:53,300 --> 00:01:57,360 +بعطي qualitative assessment of visual behavior + +24 +00:01:57,360 --> 00:02:03,280 +يعني تقييم نوعي للسلوك البصري تقييم نوعي للسلوك + +25 +00:02:03,280 --> 00:02:07,700 +البصريالآن إذا أنا بدأ أحاول أجيب طفل صغير a pre + +26 +00:02:07,700 --> 00:02:12,840 +verbal child يعني لسه ما بدأ يتكلم طفل في مرحلة ما + +27 +00:02:12,840 --> 00:02:17,020 +قبل الكلام و أجي أخدعه للحصات بتاعة المجموعة + +28 +00:02:17,020 --> 00:02:19,920 +التانية ليه quantitative assessment of visual + +29 +00:02:19,920 --> 00:02:24,800 +acuity بكون أنا مجرد بضيع الوقتليش؟ لأنه الطفل ما + +30 +00:02:24,800 --> 00:02:30,760 +بيتكلم .. يعني كل اللوحات تقييم النظر سواء ال + +31 +00:02:30,760 --> 00:02:34,400 +Snelling أو ال Gemar Chart او .. Chart او اي شيء + +32 +00:02:34,400 --> 00:02:38,620 +او ال .. ال .. Landolt Broking Rings او ما شابه .. + +33 +00:02:38,620 --> 00:02:41,980 +الطفل مش هيتعاون معاه أبدا عشان يجاوب على هذه + +34 +00:02:41,980 --> 00:02:45,430 +القضيةأو على الأسئلة اللي بوجهها إليه أو على + +35 +00:02:45,430 --> 00:02:49,090 +الإشارات اللي أنا بأشر عليها عشان هو يستجيب إليها + +36 +00:02:49,090 --> 00:02:53,250 +لأنه مابيتكلم فبالتالي الأطفال اللي في مرحلة ما + +37 +00:02:53,250 --> 00:02:58,410 +قبل الكلام بيخضعوا لفحص أو أكتر من الفحوصات + +38 +00:02:58,410 --> 00:03:02,790 +المندرجة تحت العنوان الأول اللي هو التقييم التقييم + +39 +00:03:02,790 --> 00:03:06,790 +النوعي qualitative assessmentof visual behavior + +40 +00:03:06,790 --> 00:03:11,930 +لسلوك البصري، هل سلوكه البصري مرضى ولا متوسط الحال + +41 +00:03:11,930 --> 00:03:16,190 +ولا سلوكه البصري غير مرضى، يعني في مشكلة في + +42 +00:03:16,190 --> 00:03:19,730 +الإبصار عنده؟ طبعا ممكن الأهل يسألوا يعني جديش + +43 +00:03:19,730 --> 00:03:24,280 +الإبن أو البنت بيشوففلازم احنا نكون واضحين من + +44 +00:03:24,280 --> 00:03:27,660 +البداية انه في عمر ما قبل الكلام، يعني مرحلة عمر + +45 +00:03:27,660 --> 00:03:32,040 +سنة، تسع شهور، سنة و شهرين، سنة و نصر، لسه تخيل ما + +46 +00:03:32,040 --> 00:03:36,200 +بيتكلم، ما بقدر انا افحصه بالفحوصات اللي انا ب .. + +47 +00:03:36,200 --> 00:03:40,700 +ب .. بقيم فيها حدة الإبصار لدى الأطفال الأكبر سنا + +48 +00:03:40,700 --> 00:03:45,080 +لو سن سن اربع سنوات او خمس سنوات او افحصه + +49 +00:03:45,080 --> 00:03:49,550 +بالفحوصات اللي انا بفحص فيها الناس البالغةفبالتالي + +50 +00:03:49,550 --> 00:03:53,890 +ضروري جدا هذه القضية تكون واضحة using preferential + +51 +00:03:53,890 --> 00:03:57,170 +looking tests assessment of visual behavior is + +52 +00:03:57,170 --> 00:03:59,970 +achieved as follows هنبدأ بال qualitative + +53 +00:04:01,450 --> 00:04:04,890 +assessment of visual behavior يعني تقييم السلوك + +54 +00:04:04,890 --> 00:04:09,330 +البصري بعدة فحوصات بسيطة بس ضروري انه احنا يعني + +55 +00:04:09,330 --> 00:04:14,210 +نحاول ننفذ اكبر عدد ممكن منها نشوف ايش الفحص الاول + +56 +00:04:14,210 --> 00:04:18,470 +الفحص الاول بيسموه fixation and following fixation + +57 +00:04:18,470 --> 00:04:22,170 +يعني هل الطفل بيثبت نظره ع target معين لما اعرضله + +58 +00:04:22,170 --> 00:04:26,630 +target معين وهل بيتبع هذا ال target ولا لاmay be + +59 +00:04:26,630 --> 00:04:30,270 +assessed using bright attention grabbing target + +60 +00:04:30,810 --> 00:04:35,110 +وغالبا بيكون ال face is often pissed this method + +61 +00:04:35,110 --> 00:04:38,950 +indicates whether the infant is visually alert and + +62 +00:04:38,950 --> 00:04:42,770 +is of particular value in a child suspected of + +63 +00:04:42,770 --> 00:04:45,670 +blindness ما معنى كل هذا الكلام اللي احنا ذكرنا + +64 +00:04:45,670 --> 00:04:50,910 +اول حاجة بنقول هذه الطريقة احنا بنتبعها عشان نشوف + +65 +00:04:50,910 --> 00:04:55,570 +هل الرضيع الطفل الرضيع هل هو منتبه بصريا يعني في + +66 +00:04:55,570 --> 00:05:00,440 +أشياء تجذب انتباهه بصريالما أعرضها أمامه target + +67 +00:05:00,440 --> 00:05:04,640 +باعرضه أمامه طبعا ال target بدي يكون bright واضح + +68 +00:05:04,640 --> 00:05:11,000 +.. واضح قابل إنه ينمسك grabbing target وغالبا إذا + +69 +00:05:11,000 --> 00:05:15,320 +كان في صورة وجه بيكون أفضل .. بيكون أفضل هنعرض بعض + +70 +00:05:15,320 --> 00:05:19,280 +ال targets بعد شوية بنقول أمتى أنا بستعمل هذا ال + +71 +00:05:19,280 --> 00:05:22,840 +test ممكن أستعمله عند أي طفل pre verbal لم ينطق + +72 +00:05:22,840 --> 00:05:27,950 +بعدو بالذات هذا ال test هيفيدني كتير عشان الطفل + +73 +00:05:27,950 --> 00:05:32,090 +اللي أهله متوقعين أنه في عنده يعني a blindness + +74 +00:05:32,090 --> 00:05:36,190 +يعني مابشوفش بالمرة إذا أنا أثبتلهم أن الطفل بقدر + +75 +00:05:36,190 --> 00:05:39,950 +يعمل fixation and following يعني بقدر يعمل + +76 +00:05:39,950 --> 00:05:45,420 +fixation على ال target اللي أنابعرضه أمامه و بيقدر + +77 +00:05:45,420 --> 00:05:49,140 +يتبعه لو حركت انا ال target هدأ في اتجاهات مختلفة + +78 +00:05:49,140 --> 00:05:52,980 +من الفرق و تبعه ببصره معناته هو شايف هذا ال target + +79 +00:05:52,980 --> 00:05:57,220 +فساعتها بيقولش عن هذا الطفل انه أعمى بالكامل و + +80 +00:05:57,220 --> 00:06:01,420 +انما انه منتبه بصري .. منتبه بصري يعني يا ترى ايش + +81 +00:06:01,420 --> 00:06:04,840 +ال targets اللي ممكن تستعمل؟ في عندي targets لا + +82 +00:06:04,840 --> 00:06:10,880 +حصرة لها حقيقة و ممكن بعض يعني كل إنسانمنها انه + +83 +00:06:10,880 --> 00:06:16,660 +يعني يعمله او يجهزه في البيت بشكل سريع وبشكل يعني + +84 +00:06:16,660 --> 00:06:21,480 +يكون جذاب للطفل يعني هنا عندنا صورة face تمام .. + +85 +00:06:21,480 --> 00:06:27,430 +تمام هنا عندنا صورة دفضع او هنا .. هنا يعني ..مجسم + +86 +00:06:27,430 --> 00:06:32,490 +لكلب صغير، مجسم لسفينة وما إلى ذلك، هنا صورة + +87 +00:06:32,490 --> 00:06:36,550 +عصفور، يعني لا حصرة لها عدد ال targets اللي ممكن + +88 +00:06:36,550 --> 00:06:40,810 +أعملها و أعرضها أمام الطفل، ضروري جدا ما أستخدمش + +89 +00:06:40,810 --> 00:06:46,030 +أصوات مثل الصفير أو الخرخشة أو ما شابهعشان ينتبه + +90 +00:06:46,030 --> 00:06:50,610 +الطفل باتجاهي لأن ساعتها انا مش هاعرف هل الطفل + +91 +00:06:50,610 --> 00:06:55,250 +منتبه للصوت ولا للصورة احنا بنفحص نظر اذا احنا + +92 +00:06:55,250 --> 00:07:00,290 +بدنا نلغي قضية الصوت فبالتالي طبعا بعض التطبيقات + +93 +00:07:00,290 --> 00:07:06,510 +في ال .. في ال .. في الهواتف الذكيةممكن تكون عبارة + +94 +00:07:06,510 --> 00:07:12,950 +عن صورة ومصاحبة بصوت ولكن الأفضل اجعل هذا الصورة + +95 +00:07:12,950 --> 00:07:18,030 +صامتة حتى اعرف هل الطفل منتبه بصريا او لا طبعا + +96 +00:07:18,030 --> 00:07:23,840 +بعرض واحد من هذه ال targets امامالطفل و أمامه + +97 +00:07:23,840 --> 00:07:27,440 +مباشرة و بعد هيك بصمت ببدأ أحرك ال target يمين + +98 +00:07:27,440 --> 00:07:32,200 +شمال فوق تحت إذا الطفل بيتبع ببصره ساعتها الطفل + +99 +00:07:32,200 --> 00:07:35,340 +منتبه بصريا و بيكون ال fixation أو ال following + +100 +00:07:35,340 --> 00:07:39,280 +بينكتب في ملف فوق النتيجة أنه fixes and follows + +101 +00:07:39,280 --> 00:07:43,720 +fixes and follows مثلا in all directions of gaze + +102 +00:07:43,720 --> 00:07:47,960 +أو in particular direction of gaze إذا بيتبع فيه + +103 +00:07:48,110 --> 00:07:53,270 +أيضا في عندي targets يعني .. يعني ممكن يعني الأداة + +104 +00:07:53,270 --> 00:07:56,430 +اللي بعمل فيها ال cover test مثلا ممكن أستخدم أحد + +105 +00:07:56,430 --> 00:07:59,830 +أسطحها + +106 +00:07:59,830 --> 00:08:03,850 +عشان أني أرسم عليه ال face أو يعني ألسق عليه صورة + +107 +00:08:03,850 --> 00:08:09,350 +ال face و أخل الطفل يتبع هذه .. هذا ال target أو + +108 +00:08:09,350 --> 00:08:13,980 +هذه الصورةأيضا في عندي targets ب .. بأشكال مختلفة + +109 +00:08:13,980 --> 00:08:18,020 +طبعا على tongue depressor خافض اللسان اللي ممكن + +110 +00:08:18,020 --> 00:08:21,860 +يعني أحصل عليه من الصيدليات أني أنا ألسق صور + +111 +00:08:21,860 --> 00:08:26,080 +مختلفة و يكون عندي targets متعددة و أستخدمها + +112 +00:08:26,080 --> 00:08:30,180 +للأطفال و أستخدمها للأطفال، إذا ال test الأول هو + +113 +00:08:30,180 --> 00:08:33,850 +fixation and followingال test التاني اللي هو ال + +114 +00:08:33,850 --> 00:08:36,830 +comparison between the behavior of the two eyes + +115 +00:08:36,830 --> 00:08:42,630 +بدنا نقارن فيه في ال test التاني السلوك بتاع كل من + +116 +00:08:42,630 --> 00:08:47,310 +العينتين may reveal unilateral preference كيف أنا + +117 +00:08:47,310 --> 00:08:52,730 +بقارن .. كيف أنا بقارن بين سلوك العينتين البصري + +118 +00:08:52,730 --> 00:08:57,750 +سلوك العين اليمين وسلوك العين الشمالبطريقة ال + +119 +00:08:57,750 --> 00:09:02,210 +exclusion .. exclusion of one eye if strongly + +120 +00:09:02,210 --> 00:09:06,070 +objected by the child indicates poorer acuity in + +121 +00:09:06,070 --> 00:09:09,610 +the other eye ايش معناة الكلام هذا؟ لما انا بغطي + +122 +00:09:09,610 --> 00:09:14,310 +العين اليمين و بلاقي الطفل بيقاوم جدا تغطاية العين + +123 +00:09:14,310 --> 00:09:17,590 +اليمين معناته هو مش معتمد على العين الشمال في + +124 +00:09:17,590 --> 00:09:21,770 +الرؤيةأنا غطيتله اليمين و تركته الاشمال مفتوحة و + +125 +00:09:21,770 --> 00:09:25,330 +مع ذلك هو بيرفض هذه القضية بيرفضها بشدة بيقاوم + +126 +00:09:25,330 --> 00:09:29,030 +بيحاول ينزع ال .. ال .. ال batch عن العين اليمين + +127 +00:09:29,030 --> 00:09:32,210 +معناته هو معتمد على العين اليمين و غالبا العين + +128 +00:09:32,210 --> 00:09:37,250 +اليسار فيها كذا، اذاocclusion of one eye نفرض + +129 +00:09:37,250 --> 00:09:41,230 +العين اليمين if strongly objected إذا تم معارضته + +130 +00:09:41,230 --> 00:09:46,630 +بشدة من قبل الطفل هذا indicates هذا بيأشر أنه ممكن + +131 +00:09:46,630 --> 00:09:49,910 +يكون عندي poorer acuity in the other eye كلمة + +132 +00:09:49,910 --> 00:09:53,170 +poorer مش معناته أنه النظر منعدم فيها ولكن إنها + +133 +00:09:53,170 --> 00:09:56,550 +أسوأ في النظر من العين اليمين وإن الطفل بيعتمد على + +134 +00:09:56,550 --> 00:10:01,830 +عينه اليمين كمثال يعني كما قلنافبالتالي إذا رافض + +135 +00:10:01,830 --> 00:10:04,770 +تغطية إحدى العينين معناته هذه العين اللي رافض + +136 +00:10:04,770 --> 00:10:10,090 +تغطيتها بيعتمد عليها في النظر عشان هيك يعني بدوش + +137 +00:10:10,090 --> 00:10:17,030 +أيانة نغطيها طيب ممكن إنسان يرفض التغطية في العين + +138 +00:10:17,030 --> 00:10:21,550 +اليمين ويرفض أيضا التغطية في العين الشمال طيب + +139 +00:10:21,550 --> 00:10:24,350 +however it is possible to have good visual + +140 +00:10:24,350 --> 00:10:28,550 +attention and unequal visual acuity يعني ممكن .. + +141 +00:10:28,550 --> 00:10:33,580 +ممكن تكونال visual attention الانتباه البصري موجود + +142 +00:10:33,580 --> 00:10:37,980 +في العين تان بس ال vision مش متساوي طيب و رفض + +143 +00:10:37,980 --> 00:10:41,340 +تغطية العين اليمين و ايضا رفض تغطية العين الشمال + +144 +00:10:41,340 --> 00:10:45,340 +هذا لا يعني انه بالضرورة يكون عندي كسل في العين + +145 +00:10:45,340 --> 00:10:49,970 +تان و انماكون إنه رفض تغطية العين اليمين و رفض + +146 +00:10:49,970 --> 00:10:54,410 +تغطية العين الشمال، بدأ أسجل في ملفه إنه objects + +147 +00:10:54,410 --> 00:10:58,110 +to occlusion of right eye and objects to occlusion + +148 +00:10:58,110 --> 00:11:02,130 +of left eye، هذه نتيجة ال test و بدأ أخد عوامل أو + +149 +00:11:02,130 --> 00:11:07,150 +ال risk factors for amblyopia بعين الاعتبارما هي + +150 +00:11:07,150 --> 00:11:10,570 +ال risk factors for amblyopia؟ هي تم الحديث عنها + +151 +00:11:10,570 --> 00:11:13,650 +في المحاضرات السابقة هي نفس أنواع ال amblyopia + +152 +00:11:13,650 --> 00:11:17,670 +يعني هل في strabismus عند الطفل مركز في عين دون + +153 +00:11:17,670 --> 00:11:21,270 +عين؟ هل في عندي anisometropia؟ هل في عندي high + +154 +00:11:21,270 --> 00:11:24,440 +bilateral refractive error؟هل عندي high bilateral + +155 +00:11:24,440 --> 00:11:29,400 +astigmatism meridional amblyopia؟ هل في عندي شيء + +156 +00:11:29,400 --> 00:11:33,040 +بيمنع وصول الضوء ل .. لإحدى العنتين زي ال cataract + +157 +00:11:33,040 --> 00:11:36,380 +زي ال ptosis زي ال vitreous hemorrhage ما إلى ذلك + +158 +00:11:36,380 --> 00:11:41,320 +أو ال corneal obesity لازم أخد بعين الاعتباركل ال + +159 +00:11:41,320 --> 00:11:45,640 +risk factors for amblyopia في نقطة يعني قبل ما + +160 +00:11:45,640 --> 00:11:49,540 +نتحرك لل test رقم تلاتة بدنا .. بدنا نذكر فيها انه + +161 +00:11:49,540 --> 00:11:55,660 +ال qualitative assessment of visual behavior أقل + +162 +00:11:55,660 --> 00:11:58,900 +دقة من ال quantitative assessment of visual acuity + +163 +00:11:58,940 --> 00:12:03,280 +هذه بتعطيني فكرة عن السلوك البصري للطفل هل هو جيد + +164 +00:12:03,280 --> 00:12:07,220 +ولا نص نص ولا سيء أما ال quantitative assessment + +165 +00:12:07,220 --> 00:12:11,540 +بيعطيني رقم للإنسان اللي أنا بفحصه جداش بيشوف جداش + +166 +00:12:11,540 --> 00:12:17,730 +بيشوف فبالتالي من ناحية الدقةالدقة لا تقارن في ال + +167 +00:12:17,730 --> 00:12:20,570 +quantitative assessment أفضل بكثير من ال + +168 +00:12:20,570 --> 00:12:24,930 +qualitative assessment ولكن احنا مضطرين نلجأ لهذه + +169 +00:12:24,930 --> 00:12:28,550 +الفحوصات اللي أقل دقة لأن هي اللي بنقدر ناخد + +170 +00:12:28,550 --> 00:12:33,650 +معلومات عن طريقها عن عين الطفل إيش وضع .. إيش وضع + +171 +00:12:33,650 --> 00:12:40,770 +هذه ال targetsمختلفة، هي عندي أنا طفل غطيتله العين + +172 +00:12:40,770 --> 00:12:46,230 +لشمال، غطيتله العين لشمال، يرفض تماما، هي بيدفع + +173 +00:12:46,230 --> 00:12:51,150 +بيد الفاحص بعيدا عن نفسه، تمام؟ معناته بيعتمد على + +174 +00:12:51,150 --> 00:12:54,900 +العين لشمال بالرؤية، tightالان غطينا العين اليومين + +175 +00:12:54,900 --> 00:13:00,720 +نفس القضية بيحاول يدفع بيد ال examiner بعيدا عن + +176 +00:13:00,720 --> 00:13:04,620 +عينه يعني هو معتمد على العينتين التنتين is an + +177 +00:13:04,620 --> 00:13:07,940 +objection to occlusion to rule out difference of + +178 +00:13:07,940 --> 00:13:11,880 +vision between two eyesالمثال التاني هو هذا يعني + +179 +00:13:11,880 --> 00:13:15,360 +بنقدر نقول أن السلوك البصري للعنتين تقريبا equal + +180 +00:13:15,360 --> 00:13:19,500 +تقريبا equal vision جداش مابنقدرش نقول جداش لأن + +181 +00:13:19,500 --> 00:13:23,600 +هذا qualitative assessment of visual behavior نيجي + +182 +00:13:23,600 --> 00:13:28,930 +للمثال التاني للمثال التاني غطينا العين لإشمالواضح + +183 +00:13:28,930 --> 00:13:33,670 +أن الطفل هادق و calm مافي أي مشكلة، غطينا العين + +184 +00:13:33,670 --> 00:13:37,630 +اليمين الطفل يعني أصبح يعني في وضع من الحزن و + +185 +00:13:37,630 --> 00:13:40,970 +البكاء و ما إلى ذلك، لما غطينا اليمين اللي هو + +186 +00:13:40,970 --> 00:13:44,730 +بيعتمد عليها في النظروفتحنا لشمال اللي هي + +187 +00:13:44,730 --> 00:13:48,910 +amblyobic eye عين فيها كسل أصبح يعاني في الرؤية + +188 +00:13:48,910 --> 00:13:53,150 +فبالتالي بدأ يبكي ويعني .. يعني حالته النفسية + +189 +00:13:53,150 --> 00:13:56,850 +تتغير لما غطينا ال amblyobic eye اللي مابعتمدش + +190 +00:13:56,850 --> 00:14:00,920 +عليها في النظر الطفل calm وهادق وربما ..يكون مبتسم + +191 +00:14:00,920 --> 00:14:04,640 +ومش فارقة معاها أنه أصلا هو مش معتمد عليها هذا ال + +192 +00:14:04,640 --> 00:14:09,240 +test بأكد لي أن العين الشمال فيها amblyopia و لازم + +193 +00:14:09,240 --> 00:14:12,940 +أخد هذا في عين الاعتبار هذا اللي هو ال behavior of + +194 +00:14:12,940 --> 00:14:16,820 +the two eyes نيجي لتالت + +195 +00:14:19,970 --> 00:14:24,130 +فحص من فحصات ال qualitative assessment of visual + +196 +00:14:24,130 --> 00:14:27,550 +behavior اللي هو ال fixation behavior ال fixation + +197 +00:14:27,550 --> 00:14:32,290 +behavior بختلف عن ال behavior of the two او ال + +198 +00:14:32,290 --> 00:14:35,810 +comparison of the two eyes ايش هو ال fixation + +199 +00:14:35,810 --> 00:14:41,760 +behavior بدنا نقرأ و بعدين نشرح ايش اللي ..يعني ما + +200 +00:14:41,760 --> 00:14:45,860 +هو سر هذا ال test؟ fixation behavior can be used + +201 +00:14:45,860 --> 00:14:49,040 +to establish unilateral preference if manifest + +202 +00:14:49,040 --> 00:14:53,680 +squint is present هذا ال test أنا بستخدمه لما يكون + +203 +00:14:53,680 --> 00:14:56,940 +في عندي manifest squint بمعنى في عندي ترابية في + +204 +00:14:56,940 --> 00:15:03,260 +عندي ترابية بدي أشوف هل الطفل اللي عنده ترابيةالـ + +205 +00:15:03,260 --> 00:15:06,140 +Endotropia يعني إيزوتروبيا أو إكزوتروبيا أو + +206 +00:15:06,140 --> 00:15:12,000 +هايبروتروبيا أو هايبوتروبيا، هل هو بيفضّل يركّز + +207 +00:15:12,000 --> 00:15:16,820 +بعين ولا بيفضّل يركّز مرة بالعين اليمين و مرة .. + +208 +00:15:16,820 --> 00:15:20,680 +يعني بتبادل التركيز مرة بعمل fixation بال right + +209 +00:15:20,680 --> 00:15:23,860 +eye و مرة بعمل fixation بال left eye كيف هذا + +210 +00:15:23,860 --> 00:15:27,960 +منعمل؟fixation is promoted in the squinting eye by + +211 +00:15:27,960 --> 00:15:31,680 +occluding the dominant eye يعني بشجع ال fixation + +212 +00:15:31,680 --> 00:15:34,340 +في العين اللي فيها الحوال كيف .. كيف بدي أخلي + +213 +00:15:34,340 --> 00:15:37,880 +العين اللي فيها الحوال تعمل fixation أني بخلي .. + +214 +00:15:37,880 --> 00:15:41,060 +بغلقله بعمل occlusion لل dominant eye العين ال + +215 +00:15:41,060 --> 00:15:45,300 +straight while the child fixates a target of + +216 +00:15:45,300 --> 00:15:49,320 +interestpreferably incorporating a light يعني أنا + +217 +00:15:49,320 --> 00:15:54,800 +بعرض أمام الطفل target شيق عشان يتطلع عليه ويفضل + +218 +00:15:54,800 --> 00:15:58,020 +أنه هذا ال target الشيق يكون فيه ضوء عشان أشوف ال + +219 +00:15:58,020 --> 00:16:01,060 +corneal light reflex و أشوف هل عدلت عينه ولا ما + +220 +00:16:01,060 --> 00:16:05,350 +عدلت عينهإذن أول حاجة بدي أشجع الـ fixation في الـ + +221 +00:16:05,350 --> 00:16:11,910 +squinting eye وهذا هنشوفه بعد شوية كفيديو و بطريقة + +222 +00:16:11,910 --> 00:16:16,270 +أني أسكر الضوء أو أغلق أو أعمل batching أو أسكر + +223 +00:16:16,270 --> 00:16:20,570 +بإيدي أمام العين السليمة طيب سكرنا أمام العين + +224 +00:16:20,570 --> 00:16:24,030 +السليمة و خلينا الطفل يتطلع ع target interesting + +225 +00:16:24,030 --> 00:16:29,430 +target بعد هيك أول ما بسكر العين السليمة بعمل + +226 +00:16:29,430 --> 00:16:33,460 +تقييم لل fixation في العين اللي فيها الحواربنقبل + +227 +00:16:33,460 --> 00:16:36,000 +إيش هو التقييم عبارة عن إيش؟ بده أقول هل هو + +228 +00:16:36,000 --> 00:16:40,120 +central؟fixation ولا non-central fixation يعني ضال + +229 +00:16:40,120 --> 00:16:44,140 +العين فيها حول ولا عدلت وصارت في ال center إذا + +230 +00:16:44,140 --> 00:16:47,460 +central fixation ولا non-central fixation هذا + +231 +00:16:47,460 --> 00:16:51,060 +النقطة النقطة التانية هل هو steady fixation ولا + +232 +00:16:51,060 --> 00:16:55,400 +unsteady fixation طبعا كيف أعرف steady ولا مش + +233 +00:16:55,400 --> 00:16:59,100 +steady يعني العين بترج ولا ثابتة باتجاه الضوء إذا + +234 +00:16:59,100 --> 00:17:02,980 +بتبع الضوء the corner reflection can be observed + +235 +00:17:03,430 --> 00:17:07,410 +طيب تالت شئ بده اعمله اذا اول حاجة قيمتها هل هو + +236 +00:17:07,410 --> 00:17:10,170 +فيه central fixation ولا مافيش central fixation + +237 +00:17:10,170 --> 00:17:14,030 +تاني حاجة steady fixation ولا unsteady fixation + +238 +00:17:14,030 --> 00:17:19,070 +يعني ثابت ولا مهتز تالت شئ بدي العين اللي غطيتها + +239 +00:17:19,070 --> 00:17:24,030 +اللي هي normal eye بدي ارفع الغط عنها ونشوفإيش + +240 +00:17:24,030 --> 00:17:28,290 +السيناريو اللي هيحجث عندى بعد ما رفعت الغطا عن + +241 +00:17:28,290 --> 00:17:31,990 +العين السليمة حقيقة في عندي تلت سيناريوهات بس قبل + +242 +00:17:31,990 --> 00:17:35,050 +ما نحكي هذه التلت سيناريوهات بدنا نروح نشوف + +243 +00:17:35,050 --> 00:17:39,050 +بالفيديو كيف الأمر هذا، نشوف قضية ال fixation + +244 +00:17:41,690 --> 00:17:46,070 +هذا مريض عنده left exotropia إذا ال normal eye + +245 +00:17:46,070 --> 00:17:49,010 +طبعا احنا بنحكي عن الأطفال هذا مريض بالغ بس هي .. + +246 +00:17:49,010 --> 00:17:54,010 +هيقدّي الفكرة و هيوصل الفكرة الآن هذا عنده left + +247 +00:17:54,010 --> 00:17:57,810 +exotropia ال squinting eye هي ال left eye و ال + +248 +00:17:57,810 --> 00:18:01,910 +straight eye أو ال fixating eye هي ال right eye + +249 +00:18:02,110 --> 00:18:05,750 +الان بدنا نشجع ال fixation في ال left eye بإننا + +250 +00:18:05,750 --> 00:18:09,270 +نغطي العين اليمين بإننا نغطي العين اليمين زي ما + +251 +00:18:09,270 --> 00:18:12,390 +بعد شوية هنشوف كيف هذا الكلام هيصير + +252 +00:18:19,860 --> 00:18:23,440 +الان عملنا cover للعين اليمين طبعا هو بتطلع target + +253 +00:18:23,440 --> 00:18:27,980 +إذا هنا عدّل أول حاجة أول حاجة بتقول هل هو central + +254 +00:18:27,980 --> 00:18:31,540 +fixation و لا مش central fixation طبعا النتيجة هنا + +255 +00:18:31,540 --> 00:18:34,500 +أمامي central fixation لأن العين سارت في النص تمام + +256 +00:18:34,500 --> 00:18:37,560 +و ال corneal light reflex صحيح جاي لفوق بس هو جاي + +257 +00:18:37,560 --> 00:18:42,020 +بالظبط ع جبال ال center بتاع ال corneaهل هدى + +258 +00:18:42,020 --> 00:18:47,180 +المريض لما أرفع الغطاء .. لما أرفع الغطاء .. طبعا + +259 +00:18:47,180 --> 00:18:50,840 +هنا central و steady يعني العين مابتهتزش .. العين + +260 +00:18:50,840 --> 00:18:55,300 +مابتهتزش مافيش stigma فيها أو حركات عشوائية فيها + +261 +00:18:55,300 --> 00:19:01,430 +.. كانت exo بمجرد مغطينا العينال normal eye او ال + +262 +00:19:01,430 --> 00:19:04,850 +straight eye طبعا هذه اللي عينها على السريع أخدت + +263 +00:19:04,850 --> 00:19:09,330 +ال fixation .. takes .. يعني takes up fixation + +264 +00:19:09,330 --> 00:19:13,730 +..بالتالي صارت تطلع ال target بقى سجل في ملف .. في + +265 +00:19:13,730 --> 00:19:18,390 +ملف المريض انه when covered the right eye the left + +266 +00:19:18,390 --> 00:19:23,520 +eyetalk fixation and it was central and steady + +267 +00:19:23,520 --> 00:19:26,140 +..central and steady ..central يعني جاي في النص + +268 +00:19:26,140 --> 00:19:30,100 +يعني العين مركزة تمام و steady يعني بدون ما يكون + +269 +00:19:30,100 --> 00:19:34,120 +فيه stigma أو حركات نكمل نشوف إيش اللي هيحصل معنا + +270 +00:19:43,290 --> 00:19:47,490 +الان بس نرفع الغطاء يا ترى إيش اللي هيصير معناه هل + +271 +00:19:47,490 --> 00:19:52,830 +هيظل مركز بعينه الشمال و .. ولا ع السريع التركيز + +272 +00:19:52,830 --> 00:19:55,790 +هيرجع لعينه اليمين و العين الشمال هترجع لوضعيتها + +273 +00:19:55,790 --> 00:19:59,610 +الأولى اللي هي X وهذا اللي هنشوفه بعد شوية .. هذا + +274 +00:19:59,610 --> 00:20:03,390 +اللي هنشوفه بعد شوية حقيقة لما بنرفع الغطاء قبل ما + +275 +00:20:03,390 --> 00:20:06,550 +نعرض الفيديو هيصير عندي سيناريوهات تلاتة .. عندي + +276 +00:20:06,550 --> 00:20:12,010 +سيناريوهات تلاتةهذه السيناريوهات التلاتة لما برفع + +277 +00:20:12,010 --> 00:20:15,510 +الغطة ممكن يظل عامل fixation في العين الـ + +278 +00:20:15,510 --> 00:20:18,610 +squinting eye و تكون تصير هادي ال squint ينتقل عن + +279 +00:20:18,610 --> 00:20:21,850 +ناحية التانية ساعتها بقول ال vision في العين + +280 +00:20:21,850 --> 00:20:25,790 +الشمال ال squinting eye good ليش good؟ لأنه لما + +281 +00:20:25,790 --> 00:20:29,170 +رفعت الغطة عن ال straight eye دلت هي اللي هي عاملة + +282 +00:20:29,170 --> 00:20:32,470 +fixation و ال straight eye صارت هي ال squinting + +283 +00:20:32,470 --> 00:20:36,970 +هذه نقطة طيب السيناريو التاني المحتملإنه يضلوا + +284 +00:20:36,970 --> 00:20:41,150 +يرمش في محاولة إنه يضلوا عامل fixation يضلوا يرمش + +285 +00:20:41,150 --> 00:20:46,710 +بعينيه عشان يحاول يضل يخلي العين ال straight اللي + +286 +00:20:46,710 --> 00:20:50,510 +هي العين الشمال straight يحاول بطريقة الترميش إنه + +287 +00:20:50,510 --> 00:20:54,330 +يوضح الصورة فيها أكتر وأكتر بنقول ساعتها ال vision + +288 +00:20:54,330 --> 00:20:58,310 +في ال left eye is probably goodالسيناريو الأول + +289 +00:20:58,310 --> 00:21:01,170 +قلنا good السيناريو التاني قلنا probably good + +290 +00:21:01,170 --> 00:21:05,110 +احتمال ان يكون النظر يعني لا بأس به ننساش ان هذا + +291 +00:21:05,110 --> 00:21:08,790 +ال test بنعمل عند اتفاق طيب لو احنا رفعنا الغطاء + +292 +00:21:08,790 --> 00:21:11,990 +السيناريو التالت والاخير رفعنا الغطاء و مجرد ما + +293 +00:21:11,990 --> 00:21:14,690 +رفعنا الغطاء عن ال normal eye رجعت هي تاخد ال + +294 +00:21:14,690 --> 00:21:17,510 +fixation وهذه رجعت لوضعية الحوار اللي كانت عليه + +295 +00:21:17,510 --> 00:21:21,430 +يعني لوضعية ال exo زي ما في ال video بيبين ساعتها + +296 +00:21:21,430 --> 00:21:25,210 +بنقول غالبا النظر في العين الشمال bad في غالبا + +297 +00:21:25,210 --> 00:21:30,100 +النظر badنشوف السيناريو هذا هنا الفيديو بيعدد + +298 +00:21:30,100 --> 00:21:33,740 +السيناريو رقم تلاتة السيناريو رقم تلاتة نشوف لما + +299 +00:21:33,740 --> 00:21:40,060 +بيرفع الغطاء ايش اللي حيصير طبعا لما حطينا الغطاء + +300 +00:21:40,060 --> 00:21:43,680 +اخدت fixation ال fixation قيمنا انه central و + +301 +00:21:43,680 --> 00:21:47,420 +steady central و steady الان نشوف الان بنرفع + +302 +00:21:47,420 --> 00:21:53,980 +الغطاء فورا ال fixation رجع لليمينرجع لليمين و + +303 +00:21:53,980 --> 00:21:57,620 +أصبحت الشمال في وضع ال ex و معناته اليمين هي + +304 +00:21:57,620 --> 00:22:01,920 +الأحسن في النظر و هذه النظر فيها سيئ نرجع بس مرة + +305 +00:22:01,920 --> 00:22:07,930 +تانية نشوف هذه القضية عشان بس يعني ..ع السريع مجرد + +306 +00:22:07,930 --> 00:22:12,130 +ما رفعنا الغطاء اللي رجع عمل fixation هو ال right + +307 +00:22:12,130 --> 00:22:16,330 +eye و أصبحت الشمال في وضع ال exo معناته هذه ال + +308 +00:22:16,330 --> 00:22:20,330 +vision فيها bad ال vision فيها bad على قضية ال + +309 +00:22:20,330 --> 00:22:24,690 +steady و ال unsteady fixation هنشوف فيديو بعد شوية + +310 +00:22:24,690 --> 00:22:29,010 +بيوضح قضية ال unsteady fixation unsteady fixation + +311 +00:22:33,090 --> 00:22:36,710 +طبعا لو ال scenario ضال انه .. لو ال scenario ضال + +312 +00:22:36,710 --> 00:22:41,070 +.. لو ال scenario ضال انه بمجرد ما رفعنا الغطاء ان + +313 +00:22:41,070 --> 00:22:43,810 +العين الشمال دلت عاملة fixation زي ما هذه اللحظة + +314 +00:22:43,810 --> 00:22:47,370 +بتبين و العين اليمين اللي هي ال normal eye صارت في + +315 +00:22:47,370 --> 00:22:50,570 +وضع ال exo ممكن سان يقول ليش في وضع ال exo لأن هذه + +316 +00:22:50,570 --> 00:22:54,020 +لما بتعدل من ال exo لل straightحسب hearing loss + +317 +00:22:54,020 --> 00:22:56,840 +هذه هتروح في نفس الاتجاه هذه راحت باتجاه اليمين + +318 +00:22:56,840 --> 00:23:00,620 +فهذه هتتحول ل exo فبالتالي ضروري جدا نفهم هذه + +319 +00:23:00,620 --> 00:23:05,540 +القضية نشوف لو ضلت زي هيك يقولنا ال vision is good + +320 +00:23:05,540 --> 00:23:09,020 +لو ضلت زي هيك يقولنا ال vision is good بس هي للأسف + +321 +00:23:09,020 --> 00:23:13,720 +أول ما رفعنا الغطاء عن العين اليمين اتحركت ورجعت + +322 +00:23:13,720 --> 00:23:18,120 +لوضعية ال exo اللي كانت عليه قبل ذلك قبل ذلك + +323 +00:23:23,860 --> 00:23:28,800 +لشيء جديد هنا بدنا احنا هنشوف فيديو اخر اللي هو + +324 +00:23:28,800 --> 00:23:35,240 +يوضح لل unsteady fixation بس هنمثله بفيديو مقارب + +325 +00:24:05,580 --> 00:24:09,820 +طيب اذا if fixation immediately بعد ما نرفع الغطاء + +326 +00:24:09,820 --> 00:24:13,460 +عن ال straight eye if fixation immediately returns + +327 +00:24:13,460 --> 00:24:16,740 +to the uncovered eye then visual acuity is + +328 +00:24:16,740 --> 00:24:20,100 +probably impaired زي ما حصل معنا في الفيديو بمجرد + +329 +00:24:20,100 --> 00:24:24,280 +ما رفعنا الغطاء عن العين اليمين ال .. ال .. ال .. + +330 +00:24:24,410 --> 00:24:27,130 +الـ fixation رجع للعين اليمين اللي هي السليمة و ال + +331 +00:24:27,130 --> 00:24:30,010 +exo رجعت في العين الشمال إذا العين الشمال probably + +332 +00:24:30,010 --> 00:24:34,330 +impaired vision if fixation is maintained إذا دلت + +333 +00:24:34,330 --> 00:24:37,410 +العين الشمال مركزة زي ما المثال بتاعنا بيحكي أن + +334 +00:24:37,410 --> 00:24:40,130 +العين الشمال هي اللي فيها المشكلة through a blink + +335 +00:24:40,130 --> 00:24:44,250 +then visual acuity is probably goodif patient + +336 +00:24:44,250 --> 00:24:47,470 +alternates fixation إذا مرة بيركز باليمين و برة + +337 +00:24:47,470 --> 00:24:50,810 +بيركز بالإشمال بعد ما فتحنا الانتين then the two + +338 +00:24:50,810 --> 00:24:53,450 +eyes have equal vision يعني إذا عندي حتى تلات + +339 +00:24:53,450 --> 00:24:57,290 +سيناريوهات ممكن هذا بيبين بعد ما أرفع الغطا عن ال + +340 +00:24:57,290 --> 00:25:00,170 +straight eye بعد ما أرفع الغطا عن ال straight eye + +341 +00:25:00,170 --> 00:25:08,310 +نشوف هنا لسه لحد تلان ما فيش response لأ هاي هو + +342 +00:25:08,310 --> 00:25:09,230 +اللي اشتغل + +343 +00:25:11,750 --> 00:25:14,830 +هنشوف موضوع ال unsteady fixation ال unsteady + +344 +00:25:14,830 --> 00:25:19,570 +fixation أول + +345 +00:25:19,570 --> 00:25:22,590 +ما غطينا إحدى العينتين صار هذا unsteady fixation + +346 +00:25:22,590 --> 00:25:28,040 +العين بتهتز هذا بيسموه latent stagmasهنا مافيه + +347 +00:25:28,040 --> 00:25:31,540 +اهتزاز تقريبا اول ما اغطينا احدى العين تانى هذا + +348 +00:25:31,540 --> 00:25:35,540 +يسمى .. صحيح انه central بس unsteady fixation + +349 +00:25:35,540 --> 00:25:39,300 +ضروري جدا لما بعمل occlusion ل one eye عند الطفل + +350 +00:25:39,300 --> 00:25:42,780 +بدأ اقيم النظر اشوف العين التانية هيك هقول central + +351 +00:25:42,780 --> 00:25:45,460 +unsteady .. central unsteady اذا صار معايا + +352 +00:25:45,460 --> 00:25:49,140 +السيناريو اللي احنا شايفينهالان و اللي هو واضح جدا + +353 +00:25:49,140 --> 00:25:55,100 +انه عندي صحيح central light reflex بس ال .. ال .. + +354 +00:25:55,100 --> 00:25:59,560 +ال fixation مش steady مش steady نيجي احنا نكمل + +355 +00:25:59,560 --> 00:26:05,540 +بنقول تالي او رابع test the 10-prism test is + +356 +00:26:05,540 --> 00:26:09,000 +similar and can be used regardless of whether a + +357 +00:26:09,000 --> 00:26:12,700 +manifest squint is present يعني ال 10-prism test + +358 +00:26:12,700 --> 00:26:21,200 +يستخدم كتقييم لحدة الإبصارو سواء الطفل اللي هو ال + +359 +00:26:21,200 --> 00:26:24,800 +pre-verbal اللي مابينطقش سواء عنده حول أو عينيه + +360 +00:26:24,800 --> 00:26:28,620 +straight بس مجرد بدنا نقيم حدة الإبصار عنده كيف + +361 +00:26:28,620 --> 00:26:32,180 +بينعمل هذا ال test it involves the promotion of + +362 +00:26:32,180 --> 00:26:36,860 +diplopia بتأحدث diplopia عند الطفل باستعمال ten + +363 +00:26:36,860 --> 00:26:42,100 +prism vertical orientation ten prism diopter test + +364 +00:26:42,500 --> 00:26:45,680 +Alternation between diplopic targets suggests + +365 +00:26:45,680 --> 00:26:50,140 +equal visual acuity لما بنشوف هذا المنظر أنا عارض + +366 +00:26:50,140 --> 00:26:53,680 +للطفل أمامه بالضبط target زي ال targets اللي احنا + +367 +00:26:53,680 --> 00:27:00,560 +حكينا عنها قبل شوية هذه ال targets و لما أنا بحط + +368 +00:27:00,560 --> 00:27:05,870 +قدام إحدى العنتينلما بحط قدام إحدى العين تان تان + +369 +00:27:05,870 --> 00:27:08,990 +بريزم ديوبتر vertical orientation سواء based down + +370 +00:27:08,990 --> 00:27:11,390 +زي ما الصورة هاي بتورجيني أو based up بالمهم + +371 +00:27:11,390 --> 00:27:15,090 +vertical ليش vertical؟ عشان أحدث دبلوب يعنو ال .. + +372 +00:27:15,090 --> 00:27:18,450 +ال .. تان بريزم لو حطيتها horizontal ما بتكفيش + +373 +00:27:18,450 --> 00:27:22,290 +لإحداث دبلوب يعنو ال fusional vergence ال vertical + +374 +00:27:23,660 --> 00:27:27,060 +الدماغ الإنسان بتتحمل من اتنين لتلاتة Prism أكتر + +375 +00:27:27,060 --> 00:27:30,720 +من هيك هيصير عندي الشيء كإني أحدثت vertical + +376 +00:27:30,720 --> 00:27:34,460 +diplopia طيب، الآن إيش ال response بتاع الطفل + +377 +00:27:34,460 --> 00:27:39,560 +بقيمه؟ بقيم ال response بتاع الطفل حطينا التن + +378 +00:27:39,560 --> 00:27:45,640 +Prism، هيصير الطفل يشوف double vision الصورة اللي + +379 +00:27:45,640 --> 00:27:48,920 +تحت العين الشمال، بما أنه based down، هتكون جاية + +380 +00:27:48,920 --> 00:27:53,190 +لفوقالصورة الأعلى بتشوفها العين الشمال لنفس ال + +381 +00:27:53,190 --> 00:27:56,990 +target والصورة اللي دُغري مستقيمة هيشوفها العين + +382 +00:27:56,990 --> 00:28:00,030 +اليمين إذا دل يتطلع بالشكل هذا معناته هو جاعت + +383 +00:28:00,030 --> 00:28:04,380 +بيستخدم عينه اليمين لأن عينيه ما يطلعوا لأعلىعشان + +384 +00:28:04,380 --> 00:28:07,860 +يتطلع صورة العين الي شمال هو هيشوفها لأعلى لإن ال + +385 +00:28:07,860 --> 00:28:11,160 +prism ال apex بتاعته لأعلى دايما الصورة بتتجه + +386 +00:28:11,160 --> 00:28:15,040 +باتجاه ال apex بتاعت ال prism إذا ضال ال scenario + +387 +00:28:15,040 --> 00:28:18,580 +زي هيك معناته الطفل بيستخدم عينه اليمين و بيستخدمش + +388 +00:28:18,580 --> 00:28:21,580 +عينه الشمال لإن لو بيستخدم عينه الشمال المفروض + +389 +00:28:21,580 --> 00:28:25,680 +يتطلع لفوقالسيناريو التاني ال .. ال .. ال result + +390 +00:28:25,680 --> 00:28:29,000 +التاني اللي possible أنه يصير يتطلع لفوق، معناته + +391 +00:28:29,000 --> 00:28:31,820 +هو بيستخدمش عينه اليمين، بيركزش بعينه اليمين، هو + +392 +00:28:31,820 --> 00:28:35,320 +بيركز بعينه الشمال، فعينه الشمال الصورة بالنسبة + +393 +00:28:35,320 --> 00:28:38,820 +إليها طلعت لفوق، لأن ال apex بتاعة ال prism لفوق، + +394 +00:28:38,820 --> 00:28:42,770 +طيب و العين اليمين ليش طلعت لفوق؟طالما بيشوفش فيها + +395 +00:28:42,770 --> 00:28:46,230 +حسب hearing load طالما هاي طلعت معناته هادي هتطلع + +396 +00:28:46,230 --> 00:28:49,530 +معاه طيب إذا ال scenario الأول بيقوللي أنه العين + +397 +00:28:49,530 --> 00:28:52,930 +اليمين هي اللي شغالة ال scenario التاني العين + +398 +00:28:52,930 --> 00:28:56,210 +الشمال هي الشغالة لو الطفل لاحظ أنه مرة بتطلع + +399 +00:28:56,210 --> 00:28:59,770 +دُغري و مرة بتطلع لفوق بعينيتين تان يعني مرة هذا + +400 +00:28:59,770 --> 00:29:02,250 +ال scenario و بعد لحظة هذا ال scenario و بيرجع + +401 +00:29:02,250 --> 00:29:06,120 +بعدكللسيناريو الأول برجع بعدك للسيناريو التاني + +402 +00:29:06,120 --> 00:29:09,560 +ببدل بين السيناريوين معناته عنده equal vision + +403 +00:29:09,560 --> 00:29:13,580 +between the two eyes اذا alternation between the + +404 +00:29:13,580 --> 00:29:17,540 +diplopic targets suggest equal visual acuity جداش + +405 +00:29:17,540 --> 00:29:20,440 +ما بنقدرش نقول جداش بس بنقدر نقول ان ال vision في + +406 +00:29:20,440 --> 00:29:24,560 +العين تاني تقريبا متساوي تقريبا متساوي وطبعا هذا + +407 +00:29:24,560 --> 00:29:29,560 +يعتبر qualitative test qualitative test الان ال + +408 +00:29:29,560 --> 00:29:36,470 +test رقم خمسة وستةو سبعة هيكون في المحاضرة التالية + +409 +00:29:36,470 --> 00:29:39,770 +ان شاء الله تعالى ويعطيكم العافية والسلام عليكم + +410 +00:29:39,770 --> 00:29:41,790 +ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/I-j76JXQmsQ_raw.json 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0.9150390625}, {"start": 1227.49, "end": 1227.85, "word": " eye", "probability": 0.92724609375}, {"start": 1227.85, "end": 1228.31, "word": " دلت", "probability": 0.7061767578125}, {"start": 1228.31, "end": 1228.57, "word": " هي", "probability": 0.322021484375}, {"start": 1228.57, "end": 1228.73, "word": " اللي", "probability": 0.9677734375}, {"start": 1228.73, "end": 1228.89, "word": " هي", "probability": 0.68505859375}, {"start": 1228.89, "end": 1229.17, "word": " عاملة", "probability": 0.9869791666666666}, {"start": 1229.17, "end": 1229.75, "word": " fixation", "probability": 0.953857421875}, {"start": 1229.75, "end": 1229.89, "word": " و", "probability": 0.478515625}, {"start": 1229.89, "end": 1229.97, "word": " ال", "probability": 0.875}, {"start": 1229.97, "end": 1230.29, "word": " straight", "probability": 0.94091796875}, {"start": 1230.29, "end": 1230.63, "word": " eye", "probability": 0.93603515625}, {"start": 1230.63, "end": 1231.35, "word": " صارت", "probability": 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الشمال straight يحاول بطريقة الترميش إنه يوضح الصورة فيها أكتر وأكتر بنقول ساعتها ال vision في ال left eye is probably good", "tokens": [28814, 1863, 3224, 7251, 11242, 1211, 14407, 7251, 2288, 2304, 8592, 8978, 3714, 5016, 995, 12610, 3660, 36145, 3224, 7251, 11242, 1211, 14407, 6225, 10943, 1211, 3191, 399, 7251, 11242, 1211, 14407, 7251, 2288, 2304, 8592, 45030, 9957, 1829, 3224, 6225, 8592, 7649, 7251, 5016, 995, 12610, 7251, 11242, 1211, 7251, 9778, 20292, 18863, 9957, 2423, 2997, 13672, 1829, 39896, 18863, 9957, 25124, 2304, 6027, 2997, 7251, 5016, 995, 12610, 4724, 9566, 16572, 28671, 16712, 2288, 2304, 1829, 8592, 36145, 3224, 7251, 2407, 11242, 5016, 31767, 13063, 3660, 8978, 11296, 5551, 4117, 2655, 2288, 36725, 4117, 2655, 2288, 44945, 39648, 8608, 995, 34268, 11296, 2423, 5201, 8978, 2423, 1411, 3313, 307, 1391, 665], "avg_logprob": -0.1144462707534171, "compression_ratio": 1.8224299065420562, "no_speech_prob": 1.4901161193847656e-06, "words": [{"start": 1236.13, "end": 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"probability": 0.60693359375}, {"start": 1248.31, "end": 1248.83, "word": " يحاول", "probability": 0.96240234375}, {"start": 1248.83, "end": 1249.77, "word": " بطريقة", "probability": 0.861083984375}, {"start": 1249.77, "end": 1250.27, "word": " الترميش", "probability": 0.98818359375}, {"start": 1250.27, "end": 1250.51, "word": " إنه", "probability": 0.808837890625}, {"start": 1250.51, "end": 1250.89, "word": " يوضح", "probability": 0.9681396484375}, {"start": 1250.89, "end": 1251.29, "word": " الصورة", "probability": 0.98486328125}, {"start": 1251.29, "end": 1251.51, "word": " فيها", "probability": 0.994384765625}, {"start": 1251.51, "end": 1251.91, "word": " أكتر", "probability": 0.964111328125}, {"start": 1251.91, "end": 1252.27, "word": " وأكتر", "probability": 0.93115234375}, {"start": 1252.27, "end": 1252.71, "word": " بنقول", "probability": 0.667724609375}, {"start": 1252.71, "end": 1253.63, "word": " ساعتها", "probability": 0.9747314453125}, {"start": 1253.63, "end": 1253.93, "word": " ال", "probability": 0.93603515625}, {"start": 1253.93, "end": 1254.33, "word": " vision", "probability": 0.92431640625}, {"start": 1254.33, "end": 1254.55, "word": " في", "probability": 0.91845703125}, {"start": 1254.55, "end": 1254.69, "word": " ال", "probability": 0.8203125}, {"start": 1254.69, "end": 1254.93, "word": " left", "probability": 0.95556640625}, {"start": 1254.93, "end": 1255.29, "word": " eye", "probability": 0.90625}, {"start": 1255.29, "end": 1255.59, "word": " is", "probability": 0.96240234375}, {"start": 1255.59, "end": 1256.35, "word": " probably", "probability": 0.962890625}, {"start": 1256.35, "end": 1256.87, "word": " good", "probability": 0.93701171875}], "temperature": 1.0}, {"id": 61, "seek": 128617, "start": 1257.35, "end": 1286.17, "text": "السيناريو الأول قلنا good السيناريو التاني قلنا probably good احتمال ان يكون النظر يعني لا بأس به ننساش ان هذا ال test بنعمل عند اتفاق طيب لو احنا رفعنا الغطاء السيناريو التالت والاخير رفعنا الغطاء و مجرد ما رفعنا الغطاء عن ال normal eye رجعت هي تاخد ال fixation وهذه رجعت لوضعية الحوار اللي كانت عليه يعني لوضعية ال exo زي ما في ال video بيبين ساعتها بنقول غالبا النظر في العين الشمال bad في غالبا النظر bad", "tokens": [6027, 3794, 1829, 8315, 16572, 2407, 16247, 12610, 12174, 1211, 8315, 665, 21136, 1829, 8315, 16572, 2407, 16712, 7649, 1829, 12174, 1211, 8315, 1391, 665, 1975, 33753, 2304, 6027, 16472, 7251, 30544, 28239, 19913, 2288, 37495, 22653, 20193, 4724, 10721, 3794, 39627, 8717, 1863, 3794, 33599, 16472, 23758, 2423, 1500, 44945, 25957, 1211, 43242, 1975, 2655, 5172, 995, 4587, 23032, 1829, 3555, 45164, 1975, 5016, 8315, 12602, 5172, 3615, 8315, 6024, 118, 9566, 16606, 21136, 1829, 8315, 16572, 2407, 16712, 6027, 2655, 16070, 47283, 13546, 12602, 5172, 3615, 8315, 6024, 118, 9566, 16606, 4032, 3714, 7435, 2288, 3215, 19446, 12602, 5172, 3615, 8315, 6024, 118, 9566, 16606, 18871, 2423, 2710, 3313, 12602, 7435, 34268, 39896, 6055, 47283, 3215, 2423, 3191, 399, 37037, 24192, 12602, 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التاني", "probability": 0.9142252604166666}, {"start": 1260.05, "end": 1260.31, "word": " قلنا", "probability": 0.96240234375}, {"start": 1260.31, "end": 1260.89, "word": " probably", "probability": 0.88671875}, {"start": 1260.89, "end": 1261.17, "word": " good", "probability": 0.61328125}, {"start": 1261.17, "end": 1261.63, "word": " احتمال", "probability": 0.9224853515625}, {"start": 1261.63, "end": 1261.73, "word": " ان", "probability": 0.387451171875}, {"start": 1261.73, "end": 1262.01, "word": " يكون", "probability": 0.772705078125}, {"start": 1262.01, "end": 1262.43, "word": " النظر", "probability": 0.9739583333333334}, {"start": 1262.43, "end": 1262.73, "word": " يعني", "probability": 0.857177734375}, {"start": 1262.73, "end": 1262.97, "word": " لا", "probability": 0.806640625}, {"start": 1262.97, "end": 1263.35, "word": " بأس", "probability": 0.9659830729166666}, {"start": 1263.35, "end": 1263.95, "word": " به", "probability": 0.44921875}, {"start": 1263.95, "end": 1264.67, 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1268.79, "word": " الغطاء", "probability": 0.8790283203125}, {"start": 1268.79, "end": 1269.29, "word": " السيناريو", "probability": 0.904296875}, {"start": 1269.29, "end": 1269.69, "word": " التالت", "probability": 0.9615885416666666}, {"start": 1269.69, "end": 1270.19, "word": " والاخير", "probability": 0.7853190104166666}, {"start": 1270.19, "end": 1270.57, "word": " رفعنا", "probability": 0.9586181640625}, {"start": 1270.57, "end": 1271.03, "word": " الغطاء", "probability": 0.9866943359375}, {"start": 1271.03, "end": 1271.45, "word": " و", "probability": 0.6953125}, {"start": 1271.45, "end": 1271.89, "word": " مجرد", "probability": 0.91943359375}, {"start": 1271.89, "end": 1271.99, "word": " ما", "probability": 0.9013671875}, {"start": 1271.99, "end": 1272.39, "word": " رفعنا", "probability": 0.9937744140625}, {"start": 1272.39, "end": 1272.75, "word": " الغطاء", "probability": 0.962158203125}, {"start": 1272.75, "end": 1272.91, "word": " عن", "probability": 0.96142578125}, {"start": 1272.91, "end": 1273.03, "word": " ال", "probability": 0.94384765625}, {"start": 1273.03, "end": 1273.31, "word": " normal", "probability": 0.76904296875}, {"start": 1273.31, "end": 1273.59, "word": " eye", "probability": 0.4306640625}, {"start": 1273.59, "end": 1274.01, "word": " رجعت", "probability": 0.9866536458333334}, {"start": 1274.01, "end": 1274.17, "word": " هي", "probability": 0.88916015625}, {"start": 1274.17, "end": 1274.57, "word": " تاخد", "probability": 0.98046875}, {"start": 1274.57, "end": 1274.69, "word": " ال", "probability": 0.9423828125}, {"start": 1274.69, "end": 1275.19, "word": " fixation", "probability": 0.93310546875}, {"start": 1275.19, "end": 1275.45, "word": " وهذه", "probability": 0.710693359375}, {"start": 1275.45, "end": 1275.87, "word": " رجعت", "probability": 0.9886067708333334}, {"start": 1275.87, "end": 1276.39, "word": " لوضعية", "probability": 0.74423828125}, {"start": 1276.39, "end": 1276.77, "word": " الحوار", "probability": 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fixation أول ما غطينا إحدى العينتين صار هذا unsteady fixation العين بتهتز هذا بيسموه latent stagmas", "tokens": [3224, 1863, 8592, 38688, 3714, 2407, 11242, 45367, 2423, 18799, 2056, 88, 3191, 399, 2423, 18799, 2056, 88, 3191, 399, 5551, 12610, 19446, 32771, 9566, 1829, 8315, 11933, 24401, 7578, 18863, 9957, 2655, 9957, 20328, 9640, 23758, 18799, 2056, 88, 3191, 399, 18863, 9957, 39894, 3224, 2655, 11622, 23758, 4724, 1829, 38251, 2407, 3224, 48994, 342, 559, 3799], "avg_logprob": -0.24496821579286607, "compression_ratio": 1.474820143884892, "no_speech_prob": 0.0, "words": [{"start": 1511.75, "end": 1512.11, "word": "هنشوف", "probability": 0.7259674072265625}, {"start": 1512.11, "end": 1512.49, "word": " موضوع", "probability": 0.95703125}, {"start": 1512.49, "end": 1512.65, "word": " ال", "probability": 0.8876953125}, {"start": 1512.65, "end": 1513.39, "word": " unsteady", "probability": 0.77685546875}, {"start": 1513.39, "end": 1514.13, "word": " fixation", "probability": 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"start": 1622.93, "end": 1642.29, "text": "لما بحط قدام إحدى العين تان تان بريزم ديوبتر vertical orientation سواء based down زي ما الصورة هاي بتورجيني أو based up بالمهم vertical ليش vertical؟ عشان أحدث دبلوب يعنو ال .. ال .. تان بريزم لو حطيتها horizontal ما بتكفيش لإحداث دبلوب يعنو ال fusional vergence ال vertical", "tokens": [1211, 15042, 4724, 5016, 9566, 12174, 3215, 10943, 11933, 24401, 7578, 18863, 9957, 6055, 7649, 6055, 7649, 4724, 16572, 11622, 2304, 11778, 1829, 37746, 2655, 2288, 9429, 14764, 8608, 2407, 16606, 2361, 760, 30767, 1829, 19446, 31767, 13063, 3660, 8032, 47302, 39894, 13063, 7435, 9957, 1829, 34051, 2361, 493, 20666, 2304, 16095, 9429, 32239, 8592, 9429, 22807, 6225, 8592, 7649, 5551, 24401, 12984, 11778, 36150, 37746, 37495, 1863, 2407, 2423, 4386, 2423, 4386, 6055, 7649, 4724, 16572, 11622, 2304, 45164, 11331, 9566, 36081, 11296, 12750, 19446, 39894, 4117, 41185, 8592, 5296, 28814, 24401, 5718, 104, 11778, 36150, 37746, 37495, 1863, 2407, 2423, 23100, 304, 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عندهم لإنه + +6 +00:00:30,070 --> 00:00:35,070 +فيها نوعا ما صعوبة و الطفل غالبا بيكون غير متعاون + +7 +00:00:35,070 --> 00:00:40,420 +إلا إنه باتباع بعض الفحوصاتاللي هنسردها في + +8 +00:00:40,420 --> 00:00:44,640 +المحاطرة هناجي أنه الأمر ليس بالصعوبة الشديدة + +9 +00:00:44,640 --> 00:00:52,860 +وإنما يعني شيء ممكن أدائه وبإتقان أيضا أول شيء + +10 +00:00:52,860 --> 00:00:58,340 +لازم نفرج بين حاجة بنسميها qualitative assessment + +11 +00:00:58,340 --> 00:01:02,860 +of visual behavior و quantitative assessment of + +12 +00:01:02,860 --> 00:01:06,700 +visual acuity quantitative assessment of visual + +13 +00:01:06,700 --> 00:01:12,150 +acuity التقييم الكمالكم لحدة الإبصار يعني لازم في + +14 +00:01:12,150 --> 00:01:16,490 +نهاية هذا التقييم أو هذا ال test اقول 6 ع جديش او + +15 +00:01:16,490 --> 00:01:21,130 +جديش من عشرة او باللغة باللغ مارت شارت جديش تساوي + +16 +00:01:21,130 --> 00:01:25,130 +حدة الإبصار يعني في عندي كام بدي انا ابينه في ملف + +17 +00:01:25,130 --> 00:01:29,090 +المريض و احكي مثلا المريض بيشوف 6 على 12 هذا يسمى + +18 +00:01:29,090 --> 00:01:33,590 +quantitative assessment of visual acuity يعني في + +19 +00:01:33,590 --> 00:01:39,160 +نهاية ال test او اي test من التستات الليبتندرج تحت + +20 +00:01:39,160 --> 00:01:44,060 +هذه ال .. تحت هذا العنوان لازم في نهايته أعطي كام + +21 +00:01:44,060 --> 00:01:48,620 +أو أعطي قيمة لل visual acuity في عندي مجموعة من + +22 +00:01:48,620 --> 00:01:53,300 +الفحوصات ب .. بنهاية الفحص ما بعطي أنا كام وإنما + +23 +00:01:53,300 --> 00:01:57,360 +بعطي qualitative assessment of visual behavior + +24 +00:01:57,360 --> 00:02:03,280 +يعني تقييم نوعي للسلوك البصري تقييم نوعي للسلوك + +25 +00:02:03,280 --> 00:02:07,700 +البصريالآن إذا أنا بدأ أحاول أجيب طفل صغير a pre + +26 +00:02:07,700 --> 00:02:12,840 +verbal child يعني لسه ما بدأ يتكلم طفل في مرحلة ما + +27 +00:02:12,840 --> 00:02:17,020 +قبل الكلام و أجي أخدعه للحصات بتاعة المجموعة + +28 +00:02:17,020 --> 00:02:19,920 +التانية ليه quantitative assessment of visual + +29 +00:02:19,920 --> 00:02:24,800 +acuity بكون أنا مجرد بضيع الوقتليش؟ لأنه الطفل ما + +30 +00:02:24,800 --> 00:02:30,760 +بيتكلم .. يعني كل اللوحات تقييم النظر سواء ال + +31 +00:02:30,760 --> 00:02:34,400 +Snelling أو ال Gemar Chart او .. Chart او اي شيء + +32 +00:02:34,400 --> 00:02:38,620 +او ال .. ال .. Landolt Broking Rings او ما شابه .. + +33 +00:02:38,620 --> 00:02:41,980 +الطفل مش هيتعاون معاه أبدا عشان يجاوب على هذه + +34 +00:02:41,980 --> 00:02:45,430 +القضيةأو على الأسئلة اللي بوجهها إليه أو على + +35 +00:02:45,430 --> 00:02:49,090 +الإشارات اللي أنا بأشر عليها عشان هو يستجيب إليها + +36 +00:02:49,090 --> 00:02:53,250 +لأنه مابيتكلم فبالتالي الأطفال اللي في مرحلة ما + +37 +00:02:53,250 --> 00:02:58,410 +قبل الكلام بيخضعوا لفحص أو أكتر من الفحوصات + +38 +00:02:58,410 --> 00:03:02,790 +المندرجة تحت العنوان الأول اللي هو التقييم التقييم + +39 +00:03:02,790 --> 00:03:06,790 +النوعي qualitative assessmentof visual behavior + +40 +00:03:06,790 --> 00:03:11,930 +لسلوك البصري، هل سلوكه البصري مرضى ولا متوسط الحال + +41 +00:03:11,930 --> 00:03:16,190 +ولا سلوكه البصري غير مرضى، يعني في مشكلة في + +42 +00:03:16,190 --> 00:03:19,730 +الإبصار عنده؟ طبعا ممكن الأهل يسألوا يعني جديش + +43 +00:03:19,730 --> 00:03:24,280 +الإبن أو البنت بيشوففلازم احنا نكون واضحين من + +44 +00:03:24,280 --> 00:03:27,660 +البداية انه في عمر ما قبل الكلام، يعني مرحلة عمر + +45 +00:03:27,660 --> 00:03:32,040 +سنة، تسع شهور، سنة و شهرين، سنة و نصر، لسه تخيل ما + +46 +00:03:32,040 --> 00:03:36,200 +بيتكلم، ما بقدر انا افحصه بالفحوصات اللي انا ب .. + +47 +00:03:36,200 --> 00:03:40,700 +ب .. بقيم فيها حدة الإبصار لدى الأطفال الأكبر سنا + +48 +00:03:40,700 --> 00:03:45,080 +لو سن سن اربع سنوات او خمس سنوات او افحصه + +49 +00:03:45,080 --> 00:03:49,550 +بالفحوصات اللي انا بفحص فيها الناس البالغةفبالتالي + +50 +00:03:49,550 --> 00:03:53,890 +ضروري جدا هذه القضية تكون واضحة using preferential + +51 +00:03:53,890 --> 00:03:57,170 +looking tests assessment of visual behavior is + +52 +00:03:57,170 --> 00:03:59,970 +achieved as follows هنبدأ بال qualitative + +53 +00:04:01,450 --> 00:04:04,890 +assessment of visual behavior يعني تقييم السلوك + +54 +00:04:04,890 --> 00:04:09,330 +البصري بعدة فحوصات بسيطة بس ضروري انه احنا يعني + +55 +00:04:09,330 --> 00:04:14,210 +نحاول ننفذ اكبر عدد ممكن منها نشوف ايش الفحص الاول + +56 +00:04:14,210 --> 00:04:18,470 +الفحص الاول بيسموه fixation and following fixation + +57 +00:04:18,470 --> 00:04:22,170 +يعني هل الطفل بيثبت نظره ع target معين لما اعرضله + +58 +00:04:22,170 --> 00:04:26,630 +target معين وهل بيتبع هذا ال target ولا لاmay be + +59 +00:04:26,630 --> 00:04:30,270 +assessed using bright attention grabbing target + +60 +00:04:30,810 --> 00:04:35,110 +وغالبا بيكون ال face is often pissed this method + +61 +00:04:35,110 --> 00:04:38,950 +indicates whether the infant is visually alert and + +62 +00:04:38,950 --> 00:04:42,770 +is of particular value in a child suspected of + +63 +00:04:42,770 --> 00:04:45,670 +blindness ما معنى كل هذا الكلام اللي احنا ذكرنا + +64 +00:04:45,670 --> 00:04:50,910 +اول حاجة بنقول هذه الطريقة احنا بنتبعها عشان نشوف + +65 +00:04:50,910 --> 00:04:55,570 +هل الرضيع الطفل الرضيع هل هو منتبه بصريا يعني في + +66 +00:04:55,570 --> 00:05:00,440 +أشياء تجذب انتباهه بصريالما أعرضها أمامه target + +67 +00:05:00,440 --> 00:05:04,640 +باعرضه أمامه طبعا ال target بدي يكون bright واضح + +68 +00:05:04,640 --> 00:05:11,000 +.. واضح قابل إنه ينمسك grabbing target وغالبا إذا + +69 +00:05:11,000 --> 00:05:15,320 +كان في صورة وجه بيكون أفضل .. بيكون أفضل هنعرض بعض + +70 +00:05:15,320 --> 00:05:19,280 +ال targets بعد شوية بنقول أمتى أنا بستعمل هذا ال + +71 +00:05:19,280 --> 00:05:22,840 +test ممكن أستعمله عند أي طفل pre verbal لم ينطق + +72 +00:05:22,840 --> 00:05:27,950 +بعدو بالذات هذا ال test هيفيدني كتير عشان الطفل + +73 +00:05:27,950 --> 00:05:32,090 +اللي أهله متوقعين أنه في عنده يعني a blindness + +74 +00:05:32,090 --> 00:05:36,190 +يعني مابشوفش بالمرة إذا أنا أثبتلهم أن الطفل بقدر + +75 +00:05:36,190 --> 00:05:39,950 +يعمل fixation and following يعني بقدر يعمل + +76 +00:05:39,950 --> 00:05:45,420 +fixation على ال target اللي أنابعرضه أمامه و بيقدر + +77 +00:05:45,420 --> 00:05:49,140 +يتبعه لو حركت انا ال target هدأ في اتجاهات مختلفة + +78 +00:05:49,140 --> 00:05:52,980 +من الفرق و تبعه ببصره معناته هو شايف هذا ال target + +79 +00:05:52,980 --> 00:05:57,220 +فساعتها بيقولش عن هذا الطفل انه أعمى بالكامل و + +80 +00:05:57,220 --> 00:06:01,420 +انما انه منتبه بصري .. منتبه بصري يعني يا ترى ايش + +81 +00:06:01,420 --> 00:06:04,840 +ال targets اللي ممكن تستعمل؟ في عندي targets لا + +82 +00:06:04,840 --> 00:06:10,880 +حصرة لها حقيقة و ممكن بعض يعني كل إنسانمنها انه + +83 +00:06:10,880 --> 00:06:16,660 +يعني يعمله او يجهزه في البيت بشكل سريع وبشكل يعني + +84 +00:06:16,660 --> 00:06:21,480 +يكون جذاب للطفل يعني هنا عندنا صورة face تمام .. + +85 +00:06:21,480 --> 00:06:27,430 +تمام هنا عندنا صورة دفضع او هنا .. هنا يعني ..مجسم + +86 +00:06:27,430 --> 00:06:32,490 +لكلب صغير، مجسم لسفينة وما إلى ذلك، هنا صورة + +87 +00:06:32,490 --> 00:06:36,550 +عصفور، يعني لا حصرة لها عدد ال targets اللي ممكن + +88 +00:06:36,550 --> 00:06:40,810 +أعملها و أعرضها أمام الطفل، ضروري جدا ما أستخدمش + +89 +00:06:40,810 --> 00:06:46,030 +أصوات مثل الصفير أو الخرخشة أو ما شابهعشان ينتبه + +90 +00:06:46,030 --> 00:06:50,610 +الطفل باتجاهي لأن ساعتها انا مش هاعرف هل الطفل + +91 +00:06:50,610 --> 00:06:55,250 +منتبه للصوت ولا للصورة احنا بنفحص نظر اذا احنا + +92 +00:06:55,250 --> 00:07:00,290 +بدنا نلغي قضية الصوت فبالتالي طبعا بعض التطبيقات + +93 +00:07:00,290 --> 00:07:06,510 +في ال .. في ال .. في الهواتف الذكيةممكن تكون عبارة + +94 +00:07:06,510 --> 00:07:12,950 +عن صورة ومصاحبة بصوت ولكن الأفضل اجعل هذا الصورة + +95 +00:07:12,950 --> 00:07:18,030 +صامتة حتى اعرف هل الطفل منتبه بصريا او لا طبعا + +96 +00:07:18,030 --> 00:07:23,840 +بعرض واحد من هذه ال targets امامالطفل و أمامه + +97 +00:07:23,840 --> 00:07:27,440 +مباشرة و بعد هيك بصمت ببدأ أحرك ال target يمين + +98 +00:07:27,440 --> 00:07:32,200 +شمال فوق تحت إذا الطفل بيتبع ببصره ساعتها الطفل + +99 +00:07:32,200 --> 00:07:35,340 +منتبه بصريا و بيكون ال fixation أو ال following + +100 +00:07:35,340 --> 00:07:39,280 +بينكتب في ملف فوق النتيجة أنه fixes and follows + +101 +00:07:39,280 --> 00:07:43,720 +fixes and follows مثلا in all directions of gaze + +102 +00:07:43,720 --> 00:07:47,960 +أو in particular direction of gaze إذا بيتبع فيه + +103 +00:07:48,110 --> 00:07:53,270 +أيضا في عندي targets يعني .. يعني ممكن يعني الأداة + +104 +00:07:53,270 --> 00:07:56,430 +اللي بعمل فيها ال cover test مثلا ممكن أستخدم أحد + +105 +00:07:56,430 --> 00:07:59,830 +أسطحها + +106 +00:07:59,830 --> 00:08:03,850 +عشان أني أرسم عليه ال face أو يعني ألسق عليه صورة + +107 +00:08:03,850 --> 00:08:09,350 +ال face و أخل الطفل يتبع هذه .. هذا ال target أو + +108 +00:08:09,350 --> 00:08:13,980 +هذه الصورةأيضا في عندي targets ب .. بأشكال مختلفة + +109 +00:08:13,980 --> 00:08:18,020 +طبعا على tongue depressor خافض اللسان اللي ممكن + +110 +00:08:18,020 --> 00:08:21,860 +يعني أحصل عليه من الصيدليات أني أنا ألسق صور + +111 +00:08:21,860 --> 00:08:26,080 +مختلفة و يكون عندي targets متعددة و أستخدمها + +112 +00:08:26,080 --> 00:08:30,180 +للأطفال و أستخدمها للأطفال، إذا ال test الأول هو + +113 +00:08:30,180 --> 00:08:33,850 +fixation and followingال test التاني اللي هو ال + +114 +00:08:33,850 --> 00:08:36,830 +comparison between the behavior of the two eyes + +115 +00:08:36,830 --> 00:08:42,630 +بدنا نقارن فيه في ال test التاني السلوك بتاع كل من + +116 +00:08:42,630 --> 00:08:47,310 +العينتين may reveal unilateral preference كيف أنا + +117 +00:08:47,310 --> 00:08:52,730 +بقارن .. كيف أنا بقارن بين سلوك العينتين البصري + +118 +00:08:52,730 --> 00:08:57,750 +سلوك العين اليمين وسلوك العين الشمالبطريقة ال + +119 +00:08:57,750 --> 00:09:02,210 +exclusion .. exclusion of one eye if strongly + +120 +00:09:02,210 --> 00:09:06,070 +objected by the child indicates poorer acuity in + +121 +00:09:06,070 --> 00:09:09,610 +the other eye ايش معناة الكلام هذا؟ لما انا بغطي + +122 +00:09:09,610 --> 00:09:14,310 +العين اليمين و بلاقي الطفل بيقاوم جدا تغطاية العين + +123 +00:09:14,310 --> 00:09:17,590 +اليمين معناته هو مش معتمد على العين الشمال في + +124 +00:09:17,590 --> 00:09:21,770 +الرؤيةأنا غطيتله اليمين و تركته الاشمال مفتوحة و + +125 +00:09:21,770 --> 00:09:25,330 +مع ذلك هو بيرفض هذه القضية بيرفضها بشدة بيقاوم + +126 +00:09:25,330 --> 00:09:29,030 +بيحاول ينزع ال .. ال .. ال batch عن العين اليمين + +127 +00:09:29,030 --> 00:09:32,210 +معناته هو معتمد على العين اليمين و غالبا العين + +128 +00:09:32,210 --> 00:09:37,250 +اليسار فيها كذا، اذاocclusion of one eye نفرض + +129 +00:09:37,250 --> 00:09:41,230 +العين اليمين if strongly objected إذا تم معارضته + +130 +00:09:41,230 --> 00:09:46,630 +بشدة من قبل الطفل هذا indicates هذا بيأشر أنه ممكن + +131 +00:09:46,630 --> 00:09:49,910 +يكون عندي poorer acuity in the other eye كلمة + +132 +00:09:49,910 --> 00:09:53,170 +poorer مش معناته أنه النظر منعدم فيها ولكن إنها + +133 +00:09:53,170 --> 00:09:56,550 +أسوأ في النظر من العين اليمين وإن الطفل بيعتمد على + +134 +00:09:56,550 --> 00:10:01,830 +عينه اليمين كمثال يعني كما قلنافبالتالي إذا رافض + +135 +00:10:01,830 --> 00:10:04,770 +تغطية إحدى العينين معناته هذه العين اللي رافض + +136 +00:10:04,770 --> 00:10:10,090 +تغطيتها بيعتمد عليها في النظر عشان هيك يعني بدوش + +137 +00:10:10,090 --> 00:10:17,030 +أيانة نغطيها طيب ممكن إنسان يرفض التغطية في العين + +138 +00:10:17,030 --> 00:10:21,550 +اليمين ويرفض أيضا التغطية في العين الشمال طيب + +139 +00:10:21,550 --> 00:10:24,350 +however it is possible to have good visual + +140 +00:10:24,350 --> 00:10:28,550 +attention and unequal visual acuity يعني ممكن .. + +141 +00:10:28,550 --> 00:10:33,580 +ممكن تكونال visual attention الانتباه البصري موجود + +142 +00:10:33,580 --> 00:10:37,980 +في العين تان بس ال vision مش متساوي طيب و رفض + +143 +00:10:37,980 --> 00:10:41,340 +تغطية العين اليمين و ايضا رفض تغطية العين الشمال + +144 +00:10:41,340 --> 00:10:45,340 +هذا لا يعني انه بالضرورة يكون عندي كسل في العين + +145 +00:10:45,340 --> 00:10:49,970 +تان و انماكون إنه رفض تغطية العين اليمين و رفض + +146 +00:10:49,970 --> 00:10:54,410 +تغطية العين الشمال، بدأ أسجل في ملفه إنه objects + +147 +00:10:54,410 --> 00:10:58,110 +to occlusion of right eye and objects to occlusion + +148 +00:10:58,110 --> 00:11:02,130 +of left eye، هذه نتيجة ال test و بدأ أخد عوامل أو + +149 +00:11:02,130 --> 00:11:07,150 +ال risk factors for amblyopia بعين الاعتبارما هي + +150 +00:11:07,150 --> 00:11:10,570 +ال risk factors for amblyopia؟ هي تم الحديث عنها + +151 +00:11:10,570 --> 00:11:13,650 +في المحاضرات السابقة هي نفس أنواع ال amblyopia + +152 +00:11:13,650 --> 00:11:17,670 +يعني هل في strabismus عند الطفل مركز في عين دون + +153 +00:11:17,670 --> 00:11:21,270 +عين؟ هل في عندي anisometropia؟ هل في عندي high + +154 +00:11:21,270 --> 00:11:24,440 +bilateral refractive error؟هل عندي high bilateral + +155 +00:11:24,440 --> 00:11:29,400 +astigmatism meridional amblyopia؟ هل في عندي شيء + +156 +00:11:29,400 --> 00:11:33,040 +بيمنع وصول الضوء ل .. لإحدى العنتين زي ال cataract + +157 +00:11:33,040 --> 00:11:36,380 +زي ال ptosis زي ال vitreous hemorrhage ما إلى ذلك + +158 +00:11:36,380 --> 00:11:41,320 +أو ال corneal obesity لازم أخد بعين الاعتباركل ال + +159 +00:11:41,320 --> 00:11:45,640 +risk factors for amblyopia في نقطة يعني قبل ما + +160 +00:11:45,640 --> 00:11:49,540 +نتحرك لل test رقم تلاتة بدنا .. بدنا نذكر فيها انه + +161 +00:11:49,540 --> 00:11:55,660 +ال qualitative assessment of visual behavior أقل + +162 +00:11:55,660 --> 00:11:58,900 +دقة من ال quantitative assessment of visual acuity + +163 +00:11:58,940 --> 00:12:03,280 +هذه بتعطيني فكرة عن السلوك البصري للطفل هل هو جيد + +164 +00:12:03,280 --> 00:12:07,220 +ولا نص نص ولا سيء أما ال quantitative assessment + +165 +00:12:07,220 --> 00:12:11,540 +بيعطيني رقم للإنسان اللي أنا بفحصه جداش بيشوف جداش + +166 +00:12:11,540 --> 00:12:17,730 +بيشوف فبالتالي من ناحية الدقةالدقة لا تقارن في ال + +167 +00:12:17,730 --> 00:12:20,570 +quantitative assessment أفضل بكثير من ال + +168 +00:12:20,570 --> 00:12:24,930 +qualitative assessment ولكن احنا مضطرين نلجأ لهذه + +169 +00:12:24,930 --> 00:12:28,550 +الفحوصات اللي أقل دقة لأن هي اللي بنقدر ناخد + +170 +00:12:28,550 --> 00:12:33,650 +معلومات عن طريقها عن عين الطفل إيش وضع .. إيش وضع + +171 +00:12:33,650 --> 00:12:40,770 +هذه ال targetsمختلفة، هي عندي أنا طفل غطيتله العين + +172 +00:12:40,770 --> 00:12:46,230 +لشمال، غطيتله العين لشمال، يرفض تماما، هي بيدفع + +173 +00:12:46,230 --> 00:12:51,150 +بيد الفاحص بعيدا عن نفسه، تمام؟ معناته بيعتمد على + +174 +00:12:51,150 --> 00:12:54,900 +العين لشمال بالرؤية، tightالان غطينا العين اليومين + +175 +00:12:54,900 --> 00:13:00,720 +نفس القضية بيحاول يدفع بيد ال examiner بعيدا عن + +176 +00:13:00,720 --> 00:13:04,620 +عينه يعني هو معتمد على العينتين التنتين is an + +177 +00:13:04,620 --> 00:13:07,940 +objection to occlusion to rule out difference of + +178 +00:13:07,940 --> 00:13:11,880 +vision between two eyesالمثال التاني هو هذا يعني + +179 +00:13:11,880 --> 00:13:15,360 +بنقدر نقول أن السلوك البصري للعنتين تقريبا equal + +180 +00:13:15,360 --> 00:13:19,500 +تقريبا equal vision جداش مابنقدرش نقول جداش لأن + +181 +00:13:19,500 --> 00:13:23,600 +هذا qualitative assessment of visual behavior نيجي + +182 +00:13:23,600 --> 00:13:28,930 +للمثال التاني للمثال التاني غطينا العين لإشمالواضح + +183 +00:13:28,930 --> 00:13:33,670 +أن الطفل هادق و calm مافي أي مشكلة، غطينا العين + +184 +00:13:33,670 --> 00:13:37,630 +اليمين الطفل يعني أصبح يعني في وضع من الحزن و + +185 +00:13:37,630 --> 00:13:40,970 +البكاء و ما إلى ذلك، لما غطينا اليمين اللي هو + +186 +00:13:40,970 --> 00:13:44,730 +بيعتمد عليها في النظروفتحنا لشمال اللي هي + +187 +00:13:44,730 --> 00:13:48,910 +amblyobic eye عين فيها كسل أصبح يعاني في الرؤية + +188 +00:13:48,910 --> 00:13:53,150 +فبالتالي بدأ يبكي ويعني .. يعني حالته النفسية + +189 +00:13:53,150 --> 00:13:56,850 +تتغير لما غطينا ال amblyobic eye اللي مابعتمدش + +190 +00:13:56,850 --> 00:14:00,920 +عليها في النظر الطفل calm وهادق وربما ..يكون مبتسم + +191 +00:14:00,920 --> 00:14:04,640 +ومش فارقة معاها أنه أصلا هو مش معتمد عليها هذا ال + +192 +00:14:04,640 --> 00:14:09,240 +test بأكد لي أن العين الشمال فيها amblyopia و لازم + +193 +00:14:09,240 --> 00:14:12,940 +أخد هذا في عين الاعتبار هذا اللي هو ال behavior of + +194 +00:14:12,940 --> 00:14:16,820 +the two eyes نيجي لتالت + +195 +00:14:19,970 --> 00:14:24,130 +فحص من فحصات ال qualitative assessment of visual + +196 +00:14:24,130 --> 00:14:27,550 +behavior اللي هو ال fixation behavior ال fixation + +197 +00:14:27,550 --> 00:14:32,290 +behavior بختلف عن ال behavior of the two او ال + +198 +00:14:32,290 --> 00:14:35,810 +comparison of the two eyes ايش هو ال fixation + +199 +00:14:35,810 --> 00:14:41,760 +behavior بدنا نقرأ و بعدين نشرح ايش اللي ..يعني ما + +200 +00:14:41,760 --> 00:14:45,860 +هو سر هذا ال test؟ fixation behavior can be used + +201 +00:14:45,860 --> 00:14:49,040 +to establish unilateral preference if manifest + +202 +00:14:49,040 --> 00:14:53,680 +squint is present هذا ال test أنا بستخدمه لما يكون + +203 +00:14:53,680 --> 00:14:56,940 +في عندي manifest squint بمعنى في عندي ترابية في + +204 +00:14:56,940 --> 00:15:03,260 +عندي ترابية بدي أشوف هل الطفل اللي عنده ترابيةالـ + +205 +00:15:03,260 --> 00:15:06,140 +Endotropia يعني إيزوتروبيا أو إكزوتروبيا أو + +206 +00:15:06,140 --> 00:15:12,000 +هايبروتروبيا أو هايبوتروبيا، هل هو بيفضّل يركّز + +207 +00:15:12,000 --> 00:15:16,820 +بعين ولا بيفضّل يركّز مرة بالعين اليمين و مرة .. + +208 +00:15:16,820 --> 00:15:20,680 +يعني بتبادل التركيز مرة بعمل fixation بال right + +209 +00:15:20,680 --> 00:15:23,860 +eye و مرة بعمل fixation بال left eye كيف هذا + +210 +00:15:23,860 --> 00:15:27,960 +منعمل؟fixation is promoted in the squinting eye by + +211 +00:15:27,960 --> 00:15:31,680 +occluding the dominant eye يعني بشجع ال fixation + +212 +00:15:31,680 --> 00:15:34,340 +في العين اللي فيها الحوال كيف .. كيف بدي أخلي + +213 +00:15:34,340 --> 00:15:37,880 +العين اللي فيها الحوال تعمل fixation أني بخلي .. + +214 +00:15:37,880 --> 00:15:41,060 +بغلقله بعمل occlusion لل dominant eye العين ال + +215 +00:15:41,060 --> 00:15:45,300 +straight while the child fixates a target of + +216 +00:15:45,300 --> 00:15:49,320 +interestpreferably incorporating a light يعني أنا + +217 +00:15:49,320 --> 00:15:54,800 +بعرض أمام الطفل target شيق عشان يتطلع عليه ويفضل + +218 +00:15:54,800 --> 00:15:58,020 +أنه هذا ال target الشيق يكون فيه ضوء عشان أشوف ال + +219 +00:15:58,020 --> 00:16:01,060 +corneal light reflex و أشوف هل عدلت عينه ولا ما + +220 +00:16:01,060 --> 00:16:05,350 +عدلت عينهإذن أول حاجة بدي أشجع الـ fixation في الـ + +221 +00:16:05,350 --> 00:16:11,910 +squinting eye وهذا هنشوفه بعد شوية كفيديو و بطريقة + +222 +00:16:11,910 --> 00:16:16,270 +أني أسكر الضوء أو أغلق أو أعمل batching أو أسكر + +223 +00:16:16,270 --> 00:16:20,570 +بإيدي أمام العين السليمة طيب سكرنا أمام العين + +224 +00:16:20,570 --> 00:16:24,030 +السليمة و خلينا الطفل يتطلع ع target interesting + +225 +00:16:24,030 --> 00:16:29,430 +target بعد هيك أول ما بسكر العين السليمة بعمل + +226 +00:16:29,430 --> 00:16:33,460 +تقييم لل fixation في العين اللي فيها الحواربنقبل + +227 +00:16:33,460 --> 00:16:36,000 +إيش هو التقييم عبارة عن إيش؟ بده أقول هل هو + +228 +00:16:36,000 --> 00:16:40,120 +central؟fixation ولا non-central fixation يعني ضال + +229 +00:16:40,120 --> 00:16:44,140 +العين فيها حول ولا عدلت وصارت في ال center إذا + +230 +00:16:44,140 --> 00:16:47,460 +central fixation ولا non-central fixation هذا + +231 +00:16:47,460 --> 00:16:51,060 +النقطة النقطة التانية هل هو steady fixation ولا + +232 +00:16:51,060 --> 00:16:55,400 +unsteady fixation طبعا كيف أعرف steady ولا مش + +233 +00:16:55,400 --> 00:16:59,100 +steady يعني العين بترج ولا ثابتة باتجاه الضوء إذا + +234 +00:16:59,100 --> 00:17:02,980 +بتبع الضوء the corner reflection can be observed + +235 +00:17:03,430 --> 00:17:07,410 +طيب تالت شئ بده اعمله اذا اول حاجة قيمتها هل هو + +236 +00:17:07,410 --> 00:17:10,170 +فيه central fixation ولا مافيش central fixation + +237 +00:17:10,170 --> 00:17:14,030 +تاني حاجة steady fixation ولا unsteady fixation + +238 +00:17:14,030 --> 00:17:19,070 +يعني ثابت ولا مهتز تالت شئ بدي العين اللي غطيتها + +239 +00:17:19,070 --> 00:17:24,030 +اللي هي normal eye بدي ارفع الغط عنها ونشوفإيش + +240 +00:17:24,030 --> 00:17:28,290 +السيناريو اللي هيحجث عندى بعد ما رفعت الغطا عن + +241 +00:17:28,290 --> 00:17:31,990 +العين السليمة حقيقة في عندي تلت سيناريوهات بس قبل + +242 +00:17:31,990 --> 00:17:35,050 +ما نحكي هذه التلت سيناريوهات بدنا نروح نشوف + +243 +00:17:35,050 --> 00:17:39,050 +بالفيديو كيف الأمر هذا، نشوف قضية ال fixation + +244 +00:17:41,690 --> 00:17:46,070 +هذا مريض عنده left exotropia إذا ال normal eye + +245 +00:17:46,070 --> 00:17:49,010 +طبعا احنا بنحكي عن الأطفال هذا مريض بالغ بس هي .. + +246 +00:17:49,010 --> 00:17:54,010 +هيقدّي الفكرة و هيوصل الفكرة الآن هذا عنده left + +247 +00:17:54,010 --> 00:17:57,810 +exotropia ال squinting eye هي ال left eye و ال + +248 +00:17:57,810 --> 00:18:01,910 +straight eye أو ال fixating eye هي ال right eye + +249 +00:18:02,110 --> 00:18:05,750 +الان بدنا نشجع ال fixation في ال left eye بإننا + +250 +00:18:05,750 --> 00:18:09,270 +نغطي العين اليمين بإننا نغطي العين اليمين زي ما + +251 +00:18:09,270 --> 00:18:12,390 +بعد شوية هنشوف كيف هذا الكلام هيصير + +252 +00:18:19,860 --> 00:18:23,440 +الان عملنا cover للعين اليمين طبعا هو بتطلع target + +253 +00:18:23,440 --> 00:18:27,980 +إذا هنا عدّل أول حاجة أول حاجة بتقول هل هو central + +254 +00:18:27,980 --> 00:18:31,540 +fixation و لا مش central fixation طبعا النتيجة هنا + +255 +00:18:31,540 --> 00:18:34,500 +أمامي central fixation لأن العين سارت في النص تمام + +256 +00:18:34,500 --> 00:18:37,560 +و ال corneal light reflex صحيح جاي لفوق بس هو جاي + +257 +00:18:37,560 --> 00:18:42,020 +بالظبط ع جبال ال center بتاع ال corneaهل هدى + +258 +00:18:42,020 --> 00:18:47,180 +المريض لما أرفع الغطاء .. لما أرفع الغطاء .. طبعا + +259 +00:18:47,180 --> 00:18:50,840 +هنا central و steady يعني العين مابتهتزش .. العين + +260 +00:18:50,840 --> 00:18:55,300 +مابتهتزش مافيش stigma فيها أو حركات عشوائية فيها + +261 +00:18:55,300 --> 00:19:01,430 +.. كانت exo بمجرد مغطينا العينال normal eye او ال + +262 +00:19:01,430 --> 00:19:04,850 +straight eye طبعا هذه اللي عينها على السريع أخدت + +263 +00:19:04,850 --> 00:19:09,330 +ال fixation .. takes .. يعني takes up fixation + +264 +00:19:09,330 --> 00:19:13,730 +..بالتالي صارت تطلع ال target بقى سجل في ملف .. في + +265 +00:19:13,730 --> 00:19:18,390 +ملف المريض انه when covered the right eye the left + +266 +00:19:18,390 --> 00:19:23,520 +eyetalk fixation and it was central and steady + +267 +00:19:23,520 --> 00:19:26,140 +..central and steady ..central يعني جاي في النص + +268 +00:19:26,140 --> 00:19:30,100 +يعني العين مركزة تمام و steady يعني بدون ما يكون + +269 +00:19:30,100 --> 00:19:34,120 +فيه stigma أو حركات نكمل نشوف إيش اللي هيحصل معنا + +270 +00:19:43,290 --> 00:19:47,490 +الان بس نرفع الغطاء يا ترى إيش اللي هيصير معناه هل + +271 +00:19:47,490 --> 00:19:52,830 +هيظل مركز بعينه الشمال و .. ولا ع السريع التركيز + +272 +00:19:52,830 --> 00:19:55,790 +هيرجع لعينه اليمين و العين الشمال هترجع لوضعيتها + +273 +00:19:55,790 --> 00:19:59,610 +الأولى اللي هي X وهذا اللي هنشوفه بعد شوية .. هذا + +274 +00:19:59,610 --> 00:20:03,390 +اللي هنشوفه بعد شوية حقيقة لما بنرفع الغطاء قبل ما + +275 +00:20:03,390 --> 00:20:06,550 +نعرض الفيديو هيصير عندي سيناريوهات تلاتة .. عندي + +276 +00:20:06,550 --> 00:20:12,010 +سيناريوهات تلاتةهذه السيناريوهات التلاتة لما برفع + +277 +00:20:12,010 --> 00:20:15,510 +الغطة ممكن يظل عامل fixation في العين الـ + +278 +00:20:15,510 --> 00:20:18,610 +squinting eye و تكون تصير هادي ال squint ينتقل عن + +279 +00:20:18,610 --> 00:20:21,850 +ناحية التانية ساعتها بقول ال vision في العين + +280 +00:20:21,850 --> 00:20:25,790 +الشمال ال squinting eye good ليش good؟ لأنه لما + +281 +00:20:25,790 --> 00:20:29,170 +رفعت الغطة عن ال straight eye دلت هي اللي هي عاملة + +282 +00:20:29,170 --> 00:20:32,470 +fixation و ال straight eye صارت هي ال squinting + +283 +00:20:32,470 --> 00:20:36,970 +هذه نقطة طيب السيناريو التاني المحتملإنه يضلوا + +284 +00:20:36,970 --> 00:20:41,150 +يرمش في محاولة إنه يضلوا عامل fixation يضلوا يرمش + +285 +00:20:41,150 --> 00:20:46,710 +بعينيه عشان يحاول يضل يخلي العين ال straight اللي + +286 +00:20:46,710 --> 00:20:50,510 +هي العين الشمال straight يحاول بطريقة الترميش إنه + +287 +00:20:50,510 --> 00:20:54,330 +يوضح الصورة فيها أكتر وأكتر بنقول ساعتها ال vision + +288 +00:20:54,330 --> 00:20:58,310 +في ال left eye is probably goodالسيناريو الأول + +289 +00:20:58,310 --> 00:21:01,170 +قلنا good السيناريو التاني قلنا probably good + +290 +00:21:01,170 --> 00:21:05,110 +احتمال ان يكون النظر يعني لا بأس به ننساش ان هذا + +291 +00:21:05,110 --> 00:21:08,790 +ال test بنعمل عند اتفاق طيب لو احنا رفعنا الغطاء + +292 +00:21:08,790 --> 00:21:11,990 +السيناريو التالت والاخير رفعنا الغطاء و مجرد ما + +293 +00:21:11,990 --> 00:21:14,690 +رفعنا الغطاء عن ال normal eye رجعت هي تاخد ال + +294 +00:21:14,690 --> 00:21:17,510 +fixation وهذه رجعت لوضعية الحوار اللي كانت عليه + +295 +00:21:17,510 --> 00:21:21,430 +يعني لوضعية ال exo زي ما في ال video بيبين ساعتها + +296 +00:21:21,430 --> 00:21:25,210 +بنقول غالبا النظر في العين الشمال bad في غالبا + +297 +00:21:25,210 --> 00:21:30,100 +النظر badنشوف السيناريو هذا هنا الفيديو بيعدد + +298 +00:21:30,100 --> 00:21:33,740 +السيناريو رقم تلاتة السيناريو رقم تلاتة نشوف لما + +299 +00:21:33,740 --> 00:21:40,060 +بيرفع الغطاء ايش اللي حيصير طبعا لما حطينا الغطاء + +300 +00:21:40,060 --> 00:21:43,680 +اخدت fixation ال fixation قيمنا انه central و + +301 +00:21:43,680 --> 00:21:47,420 +steady central و steady الان نشوف الان بنرفع + +302 +00:21:47,420 --> 00:21:53,980 +الغطاء فورا ال fixation رجع لليمينرجع لليمين و + +303 +00:21:53,980 --> 00:21:57,620 +أصبحت الشمال في وضع ال ex و معناته اليمين هي + +304 +00:21:57,620 --> 00:22:01,920 +الأحسن في النظر و هذه النظر فيها سيئ نرجع بس مرة + +305 +00:22:01,920 --> 00:22:07,930 +تانية نشوف هذه القضية عشان بس يعني ..ع السريع مجرد + +306 +00:22:07,930 --> 00:22:12,130 +ما رفعنا الغطاء اللي رجع عمل fixation هو ال right + +307 +00:22:12,130 --> 00:22:16,330 +eye و أصبحت الشمال في وضع ال exo معناته هذه ال + +308 +00:22:16,330 --> 00:22:20,330 +vision فيها bad ال vision فيها bad على قضية ال + +309 +00:22:20,330 --> 00:22:24,690 +steady و ال unsteady fixation هنشوف فيديو بعد شوية + +310 +00:22:24,690 --> 00:22:29,010 +بيوضح قضية ال unsteady fixation unsteady fixation + +311 +00:22:33,090 --> 00:22:36,710 +طبعا لو ال scenario ضال انه .. لو ال scenario ضال + +312 +00:22:36,710 --> 00:22:41,070 +.. لو ال scenario ضال انه بمجرد ما رفعنا الغطاء ان + +313 +00:22:41,070 --> 00:22:43,810 +العين الشمال دلت عاملة fixation زي ما هذه اللحظة + +314 +00:22:43,810 --> 00:22:47,370 +بتبين و العين اليمين اللي هي ال normal eye صارت في + +315 +00:22:47,370 --> 00:22:50,570 +وضع ال exo ممكن سان يقول ليش في وضع ال exo لأن هذه + +316 +00:22:50,570 --> 00:22:54,020 +لما بتعدل من ال exo لل straightحسب hearing loss + +317 +00:22:54,020 --> 00:22:56,840 +هذه هتروح في نفس الاتجاه هذه راحت باتجاه اليمين + +318 +00:22:56,840 --> 00:23:00,620 +فهذه هتتحول ل exo فبالتالي ضروري جدا نفهم هذه + +319 +00:23:00,620 --> 00:23:05,540 +القضية نشوف لو ضلت زي هيك يقولنا ال vision is good + +320 +00:23:05,540 --> 00:23:09,020 +لو ضلت زي هيك يقولنا ال vision is good بس هي للأسف + +321 +00:23:09,020 --> 00:23:13,720 +أول ما رفعنا الغطاء عن العين اليمين اتحركت ورجعت + +322 +00:23:13,720 --> 00:23:18,120 +لوضعية ال exo اللي كانت عليه قبل ذلك قبل ذلك + +323 +00:23:23,860 --> 00:23:28,800 +لشيء جديد هنا بدنا احنا هنشوف فيديو اخر اللي هو + +324 +00:23:28,800 --> 00:23:35,240 +يوضح لل unsteady fixation بس هنمثله بفيديو مقارب + +325 +00:24:05,580 --> 00:24:09,820 +طيب اذا if fixation immediately بعد ما نرفع الغطاء + +326 +00:24:09,820 --> 00:24:13,460 +عن ال straight eye if fixation immediately returns + +327 +00:24:13,460 --> 00:24:16,740 +to the uncovered eye then visual acuity is + +328 +00:24:16,740 --> 00:24:20,100 +probably impaired زي ما حصل معنا في الفيديو بمجرد + +329 +00:24:20,100 --> 00:24:24,280 +ما رفعنا الغطاء عن العين اليمين ال .. ال .. ال .. + +330 +00:24:24,410 --> 00:24:27,130 +الـ fixation رجع للعين اليمين اللي هي السليمة و ال + +331 +00:24:27,130 --> 00:24:30,010 +exo رجعت في العين الشمال إذا العين الشمال probably + +332 +00:24:30,010 --> 00:24:34,330 +impaired vision if fixation is maintained إذا دلت + +333 +00:24:34,330 --> 00:24:37,410 +العين الشمال مركزة زي ما المثال بتاعنا بيحكي أن + +334 +00:24:37,410 --> 00:24:40,130 +العين الشمال هي اللي فيها المشكلة through a blink + +335 +00:24:40,130 --> 00:24:44,250 +then visual acuity is probably goodif patient + +336 +00:24:44,250 --> 00:24:47,470 +alternates fixation إذا مرة بيركز باليمين و برة + +337 +00:24:47,470 --> 00:24:50,810 +بيركز بالإشمال بعد ما فتحنا الانتين then the two + +338 +00:24:50,810 --> 00:24:53,450 +eyes have equal vision يعني إذا عندي حتى تلات + +339 +00:24:53,450 --> 00:24:57,290 +سيناريوهات ممكن هذا بيبين بعد ما أرفع الغطا عن ال + +340 +00:24:57,290 --> 00:25:00,170 +straight eye بعد ما أرفع الغطا عن ال straight eye + +341 +00:25:00,170 --> 00:25:08,310 +نشوف هنا لسه لحد تلان ما فيش response لأ هاي هو + +342 +00:25:08,310 --> 00:25:09,230 +اللي اشتغل + +343 +00:25:11,750 --> 00:25:14,830 +هنشوف موضوع ال unsteady fixation ال unsteady + +344 +00:25:14,830 --> 00:25:19,570 +fixation أول + +345 +00:25:19,570 --> 00:25:22,590 +ما غطينا إحدى العينتين صار هذا unsteady fixation + +346 +00:25:22,590 --> 00:25:28,040 +العين بتهتز هذا بيسموه latent stagmasهنا مافيه + +347 +00:25:28,040 --> 00:25:31,540 +اهتزاز تقريبا اول ما اغطينا احدى العين تانى هذا + +348 +00:25:31,540 --> 00:25:35,540 +يسمى .. صحيح انه central بس unsteady fixation + +349 +00:25:35,540 --> 00:25:39,300 +ضروري جدا لما بعمل occlusion ل one eye عند الطفل + +350 +00:25:39,300 --> 00:25:42,780 +بدأ اقيم النظر اشوف العين التانية هيك هقول central + +351 +00:25:42,780 --> 00:25:45,460 +unsteady .. central unsteady اذا صار معايا + +352 +00:25:45,460 --> 00:25:49,140 +السيناريو اللي احنا شايفينهالان و اللي هو واضح جدا + +353 +00:25:49,140 --> 00:25:55,100 +انه عندي صحيح central light reflex بس ال .. ال .. + +354 +00:25:55,100 --> 00:25:59,560 +ال fixation مش steady مش steady نيجي احنا نكمل + +355 +00:25:59,560 --> 00:26:05,540 +بنقول تالي او رابع test the 10-prism test is + +356 +00:26:05,540 --> 00:26:09,000 +similar and can be used regardless of whether a + +357 +00:26:09,000 --> 00:26:12,700 +manifest squint is present يعني ال 10-prism test + +358 +00:26:12,700 --> 00:26:21,200 +يستخدم كتقييم لحدة الإبصارو سواء الطفل اللي هو ال + +359 +00:26:21,200 --> 00:26:24,800 +pre-verbal اللي مابينطقش سواء عنده حول أو عينيه + +360 +00:26:24,800 --> 00:26:28,620 +straight بس مجرد بدنا نقيم حدة الإبصار عنده كيف + +361 +00:26:28,620 --> 00:26:32,180 +بينعمل هذا ال test it involves the promotion of + +362 +00:26:32,180 --> 00:26:36,860 +diplopia بتأحدث diplopia عند الطفل باستعمال ten + +363 +00:26:36,860 --> 00:26:42,100 +prism vertical orientation ten prism diopter test + +364 +00:26:42,500 --> 00:26:45,680 +Alternation between diplopic targets suggests + +365 +00:26:45,680 --> 00:26:50,140 +equal visual acuity لما بنشوف هذا المنظر أنا عارض + +366 +00:26:50,140 --> 00:26:53,680 +للطفل أمامه بالضبط target زي ال targets اللي احنا + +367 +00:26:53,680 --> 00:27:00,560 +حكينا عنها قبل شوية هذه ال targets و لما أنا بحط + +368 +00:27:00,560 --> 00:27:05,870 +قدام إحدى العنتينلما بحط قدام إحدى العين تان تان + +369 +00:27:05,870 --> 00:27:08,990 +بريزم ديوبتر vertical orientation سواء based down + +370 +00:27:08,990 --> 00:27:11,390 +زي ما الصورة هاي بتورجيني أو based up بالمهم + +371 +00:27:11,390 --> 00:27:15,090 +vertical ليش vertical؟ عشان أحدث دبلوب يعنو ال .. + +372 +00:27:15,090 --> 00:27:18,450 +ال .. تان بريزم لو حطيتها horizontal ما بتكفيش + +373 +00:27:18,450 --> 00:27:22,290 +لإحداث دبلوب يعنو ال fusional vergence ال vertical + +374 +00:27:23,660 --> 00:27:27,060 +الدماغ الإنسان بتتحمل من اتنين لتلاتة Prism أكتر + +375 +00:27:27,060 --> 00:27:30,720 +من هيك هيصير عندي الشيء كإني أحدثت vertical + +376 +00:27:30,720 --> 00:27:34,460 +diplopia طيب، الآن إيش ال response بتاع الطفل + +377 +00:27:34,460 --> 00:27:39,560 +بقيمه؟ بقيم ال response بتاع الطفل حطينا التن + +378 +00:27:39,560 --> 00:27:45,640 +Prism، هيصير الطفل يشوف double vision الصورة اللي + +379 +00:27:45,640 --> 00:27:48,920 +تحت العين الشمال، بما أنه based down، هتكون جاية + +380 +00:27:48,920 --> 00:27:53,190 +لفوقالصورة الأعلى بتشوفها العين الشمال لنفس ال + +381 +00:27:53,190 --> 00:27:56,990 +target والصورة اللي دُغري مستقيمة هيشوفها العين + +382 +00:27:56,990 --> 00:28:00,030 +اليمين إذا دل يتطلع بالشكل هذا معناته هو جاعت + +383 +00:28:00,030 --> 00:28:04,380 +بيستخدم عينه اليمين لأن عينيه ما يطلعوا لأعلىعشان + +384 +00:28:04,380 --> 00:28:07,860 +يتطلع صورة العين الي شمال هو هيشوفها لأعلى لإن ال + +385 +00:28:07,860 --> 00:28:11,160 +prism ال apex بتاعته لأعلى دايما الصورة بتتجه + +386 +00:28:11,160 --> 00:28:15,040 +باتجاه ال apex بتاعت ال prism إذا ضال ال scenario + +387 +00:28:15,040 --> 00:28:18,580 +زي هيك معناته الطفل بيستخدم عينه اليمين و بيستخدمش + +388 +00:28:18,580 --> 00:28:21,580 +عينه الشمال لإن لو بيستخدم عينه الشمال المفروض + +389 +00:28:21,580 --> 00:28:25,680 +يتطلع لفوقالسيناريو التاني ال .. ال .. ال result + +390 +00:28:25,680 --> 00:28:29,000 +التاني اللي possible أنه يصير يتطلع لفوق، معناته + +391 +00:28:29,000 --> 00:28:31,820 +هو بيستخدمش عينه اليمين، بيركزش بعينه اليمين، هو + +392 +00:28:31,820 --> 00:28:35,320 +بيركز بعينه الشمال، فعينه الشمال الصورة بالنسبة + +393 +00:28:35,320 --> 00:28:38,820 +إليها طلعت لفوق، لأن ال apex بتاعة ال prism لفوق، + +394 +00:28:38,820 --> 00:28:42,770 +طيب و العين اليمين ليش طلعت لفوق؟طالما بيشوفش فيها + +395 +00:28:42,770 --> 00:28:46,230 +حسب hearing load طالما هاي طلعت معناته هادي هتطلع + +396 +00:28:46,230 --> 00:28:49,530 +معاه طيب إذا ال scenario الأول بيقوللي أنه العين + +397 +00:28:49,530 --> 00:28:52,930 +اليمين هي اللي شغالة ال scenario التاني العين + +398 +00:28:52,930 --> 00:28:56,210 +الشمال هي الشغالة لو الطفل لاحظ أنه مرة بتطلع + +399 +00:28:56,210 --> 00:28:59,770 +دُغري و مرة بتطلع لفوق بعينيتين تان يعني مرة هذا + +400 +00:28:59,770 --> 00:29:02,250 +ال scenario و بعد لحظة هذا ال scenario و بيرجع + +401 +00:29:02,250 --> 00:29:06,120 +بعدكللسيناريو الأول برجع بعدك للسيناريو التاني + +402 +00:29:06,120 --> 00:29:09,560 +ببدل بين السيناريوين معناته عنده equal vision + +403 +00:29:09,560 --> 00:29:13,580 +between the two eyes اذا alternation between the + +404 +00:29:13,580 --> 00:29:17,540 +diplopic targets suggest equal visual acuity جداش + +405 +00:29:17,540 --> 00:29:20,440 +ما بنقدرش نقول جداش بس بنقدر نقول ان ال vision في + +406 +00:29:20,440 --> 00:29:24,560 +العين تاني تقريبا متساوي تقريبا متساوي وطبعا هذا + +407 +00:29:24,560 --> 00:29:29,560 +يعتبر qualitative test qualitative test الان ال + +408 +00:29:29,560 --> 00:29:36,470 +test رقم خمسة وستةو سبعة هيكون في المحاضرة التالية + +409 +00:29:36,470 --> 00:29:39,770 +ان شاء الله تعالى ويعطيكم العافية والسلام عليكم + +410 +00:29:39,770 --> 00:29:41,790 +ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/LobzMcnF71g.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/LobzMcnF71g.srt new file mode 100644 index 0000000000000000000000000000000000000000..227ab8fb3b69278f100a863e3022c0212daa3350 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/LobzMcnF71g.srt @@ -0,0 +1,2046 @@ +1 +00:00:04,490 --> 00:00:07,510 +بسم الله الرحمن الرحيم نستكمل محاضرات حول واحد + +2 +00:00:07,510 --> 00:00:13,630 +وتوقفنا عند الretinomotor value هي ترى إيش هو + +3 +00:00:13,630 --> 00:00:20,390 +المقصود بالretinomotor value و + +4 +00:00:20,390 --> 00:00:26,610 +هذا الطبيعي، لما يكون عندي target أو هدف في ال + +5 +00:00:26,610 --> 00:00:29,630 +peripheral field، مش متوقع أن صورته تسقط على + +6 +00:00:29,630 --> 00:00:35,230 +الفوفيا، وإنما أثناء تركيز الشخص + +7 +00:00:35,790 --> 00:00:39,190 +في target أمامه أي target آخر في الperipheral + +8 +00:00:39,190 --> 00:00:43,850 +field بتصبط صورته على extra-foveal element يعني في + +9 +00:00:43,850 --> 00:00:48,110 +أي منطقة من الشبكية بعيدا عن الفوفيا ممكن يكون جنب + +10 +00:00:48,110 --> 00:00:52,030 +الفوفيا أو بعيد كثير عن الفوفيا أو متوسط البعد عن + +11 +00:00:52,030 --> 00:00:57,530 +الفوفيا يعني فيه ما تبقى من الretina to establish + +12 +00:00:57,530 --> 00:01:01,530 +fixation on this target or on this object a + +13 +00:01:01,530 --> 00:01:05,390 +saccadic version of accurate amplitude is required + +14 +00:01:05,390 --> 00:01:09,050 +بنفهم هذه الجملة saccadic version .. version مفهومة + +15 +00:01:09,050 --> 00:01:14,910 +binocular movement saccadic معناتها سريعة احنا جسمنا + +16 +00:01:14,910 --> 00:01:19,790 +زمان حركات العين reductions و versions و versions + +17 +00:01:19,790 --> 00:01:23,210 +اليوم احنا بنجسمهم من ناحية الصورة على pursuit + +18 +00:01:23,210 --> 00:01:27,970 +movement حركة بطيئةو Saccadic movement ليه حركة + +19 +00:01:27,970 --> 00:01:32,590 +سريعة طبعا لما إنسان بيدينقل بصره من target ل + +20 +00:01:32,590 --> 00:01:35,510 +target آخر في الperipheral field يعني يركز على ال + +21 +00:01:35,510 --> 00:01:38,870 +target اللي في الperipheral field ما بينقل بصره + +22 +00:01:38,870 --> 00:01:42,810 +ببطء عادة هو بيعمل Saccadic version يعني حركة + +23 +00:01:42,810 --> 00:01:49,500 +سريعة بالعينتينطبعا مش بس سريعة فقط .. مطلوب أيضا + +24 +00:01:49,500 --> 00:01:54,080 +انها تكون of accurate amplitude يعني مقدارها مناسب + +25 +00:01:54,080 --> 00:01:57,840 +.. مقدارها مناسب يعني ما يتعدى الtarget اللي هو + +26 +00:01:57,840 --> 00:02:02,100 +رايح او ناوي يتفرج عليه ولا يقصر عنه .. يعني هينقل + +27 +00:02:02,100 --> 00:02:05,520 +بصره من الtarget الأول اللي كان هو مركز فيه لل + +28 +00:02:05,520 --> 00:02:11,470 +target التاني اللي في الperipheral fieldيعني عايز + +29 +00:02:11,470 --> 00:02:14,730 +يتطلع عليه، إذا لازم يكون عندي saccadic version of + +30 +00:02:14,730 --> 00:02:20,110 +accurate amplitude is required ليش؟ مطلوب ليش؟ to + +31 +00:02:20,110 --> 00:02:24,270 +fixate on a target in the peripheral visual field + +32 +00:02:24,270 --> 00:02:28,390 +each extra foveal retinal element therefore has a + +33 +00:02:28,390 --> 00:02:32,490 +retinomotor value proportional to its distance + +34 +00:02:32,490 --> 00:02:39,470 +from the foveaالـRetinomotor value لكل target أو + +35 +00:02:39,470 --> 00:02:45,650 +لكل منطقة من الشبكية هي مقدار الحركة مقدار الحركة + +36 +00:02:45,650 --> 00:02:50,710 +اللازمة عملها من قبل العنتين لوضع صورة هذا ال + +37 +00:02:50,710 --> 00:02:55,910 +target من المكان اللي كان فيه على الشبكية لنقلها + +38 +00:02:55,910 --> 00:03:00,250 +على الفوفيا عشان تتم التركيز فيها نخد رسمة توضح + +39 +00:03:00,250 --> 00:03:02,610 +هذا المثال بنقول كالادي + +40 +00:03:06,370 --> 00:03:09,470 +الان هدول العنتين بيركزوا في الtarget الأحمر + +41 +00:03:09,470 --> 00:03:16,200 +فلنطلع لتكبير بيركزوا في الtarget الأحمربالنسبة + +42 +00:03:16,200 --> 00:03:19,040 +لهدولة اللي عندهين أو لهدا الشخص الtarget لblack + +43 +00:03:19,040 --> 00:03:22,540 +target الاسود يعتبر في الperipheral field كلمة + +44 +00:03:22,540 --> 00:03:26,000 +peripheral field لا تعني فقط الextreme periphery + +45 +00:03:26,000 --> 00:03:29,080 +وإنما تعني كل ما هو مش مركزي يعني هذاperipheral + +46 +00:03:29,080 --> 00:03:31,300 +field و هنا peripheral field و هنا peripheral + +47 +00:03:31,300 --> 00:03:35,700 +field طبعا يزداد بعدا أو قربا من الcentral field + +48 +00:03:35,700 --> 00:03:37,360 +من الcentral field + +49 +00:03:41,520 --> 00:03:47,340 +عشان أنقل بصري من الtarget الأحمر للtarget + +50 +00:03:47,340 --> 00:03:51,060 +الأسود، يعني عشان أنقل تركيزي من الtarget الأحمر + +51 +00:03:51,060 --> 00:03:55,140 +للtarget الأسودالان مابقدرش بعناية احرك الtarget + +52 +00:03:55,140 --> 00:03:58,400 +اقوله تعال مكان الtarget الأحمر هذا ما بيصير في + +53 +00:03:58,400 --> 00:04:02,200 +الوضع الطبيعي ما بنقول للtarget او للهدف اتحرك + +54 +00:04:02,200 --> 00:04:06,760 +هنا قدامي عشان اشوفك وانما العينين بدهم يتحركوا + +55 +00:04:06,760 --> 00:04:10,180 +باتجاهه بمعنى اخر الفوفيا طبعا صورة الtarget + +56 +00:04:10,180 --> 00:04:14,760 +الأسود تسقط على الtemporal retina في النقطة هنا + +57 +00:04:14,760 --> 00:04:18,360 +في العين اليمين وبتسقط على الnasal retina في + +58 +00:04:18,360 --> 00:04:23,950 +العين الشمال طيب الفوفيا هنا بتتحرك هيكوالفوفيا + +59 +00:04:23,950 --> 00:04:27,910 +هنا بتتحرك هيك في نفس اللحظة وبنفس القدر إذا ال + +60 +00:04:27,910 --> 00:04:32,130 +retinomotor value هو كمية الحركة كمية الحركة إذا + +61 +00:04:32,130 --> 00:04:38,330 +الretinomotor value بتاعة النقطة في الtemporal + +62 +00:04:38,330 --> 00:04:40,930 +retina هاي والنقطة المثيلة إلى في الnasal retina + +63 +00:04:40,930 --> 00:04:45,770 +هاي مقدارها أنه تتحرك لإنت سكتك version to the left + +64 +00:04:45,770 --> 00:04:49,590 +احنا الفوفيا هتروح to the right الفوفيا + +65 +00:04:55,260 --> 00:04:58,240 +فالعنتين والتنتين هيروحوا to the left وبالتالي + +66 +00:04:58,240 --> 00:05:02,520 +بتصير الفوفيا موجهة والفوفيا موجهة باتجاه ال + +67 +00:05:02,520 --> 00:05:06,120 +target الأسود طب لو فرضنا أنه في target تالت + +68 +00:05:08,040 --> 00:05:11,120 +التارجت التالت أبعد، إذا صورته هنا على الـ + +69 +00:05:11,120 --> 00:05:13,620 +Temporal Retina ستكون أبعد، وعلى الـNasal Retina + +70 +00:05:13,620 --> 00:05:16,820 +ستكون أبعد، فعشان الـFovea، الـBoth Fovea + +71 +00:05:16,820 --> 00:05:21,460 +ينتقلوا لهذا التارجت التالت، بلزمهم حركة أكبر، إذا + +72 +00:05:21,460 --> 00:05:25,380 +كل ما كان الـTarget أبعد في الـField كل ما كان + +73 +00:05:25,380 --> 00:05:29,460 +الـRetinomotor Value له أكبر، يعني بمعنى آخر + +74 +00:05:29,790 --> 00:05:34,630 +الحركة اللازمة من الانتين لوضع صورة الtarget على + +75 +00:05:34,630 --> 00:05:40,170 +الfovea بتكون أكبر كل ما كان الtarget أبعد في ال + +76 +00:05:40,170 --> 00:05:44,550 +peripheral field وكل ما كان الtarget أقرب ل ال + +77 +00:05:44,550 --> 00:05:50,010 +central target أقرب اذا بيكون الretino صورته + +78 +00:05:50,010 --> 00:05:53,210 +بتسقط قريب من الfovea وبالتالي الretinomotor + +79 +00:05:53,210 --> 00:06:00,550 +value بتاعه بيكون صغير الان لو اجى سؤالما هو ال + +80 +00:06:00,550 --> 00:06:06,230 +retinomotor value لـtarget صورته بتقع على او ما + +81 +00:06:06,230 --> 00:06:10,050 +هو الretinomotor value عند الفوفيا عند الفوفيا + +82 +00:06:10,050 --> 00:06:15,150 +بنقول صفر الretinomotor value عند الفوفيا يساوي + +83 +00:06:15,150 --> 00:06:19,150 +صفر ليش لأنه لو صورة target وقعت على الفوفيا + +84 +00:06:19,150 --> 00:06:22,690 +معناته هذا الشخص بيركز في هذا الtarget ولو قلنا + +85 +00:06:22,690 --> 00:06:27,130 +له ركز في الtarget مش هيحرك عينيه تماما بتاتا ولا + +86 +00:06:27,130 --> 00:06:31,080 +شيءلسبب انه already الصورة بتاعة هذا الtarget + +87 +00:06:31,080 --> 00:06:34,240 +جاية على الفوفيا وبالتالي الretinomotor + +88 +00:06:34,240 --> 00:06:38,300 +value عند الفوفيا يساوي صفر أبعدنا شوية عن الفوفيا + +89 +00:06:38,300 --> 00:06:42,260 +بيصير فيه قيمة له أبعدنا أكثر بتكبر هذه القيمة + +90 +00:06:42,260 --> 00:06:45,700 +بتكبر هذه القيمة فبالتالي هذا هو الretinomotor + +91 +00:06:45,700 --> 00:06:50,260 +value هو كمية الحركة اللازم عملها لوضع صورة + +92 +00:06:50,970 --> 00:06:56,290 +لوضع صورة target كان يسقط على الperipheral retina + +93 +00:06:56,290 --> 00:07:02,510 +لوضع هذه الصورة على اللي هي الفوفيا، اذا the image + +94 +00:07:02,510 --> 00:07:06,110 +of an object in the peripheral visual field falls + +95 +00:07:06,110 --> 00:07:11,520 +on an extra foveal elementلإصلاح مقاومة على هذا + +96 +00:07:11,520 --> 00:07:16,400 +المجلد، يتطلب منه مقاومة سكاتية محدودة ومتأكدة، كل + +97 +00:07:16,400 --> 00:07:21,200 +مجلد رتينو أكترفوفيا لديه قيمة رتينو موتور + +98 +00:07:21,200 --> 00:07:26,930 +المقاومة تقريبًا من المقاومة، كل مكانأي retinal + +99 +00:07:26,930 --> 00:07:32,030 +element أو extra fovea retinal element كل مكان + +100 +00:07:32,030 --> 00:07:35,510 +أبعد عن الفوفيا الretinomotor value بتاعه بيكون + +101 +00:07:35,510 --> 00:07:39,330 +أكبر which guides the amplitude of saccadic + +102 +00:07:39,330 --> 00:07:44,250 +movement required to look at it retinomotor value + +103 +00:07:44,250 --> 00:07:47,810 +zero at the fovea increases progressively toward + +104 +00:07:47,810 --> 00:07:52,590 +the retinal periphery و هذا هو المقصود بال + +105 +00:07:52,590 --> 00:07:57,490 +retinomotor valuenالنقطة اللي بعدها بدي نحكي عنها + +106 +00:07:57,490 --> 00:08:02,410 +اللي هي الcorresponding retinal points وهي موضوع + +107 +00:08:02,410 --> 00:08:06,990 +سبق انه حكينا عنه بس بنذكر فيه تذكير ال + +108 +00:08:06,990 --> 00:08:10,450 +corresponding points are areas on each retina that + +109 +00:08:10,450 --> 00:08:14,880 +share the same visual directionthat share the same + +110 +00:08:14,880 --> 00:08:18,500 +visual direction هو منطقة أو مساحات من شبكية + +111 +00:08:18,500 --> 00:08:21,900 +الهنتين اللي هم نفس الvisual direction يعني + +112 +00:08:21,900 --> 00:08:26,680 +بيبصوا على نفس المنطقة من الفرار على سبيل المثال + +113 +00:08:26,680 --> 00:08:29,840 +the fovea الfovea في اليمين و الfovea في الشمال + +114 +00:08:29,840 --> 00:08:33,320 +share the primary visual direction share يعني + +115 +00:08:33,320 --> 00:08:35,680 +بيشتركوا الfovea تحت العين اليمين و تحت العين + +116 +00:08:35,680 --> 00:08:39,080 +الشمال بيشتركوا في الprimary visual direction + +117 +00:08:39,610 --> 00:08:42,970 +points on the nasal retina of one eye have + +118 +00:08:42,970 --> 00:08:46,030 +corresponding points on the temporal retina of the + +119 +00:08:46,030 --> 00:08:49,750 +other eye and vice versa والعكس بالعكس الtemporal + +120 +00:08:49,750 --> 00:08:53,530 +retina في العين التانية شريكة مع الnasal retina + +121 +00:08:53,530 --> 00:08:57,210 +في العين الأولى في نفس الاتجاه البصري في نفس + +122 +00:08:57,210 --> 00:08:59,070 +الاتجاه البصري + +123 +00:09:01,450 --> 00:09:05,450 +على سبيل المثال، مصورة تنتج صورة على الright + +124 +00:09:05,450 --> 00:09:10,850 +nasal retina و left temporal retina ستتجه إلى + +125 +00:09:10,850 --> 00:09:15,590 +الجانب اليساري من المجال الفيزيوكي هذا هو أساس الـ + +126 +00:09:15,590 --> 00:09:19,050 +normal retinal correspondence لو تصورنا إنه فيه + +127 +00:09:19,050 --> 00:09:23,030 +target، هذا الtarget صورته تسقط على الnasal + +128 +00:09:23,030 --> 00:09:26,410 +retina في الright eyeو الtemporal retina في الـ + +129 +00:09:26,410 --> 00:09:30,410 +left eye هذا الtarget هيكون projected المريض + +130 +00:09:30,410 --> 00:09:33,710 +هيعبر عنه أنه جاي عنده على جهته اليمين أو على ال + +131 +00:09:33,710 --> 00:09:36,950 +field اليمين بالنسبة له ليش؟ لأن هذا الtarget + +132 +00:09:36,950 --> 00:09:40,030 +sort وسقطت صورته علىretina في الright eye وهي + +133 +00:09:40,030 --> 00:09:42,990 +موجهة to the right و الtemporal retina في الleft + +134 +00:09:42,990 --> 00:09:45,310 +eye وهي موجهة أيضا to the right فال + +135 +00:09:45,310 --> 00:09:48,030 +interpretation أو الprojection تاع هذا الtarget + +136 +00:09:48,030 --> 00:09:54,090 +هيكون to the right fieldطبعا هذا الكلام هو القاعدة + +137 +00:09:54,090 --> 00:09:57,450 +الأساسية أو الفكرة الأساسية في موضوع الnormal + +138 +00:09:57,450 --> 00:10:01,950 +retinal correspondence طيب احنا قلنا كمان ان هذا + +139 +00:10:01,950 --> 00:10:06,290 +التناسق بين شبكية الانتين والشراكة في الاتجاهات + +140 +00:10:06,290 --> 00:10:11,620 +المختلفة في الfieldمش بس مقتصرة على شبكية العين + +141 +00:10:11,620 --> 00:10:16,020 +اليمين وشبكية العين الشمال نفس الترتيب بنلاقيه في + +142 +00:10:16,020 --> 00:10:19,000 +كل مناطق الvisual pathway يعني في الlateral + +143 +00:10:19,000 --> 00:10:22,320 +geniculate body في الsuperior colliculus في ال + +144 +00:10:22,320 --> 00:10:27,420 +visual cortex كله مرتب بنفس الطريقة بمعنىإنه ترتيب + +145 +00:10:27,420 --> 00:10:31,260 +المعلومات هيكون مرتب بنفس الطريقة اللي مرتبة + +146 +00:10:31,260 --> 00:10:35,940 +تلقيها في الشبكية، this retinotopic organization + +147 +00:10:35,940 --> 00:10:40,700 +is reflected back along the visual pathway, each + +148 +00:10:40,700 --> 00:10:43,820 +eye maintaining separate image under the visual + +149 +00:10:43,820 --> 00:10:47,440 +pathway converge into binocularly responsive + +150 +00:10:47,440 --> 00:10:51,600 +neuron in the primary visual cortexيعني بيظل الصور + +151 +00:10:51,600 --> 00:10:54,620 +منفصلة عن بعضها البعض لغاية ما تصل للvisual + +152 +00:10:54,620 --> 00:10:59,360 +cortex وبالتحديد لغاية ما تصل للbinocularly + +153 +00:10:59,360 --> 00:11:02,560 +responsive neurons في الprimary visual cortex + +154 +00:11:02,560 --> 00:11:07,000 +وبتم توحيدها في صورة واحدة وعشان يتم توحيدها في + +155 +00:11:07,000 --> 00:11:11,060 +صورة واحدةلازم قضية هذا التناسق اللي احنا حكينا + +156 +00:11:11,060 --> 00:11:14,920 +عليه اللي هو ال .. الnormal retinal أو الصح نسميه + +157 +00:11:14,920 --> 00:11:18,160 +normal retinocortical correspondence normal + +158 +00:11:18,160 --> 00:11:23,090 +retinocortical correspondenceniجي للشيء التالت + +159 +00:11:23,090 --> 00:11:28,010 +اليوم و اللي هو بنقول عنه الhoropter أو الأفق لما + +160 +00:11:28,010 --> 00:11:32,150 +إنسان بسمع كلمة horopter أو أفق بيتخيل أنه احنا + +161 +00:11:32,150 --> 00:11:36,230 +بنحكي للأفق البعيد اللي بيبين عند الغروب و اللي هو + +162 +00:11:36,230 --> 00:11:40,130 +عبارة أو حتى في أي وقت من اليوم اللي هو عبارة عن + +163 +00:11:40,130 --> 00:11:43,650 +انطباق السماء على الأرض و الخط الفاصل بين السماء و + +164 +00:11:43,650 --> 00:11:49,400 +الأرضفي أبعد مسافة مستطيع الإنسان يراها لكن ال + +165 +00:11:49,400 --> 00:11:54,760 +horopter في تعريف علم الحوال له تعريف آخر ومعنى + +166 +00:11:54,760 --> 00:11:59,820 +آخر هو عبارة عن imaginary plane in the external + +167 +00:11:59,820 --> 00:12:05,180 +space وعبارة عن مستوى فراغي تخيليفي الفراغ الخارجي + +168 +00:12:05,180 --> 00:12:09,980 +خارج الشخص يعني هو عبارة عن مستوى تخيّلي طبعا بعض + +169 +00:12:09,980 --> 00:12:14,620 +الرسمات بترسم كخط line ولكن هو مستوى فراغي وفي فرق + +170 +00:12:14,620 --> 00:12:17,960 +بين المستوى الفراغي و الline إذا هو imaginary .. + +171 +00:12:17,960 --> 00:12:22,700 +imaginary plane in the external space all points + +172 +00:12:22,700 --> 00:12:26,320 +on which stimulate corresponding retinal elements + +173 +00:12:27,140 --> 00:12:31,120 +يعني ماذا أو ليش العلماء حددوا مستوى في الفراغ و + +174 +00:12:31,120 --> 00:12:35,060 +جالوا عنه الهروبتر؟ لأنه فيه ميزة لهذا الهروبتر، + +175 +00:12:35,060 --> 00:12:39,370 +هذا المستوى الفراغي، أي target موجود عليهفي هذا + +176 +00:12:39,370 --> 00:12:43,790 +المكان في أي مكان من هذا المستوى الفراغي لو سقطت + +177 +00:12:43,790 --> 00:12:48,070 +صورته على شبكيات العينين هتسقط على totally + +178 +00:12:48,070 --> 00:12:52,530 +corresponding retinal points بمعنى آخر مافيش أي + +179 +00:12:52,530 --> 00:12:56,870 +مجهود يبذلوا الدماغ لتحريك العينين لتصحيح وضع + +180 +00:12:56,870 --> 00:13:00,870 +الصورة لأن الصورتين الصورتين على العين اليمين وعلى + +181 +00:13:00,870 --> 00:13:05,160 +العين الشمال سقطين تماما على مناطق متماثلةوهذا + +182 +00:13:05,160 --> 00:13:08,160 +اللي بيميز الهروبتر أو هذا اللي بيميز هذا المستوى + +183 +00:13:08,160 --> 00:13:12,600 +الفراغي في الفراغ اللي أطلقنا عليه أو أطلق عليه + +184 +00:13:12,600 --> 00:13:16,740 +العلماء كلمة horopter أو الأفق إذا + +201 +00:14:19,870 --> 00:14:23,870 +العظمة الـ three-dimensional بنقول هذا الجواب على + +202 +00:14:23,870 --> 00:14:30,770 +هذا السؤال هنقشله شوية في خضم هذه المحاضرة طيب نرجع + +203 +00:14:30,770 --> 00:14:33,850 +نحكي عن الهروبتر اللي هو الـ imaginary plane بنقول + +204 +00:14:33,850 --> 00:14:38,020 +this plane passes through the intersection of the + +205 +00:14:38,020 --> 00:14:42,640 +visual axis and therefore includes the point of + +206 +00:14:42,640 --> 00:14:46,560 +fixation in binocular single vision طبعا هذا + +207 +00:14:46,560 --> 00:14:51,080 +الهروبتر لابد أن يمر في نقطة تقاطع الـ visual axis + +208 +00:14:51,080 --> 00:14:54,140 +لعين اليمين و الـ visual axis لعين الشمال + +209 +00:14:54,140 --> 00:14:58,520 +طب في الوضع الطبيعي الـ two visual axes بتقطع عند + +210 +00:14:58,520 --> 00:15:02,820 +الـ point of fixation فبالتالي الهروبتر لابد أن يمر + +211 +00:15:02,820 --> 00:15:06,290 +في الـ point of fixation طيب الـ point of fixation + +212 +00:15:06,290 --> 00:15:10,630 +بتتغير كيف بتتغير مع تغير الـ target اللي أنا بتطلع + +213 +00:15:10,630 --> 00:15:13,750 +عليه كنت بتطلع على الصبورة إذا الـ point of + +214 +00:15:13,750 --> 00:15:17,510 +fixation بتاعتي عند الصبورة بعد شوية صرت أطلع في + +215 +00:15:17,510 --> 00:15:20,730 +الدفتر انتقلت الـ point of fixation اللي عندي عند + +216 +00:15:20,730 --> 00:15:25,170 +الدفتر بعد هيك صرت أطلع في زميلي بعيد عني تقريبا + +217 +00:15:25,170 --> 00:15:31,260 +متر أيضا بيكون عندي الـ point of fixation انتقلت و + +218 +00:15:31,260 --> 00:15:36,340 +صارت على .. عند زميلي .. أه فهنا بدنا نفهم قضية أن + +219 +00:15:36,340 --> 00:15:42,520 +الهروبتر أو الأفق في علم الحوال متنقلمتنقل لأنه + +220 +00:15:42,520 --> 00:15:45,980 +دائما من شروطه أنه لازم يمر في الـ point of + +221 +00:15:45,980 --> 00:15:49,280 +fixation يعني في النقطة اللي الإنسان بيركز فيها + +222 +00:15:49,280 --> 00:15:52,320 +طالما النقطة اللي الإنسان بيركز فيها بتتغير بين + +223 +00:15:52,320 --> 00:15:56,600 +لحظة و أخرى إذا الـ heropter .. الـ heropter أفق هذا + +224 +00:15:56,600 --> 00:16:00,460 +الإنسان أثناء نظره لشيء معين عند هذا الشيء المعين + +225 +00:16:00,790 --> 00:16:04,750 +صار ينظر لشيء آخر، إذا ينتقل الهروبتر إلى هذا + +226 +00:16:04,750 --> 00:16:08,610 +الشيء الآخر، إذا this plane اللي هو الـ imaginary + +227 +00:16:08,610 --> 00:16:12,250 +plane أو الهروبتر، this plane passes through the + +228 +00:16:12,250 --> 00:16:16,730 +intersection of the visual axes وعلى هذا طالما هو + +229 +00:16:16,730 --> 00:16:21,150 +بيمر في النقطة اللي بتقاطع فيها الـ two visual axes + +230 +00:16:21,820 --> 00:16:24,980 +therefore includes the point of fixation in + +231 +00:16:24,980 --> 00:16:28,420 +binocular single vision وهذا طبعا احنا بنحكي عن + +232 +00:16:28,420 --> 00:16:32,080 +الوضع الطبيعي عن الوضع الطبيعي نشوف بعض الرسمات + +233 +00:16:32,080 --> 00:16:36,820 +اللي بتوضح هذه القضية هاي هو عندي الـ two eyes + +234 +00:16:36,820 --> 00:16:43,280 +خلينا نطلع لعرض مكبر شوية هاي الـ two eyes هاي one + +235 +00:16:43,280 --> 00:16:47,740 +eye نفرض الـ right eye وهي الـ left eye وهي مستوى + +236 +00:16:47,740 --> 00:16:54,870 +تخيلي زي جوس عاملوهي المستوى التخيلي هنا يعني موضح + +237 +00:16:54,870 --> 00:17:00,290 +بخط بس هو مش خط هو عبارة عن imaginary plane زي ما + +238 +00:17:00,290 --> 00:17:03,970 +الصورة بتوضح هاي الـ point of fixation بيمر بالـ + +239 +00:17:03,970 --> 00:17:08,130 +point of fixation بيمر بالـ point of fixation اذا + +240 +00:17:08,130 --> 00:17:11,850 +هذا هو الهروبتر هذا المستوى التخيلي اللي مرسوم + +241 +00:17:11,850 --> 00:17:18,150 +بطريقة تقريبا three-dimensional عبارة عن imaginary + +242 +00:17:18,150 --> 00:17:23,070 +plane مستوى تخيلي طبعا مش مستوى تخيلي زي المستويات + +243 +00:17:23,070 --> 00:17:25,610 +اللي اتعلمناها في الهندسة انه مستوى مش منحني لأ هذا + +244 +00:17:25,610 --> 00:17:31,810 +مستوى تخيلي منحني يعني حسب ما بتوضح الصورة ودائما و + +245 +00:17:31,810 --> 00:17:35,890 +أبدا لابد أن يمر بالـ point of fixation لو الـ point + +246 +00:17:35,890 --> 00:17:38,630 +of fixation اللي هي الـ red dot هاي اللي بتطلعوا + +247 +00:17:38,630 --> 00:17:42,010 +عليها الانتين لو بعدت يعني صارت طلعة target تاني + +248 +00:17:42,010 --> 00:17:45,470 +كل الـ heropter بنتقل هناك لو جربت الـ heropter + +249 +00:17:45,470 --> 00:17:48,450 +بيجرب بيجرب هنا طبعا two-dimensional + +250 +00:17:48,450 --> 00:17:53,290 +representation لنفس الصورة بتوضح الفكرة بشكل أكبر + +251 +00:17:53,290 --> 00:18:00,650 +بشكل أكبر هي .. يعني .. صورة .. يعني بتشرح الأمر + +252 +00:18:00,650 --> 00:18:04,450 +بشكل أكثر احنا عندنا هنا الـ right eye مثلا و الـ + +253 +00:18:04,450 --> 00:18:08,370 +left eye هاي الـ point of fixation F1 إذا الهروبتر + +254 +00:18:08,370 --> 00:18:13,510 +هيمر في F1 .. في F1 في نفس اللحظة في عندي target + +255 +00:18:13,510 --> 00:18:17,730 +تاني بعيد عن الهروبتر قدام الهروبتر .. قدام + +256 +00:18:17,730 --> 00:18:23,930 +الهروبتر فبالتالي طب .. الـ point of fixation الـ + +257 +00:18:23,930 --> 00:18:29,450 +point of fixation كلها بيمر فيها الهروبتر ويقولنا + +258 +00:18:29,450 --> 00:18:34,050 +أي target موجود على الهروبتر stimulates to + +259 +00:18:34,050 --> 00:18:37,790 +totally corresponding retinal points طيب معناته + +260 +00:18:37,790 --> 00:18:41,010 +قدام الهروبتر و ورا الهروبتر لو فيه targets + +261 +00:18:41,010 --> 00:18:45,130 +بتعمل stimulation ل non-corresponding retinal + +262 +00:18:45,130 --> 00:18:48,680 +points هذا الكلام صحيح مية في المية وبالتالي .. + +263 +00:18:48,680 --> 00:18:54,460 +وبالتالي بتكون إيش؟ في عندي retinal disparity .. + +264 +00:18:54,460 --> 00:18:58,300 +retinal disparity هنا بنقول كالقاعدة، هاي الـ point + +265 +00:18:58,300 --> 00:19:01,960 +of fixation .. هاي الـ point of fixation .. هاي الـ + +266 +00:19:01,960 --> 00:19:06,000 +point of fixation، هذا اللي هربتاللي هو جاي بشكل + +267 +00:19:06,000 --> 00:19:09,600 +دائرة طبعا هنا مفيش إله .. هنا يعني مجرد أساس نقول + +268 +00:19:09,600 --> 00:19:14,720 +إنه كأنه جزء من دائرة في الفرار أو .. أو مستوى + +269 +00:19:14,720 --> 00:19:19,040 +منحني بشكل انحناء دائري هاي الـ point of fixation + +270 +00:19:19,040 --> 00:19:23,020 +الـ point of fixation صورتها هنا لو في target عند + +271 +00:19:23,020 --> 00:19:30,600 +كلمة fix صورته بتقع على على الفوفيا هنا وعلى + +272 +00:19:30,600 --> 00:19:33,000 +الفوفيا هنا ومعروف ان الفوفيا في الانتين + +273 +00:19:33,000 --> 00:19:36,720 +corresponding retinal areas طيب إذا هذا الـ target + +274 +00:19:36,720 --> 00:19:42,100 +هينشاف بشكل single يعني مافيش دبلوبيا و هيكون في + +275 +00:19:42,100 --> 00:19:47,710 +عندي single vision و هنشوف two-dimensional مش + +276 +00:19:47,710 --> 00:19:50,330 +three-dimensional و قولنا ليش مش three-dimensional + +277 +00:19:50,330 --> 00:19:54,930 +احنا حقيقة هنشوفه three-dimensional بس بدنا نشرح + +278 +00:19:54,930 --> 00:19:58,190 +ليش احنا هنا بنقول two-dimensional ليش بنقول two + +279 +00:19:58,190 --> 00:20:01,710 +dimensional بعد شوية إن شاء الله تعالى هاي في عندي + +280 +00:20:01,710 --> 00:20:06,030 +target آخر target آخر بيسقط على temporal retina + +281 +00:20:06,030 --> 00:20:12,120 +هنا و بيسقط على nasal retina هنا بس بيبعد مسافة X + +282 +00:20:12,120 --> 00:20:16,940 +في الـ left eye عن الفوفيا باتجاه النازل و بيبعد + +283 +00:20:16,940 --> 00:20:21,620 +مسافة Y باتجاه الـ temporal عن الفوفيا في الـ right + +284 +00:20:21,620 --> 00:20:25,820 +eye بما أنه الـ target بما أنه الـ target يقع على + +285 +00:20:25,820 --> 00:20:30,850 +الهروبتر إذا حكمه حكم الـ target اللي عامل عليه + +286 +00:20:30,850 --> 00:20:35,390 +fixation هدولة العينتين بنقول طالما Y و X مسافات + +287 +00:20:35,390 --> 00:20:41,670 +متساوية إذا هو يقع على نقطة هنا ونقطة هنا متماثلات + +288 +00:20:41,670 --> 00:20:44,190 +تماما و corresponding retinal points totally + +289 +00:20:44,190 --> 00:20:46,970 +corresponding retinal points إحنا قولنا أي target + +290 +00:20:46,970 --> 00:20:50,510 +على الهروبتر لو الـ target موجود هنا و أنا بأشر بالـ + +291 +00:20:50,510 --> 00:20:55,880 +mouse أو هنا أو هنا أو هنا أو هنا المهم يكون على + +292 +00:20:55,880 --> 00:21:00,620 +الهروبتر هيعمل stimulation ل totally corresponding + +293 +00:21:00,620 --> 00:21:03,880 +retinal points وبالتالي بنشوف single و two- + +294 +00:21:03,880 --> 00:21:10,010 +dimensional في حالة وجود target برا منطقة الهروبتر + +295 +00:21:10,010 --> 00:21:13,870 +زي الـ target هذا الأبيض حيسقط صحيح على temporal + +296 +00:21:13,870 --> 00:21:18,010 +retina هنا وحيسقط على nasal retina هنا بس على + +297 +00:21:18,010 --> 00:21:22,890 +مناطق غير متماثلة على مناطق غير متماثلة بمعنى آخر + +298 +00:21:22,890 --> 00:21:27,450 +المسافة Y اللي بيبعتها هنا صورة الـ target سقطت + +299 +00:21:27,450 --> 00:21:30,810 +وخلصت سقطت هنا على النقطة هاي اللي بتبعد Y عن + +300 +00:21:30,810 --> 00:21:35,000 +الفوفيا ونفس الـ target sort of سقطت عنه زر ريتنا + +301 +00:21:35,000 --> 00:21:39,860 +هنا تبعد مسافة X عن الفوفيا بس في هذه الحالة لأنه + +302 +00:21:39,860 --> 00:21:44,240 +مش موجود على الهروبتر الـ target نفسه X لا تساوي Y + +303 +00:21:44,240 --> 00:21:49,460 +معروف أو أو واضح حسب الرسم أن X أكبر أو أبعد من + +304 +00:21:49,460 --> 00:21:54,980 +بعد Y عن الفوفيا X أبعد المسافة X أطول من المسافة + +305 +00:21:54,980 --> 00:22:00,930 +Y إذا أصبح هذا الـ target يعني يصبط على non- + +306 +00:22:00,930 --> 00:22:06,690 +corresponding retinal points قبل ما نقول إن هذا + +307 +00:22:06,690 --> 00:22:11,810 +الـ target هيصير double vision هذا الـ target أو أي + +308 +00:22:11,810 --> 00:22:16,490 +target آخر .. هذا الـ target أو أي target آخر برا ت + +309 +00:22:16,490 --> 00:22:19,870 +الهروبتر .. إيش يعني برا ت الهروبتر؟ يعني إما وراه + +310 +00:22:19,870 --> 00:22:23,530 +زي هذه الحالة أو أمامه زي ما أنا بقشر هنا يعني + +311 +00:22:23,530 --> 00:22:27,450 +أقرب للعين من الهروبتر فبالتالي أي target برا ت + +312 +00:22:27,450 --> 00:22:31,570 +الهروبتر بيعمل stimulation ل non-corresponding + +313 +00:22:31,570 --> 00:22:36,230 +retinal points يترى هل هينشاف double ولا في أحيانا + +314 +00:22:36,230 --> 00:22:40,270 +الابنين ممكن يتاخد إجراءات معينة هذا اللي هنعرفه + +315 +00:22:40,270 --> 00:22:45,310 +بعد شوية إن شاء الله تعالى إذا هذه الصور بتوضح لي + +316 +00:22:45,310 --> 00:22:50,210 +موضوع الـ corresponding retinal areas وبالتالي هذا + +317 +00:22:50,210 --> 00:22:55,150 +بالنسبة لتعريف الهروبتر وبنستكمل بعد الهروبتر + +318 +00:22:55,150 --> 00:22:58,790 +بيجي عندي حاجة اسمها الـ panumfuginal space + +319 +00:22:58,790 --> 00:23:06,530 +panumfuginal space طبعا الفراغ الفراغ بتاع Panum + +320 +00:23:06,530 --> 00:23:10,410 +Panum اسم العالم اللي وصف هذه القضية Fuional + +321 +00:23:10,410 --> 00:23:14,310 +Space وكأنه بيقول في فراغ حوالين الهروبتر بتتم في + +322 +00:23:14,310 --> 00:23:18,710 +عملية الـ fusion على الرغم على الرغم من أنه الـ + +323 +00:23:18,710 --> 00:23:22,210 +target stimulates slightly non-corresponding + +324 +00:23:22,210 --> 00:23:26,050 +retinal elements بنشوف الرسمة هاي و بنرجع بنقول + +325 +00:23:26,050 --> 00:23:30,320 +هاي عندي أنا الخط الأزرق الخط الأزرق بيمثل + +326 +00:23:30,320 --> 00:23:35,560 +الهروبتر، واحنا قولنا الهروبتر .. الهروبتر .. + +327 +00:23:35,560 --> 00:23:41,440 +كل target بيقع على الهروبتر، اللي هو مستوى فراغي + +328 +00:23:41,440 --> 00:23:45,820 +تخيلي، بيعمل stimulation ل corresponding retinal + +329 +00:23:45,820 --> 00:23:48,900 +areas، بيعمل stimulation ل corresponding retinal + +330 +00:23:48,900 --> 00:23:52,600 +areas، و بدون ما يتعب الدماغ، بيتم توحيد الصورتين، + +331 +00:23:52,600 --> 00:23:56,910 +مثال high target أزرق اللي هو جاي على الـ point of + +332 +00:23:56,910 --> 00:24:00,510 +fixation صورة هذا ال target الأزرق تسقط على الـ fovea + +333 +00:24:00,510 --> 00:24:02,750 +في الـ right eye و على الـ fovea في الـ left eye + +334 +00:24:02,750 --> 00:24:09,040 +تمام، الآن في عندي منطقة أمام و خلف الهروبتر بس + +335 +00:24:09,040 --> 00:24:15,500 +محيطة فيه يعني ملاسقة له منطقة أمام و خلف اللي هو + +336 +00:24:15,500 --> 00:24:20,480 +الهروبتر أي target فيها أي target فيها زي target + +337 +00:24:20,480 --> 00:24:24,440 +X هيو أمام الهروبتر ممكن target Z خلفه ممكن هنا + +338 +00:24:24,440 --> 00:24:28,410 +ممكن هنا المهم مش على الهروبتر يا أمامه يا خلفه في + +339 +00:24:28,410 --> 00:24:31,690 +الفراغ بس مش بعيد كتير يعني في .. في .. في ضمن + +340 +00:24:31,690 --> 00:24:35,970 +المنطقة الفراغية اللي ملونة باللون الأصفر أي + +341 +00:24:35,970 --> 00:24:39,750 +target within the panormifuginal area بيعمل + +342 +00:24:39,750 --> 00:24:43,790 +stimulation ل slightly .. slightly non- + +343 +00:24:43,790 --> 00:24:47,410 +corresponding retinal point يعني هذا الـ target + +344 +00:24:47,410 --> 00:24:52,070 +سقط على المنطقة X في الـ nasal retina و سقط على + +345 +00:24:52,070 --> 00:24:55,750 +المنطقة X في الـ temporal retina بس هي الأفضل نقول + +346 +00:24:56,880 --> 00:25:00,340 +سقط على x في الـ temporal area مع شوية زوغان بسيط + +347 +00:25:00,340 --> 00:25:08,020 +مع شوية زوغان بسيط عن x بمعنى يسقط على slightly + +348 +00:25:08,020 --> 00:25:12,700 +non-corresponding retinal areas طيب هذه .. هذه + +349 +00:25:13,430 --> 00:25:20,090 +القضية الزواغان البسيط بيحفظ لدماغ أنه بدل ما نشوف + +350 +00:25:20,090 --> 00:25:25,950 +هذا الـ target بشكل مزدوج يصير dyplopia بيحفظ لدماغ + +351 +00:25:25,950 --> 00:25:30,950 +أنه يحرك العينتين حركة بسيطة لتعديل وضع الـ target + +352 +00:25:30,950 --> 00:25:35,290 +هذه الحركة البسيطة عبارة عن divergence movement + +353 +00:25:35,290 --> 00:25:40,330 +divergence movement احنا قلنا الحركات deduction عين + +354 +00:25:40,330 --> 00:25:43,110 +واحدة، حركة العين الواحدة، العين الثانية مغطية، + +355 +00:25:43,110 --> 00:25:47,890 +vergences حركة العينتين في نفس الاتجاه، vergences + +356 +00:25:47,890 --> 00:25:53,290 +حركة العينتين في اتجاهين متعاكسين لازم تتم حركة + +357 +00:25:53,290 --> 00:25:58,710 +بسيطة جدا جدا بقدر الزواغان البسيط جدا جدا لصورة + +358 +00:25:58,710 --> 00:26:03,430 +الـ target X لأنها سقطت على المنطقة X في الـ nasal + +359 +00:26:03,430 --> 00:26:07,630 +retina في الـ right eye و سقطت على X في الـ temporal + +360 +00:26:07,630 --> 00:26:11,610 +retina في الـ left eye مع زواغان بسيط مع زواغان + +361 +00:26:11,610 --> 00:26:17,410 +بسيط فبالتالي هذا الزواغان البسيط لابد من تعديله + +362 +00:26:17,670 --> 00:26:20,910 +ممكن الإنسان يقول طيب ليش vergence movement معادي؟ + +363 +00:26:20,910 --> 00:26:23,270 +يعني العينتين اتحركوا على اليمين أو اتحركوا على + +364 +00:26:23,270 --> 00:26:26,750 +الشمال ما هو إذا العينتين اتحركوا vergence movement + +365 +00:26:26,750 --> 00:26:30,730 +.. vergence movement يعني في نفس الاتجاه وصارت + +366 +00:26:30,730 --> 00:26:34,250 +الصورة اللي زيغة صارت عتلة هتزوغ التانية لأن هذه + +367 +00:26:34,250 --> 00:26:37,990 +التانية already موجودة على المنطقة المطلوبة وهذه + +368 +00:26:37,990 --> 00:26:40,950 +زيغة شوية فبالتالي لو العينتين عملوا vergence + +369 +00:26:40,950 --> 00:26:45,330 +movement اللي كان زيغ عدل و اللي كان معدل هيزوغ + +370 +00:26:45,330 --> 00:26:48,850 +شوية فبالتالي مبنفعش vergence movement طبduction + +371 +00:26:48,850 --> 00:26:52,630 +movement أيضا مبنفعش اللي هينفع فقط vergences + +372 +00:26:52,630 --> 00:26:58,910 +vergences ممكن تتم في اتجاهين متعاكسين عشان تعديل + +373 +00:26:58,910 --> 00:27:04,930 +وضع الصورة عشان تعديل وضع الصورة الآن زيغة زوغان + +374 +00:27:04,930 --> 00:27:10,250 +بسيط زي الزواغان البسيط بنقول هذا الزواغان البسيط + +375 +00:27:10,250 --> 00:27:14,090 +بلزمه divergence movement إما convergence أو + +376 +00:27:14,090 --> 00:27:18,250 +divergence أو حتى ممكن يلزمه vertical divergence + +377 +00:27:18,250 --> 00:27:23,230 +إذا كان الزواغان بشكل رأسي هذه الحركة لأنه + +378 +00:27:23,2 + +401 +00:29:16,750 --> 00:29:20,210 +يؤمر عضلات العين لتحريك العينتين عشان تعديل + +402 +00:29:20,210 --> 00:29:25,840 +الزواغان البسيط برات المنطقة هايبلزم حركة أكبر، + +403 +00:29:25,840 --> 00:29:31,060 +الدماغ مش قادر يعملها، فبالتالي أي target .. أي + +404 +00:29:31,060 --> 00:29:36,490 +target برّات ال panofusional area .. ب .. برّات ال + +405 +00:29:36,490 --> 00:29:40,030 +panofusional area لازم ينشاف double لازم ينشاف + +406 +00:29:40,030 --> 00:29:46,430 +double و بالتالي هذا هيعطيني موضوع ال .. ال + +407 +00:29:46,430 --> 00:29:49,570 +diplopia أو ال physiological diplopia اللي هنحكي + +408 +00:29:49,570 --> 00:29:53,350 +عنه إذا الفراغ تلخيصا لكل الكلام اللي حكيناه + +409 +00:29:53,350 --> 00:29:58,790 +الفراغ يقسم لثلاثة .. لتعبير لثلاثة أقسم أول + +410 +00:29:58,790 --> 00:30:04,780 +قسم هو المستوى الفراغي اللي سمناه الهوروبتر ثاني + +411 +00:30:04,780 --> 00:30:09,500 +قسم هو الفراغ اللي محيط بالهوروبتر أمامه و خلفه + +412 +00:30:09,500 --> 00:30:14,500 +يعني كأنه يشمل الهوروبتر ثالث شيء المنطقة اللي + +413 +00:30:14,500 --> 00:30:18,400 +برات ال panofusional area اللي هي أمامها أو خلفها + +414 +00:30:18,400 --> 00:30:22,520 +أمامها باتجاه العين أو خلفها هدول الثلاثة مناطق من + +415 +00:30:22,520 --> 00:30:27,240 +الفراغ إذا الهوروبتر ال panofusional space space + +416 +00:30:27,240 --> 00:30:35,150 +أفضل نسميه space أفضل هنقول ليش space أفضل ال pan + +417 +00:30:35,150 --> 00:30:38,350 +-infusional space ثاني حاجة أول حاجة اللي هو + +418 +00:30:38,350 --> 00:30:41,510 +الهوروبتر، ثاني حاجة ال pan-infusional space، ثالث + +419 +00:30:41,510 --> 00:30:45,510 +حاجة المنطقة اللي أمام و خلف ال pan-infusional + +420 +00:30:45,510 --> 00:30:50,240 +space، ال pan-infusional space الآن هدول التقسيمات + +421 +00:30:50,240 --> 00:30:54,780 +الثلاثة للفراغ وحنقول ميزة كل تقسيم ايش .. ميزة كل + +422 +00:30:54,780 --> 00:30:57,540 +تقسيم ايش بس بدنا نقول ليش احنا قولنا pan + +423 +00:30:57,540 --> 00:31:01,220 +-infusional space أفضل تعبيرا من pan-infusional + +424 +00:31:01,220 --> 00:31:05,620 +area ال pan-infusional area تطلق على المنطقة من + +425 +00:31:05,620 --> 00:31:10,300 +الشبكية أو مساحة من الشبكية في العينتين بتستقبل + +426 +00:31:10,300 --> 00:31:14,340 +صور ال targets الموجودة في pan-infusional space + +427 +00:31:14,690 --> 00:31:18,630 +يعني ال Pan-infusional space هو جزء من الفراغ + +428 +00:31:18,630 --> 00:31:22,610 +بينما ال Pan-infusional area هي مساحة من الشبكية + +429 +00:31:22,610 --> 00:31:26,350 +بتستقبل صور ال targets الموجودة في ال Pan + +430 +00:31:26,350 --> 00:31:30,250 +-infusional space هاي الفرق بين space و بين area + +431 +00:31:30,550 --> 00:31:34,350 +نرجع نقول إيش وظيفة كل جزء من الأجزاء الثلاثة من + +432 +00:31:34,350 --> 00:31:38,290 +الفراغ المحيط بالشخص اللي سمناها الهوروبتر إيش + +433 +00:31:38,290 --> 00:31:42,670 +ميزته؟ ميزته إنه كل target يقع عليه .. كل target + +434 +00:31:42,670 --> 00:31:47,690 +يقع عليه stimulates totally corresponding retinal + +435 +00:31:47,690 --> 00:31:51,950 +points أو retinal areas وبما إنه بيسقط الصور بتاعة + +436 +00:31:51,950 --> 00:31:56,020 +ال targets اللي على الهوروبتر اللي على الهوروبتر تثبت + +437 +00:31:56,020 --> 00:32:01,040 +الصور على مناطق متماثلة 100% من شبكية العين إذا + +438 +00:32:01,040 --> 00:32:05,220 +ما فيش داعي للدماغ يبذل أي مجهود هدول ال targets + +439 +00:32:05,220 --> 00:32:11,200 +بنشافه singly يعني بشكل موحد بس two dimensionally + +440 +00:32:11,200 --> 00:32:17,020 +وجربنا نجاوب ليش two dimensionally ثاني حاجة أو + +441 +00:32:17,020 --> 00:32:20,380 +ثاني جزء من الفراغ اللي هو الفراغ المحيط + +442 +00:32:20,380 --> 00:32:26,120 +بالهوروبتر أمامه وخلفه وسميناه panom fusional + +443 +00:32:26,120 --> 00:32:30,140 +space أي target within the panom fusional space + +444 +00:32:30,140 --> 00:32:34,360 +بيعمل stimulation ل .. ل slightly .. بنأكد على + +445 +00:32:34,360 --> 00:32:38,100 +كلمة slightly slightly corresponding retinal + +446 +00:32:38,100 --> 00:32:43,140 +points أو areas هذا الزوغان البسيط في صورة ال + +447 +00:32:43,140 --> 00:32:46,940 +target على شبكيت العينتين بيحفظ الدماغ انه يعمل + +448 +00:32:46,940 --> 00:32:52,200 +fusional versions أو motor fusion لتعديل الوضع هنا + +449 +00:32:52,200 --> 00:32:57,100 +بسبب شغل الدماغ بيشعر و بيصير عند الدماغ إحساس + +450 +00:32:57,100 --> 00:33:04,050 +بالبعد الثالث فكل target .. كل target يقع صورته على + +451 +00:33:04,050 --> 00:33:09,490 +أو within the panum fusional space بنشاف singly .. + +452 +00:33:09,490 --> 00:33:15,010 +singly يعني موحد مش double و two dimensionally .. + +453 +00:33:15,010 --> 00:33:18,290 +عفوا three dimensionally اللي على الهوروبتر two + +454 +00:33:18,290 --> 00:33:22,810 +dimensionally و في ال panum fusional space three + +455 +00:33:22,810 --> 00:33:27,750 +dimensionally يعني بشكل ثلاثي الأبعاد ليش يعني + +456 +00:33:27,750 --> 00:33:33,740 +الأشياء اللي موجودة .. الأشياء اللي موجودة في .. ال + +457 +00:33:33,740 --> 00:33:38,100 +Panom fusional space تُرى singly and three + +458 +00:33:38,100 --> 00:33:41,420 +dimensionally singly لأن دماغ اشتغل و عدّل وضع + +459 +00:33:41,420 --> 00:33:46,200 +العنتين عشان يتم إسقاط الصورتين على مناطق متماثلة + +460 +00:33:46,200 --> 00:33:51,060 +مائة بالمائة من الشبكيات تمهيدا لعملية ال fusion + +461 +00:33:51,060 --> 00:33:56,140 +الشغل أو المجهود البسيط اللي قام فيه دماغ بيشعره + +462 +00:33:56,140 --> 00:34:00,260 +.. بيشعره بالبعد الثالث أو ال three dimensionality + +463 +00:34:00,690 --> 00:34:04,790 +الآن أي target برة ال panofusional space سواء + +464 +00:34:04,790 --> 00:34:08,970 +أمامها أقرب للعين أو بعده .. بعد النطاق الأصفر اللي + +465 +00:34:08,970 --> 00:34:12,110 +احنا راسمينه عبارة عن فراغ أمامه و خلف الهوروبتر + +466 +00:34:12,110 --> 00:34:16,430 +أبعد منه أو أقرب منه بينشاف double زي ال target Y + +467 +00:34:16,430 --> 00:34:20,630 +عندي هيسقط على المنطقة Y هنا في ال temporal retina + +468 +00:34:20,630 --> 00:34:25,010 +ويسقط على المنطقة Y في ال nasal retina في ال left + +469 +00:34:25,010 --> 00:34:29,410 +eye بس شايفين من F ل Y هنا المسافة كيف؟ وهنا ال .. + +470 +00:34:29,410 --> 00:34:33,230 +من F ل Y المسافة كيف؟ بعادي كثير إذا المناطق + +471 +00:34:33,230 --> 00:34:37,590 +اللي سقط عليها تسمى largely uncorresponding أو non + +472 +00:34:37,590 --> 00:34:41,350 +-corresponding retinal areas بيقدرش الدماغ بيه + +473 +00:34:41,350 --> 00:34:44,910 +divergence movement انه يعدل الوضع فتشاف أو ترى + +474 +00:34:44,910 --> 00:34:49,190 +بشكل double .. ترى بشكل double طيب، الآن ممكن + +475 +00:34:49,190 --> 00:34:51,830 +انسان يقول طب ليش الأشياء اللي على ال pan or + +476 +00:34:51,830 --> 00:34:55,010 +infusional space بتنشاف two dimensionally بينما + +477 +00:34:55,010 --> 00:34:59,070 +الأشياء اللي في ال panofusional space طبعا اللي على + +478 +00:34:59,070 --> 00:35:02,290 +الهوروبتر two dimensional و اللي في ال panofusional + +479 +00:35:02,290 --> 00:35:05,530 +space three dimensional بنقول حقيقة الأجسام في + +480 +00:35:05,530 --> 00:35:10,910 +حقيقة الأمر في الحياة هي ثلاثية الأبعاد و لو احنا + +481 +00:35:10,910 --> 00:35:16,610 +ركزنا في جسم معناته الهوروبتر يمر فيه يمر فيه طب ليش + +482 +00:35:16,610 --> 00:35:20,370 +هذا الجسم أنا بشوفه ثلاثي الأبعاد مع إنه احنا + +483 +00:35:20,370 --> 00:35:24,370 +الكلام بيقول إنه طالما أنا عامل تركيز عليه وطالما + +484 +00:35:24,370 --> 00:35:28,790 +الهوروبتر بيمر فيه المفروض يرد ثنائي الأبعاد بنقول + +485 +00:35:28,790 --> 00:35:33,110 +كالعادة لأن الجسم حقيقة ثلاثي الأبعاد هيكون جزء + +486 +00:35:33,110 --> 00:35:37,150 +منه على الهوروبتر وجزء آخر أما أمام الهوروبتر أو + +487 +00:35:37,150 --> 00:35:41,530 +خلف الهوروبتر أو ممكن جزء أمام وجزء خلف في نفس + +488 +00:35:41,530 --> 00:35:46,500 +الوقت يعني .. يعني يستحيل إنه مثلا أنا بنظر لمكتب أو + +489 +00:35:46,500 --> 00:35:52,360 +مثلا كأس من الماء أو الجوال أو شيء من هذا يستحيل + +490 +00:35:52,360 --> 00:35:56,020 +أنه يكون رفيع لدرجة إنه يسير برفع المستوى الفراغي + +491 +00:35:56,020 --> 00:35:59,680 +احنا عارفين إن المستوى الفراغي لا سمك له .. لا + +492 +00:35:59,680 --> 00:36:02,720 +سمك له فبالتالي كل الأشياء اللي في حياتنا اللي + +493 +00:36:02,720 --> 00:36:06,100 +احنا بنركز فيها حتى لو مش بنركز فيها بنركز في + +494 +00:36:06,100 --> 00:36:09,920 +غيرها و هي تقع جزء منها على الهوروبتر هنلاقي إن جزء + +495 +00:36:09,920 --> 00:36:13,400 +منها يقع خارج الهوروبتر يعني وين خارج الهوروبتر؟ يعني + +496 +00:36:13,400 --> 00:36:17,140 +في ال pan-infusional space وبالتالي كل الأشياء + +497 +00:36:17,140 --> 00:36:20,600 +اللي في حياتنا بنشوفها إيش three-dimensional الآن + +498 +00:36:20,600 --> 00:36:24,860 +أي شيء خارج منطقة ال pan-infusional space بيورى + +499 +00:36:24,860 --> 00:36:29,360 +بشكل double وهنا احنا أنا بأنصح بإجراء التجربة + +500 +00:36:29,360 --> 00:36:36,610 +التالية اللي ه .. يعني أشرحها بشكل مبسط هذه التجربة + +501 +00:36:36,610 --> 00:36:41,770 +عبارة عن أن أنا ببدأ أمسك جلمين .. جلمين جلم أحطه + +502 +00:36:41,770 --> 00:36:45,930 +أمام عيني على بعد تقريبا عشرة سانتي وجلم آخر أمسكه + +503 +00:36:45,930 --> 00:36:49,470 +على امتداد إيدي أبعد ما يكون لو ركزت في الجلم اللي + +504 +00:36:49,470 --> 00:36:53,630 +قريب بالنسبة ليه هيصير الجلم اللي بعيد double؟ لو + +505 +00:36:53,630 --> 00:36:57,090 +ركزت في الجلم اللي بعيد هيكون الجلم اللي قريب + +506 +00:36:57,090 --> 00:37:00,530 +بالنسبة ليه double؟ وكل واحد ممكن يعني بواسطة + +507 +00:37:00,530 --> 00:37:04,030 +جلمين يعمل هذه التجربة ليش لما ركزت في الجلم اللي + +508 +00:37:04,030 --> 00:37:08,880 +بعيد صار double؟ ببساطة لأنه خارج ال paninfusion ال + +509 +00:37:08,880 --> 00:37:11,860 +space اللي في هذه اللحظة طيب لما ركزت في اللي بعيد + +510 +00:37:11,860 --> 00:37:17,500 +ليش القريب صار يعني double لأنه القريب في هذه + +511 +00:37:17,500 --> 00:37:21,140 +اللحظة بيكون خارج ال paninfusion ال space أو أمام + +512 +00:37:21,140 --> 00:37:26,420 +منه طبعا هذه تسمى physiological dyplopia و الكثير + +513 +00:37:26,420 --> 00:37:30,400 +منها موجودة عنده هذه طبعا ولكن لا يشعر فيها لأنه + +514 +00:37:30,400 --> 00:37:33,760 +مصاحبة بحاجة بيسميها physiological suppression + +515 +00:37:33,760 --> 00:37:37,430 +يعني الدماغ بيخلي الإنسان ينساها أو ما ياخدش باله + +516 +00:37:37,430 --> 00:37:39,550 +منها لأنه بتكون مصاحبة بيه physiological + +517 +00:37:39,550 --> 00:37:43,650 +suppression فهذا بالنسبة لموضوع الهوروبتر و ال + +518 +00:37:43,650 --> 00:37:47,690 +panofusional space و ال panem .. أو .. أو ما هو + +519 +00:37:47,690 --> 00:37:53,130 +خارج ال panofusional space و هيك احنا بنكون وصلنا + +520 +00:37:53,130 --> 00:37:56,550 +ل .. آخر شيء + +521 +00:37:59,840 --> 00:38:03,240 +اللي هو قد ايش .. قد ايش في الفراغ يمتد ال + +522 +00:38:03,240 --> 00:38:06,440 +panofusional space حوالين الهوروبتر يعني هذه + +523 +00:38:06,440 --> 00:38:11,480 +المساحة .. هذه المساحة الفراغية قد ايش بتمتد حوالين + +524 +00:38:11,480 --> 00:38:17,500 +الهوروبتر بنقول كالعادة عند ال point of fixation + +525 +00:38:17,500 --> 00:38:21,720 +بتكون shallow يعني امتدتها حوالين ال point of + +526 +00:38:21,720 --> 00:38:25,140 +fixation أمامها و خلفها بيكون قليل بينما عند + +527 +00:38:25,140 --> 00:38:28,520 +الأطراف بتصير أوسع وقدروها العلماء + +528 +00:38:31,370 --> 00:38:34,990 +Panum space is shallow at fixation تقريبا ستة + +529 +00:38:34,990 --> 00:38:38,410 +seconds of arc and deep part where the periphery + +530 +00:38:38,410 --> 00:38:41,890 +بيمتد من ثلاثين لأربعين seconds of arc at fifteen + +531 +00:38:41,890 --> 00:38:45,130 +degree from the fovea at fifteen degree from the + +532 +00:38:45,130 --> 00:38:48,610 +fovea therefore objects on the horopter are seen + +533 +00:38:48,610 --> 00:38:52,690 +singly and in one plane objects in panum fusional + +534 +00:38:52,690 --> 00:38:57,050 +space are singly and are seen singly and + +535 +00:38:57,050 --> 00:39:00,690 +stereoscopically قلنا كلمة panofusional space إذا + +536 +00:39:00,690 --> 00:39:04,730 +نتكلم عن الفراغ و panofusional area إذا نتكلم عن + +537 +00:39:04,730 --> 00:39:07,710 +المنطقة من ال retina اللي هتستقبل صور ال targets + +538 +00:39:07,710 --> 00:39:12,790 +اللي في ال panofusional space outside panofusional + +539 +00:39:12,790 --> 00:39:16,550 +area appear double physiological diplopia is + +540 +00:39:16,550 --> 00:39:19,250 +usually accompanied by physiological suppression + +541 +00:39:19,830 --> 00:39:23,790 +and many subjects remain unaware .. unaware of + +542 +00:39:23,790 --> 00:39:27,210 +this phenomenon إنهم ما بيشعروش في الدبلوبيا the + +543 +00:39:27,210 --> 00:39:31,290 +retinal areas stimulated by images falling within + +544 +00:39:31,290 --> 00:39:34,350 +panofusional space are termed أو are called + +545 +00:39:34,350 --> 00:39:38,290 +panofusional areas إذن المساحات من الشبكية في + +546 +00:39:38,290 --> 00:39:42,310 +العينتين اللي بيصير لها stimulation بواسطة أي + +547 +00:39:42,310 --> 00:39:46,630 +target موجود في ال panofusional space تسمى هذه + +548 +00:39:46,630 --> 00:39:52,180 +المناطق من الشبكية panofusional هنقف عند موضوع ال + +549 +00:39:52,180 --> 00:39:54,960 +binocular single vision و ال sensory fusion و + +550 +00:39:54,960 --> 00:39:58,760 +يعطيكم العافية والسلام عليكم ورحمة الله وبركاته diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/LobzMcnF71g_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/LobzMcnF71g_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..07ca0f86a3ec3498167bb63798e8a100bb374816 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/LobzMcnF71g_postprocess.srt @@ -0,0 +1,2200 @@ +1 +00:00:04,490 --> 00:00:07,510 +بسم الله الرحمن الرحيم نستكمل محاضرات حوال واحد + +2 +00:00:07,510 --> 00:00:13,630 +وتوقفنا عند ال retinomotor valueهي ترى إيش هو + +3 +00:00:13,630 --> 00:00:20,390 +المقصود بال retinomotor value و + +4 +00:00:20,390 --> 00:00:26,610 +هذا الطبيعي، لما يكون عندى target أو هدف في ال + +5 +00:00:26,610 --> 00:00:29,630 +peripheral field، مش متوقع أن صورته تسقط على + +6 +00:00:29,630 --> 00:00:35,230 +الفوفيا، وإنما أثناء تركيز الشخص + +7 +00:00:35,790 --> 00:00:39,190 +في target أمامه أي target آخر في ال peripheral + +8 +00:00:39,190 --> 00:00:43,850 +field بتصبط صورته على extra-foveal element يعني في + +9 +00:00:43,850 --> 00:00:48,110 +أي منطقة من الشبكية بعيدا عن الفوفيا ممكن يكون جنب + +10 +00:00:48,110 --> 00:00:52,030 +الفوفيا أو بعيد كثير عن الفوفيا أو متوسط البعد عن + +11 +00:00:52,030 --> 00:00:57,530 +الفوفيا يعني فيه ما تبقى من ال retinato establish + +12 +00:00:57,530 --> 00:01:01,530 +fixation on this target or on this object a + +13 +00:01:01,530 --> 00:01:05,390 +saccadic version of accurate amplitude is required + +14 +00:01:05,390 --> 00:01:09,050 +بنفهم هذه الجملة saccadic version .. virgin مفهومة + +15 +00:01:09,050 --> 00:01:14,910 +binocular movement سكادك معناتها سريعة احنا جسمنا + +16 +00:01:14,910 --> 00:01:19,790 +زمان حركات العين reductions و virgins و virgins + +17 +00:01:19,790 --> 00:01:23,210 +اليوم احنا بنجسمهم من ناحية الصورة على pursuit + +18 +00:01:23,210 --> 00:01:27,970 +movement حركة بطيئةو Saccadic movement ليه حركة + +19 +00:01:27,970 --> 00:01:32,590 +سريعة طبعا لما إنسان بيدينقل بصره من target ل + +20 +00:01:32,590 --> 00:01:35,510 +target آخر في ال peripheral field يعني يركز على ال + +21 +00:01:35,510 --> 00:01:38,870 +target اللي في ال peripheral field ما بينقل بصره + +22 +00:01:38,870 --> 00:01:42,810 +ببطء عادة هو بيعمل Saccadic version يعني حركة + +23 +00:01:42,810 --> 00:01:49,500 +سريعة بالعينتينطبعا مش بس سريعة فقط .. مطلوب أيضا + +24 +00:01:49,500 --> 00:01:54,080 +انها تكون of accurate amplitude يعني مقدارها مناسب + +25 +00:01:54,080 --> 00:01:57,840 +.. مقدارها مناسب يعني ما يتعدى ال target اللي هو + +26 +00:01:57,840 --> 00:02:02,100 +رايح او ناوي يتفرج عليه ولا يقصر عنه .. يعني هينقل + +27 +00:02:02,100 --> 00:02:05,520 +بصره من ال target الأول اللي كان هو مركز فيه لل + +28 +00:02:05,520 --> 00:02:11,470 +target التاني اللي في ال peripheral fieldيعني عايز + +29 +00:02:11,470 --> 00:02:14,730 +يتطلع عليه، إذا لازم يكون عندي saccadic version of + +30 +00:02:14,730 --> 00:02:20,110 +accurate amplitude is required ليش؟ مطلوب ليش؟ to + +31 +00:02:20,110 --> 00:02:24,270 +fixate on a target in the peripheral visual field + +32 +00:02:24,270 --> 00:02:28,390 +each extra foveal retinal element therefore has a + +33 +00:02:28,390 --> 00:02:32,490 +retinomotor value proportional to its distance + +34 +00:02:32,490 --> 00:02:39,470 +from the foveaالـ Retinomotor value لكل target أو + +35 +00:02:39,470 --> 00:02:45,650 +لكل منطقة من الشبكية هي مقدار الحركة مقدار الحركة + +36 +00:02:45,650 --> 00:02:50,710 +اللازمة عملها من قبل العنتين لوضع صورة هذا ال + +37 +00:02:50,710 --> 00:02:55,910 +target من المكان اللي كان فيه على الشبكية لنقلها + +38 +00:02:55,910 --> 00:03:00,250 +على الفوفيا عشان تتم التركيز فيها نخد رسمة توضح + +39 +00:03:00,250 --> 00:03:02,610 +هذا المثال بنقول كالادى + +40 +00:03:06,370 --> 00:03:09,470 +الان هدول العنتين بيركزوا في ال target الأحمر + +41 +00:03:09,470 --> 00:03:16,200 +فلنطلع لتكبير بيركزوا في ال target الأحمربالنسبة + +42 +00:03:16,200 --> 00:03:19,040 +لهدولة اللي عندهين أو لهدا الشخص ال target ل black + +43 +00:03:19,040 --> 00:03:22,540 +target الاسود يعتبر في ال peripheral field كلمة + +44 +00:03:22,540 --> 00:03:26,000 +peripheral field لا تعني فقط ال extreme periphery + +45 +00:03:26,000 --> 00:03:29,080 +وإنما تعني كل ما هو مش مركزي يعني هذا peripheral + +46 +00:03:29,080 --> 00:03:31,300 +field و هنا peripheral field و هنا peripheral + +47 +00:03:31,300 --> 00:03:35,700 +field طبعا يزداد بعدا أو قربا من ال central field + +48 +00:03:35,700 --> 00:03:37,360 +من ال central field + +49 +00:03:41,520 --> 00:03:47,340 +عشان أنقل بصري من ال target الأحمر لل target + +50 +00:03:47,340 --> 00:03:51,060 +الأسود، يعني عشان أنقل تركيزي من ال target الأحمر + +51 +00:03:51,060 --> 00:03:55,140 +لل target الأسودالان مابقدرش بعناية احرك ال target + +52 +00:03:55,140 --> 00:03:58,400 +اقوله تعال مكان ال target الأحمر هذا ما بيصير في + +53 +00:03:58,400 --> 00:04:02,200 +الوضع الطبيعي ما بنقول لل target او للهدف اتحرك + +54 +00:04:02,200 --> 00:04:06,760 +هنا قدامي عشان اشوفك وانما العينين بدهم يتحركوا + +55 +00:04:06,760 --> 00:04:10,180 +باتجاهه بمعنى اخر الفوفيا طبعا صورة ال target + +56 +00:04:10,180 --> 00:04:14,760 +الأسود تسقط على ال temporal retina في النقطة هنا + +57 +00:04:14,760 --> 00:04:18,360 +في العين اليمين وبتسقط على ال nasal retina في + +58 +00:04:18,360 --> 00:04:23,950 +العين الشمال طيب الفوفيا هنا بتتحرك هيكوالفوفيا + +59 +00:04:23,950 --> 00:04:27,910 +هنا بتتحرك هيك في نفس اللحظة وبنفس القدر إذا ال + +60 +00:04:27,910 --> 00:04:32,130 +retinomotor value هو كمية الحركة كمية الحركة إذا + +61 +00:04:32,130 --> 00:04:38,330 +ال retinomotor value بتاعة النقطة في ال temporal + +62 +00:04:38,330 --> 00:04:40,930 +retina هاي والنقطة المثيلة إلى في ال nasal retina + +63 +00:04:40,930 --> 00:04:45,770 +هاي مقدارها أنه تتحرك لإنت سكتك virgin to the left + +64 +00:04:45,770 --> 00:04:49,590 +احنا الفوفيا هتروح to the right الفوفيا + +65 +00:04:55,260 --> 00:04:58,240 +فالعنتين والتنتين هيروحوا to the left وبالتالي + +66 +00:04:58,240 --> 00:05:02,520 +بتصير الفوفيا موجهة والفوفيا موجهة باتجاه ال + +67 +00:05:02,520 --> 00:05:06,120 +target الأسود طب لو فرضنا أنه في target تالت + +68 +00:05:08,040 --> 00:05:11,120 +التارجت التالت أبعد، إذا صورته هنا على الـ + +69 +00:05:11,120 --> 00:05:13,620 +Temporal Retina ستكون أبعد، وعلى الـ Nasal Retina + +70 +00:05:13,620 --> 00:05:16,820 +ستكون أبعد، فعشان الـ Fovea، الـ Both Fovea + +71 +00:05:16,820 --> 00:05:21,460 +ينتقلوا لهذا التارجت التالت، بلزمهم حركة أكبر، إذا + +72 +00:05:21,460 --> 00:05:25,380 +كل ما كان الـ Target أبعد في الـ Field كل ما كان + +73 +00:05:25,380 --> 00:05:29,460 +الـ Retinomotor Value له أكبر، يعني بمعنى آخر + +74 +00:05:29,790 --> 00:05:34,630 +الحركة اللازمة من الانتين لوضع صورة ال target على + +75 +00:05:34,630 --> 00:05:40,170 +ال fovea بتكون أكبر كل ما كان ال target أبعد في ال + +76 +00:05:40,170 --> 00:05:44,550 +peripheral field وكل ما كان ال target أقرب ل ال + +77 +00:05:44,550 --> 00:05:50,010 +central target أقرب اذا بيكون ال retino صورته + +78 +00:05:50,010 --> 00:05:53,210 +بتسقط قريب من ال fovea وبالتالي ال retinomotor + +79 +00:05:53,210 --> 00:06:00,550 +value بتاعه بيكون صغير الان لو اجى سؤالما هو ال + +80 +00:06:00,550 --> 00:06:06,230 +retinomotor value لـ target صورته بتقع على او ما + +81 +00:06:06,230 --> 00:06:10,050 +هو ال retinomotor value عند الفوفيا عند الفوفيا + +82 +00:06:10,050 --> 00:06:15,150 +بنقول صفر ال retinomotor value عند الفوفيا يساوي + +83 +00:06:15,150 --> 00:06:19,150 +صفر ليش لأنه لو صورة target وقعت على الفوفيا + +84 +00:06:19,150 --> 00:06:22,690 +معناته هذا الشخص بيركز في هذا ال target ولو قلنا + +85 +00:06:22,690 --> 00:06:27,130 +له ركز في ال target مش هيحرك عينيه تماما بتاتا ولا + +86 +00:06:27,130 --> 00:06:31,080 +شيءلسبب انه already الصورة بتاعة هذا ال target + +87 +00:06:31,080 --> 00:06:34,240 +جاية على الفوفيا وبالتالي ال written and motor + +88 +00:06:34,240 --> 00:06:38,300 +value عند الفوفيا يساوي صفر أبعدنا شوية عن الفوفيا + +89 +00:06:38,300 --> 00:06:42,260 +بيصير فيه قيمة له أبعدنا أكتر بتكبر هذه القيمة + +90 +00:06:42,260 --> 00:06:45,700 +بتكبر هذه القيمة فبالتالي هذا هو ال written and + +91 +00:06:45,700 --> 00:06:50,260 +motor value هو كمية الحركة اللازم عملها لوضع صورة + +92 +00:06:50,970 --> 00:06:56,290 +لوضع صورة target كان يسقط على ال peripheral retina + +93 +00:06:56,290 --> 00:07:02,510 +لوضع هذه الصورة على اللي هي الفوفيا، اذا the image + +94 +00:07:02,510 --> 00:07:06,110 +of an object in the peripheral visual field falls + +95 +00:07:06,110 --> 00:07:11,520 +on an extra foveal elementلإصلاح مقاومة على هذا + +96 +00:07:11,520 --> 00:07:16,400 +المجلد، يتطلب منه مقاومة سكاتية محدودة ومتأكدة، كل + +97 +00:07:16,400 --> 00:07:21,200 +مجلد رتينو أكترفوفيا لديه قيمة رتينو موتور + +98 +00:07:21,200 --> 00:07:26,930 +المقاومة تقريبًا من المقاومة، كل مكانأي retinal + +99 +00:07:26,930 --> 00:07:32,030 +element أو extra fovea retinal element كل مكان + +100 +00:07:32,030 --> 00:07:35,510 +أبعد عن الفوفيا ال retinomotor value بتاعه بيكون + +101 +00:07:35,510 --> 00:07:39,330 +أكبر which guides the amplitude of saccadic + +102 +00:07:39,330 --> 00:07:44,250 +movement required to look at it retinomotor value + +103 +00:07:44,250 --> 00:07:47,810 +zero at the fovea increases progressively toward + +104 +00:07:47,810 --> 00:07:52,590 +the retinal periphery و هذا هو المقصود بال + +105 +00:07:52,590 --> 00:07:57,490 +retinomotor valueالنقطة اللي بعدها بدي نحكي عنها + +106 +00:07:57,490 --> 00:08:02,410 +اللي هي ال corresponding retinal points وهي موضوع + +107 +00:08:02,410 --> 00:08:06,990 +سبق انه حكينا عنه بس بنذكر فيه تذكير ال + +108 +00:08:06,990 --> 00:08:10,450 +corresponding points are areas on each retina that + +109 +00:08:10,450 --> 00:08:14,880 +share the same visual directionthat share the same + +110 +00:08:14,880 --> 00:08:18,500 +visual direction هو منطقة أو مساحات من شبكية + +111 +00:08:18,500 --> 00:08:21,900 +الهنتين اللي هم نفس ال visual direction يعني + +112 +00:08:21,900 --> 00:08:26,680 +بيبصوا على نفس المنطقة من الفرار على سبيل المثال + +113 +00:08:26,680 --> 00:08:29,840 +the fovea ال fovea في اليمين و ال fovea في الشمال + +114 +00:08:29,840 --> 00:08:33,320 +share the primary visual direction share يعني + +115 +00:08:33,320 --> 00:08:35,680 +بيشتركوا ال fovea تحت العين اليمين و تحت العين + +116 +00:08:35,680 --> 00:08:39,080 +الشمال بيشتركوا في ال primary visual direction + +117 +00:08:39,610 --> 00:08:42,970 +points on the nasal retina of one eye have + +118 +00:08:42,970 --> 00:08:46,030 +corresponding points on the temporal retina of the + +119 +00:08:46,030 --> 00:08:49,750 +other eye and vice versa والعكس بالعكس ال temporal + +120 +00:08:49,750 --> 00:08:53,530 +retina في العين التانية شريكة مع ال nasal retina + +121 +00:08:53,530 --> 00:08:57,210 +في العين الأولى في نفس الاتجاه البصري في نفس + +122 +00:08:57,210 --> 00:08:59,070 +الاتجاه البصري + +123 +00:09:01,450 --> 00:09:05,450 +على سبيل المثال، مصورة تنتج صورة على الـ right + +124 +00:09:05,450 --> 00:09:10,850 +nasal retina و left temporal retina ستتجه إلى + +125 +00:09:10,850 --> 00:09:15,590 +الجانب اليساري من المجال الفيزيوكي هذا هو أساس الـ + +126 +00:09:15,590 --> 00:09:19,050 +normal retinal correspondence لو تصورنا إنه فيه + +127 +00:09:19,050 --> 00:09:23,030 +target، هذا ال target صورته تسقط على ال nasal + +128 +00:09:23,030 --> 00:09:26,410 +retina في ال right eyeو الـ temporal retina في الـ + +129 +00:09:26,410 --> 00:09:30,410 +left eye هذا ال target هيكون projected المريض + +130 +00:09:30,410 --> 00:09:33,710 +هيعبر عنه أنه جاي عنده على جهته اليمين أو على ال + +131 +00:09:33,710 --> 00:09:36,950 +field اليمين بالنسبة له ليش؟ لأن هذا ال target + +132 +00:09:36,950 --> 00:09:40,030 +sort و سقطت عنه زر retina في ال right eye و هي + +133 +00:09:40,030 --> 00:09:42,990 +موجهة to the right و ال temporal retina في ال left + +134 +00:09:42,990 --> 00:09:45,310 +eye و هي موجهة أيضا to the right فال + +135 +00:09:45,310 --> 00:09:48,030 +interpretation أو ال projection تاع هذا ال target + +136 +00:09:48,030 --> 00:09:54,090 +هيكون to the right fieldطبعا هذا الكلام هو القاعدة + +137 +00:09:54,090 --> 00:09:57,450 +الأساسية أو الفكرة الأساسية في موضوع ال normal + +138 +00:09:57,450 --> 00:10:01,950 +retinal correspondence طيب احنا قلنا كمان ان هذا + +139 +00:10:01,950 --> 00:10:06,290 +التناسق بين شبكية الانتين والشراكة في الاتجاهات + +140 +00:10:06,290 --> 00:10:11,620 +المختلفة في ال fieldمش بس مقتصرة على شبكية العين + +141 +00:10:11,620 --> 00:10:16,020 +اليمين وشبكية العين الشمال نفس الترتيب بنلاقيه في + +142 +00:10:16,020 --> 00:10:19,000 +كل مناطق ال visual pathway يعني في ال lateral + +143 +00:10:19,000 --> 00:10:22,320 +geniculate body في ال superior colliculus في ال + +144 +00:10:22,320 --> 00:10:27,420 +visual cortex كله مرتب بنفس الطريقة بمعنىإنه ترتيب + +145 +00:10:27,420 --> 00:10:31,260 +المعلومات هيكون مرتب بنفس الطريقة اللي مرتبة + +146 +00:10:31,260 --> 00:10:35,940 +تلقيها في الشبكية، this retinotopic organization + +147 +00:10:35,940 --> 00:10:40,700 +is reflected back along the visual pathway, each + +148 +00:10:40,700 --> 00:10:43,820 +eye maintaining separate image under the visual + +149 +00:10:43,820 --> 00:10:47,440 +pathway converge into binocularly responsive + +150 +00:10:47,440 --> 00:10:51,600 +neuron in the primary visual cortexيعني بيظل الصور + +151 +00:10:51,600 --> 00:10:54,620 +منفصلة عن بعضها البعض لغاية ما تصل لل visual + +152 +00:10:54,620 --> 00:10:59,360 +cortex وبالتحديد لغاية ما تصل لل binocularly + +153 +00:10:59,360 --> 00:11:02,560 +responsive neurons في ال primary visual cortex + +154 +00:11:02,560 --> 00:11:07,000 +وبتم توحيدها في صورة واحدة وعشان يتم توحيدها في + +155 +00:11:07,000 --> 00:11:11,060 +صورة واحدةلازم قضية هذا التناسق اللي احنا حكينا + +156 +00:11:11,060 --> 00:11:14,920 +عليه اللي هو ال .. ال normal retinal أو الصح نسميه + +157 +00:11:14,920 --> 00:11:18,160 +normal retinocortical correspondence normal + +158 +00:11:18,160 --> 00:11:23,090 +retinocortical correspondenceنيجي للشيء التالت + +159 +00:11:23,090 --> 00:11:28,010 +اليوم و اللي هو بنقول عنه ال heropter أو الأفق لما + +160 +00:11:28,010 --> 00:11:32,150 +إنسان بسمع كلمة heropter أو أفق بيتخيل أنه احنا + +161 +00:11:32,150 --> 00:11:36,230 +بنحكي للأفق البعيد اللي بيبين عند الغروب و اللي هو + +162 +00:11:36,230 --> 00:11:40,130 +عبارة أو حتى في أي وقت من اليوم اللي هو عبارة عن + +163 +00:11:40,130 --> 00:11:43,650 +انطباق السماء على الأرض و الخط الفاصل بين السماء و + +164 +00:11:43,650 --> 00:11:49,400 +الأرضفي أبعد مسافة مستطيع الإنسان يراها لكن ال + +165 +00:11:49,400 --> 00:11:54,760 +heropter في تعريف علم الحوال له تعريف آخر ومعنى + +166 +00:11:54,760 --> 00:11:59,820 +آخر هو عبارة عن imaginary plane in the external + +167 +00:11:59,820 --> 00:12:05,180 +space وعبارة عن مستوى فراغي تخيليفي الفراغ الخارجي + +168 +00:12:05,180 --> 00:12:09,980 +خارج الشخص يعني هو عبارة عن مستوى تخيّلي طبعا بعض + +169 +00:12:09,980 --> 00:12:14,620 +الرسمات بترسم كخط line ولكن هو مستوى فراغي وفي فرق + +170 +00:12:14,620 --> 00:12:17,960 +بين المستوى الفراغي و ال line إذا هو imaginary .. + +171 +00:12:17,960 --> 00:12:22,700 +imaginary plane in the external space all points + +172 +00:12:22,700 --> 00:12:26,320 +on which stimulate corresponding retinal elements + +173 +00:12:27,140 --> 00:12:31,120 +يعني ماذا أو ليش العلماء حددوا مستوى في الفراغ و + +174 +00:12:31,120 --> 00:12:35,060 +جالوا عنه الهروبتر؟ لأنه فيه ميزة لهذا الهروبتر، + +175 +00:12:35,060 --> 00:12:39,370 +هذا المستوى الفراغي، أي target موجود عليهفي هذا + +176 +00:12:39,370 --> 00:12:43,790 +المكان في أي مكان من هذا المستوى الفراغي لو سقطت + +177 +00:12:43,790 --> 00:12:48,070 +صورته على شبكيات العينين هتسقط على totally + +178 +00:12:48,070 --> 00:12:52,530 +corresponding retinal points بمعنى آخر مافيش أي + +179 +00:12:52,530 --> 00:12:56,870 +مجهود يبذلوا الدماغ لتحريك العينين لتصحيح وضع + +180 +00:12:56,870 --> 00:13:00,870 +الصورة لأن الصورتين الصورتين على العين اليمين وعلى + +181 +00:13:00,870 --> 00:13:05,160 +العين الشمال سقطين تماما على مناطق متماثلةوهذا + +182 +00:13:05,160 --> 00:13:08,160 +اللي بيميز الهروبتر أو هذا اللي بيميز هذا المستوى + +183 +00:13:08,160 --> 00:13:12,600 +الفراغي في الفراغ اللي أطلقنا عليه أو أطلق عليه + +184 +00:13:12,600 --> 00:13:16,740 +العلماء كلمة هروبتر أو الأفق إذا it is an + +185 +00:13:16,740 --> 00:13:21,520 +imaginary plane in the external space all points + +186 +00:13:21,520 --> 00:13:25,180 +on which stimulate corresponding retinal elements + +187 +00:13:25,180 --> 00:13:28,900 +and are therefore seen singly and in the same + +188 +00:13:28,900 --> 00:13:34,740 +planeبالتالي إيش بينتج من إنه لو في target يقع على + +189 +00:13:34,740 --> 00:13:39,640 +الهوروبتر لو في target يقع على الهوروبتر بيعمل + +190 +00:13:39,640 --> 00:13:42,820 +stimulation ل totally corresponding retinal points + +191 +00:13:42,820 --> 00:13:47,100 +طب إيش بنستفيدنا هذا الموضوع؟ هذا الموضوع بيفيدنا + +192 +00:13:47,100 --> 00:13:50,600 +إنه لما بي .. بتسقط الصور الموجودة في الهوروبتر .. + +193 +00:13:50,600 --> 00:13:53,840 +تحت الأجسام الموجودة في الهوروبتر لما بتسقط على + +194 +00:13:53,840 --> 00:13:58,710 +totally corresponding retinal pointsبتم توحيدها من + +195 +00:13:58,710 --> 00:14:03,570 +قبل الدماغ بدون أي مجهود و ترى بشكل single يعني ما + +196 +00:14:03,570 --> 00:14:06,830 +بيصيرش دبلوبيا بالعكس بتتم توحيد الصورتين في + +197 +00:14:06,830 --> 00:14:11,490 +الصورة إذا بتصير يعني single vision و in the same + +198 +00:14:11,490 --> 00:14:14,650 +plane يعني بتكون two-dimensional two-dimensional + +199 +00:14:14,650 --> 00:14:17,270 +ممكن إنسان يستغرب يقول بس إحنا الأشياء اللي + +200 +00:14:17,270 --> 00:14:19,870 +بنشوفها في حياتنا three-dimensional غالبيتها + +201 +00:14:19,870 --> 00:14:23,870 +العظمة ال three-dimensional بنقول هذا الجواب على + +202 +00:14:23,870 --> 00:14:30,770 +هذا السؤال هنقشله شويةفي خضم هذه المحاضرة طيب نرجع + +203 +00:14:30,770 --> 00:14:33,850 +نحكي عن الهروبتر اللي هو ال imaginary plane بنقول + +204 +00:14:33,850 --> 00:14:38,020 +this planepasses through the intersection of the + +205 +00:14:38,020 --> 00:14:42,640 +visual axis and therefore includes the point of + +206 +00:14:42,640 --> 00:14:46,560 +fixation in binocular single vision طبعا هذا + +207 +00:14:46,560 --> 00:14:51,080 +الهروبتر لابد أن يمر في نقطة تقاطع ال visual axis + +208 +00:14:51,080 --> 00:14:54,140 +تع العين اليمين و ال visual axis تع العين الشمال + +209 +00:14:54,140 --> 00:14:58,520 +طب في الوضع الطبيعي ال two visual axis بتقطع عند + +210 +00:14:58,520 --> 00:15:02,820 +ال point of fixation فبالتالي الهروبتر لابد أن يمر + +211 +00:15:02,820 --> 00:15:06,290 +في ال point of fixationطيب ال point of fixation + +212 +00:15:06,290 --> 00:15:10,630 +بتتغير كيف بتتغير مع تغير ال target اللي أنا بتطلع + +213 +00:15:10,630 --> 00:15:13,750 +عليه كنت بتطلع على الصبورة إذا ال point of + +214 +00:15:13,750 --> 00:15:17,510 +fixation بتاعتي عند الصبورة بعد شوية صرت أطلع في + +215 +00:15:17,510 --> 00:15:20,730 +الدفتر انتقلت ال point of fixation اللي عندي عند + +216 +00:15:20,730 --> 00:15:25,170 +الدفتر بعد هيك صرت أطلع في زميلي بعيد عني تقريبا + +217 +00:15:25,170 --> 00:15:31,260 +مترأيضا بيكون عندى ال point of fixation انتقلت و + +218 +00:15:31,260 --> 00:15:36,340 +صارت على .. عند زميلي .. أه فهنا بدنا نفهم قضية أن + +219 +00:15:36,340 --> 00:15:42,520 +الهروبتر أو الأفق في علم الحوال متنقلمتنقل لأنه + +220 +00:15:42,520 --> 00:15:45,980 +دائما من شروطه أنه لازم يمر في ال point of + +221 +00:15:45,980 --> 00:15:49,280 +fixation يعني في النقطة اللي الإنسان بيركز فيها + +222 +00:15:49,280 --> 00:15:52,320 +طالما النقطة اللي الإنسان بيركز فيها بتتغير بين + +223 +00:15:52,320 --> 00:15:56,600 +لحظة و أخرى إذا ال heropter .. ال heropter أفق هذا + +224 +00:15:56,600 --> 00:16:00,460 +الإنسان أثناء نظره لشيء معين عند هذا الشيء المعين + +225 +00:16:00,790 --> 00:16:04,750 +صار ينظر لشيء آخر، إذا ينتقل الهروبتر إلى هذا + +226 +00:16:04,750 --> 00:16:08,610 +الشيء الآخر، إذا this plane اللي هو ال imaginary + +227 +00:16:08,610 --> 00:16:12,250 +plane أو الهروبتر، this plane passes through the + +228 +00:16:12,250 --> 00:16:16,730 +intersection of the visual axis وعلى هذا طالما هو + +229 +00:16:16,730 --> 00:16:21,150 +بيمر في النقطة اللي بتقاطع فيها ال two visual axes + +230 +00:16:21,820 --> 00:16:24,980 +therefore includes the point of fixation in + +231 +00:16:24,980 --> 00:16:28,420 +binocular single vision وهذا طبعا احنا بنحكي عن + +232 +00:16:28,420 --> 00:16:32,080 +الوضع الطبيعي عن الوضع الطبيعي نشوف بعض الرسمات + +233 +00:16:32,080 --> 00:16:36,820 +اللي بتوضح هذه القضية هاي هو عندي ال two eyes + +234 +00:16:36,820 --> 00:16:43,280 +خلينا نطلع لعرض مكبر شوية هاي ال two eyes هاي one + +235 +00:16:43,280 --> 00:16:47,740 +eye نفرض ال right eye وهي ال left eye وهي مستوى + +236 +00:16:47,740 --> 00:16:54,870 +تخيلي زي جوس عاملوهي المستوى التخيلي هنا يعني موضح + +237 +00:16:54,870 --> 00:17:00,290 +بخط بس هو مش خط هو عبارة عن imaginary plane زي ما + +238 +00:17:00,290 --> 00:17:03,970 +الصورة بتوضح هاي ال point of fixation بيمر بال + +239 +00:17:03,970 --> 00:17:08,130 +point offixation بيمر بال point of fixation اذا + +240 +00:17:08,130 --> 00:17:11,850 +هذا هو الهروبتر هذا المستوى التخيلي اللي مرسوم + +241 +00:17:11,850 --> 00:17:18,150 +بطريقة تقريبا three dimensional عبارة عن imaginary + +242 +00:17:18,150 --> 00:17:23,070 +plane مستوى تخيلي طبعا مش مستوى تخيلي زي المستويات + +243 +00:17:23,070 --> 00:17:25,610 +اللي اتعلمناها في الهندس انه مستوى مش منحني لأ هذا + +244 +00:17:25,610 --> 00:17:31,810 +مستوى تخيلي منحنييعني حسب ما بتوضح الصورة ودائما و + +245 +00:17:31,810 --> 00:17:35,890 +أبدا لابد أن يمر بال point of fixation لو ال point + +246 +00:17:35,890 --> 00:17:38,630 +of fixation اللي هي ال red dot هاي اللي بتطلعوا + +247 +00:17:38,630 --> 00:17:42,010 +عليها الانتين لو بعدت يعني صارت طلعة target تاني + +248 +00:17:42,010 --> 00:17:45,470 +كل ال heropter بنتقل هناك لو جربت ال heropter + +249 +00:17:45,470 --> 00:17:48,450 +بيجرب بيجرب هنا طبعا two dimensional + +250 +00:17:48,450 --> 00:17:53,290 +representation لنفس الصورة بتوضح الفكرة بشكل أكبر + +251 +00:17:53,290 --> 00:18:00,650 +بشكل أكبرهي .. يعني .. صورة .. يعني بتشرح الأمر + +252 +00:18:00,650 --> 00:18:04,450 +بشكل أكتر احنا عندنا هنا ال right eye مثلا و ال + +253 +00:18:04,450 --> 00:18:08,370 +left eye هاي ال point of fixation F1 إذا الهروبتر + +254 +00:18:08,370 --> 00:18:13,510 +هيمر في F1 .. في F1 في نفس اللحظة في عندي target + +255 +00:18:13,510 --> 00:18:17,730 +تاني بعيد عن الهروبتر قدام الهروبتر .. قدام + +256 +00:18:17,730 --> 00:18:23,930 +الهروبتر فبالتالي طب .. ال point of fixationالـ + +257 +00:18:23,930 --> 00:18:29,450 +point of fixation كلها بيمر فيها الهوروبتر ويقولنا + +258 +00:18:29,450 --> 00:18:34,050 +أي target موجود على الهوروبتر stimulates to + +259 +00:18:34,050 --> 00:18:37,790 +totally corresponding retinal points طيب معناته + +260 +00:18:37,790 --> 00:18:41,010 +قدام الهوروبتر و ورا الهوروبتر لو فيه targets + +261 +00:18:41,010 --> 00:18:45,130 +بتعمل stimulation ل non-corresponding retinal + +262 +00:18:45,130 --> 00:18:48,680 +pointsهذا الكلام صحيح مية في المية وبالتالي .. + +263 +00:18:48,680 --> 00:18:54,460 +وبالتالي بتكون إيش؟ في عندى retinal disparity .. + +264 +00:18:54,460 --> 00:18:58,300 +retinal disparity هنا بنقول كالقاعدة، هاي ال point + +265 +00:18:58,300 --> 00:19:01,960 +of fixation .. هاي ال point of fixation .. هاي ال + +266 +00:19:01,960 --> 00:19:06,000 +point of fixation، هذا اللي هربتاللي هو جاي بشكل + +267 +00:19:06,000 --> 00:19:09,600 +دائرة طبعا هنا مفيش إله .. هنا يعني مجرد أساس نقول + +268 +00:19:09,600 --> 00:19:14,720 +إنه كأنه جزء من دائرة في الفرار أو .. أو مستوى + +269 +00:19:14,720 --> 00:19:19,040 +منحني بشكل انحناء دائري هاي ال point of fixation + +270 +00:19:19,040 --> 00:19:23,020 +ال point of fixation صورتها هنا لو في target عند + +271 +00:19:23,020 --> 00:19:30,600 +كلمة fix صورته بتقع علىعلى الفوفيا هنا وعلى + +272 +00:19:30,600 --> 00:19:33,000 +الفوفيا هنا ومعروف ان الفوفيا في الانتين + +273 +00:19:33,000 --> 00:19:36,720 +corresponding retinal areas طيب اذا هذا ال target + +274 +00:19:36,720 --> 00:19:42,100 +هينشاف بشكل single يعني مافيش دبلوبيا و هيكون في + +275 +00:19:42,100 --> 00:19:47,710 +انديهsingle vision و هنشوف two dimensional مش + +276 +00:19:47,710 --> 00:19:50,330 +three dimensional و قولنا ليش مش three dimensional + +277 +00:19:50,330 --> 00:19:54,930 +احنا حقيقة هنشوفه three dimensional بس بدنا نشرح + +278 +00:19:54,930 --> 00:19:58,190 +ليش احنا هنا بنقول two dimensional ليش بنقول two + +279 +00:19:58,190 --> 00:20:01,710 +dimensional بعد شوية ان شاء الله تعالى هاي في عندي + +280 +00:20:01,710 --> 00:20:06,030 +target اخر target اخر بيسقط على temporal retina + +281 +00:20:06,030 --> 00:20:12,120 +هنا و بيسقط على nasal retina هنابس بيبعد مسافة X + +282 +00:20:12,120 --> 00:20:16,940 +في ال left eye عن الفوفيا باتجاه النازل و بيبعد + +283 +00:20:16,940 --> 00:20:21,620 +مسافة Y باتجاه ال temporal عن الفوفيا في ال right + +284 +00:20:21,620 --> 00:20:25,820 +eye بما انه ال target بما انه ال target يقع على + +285 +00:20:25,820 --> 00:20:30,850 +الهروبترإذا حكمه حكم ال target اللي عامل عليه + +286 +00:20:30,850 --> 00:20:35,390 +fixation هدولة العينتين بنقول طالما Y و X مسافات + +287 +00:20:35,390 --> 00:20:41,670 +متساوية إذا هو يقع على نقطة هنا ونقطة هنا متماثلات + +288 +00:20:41,670 --> 00:20:44,190 +تماما و corresponding retinal points totally + +289 +00:20:44,190 --> 00:20:46,970 +corresponding retinal points إحنا قولنا أي target + +290 +00:20:46,970 --> 00:20:50,510 +على الهروبتر لو ال target موجود هنا و أنا بأشر بال + +291 +00:20:50,510 --> 00:20:55,880 +mouse أو هنا أو هنا أو هنااو هنا المهم يكون على + +292 +00:20:55,880 --> 00:21:00,620 +الهربطة هيعمل stimulation ل totally corresponding + +293 +00:21:00,620 --> 00:21:03,880 +retinal points وبالتالي بنشوف single and two + +294 +00:21:03,880 --> 00:21:10,010 +dimensional في حالة وجود targetبرات منطقة الهروبتا + +295 +00:21:10,010 --> 00:21:13,870 +زي ال target هذا الأبيض حيسقط صحيح على temporal + +296 +00:21:13,870 --> 00:21:18,010 +retina هنا وحيسقط على nasal retina هنا بس على + +297 +00:21:18,010 --> 00:21:22,890 +مناطق غير متماثلة على مناطق غير متماثلة بمعنى آخر + +298 +00:21:22,890 --> 00:21:27,450 +المسافة Y اللي بيبعتها هنا سورة ال target سقطت + +299 +00:21:27,450 --> 00:21:30,810 +وخلصت سقطت هنا على النقطة هاي اللي بتبعد Y عن + +300 +00:21:30,810 --> 00:21:35,000 +الفوفياو نفس ال target sort of سقطت عنه زر ريتنا + +301 +00:21:35,000 --> 00:21:39,860 +هنا تبعد مسافة X عن الفوفيا بس في هذه الحالة لأنه + +302 +00:21:39,860 --> 00:21:44,240 +مش موجود على الهروبتر ال target نفسه X لا تساوي Y + +303 +00:21:44,240 --> 00:21:49,460 +معروف أو أو واضح حسب الرسم أن X أكبر أو أبعد من + +304 +00:21:49,460 --> 00:21:54,980 +بعد Y عن الفوفيا X أبعد المسافة X أطول من المسافة + +305 +00:21:54,980 --> 00:22:00,930 +Y إذا أصبح هذا ال target يعنييصبط على non + +306 +00:22:00,930 --> 00:22:06,690 +-corresponding retinal points قبل ما نقول إن هذا + +307 +00:22:06,690 --> 00:22:11,810 +ال target هيصير double visionهذا ال target او اي + +308 +00:22:11,810 --> 00:22:16,490 +target اخر .. هذا ال target او اي target اخر برا ت + +309 +00:22:16,490 --> 00:22:19,870 +الهروبتر .. ايش يعني برا ت الهروبتر؟ يعني اما وراه + +310 +00:22:19,870 --> 00:22:23,530 +زي هذه الحالة او امامه زي ما انا بقشر هنا يعني + +311 +00:22:23,530 --> 00:22:27,450 +اقرب للعين من الهروبتر فبالتالي اي target برا ت + +312 +00:22:27,450 --> 00:22:31,570 +الهروبتر بيعمل stimulation ل non-corresponding + +313 +00:22:31,570 --> 00:22:36,230 +retinal bodyيترى هل هينشاف double ولا في أحيانا + +314 +00:22:36,230 --> 00:22:40,270 +الابنين ممكن يتاخد إجراءات معينة هذا اللي هنعرفه + +315 +00:22:40,270 --> 00:22:45,310 +بعد شوية ان شاء الله تعالى اذا هذه الصور بتوضحلي + +316 +00:22:45,310 --> 00:22:50,210 +موضوع ال corresponding retinal areas وبالتالي هذا + +317 +00:22:50,210 --> 00:22:55,150 +بالنسبة لتعريف الهوروبتر وبنستكمل بعد الهوروبتر + +318 +00:22:55,150 --> 00:22:58,790 +بيجي عندي حاجة اسمها ال panoffuginal space + +319 +00:22:58,790 --> 00:23:06,530 +panoffuginal space طبعاالفراغ الفراغ بتاع Panem + +320 +00:23:06,530 --> 00:23:10,410 +Panem اسم العالم اللى وصف هذه القضية Fusional + +321 +00:23:10,410 --> 00:23:14,310 +Space وكأنه بيقول فى فراغ حوالين الهروبتر بتتم فى + +322 +00:23:14,310 --> 00:23:18,710 +عملية ال fusion على الرغم على الرغم من انه ال + +323 +00:23:18,710 --> 00:23:22,210 +target stimulates slightly non-corresponding + +324 +00:23:22,210 --> 00:23:26,050 +retinal elements بنشوف الرسمة هاى و بنرجع بنقول + +325 +00:23:26,050 --> 00:23:30,320 +هاى عندي أنا الخط الأزرقالخط الأزرق بيمثل + +326 +00:23:30,320 --> 00:23:35,560 +الهوروبتر، واحنا قولنا الهوروبتر .. الهوروبتر .. + +327 +00:23:35,560 --> 00:23:41,440 +كل target بيقع على الهوروبتر، اللي هو مستوى فراغي + +328 +00:23:41,440 --> 00:23:45,820 +تخيلي، بيعمل stimulation ل corresponding retinal + +329 +00:23:45,820 --> 00:23:48,900 +areas، بيعمل stimulation ل corresponding retinal + +330 +00:23:48,900 --> 00:23:52,600 +areas، و بدون ما يتعب الدماغ، بيتم توحيد الصورتين، + +331 +00:23:52,600 --> 00:23:56,910 +مثال high target أزرقاللي هو جاي على ال point of + +332 +00:23:56,910 --> 00:24:00,510 +fixation صورة هذا التلج الأزرق تسقط على ال fovea + +333 +00:24:00,510 --> 00:24:02,750 +في ال right eye و على ال fovea في ال left eye + +334 +00:24:02,750 --> 00:24:09,040 +تمام، الآن في عندي منطقة أمام و خلفالهوروبتر بس + +335 +00:24:09,040 --> 00:24:15,500 +محيطة فيه يعني ملاسقة له منطقة أمام و خلف اللي هو + +336 +00:24:15,500 --> 00:24:20,480 +الهوروبتر أي target فيها أي target فيها زي target + +337 +00:24:20,480 --> 00:24:24,440 +X هيو أمام الهوروبتر ممكن target Z خلفه ممكن هنا + +338 +00:24:24,440 --> 00:24:28,410 +ممكن هنا المهم مش على الهوروبتر يا أمامه يا خلفهفي + +339 +00:24:28,410 --> 00:24:31,690 +الفراغ بس مش بعيد كتير يعني في .. في .. في ضمن + +340 +00:24:31,690 --> 00:24:35,970 +المنطقة الفراغية اللي ملونة باللون الأصفر أي + +341 +00:24:35,970 --> 00:24:39,750 +target within the panormifuginal area بيعمل + +342 +00:24:39,750 --> 00:24:43,790 +stimulation ل slightly .. slightly non + +343 +00:24:43,790 --> 00:24:47,410 +-corresponding retinal point يعني هذا ال target + +344 +00:24:47,410 --> 00:24:52,070 +سقط على المنطقة X في ال nasal retina و سقط على + +345 +00:24:52,070 --> 00:24:55,750 +المنطقة X في ال temporal retina بس هي الأفضل نقول + +346 +00:24:56,880 --> 00:25:00,340 +سقط على x في ال temporal area مع شوية زوغان بسيط + +347 +00:25:00,340 --> 00:25:08,020 +مع شوية زوغان بسيط عن x بمعنى يسقط على slightly + +348 +00:25:08,020 --> 00:25:12,700 +non-corresponding retinal areas طيب هذه .. هذه + +349 +00:25:13,430 --> 00:25:20,090 +القضية الزواغان البسيط بيحفظ لدماغ انه بدل ما نشوف + +350 +00:25:20,090 --> 00:25:25,950 +هذا ال target بشكل مزدوج يصير dyplopia بيحفظ لدماغ + +351 +00:25:25,950 --> 00:25:30,950 +انه يحرك العينتين حركة بسيطة لتعديل وضع ال target + +352 +00:25:30,950 --> 00:25:35,290 +هذه الحركة البسيطة عبارة عن divergence movement + +353 +00:25:35,290 --> 00:25:40,330 +divergence movement احنا قلنا الحركات deductionعين + +354 +00:25:40,330 --> 00:25:43,110 +واحدة، حركة العين واحدة، العين التانية مغطية، + +355 +00:25:43,110 --> 00:25:47,890 +virgins حركة العينتين في نفس الاتجاه، virginses + +356 +00:25:47,890 --> 00:25:53,290 +حركة العينتين في اتجاهين متعاكسينلازم تتم حركة + +357 +00:25:53,290 --> 00:25:58,710 +بسيطة جدا جدا بقدر الزواغان البسيط جدا جدا لصورة + +358 +00:25:58,710 --> 00:26:03,430 +ال target X لأنها سقطت على المنطقة X في ال nasal + +359 +00:26:03,430 --> 00:26:07,630 +retina في ال right eye و سقطت على X في ال temporal + +360 +00:26:07,630 --> 00:26:11,610 +retina في ال left eye مع زواغان بسيط مع زواغان + +361 +00:26:11,610 --> 00:26:17,410 +بسيط فبالتالي هذا الزواغان البسيط لابد من تعديله + +362 +00:26:17,670 --> 00:26:20,910 +ممكن الإنسان يقول طيب ليش virgin movement معادي؟ + +363 +00:26:20,910 --> 00:26:23,270 +يعني العنتين اتحركوا على اليمين أو اتحركوا على + +364 +00:26:23,270 --> 00:26:26,750 +الشمال ما هو إذا العنتين اتحركوا virgin movement + +365 +00:26:26,750 --> 00:26:30,730 +.. virgin movement يعني في نفس الاتجاه وصارت + +366 +00:26:30,730 --> 00:26:34,250 +الصورة اللي زيغة صارت عتلة هتزوغ التانية لأن هذه + +367 +00:26:34,250 --> 00:26:37,990 +التانية already موجودة على المنطقة المطلوبة وهذه + +368 +00:26:37,990 --> 00:26:40,950 +زيغة شوية فبالتالي لو العنتين عملوا virgin + +369 +00:26:40,950 --> 00:26:45,330 +movementاللي كان زيغ عدل و اللي كان معدل هيزوغ + +370 +00:26:45,330 --> 00:26:48,850 +شوية فبالتالي مبنفعش virgin movement طبduction + +371 +00:26:48,850 --> 00:26:52,630 +movement أيضا مبنفعش اللي هينفع فقط virgins + +372 +00:26:52,630 --> 00:26:58,910 +virgins ممكن تتم في اتجاهين متعاكسين عشان تعديل + +373 +00:26:58,910 --> 00:27:04,930 +وضع الصورة عشان تعديل وضع الصورة الآن زيغة زوغان + +374 +00:27:04,930 --> 00:27:10,250 +بسيطزي الزواغان البسيط بنقول هذا الزواغان البسيط + +375 +00:27:10,250 --> 00:27:14,090 +بلزمه divergence movement إما convergence أو + +376 +00:27:14,090 --> 00:27:18,250 +divergence أو حتى ممكن يلزمه vertical divergence + +377 +00:27:18,250 --> 00:27:23,230 +إذا كان الزواغان بشكل رأسي هذه الحركة لأنه + +378 +00:27:23,230 --> 00:27:28,640 +divergence movement ولأنها معمولة بقصديعني عملها + +379 +00:27:28,640 --> 00:27:32,500 +دماغ أو أمر فيها دماغ بقصد يتم بعديها ال fusion + +380 +00:27:32,500 --> 00:27:36,840 +تاعة الصورة أو تاعة الصورتين في صورة واحدة عشان + +381 +00:27:36,840 --> 00:27:42,280 +هيك هذه الحركة بيسموها fusional virgences أو + +382 +00:27:42,280 --> 00:27:46,260 +بينجوسين بيسموها motor fusion لسه مش ال fusion هو + +383 +00:27:46,260 --> 00:27:51,980 +تعديل motor تعديل حركي لوضع العنتين حتى يتم إسقاط + +384 +00:27:51,980 --> 00:27:56,870 +الصورتين على مناطق متماثلة مائة بالمائةلو قلنا + +385 +00:27:56,870 --> 00:28:02,630 +سقطت على X بنسبة 100% في العين اليمين و سقطت على X + +386 +00:28:02,630 --> 00:28:08,430 +شرطة في العين الشمال بنسبة 99% و زوران 1% للصورة + +387 +00:28:08,430 --> 00:28:13,030 +هذا الـ 1% .. الدماغ ببدأ .. أو يستحث الدماغ و + +388 +00:28:13,030 --> 00:28:16,960 +بقمر عضلات العين .. هتعمل divergence movementعشان + +389 +00:28:16,960 --> 00:28:22,080 +يتم تعديل الزواغان البسيط ويتم إسقاط الصورتين على + +390 +00:28:22,080 --> 00:28:28,400 +مناطق متماثلة 100% من شبكية الهنتين تمهيدًا للـ + +391 +00:28:28,400 --> 00:28:32,340 +Sensory Fusion التعديل في وضع العين بيسموه الـ + +392 +00:28:32,340 --> 00:28:36,400 +Motor Fusion وبعض الكتب بتسميه Refusional + +393 +00:28:36,400 --> 00:28:40,300 +Vergences Refusional Vergences أو الـ Motor Fusion + +394 +00:28:40,300 --> 00:28:44,280 +عشان تعديل الهنتين تمهيدًا للـ Sensory Fusion اللي + +395 +00:28:44,280 --> 00:28:50,020 +هو الدمج الحقيقيلسورتين في صورة واحدة و اللي هيتم + +396 +00:28:50,020 --> 00:28:58,130 +في الدماغ .. اذا اي target جايزيغ شوية عن الهروبتر + +397 +00:28:58,130 --> 00:29:03,930 +أمامه أو خلفه بس ضمن .. ضمن منطقة فراغية معينة + +398 +00:29:03,930 --> 00:29:07,650 +تسمى Panems Fusional Area وكأنه العالم Panem + +399 +00:29:07,650 --> 00:29:11,690 +والعلماء معاه بيقولوا إنه في هذه المنطقة يمكن + +400 +00:29:11,690 --> 00:29:16,750 +للدماغ إنه يتصرف ويوحد الصورتين في صورة واحدة بإنه + +401 +00:29:16,750 --> 00:29:20,210 +يؤمر عضلات العين اتحرك العينتين عشان تعديل + +402 +00:29:20,210 --> 00:29:25,840 +الزواغان البسيط برات المنطقة هايبلزم حركة أكبر، + +403 +00:29:25,840 --> 00:29:31,060 +الدماغ مش جادر يعملها، فبالتالي أي target .. أي + +404 +00:29:31,060 --> 00:29:36,490 +targetبرّات ال panofusional area .. ب .. برّات ال + +405 +00:29:36,490 --> 00:29:40,030 +panofusional area لازم ينشاف double لازم ينشاف + +406 +00:29:40,030 --> 00:29:46,430 +double و بالتالي هذا هيعطيني موضوع ال .. ال + +407 +00:29:46,430 --> 00:29:49,570 +diplopia أو ال physiological diplopia اللي هنحكي + +408 +00:29:49,570 --> 00:29:53,350 +عنه إذا الفراغ تلخيصا لكل الكلام اللي حكيناه + +409 +00:29:53,350 --> 00:29:58,790 +الفراغ يقسم لتلت .. إنجاز التعبير لتلت أقسم أول + +410 +00:29:58,790 --> 00:30:04,780 +قسم هوالمستوى الفراغي اللي سمناه الهوروبتر تاني + +411 +00:30:04,780 --> 00:30:09,500 +قسم هو الفراغ اللي محيط بالهوروبتر أمامه و خلفه + +412 +00:30:09,500 --> 00:30:14,500 +يعني كأنه يشمل الهوروبتر تالت شيء المنطقة اللي + +413 +00:30:14,500 --> 00:30:18,400 +برات ال panofusional area اللي هي أمامها أو خلفها + +414 +00:30:18,400 --> 00:30:22,520 +أمامها باتجاه العين أو خلفها هدولة التلت مناطق من + +415 +00:30:22,520 --> 00:30:27,240 +الفراغ إذا الهوروبتر ال panofusional space space + +416 +00:30:27,240 --> 00:30:35,150 +أفضل نسميه space أفضلو هنقول ليش space أفضل ال pan + +417 +00:30:35,150 --> 00:30:38,350 +-infusional space تاني حاجة أول حاجة اللي هو + +418 +00:30:38,350 --> 00:30:41,510 +روبتار، تاني حاجة ال pan-infusional space، تالت + +419 +00:30:41,510 --> 00:30:45,510 +حاجة المنطقة اللي أمام و خالف ال pan-infusional + +420 +00:30:45,510 --> 00:30:50,240 +space، ال pan-infusional spaceالان هدولة التقسيمات + +421 +00:30:50,240 --> 00:30:54,780 +التلاتة للفراق وحنقول ميزة كل تقسيم ايش .. ميزة كل + +422 +00:30:54,780 --> 00:30:57,540 +تقسيم ايش بس بدنا نقول ليش احنا قولنا pan + +423 +00:30:57,540 --> 00:31:01,220 +-infusional space أفضل تعبيرا من pan-infusional + +424 +00:31:01,220 --> 00:31:05,620 +area ال pan-infusional area تطلق على المنطقة من + +425 +00:31:05,620 --> 00:31:10,300 +الشبكية أو مساحة من الشبكية في العينتين بتستقبل + +426 +00:31:10,300 --> 00:31:14,340 +صور ال targets الموجودة في pan-infusional space + +427 +00:31:14,690 --> 00:31:18,630 +يعني ال Pan-infusional space هو جزء من الفراد + +428 +00:31:18,630 --> 00:31:22,610 +بينما ال Pan-infusional area هي مساحة من الشبكية + +429 +00:31:22,610 --> 00:31:26,350 +بتستقبل صور ال targets الموجودة في ال Pan + +430 +00:31:26,350 --> 00:31:30,250 +-infusional space هاي الفرق بين space و بين area + +431 +00:31:30,550 --> 00:31:34,350 +نرجع نقول إيش وظيفة كل جزء من الأجزاء التلاتة من + +432 +00:31:34,350 --> 00:31:38,290 +الفراغ المحيط بالشخص اللي سمناها الهوروبتر إيش + +433 +00:31:38,290 --> 00:31:42,670 +ميزته؟ ميزته إنه كل target يقع عليه .. كل target + +434 +00:31:42,670 --> 00:31:47,690 +يقع عليه stimulates totally corresponding retinal + +435 +00:31:47,690 --> 00:31:51,950 +points أو retinal areas وبما إنه بيسقط الصور بتاعة + +436 +00:31:51,950 --> 00:31:56,020 +ال targets اللي على الهوروبتراللي عاله روبتار تثبت + +437 +00:31:56,020 --> 00:32:01,040 +الصور على مناطق متماثلة 100% من شبكية الانترنت إذا + +438 +00:32:01,040 --> 00:32:05,220 +مافيش داعي لدماغ يبذل أي مجهود هدول ال targets + +439 +00:32:05,220 --> 00:32:11,200 +بنشافه singly يعني بشكل موحد بس two dimensionally + +440 +00:32:11,200 --> 00:32:17,020 +وجربنا نجاوب ليش two dimensionallyتاني حاجة أو + +441 +00:32:17,020 --> 00:32:20,380 +تاني جزء من الفراغ اللي هو الفراغ المحيط + +442 +00:32:20,380 --> 00:32:26,120 +بالهوروبتر أمامه وخلفه وسميناه panom fusional + +443 +00:32:26,120 --> 00:32:30,140 +space أي target within the panom fusional space + +444 +00:32:30,140 --> 00:32:34,360 +بيعمل stimulation ل .. ل slightly .. بنأكد على + +445 +00:32:34,360 --> 00:32:38,100 +كلمة slightly slightly corresponding retinal + +446 +00:32:38,100 --> 00:32:43,140 +points أو areasهذا الزوغان البسيط في صورة ال + +447 +00:32:43,140 --> 00:32:46,940 +target على شبكيت العينتين بيحفظ الدماغ انه يعمل + +448 +00:32:46,940 --> 00:32:52,200 +fusional versions أو motor fusion لتعديل الوضع هنا + +449 +00:32:52,200 --> 00:32:57,100 +بسبب شغل الدماغ بيشعر و بيصير عند الدماغ إحساس + +450 +00:32:57,100 --> 00:33:04,050 +بالبعد التالت فكل target .. كل targetيقع صورته على + +451 +00:33:04,050 --> 00:33:09,490 +أو within the panum fusional space بنشاف singly .. + +452 +00:33:09,490 --> 00:33:15,010 +singly يعني موحد مش double و two dimensionally .. + +453 +00:33:15,010 --> 00:33:18,290 +عفوا three dimensionally اللي عاله روبتر two + +454 +00:33:18,290 --> 00:33:22,810 +dimensionally و في ال panum fusional space three + +455 +00:33:22,810 --> 00:33:27,750 +dimensionally يعني بشكل ثلاثي الأبعاد ليش يعني + +456 +00:33:27,750 --> 00:33:33,740 +الأشياء اللي موجودة .. الأشياء اللي موجودة في ..ال + +457 +00:33:33,740 --> 00:33:38,100 +Panom fusional space تُرى singly and three + +458 +00:33:38,100 --> 00:33:41,420 +dimensionally singly لأن دماغ اشتغل و عدّل وضع + +459 +00:33:41,420 --> 00:33:46,200 +العنتين عشان يتم إسقاط الصورتين على مناطق متماثلة + +460 +00:33:46,200 --> 00:33:51,060 +مائة بالمائة من الشبكيات تمهيدا لعملية ال fusion + +461 +00:33:51,060 --> 00:33:56,140 +الشغل أو المجهود البسيط اللي قام فيه دماغ بيشعره + +462 +00:33:56,140 --> 00:34:00,260 +.. بيشعره بالبعد التالت أو ال three dimensionality + +463 +00:34:00,690 --> 00:34:04,790 +الان اي target برا ت ال panofusional space سواء + +464 +00:34:04,790 --> 00:34:08,970 +امامه اقرب للعين او بعده .. بعد النطاق الأصفر اللي + +465 +00:34:08,970 --> 00:34:12,110 +احنا راسمينه عبارة عن فراق امامه و خلف الهروبطة + +466 +00:34:12,110 --> 00:34:16,430 +ابعد منه او اقرب منه بينشاف double زي ال target Y + +467 +00:34:16,430 --> 00:34:20,630 +عندى هيسقط على المنطقة Y هنا في ال temporal retina + +468 +00:34:20,630 --> 00:34:25,010 +ويسقط على المنطقة Y في ال nasal retina في ال left + +469 +00:34:25,010 --> 00:34:29,410 +eye بس شايفين من F ل Y هنا المسافة كيف؟و هنا ال .. + +470 +00:34:29,410 --> 00:34:33,230 +من اف ل واي المسافة كيف؟ بعادي كتير اذا المناطق + +471 +00:34:33,230 --> 00:34:37,590 +اللي سقط عليها تسمى largely uncorresponding او non + +472 +00:34:37,590 --> 00:34:41,350 +-corresponding retinal areas بيقدرش الدماغ بيه + +473 +00:34:41,350 --> 00:34:44,910 +divergence movement انه يعدل الوضع فتشاف او ترق + +474 +00:34:44,910 --> 00:34:49,190 +بشكل double .. ترق بشكل double طيب، الان ممكن + +475 +00:34:49,190 --> 00:34:51,830 +انسان يقول طب ليش الأشياء اللي على ال pan or + +476 +00:34:51,830 --> 00:34:55,010 +infusional space بتنشاف two dimensionally بينما + +477 +00:34:55,010 --> 00:34:59,070 +الأشياءاللي في ال panofusional space طبعا اللي على + +478 +00:34:59,070 --> 00:35:02,290 +الهروبتر two dimensional و اللي في ال panofusional + +479 +00:35:02,290 --> 00:35:05,530 +space three dimensional بنقول حقيقة الأجسام في + +480 +00:35:05,530 --> 00:35:10,910 +حقيقة الأمر في الحياة هي ثلاثية الأبعاد و لو احنا + +481 +00:35:10,910 --> 00:35:16,610 +ركزنا في جسم معناته الهروبتر يمر فيهيمر فيه طب ليش + +482 +00:35:16,610 --> 00:35:20,370 +هذا الجسم انا بشوفه ثلاثي الأبعاد مع انه احنا + +483 +00:35:20,370 --> 00:35:24,370 +الكلام بيقول انه طالما انا عامل تركيز عليه و طالما + +484 +00:35:24,370 --> 00:35:28,790 +الهوروبتر بيمر فيه المفروض يرد ثنائي الأبعاد بنقول + +485 +00:35:28,790 --> 00:35:33,110 +كالعادى لأن الجسم حقيقة ثلاثي الأبعاد هيكون جزء + +486 +00:35:33,110 --> 00:35:37,150 +منه على الهوروبتر وجزء اخر اما امام الهوروبتر او + +487 +00:35:37,150 --> 00:35:41,530 +خلف الهوروبتر او ممكن جزء امام وجزء خلف في نفس + +488 +00:35:41,530 --> 00:35:46,500 +الوقت يعني .. يعني يستحيل انه مثلا انا بنظرمكتب او + +489 +00:35:46,500 --> 00:35:52,360 +مثلا كأس من الماء او الجوال او شيء من هذا يستحيل + +490 +00:35:52,360 --> 00:35:56,020 +انه يكون رفيع لدرجة انه يسير برفع المستوى الفراغي + +491 +00:35:56,020 --> 00:35:59,680 +احنا عارفين ان المستوى الفراغي لا سمكة له .. لا + +492 +00:35:59,680 --> 00:36:02,720 +سمكة له فبالتالي كل الأشياء اللي في حياتنا اللي + +493 +00:36:02,720 --> 00:36:06,100 +احنا بنركز فيها حتى لو مش بنركز فيها بنركز في + +494 +00:36:06,100 --> 00:36:09,920 +غيرها و هي تقع جزء منها على الهروبتر هنلاقي ان جزء + +495 +00:36:09,920 --> 00:36:13,400 +منها يقع خارج الهروبتريعني وين خارج الهروبتر؟ يعني + +496 +00:36:13,400 --> 00:36:17,140 +في ال pan-infusional space وبالتالي كل الأشياء + +497 +00:36:17,140 --> 00:36:20,600 +اللي في حياتنا بنشوفها إيش three-dimensional الآن + +498 +00:36:20,600 --> 00:36:24,860 +أي شيء خارج منطقة ال pan-infusional space بيورا + +499 +00:36:24,860 --> 00:36:29,360 +بشكل double و هنا احنا أنا بأنصح بإجراء التجربة + +500 +00:36:29,360 --> 00:36:36,610 +التالية اللي ه .. يعني أشرحها بشكل مبسطهذه التجربة + +501 +00:36:36,610 --> 00:36:41,770 +عبارة عن أن أنا بدأ أمسك جلمين .. جلمين جلم أحطه + +502 +00:36:41,770 --> 00:36:45,930 +أمام عيني على بعد تقريبا عشرة سانتي وجلم آخر أمسكه + +503 +00:36:45,930 --> 00:36:49,470 +على امتداد إيدي أبعد ما يكون لو ركزت في الجلم اللي + +504 +00:36:49,470 --> 00:36:53,630 +قريب بالنسبة ليه هيصير الجلم اللي بعيد double؟ لو + +505 +00:36:53,630 --> 00:36:57,090 +ركزت في الجلم اللي بعيد هيكون الجلم اللي قريب + +506 +00:36:57,090 --> 00:37:00,530 +بالنسبة ليه double؟ وكل واحد ممكن يعني بواسطة + +507 +00:37:00,530 --> 00:37:04,030 +جلمين يعمل هذه التجربة ليش لما ركزت في الجلم اللي + +508 +00:37:04,030 --> 00:37:08,880 +بعيد صار double؟ببساطة لأنه خارج ال paninfusion ال + +509 +00:37:08,880 --> 00:37:11,860 +space اللي في هذه اللحظة طيب لما ركزت في اللي بعيد + +510 +00:37:11,860 --> 00:37:17,500 +ليش الجريب صار يعني double لأنه الجريب في هذه + +511 +00:37:17,500 --> 00:37:21,140 +اللحظة بيكون خارج ال paninfusion ال space أو أمام + +512 +00:37:21,140 --> 00:37:26,420 +منه طبعا هذه تسمى physiological dyplopia و الكتير + +513 +00:37:26,420 --> 00:37:30,400 +منها موجودة عنده هذه طبعا ولكن لا يشعر فيها لأنه + +514 +00:37:30,400 --> 00:37:33,760 +مصاحبة بحاجة بيسميها physiological suppression + +515 +00:37:33,760 --> 00:37:37,430 +يعني الإدماغ بيخل الإنسان ينساهاأو ماياخدش باله + +516 +00:37:37,430 --> 00:37:39,550 +منها لأنه بتكون مصاحبة بيه physiological + +517 +00:37:39,550 --> 00:37:43,650 +suppression فهذا بالنسبة لموضوع الهوربتر و ال + +518 +00:37:43,650 --> 00:37:47,690 +panofusional space و ال panem .. او .. او ما هو + +519 +00:37:47,690 --> 00:37:53,130 +خارج ال panofusional space و هيك احنا بنكون وصلنا + +520 +00:37:53,130 --> 00:37:56,550 +ل .. آخر شيء + +521 +00:37:59,840 --> 00:38:03,240 +اللي هو جديش .. جديش في الفراغ يمتد ال + +522 +00:38:03,240 --> 00:38:06,440 +panofusional space حوالين الهوروبتر يعني هذه + +523 +00:38:06,440 --> 00:38:11,480 +المساحة .. هذه المساحة الفراغية جديش بتمتد حوالين + +524 +00:38:11,480 --> 00:38:17,500 +الهوروبتر بنقول كالقاتي عند ال point of fixation + +525 +00:38:17,500 --> 00:38:21,720 +بتكون shallow يعني امتدتها حوالين ال point of + +526 +00:38:21,720 --> 00:38:25,140 +fixation أمامها و خلفها بيكون قليل بينما عند + +527 +00:38:25,140 --> 00:38:28,520 +الأطراف بتصير أوسع وقدروها العلماء + +528 +00:38:31,370 --> 00:38:34,990 +Panum space is shallow at fixation تقريبا ستة + +529 +00:38:34,990 --> 00:38:38,410 +seconds of arc and deep part where the periphery + +530 +00:38:38,410 --> 00:38:41,890 +بيمتد من تلاتين لاربعين seconds of arc at fifteen + +531 +00:38:41,890 --> 00:38:45,130 +degree from the fovea at fifteen degree from the + +532 +00:38:45,130 --> 00:38:48,610 +fovea therefore objects on the horopter are seen + +533 +00:38:48,610 --> 00:38:52,690 +singly and in one plane objects in panum fusional + +534 +00:38:52,690 --> 00:38:57,050 +space are singly and are seen singly and + +535 +00:38:57,050 --> 00:39:00,690 +stereoscopicallyوقلنا كلمة panofusional space إذا + +536 +00:39:00,690 --> 00:39:04,730 +نتكلم عن الفراب و panofusional area إذا نتكلم عن + +537 +00:39:04,730 --> 00:39:07,710 +المنطقة من ال retina اللي هتستقبل صور ال targets + +538 +00:39:07,710 --> 00:39:12,790 +اللي في ال panofusional space outside panofusional + +539 +00:39:12,790 --> 00:39:16,550 +area appear double physiological diplopia is + +540 +00:39:16,550 --> 00:39:19,250 +usually accompanied by physiological suppression + +541 +00:39:19,830 --> 00:39:23,790 +and many subjects remain unaware .. unaware of + +542 +00:39:23,790 --> 00:39:27,210 +this phenomenon إنهم ما بيشعورش في الدبلوبيا the + +543 +00:39:27,210 --> 00:39:31,290 +retinal areas stimulated by images falling within + +544 +00:39:31,290 --> 00:39:34,350 +panofusional space are termed أو are called + +545 +00:39:34,350 --> 00:39:38,290 +panofusional areas إذن المساحات من الشبكية في + +546 +00:39:38,290 --> 00:39:42,310 +الهنتين اللي بيصير لها stimulation بواسطة أي + +547 +00:39:42,310 --> 00:39:46,630 +target موجود في ال panofusional space تسمى هذه + +548 +00:39:46,630 --> 00:39:52,180 +المناطق من الشبكية panofusionalهنتوقف عند موضوع ال + +549 +00:39:52,180 --> 00:39:54,960 +binocular single vision و ال sensory fusion و + +550 +00:39:54,960 --> 00:39:58,760 +يعطيكم العافية والسلام عليكم ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/MAfwQYUNNGE_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/MAfwQYUNNGE_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..e1ecf148ed567c959985a908d2938e42a71085b5 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/MAfwQYUNNGE_postprocess.srt @@ -0,0 +1,1284 @@ +1 +00:00:01,770 --> 00:00:06,790 +بسم الله الرحمن الرحيم بنستكمل مع المحاضرة الخامسة + +2 +00:00:06,790 --> 00:00:11,590 +من محاضرات حوال واحد ووصلنا لل vertical rectus + +3 +00:00:11,590 --> 00:00:15,190 +muscles حقيقة ال vertical rectus muscles اللي هي + +4 +00:00:15,190 --> 00:00:17,630 +ال superior rectus muscle و ال inferior rectus + +5 +00:00:17,630 --> 00:00:21,330 +muscle بيختلفوا عن ال horizontal recta اللي هي ال + +6 +00:00:21,330 --> 00:00:25,050 +medial و ال lateral rectus في أنه لهم أكتر من + +7 +00:00:25,050 --> 00:00:29,780 +action احنا حكيناإنه ال media rectus إلها action + +8 +00:00:29,780 --> 00:00:32,380 +واحد اللي هو ال primary action اللي هو ال adoption + +9 +00:00:32,380 --> 00:00:36,660 +وال lateral rectus إلها action واحد اللي هو ال + +10 +00:00:36,660 --> 00:00:39,540 +abduction وما اللي همش subsidiary أو secondary + +11 +00:00:39,540 --> 00:00:44,290 +actionsبينما ال vertical rectus muscles اللي هي ال + +12 +00:00:44,290 --> 00:00:47,150 +superior و ال inferior rectus كلها أكتر من action + +13 +00:00:47,150 --> 00:00:50,530 +ليش ال horizontal rectus مالهاش إلا action واحد + +14 +00:00:50,530 --> 00:00:54,150 +بينما ال vertical rectus muscles اللي هي أكتر من + +15 +00:00:54,150 --> 00:00:58,790 +action السبب أن ال vertical rectus muscles ال axis + +16 +00:00:58,790 --> 00:01:03,030 +بتاع العضلة، محور العضلة، المحور الطولي للعضلة لا + +17 +00:01:03,030 --> 00:01:08,920 +يتوازى ولا يتفق معمحور العين وانما جايب زاوية + +18 +00:01:08,920 --> 00:01:12,920 +بالنسبة لمحور العين وبالتالي .. وبالتالي في إلها + +19 +00:01:12,920 --> 00:01:18,060 +أكتر من action في إلها أكتر من action بنقول + +20 +00:01:18,060 --> 00:01:21,840 +كالقاتي حسب الرسمة الآن هنعرض ال superior rectus + +21 +00:01:21,840 --> 00:01:26,320 +muscle هذه ال superior rectus muscle بتبدأ من + +22 +00:01:26,320 --> 00:01:31,440 +الannulus of zin عند ال orbital apex قمة ال orbit + +23 +00:01:31,440 --> 00:01:38,950 +ويتمر للأمامو بيصيرلها insertion بعيدا عن ال + +24 +00:01:38,950 --> 00:01:44,530 +limbus تقريبا 7 و 7 من 10 mm طيب ال superior + +25 +00:01:44,530 --> 00:01:48,290 +rectus muscle اللي احنا شايفينها في هذه الرسمة + +26 +00:01:48,290 --> 00:01:53,450 +التمثيلية بتشد باتجاه السهم الأسود يعني لما بيصير + +27 +00:01:53,450 --> 00:01:58,050 +فيها contraction، انقباط، هتتقلص، هتقصر العضلة، + +28 +00:01:58,050 --> 00:02:02,800 +هينشد ال insertion باتجاه ال originيعني مكان + +29 +00:02:02,800 --> 00:02:07,920 +التثبيت هتشده العضلة باتجاه مكان المنشأ بتاعها، + +30 +00:02:07,920 --> 00:02:13,160 +إذا هيكون قوة الشد بهذا الاتجاه واضح إن محور العين + +31 +00:02:13,160 --> 00:02:16,700 +اللي هو مرسوم بالخط الأزرق، محور العين، ال axis of + +32 +00:02:16,700 --> 00:02:21,320 +the eye و ال axis of the muscle لا تتفق مع بعضها + +33 +00:02:21,320 --> 00:02:26,030 +البعض وإنما في بينها زاوية، هذه الزاويةتقريباً + +34 +00:02:26,030 --> 00:02:30,390 +تلاتة و عشرين degree تقريباً تلاتة و عشرين degree + +35 +00:02:30,390 --> 00:02:34,670 +على فكرة .. على فكرة ال superior rectus muscle ال + +36 +00:02:34,670 --> 00:02:38,890 +axis بتاعها .. ال axis بتاعها يتفق مع ال orbital + +37 +00:02:38,890 --> 00:02:43,170 +axis محور ال orbit مش محور العين و احنا عارفين انه + +38 +00:02:43,170 --> 00:02:47,010 +محور ال orbit و محور العين بيعملوا مع بعض زاوية + +39 +00:02:47,010 --> 00:02:52,340 +تلاتة و عشرين degreeالان من مبدأ تحليل القوة + +40 +00:02:52,340 --> 00:02:59,000 +المتجهة معروف لدينا ان كل قوة متجهة ممكن تحلل ويتم + +41 +00:02:59,000 --> 00:03:05,060 +تحليلها لقوتين واحدة منهم بتعمل على الإحداث الصيني + +42 +00:03:05,060 --> 00:03:10,420 +ال X-axis وواحدة منهم بتعمل على الإحداثالصاضي اللي + +43 +00:03:10,420 --> 00:03:14,480 +هو ال Y-axis يعني هذه قوة ال superior rectus + +44 +00:03:14,480 --> 00:03:17,920 +muscle .. قوة ال superior rectus muscle بقدر + +45 +00:03:17,920 --> 00:03:23,040 +استبدلها بقوتين يعني كإني شيلت العضلة هاي و بدلتها + +46 +00:03:23,040 --> 00:03:28,060 +بعضلتين عضلة تعمل على المحور المتفق مع محور العين + +47 +00:03:28,570 --> 00:03:32,770 +والعضلة التانية بتعمل على محور عمودي على محور + +48 +00:03:32,770 --> 00:03:36,370 +العين عمودي على محور العين يعني احنا ال superior + +49 +00:03:36,370 --> 00:03:40,190 +rectus muscle بدنا نتخيل أنها مش موجودة وإنه + +50 +00:03:40,190 --> 00:03:46,870 +بدالها في عضلتين عضلة بتشد باتجاه مطابق لمحور + +51 +00:03:46,870 --> 00:03:51,990 +العين وعضلة بتشد باتجاه مطابق أو عمودي على محور + +52 +00:03:51,990 --> 00:03:56,300 +العين عمودي على محور العيناحنا قلنا الزاوية بين + +53 +00:03:56,300 --> 00:04:00,380 +محور العين، محور العين اللي أنا بقشر عليه ومحور + +54 +00:04:00,380 --> 00:04:04,260 +العضلة هي تلاتة وعشرين degree، تلاتة وعشرين + +55 +00:04:04,260 --> 00:04:09,420 +degree، إذا الزاوية بين محور العضلة والمحور الآخر + +56 +00:04:09,420 --> 00:04:15,000 +اللي هو عمودي عن محور العين تقريبا سبعة وخمسين + +57 +00:04:15,000 --> 00:04:19,820 +degree أو سبعة وستين degree، إذا .. إذا العضلة + +58 +00:04:20,080 --> 00:04:25,540 +محورها أقرب لمحور العين لما بنيجي بنحل القوة .. + +59 +00:04:25,540 --> 00:04:30,800 +لما بنيجي بنحل القوة لإحداثياتها الصيني والصعدي + +60 +00:04:30,800 --> 00:04:35,740 +بنقول إن هذه القوة نصيب الأسد منها بياخدوا المحور + +61 +00:04:35,740 --> 00:04:39,740 +الأقرب يعني لو تصورنا إن العضلة ال superior rectus + +62 +00:04:39,740 --> 00:04:44,760 +بتشد بقوة 100 نيوتن وحللنا هذه ال 100 نيوتن هي + +63 +00:04:44,760 --> 00:04:48,900 +بتشد بهذا الاتجاهحللنا الميتي نيوتن استبدلناها + +64 +00:04:48,900 --> 00:04:53,660 +بعضلتين عضلة محورها يتفق مع محور العين وعضلة + +65 +00:04:53,660 --> 00:04:58,420 +محورها عمودي على محور العين هدول العضلتين بدل ال + +66 +00:04:58,420 --> 00:05:04,820 +superior rectusالكلام .. يعني تم شرحه في المدارس + +67 +00:05:04,820 --> 00:05:08,800 +اللي هو تحليل القوة المتجهة زي ما بقدر أن قوتين + +68 +00:05:08,800 --> 00:05:15,240 +متجهات أعوض عنهم بقوة مكافئة أيضا قوة واحدة بقدر + +69 +00:05:15,240 --> 00:05:20,660 +أحللها لقوتين متعامدة الآن لو قلنا superior rectus + +70 +00:05:20,660 --> 00:05:25,690 +.. superior rectus muscle اللي احنا شايفينهابتشد + +71 +00:05:25,690 --> 00:05:29,890 +بهذا الاتجاه .. بهذا الاتجاه يعني من الأمام للخلف + +72 +00:05:29,890 --> 00:05:34,230 +بس جاية من فوق العين تمام؟ بتشد بقوة 100 نيوتن + +73 +00:05:34,230 --> 00:05:39,550 +وقلنا بنحلل هذه القوة لقوتين أو عضلتين مكافئات + +74 +00:05:39,730 --> 00:05:43,810 +هيحيكون نصيب الأسد للقوة الأقرب .. للقوة الأقرب + +75 +00:05:43,810 --> 00:05:49,150 +يعني ممكن مثلا يطلع 70% من القوة مع هذا المحور و + +76 +00:05:49,150 --> 00:05:53,770 +30% من القوة مع هذا المحور يعني هذا .. يعني أرقام + +77 +00:05:53,770 --> 00:05:59,410 +فرضية بس هيكون المحور الأقرب للقوة الحقيقية هو + +78 +00:05:59,410 --> 00:06:02,810 +اللي هو نصيب الأسد و المحور الأبعد هو اللي هو + +79 +00:06:02,810 --> 00:06:07,350 +النصيبالأقل، إله النصيب الأقل وبما أنه الزاوية بين + +80 +00:06:07,350 --> 00:06:11,410 +العضلة أو محور العضلة وبين محور العين 23 degree + +81 +00:06:11,410 --> 00:06:16,550 +إذا هذا المحور هو الأقرب هو اللي هياخد اللي هو + +82 +00:06:16,550 --> 00:06:21,670 +نصيب الأسد من القوة وكأني أنا شيلت ال superior + +83 +00:06:21,670 --> 00:06:26,310 +rectus وقلت هاي عضلتين بدالها العضلة الأقوى، + +84 +00:06:26,310 --> 00:06:29,940 +العضلة الأقوى هي العضلةالمتفقة مع محور العين + +85 +00:06:29,940 --> 00:06:33,640 +فهيكون ال primary action لما هذه العضلة تنقبض ال + +86 +00:06:33,640 --> 00:06:37,460 +elevation ال primary action هو ال elevation وال + +87 +00:06:37,460 --> 00:06:40,780 +secondary action .. ال secondary action .. الآن + +88 +00:06:40,780 --> 00:06:44,440 +بدنا ننتبه لل secondary action أنا عندي جسم كروي + +89 +00:06:44,440 --> 00:06:51,240 +.. جسم كروي بتشد عضلة عمودية عليه هيكون شد هذه + +90 +00:06:51,240 --> 00:06:55,200 +العضلة بهذا الاتجاه فهيكون in torsion يعني لما + +91 +00:06:55,200 --> 00:07:00,360 +بتشد هذه العضلةاللي أنا قاعد ب .. أشير باتجاهها + +92 +00:07:00,360 --> 00:07:04,840 +هذه عضلة إحدى العضلات المكافئة لل superior rectus + +93 +00:07:04,840 --> 00:07:06,900 +muscle هذه ال superior rectus muscle كأنها مش + +94 +00:07:06,900 --> 00:07:11,440 +موجودة كأنه في عضلتين بيسدوا عنها العضلة الأقوى + +95 +00:07:11,440 --> 00:07:15,700 +متفقة مع محور العين هتعمللي elevation والعضلة + +96 +00:07:15,700 --> 00:07:19,840 +الأضعف هتعمللي intortion intortion يعني لما يسير + +97 +00:07:19,840 --> 00:07:24,700 +فيها contraction لما اتشدهتلف العين الـ superior + +98 +00:07:24,700 --> 00:07:27,940 +limbus الساعة 12 في ال limbus هتتحرك لجوه شوية + +99 +00:07:27,940 --> 00:07:32,880 +يعني هتدور دوران برغي دوران برغي فبالتالي أول + +100 +00:07:32,880 --> 00:07:37,760 +action إليها elevation تاني action in torsion تاني + +101 +00:07:37,760 --> 00:07:42,140 +action in torsion وإن شاء الله إذا تيسرت الأمور + +102 +00:07:42,140 --> 00:07:47,200 +هنحاول نعمل simulation حقيقي بفيديو يوضح حد القضية + +103 +00:07:47,200 --> 00:07:53,400 +يوضح حد القضية إن شاء الله تعالى الآنضال action + +104 +00:07:53,400 --> 00:07:57,560 +واحد بدنا نشرحه .. ضال action واحد بدنا نشرحه بس + +105 +00:07:57,560 --> 00:08:01,320 +جابل ما نشرحه بدنا نقول في قاعدتين .. في عندي + +106 +00:08:01,320 --> 00:08:06,440 +قاعدتين القاعدة الأولى بتقول أي عضلة بيصير فيها + +107 +00:08:06,440 --> 00:08:09,800 +انقباض بغض النظر superior rectus .. superior + +108 +00:08:09,800 --> 00:08:13,600 +oblique ال media rectus ال lateral rectus أو أي + +109 +00:08:13,600 --> 00:08:18,560 +عضلة من عضلات الجسم بيصير فيها انقباض بتقصر .. + +110 +00:08:18,560 --> 00:08:22,860 +بتقصر لأن الألياف العضلية بتتداخل مع بعضهاالبعض + +111 +00:08:22,860 --> 00:08:26,440 +الألياف العضلية فبصير طولها أقصر لأنها انقبضت + +112 +00:08:26,440 --> 00:08:31,040 +لأنها انقبضت الآن طالما طولها أقصر السؤال بيطرح + +113 +00:08:31,040 --> 00:08:34,700 +نفسه هاي أنا عند ال insertion مكان انتهاء العضلة + +114 +00:08:34,700 --> 00:08:38,540 +بيسموه ال insertion وال origin مكان مبدأ العضلة من + +115 +00:08:38,540 --> 00:08:42,940 +الannulus of zen من الannulus of zen يترى لما + +116 +00:08:42,940 --> 00:08:48,200 +بتقصر العضلة واحدة من النقطتينهنا المبدأ وهنا + +117 +00:08:48,200 --> 00:08:53,200 +المنتهى مين بده ينشد باتجاه التاني العضلة قصرت إذا + +118 +00:08:53,200 --> 00:08:57,820 +لابد أنه واحد من التنين إما ال insertion إما ال + +119 +00:08:57,820 --> 00:09:02,320 +insertion ينشد هذا ال insertion ينشد باتجاه ال + +120 +00:09:02,320 --> 00:09:06,400 +origin أو ال origin ينشد باتجاه ال insertion حقيقة + +121 +00:09:06,400 --> 00:09:12,100 +قولا واحدا قولا واحدا لا استثناء في ذلك إنه دائما + +122 +00:09:12,100 --> 00:09:16,290 +ال insertion باتجاه ال origin بينشد باتجاهال + +123 +00:09:16,290 --> 00:09:20,350 +origin فبالتالي ليش؟ لأن ال origin ثابت عبارة عن + +124 +00:09:20,350 --> 00:09:25,010 +ال annulus of zen و ال annulus of zen مثبت في + +125 +00:09:25,010 --> 00:09:29,170 +العظم هو عبارة عن نسيج ضام ليفي شديد القوة + +126 +00:09:29,170 --> 00:09:35,280 +adherent ملتسق تماما بالعظم وبالتاليهيشد العضلة + +127 +00:09:35,280 --> 00:09:39,140 +باتجاهه لما العضلة تقصر فال insertion بده يت .. + +128 +00:09:39,140 --> 00:09:42,660 +يعني ينشد باتجاه ال origin طيب، ممكن الإنسان يقول + +129 +00:09:42,660 --> 00:09:47,820 +طب كل هذا إيش علاقته بال tertiary action بتاعنا؟ + +130 +00:09:47,820 --> 00:09:50,620 +قبل ما نقول ال tertiary action بتاعنا، بدنا نقول + +131 +00:09:50,620 --> 00:09:54,140 +اتجاه ال adduction باتجاه ال nose، هذا مقطع من ال + +132 +00:09:54,140 --> 00:09:58,700 +nose، هذا مقطع من ال nose، هذا مقطع من ال nose + +133 +00:09:58,810 --> 00:10:02,130 +فبالتالي لما العين تعمل abduction يعني راحة ناحية + +134 +00:10:02,130 --> 00:10:05,410 +ال nose ال cornea راحة ناحية ال nose و لما تعمل + +135 +00:10:05,410 --> 00:10:09,230 +abduction abduction يعني بعيدا عن ال nose هي ال + +136 +00:10:09,230 --> 00:10:15,190 +lateral wall الجدار الخارجي لل orbit لل orbit أو + +137 +00:10:15,190 --> 00:10:20,210 +لمحجر العين الآن لما العضلة بتقصر بنشد ال + +138 +00:10:20,210 --> 00:10:25,010 +insertion باتجاه ال origin مظبوط بشد ال insertion + +139 +00:10:25,010 --> 00:10:34,780 +باتجاه ال origin بس إذا ملاحظين هناعفوا إذا + +140 +00:10:34,780 --> 00:10:41,500 +ملاحظين هنا إن ال insertion جاي temporal بالنسبة + +141 +00:10:41,500 --> 00:10:45,680 +لل origin يعني ال origin أقرب لل nose أي شيء أقرب + +142 +00:10:45,680 --> 00:10:50,000 +لل nose تمام بيسموه medial و أي شيء أبعد من ال + +143 +00:10:50,000 --> 00:10:53,940 +nose بيسموه temporal أو lateralيعني بالنهاية ال + +144 +00:10:53,940 --> 00:10:58,020 +insertion مكان تثبيت ال superior rectus جاي لاترال + +145 +00:10:58,020 --> 00:11:03,220 +مقارنة مع مكان ال origin لما العضلة بتقصر العين + +146 +00:11:03,220 --> 00:11:07,380 +كلها تزاح إزاحة بسيطة باتجاه ال adduction يعني + +147 +00:11:07,380 --> 00:11:12,610 +مثلا كانت حسب الرسمة هناهتصير شوية صغيرة abducted + +148 +00:11:12,610 --> 00:11:16,130 +زي ما أنا قاعد بقشر abducted فال adoption اللي + +149 +00:11:16,130 --> 00:11:20,190 +بتعمل ليها ال superior rectus هو بسبب انه ال + +150 +00:11:20,190 --> 00:11:23,670 +origin بتاع العضلة و ال insertion بتاع العضلة ال + +151 +00:11:23,670 --> 00:11:29,180 +origin جاي more medialفبالتالي بيحرك العين أو + +152 +00:11:29,180 --> 00:11:35,300 +بتنشد .. بتقصر العضلة فبتنشد العين ككل .. ككل شوية + +153 +00:11:35,300 --> 00:11:37,780 +للداخل ممكن الإنسان يتخيل أن ال adduction زي ال + +154 +00:11:37,780 --> 00:11:39,980 +media rectus لأ ال media rectus لما بتعمل + +155 +00:11:39,980 --> 00:11:43,160 +adduction ال cornea بتسير هنا .. ال cornea بتسير + +156 +00:11:43,160 --> 00:11:46,580 +هنا يعني للداخل على الآخر بينما ال superior rectus + +157 +00:11:46,580 --> 00:11:50,120 +لما بتعمل adduction لا يكاد يذكر وإن كان يعني + +158 +00:11:50,120 --> 00:11:57,520 +موجود و أثبت بالتجربة .. أثبت بالتجربةفبالتالي ال + +159 +00:11:57,520 --> 00:12:01,460 +elevation هو ال primary action ال intorsion حركة + +160 +00:12:01,460 --> 00:12:06,060 +البرغة لأن ال superior limbus يتحرك ل .. الساعة 12 + +161 +00:12:06,060 --> 00:12:09,840 +من ال limbus تتحرك نيزلي .. تلف نيزلي هذه ال + +162 +00:12:09,840 --> 00:12:13,660 +secondary action و ال tertiary action هو ال + +163 +00:12:13,660 --> 00:12:16,380 +adduction إذا ال superior rectus بتعمل ليه + +164 +00:12:16,380 --> 00:12:20,900 +elevation و بتعمل intorsion و بتعمل adduction و + +165 +00:12:20,900 --> 00:12:25,980 +بتعمل adduction بنقول ده vertical rectiالو ال + +166 +00:12:25,980 --> 00:12:29,520 +superior و ال inferior rectus run in line with the + +167 +00:12:29,520 --> 00:12:33,320 +orbital axis تتفق مع ال orbital axis و ضروري احنا + +168 +00:12:33,320 --> 00:12:38,940 +مانخربطش ال orbital axis مع ال axis of the eyeand + +169 +00:12:38,940 --> 00:12:44,120 +are inserted in front of the equator يعني بيتم + +170 +00:12:44,120 --> 00:12:49,080 +تثبيتهم أمام ال equator أمام الخط المنصف للعين + +171 +00:12:49,080 --> 00:12:52,640 +يعني ال equator هو بيجي تقريبا عند المسافة high نص + +172 +00:12:52,640 --> 00:12:56,380 +العين بيقسم ال equator أو خط الاستواق بيقسم العين + +173 +00:12:56,380 --> 00:13:00,460 +لنصف أمامي ونصف خلفي ال superior و ال inferior + +174 +00:13:00,460 --> 00:13:04,220 +rectus ال insertion بتاعهم أمام ال equator يعني + +175 +00:13:04,220 --> 00:13:11,200 +جاي لقدام من ال equator جاي لقدام منال equator .. + +176 +00:13:11,200 --> 00:13:14,220 +نرجع + +177 +00:13:14,220 --> 00:13:19,280 +بس للرسمة بس هنا للتوضيح هنا بنقول ال superior + +178 +00:13:19,280 --> 00:13:23,340 +rectus تنشأ من الجزء العلوي من الannulus of زين، + +179 +00:13:23,340 --> 00:13:27,060 +هاي ال superior rectus اللي أنا بأشير عليها، اللي + +180 +00:13:27,060 --> 00:13:34,470 +بأشير عليها، اذا they therefore form an angleof 23 + +181 +00:13:34,470 --> 00:13:38,830 +degree with the visual axis أو الـ axis of ضغط إذا + +182 +00:13:38,830 --> 00:13:42,390 +ال superior و ال inferior rectus muscles بيعملوا + +183 +00:13:42,390 --> 00:13:48,670 +23 degree مع ال visual axis الرسمة هنا بتوضح ال + +184 +00:13:48,670 --> 00:13:52,710 +superior rectus muscle باللون الأحمر بالسهم الأحمر + +185 +00:13:52,710 --> 00:13:57,570 +العريض هاي الخط الأحمر المتقطع هو ال orbital axis + +186 +00:13:58,230 --> 00:14:02,650 +وهي ال axis of the eye أو ال visual axis طالما أن + +187 +00:14:02,650 --> 00:14:06,610 +ال superior rectus muscle محورها بتفق مع ال + +188 +00:14:06,610 --> 00:14:10,830 +orbital axis إذا ال superior rectus muscle محورها + +189 +00:14:10,830 --> 00:14:15,730 +بيعمل تلاتة و عشرين degree مع ال axis of the eye + +190 +00:14:15,730 --> 00:14:19,710 +أو ال visual axis وبالتالي طالما المحورين مش + +191 +00:14:19,710 --> 00:14:24,230 +منطبقين محور العضلة ومحور العين معناته في أكتر من + +192 +00:14:24,230 --> 00:14:29,570 +actionللعضلة في اكتر من action للعضلة هنا في قاعدة + +193 +00:14:29,570 --> 00:14:34,270 +احنا شرحناها قبل شوية بنقول اي جسم كروي او بيضاوي + +194 +00:14:34,270 --> 00:14:39,090 +او استواني تؤثر عليه قوة ذات اتجاه عمودي على محوره + +195 +00:14:39,090 --> 00:14:43,550 +يكون النتيجة هي الدوران بمعنى اما بيصير intortion + +196 +00:14:43,550 --> 00:14:48,910 +او بيصير extortion زي ما وضحنا في الرسمة السابقة + +197 +00:14:48,910 --> 00:14:55,560 +بنقول كالاتيقوة عمودية .. قوة عمودية .. بس نكبر + +198 +00:14:55,560 --> 00:15:01,940 +شوية أفضل .. هاي احنا عندنا قوة عمودية .. ننسا .. + +199 +00:15:01,940 --> 00:15:05,140 +احنا هادي هناخد القوة هاي فقط .. اللي هي إحدى + +200 +00:15:05,140 --> 00:15:10,320 +القوةالناتجة عن تحليل قوة الـ superior rectus هذه + +201 +00:15:10,320 --> 00:15:14,520 +القوة عمودية على جسم كراوي أو شبه كراوي، تمام؟ إذا + +202 +00:15:14,520 --> 00:15:20,200 +طالما هي بتأثر باتجاه عمودي، هيكون الاتجاه أو + +203 +00:15:20,200 --> 00:15:25,320 +الحركة هي حركة دورانية، دورانية بمعنى حركة البرغي، + +204 +00:15:25,320 --> 00:15:29,330 +يعني لما هذه القوة تشد بهذا الاتجاه وجاية من فوقو + +205 +00:15:29,330 --> 00:15:32,910 +جاية من فوق الساعة 12 تاعة ال limbus هتتحرك شوية + +206 +00:15:32,910 --> 00:15:36,150 +لقدام .. لقدام بهذا الاتجاه هذا يسمى intortion + +207 +00:15:36,150 --> 00:15:41,330 +لأنه .. انه العين لفت بطريقة البرغي لفت باتجاه + +208 +00:15:41,330 --> 00:15:45,590 +الأنف طيب لو القوة جاية هيك بهذا الاتجاه أيضا + +209 +00:15:45,590 --> 00:15:50,150 +عموديا ساعتها الساعة 12 هتتحرك برضه بحركة البرغي + +210 +00:15:50,150 --> 00:15:54,090 +اللي من ال limbus العين هتلف بطريقة كأنها برغي + +211 +00:15:54,090 --> 00:15:57,180 +تمام؟يعني أنه برغي بده يدخل في ال orbit أو برغي + +212 +00:15:57,180 --> 00:16:00,740 +بده يطلع من ال orbit هتتحرك بهذا الاتجاه وهذا يسمى + +213 +00:16:00,740 --> 00:16:06,060 +extortion لأنه اتجاه الحركة بعيدا عن ال nose بعيدا + +214 +00:16:06,060 --> 00:16:11,760 +عن ال nose إذا نرجع لل presentation بتاعنا نقول أي + +215 +00:16:11,760 --> 00:16:16,900 +جسم كروي أو بيضاوي أو شبه كروي أو استواني تؤثر + +216 +00:16:16,900 --> 00:16:21,380 +عليه قوة ذات اتجاه عمودي على محوره يكون النتيجة هي + +217 +00:16:21,380 --> 00:16:26,120 +الدوران بمعنىintortion باتجاه أو extortion + +218 +00:16:26,120 --> 00:16:30,680 +بالاتجاه العكسه السبب انه القوة عمودية على هذه + +219 +00:16:30,680 --> 00:16:34,140 +الأجسام عمودية على هذه الأجسام وهذا ينطبق مائة + +220 +00:16:34,140 --> 00:16:39,060 +بالمائة على العين ال superior rectus muscle زي ما + +221 +00:16:39,060 --> 00:16:43,320 +حكينا originates تبدأ from the upper part of the + +222 +00:16:43,320 --> 00:16:47,930 +annulus of زن من الجزء العلوي من annulus of زنو + +223 +00:16:47,930 --> 00:16:53,230 +inserts يعني بتتسبت على بعد سبعة وسبعة من عشرة + +224 +00:16:53,230 --> 00:16:56,490 +millimeter behind the superior limbus يعني بعيدا + +225 +00:16:56,490 --> 00:17:00,050 +عن ال limbus مقدار سبعة وسبعة من عشرة milli وحكينا + +226 +00:17:00,050 --> 00:17:04,090 +أن هذه الأرقام مهمة لجراح العيون إذا بدوا يجري + +227 +00:17:04,090 --> 00:17:09,170 +جراحة على أي من ال muscles the primary action is + +228 +00:17:09,170 --> 00:17:14,390 +elevation the secondary actions are intorsion and + +229 +00:17:14,390 --> 00:17:21,670 +adductionand adoption وبالتالي هدوله ال secondary + +230 +00:17:21,670 --> 00:17:27,310 +actions طيب الان بنيجي لخطوة مهمة للغاية هذه + +231 +00:17:27,310 --> 00:17:32,550 +الخطوةالمهم للغاية لو طلب مننا حد انه نختبر ال + +232 +00:17:32,550 --> 00:17:34,110 +superior rectus muscle + +233 +00:17:58,490 --> 00:18:02,890 +action واحد وهذا ال action الواحد بيدلني على بجيهة + +234 +00:18:02,890 --> 00:18:07,090 +الوظائف بتاعة العضلة حقيقة الإجابة بسيطة جدا ان لو + +235 +00:18:07,090 --> 00:18:11,250 +انا اختبرت one action من التلاتة action وطلع طبيعي + +236 +00:18:11,250 --> 00:18:15,870 +معناته بجيهة ال actions رالبا طبيعية لان العضلة + +237 +00:18:15,870 --> 00:18:19,850 +اذا كانت طبيعية معناته هتعمل وظائفها كلها بشكل + +238 +00:18:19,850 --> 00:18:23,570 +طبيعي طيب يترى اي action من ال three actions بتاعي + +239 +00:18:23,570 --> 00:18:27,580 +ال superior rectus muscleمن .. من تعيين ال + +240 +00:18:27,580 --> 00:18:33,480 +superior rectus muscle اللي انا هاختبره هل اختبر + +241 +00:18:33,480 --> 00:18:37,340 +ال intortion؟ ال intortion مابنشوفوهش في الواقع في + +242 +00:18:37,340 --> 00:18:40,420 +الحياة الواقعية في الحياة العملية مابنشوفه + +243 +00:18:40,420 --> 00:18:44,820 +وبالتالي اشي مابشوفوهش مابقدرش اختبره طيب هل اختبر + +244 +00:18:44,820 --> 00:18:48,780 +ال adduction؟لأ ما بقدر اختبر ال adoption لأن ال + +245 +00:18:48,780 --> 00:18:51,760 +adoption اللي بتعمله ال superior rectus muscle هو + +246 +00:18:51,760 --> 00:18:57,140 +action ضعيف جدا وفي نقطة تانية انه لو بدأ اطلب ان + +247 +00:18:57,140 --> 00:18:59,840 +المريض يعمل adoption هيكون ال adoption اللي عمله + +248 +00:18:59,840 --> 00:19:03,760 +غالبا ناتج عن ال media rectus action مش عن ال + +249 +00:19:03,760 --> 00:19:07,940 +superior rectus لأن أكبر adapter للعين اللي هو ال + +250 +00:19:07,940 --> 00:19:10,980 +adapter الأقوى اللي بيجيب العين لجوه هو ال media + +251 +00:19:10,980 --> 00:19:14,600 +rectus بقدرش أحيد ال media rectus عن العمل أو + +252 +00:19:14,600 --> 00:19:18,450 +أقولها توقفي عن العملعشان نشوف ال adoption بتاع ال + +253 +00:19:18,450 --> 00:19:21,810 +superior rectus اذا ال function هذه بتاعة superior + +254 +00:19:21,810 --> 00:19:24,690 +rectus muscle بقدرش اختبرها اللي هي ال intuition + +255 +00:19:24,690 --> 00:19:29,490 +لأنه مش هشوفهاالـ Adduction بقدرش أصفر عمل ال + +256 +00:19:29,490 --> 00:19:32,510 +media rectus muscle أو ألغي عملها أقولها واجفي + +257 +00:19:32,510 --> 00:19:35,770 +بالله عبالما اختبر ال superior rectus muscle بيضل + +258 +00:19:35,770 --> 00:19:39,690 +عندى اختبار ال elevation يعني لما بدى أقول للمريض + +259 +00:19:39,690 --> 00:19:43,330 +يتطلع لفوج ساعتها إذا اتطلع لفوج وطلعت اللي هي + +260 +00:19:43,330 --> 00:19:47,530 +لفوج معناته ال elevation طبيعى طيب ممكن إنسان + +261 +00:19:47,530 --> 00:19:51,590 +يعترض يقول بس أنا في عندى كمان عضلة .. كمان عضلة + +262 +00:19:51,590 --> 00:19:55,190 +غير ال superior rectus muscle .. غير ال superior + +263 +00:19:55,190 --> 00:20:01,190 +rectus muscleبتعمل elevation وهذه العضلة ضروري جدا + +264 +00:20:01,190 --> 00:20:06,630 +انه نحيدها او نصفر عملها و ساعتها ال elevation + +265 +00:20:06,630 --> 00:20:10,430 +هيكون ناتج فقط عن عمل ال superior rectus muscle + +266 +00:20:10,430 --> 00:20:14,670 +بنقول الكلام سليم مائة بالمائة يا ترى ايش العضلة + +267 +00:20:14,670 --> 00:20:20,970 +اللي احنا بدنا نحيدها عشان + +268 +00:20:20,970 --> 00:20:27,730 +..يعني نختبر ال superior rectus muscle بدنا احنا + +269 +00:20:27,730 --> 00:20:31,710 +عشان نفهم هذه القضية تطلعوا معايا لو سمحتوا على + +270 +00:20:31,710 --> 00:20:39,190 +المنظر رقم 8 والمنظر رقم 11هي هذا المنظر هو نفس + +271 +00:20:39,190 --> 00:20:42,990 +المنظر تاع العضلة اللي أنا قبل شوية شرحتها اللي هي + +272 +00:20:42,990 --> 00:20:47,030 +superior rectus muscle بدنا نشرح .. الآن العين هنا + +273 +00:20:47,030 --> 00:20:50,070 +العين عدلة في ال primary position في ال primary + +274 +00:20:50,070 --> 00:20:53,650 +position يعني بتتطلع دغري الآن ال superior rectus + +275 +00:20:53,650 --> 00:20:58,790 +muscle عاملة عاملة زاوية مع العين 23 degree الآن + +276 +00:20:58,790 --> 00:21:03,230 +لو طلبت من المريض قلتله يطلع عينه لبرا يطلع لبرا + +277 +00:21:03,230 --> 00:21:07,950 +في وضع ال upduction يا ترى إيش اللي هيحصل؟يا ترى + +278 +00:21:07,950 --> 00:21:12,890 +إيش اللي هيحصل؟ بنقول نتطلع على رقم 11 لما العين + +279 +00:21:12,890 --> 00:21:16,350 +تسير في وضع ال abduction .. في وضع ال abduction + +280 +00:21:16,350 --> 00:21:20,630 +هيتيجي لبرا ساعتها المحور تع عضلة ال superior + +281 +00:21:20,630 --> 00:21:26,840 +rectus اللي مرسومة أمامنا بينطبق مع محور العينهدا + +282 +00:21:26,840 --> 00:21:30,240 +إيش بده يفيدنا؟ بده يفيدنا إنه ننظر لرقم 8 للرسمة + +283 +00:21:30,240 --> 00:21:33,800 +رقم 8 عند ال elevator التاني بتاع العين و اللي + +284 +00:21:33,800 --> 00:21:37,520 +هنشرح عنه في وقته هو ال inferior oblique muscle + +285 +00:21:37,520 --> 00:21:40,580 +هذه هي ال inferior oblique muscle اللي بتيجي من + +286 +00:21:40,580 --> 00:21:45,660 +أسفل العين .. بتيجي من أسفل العين .. هذه هي من ضمن + +287 +00:21:45,660 --> 00:21:48,960 +ال actions بتاعتها و اللي هنشرحها في وقتهاانها + +288 +00:21:48,960 --> 00:21:52,840 +بتعمل elevation انا بتديش العين او بتديش ال + +289 +00:21:52,840 --> 00:21:56,420 +inferior oblique تساهم في ال elevation لما العين + +290 +00:21:56,420 --> 00:22:00,540 +بتعمل abduction زي ما انتوا شايفين في الرسمتين لما + +291 +00:22:00,540 --> 00:22:04,140 +العين بتعمل abduction في وضع ال abduction في وضع + +292 +00:22:04,140 --> 00:22:08,060 +ال abduction بتكون ال superior rectus محورها متفق + +293 +00:22:08,060 --> 00:22:12,540 +مع محور العين و ال inferior oblique محورها عمودي + +294 +00:22:12,540 --> 00:22:17,440 +على محور العين لما اي عضلة من العضلة بتتعامد على + +295 +00:22:18,420 --> 00:22:22,160 +محور العين لن تساهم لا في elevation ولا في + +296 +00:22:22,160 --> 00:22:25,660 +depression وإنما هيظل من ال actions ساعتها ال + +297 +00:22:25,660 --> 00:22:29,320 +torsional action ال extorsion أو ال intorsion يعني + +298 +00:22:29,320 --> 00:22:33,340 +مش elevation ساعتها بتصير ال superior rectus لأن + +299 +00:22:33,340 --> 00:22:36,800 +محورها اتفق مع محور العين في وضعية ال abduction + +300 +00:22:36,800 --> 00:22:41,640 +بتصير pure elevator elevator نقي بدون أي يعني + +301 +00:22:41,640 --> 00:22:46,140 +شوائب ولن يشارك في ال elevationالـ other elevator + +302 +00:22:46,140 --> 00:22:48,500 +of the eye اللي هو الـ inferior oblique طب ليش لن + +303 +00:22:48,500 --> 00:22:52,080 +يشاركها لأنه في وضعية ال abduction ال inferior + +304 +00:22:52,080 --> 00:22:56,880 +oblique كقوة بتكون عمودية على محور العين وبالتالي + +305 +00:22:56,880 --> 00:23:00,420 +هتعمل intorsion أو extorsion هذا هنشرحه في وقته هي + +306 +00:23:00,420 --> 00:23:05,220 +هتعمل extorsion مش هتساهم في ال elevation بالمرة + +307 +00:23:05,220 --> 00:23:08,960 +اذا انا لما بدأ اختبر ال superior rectus muscle ال + +308 +00:23:08,960 --> 00:23:12,980 +function بتاعتهابختبر ال elevation كيف اختبر ال + +309 +00:23:12,980 --> 00:23:16,820 +elevation؟ بخل المريض يتطلع لبرا و بعد ما يتطلع + +310 +00:23:16,820 --> 00:23:22,250 +لبرا بقوله يتطلع لهدف عالي يعني out and upout and + +311 +00:23:22,250 --> 00:23:26,750 +up إذا العين طلعت لبرا وبعدين من وضع برا هذه طلعت + +312 +00:23:26,750 --> 00:23:31,070 +لفوق معناته هي طلعت بفعل ال superior rectus muscle + +313 +00:23:31,070 --> 00:23:34,190 +ممكن إنسان يحتاج طب ليش ما طلعت بفعل ال superior + +314 +00:23:34,190 --> 00:23:37,050 +rectus مع ال inferior oblique؟ بنقولك مظبوط هي + +315 +00:23:37,050 --> 00:23:40,050 +طلعت بفعل ال superior rectus فقط لأن ال inferior + +316 +00:23:40,050 --> 00:23:44,090 +oblique في وضع ال abduction لا تستطيع أن تساهم في + +317 +00:23:44,090 --> 00:23:49,160 +رفع العين بسبب إنها محورها عمودي عن محور العينيعني + +318 +00:23:49,160 --> 00:23:52,940 +إذا صار فيها contraction فقط هتعمل extortion مش + +319 +00:23:52,940 --> 00:23:57,040 +elevation ..extortion مش elevation ..هنتوقف عند + +320 +00:23:57,040 --> 00:24:00,080 +هذه النقطة و المرة القادمة هنشرح ال inferior + +321 +00:24:00,080 --> 00:24:03,180 +rectus muscle و يعطيكم العافية + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/MAfwQYUNNGE_raw.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/MAfwQYUNNGE_raw.srt new file mode 100644 index 0000000000000000000000000000000000000000..e1ecf148ed567c959985a908d2938e42a71085b5 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/MAfwQYUNNGE_raw.srt @@ -0,0 +1,1284 @@ +1 +00:00:01,770 --> 00:00:06,790 +بسم الله الرحمن الرحيم بنستكمل مع المحاضرة الخامسة + +2 +00:00:06,790 --> 00:00:11,590 +من محاضرات حوال واحد ووصلنا لل vertical rectus + +3 +00:00:11,590 --> 00:00:15,190 +muscles حقيقة ال vertical rectus muscles اللي هي + +4 +00:00:15,190 --> 00:00:17,630 +ال superior rectus muscle و ال inferior rectus + +5 +00:00:17,630 --> 00:00:21,330 +muscle بيختلفوا عن ال horizontal recta اللي هي ال + +6 +00:00:21,330 --> 00:00:25,050 +medial و ال lateral rectus في أنه لهم أكتر من + +7 +00:00:25,050 --> 00:00:29,780 +action احنا حكيناإنه ال media rectus إلها action + +8 +00:00:29,780 --> 00:00:32,380 +واحد اللي هو ال primary action اللي هو ال adoption + +9 +00:00:32,380 --> 00:00:36,660 +وال lateral rectus إلها action واحد اللي هو ال + +10 +00:00:36,660 --> 00:00:39,540 +abduction وما اللي همش subsidiary أو secondary + +11 +00:00:39,540 --> 00:00:44,290 +actionsبينما ال vertical rectus muscles اللي هي ال + +12 +00:00:44,290 --> 00:00:47,150 +superior و ال inferior rectus كلها أكتر من action + +13 +00:00:47,150 --> 00:00:50,530 +ليش ال horizontal rectus مالهاش إلا action واحد + +14 +00:00:50,530 --> 00:00:54,150 +بينما ال vertical rectus muscles اللي هي أكتر من + +15 +00:00:54,150 --> 00:00:58,790 +action السبب أن ال vertical rectus muscles ال axis + +16 +00:00:58,790 --> 00:01:03,030 +بتاع العضلة، محور العضلة، المحور الطولي للعضلة لا + +17 +00:01:03,030 --> 00:01:08,920 +يتوازى ولا يتفق معمحور العين وانما جايب زاوية + +18 +00:01:08,920 --> 00:01:12,920 +بالنسبة لمحور العين وبالتالي .. وبالتالي في إلها + +19 +00:01:12,920 --> 00:01:18,060 +أكتر من action في إلها أكتر من action بنقول + +20 +00:01:18,060 --> 00:01:21,840 +كالقاتي حسب الرسمة الآن هنعرض ال superior rectus + +21 +00:01:21,840 --> 00:01:26,320 +muscle هذه ال superior rectus muscle بتبدأ من + +22 +00:01:26,320 --> 00:01:31,440 +الannulus of zin عند ال orbital apex قمة ال orbit + +23 +00:01:31,440 --> 00:01:38,950 +ويتمر للأمامو بيصيرلها insertion بعيدا عن ال + +24 +00:01:38,950 --> 00:01:44,530 +limbus تقريبا 7 و 7 من 10 mm طيب ال superior + +25 +00:01:44,530 --> 00:01:48,290 +rectus muscle اللي احنا شايفينها في هذه الرسمة + +26 +00:01:48,290 --> 00:01:53,450 +التمثيلية بتشد باتجاه السهم الأسود يعني لما بيصير + +27 +00:01:53,450 --> 00:01:58,050 +فيها contraction، انقباط، هتتقلص، هتقصر العضلة، + +28 +00:01:58,050 --> 00:02:02,800 +هينشد ال insertion باتجاه ال originيعني مكان + +29 +00:02:02,800 --> 00:02:07,920 +التثبيت هتشده العضلة باتجاه مكان المنشأ بتاعها، + +30 +00:02:07,920 --> 00:02:13,160 +إذا هيكون قوة الشد بهذا الاتجاه واضح إن محور العين + +31 +00:02:13,160 --> 00:02:16,700 +اللي هو مرسوم بالخط الأزرق، محور العين، ال axis of + +32 +00:02:16,700 --> 00:02:21,320 +the eye و ال axis of the muscle لا تتفق مع بعضها + +33 +00:02:21,320 --> 00:02:26,030 +البعض وإنما في بينها زاوية، هذه الزاويةتقريباً + +34 +00:02:26,030 --> 00:02:30,390 +تلاتة و عشرين degree تقريباً تلاتة و عشرين degree + +35 +00:02:30,390 --> 00:02:34,670 +على فكرة .. على فكرة ال superior rectus muscle ال + +36 +00:02:34,670 --> 00:02:38,890 +axis بتاعها .. ال axis بتاعها يتفق مع ال orbital + +37 +00:02:38,890 --> 00:02:43,170 +axis محور ال orbit مش محور العين و احنا عارفين انه + +38 +00:02:43,170 --> 00:02:47,010 +محور ال orbit و محور العين بيعملوا مع بعض زاوية + +39 +00:02:47,010 --> 00:02:52,340 +تلاتة و عشرين degreeالان من مبدأ تحليل القوة + +40 +00:02:52,340 --> 00:02:59,000 +المتجهة معروف لدينا ان كل قوة متجهة ممكن تحلل ويتم + +41 +00:02:59,000 --> 00:03:05,060 +تحليلها لقوتين واحدة منهم بتعمل على الإحداث الصيني + +42 +00:03:05,060 --> 00:03:10,420 +ال X-axis وواحدة منهم بتعمل على الإحداثالصاضي اللي + +43 +00:03:10,420 --> 00:03:14,480 +هو ال Y-axis يعني هذه قوة ال superior rectus + +44 +00:03:14,480 --> 00:03:17,920 +muscle .. قوة ال superior rectus muscle بقدر + +45 +00:03:17,920 --> 00:03:23,040 +استبدلها بقوتين يعني كإني شيلت العضلة هاي و بدلتها + +46 +00:03:23,040 --> 00:03:28,060 +بعضلتين عضلة تعمل على المحور المتفق مع محور العين + +47 +00:03:28,570 --> 00:03:32,770 +والعضلة التانية بتعمل على محور عمودي على محور + +48 +00:03:32,770 --> 00:03:36,370 +العين عمودي على محور العين يعني احنا ال superior + +49 +00:03:36,370 --> 00:03:40,190 +rectus muscle بدنا نتخيل أنها مش موجودة وإنه + +50 +00:03:40,190 --> 00:03:46,870 +بدالها في عضلتين عضلة بتشد باتجاه مطابق لمحور + +51 +00:03:46,870 --> 00:03:51,990 +العين وعضلة بتشد باتجاه مطابق أو عمودي على محور + +52 +00:03:51,990 --> 00:03:56,300 +العين عمودي على محور العيناحنا قلنا الزاوية بين + +53 +00:03:56,300 --> 00:04:00,380 +محور العين، محور العين اللي أنا بقشر عليه ومحور + +54 +00:04:00,380 --> 00:04:04,260 +العضلة هي تلاتة وعشرين degree، تلاتة وعشرين + +55 +00:04:04,260 --> 00:04:09,420 +degree، إذا الزاوية بين محور العضلة والمحور الآخر + +56 +00:04:09,420 --> 00:04:15,000 +اللي هو عمودي عن محور العين تقريبا سبعة وخمسين + +57 +00:04:15,000 --> 00:04:19,820 +degree أو سبعة وستين degree، إذا .. إذا العضلة + +58 +00:04:20,080 --> 00:04:25,540 +محورها أقرب لمحور العين لما بنيجي بنحل القوة .. + +59 +00:04:25,540 --> 00:04:30,800 +لما بنيجي بنحل القوة لإحداثياتها الصيني والصعدي + +60 +00:04:30,800 --> 00:04:35,740 +بنقول إن هذه القوة نصيب الأسد منها بياخدوا المحور + +61 +00:04:35,740 --> 00:04:39,740 +الأقرب يعني لو تصورنا إن العضلة ال superior rectus + +62 +00:04:39,740 --> 00:04:44,760 +بتشد بقوة 100 نيوتن وحللنا هذه ال 100 نيوتن هي + +63 +00:04:44,760 --> 00:04:48,900 +بتشد بهذا الاتجاهحللنا الميتي نيوتن استبدلناها + +64 +00:04:48,900 --> 00:04:53,660 +بعضلتين عضلة محورها يتفق مع محور العين وعضلة + +65 +00:04:53,660 --> 00:04:58,420 +محورها عمودي على محور العين هدول العضلتين بدل ال + +66 +00:04:58,420 --> 00:05:04,820 +superior rectusالكلام .. يعني تم شرحه في المدارس + +67 +00:05:04,820 --> 00:05:08,800 +اللي هو تحليل القوة المتجهة زي ما بقدر أن قوتين + +68 +00:05:08,800 --> 00:05:15,240 +متجهات أعوض عنهم بقوة مكافئة أيضا قوة واحدة بقدر + +69 +00:05:15,240 --> 00:05:20,660 +أحللها لقوتين متعامدة الآن لو قلنا superior rectus + +70 +00:05:20,660 --> 00:05:25,690 +.. superior rectus muscle اللي احنا شايفينهابتشد + +71 +00:05:25,690 --> 00:05:29,890 +بهذا الاتجاه .. بهذا الاتجاه يعني من الأمام للخلف + +72 +00:05:29,890 --> 00:05:34,230 +بس جاية من فوق العين تمام؟ بتشد بقوة 100 نيوتن + +73 +00:05:34,230 --> 00:05:39,550 +وقلنا بنحلل هذه القوة لقوتين أو عضلتين مكافئات + +74 +00:05:39,730 --> 00:05:43,810 +هيحيكون نصيب الأسد للقوة الأقرب .. للقوة الأقرب + +75 +00:05:43,810 --> 00:05:49,150 +يعني ممكن مثلا يطلع 70% من القوة مع هذا المحور و + +76 +00:05:49,150 --> 00:05:53,770 +30% من القوة مع هذا المحور يعني هذا .. يعني أرقام + +77 +00:05:53,770 --> 00:05:59,410 +فرضية بس هيكون المحور الأقرب للقوة الحقيقية هو + +78 +00:05:59,410 --> 00:06:02,810 +اللي هو نصيب الأسد و المحور الأبعد هو اللي هو + +79 +00:06:02,810 --> 00:06:07,350 +النصيبالأقل، إله النصيب الأقل وبما أنه الزاوية بين + +80 +00:06:07,350 --> 00:06:11,410 +العضلة أو محور العضلة وبين محور العين 23 degree + +81 +00:06:11,410 --> 00:06:16,550 +إذا هذا المحور هو الأقرب هو اللي هياخد اللي هو + +82 +00:06:16,550 --> 00:06:21,670 +نصيب الأسد من القوة وكأني أنا شيلت ال superior + +83 +00:06:21,670 --> 00:06:26,310 +rectus وقلت هاي عضلتين بدالها العضلة الأقوى، + +84 +00:06:26,310 --> 00:06:29,940 +العضلة الأقوى هي العضلةالمتفقة مع محور العين + +85 +00:06:29,940 --> 00:06:33,640 +فهيكون ال primary action لما هذه العضلة تنقبض ال + +86 +00:06:33,640 --> 00:06:37,460 +elevation ال primary action هو ال elevation وال + +87 +00:06:37,460 --> 00:06:40,780 +secondary action .. ال secondary action .. الآن + +88 +00:06:40,780 --> 00:06:44,440 +بدنا ننتبه لل secondary action أنا عندي جسم كروي + +89 +00:06:44,440 --> 00:06:51,240 +.. جسم كروي بتشد عضلة عمودية عليه هيكون شد هذه + +90 +00:06:51,240 --> 00:06:55,200 +العضلة بهذا الاتجاه فهيكون in torsion يعني لما + +91 +00:06:55,200 --> 00:07:00,360 +بتشد هذه العضلةاللي أنا قاعد ب .. أشير باتجاهها + +92 +00:07:00,360 --> 00:07:04,840 +هذه عضلة إحدى العضلات المكافئة لل superior rectus + +93 +00:07:04,840 --> 00:07:06,900 +muscle هذه ال superior rectus muscle كأنها مش + +94 +00:07:06,900 --> 00:07:11,440 +موجودة كأنه في عضلتين بيسدوا عنها العضلة الأقوى + +95 +00:07:11,440 --> 00:07:15,700 +متفقة مع محور العين هتعمللي elevation والعضلة + +96 +00:07:15,700 --> 00:07:19,840 +الأضعف هتعمللي intortion intortion يعني لما يسير + +97 +00:07:19,840 --> 00:07:24,700 +فيها contraction لما اتشدهتلف العين الـ superior + +98 +00:07:24,700 --> 00:07:27,940 +limbus الساعة 12 في ال limbus هتتحرك لجوه شوية + +99 +00:07:27,940 --> 00:07:32,880 +يعني هتدور دوران برغي دوران برغي فبالتالي أول + +100 +00:07:32,880 --> 00:07:37,760 +action إليها elevation تاني action in torsion تاني + +101 +00:07:37,760 --> 00:07:42,140 +action in torsion وإن شاء الله إذا تيسرت الأمور + +102 +00:07:42,140 --> 00:07:47,200 +هنحاول نعمل simulation حقيقي بفيديو يوضح حد القضية + +103 +00:07:47,200 --> 00:07:53,400 +يوضح حد القضية إن شاء الله تعالى الآنضال action + +104 +00:07:53,400 --> 00:07:57,560 +واحد بدنا نشرحه .. ضال action واحد بدنا نشرحه بس + +105 +00:07:57,560 --> 00:08:01,320 +جابل ما نشرحه بدنا نقول في قاعدتين .. في عندي + +106 +00:08:01,320 --> 00:08:06,440 +قاعدتين القاعدة الأولى بتقول أي عضلة بيصير فيها + +107 +00:08:06,440 --> 00:08:09,800 +انقباض بغض النظر superior rectus .. superior + +108 +00:08:09,800 --> 00:08:13,600 +oblique ال media rectus ال lateral rectus أو أي + +109 +00:08:13,600 --> 00:08:18,560 +عضلة من عضلات الجسم بيصير فيها انقباض بتقصر .. + +110 +00:08:18,560 --> 00:08:22,860 +بتقصر لأن الألياف العضلية بتتداخل مع بعضهاالبعض + +111 +00:08:22,860 --> 00:08:26,440 +الألياف العضلية فبصير طولها أقصر لأنها انقبضت + +112 +00:08:26,440 --> 00:08:31,040 +لأنها انقبضت الآن طالما طولها أقصر السؤال بيطرح + +113 +00:08:31,040 --> 00:08:34,700 +نفسه هاي أنا عند ال insertion مكان انتهاء العضلة + +114 +00:08:34,700 --> 00:08:38,540 +بيسموه ال insertion وال origin مكان مبدأ العضلة من + +115 +00:08:38,540 --> 00:08:42,940 +الannulus of zen من الannulus of zen يترى لما + +116 +00:08:42,940 --> 00:08:48,200 +بتقصر العضلة واحدة من النقطتينهنا المبدأ وهنا + +117 +00:08:48,200 --> 00:08:53,200 +المنتهى مين بده ينشد باتجاه التاني العضلة قصرت إذا + +118 +00:08:53,200 --> 00:08:57,820 +لابد أنه واحد من التنين إما ال insertion إما ال + +119 +00:08:57,820 --> 00:09:02,320 +insertion ينشد هذا ال insertion ينشد باتجاه ال + +120 +00:09:02,320 --> 00:09:06,400 +origin أو ال origin ينشد باتجاه ال insertion حقيقة + +121 +00:09:06,400 --> 00:09:12,100 +قولا واحدا قولا واحدا لا استثناء في ذلك إنه دائما + +122 +00:09:12,100 --> 00:09:16,290 +ال insertion باتجاه ال origin بينشد باتجاهال + +123 +00:09:16,290 --> 00:09:20,350 +origin فبالتالي ليش؟ لأن ال origin ثابت عبارة عن + +124 +00:09:20,350 --> 00:09:25,010 +ال annulus of zen و ال annulus of zen مثبت في + +125 +00:09:25,010 --> 00:09:29,170 +العظم هو عبارة عن نسيج ضام ليفي شديد القوة + +126 +00:09:29,170 --> 00:09:35,280 +adherent ملتسق تماما بالعظم وبالتاليهيشد العضلة + +127 +00:09:35,280 --> 00:09:39,140 +باتجاهه لما العضلة تقصر فال insertion بده يت .. + +128 +00:09:39,140 --> 00:09:42,660 +يعني ينشد باتجاه ال origin طيب، ممكن الإنسان يقول + +129 +00:09:42,660 --> 00:09:47,820 +طب كل هذا إيش علاقته بال tertiary action بتاعنا؟ + +130 +00:09:47,820 --> 00:09:50,620 +قبل ما نقول ال tertiary action بتاعنا، بدنا نقول + +131 +00:09:50,620 --> 00:09:54,140 +اتجاه ال adduction باتجاه ال nose، هذا مقطع من ال + +132 +00:09:54,140 --> 00:09:58,700 +nose، هذا مقطع من ال nose، هذا مقطع من ال nose + +133 +00:09:58,810 --> 00:10:02,130 +فبالتالي لما العين تعمل abduction يعني راحة ناحية + +134 +00:10:02,130 --> 00:10:05,410 +ال nose ال cornea راحة ناحية ال nose و لما تعمل + +135 +00:10:05,410 --> 00:10:09,230 +abduction abduction يعني بعيدا عن ال nose هي ال + +136 +00:10:09,230 --> 00:10:15,190 +lateral wall الجدار الخارجي لل orbit لل orbit أو + +137 +00:10:15,190 --> 00:10:20,210 +لمحجر العين الآن لما العضلة بتقصر بنشد ال + +138 +00:10:20,210 --> 00:10:25,010 +insertion باتجاه ال origin مظبوط بشد ال insertion + +139 +00:10:25,010 --> 00:10:34,780 +باتجاه ال origin بس إذا ملاحظين هناعفوا إذا + +140 +00:10:34,780 --> 00:10:41,500 +ملاحظين هنا إن ال insertion جاي temporal بالنسبة + +141 +00:10:41,500 --> 00:10:45,680 +لل origin يعني ال origin أقرب لل nose أي شيء أقرب + +142 +00:10:45,680 --> 00:10:50,000 +لل nose تمام بيسموه medial و أي شيء أبعد من ال + +143 +00:10:50,000 --> 00:10:53,940 +nose بيسموه temporal أو lateralيعني بالنهاية ال + +144 +00:10:53,940 --> 00:10:58,020 +insertion مكان تثبيت ال superior rectus جاي لاترال + +145 +00:10:58,020 --> 00:11:03,220 +مقارنة مع مكان ال origin لما العضلة بتقصر العين + +146 +00:11:03,220 --> 00:11:07,380 +كلها تزاح إزاحة بسيطة باتجاه ال adduction يعني + +147 +00:11:07,380 --> 00:11:12,610 +مثلا كانت حسب الرسمة هناهتصير شوية صغيرة abducted + +148 +00:11:12,610 --> 00:11:16,130 +زي ما أنا قاعد بقشر abducted فال adoption اللي + +149 +00:11:16,130 --> 00:11:20,190 +بتعمل ليها ال superior rectus هو بسبب انه ال + +150 +00:11:20,190 --> 00:11:23,670 +origin بتاع العضلة و ال insertion بتاع العضلة ال + +151 +00:11:23,670 --> 00:11:29,180 +origin جاي more medialفبالتالي بيحرك العين أو + +152 +00:11:29,180 --> 00:11:35,300 +بتنشد .. بتقصر العضلة فبتنشد العين ككل .. ككل شوية + +153 +00:11:35,300 --> 00:11:37,780 +للداخل ممكن الإنسان يتخيل أن ال adduction زي ال + +154 +00:11:37,780 --> 00:11:39,980 +media rectus لأ ال media rectus لما بتعمل + +155 +00:11:39,980 --> 00:11:43,160 +adduction ال cornea بتسير هنا .. ال cornea بتسير + +156 +00:11:43,160 --> 00:11:46,580 +هنا يعني للداخل على الآخر بينما ال superior rectus + +157 +00:11:46,580 --> 00:11:50,120 +لما بتعمل adduction لا يكاد يذكر وإن كان يعني + +158 +00:11:50,120 --> 00:11:57,520 +موجود و أثبت بالتجربة .. أثبت بالتجربةفبالتالي ال + +159 +00:11:57,520 --> 00:12:01,460 +elevation هو ال primary action ال intorsion حركة + +160 +00:12:01,460 --> 00:12:06,060 +البرغة لأن ال superior limbus يتحرك ل .. الساعة 12 + +161 +00:12:06,060 --> 00:12:09,840 +من ال limbus تتحرك نيزلي .. تلف نيزلي هذه ال + +162 +00:12:09,840 --> 00:12:13,660 +secondary action و ال tertiary action هو ال + +163 +00:12:13,660 --> 00:12:16,380 +adduction إذا ال superior rectus بتعمل ليه + +164 +00:12:16,380 --> 00:12:20,900 +elevation و بتعمل intorsion و بتعمل adduction و + +165 +00:12:20,900 --> 00:12:25,980 +بتعمل adduction بنقول ده vertical rectiالو ال + +166 +00:12:25,980 --> 00:12:29,520 +superior و ال inferior rectus run in line with the + +167 +00:12:29,520 --> 00:12:33,320 +orbital axis تتفق مع ال orbital axis و ضروري احنا + +168 +00:12:33,320 --> 00:12:38,940 +مانخربطش ال orbital axis مع ال axis of the eyeand + +169 +00:12:38,940 --> 00:12:44,120 +are inserted in front of the equator يعني بيتم + +170 +00:12:44,120 --> 00:12:49,080 +تثبيتهم أمام ال equator أمام الخط المنصف للعين + +171 +00:12:49,080 --> 00:12:52,640 +يعني ال equator هو بيجي تقريبا عند المسافة high نص + +172 +00:12:52,640 --> 00:12:56,380 +العين بيقسم ال equator أو خط الاستواق بيقسم العين + +173 +00:12:56,380 --> 00:13:00,460 +لنصف أمامي ونصف خلفي ال superior و ال inferior + +174 +00:13:00,460 --> 00:13:04,220 +rectus ال insertion بتاعهم أمام ال equator يعني + +175 +00:13:04,220 --> 00:13:11,200 +جاي لقدام من ال equator جاي لقدام منال equator .. + +176 +00:13:11,200 --> 00:13:14,220 +نرجع + +177 +00:13:14,220 --> 00:13:19,280 +بس للرسمة بس هنا للتوضيح هنا بنقول ال superior + +178 +00:13:19,280 --> 00:13:23,340 +rectus تنشأ من الجزء العلوي من الannulus of زين، + +179 +00:13:23,340 --> 00:13:27,060 +هاي ال superior rectus اللي أنا بأشير عليها، اللي + +180 +00:13:27,060 --> 00:13:34,470 +بأشير عليها، اذا they therefore form an angleof 23 + +181 +00:13:34,470 --> 00:13:38,830 +degree with the visual axis أو الـ axis of ضغط إذا + +182 +00:13:38,830 --> 00:13:42,390 +ال superior و ال inferior rectus muscles بيعملوا + +183 +00:13:42,390 --> 00:13:48,670 +23 degree مع ال visual axis الرسمة هنا بتوضح ال + +184 +00:13:48,670 --> 00:13:52,710 +superior rectus muscle باللون الأحمر بالسهم الأحمر + +185 +00:13:52,710 --> 00:13:57,570 +العريض هاي الخط الأحمر المتقطع هو ال orbital axis + +186 +00:13:58,230 --> 00:14:02,650 +وهي ال axis of the eye أو ال visual axis طالما أن + +187 +00:14:02,650 --> 00:14:06,610 +ال superior rectus muscle محورها بتفق مع ال + +188 +00:14:06,610 --> 00:14:10,830 +orbital axis إذا ال superior rectus muscle محورها + +189 +00:14:10,830 --> 00:14:15,730 +بيعمل تلاتة و عشرين degree مع ال axis of the eye + +190 +00:14:15,730 --> 00:14:19,710 +أو ال visual axis وبالتالي طالما المحورين مش + +191 +00:14:19,710 --> 00:14:24,230 +منطبقين محور العضلة ومحور العين معناته في أكتر من + +192 +00:14:24,230 --> 00:14:29,570 +actionللعضلة في اكتر من action للعضلة هنا في قاعدة + +193 +00:14:29,570 --> 00:14:34,270 +احنا شرحناها قبل شوية بنقول اي جسم كروي او بيضاوي + +194 +00:14:34,270 --> 00:14:39,090 +او استواني تؤثر عليه قوة ذات اتجاه عمودي على محوره + +195 +00:14:39,090 --> 00:14:43,550 +يكون النتيجة هي الدوران بمعنى اما بيصير intortion + +196 +00:14:43,550 --> 00:14:48,910 +او بيصير extortion زي ما وضحنا في الرسمة السابقة + +197 +00:14:48,910 --> 00:14:55,560 +بنقول كالاتيقوة عمودية .. قوة عمودية .. بس نكبر + +198 +00:14:55,560 --> 00:15:01,940 +شوية أفضل .. هاي احنا عندنا قوة عمودية .. ننسا .. + +199 +00:15:01,940 --> 00:15:05,140 +احنا هادي هناخد القوة هاي فقط .. اللي هي إحدى + +200 +00:15:05,140 --> 00:15:10,320 +القوةالناتجة عن تحليل قوة الـ superior rectus هذه + +201 +00:15:10,320 --> 00:15:14,520 +القوة عمودية على جسم كراوي أو شبه كراوي، تمام؟ إذا + +202 +00:15:14,520 --> 00:15:20,200 +طالما هي بتأثر باتجاه عمودي، هيكون الاتجاه أو + +203 +00:15:20,200 --> 00:15:25,320 +الحركة هي حركة دورانية، دورانية بمعنى حركة البرغي، + +204 +00:15:25,320 --> 00:15:29,330 +يعني لما هذه القوة تشد بهذا الاتجاه وجاية من فوقو + +205 +00:15:29,330 --> 00:15:32,910 +جاية من فوق الساعة 12 تاعة ال limbus هتتحرك شوية + +206 +00:15:32,910 --> 00:15:36,150 +لقدام .. لقدام بهذا الاتجاه هذا يسمى intortion + +207 +00:15:36,150 --> 00:15:41,330 +لأنه .. انه العين لفت بطريقة البرغي لفت باتجاه + +208 +00:15:41,330 --> 00:15:45,590 +الأنف طيب لو القوة جاية هيك بهذا الاتجاه أيضا + +209 +00:15:45,590 --> 00:15:50,150 +عموديا ساعتها الساعة 12 هتتحرك برضه بحركة البرغي + +210 +00:15:50,150 --> 00:15:54,090 +اللي من ال limbus العين هتلف بطريقة كأنها برغي + +211 +00:15:54,090 --> 00:15:57,180 +تمام؟يعني أنه برغي بده يدخل في ال orbit أو برغي + +212 +00:15:57,180 --> 00:16:00,740 +بده يطلع من ال orbit هتتحرك بهذا الاتجاه وهذا يسمى + +213 +00:16:00,740 --> 00:16:06,060 +extortion لأنه اتجاه الحركة بعيدا عن ال nose بعيدا + +214 +00:16:06,060 --> 00:16:11,760 +عن ال nose إذا نرجع لل presentation بتاعنا نقول أي + +215 +00:16:11,760 --> 00:16:16,900 +جسم كروي أو بيضاوي أو شبه كروي أو استواني تؤثر + +216 +00:16:16,900 --> 00:16:21,380 +عليه قوة ذات اتجاه عمودي على محوره يكون النتيجة هي + +217 +00:16:21,380 --> 00:16:26,120 +الدوران بمعنىintortion باتجاه أو extortion + +218 +00:16:26,120 --> 00:16:30,680 +بالاتجاه العكسه السبب انه القوة عمودية على هذه + +219 +00:16:30,680 --> 00:16:34,140 +الأجسام عمودية على هذه الأجسام وهذا ينطبق مائة + +220 +00:16:34,140 --> 00:16:39,060 +بالمائة على العين ال superior rectus muscle زي ما + +221 +00:16:39,060 --> 00:16:43,320 +حكينا originates تبدأ from the upper part of the + +222 +00:16:43,320 --> 00:16:47,930 +annulus of زن من الجزء العلوي من annulus of زنو + +223 +00:16:47,930 --> 00:16:53,230 +inserts يعني بتتسبت على بعد سبعة وسبعة من عشرة + +224 +00:16:53,230 --> 00:16:56,490 +millimeter behind the superior limbus يعني بعيدا + +225 +00:16:56,490 --> 00:17:00,050 +عن ال limbus مقدار سبعة وسبعة من عشرة milli وحكينا + +226 +00:17:00,050 --> 00:17:04,090 +أن هذه الأرقام مهمة لجراح العيون إذا بدوا يجري + +227 +00:17:04,090 --> 00:17:09,170 +جراحة على أي من ال muscles the primary action is + +228 +00:17:09,170 --> 00:17:14,390 +elevation the secondary actions are intorsion and + +229 +00:17:14,390 --> 00:17:21,670 +adductionand adoption وبالتالي هدوله ال secondary + +230 +00:17:21,670 --> 00:17:27,310 +actions طيب الان بنيجي لخطوة مهمة للغاية هذه + +231 +00:17:27,310 --> 00:17:32,550 +الخطوةالمهم للغاية لو طلب مننا حد انه نختبر ال + +232 +00:17:32,550 --> 00:17:34,110 +superior rectus muscle + +233 +00:17:58,490 --> 00:18:02,890 +action واحد وهذا ال action الواحد بيدلني على بجيهة + +234 +00:18:02,890 --> 00:18:07,090 +الوظائف بتاعة العضلة حقيقة الإجابة بسيطة جدا ان لو + +235 +00:18:07,090 --> 00:18:11,250 +انا اختبرت one action من التلاتة action وطلع طبيعي + +236 +00:18:11,250 --> 00:18:15,870 +معناته بجيهة ال actions رالبا طبيعية لان العضلة + +237 +00:18:15,870 --> 00:18:19,850 +اذا كانت طبيعية معناته هتعمل وظائفها كلها بشكل + +238 +00:18:19,850 --> 00:18:23,570 +طبيعي طيب يترى اي action من ال three actions بتاعي + +239 +00:18:23,570 --> 00:18:27,580 +ال superior rectus muscleمن .. من تعيين ال + +240 +00:18:27,580 --> 00:18:33,480 +superior rectus muscle اللي انا هاختبره هل اختبر + +241 +00:18:33,480 --> 00:18:37,340 +ال intortion؟ ال intortion مابنشوفوهش في الواقع في + +242 +00:18:37,340 --> 00:18:40,420 +الحياة الواقعية في الحياة العملية مابنشوفه + +243 +00:18:40,420 --> 00:18:44,820 +وبالتالي اشي مابشوفوهش مابقدرش اختبره طيب هل اختبر + +244 +00:18:44,820 --> 00:18:48,780 +ال adduction؟لأ ما بقدر اختبر ال adoption لأن ال + +245 +00:18:48,780 --> 00:18:51,760 +adoption اللي بتعمله ال superior rectus muscle هو + +246 +00:18:51,760 --> 00:18:57,140 +action ضعيف جدا وفي نقطة تانية انه لو بدأ اطلب ان + +247 +00:18:57,140 --> 00:18:59,840 +المريض يعمل adoption هيكون ال adoption اللي عمله + +248 +00:18:59,840 --> 00:19:03,760 +غالبا ناتج عن ال media rectus action مش عن ال + +249 +00:19:03,760 --> 00:19:07,940 +superior rectus لأن أكبر adapter للعين اللي هو ال + +250 +00:19:07,940 --> 00:19:10,980 +adapter الأقوى اللي بيجيب العين لجوه هو ال media + +251 +00:19:10,980 --> 00:19:14,600 +rectus بقدرش أحيد ال media rectus عن العمل أو + +252 +00:19:14,600 --> 00:19:18,450 +أقولها توقفي عن العملعشان نشوف ال adoption بتاع ال + +253 +00:19:18,450 --> 00:19:21,810 +superior rectus اذا ال function هذه بتاعة superior + +254 +00:19:21,810 --> 00:19:24,690 +rectus muscle بقدرش اختبرها اللي هي ال intuition + +255 +00:19:24,690 --> 00:19:29,490 +لأنه مش هشوفهاالـ Adduction بقدرش أصفر عمل ال + +256 +00:19:29,490 --> 00:19:32,510 +media rectus muscle أو ألغي عملها أقولها واجفي + +257 +00:19:32,510 --> 00:19:35,770 +بالله عبالما اختبر ال superior rectus muscle بيضل + +258 +00:19:35,770 --> 00:19:39,690 +عندى اختبار ال elevation يعني لما بدى أقول للمريض + +259 +00:19:39,690 --> 00:19:43,330 +يتطلع لفوج ساعتها إذا اتطلع لفوج وطلعت اللي هي + +260 +00:19:43,330 --> 00:19:47,530 +لفوج معناته ال elevation طبيعى طيب ممكن إنسان + +261 +00:19:47,530 --> 00:19:51,590 +يعترض يقول بس أنا في عندى كمان عضلة .. كمان عضلة + +262 +00:19:51,590 --> 00:19:55,190 +غير ال superior rectus muscle .. غير ال superior + +263 +00:19:55,190 --> 00:20:01,190 +rectus muscleبتعمل elevation وهذه العضلة ضروري جدا + +264 +00:20:01,190 --> 00:20:06,630 +انه نحيدها او نصفر عملها و ساعتها ال elevation + +265 +00:20:06,630 --> 00:20:10,430 +هيكون ناتج فقط عن عمل ال superior rectus muscle + +266 +00:20:10,430 --> 00:20:14,670 +بنقول الكلام سليم مائة بالمائة يا ترى ايش العضلة + +267 +00:20:14,670 --> 00:20:20,970 +اللي احنا بدنا نحيدها عشان + +268 +00:20:20,970 --> 00:20:27,730 +..يعني نختبر ال superior rectus muscle بدنا احنا + +269 +00:20:27,730 --> 00:20:31,710 +عشان نفهم هذه القضية تطلعوا معايا لو سمحتوا على + +270 +00:20:31,710 --> 00:20:39,190 +المنظر رقم 8 والمنظر رقم 11هي هذا المنظر هو نفس + +271 +00:20:39,190 --> 00:20:42,990 +المنظر تاع العضلة اللي أنا قبل شوية شرحتها اللي هي + +272 +00:20:42,990 --> 00:20:47,030 +superior rectus muscle بدنا نشرح .. الآن العين هنا + +273 +00:20:47,030 --> 00:20:50,070 +العين عدلة في ال primary position في ال primary + +274 +00:20:50,070 --> 00:20:53,650 +position يعني بتتطلع دغري الآن ال superior rectus + +275 +00:20:53,650 --> 00:20:58,790 +muscle عاملة عاملة زاوية مع العين 23 degree الآن + +276 +00:20:58,790 --> 00:21:03,230 +لو طلبت من المريض قلتله يطلع عينه لبرا يطلع لبرا + +277 +00:21:03,230 --> 00:21:07,950 +في وضع ال upduction يا ترى إيش اللي هيحصل؟يا ترى + +278 +00:21:07,950 --> 00:21:12,890 +إيش اللي هيحصل؟ بنقول نتطلع على رقم 11 لما العين + +279 +00:21:12,890 --> 00:21:16,350 +تسير في وضع ال abduction .. في وضع ال abduction + +280 +00:21:16,350 --> 00:21:20,630 +هيتيجي لبرا ساعتها المحور تع عضلة ال superior + +281 +00:21:20,630 --> 00:21:26,840 +rectus اللي مرسومة أمامنا بينطبق مع محور العينهدا + +282 +00:21:26,840 --> 00:21:30,240 +إيش بده يفيدنا؟ بده يفيدنا إنه ننظر لرقم 8 للرسمة + +283 +00:21:30,240 --> 00:21:33,800 +رقم 8 عند ال elevator التاني بتاع العين و اللي + +284 +00:21:33,800 --> 00:21:37,520 +هنشرح عنه في وقته هو ال inferior oblique muscle + +285 +00:21:37,520 --> 00:21:40,580 +هذه هي ال inferior oblique muscle اللي بتيجي من + +286 +00:21:40,580 --> 00:21:45,660 +أسفل العين .. بتيجي من أسفل العين .. هذه هي من ضمن + +287 +00:21:45,660 --> 00:21:48,960 +ال actions بتاعتها و اللي هنشرحها في وقتهاانها + +288 +00:21:48,960 --> 00:21:52,840 +بتعمل elevation انا بتديش العين او بتديش ال + +289 +00:21:52,840 --> 00:21:56,420 +inferior oblique تساهم في ال elevation لما العين + +290 +00:21:56,420 --> 00:22:00,540 +بتعمل abduction زي ما انتوا شايفين في الرسمتين لما + +291 +00:22:00,540 --> 00:22:04,140 +العين بتعمل abduction في وضع ال abduction في وضع + +292 +00:22:04,140 --> 00:22:08,060 +ال abduction بتكون ال superior rectus محورها متفق + +293 +00:22:08,060 --> 00:22:12,540 +مع محور العين و ال inferior oblique محورها عمودي + +294 +00:22:12,540 --> 00:22:17,440 +على محور العين لما اي عضلة من العضلة بتتعامد على + +295 +00:22:18,420 --> 00:22:22,160 +محور العين لن تساهم لا في elevation ولا في + +296 +00:22:22,160 --> 00:22:25,660 +depression وإنما هيظل من ال actions ساعتها ال + +297 +00:22:25,660 --> 00:22:29,320 +torsional action ال extorsion أو ال intorsion يعني + +298 +00:22:29,320 --> 00:22:33,340 +مش elevation ساعتها بتصير ال superior rectus لأن + +299 +00:22:33,340 --> 00:22:36,800 +محورها اتفق مع محور العين في وضعية ال abduction + +300 +00:22:36,800 --> 00:22:41,640 +بتصير pure elevator elevator نقي بدون أي يعني + +301 +00:22:41,640 --> 00:22:46,140 +شوائب ولن يشارك في ال elevationالـ other elevator + +302 +00:22:46,140 --> 00:22:48,500 +of the eye اللي هو الـ inferior oblique طب ليش لن + +303 +00:22:48,500 --> 00:22:52,080 +يشاركها لأنه في وضعية ال abduction ال inferior + +304 +00:22:52,080 --> 00:22:56,880 +oblique كقوة بتكون عمودية على محور العين وبالتالي + +305 +00:22:56,880 --> 00:23:00,420 +هتعمل intorsion أو extorsion هذا هنشرحه في وقته هي + +306 +00:23:00,420 --> 00:23:05,220 +هتعمل extorsion مش هتساهم في ال elevation بالمرة + +307 +00:23:05,220 --> 00:23:08,960 +اذا انا لما بدأ اختبر ال superior rectus muscle ال + +308 +00:23:08,960 --> 00:23:12,980 +function بتاعتهابختبر ال elevation كيف اختبر ال + +309 +00:23:12,980 --> 00:23:16,820 +elevation؟ بخل المريض يتطلع لبرا و بعد ما يتطلع + +310 +00:23:16,820 --> 00:23:22,250 +لبرا بقوله يتطلع لهدف عالي يعني out and upout and + +311 +00:23:22,250 --> 00:23:26,750 +up إذا العين طلعت لبرا وبعدين من وضع برا هذه طلعت + +312 +00:23:26,750 --> 00:23:31,070 +لفوق معناته هي طلعت بفعل ال superior rectus muscle + +313 +00:23:31,070 --> 00:23:34,190 +ممكن إنسان يحتاج طب ليش ما طلعت بفعل ال superior + +314 +00:23:34,190 --> 00:23:37,050 +rectus مع ال inferior oblique؟ بنقولك مظبوط هي + +315 +00:23:37,050 --> 00:23:40,050 +طلعت بفعل ال superior rectus فقط لأن ال inferior + +316 +00:23:40,050 --> 00:23:44,090 +oblique في وضع ال abduction لا تستطيع أن تساهم في + +317 +00:23:44,090 --> 00:23:49,160 +رفع العين بسبب إنها محورها عمودي عن محور العينيعني + +318 +00:23:49,160 --> 00:23:52,940 +إذا صار فيها contraction فقط هتعمل extortion مش + +319 +00:23:52,940 --> 00:23:57,040 +elevation ..extortion مش elevation ..هنتوقف عند + +320 +00:23:57,040 --> 00:24:00,080 +هذه النقطة و المرة القادمة هنشرح ال inferior + +321 +00:24:00,080 --> 00:24:03,180 +rectus muscle و يعطيكم العافية + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Mmo7O_4Jqv8_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Mmo7O_4Jqv8_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..12ff6ab1a8f4ab0ba80c5d6c72d7d5eddc613263 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Mmo7O_4Jqv8_postprocess.srt @@ -0,0 +1,1372 @@ +1 +00:00:02,020 --> 00:00:08,540 +بسم الله الرحمن الرحيم أهلا وسهلا بيكم مع المحاضرة + +2 +00:00:08,540 --> 00:00:15,120 +التالتة في مساق حوال واحد وصلنا ل anatomy of + +3 +00:00:15,120 --> 00:00:16,360 +extraocular muscles + +4 +00:00:19,150 --> 00:00:23,330 +لازم نفهم ال anatomy لل extraocular muscles بشكل + +5 +00:00:23,330 --> 00:00:30,210 +تم و جيد و ممتاز بحيث انه يسهل علينا تخيل مساق او + +6 +00:00:30,210 --> 00:00:36,130 +علم الحوال بصورة جيدة بنبدأ بنقول ان ال lateral + +7 +00:00:36,130 --> 00:00:41,150 +and medial orbital walls are at angle of 45 + +8 +00:00:41,150 --> 00:00:47,030 +degrees with each otherالأكسس الروحاني يشكل بطولة + +9 +00:00:47,030 --> 00:00:55,850 +22.5 دقائق مع كلا الجدول و الجدول المتوسطين يعني + +10 +00:00:55,850 --> 00:01:01,970 +تقريبا 23 دقائق نشرح + +11 +00:01:01,970 --> 00:01:05,810 +هذه الفقرة بالرسمة التالية + +12 +00:01:10,380 --> 00:01:16,720 +هذه الرسمة بتبين الشيء اللي .. يعني .. حكيناه قبل + +13 +00:01:16,720 --> 00:01:23,980 +شوية هاي ال right orbit .. هاي ال right orbit اللي + +14 +00:01:23,980 --> 00:01:28,580 +المحجر العظمى اللى موجود العين فيه وهي ال left .. + +15 +00:01:28,580 --> 00:01:32,080 +ال left eye و ال left orbit .. ال left orbit اللى + +16 +00:01:32,080 --> 00:01:37,160 +هو المحجر العظمى اللى موجود ال left eye فيه طبعا + +17 +00:01:37,160 --> 00:01:42,140 +هاي ال media ال orbital wallوهي ال lateral orbital + +18 +00:01:42,140 --> 00:01:47,580 +wall نفس الأشي هنا عن ناحية الشمال ال medial + +19 +00:01:47,580 --> 00:01:54,980 +orbital wall و ال lateral orbital wall طبعا هذا + +20 +00:01:54,980 --> 00:02:00,300 +منظر علوي من فوق يعني احنا كأننا يعني يعني عاملين + +21 +00:02:00,300 --> 00:02:06,020 +منظر علوي للجمجمة من الأعلى و شايلين يعني جزء من + +22 +00:02:06,020 --> 00:02:11,300 +الجمجمة و بنطلع على الانتين من الأعلىالـ Medial + +23 +00:02:11,300 --> 00:02:15,320 +Orbital Wall تحت الـ Right Eye أو تحت الـ Right + +24 +00:02:15,320 --> 00:02:23,920 +Orbit والـ Medial Orbital Wall يعني الجدار الداخلي + +25 +00:02:23,920 --> 00:02:28,260 +للـ Orbit في الناحية الشمال اتنين موازين لبعضهم + +26 +00:02:28,260 --> 00:02:35,080 +البعض بينما الـ Lateral Orbital Wallو ال media ال + +27 +00:02:35,080 --> 00:02:39,800 +orbital wall في نفس ال orbit بيعملوا زاوية 45 + +28 +00:02:39,800 --> 00:02:45,160 +degree مع بعضهم البعض وهنا أيضا بيعملوا زاوية 45 + +29 +00:02:45,160 --> 00:02:50,980 +degree مع بعضهم البعضالان احنا قلنا ال media ال + +30 +00:02:50,980 --> 00:02:54,220 +orbital wall و ال media ال orbital wall بيكونوا + +31 +00:02:54,220 --> 00:02:58,400 +متوازيات مع بعض و من البعض و كل media ال orbital + +32 +00:02:58,400 --> 00:03:01,420 +wall بتعمل مع ال lateral orbital wall على نفس + +33 +00:03:01,420 --> 00:03:04,640 +الجهة خمسة و أربعين degree هنا خمسة و أربعين + +34 +00:03:04,640 --> 00:03:09,620 +degree و هنا خمسة و أربعين degreeطب يا ترى .. يا + +35 +00:03:09,620 --> 00:03:13,200 +ترى ال lateral orbital wool و ال lateral orbital + +36 +00:03:13,200 --> 00:03:18,020 +wool كدهش بيعملوا مع بعضهم البعض، احنا بنمد الخط ل + +37 +00:03:18,020 --> 00:03:22,420 +ال lateral orbital wool، هذا الخط، هاي العظيم، هنا + +38 +00:03:22,420 --> 00:03:27,690 +الخط مغضي على العظيم تمام؟الآن احنا بنمد خط ال + +39 +00:03:27,690 --> 00:03:33,010 +lateral orbital والخط بتاعها بنمده لغاية multiple + +40 +00:03:33,010 --> 00:03:36,890 +وحنلاقي انه الزاوية بينهم تسعين درجة اذا ال + +41 +00:03:36,890 --> 00:03:40,790 +lateral مع ال lateral بيعملوا زاوية تسعين درجة ال + +42 +00:03:40,790 --> 00:03:44,990 +medial مع ال medial متوازيات ال medial مع ال + +43 +00:03:44,990 --> 00:03:49,130 +lateral على نفس الجهة بيعملوا خمسة و أربعين درجة + +44 +00:03:49,130 --> 00:03:55,690 +وهنا أيضا بيعملوا خمسة و أربعين درجةالآن في حاجة + +45 +00:03:55,690 --> 00:04:00,770 +اسمها محور ال orbit مش محور العين مش ال visual + +46 +00:04:00,770 --> 00:04:05,610 +axis ولا ال anatomical axis إنما محور ال orbit + +47 +00:04:05,610 --> 00:04:10,730 +اللي بنصف ال orbit لقسمين، هو خط وهمي بنصف ال + +48 +00:04:10,730 --> 00:04:15,190 +orbit لقسمين، لقسمين، الآن هذا ال .. ال .. ال + +49 +00:04:15,190 --> 00:04:21,380 +orbital axisبيجسم الـ 45 degree اللي هي الزاوية + +50 +00:04:21,380 --> 00:04:24,460 +بين ال media و ال lateral orbital wall بيجسمها + +51 +00:04:24,460 --> 00:04:30,700 +لنصين يعني هنا 22.5 و هنا 22.5 طبعا مش هنضلنا نقول + +52 +00:04:30,700 --> 00:04:38,720 +22.5 بنقول تقريبا 23 degree تقريبا 23 degree إذا + +53 +00:04:38,720 --> 00:04:43,720 +ال orbital axis و ننتبه لكلمة orbital axisلا نعني + +54 +00:04:43,720 --> 00:04:47,840 +في ال axis of the I لا نعني في ال axis of the I في + +55 +00:04:47,840 --> 00:04:53,980 +نقطة تانية بدي أنبه عليها انه احنا في المحاضرة + +56 +00:04:53,980 --> 00:04:59,800 +السابقةميزنا بين محورين ال visual axis و ال + +57 +00:04:59,800 --> 00:05:04,300 +anatomical axis بس لأنه الزاوية بينهم اللي هو ال + +58 +00:05:04,300 --> 00:05:08,360 +angle كبّا خمسة degree أو أقل عادة احنا في علم + +59 +00:05:08,360 --> 00:05:11,620 +الحوار مش هنضلنا نقول visual axis و anatomical + +60 +00:05:11,620 --> 00:05:18,930 +axis، هنقول axis of the eyeيعني كأنه في عندي محور + +61 +00:05:18,930 --> 00:05:23,230 +واحد للعين بيسد عن ال two axis بيسد عن ال + +62 +00:05:23,230 --> 00:05:27,990 +anatomical axis و ال visual axis من باب التبسيط + +63 +00:05:27,990 --> 00:05:36,570 +البسيط وهذا لا يخل بيعني هذا العلم، اذا عندي axis + +64 +00:05:36,570 --> 00:05:42,010 +of the eye و ال orbital axis axis of the eye و ال + +65 +00:05:42,010 --> 00:05:47,370 +orbital axis ليش انا بقول axis of the eyeوالـ + +66 +00:05:47,370 --> 00:05:53,210 +orbital axis عساس انه نستنتج كدهش الزاوية بين ال + +67 +00:05:53,210 --> 00:05:58,370 +axis of the eye وهي ال axis of the eye وهي ال axis + +68 +00:05:58,370 --> 00:06:03,450 +of the eye وهي ال orbital axis هذه الرسمة هنا + +69 +00:06:03,450 --> 00:06:07,710 +تمثيل لل orbit هذه ال media ال orbital wallوهي ال + +70 +00:06:07,710 --> 00:06:12,010 +lateral orbital wall في حقيقة الأمر ال orbital + +71 +00:06:12,010 --> 00:06:15,610 +axis هذه نفس الرسمة بس بدون رسمة العين هذه ال + +72 +00:06:15,610 --> 00:06:19,290 +orbit لحالها هذه الزاوية بين ال media ال orbital + +73 +00:06:19,290 --> 00:06:24,190 +wall و ال lateral orbital wall 45 degreeطبعا ال + +74 +00:06:24,190 --> 00:06:27,910 +orbital axis بيقسم محجر العين أو بيقسم ال orbit + +75 +00:06:27,910 --> 00:06:34,230 +لقسمين كل قسم 22.5 degree و هنا نفس الشي 22.5 + +76 +00:06:34,230 --> 00:06:41,370 +degree تجاوزا هنقول 23 degree طيب + +77 +00:06:41,370 --> 00:06:48,150 +طالما ال axis of the eye طالما ال axis of the eye + +78 +00:06:48,150 --> 00:06:54,090 +موازي لل media wall أيضابالتناظر هذه الزاوية تلاتة + +79 +00:06:54,090 --> 00:06:57,610 +و عشرين ديجري بتكون هذه الزاوية تلاتة و عشرين + +80 +00:06:57,610 --> 00:07:03,090 +ديجري يعني هدولا خطين متوازين و قطعهم خط تالت + +81 +00:07:03,090 --> 00:07:07,170 +قطعهم خط تالت اللي هو مرسوم باللون الأحمر اللي هو + +82 +00:07:07,170 --> 00:07:11,330 +ال orbital axis إذا هذه الزاوية تساوي هذه الزاوية + +83 +00:07:11,330 --> 00:07:16,370 +بالتناظر بالتناظر فبالتالي طالما بتساويها بالتناظر + +84 +00:07:16,370 --> 00:07:21,900 +معناتههذه الزاوية تلاتة و عشرين degree بيصف معانا + +85 +00:07:21,900 --> 00:07:28,100 +انه ال axis of the eye ال axis of the eye و ال + +86 +00:07:28,100 --> 00:07:32,800 +orbital axis الزاوية بينهم تلاتة و عشرين degree + +87 +00:07:32,800 --> 00:07:39,080 +تلاتة و عشرين degree when + +88 +00:07:39,080 --> 00:07:42,320 +the eye is looking straight ahead at a fixed point + +89 +00:07:42,320 --> 00:07:46,990 +on the horizonwith the head erect اللي بيسموه + +90 +00:07:46,990 --> 00:07:50,630 +primary position of gaze the visual axis أو the + +91 +00:07:50,630 --> 00:07:55,470 +axis of the eye forms an angle of 23 degree with + +92 +00:07:55,470 --> 00:08:00,730 +the orbital axis لما الإنسان بيكون رأسه معتدلا + +93 +00:08:00,730 --> 00:08:06,890 +وبيطلع إلى الأفق البعيد يعني العين straight العين + +94 +00:08:06,890 --> 00:08:12,170 +straightساعتها ال axis of the eye و ال orbital + +95 +00:08:12,170 --> 00:08:17,470 +axis بيعملوا مع بعض هم البعض تلاتة و عشرين degree + +96 +00:08:17,470 --> 00:08:22,530 +the action of the extraocular muscles depends on + +97 +00:08:22,530 --> 00:08:25,830 +the position of the globe at the time of muscle + +98 +00:08:25,830 --> 00:08:32,690 +contraction هذه قاعدة غاية في الأهمية يعني الوظيفة + +99 +00:08:32,690 --> 00:08:38,270 +تحت أي عضلةأو الفعل بتاع أي عضلة من العضلات اللي + +100 +00:08:38,270 --> 00:08:42,610 +هي خارج العين العضلات الستة ال media rectus وال + +101 +00:08:42,610 --> 00:08:45,210 +lateral rectus وال superior rectus وال inferior + +102 +00:08:45,210 --> 00:08:48,350 +rectus وال superior oblique وال inferior oblique + +103 +00:08:48,350 --> 00:08:54,910 +الفعل بتاع أي عضلة من هذه العضلات بيعتمد بشكل + +104 +00:08:54,910 --> 00:09:01,210 +أساسي على موقع العين ال position of the globe عند + +105 +00:09:01,210 --> 00:09:06,350 +بداية انقباض هذه العضلةعن بداية انقباض هذه العضلة + +106 +00:09:06,350 --> 00:09:10,290 +ممكن الإنسان يقول .. بدنا مثل عشان يوضح هذا الكلام + +107 +00:09:10,290 --> 00:09:18,570 +بنقوله كالقاتل الإنسان ممكن يعني يقول ال .. ال + +108 +00:09:18,570 --> 00:09:22,650 +superior rectus muscle بما أن اسمها superior + +109 +00:09:22,650 --> 00:09:26,750 +rectus يعني جاية من فوق معنى وظيفتها أنها ترفع + +110 +00:09:26,750 --> 00:09:33,780 +العين مظبوط .. بس هذا الكلام رفعها للعينبيفرق بين + +111 +00:09:33,780 --> 00:09:37,160 +أوضاع مختلفة لما تكون في ال primary position يعني + +112 +00:09:37,160 --> 00:09:41,220 +و العين معتادلة غير لما تكون و العين في وضع ال + +113 +00:09:41,220 --> 00:09:45,160 +abduction يعني و العين تتطلع لبرا غير ما تكون في + +114 +00:09:45,160 --> 00:09:49,300 +وضع ال adduction و العين تتطلع لجوه يعني بمعنى آخر + +115 +00:09:49,300 --> 00:09:54,320 +لما تنقبض ال superior rectus muscle الأثر تاعها + +116 +00:09:54,320 --> 00:10:00,810 +على العين بيختلف بحسبأين كانت العين أثناء بد + +117 +00:10:00,810 --> 00:10:06,010 +انقباض ال superior rectus muscle وهذا سأشرحه في + +118 +00:10:06,010 --> 00:10:13,110 +الصفحات التالية في + +119 +00:10:13,110 --> 00:10:25,430 +بعض + +120 +00:10:25,430 --> 00:10:31,990 +العضلات من الست عضلاتالها just one action بيسموه + +121 +00:10:31,990 --> 00:10:36,910 +ال primary action عضلات أخرى الها بالإضافة ل ال + +122 +00:10:36,910 --> 00:10:41,510 +primary action subsidiary action يعني أفعال ثانوية + +123 +00:10:41,510 --> 00:10:46,750 +في فعل رئيسي لكل عضلة و بعض العضلات مش كل العضلات + +124 +00:10:46,750 --> 00:10:52,830 +الها أفعال ثانوية يعني بالإضافة لفعلها الرئيسي ال + +125 +00:10:52,830 --> 00:10:58,050 +primary actionof a muscle is its major effect when + +126 +00:10:58,050 --> 00:11:02,010 +the eye is in the primary position يعني أكتر فعل + +127 +00:11:02,010 --> 00:11:07,790 +أو أهم فعل للعضلة أثناء وجود .. أثناء وجود العين + +128 +00:11:07,790 --> 00:11:11,150 +في ال straight ahead position أو اللي احنا طلقنا + +129 +00:11:11,150 --> 00:11:14,950 +عليه اسم ال primary position يعني في وضع الاعتدال + +130 +00:11:14,950 --> 00:11:19,590 +مثال على ذلك لو سألنا سؤال ال medial rectus muscle + +131 +00:11:20,550 --> 00:11:25,150 +إيش أهم فعل إلها أو ال primary action بتاعها لل + +132 +00:11:25,150 --> 00:11:29,570 +media rectus لما تكون العين في وضع الاعتدال؟ بنقول + +133 +00:11:29,570 --> 00:11:34,490 +ال primary action لل media rectus أثناء وجود العين + +134 +00:11:34,490 --> 00:11:38,470 +في وضع ال straight ahead position هو ال adduction + +135 +00:11:39,040 --> 00:11:43,280 +هو ال adduction بمعنى لو بدأت ال media rectus تنقى + +136 +00:11:43,280 --> 00:11:48,080 +وبتعمل contraction والعين في وضع الاعتدال ع السريع + +137 +00:11:48,080 --> 00:11:52,020 +بمجرد بدء ال contraction والانقباض بتاع ال media + +138 +00:11:52,020 --> 00:11:56,300 +rectus هتيجي العين لجوه يعني هيصير adduction في + +139 +00:11:56,300 --> 00:12:01,060 +هذه العينالان ال subsidiary action الأفعال + +140 +00:12:01,060 --> 00:12:04,760 +الثانوية ال media rectus muscle من ضمن العضلات + +141 +00:12:04,760 --> 00:12:09,980 +التي ليس لها سوى primary action يعني مالهاش أي فعل + +142 +00:12:09,980 --> 00:12:14,060 +ثانوي آخر يعني إيش فعل ثانوي آخر؟ يعني بالإضافة لل + +143 +00:12:14,060 --> 00:12:18,340 +adoption اللي بتعملون هل ممكن ترفع العين أو تنزل + +144 +00:12:18,340 --> 00:12:22,300 +العين؟ هذا الكلام طبعا مش وارد هذا الكلام مش وارد + +145 +00:12:22,300 --> 00:12:27,540 +هي فقط بتعمل adoption إذا ال subsidiary actionsare + +146 +00:12:27,540 --> 00:12:31,300 +the additional effect which depend on the position + +147 +00:12:31,300 --> 00:12:34,340 +of the eye which .. which depend on the position + +148 +00:12:34,340 --> 00:12:40,100 +of the eye هنا بالنسبة للمثال اللي ضربنا عن ال + +149 +00:12:40,100 --> 00:12:44,060 +media rectus بغض النظر عن position of the eye ال + +150 +00:12:44,060 --> 00:12:48,320 +media rectus غير ال adoption ما بتعمل ولا أي شيء + +151 +00:12:48,320 --> 00:12:55,840 +ولا أي شيء الآن بدنا نحكي عن ما يسمى بال listing + +152 +00:12:55,840 --> 00:13:01,500 +planeالـ listing plane is an imaginary coronal + +153 +00:13:01,500 --> 00:13:05,360 +plane passing through the center of rotation of + +154 +00:13:05,360 --> 00:13:09,620 +the globe. The globe rotates on the axis on the x + +155 +00:13:09,620 --> 00:13:15,400 +and z axis of it which intersect in the listing + +156 +00:13:15,400 --> 00:13:21,100 +plane هذا الكلام حقيقة بده شرح و شرحه بيتم بالرسمة + +157 +00:13:21,100 --> 00:13:22,000 +التالية + +158 +00:13:27,110 --> 00:13:31,070 +عندي هاي كرة العين هاي الجزء الأمامي من العين وهي + +159 +00:13:31,070 --> 00:13:37,090 +الجزء الخلفي من العين طبعا طالما العين تتحرك لازم + +160 +00:13:37,090 --> 00:13:44,370 +نسأل حالنا ما طبيعة حركة العين الحركات الموجودة في + +161 +00:13:44,370 --> 00:13:49,310 +حياتنا أو اللي بنعرفها في حياتها كثيرة جدا ولكن + +162 +00:13:49,310 --> 00:13:57,560 +تقسم إلى نوعين رئيسيين من الحركة حركة دورانيةوحركة + +163 +00:13:57,560 --> 00:14:03,180 +إزاحية .. وحركة إزاحية إيش الفرق بين الحركة + +164 +00:14:03,180 --> 00:14:07,740 +الدورانية اللي هي rotational movement أو rotation + +165 +00:14:07,740 --> 00:14:13,860 +و الحركة الإزاحية اللي هي translational movement + +166 +00:14:13,860 --> 00:14:20,240 +أو translation يعني لو سألنا أنفسنا سؤال إنسان + +167 +00:14:20,240 --> 00:14:27,020 +عينين في وضع الاعتدالوحاب يتطلع على اليمين، هل + +168 +00:14:27,020 --> 00:14:32,800 +العين بتتحرك لليمين دورانيا ولا إزاحيا؟ يعني هل + +169 +00:14:32,800 --> 00:14:35,700 +العين بتخرج من محجر العين، بتمشي لا خطوة ولا + +170 +00:14:35,700 --> 00:14:39,060 +الأمام، بعدين بتروح من ميلة على اليمين، ولو هي في + +171 +00:14:39,060 --> 00:14:43,440 +مكانها بتلف على اليمين ومركز الدوران بتاعها ثابت؟ + +172 +00:14:43,940 --> 00:14:50,340 +حقيقة كل حركات العين دورانية يعني مش إزاحية العين + +173 +00:14:50,340 --> 00:14:54,660 +عبارة عن جسم شبه كراوي .. شبه كراوي و هذا الجسم + +174 +00:14:54,660 --> 00:14:59,280 +شبه الكراوي له مركز للدوران يعني center of + +175 +00:14:59,280 --> 00:15:02,460 +rotation اللي هي النقطة اللي أنا بقشر عليها العين + +176 +00:15:02,460 --> 00:15:06,180 +لما بده تطلع للأعلى الجزء الأمامي اللي هو القرانية + +177 +00:15:06,180 --> 00:15:09,680 +بيصعد للأعلى و الجزء الخلفي اللي هو ناحية الفوفيا + +178 +00:15:09,680 --> 00:15:13,160 +و ال optic nerve بنزل للأسفل بس مركز الدوران في + +179 +00:15:13,160 --> 00:15:18,670 +مكانهما بتنزح العين للأعلى فقط بتدور دوران حول + +180 +00:15:18,670 --> 00:15:23,170 +المركز هذا اللي هو هذا المركز الهندسي بتاعة + +181 +00:15:23,170 --> 00:15:27,830 +الدوران طيب يعني العين ما بتطلع برا محجر العين + +182 +00:15:27,830 --> 00:15:32,150 +وبعدين بتروح عملالها تلت قفزات لفوق للأعلى عشان + +183 +00:15:32,150 --> 00:15:35,630 +تتطلع ع شيء و بعدين تنزل و ترجع في مكانها لو هذا + +184 +00:15:35,630 --> 00:15:39,570 +الكلام بيصير كان ساعتها بنقول إنه حركة العين + +185 +00:15:39,570 --> 00:15:44,910 +إزاحية انتقلت من منطقة في الفراغإلى منطقة أخرى في + +186 +00:15:44,910 --> 00:15:49,810 +الفرار وإنما العين مركز دورانها ثابت في مكانه + +187 +00:15:49,810 --> 00:15:53,950 +اللهم إن القرانية طلعت لفوق وهذا طالما القرانية + +188 +00:15:53,950 --> 00:15:57,890 +طلعت لفوق الجزء الخلفي من العين نزل لتحت طيب لو + +189 +00:15:57,890 --> 00:16:02,270 +جينا مثلا العين ده تطلع لبرا تعمل abduction الجزء + +190 +00:16:02,270 --> 00:16:05,970 +الأمامي من العين بطلع للخارج والجزء الخلفي الفوفيا + +191 +00:16:05,970 --> 00:16:10,450 +بدخل للداخل بمعنى آخر الرسمة السابقة بتوضح أكتر + +192 +00:16:11,040 --> 00:16:13,840 +يعني هاي عندى ال lateral wall عندنا نعمل abduction + +193 +00:16:13,840 --> 00:16:17,240 +يعني القرانية بدا تيجي هنا في المنطقة هاى و + +194 +00:16:17,240 --> 00:16:20,180 +الفوفيا بدا تيجي هنا في المنطقة هاى هي كرة و لفت + +195 +00:16:20,180 --> 00:16:25,040 +في مكانها مركز الدوران مركز الدوران ضال زي ما هو + +196 +00:16:25,040 --> 00:16:32,500 +العين راحت ليمين الصورة و الفوفيا راحت لشمال + +197 +00:16:32,500 --> 00:16:37,000 +الصورة يعني لفت في مكانها اذا كل حركات العين + +198 +00:16:38,150 --> 00:16:43,670 +دورانية في مركز للدوران الان في خط او في .. في + +199 +00:16:43,670 --> 00:16:50,310 +مستوى تخيلي اللي انا بقشر عليه بيمر بمركز الدوران + +200 +00:16:50,310 --> 00:16:55,250 +بيمر بمركز الدوران هذا المستوى التخيلي بيسموه + +201 +00:16:55,250 --> 00:17:00,250 +listing plane listing plane و هذا المستوى التخيلي + +202 +00:17:00,250 --> 00:17:06,560 +جاييعني بنصف العين لنصفين، نصف أمامي و نصف خلفي، + +203 +00:17:06,560 --> 00:17:13,120 +هذا المستوى بيسموه مستوى .. a listing plane طبعا + +204 +00:17:13,120 --> 00:17:19,860 +هذا المستوى جاي بشكل coronal .. coronal plane + +205 +00:17:19,860 --> 00:17:25,920 +coronal plane يعني مستوى يعني بيشبه كأنه ..التاج + +206 +00:17:25,920 --> 00:17:30,660 +لأن التاج لما بيوضع على الرأس بيوضعش بشكل أمامي + +207 +00:17:30,660 --> 00:17:38,760 +خلفي وانما بشكل انه بالظبط زي ما هاد القضية بنفس + +208 +00:17:38,760 --> 00:17:43,440 +المستوى يعني بيجي التاج على منتصف الرأس أو على + +209 +00:17:43,440 --> 00:17:49,820 +مقدمة الرأس بس بنفس اللي هو الاتجاه اللي يعني ال + +210 +00:17:49,820 --> 00:17:55,630 +listing plane موجود فيهعشان نلخص الكلام و نقول + +211 +00:17:55,630 --> 00:18:01,250 +حركة العين في الطبيعة حركة دورانية طالما حركة + +212 +00:18:01,250 --> 00:18:04,310 +دورانية، إذا العين سواء بدأت تطلع لأعلى، تنزل + +213 +00:18:04,310 --> 00:18:08,050 +لأسفل، تروح يمين، تروح شمال، تتحرك .. إيش بدها + +214 +00:18:08,050 --> 00:18:12,710 +تتحرك حركات؟ لازم يكون في مركز للدوران للعين، وهذا + +215 +00:18:12,710 --> 00:18:16,090 +المركز موجود اللي هي ال center of rotation هو + +216 +00:18:16,090 --> 00:18:21,620 +عبارة عن المركز الهندسي لكرة العينطيب، إذا العين + +217 +00:18:21,620 --> 00:18:27,740 +هتدور حوالين هذه النقطة بحيث أنه بدها تروح يمين، + +218 +00:18:27,740 --> 00:18:32,160 +شمال، فوق، تحت، هتدور حوالين هذه النقطة بيمر في + +219 +00:18:32,160 --> 00:18:37,280 +النقطة هذه مستوى تخيلي بيسموه listing plane طبعا + +220 +00:18:37,280 --> 00:18:43,560 +اتجاهات الدوران بدها تم حوالين محاور ثلاثةفي + +221 +00:18:43,560 --> 00:18:47,540 +المحور الأفقي اللي هو ال X العين هتصعد للأعلى و + +222 +00:18:47,540 --> 00:18:52,960 +تنزل للأسفل حوالين المحور X يعني هتعمل elevation و + +223 +00:18:52,960 --> 00:18:58,960 +depression حوالين المحور X وفي المحور العمودي Z + +224 +00:18:58,960 --> 00:19:05,520 +هيعمل حوالين العين هتعمل abduction و abduction طيب + +225 +00:19:05,520 --> 00:19:11,160 +وفي محور أمامي خلفي بيخترق العين كأنه ال axis of + +226 +00:19:11,160 --> 00:19:16,050 +the eyeمحور أمامي خالفي حواليه بتتمحو حاجة اسمها + +227 +00:19:16,050 --> 00:19:22,410 +intortion و extortion حركة العين لداخل ولا الخارج + +228 +00:19:22,410 --> 00:19:28,950 +دورانيا أو بالظبط كأن نتخيل احنا الآن بدنا نثبت + +229 +00:19:28,950 --> 00:19:35,810 +برغي بواسطة مفك في لوح من الخشب لما بنلف البرغي + +230 +00:19:35,810 --> 00:19:40,570 +يمينلما بنلف البرغي يمين بيدخل البرغي في الخشب، + +231 +00:19:40,570 --> 00:19:45,530 +لما بنلف البرغي شمال بيطلع البرغي من الخشب، هذه + +232 +00:19:45,530 --> 00:19:50,570 +الحركة بيسموها Intortion و Extortion، الآن ال + +233 +00:19:50,570 --> 00:19:54,670 +Intortion و ال Extortion بتتم حوالين محور Y + +234 +00:19:57,520 --> 00:20:01,120 +اللي هو بيخترق العين من الأمام للخلف زي الرسم ما + +235 +00:20:01,120 --> 00:20:06,600 +بتوضح وبالتالي هذه أنواع الحركات حوالين المحاول + +236 +00:20:06,600 --> 00:20:12,900 +التلاتة، اذا حوالين المحور Xحوالين المحور X بتتم + +237 +00:20:12,900 --> 00:20:17,440 +عملية ال elevation و ال depression اللي هو أنه + +238 +00:20:17,440 --> 00:20:22,140 +لعين تطلع لفوق و تنزل لتحت حوالين المحور Z بيتم ال + +239 +00:20:22,140 --> 00:20:27,060 +abduction لعين تطلع لبرا تتحرك للخارج و adduction + +240 +00:20:27,060 --> 00:20:32,740 +حوالين المحور Y intorsion و extorsionبدنا نتخيل + +241 +00:20:32,740 --> 00:20:37,760 +القرانية كأنها .. كأنها رأس البرغي لما الساعة + +242 +00:20:37,760 --> 00:20:42,660 +اتناش في القرانية القرانية تشبه دائرة الساعة و هنا + +243 +00:20:42,660 --> 00:20:45,980 +عندي الساعة اتناش و هنا عندي الساعة ستة و لجوه + +244 +00:20:45,980 --> 00:20:49,400 +ناحية ال nose is هذه ال right eye هذه ناحية ال + +245 +00:20:49,400 --> 00:20:52,400 +nose مثلا ال nose هنا تمام؟ معناته هنا الساعة + +246 +00:20:52,400 --> 00:20:57,980 +تلاتة و هنا ال temporal side الساعة تسعة لما + +247 +00:20:57,980 --> 00:21:03,730 +الساعة اتناش في القرانية بتلف لجوهلجوة هذا بيسموه + +248 +00:21:03,730 --> 00:21:08,530 +in torsion لما الساعة اتناش بتلف لبرا بيسموه + +249 +00:21:08,530 --> 00:21:13,670 +extortion وهدى حركة بتتم او هدول الحركتين بتتموا + +250 +00:21:13,670 --> 00:21:18,330 +حوالين المحور Y طبعا احنا ال elevation و ال + +251 +00:21:18,330 --> 00:21:23,060 +depression حوالين Xو ال abduction و ال abduction + +252 +00:21:23,060 --> 00:21:27,340 +حوالين z بنشوفهم بشكل واضح واحد بتطلع يمين، بتطلع + +253 +00:21:27,340 --> 00:21:31,760 +شمال، بتطلع فوق، بتطلع تحت طيب ال intortion و ال + +254 +00:21:31,760 --> 00:21:36,400 +extortion حركات احنا مش .. ماعمرناش لحظناها بنقول + +255 +00:21:36,400 --> 00:21:41,840 +الكلام سليم ولكن هذه الحركات بتحدث يوميا .. يوميا + +256 +00:21:41,840 --> 00:21:47,340 +و هنيجي نشرحها في وقتها ليش بتحدث يوميا و ليش احنا + +257 +00:21:47,340 --> 00:21:51,230 +مابنلاحظهاشو هذه الحركات مهمة جدا حركة ال + +258 +00:21:51,230 --> 00:21:56,130 +intortion و ال extortion حركات مهمة جدا بس احنا + +259 +00:21:56,130 --> 00:22:00,110 +بدنا نعطي مقدمة بسيطة عنها .. مقدمة بسيطة عنها + +260 +00:22:00,110 --> 00:22:04,930 +بنقول انه ال intortion و ال extortion هدفهم + +261 +00:22:04,930 --> 00:22:10,150 +الرئيسي تصحيح وضع العين تصحيح وضع العين بمعنى آخر + +262 +00:22:10,150 --> 00:22:16,340 +إنسان رأسه معتدلوبيتطلع على مثلا هدف معين أمامه، + +263 +00:22:16,340 --> 00:22:21,800 +بناء أو شجرة أو ما شابه ثم مال الرأس ميلان إلى + +264 +00:22:21,800 --> 00:22:28,740 +اليمين ميلان إلى اليمين يعني لو حبينا مثلا نمثل + +265 +00:22:28,740 --> 00:22:35,060 +بصورة كيف الرأس مائل إلى اليمين بنروح على ال .. + +266 +00:22:35,060 --> 00:22:39,520 +نحاول ناخد الصور يعني + +267 +00:22:39,520 --> 00:22:40,400 +head, tilt + +268 +00:22:43,430 --> 00:22:51,230 +to the right أي + +269 +00:22:51,230 --> 00:22:54,430 +صورة بتوضح الكلام + +270 +00:23:06,890 --> 00:23:09,870 +بمجرد ما يصير head tilt to the right .. هاي كان ال + +271 +00:23:09,870 --> 00:23:13,630 +head معتدل .. كان ال head معتدل .. بمجرد ما يصير + +272 +00:23:13,630 --> 00:23:17,250 +head tilt to the right العين اليمين هتعمل + +273 +00:23:17,250 --> 00:23:20,790 +intuition عكس اتجاه ميالان الرأس .. يعني الرأس مال + +274 +00:23:20,790 --> 00:23:25,330 +إلى اليمينالعينين التنتين هيميلوا إلى الشمال بحيث + +275 +00:23:25,330 --> 00:23:29,350 +أن الساعة 12 في الكورنيا في العين اليمين هتروح + +276 +00:23:29,350 --> 00:23:35,910 +نازلي و الساعة 12 في الكورنيا في ال left eye هتروح + +277 +00:23:35,910 --> 00:23:40,050 +temporal يعني هذه العين هتعمل intortion و العين + +278 +00:23:40,050 --> 00:23:45,870 +التانية هتعمل extortion حسبحسب او على axis Y على + +279 +00:23:45,870 --> 00:23:49,630 +محور Y هذه على محور Y وهذه على محور Y هنا في وضع + +280 +00:23:49,630 --> 00:23:54,010 +الاعتدال هي هنا الساعة 12 وهي هنا الساعة 12 اللي + +281 +00:23:54,010 --> 00:23:59,570 +هي قمة ال X مجسمة لأربع مربعات أو لأربع أجزاء اللي + +282 +00:23:59,570 --> 00:24:02,930 +هنا الساعة 12 هنا الساعة 6 هنا الساعة 3 هنا الساعة + +283 +00:24:02,930 --> 00:24:08,030 +9 و هكذا فبالتالي بالظبط زي تجسيمة الساعة طب ايش + +284 +00:24:08,030 --> 00:24:12,030 +الهدفمن إنه إذا الرأس مال لليمين، العينين بيميلوا + +285 +00:24:12,030 --> 00:24:15,930 +للشمال، ولو الرأس مال للشمال .. لو الرأس مال + +286 +00:24:15,930 --> 00:24:20,430 +للشمال .. لو الرأس مال للشمال، العينين بيميلوا + +287 +00:24:20,430 --> 00:24:24,130 +إيش؟ لليمين، يعني دائما هاي الرأس مال للشمال، + +288 +00:24:24,130 --> 00:24:28,110 +العينين مالوا لليمين، إيش معنى هذا الكلام بيصير؟ + +289 +00:24:28,110 --> 00:24:33,430 +هذا الكلام بيصير على أساس تصحيح رد أو .. أو هاد + +290 +00:24:33,430 --> 00:24:38,140 +بيسموها ردود الأفعال التصحيحية بمعنى آخرحتى يتم + +291 +00:24:38,140 --> 00:24:42,420 +ثبات الصورة اللي بتطلع عليها الإنسان على سطح + +292 +00:24:42,420 --> 00:24:47,180 +الشبكية وما تميلش الأجسام .. ما تميلش الأجسام مع + +293 +00:24:47,180 --> 00:24:50,920 +ميلان الرأس بمعنى آخر احنا لما بنطلع على شجرة أو + +294 +00:24:50,920 --> 00:24:55,780 +نخلة أو مبنى أو ما شابه ومال رأسنا فجأة ما بنلاحظ + +295 +00:24:55,780 --> 00:24:59,320 +أن النخلة أو الشجرة أو المبنى أو السيارة مالك + +296 +00:24:59,320 --> 00:25:03,100 +معانا بالنفس الاتجاه الميلان إيش السبب أنه ما + +297 +00:25:03,100 --> 00:25:06,600 +بتميلش؟لو لا وجود هذه قضية ال intorsion و ال + +298 +00:25:06,600 --> 00:25:13,040 +extorsion للاحظنا مع كل ميلان يعني تلقائي للرأس + +299 +00:25:13,040 --> 00:25:16,160 +ولو بسيط هنلاقي كل الأشياء اللي بتطلع عليها مالت + +300 +00:25:16,160 --> 00:25:21,240 +من نفس الاتجاه عدلنا وضع رأسنا هنلاقي أنه الرأس أو + +301 +00:25:21,240 --> 00:25:24,980 +المنظر اعتدى لكله معانا تصور إنسان بتطلع على + +302 +00:25:24,980 --> 00:25:29,740 +مجموعة من المباني مالت رأسه شوية يمين أو شماللو .. + +303 +00:25:29,740 --> 00:25:32,500 +لو لا وجود ال intortion و ال extortion و اللي + +304 +00:25:32,500 --> 00:25:35,960 +سمناهم قبل شوية writing reflexes أو ردود الأفعال + +305 +00:25:35,960 --> 00:25:39,760 +التصحيحية .. تصحيح لوضع الصورة ع الشبكية لو لا + +306 +00:25:39,760 --> 00:25:43,320 +وجودهم كان لاجينا بمجرد ما يلان الرأس كل المباني و + +307 +00:25:43,320 --> 00:25:46,500 +كل السيارات و كل الأشياء و الأشجار و ما إلى ذلك + +308 +00:25:46,500 --> 00:25:49,100 +اللي احنا بنتطلع عليهم كان بتميل معانا و هذا شيء + +309 +00:25:49,100 --> 00:25:53,310 +مزعج جدافربنا عز وجل خلّى هذا ال reflex موجود فينا + +310 +00:25:53,310 --> 00:25:59,910 +وبالتالي بتدور العينتين عكس دوران الرأس حتى تبقى + +311 +00:25:59,910 --> 00:26:04,330 +الصور ثابتة على سطح الشبكية في مكانها اللي هى + +312 +00:26:04,330 --> 00:26:08,190 +انطبعت عليه في المرة أول ما بدى الإنسان يتطلع هادي + +313 +00:26:08,190 --> 00:26:09,830 +على هذا المنظر + +314 +00:26:13,530 --> 00:26:19,030 +العين تدور حول مركز دورانها تدور حركة دورانية و + +315 +00:26:19,030 --> 00:26:22,810 +ليست إزاحية في عندي مركز الدوران بيمر فيه ال + +316 +00:26:22,810 --> 00:26:29,250 +listing plane ال listing plane في محورينوفي محور + +317 +00:26:29,250 --> 00:26:32,630 +تالت عمودي على ال listing plane المحورين الموجودين + +318 +00:26:32,630 --> 00:26:37,290 +في ضمن ال listing plane المحور X ومحور Z والمحور + +319 +00:26:37,290 --> 00:26:40,930 +العمودي على ال listing plane اللي هو محور Y طبعا + +320 +00:26:40,930 --> 00:26:44,450 +المحور X بتم حوالينه .. حوالين هذا المحور + +321 +00:26:44,450 --> 00:26:50,110 +elevation أو depression بينما المحور Z المحور + +322 +00:26:50,110 --> 00:26:55,190 +العمودي بتم ال abduction و ال adductionوالمحور Y + +323 +00:26:55,190 --> 00:26:59,470 +بتام ال intortion و ال extortion ال intortion و ال + +324 +00:26:59,470 --> 00:27:02,730 +extortion طبعا احنا بنشوف ال elevation و ال + +325 +00:27:02,730 --> 00:27:06,490 +depression و بنشوف ال abduction و ال adduction + +326 +00:27:06,490 --> 00:27:11,490 +ولكن مابنشوفش ال intortion و ال extortion و هدولة + +327 +00:27:11,490 --> 00:27:15,750 +موجودين رغم انه احنا مابنقدرش نشوفهم .. مابنقدرش + +328 +00:27:15,750 --> 00:27:21,390 +نشوفهمthe globe rotates left and right يعني up + +329 +00:27:21,390 --> 00:27:25,850 +-duction و up-duction on the vertical z-axis the + +330 +00:27:25,850 --> 00:27:29,810 +globe moves up and down on the horizontal x-axis + +331 +00:27:29,810 --> 00:27:33,570 +الـ torsional movement أو الـ wheel rotation يعني + +332 +00:27:33,570 --> 00:27:37,390 +العين بتلف كأنه عجل أو كأنه برغي زي ما حكينا on + +333 +00:27:37,390 --> 00:27:41,830 +the y-sagittal axis which traverses the globe from + +334 +00:27:41,830 --> 00:27:46,630 +front to back ال y-axis بيعدي عبر العين من الأمام + +335 +00:27:46,630 --> 00:27:50,220 +إلى الخلفsimilar to the anatomical axis of the eye + +336 +00:27:50,220 --> 00:27:53,800 +وكأنه بالظبط بينطبق على anatomical axis of the eye + +337 +00:27:53,800 --> 00:27:57,640 +entortion occurs when the superior limbus الساعة + +338 +00:27:57,640 --> 00:28:01,880 +اتناش في ال limbus rotates nasally and extortion + +339 +00:28:01,880 --> 00:28:05,960 +on temporal rotation لما بتحرك الساعة اتناش او + +340 +00:28:05,960 --> 00:28:10,320 +superior limbus باتجاه ال temporal side يعني بعيدا + +341 +00:28:10,320 --> 00:28:16,600 +عن النزلهنتوقف عند ال horizontal rectus muscle + +342 +00:28:16,600 --> 00:28:22,040 +عشان نناقش كل واحدة منهم يعني العمل بتاعها و هدف + +343 +00:28:22,040 --> 00:28:25,600 +المحاضرة القادمة ان شاء الله و يعطيكم العافية + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/P-KQTpXsxFg.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/P-KQTpXsxFg.srt new file mode 100644 index 0000000000000000000000000000000000000000..d683f00a70ad6e83b348a4d7629fc7b7cadefcca --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/P-KQTpXsxFg.srt @@ -0,0 +1,1238 @@ +1 +00:00:02,900 --> 00:00:07,420 +بسم الله الرحمن الرحيم هنبدأ + +2 +00:00:07,420 --> 00:00:11,980 +مع محاضرات حول واحد واللي بيعتمد عليه حول اتنين + +3 +00:00:11,980 --> 00:00:16,100 +بشكل كبير جدا ويعتبر هو الـ basic science بالنسبة + +4 +00:00:16,100 --> 00:00:21,680 +لحول اتنين طبعا حول واحد مملوء بالتعريفات اللي + +5 +00:00:21,680 --> 00:00:27,060 +لابد من أن أخصائي البصريات يتقنها تماما حتى يعرف + +6 +00:00:27,060 --> 00:00:28,880 +يتعامل مع مرضى حول + +7 +00:00:37,530 --> 00:00:40,710 +أول تعريف اللي هو الـ visual axis أو الـ line of + +8 +00:00:40,710 --> 00:00:45,540 +vision اللي هو خط الإبصار أو المحور البصري المحور + +9 +00:00:45,540 --> 00:00:48,240 +البصري passes from the fovea through the nodal + +10 +00:00:48,240 --> 00:00:51,920 +point of the eye to the point of fixation أو + +11 +00:00:51,920 --> 00:00:55,260 +بعبارة أخرى to the object of regard يعني للـ object + +12 +00:00:55,260 --> 00:00:58,940 +اللي بيتطلع عليه الإنسان إذا الـ visual axis بيبدأ + +13 +00:00:58,940 --> 00:01:03,560 +من الـ fovea وبينتهي عند الـ object بيمر في طريقه في + +14 +00:01:03,560 --> 00:01:06,040 +الـ nodal point بتاعة العين طبعا العين تعتبر + +15 +00:01:06,040 --> 00:01:11,690 +optical system كل عين لها visual axis خاص فيها الـ + +16 +00:01:11,690 --> 00:01:14,490 +two visual axes في الـ normal binocular single + +17 +00:01:14,490 --> 00:01:18,810 +vision بيكونوا الـ two visual axes intersect + +18 +00:01:18,810 --> 00:01:22,010 +بيتقاطعوا at the point of fixation لأن العينتين + +19 +00:01:22,010 --> 00:01:25,570 +بيكونوا متوازيات وبيتطلعوا على نفس الـ target أو نفس + +20 +00:01:25,570 --> 00:01:29,570 +الهدف أو نفس الـ object فبالتالي الـ visual axis + +21 +00:01:29,570 --> 00:01:31,710 +بتاع العين اليمين والـ visual axis بتاع العين + +22 +00:01:31,710 --> 00:01:36,530 +الشمال بيكونوا موجهين باتجاه الجسم المنظر وبالتالي + +23 +00:01:36,530 --> 00:01:41,580 +بيتقاطعوا عنده in normal binocular single vision the + +24 +00:01:41,580 --> 00:01:45,100 +two visual axes intersect at the point of fixation + +25 +00:01:45,100 --> 00:01:52,300 +طيب الآن طالما الـ fovea موجهة باتجاه الـ visual axis + +26 +00:01:52,300 --> 00:01:55,160 +باتجاه الـ target والـ fovea في العين التانية + +27 +00:01:55,160 --> 00:01:59,240 +موجهة باتجاه الـ target إذا صورة الـ target بتنطبع + +28 +00:01:59,240 --> 00:02:03,620 +وبتلتقط على الـ fovea تحت العين اليمين وعلى الـ fovea + +29 +00:02:03,620 --> 00:02:08,800 +تحت العين الشمال ثم بترسل الصورتين إلى الدماغ + +30 +00:02:08,800 --> 00:02:13,640 +لتوحيد لتوحيدهم بواسطة قالية أو reflex بيسموه + +31 +00:02:13,640 --> 00:02:18,020 +الـ fusion reflex في هذا الـ fusion reflex بيتم دمج + +32 +00:02:18,020 --> 00:02:21,580 +صورتين في صورة واحدة بواسطة الـ binocular + +33 +00:02:21,580 --> 00:02:25,540 +responsive cells binocular responsive cells اللي + +34 +00:02:25,540 --> 00:02:28,440 +هي الخلايا اللي موجودة في الـ visual cortex واللي + +35 +00:02:28,440 --> 00:02:32,620 +بتستجيب للمعلومات أو للصور القادمة من العينتين، + +36 +00:02:32,620 --> 00:02:35,960 +العينتين طبعا هذا الكلام بيتم في الـ visual cortex + +37 +00:02:35,960 --> 00:02:41,120 +وينتج عنه binocular single vision يعني رؤية موحدة + +38 +00:02:41,120 --> 00:02:45,980 +بواسطة العينتين طبعا لو حبينا نشوف الرسمة هذه + +39 +00:02:45,980 --> 00:02:50,140 +بالنسبة للـ visual axis بيبتدأ من الـ fovea الـ fovea + +40 +00:02:50,140 --> 00:02:54,140 +ممثلة هنا في الرسمة بالنقطة الحمراء بيمر بالنقطة + +41 +00:02:54,140 --> 00:02:56,360 +السوداء اللي هي الـ nodal point بتاعت العين هي + +42 +00:02:56,360 --> 00:02:59,640 +المفروض للخلف قليلا الـ nodal point بتيجي تقريبا + +43 +00:02:59,640 --> 00:03:02,470 +على الـ posterior surface هنا خطأ في الرسمة على + +44 +00:03:02,470 --> 00:03:06,470 +الـ posterior surface بتاعة الـ lens وباتجاه الـ point + +45 +00:03:06,470 --> 00:03:09,230 +الـ fixation point أو الـ target اللي احنا بنطلع + +46 +00:03:09,230 --> 00:03:12,870 +عليه إذا الخط الأحمر هذا كله هو الـ visual axis + +47 +00:03:12,870 --> 00:03:16,950 +أو له اسم ثاني الـ line of sight الـ line of + +48 +00:03:16,950 --> 00:03:21,230 +sight فبالتالي هذه القضية بدها تكون واضحة إن شاء + +49 +00:03:21,230 --> 00:03:25,220 +الله تعالى التعريف الثاني اللي هو الـ Orthophoria + +50 +00:03:25,220 --> 00:03:28,580 +Orthophoria يعني لا يوجد أي نوع من حول هذا + +51 +00:03:28,580 --> 00:03:32,880 +المصطلح بيعني perfect ocular alignment يعني اتزان + +52 +00:03:32,880 --> 00:03:41,060 +كامل وتم للعينين فبالتالي طبعا بشرط بشرط + +53 +00:03:41,060 --> 00:03:45,220 +perfect ocular alignment بشرط in the absence of + +54 +00:03:45,220 --> 00:03:49,980 +any stimulus for fusion which is uncommon يعني + +55 +00:03:49,980 --> 00:03:54,560 +اتزان تم للعينين للعينتين يعني طبيعتهم + +56 +00:03:54,560 --> 00:04:00,200 +متوازيات بدون تدخل من الدماغ عشان قضية الـ + +57 +00:04:00,200 --> 00:04:03,320 +fusion يعني الـ fusion بتم بشكل سلس جدا بدون + +58 +00:04:03,320 --> 00:04:06,820 +مجهود من الدماغ ممكن إنسان يسأل طب وإيش المجهود + +59 +00:04:06,820 --> 00:04:11,160 +المطلوب من الدماغ؟ إذا كان إذا كان صورتين + +60 +00:04:11,160 --> 00:04:15,000 +سقطوا على مناطق متماثلة من شبكية العين اليمين + +61 +00:04:15,000 --> 00:04:18,760 +وشبكية العين الشمال هو حقيقة الأمر هذا الكلام + +62 +00:04:18,760 --> 00:04:21,480 +هنشرحه في التعريف الثالث اللي هو الـ heterophoria + +63 +00:04:21,480 --> 00:04:27,160 +الآن قلة قليلة من الناس اللي بتستمتع بموضوع الـ + +64 +00:04:27,160 --> 00:04:30,940 +orthophoria أن عينها متوازيات بنسبة 100% يعني لا + +65 +00:04:30,940 --> 00:04:35,570 +يوجد أي نوع من حول لا حول خفي ولا حول ظاهر هذه + +66 +00:04:35,570 --> 00:04:39,030 +النسبة نسبة قليلة جدا من الناس بيكون يعني + +67 +00:04:39,030 --> 00:04:44,270 +نصيبه أن عينيه في الفراغ متوازنتان بشكل 100% وصورة + +68 +00:04:44,270 --> 00:04:48,290 +أي target في الفراغ أو أي جسم في الفراغ بيسقط على + +69 +00:04:48,290 --> 00:04:53,250 +مناطق متماثلة 100% من شبكية العين اليمين وشبكية + +70 +00:04:53,250 --> 00:04:56,590 +العين اليسرى الآن ممكن إنسان يقول إيش يعني مناطق + +71 +00:04:56,590 --> 00:05:00,310 +متماثلة من شبكية العين اليمين وشبكية العين اليسرى؟ + +72 +00:05:00,310 --> 00:05:05,330 +بنقول كالقاعدة كل منطقة في شبكية العين اليمين لها + +73 +00:05:05,330 --> 00:05:09,150 +ما يماثلها أو لها نظيرتها في شبكية العين اليسرى + +74 +00:05:09,150 --> 00:05:12,550 +إيش يعني لها نظيرتها أو لها ما يماثلها؟ يعني هدول + +75 +00:05:12,550 --> 00:05:17,230 +المناطق بيتطلعوا وبيبصوا على نفس المنطقة من الفراغ + +76 +00:05:17,230 --> 00:05:21,750 +أو بعبارة أخرى بيستقبلوا من نفس المنطقة من الفراغ + +77 +00:05:21,750 --> 00:05:27,500 +من الـ field of في حالة الـ orthophoria الصورة بتسقط + +78 +00:05:27,500 --> 00:05:33,600 +تمامًا على مناطق متماثلة جدا بنسبة 100% من شبكية + +79 +00:05:33,600 --> 00:05:38,120 +العينتين وبالتالي الدماغ ما بيذل أي مجهود لتوحيد + +80 +00:05:38,120 --> 00:05:42,480 +الصور لأن الصور هتصل لنفس الخلايا في الـ visual + +81 +00:05:42,480 --> 00:05:47,960 +cortex عند ما يتم دمج الصور فبالتالي هذا بيشبه أن + +82 +00:05:47,960 --> 00:05:52,740 +استلمنا صفة أو أو كمية من أوراق الـ A4 مرتبة + +83 +00:05:52,740 --> 00:05:57,500 +بشكل 100% لو طلبنا من الإنسان قلنا له رتبها هيقول + +84 +00:05:57,500 --> 00:06:01,440 +ما هي أصلا مرتبة يعني بمعنى آخر لن يبذل أي مجهود + +85 +00:06:01,440 --> 00:06:05,760 +لأنه شايفها مرتبة بينما التعريف الثالث اللي هو الـ + +86 +00:06:05,760 --> 00:06:10,280 +heterophoria أو اختصارا الفوريا هو حول الخفي + +87 +00:06:10,280 --> 00:06:15,120 +حول الخفي أن في عندي زاوية بسيط جدا لـ + +88 +00:06:15,120 --> 00:06:19,200 +للعين العين من العينتين بالنسبة للعين الثانية + +89 +00:06:19,200 --> 00:06:25,300 +وبالتالي بيسقط بتسقط الصورة اللي بيتطلع عليه + +90 +00:06:25,300 --> 00:06:30,980 +هذا الإنسان اللي عنده حول خفي على يعني منطقة معينة + +91 +00:06:30,980 --> 00:06:35,020 +نقول الـ fovea في شبكية العين من العينتين تسقط الصورة + +92 +00:06:35,020 --> 00:06:38,460 +على الـ fovea في شبكية عين من العينتين وبتسقط على + +93 +00:06:38,460 --> 00:06:41,960 +الـ fovea في شبكية العين الثانية بس مع زاوية بسيط + +94 +00:06:41,960 --> 00:06:47,900 +يعني لا تعد مثلا نقول 1% أو أو أقل هذا الزاوية + +95 +00:06:47,900 --> 00:06:51,580 +البسيط هذا الزاوية البسيط بسبب حول الخفي + +96 +00:06:51,580 --> 00:06:56,600 +تمام؟ الدماغ بينتبه بينتبه وبيحاول يعدل وضع + +97 +00:06:56,600 --> 00:07:01,120 +العين عشان يتم إسقاط الصورتين على مناطق متماثلة + +98 +00:07:01,120 --> 00:07:07,720 +100% من الشبكات ليش الدماغ معني بأن الصور تسقط على + +99 +00:07:07,720 --> 00:07:13,520 +مناطق متماثلة تماما 100% من شبكية العينتين؟ حتى يتم + +100 +00:07:13,520 --> 00:07:17,480 +دمجهم في صورة واحدة ثلاثية الأبعاد لو ضال الزاوية + +101 +00:07:17,480 --> 00:07:20,800 +البسيط هذا موجود يعني الصورة سقطت على المنطقة سين + +102 +00:07:20,800 --> 00:07:26,040 +في شبكية العين اليمين وفي منطقة سين شرطة في شبكية + +103 +00:07:26,040 --> 00:07:29,680 +العين اليسرى مماثلة لمنطقة سين يعني بتتطلع على نفس + +104 +00:07:29,680 --> 00:07:34,600 +المنطقة من الفرق سقطت صورة الـ target على منطقة سين + +105 +00:07:34,600 --> 00:07:38,920 +في شبكية العين اليمين وسقطت على سين شرطة بس مع + +106 +00:07:38,920 --> 00:07:44,260 +زاوية بسيط هذا الزاوية البسيط بحفظ إدماج عشان يعمل + +107 +00:07:44,260 --> 00:07:49,290 +fusion للـ reflex بحفز الدماغ القصة بتبدأ من تحفيز + +108 +00:07:49,290 --> 00:07:52,410 +الدماغ نتيجة الزاوية البسيط هذا الدماغ بيرسل + +109 +00:07:52,410 --> 00:07:56,330 +إشارات عصبية عبر أعصاب العين اللي بتحرك العضلات + +110 +00:07:56,330 --> 00:08:01,470 +العصب الثالث والرابع والسادس بحيث تم تعديل وضع + +111 +00:08:01,470 --> 00:08:05,390 +العين اللي زي زاوية بسيط لا يكاد يذكر بحيث أنه + +112 +00:08:05,390 --> 00:08:10,030 +تسقط الصورة أيضا على سين شرطة بنسبة 100% الآن تم + +113 +00:08:10,030 --> 00:08:16,780 +الأمر هذا بعد هيك الدماغ بييجي بيوحد هدول الصورتين + +114 +00:08:16,780 --> 00:08:20,360 +في صورة واحدة قبل ما يتم تعديل وضع العينتين + +115 +00:08:22,860 --> 00:08:28,280 +بيسموه الـ motor fusion يعني حركة حركة لإسقاط + +116 +00:08:28,280 --> 00:08:32,020 +حركة حركة بتكون فيها العينتين عشان يتعدل وضعهم + +117 +00:08:32,020 --> 00:08:35,520 +بالنسبة لبعضهم البعض عشان يتم إسقاط الصور على + +118 +00:08:35,520 --> 00:08:40,540 +مناطق متماثلة من شبكية العينتين وطالما سقطت على + +119 +00:08:40,540 --> 00:08:45,960 +مناطق متماثلة بيترسل الصور لنفس النقطة أو لنفس الـ + +120 +00:08:45,960 --> 00:08:50,780 +الـ الـ الـ المساحة من الدماغ المعنية بتوحيد + +121 +00:08:50,780 --> 00:08:54,640 +الصور من هذه المناطق وبالتالي بتتم توحيد الصور في + +122 +00:08:54,640 --> 00:08:58,460 +صورة واحدة إذا الـ heterophoria أو الـ phoria هي + +123 +00:08:58,460 --> 00:09:03,320 +حول الخفي implies تعني tendency of the eyes to + +124 +00:09:03,320 --> 00:09:08,000 +deviate when fusion is blocked معناته هذه العين + +125 +00:09:08,000 --> 00:09:11,780 +بتحاول تزور لما الـ fusion يكون مش شغال لما الـ + +126 +00:09:11,780 --> 00:09:14,880 +fusion الـ fusion اللي بيقوم فيه الـ brain لما الـ + +127 +00:09:14,880 --> 00:09:19,440 +brain يكون مصحصح بيشعر بالزاوية البسيط وبيؤمر + +128 +00:09:19,440 --> 00:09:22,500 +العين يتعدل نفسها عشان هيك الإنسان اللي عنده + +129 +00:09:22,500 --> 00:09:25,620 +phoria أو حول خفي وهو مصحصح وجايين على + +130 +00:09:25,620 --> 00:09:28,900 +العيادة أو على المركز الصحي أو المستشفى هيكون + +131 +00:09:28,900 --> 00:09:33,300 +عينيه معتدلات 100% مش هنفرجه تماما عن الإنسان الـ + +132 +00:09:33,300 --> 00:09:37,150 +orthophoric ومش هنعرف إنه عنده حول خفي إلا بإجراء + +133 +00:09:37,150 --> 00:09:42,250 +فحوصات معينة ليس الآن وقت تفكيرها طيب هذا الإنسان + +134 +00:09:42,250 --> 00:09:45,730 +اللي عنده heterophoria عنده حول خفي مين اللي مخلي + +135 +00:09:45,730 --> 00:09:50,490 +حول الخفي خفي ما يظهرش؟ للدماغ بسبب موضوع الـ + +136 +00:09:50,490 --> 00:09:54,610 +fusion reflex للدماغ عاوز يعمل fusion damage + +137 +00:09:54,610 --> 00:09:58,830 +للصورتين لأن العينتين مفتوحتين وبيستقبلوا صور لأي + +138 +00:09:58,830 --> 00:10:03,310 +target بيتطلعوا عليه مع بعضهم نتيجة الزاوية البسيط + +139 +00:10:03,310 --> 00:10:07,410 +بيتحفز الدماغ وبيؤمر العينين عبر الأعصاب أن + +140 +00:10:07,410 --> 00:10:11,990 +تعدل وضعها عشان تسقط الصورة في العين اليمين مثلا + +141 +00:10:11,990 --> 00:10:15,530 +على المنطقة سين وتسقط تماما على سين شرطة اللي هي + +142 +00:10:15,530 --> 00:10:19,130 +نظيرة سين في العين اليسرى طبعا ويتم إرسال الصور + +143 +00:10:19,130 --> 00:10:23,450 +لنفس المنطقة من التحليل في الـ visual cortex إذا + +144 +00:10:23,450 --> 00:10:27,520 +implies tendency of the eyes to deviate when + +145 +00:10:27,520 --> 00:10:31,560 +fusion is blocked وهذا بنسمي latent squint طيب + +146 +00:10:31,560 --> 00:10:37,020 +أمتى الـ fusion اللي الدماغ مشغله ويعني مشغله + +147 +00:10:37,020 --> 00:10:42,140 +عشان يعدل وضع العينتين ومتنشط عشان يعمل قضية + +148 +00:10:42,140 --> 00:10:45,660 +fusion أمتى الـ fusion بيصير له block يعني + +149 +00:10:45,660 --> 00:10:50,920 +بينتهي لما يصير عنده إرهاق للدماغ لما بترتفع درجة + +150 +00:10:50,920 --> 00:10:53,760 +الحرارة، لما بيمرض المريض، يعني مش قادر يركز + +151 +00:10:53,760 --> 00:10:58,020 +بدماغه، لما بيرهق بشكل كبير، ساعتها حول الخافي + +152 +00:10:58,020 --> 00:11:01,080 +بيبدأ بالظهور مثلا إنسان عنده حول خافي بيجي + +153 +00:11:01,080 --> 00:11:06,760 +بيقول أنا والله أحيانا لما بقعد مثلا على الجوال + +154 +00:11:06,760 --> 00:11:12,100 +أربع خمس ساعات متواصلة ببدأ أحس مثلا أن عيني زاغت + +155 +00:11:12,100 --> 00:11:16,600 +تمام مظبوط عينه زاغت عنده حول خفي، لا وكان دماغه + +156 +00:11:16,600 --> 00:11:19,760 +مسيطر عليه طالما هو لسه مصحصح الآن مع الإرهاق + +157 +00:11:19,760 --> 00:11:23,680 +نتيجة متابعة الجوال أو الدراسة أو المرض أو ارتفاع + +158 +00:11:23,680 --> 00:11:28,120 +درجة الحرارة دماغه بيفقد السيطرة فبالتالي حول + +159 +00:11:28,120 --> 00:11:32,160 +الخفي هذا بيبدأ بالظهور إذا الـ heterophoria + +160 +00:11:32,160 --> 00:11:36,780 +implies tendency of the eyes to deviate محاولة + +161 +00:11:36,780 --> 00:11:40,840 +العينين أنها تنحرف لما الـ fusion يُعطّل الـ fusion + +162 +00:11:40,840 --> 00:11:44,520 +يُعطّل بمعنى أن الدماغ يتعب هذه الجملة كلها + +163 +00:11:44,520 --> 00:11:47,700 +اختصارها بين جملتين latent squint يعني الفوريا + +164 +00:11:47,700 --> 00:11:51,440 +هي الـ latent squint أو حول الخفي وبنتذكر من + +165 +00:11:51,440 --> 00:11:55,280 +اسمه خفي يعني ما بيظهر مش كل إنسان دخل العيادة + +166 +00:11:55,280 --> 00:12:00,300 +عندنا أو المستشفى واحنا طلبنا كأخصائيين بصريات أن + +167 +00:12:00,300 --> 00:12:03,820 +نفحصه ولجينا عينيه بال للوهلة الأولى معتدلات أن + +168 +00:12:03,820 --> 00:12:06,220 +نقوله أنت ما فيش فيك شيء لأنه ممكن يكون في عنده + +169 +00:12:06,220 --> 00:12:10,920 +حول خفي slightphoria slightphoria is present + +170 +00:12:10,920 --> 00:12:15,160 +in most normal individuals غالبية العظمة من البشر + +171 +00:12:15,160 --> 00:12:19,040 +عندهم حول خفي بسيط slight slight طبعا هذا + +172 +00:12:19,040 --> 00:12:23,070 +حول الخفي البسيط البسيط اللي كميته بسيطة is + +173 +00:12:23,070 --> 00:12:26,650 +overcome by the fusion reflex بيتغلب عليه الـ + +174 +00:12:26,650 --> 00:12:30,810 +fusion reflex طبعا الـ fusion reflex مصدره الدماغ + +175 +00:12:30,810 --> 00:12:35,050 +فلما الدماغ بيضعف بيبدأ الـ fusion reflex يضعف + +176 +00:12:35,050 --> 00:12:39,450 +وبالتالي بيبدأ حول الخافي في الظهور بس في مرحلة + +177 +00:12:39,450 --> 00:1 + +201 +00:14:14,610 --> 00:14:19,690 +بواسطة ال fusion reflex .. مسيطر عليه بواسطة ال + +202 +00:14:19,690 --> 00:14:24,550 +fusion reflex، إذا لم يقدر المريض أو لم يجيء + +203 +00:14:24,550 --> 00:14:27,570 +المريض لأن هو لا يرى حوله والناس اللي حوله لا + +204 +00:14:27,570 --> 00:14:31,030 +يرون عليه حوله وهو لا يشكو من أي أعراض، ولكن هذا + +205 +00:14:31,030 --> 00:14:35,630 +ال حوالي الخفي عند ضعف الدماغ يبدأ ينهار، الموضوع ال + +206 +00:14:35,630 --> 00:14:39,350 +fusion reflex ويبدأ الح حوالي الخفي يتحول إلى + +207 +00:14:39,350 --> 00:14:42,310 +decompensating phoria يعني الفوريا المنهارة أو + +208 +00:14:42,310 --> 00:14:46,070 +الح حوالي الخفي المنهار الذي بدأ يتحول بالتدريج إلى حوا + +209 +00:14:46,070 --> 00:14:50,230 +لظاهر، بمعنى آخر يبدأ فعلاً ال visual access بتاع + +210 +00:14:50,230 --> 00:14:53,030 +عين من العينين يزيغ عن ال visual access بتاع العين + +211 +00:14:53,030 --> 00:14:57,090 +الأخرى، ويبدأ أعراض مثل أعراض الإرهاق البصري، لا + +212 +00:14:57,090 --> 00:14:59,830 +يستطيع التركيز في ال target اللي هو يركز فيه سواء + +213 +00:14:59,830 --> 00:15:03,690 +جواله أو دراسته أو التلفزيون أو هكذا لفترات طويلة + +214 +00:15:03,690 --> 00:15:07,470 +يبدأ one من ال visual access يزيغ، يعني واحدة من + +215 +00:15:07,470 --> 00:15:10,990 +العينين تزيغ، وبالتالي يبدأ يصير عندهم إرهاق؛ لأن + +216 +00:15:10,990 --> 00:15:15,760 +يحكم العينين أنهم يظلوا موجّهتين باتجاه ال target + +217 +00:15:15,760 --> 00:15:19,920 +يبذل مجهود مضاعف، وهذا يسبّب له إرهاق بصري أو + +218 +00:15:19,920 --> 00:15:23,140 +ال asthenopia أو يٌسمّى asthenopia أو ocular + +219 +00:15:23,140 --> 00:15:27,460 +discomfort، عدم راحة، عندما ينفذ حاجات تتطلب مجهود + +220 +00:15:27,460 --> 00:15:31,360 +من العين مثل الدراسة، الجوال، التلفزيون إلى آخره أيضاً + +221 +00:15:31,360 --> 00:15:35,160 +ممكن الزيغان يكون أشد من احتماله على السيطرة + +222 +00:15:35,160 --> 00:15:39,060 +فبالتالي يبدأ أعراض ازدواجية النظر تظهر، تبدأ + +223 +00:15:39,060 --> 00:15:43,490 +أعراض الازدواجية في النظر تظهر مثل ما نحن حكينا أنّ + +224 +00:15:43,490 --> 00:15:46,410 +في الـ في الـ normal binocular single vision طبعاً + +225 +00:15:46,410 --> 00:15:50,710 +هذه الرسمة هنا، هذا الـ الـ اللي أنا أشير + +226 +00:15:50,710 --> 00:15:54,350 +عليه هو ال nose، ال nose هنا عندي ال visual axis + +227 +00:15:54,350 --> 00:15:57,610 +هنا عندي ال right eye عفواً، وال left eye، هاي ال + +228 +00:15:57,610 --> 00:16:00,670 +visual axis بتاع ال right eye، وهاي ال visual axis + +229 +00:16:00,670 --> 00:16:03,910 +بتاع ال left eye، لازم يتقاطعوا في ال object اللي + +230 +00:16:03,910 --> 00:16:08,100 +ينظر إليه هذا الإنسان، يعني لازم يتقاطعوا في ال + +231 +00:16:08,100 --> 00:16:12,800 +point of fixation، هذا في ال normal person، في ال + +232 +00:16:12,800 --> 00:16:16,780 +normal person، وبالتالي عندما يصير عندي حول، العين + +233 +00:16:16,780 --> 00:16:19,780 +زيغت مثلاً العين اليسرى زيغت للداخل، معناته ال visual + +234 +00:16:19,780 --> 00:16:23,260 +axis بتاعها سيصير في الاتجاه هذا، وبالتالي لن يتقاطعوا + +235 +00:16:23,260 --> 00:16:26,240 +في ال point of fixation، طب لو صارت exo، يعني العين + +236 +00:16:26,240 --> 00:16:29,020 +اليسرى زيغت للخارج، ساعتها ال visual axis بتاعها + +237 +00:16:29,020 --> 00:16:32,000 +سيصير في هذا الاتجاه اللي أنا أشير إليه أيضاً، لن + +238 +00:16:32,000 --> 00:16:36,900 +يتقاطع ال two visual axes في ال point of fixation + +239 +00:16:36,900 --> 00:16:39,340 +ستكون عين من العين الأخرى مركزة على ال target + +240 +00:16:39,340 --> 00:16:43,360 +والعين الأخرى زيغة إما للداخل يُسمّى eso أو للخارج + +241 +00:16:43,360 --> 00:16:47,920 +exo أو للأعلى hyper أو للأسفل hypo أو للأسفل + +242 +00:16:47,920 --> 00:16:52,860 +hypo، طبعاً الفوريا الح حوالي الخافي ممكن تكون إيزو + +243 +00:16:52,860 --> 00:16:57,440 +فوريا أو اكزو فوريا، ولكن علينا التنبيه على قضية مهمة + +244 +00:16:57,440 --> 00:17:01,320 +للغاية أن ال إيزو فوريا أو ال اكزو فوريا أو ال + +245 +00:17:01,320 --> 00:17:06,240 +hyperphoria أو ال hypophoria، كل هؤلاء المرضى عندهم + +246 +00:17:06,240 --> 00:17:09,660 +فوريا، فوريا يعني حوالي خفي، يعني هو سيدخل المركز + +247 +00:17:09,660 --> 00:17:14,000 +الصحي وعينيه مستقيمتان، ولن نستطيع أن نعرف أنّه عنده + +248 +00:17:14,000 --> 00:17:19,460 +إيزو فوريا أو اكزو فوريا إلا فقط فقط بفحوصات معينة + +249 +00:17:19,460 --> 00:17:23,000 +ستأتي في وقتها، وسنشرحها في وقتها when fusion is + +250 +00:17:23,000 --> 00:17:26,660 +insufficient، عندما يكون ال fusion mechanism أو ال + +251 +00:17:26,660 --> 00:17:30,860 +fusion reflex لا يكفي to control the imbalance، لا + +252 +00:17:30,860 --> 00:17:34,880 +يكفي للسيطرة على عدم الاتزان أو على الفوريا، ساعتها + +253 +00:17:34,880 --> 00:17:39,160 +الفوريا is described، نصفها، as decompensating + +254 +00:17:39,160 --> 00:17:45,210 +أنها قاعدة تنهار وتتحول إلى tropia، إذا هي + +255 +00:17:45,210 --> 00:17:48,350 +described as decompensating and is often + +256 +00:17:48,350 --> 00:17:52,350 +associated with symptoms of binocular discomfort + +257 +00:17:52,350 --> 00:17:56,050 +or double vision، عندما يكون الزيغان بسيط، ساعتها + +258 +00:17:56,050 --> 00:18:00,790 +الدماغ سيحاول يبذل مجهود مضاعف لكي يسيطر على + +259 +00:18:00,790 --> 00:18:05,670 +العينين ويوازنهم، ولكن ساعتها المريض سيحسّ نفسه مرهقاً، و + +260 +00:18:05,670 --> 00:18:09,610 +عندما يستعمل عينيه الاثنتين مع بعض، على فكرة الإنسان + +261 +00:18:09,610 --> 00:18:14,230 +الذي عنده binocular discomfort يعني decompensating + +262 +00:18:14,230 --> 00:18:19,010 +phoria أدّت إلى binocular discomfort، أنّه لا يُشعر بالراحة، و + +263 +00:18:19,010 --> 00:18:21,970 +هو يستخدم عينيه الاثنتين، لو قلنا له مثلاً أمسك + +264 +00:18:21,970 --> 00:18:25,430 +الجوال أو القرآن أو أي شيء اقرأ فيه، واغطِ عين من + +265 +00:18:25,430 --> 00:18:30,660 +عينيه الاثنتين سيحسّ حاله أفضل، وهذا يُؤكّد موضوع لماذا + +266 +00:18:30,660 --> 00:18:34,040 +سيحسّ حاله أفضل، لأنه لا يُضطّر إلى موازنة العين المفتوحة + +267 +00:18:34,040 --> 00:18:36,960 +مع العين المغلقة، العين المغلقة توقفت عن استقبال الصورة، + +268 +00:18:36,960 --> 00:18:39,900 +فبالتالي هو قاعد يعتمد على عين واحدة في الرؤية + +269 +00:18:39,900 --> 00:18:44,700 +وهذا سيُريحه، لا يُحسّ أن عينيه شدّتان عليه، أحياناً ال + +270 +00:18:44,700 --> 00:18:49,000 +decompensating phoria تكون شديدة لدرجة أنّ الدماغ + +271 +00:18:49,000 --> 00:18:54,800 +لا يستطيع السيطرة عليها، وفي مرحلة يعني فقدان السيطرة + +272 +00:18:54,800 --> 00:18:57,600 +يبدأ المريض يشكو من double vision أو أنّه يرى + +273 +00:18:57,600 --> 00:19:01,460 +الصورة صورتين، واللي هي مصطلحها العلمي diplopia، + +274 +00:19:01,460 --> 00:19:06,760 +مصطلحها العلمي diplopia، الآن خلينا نحن نحكي عن + +275 +00:19:06,760 --> 00:19:10,040 +الـ heterotropia أو الحول الظاهر، الذي اختصاراً + +276 +00:19:10,040 --> 00:19:13,880 +سنسمّيه tropia نحن، ال heterophoria، الحول الخفي + +277 +00:19:13,880 --> 00:19:17,720 +الذي بقينا قبل قليل نحكي عنه، اختصرناه بكلمة phoria + +278 +00:19:17,720 --> 00:19:21,140 +لن نضلّ نقول heterophoria، وإنما سيختصر ب phoria + +279 +00:19:21,140 --> 00:19:24,740 +ال heterotropia أيضاً لن نضلّ نقول heterotropia + +280 +00:19:24,740 --> 00:19:28,740 +وإنما سنقول tropia اختصاراً، يعني حول ظاهر، الحول + +281 +00:19:28,740 --> 00:19:33,720 +الظاهر بكل ما تعنيه كلمة ظاهر، بمعنى أنّ كل الناس + +282 +00:19:33,720 --> 00:19:39,820 +تعرف أنّ المريض الفلاني مثلاً عنده حول في عين من + +283 +00:19:39,820 --> 00:19:44,300 +العينين، بمعنى أنّ عينه يعني منحرفة مقارنة مع العين + +284 +00:19:44,300 --> 00:19:49,240 +الأخرى، الآن في عندي أربعة مصطلحات نحن مرّت علينا + +285 +00:19:49,240 --> 00:19:53,840 +بينّا نذكر فيها ال orthophoria، ال heterophoria، ال + +286 +00:19:53,840 --> 00:19:57,500 +decompensating phoria، وال tropia، خلّيني أحكيها مرة + +287 +00:19:57,500 --> 00:20:01,420 +ثانية باختصارات، ال orthophoria لا تُختصر، وقلنا قلة + +288 +00:20:01,420 --> 00:20:05,180 +من الناس، قليلة عندها orthophoria، بمعنى أنّ العينين + +289 +00:20:05,180 --> 00:20:09,340 +ما شاء الله بعد إجراء جميع الفحوصات، لا يوجد عنده + +290 +00:20:09,340 --> 00:20:13,840 +أي نوع من الحول، لا خفي ولا ظاهر، هذا النوع الأول، + +291 +00:20:13,840 --> 00:20:18,550 +النوع الثاني، وهذا قلة من البشر، النوع الثاني يشتمل + +292 +00:20:18,550 --> 00:20:21,850 +غالبيّة البشر، اللي هم اللي عندهم phoria، ال phoria + +293 +00:20:21,850 --> 00:20:24,850 +الذي هو وجود حول خفي مسيطر عليه من قبل الدماغ + +294 +00:20:24,850 --> 00:20:30,250 +النوع الثالث اللي هو ال decompensating phoria، حول + +295 +00:20:30,250 --> 00:20:35,510 +خفي أيضاً، ولكن بدأ يفقد الدماغ السيطرة نتيجة إرهاق + +296 +00:20:35,510 --> 00:20:39,050 +أو تعب أو ارتفاع في درجة الحرارة أو هكذا، والنوع + +297 +00:20:39,050 --> 00:20:43,330 +الرابع، تكون الأمور يعني بالنسبة للدماغ ولل + +298 +00:20:43,330 --> 00:20:47,380 +fusion reflex فشلت بشكل يعني كامل، والمريض أصبح + +299 +00:20:47,380 --> 00:20:52,280 +عنده حول ظاهر لا.. لا يوجد أيّ.. يعني لا يحتاج + +300 +00:20:52,280 --> 00:20:57,480 +إلى كبير مهارة في اكتشافه، ال heterotopia implies + +301 +00:20:57,480 --> 00:21:01,580 +manifest deviation، manifest deviation، بمعنى أنّ + +302 +00:21:01,580 --> 00:21:05,780 +حول ظاهر، in which the two visual axes do not + +303 +00:21:05,780 --> 00:21:09,540 +intersect at the point of fixation، at the point of + +304 +00:21:09,540 --> 00:21:15,240 +fixation، تمام، طالما.. طالما كل visual axes موجّه + +305 +00:21:15,240 --> 00:21:21,600 +باتجاه مختلف عن ال visual axis الآخر في الفراغ + +306 +00:21:21,600 --> 00:21:25,440 +معناته ال images from the two eyes are misaligned، + +307 +00:21:25,440 --> 00:21:30,640 +الصورة تسقط على شبكية العين اللي نقول ال fixating + +308 +00:21:30,640 --> 00:21:34,700 +eye، سواء right أو left، ال fixating eye تسقط عليها + +309 +00:21:34,700 --> 00:21:38,380 +الصورة على الفوفيا، بينما ال non-fixating eye + +310 +00:21:38,380 --> 00:21:42,380 +العين التي فيها الحول تسقط على extra foveal area + +311 +00:21:42,380 --> 00:21:46,840 +أو non-foveal area، خارج الفوفيا، وبالتالي سترسل هذه + +312 +00:21:46,840 --> 00:21:52,240 +الصور إلى مناطق مختلفة من التحليل في ال visual + +313 +00:21:52,240 --> 00:21:55,980 +cortex، ولن يتم damage لها لأنها ليست ثابتة على مناطق + +314 +00:21:55,980 --> 00:22:00,790 +متماثلة من شبكية العينين، طالما لن يتم damage لها + +315 +00:22:00,790 --> 00:22:04,770 +ستظلّ الصورتان صورتين، فبالتالي سيصير عندي double + +316 +00:22:04,770 --> 00:22:09,890 +vision أو diplopia، أو عند الأطفال الدماغ ممكن يعني + +317 +00:22:09,890 --> 00:22:14,670 +يعني يقوم بعملية تُسمّى ال suppression، إيقاف + +318 +00:22:14,670 --> 00:22:19,870 +استقبال صورة أو رفض صورة من الدماغ، طبعاً غالباً، بس + +319 +00:22:19,870 --> 00:22:23,490 +ليس دائماً، غالباً تكون الصورة من ال deviating eye + +320 +00:22:23,490 --> 00:22:26,860 +العين التي فيها الانحراف، يُهملها الدماغ ويقول طالما + +321 +00:22:26,860 --> 00:22:32,400 +ستأتي بشكل غير سليم معناته سيهملها، وهذا + +322 +00:22:32,400 --> 00:22:35,140 +يحدث غالباً عند الأطفال، لذلك الأطفال يشكون من + +323 +00:22:35,140 --> 00:22:40,220 +ازدواجية، تكون العين مفتوحة وفيها حول، والدماغ + +324 +00:22:40,220 --> 00:22:42,980 +يستقبل من العين السليمة التي هي المعتدلة أو التي + +325 +00:22:42,980 --> 00:22:46,560 +تقوم بعملية fixation، وهذه العملية تُسمّى suppression، و + +326 +00:22:46,560 --> 00:22:49,300 +هذه العملية هي العملية الغالبة عند الأطفال، لذلك + +327 +00:22:49,300 --> 00:22:52,940 +الأطفال الذين عندهم حول ظاهر نادر جداً من + +328 +00:22:52,940 --> 00:22:56,310 +الأطفال، لأنّه يأتي طفل مثلاً عمره ست سنوات أو سبع + +329 +00:22:56,310 --> 00:23:01,390 +سنوات ويشكو من ازدواجية في النظر، بينما الكبار + +330 +00:23:01,390 --> 00:23:05,410 +غالباً عندما يصير معه حول غالباً يشكو.. غالباً + +331 +00:23:05,410 --> 00:23:12,270 +يشكو من ازدواجية في النظر، سنتوقّف عند الأسباب التي + +332 +00:23:12,270 --> 00:23:16,510 +ممكن تؤدّي إلى ظهور الحول ويعطيكم العافية.. السلام + +333 +00:23:16,510 --> 00:23:16,930 +عليكم diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/P-KQTpXsxFg_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/P-KQTpXsxFg_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..fe1abbca3cfecf93a8127686dfd969ebc37b020f --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/P-KQTpXsxFg_postprocess.srt @@ -0,0 +1,1332 @@ +1 +00:00:02,900 --> 00:00:07,420 +بسم الله الرحمن الرحيم هنبدأ + +2 +00:00:07,420 --> 00:00:11,980 +مع محاضرات حوال واحد و اللي بيعتمد عليه حوال اتنين + +3 +00:00:11,980 --> 00:00:16,100 +بشكل كبير جدا و يعتبر هو ال basic science بالنسبة + +4 +00:00:16,100 --> 00:00:21,680 +لحوال اتنين طبعا حوال واحد مملوء بالتعريفات اللي + +5 +00:00:21,680 --> 00:00:27,060 +لابد من إنسان أخصاء البصريات يتقنها تماما حتى يعرف + +6 +00:00:27,060 --> 00:00:28,880 +يتعامل مع مرضى الحوال + +7 +00:00:37,530 --> 00:00:40,710 +أول تعريف اللي هو ال visual axis أو ال line of + +8 +00:00:40,710 --> 00:00:45,540 +vision اللي هو خط الإبصار أو المحور البصريالمحور + +9 +00:00:45,540 --> 00:00:48,240 +البصري passes from the fovea through the nodal + +10 +00:00:48,240 --> 00:00:51,920 +point of the eye to the point of fixation أو + +11 +00:00:51,920 --> 00:00:55,260 +بعبارة أخرى to the object of regard يعني لل object + +12 +00:00:55,260 --> 00:00:58,940 +اللي بيتطلع عليه الإنسان إذا ال visual axis بيبدأ + +13 +00:00:58,940 --> 00:01:03,560 +من ال fovea وبينتهي عند ال object بمر في طريقه في + +14 +00:01:03,560 --> 00:01:06,040 +ال nodal point بتاعة العين طبعا العين تعتبر + +15 +00:01:06,040 --> 00:01:11,690 +optical systemكل عين لها visual axis خاص فيها ال + +16 +00:01:11,690 --> 00:01:14,490 +two visual axis في ال normal binocular single + +17 +00:01:14,490 --> 00:01:18,810 +vision بيكونوا ال two visual axis intersect + +18 +00:01:18,810 --> 00:01:22,010 +بيتقاطعوا at the point of fixation لأن العينتين + +19 +00:01:22,010 --> 00:01:25,570 +بيكونوا متزينات وبيتطلعوا على نفس ال target أو نفس + +20 +00:01:25,570 --> 00:01:29,570 +الهدف أو نفس ال object فبالتالي ال visual axis + +21 +00:01:29,570 --> 00:01:31,710 +بتاع العين اليمين و ال visual axis بتاع العين + +22 +00:01:31,710 --> 00:01:36,530 +الشمال بيكونوا موجهين باتجاه الجسم المنظر وبالتالي + +23 +00:01:36,530 --> 00:01:41,580 +بتقاطعوا عندهin normal binocular single vision the + +24 +00:01:41,580 --> 00:01:45,100 +two visual axes intersect at the point of fixation + +25 +00:01:45,100 --> 00:01:52,300 +طيب الآن طالما الفوفيا موجهة باتجاه ال visual axis + +26 +00:01:52,300 --> 00:01:55,160 +.. باتجاه ال target والفوفيا في العين التانية + +27 +00:01:55,160 --> 00:01:59,240 +موجهة باتجاه ال target إذا صورة ال target بتنطبع + +28 +00:01:59,240 --> 00:02:03,620 +وبتلتقط على الفوفيا تحت العين اليمين وعلى الفوفيا + +29 +00:02:03,620 --> 00:02:08,800 +تحت العين الشمال ثم بترسل الصورتينإلى الدماغ + +30 +00:02:08,800 --> 00:02:13,640 +لتوحيد .. لتوحيدهم بواسطة قالية أو reflex بيسموه + +31 +00:02:13,640 --> 00:02:18,020 +ال fusion reflex في هذا ال fusion reflex بيتم دمج + +32 +00:02:18,020 --> 00:02:21,580 +صورتين في صورة واحدة بواسطة ال binocular + +33 +00:02:21,580 --> 00:02:25,540 +responsive cells binocular responsive cells اللي + +34 +00:02:25,540 --> 00:02:28,440 +هي الخلايا اللي موجودة في ال visual cortex و اللي + +35 +00:02:28,440 --> 00:02:32,620 +بتستجيب للمعلومات أو للصور القادمة من العينتين، + +36 +00:02:32,620 --> 00:02:35,960 +التنتينطبعا هذا الكلام بيتم في ال visual cortex + +37 +00:02:35,960 --> 00:02:41,120 +وبينتج عنه binocular single vision يعني رؤية موحدة + +38 +00:02:41,120 --> 00:02:45,980 +بواسطة العينتين طبعا لو حابنا نشوف الرسمة هاي + +39 +00:02:45,980 --> 00:02:50,140 +بالنسبة لل visual axis بيبتد من الفوفيا الفوفيا + +40 +00:02:50,140 --> 00:02:54,140 +ممثلة هنا في الرسمة بالنقطة الحمرا بيمر بالنقطة + +41 +00:02:54,140 --> 00:02:56,360 +السودا اللي هي ال nodal point بتاعت العين هي + +42 +00:02:56,360 --> 00:02:59,640 +المفروض للخلف قليلا ال nodal point بتيجي تقريبا + +43 +00:02:59,640 --> 00:03:02,470 +على ال posterior cervis هنا خطأ في الرسمعال + +44 +00:03:02,470 --> 00:03:06,470 +posterior surface بتاعة ال lens و باتجاه ال point + +45 +00:03:06,470 --> 00:03:09,230 +.. ال fixation point أو ال target اللي احنا بنطلع + +46 +00:03:09,230 --> 00:03:12,870 +عليه .. اذا الخط الأحمر هذا كله هو ال visual axis + +47 +00:03:12,870 --> 00:03:16,950 +او له اسم تاني ال line of sight .. ال line of + +48 +00:03:16,950 --> 00:03:21,230 +sight فبالتالي هذه القضية بدها تكون واضحة ان شاء + +49 +00:03:21,230 --> 00:03:25,220 +الله تعالىالتعريف التاني اللي هو ال Orthophoria + +50 +00:03:25,220 --> 00:03:28,580 +Orthophoria يعني لا يوجد أي نوع من الحوالي هذا + +51 +00:03:28,580 --> 00:03:32,880 +المصطلح بيعني perfect ocular alignment يعني اتزان + +52 +00:03:32,880 --> 00:03:41,060 +كامل و تم للعينان فبالتالي طبعابس بشرط بس بشرط + +53 +00:03:41,060 --> 00:03:45,220 +perfect ocular alignment بشرط in the absence of + +54 +00:03:45,220 --> 00:03:49,980 +any stimulus for effusion which is uncommon يعني + +55 +00:03:49,980 --> 00:03:54,560 +اتزان تم للعينين .. للعينتين التنتين يعني طبيعتهم + +56 +00:03:54,560 --> 00:04:00,200 +متزينات بدون تدخل بتاة من الدماغ عشان قضية ال + +57 +00:04:00,200 --> 00:04:03,320 +effusion يعني ال effusion بتم بشكل سلس جدا بدون + +58 +00:04:03,320 --> 00:04:06,820 +مجهود من الدماغ ممكن إنسان يسأل طب و إيش المجهود + +59 +00:04:06,820 --> 00:04:11,160 +المطلوب من الدماغ؟إذا كان .. إذا كان السورتين + +60 +00:04:11,160 --> 00:04:15,000 +سقطوا على مناطق متماثلة من شبكية العين اليمين + +61 +00:04:15,000 --> 00:04:18,760 +وشبكية العين الشمال هو حقيقة الأمر .. هذا الكلام + +62 +00:04:18,760 --> 00:04:21,480 +هنشرحه في التعريف التالت اللي هو الـ heterophoria + +63 +00:04:21,480 --> 00:04:27,160 +الآن قلة قليلة من الناس اللي بتستمتع بموضوع الـ + +64 +00:04:27,160 --> 00:04:30,940 +orthophoria أن عينها متزينات بنسبة 100% يعني لا + +65 +00:04:30,940 --> 00:04:35,570 +يوجد أي نوع من الحوال لا حوال خفي ولا حوال ظاهرهذه + +66 +00:04:35,570 --> 00:04:39,030 +النسبة .. نسبة قليلة جدا من الناس بيكون .. يعني + +67 +00:04:39,030 --> 00:04:44,270 +نصيبه إن عينيه في الفراغ متوازنات بشكل 100% وصورة + +68 +00:04:44,270 --> 00:04:48,290 +أي target في الفراغ أو أي جسم في الفراغ بيسقط على + +69 +00:04:48,290 --> 00:04:53,250 +مناطق متماثلة 100% من شبكية العين اليمين وشبكية + +70 +00:04:53,250 --> 00:04:56,590 +العين الإشمالالآن ممكن إنسان يقول إيش يعني مناطق + +71 +00:04:56,590 --> 00:05:00,310 +متماثلة من شبكية العين اليمين وشبكية العين الشمال؟ + +72 +00:05:00,310 --> 00:05:05,330 +بنقول كالقادة، كل منطقة في شبكية العين اليمين لها + +73 +00:05:05,330 --> 00:05:09,150 +ما يماثلها أو لها نظيرتها في شبكية العين الشمال + +74 +00:05:09,150 --> 00:05:12,550 +إيش يعني لها نظيرتها أو لها ما يماثلها؟ يعني هدول + +75 +00:05:12,550 --> 00:05:17,230 +المناطق بيتطلعوا وبيبصوا على نفس المنطقة من الفراغ + +76 +00:05:17,230 --> 00:05:21,750 +أو بعبارة أخرى بيستقبلوا من نفس المنطقة من الفراغ + +77 +00:05:21,750 --> 00:05:27,500 +من ال field ofففي حالة ال orthophoria الصورة بتسقط + +78 +00:05:27,500 --> 00:05:33,600 +تماما على مناطق متماثلة جدا بنسبة 100% من شبكية + +79 +00:05:33,600 --> 00:05:38,120 +العينتين وبالتالي الدماغ مابيبذل اي مجهود لتوحيد + +80 +00:05:38,120 --> 00:05:42,480 +الصور لان الصور هتصل لنفس الخلايافي ال visual + +81 +00:05:42,480 --> 00:05:47,960 +cortex عند ما يتم دمج الصور فبالتالي هذا بيشبه انه + +82 +00:05:47,960 --> 00:05:52,740 +استلمنا صفة او .. او كمية من أوراق ال A4 مرتبة + +83 +00:05:52,740 --> 00:05:57,500 +بشكل 100% لو طلبنا من الإنسان قلنا له رتبها هيقول + +84 +00:05:57,500 --> 00:06:01,440 +ما هي أصلا مرتبة يعني بمعنى آخر لن يبذل أي مجهود + +85 +00:06:01,440 --> 00:06:05,760 +لأنه شايفها مرتبةبينما التعريف التالت اللي هو ال + +86 +00:06:05,760 --> 00:06:10,280 +heterophoria أو اختصارا الفوريا هو الحوال الخفي + +87 +00:06:10,280 --> 00:06:15,120 +الحوال الخفي انه في عندي زواغان بسيط جدا ل .. + +88 +00:06:15,120 --> 00:06:19,200 +للعين العين من العينتين بالنسبة للعين التانية + +89 +00:06:19,200 --> 00:06:25,300 +وبالتالي بيسقط .. بتسقط الصورة اللي بيتطلع عليه + +90 +00:06:25,300 --> 00:06:30,980 +هذا الإنسان اللي عنده حوال خفي علىيعني منطقة معينة + +91 +00:06:30,980 --> 00:06:35,020 +نقول الفوفيا في شبكية العين من العنتين تسقط الصورة + +92 +00:06:35,020 --> 00:06:38,460 +على الفوفيا في شبكية عين من العنتين و بتسقط على + +93 +00:06:38,460 --> 00:06:41,960 +الفوفيا في شبكية العين التانية بس مع زواغان بسيط + +94 +00:06:41,960 --> 00:06:47,900 +يعني لا تعد مثلا نقول 1%أو .. أو أقل هذا الزوران + +95 +00:06:47,900 --> 00:06:51,580 +البسيط .. هذا الزوران البسيط بسبب الحول الخفي + +96 +00:06:51,580 --> 00:06:56,600 +تمام؟ الدماغ بينتبه .. بينتبه و بيحاول يعدل وضع + +97 +00:06:56,600 --> 00:07:01,120 +العين عشان يتم إسقاط الصورتين على مناطق متماثلة + +98 +00:07:01,120 --> 00:07:07,720 +100% من الشبكيات ليش دماغ معني بإن الصور تسقط على + +99 +00:07:07,720 --> 00:07:13,520 +مناطق متماثلة تماما 100% من شبكية العينتين؟حتى يتم + +100 +00:07:13,520 --> 00:07:17,480 +دمجهم في صورة واحدة ثلاثية الأبعاد لو ضال الزواغان + +101 +00:07:17,480 --> 00:07:20,800 +البسيط هذا موجود يعني الصورة سقطت على المنطقة سين + +102 +00:07:20,800 --> 00:07:26,040 +في شبكية العين اليمينوفي منطقة سين شرطة في شبكية + +103 +00:07:26,040 --> 00:07:29,680 +العين الشمال مماثلة لمنطقة سين يعني بتتطلع على نفس + +104 +00:07:29,680 --> 00:07:34,600 +المنطقة من الفرق سقطت صورة ال target على منطقة سين + +105 +00:07:34,600 --> 00:07:38,920 +في شبكية العين اليمين وسقطت على سين شرطة بس مع + +106 +00:07:38,920 --> 00:07:44,260 +زوغان بسيط هذا الزوغان البسيط بحفظ ادماج عشان يعمل + +107 +00:07:44,260 --> 00:07:49,290 +fusion لـreflexبحفز الدماغ القصة بتبدأ من تحفيز + +108 +00:07:49,290 --> 00:07:52,410 +الدماغ نتيجة الزوغان البسيط هذا الدماغ بيرسل + +109 +00:07:52,410 --> 00:07:56,330 +إشارات عصبية عبر أعصاب العين اللي بتحرك العضلات + +110 +00:07:56,330 --> 00:08:01,470 +العصب التالت والرابع والسادس بحيث تم تعديل وضع + +111 +00:08:01,470 --> 00:08:05,390 +العين اللي زي غزوغان بسيط لا يكاد يذكر بحيث أنه + +112 +00:08:05,390 --> 00:08:10,030 +تسقط الصورة أيضًا على سيل شرطة بنسبة 100% الآن تم + +113 +00:08:10,030 --> 00:08:16,780 +الأمر هذابعد هيك الدماغ بييجي بيوحد هدول الصورتين + +114 +00:08:16,780 --> 00:08:20,360 +في صورة واحدة جابل ما يتم تعديل وضع العنتين + +115 +00:08:22,860 --> 00:08:28,280 +بيسموه ال motor fusion يعني حركة .. حركة لإسقاط .. + +116 +00:08:28,280 --> 00:08:32,020 +حركة .. حركة بتكون فيها العنتين عشان يتعدل وضعهم + +117 +00:08:32,020 --> 00:08:35,520 +بالنسبة لبعضهم البعض عشان يتم إسقاط الصور على + +118 +00:08:35,520 --> 00:08:40,540 +مناطق متماثلة من شبكية العنتين وطالما سقطت على + +119 +00:08:40,540 --> 00:08:45,960 +مناطق متماثلة بيترسل الصور لنفس النقطة أو لنفس ال + +120 +00:08:45,960 --> 00:08:50,780 +.. ال .. ال .. المساحة من الدماغالمعنية بتوحيد + +121 +00:08:50,780 --> 00:08:54,640 +الصور من هذه المناطق وبالتالي بتتم توحيد الصور في + +122 +00:08:54,640 --> 00:08:58,460 +صورة واحدة إذا ال heterophoria أو ال phoria هي + +123 +00:08:58,460 --> 00:09:03,320 +الحول الخفي implies تعني tendency of the eyes to + +124 +00:09:03,320 --> 00:09:08,000 +deviate when fusion is blockedمعناته هذه العين + +125 +00:09:08,000 --> 00:09:11,780 +بتحاول تزور لما ال fusion يكون مش شغال لما ال + +126 +00:09:11,780 --> 00:09:14,880 +fusion .. ال fusion اللي بيقوم فيه ال brain لما ال + +127 +00:09:14,880 --> 00:09:19,440 +brain يكون مصحصح بيشعر بالزوغان البسيط و بيؤمر + +128 +00:09:19,440 --> 00:09:22,500 +العين يتعدل نفسها عشان هيك الإنسان اللي عنده + +129 +00:09:22,500 --> 00:09:25,620 +euphoria أو حوال خفي و هو مصحصح و جايين على + +130 +00:09:25,620 --> 00:09:28,900 +العيادة أو على المركز الصحي أو المستشفى هيكون + +131 +00:09:28,900 --> 00:09:33,300 +عينيه معتدلات 100% مش هنفرجه تماما عن الإنسان ال + +132 +00:09:33,300 --> 00:09:37,150 +orthophoricو مش هنعرف إنه عنده حوال خفي إلا بإجراء + +133 +00:09:37,150 --> 00:09:42,250 +فحوصات معينة ليس الآن وقت فكرها طيب هذا الإنسان + +134 +00:09:42,250 --> 00:09:45,730 +اللي عنده heterophoria عنده حوال خفي مين اللي مخلي + +135 +00:09:45,730 --> 00:09:50,490 +الحوال الخفي خفي مايظهرش؟ لدماغ بسبب موضوع ال + +136 +00:09:50,490 --> 00:09:54,610 +fusion reflex لدماغ عاوز يعمل fusion damage + +137 +00:09:54,610 --> 00:09:58,830 +لسورتين لأن العينتين مفتحتة و بيستقبلوا صور لأي + +138 +00:09:58,830 --> 00:10:03,310 +target بتطلعوا عليه مع بعضهمبنتيجة الزرعان البسيط + +139 +00:10:03,310 --> 00:10:07,410 +بيتحفظ الدماغ وبيؤمر العين تين عبر الأعصاب أنه + +140 +00:10:07,410 --> 00:10:11,990 +تعدل وضعها عشان تسقط الصورة في العين اليمين مثلا + +141 +00:10:11,990 --> 00:10:15,530 +على المنطقة سين وتسقط تماما على سين شرطة اللي هي + +142 +00:10:15,530 --> 00:10:19,130 +نظيرة سين في العين الشمال طبعا ويتم إرسال الصور + +143 +00:10:19,130 --> 00:10:23,450 +لنفس المنطقة من التحليل في ال visual cortex إذا + +144 +00:10:23,450 --> 00:10:27,520 +implies tendency of the eyes to deviatewhen + +145 +00:10:27,520 --> 00:10:31,560 +effusion is blocked وهذا بنسمي latent squint طيب + +146 +00:10:31,560 --> 00:10:37,020 +أمتى ال effusion اللي الدماغ مشغله ويعني مشغله + +147 +00:10:37,020 --> 00:10:42,140 +عشان يعدل وضع العنتين ومتنشط عشان يعمل قضية + +148 +00:10:42,140 --> 00:10:45,660 +effusion أمتى ال effusion بيصيرله block يعني + +149 +00:10:45,660 --> 00:10:50,920 +بينتهي لما يصير عنده إرهاق للدماغلما بترتفع درجة + +150 +00:10:50,920 --> 00:10:53,760 +الحرارة، لما بيمرض المريض، يعني مش قادر يركز + +151 +00:10:53,760 --> 00:10:58,020 +بدماغه، لما بيرهق بشكل كبير، ساعتها الحوالي الخافي + +152 +00:10:58,020 --> 00:11:01,080 +بيبدأ بالظهور مثلا إنسان عنده حوالي الخافي بيجي + +153 +00:11:01,080 --> 00:11:06,760 +بقول أنا والله أحيانا لما بقعد مثلا على الجوال + +154 +00:11:06,760 --> 00:11:12,100 +أربع خمس ساعات متواصلة ببدأ أحس مثلا أنهعيني زاغت + +155 +00:11:12,100 --> 00:11:16,600 +تمام، مظبوط عينه زاغت عنده حوال خفي، لأ وكان دماغه + +156 +00:11:16,600 --> 00:11:19,760 +مسيطر عليه طالما هو لسه مسحسح، الآن مع الإرهاق + +157 +00:11:19,760 --> 00:11:23,680 +نتيجة متابعة الجوال أو الدراسة أو المرض أو ارتفاع + +158 +00:11:23,680 --> 00:11:28,120 +درجة الحرارة، دماغه بيفقد السيطرة فبالتالي الحوال + +159 +00:11:28,120 --> 00:11:32,160 +الخفي هذا بيبدأ بالظهورإذا الـ heterophoria + +160 +00:11:32,160 --> 00:11:36,780 +implies tendency of the eyes to deviate محاولة + +161 +00:11:36,780 --> 00:11:40,840 +العينين إنها تنحرف لما ال fusion يُعطّل ال fusion + +162 +00:11:40,840 --> 00:11:44,520 +يُعطّل بمعنى إن الدماغ يتعب هذه الجملة كلها + +163 +00:11:44,520 --> 00:11:47,700 +اختصارها بين جثين latent and squint يعني الفوريا + +164 +00:11:47,700 --> 00:11:51,440 +هي ال latent squint أو الحوالي الخفي وبنتذكر من + +165 +00:11:51,440 --> 00:11:55,280 +اسمه خفي يعني ما بيظهر مش كل إنسان دخل العيادة + +166 +00:11:55,280 --> 00:12:00,300 +عندنا أو المستشفىو احنا طولبنا كأخصائين بصريات أنه + +167 +00:12:00,300 --> 00:12:03,820 +نفحصه و لجينا عينيه بال .. للوهلة الأولى عدلات أنه + +168 +00:12:03,820 --> 00:12:06,220 +نقوله أنت مافيش فيك إشي لأنه ممكن يكون في عنده + +169 +00:12:06,220 --> 00:12:10,920 +حوال خفي slightphoria .. slightphoria is present + +170 +00:12:10,920 --> 00:12:15,160 +in most normal individuals غالبية العظمة من البشر + +171 +00:12:15,160 --> 00:12:19,040 +عندهم حوال خفي بسيط slight .. slight طبعا هذا + +172 +00:12:19,040 --> 00:12:23,070 +الحوال الخفي البسيط .. البسيط اللي كميته بسيطةis + +173 +00:12:23,070 --> 00:12:26,650 +overcome by the fusion reflex بيتغلب عليه ال + +174 +00:12:26,650 --> 00:12:30,810 +fusion reflex طبعا ال fusion reflex مصدره الدماغ + +175 +00:12:30,810 --> 00:12:35,050 +فلما الدماغ بيضعف بيبدأ ال fusion reflex يضعف + +176 +00:12:35,050 --> 00:12:39,450 +وبالتالي بيبدأ الحوال الخافي في الظهور بس في مرحلة + +177 +00:12:39,450 --> 00:12:43,610 +قبل ما يظهر الحوال الخافي ويتحول لحوال ظاهر يعني + +178 +00:12:43,610 --> 00:12:47,190 +اتحول من حوال خافي لحوال ظاهر بيسموه في مرحلة + +179 +00:12:47,190 --> 00:12:51,380 +بينية بينهم بيسموها ال decompensatingيعني ال foria + +180 +00:12:51,380 --> 00:12:54,640 +المنهارة، الحوا للخافي المنهار، إيش يعني المنهار؟ + +181 +00:12:54,640 --> 00:12:58,720 +اللي يعني بدأ بالتدريج يتحول لحوا الظاهر، لا ي .. + +182 +00:12:58,720 --> 00:13:03,680 +لا يعني .. لا يلزم يعني كثير مهارة لمعرفته، يعني + +183 +00:13:03,680 --> 00:13:06,520 +الإنسان اللي مش متخصص يقولك هذا مثلا عينه زيغة + +184 +00:13:06,520 --> 00:13:10,150 +لبرا، عينه زيغة لفوق، عينه زيغة للتحتعينه زيغة + +185 +00:13:10,150 --> 00:13:14,570 +للداخل يعني ISO أو EXO أو Hyper أو Hypo بمعنى .. + +186 +00:13:14,570 --> 00:13:18,430 +من حيث ال .. من حيث الاتجاه فبالتالي في عندي أنا + +187 +00:13:18,430 --> 00:13:21,910 +مرحلة بيسموها ال fourier الحوالي الخافي وهو دي + +188 +00:13:21,910 --> 00:13:26,420 +موجودة عند معظم الناس وإن كان بشكل بسيطوهذه الحوال + +189 +00:13:26,420 --> 00:13:29,820 +الخافي متغلب عليه وبيضل في مرحلة الخفاء بمعنى أن + +190 +00:13:29,820 --> 00:13:32,620 +العنتين هيكون عدلات لما ننظر لهذا المريض اللي عنده + +191 +00:13:32,620 --> 00:13:36,180 +حوال خافية بواسطة ال fusion reflex الآن في عيني + +192 +00:13:36,180 --> 00:13:40,500 +حوال ظاهر، هنحكي عنه بعد شوية، بس في مرحلة بينية + +193 +00:13:40,500 --> 00:13:44,580 +بينهم لما الدماغ بيبدأ يضعف نتيجة الإرهاق أو التعب + +194 +00:13:44,580 --> 00:13:49,220 +أو المرض أو الحرارة أو الوقوع مثلا من علو أو ما + +195 +00:13:49,220 --> 00:13:55,930 +إلى ذلكفبالتالي بتبدأ الخفي ينهار decompensating + +196 +00:13:55,930 --> 00:14:00,290 +phoria في هذه المرحلة البيينية بيبدأ المريض يشكي + +197 +00:14:00,290 --> 00:14:04,390 +من أعراض و بيبدأ يراجعالمستشفيات و المراكز الصحية + +198 +00:14:04,390 --> 00:14:07,850 +عشان يشوف إيش سبب هذه الأعراض، يا ترى إيش سبب + +199 +00:14:07,850 --> 00:14:10,910 +الأعراض؟ إنه أنا عندي حوال خافي، مريض عنده حوال + +200 +00:14:10,910 --> 00:14:14,610 +خافي طالما هو خافي .. طالما هو خافي و مسيطر عليه + +201 +00:14:14,610 --> 00:14:19,690 +بواسطة ال fusion reflex .. مسيطر عليه بواسطة ال + +202 +00:14:19,690 --> 00:14:24,550 +fusion reflex، إذاإذا مش هيقدر المريض أو مش هييجي + +203 +00:14:24,550 --> 00:14:27,570 +المريض لإن هو مش شايف حوال و الناس اللي حواليه مش + +204 +00:14:27,570 --> 00:14:31,030 +شايفين عليه حوال و هو مابشكيش من أي أعراض بس هذا + +205 +00:14:31,030 --> 00:14:35,630 +الحوال الخفي عند ضعف الدماغ ببدأ ينهار الموضوع ال + +206 +00:14:35,630 --> 00:14:39,350 +fusion reflex و ببدأ الحوال الخفي يتحول ل + +207 +00:14:39,350 --> 00:14:42,310 +decompensating phoria يعني الفوريا المنهارة أو + +208 +00:14:42,310 --> 00:14:46,070 +الحوال الخفي المنهاراللي جاعت بتتحول بالتدريج لحوا + +209 +00:14:46,070 --> 00:14:50,230 +الظاهر بمعنى أخر بيبدأ فعلا ال visual access بتاع + +210 +00:14:50,230 --> 00:14:53,030 +عين من العنتين يزوغ عن ال visual access بتاع العين + +211 +00:14:53,030 --> 00:14:57,090 +التانية و بتبدأ أعراض زي أعراض الإرهاق البصري مش + +212 +00:14:57,090 --> 00:14:59,830 +جادر يركز في ال target اللي هو بيركز فيه سواء + +213 +00:14:59,830 --> 00:15:03,690 +جواله أو دراسته أو التلفزيون أو كده لفترات طويلة + +214 +00:15:03,690 --> 00:15:07,470 +بيبدأ one من ال visual access يزوغ يعني واحدة من + +215 +00:15:07,470 --> 00:15:10,990 +العنتين يزوغ وبالتالي بيبدأ يصير عندهم إرهاق عشان + +216 +00:15:10,990 --> 00:15:15,760 +يحكم العنتينإنهم يظلوا موجهات باتجاه ال target + +217 +00:15:15,760 --> 00:15:19,920 +بيبذل مجهود مضاعف وهذا بيسببله إرهاق بصري أو + +218 +00:15:19,920 --> 00:15:23,140 +الastinopia أو بيسموها astinopia أو ocular + +219 +00:15:23,140 --> 00:15:27,460 +discomfort عدم مراحة لما ينفذ حاجات بتتطلب مجهود + +220 +00:15:27,460 --> 00:15:31,360 +من العين زي الدراسة لجوال التلفزيون إلى آخرين أيضا + +221 +00:15:31,360 --> 00:15:35,160 +ممكن الزواغان يكون أشد من احتماله على السيطرة + +222 +00:15:35,160 --> 00:15:39,060 +فبالتالي بتبدأ أعراض الإزدواجية في النظر تظهر تبدأ + +223 +00:15:39,060 --> 00:15:43,490 +أعراض الإزدواجية في النظر تظهرزي ما احنا حكينا انه + +224 +00:15:43,490 --> 00:15:46,410 +في ال .. في ال normal binocular single vision طبعا + +225 +00:15:46,410 --> 00:15:50,710 +هذه الرسمة هنا .. هذا ال .. ال .. اللي انا بأشير + +226 +00:15:50,710 --> 00:15:54,350 +عليه هو ال nose .. ال nose هنا عندي ال visual axis + +227 +00:15:54,350 --> 00:15:57,610 +هنا عندي ال right eye عفوا و ال left eye هاي ال + +228 +00:15:57,610 --> 00:16:00,670 +visual axis بتاع ال right eye و هاي ال visual axis + +229 +00:16:00,670 --> 00:16:03,910 +بتاع ال left eye لازم يتقاطعوا في ال object اللي + +230 +00:16:03,910 --> 00:16:08,100 +بتطلع عليه هذا البني آدميعني لازم يتقاطعوا في ال + +231 +00:16:08,100 --> 00:16:12,800 +point of fixation هذا في ال normal person .. في ال + +232 +00:16:12,800 --> 00:16:16,780 +normal person وبالتالي لما بيصير عندي حول العين + +233 +00:16:16,780 --> 00:16:19,780 +زاغت مثلا العين الشمال زاغت لجوه معناته ال visual + +234 +00:16:19,780 --> 00:16:23,260 +axis بتاعه هيصير في الاتجاه هذا وبالتالي بتقاطعوش + +235 +00:16:23,260 --> 00:16:26,240 +في ال point of fixationطب لو صارت exo يعني العين + +236 +00:16:26,240 --> 00:16:29,020 +الشمال زاغت لبرا ساعتها ال visual axis بتاعها + +237 +00:16:29,020 --> 00:16:32,000 +هيصير بهذا الاتجاه اللي أنا بأشير فيه أيضا لن + +238 +00:16:32,000 --> 00:16:36,900 +يتقاقع ال two visual axis في ال point of fixation + +239 +00:16:36,900 --> 00:16:39,340 +هتكون عين من العين تانية مركزة على ال target + +240 +00:16:39,340 --> 00:16:43,360 +والعين التانية زاغة إما لجوه بيسمي easo أو لبرا + +241 +00:16:43,360 --> 00:16:47,920 +exo أو للأعلى hyper أو للأسفل hyper أو للأسفل + +242 +00:16:47,920 --> 00:16:52,860 +hyperطبعا الفوريا الحوالي الخافي ممكن تكون ايزو + +243 +00:16:52,860 --> 00:16:57,440 +فوريا او اكزو فوريا بس بدنا نبّه على قضية مهمة + +244 +00:16:57,440 --> 00:17:01,320 +للغاية ان ال ايزو فوريا او ال اكزو فوريا او ال + +245 +00:17:01,320 --> 00:17:06,240 +hyperfuria او ال hypofuria كل هؤلاء المرضى عندهم + +246 +00:17:06,240 --> 00:17:09,660 +فوريا فوريا يعني حوالي الخافي يعني هو هيدخل المركز + +247 +00:17:09,660 --> 00:17:14,000 +الصحي وعينيه عدلات ولن نستطيع ان نعرف انه عنده + +248 +00:17:14,000 --> 00:17:19,460 +ايزو فوريا او اكزو فوريا الا فقطفقط بفحصات معينة + +249 +00:17:19,460 --> 00:17:23,000 +هتيجي في وجدها و هنشرحها في وجدها when fusion is + +250 +00:17:23,000 --> 00:17:26,660 +insufficient لما يكون ال fusion mechanism او ال + +251 +00:17:26,660 --> 00:17:30,860 +fusion reflex مش كافي to control the imbalance مش + +252 +00:17:30,860 --> 00:17:34,880 +كافي للسيطرة على عدم الاتزان او على الفوريا ساعتها + +253 +00:17:34,880 --> 00:17:39,160 +الفوريا is described بنوصفها as decompensating + +254 +00:17:39,160 --> 00:17:45,210 +انها قاعدة بتنهار و بتتحول ل Trobia اذا الis + +255 +00:17:45,210 --> 00:17:48,350 +described as decompensating and is often + +256 +00:17:48,350 --> 00:17:52,350 +associated with symptoms of binocular discomfort + +257 +00:17:52,350 --> 00:17:56,050 +or double vision لما بيكون الزواغان بسيط ساعتها + +258 +00:17:56,050 --> 00:18:00,790 +الدماغ هيحاول يبذل مجهود مضاعف عشان يسيطر على + +259 +00:18:00,790 --> 00:18:05,670 +العنتين ويوازنهمبس ساعتها المريض هيحس نفسه مرهق و + +260 +00:18:05,670 --> 00:18:09,610 +لما يستعمل عينيك التنتين مع بعض على فكرة الإنسان + +261 +00:18:09,610 --> 00:18:14,230 +اللي عنده binocular discomfort يعني decompensating + +262 +00:18:14,230 --> 00:18:19,010 +phoria أدت ل binocular discomfort إنه مش مرتاح و + +263 +00:18:19,010 --> 00:18:21,970 +هو بيستخدم عينيك التنتين لو قلنا له مثلا امسك + +264 +00:18:21,970 --> 00:18:25,430 +الجوال أو القرآن أو أي شيء اقرأ فيه و غطي عين من + +265 +00:18:25,430 --> 00:18:30,660 +عينيك التنتينهيحس حاله أفضل وهذا بيأكد موضوع ليش + +266 +00:18:30,660 --> 00:18:34,040 +هيحس حاله أفضل لإنه مش مضطر يوازن العين المفتوحة + +267 +00:18:34,040 --> 00:18:36,960 +مع العين المغلقة العين المغلقة بطلت تستجبل صورة + +268 +00:18:36,960 --> 00:18:39,900 +فبالتالي هو قاعد بعتمد على عين واحدة في الرؤية + +269 +00:18:39,900 --> 00:18:44,700 +وهذا هيريحه مش هيحس أنه عينيه شدين عليه أحيانا ال + +270 +00:18:44,700 --> 00:18:49,000 +decompensating phoria بتكون شديدة لدرجة أن الدماغ + +271 +00:18:49,000 --> 00:18:54,800 +مش قادر يسيطر عليها وفي مرحلةيعني فقدان السيطرة + +272 +00:18:54,800 --> 00:18:57,600 +بيبدأ المريض يشكي من double vision أو انه بيشوف + +273 +00:18:57,600 --> 00:19:01,460 +الصورة سرتين و اللي هي مصطلحها العلمي diplopia .. + +274 +00:19:01,460 --> 00:19:06,760 +مصطلحها العلمي diplopia .. الآن خلينا احنانحكي عن + +275 +00:19:06,760 --> 00:19:10,040 +الـ heterotropia أو الحوال الظاهر اللي اختصارا + +276 +00:19:10,040 --> 00:19:13,880 +هنسميه Etropia احنا ال heterophoria الحوال الخفي + +277 +00:19:13,880 --> 00:19:17,720 +اللي قعدنا قبل شوية نحكي عنه اختصرناه بكلمة phoria + +278 +00:19:17,720 --> 00:19:21,140 +مش هنضلنا نقول heterophoria وإنما هيختصر ب phoria + +279 +00:19:21,140 --> 00:19:24,740 +ال heterotropia أيضا مش هنضلنا نقول heterotropia + +280 +00:19:24,740 --> 00:19:28,740 +وإنما هنقول Etropia اختصارا يعني حوال ظاهر الحوال + +281 +00:19:28,740 --> 00:19:33,720 +الظاهر بكل ما تعنيه كلمة ظاهر بمعنى انه كل الناس + +282 +00:19:33,720 --> 00:19:39,820 +عارفة انهالمريض الفلاني مثلا عنده حوال في عين من + +283 +00:19:39,820 --> 00:19:44,300 +العنتين بمعنى أن عينه يعني منحرفة بمقارنة مع العين + +284 +00:19:44,300 --> 00:19:49,240 +التانية الآن في عندي أربع مصطلحات احنا مرت علينا + +285 +00:19:49,240 --> 00:19:53,840 +بينا نذكر فيها ال orthophoriaالـ heterophoria الـ + +286 +00:19:53,840 --> 00:19:57,500 +decompensating phoria والتروبيا خلّيني أحكيها مرة + +287 +00:19:57,500 --> 00:20:01,420 +تانية باختصارات ال orthophoria لا تختصر وقلنا قلة + +288 +00:20:01,420 --> 00:20:05,180 +من الناس قليلة عندها orthophoria بمعنى أن العينين + +289 +00:20:05,180 --> 00:20:09,340 +ما شاء الله بعد إجراء جميع الفحوصات لا يوجد عنده + +290 +00:20:09,340 --> 00:20:13,840 +أي نوع من الحوى لا خفي ولا ظاهر هذه النوع الأول + +291 +00:20:13,840 --> 00:20:18,550 +النوع التاني وهذا قلة من البشر النوع التانيبيشمل + +292 +00:20:18,550 --> 00:20:21,850 +غالبية البشر اللي هم اللي عندهم phoria ال phoria + +293 +00:20:21,850 --> 00:20:24,850 +اللي هو وجود حوال خفي مسيطر عليه من قبل الدماغ + +294 +00:20:24,850 --> 00:20:30,250 +النوع التالت اللي هو ال decompensating phoria حوال + +295 +00:20:30,250 --> 00:20:35,510 +خفي أيضا ولكن بدأ يفقد الدماغ السيطرة نتيجة إرهاق + +296 +00:20:35,510 --> 00:20:39,050 +أو تعب أو ارتفاع في درجة الحرارة أو كذا و النوع + +297 +00:20:39,050 --> 00:20:43,330 +الرابع بتكون الأمور يعني بالنسبة للدماغ و لل + +298 +00:20:43,330 --> 00:20:47,380 +fusion reflex فشلت بشكليعني كامل و المريض أصبح + +299 +00:20:47,380 --> 00:20:52,280 +عنده حوالظاهر لا .. لا يوجد أي .. يعني لا يحتاج + +300 +00:20:52,280 --> 00:20:57,480 +إلى كبير مهارة في اكتشافه ال heterotopia implies + +301 +00:20:57,480 --> 00:21:01,580 +manifest deviation manifest deviation بمعنى انه + +302 +00:21:01,580 --> 00:21:05,780 +حوالظاهر in which the two visual axes do not + +303 +00:21:05,780 --> 00:21:09,540 +intersect at the point of fixation at the point of + +304 +00:21:09,540 --> 00:21:15,240 +fixation تمام طالما .. طالما كل visual axesموجه + +305 +00:21:15,240 --> 00:21:21,600 +باتجاه مختلف عن ال visual axis التاني في الفراغ + +306 +00:21:21,600 --> 00:21:25,440 +معناته ال images from the two eyes are misaligned + +307 +00:21:25,440 --> 00:21:30,640 +الصورة بتسبط على شبكية العين اللي نقول ال fixating + +308 +00:21:30,640 --> 00:21:34,700 +eye سواء right أو leftالـ fixating eye بتسقط عليها + +309 +00:21:34,700 --> 00:21:38,380 +الصورة على الفوفيا بينما الـ non-fixating eye + +310 +00:21:38,380 --> 00:21:42,380 +العين اللي فيها الحوال بتسقط على extra foveal area + +311 +00:21:42,380 --> 00:21:46,840 +أو non-foveal area برا الفوفيا وبالتالي سترسل هذه + +312 +00:21:46,840 --> 00:21:52,240 +الصور إلى مناطق مختلفة من التحليل في ال visual + +313 +00:21:52,240 --> 00:21:55,980 +cortex ولن يتم damageها لأنها مش ثابتة على مناطق + +314 +00:21:55,980 --> 00:22:00,790 +متماثلةمن شبكية العنتين طالما مش هيتم damageها + +315 +00:22:00,790 --> 00:22:04,770 +هتظل الصورتين صورتين فبالتالي هيصير عندي double + +316 +00:22:04,770 --> 00:22:09,890 +vision او diplopia او عند الأطفال الدماغ ممكن يعني + +317 +00:22:09,890 --> 00:22:14,670 +.. يعني يقوم بعملية تسمى ال suppression ايقاف + +318 +00:22:14,670 --> 00:22:19,870 +استقبال صورة او رفض صورة من الدماغ طبعا غالبا بس + +319 +00:22:19,870 --> 00:22:23,490 +مش دائما غالبا بتكون الصورة من ال deviating eye + +320 +00:22:23,490 --> 00:22:26,860 +العين اللي فيها الانحرافبيوجفها دماغ وبيقول طالما + +321 +00:22:26,860 --> 00:22:32,400 +بدها تيجي بشكل مش سليم معناته بدها بيوجفها وهذا + +322 +00:22:32,400 --> 00:22:35,140 +بيحدث غالبا عند الأطفال عشان هيك الأطفال بيشكوش من + +323 +00:22:35,140 --> 00:22:40,220 +أزدواجية بتكون العين مفتوحة وفيها حوال و الدماغ + +324 +00:22:40,220 --> 00:22:42,980 +بيستقبل من العين السليمة اللي هي المعتدلة أو اللي + +325 +00:22:42,980 --> 00:22:46,560 +عاملة fixation و هذه العملية بيسموها suppression و + +326 +00:22:46,560 --> 00:22:49,300 +هذه العملية هي العملية الغالبة عند الأطفال عشان + +327 +00:22:49,300 --> 00:22:52,940 +هيك الأطفال اللي عندهم حوال ظاهر نادر جدا من + +328 +00:22:52,940 --> 00:22:56,310 +الأطفالإنه ييجي طفل مثلا عمره ست سنوات أو سبع + +329 +00:22:56,310 --> 00:23:01,390 +سنوات و يشكي من ازدواجية في النظر بينما الكبار + +330 +00:23:01,390 --> 00:23:05,410 +غالبا لما بيسير معاه حول غالبا بيشكي .. غالبا + +331 +00:23:05,410 --> 00:23:12,270 +بيشكي من ازدواجية في النظر هنتوقف عند الأسباب اللي + +332 +00:23:12,270 --> 00:23:16,510 +ممكن تأدي لظهور الحول و يعطيكم العافية .. السلام + +333 +00:23:16,510 --> 00:23:16,930 +عليكم + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/TgoRbAOiFTg_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/TgoRbAOiFTg_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..64ac25e9b8569c098667b30503654b12fa01ae3f --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/TgoRbAOiFTg_postprocess.srt @@ -0,0 +1,160 @@ +1 +00:00:02,230 --> 00:00:06,350 +بسم الله الرحمن الرحيم اليوم ده نعرف كيف ال + +2 +00:00:06,350 --> 00:00:10,490 +pagolini striated glasses بتعمل بنقول pagolini + +3 +00:00:10,490 --> 00:00:16,070 +striated glasses عبارة عن نضارة في كل عدسة من + +4 +00:00:16,070 --> 00:00:20,620 +عدساتها فيه striationهذه الـ striation مثلا لإحدى + +5 +00:00:20,620 --> 00:00:25,480 +الأنتين ميلة على زاوية 45 وهذه ميلة باتجاه 135 + +6 +00:00:25,480 --> 00:00:29,400 +يعني اتجاه ال striation هنا التخطيطات عمودي على + +7 +00:00:29,400 --> 00:00:32,540 +اتجاه التخطيطات في العدسات التانية ايش هي + +8 +00:00:32,540 --> 00:00:35,400 +التخطيطات المادوكس رود بيوضح لي هذه القضية انا + +9 +00:00:35,400 --> 00:00:38,660 +بقدر استخدم double مادوكس رود عشان تشوف ال + +10 +00:00:38,660 --> 00:00:41,640 +striation زي ما احنا شايفين هنا التخطيطات عبارة عن + +11 +00:00:41,640 --> 00:00:47,020 +يعني فواصل اوكل واحدة عبارة عن cylinder كل واحدة + +12 +00:00:47,020 --> 00:00:51,420 +عبارة عن cylinder طيب هنا ممكن تكون أمام عين ميلة + +13 +00:00:51,420 --> 00:00:57,140 +على 135 زي ما احنا شايفين و ممكن تسير قدام العين + +14 +00:00:57,140 --> 00:01:00,440 +التانية ميلة على 45 زي ما احنا شايفين اتجاه ال + +15 +00:01:00,440 --> 00:01:04,120 +استرياشي الان ايش اللي بيحصل عندى ايش اللي بيحصل + +16 +00:01:04,120 --> 00:01:11,280 +عندى لما انا بتطلع على الضوء هذا الضوء هذا الضوء + +17 +00:01:12,160 --> 00:01:16,360 +لما انا باطلع عليه ال maddox rod او ال bageline + +18 +00:01:16,360 --> 00:01:19,620 +striated glasses بتحوله ل streak بتحوله ل line of + +19 +00:01:19,620 --> 00:01:23,100 +light هذا ال line of light عمودي على اتجاه ال + +20 +00:01:23,100 --> 00:01:26,380 +striation عمودي على اتجاه ال striation زي ما احنا + +21 +00:01:26,380 --> 00:01:30,400 +شايفين زي ما احنا شايفين لو غيرت اتجاه ال + +22 +00:01:30,400 --> 00:01:35,000 +striation هذا ال spot of light بتغير بيصير عمودي + +23 +00:01:35,000 --> 00:01:40,000 +على اتجاه ال striation دائما و ابدا دائما و ابدا + +24 +00:01:40,240 --> 00:01:47,040 +فاللي هيحصل اللي هيحصل ان العين اليمين هتشوف خط + +25 +00:01:47,040 --> 00:01:52,740 +بالشكل هذا مضيق والعين الشمال هتشوف خط بالشكل هذا + +26 +00:01:52,740 --> 00:01:57,700 +إذا كان شاف cross وفات عين التنتين معناته عنده + +27 +00:01:57,700 --> 00:02:02,650 +binocular single vision إذا شاف خطمائل على هذا + +28 +00:02:02,650 --> 00:02:05,750 +الاتجاه معناته هذا العين شافته معناته هذا العين + +29 +00:02:05,750 --> 00:02:08,650 +شافته و العين التانية فيها suppression اذا شاف بس + +30 +00:02:08,650 --> 00:02:12,630 +الخط هذا بدون الخط هذا معناته العين هيشغالة و + +31 +00:02:12,630 --> 00:02:16,230 +العين هيفيها suppression دائما نتذكر ان الخط + +32 +00:02:16,230 --> 00:02:20,270 +المضيق اللي بنشوفه هو عمودي على اتجاه الastration + +33 +00:02:20,270 --> 00:02:25,410 +زي ما احنا هنا بال Maddox road وضحنا هاي انا عند + +34 +00:02:25,410 --> 00:02:29,590 +الastration لها اتجاه معين واضح اتجاه الastration + +35 +00:02:29,590 --> 00:02:33,880 +واضح اتجاهالـ line of light إنه متعمدين على بعضهم + +36 +00:02:33,880 --> 00:02:38,480 +البعض طيب لو خلنا احنا مثلا على تسعين درجة هنلاقي + +37 +00:02:38,480 --> 00:02:43,220 +الضوء صار أفقي لو خلناه ع مية و تمانين درجة هنلاقي + +38 +00:02:43,220 --> 00:02:46,920 +الضوء صار عمودي وهذه فكرة الباجولين استراييت ال + +39 +00:02:46,920 --> 00:02:50,200 +glasses يعطيكم العافية والسلام عليكم ورحمة الله + +40 +00:02:50,200 --> 00:02:51,240 +وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/VO318morVKE_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/VO318morVKE_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..283db78b1fa5b92ecdfe42a2f5fd5fe22a697b9d --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/VO318morVKE_postprocess.srt @@ -0,0 +1,1412 @@ +1 +00:00:02,070 --> 00:00:06,750 +بسم الله الرحمن الرحيم نستكمل مع محاضرات حوال واحد + +2 +00:00:06,750 --> 00:00:10,530 +ووصلنا عند ال virgins اللي هي تاني نوع من أنواع + +3 +00:00:10,530 --> 00:00:14,370 +حركة العين النوع الأول اللي هو the ducations + +4 +00:00:14,370 --> 00:00:18,510 +وقولنا هو عبارة عن monocular movements in by + +5 +00:00:18,510 --> 00:00:22,370 +particular direction of gaze يعني حركة العين واحدة + +6 +00:00:22,370 --> 00:00:26,790 +في اتجاه معين بمعنى اخر ان العين التانية بدها تغلق + +7 +00:00:26,790 --> 00:00:33,370 +باليد او بلاسق او ما شابهال virgins تعريفها بيشمل + +8 +00:00:33,370 --> 00:00:37,550 +على تلت كلمات مهمة virgins are binocular هاي أول + +9 +00:00:37,550 --> 00:00:42,870 +كلمة simultaneous هاي تاني كلمة conjugate هاي تلت + +10 +00:00:42,870 --> 00:00:46,350 +كلمة movements in the same direction conjugate + +11 +00:00:46,350 --> 00:00:51,130 +movement يعني تعني in the same directionحركة ال + +12 +00:00:51,130 --> 00:00:54,850 +virgins عبارة عن binocular يعني بالعين تان، بعين + +13 +00:00:54,850 --> 00:00:58,650 +واحدة لا تتم لأنه بتصير .. ساعتها بتصير reduction، + +14 +00:00:58,650 --> 00:01:02,070 +اذا ان هي binocular simultaneous في نفس اللحظة + +15 +00:01:02,070 --> 00:01:05,310 +بتحدث عمره انسان ما اتطلع على اليمين، احنا نحكي + +16 +00:01:05,310 --> 00:01:07,610 +على الوضع الطبيعي، مثلا اتطلع على اليمين، عينه + +17 +00:01:07,610 --> 00:01:10,550 +اليمين راحت لليمين و بعدها بتجيجلح حاجات عينه + +18 +00:01:10,550 --> 00:01:13,670 +الشمال، طبعا هذا الكلام مابيصيرش، اذا ان هي + +19 +00:01:13,670 --> 00:01:17,430 +binocular، ال virgins هي binocularsimultaneous + +20 +00:01:17,430 --> 00:01:20,730 +يعني في نفس اللحظة conjugate في نفس الاتجاه + +21 +00:01:20,730 --> 00:01:25,160 +movements يعني in the same directiondextroversion + +22 +00:01:25,160 --> 00:01:28,360 +and levoversion اللي هي gaze right و gaze left + +23 +00:01:28,360 --> 00:01:31,840 +يعني dextroversion لما الإنسان بتطلع بعيني التنتين + +24 +00:01:31,840 --> 00:01:37,080 +باتجاه اليمين levoversion لما بتطلع بعيني التنتين + +25 +00:01:37,080 --> 00:01:40,860 +باتجاه الشمال اللي هم بيسموهم باللغة الإنقليزية + +26 +00:01:40,860 --> 00:01:46,100 +right gaze و left gaze بالاسم أو بالمصطلح العلمي + +27 +00:01:46,100 --> 00:01:49,160 +ال right gaze بيسميه dextroversion و ال left gaze + +28 +00:01:49,160 --> 00:01:54,620 +بيسميه levoversion ال elevation بيسموها up gazeوال + +29 +00:01:54,620 --> 00:01:58,780 +depression بيسموها down gaze هدول الأربع .. الأربع + +30 +00:01:58,780 --> 00:02:04,280 +مواقع بي .. بينقلوا العينتين لما يسمى .. إلى ما + +31 +00:02:04,280 --> 00:02:08,300 +يسمى بال secondary positions of gaze these four + +32 +00:02:08,300 --> 00:02:12,100 +movements bring the globe into the secondary + +33 +00:02:12,100 --> 00:02:15,620 +positions of gaze by rotation around either + +34 +00:02:15,620 --> 00:02:20,760 +vertical z axis or horizontal x axis of it خلينا + +35 +00:02:20,760 --> 00:02:22,440 +نشوف هذه الأربع مواقع + +36 +00:02:26,190 --> 00:02:30,290 +و نطلع على التكبير عشان يوضح أكتر بنقول + +37 +00:02:30,290 --> 00:02:34,010 +Dextroversion هي بتطلع بعينيه التنتين لليمين + +38 +00:02:34,010 --> 00:02:40,210 +Levoversion بتطلع بعينيه التنتين للشمال elevation + +39 +00:02:40,210 --> 00:02:44,490 +بتطلع بعينيه لفوق و depression بتطلع بعينيه لتحت + +40 +00:02:44,490 --> 00:02:48,670 +هدول الأربع مواقع له هذا الموقع اليمين نظر لليمين + +41 +00:02:48,670 --> 00:02:54,880 +للشمال لفوق لتحت هذه بيسموهsecondary positions of + +42 +00:02:54,880 --> 00:02:58,480 +gaze وزي انتم ملاحظين انا كاتب الرقم اتنين عشان + +43 +00:02:58,480 --> 00:03:02,320 +نقول انه هذه secondary positions of gaze ال + +44 +00:03:02,320 --> 00:03:04,960 +tertiary positions of gaze اللي هي الأربعة اللي + +45 +00:03:04,960 --> 00:03:07,720 +ضايلة طبعا هذا ال primary position هذا حياجين + +46 +00:03:07,720 --> 00:03:10,480 +المريض فيه هذه الأربعة اللي ضايلة ال tertiary + +47 +00:03:10,480 --> 00:03:14,940 +position هنحكي عنها لاحقا طب ليش هذه سميناها + +48 +00:03:14,940 --> 00:03:19,750 +secondary positions لأن اي واحد من الأربعمواقع + +49 +00:03:19,750 --> 00:03:23,150 +اللي بتذهب لهم العين اللي انا بأشر عليهم ال up و + +50 +00:03:23,150 --> 00:03:28,290 +ال down و ال right و ال leftبيتم بواسطة حركة + +51 +00:03:28,290 --> 00:03:32,390 +العنتين حوالين محور واحد فقط من محاور الحركة + +52 +00:03:32,390 --> 00:03:35,930 +التلاتة احنا محاور الحركة التلاتة عارفين انهم اللي + +53 +00:03:35,930 --> 00:03:40,990 +هو ال z axis اللي هو عمودي بتتم حواليه الحركة .. + +54 +00:03:40,990 --> 00:03:43,490 +حركة ال adoption و ال abduction بس احنا اليوم مش + +55 +00:03:43,490 --> 00:03:45,950 +هنسميها adoption و abduction .. و abduction + +56 +00:03:45,950 --> 00:03:49,290 +هنسميها right و left اذا هدولة ال .. ال two + +57 +00:03:49,290 --> 00:03:53,530 +positions اللي هو dextroversion او right gazeو ال + +58 +00:03:53,530 --> 00:03:56,770 +leave of version بتتم حوالين المحور العمودي يعني + +59 +00:03:56,770 --> 00:04:00,030 +العين بتلف حوالين المحور العمودي كل عين بتلف + +60 +00:04:00,030 --> 00:04:04,190 +حوالين المحور العمودي Z وهنا نفس الأشياء كل عين + +61 +00:04:04,190 --> 00:04:08,330 +بتلف حوالين المحور العمودي Z بينما ال elevation و + +62 +00:04:08,330 --> 00:04:12,530 +ال depression بتتم حوالين المحور العمودي X المحور + +63 +00:04:12,530 --> 00:04:17,880 +العموديX وبالتالي هدولة الأربع مواقع بسميهم + +64 +00:04:17,880 --> 00:04:22,280 +secondary positions of gaze لأن فيهم الانتين + +65 +00:04:22,280 --> 00:04:28,120 +بيدوروا حوالين محور واحد من المحاور إما حوالين Z + +66 +00:04:28,120 --> 00:04:32,940 +إما حوالين Z زي ال right gaze و ال left gaze أو + +67 +00:04:32,940 --> 00:04:38,980 +حوالين X يعني زي ال up gaze و ال down gaze نطلع من + +68 +00:04:38,980 --> 00:04:40,460 +العرض و نرجع نكمل + +69 +00:04:44,310 --> 00:04:47,730 +هي عندى الأربع مواقع بس مرسومين فوق بعض هنا ال + +70 +00:04:47,730 --> 00:04:52,730 +right gaze هنا ال left gazeهنا ال up gaze وهنا ال + +71 +00:04:52,730 --> 00:04:55,870 +down gaze الملاحظين انا عشان اخلي المريض يتطلع + +72 +00:04:55,870 --> 00:05:00,190 +لازم استخدم اداء تجفي بانتباه المريض في هذه الحالة + +73 +00:05:00,190 --> 00:05:03,910 +الصورة بتبين انه فيه torch ضوء انا بخلي المريض + +74 +00:05:03,910 --> 00:05:07,410 +يتتبع جلم الضوء او ال pin torch بتاعي هاي ال pin + +75 +00:05:07,410 --> 00:05:10,670 +torch جاي من اليمين فهو هيتطلع على اليمين الصورة + +76 +00:05:10,670 --> 00:05:13,870 +التانية جاي من الشمال الصورة التالتة جاي من اعلى + +77 +00:05:13,870 --> 00:05:18,700 +فالمريض بتطلع عليه الصورة الأخيرة جاي من أسفلright + +78 +00:05:18,700 --> 00:05:23,280 +gaze او dextroversion, levoversion, up gaze او + +79 +00:05:23,280 --> 00:05:26,620 +elevation, down gaze او depression هدولة بيسموهم + +80 +00:05:26,620 --> 00:05:31,240 +secondary positions of gaze طبعا في ال right gaze + +81 +00:05:31,240 --> 00:05:35,200 +و ال left gaze الدوران بيتم دوران العين و حركة + +82 +00:05:35,200 --> 00:05:39,280 +العين حوالين ال vertical axis X و في ال elevation + +83 +00:05:39,280 --> 00:05:43,820 +و ال depression بيتم حوالين ال horizontal axis X + +84 +00:05:43,820 --> 00:05:50,210 +هنا حوالين Z و هنا حوالين Xdextro elevation، الآن + +85 +00:05:50,210 --> 00:05:54,530 +نحكي عن الأربع مواقع اللي ضالت، اللي هي dextro + +86 +00:05:54,530 --> 00:05:59,450 +elevation، dextro depression، levo elevation، + +87 +00:05:59,450 --> 00:06:02,870 +levodepression، نقولها باللغة الإنجليزية، مش + +88 +00:06:02,870 --> 00:06:06,030 +بالمصطلح العلمي، dextro elevation يعني up and + +89 +00:06:06,030 --> 00:06:11,090 +right، لفوق وعاليمين، dextro depression يعني down + +90 +00:06:11,090 --> 00:06:16,710 +and right، يعني لتحت وعاليمينLevo elevation عشمال + +91 +00:06:16,710 --> 00:06:20,930 +ولا فوق Levo depression عشمال ولا تحت عشمال ولا + +92 +00:06:20,930 --> 00:06:25,370 +تحت هذه المواقع بيسموها tertiary positions of gaze + +93 +00:06:25,370 --> 00:06:29,770 +المواقع اللي هي ال tertiary position of gaze إذا + +94 +00:06:29,770 --> 00:06:33,530 +عندي تلت أصناف من الواقع عندي ال primary position + +95 +00:06:33,530 --> 00:06:37,450 +اللي هو وضع فيه العينين بيكونوا مستقيمات اللي هو + +96 +00:06:37,450 --> 00:06:40,030 +الوضع اللي هيجيني فيه المريض المريض هييجي بالوضع + +97 +00:06:40,030 --> 00:06:43,750 +هذا لما ببدأ أختبر حركات العينتين أو ال virgin + +98 +00:06:43,750 --> 00:06:48,180 +هاخبره فيهتمن مواقع أخرى فبيكمل عندي بالإضافة لهذا + +99 +00:06:48,180 --> 00:06:52,800 +الموقع مع التمن مواقع بيصير عندي nine positions of + +100 +00:06:52,800 --> 00:06:56,400 +gaze ال primary position و أربعة secondary + +101 +00:06:56,400 --> 00:07:01,140 +positions اللي هو right و left و up و down و أربعة + +102 +00:07:01,140 --> 00:07:04,040 +tertiary positions واحد زائد أربعة زائد أربعة + +103 +00:07:04,040 --> 00:07:07,840 +بيصير عندي تسعة بيسموهم diagnostic positions of + +104 +00:07:07,840 --> 00:07:11,550 +gaze nine diagnostic positions of gazeطيب ليش احنا + +105 +00:07:11,550 --> 00:07:15,210 +الأربع مواقع اللي ضلت سميناها tertiary positions + +106 +00:07:15,210 --> 00:07:19,130 +of gaze ليش ما سميناها secondary لأن العلماء + +107 +00:07:19,130 --> 00:07:23,530 +بيقولوا ان عشان العين تصل لهذا الموقع لازم تتحرك + +108 +00:07:23,530 --> 00:07:27,670 +حوالين محورين من محاور الحركة يعني نجيب مثلا العين + +109 +00:07:27,670 --> 00:07:31,890 +اليمين في ال up and right لازم تتحرك لبرا حوالين z + +110 +00:07:31,890 --> 00:07:35,930 +axis صارت لبرا و بعدين تطلع لفوق حوالين x axis و + +111 +00:07:35,930 --> 00:07:41,620 +كأنها اتحركت حوالين z and x axisz and x axis هنا + +112 +00:07:41,620 --> 00:07:45,660 +نفس القضية بدها تيجي لجوا يعني بتتحرك حوالين z + +113 +00:07:45,660 --> 00:07:50,100 +axis بدها تطلع لفوق حوالين x axis طبعا الحركة + +114 +00:07:50,100 --> 00:07:54,260 +الرأسية حوالين محور عرضي والحركة العرضية حوالين + +115 +00:07:54,260 --> 00:07:59,700 +محور رأسي هذا الكلام مفهوم من اللي هو الهندسة + +116 +00:07:59,700 --> 00:08:06,460 +ويعني الحركة حاول المحاول الحركة حاول المحاول + +117 +00:08:08,070 --> 00:08:11,510 +dextro elevation and dextro depression، ال dextro + +118 +00:08:11,510 --> 00:08:13,850 +elevation اللي هي up and right، و ال dextro + +119 +00:08:13,850 --> 00:08:16,810 +depression اللي هي down and right، and levo + +120 +00:08:16,810 --> 00:08:21,890 +elevation and levodepression، اللي هي up and left، + +121 +00:08:21,890 --> 00:08:25,130 +و ال levodepression down and left، هدول الأربع + +122 +00:08:25,130 --> 00:08:28,710 +مواقع، these four oblique movements، oblique + +123 +00:08:28,710 --> 00:08:31,750 +movements هذه المحاور المائلة أو المواقع المائلة + +124 +00:08:31,750 --> 00:08:36,610 +هنا و هنا و كأنه العين راحت هيك باتجاه فوقأو راحت + +125 +00:08:36,610 --> 00:08:40,210 +هيك باتجاه فوق أو راحت هيك باتجاه فوق أو راحت .. + +126 +00:08:40,210 --> 00:08:44,130 +يعني ما نزلت straight ولا طلعت straight فبالتالي + +127 +00:08:44,130 --> 00:08:47,290 +ولا راحت شمال straight أو يمين straight وكانها + +128 +00:08:47,290 --> 00:08:51,370 +راحت بشكل oblique بشكل مباشر هيك oblique يعني مائل + +129 +00:08:51,370 --> 00:08:57,370 +بشكل مائل فبالتالي هذه المواقع الأربعة these four + +130 +00:08:57,370 --> 00:09:01,690 +oblique movements bring the eyes into the tertiary + +131 +00:09:01,690 --> 00:09:06,030 +positions of gaze by rotationaround oblique axis + +132 +00:09:06,030 --> 00:09:10,230 +lying in listing plane equivalent وكأنها اتحركت + +133 +00:09:10,230 --> 00:09:16,210 +حوالين محور مائل موجود في ال .. موجود في ال + +134 +00:09:16,210 --> 00:09:21,810 +listing plane وكأنه اتحركت حوالين محور خاص هذا + +135 +00:09:21,810 --> 00:09:26,930 +المحور مائل وهو يكافئ simultaneous movement about + +136 +00:09:26,930 --> 00:09:30,610 +both horizontal and vertical axis يعني احنا ممكن + +137 +00:09:30,610 --> 00:09:36,110 +نقول لو جينا حابنا نوصفهذا ال position of gaze، + +138 +00:09:36,110 --> 00:09:40,510 +هذه النظرة من العنتين right and up، بنقول .. ممكن + +139 +00:09:40,510 --> 00:09:44,790 +نقول ببساطة أن العنتين اتحركوا حوالين محور ما بهذا + +140 +00:09:44,790 --> 00:09:49,470 +الاتجاه أو ممكن نقول العنتين راحوا rightالاتنين + +141 +00:09:49,470 --> 00:09:53,850 +راحوا right في الأول حوالين z axis ثم اتجهوا + +142 +00:09:53,850 --> 00:09:58,490 +للأعلى حوالين x axis وكأنه اتحركوا حوالين محورين + +143 +00:09:58,490 --> 00:10:02,130 +من محاور الحركة وعشان هيك طالما الحركة حوالين + +144 +00:10:02,130 --> 00:10:05,710 +محورين في نفس اللحظة معناته هذا مش secondary + +145 +00:10:05,710 --> 00:10:10,870 +position وإنما tertiary position of gaze tertiary + +146 +00:10:10,870 --> 00:10:15,010 +position of gaze هاي احنا جمعناهم في صور up and + +147 +00:10:15,010 --> 00:10:21,310 +right down and right up and leftdown and left up + +148 +00:10:21,310 --> 00:10:25,110 +and right لفوق وعاليمين down and right لتحت + +149 +00:10:25,110 --> 00:10:29,750 +وعاليمين up and left لفوق وعالشمال down and left + +150 +00:10:29,750 --> 00:10:34,170 +لتحت وعالشمال بالمصطلح العلمي dextro elevation, + +151 +00:10:34,950 --> 00:10:39,070 +dextro depression, levo elevation, levo depression + +152 +00:10:39,070 --> 00:10:42,950 +هذي tertiary positions ofof gaze هدى ال tertiary + +153 +00:10:42,950 --> 00:10:47,650 +positions of gaze هنا رسمها بالألوان انه بتوضح + +154 +00:10:47,650 --> 00:10:50,710 +لإنه العينين من ال primary position ممكن يروحوا لل + +155 +00:10:50,710 --> 00:10:55,730 +left side left gaze هدى اللى هى الأسهم البنافسجية + +156 +00:10:55,730 --> 00:10:59,770 +هدى بيسموها levoversion أو الأسهم الزهرية بيسموها + +157 +00:10:59,770 --> 00:11:05,080 +dextroversionأو الأسهم البيضة بيسموها elevation أو + +158 +00:11:05,080 --> 00:11:13,940 +الأسهم الزرقاء depression أحيانا ايضا نشوف الأسهم + +159 +00:11:13,940 --> 00:11:16,840 +الخضراء هذه العين عملت intortion وهذه extortion + +160 +00:11:16,840 --> 00:11:21,760 +هذا بيسموه dextrocyclovergenأو الأسهم الزرقاء أو + +161 +00:11:21,760 --> 00:11:28,540 +السماوية يعني يدوبها واضحة اللي هي levocyclovirgin + +162 +00:11:28,540 --> 00:11:32,400 +وقولنا احنا ال cyclovertical أو ال cyclovirgin + +163 +00:11:32,400 --> 00:11:36,940 +يعني غالبا بيبينش في الوضع الطبيعي و ممكن يبين في + +164 +00:11:36,940 --> 00:11:42,780 +بعض الحالات المرضية على العموم سواء الرسمات هاي + +165 +00:11:42,780 --> 00:11:49,430 +اللي احنا استعرضناها أو الرسمة هايبتوضح أن العنتين + +166 +00:11:49,430 --> 00:11:53,130 +لازم يكونوا مفتوحات، هاي نقطة، النقطة التانية لازم + +167 +00:11:53,130 --> 00:11:56,570 +يتحركوا في نفس الاتجاه، النقطة التالتة لازم + +168 +00:11:56,570 --> 00:12:00,190 +يتحركوا في نفس اللحظة وهذا هو تعريف ال virgin، كل + +169 +00:12:00,190 --> 00:12:04,030 +ما سوى ذلك معناته مش virgin ال virgins لازم تكون + +170 +00:12:04,030 --> 00:12:07,450 +binocular، هاي أول شرط فيها، تاني شرط فيها لازم + +171 +00:12:07,450 --> 00:12:10,150 +تكون simultaneous، يعني تحدث في نفس اللحظة، يعني + +172 +00:12:10,150 --> 00:12:13,650 +مافيش عين بتتأخر عن عين في الحركةيعني لو حب هذا + +173 +00:12:13,650 --> 00:12:17,610 +المريض أو واطناه هنا target يتطلع عليه على شماله + +174 +00:12:17,610 --> 00:12:21,150 +عشان يعملنا leave و virgin ما بنلاحظ أنه مثلا + +175 +00:12:21,150 --> 00:12:24,370 +العين الشمال راحت و لسه العين اليمين واقفة في النص + +176 +00:12:24,370 --> 00:12:27,430 +طبعا في الوضع الطبيعي لأن في .. في .. في بعض + +177 +00:12:27,430 --> 00:12:31,930 +الأمراض بيصير هذا الكلام لازم في ال virgin الطبيعي + +178 +00:12:31,930 --> 00:12:34,950 +أنه العنتين راحوا على الشمال معناته في نفس الاتجاه + +179 +00:12:35,140 --> 00:12:41,620 +و في نفس اللحظة .. في نفس اللحظة و التنتين مع بعض + +180 +00:12:41,620 --> 00:12:44,860 +مش عين واحدة لإن لو واحدة هي اللي اتحركت و التانية + +181 +00:12:44,860 --> 00:12:48,480 +مغطية ده بسميها induction movements اللي هي النوع + +182 +00:12:48,480 --> 00:12:52,420 +الأول اللي اتحدثنا عنه المحاضرة الماضية إذا هذا + +183 +00:12:52,420 --> 00:12:56,880 +بالنسبة ل ال virgin إذا torsional movement من .. + +184 +00:12:56,880 --> 00:13:00,920 +اللي هو ال cycloversionالديكسترو سايكلو فيرجين + +185 +00:13:00,920 --> 00:13:04,300 +والليفو سايكلو فيرجين ان الانتين يعملوا torsion + +186 +00:13:04,300 --> 00:13:08,760 +لليمين يعني اليمين تعمل X-torsion والشمال تعمل N + +187 +00:13:08,760 --> 00:13:12,600 +-torsion أو الليفو سايكلو فيرجين الشمال تعمل X + +188 +00:13:12,600 --> 00:13:15,680 +-torsion واليمين تعمل N-torsion هذه ال torsional + +189 +00:13:15,680 --> 00:13:18,880 +movements to maintain a bright image or care on + +190 +00:13:18,880 --> 00:13:22,330 +tilting the headthese are known as the writing + +191 +00:13:22,330 --> 00:13:27,270 +reflexes هذه الحاجات تسمى ردود الأفعال التصحيحية + +192 +00:13:27,270 --> 00:13:31,710 +إيش يعني ردود الأفعال التصحيحية؟ بنقول كالقاتي + +193 +00:13:31,710 --> 00:13:39,890 +ناخد المثال من الصورة هاي بنقول هذه الشخص في + +194 +00:13:39,890 --> 00:13:44,050 +البداية يعني بتطلع straight ahead قدامه مثلا شجرة + +195 +00:13:44,050 --> 00:13:50,780 +أو بناء وهو بتطلع على هذا البناء فجأة لسببأو لآخر + +196 +00:13:50,780 --> 00:13:57,620 +راسه تعبت كذا فميل راسه على اليمين تلقائيًا + +197 +00:13:57,620 --> 00:14:01,300 +العنتين بيميلوا عكس ميلان الراس عشان يحافظوا على + +198 +00:14:01,300 --> 00:14:05,740 +صورة الشجرة أو البناء اللي هو بتطلع عليه انه يضلوا + +199 +00:14:05,740 --> 00:14:10,080 +صورة الشجرة أو البناء على نفس الموقع من الشبكية + +200 +00:14:10,080 --> 00:14:15,100 +عشان يضلها وضع الصورة أو رؤيته للصورة بشكل صحيح + +201 +00:14:15,100 --> 00:14:18,450 +عشان هيك بتسمى writing reflexesردود الأفعال + +202 +00:14:18,450 --> 00:14:22,230 +التصحيحية، لو لاحدث هذه الحركات اللي احنا شايفينها + +203 +00:14:22,230 --> 00:14:26,050 +أو ممثلة بأسهم، كان أي إنسان بيميل راسه يمين أو + +204 +00:14:26,050 --> 00:14:29,670 +شمال بيلاقي كل ال field أو كل الحقل اللي هو بتطلع + +205 +00:14:29,670 --> 00:14:33,130 +عليه أو كل ال visual field اللي بتطلع عليه، سيارة، + +206 +00:14:33,130 --> 00:14:36,630 +بناء، شجرة، أي شيء، بني أدمين ماشيين بيلاقيهم + +207 +00:14:36,630 --> 00:14:40,370 +مالوا باتجاه ما يلعن الراسأو عكس اتجاه ميلان الرأس + +208 +00:14:40,370 --> 00:14:43,630 +يعني بتضلش ال بيئة ثابتة وهذا شيء مزعج بينما هذه + +209 +00:14:43,630 --> 00:14:48,470 +ال reflex ال writing reflex بيحافظ على انه وين + +210 +00:14:48,470 --> 00:14:51,770 +بيميل الرأس العينين بيميلوا عكسه هنا الرأس ميل على + +211 +00:14:51,770 --> 00:14:54,930 +اليمين اذا العينتين بيميلوا على الشمال العين + +212 +00:14:54,930 --> 00:14:57,510 +اليمين بتعمل in torsion يعني الساعة اتناش فيها + +213 +00:14:57,510 --> 00:15:02,150 +بتدخل ناحية ال nose بتلف ناحية ال nose و ال left + +214 +00:15:02,150 --> 00:15:06,230 +eye بتعمل extortion الساعة اتناش بتلف ناحية او + +215 +00:15:06,230 --> 00:15:10,190 +بعيدا عن ال noseإذا هذه بتعمل in torsion وهذه + +216 +00:15:10,190 --> 00:15:13,890 +بتعمل extorsion طيب لو ميل رأسه على الشمال + +217 +00:15:13,890 --> 00:15:17,770 +العينتين بيميلوا على اليمين يعني دايما ميلان الرأس + +218 +00:15:17,770 --> 00:15:21,990 +وميلان العينتين متعاكس عشان يتظلها موقع الصور + +219 +00:15:21,990 --> 00:15:26,190 +للعين اللي بتتفرج على شيء معين يظل موقع الصورة على + +220 +00:15:26,190 --> 00:15:31,370 +الشبكية يعني ثابت ومايتغيرش كتير .. مايتغيرش كتير + +221 +00:15:31,370 --> 00:15:35,810 +فبالتالي torsional movements to maintain the + +222 +00:15:35,810 --> 00:15:40,450 +uprightimages who care عشان تظل الصورة عدلة وما + +223 +00:15:40,450 --> 00:15:43,770 +تميلش who care on tilting of the head these are + +224 +00:15:43,770 --> 00:15:47,270 +known as the righting reflexes on head tilt to the + +225 +00:15:47,270 --> 00:15:50,250 +right the superior limb by of the two eyes rotate + +226 +00:15:50,250 --> 00:15:55,320 +to the left بمعنى آخرon tilting to the right ال + +227 +00:15:55,320 --> 00:15:59,300 +superior limbus هنا و ال superior limbus هنا بيلفه + +228 +00:15:59,300 --> 00:16:03,400 +على الشمال لأن الراس مال على اليمين طيب لما ال + +229 +00:16:03,400 --> 00:16:05,940 +superior limbus هنا يميل على الشمال معناته صار + +230 +00:16:05,940 --> 00:16:08,740 +entorsion لأنه جرب من النوز و لما ال superior + +231 +00:16:08,740 --> 00:16:11,540 +limbus الساعة اتناشه اتميل على الشمال هنا في العين + +232 +00:16:11,540 --> 00:16:14,960 +الشمال معناته بعدت عن النوز إذا هذه entorsion وهذه + +233 +00:16:14,960 --> 00:16:18,180 +extortion + +234 +00:16:18,730 --> 00:16:22,430 +الـ superior limbi of the two eyes rotates to the + +235 +00:16:22,430 --> 00:16:25,830 +left, causing the intorsion of the right globe and + +236 +00:16:25,830 --> 00:16:29,820 +extortion of the left زي مهاد الرسمةبالضبط إيش + +237 +00:16:29,820 --> 00:16:34,500 +بتحكي لأن لما ال head بيصير له tilt للشمال ال + +238 +00:16:34,500 --> 00:16:37,380 +superior limb by ال superior limb بس هنا و ال + +239 +00:16:37,380 --> 00:16:42,380 +superior limb بس هنا بيصير لهم عكس ال tilt ال tilt + +240 +00:16:42,380 --> 00:16:44,720 +للشمال معناته ال superior limb بس هنا و ال + +241 +00:16:44,720 --> 00:16:47,980 +superior limb بس هنا هيتحركوا عاليمين هنا هيتحرك + +242 +00:16:47,980 --> 00:16:51,520 +عاليمين بمعنى آخر هيبعد عن ال nose هيصير extortion + +243 +00:16:51,520 --> 00:16:57,320 +هنا و هنا هيجرب من ال nose هيصير intortion + +244 +00:16:57,900 --> 00:17:02,920 +نيجي لتالت نوع من أنواع الحركة اللي هي ال virgins + +245 +00:17:02,920 --> 00:17:08,260 +ال virgins أيضا فيها تلت كلمات مهمة جدا في التعريف + +246 +00:17:08,260 --> 00:17:11,940 +وهي بتفرق في كلمة واحدة فقط عن ال virgins ال + +247 +00:17:11,940 --> 00:17:17,280 +virgins حكينا فيها تلت كلمات نذكر فيهم أول كلمة + +248 +00:17:17,280 --> 00:17:21,930 +binocularتانية كلمة simultaneous تالت كلمة + +249 +00:17:21,930 --> 00:17:26,630 +conjugate binocular والعينتين مفتوحات simultaneous + +250 +00:17:26,630 --> 00:17:30,610 +في نفس اللحظة بتتم الحركات ال virgins اللي هي في + +251 +00:17:30,610 --> 00:17:33,170 +الاتجاهات التمانية بالإضافة لل primary position + +252 +00:17:33,170 --> 00:17:37,950 +اللي هي تسع .. تسع مواقع binocular simultaneous في + +253 +00:17:37,950 --> 00:17:41,570 +نفس اللحظة conjugate هذه أهم نقطة conjugate يعني + +254 +00:17:41,570 --> 00:17:44,430 +in the same direction in the same direction + +255 +00:17:44,430 --> 00:17:49,460 +بالنسبة لل virginsهذا بالنسبة لل virgin ال + +256 +00:17:49,460 --> 00:17:53,180 +virgences بتختلف في كلمة واحدة اول حاجة بتتشبه + +257 +00:17:53,180 --> 00:17:56,920 +انها binocular ايضا لازم يكون المريض مفتح عينيتين + +258 +00:17:56,920 --> 00:18:01,320 +تاني و تاني حاجة بتشبه ال virgin انها simultaneous + +259 +00:18:01,320 --> 00:18:06,660 +برضه في نفس اللحظة بس باتجاهات متعاكسة .. باتجاهات + +260 +00:18:06,660 --> 00:18:10,360 +متعاكسةعشان هيك ال virgences are binocular, + +261 +00:18:10,880 --> 00:18:14,880 +simulataneous, disjugate او disjunctive .. + +262 +00:18:14,880 --> 00:18:17,940 +disjugate او disjunctive ايش يعني disjugate او + +263 +00:18:17,940 --> 00:18:20,900 +disjunctive؟ يعني in opposite direction يعني إذا + +264 +00:18:20,900 --> 00:18:24,920 +العين اليمين راحت شمال، العين الشمال بتروح يمين، + +265 +00:18:24,920 --> 00:18:28,840 +خلف خلف إذا العين اليمين راحت يمين، العين الشمال + +266 +00:18:28,840 --> 00:18:32,560 +بتروح شمال يعني وين بتروح العين اليمين؟ بتروح في + +267 +00:18:32,560 --> 00:18:36,280 +اتجاه معاكس لها العين الشماليعني التنين عكس بعض + +268 +00:18:36,280 --> 00:18:39,480 +عشان هيك بيسموها disjunctive أو disjugade movement + +269 +00:18:39,480 --> 00:18:43,000 +عندي نوعين من حركات ال virgences عندي ال + +270 +00:18:43,000 --> 00:18:48,400 +convergence و ال divergence ممكن إنسان يتسأل طيب + +271 +00:18:48,400 --> 00:18:52,880 +ال convergence ممكن نسويه يعني أنا كنت أطلع أشي + +272 +00:18:52,880 --> 00:18:58,490 +بعيد و عنيا straight يعني عنيا straightوفجأة يعني + +273 +00:18:58,490 --> 00:19:02,090 +حبيت أطلع على جوالي أو شيء target قريب ساعتها + +274 +00:19:02,090 --> 00:19:05,370 +عينيا بيعمل convergence يعني العين اليمين بتدخل ل + +275 +00:19:05,370 --> 00:19:09,430 +.. بتتجه باتجاه الشمال يعني باتجاه النز و العين + +276 +00:19:09,430 --> 00:19:12,290 +الشمال بتتجه باتجاه اليمين باتجاه النز يعني هذه + +277 +00:19:12,290 --> 00:19:15,950 +اتجاهها لما دخلت لجوة ناحية النز هيك بهذا الاتجاه + +278 +00:19:15,950 --> 00:19:19,910 +وهذه اتجاهها برضه هيك عكس بعضهم يعني هذه راحت .. + +279 +00:19:20,150 --> 00:19:24,190 +عالشمال و هذه راحت على اليمين فبالتالي هذا بيسموه + +280 +00:19:24,190 --> 00:19:27,550 +convergence بس هل الإنسان بيقدر يعمل divergence؟ + +281 +00:19:27,550 --> 00:19:31,290 +ممكن الإنسان يتخيل انه .. انه لا يمكن حركة ال + +282 +00:19:31,290 --> 00:19:35,630 +divergence انها تتم إذا رجعنا للتعريف و قرأناه + +283 +00:19:35,630 --> 00:19:41,130 +بدقة بيلاقي أن ال divergence أيضا بيحدثبس from a + +284 +00:19:41,130 --> 00:19:45,610 +convergent position إيش يعني ال divergence بيحدث و + +285 +00:19:45,610 --> 00:19:48,990 +عند كل الناس إلا اللي عنده خلل مثلا كل الناس + +286 +00:19:48,990 --> 00:19:52,230 +الطبيعية بتعمل divergence from a convergent + +287 +00:19:52,230 --> 00:19:55,450 +position إيش يعني from a convergent position يعني + +288 +00:19:55,450 --> 00:19:58,410 +أنا كنت بتطلع على إش بعيد و بعدين اتطلعت على إش + +289 +00:19:58,410 --> 00:20:04,400 +جريب زي ما الصورة هاي بتوضح خليني أكبر الصورةالعين + +290 +00:20:04,400 --> 00:20:07,260 +اليمين رحت على الشمال والعين الشمال رحت على اليمين + +291 +00:20:07,260 --> 00:20:10,360 +عكس بعضهم إذا صار ال convergence العينين التنتين + +292 +00:20:10,360 --> 00:20:14,400 +دخلوا لجوا .. العينين التنتين دخلوا لجوا فبالتالي + +293 +00:20:14,400 --> 00:20:19,360 +.. فبالتالي أصبحوا العينين grab من بعض أو grab من + +294 +00:20:19,360 --> 00:20:22,980 +النزل هذا ال convergence الآن ال divergence بيحدث + +295 +00:20:22,980 --> 00:20:28,000 +من هذه الوضعية .. من هذه الوضعية كيف بيحدث من هذه + +296 +00:20:28,000 --> 00:20:31,280 +الوضعية العين هذه لما بدها تتعدل هتروح بالاتجاه + +297 +00:20:31,280 --> 00:20:35,270 +اليمين .. هتروح بالاتجاه اليمينوالشمال هتروح + +298 +00:20:35,270 --> 00:20:38,110 +باتجاه الشمال لغاية ما يصلوا لوضع ال primary + +299 +00:20:38,110 --> 00:20:42,550 +position هذا هذا يسمى divergence صحيح هو وضع ال + +300 +00:20:42,550 --> 00:20:45,570 +primary position بس كونوا ان العين اليمين اتحركت + +301 +00:20:45,570 --> 00:20:49,750 +في اتجاه والعين الشمال اتحركت في اتجاه معاكس لها + +302 +00:20:49,750 --> 00:20:53,870 +والتنتين مفتوحات والتنتين ..تمت الحركة فيهم في نفس + +303 +00:20:53,870 --> 00:20:58,150 +اللحظة أنه اليمين عدلت ليمينها لغاية ما وصلت للنص + +304 +00:20:58,150 --> 00:21:01,950 +والإشمال عدلت لشمالها لغاية ما يوصلت للنص هذا يسمى + +305 +00:21:01,950 --> 00:21:06,110 +divergence لو لا هذا ال divergence اللي بيحدث from + +306 +00:21:06,110 --> 00:21:10,210 +a convergent position كان الإنسان معاه فرصة واحدة + +307 +00:21:10,210 --> 00:21:14,110 +فقط يطلع شيء قريب ويضل عينيه بعد ذلك للأبد طول + +308 +00:21:14,110 --> 00:21:17,810 +حياته في هذا الوضع وهذا ما بيحدثشاحنا بنطلع على + +309 +00:21:17,810 --> 00:21:20,450 +التلفزيون، بعدين بنطلع على جوالاتنا، بعدين بنطلع + +310 +00:21:20,450 --> 00:21:24,850 +على شيء بعيد مثلا الأب أو الأم أو الأخ أو الأخت، + +311 +00:21:24,850 --> 00:21:28,350 +يعني نتحدث مع الناس، بنقرأ قرآن، بنقرأ في .. في + +312 +00:21:28,350 --> 00:21:31,720 +دروسنا، في محاضراتنايعني عينينا بتنقلوا بين + +313 +00:21:31,720 --> 00:21:36,140 +distant targets و near targets مرات عديدة و متكررة + +314 +00:21:36,140 --> 00:21:39,520 +كل يوم إذا بيصير دائما عملية ال convergence و + +315 +00:21:39,520 --> 00:21:42,680 +بعدها لما أنقل من شيء قريب لشيء بعيد في النظر + +316 +00:21:42,680 --> 00:21:46,320 +بيصير عندي divergence from a convergent position و + +317 +00:21:46,320 --> 00:21:48,940 +المقصود في divergence from a convergent position + +318 +00:21:48,940 --> 00:21:52,500 +إنه من وضعية ال convergence بيتباعدوا لعينتين + +319 +00:21:52,500 --> 00:21:55,200 +لغاية ما يصلوا لأال primary position وهذا + +320 +00:21:55,200 --> 00:21:58,080 +divergence ليش هذا divergence؟ لأن العين اليمين + +321 +00:21:58,080 --> 00:22:02,500 +راحت لليمين والعين الشمال راحت للشمال فلو جينا + +322 +00:22:02,500 --> 00:22:07,020 +احنا نقول ايش .. كيف تعريف ال .. ال divergence + +323 +00:22:07,020 --> 00:22:10,560 +movement او ال divergence اللي صار انه العينتين + +324 +00:22:10,560 --> 00:22:15,290 +مفتوحاتالعنتين مفتوحات وفي نفس اللحظة راحت اليمين + +325 +00:22:15,290 --> 00:22:18,470 +عدلت لل primary position يعني راحت باتجاه اليمين + +326 +00:22:18,470 --> 00:22:22,070 +والشمال عدلت باتجاه ال primary position يعني راحت + +327 +00:22:22,070 --> 00:22:25,150 +للشمال يعني اتجاه الحركة في هذه اللحظة عكس بعضهم + +328 +00:22:25,150 --> 00:22:28,950 +فتمت divergence فاعتدلوا العنتين بعد ما كانوا في + +329 +00:22:28,950 --> 00:22:31,950 +وضعية ال convergence .. في وضعية ال convergence + +330 +00:22:33,760 --> 00:22:37,820 +convergence convergence is simultaneous adduction + +331 +00:22:37,820 --> 00:22:43,840 +حقيقة رغم أن الكاتب كلمة adduction إلا أن الكلمة + +332 +00:22:43,840 --> 00:22:47,160 +الأسلم هي مش adduction هي convergence is + +333 +00:22:47,160 --> 00:22:52,080 +simultaneous inward turning يعني simultaneous في + +334 +00:22:52,080 --> 00:22:55,700 +نفس اللحظة العنتين بدخلوا لجوا و الأفضل مانسميهوش + +335 +00:22:55,700 --> 00:23:00,600 +adduction divergence is outward movement from a + +336 +00:23:00,600 --> 00:23:05,790 +convergent position convergenceDivergence is + +337 +00:23:05,790 --> 00:23:10,410 +outward movement from a convergentposition طبعا + +338 +00:23:10,410 --> 00:23:14,630 +الان بدنا نحكي عن ال divergence بدناش نحكي عن ال + +339 +00:23:14,630 --> 00:23:18,610 +divergence بدنا نحكي عن ال convergence و أنواعه + +340 +00:23:18,610 --> 00:23:21,190 +بدنا نحكي عن ال convergence و أنواعه ال + +341 +00:23:21,190 --> 00:23:25,590 +convergence may be voluntary or reflex يعني ممكن + +342 +00:23:25,590 --> 00:23:29,310 +يكون ال convergence إرادي .. إرادي يعني أنا متعمد + +343 +00:23:29,310 --> 00:23:35,070 +بدأ أطلع شيء قريب أو ممكن يكون reflex لا إرادي أو + +344 +00:23:35,070 --> 00:23:38,870 +ممكن يكون إرادي إن أنا بدأ أحول عينيا لداخلبشكل + +345 +00:23:38,870 --> 00:23:43,310 +متعمد زي ما بعض الأطفال بيعمله دون وجود هدف أطلع + +346 +00:23:43,310 --> 00:23:48,050 +عليه يعني بدون وجود target جريب من العين ساعتها + +347 +00:23:48,050 --> 00:23:53,490 +بيتسمى هدف الـ Unitary ال reflex convergence ال + +348 +00:23:53,490 --> 00:23:57,010 +reflex convergence يعني تخول العينتين بشكل لا + +349 +00:23:57,010 --> 00:24:02,500 +إرادي بشكل reflex رد فعل فيه له أربع أنواعأو خلينا + +350 +00:24:02,500 --> 00:24:06,780 +نقول له أربع components .. أربع components هدولة + +351 +00:24:06,780 --> 00:24:09,720 +الأربع components هنحكي عنهم المرة القادمة ان شاء + +352 +00:24:09,720 --> 00:24:13,160 +الله تعالى ويعطيكم العافية والسلام عليكم ورحمة + +353 +00:24:13,160 --> 00:24:14,300 +الله وبركة + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/WiibPyNebaY.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/WiibPyNebaY.srt new file mode 100644 index 0000000000000000000000000000000000000000..11ee3575162045ea7db52adc99bdad3de6a5d993 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/WiibPyNebaY.srt @@ -0,0 +1,103 @@ +1 +00:00:01,280 --> 00:00:05,440 +الرحمن الرحيم عندما نموذج للـ orbit و ال eye globe + +2 +00:00:05,440 --> 00:00:11,240 +يوضح عمل ال extraocular muscles هاي ال eye globe، + +3 +00:00:11,240 --> 00:00:13,420 +هاي ال lateral wall، هاي ال medial wall، هاي ال + +4 +00:00:13,420 --> 00:00:16,840 +nose طبعا هذا الخيط أنا حاطيته عشان أبين قضية ال + +5 +00:00:16,840 --> 00:00:20,010 +intortion و ال extortion اللي بتعملها العضلات، نبدأ + +6 +00:00:20,010 --> 00:00:23,010 +مع عضلة superior rectus muscle، superior rectus + +7 +00:00:23,010 --> 00:00:27,870 +muscle بتنشأ من ال annulus of Zinn و بتعمل axis مع + +8 +00:00:27,870 --> 00:00:31,330 +محور العين تقريبا تلاتة و عشرين degree يعني + +9 +00:00:31,330 --> 00:00:35,250 +الزاوية بين محور العضلة و محور العين هي محور العين + +10 +00:00:35,250 --> 00:00:38,990 +و محور العضلة تلاتة و عشرين degree، ال function + +11 +00:00:38,990 --> 00:00:41,910 +بتاعة superior rectus muscle لها three functions + +12 +00:00:41,910 --> 00:00:47,220 +زي ما هنشوف الآن، تعمل elevation في العين + +13 +00:00:47,220 --> 00:00:50,020 +نفس الوقت الـ superior limbus بتحرك نزلي in + +14 +00:00:50,020 --> 00:00:55,000 +torsion، in torsion، وفي نفس الوقت adduction العين + +15 +00:00:55,000 --> 00:00:59,840 +كلها نزحت لجوة، العين كلها نزحت لجوة، يعني هذه ال + +16 +00:00:59,840 --> 00:01:03,640 +midline اللي هو الخيط، الغالبية الأقل من العين تقع + +17 +00:01:03,640 --> 00:01:09,780 +medial to the midline، فبالتالي adduction، إذا نعيد + +18 +00:01:09,780 --> 00:01:16,060 +ال function: elevation، in torsion، و adduction + +19 +00:01:16,060 --> 00:01:19,540 +elevation and torsion و adduction، طبعا مش متوقع ال + +20 +00:01:19,540 --> 00:01:21,820 +adduction بتاع ال superior rectus يكون زي ال ad + +21 +00:01:21,820 --> 00:01:24,180 +action بتاع ال medial rectus، إذا ال function + +22 +00:01:24,180 --> 00:01:28,800 +بنعيدها elevation و in torsion و adduction، هي العين + +23 +00:01:28,800 --> 00:01:33,060 +في ال primary position لما بصير contraction بتعمل + +24 +00:01:33,060 --> 00:01:36,460 +elevation، واضح أن العين بتطلع لفوق، و in torsion + +25 +00:01:36,460 --> 00:01:40,740 +و adduction، يعطيكم العافية والسلام عليكم ورحمة + +26 +00:01:40,740 --> 00:01:42,220 +الله وبركاته diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Ycg6o67GOeo_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Ycg6o67GOeo_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..576dbe816ac0434135c0a8efe0232480f91dc3bc --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Ycg6o67GOeo_postprocess.srt @@ -0,0 +1,1796 @@ +1 +00:00:01,580 --> 00:00:07,520 +بسم الله الرحمن الرحيم اتوقفنا في المرة الماضية + +2 +00:00:07,520 --> 00:00:12,140 +عند موضوع ال motor effusion و ال effusional + +3 +00:00:12,140 --> 00:00:16,020 +virgences فاليوم نستغلف من هذه النقطة ان شاء الله + +4 +00:00:16,020 --> 00:00:20,040 +تعالى، اتوقفنا عند هذه ال slide أو عند هذه الرسمة + +5 +00:00:20,430 --> 00:00:24,830 +وقولنا لما احنا بنطلع على target بعيد، ال target + +6 +00:00:24,830 --> 00:00:27,710 +الجريب بيكون صوته ع temporal written هنا، ع + +7 +00:00:27,710 --> 00:00:31,170 +temporal written هنا وبالتالي بيكون فيه ending bi + +8 +00:00:31,170 --> 00:00:34,530 +temporal image disparity لإن ال temporal مع ال + +9 +00:00:34,530 --> 00:00:41,370 +temporal مش نقات متناسقة وإيه لما بنطلع على إش + +10 +00:00:41,370 --> 00:00:45,570 +جريب؟الاشي اللي بعيد بيكون عامل by nasal image + +11 +00:00:45,570 --> 00:00:48,510 +disparity يعني صورته بتسقط على nasal retina و + +12 +00:00:48,510 --> 00:00:51,590 +nasal retina فبالتالي بيكون فيه عندى by nasal + +13 +00:00:51,590 --> 00:00:55,090 +image disparity ال by temporal image disparity + +14 +00:00:56,010 --> 00:01:00,050 +بتحفظ ال fusional convergence، ليش؟ لأن الفوفيا + +15 +00:01:00,050 --> 00:01:04,010 +هتروح باتجاه الصورة، و هنا الفوفيا هتروح باتجاه + +16 +00:01:04,010 --> 00:01:07,290 +الصورة، يعني ال two fovea بيروحوا temporally، فال + +17 +00:01:07,290 --> 00:01:10,930 +anterior part of the eye بيروح، يعني nasally، هذه + +18 +00:01:10,930 --> 00:01:13,270 +اللي هي بتروح inward، وهذه اللي هي بتروح inward، + +19 +00:01:13,270 --> 00:01:16,010 +inward يعني convergenceو الهدف من هذا ال + +20 +00:01:16,010 --> 00:01:19,050 +convergence هو عملية ال fusion عشان الصورة تسقط + +21 +00:01:19,050 --> 00:01:24,030 +على نقاط متماثلة من الشبكيتين وهذا يسمى fusional + +22 +00:01:24,030 --> 00:01:27,550 +convergence العكس تماما بالنسبة للصورة التانية + +23 +00:01:27,550 --> 00:01:36,860 +الفوفيا .. الفوفيا اللي هي عند النقطة الزرقاءلأن + +24 +00:01:36,860 --> 00:01:39,740 +الإنسان بيركز على ال target الأزرق فهي صورة ال + +25 +00:01:39,740 --> 00:01:42,540 +target الأزرق على ال fovea وهنا صورة ال target + +26 +00:01:42,540 --> 00:01:47,060 +نفسه على ال fovea فبالتالي ال two fovea بيروحوا + +27 +00:01:47,060 --> 00:01:50,800 +temporally إذا بينجل التركيز على ال target الأحمر + +28 +00:01:50,800 --> 00:01:55,980 +ال two fovea بيروحوا nasally + +29 +00:01:57,210 --> 00:02:00,830 +توفوف يروحوا نازلي فلانتين بيروحوا temporally يعني + +30 +00:02:00,830 --> 00:02:04,850 +بيعملوا divergence وهذا يسمى fusional divergence + +31 +00:02:04,850 --> 00:02:09,590 +إذا الحافظ لال fusional convergence هو ال bi + +32 +00:02:09,590 --> 00:02:14,110 +temporal image disparity بينما الحافظ لال fusional + +33 +00:02:14,110 --> 00:02:21,930 +divergence هو ال bi nasal image disparity الحاجة + +34 +00:02:21,930 --> 00:02:26,530 +هنا أن ال motor fusionبنقدر نطلق عليه اسم تاني هو + +35 +00:02:26,530 --> 00:02:31,190 +ال fusional variances هو عبارة عن حركات الهدف منها + +36 +00:02:31,190 --> 00:02:36,000 +تعديل وضع العين، يعني حركات بتجوم فيها العينعشان + +37 +00:02:36,000 --> 00:02:42,020 +تسقط الصورتين على مناطق متماثلة تماما من الشبكيات + +38 +00:02:42,020 --> 00:02:44,920 +وبالتالي بعدها يأتي المرحلة التالية لل motor + +39 +00:02:44,920 --> 00:02:48,040 +fusion اللي هي ال sensory fusion وهو ال fusion + +40 +00:02:48,040 --> 00:02:52,080 +الحقيقي اللي بيتم فيه damage صورتين في صورة واحد + +41 +00:02:52,080 --> 00:02:55,760 +إذا ال motor fusion involves the maintenance of + +42 +00:02:55,760 --> 00:02:59,780 +motor alignment of the eyes to sustain bifovial + +43 +00:02:59,780 --> 00:03:05,760 +fixationهو يعني .. يعني يقصد في ال motor fusion هو + +44 +00:03:05,760 --> 00:03:10,880 +ابقاء حالة من الاتزان من .. بين العنتين عشان يظل + +45 +00:03:10,880 --> 00:03:15,640 +في عيندي by foveal fixation it is driving by + +46 +00:03:15,640 --> 00:03:18,420 +retinal image disparity يعني إيش اللي بيحفظ ال + +47 +00:03:18,420 --> 00:03:22,480 +motor fusion وجود ال image disparity على ال retina + +48 +00:03:22,480 --> 00:03:24,740 +إيش يعني ال image disparity على ال retina أو ال + +49 +00:03:24,740 --> 00:03:28,440 +retinal image disparity يعني إن الصورة في مكان مع + +50 +00:03:28,440 --> 00:03:32,450 +ال retina في العين اليمينوفي مكان مش متناسق معاه + +51 +00:03:32,450 --> 00:03:38,990 +تماما في شبكية العين الشمال طبعا هذا هيحفظ ل motor + +52 +00:03:38,990 --> 00:03:50,070 +fusion او بينجوسين refusional virgences عشان + +53 +00:03:50,070 --> 00:03:53,830 +نقول إيش اللي بيحصل بيقول برضه هذا مثال بيوضح + +54 +00:03:53,830 --> 00:03:57,910 +القضية هاي .. هاي ال right eyeوهي ال left eye + +55 +00:03:57,910 --> 00:04:01,710 +التنتين هدول ال right و ال left هدول ال right و ال + +56 +00:04:01,710 --> 00:04:02,950 +left هدول ال right و ال left هدول ال right و ال + +57 +00:04:02,950 --> 00:04:06,730 +left هدول ال right و ال left هدول ال right + +58 +00:04:06,730 --> 00:04:09,390 +و ال left هدول ال right و ال left هدول ال right و + +59 +00:04:09,390 --> 00:04:09,450 +left هدول ال right و ال left هدول ال right و ال + +60 +00:04:09,450 --> 00:04:16,960 +left هدول ال right و البتسقط على الفوفيا في العين + +61 +00:04:16,960 --> 00:04:21,320 +الشمال وكانت تسقط صورة ال target X نفسه على + +62 +00:04:21,320 --> 00:04:25,280 +الفوفيا في العين اليمين روحنا هنا حطينا base in + +63 +00:04:25,280 --> 00:04:29,640 +prism جدام العين اليمين طبعا ال prism بيحرف الأشعة + +64 +00:04:29,640 --> 00:04:33,360 +باتجاه ال base دهيعني صورة ال target X يعني + +65 +00:04:33,360 --> 00:04:36,220 +الأشياء اللي خارجها من ال target X أو المنعكزة من + +66 +00:04:36,220 --> 00:04:40,780 +ال target X هتنحرف باتجاه ال base بتاعة ال Prism + +67 +00:04:40,780 --> 00:04:43,760 +فهتيجي بدل ما هتيجي على الفوفيا زي ما كانت قبل ما + +68 +00:04:43,760 --> 00:04:49,820 +نحط ال Prism هتيجي على nasal retinaطيب، الآن بعد + +69 +00:04:49,820 --> 00:04:52,500 +ما حطينا ال Prism إجت الصورة على nasal retina في + +70 +00:04:52,500 --> 00:04:55,660 +ال right eye وعلى ال fovea في ال left eye طبعا ال + +71 +00:04:55,660 --> 00:04:58,960 +fovea في ال left eye مع ال nasal retina في ال .. + +72 +00:04:58,960 --> 00:05:01,860 +في ال right eye مش corresponding retinal areas + +73 +00:05:01,860 --> 00:05:05,860 +وبالتالي أصبحت في انديا retina ال image disparity + +74 +00:05:05,860 --> 00:05:11,780 +اختلال في سقوط الصورتين على المواقع المتماثلة من + +75 +00:05:11,780 --> 00:05:14,440 +شبكية الانتين يعني المفروض إذا سقطت على ال fovea + +76 +00:05:14,440 --> 00:05:17,520 +هنا تسقط على ال fovea هنا لأن ال fovea مع ال fovea + +77 +00:05:18,010 --> 00:05:21,710 +مماطق متماثلة، إلها نفس ال visual direction، إلها + +78 +00:05:21,710 --> 00:05:25,090 +نفس الاتجاه في الفرق، ال brain بيرفض هذه الوضع، + +79 +00:05:25,090 --> 00:05:30,170 +ففورا .. ففورا بفعل refusional virgences، هنا + +80 +00:05:30,170 --> 00:05:33,730 +الفوفيا بأمر من ال brain طبعا بمساعدة العضلات + +81 +00:05:33,730 --> 00:05:38,620 +حتتحرك نزليإذا الفوفيا هتتحرك نيزلي عشان تتلقى + +82 +00:05:38,620 --> 00:05:41,900 +صورة ال target X معناته ال anterior part of the + +83 +00:05:41,900 --> 00:05:45,260 +eye زي ما السهم بيشيه هتتحرك temporarily يعني هذه + +84 +00:05:45,260 --> 00:05:50,160 +نفس العين اليمين بعد ما ال brain أمر و نفذ الأمر + +85 +00:05:50,160 --> 00:05:54,260 +بعد ما ال brain أمر و طبعا العضلات نفذت الأمر اللي + +86 +00:05:54,260 --> 00:05:58,060 +صار عندي divergence اللي صار عندي divergence فهذا + +87 +00:05:58,060 --> 00:06:02,640 +ال nasal image disparity بتعمل stimulation لل + +88 +00:06:02,640 --> 00:06:06,880 +divergence لو حطينا ال base العكسهتنحر في الصورة + +89 +00:06:06,880 --> 00:06:10,260 +على ال temporal retina، الفوفيا هتتحرك باتجاه ال + +90 +00:06:10,260 --> 00:06:13,020 +temporal retina، معناته ال .. ال .. ال .. ال + +91 +00:06:13,020 --> 00:06:15,420 +anterior part of the eye هيروح in، يعني + +92 +00:06:15,420 --> 00:06:19,920 +convergence، اذا ال temporal image disparity هيحفظ + +93 +00:06:19,920 --> 00:06:23,540 +ال convergence، ال fusional convergence، وال nasal + +94 +00:06:23,540 --> 00:06:28,300 +image disparity هيحفظ ال divergence، هيحفظ ال + +95 +00:06:28,300 --> 00:06:33,120 +divergenceنجي لها الفيوجينال فيرجانسي الفيوجينال + +96 +00:06:33,120 --> 00:06:35,780 +فيرجانسي الفيوجينال الفيوجينال الفيوجينال + +97 +00:06:35,780 --> 00:06:36,020 +الفيوجينال الفيوجينال الفيوجينال الفيوجينال + +98 +00:06:36,020 --> 00:06:36,160 +الفيوجينال الفيوجينال الفيوجينال الفيوجينال + +99 +00:06:36,160 --> 00:06:36,600 +الفيوجينال الفيوجينال الفيوجينال الفيوجينال + +100 +00:06:36,600 --> 00:06:45,200 +الفيوجين + +101 +00:06:45,710 --> 00:06:49,530 +حرف الأشعة باتجاه ال base بتاعته يعني هتسقط على ال + +102 +00:06:49,530 --> 00:06:53,010 +nasal retina الفوفيا اتحركت بهذا الاتجاه ال Prism + +103 +00:06:53,010 --> 00:06:58,490 +قوته عشرة Prism ده يبدأ جبت Prism أعلى منه خمس عشر + +104 +00:06:58,490 --> 00:07:01,470 +Prism هيكون انحراف الصورة باتجاه ال base أكتر يعني + +105 +00:07:01,470 --> 00:07:05,760 +الصورة بدل ما تسقط هنا هتسقطمثلا في النقطة هاي + +106 +00:07:05,760 --> 00:07:08,900 +اللي انا بقشر عليها الفوفيا ايضا بعمر من ال brain + +107 +00:07:08,900 --> 00:07:13,960 +بدها تروح تتحرك عشان تتلقى الصورة طيب نفرض انه + +108 +00:07:13,960 --> 00:07:18,240 +العملية تخت .. الآن غيرت ال 15 بريزم ديوبتر ب 20 + +109 +00:07:18,240 --> 00:07:22,580 +بريزم ديوبتر .. خلت ال بريزم اقوى و اقوى .. لعند + +110 +00:07:22,580 --> 00:07:27,120 +وين؟بيقدر ال brain يعوض عن ال retinal image + +111 +00:07:27,120 --> 00:07:31,500 +disparity و يحرك العين بحيث انه يسقط الصورتين على + +112 +00:07:31,500 --> 00:07:36,680 +مناطق متماثلة، في حد اعلى اكتر منه ال brain بيقدرش + +113 +00:07:36,680 --> 00:07:42,640 +يوصل انه يحرك ال fovea لهذا الحد الاعلى او اذا كان + +114 +00:07:42,640 --> 00:07:47,050 +انا استعملت prismأكتر من الحد الأعلى لقدرة ال + +115 +00:07:47,050 --> 00:07:50,430 +brain على التأقلم، لقدرة ال brain على التأقلم، إذا + +116 +00:07:50,430 --> 00:07:54,630 +في عندي حاجة اسمها ال fusional virgences، ال range + +117 +00:07:54,630 --> 00:07:58,650 +بتاع ال fusional virgencesالـ fusional divergence + +118 +00:07:58,650 --> 00:08:02,010 +involves this to gate I movements to overcome + +119 +00:08:02,010 --> 00:08:06,250 +retinal image disparity إذن الهدف من ال fusional + +120 +00:08:06,250 --> 00:08:09,750 +divergence أو ال fusional divergence أو بين جثين + +121 +00:08:09,750 --> 00:08:15,070 +ال motor fusion أنه أتغلب أعمل overcome لل retinal + +122 +00:08:15,070 --> 00:08:18,470 +image disparity للخلل في هذا في وضع الصور على + +123 +00:08:18,470 --> 00:08:22,410 +الشبكيات لا شك أنه سقوط صورة ال target X على + +124 +00:08:22,410 --> 00:08:27,870 +الفوفيا في ال left eye وسقوطه علىبمساعدة طبعاً + +125 +00:08:27,870 --> 00:08:31,430 +لبريزم سقوط صورة ال target x على nasal retina هذا + +126 +00:08:31,430 --> 00:08:35,230 +يعتبر خلل في موقع الصورة ال target x ولابد من + +127 +00:08:35,230 --> 00:08:39,850 +تصحيح الخلل تصحيح الخلل بتم بواسطة versions + +128 +00:08:39,850 --> 00:08:46,090 +movement احنا قلنا في عندي تلت أنواع من الحركةأول + +129 +00:08:46,090 --> 00:08:50,330 +حاجة في الدكشن و ال virgin و ال virginess الدكشن + +130 +00:08:50,330 --> 00:08:54,050 +بيكون العين من العينتين مغطية إذا في عين من + +131 +00:08:54,050 --> 00:08:56,730 +العينتين مغطية معناته قضية ال fusion هذه خلاص + +132 +00:08:56,730 --> 00:09:00,490 +انتهت تماما لإن أنا عندي صورة واحدة لا تحتاج إلى + +133 +00:09:00,490 --> 00:09:04,230 +دمج مع نفسها هي أصلا صورة واحدة أما لو عندي صورتين + +134 +00:09:04,230 --> 00:09:09,020 +فأكثرمعناته هدول السورتين لابد من توحيدهم في صورة + +135 +00:09:09,020 --> 00:09:13,340 +واحدة لهذا ال target و هذا الكلام بنسميه ال fusion + +136 +00:09:13,340 --> 00:09:16,740 +اذا الduction .. الduction movement ما بتنفع عشان + +137 +00:09:16,740 --> 00:09:20,120 +موضوع ال fusion لأن الduction movement عبارة عن + +138 +00:09:20,120 --> 00:09:22,760 +monocular movement و طالما قلنا monocular movement + +139 +00:09:22,760 --> 00:09:25,820 +معناته العين التانية مغطية و طالما العين التانية + +140 +00:09:25,820 --> 00:09:29,480 +مغطية معناته فيادي صورة واحدة فصورة واحدة تدمج مع + +141 +00:09:29,480 --> 00:09:34,410 +إيش؟فبالتالي هذه القضية بدها تكون واضحة إذا ندقش + +142 +00:09:34,410 --> 00:09:37,490 +ال movement مش في موضوع ال fusion يعني ليس لها + +143 +00:09:37,490 --> 00:09:41,690 +عداقة في ال fusion طب بيظل عندي نوعين من الحركة .. + +144 +00:09:41,690 --> 00:09:46,430 +نوعين من الحركة ال virgins و ال virgins لو قلنا + +145 +00:09:46,430 --> 00:09:50,190 +جدلا أنه ال brain بده يؤمر العنتين أنهم يعملوا + +146 +00:09:50,190 --> 00:09:53,530 +virgin movement virgin movement يعني العنتين بدهم + +147 +00:09:53,530 --> 00:09:58,150 +اتحركوا في نفس الاتجاه يعني هذه اللي عندها تعمل + +148 +00:09:58,150 --> 00:10:02,440 +divergence تتروح اليمينعشان تصير الصورة على + +149 +00:10:02,440 --> 00:10:06,940 +الفوفيا وحسب قضية ال virgin ال virgin هي عبارة عن + +150 +00:10:06,940 --> 00:10:11,200 +binocular simultaneously تكله مفهوم بس أهم نقطة in + +151 +00:10:11,200 --> 00:10:14,140 +the same direction يعني إذا هذه اتحركت عاليمين زي + +152 +00:10:14,140 --> 00:10:17,200 +ما هي الصورة بتوضح المفروض العين التانية تتحرك + +153 +00:10:17,200 --> 00:10:20,980 +عاليمين العين التانية تتحرك عاليمين طيب هذه اتحركت + +154 +00:10:20,980 --> 00:10:24,860 +عاليمين و الفوفيا هيك راحت و هذه اتحركت عاليمين و + +155 +00:10:24,860 --> 00:10:28,780 +الفوفيا هيك راحت أصبحت صورة x على الفوفياطيب في + +156 +00:10:28,780 --> 00:10:32,680 +نفس الوقت إذا هتتحركت على اليمين إذا صورة X بعدت + +157 +00:10:32,680 --> 00:10:37,860 +عن الفوية، إذا ال virgin movement بتثبتش، مابتثبت، + +158 +00:10:37,860 --> 00:10:42,760 +عشان لو عدلت بالنسبة للعين اليمين، يصير موقع + +159 +00:10:42,760 --> 00:10:46,500 +الصورة مختلف بالنسبة للعين الشمالولو عدلت بالنسبة + +160 +00:10:46,500 --> 00:10:49,660 +للعين الشمال، هتختل بالنسبة للعين اللانية، إذا + +161 +00:10:49,660 --> 00:10:53,440 +الحركة الوحيدة اللي ممكن تعدل لوضع الصورة على + +162 +00:10:53,440 --> 00:10:58,100 +الشبكية و تعمل overcome .. و تعمل overcome لل + +163 +00:10:58,100 --> 00:11:00,860 +retinal image disparity هي ال divergence movement + +164 +00:11:01,380 --> 00:11:04,760 +ال divergence movement binocular simultaneous + +165 +00:11:04,760 --> 00:11:08,280 +disjunctive أو disjugate movement، disjugate + +166 +00:11:08,280 --> 00:11:13,120 +movement يعني حركات متعاكزة، حركات متعاكزة، العين + +167 +00:11:13,120 --> 00:11:17,100 +اليمين راحت divergence أو على اليمين، العين الشمال + +168 +00:11:17,100 --> 00:11:19,700 +هتروح divergence أو على الشمال، العين اليمين راحت + +169 +00:11:19,700 --> 00:11:22,630 +على اليمين و العين الشمال راحت على الشمالأو العين + +170 +00:11:22,630 --> 00:11:25,810 +اليامين راحت علي شمال و العين الي شمال راحت علي + +171 +00:11:25,810 --> 00:11:29,430 +يامين هذا ال convergence فبالتالي هذا يسمى ال + +172 +00:11:29,430 --> 00:11:33,170 +convergence moment هذه الحركة هي الوحيدة الكفيلة + +173 +00:11:33,170 --> 00:11:41,850 +بتعديل .. بتعديل وضع الصورة عشان تسقط على .. عشان + +174 +00:11:41,850 --> 00:11:47,070 +تسقط على مناطق متماثلة من شبكية العنتين .. من + +175 +00:11:47,070 --> 00:11:52,540 +شبكية العنتين طيب هل ..كل زوران للصورة بيقدر ال + +176 +00:11:52,540 --> 00:11:56,480 +brain يتغلب عليه، يعني بمعنى أخر نسأل السؤال، نقول + +177 +00:11:56,480 --> 00:12:02,540 +عند وين بيقدر الدمار يعمل overcome لل retinal + +178 +00:12:02,540 --> 00:12:07,040 +image disparityالجواب ببساطة شديدة جدا، ال .. + +179 +00:12:07,040 --> 00:12:10,500 +الدماغ أو ال brain ب .. بيقدر يعمل overcome لل + +180 +00:12:10,500 --> 00:12:14,600 +retinal image disparity إذا كان ال retinal image + +181 +00:12:14,600 --> 00:12:19,260 +disparity .. إذا كان زوابان الصورة ضمن نطاق معين + +182 +00:12:19,260 --> 00:12:23,680 +هو ال amplitude تاع ال fusional virgins ال + +183 +00:12:23,680 --> 00:12:28,120 +fusional virgins إلى حد أعلى بعد ما بتقدرش يعني + +184 +00:12:28,120 --> 00:12:35,130 +تواصل العمل، بمعنى آخربنقول لو احنا زودنا قيمة ال + +185 +00:12:35,130 --> 00:12:38,370 +Prism هنا صورة هتنحرف باتجاه ال base أكتر زودنا + +186 +00:12:38,370 --> 00:12:42,530 +أكتر هتنحرف أكتر و في كل حالة من الحالات هيتطر ال + +187 +00:12:42,530 --> 00:12:46,470 +brain يعمل fusional divergence أو يؤمر ب fusional + +188 +00:12:46,470 --> 00:12:49,990 +divergence لعند حد معين أكتر من هيك هيصير هذا + +189 +00:12:49,990 --> 00:12:55,090 +الإنسان شايف double vision يعني مش هيقدر يعود يعني + +190 +00:12:55,090 --> 00:12:58,870 +نفرض أن الصورة بتاعة ال target X استعملنا Prism + +191 +00:12:59,400 --> 00:13:03,680 +مثلا خمسة و عشرين بريزم ديوبتر base N والصورة صارت + +192 +00:13:03,680 --> 00:13:08,580 +هنا ال brain راح أصدر order للعضلات أنه تتحرك + +193 +00:13:08,580 --> 00:13:12,140 +الفوفيا باتجاه الصورة اللي هنا الفوفيا اتحركت + +194 +00:13:12,140 --> 00:13:17,020 +لعندها دي النقطةوماقدر اتصل هيضل الخلل في موقع + +195 +00:13:17,020 --> 00:13:20,560 +الصورة انه هنا جاية على الفوفيا في ال left eye و + +196 +00:13:20,560 --> 00:13:24,260 +هنا جاية قريب من الفوفيا بس ماوصلت من الفوفيا اذا + +197 +00:13:24,260 --> 00:13:28,640 +لازالت الصور تسقط على مناطق غير متماثلة لازال في + +198 +00:13:28,640 --> 00:13:32,260 +عندي image disparity وبالتالي التوحيد الصورتين او + +199 +00:13:32,260 --> 00:13:35,960 +ال sensory fusion cannot take place وبالتالي بينتج + +200 +00:13:35,960 --> 00:13:39,760 +double vision تقاس من هذا بينتج من هذا الكلام اللي + +201 +00:13:39,760 --> 00:13:44,360 +بنحكي بينتج انه انا ممكن اجيسمقدار الفيوجينال + +202 +00:13:44,360 --> 00:13:48,400 +convergence amplitudes كدهش مقدارها باستعمال + +203 +00:13:48,400 --> 00:13:51,600 +Librasm بدي أجيس ال divergence الفيوجينال + +204 +00:13:51,600 --> 00:13:55,480 +divergence باستعمال based in Librasm بدي أجيس + +205 +00:13:55,480 --> 00:14:02,340 +الفيوجينال convergence باستعمل based out Librasm + +206 +00:14:02,340 --> 00:14:06,940 +بدي أجيس ال vertical divergence الخلل الرأسي في + +207 +00:14:06,940 --> 00:14:09,820 +موقع الصورة في شبكية بالنسبة للشبكية التانية + +208 +00:14:09,820 --> 00:14:13,290 +الصورة جاية أعلى شوية أو أوطى شويةفي شبكية العين + +209 +00:14:13,290 --> 00:14:16,050 +اليمين مقارنة مع شبكية العين الشمال بستعمل + +210 +00:14:16,050 --> 00:14:21,970 +vertical abrasive جبل ما نحكي في الأرقام بدنا نروح + +211 +00:14:21,970 --> 00:14:26,670 +لهذه القضية بنقولهي أنا استعملت base out .. base + +212 +00:14:26,670 --> 00:14:29,930 +out ال prism ال .. ال .. ال .. ال .. ال .. ال .. + +213 +00:14:29,930 --> 00:14:30,050 +ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال + +214 +00:14:30,050 --> 00:14:30,650 +.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. + +215 +00:14:30,650 --> 00:14:30,890 +ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال + +216 +00:14:30,890 --> 00:14:31,870 +.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. + +217 +00:14:31,870 --> 00:14:33,130 +ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال + +218 +00:14:33,130 --> 00:14:40,490 +.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. + +219 +00:14:40,490 --> 00:14:40,530 +ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال + +220 +00:14:40,530 --> 00:14:40,590 +.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. + +221 +00:14:40,590 --> 00:14:40,690 +ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال + +222 +00:14:40,690 --> 00:14:45,190 +.. ال .. ال .. ال .. ال .. الوهذا الشعاع .. او هذا + +223 +00:14:45,190 --> 00:14:48,450 +الprism هيحرف الشعاع باتجاه ال base عند الفوفيا + +224 +00:14:48,450 --> 00:14:51,590 +اللي هي النقطة الحمراء هذه .. هذه ال .. الوضعية + +225 +00:14:51,590 --> 00:14:54,330 +هذه ال target اللي هو جاية على مسافة بعيدة مش + +226 +00:14:54,330 --> 00:14:58,210 +مرسومة عندنا جاية الأشعة منه متوازية دخلت في + +227 +00:14:58,210 --> 00:15:00,470 +الprism ال .. ال .. ال .. اللي هو بتاع العين + +228 +00:15:00,470 --> 00:15:02,990 +اليمين يقول و الprism بتاع العين الشمال و كل من + +229 +00:15:02,990 --> 00:15:06,570 +الprismين حرفوا الأشعة باتجاه ال base أصبح في عندي + +230 +00:15:06,570 --> 00:15:09,490 +bi temporal image disparity هي ال nose .. هي ال + +231 +00:15:09,490 --> 00:15:12,710 +nose هنا بين العينينهذه nasal retina .. nasal + +232 +00:15:12,710 --> 00:15:16,290 +retina ومن بعد الفوفيا و هيك .. و من بعد الفوفيا و + +233 +00:15:16,290 --> 00:15:19,470 +هيك temporal retina أصبحت الصورة هنا تسقط على + +234 +00:15:19,470 --> 00:15:22,190 +temporal retina بعد ما كانت تسقط على الفوفيا قبل + +235 +00:15:22,190 --> 00:15:27,050 +وجود لبرزم و هنا أصبحت على temporal retina بعد ما + +236 +00:15:27,050 --> 00:15:31,760 +كانت تسقط على الفوفيا قبل منحوط لبرزمبيتمبرال إميش + +237 +00:15:31,760 --> 00:15:32,400 +ديسبيريتي + +238 +00:16:00,710 --> 00:16:04,090 +corresponding retinal areas هذه الرسومات بتوضح + +239 +00:16:04,090 --> 00:16:07,470 +فكرة قداش أنا فيها عندي amplitude، قداش فيها عندي + +240 +00:16:07,470 --> 00:16:09,830 +reserve، قداش فيها عندي احتياق من ال virgins + +241 +00:16:09,830 --> 00:16:14,490 +movement أو من ال fusional virgins نقول هاي العين + +242 +00:16:14,490 --> 00:16:17,970 +اليمين و العين الشمالبتطلعوا على target بعيد + +243 +00:16:17,970 --> 00:16:21,890 +الأشعة جاية منه متوازية تسقط على الفوفيا اللي هي + +244 +00:16:21,890 --> 00:16:25,570 +بالنقطة الحمراء وعلى الفوفيا وعندي binocular + +245 +00:16:25,570 --> 00:16:29,390 +single vision لأن الفوفيا مع الفوفيا مناطق متماخلة + +246 +00:16:29,390 --> 00:16:33,920 +من شبكية العين تانيةلأن حطيت based out برزم في كل + +247 +00:16:33,920 --> 00:16:37,740 +عين فأصبحت في عندي bi temporal image disparity + +248 +00:16:37,740 --> 00:16:41,940 +ليش؟ لأن كل برزمين .. كل من البرزمين حرف الأشعة + +249 +00:16:41,940 --> 00:16:45,180 +باتجاه القاعدة بتاعته فبالتالي هتيجي الصورة ع + +250 +00:16:45,180 --> 00:16:48,180 +temporal retina هنا و temporal retina هنا وقولنا + +251 +00:16:48,180 --> 00:16:50,480 +ال temporal مع ال temporal مش corresponding + +252 +00:16:50,480 --> 00:16:55,360 +retinal areas فبالتالي ال brain بتحفظ عشان يعمل + +253 +00:16:55,360 --> 00:16:59,980 +motor fusion أو fusional divergence movementجابل + +254 +00:16:59,980 --> 00:17:03,140 +ما يتم ال sensory fusion فهيؤمر الفوفيا طبعا عبر + +255 +00:17:03,140 --> 00:17:07,180 +العضلات، هيحرك الفوفيا عبر العضلات، الفوفيا هنا + +256 +00:17:07,180 --> 00:17:09,580 +هتروح لبرا، يعني ال media rectus هنا هيصير فيها + +257 +00:17:09,580 --> 00:17:12,440 +contraction، وهنا الفوفيا هتروح لبرا، يعني ال + +258 +00:17:12,440 --> 00:17:15,240 +media rectus هيصير فيها contraction، فالانتين + +259 +00:17:15,240 --> 00:17:18,620 +هيدخلوا لجوة، يعني هذا fusional convergence، + +260 +00:17:18,620 --> 00:17:23,420 +fusional convergence يحفظ .. يحفظ بواسطة + +261 +00:17:23,420 --> 00:17:27,690 +الـbipemporal image disparityلو أنا بدلت ل بريزمين + +262 +00:17:27,690 --> 00:17:31,810 +ب .. ب .. ب .. بمنشورين او بريزمين اقوى الكمية + +263 +00:17:31,810 --> 00:17:35,670 +الانحراف باتجاه ال base هتصير اكتر فبالتالي الصورة + +264 +00:17:35,670 --> 00:17:38,070 +هتكون ايضا ع ال temporal لو temporal روحنا بس + +265 +00:17:38,070 --> 00:17:41,930 +هتبعد اكتر عن ال fovea هتبعد اكتر عن ال fovea + +266 +00:17:41,930 --> 00:17:45,290 +هيلزم عمل fusional convergence يعني ال fovea هذه + +267 +00:17:45,290 --> 00:17:48,430 +هتروح هيك بها اتجاه السهم باتجاه ال temporal side + +268 +00:17:48,430 --> 00:17:51,950 +و هنا في نفس اللحظة هتروح باتجاه ال temporal side + +269 +00:17:51,950 --> 00:17:55,580 +فال anterior part of the eye هيعملconvergence + +270 +00:17:55,580 --> 00:17:59,020 +هيعمل convergence لأن طالما راحت الفوفيا برا + +271 +00:17:59,020 --> 00:18:03,200 +الكورنيا بتدخل لجوة و هنا طالما راحت الفوفيا برا + +272 +00:18:03,200 --> 00:18:07,500 +الكورنيا بتدخل لوين لجوة فبالتالي هذا أيضا + +273 +00:18:07,500 --> 00:18:11,820 +fusional convergence لغاية قداش قوة ال prism بيقدر + +274 +00:18:11,820 --> 00:18:14,840 +الإنسان يظل محتفظ بال binocular single vision يعني + +275 +00:18:14,840 --> 00:18:19,020 +بيقدر يحرك الفوفيا عشان يصل لصورة ال target اللي + +276 +00:18:19,020 --> 00:18:24,480 +بسقط في ال temporal retinaالحد الأعلى يسمى ال .. + +277 +00:18:24,480 --> 00:18:28,520 +ال amplitude أو اللي هو ال maximum بتاع ال + +278 +00:18:28,520 --> 00:18:31,040 +fusional convergence .. ال maximum بتاع ال + +279 +00:18:31,040 --> 00:18:36,700 +fusional convergence نفس القضية بس باتجاه مختلف + +280 +00:18:36,700 --> 00:18:40,400 +اللي هي ال fusional divergence لما أنا بحط base in + +281 +00:18:40,400 --> 00:18:45,040 +prism قدام العنتين بتصير عندى bi nasal image + +282 +00:18:45,040 --> 00:18:47,970 +disparityعال nasal retina هنا و ال nasal retina + +283 +00:18:47,970 --> 00:18:51,190 +هنا، ليش by nasal؟ لأنه كل بريسم هيحرف الأشعة + +284 +00:18:51,190 --> 00:18:55,610 +باتجاه ال base بتاعته، باتجاه ال base بتاعته، فكل + +285 +00:18:55,610 --> 00:18:59,230 +بريسم هيحرف الأشعة بالاتجاه ال base بتاعته، عندي + +286 +00:18:59,230 --> 00:19:03,090 +by nasal image disparity، ال nasal مع ال nasalمش + +287 +00:19:03,090 --> 00:19:07,070 +corresponding retinal areas فبالتالي لازم ال brain + +288 +00:19:07,070 --> 00:19:11,070 +ياخد إجراء قبل ما يوحد الصورتين أنه يعيد أسقاط + +289 +00:19:11,070 --> 00:19:14,250 +الصورتين على corresponding retinal areas أو + +290 +00:19:14,250 --> 00:19:17,790 +بالأحرى على الفوفيا فهتتحرك الفوفيا نازلي هنا + +291 +00:19:18,180 --> 00:19:21,560 +هتتحرك الفوفيا نازلي هنا طالما ال two fovia + +292 +00:19:21,560 --> 00:19:25,440 +تتحركوا نازلي ال two corneas بتتحركوا temporally + +293 +00:19:25,440 --> 00:19:28,320 +هدى لبرا وهدى لبرا وهدى يسمى fusional divergence + +294 +00:19:28,320 --> 00:19:32,300 +يعني أصبح divergence القصد منه أنه يحدث ال fusion + +295 +00:19:32,300 --> 00:19:39,230 +تمهيد لل fusion طيب زودنا قوة ال prisonهيحرف كل من + +296 +00:19:39,230 --> 00:19:43,050 +ال بريزمين القويين الصورة باتجاه القاعدة بتاعته، + +297 +00:19:43,050 --> 00:19:46,110 +يعني هتكون أيضًا by nasal image disparity زي + +298 +00:19:46,110 --> 00:19:50,210 +المثال الأول، بس بقدر أكبر، يعني الصورة أبعد عن + +299 +00:19:50,210 --> 00:19:53,230 +الفوفيا، وهنا أبعد عن الفوفيا، أيضًا ال brain + +300 +00:19:53,230 --> 00:19:59,250 +هيؤمر بحركةDivergence عشان يتم ال diffusion بس لو + +301 +00:19:59,250 --> 00:20:02,830 +سؤالنا نفسنا سؤال ايش اعلى برزم بيقدر يتحمله هذا + +302 +00:20:02,830 --> 00:20:06,750 +الإنسان او ال brain يعني بمعنى اخر لو استعملت برزم + +303 +00:20:06,750 --> 00:20:10,950 +اقوى و اقوى هاصل لنقطة ان الفوفيا مش قادرة تصل + +304 +00:20:10,950 --> 00:20:16,170 +لموقع الصورة بمعنى أصبح انه لازال عندي ان الفوفيا + +305 +00:20:16,170 --> 00:20:20,600 +بعيدة عن الصورةعن إنها تصل للصورة على ال nasal + +306 +00:20:20,600 --> 00:20:24,220 +retina وبالتالي لازال عندي binasal image disparity + +307 +00:20:24,220 --> 00:20:27,960 +و double vision هذا الحد الأعلى اللي بعدي ال brain + +308 +00:20:27,960 --> 00:20:32,880 +بيفشل في تعويض موقع الصورة أو في .. بيفشل to + +309 +00:20:32,880 --> 00:20:37,120 +overcome .. يعني fails to overcome ال retinal + +310 +00:20:37,120 --> 00:20:41,680 +image disparity هذا يعتبر الحد الأعلى لل fusional + +311 +00:20:41,680 --> 00:20:46,610 +divergenceحقيقة العلماء جاسوا هذه القضية بالنسبة + +312 +00:20:46,610 --> 00:20:50,090 +لل convergence الحد الأعلى ل ال fusional + +313 +00:20:50,090 --> 00:20:52,810 +convergence يعني ال amplitude بتاعة ال fusional + +314 +00:20:52,810 --> 00:20:57,930 +convergence من 15 ل 20 prism على ال distance إذا + +315 +00:20:57,930 --> 00:21:02,350 +ال target عندي على ال distance و 25 prism إذا كان + +316 +00:21:02,350 --> 00:21:06,010 +ال target عندي عنه بمعنى لو أنا جيت حطيت target + +317 +00:21:06,010 --> 00:21:10,310 +على بعد 6 متر و قلت لا هذا الإنسان يتطلع عليه + +318 +00:21:10,750 --> 00:21:16,390 +وحطتله بريزمات based out .. based out عشان احفظ ال + +319 +00:21:16,390 --> 00:21:19,510 +convergence عشان اعمل by temporal image disparity + +320 +00:21:19,510 --> 00:21:23,170 +.. based out عشان اعمل by temporal image disparity + +321 +00:21:23,170 --> 00:21:26,850 +.. by temporal image disparity وضلت ازود في هدول + +322 +00:21:26,850 --> 00:21:30,470 +بريزمات لعند ما وصلت لعشرين بريزم و أحيانا + +323 +00:21:30,470 --> 00:21:34,510 +لخمستاشر بريزم طبعا ال target ع ال distance ببدأ + +324 +00:21:34,510 --> 00:21:39,490 +الإنسان هذا يشكيمن double vision او diplopia مش + +325 +00:21:39,490 --> 00:21:42,950 +قادر يعمل overcome لل retinal image disparity مش + +326 +00:21:42,950 --> 00:21:46,070 +قادر يتقلب على ال retinal image disparity ويثبت + +327 +00:21:46,070 --> 00:21:49,910 +الصورتين على ال two foveas اللي هما corresponding + +328 +00:21:49,910 --> 00:21:54,110 +retinal areas طبعا بالنسبة لل divergence الأرقام + +329 +00:21:54,110 --> 00:21:59,600 +أقل لو حطيت base in the prismقدام العينتين بتحمل + +330 +00:21:59,600 --> 00:22:03,180 +هذا الإنسان من ستة لعشرة prism أكتر من هيك بيصير + +331 +00:22:03,180 --> 00:22:06,940 +عنده double vision عنير بيتحمل base in prism طبعا + +332 +00:22:06,940 --> 00:22:10,100 +ال divergence لما بحط ال target عنها ممكن الإنسان + +333 +00:22:10,100 --> 00:22:14,080 +يتحمل بريزمات base in من اتناشر لاربعتاشر prism + +334 +00:22:14,080 --> 00:22:18,320 +هذه الأرقام .. هذه الأرقام يعني ممكن تختلف من شخص + +335 +00:22:18,320 --> 00:22:22,200 +لشخص ممكن تكون أقوى من هيك أو أكتر من هيك وممكن + +336 +00:22:22,200 --> 00:22:27,970 +تكون أقل من هيك طبعا لو سألنا سؤالإنها تكون أكتر + +337 +00:22:27,970 --> 00:22:31,690 +بيكون أفضل ولا تكون أقل بيكون أفضل الجواب ببساطة + +338 +00:22:31,690 --> 00:22:35,410 +شديدة كل ما كانت أكتر كل ما كان أفضل لأنه كل ما + +339 +00:22:35,410 --> 00:22:38,510 +كانت أكتر معناته ال .. ال .. ال .. الدماغ بتحمل .. + +340 +00:22:38,510 --> 00:22:42,910 +الدماغ الإنسان بتحمل ال .. ال .. ال .. ال image + +341 +00:22:42,910 --> 00:22:45,650 +disparity عن ال retina و بيقدر يتغلب عليها مهما + +342 +00:22:45,650 --> 00:22:49,510 +كانت كبيرة فبالتالي كل ما كان الأرقام أو ال + +343 +00:22:49,510 --> 00:22:53,290 +fusional amplitudes أعلى كل ما كان أفضل سواء في ال + +344 +00:22:53,290 --> 00:22:56,460 +fusional convergence أو ال fusional divergenceأو + +345 +00:22:56,460 --> 00:22:59,460 +في ال vertical vergence أو في ال cyclovergence زي + +346 +00:22:59,460 --> 00:23:02,500 +ما هنحكي بعد شوية .. إذا كل ما كانت الأرقام أعلى + +347 +00:23:02,500 --> 00:23:06,100 +كل ما كان أفضل بس هذا ال range اللي مشروع كأرقام + +348 +00:23:06,100 --> 00:23:11,360 +هنا هو المتوسط اللي يعني تم استنتاجه من إجراء + +349 +00:23:11,360 --> 00:23:16,240 +دراسات على العديد من الأشخاص على العديد من الأشخاص + +350 +00:23:16,240 --> 00:23:20,470 +.. إذا the fusional vergencesهي حركات this you get + +351 +00:23:20,470 --> 00:23:23,350 +I movements عبارة عن virgins movement بس صميناها + +352 +00:23:23,350 --> 00:23:27,310 +fusional virgins عشان انه الهدف من هذه ال virgins + +353 +00:23:27,310 --> 00:23:31,130 +movement انه يتم الفيوجين انه يتم الفيوجين انه ال + +354 +00:23:31,130 --> 00:23:35,340 +virgins movement اللي قمر فيها دماغبعدها سقطت + +355 +00:23:35,340 --> 00:23:40,120 +الصورتين على مناطق متماثلة و أرسلت إلى ال visual + +356 +00:23:40,120 --> 00:23:44,500 +cortex و تم توحيدها لأنها سقطت على مناطق متماثلة + +357 +00:23:44,500 --> 00:23:49,240 +من شبكية العنتين أو بنجوسين على ال two foveas + +358 +00:23:49,240 --> 00:23:53,100 +فبالتالي هذه ال effusion divergence أو بنجوسين ال + +359 +00:23:53,100 --> 00:23:57,200 +motor effusion بيمهد لل sensory effusion بيمهد لل + +360 +00:23:57,200 --> 00:24:03,760 +sensory effusion الآن في عندي كمان اللي هيvertical + +361 +00:24:03,760 --> 00:24:13,180 +versions هذا الدائرة عبارة عن دائرة فاتحة الشبكية + +362 +00:24:15,300 --> 00:24:18,720 +داخل هذه الدائرة احنا شايفين مقطع من شبكية العين + +363 +00:24:18,720 --> 00:24:22,820 +الشمال و هنا شايفين مقطع من شبكية العين اليمين، + +364 +00:24:22,820 --> 00:24:27,060 +هذه مش العين، هذه الدائرة أو الجسم البيضاوي ليس + +365 +00:24:27,060 --> 00:24:30,580 +العينه، لأ و إنما هي .. هذه window، شباك بنطل منه + +366 +00:24:30,580 --> 00:24:34,680 +على شبكية العين اليمين، في target بعيد أو قريب مش + +367 +00:24:34,680 --> 00:24:38,780 +مشكلة، بينظر عليه هذا الإنسان اللي هو هاي عينه + +368 +00:24:38,780 --> 00:24:42,280 +اليمين و هاي عينه الشمالهذا ال target عبارة عن خط + +369 +00:24:42,280 --> 00:24:47,420 +وفيه نقطة مميزة .. فيه نقطة مميزة لهذا الخط .. + +370 +00:24:47,420 --> 00:24:51,420 +يعني فيه نقطة في المصر خميلة شوية تمام؟ سقطت .. + +371 +00:24:51,420 --> 00:24:56,680 +سقطت صورة الخط على ال left eye على ال retina منطقة + +372 +00:24:57,300 --> 00:25:02,000 +و سقطت على فرع ال right أي على منطقة يعني منخفضة + +373 +00:25:02,000 --> 00:25:05,800 +عنها يعني مش هنا على ال superior retina سقطت و هنا + +374 +00:25:05,800 --> 00:25:09,220 +على ال inferior retina سقطت المسافة بينهم ممكن + +375 +00:25:09,220 --> 00:25:13,720 +تكون ملي اتنين ملي تلاتة ملي مش قضية كبيرة المهم + +376 +00:25:13,720 --> 00:25:17,890 +انه سقطت على مناطقفيها اختلال او في image + +377 +00:25:17,890 --> 00:25:21,190 +disparity vertical image disparity vertical image + +378 +00:25:21,190 --> 00:25:25,490 +disparity طبعا اول حاجة طالما vertical image + +379 +00:25:25,490 --> 00:25:30,630 +disparity هذه الحلقة بتقول لي انه مش موحدة + +380 +00:25:30,630 --> 00:25:34,330 +الصورتين الصورة ع شبكية العين اليمين و الصورة ع + +381 +00:25:34,330 --> 00:25:37,430 +شبكية العين الشمال هو نفس ال target ال target عندى + +382 +00:25:37,430 --> 00:25:42,720 +واحد بس لأنه سقطعلى superior retina في ال left eye + +383 +00:25:42,720 --> 00:25:45,400 +وعلى ال inferior retina في ال right eye إذا في + +384 +00:25:45,400 --> 00:25:48,260 +عندي vertical image disparity، الدماغ مش متحمل + +385 +00:25:48,260 --> 00:25:53,380 +فهنا double vision، unfused percept يعني التقاط ما + +386 +00:25:53,380 --> 00:25:56,680 +تمش توحيده، ما تمش توحيده، ما صار لهش confusion + +387 +00:25:57,140 --> 00:26:00,960 +Fused Percept إذا كان الـ Amplitudes الـ Vertical + +388 +00:26:00,960 --> 00:26:04,940 +Vergence Amplitudes القدرة تحت الدماغ على تعديل + +389 +00:26:04,940 --> 00:26:09,420 +الوضع بتاع الشبكية رأسيا عشان يتم إسقاط الصورتين + +390 +00:26:09,420 --> 00:26:13,380 +على مناطق متماثلة إذا كان ضمن ال range اللي جادر + +391 +00:26:13,380 --> 00:26:17,100 +عليه الدماغ بيوحد الصورتين في صورة واحدة و بيقوم ب + +392 +00:26:17,100 --> 00:26:20,480 +Vergence Movement إن عين بتظهر ثابتة و العين اللي + +393 +00:26:20,480 --> 00:26:26,760 +كانت منخفضة بتطلع لل straight position أو العينإذا + +394 +00:26:26,760 --> 00:26:31,800 +كانت لفوق بتنزل لتحت بحيث أنه يتم تعديل ووضع + +395 +00:26:31,800 --> 00:26:37,100 +الصورتين ويتم توحيد ال percept أو الصورة تاع ال + +396 +00:26:37,100 --> 00:26:42,560 +target في صورة واحدة ال range ده ال vertical + +397 +00:26:42,560 --> 00:26:46,700 +fusional range أقل من ال horizontal fusional range + +398 +00:26:46,700 --> 00:26:52,160 +نحن عشان نذكر بالأرقامبنقول ال convergence ع ال + +399 +00:26:52,160 --> 00:26:55,900 +distance من 15 ل 20 بريزم بتحمل الإنسان وع ال near + +400 +00:26:55,900 --> 00:27:01,160 +بتحمل ل 25 بعض الأشخاص ل 30 و أكتر ال divergence + +401 +00:27:01,160 --> 00:27:06,100 +على ال distance من 6 ل 10 بريزم بتحمل و ال + +402 +00:27:06,100 --> 00:27:09,240 +fusional range اللي هو ال fusional divergence على + +403 +00:27:09,240 --> 00:27:15,170 +ال near من 12 ل 14 بريزمفينما ال vertical fusional + +404 +00:27:15,170 --> 00:27:21,110 +amplitude بتتراوح من اتنين لتلاتة prism، ايش يعني + +405 +00:27:21,110 --> 00:27:24,010 +بتتراوح من اتنين لتلاتة prism؟ يعني لو انا انسان + +406 +00:27:24,010 --> 00:27:30,420 +بتطلع ع target بعيدشامعة أو مثلا إشارة الست على + +407 +00:27:30,420 --> 00:27:34,400 +ستين في ال snail chart حرف الست على ستين في ال + +408 +00:27:34,400 --> 00:27:38,080 +snail chart وشايفه بعينيه تنتين وفاتع عينيه تنتين + +409 +00:27:38,080 --> 00:27:41,460 +وشايفه target واحد وروحت انا حاطيتله vertical + +410 +00:27:41,460 --> 00:27:45,240 +prism سواء حاطيته base up او base down او base + +411 +00:27:45,240 --> 00:27:49,900 +down قدام عين من عينيه تنتين هيتحمل لغاية اتنين + +412 +00:27:49,900 --> 00:27:54,090 +لتلاتة prism في الطبيعيلو حطيتله أكتر، هيصير يشوف + +413 +00:27:54,090 --> 00:27:57,530 +vertical diplopia، هيشوف الحرف و صورته إما فوقه أو + +414 +00:27:57,530 --> 00:28:01,270 +تحته حسب اتجاه الprism، إذا ال .. ال .. ال + +415 +00:28:01,270 --> 00:28:05,610 +vertical fusional range جليل و بتروح من اتنين + +416 +00:28:05,610 --> 00:28:09,860 +لتلاتة prismالـ Cyclovergence يعني إذا أنا إنسان + +417 +00:28:09,860 --> 00:28:15,000 +بتطلع على target مثلا شمعة و روحت بواسطة ما .. + +418 +00:28:15,000 --> 00:28:18,800 +بواسطة ما و في أجهزة بتعمل القضية هذه خلت صورة + +419 +00:28:18,800 --> 00:28:22,400 +الشمعة الشبكية في العين اليمين معتادلة زي ما هي و + +420 +00:28:22,400 --> 00:28:26,420 +على شبكية العين الشمال خلتها ميلة .. خلتها ميلة + +421 +00:28:26,420 --> 00:28:32,460 +جداش بتحمل ميلان طبعا حتى لو إجت على الفوفيا و على + +422 +00:28:32,460 --> 00:28:35,420 +الفوفيا الفوفيا و الفوفيا corresponding retinal + +423 +00:28:35,420 --> 00:28:39,290 +areas زي ما احنا عارفينولكن إذا كان في صورة معتادة + +424 +00:28:39,290 --> 00:28:43,290 +قائمة شمعة قائمة وشمعة ميلة مثلا تلاتين أو أربعين + +425 +00:28:43,290 --> 00:28:46,450 +درجة هل بتحمل .. هل هذا يعتبر في البداية image + +426 +00:28:46,450 --> 00:28:49,690 +disparity؟ طبعا يعتبر image disparity لأن إذا + +427 +00:28:49,690 --> 00:28:53,750 +الصورة معتادة لو قائمة في .. على ..شبكية العين + +428 +00:28:53,750 --> 00:28:56,050 +اليمين أو الفوبيا تحت العين اليمين لازم تكون + +429 +00:28:56,050 --> 00:28:59,910 +معتادلة وقائمة على شبكية العين الشمال ما تكون ميلة + +430 +00:28:59,910 --> 00:29:05,090 +كدهش متحمل ال brain الميلان هذا او ال cycle .. ال + +431 +00:29:05,090 --> 00:29:08,830 +cycle image disparity .. ال cycle image disparity + +432 +00:29:08,830 --> 00:29:12,370 +يعني فيه اندي image disparity بس مش انه زيغة هي + +433 +00:29:12,370 --> 00:29:15,670 +جاية عصين في العين اليمين وعصين شرطة في العين + +434 +00:29:15,670 --> 00:29:19,010 +الشمال مش زيغة زبغان وانما ميلة ميلان وهي موجودة + +435 +00:29:19,350 --> 00:29:23,530 +على scene شرطة في شبكية العين الشمالي ومعتدلا .. + +436 +00:29:23,530 --> 00:29:26,750 +ومعتدلا في شبكية العين اليمين جدش بقدر يتحمل + +437 +00:29:26,750 --> 00:29:29,850 +الدراسات القديمة بتقول من اتنين لتلاتة degree + +438 +00:29:29,850 --> 00:29:33,910 +ميلان .. من اتنين لتلاتة degree الدراسات الأحدث + +439 +00:29:33,910 --> 00:29:37,690 +بتقول لغاية تمانية degree وهي الحقيقة الدراسات + +440 +00:29:37,690 --> 00:29:41,230 +الأحدث هي الأدق في هذهالقضية فهذه الأرقام وهذه + +441 +00:29:41,230 --> 00:29:44,530 +أرقام قديمة من اتنين لتلاتة degree هي ال .. + +442 +00:29:44,530 --> 00:29:48,630 +الانسان بتحمل cycloversions سواء ميلان على اليمين + +443 +00:29:48,630 --> 00:29:52,030 +أو ميلان على الشمال أو بالأصح سواء N cyclo image + +444 +00:29:52,030 --> 00:29:56,050 +disparity أو X cyclo image disparity بتحم .. بتحمل + +445 +00:29:56,050 --> 00:30:02,640 +لغاية تمانية degree وربما أكتر طيبإيش الهدف من كل + +446 +00:30:02,640 --> 00:30:06,760 +هذه الفيوجينال convergence؟ الفيوجينال convergence + +447 +00:30:06,760 --> 00:30:11,350 +helps to control an exophoriahelps to control an + +448 +00:30:11,350 --> 00:30:15,350 +exophoria whereas fusional divergence helps to + +449 +00:30:15,350 --> 00:30:17,410 +control an esophoria + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Ycg6o67GOeo_raw.json b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/Ycg6o67GOeo_raw.json 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"word": " الله", "probability": 0.951171875}, {"start": 16.02, "end": 16.54, "word": " تعالى،", "probability": 0.817626953125}, {"start": 16.54, "end": 17.1, "word": " اتوقفنا", "probability": 0.940234375}, {"start": 17.1, "end": 17.28, "word": " عند", "probability": 0.9931640625}, {"start": 17.28, "end": 17.52, "word": " هذه", "probability": 0.77001953125}, {"start": 17.52, "end": 17.86, "word": " ال", "probability": 0.96826171875}, {"start": 17.86, "end": 18.34, "word": " slide", "probability": 0.81982421875}, {"start": 18.34, "end": 19.12, "word": " أو", "probability": 0.4384765625}, {"start": 19.12, "end": 19.26, "word": " عند", "probability": 0.966796875}, {"start": 19.26, "end": 19.46, "word": " هذه", "probability": 0.9462890625}, {"start": 19.46, "end": 20.04, "word": " الرسمة", "probability": 0.9767252604166666}], "temperature": 1.0}, {"id": 2, "seek": 4215, "start": 20.43, "end": 42.15, "text": "وقولنا لما احنا بنطلع على target بعيد، ال target الجريب بيكون صوته ع temporal written هنا، ع temporal written هنا وبالتالي بيكون فيه ending bi temporal image disparity لإن ال temporal مع ال temporal مش نقات متناسقة وإيه لما بنطلع على إش جريب؟", "tokens": [2407, 39648, 8315, 5296, 15042, 1975, 5016, 8315, 44945, 9566, 1211, 3615, 15844, 3779, 45030, 25708, 12399, 2423, 3779, 25724, 16572, 3555, 4724, 1829, 30544, 20328, 35473, 3224, 6225, 30881, 3720, 34105, 12399, 6225, 30881, 3720, 34105, 46599, 6027, 2655, 6027, 1829, 4724, 1829, 30544, 8978, 3224, 8121, 3228, 30881, 3256, 47415, 5296, 28814, 1863, 2423, 30881, 20449, 2423, 30881, 37893, 8717, 4587, 9307, 44650, 8315, 3794, 28671, 4032, 28814, 1829, 3224, 5296, 15042, 44945, 9566, 1211, 3615, 15844, 11933, 8592, 10874, 16572, 3555, 22807], "avg_logprob": -0.23437500259903973, "compression_ratio": 1.77, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 20.43, "end": 20.93, "word": "وقولنا", "probability": 0.6435546875}, {"start": 20.93, "end": 21.23, "word": " لما", "probability": 0.91259765625}, 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"word": " written", "probability": 0.65771484375}, {"start": 27.05, "end": 27.55, "word": " هنا،", "probability": 0.6859130859375}, {"start": 27.55, "end": 27.71, "word": " ع", "probability": 0.9091796875}, {"start": 27.71, "end": 28.03, "word": " temporal", "probability": 0.98876953125}, {"start": 28.03, "end": 28.39, "word": " written", "probability": 0.8828125}, {"start": 28.39, "end": 28.71, "word": " هنا", "probability": 0.99560546875}, {"start": 28.71, "end": 29.95, "word": " وبالتالي", "probability": 0.829248046875}, {"start": 29.95, "end": 30.47, "word": " بيكون", "probability": 0.9518229166666666}, {"start": 30.47, "end": 30.73, "word": " فيه", "probability": 0.5841064453125}, {"start": 30.73, "end": 30.91, "word": " ending", "probability": 0.1768798828125}, {"start": 30.91, "end": 31.17, "word": " bi", "probability": 0.376220703125}, {"start": 31.17, "end": 31.61, "word": " temporal", "probability": 0.6748046875}, {"start": 31.61, "end": 31.99, "word": " image", "probability": 0.9267578125}, {"start": 31.99, "end": 32.67, "word": " disparity", "probability": 0.96240234375}, {"start": 32.67, "end": 33.69, "word": " لإن", "probability": 0.730712890625}, {"start": 33.69, "end": 33.83, "word": " ال", "probability": 0.6982421875}, {"start": 33.83, "end": 34.21, "word": " temporal", "probability": 0.97900390625}, {"start": 34.21, "end": 34.41, "word": " مع", "probability": 0.9619140625}, {"start": 34.41, "end": 34.53, "word": " ال", "probability": 0.59326171875}, {"start": 34.53, "end": 34.99, "word": " temporal", "probability": 0.9912109375}, {"start": 34.99, "end": 36.43, "word": " مش", "probability": 0.98291015625}, {"start": 36.43, "end": 38.71, "word": " نقات", "probability": 0.7809244791666666}, {"start": 38.71, "end": 39.63, "word": " متناسقة", "probability": 0.9459228515625}, {"start": 39.63, "end": 40.33, "word": " وإيه", "probability": 0.75738525390625}, {"start": 40.33, "end": 40.49, "word": " لما", "probability": 0.9716796875}, {"start": 40.49, "end": 41.03, "word": " بنطلع", "probability": 0.9593505859375}, {"start": 41.03, "end": 41.21, "word": " على", "probability": 0.79736328125}, {"start": 41.21, "end": 41.37, "word": " إش", "probability": 0.773193359375}, {"start": 41.37, "end": 42.15, "word": " جريب؟", "probability": 0.9793701171875}], "temperature": 1.0}, {"id": 3, "seek": 5509, "start": 42.61, "end": 55.09, "text": "الاشي اللي بعيد بيكون عامل by nasal image disparity يعني صورته بتسقط على nasal retina و nasal retina فبالتالي بيكون فيه عندى by nasal image disparity ال by temporal image disparity", "tokens": [6027, 33599, 1829, 13672, 1829, 45030, 25708, 4724, 1829, 30544, 6225, 10943, 1211, 538, 41575, 3256, 47415, 37495, 22653, 20328, 13063, 47395, 39894, 3794, 47432, 15844, 41575, 1533, 1426, 4032, 41575, 1533, 1426, 6156, 3555, 6027, 2655, 6027, 1829, 4724, 1829, 30544, 8978, 3224, 43242, 7578, 538, 41575, 3256, 47415, 2423, 538, 30881, 3256, 47415], "avg_logprob": -0.2014508909944977, "compression_ratio": 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"probability": 0.9611002604166666}, {"start": 47.27, "end": 47.51, "word": " على", "probability": 0.83447265625}, {"start": 47.51, "end": 47.81, "word": " nasal", "probability": 0.9453125}, {"start": 47.81, "end": 48.29, "word": " retina", "probability": 0.98388671875}, {"start": 48.29, "end": 48.51, "word": " و", "probability": 0.9892578125}, {"start": 48.51, "end": 48.79, "word": " nasal", "probability": 0.9287109375}, {"start": 48.79, "end": 49.59, "word": " retina", "probability": 0.9814453125}, {"start": 49.59, "end": 50.43, "word": " فبالتالي", "probability": 0.922607421875}, {"start": 50.43, "end": 50.63, "word": " بيكون", "probability": 0.8466796875}, {"start": 50.63, "end": 50.87, "word": " فيه", "probability": 0.687744140625}, {"start": 50.87, "end": 51.07, "word": " عندى", "probability": 0.577880859375}, {"start": 51.07, "end": 51.25, "word": " by", "probability": 0.96923828125}, {"start": 51.25, "end": 51.59, "word": " nasal", "probability": 0.9921875}, {"start": 51.59, "end": 51.99, "word": " image", "probability": 0.9365234375}, {"start": 51.99, "end": 52.63, "word": " disparity", "probability": 0.97119140625}, {"start": 52.63, "end": 53.35, "word": " ال", "probability": 0.5458984375}, {"start": 53.35, "end": 53.63, "word": " by", "probability": 0.8037109375}, {"start": 53.63, "end": 54.03, "word": " temporal", "probability": 0.96044921875}, {"start": 54.03, "end": 54.47, "word": " image", "probability": 0.93505859375}, {"start": 54.47, "end": 55.09, "word": " disparity", "probability": 0.962890625}], "temperature": 1.0}, {"id": 4, "seek": 7447, "start": 56.01, "end": 74.47, "text": "بتحفظ ال fusional convergence، ليش؟ لأن الفوفيا هتروح باتجاه الصورة، و هنا الفوفيا هتروح باتجاه الصورة، يعني ال two fovea بيروحوا temporally، فال anterior part of the eye بيروح، يعني nasally، هذه اللي هي بتروح inward، وهذه اللي هي بتروح inward، inward يعني convergence", "tokens": [3555, 2655, 5016, 5172, 19913, 2423, 23100, 304, 32181, 12399, 32239, 8592, 22807, 5296, 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"probability": 0.6585693359375}, {"start": 58.79, "end": 59.37, "word": " ليش؟", "probability": 0.9358723958333334}, {"start": 59.37, "end": 59.61, "word": " لأن", "probability": 0.87939453125}, {"start": 59.61, "end": 60.05, "word": " الفوفيا", "probability": 0.7568359375}, {"start": 60.05, "end": 60.81, "word": " هتروح", "probability": 0.9530029296875}, {"start": 60.81, "end": 61.63, "word": " باتجاه", "probability": 0.9234619140625}, {"start": 61.63, "end": 62.63, "word": " الصورة،", "probability": 0.9024658203125}, {"start": 62.63, "end": 62.67, "word": " و", "probability": 0.44921875}, {"start": 62.67, "end": 62.79, "word": " هنا", "probability": 0.84130859375}, {"start": 62.79, "end": 63.21, "word": " الفوفيا", "probability": 0.9404296875}, {"start": 63.21, "end": 63.57, "word": " هتروح", "probability": 0.99072265625}, {"start": 63.57, "end": 64.01, "word": " باتجاه", "probability": 0.95166015625}, {"start": 64.01, "end": 64.47, "word": " الصورة،", "probability": 0.9427490234375}, {"start": 64.47, "end": 64.59, "word": " يعني", "probability": 0.9580078125}, {"start": 64.59, "end": 65.09, "word": " ال", "probability": 0.71142578125}, {"start": 65.09, "end": 65.25, "word": " two", "probability": 0.90234375}, {"start": 65.25, "end": 65.67, "word": " fovea", "probability": 0.6018880208333334}, {"start": 65.67, "end": 66.11, "word": " بيروحوا", "probability": 0.90791015625}, {"start": 66.11, "end": 67.09, "word": " temporally،", "probability": 0.6858723958333334}, {"start": 67.09, "end": 67.29, "word": " فال", "probability": 0.967041015625}, {"start": 67.29, "end": 67.69, "word": " anterior", "probability": 0.7265625}, {"start": 67.69, "end": 68.19, "word": " part", "probability": 0.947265625}, {"start": 68.19, "end": 68.37, "word": " of", "probability": 0.9833984375}, {"start": 68.37, "end": 68.55, "word": " the", "probability": 0.88330078125}, {"start": 68.55, "end": 68.71, "word": " eye", "probability": 0.921875}, {"start": 68.71, "end": 69.43, "word": " بيروح،", "probability": 0.8316650390625}, {"start": 69.43, "end": 69.77, "word": " يعني", "probability": 0.978515625}, {"start": 69.77, "end": 70.75, "word": " nasally،", "probability": 0.9138997395833334}, {"start": 70.75, "end": 70.93, "word": " هذه", "probability": 0.3564453125}, {"start": 70.93, "end": 71.09, "word": " اللي", "probability": 0.888916015625}, {"start": 71.09, "end": 71.13, "word": " هي", "probability": 0.31689453125}, {"start": 71.13, "end": 71.53, "word": " بتروح", "probability": 0.9580078125}, {"start": 71.53, "end": 72.11, "word": " inward،", "probability": 0.76611328125}, {"start": 72.11, "end": 72.35, "word": " وهذه", "probability": 0.801513671875}, {"start": 72.35, "end": 72.43, "word": " اللي", "probability": 0.99462890625}, {"start": 72.43, "end": 72.49, "word": " هي", "probability": 0.9716796875}, {"start": 72.49, "end": 72.75, "word": " بتروح", "probability": 0.9225260416666666}, {"start": 72.75, "end": 73.27, "word": " inward،", "probability": 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ما", "probability": 0.98291015625}, {"start": 927.05, "end": 927.35, "word": " كانت", "probability": 0.98974609375}, {"start": 927.35, "end": 927.73, "word": " تسقط", "probability": 0.99365234375}, {"start": 927.73, "end": 927.93, "word": " على", "probability": 0.96044921875}, {"start": 927.93, "end": 928.45, "word": " الفوفيا", "probability": 0.921875}, {"start": 928.45, "end": 928.79, "word": " قبل", "probability": 0.996337890625}, {"start": 928.79, "end": 929.31, "word": " منحوط", "probability": 0.79638671875}, {"start": 929.31, "end": 929.79, "word": " لبرزم", "probability": 0.98974609375}], "temperature": 1.0}, {"id": 44, "seek": 93240, "start": 929.96, "end": 932.4, "text": "بيتمبرال إميش ديسبيريتي", "tokens": [3555, 36081, 2304, 26890, 6027, 11933, 2304, 1829, 8592, 11778, 1829, 35457, 13546, 1829, 31371], "avg_logprob": -0.6196288950741291, "compression_ratio": 0.9361702127659575, "no_speech_prob": 0.5185546875, "words": [{"start": 929.96, "end": 931.42, "word": "بيتمبرال", 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corresponding retinal areas فبالتالي ال brain بتحفظ عشان يعمل motor fusion أو fusional divergence movement", "tokens": [1211, 33456, 11331, 9566, 36081, 2361, 484, 4724, 2288, 11622, 2304, 8978, 28242, 6225, 9957, 6156, 10721, 9381, 3555, 33753, 8978, 18871, 16254, 3228, 30881, 3256, 47415, 32239, 8592, 22807, 5296, 33456, 28242, 4724, 2288, 11622, 2304, 9957, 4386, 28242, 9154, 2423, 26890, 11622, 2304, 9957, 11331, 28480, 16247, 8592, 27884, 4724, 9307, 7435, 40294, 25062, 995, 22488, 3660, 39894, 995, 34268, 3224, 6156, 3555, 6027, 2655, 6027, 1829, 8032, 31371, 7435, 1829, 31767, 13063, 3660, 6225, 30881, 1533, 1426, 34105, 4032, 30881, 1533, 1426, 34105, 4032, 39648, 8315, 2423, 30881, 20449, 2423, 30881, 37893, 11760, 1533, 2071, 3179, 6156, 3555, 6027, 2655, 6027, 1829, 2423, 3567, 39894, 5016, 5172, 19913, 6225, 8592, 7649, 7251, 25957, 1211, 5932, 23100, 34051, 23100, 304, 47387, 3963], "avg_logprob": -0.15362499761581422, "compression_ratio": 1.754325259515571, 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1.7134146341463414, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 1480.54, "end": 1480.84, "word": "هذا", "probability": 0.94482421875}, {"start": 1480.84, "end": 1480.94, "word": " ال", "probability": 0.91796875}, {"start": 1480.94, "end": 1481.2, "word": " target", "probability": 0.984375}, {"start": 1481.2, "end": 1481.64, "word": " عبارة", "probability": 0.9957275390625}, {"start": 1481.64, "end": 1481.84, "word": " عن", "probability": 0.99755859375}, {"start": 1481.84, "end": 1482.28, "word": " خط", "probability": 0.995849609375}, {"start": 1482.28, "end": 1483.16, "word": " وفيه", "probability": 0.7447916666666666}, {"start": 1483.16, "end": 1483.58, "word": " نقطة", "probability": 0.98486328125}, {"start": 1483.58, "end": 1484.24, "word": " مميزة", "probability": 0.99150390625}, {"start": 1484.24, "end": 1484.28, "word": " ..", "probability": 0.5810546875}, {"start": 1484.28, "end": 1484.54, "word": " فيه", "probability": 0.8369140625}, {"start": 1484.54, "end": 1485.14, "word": " نقطة", "probability": 0.9920247395833334}, {"start": 1485.14, "end": 1486.22, "word": " مميزة", "probability": 0.99130859375}, {"start": 1486.22, "end": 1486.9, "word": " لهذا", "probability": 0.943603515625}, {"start": 1486.9, "end": 1487.34, "word": " الخط", "probability": 0.9873046875}, {"start": 1487.34, "end": 1487.42, "word": " ..", "probability": 0.4560546875}, {"start": 1487.42, "end": 1487.5, "word": " يعني", "probability": 0.864013671875}, {"start": 1487.5, "end": 1487.72, "word": " فيه", "probability": 0.942626953125}, {"start": 1487.72, "end": 1487.96, "word": " نقطة", "probability": 0.99169921875}, {"start": 1487.96, "end": 1488.04, "word": " في", "probability": 0.9267578125}, {"start": 1488.04, "end": 1488.42, "word": " المصر", "probability": 0.7312825520833334}, {"start": 1488.42, "end": 1488.78, "word": " خميلة", "probability": 0.9442138671875}, {"start": 1488.78, "end": 1489.12, "word": " شوية", "probability": 0.9573567708333334}, {"start": 1489.12, "end": 1490.24, "word": " تمام؟", "probability": 0.6116536458333334}, {"start": 1490.24, "end": 1490.94, "word": " سقطت", "probability": 0.9524739583333334}, {"start": 1490.94, "end": 1491.42, "word": " ..", "probability": 0.93017578125}, {"start": 1491.42, "end": 1492.16, "word": " سقطت", "probability": 0.9912109375}, {"start": 1492.16, "end": 1492.98, "word": " صورة", "probability": 0.9959309895833334}, {"start": 1492.98, "end": 1493.6, "word": " الخط", "probability": 0.994140625}, {"start": 1493.6, "end": 1494.88, "word": " على", "probability": 0.81103515625}, {"start": 1494.88, "end": 1494.98, "word": " ال", "probability": 0.77392578125}, {"start": 1494.98, "end": 1495.14, "word": " left", "probability": 0.9267578125}, {"start": 1495.14, "end": 1495.38, "word": " eye", "probability": 0.91259765625}, {"start": 1495.38, "end": 1495.6, "word": " على", "probability": 0.58642578125}, {"start": 1495.6, "end": 1495.74, "word": " ال", "probability": 0.919921875}, {"start": 1495.74, "end": 1496.06, "word": " retina", "probability": 0.870849609375}, {"start": 1496.06, "end": 1496.68, "word": " منطقة", "probability": 0.9052734375}], "temperature": 1.0}, {"id": 69, "seek": 151560, "start": 1497.3, "end": 1515.6, "text": "و سقطت على فرع ال right أي على منطقة يعني منخفضة عنها يعني مش هنا على ال superior retina سقطت و هنا على ال inferior retina سقطت المسافة بينهم ممكن تكون ملي اتنين ملي تلاتة ملي مش قضية كبيرة المهم انه سقطت على مناطق", "tokens": [2407, 8608, 47432, 2655, 15844, 6156, 2288, 3615, 2423, 558, 36632, 15844, 9154, 9566, 28671, 37495, 22653, 9154, 9778, 5172, 11242, 3660, 18871, 11296, 37495, 22653, 37893, 34105, 15844, 2423, 13028, 1533, 1426, 8608, 47432, 2655, 4032, 34105, 15844, 2423, 24249, 1533, 1426, 8608, 47432, 2655, 9673, 3794, 31845, 3660, 49374, 16095, 3714, 43020, 6055, 30544, 3714, 20292, 1975, 2655, 1863, 9957, 3714, 20292, 6055, 1211, 9307, 3660, 3714, 20292, 37893, 12174, 11242, 10632, 9122, 3555, 48923, 9673, 16095, 16472, 3224, 8608, 47432, 2655, 15844, 9154, 41193, 4587], "avg_logprob": -0.15045645531643642, "compression_ratio": 1.8624338624338623, "no_speech_prob": 1.2516975402832031e-06, "words": [{"start": 1497.3, "end": 1497.44, "word": "و", "probability": 0.6025390625}, {"start": 1497.44, "end": 1498.16, "word": " سقطت", "probability": 0.9137369791666666}, {"start": 1498.16, "end": 1498.8, "word": " على", "probability": 0.89599609375}, {"start": 1498.8, "end": 1499.58, "word": " فرع", "probability": 0.5594075520833334}, {"start": 1499.58, "end": 1499.72, "word": " ال", "probability": 0.60205078125}, {"start": 1499.72, "end": 1499.88, "word": " right", "probability": 0.80908203125}, {"start": 1499.88, "end": 1500.08, "word": " أي", "probability": 0.315185546875}, {"start": 1500.08, "end": 1500.2, "word": " على", "probability": 0.36083984375}, {"start": 1500.2, "end": 1500.7, "word": " منطقة", "probability": 0.97314453125}, {"start": 1500.7, "end": 1501.32, "word": " يعني", "probability": 0.862060546875}, {"start": 1501.32, "end": 1502.0, "word": " منخفضة", "probability": 0.97080078125}, {"start": 1502.0, "end": 1502.32, "word": " عنها", "probability": 0.90380859375}, {"start": 1502.32, "end": 1502.96, "word": " يعني", "probability": 0.7088623046875}, {"start": 1502.96, "end": 1503.6, "word": " مش", "probability": 0.9853515625}, {"start": 1503.6, "end": 1504.08, "word": " هنا", "probability": 0.86328125}, {"start": 1504.08, "end": 1504.24, "word": " على", "probability": 0.73974609375}, {"start": 1504.24, "end": 1504.32, "word": " ال", "probability": 0.84912109375}, {"start": 1504.32, "end": 1504.6, "word": " superior", "probability": 0.8837890625}, {"start": 1504.6, "end": 1504.98, "word": " retina", "probability": 0.74462890625}, {"start": 1504.98, "end": 1505.54, "word": " سقطت", "probability": 0.98486328125}, {"start": 1505.54, "end": 1505.64, "word": " و", "probability": 0.6494140625}, {"start": 1505.64, "end": 1505.8, "word": " هنا", "probability": 0.91357421875}, {"start": 1505.8, "end": 1506.02, 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1510.72, "word": " تلاتة", "probability": 0.9388427734375}, {"start": 1510.72, "end": 1511.02, "word": " ملي", "probability": 0.9560546875}, {"start": 1511.02, "end": 1511.98, "word": " مش", "probability": 0.9482421875}, {"start": 1511.98, "end": 1512.46, "word": " قضية", "probability": 0.9873046875}, {"start": 1512.46, "end": 1513.1, "word": " كبيرة", "probability": 0.97509765625}, {"start": 1513.1, "end": 1513.72, "word": " المهم", "probability": 0.965087890625}, {"start": 1513.72, "end": 1514.18, "word": " انه", "probability": 0.8232421875}, {"start": 1514.18, "end": 1514.72, "word": " سقطت", "probability": 0.9943033854166666}, {"start": 1514.72, "end": 1514.96, "word": " على", "probability": 0.94775390625}, {"start": 1514.96, "end": 1515.6, "word": " مناطق", "probability": 0.9736328125}], "temperature": 1.0}, {"id": 70, "seek": 153945, "start": 1515.71, "end": 1539.45, "text": "فيها اختلال او في image disparity vertical image disparity vertical image disparity طبعا اول حاجة طالما vertical image disparity هذه الحلقة بتقول لي انه مش موحدة الصورتين الصورة ع شبكية العين اليمين و الصورة ع شبكية العين الشمال هو نفس ال target ال target عندى واحد بس لأنه سقط", "tokens": [41185, 11296, 1975, 46456, 1211, 6027, 1975, 2407, 8978, 3256, 47415, 9429, 3256, 47415, 9429, 3256, 47415, 23032, 3555, 3615, 995, 1975, 12610, 11331, 26108, 3660, 23032, 6027, 15042, 9429, 3256, 47415, 29538, 21542, 1211, 28671, 39894, 39648, 32239, 16472, 3224, 37893, 3714, 2407, 24401, 3660, 31767, 13063, 2655, 9957, 31767, 13063, 3660, 6225, 13412, 3555, 4117, 10632, 18863, 9957, 2423, 32640, 9957, 4032, 31767, 13063, 3660, 6225, 13412, 3555, 4117, 10632, 18863, 9957, 25124, 2304, 6027, 31439, 8717, 36178, 2423, 3779, 2423, 3779, 43242, 7578, 36764, 24401, 4724, 3794, 5296, 33456, 3224, 8608, 47432], "avg_logprob": -0.16414387927701077, "compression_ratio": 2.0294117647058822, "no_speech_prob": 1.633167266845703e-05, "words": [{"start": 1515.71, "end": 1516.23, "word": "فيها", "probability": 0.6282958984375}, {"start": 1516.23, "end": 1516.97, "word": " اختلال", "probability": 0.9605712890625}, {"start": 1516.97, "end": 1517.41, "word": " او", "probability": 0.92822265625}, {"start": 1517.41, "end": 1517.55, "word": " في", "probability": 0.7880859375}, {"start": 1517.55, "end": 1517.89, "word": " image", "probability": 0.552734375}, {"start": 1517.89, "end": 1518.51, "word": " disparity", "probability": 0.94140625}, {"start": 1518.51, "end": 1519.09, "word": " vertical", "probability": 0.3330078125}, {"start": 1519.09, "end": 1519.61, "word": " image", "probability": 0.93115234375}, {"start": 1519.61, "end": 1520.07, "word": " disparity", "probability": 0.953125}, {"start": 1520.07, "end": 1520.55, "word": " vertical", "probability": 0.219970703125}, {"start": 1520.55, "end": 1521.19, "word": " image", "probability": 0.927734375}, {"start": 1521.19, "end": 1522.49, "word": " disparity", "probability": 0.96044921875}, {"start": 1522.49, "end": 1523.21, "word": " طبعا", "probability": 0.9547119140625}, {"start": 1523.21, "end": 1523.95, "word": " اول", "probability": 0.78271484375}, {"start": 1523.95, "end": 1524.35, "word": " حاجة", "probability": 0.9830729166666666}, {"start": 1524.35, "end": 1524.67, "word": " طالما", "probability": 0.9117838541666666}, {"start": 1524.67, "end": 1525.03, "word": " vertical", "probability": 0.426513671875}, {"start": 1525.03, "end": 1525.49, "word": " image", "probability": 0.93896484375}, {"start": 1525.49, "end": 1526.11, "word": " disparity", "probability": 0.97412109375}, {"start": 1526.11, "end": 1527.23, "word": " هذه", "probability": 0.857421875}, {"start": 1527.23, "end": 1527.75, "word": " الحلقة", "probability": 0.8688151041666666}, {"start": 1527.75, "end": 1528.57, "word": " بتقول", "probability": 0.9306640625}, {"start": 1528.57, "end": 1528.71, "word": " لي", "probability": 0.5263671875}, {"start": 1528.71, "end": 1529.23, "word": " انه", "probability": 0.924560546875}, {"start": 1529.23, "end": 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+muscles equally بتعني التأثيرات العضلية .. + +4 +00:00:14,540 --> 00:00:19,460 +التأثيرات العضلية، وهذه .. هذه أيضا تابعة لموضوع + +5 +00:00:19,460 --> 00:00:22,140 +ال paralytic squint أو ال paretic squint، و + +6 +00:00:22,140 --> 00:00:27,200 +الحَوَلُ الشللي، يترى لو صار في عندي شلل أو + +7 +00:00:27,200 --> 00:00:31,120 +paralysis أو paralysis في one of the extraocular + +8 +00:00:31,120 --> 00:00:35,670 +muscles، هل هتتأثر العضلات الثانية؟ وإذا كان الأمر + +9 +00:00:35,670 --> 00:00:39,350 +كذلك، فهل التأثر هيقتصر على العين اللي فيها العضلة + +10 +00:00:39,350 --> 00:00:46,810 +المشلولة أم هيمتد عشان يشمل العينتين؟ طبعا الجواب + +11 +00:00:46,810 --> 00:00:49,990 +على السؤال الأول هو: هل هتتأثر العضلات الأخرى + +12 +00:00:49,990 --> 00:00:56,010 +السليمة بشلل في عضلة ما؟ نعم، إذا يعني طول وقت + +13 +00:00:56,010 --> 00:01:00,190 +الشلل وصار long standing palsy أو Parises + +14 +00:01:01,130 --> 00:01:05,230 +هتأثر العضلات الثانية، الجواب على السؤال الثاني: هل + +15 +00:01:05,230 --> 00:01:08,250 +هيشمل التأثر العين .. العين الواحدة ولا العين الثانية + +16 +00:01:08,250 --> 00:01:13,670 +حقيقة أنه هيشمل العين الثانية بسبب قوانين الحركة + +17 +00:01:13,670 --> 00:01:17,190 +اللي هي Sherrington's law و Herring's law، Sherrington + +18 +00:01:17,190 --> 00:01:21,130 +law و Herring's law، إذا muscle sequelae are the + +19 +00:01:21,130 --> 00:01:25,290 +effects، يعني التأثرات العضلية are the effects of + +20 +00:01:25,290 --> 00:01:29,010 +the interactions described by these laws، اللي هو + +21 +00:01:29,010 --> 00:01:34,410 +Sherrington's law و Herring's law، هي مهمة أكثر في تدريس + +22 +00:01:34,410 --> 00:01:40,330 +مخاطر الحَوَلُ العينية، وفي الواضحة في تحقيق + +23 +00:01:40,330 --> 00:01:44,450 +حكومة قبل قليل من حكومة Longstanding palsy، يعني إنسان + +24 +00:01:44,450 --> 00:01:49,030 +عنده شلل في عضلة ما؟ نقول مثلا ال left medial + +25 +00:01:49,030 --> 00:01:55,190 +rectus muscle مشلولة، هل هتتأثر باقي العضلات؟ إذا + +26 +00:01:55,190 --> 00:02:01,270 +كان مرض وقت طويل على هذه الشلل في ال left medial + +27 +00:02:01,270 --> 00:02:05,030 +rectus، هلاجي إنه بعض العضلات الأخرى، بعضها وليس + +28 +00:02:05,030 --> 00:02:10,150 +كلها تأثرت، وبالتالي بعرف من وجود هذه الآثار على + +29 +00:02:10,150 --> 00:02:13,970 +العضلات الثانية بعرف إنه هذه long standing medial + +30 +00:02:13,970 --> 00:02:19,650 +rectus palsy، بينما لو لجيت إنه ما فيش آثار عضلية أو + +31 +00:02:19,650 --> 00:02:23,910 +ما فيش muscle sequelae، معناته هذه recent palsy، يعني + +32 +00:02:23,910 --> 00:02:29,130 +جديد لسه حدثت، اللي هو ال medial rectus palsy اللي + +33 +00:02:29,130 --> 00:02:34,150 +اتخذناها كمثال، إذا أول شيء ال muscle sequelae وجودها + +34 +00:02:34,150 --> 00:02:40,690 +من عدمه بساعدني أميز أعمل distinguishing بين ال + +35 +00:02:40,690 --> 00:02:44,610 +recently acquired palsy والـ long standing palsy + +36 +00:02:44,610 --> 00:02:48,270 +إنه الحَوَلُ هل هو قديم ولا مش قديم، إذا ال muscle + +37 +00:02:48,270 --> 00:02:52,060 +sequelae موجودة، معناته الحَوَلُ قديم، إذا ال muscle + +38 +00:02:52,060 --> 00:02:56,320 +sequelae مش موجودة، وفقط هي العضلة المشلولة اللي + +39 +00:02:56,320 --> 00:03:03,000 +بين ضعفها وبين جيتها، العضلات سليمة، ساعتها ال .. ال .. + +40 +00:03:03,000 --> 00:03:06,620 +اللي هو ال paralytic squint يكون جديد ولسه + +41 +00:03:06,620 --> 00:03:10,780 +مايلهوش فترة طويلة، يا ترى عبارة عن إيش ال muscle + +42 +00:03:10,780 --> 00:03:14,060 +sequelae؟ أو كيف بتتأثر العضلات؟ هي هل العضلات + +43 +00:03:14,060 --> 00:03:18,140 +بتجوى، بتضعف، هل جزء منها بيجوى، جزء منها بيضعف، + +44 +00:03:18,140 --> 00:03:22,470 +هذا هنشرحه الآن، the full pattern of changes takes + +45 +00:03:22,470 --> 00:03:26,430 +time to develop and can be summarized as follows + +46 +00:03:26,430 --> 00:03:31,110 +يعني التأثيرات العضلية بشلة العضلات بياخد وقت + +47 +00:03:31,110 --> 00:03:37,730 +عشان يصير، وهنلخصه في الجمل القليلة القادمة، بس قبل + +48 +00:03:37,730 --> 00:03:45,970 +ما نلخصه بدنا نفهم بعض الأشياء قبل ما نتكلم في + +49 +00:03:45,970 --> 00:03:52,110 +موضوع التأثيرات العضلية، أول شيء بدنا نفهمه إنه نفرض + +50 +00:03:52,110 --> 00:03:55,210 +هنا عندي ال agonist وهنا ال antagonist، يعني هنا + +51 +00:03:55,210 --> 00:03:58,610 +عضلة مثلا ال lateral rectus وهنا medial rectus أو + +52 +00:03:58,610 --> 00:04:03,290 +هنا superior rectus وهنا inferior rectus، هنسمي + +53 +00:04:03,290 --> 00:04:15,930 +عشان توضح الأمور بشكل أفضل، هنسمي هنا agonist بغض + +54 +00:04:15,930 --> 00:04:19,250 +النظر superior rectus medial rectus إلى آخرها + +55 +00:04:22,420 --> 00:04:30,180 +وهنا هنسميه antagonist، و + +56 +00:04:30,180 --> 00:04:34,140 +هنا + +57 +00:04:34,140 --> 00:04:37,580 +هنسميه antagonist، ليش سميناه antagonist؟ لأنه مضاد + +58 +00:04:37,580 --> 00:04:50,140 +يعني بشد في اتجاه عكس ال agonist + +59 +00:04:50,140 --> 00:04:51,220 +فبالتالي + +60 +00:04:56,410 --> 00:05:00,190 +لما احنا بنقول agonist، إذن هي العضلة الأساسية اللي + +61 +00:05:00,190 --> 00:05:04,910 +بتحرك العين باتجاه معين، نفرض هذه العضلة اللي هو + +62 +00:05:04,910 --> 00:05:08,810 +بيمثلها إنسان، نفرض هذه العضلة بتحرك العين بهذا + +63 +00:05:08,810 --> 00:05:13,210 +الاتجاه، طيب عشان العين تتحرك بهذا الاتجاه اللي + +64 +00:05:13,210 --> 00:05:14,210 +أنا بأشر عليه + +65 +00:05:26,720 --> 00:05:30,140 +عشان العين عندك تتحرك بهذا الاتجاه اللي بيؤشر عليه + +66 +00:05:30,140 --> 00:05:36,720 +السهم، مفروض هذه العضلة أو هذا الشخص يكون عنده ما + +67 +00:05:36,720 --> 00:05:42,320 +يكفي من القوة لفعل شيئين، الشيء الأول إنه يصفر ال + +68 +00:05:42,320 --> 00:05:46,520 +antagonist، إيش يعني يصفر ال antagonist؟ يعني يلغي + +69 +00:05:46,520 --> 00:05:52,360 +قوته، ثم الشيء الثاني إنه يفضل معاه أو يزيد معاه + +70 +00:05:52,360 --> 00:05:58,080 +قليل من القوة عشان يحرك الإشارة أو يحرك العين في + +71 +00:05:58,080 --> 00:06:03,520 +قصتنا مع الحَوَلُ، يحركها باتجاهه، مثال على ذلك لو هذا + +72 +00:06:03,520 --> 00:06:09,680 +الشخص بيشد بقوة خمسين نيوتن، وال antagonist بتاعه + +73 +00:06:09,680 --> 00:06:14,680 +الشخص الآخر بيشد بقوة خمسين نيوتن، ال target أو + +74 +00:06:14,680 --> 00:06:18,880 +العين مش هتتحرك أبدا، بمعنى لو العضلة ال lateral + +75 +00:06:18,880 --> 00:06:23,650 +rectus أو ال superior rectus بتشد بقوة خمسين نيوتن، + +76 +00:06:23,650 --> 00:06:29,050 +والانتاجونيست بتاعتها بتشد بنفس القوة، إذا العين مش + +77 +00:06:29,050 --> 00:06:32,810 +هيتم فيها أي حركة، واحد بيشد بقوة في اتجاه معين + +78 +00:06:32,810 --> 00:06:37,930 +والثاني بيشد بقوة مكافئة لها ومساوية لها باتجاه عكسه + +79 +00:06:37,930 --> 00:06:42,810 +مئتان وثمانين درجة، إذا مش هتتحرك، إذا أول شغل في شغل + +80 +00:06:42,810 --> 00:06:50,370 +العضلات في شغل العضلات لابد إنه العضلة من الست + +81 +00:06:50,370 --> 00:06:56,100 +عضلات المحيطة بالعين عشان تحرك العين باتجاهها، لازم + +82 +00:06:56,100 --> 00:07:01,060 +يكون قوتها أكبر قليلا من قوة ال antagonist عشان + +83 +00:07:01,060 --> 00:07:06,060 +تعطي جزء من قوتها لتصفير وإلغاء قوة شد ال + +84 +00:07:06,060 --> 00:07:12,640 +antagonist، وإنه يظل معها زيادة شوية لتحرك العين + +85 +00:07:12,640 --> 00:07:19,900 +باتجاهها، طيب، الآن بدنا نفرض جدلا .. جدلا إنه ال + +86 +00:07:19,900 --> 00:07:27,850 +antagonist ضعيف، ال antagonist ضعف، + +87 +00:07:27,850 --> 00:07:35,870 +بدنا نفرض جدلا إن ال antagonist ضعف، إيش + +88 +00:07:35,870 --> 00:07:41,810 +اللي هيحصل؟ ضعف يعني صار فيه شلل، هينتج عن هذا + +89 +00:07:41,810 --> 00:07:49,050 +الشلل إن ال agonist مش محتاج قوة كتير، ليش؟ احنا + +90 +00:07:49,050 --> 00:07:52,390 +قلنا إذا كان ال antagonist في الوضع الطبيعي بشد + +91 +00:07:52,390 --> 00:07:57,630 +بقوة خمسين نيوتن، إذا لازم يكون ال agonist المحرك + +92 +00:07:57,630 --> 00:08:01,730 +الأساسي للعين عنده أكثر من خمسين، واحد وخمسين، + +93 +00:08:01,730 --> 00:08:04,970 +اثنين وخمسين، خمسة وخمسين، ستين، المهم أكثر من + +94 +00:08:04,970 --> 00:08:09,830 +خمسين، طب لما بيصير عندي أنا ال antagonist ضعيف، + +95 +00:08:09,830 --> 00:08:15,110 +مشلول، أصبح قوة شده أقل من خمسين نيوتن، نقول مثلا + +96 +00:08:15,110 --> 00:08:20,230 +أصبح قوة شده عشرة نيوتن، عشان هيك ال agonist بيصبح + +97 +00:08:20,230 --> 00:08:25,760 +بده قوة أقل عشان يشد باتجاهه، بمعنى أصبح بسبب شلل + +98 +00:08:25,760 --> 00:08:29,820 +هذه العضلة بسبب .. بسبب شلل ال antagonist، ال + +99 +00:08:29,820 --> 00:08:34,460 +agonist عشان يحرك العين في اتجاهه بده قوة أقل من + +100 +00:08:34,460 --> 00:08:39,640 +اللازم، أنا زمان كنت بدي ستين نيوتن عشان خمسين + +101 +00:08:39,640 --> 00:08:44,520 +أصرفهم على تصفير ال antagonist وعشرة يزيدوا معاي + +102 +00:08:44,520 --> 00:08:50,360 +على إيش؟ على الشد باتجاهي، اليوم أنا عشان أحرك أو + +103 +00:08:50,360 --> 00:08:55,700 +أقوم بهذا العمل أنا ك agonist، بدي عشرة أصفر فيها + +104 +00:08:55,700 --> 00:08:59,600 +قوة الانتاجونيس، لإنه أصبح قوة شده عشرة لإنه مشلول + +105 +00:08:59,600 --> 00:09:05,180 +بجوش تغذية عصبية، فبالتالي أنا خمسة عشر بيكفيني، إذا + +106 +00:09:05,180 --> 00:09:11,260 +في حالة حدوث شلل، لما بيطول هذا الشلل .. لما بيطول + +107 +00:09:11,260 --> 00:09:17,640 +هذا الشلل، بيصبح إنه العضلة المضادة للعضلة المشلولة + +108 +00:09:17,850 --> 00:09:21,250 +العضلة المضادة للعضلة المشلولة بدها أقل + +109 +00:09:21,250 --> 00:09:26,550 +innervation، وبالتالي يعني هذه ضرورية جدا نتذكرها + +110 +00:09:26,550 --> 00:09:34,170 +هذه النقطة، النقطة الثانية إنه لو فرضنا إنه في عندي + +111 +00:09:34,170 --> 00:09:42,210 +عضلة مشلولة اللي هي نفرض عضلة ال antagonist، إيش + +112 +00:09:42,210 --> 00:09:46,770 +بيحدث في العضلة المضادة إليها اللي هنا كاتبين + +113 +00:09:46,770 --> 00:09:51,570 +عليها agonist مع مرور الوقت؟ في الوضع الطبيعي قبل + +114 +00:09:51,570 --> 00:09:56,410 +وجود الشلل، العضلات بتتبادل الوظائف، مرة هي بتشد + +115 +00:09:56,410 --> 00:10:01,110 +وهذه بترخي ومرة هي بتشد والتانية بترخي، فبيجي + +116 +00:10:01,110 --> 00:10:07,190 +على العضلة أوقات شغالة فيها وأوقات مرتاحة فيها .. + +117 +00:10:07,190 --> 00:10:12,110 +وأوقات مرتاحة فيها، قضية الشغل والراحة بتخلي العضلة + +118 +00:10:12,110 --> 00:10:15,890 +التون بتاعها .. التون بتاعها والانشدادية بتاعتها + +119 +00:10:15,890 --> 00:10:20,750 +مش زائدة عن اللزوم، بالعكس هي يعني انشدادية معقولة + +120 +00:10:20,750 --> 00:10:24,530 +يعني بين إنها راخية وبين إنها شديدة، مرة بترخي ومرة + +121 +00:10:24,530 --> 00:10:29,350 +بتشد، يعني مرة هي بتشتغل والمقابلة بترتاح ومرة هي + +122 +00:10:29,350 --> 00:10:33,130 +بترتاح والمقابلة أو ال antagonist بتاعتها بتشتغل، + +123 +00:10:33,130 --> 00:10:39,370 +الآن في حالة الشلل، لما الشلل بيصيب عضلة ما، نفرض + +124 +00:10:39,370 --> 00:10:46,350 +هذه العضلة، ساعتها .. ساعتها بتظل العضلة المقابلة + +125 +00:10:46,650 --> 00:10:50,110 +المقابلة هذه انشلت، بتظل العضل المقابلة + +126 +00:10:50,110 --> 00:10:55,170 +contracted، متقلصة، بيجيش عليها وقت ترتاح، ليش؟ + +127 +00:10:55,170 --> 00:11:00,030 +ليش بيجيش عليها وقت ترتاح؟ لأنه عشان ترتاح، عشان + +128 +00:11:00,030 --> 00:11:03,630 +ترتاح، لازم اللي عاجبالها تشد، طب واللي عاجبالها + +129 +00:11:03,630 --> 00:11:07,640 +مشلولة مش راضية تشد؟ فبالتالي بتضلها في وضع تقلص + +130 +00:11:07,640 --> 00:11:12,920 +ومعروف إن العضلة المتقلصة بتكون قوية ومتشنجة، قوية + +131 +00:11:12,920 --> 00:11:17,920 +ومتشنجة، فبالتالي بتكون أقوى من اللازم، نتيجة إن هي + +132 +00:11:17,920 --> 00:11:22,380 +دائما مشدودة .. دائما مشدودة، وطالما أقوى من اللازم + +133 +00:11:22,380 --> 00:11:26,780 +بيكون لازمها innervation أقل لتنفيذ العمل، نيجي احنا + +134 +00:11:26,780 --> 00:11:32,140 +ناخد صورة ثانية، بنقول لو هذا الشخص صاحب الذراع + +135 +00:11:32,140 --> 00:11:38,380 +القوية وصاحب العضلات المفتولة حاول يسلم على هذا + +136 +00:11:38,380 --> 00:11:44,020 +الشخص صاحب العضلات الضعيفة و .. اللي هي يعني weak + +137 +00:11:44,020 --> 00:11:50,000 +muscles، ممكن يكون هذا الشخص بيسلم أو بيدغط بيده + +138 +00:11:50,000 --> 00:11:54,860 +بشكل تلقائي بسيط جدا ومش قصده إنه يأذي أو شيء من + +139 +00:11:54,860 --> 00:11:59,980 +هذا القبيل، ولكن إن الشخص الآخر بيشعر لما يحط إيده + +140 +00:11:59,980 --> 00:12:06,160 +في إيد مفتول العضلات بيحس بألم وكأنه بينضغط على + +141 +00:12:06,160 --> 00:12:10,610 +يده مع إنه هذا .. ليش .. ليش هذا الكلام بيحدث؟ لأن + +142 +00:12:10,610 --> 00:12:14,330 +هذا طبيعي تقيده إنه صارت متقلصة contracted مع .. + +143 +00:12:14,330 --> 00:12:17,650 +مع التدريب ومع حمل الأثقال ومع ومع ومع .. + +144 +00:12:17,650 --> 00:12:23,480 +فبالتالي هو بيسلم بأقل قوة ممكنة من عنده، ولكن الفعل + +145 +00:12:23,480 --> 00:12:27,300 +تاع هذه القوة اللي بالنسبة له قليلة يعتبر ضغط + +146 +00:12:27,300 --> 00:12:33,400 +كثيرًا على يد اللي هي الإنسان الضعيف، وهذا اللي + +147 +00:12:33,400 --> 00:12:37,960 +بيحدث في ال muscle لما ال muscle بتضلها منشدة وما + +148 +00:12:37,960 --> 00:12:41,940 +.. وما بترتاحش بالمرة بسبب إنه اللي عاجبالها + +149 +00:12:41,940 --> 00:12:45,590 +ما بتشتغلش، هي أمتى بترتاح؟ لما اللي عاجبالها يشتغل، + +150 +00:12:45,590 --> 00:12:49,070 +ما هو حسب قانون Sherrington، حسب Sherrington's law + +151 +00:12:49,070 --> 00:12:53,030 +تعريس ال reciprocal innervation، هي أجهها innervation + +152 +00:12:53,030 --> 00:12:57,330 +عشان تشتغل، معناته هذه بيجيها inhibition عشان + +153 +00:12:57,330 --> 00:13:01,330 +تريح، طيب هذه مش راضية تشتغل بالمرة فبتظل هذه + +154 +00:13:01,330 --> 00:13:05,110 +اللي عاجبالها يعني شادة وما بيجيهاش أوقات إنها + +155 +00:13:05,110 --> 00:13:09,910 +ترتاح فيها، هذه المقدمات لازم جدا عشان نفهم ال + +156 +00:13:09,910 --> 00:13:13,330 +muscle sequelae، عشان نفهم ال muscle sequelae، + +157 +00:13:13,330 --> 00:13:17,790 +فبنقول كالقاتل، يا ترى ب .. إيش .. إيش اللي بلخصلي + +158 +00:13:17,790 --> 00:13:22,230 +أو الجمل اللي بتلخص التأثيرات العضلية بشال العضلة + +159 +00:13:22,230 --> 00:13:29,140 +ما؟ أول حاجة بيحدث primary under action، primary + +160 +00:13:29,140 --> 00:13:33,660 +under action، يعني ضعف في العضلة المشلولة، وهذا شيء + +161 +00:13:33,660 --> 00:13:37,160 +منطقي، إن العضلة انشلت بيجيهاش innervation، + +162 +00:13:37,160 --> 00:13:39,920 +فبالتالي هيصير فيها primary under action، ولما + +163 +00:13:39,920 --> 00:13:42,780 +بيقول primary يعني معناته هي أساس العلة، من عندها + +164 +00:13:42,780 --> 00:13:47,660 +بدأت المشكلة، من عندها بدأت المشكلة، هنا المثال، + +165 +00:13:47,660 --> 00:13:50,660 +يعطيني مثال، نفرض مثلا ال left superior oblique + +166 +00:13:50,660 --> 00:13:55,160 +صار فيها شلل، left superior oblique palsy، أو نقدر + +167 +00:13:55,160 --> 00:13:58,700 +نقول عنها left fourth nerve palsy، ليش left fourth + +168 +00:13:58,700 --> 00:14:01,900 +nerve palsy؟ لأن ال fourth nerve هو اللي بيغذي ال + +169 +00:14:01,900 --> 00:14:05,940 +superior oblique muscle، إذا primary under action + +170 +00:14:05,940 --> 00:14:10,680 +في العضلة المشلولة وهذا مفهوم، ما فيش فيه أي مشكلة + +171 +00:14:10,680 --> 00:14:14,840 +ثاني شيء secondary + +172 +00:14:14,840 --> 00:14:20,510 +contracture of the unopposed direct antagonist، اللي + +173 +00:14:20,510 --> 00:14:25,090 +هي الـ Left Inferior Oblique، طيب بما إنه .. بما + +174 +00:14:25,090 --> 00:14:29,940 +إنه ال left superior oblique صار فيها primary + +201 +00:16:11,770 --> 00:16:14,710 +action ال under action مش طبيعي وال over action + +202 +00:16:14,710 --> 00:16:18,110 +أيضا مش طبيعي الطبيعي أنه يكون عندي normal action + +203 +00:16:18,110 --> 00:16:22,830 +أي عضلة في الدنيا بما فيها عضلات العين لا تعدّ + +204 +00:16:22,830 --> 00:16:26,650 +حالتها اللي بتكون عليها إحدى ثلاث حالات إما تكون + +205 +00:16:26,650 --> 00:16:30,530 +normal acting muscle فهذا الطبيعي والمطلوب أو + +206 +00:16:30,530 --> 00:16:34,870 +underacting muscle مش مطلوب ضعيف أو overacting + +207 +00:16:34,870 --> 00:16:38,910 +muscle وهذا أيضا مش مطلوب لأنه قوي زيادة عن اللزوم + +208 +00:16:38,910 --> 00:16:43,050 +بدليل لما إنسان بيكون بيلعب كرة قدم وفجأة بتتقلص + +209 +00:16:43,050 --> 00:16:46,970 +عضلات الرجلين بت... يعني بتنشد بقوة ما بنقول إنه + +210 +00:16:46,970 --> 00:16:50,550 +هذا شيء طبيعي وممتاز ويعني هذا شيء ياريت يحدث كل + +211 +00:16:50,550 --> 00:16:54,190 +يوم لأ بتوقف اللعب وبيبدأ يعني أخصائي العلاج + +212 +00:16:54,190 --> 00:16:57,870 +الطبيعي والطب الرياضي وما إلى ذلك يتدخلوا و + +213 +00:16:57,870 --> 00:17:03,100 +يحاولوا يعني يعمله إرخاء أو تدليك للمنطقة المتشنجة + +214 +00:17:03,100 --> 00:17:08,060 +من القدم فبالتالي ال over action مش مطلوب ويعتبر أثر + +215 +00:17:08,060 --> 00:17:12,080 +يعني مش جيد وال under action أيضا مش مطلوب ويعتبر + +216 +00:17:12,080 --> 00:17:16,060 +أثر مش جيد إذا احنا بدينا ب lift superior oblique + +217 +00:17:16,060 --> 00:17:21,660 +muscle بالسي إذا under action وهي العضلة الأساسية + +218 +00:17:21,660 --> 00:17:25,380 +اللي بدأت المشكلة طولت ال lift superior oblique + +219 +00:17:25,760 --> 00:17:30,140 +بالسي قد ذلك.. إيش يعني الطولات؟ يعني دائما يوم، + +220 +00:17:30,140 --> 00:17:34,300 +يومين، ثلاثة، شهر، شهرين، ستة أشهر وأكثر تمام؟ وهي + +221 +00:17:34,300 --> 00:17:38,100 +مرخية فبالتالي حيصير عندي contraction لل + +222 +00:17:38,100 --> 00:17:43,150 +antagonist اللي هو ال inferior oblique حيصير عندي + +223 +00:17:43,150 --> 00:17:47,010 +عضلتين عضلة تأثرت بسبب شلل في العضلة الثانية، إذا + +224 +00:17:47,010 --> 00:17:50,930 +contraction of the inferior oblique طيب لما بنقول + +225 +00:17:50,930 --> 00:17:53,370 +ال inferior oblique صار فيها contraction صارت + +226 +00:17:53,370 --> 00:17:58,750 +قوية، بيلزمها innervation أقل، بيلزمها innervation + +227 +00:17:58,750 --> 00:18:03,210 +أقل، ليش بيلزمها innervation أقل؟ لأنه عشان تؤدي + +228 +00:18:03,210 --> 00:18:08,370 +عملها ال inferior oblique بيلزمها قوة تصفر ال + +229 +00:18:08,370 --> 00:18:12,110 +superior oblique action وبعدين قليل من القوة.. + +230 +00:18:12,110 --> 00:18:15,970 +قليل من القوة عشان تزيح العين في اتجاهها عشان تزيح + +231 +00:18:15,970 --> 00:18:19,190 +العين في اتجاهها طيب ال antagonist بتاعها اللي + +232 +00:18:19,190 --> 00:18:22,830 +بدها تصفره ضعيف أصلا فبيصير بيلزمها innervation أقل + +233 +00:18:23,010 --> 00:18:26,730 +فبالتالي عشان تنفذ شغلها بدها innervation أقل يعني + +234 +00:18:26,730 --> 00:18:31,130 +هي عضلة قوية over acting.. over acting بس ب + +235 +00:18:31,130 --> 00:18:34,990 +innervation أقل.. ب innervation أقل الآن بدنا نرمز + +236 +00:18:34,990 --> 00:18:46,710 +باسم للعضلة ال under acting بسهم نازل لتحت عشان + +237 +00:18:46,710 --> 00:18:48,630 +..عشان يعني نقول أنها + +238 +00:18:51,300 --> 00:18:54,740 +بسهم نازل لتحتها هي ال superior oblique لما بنشوف + +239 +00:18:54,740 --> 00:19:01,060 +السهم هذا بنقول إيه إنه under + +240 +00:19:01,060 --> 00:19:05,740 +acting وهنا احنا عندنا ال inferior oblique سهم + +241 +00:19:05,740 --> 00:19:09,920 +طالع لفوق عشان نقول إنها over acting muscle over + +242 +00:19:09,920 --> 00:19:18,420 +acting muscle إذا ملاحظين ال under action وال over + +243 +00:19:18,420 --> 00:19:21,820 +action مش مرتبط بال innervation.. مش مرتبط بال + +244 +00:19:21,820 --> 00:19:25,600 +innervation احنا بنقول هنا عضلة مشلولة مش وصلها + +245 +00:19:25,600 --> 00:19:30,520 +تغذية عصبية.. مش وصلها تغذية عصبية و under action + +246 +00:19:30,520 --> 00:19:36,160 +..هذا منطقي بس هنا العضلة وصلها innervation أقل و + +247 +00:19:36,160 --> 00:19:40,080 +مع ذلك هي over acting يعني ال innervation حاجة وال + +248 +00:19:40,080 --> 00:19:45,380 +..وال..وال action over action أو under action + +249 +00:19:45,380 --> 00:19:48,820 +حاجة ثانية.. حاجة ثانية.. يعني بمعنى آخر.. + +250 +00:19:48,820 --> 00:19:53,680 +بمعنى آخر ممكن إنسان نهمس له أنه اذهب احضر الشيء + +251 +00:19:53,680 --> 00:19:57,600 +الفلاني همسا بمجرد ما يسمع ينفذ الأمر.. تنفيذ + +252 +00:19:57,600 --> 00:20:01,720 +الأمر شيء وعلو الصوت في الطلب شيء ثاني.. ممكن + +253 +00:20:01,720 --> 00:20:05,680 +إنسان أُعلي صوتي وأقول له روح جيب الشيء الفلاني ومع + +254 +00:20:05,680 --> 00:20:09,710 +ذلك ما..ما ينفذش.. وأيضا ال innervation ال + +255 +00:20:09,710 --> 00:20:12,630 +innervation هو عبارة عن إيش؟ ال innervation هو عبارة + +256 +00:20:12,630 --> 00:20:17,770 +order نازل من الدماغ للعضلة عشان تنفذ عمل ما ممكن + +257 +00:20:17,770 --> 00:20:21,250 +ال innervation يكون قليل والعضلة تنفذه بشكل جيد وأكثر + +258 +00:20:21,250 --> 00:20:24,670 +من جيد يعني over acting وممكن ال innervation + +259 +00:20:24,670 --> 00:20:29,290 +يكون كثير والعضلة ما تنفذوش والعضلة ما تنفذوش الآن + +260 +00:20:29,290 --> 00:20:35,740 +..الآن هنا عندي under action لأنها عضلة مشلولة طول + +261 +00:20:35,740 --> 00:20:40,280 +الشلل أول عضلة تأثرت أو من العضلات اللي تأثرت ال + +262 +00:20:40,280 --> 00:20:42,720 +inferior oblique اللي هي ال antagonist بتاعة ال + +263 +00:20:42,720 --> 00:20:47,580 +superior oblique وبالتالي صار فيها تقلصات نتيجة أن + +264 +00:20:47,580 --> 00:20:50,700 +اللي عاجبها راخي دائما وهي مشدودة دائما ما بيجهاش + +265 +00:20:50,700 --> 00:20:55,340 +وجه ترتاح صارت عضلة قوية.. صارت عضلة قوية.. + +266 +00:20:55,340 --> 00:21:01,010 +طيب العضلة القوية بأقل innervation بتنفذ شغل كثير زي + +267 +00:21:01,010 --> 00:21:06,310 +ما يكون بأقل ضغطة من إيده بيحس إنه إيده طبعا كأنها + +268 +00:21:06,310 --> 00:21:11,650 +يعني تكسرت أو انضغطت بشدة هنا ال inferior oblique + +269 +00:21:11,650 --> 00:21:15,890 +بأقل innervation بتصير over acting أو هي أصبحت over + +270 +00:21:15,890 --> 00:21:21,810 +acting طيب، ممتاز جدا، الآن ما العضلة رقم ثلاثة؟ + +271 +00:21:22,190 --> 00:21:26,530 +اللي تأثرت بواسطة شلل ال superior oblique muscle + +272 +00:21:26,530 --> 00:21:30,310 +طبعا احنا عارفين إن ال inferior oblique ال + +273 +00:21:30,310 --> 00:21:33,250 +inferior oblique في ال left eye بيوصلها + +274 +00:21:33,250 --> 00:21:36,670 +innervation قليل لأنه مش لازمها كثير وع فكرة دماغ + +275 +00:21:36,670 --> 00:21:40,310 +بيبعت على الجد، دماغ بتاع الإنسان ما بيبعت + +276 +00:21:40,310 --> 00:21:44,850 +innervation يلا يعني جد ما بدنا بنبعت، لأ اللي + +277 +00:21:44,850 --> 00:21:50,300 +لازم، لازم، زمان نفرض مثلا زمان قبل ما تنشل هذه + +278 +00:21:50,300 --> 00:21:55,340 +العضلة كانت تشتغل وتشد بمقدار أو خلينا نقول + +279 +00:21:55,340 --> 00:21:59,640 +بيصلها.. بيصلها عشر شحنات أو عشر نبضات من ال + +280 +00:21:59,640 --> 00:22:03,780 +brain عشان تشتغل، إذا ال inferior oblique عشان تشد + +281 +00:22:03,780 --> 00:22:07,940 +العين باتجاهها، باتجاه منطقة عملها، هذه يوصلها عشر + +282 +00:22:07,940 --> 00:22:13,870 +شحنات، هذه حيصلها فقط 11 شحنة عشان.. يعني العشرة + +283 +00:22:13,870 --> 00:22:19,610 +لتصفير ال superior oblique muscle action وبيظل + +284 +00:22:19,610 --> 00:22:23,290 +عندها قليل من الشحنات شحنة أو اثنتين عشان تتحرك + +285 +00:22:23,290 --> 00:22:27,590 +العين باتجاهها حدث شلل هنا أصبح اللي بيوصل من + +286 +00:22:27,590 --> 00:22:32,910 +النبضات العصبية نبضتين فقط نبضتين فبالتالي هنا ممكن + +287 +00:22:32,910 --> 00:22:37,670 +ثلاث نبضات أو أربع نبضات يكفي لتنفيذ نفس الشغل اللي + +288 +00:22:37,670 --> 00:22:42,110 +كانت تحتاج فيه اثنتا عشرة أو ثلاث عشرة نبضة قديما قبل ما + +289 +00:22:42,110 --> 00:22:46,330 +تنشل العضلة إذا ال brain بيبعت على الجد طيب وصل لهذه + +290 +00:22:46,330 --> 00:22:51,490 +innervation أقل بسبب أن العضلة المضادة اللي أصبحت + +291 +00:22:51,490 --> 00:22:55,670 +في وضع شلل هذه أصبحت contracted وبتشتغل بأقل + +292 +00:22:55,670 --> 00:23:00,930 +innervation ومع ذلك إنها over action طالما وصل لل + +293 +00:23:00,930 --> 00:23:05,210 +inferior oblique innervation أقل حسب Hering law + +294 +00:23:05,210 --> 00:23:10,670 +..حسب Hering law لازم اللي بيصل لل yoke muscle + +295 +00:23:10,670 --> 00:23:14,810 +بتاعتها يكون نفس القدر من ال innervation قبل ما + +296 +00:23:14,810 --> 00:23:17,590 +نقول مين ال yoke muscle بتاعتها بدنا نقول إيش ال + +297 +00:23:17,590 --> 00:23:21,690 +Hering law ال Hering law بيقول إنه equal and + +298 +00:23:21,690 --> 00:23:25,410 +simultaneous innervation equal + +299 +00:23:26,940 --> 00:23:29,920 +unsimultaneous innervation flows to the yoke + +300 +00:23:29,920 --> 00:23:36,100 +muscle ما بينفع أبدا.. ما بينفع أبدا إنه ال + +301 +00:23:36,100 --> 00:23:40,620 +inferior oblique إجاها أقل innervation وال yoke + +302 +00:23:40,620 --> 00:23:44,540 +muscle بتاعتها يجيها innervation بيختلف عنه، لازم + +303 +00:23:44,540 --> 00:23:48,240 +يجيها نفس الكم من ال innervation طب هنا إجاها + +304 +00:23:48,240 --> 00:23:53,510 +قليل، أقل من الطبيعي إذا ال yoke muscle بتاعتها بدي + +305 +00:23:53,510 --> 00:23:57,730 +يجيها برضه قليل أقل من الطبيعي ليش هنا إيجاه أقل + +306 +00:23:57,730 --> 00:24:02,290 +من الطبيعي؟ لأنها مش محتاجة كثير عشان تشتغل على + +307 +00:24:02,290 --> 00:24:05,690 +اللي عاجبها مشلول فبالتالي هي مش محتاجة تبذل + +308 +00:24:05,690 --> 00:24:09,890 +الجهد كثير عشان تتحرك العين باتجاهها الآن مين ال + +309 +00:24:09,890 --> 00:24:13,950 +yoke muscle بتاعت ال left inferior oblique؟ ال + +310 +00:24:13,950 --> 00:24:18,820 +right superior rectus ال right superior rectus والـ + +311 +00:24:18,820 --> 00:24:25,500 +left inferior oblique هم yoke muscle ومكان عملهم up + +312 +00:24:25,500 --> 00:24:29,940 +and right up and right left inferior oblique و + +313 +00:24:29,940 --> 00:24:34,440 +right superior rectus بيشتغلوا في ال up and right + +314 +00:24:34,440 --> 00:24:38,760 +position هم yoke muscle مع بعضهم نرجع لصورة ال + +315 +00:24:38,760 --> 00:24:43,720 +virgins هاي عندنا left inferior oblique و right + +316 +00:24:43,720 --> 00:24:46,600 +superior rectus هدول yoke muscle بيجيبوا العينتين + +317 +00:24:46,600 --> 00:24:51,310 +right and up يعني ال target هنا right and up + +318 +00:24:51,310 --> 00:24:54,270 +فبالتالي هدول yoke muscle طالما ال left inferior + +319 +00:24:54,270 --> 00:25:00,410 +oblique طالما ال left inferior oblique اجاها + +320 +00:25:00,410 --> 00:25:05,490 +innervation أقل لأن ال superior oblique اللي بتنزل + +321 +00:25:05,490 --> 00:25:08,710 +العين في ال down position مشلولة طالما وصل + +322 +00:25:08,710 --> 00:25:11,890 +innervation أقل معناته ال superior rectus في العين + +323 +00:25:11,890 --> 00:25:17,940 +الثانية لازم يجيها innervation أقل طيب بس هنا فيه + +324 +00:25:17,940 --> 00:25:22,540 +فرق، هنا فيه فرق، ما الفرق؟ هم أجاهم نفس ال + +325 +00:25:22,540 --> 00:25:27,720 +innervation، نفس ال innervation هذه جاها innervation + +326 +00:25:27,720 --> 00:25:31,240 +مثلا ثلاث نبضات عصبية وهي قليل بالنسبة للوضع + +327 +00:25:31,240 --> 00:25:36,460 +الطبيعي، هنا حييجيها ثلاث نبضات عصبية، بس فيه فرق، + +328 +00:25:36,460 --> 00:25:41,620 +جسم العضلة هنا زي لاعب كمال الأجسام، وجسم العضلة + +329 +00:25:41,620 --> 00:25:46,870 +هنا عادي عادي يعني مش contracted مش متقلص ليش هذه + +330 +00:25:46,870 --> 00:25:52,870 +جسمها متقلص بينما هذه جسمها مش متقلص لأن هاي مش + +331 +00:25:52,870 --> 00:25:56,130 +متقلص لأن بيجيها أوقات بترتاح لما تشد ال inferior + +332 +00:25:56,130 --> 00:26:00,950 +rectus تمام؟ وبتيجي وقت بتشتغل لما تريح ال + +333 +00:26:00,950 --> 00:26:03,350 +inferior rectus يعني بيجي أوقات ترتاح وتشتغل + +334 +00:26:03,350 --> 00:26:08,930 +فبيظل فيه مرونة وفيه ليونة في ال muscle بينما هاي + +335 +00:26:08,930 --> 00:26:11,690 +..ليه ال inferior oblique؟ بسبب شلل ال superior + +336 +00:26:11,690 --> 00:26:15,400 +oblique دائما مشدودة وبالتالي..وبالتالي + +337 +00:26:15,400 --> 00:26:21,440 +contracted ومتقلصة وفيها contracture تقلصات يعني + +338 +00:26:21,440 --> 00:26:27,240 +دائمة.. تقلصات دائمة.. طيب بغض النظر ال inferior + +339 +00:26:27,240 --> 00:26:29,640 +oblique هنا في ال left eye وال superior oblique + +340 +00:26:29,640 --> 00:26:34,520 +هنا في ال right eye الاثنين.. الاثنين بيجيهم نفس ال + +341 +00:26:34,520 --> 00:26:37,380 +inner rotation بس هذه لأنها متقلصة بتصير over + +342 +00:26:37,380 --> 00:26:42,070 +acting وهاي عشانها عادية وجهها أقل innervation + +343 +00:26:42,070 --> 00:26:47,110 +بتصير under acting under acting superior rectus + +344 +00:26:47,110 --> 00:26:55,090 +حتصير under acting muscle بسبب إن وصلها أقل + +345 +00:26:55,090 --> 00:27:00,830 +innervation إذا أصبحت كأنها عضلة مشلولة هي مش + +346 +00:27:00,830 --> 00:27:06,930 +مشلولة حقيقة بس بسبب تأثرها بالعضلة الأساسية + +347 +00:27:06,930 --> 00:27:12,940 +المشلولة لحتى الآن لحتى الآن أصبح عندي عضلتين غير + +348 +00:27:12,940 --> 00:27:16,460 +العضلة الأساسية هذا يعتبر muscle sequel هذا يعتبر + +349 +00:27:16,460 --> 00:27:19,360 +muscle sequel زي ما احنا شايفين أيضا العينتين + +350 +00:27:19,360 --> 00:27:22,460 +تأثروا العضلات في العينتين تأثروا مش بس في العين + +351 +00:27:22,460 --> 00:27:27,040 +اللي فيها العضلة المشهورة القضية لسه ما انتهت الآن + +352 +00:27:27,040 --> 00:27:31,820 +هذه عضلة أصبحت under acting under acting بسبب إنه + +353 +00:27:31,820 --> 00:27:35,890 +ال innervation ما إجاهاش بالكمية اللازمة هذه + +354 +00:27:35,890 --> 00:27:39,670 +العضلة بتتعرض لحاجة بنسميها inhibitional pulse + +355 +00:28:11,900 --> 00:28:18,460 +إذن inhibitional palsy بمعنى آخر إنه كأنها فيها + +356 +00:28:18,460 --> 00:28:21,900 +palsy بس مش بالسبب إنه فعلا فيها palsy بس بسبب إنه + +357 +00:28:21,900 --> 00:28:25,460 +Hering law حكم عليها إنه لازم يجيها أقل + +358 +00:28:25,460 --> 00:28:29,090 +innervation بسبب إن ال yoke muscle بتاعتها اللي هي + +359 +00:28:29,090 --> 00:28:32,550 +ال left inferior oblique أيضا أخذت أقل innervation + +360 +00:28:32,550 --> 00:28:37,330 +ما بيصير هنا أخد innervation كثير وهنا أو أخد + +361 +00:28:37,330 --> 00:28:40,270 +innervation قليل وهنا أخد innervation كثير لأ هنا + +362 +00:28:40,270 --> 00:28:43,510 +قليل معناته هنا قليل لأن هدول الاثنتين yoke muscle + +363 +00:28:43,510 --> 00:28:46,810 +وحسب Hering law ال yoke muscle لازم ياخدوا equal + +364 +00:28:46,810 --> 00:28:50,250 +and simultaneous innervation and simultaneous + +365 +00:28:50,250 --> 00:28:55,250 +innervation لحتى الآن بدنا نقول الأسهم اللي أنا + +366 +00:28:55,250 --> 00:28:58,770 +برسمها تشير إلى ال action، under action و over + +367 +00:28:58,770 --> 00:29:01,990 +action، لا تشير إلى ال inner vision، ما لهاش علاقة + +368 +00:29:01,990 --> 00:29:05,090 +في ال inner vision، ما لهاش علاقة في ال inner + +369 +00:29:05,090 --> 00:29:11,570 +vision، تمام؟ فبالتالي هذه القضية ضروري جدا يعني + +370 +00:29:11,570 --> 00:29:15,450 +نستوعبها، الآن ضال العضلة الرابعة من العضلات اللي + +371 +00:29:16,060 --> 00:29:24,400 +بتتأثر أو بتخضع ل..أو بتأثر بشلل العضلة الأساسية + +372 +00:29:24,400 --> 00:29:27,740 +اللي هي في المثال عندنا left superior oblique، إذا + +373 +00:29:27,740 --> 00:29:32,760 +ما هي العضلة الرابعة؟ هي ال right inferior rectus + +374 +00:29:36,010 --> 00:29:39,210 +ال right inferior rectus عشان نعرف هل فيها over + +375 +00:29:39,210 --> 00:29:45,110 +action ولا under action لازم..لازم نفهمها من أحد + +376 +00:29:45,110 --> 00:29:48,330 +الطريقين.. من أحد الطريقين في الطريق الأسهل + +377 +00:29:48,330 --> 00:29:53,590 +للفاهم بن + +401 +00:31:28,330 --> 00:31:31,230 +lift superior oblique palsy بدنا ندور على المنظر + +402 +00:31:31,230 --> 00:31:50,810 +يشرح الموضوع أو يسهل شرح الموضوع حتى + +403 +00:31:50,810 --> 00:31:51,190 +الآن + +404 +00:32:09,490 --> 00:32:16,430 +ربما تكون الصورة تمام هذه الصورة bilateral + +405 +00:32:16,430 --> 00:32:19,710 +superior oblique palsy بس احنا بنركز على هذا + +406 +00:32:19,710 --> 00:32:24,290 +الجزء من الصورة هذا الجزء من الصورة بدنا نقول + +407 +00:32:24,290 --> 00:32:27,890 +هيفيدنا إن شاء الله تعالى في توضيح الفكرة + +408 +00:32:39,810 --> 00:32:56,210 +هنقتص هذا الجزء عشان + +409 +00:32:56,210 --> 00:33:06,030 +يوضح الفكرة المريض + +410 +00:33:06,030 --> 00:33:08,130 +اللي عنده left superior oblique palsy + +411 +00:33:10,640 --> 00:33:15,300 +بيجي بالمنظر هذا ليش بيجي بالمنظر هذا لأن ال + +412 +00:33:15,300 --> 00:33:18,540 +superior oblique depressor superior oblique + +413 +00:33:18,540 --> 00:33:21,140 +depressor يعني بتنزل العين من ضمن ال function + +414 +00:33:21,140 --> 00:33:24,980 +بتاعتها بتنزل العين في حالة left superior oblique + +415 +00:33:24,980 --> 00:33:28,380 +palsy دل عندي one depressor شغال اللي هو ال + +416 +00:33:28,380 --> 00:33:31,580 +inferior rectus وال other depressor راح اللي هو + +417 +00:33:31,580 --> 00:33:35,390 +superior oblique بينما في عندي two elevatorاللي هي + +418 +00:33:35,390 --> 00:33:38,270 +superior rectus و ال inferior oblique طالما عندي + +419 +00:33:38,270 --> 00:33:42,350 +two elevator شغالين بشكل طبيعي و one depressor + +420 +00:33:42,350 --> 00:33:45,310 +معناته المعادلة راحت لصارح ال elevator فالعين + +421 +00:33:45,310 --> 00:33:50,250 +هتكون hypertrophic .. hypertrophic طيب لو هذا + +422 +00:33:50,250 --> 00:33:53,510 +الإنسان قلناله اللي عنده lift superior oblique + +423 +00:33:53,510 --> 00:33:58,610 +bulgy و عنده lift hypertrophia قولنا له حاول تركز + +424 +00:33:58,610 --> 00:34:01,350 +بعينك لشمال، معناته لازم ينزلها لل primary + +425 +00:34:01,350 --> 00:34:05,330 +position عشان ينزلها لل primary position، عشان + +426 +00:34:05,330 --> 00:34:09,550 +ينزلها لل primary position، لازم ييجي innervation + +427 +00:34:09,550 --> 00:34:13,570 +كثير لل superior oblique muscle في محاولة + +428 +00:34:13,570 --> 00:34:20,040 +لتشغيلها، في محاولة لتشغيلها، ال brain هيبعت إشارات + +429 +00:34:20,040 --> 00:34:24,620 +عصبية طبعا مش هتصل في حالة الشلل أو هتصل بشكل قليل + +430 +00:34:24,620 --> 00:34:28,740 +فهيبعت أكثر وأكثر يعني هيعمل increased innervation + +431 +00:34:28,740 --> 00:34:32,220 +لل superior oblique increased innervation لل + +432 +00:34:32,220 --> 00:34:35,900 +superior oblique عشان يحاول يخليها تشتغل وال + +433 +00:34:35,900 --> 00:34:40,500 +depression effect بتاعها يتفاعل طيب إذا إذا ال + +434 +00:34:40,500 --> 00:34:45,660 +brain بعت بعد لل superior oblique اللي فيها بلسي + +435 +00:34:45,660 --> 00:34:49,860 +بعد increased innervation ساعتها إيش اللي هيحصل في + +436 +00:34:49,860 --> 00:34:53,040 +ال inferior rectus هنا؟ أيضا هيصلها increased + +437 +00:34:53,040 --> 00:34:56,440 +innervation ليش؟ لأن ال superior oblique في ال + +438 +00:34:56,440 --> 00:34:59,660 +left eye و ال inferior rectus في ال right eye are + +439 +00:34:59,660 --> 00:35:03,360 +yoke muscles إذا دي وصلها مئة نبضة عصبية لازم + +440 +00:35:03,360 --> 00:35:07,600 +يوصلها هنا مئة نبضة عصبية طبعا هنا ال brain معنى + +441 +00:35:07,600 --> 00:35:12,290 +أنه يشغلها فهي مشلولة قاعد بيبعت بزيادة عن اللزوم + +442 +00:35:12,290 --> 00:35:16,870 +فهيبعت نفس القدر بزيادة عن اللزوم هنا عضلة طبيعية + +443 +00:35:16,870 --> 00:35:20,390 +وصلها innervation كثير فهتصير over acting muscle + +444 +00:35:20,390 --> 00:35:23,610 +يعني هذا التفسير حسب hearing level .. حسب hearing + +445 +00:35:23,610 --> 00:35:27,690 +level ممكن إنسان يقول هل هو superior oblique في ال + +446 +00:35:27,690 --> 00:35:30,630 +left eye و ال inferior rectus في ال right eye فعلا + +447 +00:35:30,630 --> 00:35:33,970 +هم yoke muscle؟ لا بنرجع للصورة عشان نذكر فيها + +448 +00:35:40,310 --> 00:35:44,570 +هي ال left superior oblique وهي ال inferior rectus + +449 +00:35:44,570 --> 00:35:47,810 +عشان ال left superior .. طبعا هم yoke muscle + +450 +00:35:47,810 --> 00:35:51,410 +واتجاه عاملهم اتنين مع بعض بيشتغلوا ك team في .. + +451 +00:35:51,410 --> 00:35:54,890 +في ال right and down position اللي هي dextro + +452 +00:35:54,890 --> 00:35:58,350 +depression .. dextro depression فبالتالي هم yoke + +453 +00:35:58,350 --> 00:36:00,770 +muscle اجا increased innervation لل superior + +454 +00:36:00,770 --> 00:36:04,400 +oblique عشانها مشلولة فحيجي increased innervation + +455 +00:36:04,400 --> 00:36:08,060 +لل inferior rectus بسبب أنه قانون hearing لازم + +456 +00:36:08,060 --> 00:36:12,460 +يطبق، لازم يطبق، إذا حسب hearing law تفسر ال + +457 +00:36:12,460 --> 00:36:15,400 +muscle sequely، إذا صفة عندي في ال muscle sequely + +458 +00:36:15,400 --> 00:36:21,540 +اثنتين + +459 +00:36:21,540 --> 00:36:26,140 +under acting muscles واثنتين over acting muscles + +460 +00:36:26,910 --> 00:36:30,190 +اثنتين under acting واحدة مشلولة حقيقة واحدة + +461 +00:36:30,190 --> 00:36:33,350 +inhibitional policy ضعيفة بسبب أن كمية ال + +462 +00:36:33,350 --> 00:36:37,050 +innervation اللي بيصلها أقل من اللازم ليش أقل من + +463 +00:36:37,050 --> 00:36:39,710 +اللازم؟ لأن ال York muscle بتاعتها ال inferior + +464 +00:36:39,710 --> 00:36:43,090 +oblique عن ناحية التانية وصلها أقل من اللازم طب + +465 +00:36:43,090 --> 00:36:46,490 +ليش هذه وصلها أقل من اللازم؟ رغم أنها over acting + +466 +00:36:46,490 --> 00:36:50,330 +لأنها متقلصة ما بلزمهاش innervation كثير لأن العضلة + +467 +00:36:50,330 --> 00:36:53,950 +اللي عاجبالها مشلولة فبالتالي الشغل اللي بدها + +468 +00:36:53,950 --> 00:36:57,310 +تبذله عشان تتحرك العين في اتجاهها قليل فبيعطيها ال + +469 +00:36:57,310 --> 00:37:00,460 +brain قليل innervation ليش هذه بيصلها innervation + +470 +00:37:00,460 --> 00:37:04,520 +كثير؟ لأنها ال yoke بتاعة العضلة المشغولة ال yoke + +471 +00:37:04,520 --> 00:37:08,400 +بتاعة العضلة المشغولة بنتوقف عند هذا المثال و + +472 +00:37:08,400 --> 00:37:12,600 +المرة القادمة بن .. بن .. نضرب مثال ثاني قبل ما + +473 +00:37:12,600 --> 00:37:17,020 +ننتقل للموضوع اللي هو التالي، إذا المرة القادمة + +474 +00:37:17,020 --> 00:37:21,000 +هنضرب مثال آخر و بالتالي بنتوقف هنا و يعطيكم + +475 +00:37:21,000 --> 00:37:24,260 +العافية والسلام عليكم ورحمة الله وبركاته diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/ZgrlORtTJpg_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/ZgrlORtTJpg_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..2901feebd01e28330c431d9b0596fe8dd3b6c895 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/ZgrlORtTJpg_postprocess.srt @@ -0,0 +1,1900 @@ +1 +00:00:01,690 --> 00:00:06,050 +بسم الله الرحمن الرحيم بنواصل مع محاضرات حوال واحد + +2 +00:00:06,050 --> 00:00:11,080 +واتوقفنا المرة الماضية عند ال muscles equalityو ال + +3 +00:00:11,080 --> 00:00:14,540 +muscles equally بتعني التأثيرات العضلية .. + +4 +00:00:14,540 --> 00:00:19,460 +التأثيرات العضلية و هذه .. هذه أيضا تابعة لموضوع + +5 +00:00:19,460 --> 00:00:22,140 +ال paralytic squint او ال parietic squint و + +6 +00:00:22,140 --> 00:00:27,200 +الحوالي الشللي يترى لو صار في عندي شلل او + +7 +00:00:27,200 --> 00:00:31,120 +paralysis او paralysis في one of the extraocular + +8 +00:00:31,120 --> 00:00:35,670 +muscles هل هتتأثر العضلات التانية؟وإذا كان الأمر + +9 +00:00:35,670 --> 00:00:39,350 +كذلك فهل التأثر هيقتصر على العين اللي فيها العضلة + +10 +00:00:39,350 --> 00:00:46,810 +المشلولة أم هيمتد عشان يشمل العينتين؟ طبعا الجواب + +11 +00:00:46,810 --> 00:00:49,990 +على السؤال الأول هو هل هتتأثر العضلات الأخرى + +12 +00:00:49,990 --> 00:00:56,010 +السليمة بشلل في عضلة ما؟ نعم إذا يعني طول وقت + +13 +00:00:56,010 --> 00:01:00,190 +الشلل وخدا صار long standing policy أو Parises + +14 +00:01:01,130 --> 00:01:05,230 +هتأثر العضلات التانية الجواب على السؤال التاني هل + +15 +00:01:05,230 --> 00:01:08,250 +هيشمل التأثر العين .. العين واحدة ولا العين تانية + +16 +00:01:08,250 --> 00:01:13,670 +حقيقة أنه هيشمل العين تانية بسبب قوانين الحركة + +17 +00:01:13,670 --> 00:01:17,190 +اللي هي Sherrington law و herring law Sherrington + +18 +00:01:17,190 --> 00:01:21,130 +law و herring law اذا muscle sequelae are the + +19 +00:01:21,130 --> 00:01:25,290 +effects يعني التأثرات العضلية are the effects of + +20 +00:01:25,290 --> 00:01:29,010 +the interactions described by these laws اللي هو + +21 +00:01:29,010 --> 00:01:34,410 +Sherrington law و herring lawهي مهمة أكتر في تدريس + +22 +00:01:34,410 --> 00:01:40,330 +مخاطر الحيوانات العينية، وفي الواضحة في تحقيق + +23 +00:01:40,330 --> 00:01:44,450 +حكومة قبل قليل من حكومة Longstanding Oneيعني إنسان + +24 +00:01:44,450 --> 00:01:49,030 +عنده شلل في عضلة ما؟ نقول مثلا ال left medial + +25 +00:01:49,030 --> 00:01:55,190 +rectus muscle مشلولة، هل هتتأثر باقي العضلات؟ إذا + +26 +00:01:55,190 --> 00:02:01,270 +كان مرض وقت طويل على هذه الشلل في ال left medial + +27 +00:02:01,270 --> 00:02:05,030 +rectus هلاجي إنه بعض العضلات الأخرى، بعضها وليس + +28 +00:02:05,030 --> 00:02:10,150 +كلها تأثرت وبالتالي بعرف من وجود هذه الأثار على + +29 +00:02:10,150 --> 00:02:13,970 +العضلات التانيةبعرف إنه هذه long standing media + +30 +00:02:13,970 --> 00:02:19,650 +rectus palsy بينما لو لجيت إنه مافيش أثار عضلية أو + +31 +00:02:19,650 --> 00:02:23,910 +مافيش muscle sequelae معناته هذه recent palsy يعني + +32 +00:02:23,910 --> 00:02:29,130 +جديد لسه حدثت اللي هو ال media rectus palsy اللي + +33 +00:02:29,130 --> 00:02:34,150 +اتخذناها كمثالإذا أول شيء ال muscle sequela وجودها + +34 +00:02:34,150 --> 00:02:40,690 +من عدمه بساعدني أميز أعمل distinguishing بين ال + +35 +00:02:40,690 --> 00:02:44,610 +recently acquired policy و ال long standing policy + +36 +00:02:44,610 --> 00:02:48,270 +انه الحوال هل هو جديم ولا مش جديم، إذا ال muscle + +37 +00:02:48,270 --> 00:02:52,060 +sequela موجودة معناته الحوال جديمإذا ال muscle + +38 +00:02:52,060 --> 00:02:56,320 +sequelae مش موجودة و فقط هي العضلة المشلولة اللي + +39 +00:02:56,320 --> 00:03:03,000 +بين ضعفها و بجيته العضلات سليمة ساعتها ال .. ال .. + +40 +00:03:03,000 --> 00:03:06,620 +اللي هو ال paralytic is going يكون جديد و لسه + +41 +00:03:06,620 --> 00:03:10,780 +مايلوش فترة طويلة يا ترى عبارة عن إيش ال muscle + +42 +00:03:10,780 --> 00:03:14,060 +sequelae أو كيف بتتأثر العضلات هي هل العضلات + +43 +00:03:14,060 --> 00:03:18,140 +بتجوى، بتضعف، هل جزء منها بيجوى، جزء منها بيضعف، + +44 +00:03:18,140 --> 00:03:22,470 +هذا هنشرحه الآنthe full pattern of changes takes + +45 +00:03:22,470 --> 00:03:26,430 +time to develop and can be summarized as follows + +46 +00:03:26,430 --> 00:03:31,110 +يعني التأثيرات العضلية بشلة العضلماء بياخد وقت + +47 +00:03:31,110 --> 00:03:37,730 +عشان يسير و هنلخصه في الجمال القليل القادم بس قبل + +48 +00:03:37,730 --> 00:03:45,970 +ما نلخصه بدنا نفهم بعض الأشياء قبل ما نتكلم في + +49 +00:03:45,970 --> 00:03:52,110 +موضوع التأثيرات العضلية أول شيء بدنا نفهمهإنه نفرض + +50 +00:03:52,110 --> 00:03:55,210 +هنا عندي ال agonist و هنا ال antagonist يعني هنا + +51 +00:03:55,210 --> 00:03:58,610 +عضلة مثلا ال lateral rectus و هنا medial rectus أو + +52 +00:03:58,610 --> 00:04:03,290 +هنا superior rectus و هنا inferior rectus هنسمي + +53 +00:04:03,290 --> 00:04:15,930 +عشان توضح الأمور بشكل أفضل هنسمي هنا agonist بغض + +54 +00:04:15,930 --> 00:04:19,250 +النظر superior rectus medial rectus إلى آخرها + +55 +00:04:22,420 --> 00:04:30,180 +و هنا هنسميه antagonist و + +56 +00:04:30,180 --> 00:04:34,140 +هنا + +57 +00:04:34,140 --> 00:04:37,580 +هنسميه antagonist ليش سميناه antagonist لأنه مضاد + +58 +00:04:37,580 --> 00:04:50,140 +يعني بشد في اتجاه عكس antagonist + +59 +00:04:50,140 --> 00:04:51,220 +فبالتالي + +60 +00:04:56,410 --> 00:05:00,190 +لما احنا بنقول agonist إذن هي العضلة الأساسية اللي + +61 +00:05:00,190 --> 00:05:04,910 +بتحرك العين باتجاه معين، نفرض هذه العضلة اللي هو + +62 +00:05:04,910 --> 00:05:08,810 +بيمثلها إنسان، نفرض هذه العضلة بتتحرك العين بهذا + +63 +00:05:08,810 --> 00:05:13,210 +الاتجاه، طيب عشان العين تتحرك بهذا الاتجاه اللي + +64 +00:05:13,210 --> 00:05:14,210 +أنا بأشر عليه + +65 +00:05:26,720 --> 00:05:30,140 +عشان اللي عندك تتحرك بهذا الاتجاه اللي بيؤشر عليه + +66 +00:05:30,140 --> 00:05:36,720 +السهم مفروض هذه العضلة أو هذا الشخص يكون عنده ما + +67 +00:05:36,720 --> 00:05:42,320 +يكفي من القوة لفعل شيئين الشيء الأول انه يصفر ال + +68 +00:05:42,320 --> 00:05:46,520 +antagonist ايش يعني يصفر ال antagonist يعني يلغي + +69 +00:05:46,520 --> 00:05:52,360 +قوته ثم الشيء التاني انه يفضل معاه او يزيد معاه + +70 +00:05:52,360 --> 00:05:58,080 +قليل من القوة عشان يحركالإشارة أو يحرك العين في + +71 +00:05:58,080 --> 00:06:03,520 +قصتنا مع الحوال يحركها باتجاهه مثال على ذلك لو هذا + +72 +00:06:03,520 --> 00:06:09,680 +الشخص بيشد بقوة خمسين نيوتن و ال antagonist بتاعه + +73 +00:06:09,680 --> 00:06:14,680 +الشخص الآخر بيشد بقوة خمسين نيوتن ال target أو + +74 +00:06:14,680 --> 00:06:18,880 +العين مش هتتحرك أبدا بمعنى لو العضلة ال lateral + +75 +00:06:18,880 --> 00:06:23,650 +rectus أو ال superior rectus بتشدبقوة خمسين نيوتن + +76 +00:06:23,650 --> 00:06:29,050 +والانتاجونيست بتاعتها بتشد بنفس القوة اذا العين مش + +77 +00:06:29,050 --> 00:06:32,810 +هيتم فيها اي حركة واحد بيشد بقوة في اتجاه معين + +78 +00:06:32,810 --> 00:06:37,930 +والتاني بيشد بقوة مكافئايلها ومساوئلها باتجاه عكسه + +79 +00:06:37,930 --> 00:06:42,810 +مية و تمانين درجة اذا مش هتتحرك اذا اول شغل في شغل + +80 +00:06:42,810 --> 00:06:50,370 +العضلات في شغل العضلات لابد انه العضلة من الست + +81 +00:06:50,370 --> 00:06:56,100 +عضلاتالمحيطة بالعين عشان تحرك العين باتجاهها لازم + +82 +00:06:56,100 --> 00:07:01,060 +يكون قوتها أكبر قليلا من قوة ال antagonist عشان + +83 +00:07:01,060 --> 00:07:06,060 +تعطي جزء من قوتها لتصفير وإلغاء قوة شد ال + +84 +00:07:06,060 --> 00:07:12,640 +antagonist وإنه يظل معها زيادة شوية لاتحرك العين + +85 +00:07:12,640 --> 00:07:19,900 +باتجاهها طيب، الآن بدنا نفرض جدلا .. جدلا إنه ال + +86 +00:07:19,900 --> 00:07:27,850 +antagonist ضعيفال antagonist ضعف الان + +87 +00:07:27,850 --> 00:07:35,870 +بدنا نفرض جدلا ان ال antagonist ضعف ايش + +88 +00:07:35,870 --> 00:07:41,810 +اللي هيحصل؟ ضعف يعني صار فيه شلل، هينتج عن هذا + +89 +00:07:41,810 --> 00:07:49,050 +الشلل ان ال agonist مش محتاج قوة كتيرليش؟ احنا + +90 +00:07:49,050 --> 00:07:52,390 +قلنا اذا كان ال antagonist في الوضع الطبيعي بشد + +91 +00:07:52,390 --> 00:07:57,630 +بقوة خمسين نيوتن، اذا لازم يكون ال agonist المحرك + +92 +00:07:57,630 --> 00:08:01,730 +الأساسي للعين عنده أكتر من خمسين، واحد و خمسين، + +93 +00:08:01,730 --> 00:08:04,970 +اتنين و خمسين، خمسة و خمسين، ستين، المهم أكتر من + +94 +00:08:04,970 --> 00:08:09,830 +خمسين طب لما بيصير عندي أنا ال antagonist ضعيف، + +95 +00:08:09,830 --> 00:08:15,110 +مشلول، أصبح قوة شده أقل من خمسين نيوتن، نقول مثلا + +96 +00:08:15,110 --> 00:08:20,230 +أصبح قوة شده عشرة نيوتنعشان هيك ال agonist بيصبح + +97 +00:08:20,230 --> 00:08:25,760 +بده قوة أقل عشان يشد باتجاهه، بمعنىأصبح بسبب شلل + +98 +00:08:25,760 --> 00:08:29,820 +هذه العضلة بسبب .. بسبب شلل ال antagonist ال + +99 +00:08:29,820 --> 00:08:34,460 +agonist عشان يحرك العين في اتجاهه بده قوة أقل من + +100 +00:08:34,460 --> 00:08:39,640 +اللازم أنا زمان كنت بدي ستين نيوتن عشان فمسين + +101 +00:08:39,640 --> 00:08:44,520 +أصرفهم على تصفير ال antagonist و عشرة يزيدوا معاي + +102 +00:08:44,520 --> 00:08:50,360 +على إيش؟ على الشد باتجاهي اليوم أنا عشان أحرك أو + +103 +00:08:50,360 --> 00:08:55,700 +أقوم بهذا العمل أنا ك agonistبدي عشرة أصفر فيها + +104 +00:08:55,700 --> 00:08:59,600 +قوة الانتاجونيس لإنه أصبح قوة شد عشرة لإنه مشلول + +105 +00:08:59,600 --> 00:09:05,180 +بجوش تغذية عصبية فبالتالي أنا خمستاشر بيكفيني إذا + +106 +00:09:05,180 --> 00:09:11,260 +في حالة حدوث شلل لما بيطول هذا الشلل .. لما بيطول + +107 +00:09:11,260 --> 00:09:17,640 +هذا الشلل بيصبح إنه العضلة المضادة للعضلة المشلولة + +108 +00:09:17,850 --> 00:09:21,250 +العضلة المضادة للعضلة المشلولة بدها أقل + +109 +00:09:21,250 --> 00:09:26,550 +innervation وبالتالي يعني هذه ضرورية جدا نتذكرها + +110 +00:09:26,550 --> 00:09:34,170 +هذه النقطة النقطة التانية أنه لو فرضنا أنه في عندي + +111 +00:09:34,170 --> 00:09:42,210 +عضلة مشلولة اللي هي نفرض عضلة ال antagonistإيش + +112 +00:09:42,210 --> 00:09:46,770 +بيحدث في العضلة المضادة إليها اللي هنا كاتبين + +113 +00:09:46,770 --> 00:09:51,570 +عليها agonist مع مرور الوقت؟ في الوضع الطبيعي قبل + +114 +00:09:51,570 --> 00:09:56,410 +وجود الشلال العضلات بتتبادل الوظائف، مرة هاي بتشد + +115 +00:09:56,410 --> 00:10:01,110 +و هذه بترخي و مرة هاي بتشد و التانية بترخي، فبيجي + +116 +00:10:01,110 --> 00:10:07,190 +على العضلة أوقات شغالة فيهاوأوقات مرتاحة فيها .. + +117 +00:10:07,190 --> 00:10:12,110 +وأوقات مرتاحة فيها قضية الشغل والراحة بتخلي العضلة + +118 +00:10:12,110 --> 00:10:15,890 +التون بتاعها .. التون بتاعها والانشدادية بتاعتها + +119 +00:10:15,890 --> 00:10:20,750 +مش زيدة عن اللزوم بالعكس هي يعني انشدادية معقولة + +120 +00:10:20,750 --> 00:10:24,530 +يعني بين إنها راخية وبين إنها شدة مرة بترخي ومرة + +121 +00:10:24,530 --> 00:10:29,350 +بتشد يعني مرة هي بتشتغل والمقابلة بترتاحومرة هي + +122 +00:10:29,350 --> 00:10:33,130 +بترتاح والمقابلة أو ال antagonist بتاعتها بتشتغل، + +123 +00:10:33,130 --> 00:10:39,370 +الآن في حالة الشلل، لما الشلل بصيب عضلة ما، نفرض + +124 +00:10:39,370 --> 00:10:46,350 +هذه العضلة، ساعتها .. ساعتها بتظل العضلة المقابلة + +125 +00:10:46,650 --> 00:10:50,110 +المقابلة هذه انشلت، بتظل العضل المقابلة + +126 +00:10:50,110 --> 00:10:55,170 +contracted، متقلصة، بيجيش عليها وجد ترتاح، ليش؟ + +127 +00:10:55,170 --> 00:11:00,030 +ليش بيجيش عليها وجد ترتاح؟ لأنه عشان ترتاح، عشان + +128 +00:11:00,030 --> 00:11:03,630 +ترتاح، لازم اللي عاجبالها تشد، طب و اللي عاجبالها + +129 +00:11:03,630 --> 00:11:07,640 +مشلولة مش راضية تشد؟فبالتالي بتضلها في وضع تقلص + +130 +00:11:07,640 --> 00:11:12,920 +ومعروف ان العضلة المتقلصة بتكون قوية ومتشنجة قوية + +131 +00:11:12,920 --> 00:11:17,920 +ومتشنجة فبالتالي بتكون اقوى من اللازم نتيجة ان هي + +132 +00:11:17,920 --> 00:11:22,380 +دائما مشدودة .. دائما مشدودة وطالما اقوى من اللازم + +133 +00:11:22,380 --> 00:11:26,780 +بيكون لازمها innovation اقل لتنفيذ العمل نيجي احنا + +134 +00:11:26,780 --> 00:11:32,140 +ناخد صورة تانية بنقول لو هذا الشخصصاحب الذراع + +135 +00:11:32,140 --> 00:11:38,380 +القوية و صاحب العضلات المفتولة حاول يسلم على هذا + +136 +00:11:38,380 --> 00:11:44,020 +الشخص صاحب العضلات الضعيفة و .. اللي هي يعني weak + +137 +00:11:44,020 --> 00:11:50,000 +muscles ممكن يكون هذا الشخص بيسلمأو بيدغط بيده + +138 +00:11:50,000 --> 00:11:54,860 +بشكل تلقائي بسيط جدا و مش جصده أنه يأذي أو شيء من + +139 +00:11:54,860 --> 00:11:59,980 +هذا القبيل ولكن أن الشخص الآخر بيشعر لما يحط إيده + +140 +00:11:59,980 --> 00:12:06,160 +في إيد مفتول العضلات بيحس بألم و كأنه بينضغط على + +141 +00:12:06,160 --> 00:12:10,610 +إيده مع أنه هذا ..ليش .. ليش هذا الكلام بيحدث؟ لأن + +142 +00:12:10,610 --> 00:12:14,330 +هذا طبيعي تقيده إنها صارت متقلصة contracted مع .. + +143 +00:12:14,330 --> 00:12:17,650 +مع التدريب و مع حمل الأثقال و مع و مع و مع .. + +144 +00:12:17,650 --> 00:12:23,480 +فبالتالي هو بيسلم بأقل قوة ممكنة من عنده ولكنالفعل + +145 +00:12:23,480 --> 00:12:27,300 +تاع هذه القوة اللي بالنسبةيله قليلة يعتبر ضغط + +146 +00:12:27,300 --> 00:12:33,400 +كثيرا على يد اللي هي الإنسان الضعيف، وهذا اللي + +147 +00:12:33,400 --> 00:12:37,960 +بيحدث في ال muscle لما ال muscle بتضالها منشدة وما + +148 +00:12:37,960 --> 00:12:41,940 +.. وما بترتاحش بالمرة بسبب أنه اللي عاجبالها + +149 +00:12:41,940 --> 00:12:45,590 +مابشتغلش، هي أمتى بترتاح؟لما اللي عاجبالها يشتغل، + +150 +00:12:45,590 --> 00:12:49,070 +ما هو حسب قانون Sherrington، حسب Sherrington law + +151 +00:12:49,070 --> 00:12:53,030 +تعريس ال brocal innervation، هاي أجهها innervation + +152 +00:12:53,030 --> 00:12:57,330 +عشان تشتغل، معناته هذه بيجيها inhibition عشان + +153 +00:12:57,330 --> 00:13:01,330 +تريح، طيب هذه مش راضية تشتغل، بالمرة فبتظل هذه + +154 +00:13:01,330 --> 00:13:05,110 +اللي عاجبالها يعني شادة وما بيجيهاش وأوقات انها + +155 +00:13:05,110 --> 00:13:09,910 +ترتاح فيها، هذه المقدماتلازمة جدا عشان نفهم ال + +156 +00:13:09,910 --> 00:13:13,330 +muscle sequely، عشان نفهم ال muscle sequely، + +157 +00:13:13,330 --> 00:13:17,790 +فبنقول كالقاتل، يا ترى ب .. إيش .. إيش اللي بلخصلي + +158 +00:13:17,790 --> 00:13:22,230 +أو الجمل اللي بتلخص التأثيرات العضلية بشال العضلة + +159 +00:13:22,230 --> 00:13:29,140 +ما؟ أول حاجة بيحدث primary under actionprimary + +160 +00:13:29,140 --> 00:13:33,660 +under action يعني ضعف في العضلة المشلولة وهذا شيء + +161 +00:13:33,660 --> 00:13:37,160 +منطقي، إن العضلة انشلت، بيجيهاش innervation، + +162 +00:13:37,160 --> 00:13:39,920 +فبالتالي هيصير فيها primary under action، ولمّا + +163 +00:13:39,920 --> 00:13:42,780 +بيقول primary يعني معناته هي أساس العلة، من عندها + +164 +00:13:42,780 --> 00:13:47,660 +بدأت المشكلة، من عندها بدأت المشكلة، هنا المثال، + +165 +00:13:47,660 --> 00:13:50,660 +يعطيني مثال، نفرض مثلا ال left superior oblique + +166 +00:13:50,660 --> 00:13:55,160 +صار فيها شللlift superior oblique pulse أو نقدر + +167 +00:13:55,160 --> 00:13:58,700 +نقول عنها lift fourth nerve pulse ليش lift fourth + +168 +00:13:58,700 --> 00:14:01,900 +nerve pulse؟ لأن ال fourth nerve هو اللي بيغذي ال + +169 +00:14:01,900 --> 00:14:05,940 +superior oblique muscle إذا primary under action + +170 +00:14:05,940 --> 00:14:10,680 +في العضلة المشلولة وهذا مفهوم مافيش فيه أي مشكلة + +171 +00:14:10,680 --> 00:14:14,840 +تاني شئ secondary + +172 +00:14:14,840 --> 00:14:20,510 +contracture of the unopposed direct antagonistاللي + +173 +00:14:20,510 --> 00:14:25,090 +هي الـ Left Inferior Replicate طيب بما انه .. بما + +174 +00:14:25,090 --> 00:14:29,940 +انه ال leftsuperior oblique صار فيها primary under + +175 +00:14:29,940 --> 00:14:34,740 +action عضلة ضعيفة مابتشتغلش صح لما بنيجي نختبرها + +176 +00:14:34,740 --> 00:14:37,940 +في ال in and down position مابتقدرش تنزل العين في + +177 +00:14:37,940 --> 00:14:41,680 +ال in and down position بدنا نتذكر يا جماعة اللي + +178 +00:14:41,680 --> 00:14:44,080 +هو ال function بتاعة ال extraocular muscle وال + +179 +00:14:44,080 --> 00:14:48,120 +testing position إذا في عندي primary under action + +180 +00:14:48,120 --> 00:14:54,570 +لل left superior oblique هذا القضية إذا طولتالعضلة + +181 +00:14:54,570 --> 00:14:57,430 +المضادة إلى طالما هذه راخية على الدوام، معناته هذا + +182 +00:14:57,430 --> 00:15:01,190 +هتصير متقلص على الدوام، contraction في ال inferior + +183 +00:15:01,190 --> 00:15:03,830 +oblique اللي هي ال direct antagonist بتاع ال + +184 +00:15:03,830 --> 00:15:07,230 +superior oblique، بما أن هذه راخية دائما، معناته + +185 +00:15:07,230 --> 00:15:10,650 +اللي عاجبالها بيجيهوش فرصة يرتاح، فبيظل مشدود، + +186 +00:15:10,650 --> 00:15:12,330 +فبيظل عندي انا .. + +187 +00:15:15,750 --> 00:15:19,870 +فبيضل عندى يعني مشدود وبالتالي بيصير فيه + +188 +00:15:19,870 --> 00:15:23,150 +contraction وتقلصات وبيصير عضلة قوية يعني هاد ال + +189 +00:15:23,150 --> 00:15:26,990 +inferior oblique بسبب شلل العضلة المضادة إلى ال + +190 +00:15:26,990 --> 00:15:32,010 +superior oblique بتصير تشبه اللي بلعب يعني أثقال + +191 +00:15:32,010 --> 00:15:35,370 +وكده يعني هنا هتكون كأنها ال superior oblique في + +192 +00:15:35,370 --> 00:15:38,550 +مثلها .. في مثلنا وهنا هيكون عندى كأنه ال inferior + +193 +00:15:38,550 --> 00:15:43,870 +oblique طيب الآن بنيجي ك .. كمان شغلةبس هيك انتهت + +194 +00:15:43,870 --> 00:15:48,170 +القضية، إذا قبل ما نقول أول إشي القضية ما انتهت، + +195 +00:15:48,170 --> 00:15:52,490 +بس عندي الآن بسبب شلل هذه العضلة تأثرت عضلة، يعني + +196 +00:15:52,490 --> 00:15:56,270 +صار في muscle sequely في العضلة .. في عضلة أخرى، + +197 +00:15:56,270 --> 00:16:00,090 +مش مشلولة بس تأثرت، طبعا التأثر .. التأثر ما إنسان + +198 +00:16:00,090 --> 00:16:04,710 +يتخيل أنه التأثر دائما ضعفالعضلة المفروض تعمل ال + +199 +00:16:04,710 --> 00:16:07,950 +action بتاعها بشكل normal لا هي أكتر من اللازم لا + +200 +00:16:07,950 --> 00:16:11,770 +هي قوة زيادة over action ولا هي ضعف اللي هو under + +201 +00:16:11,770 --> 00:16:14,710 +action ال under action مش طبيعي وال over action + +202 +00:16:14,710 --> 00:16:18,110 +أيضا مش طبيعي الطبيعي أنه يكون عندي normal action + +203 +00:16:18,110 --> 00:16:22,830 +أي عضلة في الدنيا بما فيها عضلات العين لا تعدوا + +204 +00:16:22,830 --> 00:16:26,650 +حالتها اللي بتكون عليها احدى تلت حالات اما تكون + +205 +00:16:26,650 --> 00:16:30,530 +normal acting muscle فهذا الطبيعي والمطلوبأو + +206 +00:16:30,530 --> 00:16:34,870 +underacting muscle مش مطلوب ضعيف أو overacting + +207 +00:16:34,870 --> 00:16:38,910 +muscle وهذا أيضا مش مطلوب لأنه قوي زيادة عن اللزوم + +208 +00:16:38,910 --> 00:16:43,050 +بدليل لما إنسان بيكون بيلعب كرة قدم و فجأة بتتقلص + +209 +00:16:43,050 --> 00:16:46,970 +عضلات الرجلين بت .. يعني بتنشد بقوة ما بنقول إنه + +210 +00:16:46,970 --> 00:16:50,550 +هذا شيء طبيعي و ممتاز و يعني هذا شيء ياريت يحدث كل + +211 +00:16:50,550 --> 00:16:54,190 +يوم لأ بتوقف اللعب و ببدأ يعني أخصاء العلاج + +212 +00:16:54,190 --> 00:16:57,870 +الطبيعي و الطب الرياضي و ما إلى ذلك يتدخلوا و + +213 +00:16:57,870 --> 00:17:03,100 +يحاولوايعني يعمله إرخاء أو تدليق للمنطقة المتشنجة + +214 +00:17:03,100 --> 00:17:08,060 +من قدم فبالتالي ال over action مش مطلوب ويعتبر أثر + +215 +00:17:08,060 --> 00:17:12,080 +يعني مش جيد و ال under action أيضا مش مطلوب ويعتبر + +216 +00:17:12,080 --> 00:17:16,060 +أثر مش جيد إذا احنا بدينا ب lift superior oblique + +217 +00:17:16,060 --> 00:17:21,660 +muscle بلسي إذا under action وهي العضلة الأساسية + +218 +00:17:21,660 --> 00:17:25,380 +اللي بدت المشكلة طولت ال lift superior oblique + +219 +00:17:25,760 --> 00:17:30,140 +بالسي قد ذلك .. إيش يعني الطولات؟ يعني دايما يوم، + +220 +00:17:30,140 --> 00:17:34,300 +يومين، تلاتة، شهر، شهرين، ست شهور وأكتر تمام؟ وهي + +221 +00:17:34,300 --> 00:17:38,100 +مرخية فبالتالي هيصير عندي contraction لل + +222 +00:17:38,100 --> 00:17:43,150 +antagonist اللي هو ال inferior obliqueهي صار عندى + +223 +00:17:43,150 --> 00:17:47,010 +عضلتين عضلة تأثرت بسبب شلل في العضلة التانية، اذا + +224 +00:17:47,010 --> 00:17:50,930 +contraction of the inferior oblique طيب لما بنقول + +225 +00:17:50,930 --> 00:17:53,370 +ال inferior oblique صار فيها contraction صارت + +226 +00:17:53,370 --> 00:17:58,750 +قوية، بلزمها innervation أقل، بلزمها innervation + +227 +00:17:58,750 --> 00:18:03,210 +أقل، ليش بلزمها innervation أقل؟لأنه عشان تؤدي + +228 +00:18:03,210 --> 00:18:08,370 +عملها ال inferior oblique بلزمها قوة تصفر ال + +229 +00:18:08,370 --> 00:18:12,110 +superior oblique action و بعدين قليل من القوة .. + +230 +00:18:12,110 --> 00:18:15,970 +قليل من القوة عشان تزيح العين في اتجاهها عشان تزيح + +231 +00:18:15,970 --> 00:18:19,190 +العين في اتجاهها طيب ال antagonist بتاعها اللي + +232 +00:18:19,190 --> 00:18:22,830 +بدها تصفره ضعيف أصلا فبيصير بلزمها innervation أقل + +233 +00:18:23,010 --> 00:18:26,730 +فبالتالي عشان تنفس شغلها بدها innovation أقل يعني + +234 +00:18:26,730 --> 00:18:31,130 +هي عضلة قوية over acting .. over acting بس ب + +235 +00:18:31,130 --> 00:18:34,990 +innovation أقل .. ب innovation أقل الآن بدنا نرمز + +236 +00:18:34,990 --> 00:18:46,710 +باسم للعضلة ال under acting بسهم نازل لتحت عشان + +237 +00:18:46,710 --> 00:18:48,630 +.. عشان يعني نقول أنها + +238 +00:18:51,300 --> 00:18:54,740 +بسهم نازل لتحتها هي ال superior oblique لما بنشوف + +239 +00:18:54,740 --> 00:19:01,060 +السهم هذا بنقول إيه انه under + +240 +00:19:01,060 --> 00:19:05,740 +acting وهنا احنا عندنا ال inferior oblique سهم + +241 +00:19:05,740 --> 00:19:09,920 +طالع لفوق عشان نقول انها over acting muscle over + +242 +00:19:09,920 --> 00:19:18,420 +acting muscle اذا ملاحظين ال under actionوال over + +243 +00:19:18,420 --> 00:19:21,820 +action مش مرتبط بال innovation .. مش مرتبط بال + +244 +00:19:21,820 --> 00:19:25,600 +innovation احنا بنقول هنا عضلة مشلولة مش وصلها + +245 +00:19:25,600 --> 00:19:30,520 +تغذية عصبية .. مش وصلها تغذية عصبية و under action + +246 +00:19:30,520 --> 00:19:36,160 +.. هذا منطقي بس هنا العضلة وصلها innovation أقل و + +247 +00:19:36,160 --> 00:19:40,080 +مع ذلك هي over acting يعني ال innovation حاجة و ال + +248 +00:19:40,080 --> 00:19:45,380 +.. و ال .. و ال actionover action أو under action + +249 +00:19:45,380 --> 00:19:48,820 +حاجة تانية .. حاجة تانية .. يعني بمعنى آخر .. + +250 +00:19:48,820 --> 00:19:53,680 +بمعنى آخر ممكن إنسان نهمسله أنه اذهب احضر الشيء + +251 +00:19:53,680 --> 00:19:57,600 +الفلاني همسا بمجرد ما يسمع ينفذ الأمر .. تنفيذ + +252 +00:19:57,600 --> 00:20:01,720 +الأمر إشي وعلو الصوت في الطلب إشي تاني .. ممكن + +253 +00:20:01,720 --> 00:20:05,680 +إنسان أعلي صوتي و أقوله روح جيب الشيء الفلاني و مع + +254 +00:20:05,680 --> 00:20:09,710 +ذلك ما .. ماينفذش .. و أيضاال innovation ال + +255 +00:20:09,710 --> 00:20:12,630 +innovation هو عبارة عن إيش؟ ال innovation هو عبارة + +256 +00:20:12,630 --> 00:20:17,770 +order نازل من الدماغ للعضلة عشان تنفذ عمل ما ممكن + +257 +00:20:17,770 --> 00:20:21,250 +ال innovation يكون قليل و العضلة تنفذه بشكل جيد و + +258 +00:20:21,250 --> 00:20:24,670 +أكتر من جيد يعني over acting و ممكن ال innovation + +259 +00:20:24,670 --> 00:20:29,290 +يكون كتير و العضلة ماتنفذوش و العضلة ماتنفذوش الآن + +260 +00:20:29,290 --> 00:20:35,740 +.. الآن هنا عندي under action لأنها عضلة مشلولةطول + +261 +00:20:35,740 --> 00:20:40,280 +الشلال أول عضلة تأثرت أو من العضلات اللي تأثرت ال + +262 +00:20:40,280 --> 00:20:42,720 +inferior oblique اللي هي ال antagonist بتاعة ال + +263 +00:20:42,720 --> 00:20:47,580 +superior oblique وبالتالي صار فيها تقلصات نتيجة ان + +264 +00:20:47,580 --> 00:20:50,700 +اللي عاجبالها راخي دايما و هي مشدودة دايما مابجهاش + +265 +00:20:50,700 --> 00:20:55,340 +وجه الترتاح صارت عضلة قوية .. صارت عضلة قوية .. + +266 +00:20:55,340 --> 00:21:01,010 +طيب العضلة القوية بأقل innovation بتنفذ شغل كتيرزي + +267 +00:21:01,010 --> 00:21:06,310 +ما يكون بأقل ضغطة من إيده بيحس إنه إيده طبعا كأنها + +268 +00:21:06,310 --> 00:21:11,650 +يعني تكسرت أو انضغطت بشدة هنا ال inferior oblique + +269 +00:21:11,650 --> 00:21:15,890 +بأقل innovation بتصير over acting أو هي أصبحت over + +270 +00:21:15,890 --> 00:21:21,810 +acting طيب، ممتاز جدا، الآن ما العضلة رقم تلاتة؟ + +271 +00:21:22,190 --> 00:21:26,530 +اللي تأثرت بواسطة شلال ال superior oblique muscle + +272 +00:21:26,530 --> 00:21:30,310 +طبعا احنا عارفين ان ال inferior oblique ال + +273 +00:21:30,310 --> 00:21:33,250 +inferior oblique في ال left eye بيوصلها + +274 +00:21:33,250 --> 00:21:36,670 +innervation قليل لأنه مش لازمها كتير وع فكرة دماغ + +275 +00:21:36,670 --> 00:21:40,310 +بيبعت على الجد، دماغ بتاع الإنسان ما بيبعت + +276 +00:21:40,310 --> 00:21:44,850 +innervation يلا يعني جد ما بدنا بنبعت، لأ اللي + +277 +00:21:44,850 --> 00:21:50,300 +لازم، لازم، زمان نفرض مثلازمان قبل ما تنشل هذه + +278 +00:21:50,300 --> 00:21:55,340 +العضلة كانت تشتغل و تشد بمقدار او خلانا نقول + +279 +00:21:55,340 --> 00:21:59,640 +بيصلها .. بيصلها عشر شحنات أو عشر نبضات من ال + +280 +00:21:59,640 --> 00:22:03,780 +brain عشان تشتغل، اذا ال inferior oblique عشان تشد + +281 +00:22:03,780 --> 00:22:07,940 +العين باتجاهها، باتجاه منطقة عملها، هذه يوصلها عشر + +282 +00:22:07,940 --> 00:22:13,870 +شحنات، هذه هيوصلها فقط 11 شحنة عشان ..يعني العشرة + +283 +00:22:13,870 --> 00:22:19,610 +لتصفير ال superior oblique muscle action وبيظل + +284 +00:22:19,610 --> 00:22:23,290 +عندها قليل من الشحنات شحنة أو تنتين عشان تتحرك + +285 +00:22:23,290 --> 00:22:27,590 +العين باتجاهها حدث شلل هنا أصبح اللي بيوصل من + +286 +00:22:27,590 --> 00:22:32,910 +النبضات العصبية نبضتين فقطنبضتين فبالتالي هنا ممكن + +287 +00:22:32,910 --> 00:22:37,670 +تلت نبضات او اربع نبضات يكفي لتنفيذ نفس الشغل اللي + +288 +00:22:37,670 --> 00:22:42,110 +كانت تحتاج فيه اتناش او تلتاشر نبضة قديما قبل ما + +289 +00:22:42,110 --> 00:22:46,330 +تنشل العضلة اذا ال brain بيبعت ع الجد طيب وصل لهذه + +290 +00:22:46,330 --> 00:22:51,490 +innervation اقل بسبب ان العضلة المضادة اللي اصبحت + +291 +00:22:51,490 --> 00:22:55,670 +في وضع شلال هذه اصبحت contracted و بتشتغل باقل + +292 +00:22:55,670 --> 00:23:00,930 +innervation و مع ذلك انها over action طالما وصللل + +293 +00:23:00,930 --> 00:23:05,210 +inferior oblique innervation أقل حسب hearing law + +294 +00:23:05,210 --> 00:23:10,670 +.. حسب hearing law لازم اللي بيصل لل yolk muscle + +295 +00:23:10,670 --> 00:23:14,810 +بتاعتها يكون نفس القدر من ال innervation قبل ما + +296 +00:23:14,810 --> 00:23:17,590 +نقول مين ال yolk muscle بتاعتها بدنا نقول ايش ال + +297 +00:23:17,590 --> 00:23:21,690 +hearing law ال hearing law بيقول انه equal and + +298 +00:23:21,690 --> 00:23:25,410 +simultaneous innervation equal + +299 +00:23:26,940 --> 00:23:29,920 +unsimultaneous innervation flows to the yoke + +300 +00:23:29,920 --> 00:23:36,100 +muscle ما بينفع أبدا .. ما بينفع أبدا أنه ال + +301 +00:23:36,100 --> 00:23:40,620 +inferior oblique إجاها أقل innervation و ال yoke + +302 +00:23:40,620 --> 00:23:44,540 +muscle بتاعتها يجيها innervation بيختلف عنه، لازم + +303 +00:23:44,540 --> 00:23:48,240 +يجيها نفس الكم من ال innervation طب هنا إجاها + +304 +00:23:48,240 --> 00:23:53,510 +جليل، أقل من الطبيعيإذا ال yoke muscle بتاعتها بدي + +305 +00:23:53,510 --> 00:23:57,730 +يجيها برضه قليل أقل من الطبيعي ليش هنا إيجاه أقل + +306 +00:23:57,730 --> 00:24:02,290 +من الطبيعي؟ لأنها مش محتاجة كتير عشان تشتغل على + +307 +00:24:02,290 --> 00:24:05,690 +اللي عاجبالها مشلول فبالتالي هي مش محتاجة تبفي + +308 +00:24:05,690 --> 00:24:09,890 +الجهد كتير عشان تتحرك العين باتجاهها الآن مين ال + +309 +00:24:09,890 --> 00:24:13,950 +yoke muscle بتاعت ال left inferior oblique؟ ال + +310 +00:24:13,950 --> 00:24:18,820 +right superior rectus ال right superior rectusوالـ + +311 +00:24:18,820 --> 00:24:25,500 +left inferior oblique هم يوك ماصل ومكان عملهم up + +312 +00:24:25,500 --> 00:24:29,940 +and right up and right left inferior oblique و + +313 +00:24:29,940 --> 00:24:34,440 +right superior rectus بشتغلوا في ال up and right + +314 +00:24:34,440 --> 00:24:38,760 +position هم يوك ماصل مع بعضهم نرجع لصورة ال + +315 +00:24:38,760 --> 00:24:43,720 +virgins هاي عيندين left inferior oblique و right + +316 +00:24:43,720 --> 00:24:46,600 +superior rectus هدولة يوك ماصل بيجيبوا العينتين + +317 +00:24:46,600 --> 00:24:51,310 +rightand up يعني ال target هنا right and up + +318 +00:24:51,310 --> 00:24:54,270 +فبالتالي هدولة يكمصل طالما ال left inferior + +319 +00:24:54,270 --> 00:25:00,410 +oblique طالما ال left inferior oblique اجاها + +320 +00:25:00,410 --> 00:25:05,490 +innovation أقل لأن ال superior oblique اللي بتنزل + +321 +00:25:05,490 --> 00:25:08,710 +العين في ال down position مشلولة طالما وصل + +322 +00:25:08,710 --> 00:25:11,890 +innovation أقل معناته ال superior rectus في العين + +323 +00:25:11,890 --> 00:25:17,940 +التانية لازم يجيها innovation أقل طيببس هنا فيه + +324 +00:25:17,940 --> 00:25:22,540 +فرق، هنا فيه فرق، ما الفرق؟ هم أجاهم نفس ال + +325 +00:25:22,540 --> 00:25:27,720 +innovation، نفس ال innovation هذه جا innovation + +326 +00:25:27,720 --> 00:25:31,240 +مثلا تلت نبضات عصبية وهي قليل بالنسبة للوضع + +327 +00:25:31,240 --> 00:25:36,460 +الطبيعي، هنا هيجيها تلت نبضات عصبية، بس فيه فرق، + +328 +00:25:36,460 --> 00:25:41,620 +جسم العضلة هنا زي لاعب كمال الأجسام، وجسم العضلة + +329 +00:25:41,620 --> 00:25:46,870 +هنا عاديعادي يعني مش contracted مش متقلص ليش هذه + +330 +00:25:46,870 --> 00:25:52,870 +جسمها متقلص بينما هذه جسمها مش متقلص لأن هاي مش + +331 +00:25:52,870 --> 00:25:56,130 +متقلص لأنه بيجيها أوقات بترتاح لما تشد ال inferior + +332 +00:25:56,130 --> 00:26:00,950 +rectus تمام؟ و بتيجي وقت بتشتغل لما تريح ال + +333 +00:26:00,950 --> 00:26:03,350 +inferior rectus يعني بيجي أوقات ترتاح و تشتغل + +334 +00:26:03,350 --> 00:26:08,930 +فبيظل فيه مرونة و فيه ليونة في ال muscle بينما هاي + +335 +00:26:08,930 --> 00:26:11,690 +.. ليه ال inferior oblique؟ بسبب شلل ال superior + +336 +00:26:11,690 --> 00:26:15,400 +obliqueدائما مشدودة وبالتالي .. وبالتالي + +337 +00:26:15,400 --> 00:26:21,440 +contracted ومتقلصة وفيها contracture تقلصات يعني + +338 +00:26:21,440 --> 00:26:27,240 +دائمة .. تقلصات دائمة .. طيب بغض النظر ال inferior + +339 +00:26:27,240 --> 00:26:29,640 +oblique هنا في ال left eye وال superior oblique + +340 +00:26:29,640 --> 00:26:34,520 +هنا في ال right eye التنين .. التنين بيجيهم نفس ال + +341 +00:26:34,520 --> 00:26:37,380 +inner rotation بس هذه لأنها متقلصة بتصير over + +342 +00:26:37,380 --> 00:26:42,070 +actingوهاي عشانها عادية وجهها أقل innervation + +343 +00:26:42,070 --> 00:26:47,110 +بتصير under acting under acting superior rectus + +344 +00:26:47,110 --> 00:26:55,090 +هتصير under acting muscle بسبب أن وصلها أقل + +345 +00:26:55,090 --> 00:27:00,830 +innervation إذا أصبحت كأنها عضلة مشلولة هي مش + +346 +00:27:00,830 --> 00:27:06,930 +مشلولة حقيقة بس بسبب تأثرها بالعضلة الأساسية + +347 +00:27:06,930 --> 00:27:12,940 +المشلولة لحتى الآنلحتى الآن أصبح عندي عضلتين غير + +348 +00:27:12,940 --> 00:27:16,460 +العضلة الأساسية هذا يعتبر muscle sequel هذا يعتبر + +349 +00:27:16,460 --> 00:27:19,360 +muscle sequel زي ما أحنا شايفين أيضا العينتين + +350 +00:27:19,360 --> 00:27:22,460 +اتأثروا العضلات في العينتين اتأثروا مش بس في العين + +351 +00:27:22,460 --> 00:27:27,040 +اللي فيها العضلة المشهورة القضية لسه ما انتهت الآن + +352 +00:27:27,040 --> 00:27:31,820 +هذه عضلة أصبحت under acting under acting بسبب أنه + +353 +00:27:31,820 --> 00:27:35,890 +ال innovation ماإيجاش إليها بالكمية اللازمةهذه + +354 +00:27:35,890 --> 00:27:39,670 +العضلة بتتعرض لحاجة بنسميها inhibitional pulse + +355 +00:28:11,900 --> 00:28:18,460 +إذن inhibitional palsy بمعنى آخر إنه كأنها فيها + +356 +00:28:18,460 --> 00:28:21,900 +palsy بس مش بالسبب إنه فعلا فيها palsy بس بسبب إنه + +357 +00:28:21,900 --> 00:28:25,460 +hearing low حكم عليها إنه لازم يجيها أقل + +358 +00:28:25,460 --> 00:28:29,090 +innervationبسبب ان ال yoke muscle بتاعتها اللي هي + +359 +00:28:29,090 --> 00:28:32,550 +ال left inferior oblique أيضا اخدت اقل innervation + +360 +00:28:32,550 --> 00:28:37,330 +ما بيصير هنا اخد innervation كتير و هنا او اخد + +361 +00:28:37,330 --> 00:28:40,270 +innervation قليل و هنا اخد innervation كتير لأ هنا + +362 +00:28:40,270 --> 00:28:43,510 +قليل معناته هنا قليل لان هدولة التنتين yoke muscle + +363 +00:28:43,510 --> 00:28:46,810 +وحسب hearing law ال yoke muscle لازم ياخدوا equal + +364 +00:28:46,810 --> 00:28:50,250 +and simultaneous innervation and simultaneous + +365 +00:28:50,250 --> 00:28:55,250 +innervation لحتى الآن بدنا نقول الأسهم اللي انا + +366 +00:28:55,250 --> 00:28:58,770 +برسمهاتشير إلى ال action، under action و over + +367 +00:28:58,770 --> 00:29:01,990 +action، لا تشير إلى ال inner vision، ما لهاش علاقة + +368 +00:29:01,990 --> 00:29:05,090 +في ال inner vision، مايلها علاقة في ال inner + +369 +00:29:05,090 --> 00:29:11,570 +vision، تمام؟ فبالتالي هذه القضية ضروري جدا يعني + +370 +00:29:11,570 --> 00:29:15,450 +نستوعبها، الآن ضال العضلة الرابعة من العضلات اللي + +371 +00:29:16,060 --> 00:29:24,400 +بيتأثر أو بتخضع ل .. أو بتأثر بشلل العضلة الأساسية + +372 +00:29:24,400 --> 00:29:27,740 +اللي هي في المثال عندنا left superior oblique، إذا + +373 +00:29:27,740 --> 00:29:32,760 +ما هي العضلة الرابعة؟ هي ال right inferior rectus + +374 +00:29:36,010 --> 00:29:39,210 +ال right inferior rectus عشان نعرف هل فيها over + +375 +00:29:39,210 --> 00:29:45,110 +action ولا under action لازم .. لازم نفهمها من أحد + +376 +00:29:45,110 --> 00:29:48,330 +الطريقين .. من أحد الطريقين في الطريق الأسهل + +377 +00:29:48,330 --> 00:29:53,590 +للفاهم بنقول طالما ال right superior rectusright + +378 +00:29:53,590 --> 00:29:57,610 +superior ecstasy إجالها أقل innervation أقل + +379 +00:29:57,610 --> 00:30:00,930 +innervation وصار عندها ما يسمى بال inhibitional + +380 +00:30:00,930 --> 00:30:04,710 +palsy إيش يعني أقل innervation؟ يعني تم تقليل ال + +381 +00:30:04,710 --> 00:30:08,170 +innervation بتاعها حسب Sherrington law حسب + +382 +00:30:08,170 --> 00:30:11,730 +Sherrington law اللي هو أن العضلة و المضادة إلها + +383 +00:30:11,730 --> 00:30:15,150 +بياخدوا كميات متعاكسة من ال innervation يعني إذا + +384 +00:30:15,150 --> 00:30:18,490 +هذه جلت هذه بتزيد إذا هذه زادت increased + +385 +00:30:18,490 --> 00:30:22,070 +innervation to an extraocular muscleis accompanied + +386 +00:30:22,070 --> 00:30:26,150 +by decreased innervation of its antagonist يعني + +387 +00:30:26,150 --> 00:30:30,610 +لما بيزيد ال innervation لعضلة ما المفروض يجيلا + +388 +00:30:30,610 --> 00:30:33,490 +عضلة اللي هي المعاكسة اللي هي المعاكسة اللي هي + +389 +00:30:33,490 --> 00:30:33,890 +المعاكسة اللي هي المعاكسة اللي هي المعاكسة اللي هي + +390 +00:30:33,890 --> 00:30:36,610 +المعاكسة اللي هي المعاكسة اللي هي المعاكسة اللي هي + +391 +00:30:36,610 --> 00:30:42,210 +المعاكسة اللي هي المعاكسة اللي هي المعاكسة اللي هي + +392 +00:30:42,210 --> 00:30:44,150 +المعاكسة اللي هي المعاكسة اللي هي المعاكسة اللي هي + +393 +00:30:44,150 --> 00:30:46,870 +المعاكسة اللي هي المعاكسة اللي هي المعاكسة اللي هي + +394 +00:30:46,870 --> 00:30:48,970 +المعاكسة اللي هي المعاكسة اللي هي المعاكسة اللي هي + +395 +00:30:48,970 --> 00:30:53,410 +المعاكوصلها innervation كتير وصلها innervation + +396 +00:30:53,410 --> 00:30:57,730 +كتير فبالتالي هتصير over acting muscle هذا تفسير + +397 +00:30:57,730 --> 00:31:03,330 +حسب .. حسب Sherrington law حسب Sherrington law طيب + +398 +00:31:03,330 --> 00:31:08,850 +.. الآن بدنا نفسرها بطريقة تانية تماما عشان نفسرها + +399 +00:31:08,850 --> 00:31:15,310 +بطريقة تانية بدنا نطلع للصور في جوجل و نكتب left + +400 +00:31:15,310 --> 00:31:17,970 +superior oblique bulgy + +401 +00:31:28,330 --> 00:31:31,230 +lift superior oblique palsy بدنا ندور على منظر + +402 +00:31:31,230 --> 00:31:50,810 +يشرح الموضوع أو يسهل شرح الموضوع حتى + +403 +00:31:50,810 --> 00:31:51,190 +الآن + +404 +00:32:09,490 --> 00:32:16,430 +ربما تكون الصورة تمام هذه الصورة bilateral + +405 +00:32:16,430 --> 00:32:19,710 +superior oblique pulsar بس احنا بنركز على هذا + +406 +00:32:19,710 --> 00:32:24,290 +الجزء من الصورة هذا الجزء من الصورة بدنا نقول + +407 +00:32:24,290 --> 00:32:27,890 +هيفيدنا ان شاء الله تعالى في توضيح الفكرة + +408 +00:32:39,810 --> 00:32:56,210 +هنقتص هذا الجزء عشان + +409 +00:32:56,210 --> 00:33:06,030 +اوضح الفكرة المريض + +410 +00:33:06,030 --> 00:33:08,130 +اللي عنده left superior oblique palsy + +411 +00:33:10,640 --> 00:33:15,300 +بيجي بالمنظر هذا ليش بيجي بالمنظر هذا لإن ال + +412 +00:33:15,300 --> 00:33:18,540 +superior oblique depressor superior oblique + +413 +00:33:18,540 --> 00:33:21,140 +depressor يعني بتنزل العين من ضمن ال function + +414 +00:33:21,140 --> 00:33:24,980 +بتاعتها بتنزل العين في حالة left superior oblique + +415 +00:33:24,980 --> 00:33:28,380 +palsy دل عندي one depressor شغال اللي هو ال + +416 +00:33:28,380 --> 00:33:31,580 +inferior rectus و ال other depressor راح اللي هو + +417 +00:33:31,580 --> 00:33:35,390 +superior oblique بينما في عندي two elevatorاللي هي + +418 +00:33:35,390 --> 00:33:38,270 +superior rectus و ال inferior oblique طالما عندي + +419 +00:33:38,270 --> 00:33:42,350 +two elevator شغالين بشكل طبيعي و one depressor + +420 +00:33:42,350 --> 00:33:45,310 +معناته المعادلة راحت لصارح ال elevator فالعين + +421 +00:33:45,310 --> 00:33:50,250 +هتكون hypertrophic .. hypertrophic طيب لو هذا + +422 +00:33:50,250 --> 00:33:53,510 +الإنسان قلناله اللي عنده lift superior oblique + +423 +00:33:53,510 --> 00:33:58,610 +bulgy و عنده lift hypertrophiaقولنا له حاول تركز + +424 +00:33:58,610 --> 00:34:01,350 +بعينك لشمال، معناته لازم ينزلها لل primary + +425 +00:34:01,350 --> 00:34:05,330 +position عشان ينزلها لل primary position، عشان + +426 +00:34:05,330 --> 00:34:09,550 +ينزلها لل primary position، لازم ييجي innervation + +427 +00:34:09,550 --> 00:34:13,570 +كتير لل superior oblique muscle في محاولة + +428 +00:34:13,570 --> 00:34:20,040 +لتشغيلها، في محاولة لتشغيلها، ال brain هيبعتإشارات + +429 +00:34:20,040 --> 00:34:24,620 +عصبية طبعا مش هتصل في حالة الشلل أو هتصل بشكل قليل + +430 +00:34:24,620 --> 00:34:28,740 +فهيبعت أكتر وأكتر يعني هيعمل increased innervation + +431 +00:34:28,740 --> 00:34:32,220 +لل superior oblique increased innervation لل + +432 +00:34:32,220 --> 00:34:35,900 +superior oblique عشان يحاول يخليها تشتغل و ال + +433 +00:34:35,900 --> 00:34:40,500 +depression effect بتاعها يتفاعل طيب إذا إذا ال + +434 +00:34:40,500 --> 00:34:45,660 +brain بعتبعد لل superior oblique اللي فيها بلسي + +435 +00:34:45,660 --> 00:34:49,860 +بعد increased innervation ساعتها إيش اللي هيحصل في + +436 +00:34:49,860 --> 00:34:53,040 +ال inferior rectus هنا؟ أيضا هيصلها increased + +437 +00:34:53,040 --> 00:34:56,440 +innervation ليش؟ لأن ال superior oblique في ال + +438 +00:34:56,440 --> 00:34:59,660 +left eye و ال inferior rectus في ال right eye are + +439 +00:34:59,660 --> 00:35:03,360 +yoke muscles إذا دي وصلها مية نبضة عصبية لازم + +440 +00:35:03,360 --> 00:35:07,600 +يوصلها هنا مية نبضة عصبية طبعا هنا ال brain معنى + +441 +00:35:07,600 --> 00:35:12,290 +إنه يشغلها فهي مشلولةقاعد بيبعت بزيادة عن اللزوم + +442 +00:35:12,290 --> 00:35:16,870 +فهيبعت نفس القدر بزيادة عن اللزوم هنا عضلة طبيعية + +443 +00:35:16,870 --> 00:35:20,390 +وصلها innervation كتير فهتصير over acting muscle + +444 +00:35:20,390 --> 00:35:23,610 +يعني هذا التفسير حسب hearing level .. حسب hearing + +445 +00:35:23,610 --> 00:35:27,690 +level ممكن إنسان يقول هل هو superior oblique في ال + +446 +00:35:27,690 --> 00:35:30,630 +left eye و ال inferior rectus في ال right eye فعلا + +447 +00:35:30,630 --> 00:35:33,970 +هم youth muscle؟ لأ بنرجع للصورة عشان نذكر فيها + +448 +00:35:40,310 --> 00:35:44,570 +هي ال left superior oblique وهي ال inferior rectus + +449 +00:35:44,570 --> 00:35:47,810 +عشان ال left superior .. طبعا هم yoke muscle + +450 +00:35:47,810 --> 00:35:51,410 +واتجاه عاملهم اتنين مع بعض بيشتغلوا ك team في .. + +451 +00:35:51,410 --> 00:35:54,890 +في ال right and down position اللي هي dextro + +452 +00:35:54,890 --> 00:35:58,350 +depression .. dextro depression فبالتالي هم yoke + +453 +00:35:58,350 --> 00:36:00,770 +muscle اجا increased innervation لل superior + +454 +00:36:00,770 --> 00:36:04,400 +oblique عشانها مشلولةفحيجي increased innervation + +455 +00:36:04,400 --> 00:36:08,060 +لل inferior rectus بسبب أنه قانون hearing لازم + +456 +00:36:08,060 --> 00:36:12,460 +يطبق، لازم يطبق، اذا حسب hearing law تفسر ال + +457 +00:36:12,460 --> 00:36:15,400 +muscle sequely، اذا صفة عندي في ال muscle sequely + +458 +00:36:15,400 --> 00:36:21,540 +تنتين + +459 +00:36:21,540 --> 00:36:26,140 +under acting muscles وتنتين over acting muscles + +460 +00:36:26,910 --> 00:36:30,190 +تنتين under acting واحدة مشلولة حقيقة واحدة + +461 +00:36:30,190 --> 00:36:33,350 +inhibitional policy ضعيفة بسبب ان كمية ال + +462 +00:36:33,350 --> 00:36:37,050 +innovation اللي بيصلها اقل من اللازمليش أقل من + +463 +00:36:37,050 --> 00:36:39,710 +اللازم؟ لأن ال York muscle بتاعتها ال inferior + +464 +00:36:39,710 --> 00:36:43,090 +oblique عن ناحية التانية وصلها أقل من اللازم طب + +465 +00:36:43,090 --> 00:36:46,490 +ليش هذه وصلها أقل من اللازم؟ رغم أنها over acting + +466 +00:36:46,490 --> 00:36:50,330 +لأنها متقلصة بلزمهاش innervation كتير لأن العضلة + +467 +00:36:50,330 --> 00:36:53,950 +اللي عاجبالها مشلولة فبالتالي الشغل اللي بدها + +468 +00:36:53,950 --> 00:36:57,310 +تبذله عشان تتحرك العين في اتجاهها قليل فبيعطيها ال + +469 +00:36:57,310 --> 00:37:00,460 +brain قليل innervationليش هذه بيصلها innovation + +470 +00:37:00,460 --> 00:37:04,520 +كتير؟ لأنها ال yoke بتاعة العضلة المشغولة ال yoke + +471 +00:37:04,520 --> 00:37:08,400 +بتاعة العضلة المشغولة بنتوقف عند هذا المثال و + +472 +00:37:08,400 --> 00:37:12,600 +المرة القادمة بن .. بن .. نضرب مثال تاني قبل ما + +473 +00:37:12,600 --> 00:37:17,020 +ننتقل لالموضوع اللي هو التالي، إذا المرة القادمة + +474 +00:37:17,020 --> 00:37:21,000 +هنضرب مثال آخر و بالتالي بنتوقف هنا و يعطيكم + +475 +00:37:21,000 --> 00:37:24,260 +العافية والسلام عليكم ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/cLrZdiDxMOk_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/cLrZdiDxMOk_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..d52628022d87671dc5d59856eb7400ca5c323153 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/cLrZdiDxMOk_postprocess.srt @@ -0,0 +1,1496 @@ +1 +00:00:03,360 --> 00:00:08,020 +بسم الله الرحمن الرحيم، اليوم محاضرتنا عبارة عن + +2 +00:00:08,020 --> 00:00:13,060 +تدريبات عملية على ال abnormal head posture أو ال + +3 +00:00:13,060 --> 00:00:17,000 +compensatory head posture اللي بتاخد مريض الحوال + +4 +00:00:17,000 --> 00:00:20,100 +عشان يستعيد ال binocular single vision ويتخلص من + +5 +00:00:20,100 --> 00:00:24,450 +الدبلوبياكانوع من ال motor adaptation to + +6 +00:00:24,450 --> 00:00:27,350 +strabismus يعني احنا في عندنا sensory adaptation + +7 +00:00:27,350 --> 00:00:32,570 +وفي عندنا motor adaptation to strabismus هذه ال + +8 +00:00:32,570 --> 00:00:37,250 +sensory adaptation قلنا عبارة عن negative اللي هو + +9 +00:00:37,250 --> 00:00:39,790 +ال suppression و positive اللي هو ال abnormal + +10 +00:00:39,790 --> 00:00:43,150 +retinal correspondence و ال motor adaptation قلنا + +11 +00:00:43,150 --> 00:00:49,710 +بيتلخص فيه انه قضية ال abnormal head posture اللي + +12 +00:00:49,710 --> 00:00:57,090 +بتاخذهاالمريض كنوع من نقل العينين لمكان بتوازن و + +13 +00:00:57,090 --> 00:01:00,130 +فيه هدول العنتين وبالتالي بيستعاد ال binocular ال + +14 +00:01:00,130 --> 00:01:05,270 +single vision بعيدا عنالمنطقة اللي بيظهر فيها + +15 +00:01:05,270 --> 00:01:10,890 +الحوار وحكينا انه كل ضعف في عضلة ما ممكن يقدي له + +16 +00:01:10,890 --> 00:01:15,010 +abnormal head posture معين كيف انا اليوم بدي + +17 +00:01:15,010 --> 00:01:21,450 +استنتج انسان عنده ضعف في عضلة ما ايش المتوقع انه + +18 +00:01:21,450 --> 00:01:25,690 +يكون عنده compensatory head posture عشان نعرف + +19 +00:01:25,690 --> 00:01:30,370 +بالضبط هذا الكلام كيف نستنتجه لازم احنا نهيدنقرأ + +20 +00:01:30,370 --> 00:01:35,130 +هذه القضية و يكون المعلومات اللي بداخلها بداخل هذا + +21 +00:01:35,130 --> 00:01:39,690 +ال slide يكون احنا متأكدين منها how to know the + +22 +00:01:39,690 --> 00:01:43,010 +abnormal head posture if we have one muscle pulse + +23 +00:01:43,010 --> 00:01:46,790 +عندنا عضلة من الاتناشر عضلات عندنا اتناشر عضلات + +24 +00:01:46,790 --> 00:01:51,900 +ستة في كل ايانوحدة فيهم من الـ 12 فيها palsy فيها + +25 +00:01:51,900 --> 00:01:57,600 +ضعف فيها شلل سواء جزء أو كله هذا المريض متوقع بسبب + +26 +00:01:57,600 --> 00:02:01,720 +هذا الشلل انه يكون في عنده misalignment يعني حول + +27 +00:02:01,720 --> 00:02:06,160 +وبالتالي انه يشكي من double vision كيف او ايش هو + +28 +00:02:06,160 --> 00:02:11,220 +ال compensatory head posture المتوقع عشان تستعار + +29 +00:02:11,220 --> 00:02:14,900 +ال binocular single vision فبنقول عشان نجاوب على + +30 +00:02:14,900 --> 00:02:19,920 +هذا السؤال البسيطبدنا نعرف تلت شغلات أول شغلة we + +31 +00:02:19,920 --> 00:02:23,000 +should know the function of the muscle and its + +32 +00:02:23,000 --> 00:02:26,780 +testing position لما بنقول ال media rectus إيش ال + +33 +00:02:26,780 --> 00:02:30,040 +function بتاعتها؟ بنقول adduction فش إلها function + +34 +00:02:30,040 --> 00:02:34,330 +تاني ال testing position بتاعهااللي هو في ال in + +35 +00:02:34,330 --> 00:02:39,090 +position بمسك ال target بحيث ان العين تروح in ال + +36 +00:02:39,090 --> 00:02:44,650 +inferior rectus نقول depression extortion و + +37 +00:02:44,650 --> 00:02:48,070 +adduction ال testing position بتاعها ال inferior + +38 +00:02:48,070 --> 00:02:51,790 +rectus down and out فبالتالي ضروري جدا انا اكون + +39 +00:02:51,790 --> 00:02:56,470 +متأكدمن ال function بتاعة ال muscle و ال testing + +40 +00:02:56,470 --> 00:03:00,890 +position بتاعه، هذا الكلام حكينا عنه باستفادة في + +41 +00:03:00,890 --> 00:03:07,230 +محاضرات ال function بتاعة ال extraocular muscles + +42 +00:03:07,230 --> 00:03:13,310 +طيب، الأن بعد ذلك then if this muscle is weak the + +43 +00:03:13,310 --> 00:03:17,310 +head will adopt a posture to put that eye far from + +44 +00:03:17,310 --> 00:03:21,010 +the action of the weak muscle لما بيصير شلل في + +45 +00:03:21,010 --> 00:03:29,090 +عضلة ماالدماغ بيخلي الرأس ال head يتخذ وضعية معينة + +46 +00:03:29,090 --> 00:03:34,810 +بحيث العنتين ينتقلوا لوضعية عكسها هذه الوضعية اللي + +47 +00:03:34,810 --> 00:03:40,030 +عكسها بعيدة عن منطقة عمل العضلة الضعيفة وكأنه احنا + +48 +00:03:40,030 --> 00:03:46,530 +بنهرب وكأنه الدماغ بيهرب العين من انها تيجي في + +49 +00:03:46,530 --> 00:03:50,170 +مجال عمل او في ال field بتاع ال action بتاع ال + +50 +00:03:50,170 --> 00:03:54,810 +weak muscleبدنا نذكر أخر حاجة remember that + +51 +00:03:55,860 --> 00:04:01,980 +remember that the head turns where the eye cannot + +52 +00:04:01,980 --> 00:04:08,240 +وبالتالي the eyes go opposite to the head زي ما + +53 +00:04:08,240 --> 00:04:12,740 +احنا حكينا في المحادرات السابقة العنتين بيروحوا في + +54 +00:04:12,740 --> 00:04:18,240 +اتجاه دائما عكس اتجاه الرأس وهذه شغل اوتوماتيكية و + +55 +00:04:18,240 --> 00:04:22,140 +الرأس هيروح ك compensatory head posture هيروح + +56 +00:04:22,140 --> 00:04:26,080 +للمنطقةللمنطقة اللي العلم مش قادر تروح عليها + +57 +00:04:26,080 --> 00:04:31,140 +وبالتالي العلمين هينتقلوا عكس هذه المنطقة فبعيدا + +58 +00:04:31,140 --> 00:04:35,240 +عن منطقة عمل ال action of the weak muscle هنضرب + +59 +00:04:35,240 --> 00:04:39,780 +أمثلة على ذلك و هنتقل ل powerpoint يساعدنا في هذه + +60 +00:04:39,780 --> 00:04:46,240 +القضية حقيقة أنا بنصح استخدام تلت رسماتلأ المبتدئ + +61 +00:04:46,240 --> 00:04:51,040 +في هذه القضية رسمة بتبين ال face turn هنا left + +62 +00:04:51,040 --> 00:04:55,240 +face turn right face turn هذه الرسمة اللي في الوسط + +63 +00:04:55,240 --> 00:04:58,720 +مش لازمة لما بيصير عندي right face turn اللي هنين + +64 +00:04:58,720 --> 00:05:02,000 +بيروحوا على الشمال زي ما السهم بيبين لما بيصير + +65 +00:05:02,000 --> 00:05:04,960 +عندي left face turn اللي هنين بيروحوا على اليمين + +66 +00:05:04,960 --> 00:05:07,980 +برضه زي ما السهم بيبين الرسمة الأولى هي هنستخدمها + +67 +00:05:07,980 --> 00:05:12,260 +عشان نشوف ال face turn وين بده يروح هذه ال head + +68 +00:05:12,260 --> 00:05:17,220 +tilthead tilt to the right و head tilt to the left + +69 +00:05:17,220 --> 00:05:21,360 +زي ما الأسهم الزرقاء بتبين العين هيصار فيها + +70 +00:05:21,360 --> 00:05:24,480 +extortion و العين هيصار فيها intortion طبعا + +71 +00:05:24,480 --> 00:05:28,100 +الاتجاه عكس ال head tilt التنتين عكس ال head tilt + +72 +00:05:28,100 --> 00:05:33,460 +الرأس لف لليمين العينتين عملوا دورانحول المحور Y + +73 +00:05:33,460 --> 00:05:38,180 +كل واحدة منهم حول المحور Y to the left الان هذه + +74 +00:05:38,180 --> 00:05:42,700 +left sided tilt left sided tilt العين الشمال عملت + +75 +00:05:42,700 --> 00:05:46,840 +N torsion و العين اليمين عملت X torsion عملت X + +76 +00:05:46,840 --> 00:05:49,800 +torsion الان بظهر الرسم التالت اللي ده استخدمها + +77 +00:05:49,800 --> 00:05:53,940 +chin up زي ما هو واضح العين زي ما بتبين الأسهم + +78 +00:05:53,940 --> 00:05:58,280 +الحمراء العينين هيروحوا downو chin down العينين + +79 +00:05:58,280 --> 00:06:01,940 +هيروحوا up العينين هيروحوا up الاستعانة بالرسمات + +80 +00:06:01,940 --> 00:06:07,800 +هيسهل الموضوع بشكل كبير جدا الان انا بدأ ابدأ اقول + +81 +00:06:07,800 --> 00:06:14,000 +في عندى على سبيل المثال lift, inferior, + +82 +00:06:15,880 --> 00:06:19,280 +rectus, pulsar + +83 +00:06:23,770 --> 00:06:29,010 +بدي اعرف ما هو السؤال ما هو ال compensatory head + +84 +00:06:29,010 --> 00:06:33,210 +posture لل left inferior rectus bulce بنقول + +85 +00:06:33,210 --> 00:06:37,130 +كالقاتى + +86 +00:06:37,130 --> 00:06:49,910 +هنشوف + +87 +00:06:49,910 --> 00:06:52,930 +ال function بتاعة ال inferior rectus + +88 +00:07:26,610 --> 00:07:29,150 +نقول الـ function بتاعة الـ inferior rectus + +89 +00:07:29,150 --> 00:07:36,630 +depression + +90 +00:07:36,630 --> 00:07:42,630 +تاني + +91 +00:07:42,630 --> 00:07:52,350 +function extortion + +92 +00:07:56,730 --> 00:08:06,970 +التالت function abduction abduction + +93 +00:08:22,580 --> 00:08:32,900 +ايش ال testing position بتاعها؟ down and out هو + +94 +00:08:32,900 --> 00:08:35,560 +ال testing position بتاع ال inferior rectus muscle + +95 +00:08:35,560 --> 00:08:45,740 +طبعا في ال left eye اذا + +96 +00:08:45,740 --> 00:08:49,940 +هدول التلاتة هدا ال primary action, secondary + +97 +00:08:49,940 --> 00:08:55,690 +action, tertiary actionhide down and out ما هو ال + +98 +00:08:55,690 --> 00:09:00,150 +compensatory head posture اللي هيتاخده المريض في + +99 +00:09:00,150 --> 00:09:04,830 +حالة ال left inferior rectus palsy الإجابة بتتلخص + +100 +00:09:04,830 --> 00:09:10,610 +في شيئين لا ثالثة لهم أنا هحط سهم على الأشياء اللي + +101 +00:09:10,610 --> 00:09:19,530 +هنستعملها هذا + +102 +00:09:19,530 --> 00:09:20,690 +السهم بدنا ننسخه + +103 +00:09:29,190 --> 00:09:34,730 +عشان نعرف ال compensatory head posture فقط بلزمنا + +104 +00:09:34,730 --> 00:09:38,990 +من ال function تاعة ال head ال muscle و من ال + +105 +00:09:38,990 --> 00:09:42,390 +testing position، يعني أخد ال testing position و + +106 +00:09:42,390 --> 00:09:45,770 +أخد ال torsional movement تاعة ال muscle، سواء + +107 +00:09:45,770 --> 00:09:50,140 +extortionزي ما في حالة inferior rectus أو + +108 +00:09:50,140 --> 00:09:53,200 +intortion زي ما في حالة superior rectus أو + +109 +00:09:53,200 --> 00:09:56,920 +superior oblique هدول اللي بلزموني عشان أعرف ال + +110 +00:09:56,920 --> 00:10:04,680 +compensatory head posture بدأ أقول كالقاتي و + +111 +00:10:04,680 --> 00:10:13,620 +هكتبها بالعربي ان شاء الله لابد ان تهرب العين + +112 +00:10:15,240 --> 00:10:19,240 +اليمنة .. الأفوان اليسرة اللي احنا فيها المشكلة + +113 +00:10:19,240 --> 00:10:32,360 +اليسرة من أن تذهب للأسفل ده تشرد من وضع الأسفل + +114 +00:10:32,360 --> 00:10:40,560 +يعني لازم تشرد للأعلى و من أن تذهب للأسفل و للخارج + +115 +00:10:40,560 --> 00:10:53,480 +و منان يحدث لها extortion + +116 +00:10:53,480 --> 00:11:08,000 +اذا + +117 +00:11:08,000 --> 00:11:12,840 +عشان اعرف ال compensatory head postureفى الـ left + +118 +00:11:12,840 --> 00:11:17,400 +inferior rectus palsy لابد أن تهرب العين اليسرى + +119 +00:11:17,400 --> 00:11:22,860 +العين اليسارى اللى فيها المشكلة left لابد أنها + +120 +00:11:22,860 --> 00:11:27,620 +تشرد من قضية أنها تروح لتحت ومن أنها تطلع لبرا out + +121 +00:11:27,620 --> 00:11:32,300 +يعني abduction أنها تعمل abduction ومن أنها تعمل + +122 +00:11:32,300 --> 00:11:35,360 +extortion هدول التلت شغلات لازم تشرد منهم كيف + +123 +00:11:35,360 --> 00:11:38,940 +عرفنا هدول التلت شغلات؟ من وين جبناهم؟ من كلمة + +124 +00:11:38,940 --> 00:11:43,910 +downأنا بختبر ال inferior rectus في ال down و في + +125 +00:11:43,910 --> 00:11:46,770 +ال out لو جبت العين لشمال في ال down و في ال out + +126 +00:11:46,770 --> 00:11:50,070 +معناته أنا بعرض العين أنه يظهر الحوار الأكتر لأن + +127 +00:11:50,070 --> 00:11:53,770 +ال left inferior rectus هي المسئولة عن ال down and + +128 +00:11:53,770 --> 00:11:56,790 +out و ال left inferior rectus فيها policy فبالتالي + +129 +00:11:56,790 --> 00:12:00,840 +طالما فيها policy فيها ضعفإذا إجت العين اليسار في + +130 +00:12:00,840 --> 00:12:05,200 +وضعية down و out معناته هذه العين هيبين عيبها و + +131 +00:12:05,200 --> 00:12:08,840 +هيزيد الحول و هيزيد الدبلوبيا إذا لازم العين .. + +132 +00:12:08,840 --> 00:12:14,880 +العين اليسار تذهب عكس ذلك تماما عكس ذلك تماما طيب + +133 +00:12:14,880 --> 00:12:18,540 +إذا ممنوع العين اليسار تروح down ممنوع العين + +134 +00:12:18,540 --> 00:12:21,540 +اليسار تروح out و ممنوع العين اليسار تعمل + +135 +00:12:21,540 --> 00:12:25,300 +extortion هدولة التلت شغلات ممنوعة تعملهم العين + +136 +00:12:25,300 --> 00:12:30,710 +اليسار لسببهدولة التلت شغلات مع بعض شغل ال + +137 +00:12:30,710 --> 00:12:33,450 +inferior rectus في ال left eye و ال inferior + +138 +00:12:33,450 --> 00:12:37,110 +rectus فيها palsy إذا بدنا نشرد من هذه الوضعيات يا + +139 +00:12:37,110 --> 00:12:43,910 +ترى كيف الدماغ .. كيف الدماغ هيشرد العين اليسار من + +140 +00:12:43,910 --> 00:12:48,330 +هذه القضية بإنه نقول كالقاتل عشان جوابنا يكون مرتب + +141 +00:12:48,330 --> 00:12:52,070 +هاي + +142 +00:12:52,070 --> 00:12:56,450 +عندي جدوة أخر للجواب + +143 +00:13:03,450 --> 00:13:08,690 +بنقول هنا أنه + +144 +00:13:08,690 --> 00:13:14,250 +ال + +145 +00:13:14,250 --> 00:13:20,250 +face turned هي ترى هيكون في هذه الحالة لا إياش و + +146 +00:13:20,250 --> 00:13:25,990 +ال head tilted و + +147 +00:13:25,990 --> 00:13:28,250 +ال chin هيكون إشوطة + +148 +00:13:34,660 --> 00:13:38,500 +إذا أنا ب .. بجاوب على التلت حاجات هدولة، بنقول + +149 +00:13:38,500 --> 00:13:44,780 +كالقاتل، نرجع للرسمة، نيجي لل face turn، طيب، احنا + +150 +00:13:44,780 --> 00:13:49,040 +قلنا العين اليسار بدها تهرب من ال out position، هي + +151 +00:13:49,040 --> 00:13:52,320 +عندي face turn to left، وهي عندي face turn to + +152 +00:13:52,320 --> 00:13:55,600 +right، يا ترى مين فيهم أنسب في ال left inferior + +153 +00:13:55,600 --> 00:13:59,980 +rectus palsy؟لو قلنا هناخد ال right face turn واضح + +154 +00:13:59,980 --> 00:14:02,740 +أنه في ال right face turn العين الشمال هتيجي out + +155 +00:14:02,740 --> 00:14:06,140 +وهذا مش مناسب إلها هذا مش مناسب إلها قلنا بدها + +156 +00:14:06,140 --> 00:14:11,800 +تهرب من أن تذهب للخارج من ال out position إذا هذا + +157 +00:14:11,800 --> 00:14:16,720 +مش مناسب إلها أنه يصير right face turn بينما لما + +158 +00:14:16,720 --> 00:14:21,600 +المريض بتاخد left face turnالعين الشمال إجت in + +159 +00:14:21,600 --> 00:14:25,180 +وهذا مناسب إليها بعيدة عن منطقة ال out اللي هي + +160 +00:14:25,180 --> 00:14:28,520 +إحدى مناطق إحنا مش قولنا down and out ال inferior + +161 +00:14:28,520 --> 00:14:33,360 +rectus تختبر هذه إحنا شردنا من ال out فبالتالي أول + +162 +00:14:33,360 --> 00:14:39,120 +حاجة المريض هيعمل face turn to to left to left إذا + +163 +00:14:39,120 --> 00:14:44,400 +left face turn face turn left هذه أول شيء + +164 +00:14:46,850 --> 00:14:51,590 +هذا تلت الجواب الان ال hit tilt .. ال hit tilt .. + +165 +00:14:51,590 --> 00:14:55,410 +ال hit tilt معنى بال torsional movement مفروض انه + +166 +00:14:55,410 --> 00:14:59,070 +يصير hit tilt .. مفروض انه يصير hit tilt في ال + +167 +00:14:59,070 --> 00:15:03,730 +compensatory posture بحيث مايصيرش extortion في ال + +168 +00:15:03,730 --> 00:15:06,930 +left eye ممنوع يصير extortion في ال left eye نروح + +169 +00:15:06,930 --> 00:15:14,930 +على الصورة بتاعة ال hit tilt طيب + +170 +00:15:14,930 --> 00:15:19,180 +..لو أخدنا ال right sided head tilt يعني هذا + +171 +00:15:19,180 --> 00:15:24,040 +المريض بده يميل رأسه ل الناحية اليمين ساعتها العين + +172 +00:15:24,040 --> 00:15:27,660 +الشمال اللي احنا بيصددها هتعمل إيش extortion وهذا + +173 +00:15:27,660 --> 00:15:31,880 +مش مناسب إلا احنا بنشرط من ال extortion طيب لو ميل + +174 +00:15:31,880 --> 00:15:37,560 +رأسه لشمال المريض ساعتها العين الشمال اللي احنا + +175 +00:15:37,560 --> 00:15:41,300 +بنحكي عنها هتعمل extortion بعيدا عن ال extortion + +176 +00:15:41,300 --> 00:15:45,920 +يعني عكس ال extortionالـ Extortion فيه مشكلة لأن + +177 +00:15:45,920 --> 00:15:49,160 +الـ inferior rectus أحد الـ Extorters فيها بلسي + +178 +00:15:49,160 --> 00:15:53,100 +فبالتالي هذا ال .. الوضعية هي الأنسب لأنه في + +179 +00:15:53,100 --> 00:15:57,700 +الوضعية هاي اللي هي left sided tilt العين الشمال + +180 +00:15:57,700 --> 00:16:01,340 +هتعمل Intortion يعني هتشرد من ال Extortion إذا + +181 +00:16:01,340 --> 00:16:06,340 +left sided tilt left sided tilt أيضا to the left + +182 +00:16:06,340 --> 00:16:07,800 +tilt to the left + +183 +00:16:14,450 --> 00:16:18,490 +بظل عندى هل هذا المريض هيتخذ chin up ولا chin down + +184 +00:16:18,490 --> 00:16:22,390 +عشان نعرف chin up ولا chin down لسه ضال عندى شغل + +185 +00:16:22,390 --> 00:16:28,230 +احنا العين هربت من وضعية ال out position وهربت من + +186 +00:16:28,230 --> 00:16:32,290 +وضعية ال extortion، الآن بدها تهرب من وضعية ال + +187 +00:16:32,290 --> 00:16:35,670 +down إنها ماتيجيش down كيف العين مابدناش نجيبها + +188 +00:16:35,670 --> 00:16:40,130 +down العين الشمال، معناته نشوف موضوع ال chin up or + +189 +00:16:40,130 --> 00:16:44,660 +downلو عمل هذا المريض chin up عينيه هيروحه down + +190 +00:16:44,660 --> 00:16:48,980 +هذا مش مناسب بينما لما يعمل chin down ينزل راسه + +191 +00:16:48,980 --> 00:16:52,360 +لتحت ساعتها عينيه هيطلع لفوق بعيدا عن ال down + +192 +00:16:52,360 --> 00:16:56,240 +position اللي هو منطقة او احدى مناطق اختبار اللي + +193 +00:16:56,240 --> 00:17:00,180 +هو ال inferior rectus مثلا اذا ال chin لازم يكون + +194 +00:17:00,180 --> 00:17:07,260 +down عشان العين تطلع عكس الراسو تصير up هيك .. لما + +195 +00:17:07,260 --> 00:17:11,760 +بنكون left face turn left head tilt و chin down + +196 +00:17:11,760 --> 00:17:15,160 +هذا هو ال compensatory head posture لل left + +197 +00:17:15,160 --> 00:17:20,200 +inferior rectus bulce هذا هو ال compensatory head + +198 +00:17:20,200 --> 00:17:27,500 +posture لاللي هي ال left inferior rectus bulce + +199 +00:17:27,500 --> 00:17:30,800 +طبعا + +200 +00:17:30,800 --> 00:17:35,100 +إذا أنا ..يعني مش عارف ال function بالأساس تاعة ال + +201 +00:17:35,100 --> 00:17:39,140 +extra ocular muscles تاع مثلا inferior rectus ومش + +202 +00:17:39,140 --> 00:17:42,820 +عارف ال testing position تاعها معناته كل الشغل هذا + +203 +00:17:42,820 --> 00:17:48,500 +هيكون خطأ ما بني على خطأ فهو خطأ ناخد مثال آخر + +204 +00:17:48,500 --> 00:17:58,140 +نقول + +205 +00:17:58,140 --> 00:17:59,500 +مثلا right + +206 +00:18:03,070 --> 00:18:09,050 +inferior oblique pulsing المرة هات في ال right eye + +207 +00:18:09,050 --> 00:18:13,650 +what is the abnormal head posture او ال + +208 +00:18:13,650 --> 00:18:16,330 +compensatory head posture بنقول كالقاتي ال + +209 +00:18:16,330 --> 00:18:20,150 +function بتاعة ال inferior oblique ال function + +210 +00:18:20,150 --> 00:18:26,690 +الأولى extortion ال + +211 +00:18:26,690 --> 00:18:29,970 +function التانية elevation + +212 +00:18:33,190 --> 00:18:40,050 +الفنكشن التالتة abduction + +213 +00:18:40,050 --> 00:18:44,450 +الان ال testing position بتاع ال inferior oblique + +214 +00:18:44,450 --> 00:18:49,870 +up + +215 +00:18:49,870 --> 00:18:58,150 +and in احنا + +216 +00:18:58,150 --> 00:19:12,140 +قلنا من هدولة كلهم هناخد فقطالـ testing position و + +217 +00:19:12,140 --> 00:19:17,440 +أيضا هناخد ال torsional movement من كل ال function + +218 +00:19:17,440 --> 00:19:22,260 +بس بالزمن ال torsional movement + +219 +00:19:22,260 --> 00:19:25,900 +ليه + +220 +00:19:25,900 --> 00:19:31,330 +ال X torsion مدام فيه NDright inferior oblique + +221 +00:19:31,330 --> 00:19:36,670 +palsy معناته right eyeفيها ضعف في ال extortion + +222 +00:19:36,670 --> 00:19:41,670 +فيها ضعف في ال up and in هتشرد .. هيشردها الدماغ + +223 +00:19:41,670 --> 00:19:45,650 +أو ال head هيشردها من هدولة التلت شغلات إنها تيجي + +224 +00:19:45,650 --> 00:19:48,910 +up أو إنها تيجي in أو إنها تعمل extortion تلت + +225 +00:19:48,910 --> 00:19:52,690 +شغلات لازم العين تشرد منهم ليش لازم العين تشرد + +226 +00:19:52,690 --> 00:19:55,550 +منهم؟ لأنه إذا إجت في هذه الأوضاع معناته لازم + +227 +00:19:55,550 --> 00:19:58,490 +تشتغل ال inferior oblique والinferior oblique مش + +228 +00:19:58,490 --> 00:20:01,590 +جادرة تشتغل لأنها فيها palsy فبدنا نشرد من هدولة + +229 +00:20:01,590 --> 00:20:06,970 +الأوضاع الآن يا ترىكيف بدأ تشرط من هذه الأوضاع؟ + +230 +00:20:06,970 --> 00:20:22,470 +ندرج الجدول هنا + +231 +00:20:22,470 --> 00:20:29,850 +نكتب + +232 +00:20:29,850 --> 00:20:30,630 +ال face tier + +233 +00:20:36,480 --> 00:20:42,340 +و هنا بنكتب ال head tilt و + +234 +00:20:42,340 --> 00:20:47,180 +هنا بنكتب ال chin هل هيكون up ولا down نيجي لقضية + +235 +00:20:47,180 --> 00:20:51,620 +ال face tier ال face tier بده قضية حللة لقضية ان + +236 +00:20:51,620 --> 00:20:57,940 +العين ماتيجيش in ماتيجيش in طيب نرجع للصورة اي عين + +237 +00:20:57,940 --> 00:21:03,710 +طبعا ليه ال right eyeلما كان عندى right face turn، + +238 +00:21:03,710 --> 00:21:07,830 +right face turn هي لافف وجهه لليمين واضح أنه العين + +239 +00:21:07,830 --> 00:21:13,230 +اليمين إجت in، إذا هذا مش مناسب لما كان عندى left + +240 +00:21:13,230 --> 00:21:17,010 +face turn، لما اتخذ left face turn، العين اليمين + +241 +00:21:17,010 --> 00:21:20,990 +إجت لبرة out، هذا مناسب، إذا left face turn، left + +242 +00:21:20,990 --> 00:21:21,790 +face turn + +243 +00:21:24,980 --> 00:21:28,420 +left face turned عشان العين اليمين في ال left face + +244 +00:21:28,420 --> 00:21:32,240 +turned بتروح لبرا زي ما هو الصورة المضحكة إذا ال + +245 +00:21:32,240 --> 00:21:42,840 +face turned to the left face + +246 +00:21:42,840 --> 00:21:45,220 +turned to the left هذا تلت الجواب نشوف ال head + +247 +00:21:45,220 --> 00:21:48,400 +tilted ال head tilted بدي يخلصني من الموضوع أن + +248 +00:21:48,400 --> 00:21:51,560 +العين اليمين تعمل extortion هنشرط من موضوع ال + +249 +00:21:51,560 --> 00:21:55,510 +extortion في العين اليمين كيف؟يا ترى ب right head + +250 +00:21:55,510 --> 00:22:00,670 +tilt ولا ب left head tilt؟ طيب I left head tilt + +251 +00:22:00,670 --> 00:22:04,430 +left head tilt شايفين العين اليمين عاملة extortion + +252 +00:22:04,430 --> 00:22:07,330 +و هذا مش مناسب لها بدناش العين اليمين تعمل + +253 +00:22:07,330 --> 00:22:10,970 +extortion لأن ال extortion عندها ضعيف عندها ضعيف + +254 +00:22:10,970 --> 00:22:14,150 +بسبب ان ال inferior oblique اللي هي ال extorter + +255 +00:22:14,150 --> 00:22:17,690 +الرئيسي فيها pulse فيها pulse إذا هذه وضعية ال + +256 +00:22:17,690 --> 00:22:21,450 +head مش مناسبة لل right eye بينما لما بيعمل right + +257 +00:22:21,450 --> 00:22:26,600 +tilt right tiltالعين اليمين اللي انا بأشير عليها + +258 +00:22:26,600 --> 00:22:30,620 +بتعمل Intortion و ال Intortion مناسب إليها لأنه + +259 +00:22:30,620 --> 00:22:34,500 +بعيد أو عكس ال extortion اللي مش قادرة تعمله اذا + +260 +00:22:34,500 --> 00:22:42,560 +right tilt right tilt hit + +261 +00:22:42,560 --> 00:22:48,040 +tilt to the right to the right اذا left fist there + +262 +00:22:48,040 --> 00:22:55,810 +و right tilt و right tilt طيبتالت شيء، ال chinبدنا + +263 +00:22:55,810 --> 00:22:59,410 +نهرب من ال up position بدنا نهرب من ال up position + +264 +00:22:59,410 --> 00:23:02,390 +يعني العين اليمين لازم تنزل لتحت لأنها مش جادرة + +265 +00:23:02,390 --> 00:23:06,310 +تروح up ليش مش جادرة تروح up؟ لأن ال inferior + +266 +00:23:06,310 --> 00:23:09,810 +oblique ضعيفة و ال inferior oblique أحد الروافع + +267 +00:23:09,810 --> 00:23:13,830 +أحد ال elevators بتاعت ال eye فبالتالي طالما العين + +268 +00:23:13,830 --> 00:23:16,530 +مش جادرة تروح up معناته العين جادرة تروح down + +269 +00:23:16,530 --> 00:23:20,930 +فبالتالي هنشوف الدماغ أو ال head كيف هيخلي العين + +270 +00:23:20,930 --> 00:23:24,080 +تروح down بعيدا عن ال upالتي هي الـ testing + +271 +00:23:24,080 --> 00:23:28,420 +position بتاع الـ inferior oblique بنروح على قضية + +272 +00:23:28,420 --> 00:23:33,440 +chin up or downلو عملت chin up لو عملت chin up + +273 +00:23:33,440 --> 00:23:36,780 +العينين هيروحوا down العينين هيروحوا down وهذا + +274 +00:23:36,780 --> 00:23:40,540 +مناسب انها تشرد من ال up position بينما لو عملت + +275 +00:23:40,540 --> 00:23:43,860 +chin down العينين هيروح او العين اليامن هتروح up + +276 +00:23:43,860 --> 00:23:47,240 +وبالتالي هذا مش مناسب لأن up هذه احدى ال function + +277 +00:23:47,240 --> 00:23:50,340 +او احدى ال testing positions بتاع ال inferior + +278 +00:23:50,340 --> 00:23:56,060 +oblique اذا ال chin up هو المناسب لهذا المريض chin + +279 +00:23:56,060 --> 00:23:58,440 +up عشان العينين يروحوا down + +280 +00:24:05,570 --> 00:24:10,790 +إذا left face turn .. left face turn عشان نهرب من + +281 +00:24:10,790 --> 00:24:14,170 +ال in position بتاع ال right eye تشوفوا مرة تانية + +282 +00:24:14,170 --> 00:24:18,430 +هنا left face turn عشان نهرب من ال in position + +283 +00:24:18,430 --> 00:24:23,790 +واضح أن العين اليمين راحت out مش in تمام right + +284 +00:24:23,790 --> 00:24:27,990 +tilt .. right tilt عشان العين اليمين تروح في ال in + +285 +00:24:27,990 --> 00:24:31,610 +torsion right tilt .. هي .. هي هذا right tilt عشان + +286 +00:24:31,610 --> 00:24:35,430 +العين اليمين تروح في ال in torsionالتالت شيء ال + +287 +00:24:35,430 --> 00:24:40,130 +chin up عشان العين اليمين تنزل لتحت بعيدا عن ال up + +288 +00:24:40,130 --> 00:24:42,550 +position اللي هو ال testing بتاعها، اذا هربنا من + +289 +00:24:42,550 --> 00:24:46,670 +ال N و هربنا من ال up و هربنا من ال extortion، اذا + +290 +00:24:46,670 --> 00:24:52,220 +اي شخص عنده right inferior oblique palsyهيكون عنده + +291 +00:24:52,220 --> 00:24:55,680 +ال face turned to the left ال head tilted to the + +292 +00:24:55,680 --> 00:25:00,040 +right ال chin هيكون up الان نيجي نقارن بين ال + +293 +00:25:00,040 --> 00:25:02,780 +right inferior oblique palsy اللي أخدناها رقم + +294 +00:25:02,780 --> 00:25:06,820 +اتنين كمثال و بين ال left inferior rectus palsy + +295 +00:25:06,820 --> 00:25:09,960 +هنا ال face turned to the left و ال head tilted to + +296 +00:25:09,960 --> 00:25:14,300 +the left و ال chin down هنا ال face turned to the + +297 +00:25:14,300 --> 00:25:17,540 +leftالـ head tilt to the right و ال chin up، إذا + +298 +00:25:17,540 --> 00:25:21,400 +بختلفوا عن بعض، كل عضلة إلها ال compensatory head + +299 +00:25:21,400 --> 00:25:25,380 +posture في حال ضعفها، اللذي طبعا يناسبها، إلها في + +300 +00:25:25,380 --> 00:25:29,760 +حال ضعفها، compensatory head posture مناسب إلها، + +301 +00:25:29,760 --> 00:25:32,480 +مناسب إلها، لأن ناخد المثال التالت + +302 +00:25:41,820 --> 00:25:47,460 +و طبعا بنأكد على موضوع إنه إذا أنا مش عارف ال .. + +303 +00:25:47,460 --> 00:25:52,020 +ال function بتاع ال extraocular muscles معناته كل + +304 +00:25:52,020 --> 00:25:55,780 +الكلام ده لأنا أستطيع أداءه عندي left superior + +305 +00:25:55,780 --> 00:25:59,620 +oblique بلسي يترى إيش ال compensatory head posture + +306 +00:25:59,620 --> 00:26:04,020 +اللي هيصير عندي في حالة ضعف ال superior oblique عن + +307 +00:26:04,020 --> 00:26:06,980 +ناحية الشمال أول إيش ال function بتاعة ال superior + +308 +00:26:06,980 --> 00:26:12,930 +oblique ال intorsion أهم function لهاوتاني + +309 +00:26:12,930 --> 00:26:17,150 +function اللي هي depression وتالت + +310 +00:26:17,150 --> 00:26:23,350 +function اللي هي ال abduction ال + +311 +00:26:23,350 --> 00:26:34,330 +testing position بتاعها down and in في هذه الحالة + +312 +00:26:34,330 --> 00:26:38,740 +احنا قلنا لازم عشان اعرفالـ Abnormal Head Posture + +313 +00:26:38,740 --> 00:26:41,860 +أو الـ Compensatory Head Posture، لازم أهرب العين + +314 +00:26:41,860 --> 00:26:44,440 +من الـ Testing Position، ممنوع تيجي في الـ Testing + +315 +00:26:44,440 --> 00:26:47,680 +Position الـ Left Eye، ليش ممنوع تيجي؟ لأن الـ + +316 +00:26:47,680 --> 00:26:51,460 +Testing Position هيكشف عيب الضعف، إيش يعني هيكشف + +317 +00:26:51,460 --> 00:26:54,620 +عيبه؟ في هذا الـ Testing Position، العينتين هيكون + +318 +00:26:54,620 --> 00:27:00,090 +توازنهم أقل ما يكون لأنه في ضعف العضلة الظهرانطلب + +319 +00:27:00,090 --> 00:27:03,870 +من العضلة أداء عمل وهي مشلولة فبالتالي هيظهر + +320 +00:27:03,870 --> 00:27:07,150 +الحوال بشكل أكبر هيكون أكبر قياس للحوال ممكن + +321 +00:27:07,150 --> 00:27:10,830 +وبالتالي ال diploma هتكون مسيطرة فبالتالي لازم + +322 +00:27:10,830 --> 00:27:15,230 +تهرب الان من إنها تيجي في وضعية ال down و ال in في + +323 +00:27:15,230 --> 00:27:19,610 +حالة ال superior oblique palsy وأيضا لازم تهرب من + +324 +00:27:19,610 --> 00:27:24,290 +قضية ال intortion لأن ال intortion ضعيف بسبب أن ال + +325 +00:27:24,290 --> 00:27:29,690 +interpreter اللي هي superior oblique ضعيفةوبالتالي + +326 +00:27:29,690 --> 00:27:36,370 +لازم نشرد العين لشمال من أنها تعمل intortion ومن + +327 +00:27:36,370 --> 00:27:40,170 +أنها تروح في ال down أو تروح في ال in العين لشمال + +328 +00:27:40,170 --> 00:27:44,170 +لازم تشرد من التلت أوضاع هذه ممنوع تيجي down ممنوع + +329 +00:27:44,170 --> 00:27:48,530 +تيجي in ممنوع تعمل intortion فبالتالي بنحط الجدول + +330 +00:27:48,530 --> 00:27:49,110 +بتاعنا + +331 +00:28:00,070 --> 00:28:06,130 +بنقول لنا ال faster يطار + +332 +00:28:06,130 --> 00:28:14,470 +حيكون وين و + +333 +00:28:14,470 --> 00:28:17,530 +ال head tilt + +334 +00:28:24,900 --> 00:28:32,220 +و اتشن يترقش هيكون اتجاه طيب هنقول كالقادم نيجي لل + +335 +00:28:32,220 --> 00:28:36,400 +face turn لازم العين الشمال تهرب من ال in position + +336 +00:28:36,400 --> 00:28:40,200 +ماتنوضعش في وضعية in بنروح على الصورة بتاعة ال + +337 +00:28:40,200 --> 00:28:46,880 +face turn لو راح عمل هذا المريض left face turn + +338 +00:28:46,880 --> 00:28:50,980 +العين الشمال هتيجي in مش مناسببينما لما يعمل right + +339 +00:28:50,980 --> 00:28:55,620 +face turn العين الشمال اللي هي هذه هتروح out يعني + +340 +00:28:55,620 --> 00:28:59,960 +بعيدا عن ال N إذا right face turn right face turn + +341 +00:28:59,960 --> 00:29:04,940 +ال + +342 +00:29:04,940 --> 00:29:09,200 +face turn هيكون to the rightالان نيجي لل head tilt + +343 +00:29:09,200 --> 00:29:12,540 +ال head tilt هيخلصني من الموضوع ان العين تعمل in + +344 +00:29:12,540 --> 00:29:16,620 +torsion بدناش العين الشمال تعمل in torsion فبنشوف + +345 +00:29:16,620 --> 00:29:20,400 +كيف الدماغ او كيف ال head هيهربها من موضوع ال in + +346 +00:29:20,400 --> 00:29:25,400 +torsion هي العين الشمال لما بيصير عندي right sided + +347 +00:29:25,400 --> 00:29:28,660 +tilt right sided tilt العين الشمالي بتعمل + +348 +00:29:28,660 --> 00:29:34,440 +extortion هذا مناسب ليش؟ لأنه بنكون هربنا من ال in + +349 +00:29:34,440 --> 00:29:38,860 +torsion طب لو عملنا left sided tiltساعتها العين + +350 +00:29:38,860 --> 00:29:41,800 +الشمال مضطرة تعمل entorsion و الـ entorsion ضعيف + +351 +00:29:41,800 --> 00:29:44,260 +بسبب ضعف ال superior oblique، اذا هذا وضع مش + +352 +00:29:44,260 --> 00:29:48,080 +مناسب، هذا هو الوضع المناسب، هذا هو ال + +353 +00:29:48,080 --> 00:29:51,640 +compensatory head posture، انه بتعمل right sided + +354 +00:29:51,640 --> 00:29:55,700 +tilt، يعني tilt للناحية اليمين، وبالتالي العين + +355 +00:29:55,700 --> 00:29:59,420 +الشمال بتصير extortion، يعني عكس ال entorsion اللي + +356 +00:29:59,420 --> 00:30:03,440 +احنا بدنا نشرد منه، اذا right sided tilt، right + +357 +00:30:03,440 --> 00:30:05,680 +sided tilt ايضا، هذا right + +358 +00:30:10,350 --> 00:30:14,690 +بظل عند ال chin هل هو up ولا down عشان العين + +359 +00:30:14,690 --> 00:30:18,290 +الشمال لازم تشرد من ال down position و تروح لل up + +360 +00:30:18,290 --> 00:30:21,650 +لازم تشرد من ال down position و تروح لل up خلينا + +361 +00:30:21,650 --> 00:30:25,130 +نشوف كيف العين ده هتروح لل up بال chin down .. بال + +362 +00:30:25,130 --> 00:30:28,470 +chin down لأنه ال chin up هيجيب العين down و ال + +363 +00:30:28,470 --> 00:30:32,270 +down هي وضعية من وضعيات اختبار ال superior oblique + +364 +00:30:32,270 --> 00:30:36,390 +إذا ال chin down هو الأنسب عشان العين الشمال هتطلع + +365 +00:30:36,390 --> 00:30:39,070 +لفوق .. هتطلع لفوق إذا ال chin down + +366 +00:30:45,650 --> 00:30:49,950 +إذا أي شخص عنده left superior oblique pulse ال + +367 +00:30:49,950 --> 00:30:53,750 +compensatory head posture عنده إنه بيعمل right + +368 +00:30:53,750 --> 00:30:58,780 +face turn، right head tiltو chin down position و + +369 +00:30:58,780 --> 00:31:02,800 +chin down position هيك بيكون الإجابة اكتملت هنكتفي + +370 +00:31:02,800 --> 00:31:06,940 +بالامثلة التلاتة المرة هاي و ان شاء الله يتعالى + +371 +00:31:06,940 --> 00:31:12,980 +المرة القادمة ايضا هنكمل ايضا بامثلة مشابهة عشان + +372 +00:31:12,980 --> 00:31:17,820 +نستكمل باقية العضلات و نفهم كيف ال compensatory + +373 +00:31:17,820 --> 00:31:21,080 +head posture بيسير و يعطيكم العافية والسلام عليكم + +374 +00:31:21,080 --> 00:31:22,900 +ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/cLrZdiDxMOk_raw.json b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/cLrZdiDxMOk_raw.json new file mode 100644 index 0000000000000000000000000000000000000000..fdd5cf51daae885ec1f0e3a9bbf11977955dcd77 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/cLrZdiDxMOk_raw.json @@ -0,0 +1 @@ +{"segments": [{"id": 1, "seek": 2174, "start": 3.36, "end": 21.74, "text": "بسم الله الرحمن الرحيم، اليوم محاضرتنا عبارة عن تدريبات 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function بتاعة الـ inferior rectus depression تاني function extortion", "tokens": [1863, 39648, 2423, 39184, 2445, 39894, 995, 27884, 2423, 39184, 24249, 11048, 301, 10799, 6055, 7649, 1829, 2445, 1279, 8136], "avg_logprob": -0.27250744047619047, "compression_ratio": 1.1149425287356323, "no_speech_prob": 0.0, "words": [{"start": 446.61, "end": 447.05, "word": "نقول", "probability": 0.609619140625}, {"start": 447.05, "end": 447.25, "word": " الـ", "probability": 0.5130615234375}, {"start": 447.25, "end": 447.57, "word": " function", "probability": 0.9248046875}, {"start": 447.57, "end": 447.85, "word": " بتاعة", "probability": 0.8103841145833334}, {"start": 447.85, "end": 448.05, "word": " الـ", "probability": 0.8037109375}, {"start": 448.05, "end": 448.39, "word": " inferior", "probability": 0.80712890625}, {"start": 448.39, "end": 449.15, "word": " rectus", "probability": 0.86083984375}, {"start": 449.15, "end": 456.63, "word": " depression", "probability": 0.8720703125}, {"start": 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down and out هو ال testing position بتاع ال inferior rectus muscle طبعا في ال left eye اذا هدول التلاتة هدا ال primary action, secondary action, tertiary action", "tokens": [47302, 8592, 2423, 4997, 2535, 39894, 45761, 11296, 22807, 760, 293, 484, 31439, 2423, 4997, 2535, 39894, 45761, 2423, 24249, 11048, 301, 8679, 23032, 3555, 3615, 995, 8978, 2423, 1411, 3313, 1975, 15730, 8032, 3215, 12610, 16712, 1211, 9307, 3660, 8032, 28259, 2423, 6194, 3069, 11, 11396, 3069, 11, 38726, 29104, 3069], "avg_logprob": -0.2722582479692855, "compression_ratio": 1.4968944099378882, "no_speech_prob": 0.0, "words": [{"start": 502.58, "end": 503.5, "word": "ايش", "probability": 0.499847412109375}, {"start": 503.5, "end": 503.62, "word": " ال", "probability": 0.96240234375}, {"start": 503.62, "end": 503.9, "word": " testing", "probability": 0.779296875}, {"start": 503.9, "end": 504.72, "word": " position", "probability": 0.96044921875}, {"start": 504.72, "end": 506.16, "word": " بتاعها؟", "probability": 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" secondary", "probability": 0.87890625}, {"start": 529.94, "end": 530.44, "word": " action,", "probability": 0.9580078125}, {"start": 530.62, "end": 530.94, "word": " tertiary", "probability": 0.966796875}, {"start": 530.94, "end": 531.48, "word": " action", "probability": 0.95849609375}], "temperature": 1.0}, {"id": 22, "seek": 56069, "start": 531.81, "end": 560.69, "text": "hide down and out ما هو ال compensatory head posture اللي هيتاخده المريض في حالة ال left inferior rectus palsy الإجابة بتتلخص في شيئين لا ثالثة لهم أنا هحط سهم على الأشياء اللي هنستعملها هذا السهم بدنا ننسخه", "tokens": [71, 482, 760, 293, 484, 19446, 31439, 2423, 11598, 4745, 1378, 18502, 13672, 1829, 39896, 2655, 47283, 3215, 3224, 9673, 16572, 11242, 8978, 11331, 6027, 3660, 2423, 1411, 24249, 11048, 301, 43806, 88, 33688, 7435, 16758, 3660, 39894, 2655, 1211, 9778, 9381, 8978, 44049, 19986, 9957, 20193, 38637, 6027, 12984, 3660, 5296, 16095, 41850, 8032, 5016, 9566, 8608, 16095, 15844, 16247, 8592, 1829, 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هنستعملها", "probability": 0.9623209635416666}, {"start": 552.93, "end": 559.53, "word": " هذا", "probability": 0.86328125}, {"start": 559.53, "end": 559.87, "word": " السهم", "probability": 0.978759765625}, {"start": 559.87, "end": 560.15, "word": " بدنا", "probability": 0.95703125}, {"start": 560.15, "end": 560.69, "word": " ننسخه", "probability": 0.9005859375}], "temperature": 1.0}, {"id": 23, "seek": 58666, "start": 569.19, "end": 586.67, "text": "عشان نعرف ال compensatory head posture فقط بلزمنا من ال function تاعة ال head ال muscle و من ال testing position، يعني أخد ال testing position و أخد ال torsional movement تاعة ال muscle، سواء extortion", "tokens": [3615, 8592, 7649, 8717, 3615, 28480, 2423, 11598, 4745, 1378, 18502, 6156, 47432, 4724, 1211, 11622, 2304, 8315, 9154, 2423, 2445, 6055, 995, 27884, 2423, 1378, 2423, 8679, 4032, 9154, 2423, 4997, 2535, 12399, 37495, 22653, 5551, 9778, 3215, 2423, 4997, 2535, 4032, 5551, 9778, 3215, 2423, 3930, 82, 1966, 3963, 6055, 995, 27884, 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671.38, "word": " posture", "probability": 0.88818359375}], "temperature": 1.0}, {"id": 27, "seek": 69928, "start": 672.28, "end": 699.28, "text": "فى الـ left inferior rectus palsy لابد أن تهرب العين اليسرى العين اليسارى اللى فيها المشكلة left لابد أنها تشرد من قضية أنها تروح لتحت ومن أنها تطلع لبرا out يعني abduction أنها تعمل abduction ومن أنها تعمل extortion هدول التلت شغلات لازم تشرد منهم كيف عرفنا هدول التلت شغلات؟ من وين جبناهم؟ من كلمة down", "tokens": [5172, 7578, 2423, 39184, 1411, 24249, 11048, 301, 3984, 3187, 5296, 16758, 3215, 14739, 6055, 3224, 25513, 18863, 9957, 45595, 3794, 2288, 7578, 18863, 9957, 45595, 3794, 9640, 7578, 13672, 7578, 8978, 11296, 9673, 8592, 28820, 3660, 1411, 5296, 16758, 3215, 14739, 11296, 6055, 46309, 3215, 9154, 12174, 11242, 10632, 14739, 11296, 6055, 32887, 5016, 5296, 2655, 33753, 4032, 27842, 14739, 11296, 6055, 9566, 1211, 3615, 5296, 3555, 23557, 484, 37495, 22653, 46465, 313, 14739, 11296, 6055, 25957, 1211, 46465, 313, 4032, 27842, 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"لو عمل هذا المريض chin up عينيه هيروحه down هذا مش مناسب بينما لما يعمل chin down ينزل راسه لتحت ساعتها عينيه هيطلع لفوق بعيدا عن ال down position اللي هو منطقة او احدى مناطق اختبار اللي هو ال inferior rectus مثلا اذا ال chin لازم يكون down عشان العين تطلع عكس الراس", "tokens": [1211, 2407, 6225, 42213, 23758, 9673, 16572, 11242, 14210, 493, 6225, 9957, 1829, 3224, 39896, 32887, 5016, 3224, 760, 23758, 37893, 3714, 8315, 35457, 49374, 15042, 5296, 15042, 7251, 25957, 1211, 14210, 760, 7251, 1863, 11622, 1211, 12602, 32277, 3224, 5296, 2655, 33753, 8608, 995, 34268, 11296, 6225, 9957, 1829, 3224, 39896, 9566, 1211, 3615, 5296, 5172, 30543, 45030, 25708, 995, 18871, 2423, 760, 2535, 13672, 1829, 31439, 9154, 9566, 28671, 1975, 2407, 1975, 24401, 7578, 9154, 41193, 4587, 1975, 46456, 3555, 9640, 13672, 1829, 31439, 2423, 24249, 11048, 301, 50113, 15040, 1975, 15730, 2423, 14210, 5296, 31377, 2304, 7251, 30544, 760, 6225, 8592, 7649, 18863, 9957, 6055, 9566, 1211, 3615, 6225, 4117, 3794, 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1397.45, "end": 1397.95, "word": " هنشوف", "probability": 0.909423828125}, {"start": 1397.95, "end": 1399.01, "word": " الدماغ", "probability": 0.8707275390625}, {"start": 1399.01, "end": 1399.25, "word": " أو", "probability": 0.6728515625}, {"start": 1399.25, "end": 1399.39, "word": " ال", "probability": 0.98974609375}, {"start": 1399.39, "end": 1399.63, "word": " head", "probability": 0.8837890625}, {"start": 1399.63, "end": 1400.11, "word": " كيف", "probability": 0.97119140625}, {"start": 1400.11, "end": 1400.65, "word": " هيخلي", "probability": 0.8419596354166666}, {"start": 1400.65, "end": 1400.93, "word": " العين", "probability": 0.989013671875}, {"start": 1400.93, "end": 1401.35, "word": " تروح", "probability": 0.9949544270833334}, {"start": 1401.35, "end": 1401.73, "word": " down", "probability": 0.84326171875}, {"start": 1401.73, "end": 1402.25, "word": " بعيدا", "probability": 0.9698893229166666}, {"start": 1402.25, "end": 1402.39, "word": " عن", "probability": 0.9814453125}, {"start": 1402.39, "end": 1402.59, "word": " ال", "probability": 0.97705078125}, {"start": 1402.59, "end": 1402.81, "word": " up", "probability": 0.98388671875}], "temperature": 1.0}, {"id": 55, "seek": 140984, "start": 1403.22, "end": 1409.84, "text": "التي هي الـ testing position بتاع الـ inferior oblique بنروح على قضية chin up or down", "tokens": [6027, 31371, 39896, 2423, 39184, 4997, 2535, 39894, 45761, 2423, 39184, 24249, 23740, 1925, 44945, 32887, 5016, 15844, 12174, 11242, 10632, 14210, 493, 420, 760], "avg_logprob": -0.39122597529337955, "compression_ratio": 1.0560747663551402, "no_speech_prob": 1.7881393432617188e-07, "words": [{"start": 1403.22, "end": 1403.54, "word": "التي", "probability": 0.452880859375}, {"start": 1403.54, "end": 1403.66, "word": " هي", "probability": 0.669921875}, {"start": 1403.66, "end": 1403.76, "word": " الـ", "probability": 0.427978515625}, {"start": 1403.76, "end": 1404.08, "word": " testing", "probability": 0.40869140625}, {"start": 1404.08, 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"duration_after_vad": 1717.3599999999956} \ No newline at end of file diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/cq1wlflMhsw.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/cq1wlflMhsw.srt new file mode 100644 index 0000000000000000000000000000000000000000..840c1ba7aa3fd4d42e98aefca32eaf54d629ec13 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/cq1wlflMhsw.srt @@ -0,0 +1,1397 @@ +1 +00:00:01,670 --> 00:00:06,010 +بسم الله الرحمن الرحيم بنواصل مع محاضرات حول واحد + +2 +00:00:06,010 --> 00:00:12,070 +وحكينا إنه فيه diffusional variances اللي لها + +3 +00:00:12,070 --> 00:00:16,390 +amplitudes وهذه الـ amplitudes كانت تقاس بواسطة + +4 +00:00:16,390 --> 00:00:20,310 +استعمال الـ prisms أو باستعمال جهاز الـ sinoptophore + +5 +00:00:20,310 --> 00:00:27,050 +اللي هنحكي عنه في حين إذا تقاس diffusional + +6 +00:00:27,050 --> 00:00:29,950 +variances بواسطة + +7 +00:00:34,540 --> 00:00:37,440 +وقلنا فيه normal values لـ convergence و لـ fusion + +8 +00:00:37,440 --> 00:00:40,380 +الـ convergence و الـ fusion الـ convergence من 15 + +9 +00:00:40,380 --> 00:00:45,370 +لـ 20 prism على الـ distance و 25 prism or more at + +10 +00:00:45,370 --> 00:00:50,870 +near و الـ fusional divergence من 6 لـ 10 prism at + +11 +00:00:50,870 --> 00:00:56,630 +distance و تقريبا من 12 لـ 14 prism at near وحكينا + +12 +00:00:56,630 --> 00:00:59,870 +أن الـ fusional divergence لها أهمية كبيرة وقلنا + +13 +00:00:59,870 --> 00:01:03,710 +الـ vertical divergence تقريبا من 2 لـ 3 بتحمل + +14 +00:01:03,710 --> 00:01:06,850 +الإنسان vertical misalignment أو vertical + +15 +00:01:06,850 --> 00:01:10,700 +disparity of retinal image و الـ cyclovergence حسب + +16 +00:01:10,700 --> 00:01:13,440 +دراسات حديثة ممكن توصل لـ 8 degree وبيقولنا + +17 +00:01:13,440 --> 00:01:17,540 +هذه الأرقام قادمة ... هذه الأرقام قادمة طيب إيش + +18 +00:01:17,540 --> 00:01:21,080 +فائدة أن الإنسان يكون عنده fusional vergances؟ + +19 +00:01:21,080 --> 00:01:24,200 +fusional vergances يعني fusional convergence و + +20 +00:01:24,200 --> 00:01:27,500 +fusional divergence و fusional أو vertical + +21 +00:01:27,500 --> 00:01:31,720 +fusional vergance و cyclovergence إيش الفائدة؟ الـ + +22 +00:01:31,720 --> 00:01:34,640 +fusional convergence .. الـ fusional convergence + +23 +00:01:34,640 --> 00:01:39,320 +helps to control an exophoria Whereas fusional + +24 +00:01:39,320 --> 00:01:42,920 +divergence helps to control an esophoria + +25 +00:01:47,190 --> 00:01:50,670 +نروح للصورة المكبرة هذا الإنسان عنده Exophoria + +26 +00:01:50,670 --> 00:01:55,570 +Exophoria يعني حول خفي للخارج حول خفي للخارج طب + +27 +00:01:55,570 --> 00:02:00,110 +لو صورنا أن العين حاولت تروح للخارج و high target + +28 +00:02:00,110 --> 00:02:02,690 +هذا الإنسان بتطلع عليه هذا الـ target اللي هو الـ + +29 +00:02:02,690 --> 00:02:07,130 +face بيسقط على الفوفيا هنا في حالة لو زاغت العين + +30 +00:02:07,130 --> 00:02:11,930 +لو زاغت أو بدأت بالزوغان heterophoria Exophoria + +31 +00:02:11,930 --> 00:02:13,170 +باتجاه الـ Exophoria + +32 +00:02:15,570 --> 00:02:18,630 +ساعتها الصورة هتسقط على temporal retina بدل ما + +33 +00:02:18,630 --> 00:02:22,370 +تسقط على الفوفيا هتسقط على temporal retina ومعروف + +34 +00:02:22,370 --> 00:02:25,490 +لما بتسقط الصورة على temporal retina هذا بيحفز الـ + +35 +00:02:25,490 --> 00:02:28,590 +fusional convergence فبتبدأ عملية الـ fusional + +36 +00:02:28,590 --> 00:02:31,930 +convergence بيرجع الـ exophoria بسيطر عليها وبيخلي + +37 +00:02:31,930 --> 00:02:35,170 +العين معتدلة بحيث تسقط الصورة على الفوفيا هنا زي + +38 +00:02:35,170 --> 00:02:41,130 +ما سقطت الصورة على الفوفيا في العين اليسرى أيضا .. + +39 +00:02:41,130 --> 00:02:46,710 +أيضا لو صار عندي fusional أو لو صار عندي esophoria + +40 +00:02:46,710 --> 00:02:51,050 +لو .. لو .. لو العكس تصورناها esophoria ساعتها + +41 +00:02:51,050 --> 00:02:54,610 +الصورة هتسقط على nasal retina هنا فحدها هيعمل + +42 +00:02:54,610 --> 00:02:57,810 +stimulation لـ fusional divergence إذا الـ fusional + +43 +00:02:57,810 --> 00:03:03,370 +convergence .. الـ fusional convergence بيسيطر لي + +44 +00:03:03,370 --> 00:03:07,270 +على الـ exophoria convergence عكس الـ exophoria + +45 +00:03:07,270 --> 00:03:11,450 +بعكسها يعني بمعنى آخر بيسيطر عليها بيدخل العين للـ + +46 +00:03:11,450 --> 00:03:15,970 +straight ahead position و الـ fusional divergence + +47 +00:03:15,970 --> 00:03:22,890 +بيعمل control للإيزوفوريا طيب، هل الـ fusional + +48 +00:03:22,890 --> 00:03:25,870 +divergence amplitude هذه الأرقام اللي عرضناها قبل + +49 +00:03:25,870 --> 00:03:32,110 +شوية هل هي أرقام ثابتة ولا قابلة للتغيير؟ حقيقة هي + +50 +00:03:32,110 --> 00:03:36,410 +أرقام يعني متغيرة أرقام متغيرة بنقول the fusional + +51 +00:03:36,410 --> 00:03:39,390 +divergence mechanism may be decreased by fatigue + +52 +00:03:39,390 --> 00:03:43,270 +or illness converting aphoria to atropia يعني الـ + +53 +00:03:43,270 --> 00:03:46,270 +fusional convergence و الـ fusional divergence و الـ + +54 +00:03:46,270 --> 00:03:49,510 +vertical divergence و الـ cyclovergence تحت ظروف + +55 +00:03:49,510 --> 00:03:53,870 +الإرهاق اللي هو الـ fatigue أو الـ illness اللي هو المرض + +56 +00:03:53,870 --> 00:04:03,030 +ممكن تقل قيمتها وبالتالي بيبطل أو بيقدرش الـ + +57 +00:04:03,030 --> 00:04:06,250 +fusion convergence يسيطر على الـ exophoria و الـ + +58 +00:04:06,250 --> 00:04:09,190 +fusion divergence بيقدرش يسيطر على الـ exophoria و + +59 +00:04:09,190 --> 00:04:13,290 +أها كذا إذا لما بيكون في exophoria غير مسيطر عليها + +60 +00:04:13,290 --> 00:04:17,670 +بتبدأ تظهر فببدأ أسميها أنا exotropia بدل exophoria + +61 +00:04:17,670 --> 00:04:20,830 +exotropia بدل exophoria لأن exotropia هي الحول الظاهر و + +62 +00:04:20,830 --> 00:04:24,350 +الـ exophoria هي الحول الخفي خفي ليش؟ لأنه مسيطر عليه + +63 +00:04:24,350 --> 00:04:27,830 +بواسطة الـ fusion convergence بواسطة الـ fusion + +64 +00:04:27,830 --> 00:04:31,830 +convergence طيب، إذن هذه في حالات الـ illness وفي + +65 +00:04:31,830 --> 00:04:35,770 +حالات الـ fatigue بتضعف الـ fusional mechanisms اللي هي + +66 +00:04:35,770 --> 00:04:38,310 +الـ fusional convergence و الـ fusional divergence و + +67 +00:04:38,310 --> 00:04:41,050 +الـ vertical divergence و الـ cyclovergence بيضعفوا + +68 +00:04:41,050 --> 00:04:45,030 +فبتتحول الـ exophoria لـ exotropia لأنه مافيش سيطرة عليها من + +69 +00:04:45,030 --> 00:04:51,410 +قبل الدماغ عشان يتحكم في عضلات العين هل ممكن تزيد + +70 +00:04:51,410 --> 00:04:55,230 +هذه الأرقام أو تتحسن؟ The amplitude of fusional + +71 +00:04:55,230 --> 00:04:58,670 +divergence mechanisms can be improved by orthoptic + +72 +00:04:58,670 --> 00:05:02,710 +exercises, particularly in the case of near + +73 +00:05:02,710 --> 00:05:05,510 +-fusional convergence for the relief of + +74 +00:05:05,510 --> 00:05:09,150 +convergence insufficiency ممكن هذه الـ fusional + +75 +00:05:09,150 --> 00:05:11,910 +divergence mechanisms أو الـ fusional amplitudes + +76 +00:05:13,100 --> 00:05:16,800 +تتحسن بالـ orthoptic exercises بالتمارين البصرية + +77 +00:05:16,800 --> 00:05:21,080 +في تمارين بصرية خاصة في هذا المجال وبالذات بيكون + +78 +00:05:21,080 --> 00:05:23,740 +مفيدة التمارين البصرية في حالة الـ convergence + +79 +00:05:23,740 --> 00:05:27,440 +insufficiency اللي هي عدم كفاية عملية الـ + +80 +00:05:27,440 --> 00:05:29,920 +convergence يعني ضعف الـ convergence زي ما الصورة + +81 +00:05:29,920 --> 00:05:35,760 +الآن هنعرضها بنقول هذا إنسان at rest at rest يعني + +82 +00:05:35,760 --> 00:05:40,340 +بتطلع على target بعيد مثلا 6 متر أو أكثر من 6 متر + +83 +00:05:40,340 --> 00:05:44,490 +العينين straight زي ما أنتم شايفينه العينين + +84 +00:05:44,490 --> 00:05:47,670 +straight زي ما أنتم شايفينها الآن حطينا target + +85 +00:05:47,670 --> 00:05:52,970 +عليه أو أمام عينيه على بعد 80 cm برضه لازالت العينين + +86 +00:05:52,970 --> 00:05:57,710 +مـ central .. central يعني ما اتحركت لجوه الـ target + +87 +00:05:57,710 --> 00:06:01,690 +بدل ما كان على 6 متر صار على بعد 80 cm أقل من 1 متر + +88 +00:06:01,690 --> 00:06:04,130 +المفروض العينين تبدأ تدخل لجوه تعمل convergence + +89 +00:06:04,130 --> 00:06:08,710 +طيب قلنا بنجرب الـ target أكثر خلينا الـ target على + +90 +00:06:08,710 --> 00:06:12,650 +20 cm لازالت العين ما اتحركت من هنا هذه القضية + +91 +00:06:12,650 --> 00:06:16,430 +بيسميها convergence insufficiency يعني عدم كفاية + +92 +00:06:16,430 --> 00:06:18,410 +في الـ convergence ممكن الإنسان يقول لأ ممكن هو + +93 +00:06:18,410 --> 00:06:20,590 +عنده مشكلة في الـ medial rectus هنا وفي الـ medial + +94 +00:06:20,590 --> 00:06:23,350 +rectus هنا عشان هيك يعني مش قضية convergence + +95 +00:06:23,350 --> 00:06:25,770 +insufficiency بيقولوا لأ الـ medial rectus شغالة لما + +96 +00:06:25,770 --> 00:06:29,710 +بتطلع على اليمين الـ left medial rectus شغالة لما + +97 +00:06:29,710 --> 00:06:33,070 +بتطلع على الشمال الـ right medial rectus شغالة إذا + +98 +00:06:33,070 --> 00:06:36,730 +المشكلة مش في العضلات آلية الـ convergence عنده + +99 +00:06:36,730 --> 00:06:40,130 +ضعيفة آلية الـ convergence ضعيفة وقلنا احنا لازم + +100 +00:06:40,130 --> 00:06:44,930 +نفرق بين تلات أنواع الحركة ductions و versions هذه + +101 +00:06:44,930 --> 00:06:49,010 +versions الصورتين اللي تحت versions بينما هذه على + +102 +00:06:49,010 --> 00:06:52,410 +بعد 20 cm convergence convergence is binocular + +103 +00:06:52,410 --> 00:06:56,550 +simultaneous disjugate يعني العين الشمال دي تروح + +104 +00:06:56,550 --> 00:06:58,550 +على اليمين والعين اليمين دي تروح على الشمال اتجاه + +105 +00:06:58,550 --> 00:07:01,610 +الحركة المفروض يكون مختلف بس احنا شايفين أنه سواء + +106 +00:07:01,610 --> 00:07:04,190 +بتطلع على 6 متر أو بتطلع على 80 cm أو + +107 +00:07:04,190 --> 00:07:06,870 +بتطلع على 20 cm هذا عنده convergence + +108 +00:07:06,870 --> 00:07:10,370 +insufficient عدم كفاية في الـ convergence أو ضعف في + +109 +00:07:10,370 --> 00:07:13,250 +الـ convergence فهدول الناس بيستفيدوا جدا من + +110 +00:07:13,250 --> 00:07:17,390 +التمارين البصرية لتقوية الـ fusional convergence + +111 +00:07:17,390 --> 00:07:21,450 +لتقوية الـ fusional convergence لتقوية الـ fusional + +112 +00:07:21,450 --> 00:07:25,790 +convergence وبالتالي هذه القضية من ضمن التمارين + +113 +00:07:25,790 --> 00:07:30,630 +البصرية في حد يسموها الـ pencil push up يعني بيمسك + +114 +00:07:30,630 --> 00:07:34,110 +قلم رصاص بتطلع على سنّه طبعا على امتداد إيده بيمد + +115 +00:07:34,110 --> 00:07:38,130 +إيده على الآخر بعيد وبيبدأ يجرب .. وبيبدأ يجرب + +116 +00:07:38,130 --> 00:07:44,070 +القلم بالتدريج من عينيه ويحاول يركز في سن القلم + +117 +00:07:44,070 --> 00:07:47,990 +إذا شاف سن القلم مزدوج معناه لسه عنده convergence + +118 +00:07:47,990 --> 00:07:51,290 +insufficiency بيحاول يوحد الصورتين في صورة واحدة + +119 +00:07:51,290 --> 00:07:55,350 +يعني يدرب عينيه إنها تعمل convergence طبعا في + +120 +00:07:55,350 --> 00:07:58,750 +المراكز الطبية اللي .. اللي بتشتغل على موضوع + +121 +00:07:58,750 --> 00:08:01,670 +العلاج البصري في ممكن بدل الـ pins الـ push up اللي + +122 +00:08:01,670 --> 00:08:04,570 +ممكن تنعمل في البيت في حاجة بيسموها الـ procstring + +123 +00:08:05,590 --> 00:08:09,510 +هذا عبارة عن حبل وفيه كورات ملونة على مسافات + +124 +00:08:09,510 --> 00:08:12,930 +متباعدة أول شيء بيبدأ يتطلع للكورة البعيدة كتير + +125 +00:08:12,930 --> 00:08:16,490 +ويحاول يركز فيها إذا ظهرت مزدوجة بيحاول يعمل + +126 +00:08:16,490 --> 00:08:20,150 +convergence يعني يوحد الصورتين في صورة واحدة + +127 +00:08:20,150 --> 00:08:25,190 +تلقائيًا هيبدأ الـ convergence يتفعل إذا استطاع ذلك + +128 +00:08:25,190 --> 00:08:28,310 +بيبدأ يتطلع للكورة الأقرب منها يعني هو كل ما + +129 +00:08:28,310 --> 00:08:31,910 +بيقترب لكورة مسافة كورة فبالتالي الـ convergence + +130 +00:08:31,910 --> 00:08:35,770 +عنده قاعد بيتدرب وبيحاول يعمل convergence وهذه + +131 +00:08:35,770 --> 00:08:38,930 +القضية تتكرر يوميًا لما يتحسن عنده الـ convergence + +132 +00:08:38,930 --> 00:08:42,030 +طبعا في وسائل كثيرة للتمارين البصرية بس هدول + +133 +00:08:42,030 --> 00:08:48,290 +مثالين بسيطين إذا تقوية .. تقوية الـ fusional + +134 +00:08:48,290 --> 00:08:51,490 +convergence mechanisms can be done by أو can be + +135 +00:08:51,490 --> 00:08:55,230 +improved by orthoptic exercise وبالذات في حالة الـ + +136 +00:08:55,230 --> 00:08:58,460 +convergence insufficiency زي ما احنا عرضنا هذا + +137 +00:08:58,460 --> 00:09:01,980 +المريض أمامكم عنده convergence insufficiency فهذا + +138 +00:09:01,980 --> 00:09:06,740 +بيستفيد جدا من قضية الـ orthoptic exercises زي ما + +139 +00:09:06,740 --> 00:09:10,380 +هو معروض عندنا في الصور اللي .. اللي .. اللي .. + +140 +00:09:10,380 --> 00:09:15,560 +يعني أنتم شايفينها للـ broke string و الـ pencil + +141 +00:09:15,560 --> 00:09:19,160 +push ups الـ pencil .. الـ pencil push ups نيجي + +142 +00:09:19,160 --> 00:09:25,520 +لموضوع جديد هو الـ stereopsis حقيقة الـ stereopsis هو + +143 +00:09:25,520 --> 00:09:29,000 +نهاية المطاف بالنسبة للـ binocular single vision الـ + +144 +00:09:29,000 --> 00:09:32,380 +binocular single vision بيمر بثلاث مراحل رئيسية + +145 +00:09:32,380 --> 00:09:35,400 +المرحلة الأولى الرئيسية اللي بيسموها simultaneous + +146 +00:09:35,400 --> 00:09:39,760 +perception الالتقاط المتزامن يعني العين اليمين أو + +147 +00:09:39,760 --> 00:09:43,560 +شبكية العين اليمين التقطت .. التقطت صورة في نفس + +148 +00:09:43,560 --> 00:09:47,500 +اللحظة شبكية العين اليسرى التقطت نفس الصورة يعني + +149 +00:09:47,500 --> 00:09:51,760 +صورة نفس الجسم لو في التقاط غير متزامن يعني العين + +150 +00:09:51,760 --> 00:09:55,340 +اليمين التقطت الصورة وبعد مثلا دقيقة أو دقيقتين و + +151 +00:09:55,340 --> 00:09:57,600 +العين اليسرى التقطت نفس الصورة مافيش حاجة مافيش + +152 +00:09:57,600 --> 00:10:01,380 +كلام عن binocular single vision لأن في عين التقطت + +153 +00:10:01,380 --> 00:10:04,920 +والعين الثانية لسه ما التقطتش إذا أول مرحلة لازم + +154 +00:10:04,920 --> 00:10:08,440 +يصير التقاط متزامن في نفس اللحظة الـ two eyes + +155 +00:10:08,440 --> 00:10:14,680 +captured يعني صورت أو التقطت يعني image لنفس الـ + +156 +00:10:14,680 --> 00:10:19,510 +object هذه المرحلة الأولى المرحلة الثانية دمج + +157 +00:10:19,510 --> 00:10:22,670 +الصورتين في صورة واحدة يعني بدل ما اتكون عندي + +158 +00:10:22,670 --> 00:10:26,850 +صورتين ارسلوا للدماغ الدماغ دمجهم في صورة واحدة + +159 +00:10:26,850 --> 00:10:30,550 +الآن المرحلة الثالثة والأخيرة أن الدماغ بدأ + +160 +00:10:30,550 --> 00:10:35,090 +يستشعر البعد الثالث لهذول الصورتين لأن هم وصلوا من + +161 +00:10:35,090 --> 00:10:40,290 +الـ two retina وصلوا ثنائية الأبعاد ممكن يقولوا لأ + +162 +00:10:40,290 --> 00:10:44,350 +يعني هي الصورة من الأساس ثلاثية الأبعاد بنقوله الـ + +163 +00:10:44,350 --> 00:10:50,590 +retina الريتينه في أي من العينين الريتينه لو .. لو + +164 +00:10:50,590 --> 00:10:56,490 +الصورة بتتكون ثلاثية الأبعاد في جلب العين كان + +165 +00:10:56,490 --> 00:10:59,550 +هيكون عندي بعدين على الشبكية والبعد الثالث أما في + +166 +00:10:59,550 --> 00:11:03,070 +الـ vitreous أو إذا كان هو hypermetroid ممكن يكون + +167 +00:11:03,070 --> 00:11:08,110 +مثلا وراء العين فبالتالي ضروري الصورة تلتقط بالوسط + +168 +00:11:08,110 --> 00:11:12,570 +الشبكية ثنائية الأبعاد والدماغ هيفهم البعد الثالث + +169 +00:11:12,570 --> 00:11:18,620 +بطريقة أنه .. هذه كاميرا التقاط وهذه كاميرا التقاط + +170 +00:11:18,620 --> 00:11:23,760 +هذه موقعها في الفراغ وهذه موقعها مختلف عنه في الفراغ + +171 +00:11:23,760 --> 00:11:27,340 +المسافة بين العينين اللي هو الـ Inter pupillary + +172 +00:11:27,340 --> 00:11:31,340 +distance يعني كأنها هي المسافة في الفراغ يعني هذه + +173 +00:11:31,340 --> 00:11:33,780 +لها موقع العين اليمين في الفراغ وهذه لها موقع + +174 +00:11:33,780 --> 00:11:37,800 +مختلف عنه إذا هذه ستصور الـ target من جهة وهذه + +175 +00:11:37,800 --> 00:11:41,060 +ستصور الـ target من جهة تختلف قليلًا عنه هذا + +176 +00:11:41,060 --> 00:11:44,700 +الاختلاف البسيط في زاوية التصوير هذا الاختلاف + +177 +00:11:44,700 --> 00:11:48,880 +البسيط في زاوية التصوير بيستخدمه الدماغ عشان يفهم + +178 +00:11:48,880 --> 00:11:53,840 +البعد الثالث اللي هو البعد .. العمق بتاع الصورة أو + +179 +00:11:53,840 --> 00:11:57,980 +الـ depth بتاع الصورة .. بتاع الصورة فبنقول + +180 +00:11:57,980 --> 00:12:03,240 +stereopsis is the perception of depth the third + +18 + +201 +00:13:12,560 --> 00:13:17,060 +الرسمة الثالثة هي العينين بتطلع على هذا المكعب أو + +202 +00:13:17,060 --> 00:13:22,320 +هذا الصندوق العين اليسرى شايفة الصورة بالشكل هذا، إن + +203 +00:13:22,320 --> 00:13:25,720 +طبعت الصورة عندها بالشكل هذا، والعين اليمنى طبعت + +204 +00:13:25,720 --> 00:13:29,560 +الصورة بالشكل هذا، وواضح أنه في اختلاف، يعني مثلاً لو + +205 +00:13:29,560 --> 00:13:34,980 +جئنا نحن على اللون الأخضر الفاتح هذا، هنلاقي أن + +206 +00:13:34,980 --> 00:13:38,300 +حجمه بالنسبة للعين اليمنى على الـ retina في العين + +207 +00:13:38,300 --> 00:13:43,220 +اليمنى أكبر من حجمه قليلاً بالنسبة للعين اليسرى على + +208 +00:13:43,220 --> 00:13:48,100 +العكس، اللون الزهري، الوجه الزهري للمكعب أو للصندوق + +209 +00:13:48,100 --> 00:13:52,080 +صورته على الـ retina في العين اليسرى أكبر من صورته + +210 +00:13:52,080 --> 00:13:55,640 +على الـ retina في العين اليمنى، هذا الاختلاف في + +211 +00:13:55,640 --> 00:14:00,440 +الصورتين، الدماغ بيستخدمه عشان يفهم العمق بتاع هذا + +212 +00:14:00,440 --> 00:14:06,160 +المكعب، الفكرة وهذه هي الفكرة، هذا هو لو حطينا الصورة + +213 +00:14:06,160 --> 00:14:08,920 +تحت العين اليمنى، احنا طبقناها على الصورة تحت العين + +214 +00:14:08,920 --> 00:14:13,020 +اليسرى، تطبيق مباشر هنلاقي أنه في disparity وكأنه + +215 +00:14:13,020 --> 00:14:20,770 +يعني الشيئين مش جايين على بعض، أنه في يعني إشكالية + +216 +00:14:20,770 --> 00:14:24,710 +بينهم أو في retinal disparity مش منطبقين أو مش + +217 +00:14:24,710 --> 00:14:28,870 +جايين تماماً على corresponding retinal areas، فهذه + +218 +00:14:28,870 --> 00:14:32,810 +القضية بتخلي الدماغ أنه يعدل وضعيته، لإن أثناء + +219 +00:14:32,810 --> 00:14:42,450 +التعديل هذا، الإلتقاط المختلف قليلاً بيستخدم للشعور + +220 +00:14:42,450 --> 00:14:49,440 +بالعمق، للشعور بالعمق هنا، إن بعض الأشياء اللي هي + +221 +00:14:49,440 --> 00:14:53,880 +very interesting.. very interesting، هذه بتوضح لي + +222 +00:14:53,880 --> 00:14:58,800 +قضية الـ stereopsis، الآن هاي شكل عين دي، لو احنا نظرنا + +223 +00:14:58,800 --> 00:15:04,200 +لهذا الشكل بالعينين، هنلاقي أنه فيه لون يعني أعمق + +224 +00:15:04,200 --> 00:15:07,280 +من اللون، يعني جاي لورا مقارنة مع اللون الثاني + +225 +00:15:07,280 --> 00:15:11,540 +بالنسبة إلي أنا، وهقول ليش أنا بحكي بالنسبة إلي + +226 +00:15:11,540 --> 00:15:15,500 +أنا شايف اللون الأحمر داخل لجوا، واللون الأزرق جاي + +227 +00:15:15,500 --> 00:15:20,160 +لقدام تقريباً أكثر منه بـ 1 centimeter، وكل ما + +228 +00:15:20,160 --> 00:15:23,540 +نبعد أكثر.. كل ما نبعد أكثر عن شاشة الـ + +229 +00:15:23,540 --> 00:15:28,200 +computer أو شاشة الـ laptop بتلاحظ الفرق أو العمق + +230 +00:15:28,200 --> 00:15:32,140 +بيظهر أكثر، مش هنا بيت القصيد، فقط عشان نفهم كيف احنا + +231 +00:15:32,140 --> 00:15:36,640 +بنشوف صورة ثلاثية الأبعاد أو الشكل الثلاثي الأبعاد + +232 +00:15:36,640 --> 00:15:39,900 +لو غمضنا عين واحدة من العينين، هنلاقي الصورة flat + +233 +00:15:39,900 --> 00:15:43,060 +تماماً، فاش لون بيتميز عن اللون، كلهم على نفس الـ + +234 +00:15:43,060 --> 00:15:47,080 +level، طيب لو جربنا غمضنا العين الثانية نفس القضية + +235 +00:15:47,080 --> 00:15:51,830 +ما في أي اختلاف، لو فتحنا العينين، لأن كل عين بتلتقط + +236 +00:15:51,830 --> 00:15:55,570 +من زاوية معينة، هذا الاختلاف البسيط بيشعرنا بالعمق + +237 +00:15:55,570 --> 00:15:59,890 +كل ما بعدنا عن سطح الشاشة يعني، هنلاقي أن العمق + +238 +00:15:59,890 --> 00:16:04,470 +بيزداد، العمق اللي بيزداد هذا هو يعني مثال على الـ + +239 +00:16:04,470 --> 00:16:09,710 +stereopsis أو الشعور بالبعد الثالث، وهو ضروري نفهم + +240 +00:16:09,710 --> 00:16:12,690 +أنه binocular function، binocular function ما فيش + +241 +00:16:12,690 --> 00:16:16,150 +حاجة اسمها stereopsis بعين واحدة، الدليل لأن هذا + +242 +00:16:16,150 --> 00:16:18,830 +المنظر اللي أمامنا لو غمضنا عيننا مرة ثانية، هنلاقي + +243 +00:16:18,830 --> 00:16:22,250 +أن الصورة flat، لو غمضنا العين الثانية برضه الصورة + +244 +00:16:22,250 --> 00:16:25,250 +flat، أمتى بنشعر أنه في عمق للصورة وأنه اللون + +245 +00:16:25,250 --> 00:16:28,350 +الأزرق بيختلف عن اللون الأحمر، أنا بالنسبة إيه + +246 +00:16:28,350 --> 00:16:31,750 +اللون الأحمر جاي لجوا واللون الأزرق جاي باتجاهي + +247 +00:16:31,750 --> 00:16:35,630 +أكثر، يعني طالع أكثر أو بارز أكثر باتجاهي، ممكن + +248 +00:16:35,630 --> 00:16:38,450 +الـ myopia يشوف العكس، الإنسان اللي عنده myopia ممكن + +249 +00:16:38,450 --> 00:16:41,170 +يشوف اللون الأحمر لإن الـ myopia اللون الأحمر + +250 +00:16:41,170 --> 00:16:45,910 +بالنسبة له، أو طالع يعني ممكن.. بس المهم أنه هيشوف في + +251 +00:16:45,910 --> 00:16:52,340 +عمق للصورة، نشوف مثال ثاني على ذلك، هيقوم احنا برسمتين + +252 +00:16:52,340 --> 00:16:56,420 +برضه، هدول الرسمتين يعني بيعطوا impression أو شعور + +253 +00:16:56,420 --> 00:17:00,520 +بيه بالأبعاد الثلاثية، طبعاً في الرسمة الأولى اللي هي + +254 +00:17:00,520 --> 00:17:03,720 +على اليمين بالنسبة لي أنا، اللون الأسود، الدائرة + +255 +00:17:03,720 --> 00:17:07,900 +ال سوداء اللي مخربش هذه جاية لقدام والمحيط اللي + +256 +00:17:07,900 --> 00:17:12,380 +باللون الأزرق جاية لورا، هنا العكس الدائرة السوداء + +257 +00:17:12,380 --> 00:17:16,660 +جاية لورا والدائرة البيضاء الحمراء هذه، الخرابيش + +258 +00:17:16,660 --> 00:17:19,440 +البيضاء اللي هي المحيط، الـ periphery جاية لقدام + +259 +00:17:19,650 --> 00:17:23,510 +الآن لما بغمض عين، كل الصورتين flat، لما بغمض العين + +260 +00:17:23,510 --> 00:17:26,770 +الثانية برضه كل الصورتين flat، وبالتالي لما بفتح + +261 +00:17:26,770 --> 00:17:30,130 +عيني الاثنين بأشعر بالـ stereopsis، بأشعر بالـ + +262 +00:17:30,130 --> 00:17:34,470 +stereopsis، مثال آخر على ذلك أيضاً، هذه القضية لو + +263 +00:17:34,470 --> 00:17:37,690 +بعدنا شوية هنلاقي أنه فيه لون بارز اللي هو اللون + +264 +00:17:37,690 --> 00:17:41,450 +الأسود، الـ periphery واللون الأحمر جاي لجوا، ممكن + +265 +00:17:41,450 --> 00:17:44,970 +إنسان يشعر فيهم العكس، بس أنا هي كده شايفهم، الآن لو + +266 +00:17:44,970 --> 00:17:48,270 +غمضنا عين من عينينا الاثنين هتكون تماماً flat الصورة + +267 +00:17:48,270 --> 00:17:51,520 +لو غمضنا الثانية وفتحنا العين الأولى برضه هتكون + +268 +00:17:51,520 --> 00:17:57,970 +flat، وممكن كل واحد فينا يجرب هذه القضية بنفسه، هنا + +269 +00:17:57,970 --> 00:18:04,490 +يعني في three targets، target الأول اللي هو الدائرة + +270 +00:18:04,490 --> 00:18:10,630 +أو القرص الأحمر في النص، بعدين الحلقة الزرقاء تحيط + +271 +00:18:10,630 --> 00:18:13,990 +فيه، وبعدين الحلقة الحمراء، شايف الحلقة الزرقاء + +272 +00:18:13,990 --> 00:18:19,910 +عندي يعني جاية بارزة كثير، والحلقة أو القرص الأحمر + +273 +00:18:19,910 --> 00:18:23,630 +والحلقة الحمراء جايين لورا وكل ما الإنسان بعيد + +274 +00:18:23,630 --> 00:18:29,970 +أكثر عن.. الشاشة بيكون البروز أكثر، لو غمضنا عيننا + +275 +00:18:29,970 --> 00:18:32,990 +إحدى العينين ثاني، مش مشكلة يمين أو شمال هنلاحظ أن + +276 +00:18:32,990 --> 00:18:38,270 +الصورة تماماً flat، تماماً flat، هنا أيضاً مثال آخر + +277 +00:18:38,270 --> 00:18:42,790 +برضه واضح جداً برضه على قضية الـ stereopsis باستعمال + +278 +00:18:42,790 --> 00:18:48,040 +عين ثانية أو باستعمال عين واحدة، أيضاً عندي مثال آخر، + +279 +00:18:48,040 --> 00:18:53,940 +هذه الرسمة لو نظرنا إليها بعين واحدة، هتكون flat + +280 +00:18:53,940 --> 00:18:58,690 +من ناحيتين، الرسمتين، لو فتحنا عينينا الاثنتين، هيكون + +281 +00:18:58,690 --> 00:19:02,090 +هنا الـ heart.. هنا الـ heart جاي لقدام.. هنا الـ + +282 +00:19:02,090 --> 00:19:05,090 +heart جاي لورا.. هنا الـ heart جاي لورا.. كلها + +283 +00:19:05,090 --> 00:19:08,950 +أمثلة على الـ stereopsis أو الـ depth perception، الـ + +284 +00:19:08,950 --> 00:19:13,750 +depth perception، فهذه أمثلة على قضية الـ stereopsis + +285 +00:19:13,750 --> 00:19:18,090 +الآن بدنا ننتقل لموضوع آخر هو الـ sensory + +286 +00:19:18,090 --> 00:19:22,850 +perceptions، الـ sensory perceptions يعني الإحساسات + +287 +00:19:22,850 --> 00:19:28,430 +اللي بتصير عند الإنسان اللي كان عنده normal + +288 +00:19:28,430 --> 00:19:32,570 +binocular single vision وفجأة صار عنده squint، كان + +289 +00:19:32,570 --> 00:19:38,030 +عنده اليوم كان عنده عينيه straight ما فيش أي مشكلة + +290 +00:19:38,030 --> 00:19:42,810 +ما فيش أي حول وفجأة مثلاً ثاني يوم صار عنده sudden + +291 +00:19:42,810 --> 00:19:46,690 +onset of squint، يا ترى الـ sensation أو الـ + +292 +00:19:46,690 --> 00:19:50,170 +perceptions اللي بتصير عنده يعني إيش هيحس فيه، إيش + +293 +00:19:50,170 --> 00:19:53,810 +هيحس فيه يعني في شغلات بيحس فيها لأنه صار عنده + +294 +00:19:53,810 --> 00:19:58,280 +الحول بشكل مفاجئ، قبل نقول إيش الإحساسات اللي بتصير + +295 +00:19:58,280 --> 00:20:07,340 +عند هذا الإنسان، بدنا نعطي مقدمة.. مقدمة أنه قضية + +296 +00:20:07,340 --> 00:20:14,060 +إنسان مثلاً جالس بهدوء وفجأة يعني شعر أو.. أو إجا + +297 +00:20:14,060 --> 00:20:19,020 +إنسان بدبوس ويعني نخزه في إيده بهذا الدبوس + +298 +00:20:19,220 --> 00:20:24,340 +فبالتالي إذا نخز في إيده بهذا الدبوس فجأة هيكون + +299 +00:20:24,340 --> 00:20:27,360 +إيش الـ response بتاعه أو الاستجابة بتاعه؟ هو هيشرد + +300 +00:20:27,360 --> 00:20:32,160 +إيده بشكل مفاجئ، بعد هيك هيكون يشعر بالألم، بعد + +301 +00:20:32,160 --> 00:20:36,220 +شوية هيسكن الألم وما إلى ذلك.. وما إلى ذلك + +302 +00:20:36,220 --> 00:20:41,000 +فبالتالي هذه القضية ضروري جداً تكون واضحة.. ضروري + +303 +00:20:41,000 --> 00:20:47,240 +جدا تكون واضحة، فيرى إيش الإحساسات اللي ممكن تصير + +304 +00:20:47,240 --> 00:20:51,140 +عند الإنسان لما يصير عنده onset of squint، لما يبدأ + +305 +00:20:51,140 --> 00:20:54,740 +عنده قضية الحوادث at the onset of squint، two + +306 +00:20:54,740 --> 00:20:58,500 +sensory perceptions arise based on the normal + +307 +00:20:58,500 --> 00:21:02,640 +projection of the retinal areas stimulated، هذا + +308 +00:21:02,640 --> 00:21:06,820 +بيدعون إيه؟ إنه في عندي إحساسين هيصيروا، بس ضروري + +309 +00:21:06,820 --> 00:21:11,790 +أتذكر الـ visual direction، ضروري أتذكر الـ normal + +310 +00:21:11,790 --> 00:21:16,330 +retinal correspondence، ضروري أتذكر الـ projection + +311 +00:21:16,330 --> 00:21:22,850 +الـ projection، الـ visual direction، أنه في عندي نقاط + +312 +00:21:22,850 --> 00:21:27,370 +في شبكية كل عين، وكل نقطة في الشبكية إلها اتجاه + +313 +00:21:27,370 --> 00:21:30,430 +معين في الفراغ، ال..الـ retinal + +314 +00:21:30,430 --> 00:21:34,070 +correspondence، أنه فيه عندي نقاط في شبكية العين الـ + +315 +00:21:34,070 --> 00:21:38,130 +..اليمنى، إلها ما يماثلها في شبكية العين اليسرى، + +316 +00:21:38,130 --> 00:21:41,270 +إيش يعني إلها ما يماثلها؟ يعني فيه corresponding + +317 +00:21:41,270 --> 00:21:43,850 +areas between the right retina and the left + +318 +00:21:43,850 --> 00:21:46,610 +retina، إيش يعني corresponding areas؟ يعني إلها + +319 +00:21:46,610 --> 00:21:50,290 +the same visual direction، طيب، ثالث إشي لـ + +320 +00:21:50,290 --> 00:21:53,990 +projection، أنه اللي صورته بتسقط على الـ superior + +321 +00:21:53,990 --> 00:21:58,000 +retina، هينشاف تحت، واللي صورته بتسقط على الـ inferior + +322 +00:21:58,000 --> 00:22:02,320 +retina، هينشاف له فوق، يعني هيعبر عنه الشخص أنه + +323 +00:22:02,320 --> 00:22:07,910 +شايفه فوق، واللي بتسقط صورته على الـ nasal retina + +324 +00:22:07,910 --> 00:22:11,610 +هينشاف temporally بالنسبة لهذه العين، فضروري نتذكر + +325 +00:22:11,610 --> 00:22:15,890 +هذه الأشياء عشان نقدر نفسر الإحساسات اللي بتصير + +326 +00:22:15,890 --> 00:22:21,410 +معانا وهذا هنستعين بالرسم في توضيح هذه الفكرة، إذا + +327 +00:22:21,410 --> 00:22:25,510 +at the onset of squint، two sensory perceptions + +328 +00:22:25,510 --> 00:22:30,610 +arise، ليش؟ لأن هذا بيعتمد على الـ normal projection + +329 +00:22:30,610 --> 00:22:35,090 +of the retinal areas stimulated، ليش؟ لأنه لما + +330 +00:22:35,090 --> 00:22:38,690 +بيصير عند الحول بدل ما الصورة تسقط على الـ fovea والـ + +331 +00:22:38,690 --> 00:22:41,170 +fovea في العينين، هتسقط على الـ fovea في الـ + +332 +00:22:41,170 --> 00:22:45,390 +straight eye بينما هتسقط على non-foveal area، على + +333 +00:22:45,390 --> 00:22:49,590 +non-foveal area في الـ squinting eye، طيب هذه الـ non + +334 +00:22:49,590 --> 00:22:52,710 +-foveal area نفرض أنها المنطقسية، طب إيش اتجاهها في + +335 +00:22:52,710 --> 00:22:57,340 +الفراغ؟ حسب اتجاهها في الفراغ ممكن أنا أشعر بإحساس + +336 +00:22:57,340 --> 00:23:01,520 +معين، وهالجد هنحكي عنه، these require simultaneous + +337 +00:23:01,520 --> 00:23:05,340 +visual perception، بمعنى the ability to perceive + +338 +00:23:05,340 --> 00:23:09,120 +images from both eyes simultaneously، عشان هدول + +339 +00:23:09,120 --> 00:23:12,720 +الإحساسين اللي هنحكي عنهم بعد شوية يصيروا، عشان + +340 +00:23:12,720 --> 00:23:17,560 +يحدثوا لازم يكون العينين قادرين على الالتقاط في + +341 +00:23:17,560 --> 00:23:23,640 +نفس اللحظة، بمعنى آخر أحياناً بيصير squint والدماغ + +342 +00:23:23,640 --> 00:23:28,120 +بيبطل يستقبل صورة من عين معينة من الـ squinting eye + +343 +00:23:28,120 --> 00:23:32,720 +بشكل كامل، مش هيصير أي نوع من الإحساسات، هذا الإنسان + +344 +00:23:32,720 --> 00:23:36,460 +اتحول من binocular single vision لـ monocular + +345 +00:23:36,460 --> 00:23:39,920 +single vision، يعني بستعمل عينه الـ straight في رؤية + +346 +00:23:39,920 --> 00:23:43,270 +الأهداف اللي بتطلع عليها، والعين الـ squinting اللي + +347 +00:23:43,270 --> 00:23:46,650 +فيها حول، دماغ بطل يستقبل منها صورة، يعني عملها + +348 +00:23:46,650 --> 00:23:50,990 +suppression، تثبيت لصورة، بدوش منها صورة يعني كأنه + +349 +00:23:50,990 --> 00:23:54,050 +أوقفها على العمر، رغم إنها مفتوحة والناس بتشوفه + +350 +00:23:54,050 --> 00:23:57,930 +مفتوحة عينيتين تانيين، ولكن وكأنها مغمضة، يعني تعتبر + +351 +00:23:57,930 --> 00:24:01,390 +كأنها مغلق العين لأن الدماغ ما بيستقبلش منها، هذا + +352 +00:24:01,390 --> 00:24:04,490 +الإنسان اللي.. اللي ما عندهوش قدرة على الالتقاط + +353 +00:24:04,490 --> 00:24:09,550 +المتزامن، مش هيحس بالإحساسين اللي هنحكي عنهم بعد.. + +354 +00:24:09,550 --> 00:24:15,790 +بعد شوية، مثال آخر يعني بيوضح الصورة بشكل لا لبس + +355 +00:24:15,790 --> 00:24:21,570 +فيه، إنسان عنده.. إنسان عمره مثلاً ست.. ستين سنة + +356 +00:24:21,570 --> 00:24:25,790 +عنده mature cataract في الـ right eye، يعني عنده مية + +357 +00:24:25,790 --> 00:24:29,870 +بيضاء ومستوية وسادة تماماً، يعني الـ.. الرؤية في الـ + +358 +00:24:29,870 --> 00:24:33,150 +right eye مثلاً hand motion، والرؤية في الـ left eye + +359 +00:24:33,150 --> 00:24:37,720 +ستة على ستة، وصار عنده squint، هل هيشكي من أي شعور؟ + +360 +00:24:37,720 --> 00:24:40,360 +لا، لأن هذا الإنسان مش binocular single vision، هو + +361 +00:24:40,360 --> 00:24:43,340 +بالأساس monocular، والعين الثانية، لأنه فيها + +362 +00:24:43,340 --> 00:24:46,580 +cataract mature، cataract.. cataract ناضجة، + +363 +00:24:46,580 --> 00:24:49,360 +معناته بتستقبلش، الصورة ما بتوصل أصلاً للـ retina + +364 +00:24:49,360 --> 00:24:53,880 +عشان يصير صورتين ويتم الـ fusion ويستمتع بالـ + +365 +00:24:53,880 --> 00:24:57,840 +binocular single vision، إذا ضروري جداً عشان تحدث هذه + +366 +00:24:57,840 --> 00:25:02,000 +الإحساسات اللي هي الـ confusion، الـ confusion والـ + +367 +00:25:02,000 --> 00:25:07,000 +pathological diplopia + +368 +00:25:07,000 --> 00:25:10,340 +هدول الإحساسين، واحد بيسموه confusion اللي خربطت + +369 +00:25:10,340 --> 00:25:13,600 +الصور في بعضها أو \ No newline at end of file diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/cq1wlflMhsw_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/cq1wlflMhsw_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..9823986d4e14e2b0c4a269c868a5c56a35ba2f1e --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/cq1wlflMhsw_postprocess.srt @@ -0,0 +1,1528 @@ +1 +00:00:01,670 --> 00:00:06,010 +بسم الله الرحمن الرحيم بنواصل مع محاضرات حوال واحد + +2 +00:00:06,010 --> 00:00:12,070 +وحكينا إنه فيه diffusional variances اللي لها + +3 +00:00:12,070 --> 00:00:16,390 +amplitudes و هذه ال amplitudes كانت قياسة بواسطة + +4 +00:00:16,390 --> 00:00:20,310 +استعمال الprismات أو باستعمال جهاز ال sinoptophore + +5 +00:00:20,310 --> 00:00:27,050 +اللي هنحكي عنه في حين إذا تقاس diffusional + +6 +00:00:27,050 --> 00:00:29,950 +variances بواسطة + +7 +00:00:34,540 --> 00:00:37,440 +وقلنا فيه normal values ال convergence ال fusion + +8 +00:00:37,440 --> 00:00:40,380 +ال convergence ال fusion ال convergence من خمستاشر + +9 +00:00:40,380 --> 00:00:45,370 +لعشرين prism على ال distanceو 25 prism or more at + +10 +00:00:45,370 --> 00:00:50,870 +near و ال fusional divergence من 6 ل 10 prism at + +11 +00:00:50,870 --> 00:00:56,630 +distance و تقريبا من 12 ل 14 prism at near و حكينا + +12 +00:00:56,630 --> 00:00:59,870 +أن ال fusional divergence إليها همية كبيرة و قولنا + +13 +00:00:59,870 --> 00:01:03,710 +ال vertical divergence تقريبا من 2 ل 3 بتحمل + +14 +00:01:03,710 --> 00:01:06,850 +الإنسان vertical misalignment أو vertical + +15 +00:01:06,850 --> 00:01:10,700 +disparity of retinal imageو ال cyclovergence حسب + +16 +00:01:10,700 --> 00:01:13,440 +دراسات حديثة ممكن توصل ل تمانية degree و بيقولنا + +17 +00:01:13,440 --> 00:01:17,540 +هذه الأرقام قادمة .. هذه الأرقام قادمة طيب إيش + +18 +00:01:17,540 --> 00:01:21,080 +فائدة إن الإنسان يكون عنده fusional vergances؟ + +19 +00:01:21,080 --> 00:01:24,200 +fusional vergances يعني fusional convergence و + +20 +00:01:24,200 --> 00:01:27,500 +fusional divergence و fusional أو vertical + +21 +00:01:27,500 --> 00:01:31,720 +fusional vergance و cyclovergence إيش الفائدة؟ ال + +22 +00:01:31,720 --> 00:01:34,640 +fusional convergence .. ال fusional convergence + +23 +00:01:34,640 --> 00:01:39,320 +helps to control an exophoriaWhereas fusional + +24 +00:01:39,320 --> 00:01:42,920 +divergence helps to control an esophilia + +25 +00:01:47,190 --> 00:01:50,670 +نروح الصورة المكبرة هذا الإنسان عنده Exophoria + +26 +00:01:50,670 --> 00:01:55,570 +Exophoria يعني حوال خفي للخارج حوال خفي للخارج طب + +27 +00:01:55,570 --> 00:02:00,110 +لو صورنا إنه العين حاولت تروح للخارج و high target + +28 +00:02:00,110 --> 00:02:02,690 +هذا الإنسان بتطلع عليه هذا ال target اللي هو ال + +29 +00:02:02,690 --> 00:02:07,130 +face بيسقط على الفوفيا هنا في حالة لو زاغت العين + +30 +00:02:07,130 --> 00:02:11,930 +لو زاغت أو بدأت بالزوغان heterophoria Exophoria + +31 +00:02:11,930 --> 00:02:13,170 +باتجاه ال Exophoria + +32 +00:02:15,570 --> 00:02:18,630 +ساعتها الصورة هتسقط على temporal retina بدل ما + +33 +00:02:18,630 --> 00:02:22,370 +تسقط على الفوفيا هتسقط على temporal retina ومعروف + +34 +00:02:22,370 --> 00:02:25,490 +لما بتسقط الصورة على temporal retina هذا بيحفظ ال + +35 +00:02:25,490 --> 00:02:28,590 +fusional convergence فبتبدأ عملية ال fusional + +36 +00:02:28,590 --> 00:02:31,930 +convergence بيرجع ال exophoria بسيطر عليها و بيخلي + +37 +00:02:31,930 --> 00:02:35,170 +العين معتادلة بحيث تسقط الصورة على الفوفيا هنا زي + +38 +00:02:35,170 --> 00:02:41,130 +ما سقطت الصورة على الفوفيا في العين لشمال أيضا .. + +39 +00:02:41,130 --> 00:02:46,710 +أيضا لو صار عندى fusionalأو لو صار عندى esophoria + +40 +00:02:46,710 --> 00:02:51,050 +لو .. لو .. لو العكس تصورناها esophoria ساعتها + +41 +00:02:51,050 --> 00:02:54,610 +الصورة هتسقط على nasal retina هنا فحده هيعمل + +42 +00:02:54,610 --> 00:02:57,810 +stimulation لل fusional divergence إذا ال fusional + +43 +00:02:57,810 --> 00:03:03,370 +convergence .. ال fusional convergence بيسيطرلي + +44 +00:03:03,370 --> 00:03:07,270 +على ال exophoria convergence عكس ال exophoria + +45 +00:03:07,270 --> 00:03:11,450 +بعكسها يعني بمعنى آخر بيسيطر عليها بيدخل العين لل + +46 +00:03:11,450 --> 00:03:15,970 +straight ahead positionو الـ fusional divergence + +47 +00:03:15,970 --> 00:03:22,890 +بيعمل control للإيزو فوريا طيب، هل ال fusional + +48 +00:03:22,890 --> 00:03:25,870 +divergence amplitude هذه الأرقام اللي عرضناها قبل + +49 +00:03:25,870 --> 00:03:32,110 +شويةهل هي أرقام ثابتة و لا قابلة للتغيير؟ حقيقة هي + +50 +00:03:32,110 --> 00:03:36,410 +أرقام يعني متغيرة أرقام متغيرة بنقول the fusional + +51 +00:03:36,410 --> 00:03:39,390 +divergence mechanism may be decreased by fatigue + +52 +00:03:39,390 --> 00:03:43,270 +or illness converting aphoria to atropia يعني ال + +53 +00:03:43,270 --> 00:03:46,270 +fusional convergence و ال fusional divergence و ال + +54 +00:03:46,270 --> 00:03:49,510 +vertical divergence و ال cyclovergence تحت ظروف + +55 +00:03:49,510 --> 00:03:53,870 +الإرهاق اللي هو الفتيق أو ال illness اللي هو المرض + +56 +00:03:53,870 --> 00:04:03,030 +ممكناتجل بيمةتجيل قيمة وبالتالي بيبطل او بيقدرش ال + +57 +00:04:03,030 --> 00:04:06,250 +fusion convergence يسيطر على ال exofuria و ال + +58 +00:04:06,250 --> 00:04:09,190 +fusion divergence بيقدرش يسيطر على ال exofuria و + +59 +00:04:09,190 --> 00:04:13,290 +اها كذا اذا لما بيكون في انديفوريا غير مسيطر عليها + +60 +00:04:13,290 --> 00:04:17,670 +بتبدأ تظهر فببدأ اسميها انا اتروبيا بدل فوريا + +61 +00:04:17,670 --> 00:04:20,830 +اتروبيا بدل فوريا لان اتروبيا هي الحوالي الظاهر و + +62 +00:04:20,830 --> 00:04:24,350 +الفوريا هي الحوالي الخفي خفي ليش لانه مسيطر عليه + +63 +00:04:24,350 --> 00:04:27,830 +بواسطة ال fusion convergence بواسطة ال fusion + +64 +00:04:27,830 --> 00:04:31,830 +convergenceطيب، إذن هذه في حالات ال illness وفي + +65 +00:04:31,830 --> 00:04:35,770 +حالات الفتيق بتضعف ال fusional mechanisms اللي هي + +66 +00:04:35,770 --> 00:04:38,310 +ال fusional convergence و ال fusional divergence و + +67 +00:04:38,310 --> 00:04:41,050 +ال vertical divergence و ال cyclovergence بيضعفوا + +68 +00:04:41,050 --> 00:04:45,030 +فبتتحول الفوريا لتروبيا لأنه مافيش سيطرة عليها من + +69 +00:04:45,030 --> 00:04:51,410 +قبل الدماغ عشان يتحكم في عضلات العلمهل ممكن تزيد + +70 +00:04:51,410 --> 00:04:55,230 +هذه الأرقام أو تتحسن؟ The amplitude of fusional + +71 +00:04:55,230 --> 00:04:58,670 +divergence mechanisms can be improved by orthoptic + +72 +00:04:58,670 --> 00:05:02,710 +exercises, particularly in the case of near + +73 +00:05:02,710 --> 00:05:05,510 +-fusional convergence for the relief of + +74 +00:05:05,510 --> 00:05:09,150 +convergence insufficiency ممكن هذه ال fusional + +75 +00:05:09,150 --> 00:05:11,910 +divergence mechanisms أو ال fusional amplitudes + +76 +00:05:13,100 --> 00:05:16,800 +تتحسن بالـ orthoptic exercises بالتمارين البصرية + +77 +00:05:16,800 --> 00:05:21,080 +في تمارين بصرية خاصة في هذا المجال و بالذات بيكون + +78 +00:05:21,080 --> 00:05:23,740 +مفيدة التمارين البصرية في حالة ال convergence + +79 +00:05:23,740 --> 00:05:27,440 +insufficiency اللي هي عدم كفاية عملية ال + +80 +00:05:27,440 --> 00:05:29,920 +convergence يعني ضعف ال convergence زي ما السورة + +81 +00:05:29,920 --> 00:05:35,760 +الآن هنعرضها بنقول هذا إنسان at rest at rest يعني + +82 +00:05:35,760 --> 00:05:40,340 +بتطلع على target بعيد مثلا 6 متر أو أكتر من 6 متر + +83 +00:05:40,340 --> 00:05:44,490 +العينين straight زي ما انتوا شايفينهالعينين + +84 +00:05:44,490 --> 00:05:47,670 +straight زي ما انتوا شايفينها الان حطينا target + +85 +00:05:47,670 --> 00:05:52,970 +عليه او امام عينيه عبقر 80 cm برضه لازالت العينين + +86 +00:05:52,970 --> 00:05:57,710 +م centra .. central يعني ما اتحركت لجوه ال target + +87 +00:05:57,710 --> 00:06:01,690 +بدل ما كان ع 6 متر صار عبقر 80 cm اقل من 1 متر + +88 +00:06:01,690 --> 00:06:04,130 +المفروض العينيه تبدأ تدخل لجوه تعمل convergence + +89 +00:06:04,130 --> 00:06:08,710 +طيب قلنا بنجرب ال target اكتر خلينا ال target على + +90 +00:06:08,710 --> 00:06:12,650 +20 cm لازلت العين ما اتحركت من هنافهذه القضية + +91 +00:06:12,650 --> 00:06:16,430 +بيسميها convergence insufficiency يعني عدم كفاية + +92 +00:06:16,430 --> 00:06:18,410 +في ال convergence ممكن الإنسان يقول لأ ممكن هو + +93 +00:06:18,410 --> 00:06:20,590 +عنده مشكلة في ال media rectus هنا و في ال media + +94 +00:06:20,590 --> 00:06:23,350 +rectus هنا عشان هيك يعني مش قضية convergence + +95 +00:06:23,350 --> 00:06:25,770 +insufficiency بيقولوا لأ ال media rectus شغالة لما + +96 +00:06:25,770 --> 00:06:29,710 +بتطلع على اليمين ال left media rectus شغالة لما + +97 +00:06:29,710 --> 00:06:33,070 +بتطلع على الشمال ال right media rectus شغالة إذا + +98 +00:06:33,070 --> 00:06:36,730 +المشكلة مش في العضلات آلية ال convergence عنده + +99 +00:06:36,730 --> 00:06:40,130 +ضعيفة آلية ال convergence ضعيفة وقولنا احنا لازم + +100 +00:06:40,130 --> 00:06:44,930 +نفرجبين تلت أنواع الحركة دكشنز وال virgins هذه + +101 +00:06:44,930 --> 00:06:49,010 +virgins الصورتين اللي تحت virgins بينما هذهعلى + +102 +00:06:49,010 --> 00:06:52,410 +عشرين صنطة convergence convergence is binocular + +103 +00:06:52,410 --> 00:06:56,550 +simultaneous disjugate يعني العين الشمال ده تروح + +104 +00:06:56,550 --> 00:06:58,550 +على اليمين و العين اليمين ده تروح على الشمال اتجاه + +105 +00:06:58,550 --> 00:07:01,610 +الحركة المفروض يكون مختلف بس احنا سايفين انه سواء + +106 +00:07:01,610 --> 00:07:04,190 +بتطلع على ستة متر او بتطلع على تمانين صنطة او + +107 +00:07:04,190 --> 00:07:06,870 +بتطلع على عشرين صنطة هذا عنده convergence + +108 +00:07:06,870 --> 00:07:10,370 +insufficient عدم كفاية في ال convergence او ضعف في + +109 +00:07:10,370 --> 00:07:13,250 +ال convergence فهدول الناس بيستفيدوا جدا من + +110 +00:07:13,250 --> 00:07:17,390 +التمرينالبصرية لتقوية الفيوجينال convergence + +111 +00:07:17,390 --> 00:07:21,450 +لتقوية الفيوجينال convergence لتقوية الفيوجينال + +112 +00:07:21,450 --> 00:07:25,790 +convergence وبالتالي هذه القضية من ضمن التمارين + +113 +00:07:25,790 --> 00:07:30,630 +البصرية في حد يسموها ال pencil push upيعني بيمسك + +114 +00:07:30,630 --> 00:07:34,110 +جلم ارصاص بتطلع على سنه طبعا على امتداد إيده بيمد + +115 +00:07:34,110 --> 00:07:38,130 +إيده على الآخر بعيد وبيبدأ يجرب .. وبيبدأ يجرب + +116 +00:07:38,130 --> 00:07:44,070 +الجلم بالتدريج من عينيه ويحاول يركز في سن الجلم + +117 +00:07:44,070 --> 00:07:47,990 +إذا شاف سن الجلم مزدوج معناته لسه عنده convergence + +118 +00:07:47,990 --> 00:07:51,290 +insufficiency بيحاول يوحد الصورتين في صورة واحدة + +119 +00:07:51,290 --> 00:07:55,350 +يعني يدرب عينيه انها تعمل convergenceطبعا في + +120 +00:07:55,350 --> 00:07:58,750 +المراكز الطبية اللي .. اللي بتشتغل على موضوع + +121 +00:07:58,750 --> 00:08:01,670 +العلاج البصري في ممكن بدل ال pins ال push up اللي + +122 +00:08:01,670 --> 00:08:04,570 +ممكن تنعمل في البيت في حاجة بيسموها ال procstring + +123 +00:08:05,590 --> 00:08:09,510 +هذا عبارة عن حبل وفيه كورات ملونة على مسافات + +124 +00:08:09,510 --> 00:08:12,930 +متباعدة أول إشي بيبدأ يتطلع الكورة لبعيدة كتير + +125 +00:08:12,930 --> 00:08:16,490 +ويحاول يركز فيها إذا زهرت مزدوجة بيحاول يعمل + +126 +00:08:16,490 --> 00:08:20,150 +convergence يعني يوحد الصورتين في صورة واحدة + +127 +00:08:20,150 --> 00:08:25,190 +تلقائيًا هيبدأ ال convergence يتفعل إذا استطاع ذلك + +128 +00:08:25,190 --> 00:08:28,310 +بيبدأ يتطلع الكورة الأقرب منها يعني هو كل ما + +129 +00:08:28,310 --> 00:08:31,910 +بيقترب كورة مسافة كورة فبالتالي ال convergence + +130 +00:08:31,910 --> 00:08:35,770 +عنده قاعد بيتدرب وبيحاول يعملconvergence وهذه + +131 +00:08:35,770 --> 00:08:38,930 +القضية تتكرر يوميا لما يتحسن عنده ال convergence + +132 +00:08:38,930 --> 00:08:42,030 +طبعا في وسائل كتيرة للتمارين البصرية بس هدولا + +133 +00:08:42,030 --> 00:08:48,290 +مثالين بسيطين اذا تقوية .. تقوية ال fusional + +134 +00:08:48,290 --> 00:08:51,490 +convergence mechanisms can be done by أو can be + +135 +00:08:51,490 --> 00:08:55,230 +improved by orthoptic exercise و بالذات في حالة ال + +136 +00:08:55,230 --> 00:08:58,460 +convergence insufficiencyزي ما احنا عرضنا هذا + +137 +00:08:58,460 --> 00:09:01,980 +المريض أمامكم عنده convergence insufficiency فهذا + +138 +00:09:01,980 --> 00:09:06,740 +بيستفيد جدا من قضية ال orthoptic exercises زي ما + +139 +00:09:06,740 --> 00:09:10,380 +هو معروض عندنا في الصور اللي .. اللي .. اللي .. + +140 +00:09:10,380 --> 00:09:15,560 +يعني انتوا شايفينها لل broke string و ال pencil + +141 +00:09:15,560 --> 00:09:19,160 +push ups ال pencil .. ال pencil push ups نيجي + +142 +00:09:19,160 --> 00:09:25,520 +لموضوع جديد هو ال stereopsis حقيقة ال stereopsisهو + +143 +00:09:25,520 --> 00:09:29,000 +نهاية المطاف بالنسبة لل binocular single vision ال + +144 +00:09:29,000 --> 00:09:32,380 +binocular single vision بيمور بتلت مراحل رئيسية + +145 +00:09:32,380 --> 00:09:35,400 +المرحلة الأولى الرئيسية اللى بيسموها simultaneous + +146 +00:09:35,400 --> 00:09:39,760 +perception الالتقاط المتزامن يعني العين اليمين أو + +147 +00:09:39,760 --> 00:09:43,560 +شبكية العين اليمين التقطت .. التقطت صورة في نفس + +148 +00:09:43,560 --> 00:09:47,500 +اللحظة شبكية العين الشمال تقطت نفس الصورة يعني + +149 +00:09:47,500 --> 00:09:51,760 +صورة نفس الجسملو في التقاط غير متزامن يعني العين + +150 +00:09:51,760 --> 00:09:55,340 +اليمين التقطت الصورة و بعد مثلا دقيقة او دقيقتين و + +151 +00:09:55,340 --> 00:09:57,600 +العين الشمال التقطت نفس الصورة مافيش حاجة مافيش + +152 +00:09:57,600 --> 00:10:01,380 +كلام عن binocular single vision لأن في عين التقطت + +153 +00:10:01,380 --> 00:10:04,920 +و العين التانية لسه مالتقطتش اذا اول مرحلة لازم + +154 +00:10:04,920 --> 00:10:08,440 +يصير التقاط متزامن في نفس اللحظة ال two eyes + +155 +00:10:08,440 --> 00:10:14,680 +captured يعني صورت او التقطت يعني image لنفس ال + +156 +00:10:14,680 --> 00:10:19,510 +object هذه المرحلة الأولى المرحلة التانيةدمج + +157 +00:10:19,510 --> 00:10:22,670 +الصورتين في صورة واحدة يعني بدل ما اتكون عندي + +158 +00:10:22,670 --> 00:10:26,850 +صورتين ارسلوا للدماغ الدماغ دمجهم في صورة واحدة + +159 +00:10:26,850 --> 00:10:30,550 +الان المرحلة التالتة والاخيرة ان الدماغ بدوا + +160 +00:10:30,550 --> 00:10:35,090 +يستشعر البعد التالث لهدول الصورتين لان هم وصلوا من + +161 +00:10:35,090 --> 00:10:40,290 +ال two retina وصلوا ثنائيات الأبعاد ممكن يقولوا لأ + +162 +00:10:40,290 --> 00:10:44,350 +يعني هي الصورة من الأساس ثلاثيت الأبعاد بنقوله ال + +163 +00:10:44,350 --> 00:10:50,590 +retinaالريتينة في أي من الانتين الريتينةلو .. لو + +164 +00:10:50,590 --> 00:10:56,490 +الصورة بتتكون ثلاثية الأبعاد في جلب العين كان + +165 +00:10:56,490 --> 00:10:59,550 +هيكون عندي بعدين على الشبكية و البعد التالت أما في + +166 +00:10:59,550 --> 00:11:03,070 +ال vitreous أو إذا كان هو hypermetroid ممكن يكون + +167 +00:11:03,070 --> 00:11:08,110 +مثلا ورا العين فبالتالي ضروري الصورة تلتقط بالوسط + +168 +00:11:08,110 --> 00:11:12,570 +الشبكية ثنائية الأبعاد و الدماغ هيفهم البعد التالت + +169 +00:11:12,570 --> 00:11:18,620 +بطريقة أنه ..هذه كامرة التقاط وهذه كامرة التقاط + +170 +00:11:18,620 --> 00:11:23,760 +هذه موقع في الفراغ وهذه موقع مختلف عنه في الفراغ + +171 +00:11:23,760 --> 00:11:27,340 +المسافة بين العينين اللي هو الـ Inter pupillary + +172 +00:11:27,340 --> 00:11:31,340 +distance يعني كأنها هي المسافة في الفراغ يعني هذه + +173 +00:11:31,340 --> 00:11:33,780 +لها موقع العين اليمين في الفراغ وهذه لها موقع + +174 +00:11:33,780 --> 00:11:37,800 +مختلف عنه إذا هذه ستصور ال target من جهة وهذه + +175 +00:11:37,800 --> 00:11:41,060 +ستصور ال target من جهة تختلف قليلا عنه هذا + +176 +00:11:41,060 --> 00:11:44,700 +الاختلاف البسيط في زاوية التصويرهذا الإختلاف + +177 +00:11:44,700 --> 00:11:48,880 +البسيط في زاوية التصوير بيستخدم الدماغ عشان يفهم + +178 +00:11:48,880 --> 00:11:53,840 +البعد التالت اللي هو البعد .. العمق بتاع الصورة أو + +179 +00:11:53,840 --> 00:11:57,980 +ال depth بتاع الصورة .. بتاع الصورة فبنقول + +180 +00:11:57,980 --> 00:12:03,240 +stereopsis is the perception of depth the third + +181 +00:12:03,240 --> 00:12:07,470 +dimensionطيب ال first two dimensions اللي هو + +182 +00:12:07,470 --> 00:12:12,250 +الأطوار الأول والتاني هو ال height و ال width يعني + +183 +00:12:12,250 --> 00:12:16,490 +هو ارتفاع الجسم اللي أنا بتطلع عليه و عرضه و تالت + +184 +00:12:16,490 --> 00:12:20,470 +.. البعد التالت اللي هو العمق بتاع هذا الجسم .. + +185 +00:12:20,470 --> 00:12:25,900 +العمق بتاع هذا الجسمتحدث عندما الوضع خلف ومقابل + +186 +00:12:25,900 --> 00:12:29,780 +نقطة المقبضة، ولكن داخل الوضع الانفجاري الانفجاري + +187 +00:12:29,780 --> 00:12:32,620 +تشغّل المواصفات الانفجارية الانفجارية تشغّل + +188 +00:12:32,620 --> 00:12:34,360 +المواصفات الانفجارية تشغّل المواصفات الانفجارية + +189 +00:12:34,360 --> 00:12:35,240 +تشغل المواصفات الانفجارية تشغل المواصفات + +190 +00:12:35,240 --> 00:12:36,060 +الانفجارية تشغل المواصفات الانفجارية تشغل + +191 +00:12:36,060 --> 00:12:38,000 +المواصفات الانفجارية تشغل المواصفات الانفجارية + +192 +00:12:38,000 --> 00:12:42,000 +تشغل المواصفات الانفجارية تشغل المواصفات + +193 +00:12:42,000 --> 00:12:45,100 +الانفجارية تشغل المواصفات الانفجارية تشغلa solid + +194 +00:12:45,100 --> 00:12:47,660 +object is seen stereoscopically in three + +195 +00:12:47,660 --> 00:12:50,900 +dimensions because each eye sees a slightly + +196 +00:12:50,900 --> 00:12:54,940 +different aspect of the object وهنا بيت القصيدة + +197 +00:12:54,940 --> 00:13:00,500 +لأنه كل عين بتشوف زاوية مختلفة من الجسم هذا بيقدر + +198 +00:13:00,500 --> 00:13:04,320 +إلى أن الدماغ يستخدم اختلاف البسيط هذا في زاوية + +199 +00:13:04,320 --> 00:13:08,480 +التصوير في الإحساس بالعمق أو البعد التالت اللي هو + +200 +00:13:08,480 --> 00:13:12,560 +ال three dimensions فبالتالي هذه القضية بتوضح في + +201 +00:13:12,560 --> 00:13:17,060 +الرسمة التالتةهي العين تين بتطلع على هذا المكعب أو + +202 +00:13:17,060 --> 00:13:22,320 +هذا الصندوق العين الشمال شايف الصورة بالشكل هذا ان + +203 +00:13:22,320 --> 00:13:25,720 +طبعت الصورة عندها بالشكل هذا والعين اليمين طبعت + +204 +00:13:25,720 --> 00:13:29,560 +الصورة بالشكل هذا وواضح أنه في اختلاف يعني مثلا لو + +205 +00:13:29,560 --> 00:13:34,980 +جينا احنا على اللون الأخضر الفاتح هذا هنلاقي أن + +206 +00:13:34,980 --> 00:13:38,300 +حجمه بالنسبة للعين اليمين على ال retina في العين + +207 +00:13:38,300 --> 00:13:43,220 +اليمين أكبر من حجمه قليلا بالنسبة للعين الشمالعلى + +208 +00:13:43,220 --> 00:13:48,100 +العكس اللون الزهري، الوجه الزهري للمكعب أو للصندوق + +209 +00:13:48,100 --> 00:13:52,080 +صورته على ال retina في العين الشمال أكبر من صورته + +210 +00:13:52,080 --> 00:13:55,640 +على ال retina في العين اليمين هذا الاختلاف في + +211 +00:13:55,640 --> 00:14:00,440 +الصورتين، الدماغ بيستخدمه عشان يفهم العمق بتاع هذا + +212 +00:14:00,440 --> 00:14:06,160 +المكعبالفكرة وهذه هي الفكرة هذا هو لو حطينا الصورة + +213 +00:14:06,160 --> 00:14:08,920 +تحت العين اليمين احنا طبقناها على الصورة تحت العين + +214 +00:14:08,920 --> 00:14:13,020 +الشمال تطبيق مباشر هنلاقي انه في disparity وكأنه + +215 +00:14:13,020 --> 00:14:20,770 +يعني الشيئين مش جايين على بعض انه في يعنيإشكالية + +216 +00:14:20,770 --> 00:14:24,710 +بينهم أو في retinal disparity مش منطبقين أو مش + +217 +00:14:24,710 --> 00:14:28,870 +جايين تماما على corresponding retinal areas فهذه + +218 +00:14:28,870 --> 00:14:32,810 +القضية بتحفظ الدماغ أنه يعدل وضعيته لينه أثناء + +219 +00:14:32,810 --> 00:14:42,450 +التعديل هذا الإلتقاط المختلف قليلا بيستخدم للشعور + +220 +00:14:42,450 --> 00:14:49,440 +بالعمل للشعور بالعمل هنا إنبعض الأشياء اللي هي + +221 +00:14:49,440 --> 00:14:53,880 +very interesting .. very interesting هذه بتوضحلي + +222 +00:14:53,880 --> 00:14:58,800 +قضية الاستليبسس، الآن هاي شكل عيندي، لو احنا نظرنا + +223 +00:14:58,800 --> 00:15:04,200 +لهذا الشكل بالعينتين، هنلاقي انه فيه لون يعنيأعمق + +224 +00:15:04,200 --> 00:15:07,280 +من اللون يعني جاي لورا مقارنة مع اللون التاني + +225 +00:15:07,280 --> 00:15:11,540 +بالنسبة إلي أنا و هقول ليش أنا بحكي بالنسبة إلي + +226 +00:15:11,540 --> 00:15:15,500 +أنا شايف اللون الأحمر داخل لجوا و اللون الأزرق جاي + +227 +00:15:15,500 --> 00:15:20,160 +لجدام تقريبا أكتر منه بواحد centimeter و كل ما + +228 +00:15:20,160 --> 00:15:23,540 +بععدنا أكتر .. كل ما بععدنا أكتر عن شاشة ال + +229 +00:15:23,540 --> 00:15:28,200 +computer أو شاشة ال laptop بتلاحظ الفرق أو العمق + +230 +00:15:28,200 --> 00:15:32,140 +بظهر أكترمش هنا بيت القصيد فقط عشان نفهم كيف احنا + +231 +00:15:32,140 --> 00:15:36,640 +بنشوف صورة ثلاثية الأبعاد أو الشكل الثلاثي الأبعاد + +232 +00:15:36,640 --> 00:15:39,900 +لو غمضنا عين واحدة من العينتين هلاجي الصورة flat + +233 +00:15:39,900 --> 00:15:43,060 +تماما فاش لون بيتميز عن اللون كلهم على نفس ال + +234 +00:15:43,060 --> 00:15:47,080 +level طيب لو جربنا غمضنا العين التانية نفس القضية + +235 +00:15:47,080 --> 00:15:51,830 +مافي اي اختلاف لو فتحنا العينتينلأن كل عين بتلتقط + +236 +00:15:51,830 --> 00:15:55,570 +من زاوية معينة هذا الاختلاف البسيط بيشعرنا بالعمق + +237 +00:15:55,570 --> 00:15:59,890 +كل ما بعدنا عن سطح الشاشة يعني هنلاقي أن العمق + +238 +00:15:59,890 --> 00:16:04,470 +بيزداد العمق اللي بيزداد هذا هو يعني مثال على ال + +239 +00:16:04,470 --> 00:16:09,710 +stereopsis أو الشعور بالبعد التالت وهو ضروري نفهم + +240 +00:16:09,710 --> 00:16:12,690 +أنه binocular function binocular function مافيش + +241 +00:16:12,690 --> 00:16:16,150 +حاجة اسمة stereopsis بعين واحدة الدليل لأن هذا + +242 +00:16:16,150 --> 00:16:18,830 +المنظر اللي أمامنا لو غمضنا عيننا مرة تانية هنلاقي + +243 +00:16:18,830 --> 00:16:22,250 +أن الصورة flatلو غمضنا العين التانية برضه الصورة + +244 +00:16:22,250 --> 00:16:25,250 +flat أمتى بنشعر أنه في عمق للصورة و أنه اللون + +245 +00:16:25,250 --> 00:16:28,350 +الأزرق بيختلف عن اللون الأحمر أنا بالنسبة إيه + +246 +00:16:28,350 --> 00:16:31,750 +اللون الأحمر جاي لجوا و اللون الأزرق جاي باتجاهي + +247 +00:16:31,750 --> 00:16:35,630 +أكتر يعني طالع أكتر أو بارز أكتر باتجاهي ممكن + +248 +00:16:35,630 --> 00:16:38,450 +الميوبي يشوف العكس الإنسان اللي عنده ميوبيا ممكن + +249 +00:16:38,450 --> 00:16:41,170 +يشوف اللون الأحمر لإن الميوبيا اللون الأحمر + +250 +00:16:41,170 --> 00:16:45,910 +بالنسبة له أوطح يعني ممكن .. بس المهم أنه هيشوف في + +251 +00:16:45,910 --> 00:16:52,340 +عمق للصورة نشوف مثال تاني على ذلكهيقن احنارسمتين + +252 +00:16:52,340 --> 00:16:56,420 +برضه، هدول الرسمتين يعني بيعطوا impression أو شعور + +253 +00:16:56,420 --> 00:17:00,520 +بيه الأبعاد الثلاثية طبعا في الرسمة الأولى اللي هي + +254 +00:17:00,520 --> 00:17:03,720 +على اليمين بالنسبة لي أنا اللون الأسودة الدائرة + +255 +00:17:03,720 --> 00:17:07,900 +السودة اللي مخربش هذه جاية لقدام و المحيط اللي + +256 +00:17:07,900 --> 00:17:12,380 +باللون الأزرق جاية لورا هنا العكس الدائرة السودة + +257 +00:17:12,380 --> 00:17:16,660 +جاية لورا و الدائرة البيضامة الحمرة هذه الخرابيش + +258 +00:17:16,660 --> 00:17:19,440 +البيضامة اللي هي المحيط ال periphery جاية لقدام + +259 +00:17:19,650 --> 00:17:23,510 +الان لما بغمض عين كل الصورتين flat لما بغمض العين + +260 +00:17:23,510 --> 00:17:26,770 +التانية برضه كل الصورتين flat وبالتالي لما بفتح + +261 +00:17:26,770 --> 00:17:30,130 +عيني التنتين بأشعر بال stereopsis بأشعر بال + +262 +00:17:30,130 --> 00:17:34,470 +stereopsis ميزال اخر على ذلك ايضا هذه القضية لو + +263 +00:17:34,470 --> 00:17:37,690 +بعدنا شوية هنلاقي انه فيه لون بارز اللي هو اللون + +264 +00:17:37,690 --> 00:17:41,450 +الأسود ال periphery و اللون الأحمر جاي لجوا ممكن + +265 +00:17:41,450 --> 00:17:44,970 +انسان يشعر فيهم العكس بس انا هي كده شايفهم الآن لو + +266 +00:17:44,970 --> 00:17:48,270 +غمضنا عين من عيننا التنتين هتكون تماما flat الصورة + +267 +00:17:48,270 --> 00:17:51,520 +لو غمضنا التانيةوفتحنا العين الأولى برضه هتكون + +268 +00:17:51,520 --> 00:17:57,970 +flat وممكن كل واحد فينا يجرب هذه القضية بنفسههنا + +269 +00:17:57,970 --> 00:18:04,490 +يعني في three targets target الأول اللي هو الدائرة + +270 +00:18:04,490 --> 00:18:10,630 +أو القرص الأحمر في النصب بعدين الحلقة الزرقاء تحيط + +271 +00:18:10,630 --> 00:18:13,990 +فيه و بعدين الحلقة الحمراء شايف الحلقة الزرقاء + +272 +00:18:13,990 --> 00:18:19,910 +عندي يعني جاية بارزة كتير و الحلقة أو القرص الأحمر + +273 +00:18:19,910 --> 00:18:23,630 +و الحلقة الحمراء جايين لورا و كل ما الإنسان بعيد + +274 +00:18:23,630 --> 00:18:29,970 +أكتر عن ..الشاشة بيكون البروز اكتر لو غمضنا عيننا + +275 +00:18:29,970 --> 00:18:32,990 +احدى العين تانى مش مشكلة يمين او شمال هنلحظ ان + +276 +00:18:32,990 --> 00:18:38,270 +الصورة تماما افلات تماما افلات هنا ايضا مثال اخر + +277 +00:18:38,270 --> 00:18:42,790 +برضه واضح جدا برضه على قضية الاستريوبس باستعمال + +278 +00:18:42,790 --> 00:18:48,040 +عين تانى او باستعمال عين واحدةأيضا عندي مثال آخر، + +279 +00:18:48,040 --> 00:18:53,940 +هذه الرسمة لو نظرنا إليها بعين واحدة، هتكون flat + +280 +00:18:53,940 --> 00:18:58,690 +عن ناحيتين، الرسمتين، لو فتحنا عيننا كترتينهيكون + +281 +00:18:58,690 --> 00:19:02,090 +هنا ال heart .. هنا ال heart جاي لقدام .. هنا ال + +282 +00:19:02,090 --> 00:19:05,090 +heart جاي لورا .. هنا ال heart جاي لورا .. كلها + +283 +00:19:05,090 --> 00:19:08,950 +أمثلة على ال stereopsis أو ال depth perception ال + +284 +00:19:08,950 --> 00:19:13,750 +depth perception فهذه أمثلة على قضية ال stereopsis + +285 +00:19:13,750 --> 00:19:18,090 +الآن بدنا ننتقل لموضوع آخر هو ال sensory + +286 +00:19:18,090 --> 00:19:22,850 +perceptions ال sensory perceptions يعني الإحساسات + +287 +00:19:22,850 --> 00:19:28,430 +اللي بتصير عند الإنسان اللي كان عندهnormal + +288 +00:19:28,430 --> 00:19:32,570 +binocular single vision و فجأة صار عنده squint كان + +289 +00:19:32,570 --> 00:19:38,030 +عنده اليوم كان عنده عينيه straight مافيش اي مشكلة + +290 +00:19:38,030 --> 00:19:42,810 +مافيش اي حول و فجأة مثلا تاني يوم صار عنده sudden + +291 +00:19:42,810 --> 00:19:46,690 +onset of squint يا ترى ال sensation او ال + +292 +00:19:46,690 --> 00:19:50,170 +perceptions اللي بتصير عنده يعني ايش هيحس فيه ايش + +293 +00:19:50,170 --> 00:19:53,810 +هيحس فيه يعني في شغلات بيحس فيها لأنه صار عنده + +294 +00:19:53,810 --> 00:19:58,280 +الحول بشكل مفاجئقبل نقول إيش الإحساسات اللي بتصير + +295 +00:19:58,280 --> 00:20:07,340 +عند هذا الإنسان، بدنا نعطي تقدمة .. تقدمة أنه قضية + +296 +00:20:07,340 --> 00:20:14,060 +إنسان مثلا جالس بهدوء و فجأة يعني شعر أو .. أو إجا + +297 +00:20:14,060 --> 00:20:19,020 +إنسان بدبوس و يعني نخزه في إيده بهذا الدبوس + +298 +00:20:19,220 --> 00:20:24,340 +فبالتالي إذا نخز في إيده في هذا الدبوس فجأة هيكون + +299 +00:20:24,340 --> 00:20:27,360 +إيش ال response بتاعه أو الاستجابة بتاعه؟ هو هيشرد + +300 +00:20:27,360 --> 00:20:32,160 +إيده بشكل مفاجئ بعد هيك هيكون يشعر بالألم، بعد + +301 +00:20:32,160 --> 00:20:36,220 +شوية هيسكن الألم و ما إلى ذلك .. و ما إلى ذلك + +302 +00:20:36,220 --> 00:20:41,000 +فبالتالي هذه القضية ضروري جدا تكون واضحة .. ضروري + +303 +00:20:41,000 --> 00:20:47,240 +جدا تكون واضحةفيترى إيش الإحساسات اللى ممكن تصير + +304 +00:20:47,240 --> 00:20:51,140 +عند الإنسان لما يصير عنده onset of squint لما يبدأ + +305 +00:20:51,140 --> 00:20:54,740 +عنده قضية الحوادث at the onset of squint two + +306 +00:20:54,740 --> 00:20:58,500 +sensory perceptions arise based on the normal + +307 +00:20:58,500 --> 00:21:02,640 +projection of the retinal areas stimulated هذا + +308 +00:21:02,640 --> 00:21:06,820 +بيدعون إيه؟ إنه في عندي إحساسين هيصيروا بس ضروري + +309 +00:21:06,820 --> 00:21:11,790 +أتذكر ال visual directionضروري اتذكر ال normal + +310 +00:21:11,790 --> 00:21:16,330 +retinal correspondence ضروري اتذكر ال projection + +311 +00:21:16,330 --> 00:21:22,850 +ال projection ال visual direction انه في عندى نقاط + +312 +00:21:22,850 --> 00:21:27,370 +في شبكية كل عين و كل نقطة في الشبكية إلها اتجاه + +313 +00:21:27,370 --> 00:21:30,430 +معين في الفراعال .. ال .. ال retinal + +314 +00:21:30,430 --> 00:21:34,070 +correspondence أنه فيه عندي نقاط في شبكية العين ال + +315 +00:21:34,070 --> 00:21:38,130 +.. اليمين، إلها ما يماثلها في شبكية العين الشمال، + +316 +00:21:38,130 --> 00:21:41,270 +إيش يعني إلها ما يماثلها؟ يعني فيه corresponding + +317 +00:21:41,270 --> 00:21:43,850 +areas between the right retina and the left + +318 +00:21:43,850 --> 00:21:46,610 +retina، إيش يعني corresponding areas؟ يعني إلها + +319 +00:21:46,610 --> 00:21:50,290 +the same visual direction طيب، تالت إشي لـ + +320 +00:21:50,290 --> 00:21:53,990 +projection، أنه اللي صورته بتسقط على ال superior + +321 +00:21:53,990 --> 00:21:58,000 +retina، هينشف تحتواللي صورته بتسقط على ال inferior + +322 +00:21:58,000 --> 00:22:02,320 +retina، هينشافلة فوق، يعني هيعبر عنه الشخص أنه + +323 +00:22:02,320 --> 00:22:07,910 +شايفه فوقواللي بتسقط صورته على ال nasal retina + +324 +00:22:07,910 --> 00:22:11,610 +هينشف temporarily بالنسبة لهذه العين فضروري نتذكر + +325 +00:22:11,610 --> 00:22:15,890 +هذه الأشياء عشان نقدر نفسر الإحساسات اللي بتصير + +326 +00:22:15,890 --> 00:22:21,410 +معانا وهذا هنستعين بالرسم في توضيح هذه الفكرة اذا + +327 +00:22:21,410 --> 00:22:25,510 +at the onset of squint two sensory perceptions + +328 +00:22:25,510 --> 00:22:30,610 +ariseليش؟ لأن هذا بيعتمد على ال normal projection + +329 +00:22:30,610 --> 00:22:35,090 +of the retinal areas stimulated ليش؟ لأنه لما + +330 +00:22:35,090 --> 00:22:38,690 +بيصير عند الحوال بدل ما الصورة تسقط على ال fovea و + +331 +00:22:38,690 --> 00:22:41,170 +ال fovea في العنتين هتسقط على ال fovea في ال + +332 +00:22:41,170 --> 00:22:45,390 +straight eye بينما هتسقط على non-foveal area على + +333 +00:22:45,390 --> 00:22:49,590 +non-foveal area في ال squinting eye طيب هذه ال non + +334 +00:22:49,590 --> 00:22:52,710 +-foveal area نفرض أنها المنطقسية طب إيش اتجاهها في + +335 +00:22:52,710 --> 00:22:57,340 +الفراغ؟ حسب اتجاهها في الفراغ ممكن أناأشعر بإحساس + +336 +00:22:57,340 --> 00:23:01,520 +معين وهالجد هنحكي عنه these require simultaneous + +337 +00:23:01,520 --> 00:23:05,340 +visual perception بمعنى the ability to perceive + +338 +00:23:05,340 --> 00:23:09,120 +images from both eyes simultaneously عشان هدول + +339 +00:23:09,120 --> 00:23:12,720 +الإحساسين اللي هنحكي عنهم بعد شوية يصيروا عشان + +340 +00:23:12,720 --> 00:23:17,560 +يحدثوا لازم يكون الانتين قادرين على الالتقاط في + +341 +00:23:17,560 --> 00:23:23,640 +نفس اللحظة بمعنى آخر أحيانا بيصير squintوالدماغ + +342 +00:23:23,640 --> 00:23:28,120 +بيبطل يستقبل صورة من عين معينة من ال squinting eye + +343 +00:23:28,120 --> 00:23:32,720 +بشكل كامل مش هيصير أي نوع من الإحساسات هذا الإنسان + +344 +00:23:32,720 --> 00:23:36,460 +اتحول من binocular single vision ل monocular + +345 +00:23:36,460 --> 00:23:39,920 +single vision يعني بستعمل عينه ال straight في رؤية + +346 +00:23:39,920 --> 00:23:43,270 +الأهداف اللي بتطلع عليهاوالعين الـ squinting اللي + +347 +00:23:43,270 --> 00:23:46,650 +فيها حوال دماغ بطل استقبل منها صورة يعني عملها + +348 +00:23:46,650 --> 00:23:50,990 +subversion تثبيت لصورة بدوش منها صورة يعني كأنه + +349 +00:23:50,990 --> 00:23:54,050 +أوقفها على العمر رغم إنها مفتوحة و الناس بتشوفه + +350 +00:23:54,050 --> 00:23:57,930 +مفتة عينيتين تانيين ولكن و كأنها مغمضة يعني تعتبر + +351 +00:23:57,930 --> 00:24:01,390 +كأنها مغلق العين لأن الدماغ مابستقبلش منها هذا + +352 +00:24:01,390 --> 00:24:04,490 +الإنسان اللي .. اللي ماعندوش قدرة على الالتقاط + +353 +00:24:04,490 --> 00:24:09,550 +المتزامنمش هيحس بالإحساسين اللي هنحكي عنهم بعد .. + +354 +00:24:09,550 --> 00:24:15,790 +بعد شوية مثال آخر يعني بيوضح الصورة بشكل لا لبس + +355 +00:24:15,790 --> 00:24:21,570 +فيه إنسان عنده .. إنسان عمره مثلا ست .. ستين سنة + +356 +00:24:21,570 --> 00:24:25,790 +عنده mature cataract في ال right eye يعني عنده ميه + +357 +00:24:25,790 --> 00:24:29,870 +بيضه و مستوية و سادة تماما يعني ال .. الرؤية في ال + +358 +00:24:29,870 --> 00:24:33,150 +right eye مثلا hand motion و الرؤية في ال left eye + +359 +00:24:33,150 --> 00:24:37,720 +ستة ع ستة و صار عنده squintهل هيشكي من أي شعور؟ + +360 +00:24:37,720 --> 00:24:40,360 +لأ، لأن هذا الإنسان مش binocular single vision، هو + +361 +00:24:40,360 --> 00:24:43,340 +بالأساس monocular والعين التانية، لأنه فيها + +362 +00:24:43,340 --> 00:24:46,580 +cataract mature، cataract .. cataract ناضجة، + +363 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عنده حوال لابد + +375 +00:25:31,860 --> 00:25:35,200 +يكون عنده القدرة على استقبال صورتين صورة في العين + +376 +00:25:35,200 --> 00:25:38,340 +السليمة و صورة في العين اللي فيها الحوال يعني the + +377 +00:25:38,340 --> 00:25:42,000 +ability to perceive images from both eyes + +378 +00:25:42,000 --> 00:25:45,800 +simultaneously .. simultaneously المرة القادمة ان + +379 +00:25:45,800 --> 00:25:49,090 +شاء الله تعالى هنبدأ في الحكي عن ال confusionو ال + +380 +00:25:49,090 --> 00:25:52,030 +pathological deviation .. ال pathological diplopia + +381 +00:25:52,030 --> 00:25:55,350 +عفوا و يعطيكم العافية والسلام عليكم ورحمة الله + +382 +00:25:55,350 --> 00:25:56,310 +وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/cq1wlflMhsw_raw.json b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/cq1wlflMhsw_raw.json new file mode 100644 index 0000000000000000000000000000000000000000..5b2b8f61bfe8526ca9bf7e93d7c02428cc6c3f6c --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/cq1wlflMhsw_raw.json @@ -0,0 +1 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40799, "start": 401.23, "end": 407.99, "text": "بين تلت أنواع الحركة دكشنز وال virgins هذه virgins الصورتين اللي تحت virgins بينما هذه", "tokens": [3555, 9957, 6055, 1211, 2655, 14739, 14407, 3615, 21542, 31747, 3660, 11778, 4117, 8592, 1863, 11622, 16070, 4107, 23320, 29538, 4107, 23320, 31767, 13063, 2655, 9957, 13672, 1829, 6055, 33753, 4107, 23320, 49374, 15042, 29538], "avg_logprob": -0.283854173289405, "compression_ratio": 1.3047619047619048, "no_speech_prob": 1.0728836059570312e-05, "words": [{"start": 401.23, "end": 401.59, "word": "بين", "probability": 0.820556640625}, {"start": 401.59, "end": 402.11, "word": " تلت", "probability": 0.8743489583333334}, {"start": 402.11, "end": 402.45, "word": " أنواع", "probability": 0.9142252604166666}, {"start": 402.45, "end": 402.91, "word": " الحركة", "probability": 0.9541015625}, {"start": 402.91, "end": 403.61, "word": " دكشنز", "probability": 0.594384765625}, {"start": 403.61, "end": 404.11, "word": " وال", "probability": 0.5654296875}, 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مختلف بس احنا سايفين انه سواء بتطلع على ستة متر او بتطلع على تمانين صنطة او بتطلع على عشرين صنطة هذا عنده convergence insufficient عدم كفاية في ال convergence او ضعف في ال convergence فهدول الناس بيستفيدوا جدا من التمرين", "tokens": [3615, 23942, 6225, 46309, 9957, 20328, 1863, 9566, 3660, 32181, 32181, 307, 5171, 905, 1040, 46218, 717, 42068, 473, 37495, 22653, 18863, 9957, 25124, 2304, 6027, 11778, 3224, 6055, 32887, 5016, 15844, 2423, 32640, 9957, 4032, 18863, 9957, 2423, 32640, 9957, 11778, 3224, 6055, 32887, 5016, 15844, 25124, 2304, 6027, 1975, 2655, 7435, 40294, 21542, 31747, 3660, 9673, 5172, 32887, 11242, 7251, 30544, 3714, 46456, 46538, 4724, 3794, 1975, 5016, 8315, 8608, 995, 33911, 9957, 16472, 3224, 8608, 2407, 16606, 39894, 9566, 1211, 3615, 15844, 8608, 2655, 3660, 44650, 2288, 1975, 2407, 39894, 9566, 1211, 3615, 15844, 46811, 7649, 9957, 20328, 1863, 9566, 3660, 1975, 2407, 39894, 9566, 1211, 3615, 15844, 6225, 46309, 9957, 20328, 1863, 9566, 3660, 23758, 43242, 3224, 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سن الجلم إذا شاف سن الجلم مزدوج معناته لسه عنده convergence insufficiency بيحاول يوحد الصورتين في صورة واحدة يعني يدرب عينيه انها تعمل convergence", "tokens": [40228, 22653, 4724, 32640, 3794, 4117, 10874, 19528, 1975, 2288, 9381, 33546, 39894, 9566, 1211, 3615, 15844, 8608, 1863, 3224, 23032, 3555, 3615, 995, 15844, 1975, 2304, 2655, 3215, 18513, 11933, 25708, 3224, 4724, 32640, 3215, 11933, 25708, 3224, 15844, 6024, 95, 34740, 45030, 25708, 4032, 21292, 44510, 10721, 7251, 7435, 25513, 4386, 4032, 21292, 44510, 10721, 7251, 7435, 25513, 25724, 19528, 20666, 2655, 3215, 16572, 7435, 9154, 6225, 9957, 1829, 3224, 4032, 1829, 5016, 995, 12610, 7251, 31747, 11622, 8978, 8608, 1863, 25724, 19528, 11933, 15730, 13412, 31845, 8608, 1863, 25724, 19528, 3714, 11622, 3215, 29245, 20449, 8315, 47395, 5296, 3794, 3224, 43242, 3224, 32181, 1028, 1245, 42081, 4724, 1829, 5016, 995, 12610, 7251, 2407, 24401, 31767, 13063, 2655, 9957, 8978, 20328, 13063, 3660, 36764, 24401, 3660, 37495, 22653, 7251, 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+00:00:06,010 --> 00:00:12,070 +وحكينا إنه فيه diffusional variances اللي لها + +3 +00:00:12,070 --> 00:00:16,390 +amplitudes و هذه ال amplitudes كانت قياسة بواسطة + +4 +00:00:16,390 --> 00:00:20,310 +استعمال الprismات أو باستعمال جهاز ال sinoptophore + +5 +00:00:20,310 --> 00:00:27,050 +اللي هنحكي عنه في حين إذا تقاس diffusional + +6 +00:00:27,050 --> 00:00:29,950 +variances بواسطة + +7 +00:00:34,540 --> 00:00:37,440 +وقلنا فيه normal values ال convergence ال fusion + +8 +00:00:37,440 --> 00:00:40,380 +ال convergence ال fusion ال convergence من خمستاشر + +9 +00:00:40,380 --> 00:00:45,370 +لعشرين prism على ال distanceو 25 prism or more at + +10 +00:00:45,370 --> 00:00:50,870 +near و ال fusional divergence من 6 ل 10 prism at + +11 +00:00:50,870 --> 00:00:56,630 +distance و تقريبا من 12 ل 14 prism at near و حكينا + +12 +00:00:56,630 --> 00:00:59,870 +أن ال fusional divergence إليها همية كبيرة و قولنا + +13 +00:00:59,870 --> 00:01:03,710 +ال vertical divergence تقريبا من 2 ل 3 بتحمل + +14 +00:01:03,710 --> 00:01:06,850 +الإنسان vertical misalignment أو vertical + +15 +00:01:06,850 --> 00:01:10,700 +disparity of retinal imageو ال cyclovergence حسب + +16 +00:01:10,700 --> 00:01:13,440 +دراسات حديثة ممكن توصل ل تمانية degree و بيقولنا + +17 +00:01:13,440 --> 00:01:17,540 +هذه الأرقام قادمة .. هذه الأرقام قادمة طيب إيش + +18 +00:01:17,540 --> 00:01:21,080 +فائدة إن الإنسان يكون عنده fusional vergances؟ + +19 +00:01:21,080 --> 00:01:24,200 +fusional vergances يعني fusional convergence و + +20 +00:01:24,200 --> 00:01:27,500 +fusional divergence و fusional أو vertical + +21 +00:01:27,500 --> 00:01:31,720 +fusional vergance و cyclovergence إيش الفائدة؟ ال + +22 +00:01:31,720 --> 00:01:34,640 +fusional convergence .. ال fusional convergence + +23 +00:01:34,640 --> 00:01:39,320 +helps to control an exophoriaWhereas fusional + +24 +00:01:39,320 --> 00:01:42,920 +divergence helps to control an esophilia + +25 +00:01:47,190 --> 00:01:50,670 +نروح الصورة المكبرة هذا الإنسان عنده Exophoria + +26 +00:01:50,670 --> 00:01:55,570 +Exophoria يعني حوال خفي للخارج حوال خفي للخارج طب + +27 +00:01:55,570 --> 00:02:00,110 +لو صورنا إنه العين حاولت تروح للخارج و high target + +28 +00:02:00,110 --> 00:02:02,690 +هذا الإنسان بتطلع عليه هذا ال target اللي هو ال + +29 +00:02:02,690 --> 00:02:07,130 +face بيسقط على الفوفيا هنا في حالة لو زاغت العين + +30 +00:02:07,130 --> 00:02:11,930 +لو زاغت أو بدأت بالزوغان heterophoria Exophoria + +31 +00:02:11,930 --> 00:02:13,170 +باتجاه ال Exophoria + +32 +00:02:15,570 --> 00:02:18,630 +ساعتها الصورة هتسقط على temporal retina بدل ما + +33 +00:02:18,630 --> 00:02:22,370 +تسقط على الفوفيا هتسقط على temporal retina ومعروف + +34 +00:02:22,370 --> 00:02:25,490 +لما بتسقط الصورة على temporal retina هذا بيحفظ ال + +35 +00:02:25,490 --> 00:02:28,590 +fusional convergence فبتبدأ عملية ال fusional + +36 +00:02:28,590 --> 00:02:31,930 +convergence بيرجع ال exophoria بسيطر عليها و بيخلي + +37 +00:02:31,930 --> 00:02:35,170 +العين معتادلة بحيث تسقط الصورة على الفوفيا هنا زي + +38 +00:02:35,170 --> 00:02:41,130 +ما سقطت الصورة على الفوفيا في العين لشمال أيضا .. + +39 +00:02:41,130 --> 00:02:46,710 +أيضا لو صار عندى fusionalأو لو صار عندى esophoria + +40 +00:02:46,710 --> 00:02:51,050 +لو .. لو .. لو العكس تصورناها esophoria ساعتها + +41 +00:02:51,050 --> 00:02:54,610 +الصورة هتسقط على nasal retina هنا فحده هيعمل + +42 +00:02:54,610 --> 00:02:57,810 +stimulation لل fusional divergence إذا ال fusional + +43 +00:02:57,810 --> 00:03:03,370 +convergence .. ال fusional convergence بيسيطرلي + +44 +00:03:03,370 --> 00:03:07,270 +على ال exophoria convergence عكس ال exophoria + +45 +00:03:07,270 --> 00:03:11,450 +بعكسها يعني بمعنى آخر بيسيطر عليها بيدخل العين لل + +46 +00:03:11,450 --> 00:03:15,970 +straight ahead positionو الـ fusional divergence + +47 +00:03:15,970 --> 00:03:22,890 +بيعمل control للإيزو فوريا طيب، هل ال fusional + +48 +00:03:22,890 --> 00:03:25,870 +divergence amplitude هذه الأرقام اللي عرضناها قبل + +49 +00:03:25,870 --> 00:03:32,110 +شويةهل هي أرقام ثابتة و لا قابلة للتغيير؟ حقيقة هي + +50 +00:03:32,110 --> 00:03:36,410 +أرقام يعني متغيرة أرقام متغيرة بنقول the fusional + +51 +00:03:36,410 --> 00:03:39,390 +divergence mechanism may be decreased by fatigue + +52 +00:03:39,390 --> 00:03:43,270 +or illness converting aphoria to atropia يعني ال + +53 +00:03:43,270 --> 00:03:46,270 +fusional convergence و ال fusional divergence و ال + +54 +00:03:46,270 --> 00:03:49,510 +vertical divergence و ال cyclovergence تحت ظروف + +55 +00:03:49,510 --> 00:03:53,870 +الإرهاق اللي هو الفتيق أو ال illness اللي هو المرض + +56 +00:03:53,870 --> 00:04:03,030 +ممكناتجل بيمةتجيل قيمة وبالتالي بيبطل او بيقدرش ال + +57 +00:04:03,030 --> 00:04:06,250 +fusion convergence يسيطر على ال exofuria و ال + +58 +00:04:06,250 --> 00:04:09,190 +fusion divergence بيقدرش يسيطر على ال exofuria و + +59 +00:04:09,190 --> 00:04:13,290 +اها كذا اذا لما بيكون في انديفوريا غير مسيطر عليها + +60 +00:04:13,290 --> 00:04:17,670 +بتبدأ تظهر فببدأ اسميها انا اتروبيا بدل فوريا + +61 +00:04:17,670 --> 00:04:20,830 +اتروبيا بدل فوريا لان اتروبيا هي الحوالي الظاهر و + +62 +00:04:20,830 --> 00:04:24,350 +الفوريا هي الحوالي الخفي خفي ليش لانه مسيطر عليه + +63 +00:04:24,350 --> 00:04:27,830 +بواسطة ال fusion convergence بواسطة ال fusion + +64 +00:04:27,830 --> 00:04:31,830 +convergenceطيب، إذن هذه في حالات ال illness وفي + +65 +00:04:31,830 --> 00:04:35,770 +حالات الفتيق بتضعف ال fusional mechanisms اللي هي + +66 +00:04:35,770 --> 00:04:38,310 +ال fusional convergence و ال fusional divergence و + +67 +00:04:38,310 --> 00:04:41,050 +ال vertical divergence و ال cyclovergence بيضعفوا + +68 +00:04:41,050 --> 00:04:45,030 +فبتتحول الفوريا لتروبيا لأنه مافيش سيطرة عليها من + +69 +00:04:45,030 --> 00:04:51,410 +قبل الدماغ عشان يتحكم في عضلات العلمهل ممكن تزيد + +70 +00:04:51,410 --> 00:04:55,230 +هذه الأرقام أو تتحسن؟ The amplitude of fusional + +71 +00:04:55,230 --> 00:04:58,670 +divergence mechanisms can be improved by orthoptic + +72 +00:04:58,670 --> 00:05:02,710 +exercises, particularly in the case of near + +73 +00:05:02,710 --> 00:05:05,510 +-fusional convergence for the relief of + +74 +00:05:05,510 --> 00:05:09,150 +convergence insufficiency ممكن هذه ال fusional + +75 +00:05:09,150 --> 00:05:11,910 +divergence mechanisms أو ال fusional amplitudes + +76 +00:05:13,100 --> 00:05:16,800 +تتحسن بالـ orthoptic exercises بالتمارين البصرية + +77 +00:05:16,800 --> 00:05:21,080 +في تمارين بصرية خاصة في هذا المجال و بالذات بيكون + +78 +00:05:21,080 --> 00:05:23,740 +مفيدة التمارين البصرية في حالة ال convergence + +79 +00:05:23,740 --> 00:05:27,440 +insufficiency اللي هي عدم كفاية عملية ال + +80 +00:05:27,440 --> 00:05:29,920 +convergence يعني ضعف ال convergence زي ما السورة + +81 +00:05:29,920 --> 00:05:35,760 +الآن هنعرضها بنقول هذا إنسان at rest at rest يعني + +82 +00:05:35,760 --> 00:05:40,340 +بتطلع على target بعيد مثلا 6 متر أو أكتر من 6 متر + +83 +00:05:40,340 --> 00:05:44,490 +العينين straight زي ما انتوا شايفينهالعينين + +84 +00:05:44,490 --> 00:05:47,670 +straight زي ما انتوا شايفينها الان حطينا target + +85 +00:05:47,670 --> 00:05:52,970 +عليه او امام عينيه عبقر 80 cm برضه لازالت العينين + +86 +00:05:52,970 --> 00:05:57,710 +م centra .. central يعني ما اتحركت لجوه ال target + +87 +00:05:57,710 --> 00:06:01,690 +بدل ما كان ع 6 متر صار عبقر 80 cm اقل من 1 متر + +88 +00:06:01,690 --> 00:06:04,130 +المفروض العينيه تبدأ تدخل لجوه تعمل convergence + +89 +00:06:04,130 --> 00:06:08,710 +طيب قلنا بنجرب ال target اكتر خلينا ال target على + +90 +00:06:08,710 --> 00:06:12,650 +20 cm لازلت العين ما اتحركت من هنافهذه القضية + +91 +00:06:12,650 --> 00:06:16,430 +بيسميها convergence insufficiency يعني عدم كفاية + +92 +00:06:16,430 --> 00:06:18,410 +في ال convergence ممكن الإنسان يقول لأ ممكن هو + +93 +00:06:18,410 --> 00:06:20,590 +عنده مشكلة في ال media rectus هنا و في ال media + +94 +00:06:20,590 --> 00:06:23,350 +rectus هنا عشان هيك يعني مش قضية convergence + +95 +00:06:23,350 --> 00:06:25,770 +insufficiency بيقولوا لأ ال media rectus شغالة لما + +96 +00:06:25,770 --> 00:06:29,710 +بتطلع على اليمين ال left media rectus شغالة لما + +97 +00:06:29,710 --> 00:06:33,070 +بتطلع على الشمال ال right media rectus شغالة إذا + +98 +00:06:33,070 --> 00:06:36,730 +المشكلة مش في العضلات آلية ال convergence عنده + +99 +00:06:36,730 --> 00:06:40,130 +ضعيفة آلية ال convergence ضعيفة وقولنا احنا لازم + +100 +00:06:40,130 --> 00:06:44,930 +نفرجبين تلت أنواع الحركة دكشنز وال virgins هذه + +101 +00:06:44,930 --> 00:06:49,010 +virgins الصورتين اللي تحت virgins بينما هذهعلى + +102 +00:06:49,010 --> 00:06:52,410 +عشرين صنطة convergence convergence is binocular + +103 +00:06:52,410 --> 00:06:56,550 +simultaneous disjugate يعني العين الشمال ده تروح + +104 +00:06:56,550 --> 00:06:58,550 +على اليمين و العين اليمين ده تروح على الشمال اتجاه + +105 +00:06:58,550 --> 00:07:01,610 +الحركة المفروض يكون مختلف بس احنا سايفين انه سواء + +106 +00:07:01,610 --> 00:07:04,190 +بتطلع على ستة متر او بتطلع على تمانين صنطة او + +107 +00:07:04,190 --> 00:07:06,870 +بتطلع على عشرين صنطة هذا عنده convergence + +108 +00:07:06,870 --> 00:07:10,370 +insufficient عدم كفاية في ال convergence او ضعف في + +109 +00:07:10,370 --> 00:07:13,250 +ال convergence فهدول الناس بيستفيدوا جدا من + +110 +00:07:13,250 --> 00:07:17,390 +التمرينالبصرية لتقوية الفيوجينال convergence + +111 +00:07:17,390 --> 00:07:21,450 +لتقوية الفيوجينال convergence لتقوية الفيوجينال + +112 +00:07:21,450 --> 00:07:25,790 +convergence وبالتالي هذه القضية من ضمن التمارين + +113 +00:07:25,790 --> 00:07:30,630 +البصرية في حد يسموها ال pencil push upيعني بيمسك + +114 +00:07:30,630 --> 00:07:34,110 +جلم ارصاص بتطلع على سنه طبعا على امتداد إيده بيمد + +115 +00:07:34,110 --> 00:07:38,130 +إيده على الآخر بعيد وبيبدأ يجرب .. وبيبدأ يجرب + +116 +00:07:38,130 --> 00:07:44,070 +الجلم بالتدريج من عينيه ويحاول يركز في سن الجلم + +117 +00:07:44,070 --> 00:07:47,990 +إذا شاف سن الجلم مزدوج معناته لسه عنده convergence + +118 +00:07:47,990 --> 00:07:51,290 +insufficiency بيحاول يوحد الصورتين في صورة واحدة + +119 +00:07:51,290 --> 00:07:55,350 +يعني يدرب عينيه انها تعمل convergenceطبعا في + +120 +00:07:55,350 --> 00:07:58,750 +المراكز الطبية اللي .. اللي بتشتغل على موضوع + +121 +00:07:58,750 --> 00:08:01,670 +العلاج البصري في ممكن بدل ال pins ال push up اللي + +122 +00:08:01,670 --> 00:08:04,570 +ممكن تنعمل في البيت في حاجة بيسموها ال procstring + +123 +00:08:05,590 --> 00:08:09,510 +هذا عبارة عن حبل وفيه كورات ملونة على مسافات + +124 +00:08:09,510 --> 00:08:12,930 +متباعدة أول إشي بيبدأ يتطلع الكورة لبعيدة كتير + +125 +00:08:12,930 --> 00:08:16,490 +ويحاول يركز فيها إذا زهرت مزدوجة بيحاول يعمل + +126 +00:08:16,490 --> 00:08:20,150 +convergence يعني يوحد الصورتين في صورة واحدة + +127 +00:08:20,150 --> 00:08:25,190 +تلقائيًا هيبدأ ال convergence يتفعل إذا استطاع ذلك + +128 +00:08:25,190 --> 00:08:28,310 +بيبدأ يتطلع الكورة الأقرب منها يعني هو كل ما + +129 +00:08:28,310 --> 00:08:31,910 +بيقترب كورة مسافة كورة فبالتالي ال convergence + +130 +00:08:31,910 --> 00:08:35,770 +عنده قاعد بيتدرب وبيحاول يعملconvergence وهذه + +131 +00:08:35,770 --> 00:08:38,930 +القضية تتكرر يوميا لما يتحسن عنده ال convergence + +132 +00:08:38,930 --> 00:08:42,030 +طبعا في وسائل كتيرة للتمارين البصرية بس هدولا + +133 +00:08:42,030 --> 00:08:48,290 +مثالين بسيطين اذا تقوية .. تقوية ال fusional + +134 +00:08:48,290 --> 00:08:51,490 +convergence mechanisms can be done by أو can be + +135 +00:08:51,490 --> 00:08:55,230 +improved by orthoptic exercise و بالذات في حالة ال + +136 +00:08:55,230 --> 00:08:58,460 +convergence insufficiencyزي ما احنا عرضنا هذا + +137 +00:08:58,460 --> 00:09:01,980 +المريض أمامكم عنده convergence insufficiency فهذا + +138 +00:09:01,980 --> 00:09:06,740 +بيستفيد جدا من قضية ال orthoptic exercises زي ما + +139 +00:09:06,740 --> 00:09:10,380 +هو معروض عندنا في الصور اللي .. اللي .. اللي .. + +140 +00:09:10,380 --> 00:09:15,560 +يعني انتوا شايفينها لل broke string و ال pencil + +141 +00:09:15,560 --> 00:09:19,160 +push ups ال pencil .. ال pencil push ups نيجي + +142 +00:09:19,160 --> 00:09:25,520 +لموضوع جديد هو ال stereopsis حقيقة ال stereopsisهو + +143 +00:09:25,520 --> 00:09:29,000 +نهاية المطاف بالنسبة لل binocular single vision ال + +144 +00:09:29,000 --> 00:09:32,380 +binocular single vision بيمور بتلت مراحل رئيسية + +145 +00:09:32,380 --> 00:09:35,400 +المرحلة الأولى الرئيسية اللى بيسموها simultaneous + +146 +00:09:35,400 --> 00:09:39,760 +perception الالتقاط المتزامن يعني العين اليمين أو + +147 +00:09:39,760 --> 00:09:43,560 +شبكية العين اليمين التقطت .. التقطت صورة في نفس + +148 +00:09:43,560 --> 00:09:47,500 +اللحظة شبكية العين الشمال تقطت نفس الصورة يعني + +149 +00:09:47,500 --> 00:09:51,760 +صورة نفس الجسملو في التقاط غير متزامن يعني العين + +150 +00:09:51,760 --> 00:09:55,340 +اليمين التقطت الصورة و بعد مثلا دقيقة او دقيقتين و + +151 +00:09:55,340 --> 00:09:57,600 +العين الشمال التقطت نفس الصورة مافيش حاجة مافيش + +152 +00:09:57,600 --> 00:10:01,380 +كلام عن binocular single vision لأن في عين التقطت + +153 +00:10:01,380 --> 00:10:04,920 +و العين التانية لسه مالتقطتش اذا اول مرحلة لازم + +154 +00:10:04,920 --> 00:10:08,440 +يصير التقاط متزامن في نفس اللحظة ال two eyes + +155 +00:10:08,440 --> 00:10:14,680 +captured يعني صورت او التقطت يعني image لنفس ال + +156 +00:10:14,680 --> 00:10:19,510 +object هذه المرحلة الأولى المرحلة التانيةدمج + +157 +00:10:19,510 --> 00:10:22,670 +الصورتين في صورة واحدة يعني بدل ما اتكون عندي + +158 +00:10:22,670 --> 00:10:26,850 +صورتين ارسلوا للدماغ الدماغ دمجهم في صورة واحدة + +159 +00:10:26,850 --> 00:10:30,550 +الان المرحلة التالتة والاخيرة ان الدماغ بدوا + +160 +00:10:30,550 --> 00:10:35,090 +يستشعر البعد التالث لهدول الصورتين لان هم وصلوا من + +161 +00:10:35,090 --> 00:10:40,290 +ال two retina وصلوا ثنائيات الأبعاد ممكن يقولوا لأ + +162 +00:10:40,290 --> 00:10:44,350 +يعني هي الصورة من الأساس ثلاثيت الأبعاد بنقوله ال + +163 +00:10:44,350 --> 00:10:50,590 +retinaالريتينة في أي من الانتين الريتينةلو .. لو + +164 +00:10:50,590 --> 00:10:56,490 +الصورة بتتكون ثلاثية الأبعاد في جلب العين كان + +165 +00:10:56,490 --> 00:10:59,550 +هيكون عندي بعدين على الشبكية و البعد التالت أما في + +166 +00:10:59,550 --> 00:11:03,070 +ال vitreous أو إذا كان هو hypermetroid ممكن يكون + +167 +00:11:03,070 --> 00:11:08,110 +مثلا ورا العين فبالتالي ضروري الصورة تلتقط بالوسط + +168 +00:11:08,110 --> 00:11:12,570 +الشبكية ثنائية الأبعاد و الدماغ هيفهم البعد التالت + +169 +00:11:12,570 --> 00:11:18,620 +بطريقة أنه ..هذه كامرة التقاط وهذه كامرة التقاط + +170 +00:11:18,620 --> 00:11:23,760 +هذه موقع في الفراغ وهذه موقع مختلف عنه في الفراغ + +171 +00:11:23,760 --> 00:11:27,340 +المسافة بين العينين اللي هو الـ Inter pupillary + +172 +00:11:27,340 --> 00:11:31,340 +distance يعني كأنها هي المسافة في الفراغ يعني هذه + +173 +00:11:31,340 --> 00:11:33,780 +لها موقع العين اليمين في الفراغ وهذه لها موقع + +174 +00:11:33,780 --> 00:11:37,800 +مختلف عنه إذا هذه ستصور ال target من جهة وهذه + +175 +00:11:37,800 --> 00:11:41,060 +ستصور ال target من جهة تختلف قليلا عنه هذا + +176 +00:11:41,060 --> 00:11:44,700 +الاختلاف البسيط في زاوية التصويرهذا الإختلاف + +177 +00:11:44,700 --> 00:11:48,880 +البسيط في زاوية التصوير بيستخدم الدماغ عشان يفهم + +178 +00:11:48,880 --> 00:11:53,840 +البعد التالت اللي هو البعد .. العمق بتاع الصورة أو + +179 +00:11:53,840 --> 00:11:57,980 +ال depth بتاع الصورة .. بتاع الصورة فبنقول + +180 +00:11:57,980 --> 00:12:03,240 +stereopsis is the perception of depth the third + +181 +00:12:03,240 --> 00:12:07,470 +dimensionطيب ال first two dimensions اللي هو + +182 +00:12:07,470 --> 00:12:12,250 +الأطوار الأول والتاني هو ال height و ال width يعني + +183 +00:12:12,250 --> 00:12:16,490 +هو ارتفاع الجسم اللي أنا بتطلع عليه و عرضه و تالت + +184 +00:12:16,490 --> 00:12:20,470 +.. البعد التالت اللي هو العمق بتاع هذا الجسم .. + +185 +00:12:20,470 --> 00:12:25,900 +العمق بتاع هذا الجسمتحدث عندما الوضع خلف ومقابل + +186 +00:12:25,900 --> 00:12:29,780 +نقطة المقبضة، ولكن داخل الوضع الانفجاري الانفجاري + +187 +00:12:29,780 --> 00:12:32,620 +تشغّل المواصفات الانفجارية الانفجارية تشغّل + +188 +00:12:32,620 --> 00:12:34,360 +المواصفات الانفجارية تشغّل المواصفات الانفجارية + +189 +00:12:34,360 --> 00:12:35,240 +تشغل المواصفات الانفجارية تشغل المواصفات + +190 +00:12:35,240 --> 00:12:36,060 +الانفجارية تشغل المواصفات الانفجارية تشغل + +191 +00:12:36,060 --> 00:12:38,000 +المواصفات الانفجارية تشغل المواصفات الانفجارية + +192 +00:12:38,000 --> 00:12:42,000 +تشغل المواصفات الانفجارية تشغل المواصفات + +193 +00:12:42,000 --> 00:12:45,100 +الانفجارية تشغل المواصفات الانفجارية تشغلa solid + +194 +00:12:45,100 --> 00:12:47,660 +object is seen stereoscopically in three + +195 +00:12:47,660 --> 00:12:50,900 +dimensions because each eye sees a slightly + +196 +00:12:50,900 --> 00:12:54,940 +different aspect of the object وهنا بيت القصيدة + +197 +00:12:54,940 --> 00:13:00,500 +لأنه كل عين بتشوف زاوية مختلفة من الجسم هذا بيقدر + +198 +00:13:00,500 --> 00:13:04,320 +إلى أن الدماغ يستخدم اختلاف البسيط هذا في زاوية + +199 +00:13:04,320 --> 00:13:08,480 +التصوير في الإحساس بالعمق أو البعد التالت اللي هو + +200 +00:13:08,480 --> 00:13:12,560 +ال three dimensions فبالتالي هذه القضية بتوضح في + +201 +00:13:12,560 --> 00:13:17,060 +الرسمة التالتةهي العين تين بتطلع على هذا المكعب أو + +202 +00:13:17,060 --> 00:13:22,320 +هذا الصندوق العين الشمال شايف الصورة بالشكل هذا ان + +203 +00:13:22,320 --> 00:13:25,720 +طبعت الصورة عندها بالشكل هذا والعين اليمين طبعت + +204 +00:13:25,720 --> 00:13:29,560 +الصورة بالشكل هذا وواضح أنه في اختلاف يعني مثلا لو + +205 +00:13:29,560 --> 00:13:34,980 +جينا احنا على اللون الأخضر الفاتح هذا هنلاقي أن + +206 +00:13:34,980 --> 00:13:38,300 +حجمه بالنسبة للعين اليمين على ال retina في العين + +207 +00:13:38,300 --> 00:13:43,220 +اليمين أكبر من حجمه قليلا بالنسبة للعين الشمالعلى + +208 +00:13:43,220 --> 00:13:48,100 +العكس اللون الزهري، الوجه الزهري للمكعب أو للصندوق + +209 +00:13:48,100 --> 00:13:52,080 +صورته على ال retina في العين الشمال أكبر من صورته + +210 +00:13:52,080 --> 00:13:55,640 +على ال retina في العين اليمين هذا الاختلاف في + +211 +00:13:55,640 --> 00:14:00,440 +الصورتين، الدماغ بيستخدمه عشان يفهم العمق بتاع هذا + +212 +00:14:00,440 --> 00:14:06,160 +المكعبالفكرة وهذه هي الفكرة هذا هو لو حطينا الصورة + +213 +00:14:06,160 --> 00:14:08,920 +تحت العين اليمين احنا طبقناها على الصورة تحت العين + +214 +00:14:08,920 --> 00:14:13,020 +الشمال تطبيق مباشر هنلاقي انه في disparity وكأنه + +215 +00:14:13,020 --> 00:14:20,770 +يعني الشيئين مش جايين على بعض انه في يعنيإشكالية + +216 +00:14:20,770 --> 00:14:24,710 +بينهم أو في retinal disparity مش منطبقين أو مش + +217 +00:14:24,710 --> 00:14:28,870 +جايين تماما على corresponding retinal areas فهذه + +218 +00:14:28,870 --> 00:14:32,810 +القضية بتحفظ الدماغ أنه يعدل وضعيته لينه أثناء + +219 +00:14:32,810 --> 00:14:42,450 +التعديل هذا الإلتقاط المختلف قليلا بيستخدم للشعور + +220 +00:14:42,450 --> 00:14:49,440 +بالعمل للشعور بالعمل هنا إنبعض الأشياء اللي هي + +221 +00:14:49,440 --> 00:14:53,880 +very interesting .. very interesting هذه بتوضحلي + +222 +00:14:53,880 --> 00:14:58,800 +قضية الاستليبسس، الآن هاي شكل عيندي، لو احنا نظرنا + +223 +00:14:58,800 --> 00:15:04,200 +لهذا الشكل بالعينتين، هنلاقي انه فيه لون يعنيأعمق + +224 +00:15:04,200 --> 00:15:07,280 +من اللون يعني جاي لورا مقارنة مع اللون التاني + +225 +00:15:07,280 --> 00:15:11,540 +بالنسبة إلي أنا و هقول ليش أنا بحكي بالنسبة إلي + +226 +00:15:11,540 --> 00:15:15,500 +أنا شايف اللون الأحمر داخل لجوا و اللون الأزرق جاي + +227 +00:15:15,500 --> 00:15:20,160 +لجدام تقريبا أكتر منه بواحد centimeter و كل ما + +228 +00:15:20,160 --> 00:15:23,540 +بععدنا أكتر .. كل ما بععدنا أكتر عن شاشة ال + +229 +00:15:23,540 --> 00:15:28,200 +computer أو شاشة ال laptop بتلاحظ الفرق أو العمق + +230 +00:15:28,200 --> 00:15:32,140 +بظهر أكترمش هنا بيت القصيد فقط عشان نفهم كيف احنا + +231 +00:15:32,140 --> 00:15:36,640 +بنشوف صورة ثلاثية الأبعاد أو الشكل الثلاثي الأبعاد + +232 +00:15:36,640 --> 00:15:39,900 +لو غمضنا عين واحدة من العينتين هلاجي الصورة flat + +233 +00:15:39,900 --> 00:15:43,060 +تماما فاش لون بيتميز عن اللون كلهم على نفس ال + +234 +00:15:43,060 --> 00:15:47,080 +level طيب لو جربنا غمضنا العين التانية نفس القضية + +235 +00:15:47,080 --> 00:15:51,830 +مافي اي اختلاف لو فتحنا العينتينلأن كل عين بتلتقط + +236 +00:15:51,830 --> 00:15:55,570 +من زاوية معينة هذا الاختلاف البسيط بيشعرنا بالعمق + +237 +00:15:55,570 --> 00:15:59,890 +كل ما بعدنا عن سطح الشاشة يعني هنلاقي أن العمق + +238 +00:15:59,890 --> 00:16:04,470 +بيزداد العمق اللي بيزداد هذا هو يعني مثال على ال + +239 +00:16:04,470 --> 00:16:09,710 +stereopsis أو الشعور بالبعد التالت وهو ضروري نفهم + +240 +00:16:09,710 --> 00:16:12,690 +أنه binocular function binocular function مافيش + +241 +00:16:12,690 --> 00:16:16,150 +حاجة اسمة stereopsis بعين واحدة الدليل لأن هذا + +242 +00:16:16,150 --> 00:16:18,830 +المنظر اللي أمامنا لو غمضنا عيننا مرة تانية هنلاقي + +243 +00:16:18,830 --> 00:16:22,250 +أن الصورة flatلو غمضنا العين التانية برضه الصورة + +244 +00:16:22,250 --> 00:16:25,250 +flat أمتى بنشعر أنه في عمق للصورة و أنه اللون + +245 +00:16:25,250 --> 00:16:28,350 +الأزرق بيختلف عن اللون الأحمر أنا بالنسبة إيه + +246 +00:16:28,350 --> 00:16:31,750 +اللون الأحمر جاي لجوا و اللون الأزرق جاي باتجاهي + +247 +00:16:31,750 --> 00:16:35,630 +أكتر يعني طالع أكتر أو بارز أكتر باتجاهي ممكن + +248 +00:16:35,630 --> 00:16:38,450 +الميوبي يشوف العكس الإنسان اللي عنده ميوبيا ممكن + +249 +00:16:38,450 --> 00:16:41,170 +يشوف اللون الأحمر لإن الميوبيا اللون الأحمر + +250 +00:16:41,170 --> 00:16:45,910 +بالنسبة له أوطح يعني ممكن .. بس المهم أنه هيشوف في + +251 +00:16:45,910 --> 00:16:52,340 +عمق للصورة نشوف مثال تاني على ذلكهيقن احنارسمتين + +252 +00:16:52,340 --> 00:16:56,420 +برضه، هدول الرسمتين يعني بيعطوا impression أو شعور + +253 +00:16:56,420 --> 00:17:00,520 +بيه الأبعاد الثلاثية طبعا في الرسمة الأولى اللي هي + +254 +00:17:00,520 --> 00:17:03,720 +على اليمين بالنسبة لي أنا اللون الأسودة الدائرة + +255 +00:17:03,720 --> 00:17:07,900 +السودة اللي مخربش هذه جاية لقدام و المحيط اللي + +256 +00:17:07,900 --> 00:17:12,380 +باللون الأزرق جاية لورا هنا العكس الدائرة السودة + +257 +00:17:12,380 --> 00:17:16,660 +جاية لورا و الدائرة البيضامة الحمرة هذه الخرابيش + +258 +00:17:16,660 --> 00:17:19,440 +البيضامة اللي هي المحيط ال periphery جاية لقدام + +259 +00:17:19,650 --> 00:17:23,510 +الان لما بغمض عين كل الصورتين flat لما بغمض العين + +260 +00:17:23,510 --> 00:17:26,770 +التانية برضه كل الصورتين flat وبالتالي لما بفتح + +261 +00:17:26,770 --> 00:17:30,130 +عيني التنتين بأشعر بال stereopsis بأشعر بال + +262 +00:17:30,130 --> 00:17:34,470 +stereopsis ميزال اخر على ذلك ايضا هذه القضية لو + +263 +00:17:34,470 --> 00:17:37,690 +بعدنا شوية هنلاقي انه فيه لون بارز اللي هو اللون + +264 +00:17:37,690 --> 00:17:41,450 +الأسود ال periphery و اللون الأحمر جاي لجوا ممكن + +265 +00:17:41,450 --> 00:17:44,970 +انسان يشعر فيهم العكس بس انا هي كده شايفهم الآن لو + +266 +00:17:44,970 --> 00:17:48,270 +غمضنا عين من عيننا التنتين هتكون تماما flat الصورة + +267 +00:17:48,270 --> 00:17:51,520 +لو غمضنا التانيةوفتحنا العين الأولى برضه هتكون + +268 +00:17:51,520 --> 00:17:57,970 +flat وممكن كل واحد فينا يجرب هذه القضية بنفسههنا + +269 +00:17:57,970 --> 00:18:04,490 +يعني في three targets target الأول اللي هو الدائرة + +270 +00:18:04,490 --> 00:18:10,630 +أو القرص الأحمر في النصب بعدين الحلقة الزرقاء تحيط + +271 +00:18:10,630 --> 00:18:13,990 +فيه و بعدين الحلقة الحمراء شايف الحلقة الزرقاء + +272 +00:18:13,990 --> 00:18:19,910 +عندي يعني جاية بارزة كتير و الحلقة أو القرص الأحمر + +273 +00:18:19,910 --> 00:18:23,630 +و الحلقة الحمراء جايين لورا و كل ما الإنسان بعيد + +274 +00:18:23,630 --> 00:18:29,970 +أكتر عن ..الشاشة بيكون البروز اكتر لو غمضنا عيننا + +275 +00:18:29,970 --> 00:18:32,990 +احدى العين تانى مش مشكلة يمين او شمال هنلحظ ان + +276 +00:18:32,990 --> 00:18:38,270 +الصورة تماما افلات تماما افلات هنا ايضا مثال اخر + +277 +00:18:38,270 --> 00:18:42,790 +برضه واضح جدا برضه على قضية الاستريوبس باستعمال + +278 +00:18:42,790 --> 00:18:48,040 +عين تانى او باستعمال عين واحدةأيضا عندي مثال آخر، + +279 +00:18:48,040 --> 00:18:53,940 +هذه الرسمة لو نظرنا إليها بعين واحدة، هتكون flat + +280 +00:18:53,940 --> 00:18:58,690 +عن ناحيتين، الرسمتين، لو فتحنا عيننا كترتينهيكون + +281 +00:18:58,690 --> 00:19:02,090 +هنا ال heart .. هنا ال heart جاي لقدام .. هنا ال + +282 +00:19:02,090 --> 00:19:05,090 +heart جاي لورا .. هنا ال heart جاي لورا .. كلها + +283 +00:19:05,090 --> 00:19:08,950 +أمثلة على ال stereopsis أو ال depth perception ال + +284 +00:19:08,950 --> 00:19:13,750 +depth perception فهذه أمثلة على قضية ال stereopsis + +285 +00:19:13,750 --> 00:19:18,090 +الآن بدنا ننتقل لموضوع آخر هو ال sensory + +286 +00:19:18,090 --> 00:19:22,850 +perceptions ال sensory perceptions يعني الإحساسات + +287 +00:19:22,850 --> 00:19:28,430 +اللي بتصير عند الإنسان اللي كان عندهnormal + +288 +00:19:28,430 --> 00:19:32,570 +binocular single vision و فجأة صار عنده squint كان + +289 +00:19:32,570 --> 00:19:38,030 +عنده اليوم كان عنده عينيه straight مافيش اي مشكلة + +290 +00:19:38,030 --> 00:19:42,810 +مافيش اي حول و فجأة مثلا تاني يوم صار عنده sudden + +291 +00:19:42,810 --> 00:19:46,690 +onset of squint يا ترى ال sensation او ال + +292 +00:19:46,690 --> 00:19:50,170 +perceptions اللي بتصير عنده يعني ايش هيحس فيه ايش + +293 +00:19:50,170 --> 00:19:53,810 +هيحس فيه يعني في شغلات بيحس فيها لأنه صار عنده + +294 +00:19:53,810 --> 00:19:58,280 +الحول بشكل مفاجئقبل نقول إيش الإحساسات اللي بتصير + +295 +00:19:58,280 --> 00:20:07,340 +عند هذا الإنسان، بدنا نعطي تقدمة .. تقدمة أنه قضية + +296 +00:20:07,340 --> 00:20:14,060 +إنسان مثلا جالس بهدوء و فجأة يعني شعر أو .. أو إجا + +297 +00:20:14,060 --> 00:20:19,020 +إنسان بدبوس و يعني نخزه في إيده بهذا الدبوس + +298 +00:20:19,220 --> 00:20:24,340 +فبالتالي إذا نخز في إيده في هذا الدبوس فجأة هيكون + +299 +00:20:24,340 --> 00:20:27,360 +إيش ال response بتاعه أو الاستجابة بتاعه؟ هو هيشرد + +300 +00:20:27,360 --> 00:20:32,160 +إيده بشكل مفاجئ بعد هيك هيكون يشعر بالألم، بعد + +301 +00:20:32,160 --> 00:20:36,220 +شوية هيسكن الألم و ما إلى ذلك .. و ما إلى ذلك + +302 +00:20:36,220 --> 00:20:41,000 +فبالتالي هذه القضية ضروري جدا تكون واضحة .. ضروري + +303 +00:20:41,000 --> 00:20:47,240 +جدا تكون واضحةفيترى إيش الإحساسات اللى ممكن تصير + +304 +00:20:47,240 --> 00:20:51,140 +عند الإنسان لما يصير عنده onset of squint لما يبدأ + +305 +00:20:51,140 --> 00:20:54,740 +عنده قضية الحوادث at the onset of squint two + +306 +00:20:54,740 --> 00:20:58,500 +sensory perceptions arise based on the normal + +307 +00:20:58,500 --> 00:21:02,640 +projection of the retinal areas stimulated هذا + +308 +00:21:02,640 --> 00:21:06,820 +بيدعون إيه؟ إنه في عندي إحساسين هيصيروا بس ضروري + +309 +00:21:06,820 --> 00:21:11,790 +أتذكر ال visual directionضروري اتذكر ال normal + +310 +00:21:11,790 --> 00:21:16,330 +retinal correspondence ضروري اتذكر ال projection + +311 +00:21:16,330 --> 00:21:22,850 +ال projection ال visual direction انه في عندى نقاط + +312 +00:21:22,850 --> 00:21:27,370 +في شبكية كل عين و كل نقطة في الشبكية إلها اتجاه + +313 +00:21:27,370 --> 00:21:30,430 +معين في الفراعال .. ال .. ال retinal + +314 +00:21:30,430 --> 00:21:34,070 +correspondence أنه فيه عندي نقاط في شبكية العين ال + +315 +00:21:34,070 --> 00:21:38,130 +.. اليمين، إلها ما يماثلها في شبكية العين الشمال، + +316 +00:21:38,130 --> 00:21:41,270 +إيش يعني إلها ما يماثلها؟ يعني فيه corresponding + +317 +00:21:41,270 --> 00:21:43,850 +areas between the right retina and the left + +318 +00:21:43,850 --> 00:21:46,610 +retina، إيش يعني corresponding areas؟ يعني إلها + +319 +00:21:46,610 --> 00:21:50,290 +the same visual direction طيب، تالت إشي لـ + +320 +00:21:50,290 --> 00:21:53,990 +projection، أنه اللي صورته بتسقط على ال superior + +321 +00:21:53,990 --> 00:21:58,000 +retina، هينشف تحتواللي صورته بتسقط على ال inferior + +322 +00:21:58,000 --> 00:22:02,320 +retina، هينشافلة فوق، يعني هيعبر عنه الشخص أنه + +323 +00:22:02,320 --> 00:22:07,910 +شايفه فوقواللي بتسقط صورته على ال nasal retina + +324 +00:22:07,910 --> 00:22:11,610 +هينشف temporarily بالنسبة لهذه العين فضروري نتذكر + +325 +00:22:11,610 --> 00:22:15,890 +هذه الأشياء عشان نقدر نفسر الإحساسات اللي بتصير + +326 +00:22:15,890 --> 00:22:21,410 +معانا وهذا هنستعين بالرسم في توضيح هذه الفكرة اذا + +327 +00:22:21,410 --> 00:22:25,510 +at the onset of squint two sensory perceptions + +328 +00:22:25,510 --> 00:22:30,610 +ariseليش؟ لأن هذا بيعتمد على ال normal projection + +329 +00:22:30,610 --> 00:22:35,090 +of the retinal areas stimulated ليش؟ لأنه لما + +330 +00:22:35,090 --> 00:22:38,690 +بيصير عند الحوال بدل ما الصورة تسقط على ال fovea و + +331 +00:22:38,690 --> 00:22:41,170 +ال fovea في العنتين هتسقط على ال fovea في ال + +332 +00:22:41,170 --> 00:22:45,390 +straight eye بينما هتسقط على non-foveal area على + +333 +00:22:45,390 --> 00:22:49,590 +non-foveal area في ال squinting eye طيب هذه ال non + +334 +00:22:49,590 --> 00:22:52,710 +-foveal area نفرض أنها المنطقسية طب إيش اتجاهها في + +335 +00:22:52,710 --> 00:22:57,340 +الفراغ؟ حسب اتجاهها في الفراغ ممكن أناأشعر بإحساس + +336 +00:22:57,340 --> 00:23:01,520 +معين وهالجد هنحكي عنه these require simultaneous + +337 +00:23:01,520 --> 00:23:05,340 +visual perception بمعنى the ability to perceive + +338 +00:23:05,340 --> 00:23:09,120 +images from both eyes simultaneously عشان هدول + +339 +00:23:09,120 --> 00:23:12,720 +الإحساسين اللي هنحكي عنهم بعد شوية يصيروا عشان + +340 +00:23:12,720 --> 00:23:17,560 +يحدثوا لازم يكون الانتين قادرين على الالتقاط في + +341 +00:23:17,560 --> 00:23:23,640 +نفس اللحظة بمعنى آخر أحيانا بيصير squintوالدماغ + +342 +00:23:23,640 --> 00:23:28,120 +بيبطل يستقبل صورة من عين معينة من ال squinting eye + +343 +00:23:28,120 --> 00:23:32,720 +بشكل كامل مش هيصير أي نوع من الإحساسات هذا الإنسان + +344 +00:23:32,720 --> 00:23:36,460 +اتحول من binocular single vision ل monocular + +345 +00:23:36,460 --> 00:23:39,920 +single vision يعني بستعمل عينه ال straight في رؤية + +346 +00:23:39,920 --> 00:23:43,270 +الأهداف اللي بتطلع عليهاوالعين الـ squinting اللي + +347 +00:23:43,270 --> 00:23:46,650 +فيها حوال دماغ بطل استقبل منها صورة يعني عملها + +348 +00:23:46,650 --> 00:23:50,990 +subversion تثبيت لصورة بدوش منها صورة يعني كأنه + +349 +00:23:50,990 --> 00:23:54,050 +أوقفها على العمر رغم إنها مفتوحة و الناس بتشوفه + +350 +00:23:54,050 --> 00:23:57,930 +مفتة عينيتين تانيين ولكن و كأنها مغمضة يعني تعتبر + +351 +00:23:57,930 --> 00:24:01,390 +كأنها مغلق العين لأن الدماغ مابستقبلش منها هذا + +352 +00:24:01,390 --> 00:24:04,490 +الإنسان اللي .. اللي ماعندوش قدرة على الالتقاط + +353 +00:24:04,490 --> 00:24:09,550 +المتزامنمش هيحس بالإحساسين اللي هنحكي عنهم بعد .. + +354 +00:24:09,550 --> 00:24:15,790 +بعد شوية مثال آخر يعني بيوضح الصورة بشكل لا لبس + +355 +00:24:15,790 --> 00:24:21,570 +فيه إنسان عنده .. إنسان عمره مثلا ست .. ستين سنة + +356 +00:24:21,570 --> 00:24:25,790 +عنده mature cataract في ال right eye يعني عنده ميه + +357 +00:24:25,790 --> 00:24:29,870 +بيضه و مستوية و سادة تماما يعني ال .. الرؤية في ال + +358 +00:24:29,870 --> 00:24:33,150 +right eye مثلا hand motion و الرؤية في ال left eye + +359 +00:24:33,150 --> 00:24:37,720 +ستة ع ستة و صار عنده squintهل هيشكي من أي شعور؟ + +360 +00:24:37,720 --> 00:24:40,360 +لأ، لأن هذا الإنسان مش binocular single vision، هو + +361 +00:24:40,360 --> 00:24:43,340 +بالأساس monocular والعين التانية، لأنه فيها + +362 +00:24:43,340 --> 00:24:46,580 +cataract mature، cataract .. cataract ناضجة، + +363 +00:24:46,580 --> 00:24:49,360 +معناته بتستقبلش، الصورة ما بتوصل أصلا لل retina + +364 +00:24:49,360 --> 00:24:53,880 +عشان يصير صورتين و يتم الهم fusion و يستمتع بال + +365 +00:24:53,880 --> 00:24:57,840 +binocular single visionإذا ضروري جدا عشان تحدث هذه + +366 +00:24:57,840 --> 00:25:02,000 +الإحساسات اللي هي ال confusion ال confusion و ال + +367 +00:25:02,000 --> 00:25:07,000 +pathological dyplopia + +368 +00:25:07,000 --> 00:25:10,340 +هدول الإحساسين واحد بيسموه confusion اللي خربطت + +369 +00:25:10,340 --> 00:25:13,600 +الصور في بعضها أو تدخيل الصور على بعضها وقتها + +370 +00:25:13,600 --> 00:25:18,020 +هنشرحه بالتفصيل و ال pathological dyplopia اللي هي + +371 +00:25:18,020 --> 00:25:21,460 +الإزدواجية بس الإزدواجية مش الطبيعية الإزدواجية + +372 +00:25:21,460 --> 00:25:24,940 +المرضيةالازدواجية الناتجة عن الحوال .. الازدواجية + +373 +00:25:24,940 --> 00:25:27,900 +الناتجة عن الحوال هدول الإحساسين عشان يسيروا و + +374 +00:25:27,900 --> 00:25:31,860 +يشعر فيهم الإنسان اللي صار فجأة عنده حوال لابد + +375 +00:25:31,860 --> 00:25:35,200 +يكون عنده القدرة على استقبال صورتين صورة في العين + +376 +00:25:35,200 --> 00:25:38,340 +السليمة و صورة في العين اللي فيها الحوال يعني the + +377 +00:25:38,340 --> 00:25:42,000 +ability to perceive images from both eyes + +378 +00:25:42,000 --> 00:25:45,800 +simultaneously .. simultaneously المرة القادمة ان + +379 +00:25:45,800 --> 00:25:49,090 +شاء الله تعالى هنبدأ في الحكي عن ال confusionو ال + +380 +00:25:49,090 --> 00:25:52,030 +pathological deviation .. ال pathological diplopia + +381 +00:25:52,030 --> 00:25:55,350 +عفوا و يعطيكم العافية والسلام عليكم ورحمة الله + +382 +00:25:55,350 --> 00:25:56,310 +وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/dx4aWYFv-2M.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/dx4aWYFv-2M.srt new file mode 100644 index 0000000000000000000000000000000000000000..286b8e1b58407539633900121e41eb3d71d497e9 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/dx4aWYFv-2M.srt @@ -0,0 +1,1267 @@ +1 +00:00:01,650 --> 00:00:05,350 +بسم الله الرحمن الرحيم، بنواصل مع محاضرات حول واحد + +2 +00:00:05,350 --> 00:00:09,870 +واتوقفنا عند ال near point of convergence، near + +3 +00:00:09,870 --> 00:00:13,870 +point of convergence هي أقرب نقطة بيستطيع الـ both + +4 +00:00:13,870 --> 00:00:17,610 +eyes إنهم يعملوا عليها binocular fixation، إذن the + +5 +00:00:17,610 --> 00:00:20,890 +near point of convergence is the nearest point + +6 +00:00:20,890 --> 00:00:25,110 +أقرب نقطة on which the eyes can maintain binocular + +7 +00:00:25,110 --> 00:00:28,830 +fixation اللي بيقدروا يضلوا العينتين مع بعض متجهين + +8 +00:00:28,830 --> 00:00:33,390 +ناحيتها و بيركزوا عليها، أقرب منها هيكون عين واحدة + +9 +00:00:33,390 --> 00:00:37,050 +مركزة والتانية مش قادرة تركز، it can be measured + +10 +00:00:37,480 --> 00:00:40,640 +بقدر أجيس ال near point of convergence with the + +11 +00:00:40,640 --> 00:00:45,800 +RAF rule، الـ RAF rule اللي هي royal air force rule + +12 +00:00:45,800 --> 00:00:50,620 +royal air force rule which rests on the patient's + +13 +00:00:50,620 --> 00:00:54,300 +cheek، a target is slowly moved along the rule + +14 +00:00:54,300 --> 00:00:57,880 +towards the patient's eye until one eye loses + +15 +00:00:57,880 --> 00:01:01,490 +fixation and it drifts laterally، هذه بيسموها ال + +16 +00:01:01,490 --> 00:01:04,530 +objective near point of convergence، أما الـ + +17 +00:01:04,530 --> 00:01:07,750 +subjective near point of convergence بضل أقرب الـ + +18 +00:01:07,750 --> 00:01:12,190 +target على الـ rule على المسطرة لغاية ما to + +19 +00:01:12,190 --> 00:01:15,630 +the point at which patient reports diplopia، إذا + +20 +00:01:15,630 --> 00:01:19,370 +المريض شعر أن ال target صار اتنين، معناته هذه أقرب + +21 +00:01:19,370 --> 00:01:22,450 +نقطة بيستطيع يعمل عليها fixation، هذه بيسموها + +22 +00:01:22,450 --> 00:01:26,510 +subjective near point of convergence، الـ objective + +23 +00:01:26,510 --> 00:01:30,310 +near of .. near point of convergence أنا بضل أطلع + +24 +00:01:30,310 --> 00:01:33,710 +على عينين المريض و أجرب ال target من عينينه لغاية + +25 +00:01:33,710 --> 00:01:36,870 +ما واحدة من العين تانية يصير لها drift lateral، + +26 +00:01:36,870 --> 00:01:41,530 +drift يعني إنها ما تقدر تعمل convergence و تتحرك + +27 +00:01:41,530 --> 00:01:46,170 +للخارج للخارج، الـ normal near point of convergence + +28 +00:01:46,170 --> 00:01:49,870 +should be nearer than عشرة سنتي without undue + +29 +00:01:49,870 --> 00:01:55,050 +effort، يعني لازم ال near point of convergence تكون + +30 +00:01:55,050 --> 00:01:59,990 +عندي عشرة سنتي في أقرب بدون مجهود يذكر .. بدون + +31 +00:01:59,990 --> 00:02:03,590 +مجهود يذكر، طبعا إذا كان ال near point of + +32 +00:02:03,590 --> 00:02:07,490 +convergence بعيدة، معناته بيكون عندي أنا .. + +33 +00:02:07,520 --> 00:02:10,500 +convergence insufficiency، عدم كفاية في ال + +34 +00:02:10,500 --> 00:02:13,600 +convergence، إذا قريبة بيكون عندي convergence + +35 +00:02:13,600 --> 00:02:18,100 +excess، convergence excess، نشوف ال RAF rule وكيف + +36 +00:02:18,100 --> 00:02:21,860 +احنا بنجيس عليها ال near point of convergence، هاي + +37 +00:02:21,860 --> 00:02:26,940 +ال RAF rule، نطلع لعرض مكبر عبارة عن عمود معدني + +38 +00:02:28,870 --> 00:02:33,430 +مقطعه مربع، مقطعه مربع بمعنى لو أنا جيت أعمل cross + +39 +00:02:33,430 --> 00:02:37,810 +section هنا، يعني إله أوجه أربعة، إله أوجه أربعة، + +40 +00:02:37,810 --> 00:02:42,170 +في وجه يعني عليه قياس بالصنتيمترات، في وجه عليه + +41 +00:02:42,170 --> 00:02:45,910 +قياس بالأعمار، في وجه عليه قياس بال diopters وهكذا، + +42 +00:02:45,910 --> 00:02:54,050 +الآن هذا العمود المعدني الأسود مثبت عليه صندوق + +43 +00:02:54,050 --> 00:02:59,550 +بشكل متوازي مستطيلات، إله أربع أوجه، طبعا هو إله + +44 +00:02:59,550 --> 00:03:03,130 +ست أوجه، بس وجهين للتثبيت، اللي هو الوجهين السودة + +45 +00:03:03,130 --> 00:03:07,860 +الجانبيين، والأربع أوجه عليها فيه targets + +46 +00:03:07,860 --> 00:03:10,680 +عليها فيها targets، هنشوف إيش ال targets اللي على + +47 +00:03:10,680 --> 00:03:16,180 +الأربع أوجه، طبعا هذا الصندوق أو هذا الصندوق طبعا + +48 +00:03:16,180 --> 00:03:19,920 +بستطيع أني أوجه أي target يعني بقدر ألفه بحيث أنه + +49 +00:03:19,920 --> 00:03:24,140 +يكون أي واجهة باتجاه المريض، أيضا في عندنا هنا + +50 +00:03:24,140 --> 00:03:29,560 +ركزات، بتركز على وجه المريض على الـ cheek على خد + +51 +00:03:29,560 --> 00:03:33,660 +المريض على الناحيتين تمام، وهنا الفراغ اللي بينهم + +52 +00:03:33,660 --> 00:03:37,400 +عشان الأنف .. عشان الأنف، هذه ال handle أنا بأمسك + +53 +00:03:37,400 --> 00:03:40,980 +بإيدي من .. من هنا على أساس أنه أنا أستطيع بإيد + +54 +00:03:40,980 --> 00:03:44,460 +أمسك والإيد التاني أحرك هذا، طبعا يمكن تحريك هذا + +55 +00:03:44,460 --> 00:03:50,550 +الصندوق أقربه من المريض أو أبعده عن المريض، الأوجه + +56 +00:03:50,550 --> 00:03:53,230 +الأربعة يا ترى إيش مرسوم عليها، هي ال targets + +57 +00:03:53,230 --> 00:03:59,690 +الأربعة، هنا في عندي chart صغير من أحرف، هنا في عندي + +58 +00:03:59,690 --> 00:04:05,490 +جمل، كل جملة إلها حجم معين and five and تمانين اللي + +59 +00:04:05,490 --> 00:04:11,390 +هي ال near chart، وهنا أيضا كلمات برضه، هنا عندي + +60 +00:04:11,390 --> 00:04:13,790 +ال target اللي أنا بستخدمه لموضوع ال convergence + +61 +00:04:13,790 --> 00:04:18,090 +عبارة عن dot، عن dot في المنتصف، المفروض يركز فيها + +62 +00:04:18,090 --> 00:04:20,750 +المريض لما بدي أجيسله ال near point of convergence + +63 +00:04:21,240 --> 00:04:25,500 +الخط اللي مارر في ال dot I بساعدني أو بساعد المريض + +64 +00:04:25,500 --> 00:04:29,620 +أنه يعني يشوف امتى صارت ال diplopia عشان مايصيرش + +65 +00:04:29,620 --> 00:04:33,100 +عندي suppression في one eye فمايشعرش انه صارت عنده + +66 +00:04:33,100 --> 00:04:36,680 +diplopia، لما بدي أجيس ال near point of convergence + +67 +00:04:36,680 --> 00:04:40,600 +الـ subjective وطبعا في ال subjective لازم المريض + +68 +00:04:40,600 --> 00:04:44,560 +يقوللي امتى صار يشوف ال target اتنين، امتى شاف يصير + +69 +00:04:44,560 --> 00:04:48,230 +يشوف ال target اتنين، الآن أنا اللي بعمله أني بركز + +70 +00:04:48,230 --> 00:04:52,270 +هذه ال .. الـ RAF rule على خد المريض .. على خد + +71 +00:04:52,270 --> 00:04:57,270 +المريض، بخليها ت .. تعتمد على العظم بتاع المكسلة + +72 +00:04:57,270 --> 00:05:01,740 +اللي هو الفك الأعلى، وبيكون ال .. الـ position بتاع + +73 +00:05:01,740 --> 00:05:04,740 +slightly down، كأنه في الـ reading position، تمام + +74 +00:05:04,740 --> 00:05:12,060 +ببدأ من بعيد بأمسك الصندوق و بحركه ب .. بجربه من + +75 +00:05:12,060 --> 00:05:14,620 +المريض، طبعا لما بدأ أجيس ال near point of + +76 +00:05:14,620 --> 00:05:18,040 +convergence بكون أستعمل ال target هذا .. بكون + +77 +00:05:18,040 --> 00:05:22,820 +أستعمل ال target هذا، بضل أجرب من المريض .. أجرب + +78 +00:05:22,820 --> 00:05:27,520 +من المريض لغاية ما يحدث حاجة من حاجتين، إذا كان مثلا + +79 +00:05:27,520 --> 00:05:30,540 +عند النقطة high مثلا عند تمانية سنتي على سبيل + +80 +00:05:30,540 --> 00:05:34,680 +المثال، قاللي أنا شوفت دبلوبيا، أنا صرت أشوف ال + +81 +00:05:34,680 --> 00:05:39,660 +target، هذا الخط، صار خطين، معناته هذه عند تمانية + +82 +00:05:39,660 --> 00:05:43,640 +سنتي، بسجل أنه near .. الـ subjective .. near + +83 +00:05:43,640 --> 00:05:48,660 +point of convergence 8 cm، طبيعي؟ اه طبيعي الرقم + +84 +00:05:48,660 --> 00:05:55,700 +طبيعي لأنه أقل من 10 cm، طيب أنا بعد 8 cm جربت كمان + +85 +00:05:55,700 --> 00:06:00,400 +ل 7 cm .. 6.5 cm .. لجيت واحدة من العينتين عملت + +86 +00:06:00,400 --> 00:06:04,100 +lateral drift، بطلت تركز، مش قادرة تركز، عين دلت + +87 +00:06:04,100 --> 00:06:07,520 +المركزة والتاني عمل lateral drift، يعني هو مش قادر + +88 +00:06:07,520 --> 00:06:11,020 +أكثر من هيك يعمل convergence، فهذه الـ objective + +89 +00:06:11,020 --> 00:06:14,680 +near point of convergence، ممكن الـ subjective والـ + +90 +00:06:14,680 --> 00:06:18,280 +objective near point of convergence يكونوا في نفس + +91 +00:06:18,280 --> 00:06:22,840 +المكان، يعني مثلا تسعة سنتي قيمة كل منهم، بغض النظر + +92 +00:06:22,840 --> 00:06:26,020 +لازم ال near point of convergence لازم تكون أقرب + +93 +00:06:26,020 --> 00:06:29,920 +من عشرة سنتي بغض النظر عن العمر .. بغض النظر عن + +94 +00:06:29,920 --> 00:06:33,560 +العمر، near point of convergence مالهاش ارتباط في + +95 +00:06:33,560 --> 00:06:37,240 +عمر الإنسان، إنه كل ما تقدم فيه السن مثلا بتبعد + +96 +00:06:37,240 --> 00:06:40,280 +أكثر لأ، فبالتالي الإنسان لازم يقدر يعمل + +97 +00:06:40,280 --> 00:06:44,240 +convergence عشرة سنتي فيها أقرب، عشرة سنتي فأقرب، + +98 +00:06:44,240 --> 00:06:48,720 +طيب، لو احنا أجرينا ال test لشخص، أجرينا ال test + +99 +00:06:48,720 --> 00:06:53,810 +لشخص، فلاجينا على بعد أربعين سنتي بشكي من دبلوبيا أو + +100 +00:06:53,810 --> 00:06:56,810 +صار ال lateral drift على تلاتين أو خمسة و تلاتين + +101 +00:06:56,810 --> 00:06:59,010 +أو أربعين سنتي، معناته عنده convergence + +102 +00:06:59,010 --> 00:07:02,590 +insufficiency، يعني علة في ال convergence أنه مش + +103 +00:07:02,590 --> 00:07:05,290 +قادر يعمل ال convergence، مش قادر أو ال + +104 +00:07:05,290 --> 00:07:08,550 +convergence عنده ضعيف، طيب ممكن السان يقول طب إيش + +105 +00:07:08,550 --> 00:07:11,910 +فائدة كل هذا الكلام؟ يعني ليش احنا بنجري في قصاد + +106 +00:07:11,910 --> 00:07:15,450 +من هذا القبيل؟ الجواب بسيط جدا، أنه أحيانا بيجي + +107 +00:07:15,450 --> 00:07:19,130 +المريض يشكي أنه أحيانا لما يقرأ أو يستعمل جواله أو + +108 +00:07:19,130 --> 00:07:22,890 +يجوم بأي عالم قريب، بيشكي من blurring of vision، + +109 +00:07:22,890 --> 00:07:26,130 +غباش في الرؤية أو بيشكي من diplopia، أنه بعد مثلا + +110 +00:07:26,130 --> 00:07:30,650 +ما يقرأ خمس دقائق أو عشر دقائق أو ربع ساعة، بيقدرش + +111 +00:07:30,650 --> 00:07:34,420 +يستمر في القراة بسبب ال diplopia، طيب احنا قلنا يمكن + +112 +00:07:34,420 --> 00:07:37,140 +مثلا عنده حوال وهذا الحوال هو اللي مسببله + +113 +00:07:37,140 --> 00:07:40,760 +الدبلوبيا، فلما أجرينا فحوصات الحوال وسلسلة ال + +114 +00:07:40,760 --> 00:07:43,600 +cover test طالع عنده مافيش أي نوع من الحوال لا عن + +115 +00:07:43,600 --> 00:07:47,460 +distance ولا عن near، لازم ساعتها أنا أفكر أنه في + +116 +00:07:47,460 --> 00:07:50,340 +عنده مشكلة في ال convergence بتمنعه أنه يقرأ + +117 +00:07:50,340 --> 00:07:53,920 +براحته على القريب، فبالتالي بقى أجيسله ال near + +118 +00:07:53,920 --> 00:07:58,020 +point of convergence، وأحيانا بتطلع فعلا أن الـ + +119 +00:07:58,020 --> 00:08:01,260 +near point of convergence بعيدة، يعني ممكن تلاقيها + +120 +00:08:01,260 --> 00:08:04,740 +على عشرين سنتي أربعين سنتي خمسين سنتي حسب ضعف ال + +121 +00:08:04,740 --> 00:08:08,820 +convergence، هذا المريض مشكلته حقيقية، مش معناته أنه + +122 +00:08:08,820 --> 00:08:12,320 +مافيش معاه حوال، معناته أنه مش لازم يشك من diplopia + +123 +00:08:12,320 --> 00:08:16,250 +أو blurring of vision، فبالتالي بنبدأ يا علاج ال + +124 +00:08:16,250 --> 00:08:18,670 +convergence insufficiency أو ال convergence + +125 +00:08:18,670 --> 00:08:23,230 +weakness بال orthoptic exercises اللي يعني اللي هي + +126 +00:08:23,230 --> 00:08:26,690 +التمرين البصرية اللي المفروض أنها تحسن وضع ال + +127 +00:08:26,690 --> 00:08:29,890 +convergence، لو ما نفعش ال orthoptic exercises + +128 +00:08:29,890 --> 00:08:33,490 +بنلجأ لوسائل أخرى هنحكي عنها إن شاء الله تعالى في + +129 +00:08:33,490 --> 00:08:37,090 +حوال اتنين، إذا ال near point of convergence + +130 +00:08:37,090 --> 00:08:42,280 +بتساعدني على إن أعرف هل في ضعف ال convergence ولا + +131 +00:08:42,280 --> 00:08:46,980 +مافيش ضعف في ال convergence، تاني حاجة بدي أجيسها + +132 +00:08:46,980 --> 00:08:49,940 +أيضا أو من الفحوصات تاعت محاضرة اليوم اللي هي ال + +133 +00:08:49,940 --> 00:08:53,540 +near point of accommodation، قبل ما نقول near point + +134 +00:08:53,540 --> 00:08:56,140 +of accommodation، ال near point of convergence لما + +135 +00:08:56,140 --> 00:09:00,140 +.. ب .. بأجر الفحص لا يمكن إجراءها على عين واحدة + +136 +00:09:00,140 --> 00:09:04,760 +ليش؟ لأن ال convergence عبارة عن binocular + +137 +00:09:04,760 --> 00:09:09,400 +movement، فبالتالي ما بقدر أفحص convergence وعين + +138 +00:09:09,400 --> 00:09:14,440 +مغلقة، بينما ال near point of accommodation ممكن + +139 +00:09:14,440 --> 00:09:19,830 +تجرى لعين عين، ده near point of accommodation is + +140 +00:09:19,830 --> 00:09:23,770 +the nearest point on which the eyes can maintain + +141 +00:09:23,770 --> 00:09:30,030 +clear focus، أقرب نقطة بنشوف فيها أو عيننا بتشوف + +142 +00:09:30,030 --> 00:09:34,390 +فيها ال clear focus ل print بيكون واضح، أقرب منها + +143 +00:09:34,390 --> 00:09:38,550 +مهما بذلنا من accommodation لن نستطيع أن نكون واضح + +144 +00:09:39,150 --> 00:09:43,390 +أقرب نقطة بنشوف فيها ال .. ال .. ال print واضح + +145 +00:09:43,390 --> 00:09:47,250 +حاجة بيسمها near point of accommodation، بقدر + +146 +00:09:47,250 --> 00:09:53,670 +أجيسها بالـ RAF rule، بالـ RAF rule باستعمال الـ RAF + +147 +00:09:53,670 --> 00:09:58,370 +rule بس بواجهة أخرى من الصندوق اللي استعملناه + +148 +00:09:58,370 --> 00:10:06,630 +فبالتالي ب .. ب .. أجيسها بالـ RAF rule باستعمال + +149 +00:10:06,630 --> 00:10:12,030 +إحدى هذه الواجهات، وغالبا بيستعمل حسب الخط اللي + +150 +00:10:12,030 --> 00:10:15,850 +متعود المريض يقرأ فيه، يعني إذا كان هو مثلا متعود + +151 +00:10:15,850 --> 00:10:20,050 +يقرأ ال newspaper اللي هو الجريدة أو المجلة وعنده + +152 +00:10:20,050 --> 00:10:24,230 +يعني متعود على خط N8 بستعمله الـ N8، إذا متعود على + +153 +00:10:24,230 --> 00:10:31,140 +N5 يعني هذا عشان يعني .. أنه حاكي عمليا الخط اللي + +154 +00:10:31,140 --> 00:10:35,040 +هو متعود يقرأ فيه .. في حياته العملية .. في حياته + +155 +00:10:35,040 --> 00:10:40,160 +العملية، ببدأ من بعيد، يعني بالواجهة هاي مثلا + +156 +00:10:40,160 --> 00:10:45,180 +بنستعمله خط N تمانية، وببدأ أقرب بالتدريج طبعا + +157 +00:10:45,180 --> 00:10:48,640 +بيكون يعني مغطي عين من عينيتي متين إما بإيده أو + +158 +00:10:48,640 --> 00:10:53,000 +بنكون مغطيينها ب batch، وبنشوف ال near point of + +159 +00:10:53,000 --> 00:11:00,180 +accommodation لكل عين على حده و .. with correction + +160 +00:11:00,180 --> 00:11:03,120 +و without correction، يعني هو لابس النضارة وهو مش + +161 +00:11:03,120 --> 00:11:07,320 +لابس النضارة عشان نشوف عنده في ال near point of + +162 +00:11:07,320 --> 00:11:11,260 +accommodation هل هي طبيعية ولا في عنده ضعف في ال + +163 +00:11:11,260 --> 00:11:16,480 +accommodation بيسببله مشكلة في القراءة بيسببله + +164 +00:11:16,480 --> 00:11:19,860 +مشكلة في القراءة، طبعا ده ناخد بالنا أن ال near + +165 +00:11:19,860 --> 00:11:24,300 +point of accommodation مع تقدم العمر بتبعد، مع تقدم + +166 +00:11:24,300 --> 00:11:29,810 +العمر بتبعد، فبالتالي ضروري ننتبه لهذه القضية، إذا + +167 +00:11:29,810 --> 00:11:33,970 +the patient fixates a line of print which is then + +168 +00:11:33,970 --> 00:11:37,110 +slowly moved toward the patient until it becomes + +169 +00:11:37,110 --> 00:11:40,290 +blurred، the distance at which this is first + +170 +00:11:40,290 --> 00:11:43,990 +reported is read of the rule and denotes the near + +171 +00:11:43,990 --> 00:11:47,450 +point of accommodation، بضل أجرب ل print من عين + +172 +00:11:47,450 --> 00:11:52,630 +المريض لغاية ما تغبش ومايقدرش يخليه واضح حتى لو + +173 +00:11:52,630 --> 00:11:55,910 +عمل accommodation، الـ near point of accommodation + +174 +00:11:55,910 --> 00:12:00,510 +recedes with age، يعني بتبعد مع تقدم السن، when + +175 +00:12:00,510 --> 00:12:03,350 +it becomes sufficiently far away to render reading difficult, + +176 +00:12:03,750 --> 00:12:07,050 +without optical correction, presbyopia is present، + +177 +00:12:07,050 --> 00:12:09,590 +يعني لما بتصير بعيدة ال near point of + +178 +00:12:09,590 --> 00:12:15,170 +accommodation، بساعتها بعرف أنه المريض عشان يقرأ ال + +179 +00:12:15,170 --> 00:12:19,130 +brain لازم يبعد عشان يشوفه واضح، فبت + +201 +00:13:38,500 --> 00:13:41,120 +amplitude of accommodation، قد إيش بيقدر يبذل + +202 +00:13:41,120 --> 00:13:44,640 +accommodation مثلًا عند minus تلاتة غبش كثير و مش + +203 +00:13:44,640 --> 00:13:47,560 +قادر يعمل واضح، مش قادر يبذل accommodation أكثر من + +204 +00:13:47,560 --> 00:13:51,940 +هيك، فبنقول amplitude of accommodation عنده -3 أو + +205 +00:13:51,940 --> 00:13:55,200 +تلاتة ديوبتر بيقدر يتغلب على minus تلاتة ديوبتر + +206 +00:13:55,200 --> 00:13:59,080 +minus تلاتة و نص بيقدرش يتغلب عليها إذا بقدر أنا + +207 +00:13:59,080 --> 00:14:02,880 +بِطريقة الـ minus lenses على ال distance أن أجيس ال + +208 +00:14:02,880 --> 00:14:06,780 +amplitude of accommodation هذا بالنسبة لل near + +209 +00:14:06,780 --> 00:14:11,120 +point of accommodation طبعًا في بعض الحالات المرضية + +210 +00:14:11,120 --> 00:14:15,020 +بيكون ال accommodation ضعيف وبالتالي في blurring of + +211 +00:14:15,020 --> 00:14:18,950 +vision، فبالتالي هذا المريض اللي عنده + +212 +00:14:18,950 --> 00:14:22,630 +accommodation ضعيف سواء ضعف طبيعي نتيجة presbyopia + +213 +00:14:22,630 --> 00:14:26,090 +بعد سن الأربعين أو ضعف مش طبيعي نتيجة مرض + +214 +00:14:26,090 --> 00:14:30,610 +معين لازم يلبس reading glasses لازم نلبس reading + +215 +00:14:30,610 --> 00:14:36,570 +glasses نيجي للحاجة التالتة اللي هي fusional + +216 +00:14:36,570 --> 00:14:40,010 +amplitudes، fusional amplitudes أو fusional + +217 +00:14:40,010 --> 00:14:40,770 +vergences + +218 +00:14:44,250 --> 00:14:47,970 +أو ال motor fusion أيضًا لازم أجيسها عند المريض + +219 +00:14:47,970 --> 00:14:51,950 +بِتفيدني جدًا قياسها قد إيش الإنسان بيقدر يعمل + +220 +00:14:51,950 --> 00:14:55,950 +compensation لو في فرق في مواقع الصور على شبكية + +221 +00:14:55,950 --> 00:14:59,390 +العينين قد إيش بيقدر يعمل fusional convergence قد إيش + +222 +00:14:59,390 --> 00:15:02,850 +بيقدر يعمل fusional divergence قد إيش بيقدر يعمل + +223 +00:15:02,850 --> 00:15:06,090 +vertical divergence طب في إيش فايدتها هذه القضية؟ + +224 +00:15:06,090 --> 00:15:10,490 +فايدتها إنه مثلًا إنسان عنده حَوَل أنسي يعني عنده + +225 +00:15:10,490 --> 00:15:14,490 +إيزوتروبيا، يعني إيه داخلة لجوه، وبعد العملية صار + +226 +00:15:14,490 --> 00:15:18,750 +عنده إكزوتروبيا، صار عنده إكزوتروبيا بسيط، يعني لو + +227 +00:15:18,750 --> 00:15:22,530 +حبينا نشوف هذه القضية، بنقول كالآتي + +228 +00:15:29,660 --> 00:15:34,540 +إذا فائدة ال fusional convergence بتتضح من المثال + +229 +00:15:34,540 --> 00:15:38,240 +التاني، عندي مريض عنده left esotropia مقدرة خمسة و + +230 +00:15:38,240 --> 00:15:43,640 +تلاتين بريزم ديوبتر، إيزوتروبيا preoperative بعد + +231 +00:15:43,640 --> 00:15:48,300 +العملية العين رخت شوي لبرا صار عندي تمانية بريزم + +232 +00:15:48,300 --> 00:15:51,640 +إكزوتروبيا، ال fusional convergence + +233 +00:15:56,690 --> 00:16:02,550 +الـ fusional convergence مهمته يرجع العين، يرجع + +234 +00:16:02,550 --> 00:16:08,550 +العين لـ ال primary position أو يعدل ال exo اللي + +235 +00:16:08,550 --> 00:16:12,910 +نتجت، فبالتالي ال fusional convergence هيتغلب لي + +236 +00:16:12,910 --> 00:16:16,410 +على ال exo-tropia أو ال exophoria و ال fusional + +237 +00:16:16,410 --> 00:16:19,670 +divergence هيتغلب على ال exo-tropia لو كانت + +238 +00:16:19,670 --> 00:16:25,090 +الموضوع العكس إنه عندي هذه preoperatively عند اكزو + +239 +00:16:25,090 --> 00:16:29,710 +كمية طبعًا كبيرة وعملنا لها عملية و أصبح التاني يوم + +240 +00:16:29,710 --> 00:16:34,070 +أو بعد العملية فيه شوية اكزو بسيطة ممكن الـ + +241 +00:16:34,070 --> 00:16:38,210 +fusional divergence يتغلب عليها، فضروري أنا أجيز ال + +242 +00:16:38,210 --> 00:16:42,030 +fusional amplitudes و قياسها بيتم على ال prism + +243 +00:16:42,030 --> 00:16:46,360 +bar، باستخدام الـ Prism Bar أو باستخدام ال synoptophore + +244 +00:16:46,360 --> 00:16:51,000 +كيف تنجز من وضعية الصفر من وضعية الصفر أو من وضعية + +245 +00:16:51,000 --> 00:16:55,220 +الحول إذا كان المريض عنده حَوَل ببدأ أجرب أدراعات + +246 +00:16:55,220 --> 00:16:58,300 +ال synoptophore عشان يعمل convergence أو أبعدهم عن + +247 +00:16:58,300 --> 00:17:01,760 +بعض عشان يعمل divergence لغاية ما المريض يقول لي أنا + +248 +00:17:01,760 --> 00:17:06,180 +شايف دبلو يعني لغاية ما يقول لي أن أنا شايف double + +249 +00:17:06,180 --> 00:17:09,600 +vision عند هذه النقطة بيكون كمية ال Prismات اللي + +250 +00:17:09,600 --> 00:17:13,790 +اتحملها أو اللي اتحمله ال brain بتاعه، هذه هي الـ + +251 +00:17:13,790 --> 00:17:18,450 +fusional convergence أو divergence، وأيضًا بجيس ال + +252 +00:17:18,450 --> 00:17:22,210 +vertical fusional vergence بواسطة ال prism أو + +253 +00:17:22,210 --> 00:17:26,510 +بواسطة ال synaptophore Increasingly, strong prisms + +254 +00:17:26,510 --> 00:17:30,510 +are placed in front one eye which will then abduct + +255 +00:17:30,510 --> 00:17:36,270 +or adduct depending on whether the prism is base + +256 +00:17:36,270 --> 00:17:40,010 +in حتعمل abduction أو base out حتعمل adduction + +257 +00:17:40,880 --> 00:17:44,200 +ليش بِتِضطر العين تعمل هيك؟ in order to maintain + +258 +00:17:44,200 --> 00:17:47,940 +bifovial fixation when a prism greater than the + +259 +00:17:47,940 --> 00:17:53,710 +fusional amplitude is reached. Diplopia is reported + +260 +00:17:53,710 --> 00:17:57,410 +or one eye drifts the other way، يعني بيصير عندي + +261 +00:17:57,410 --> 00:18:01,250 +سبرشي، this is the limit of fusion's ability، كل + +262 +00:18:01,250 --> 00:18:06,430 +إنسان إله مقدرة معينة من الـ fusional vergence، the + +263 +00:18:06,430 --> 00:18:09,770 +prism fusion range must be assessed in any + +264 +00:18:09,770 --> 00:18:13,290 +binocular patient before strabismus surgery، عشان + +265 +00:18:13,290 --> 00:18:17,700 +أعرف هل أنا لو صار عندي over correction أو under + +266 +00:18:17,700 --> 00:18:21,240 +correction يعني هيدي صار عندي over correction تم + +267 +00:18:21,240 --> 00:18:25,320 +التصحيح وبزيادة جلبت من ISO لـ EXO فال fusional + +268 +00:18:25,320 --> 00:18:31,340 +convergence حقها يعني عدل شوية الـ EXO، طيب لو أنا جاب + +269 +00:18:31,340 --> 00:18:34,980 +للعملية خمسة و تلاتين prism إيزوتروبيا وبعد + +270 +00:18:34,980 --> 00:18:42,160 +العملية صارت نفرض بعد العملية صارت إيزوتروبيا بس + +271 +00:18:42,160 --> 00:18:47,650 +مثلًا خمسة prism كمية بسيطة إيزوتروبيا خمسة بريزم + +272 +00:18:47,650 --> 00:18:51,210 +هذه الخمسة بريزم إيزوتروبيا ممكن ال fusion + +273 +00:18:51,210 --> 00:18:55,650 +divergence يتغلب عليها ويصير عندي أنا straight eyes + +274 +00:18:55,650 --> 00:19:03,550 +فبالتالي ال fusion divergence ضروري تنجز قبل + +275 +00:19:03,550 --> 00:19:07,010 +إجراء العملية عند أي binocular patient نشوف الآن + +276 +00:19:07,010 --> 00:19:10,170 +فيديو بيوضح قضية قياس ال fusion divergence + +277 +00:19:17,200 --> 00:19:19,620 +Fusional convergence amplitudes are measures of + +278 +00:19:19,620 --> 00:19:21,840 +the amount of prism that can be placed before the + +279 +00:19:21,840 --> 00:19:24,620 +eyes without the patient experiencing a sustained + +280 +00:19:24,620 --> 00:19:27,480 +blur or double image. They are typically measured + +281 +00:19:27,480 --> 00:19:30,520 +with both 33 centimeter targets and 6 meter + +282 +00:19:30,520 --> 00:19:33,980 +targets. The fusional convergence amplitude is a + +283 +00:19:33,980 --> 00:19:36,100 +measurement of the degree to which a person is + +284 +00:19:36,100 --> 00:19:38,920 +able to converge his eyes to maintain binocular + +285 +00:19:38,920 --> 00:19:42,520 +focus on a target. This is easily tested using a + +286 +00:19:42,520 --> 00:19:45,840 +horizontal prism bar. While asking the patient to + +287 +00:19:45,840 --> 00:19:48,880 +focus on the target, the examiner slowly increases + +288 +00:19:48,880 --> 00:19:52,240 +the magnitude of base out prism until the patient + +289 +00:19:52,240 --> 00:19:54,640 +is no longer able to maintain a single image. + +290 +00:19:55,260 --> 00:19:58,040 +Normal values are at least 11 prism diopters at + +291 +00:19:58,040 --> 00:20:03,860 +far and 16 at near. معاملة الـ Divergence Amplitude + +292 +00:20:03,860 --> 00:20:07,420 +القياس بِشكل مشابه، ولكن الاختبار سيستخدم مصممة + +293 +00:20:07,420 --> 00:20:10,860 +في الـ Prism Bar. إذا كنت تجربين كامة Divergence + +294 +00:20:10,860 --> 00:20:14,620 +وكامة Convergence ومساعدة الـ Divergence Amplitude + +295 +00:20:14,620 --> 00:20:17,980 +أولًا ستحصل على نتيجة أكثر صحيحة. قيمة عادية + +296 +00:20:17,980 --> 00:20:20,960 +يكونون أقل من سبع Prism Diopters في FAR و 14 في + +297 +00:20:20,960 --> 00:20:25,600 +NEAR. Vertical fusional amplitudes are measured + +298 +00:20:25,600 --> 00:20:28,360 +using either a base up or base down prism bar. + +299 +00:20:28,920 --> 00:20:31,460 +Normal values are approximately 1 to 2 prism + +300 +00:20:31,460 --> 00:20:34,320 +diopters. Patients with long standing or + +301 +00:20:34,320 --> 00:20:36,820 +congenital fourth nerve palsies may have vertical + +302 +00:20:36,820 --> 00:20:39,980 +fusional amplitudes of 8 to 10 prism diopters or + +303 +00:20:39,980 --> 00:20:44,260 +even more. هأعيد + +304 +00:20:44,260 --> 00:20:49,020 +أنا اللي هو ال .. الفيديو بس مع تخفيض الصوت + +305 +00:20:54,840 --> 00:20:58,160 +يعني ال fusional divergence amplitudes بنجيسها، ال + +306 +00:20:58,160 --> 00:21:01,800 +fusional convergence بنحط base out، ال fusional + +307 +00:21:01,800 --> 00:21:06,760 +divergence هنحط base in، و ال vertical divergence + +308 +00:21:06,760 --> 00:21:11,500 +إما بنحط base out أو base up أو base down أو base + +309 +00:21:11,500 --> 00:21:16,200 +down الآن هنبدأ العملية، نجيس ال fusional + +310 +00:21:16,200 --> 00:21:19,160 +convergence، هاي ال apex بتاعة ال prism + +311 +00:21:22,190 --> 00:21:25,910 +هي ال base، محتوطة out و ال apex in، بنضل نزود + +312 +00:21:25,910 --> 00:21:29,770 +لغاية المريض ما يعمل reporting لدبلوبيا، يقول إن + +313 +00:21:29,770 --> 00:21:33,690 +أنا شايف double vision، double vision، بنجيس الـ + +314 +00:21:33,690 --> 00:21:36,430 +fusional convergence على ال distance و على الـ + +315 +00:21:36,430 --> 00:21:40,010 +near، على ال distance و على ال near، ال fusional + +316 +00:21:40,010 --> 00:21:43,770 +divergence أيضًا بنجيسها بس بال base in بريزم لغاية + +317 +00:21:43,770 --> 00:21:47,310 +ما يقول أنا شوفت blurred vision أو شوفت double + +318 +00:21:47,310 --> 00:21:52,050 +image لل target، طبعًا في قيم لل distance وفي قيم + +319 +00:21:52,050 --> 00:21:57,530 +لل near، بالنسبة لـ بالنسبة لـ fusional convergence + +320 +00:21:57,530 --> 00:22:00,170 +على الـ distance زي ما الفيديو بيحكي على الـ + +321 +00:22:00,170 --> 00:22:03,650 +distance 11 بريزم بيقدر الإنسان يتحمل fusional + +322 +00:22:03,650 --> 00:22:07,670 +convergence، وعن near 16 بريزم طبعًا في أرقام أعلى + +323 +00:22:07,670 --> 00:22:12,370 +من هيك حسب الدراسات المختلفة، ال fusional + +324 +00:22:12,370 --> 00:22:15,170 +divergence على ال distance وعلى ال near أيضًا + +325 +00:22:15,170 --> 00:22:21,170 +الأرقام بتاعته بتختلف، هذه + +326 +00:22:21,170 --> 00:22:23,510 +بنجيس ال fusional divergence الآن ال vertical + +327 +00:22:23,510 --> 00:22:28,320 +divergence هي ال base بتاعة ال prism للأسفل base + +328 +00:22:28,320 --> 00:22:33,140 +down .. base down بضل أزود طبعًا ال fusional أو ال + +329 +00:22:33,140 --> 00:22:36,720 +vertical versions من واحد لاتنين prism في الطبيعي + +330 +00:22:36,720 --> 00:22:39,940 +في كتب بتقول من اتنين لتلاتة prism بس إذا كان + +331 +00:22:39,940 --> 00:22:44,150 +الإنسان عنده 4th nerve palsy بيكون عادة الرقم أعلى + +332 +00:22:44,150 --> 00:22:50,150 +من ذلك بكثير، فهذا بالنسبة لل fusional vergence + +333 +00:22:50,150 --> 00:22:55,410 +amplitudes ال horizontal و ال vertical، وأيضًا ممكن + +334 +00:22:55,410 --> 00:22:58,510 +أجيس ال torsional fusional amplitude بواسطة الـ + +335 +00:22:58,510 --> 00:23:02,150 +double Maddox rod بواسطة ال double Maddox rod و هذا + +336 +00:23:02,150 --> 00:23:07,010 +هييجي الكلام عليه في موعده إن شاء الله تعالى، وهنا + +337 +00:23:07,010 --> 00:23:09,910 +بتنتهي محاضرتنا ويعطيكم العافية والسلام عليكم + +338 +00:23:09,910 --> 00:23:11,470 +ورحمة الله وبركاته diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/gSZSurtsqao.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/gSZSurtsqao.srt new file mode 100644 index 0000000000000000000000000000000000000000..c73c2d2ed32ee6bf4b15c33d873c393761d58ef8 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/gSZSurtsqao.srt @@ -0,0 +1,1510 @@ +1 +00:00:01,350 --> 00:00:05,250 +بسم الله الرحمن الرحيم بنواصل محاضرات حول واحد + +2 +00:00:05,250 --> 00:00:09,970 +واتوقفنا المرة الماضية عند ال microtopia واللي هي + +3 +00:00:09,970 --> 00:00:14,270 +مثال بيتضح فيه بعض الأشياء زي ال central + +4 +00:00:14,270 --> 00:00:17,690 +suppression scotoma وزي ال abnormal retinal + +5 +00:00:17,690 --> 00:00:23,900 +correspondence حقيقة عشان نذكر بال abnormal retinal + +6 +00:00:23,900 --> 00:00:26,920 +correspondence قولنا أن ال abnormal retinal + +7 +00:00:26,920 --> 00:00:30,880 +correspondence عشان يصير لابد له من شروط ثلاثة + +8 +00:00:30,880 --> 00:00:34,940 +أول شيء الحول يكون كميته قليلة، ثاني شيء يكون + +9 +00:00:34,940 --> 00:00:40,160 +الحول ثابت مش متغير مش variable angle، الثالث شيء + +10 +00:00:40,160 --> 00:00:45,700 +أنه يكون مدة الحول يعني مضى فترة يعني طويلة نوعًا + +11 +00:00:45,700 --> 00:00:50,260 +ما على الحول ال microtropia اللي هي أحد أنواع + +12 +00:00:50,260 --> 00:00:55,230 +الحول هي نوع من الحول اتوفرت فيه ثلاث شروط، الشرط + +13 +00:00:55,230 --> 00:00:58,750 +الأول أن يكون زاوية الحول صغيرة فعلًا هي ال micro + +14 +00:00:58,750 --> 00:01:02,450 +-tropia سميت micro-tropia لأنها micro لأنها micro + +15 +00:01:02,450 --> 00:01:07,090 +يعني هي تروبيا حول ظاهر .. حول ظاهر بس قليل جدًا + +16 +00:01:07,090 --> 00:01:11,330 +يعني مجيازه عشرة prism فأقل يعني ممكن يكون خمسة + +17 +00:01:11,330 --> 00:01:15,130 +prism، ستة prism، سبعة prism يعني ما بيزيد عن عشرة + +18 +00:01:15,130 --> 00:01:20,420 +prism، زاوية الحول صغيرة .. زاوية الحول صغيرة، ثاني + +19 +00:01:20,420 --> 00:01:24,280 +شيء في ال microtopia أنه مش بس زاوية الحول صغيرة + +20 +00:01:24,280 --> 00:01:30,280 +أنه زاوية الحول ثابتة stable angle مابتتغيرش مع + +21 +00:01:30,280 --> 00:01:35,700 +الوقت .. مع الوقت مابتتغيرش، ثالث شيء أن هذه ال + +22 +00:01:35,700 --> 00:01:41,160 +microtopia كزاوية حول صغيرة وثابتة أيضًا توجد عند + +23 +00:01:41,160 --> 00:01:44,180 +المريض لفترات طويلة وممكن تكون عنده طول العمر + +24 +00:01:44,180 --> 00:01:48,440 +ممكن تكون عنده طول العمر، فبناء على توفر الشروط + +25 +00:01:48,440 --> 00:01:52,340 +الثلاثة ال microtropia يعني أحد الأمراض أو أحد + +26 +00:01:52,340 --> 00:01:56,600 +أنواع الحول اللي بيتوفر فيها الشروط وإيه بيحدث + +27 +00:01:56,600 --> 00:02:00,580 +فيها ال abnormal retinal correspondence لأن شروطه + +28 +00:02:00,580 --> 00:02:05,360 +متوفرة، إذا ال microtropia is a small angle squint + +29 +00:02:05,780 --> 00:02:09,940 +عبارة عن squint بس ال angle بتاعته زاوية الحول + +30 +00:02:09,940 --> 00:02:15,040 +مجياز الحول بال prism ديوبتر صغير أقل من عشرة + +31 +00:02:15,040 --> 00:02:19,080 +prism ديوبتر in which stereopsis is present but + +32 +00:02:19,080 --> 00:02:23,550 +reduced and there is a relative amylobia of the + +33 +00:02:23,550 --> 00:02:28,330 +more amyotropic eye، الآن عشان نفهم هذا الكلام بنقول + +34 +00:02:28,330 --> 00:02:32,530 +كالقادة، أول حاجة أنه ال .. ال microtropia عبارة عن + +35 +00:02:32,530 --> 00:02:36,410 +small angle طبعًا هذه مفهومة وعشان هي كأطلق على + +36 +00:02:36,410 --> 00:02:41,450 +هذا المرض microtropia ممكن يكون microesotropia أو + +37 +00:02:41,450 --> 00:02:48,490 +microexotropia أو microexotropia، فبالتالي هذا + +38 +00:02:48,490 --> 00:02:51,890 +الحول كميته قليلة سواء microesotropia أو + +39 +00:02:51,890 --> 00:02:56,190 +microexotropia، ثاني حاجة ثابتة يعني إذا مثلًا فرضنا + +40 +00:02:56,190 --> 00:03:00,110 +أنه عند .. سين من الناس بقياس الحول أنه عنده + +41 +00:03:00,110 --> 00:03:04,050 +إيزوتروبيا ثمانية بريزم هذه ثمانية بريزم stable + +42 +00:03:04,050 --> 00:03:07,430 +يعني اليوم جيستله ثمانية بريزم بعد أسبوع جيستله + +43 +00:03:07,430 --> 00:03:12,590 +أيضًا ثمانية بريزم بعد سنة جيستله ثمانية بريزم يعني + +44 +00:03:12,590 --> 00:03:17,230 +،وثالث شيء أنه مستمرة يعني لا ت .. لا يعني .. + +45 +00:03:17,270 --> 00:03:20,690 +لاتنتهي بعد يوم أو يومين أو ثلاثة أو أربعة يعني + +46 +00:03:20,690 --> 00:03:24,570 +مدة الحول مدة طويلة، هذا المفهوم إيش يعني + +47 +00:03:24,570 --> 00:03:27,890 +stereopsis is present but reduced، ال stereopsis + +48 +00:03:27,890 --> 00:03:31,790 +اللي هي رؤية ثلاثية الأبعاد موجودة عند هدول الناس + +49 +00:03:31,790 --> 00:03:35,950 +زيهم زي الناس العادين زي الإنسان الطبيعي بس مش + +50 +00:03:35,950 --> 00:03:40,830 +بنفس الدرجة، مش بنفس الدرجة، أقل أقل جودة، طب إيش + +51 +00:03:40,830 --> 00:03:43,770 +معنى ال stereopsis احنا اللي بنتكلم عنه اللي هو + +52 +00:03:43,770 --> 00:03:48,010 +الرؤية ثلاثية الأبعاد لأنها هيقمة ال binocular + +53 +00:03:48,010 --> 00:03:51,030 +single vision، يعني إذا إنسان بدأ أفحص عنده هل في + +54 +00:03:51,030 --> 00:03:54,610 +عنده binocular single vision ولا لأ، بفحصله ال + +55 +00:03:54,610 --> 00:03:57,550 +stereopsis، إذا ال stereopsis عنده طبيعي، بقول + +56 +00:03:57,550 --> 00:04:00,530 +عنده normal binocular single vision، إذا ال + +57 +00:04:00,530 --> 00:04:05,350 +stereopsis عنده يعني reduced، يعني أقل من الطبيعي، + +58 +00:04:05,350 --> 00:04:08,130 +معناته في عنده normal .. عنده binocular single + +59 +00:04:08,130 --> 00:04:12,260 +vision بس، مش normal، مش normal، فبالتالي هدول + +60 +00:04:12,260 --> 00:04:15,080 +الناس اللي عندهم microtropia موجود عنده stereopsis + +61 +00:04:15,080 --> 00:04:18,660 +بس لما باخضع لفحوصات ال stereopsis بيكون النتائج + +62 +00:04:18,660 --> 00:04:23,180 +عنده أقل من الإنسان الطبيعي وطبعًا في فحوصات خاصة + +63 +00:04:23,180 --> 00:04:28,330 +ومتنوعة لقياس ال stereopsis، and there is relative + +64 +00:04:28,330 --> 00:04:31,610 +amylobia of the more amyotropic eye، وجدوا + +65 +00:04:31,610 --> 00:04:35,430 +بالدراسات أن ال microotropic patient عادة بيكون + +66 +00:04:35,430 --> 00:04:38,950 +عندهم مش بس microotopia وأيضًا بيكون عندهم + +67 +00:04:38,950 --> 00:04:42,030 +amylobia ويكون عندهم amylobia كسل في العين اللي + +68 +00:04:42,030 --> 00:04:45,770 +فيها ال microotopia بس من غريب الأشياء أن الكسل هذا + +69 +00:04:45,770 --> 00:04:50,390 +مش ناتج عن ال microtropia بحد ذاتها وإنما ناتج عن + +70 +00:04:50,390 --> 00:04:54,470 +ال anisometropia، هدول المرضى من ضمن علامات أو + +71 +00:04:54,470 --> 00:04:58,570 +الأشياء المصاحبة لل microtropia أيضًا أنه في عنده + +72 +00:04:58,570 --> 00:05:03,540 +anisometropia يعني فرق في الـ Refractive Error بين + +73 +00:05:03,540 --> 00:05:07,240 +العينين، وعادة الـ Microtropic eye هي الـ More + +74 +00:05:07,240 --> 00:05:11,140 +Amitropic eye فيها Refractive Error أكثر فبيكون + +75 +00:05:11,140 --> 00:05:15,800 +الكسل البصري اللي في الـ Microtropic eye ناتج عن الـ + +76 +00:05:15,800 --> 00:05:19,840 +Amitropia ناتج عن الـ Anisotropia أكثر من إنه ناتج + +77 +00:05:19,840 --> 00:05:27,380 +عن الـ Microtropia بحد ذاتها، بحد ذاتها، طيب الـ + +78 +00:05:27,380 --> 00:05:31,980 +Microtopia في لها نوعين has two forms، أول شيء + +79 +00:05:31,980 --> 00:05:37,100 +Microtopia with identity و Microtopia without + +80 +00:05:37,100 --> 00:05:41,600 +identity، with identity و without identity إيش يعني + +81 +00:05:41,600 --> 00:05:45,700 +Microtopia with identity و Microtopia without + +82 +00:05:45,700 --> 00:05:51,420 +identity، with identity يعني معرفة الهوية، معرفة + +83 +00:05:51,420 --> 00:05:57,440 +الهوية، طيب without identity يعني غير معرفة الهوية + +84 +00:05:57,440 --> 00:06:02,300 +غير معرفة الهوية، نيجي نقول كالقادم، هاي إنسان نطلع + +85 +00:06:02,300 --> 00:06:07,480 +للصورة المكبرة، هاي إنسان عنده microtropia، ال right + +86 +00:06:07,480 --> 00:06:11,020 +eye فيها شوية إيزوتروبيا بسيطة، فيها شوية + +87 +00:06:11,020 --> 00:06:16,180 +إيزوتروبيا بسيطة، هذه الإيزوتروبيا البسيطة خلت + +88 +00:06:16,180 --> 00:06:20,900 +النقطة اللي أنا بأشر عليها اللي مكتوب عليها CF أو + +89 +00:06:20,900 --> 00:06:26,560 +EF شريكة مع الفوفيا في العين اليسار في الـ visual + +90 +00:06:26,560 --> 00:06:30,740 +direction، في الـ visual direction، إذا المنطقة high + +91 +00:06:30,740 --> 00:06:35,640 +اللي هي ال EF شريكة مع الفوفيا، طب والفوفيا في ال + +92 +00:06:35,640 --> 00:06:38,460 +right eye، الفوفيا في ال right eye عشان ما يصيرش + +93 +00:06:38,460 --> 00:06:42,320 +confusion، صار فيها suppression بسميه central + +94 +00:06:42,320 --> 00:06:46,580 +suppression، إذا هذا مريض عنده microtropia نفرض + +95 +00:06:46,580 --> 00:06:52,830 +سبعة prism أو ثمانية prism، هذه النقطة أصبح اتجاهها + +96 +00:06:52,830 --> 00:06:57,390 +في الفراغ مشارك مع الفوفيا، له نفس الاتجاه بتاع + +97 +00:06:57,390 --> 00:07:01,690 +الفوفيا في العين اليسار وبالتالي الدماغ اعتمدها + +98 +00:07:01,690 --> 00:07:07,170 +كفوفيا بديلة، pseudofobia كمركز بديل للإبصار في + +99 +00:07:07,170 --> 00:07:09,930 +العين اليمنى، طب والمركز الأصلي اللي هي الفوفيا + +100 +00:07:09,930 --> 00:07:13,550 +الأصلية الـ .. ال .. ال brain عملها suppression + +101 +00:07:13,550 --> 00:07:17,670 +عشان لو إجا شيء في الفراغ ع جبالها ما يصيرش + +102 +00:07:17,670 --> 00:07:20,890 +confusion بينه وبين ال target اللي سقط على + +103 +00:07:20,890 --> 00:07:24,150 +الفوفيا لشمال، بينه وبين ال target اللي سقط على + +104 +00:07:24,150 --> 00:07:27,450 +الفوفيا لشمال، إذا هنا عندي في central suppression + +105 +00:07:27,450 --> 00:07:33,670 +scotoma، طيب، الآن طالما دماغ اعتمد نقطة جديدة + +106 +00:07:33,670 --> 00:07:39,110 +هيرتب النقاط حول هذه النقطة الجديدة ترتيب جديد + +107 +00:07:39,110 --> 00:07:43,090 +فبالتالي أصبح عندي .. أنا في عندي abnormal retinal + +108 +00:07:43,090 --> 00:07:46,610 +correspondence، abnormal retinal correspondence + +109 +00:07:46,610 --> 00:07:50,270 +بطلت الفوفيا والفوفيا شرطة شركاء في ال visual + +110 +00:07:50,270 --> 00:07:53,910 +direction، بطلت scene و scene شرطة شركاء في ال + +111 +00:07:53,910 --> 00:07:58,350 +visual direction، بطلت عين وعين شرطة وهكذا كل + +112 +00:07:58,350 --> 00:08:02,360 +نقطة أصبح لها شريك جديد في العين الثانية، إيش يعني + +113 +00:08:02,360 --> 00:08:06,800 +شريك جديد في العين الثانية؟ هذا الشريك الجديد يعني + +114 +00:08:06,800 --> 00:08:11,340 +له نفس ال visual direction والشريك القديم أصبح + +115 +00:08:11,340 --> 00:08:16,500 +بسبب ال esotropia له اتجاه آخر وهذه القضية ثبتت + +116 +00:08:16,500 --> 00:08:19,900 +واعتمدها الدماغ فأصبح عنده هنا ال phobia الجديدة + +117 +00:08:19,900 --> 00:08:24,650 +أو القائد الجديد إذا صح التعبير للعين، هذا الكلام + +118 +00:08:24,650 --> 00:08:28,090 +ممتاز، إذا أول شغلة في ال microtopia في عندي ال + +119 +00:08:28,090 --> 00:08:31,710 +central suppression scotoma، هاي أول علامة، ليش ال + +120 +00:08:31,710 --> 00:08:34,890 +central suppression scotoma؟ عشان ما يصيرش عندي + +121 +00:08:34,890 --> 00:08:38,410 +confusion، ثاني حاجة، في عندي abnormal retinal + +122 +00:08:38,410 --> 00:08:43,530 +correspondence، ترتيبة جديدة، ثالث حاجة في عندي + +123 +00:08:43,530 --> 00:08:46,270 +peripheral fusion، إيش يعني peripheral fusion؟ + +124 +00:08:46,270 --> 00:08:49,710 +يعني صحيح صار عندي central separation scotoma بس + +125 +00:08:49,710 --> 00:08:54,890 +بجيت الردنة بالترتيب الجديد، كل نقطة معاشركتها، + +126 +00:08:54,890 --> 00:08:58,890 +لدماغ مستعد يدمج الصور منهم، فهذا بيسموه + +127 +00:08:58,890 --> 00:09:04,020 +peripheral fusion، يعني كل أجزاء الصورة تنقلكل + +128 +00:09:04,020 --> 00:09:07,660 +أجزاء الصورة تنقل معادة لجزء اللي وقع الفوفيا + +129 +00:09:07,660 --> 00:09:12,680 +الحقيقية، إذا في عندي ثلاث شغلات لحد الآن ذكرناهم في + +130 +00:09:12,680 --> 00:09:17,740 +ال .. ال microtropia، الشغلة الأولى من الثلاث شغلات + +131 +00:09:17,740 --> 00:09:21,180 +أنه في عندي central suppression scotoma، الشغلة + +132 +00:09:21,180 --> 00:09:25,340 +الثانية أنه عندي abnormal retinal correspondence + +133 +00:09:25,340 --> 00:09:29,560 +كل النقاط مرتبة ترتيب جديد ومركز النقاط أو الفوفيا + +134 +00:09:29,560 --> 00:09:32,700 +الجديدة هي اللي أنا بأشر عليها اللي مكتوب عليها EF + +135 +00:09:33,310 --> 00:09:36,130 +ثالث شيء إذا في عندي central separation، إذا كنتم + +136 +00:09:36,130 --> 00:09:39,950 +أول شيء abnormal retinal correspondence، ثاني شيء + +137 +00:09:39,950 --> 00:09:44,410 +ثالث شيء اللي هو ال peripheral fusion يعني كل أجزاء + +138 +00:09:44,410 --> 00:09:46,950 +الصورة اللي وقعت على ال peripheral retina هنا + +139 +00:09:46,950 --> 00:09:51,220 +أصبحت هنا ال center، والـ Peripheral Retina الأجزاء + +140 +00:09:51,220 --> 00:09:56,160 +بيدم .. يعني دمجها مع شركاءها الجدد في العين + +141 +00:09:56,160 --> 00:09:59,720 +الشمالية، إذا في Peripheral Effusion، هدول الثلاث + +142 +00:09:59,720 --> 00:10:04,580 +أشياء .. هدول الثلاث أشياء، طيب، حتى الآن ما فهمناش + +143 +00:10:04,580 --> 00:10:09,440 +إيش معناة معرفة الهوية وغير معرفة الهوية، معرفة الهوية + +144 +00:10:09,440 --> 00:10:14,140 +بمعنى أنه القائد الجديد with identity، معرفة الهوية + +145 +00:10:14,140 --> 00:10:20,320 +Microtropia، معرفة الهوية أنه القائد الجديد، القائد + +146 +00:10:20,320 --> 00:10:24,840 +الجديد بيضل يقود نقاط الشبكية كلها وبيضل الدماغ + +147 +00:10:24,840 --> 00:10:30,640 +معتمد هذه النقطة تحت جميع الظروف، إيش يعني تحت + +148 +00:10:30,640 --> 00:10:36,680 +جميع الظروف؟ أنا في عندي ظروف أن الإنسان ممكن + +149 +00:10:36,680 --> 00:10:41,820 +يفتح عينيتين مع بعض أو ممكن يغلق عين ويفتح الثانية + +150 +00:10:42,600 --> 00:10:47,440 +لما بنقول microtopia with identity معرفة الهوية + +151 +00:10:47,440 --> 00:10:52,020 +يعني معرفة القائد، يعني معرفة ال center الجديد، إيش + +152 +00:10:52,020 --> 00:10:56,120 +يعني معرفة ال center الجديد؟ يعني ال center الجديد + +153 +00:10:56,120 --> 00:11:00,820 +هو مركز الإبصار الجديد اللي بيعتمدوا دماغ تحت جميع + +154 +00:11:00,820 --> 00:11:05,670 +الظروف، هو القائد، بغض النظر عن الظروف، سواء فتحنا + +155 +00:11:05,670 --> 00:11:09,050 +عينينا الاثنتين، إذا فتحنا عينينا الاثنتين أو المريض + +156 +00:11:09,050 --> 00:11:13,090 +فتح عينيه الاثنتين هذا بيكون قائده إلى نفس ال + +157 +00:11:13,090 --> 00:11:17,970 +visual direction، نفس ال visual direction مع + +158 +00:11:17,970 --> 00:11:22,950 +الفوفيا السليمة، النقطة هي under binocular + +159 +00:11:22,950 --> 00:11:27,670 +viewing، هي القائد، طيب و under monocular viewing + +160 +00:11:27,670 --> 00:11:31,290 +يعني لو احنا غطينا العين اليسار وقلنا له اتطلع + +161 +00:11:31,290 --> 00:11:35,350 +بعينك اليمنى، هيركز بالنقطة هاي أيضًا، إذا النقطة هاي + +162 +00:11:35,350 --> 00:11:39,490 +دماغ اعتمدها في جميع الأحوال سواء في ال monocular + +163 +00:11:39,490 --> 00:11:43,750 +viewing أو في ال binocular viewing أن هي النقطة + +164 +00:11:43,750 --> 00:11:47,390 +القائدة وأنها هي المركز الإبصار المعتمد، هي مركز + +165 +00:11:47,390 --> 00:11:52,010 +الإبصار المعتمد، طيب إيش يعني microtopia without + +166 +00:11:52,010 --> 00:12:02,380 +identity بنقول كالقادم، without identity، لو غطينا + +167 +00:12:02,380 --> 00:12:05,960 +العين اليمنى، لو غطينا .. عفوا، لو غطينا العين + +168 +00:12:05,960 --> 00:12:11,250 +اليسار النقطة المعتمدة هي النقطة مثلًا EF اللي + +169 +00:12:11,250 --> 00:12:15,590 +مرسومة أمامنا في الرسمة، هي قائد الإبصار، هي اللي + +170 +00:12:15,590 --> 00:12:21,290 +دماغ معتمدها .. هي اللي دماغ معتمدها ومعتمدها ك + +171 +00:12:21,290 --> 00:12:24,930 +center للرؤية بدل الفوفيا اللي فيها suppression زي + +172 +00:12:24,930 --> 00:12:29,680 +ما اتفقنا، هذا under monocular view، طيب لو فتحنا + +173 +00:12:29,680 --> 00:12:32,840 +العين اليسار، يعني صار مفتح المريض عينه الاثنتين + +174 +00:12:32,840 --> 00:12:36,700 +أصبح فيه قائد جديد آخر نفرض النقطة الأخرى، نفرض + +175 +00:12:36,700 --> 00:12:40,460 +هنا النقطة C هي القائد، إيش السبب؟ أنه تغيرت + +176 +00:12:40,460 --> 00:12:43,900 +القيادة، عندي هنا الـ pseudophobia رقم واحد ومثلا + +177 +00:12:43,900 --> 00:12:46,620 +الـ pseudophobia رقم اثنين، ليش تغيرت القيادة؟ + +178 +00:12:46,620 --> 00:12:51,020 +لأن النقطة الجديدة هاي اعتمدت قيادة لأنه صدف .. + +179 +00:12:51,020 --> 00:12:59,520 +صد + +201 +00:14:25,880 --> 00:14:30,890 +without identity لو غطينا العين السليمة العين هي .. + +202 +00:14:30,890 --> 00:14:34,390 +هتتحرك بحيث أن ال target ييجي على النقطة الثانية + +203 +00:14:34,390 --> 00:14:38,010 +أو الفوفيا الثانية اللي هي سميناها scene فبالتالي + +204 +00:14:38,010 --> 00:14:42,950 +في ال microtopia without identity في ال cover test + +205 +00:14:42,950 --> 00:14:48,930 +بيصير في عندي movement بينما في ال microtopia with + +206 +00:14:48,930 --> 00:14:53,170 +identity ما بيصيرش أي movement ما بيصيرش أي movement + +207 +00:14:53,170 --> 00:14:58,420 +ممكن الإنسان يتساءل ويقول يعني ما هذه الأشياء + +208 +00:14:58,420 --> 00:15:02,660 +الموضوعة أمام العينين المريض هذه ال Bagolini + +209 +00:15:02,660 --> 00:15:07,080 +striated glasses اللي بتحول ال spot of light ل + +210 +00:15:07,080 --> 00:15:11,260 +streak ل line of light طبعًا إذا هنا على خمسة و + +211 +00:15:11,260 --> 00:15:15,340 +أربعين إذا هنا ميلان ال striation على خمسة و + +212 +00:15:15,340 --> 00:15:19,380 +أربعين العين اليسرى حتشوف على مية وخمسة وتلاتين + +213 +00:15:19,380 --> 00:15:22,740 +إذا هنا ميلان ال striation على مية وخمسة وتلاتين + +214 +00:15:22,740 --> 00:15:28,500 +العين اليمنى حتشوف على يعني 45 فبالتالي العين + +215 +00:15:28,500 --> 00:15:32,720 +اليمنى هتشوف خط مائل والعين اليسرى هتشوف خط مائل + +216 +00:15:32,720 --> 00:15:36,020 +عكسه يعني عمودي على ميلان الأول فبالتالي هم + +217 +00:15:36,020 --> 00:15:41,440 +هي سيروا يشوفوا cross طبعًا كونه أن المريض شاف cross + +218 +00:15:41,440 --> 00:15:44,160 +معناته عنده peripheral fusion طبعًا في ال + +219 +00:15:44,160 --> 00:15:47,580 +microtopia لازم يكون في عندي defect بسيط في ال + +220 +00:15:47,580 --> 00:15:51,280 +center ممكن بعض المرضى ما يلاحظوش عشان + +221 +00:15:59,830 --> 00:16:04,250 +عشان ما يلاحظوش عشان أنه في عنده central suppression + +222 +00:16:04,250 --> 00:16:07,950 +scotoma طبعًا ال central suppression scotoma ممكن + +223 +00:16:07,950 --> 00:16:11,850 +تكون كميتها بسيطة لدرجة أنه يفكر أنه ال cross كامل + +224 +00:16:11,850 --> 00:16:16,090 +وقلة من المرضى اللي عندهم microtropia اللي بيلاحظ + +225 +00:16:16,090 --> 00:16:21,030 +ال central suppression scotoma إذا in microtropia + +226 +00:16:21,030 --> 00:16:25,860 +with identity the point used النقطة اللي بتستعمل + +227 +00:16:25,860 --> 00:16:30,380 +for monocular fixation by the squinting eye النقطة + +228 +00:16:30,380 --> 00:16:32,960 +اللي بتستعملها العين اللي فيها ال .. ال .. ال .. + +229 +00:16:32,960 --> 00:16:36,000 +ال monocular fixation اللي .. اللي فيها ال + +230 +00:16:36,000 --> 00:16:40,280 +microtopia also corresponds with the fovea of the + +231 +00:16:40,280 --> 00:16:43,200 +straight eye under binocular viewing condition + +232 +00:16:43,200 --> 00:16:47,000 +يعني النقطة اللي بتستعملها بتستعملها العين ال + +233 +00:16:47,000 --> 00:16:50,460 +microtropic eye عشان تعمل فيها fixation في ال + +234 +00:16:50,460 --> 00:16:54,770 +monocular viewing هي نفس النقطة للشريكة مع الفوفيا + +235 +00:16:54,770 --> 00:16:58,110 +في ال binocular في الفوفيا السليمة في ال binocular + +236 +00:16:58,110 --> 00:17:02,270 +viewing فبالتالي therefore on cover test there is + +237 +00:17:02,270 --> 00:17:05,990 +no movement of the squinting eye when it takes up + +238 +00:17:05,990 --> 00:17:11,090 +monocular fixation لسبب أن الـ target جاي بالضبط + +239 +00:17:11,090 --> 00:17:14,850 +على المنطقة الجديدة أو الـ fovea الجديدة المعتمدة + +240 +00:17:14,850 --> 00:17:19,150 +في جميع الأحوال زي ما شرحنا in microtropia without + +241 +00:17:19,150 --> 00:17:22,830 +identity the monocular fixation point of the + +242 +00:17:22,830 --> 00:17:26,890 +squinting eye does not correspond with the fovea + +243 +00:17:26,890 --> 00:17:30,090 +of the straight eye in binocular viewing يعني لو + +244 +00:17:30,090 --> 00:17:35,700 +رجعنا للرسمة إحنا وقلنا هذه النقطة النقطة المعتمدة + +245 +00:17:35,700 --> 00:17:40,400 +لما أكون أنا مغطي العين اليسرى للمريض هذه النقطة + +246 +00:17:40,400 --> 00:17:43,200 +اللي معتمدها دماغ لل fixation هذه الـ pseudophobia + +247 +00:17:43,200 --> 00:17:49,060 +طيب كشفنا العين اليسرى في نقطة أخرى correspond to + +248 +00:17:49,060 --> 00:17:52,240 +the phobia اللي هي النقطة C إيش هي النقطة C؟ ليش + +249 +00:17:52,240 --> 00:17:54,800 +correspond to the phobia؟ لأنه لها نفس ال visual + +250 +00:17:54,800 --> 00:17:59,410 +direction لما أكون مغطي العين السليمة النقطة EF هي + +251 +00:17:59,410 --> 00:18:03,230 +المعتمدة لما بيكون مفتح عينيك إثنتين النقطة C هي + +252 +00:18:03,230 --> 00:18:06,910 +المعتمدة ليش؟ إيش معنى هذا الكلام؟ لأن النقطة C + +253 +00:18:06,910 --> 00:18:10,810 +لها نفس ال visual direction يعني في ال monocular + +254 +00:18:10,810 --> 00:18:15,470 +viewing في قائد أو في center وفي ال binocular + +255 +00:18:15,470 --> 00:18:19,970 +viewing في center آخر إذا فش center معتمد وحيد + +256 +00:18:19,970 --> 00:18:24,790 +فعشان هيك بنسميها غير معرفة الهوية عند غير معرفة + +257 +00:18:24,790 --> 00:18:29,500 +الهوية إذا في ميكروتروبيا بدون اكتشاف، مقاومة + +258 +00:18:29,500 --> 00:18:35,900 +الميكروتروبيا للعين المساعدة لا تتجاوز مع فويا + +259 +00:18:35,900 --> 00:18:38,120 +العين المساعدة في الملاحظة الميكروتروبيا + +260 +00:18:41,540 --> 00:18:46,680 +هناك حركة صغيرة للعين المتحركة عندما تأخذ مصادر + +261 +00:18:46,680 --> 00:18:53,360 +ميكروفينية على محاولة مقاومة عامة عامة عامة عامة + +262 +00:18:53,360 --> 00:18:54,200 +عامة عامة عامة عامة عامة عامة عامة عامة عامة عامة + +263 +00:18:54,200 --> 00:18:54,640 +عامة عامة عامة عامة عامة عامة عامة عامة عامة عامة + +264 +00:18:54,640 --> 00:18:55,180 +عامة عامة عامة عامة عامة عامة عامة عامة عامة عامة + +265 +00:18:55,180 --> 00:18:55,220 +عامة عامة عامة عامة عامة عامة عامة عامة عامة عامة + +266 +00:18:55,220 --> 00:18:59,210 +عامة عامة عامة عامة عامة عام في عندي نوع من الحوال + +267 +00:18:59,210 --> 00:19:03,170 +بيسموه ال accommodative esotropia الصعب أنه في هذا + +268 +00:19:03,170 --> 00:19:06,370 +النوع يصير في عندي abnormal retinal correspondence + +269 +00:19:06,370 --> 00:19:10,610 +ليش صعب أنه يصير؟ لأنه اختل شرط من الشروط الثلاثة + +270 +00:19:10,610 --> 00:19:13,430 +أنه قضية ال stable angle مش موجودة في ال + +271 +00:19:13,430 --> 00:19:17,130 +accommodative esotropia لأن هذه esotropia ناجمة عن + +272 +00:19:17,130 --> 00:19:20,250 +ال accommodation وبالتالي ال accommodation طالما + +273 +00:19:20,250 --> 00:19:24,610 +بتغير بتغير بُعد ال target إذا زاوية الحوال بتظل + +274 +00:19:24,610 --> 00:19:28,630 +تتغير وبتثبتش على زاوية واحدة because of the + +275 +00:19:28,630 --> 00:19:31,850 +variability of the angle of deviation صعب دماغي + +276 +00:19:31,850 --> 00:19:34,950 +يعتمد نقطة لأن مرة بتيجي النقطة C مع الفوفيا + +277 +00:19:34,950 --> 00:19:38,230 +السليمة، مرة بتيجي النقطة صاد مع الفوفيا السليمة، + +278 +00:19:38,230 --> 00:19:42,280 +مرة بتيجي I، مرة بتيجي K، مرة بتيجي L يعني حسب تغير + +279 +00:19:42,280 --> 00:19:46,740 +زاوية الحوال فبالتالي دماغ صعب جدا يعتمد نقطة + +280 +00:19:46,740 --> 00:19:50,140 +معينة ك pseudophobia أو كcenter جديد لل vision + +281 +00:19:50,140 --> 00:19:54,180 +بسبب ال variability ثاني .. ثاني شيء أيضًا ال + +282 +00:19:54,180 --> 00:19:58,780 +abnormal retinal correspondence صعب يصير لما يكون + +283 +00:19:58,780 --> 00:20:02,700 +عندي large angle deviation لأ ليش؟ بسبب أن ال + +284 +00:20:02,700 --> 00:20:05,920 +separation of the image is too great فأسهل على + +285 +00:20:05,920 --> 00:20:09,160 +المريض أو أسهل على الدماغ بتاع المريض أنه يعمل + +286 +00:20:10,400 --> 00:20:13,580 +suppression يعني لو كان عندي الـ Esotropia كبيرة + +287 +00:20:13,580 --> 00:20:16,700 +جدا بحيث أن النقطة هايلة في ال peripheral retina + +288 +00:20:16,700 --> 00:20:22,080 +تكون مشاركة الفوفيا هس أصبح بسبب دخول العين كثير + +289 +00:20:22,080 --> 00:20:24,960 +أصبحت هذه النقطة هي اللي جاية على جبال ال target + +290 +00:20:24,960 --> 00:20:27,940 +النقطة البعيدة في ال peripheral retina صعب ال + +291 +00:20:27,940 --> 00:20:31,460 +brain يعتمد هي ك center لل vision وإحنا حكينا أيضًا + +292 +00:20:31,460 --> 00:20:34,420 +في المثال اللي ضربناه المرة الماضية في المحاضرة + +293 +00:20:34,420 --> 00:20:38,760 +الماضية أنه صعب إنسان أو موظف بسيط في الشركة ينوب + +294 +00:20:38,760 --> 00:20:42,960 +عن المدير حين غيابه عشان يتعامل مع إدارة الشركة + +295 +00:20:42,960 --> 00:20:46,500 +الأخرى، وإنما اللي بينوب عن المدير في حال غيابه هو + +296 +00:20:46,500 --> 00:20:52,320 +نائب المدير أو يعني أحد كبار الموظفين، يعني + +297 +00:20:52,320 --> 00:20:56,640 +عشان تنوب عن الفوفيا الأصلية لازم يكون نقطة قريبة + +298 +00:20:56,640 --> 00:21:00,020 +من الفوفيا الأصلية تعتمد ك center لل vision طب لو + +299 +00:21:00,020 --> 00:21:04,720 +زاوية الحوالي كبيرة ساعتها في ال large angle عشان + +300 +00:21:04,720 --> 00:21:07,200 +ال separation بتاع ال images بتاع ال image بتاعة + +301 +00:21:07,200 --> 00:21:10,380 +ال right eye و ال left eye is too great الأسهل على + +302 +00:21:10,380 --> 00:21:13,200 +ال brain أنه يعمل suppression الأسهل على ال brain + +303 +00:21:13,200 --> 00:21:17,140 +أنه يعمل suppression هنا مرسومة ال retina تحت + +304 +00:21:17,140 --> 00:21:23,040 +العين اليمنى وال retina بتاعة العين اليسرى وهنا + +305 +00:21:23,040 --> 00:21:27,480 +منطقة محددة بال central suppression scotoma هذه + +306 +00:21:27,480 --> 00:21:31,880 +المنطقة وهو مفتح عينيه إثنتين مش شغالة بالمرة مش + +307 +00:21:31,880 --> 00:21:35,720 +شغالة بالمرة إذا central suppression scotoma على + +308 +00:21:35,720 --> 00:21:39,020 +فكرة المايكروتروبيا زمان كان يسموها mono fixation + +309 +00:21:39,020 --> 00:21:42,200 +syndrome يعني هو بيعتمد عين واحدة اللي هي العين + +310 +00:21:42,200 --> 00:21:44,080 +السليمة لل fixation للعين + +311 +00:21:46,760 --> 00:21:52,280 +للفكساشن فبالتالي يعني بيعتبر عندي central + +312 +00:21:52,280 --> 00:21:57,000 +suppression scotoma هنا في test لأن ليس أوان أنه + +313 +00:21:57,000 --> 00:22:01,620 +نشرحه اسمه ال four dot test فكرة ال four dot test + +314 +00:22:01,620 --> 00:22:08,820 +أنه في عندي أربع نقاط أربع نقاط بألوان مختلفة و + +315 +00:22:08,820 --> 00:22:12,680 +هنشرحه في وجهته بس من الأربع نقاط العين اليمنى + +316 +00:22:12,680 --> 00:22:16,430 +مثلًا بتشوف تلاتة هيهم جايين على الفوفيا نقطة، + +317 +00:22:16,430 --> 00:22:22,250 +نقطتين، تلاتة، والعين اليسرى بتشوف نقطتين، + +318 +00:22:22,250 --> 00:22:26,550 +نقطتين، طبعًا لونهم أحمر هيكون، وهنا الثلاثة لونهم + +319 +00:22:26,550 --> 00:22:30,170 +أخضر، فواضح أنه طبعًا ال test معمول على مسافة + +320 +00:22:30,170 --> 00:22:33,450 +بعيدة، فالنقطتين هنا جايين في مجال ال central + +321 +00:22:33,450 --> 00:22:36,230 +suppression scotoma، في المنطقة اللي مستقبلش منها + +322 +00:22:36,230 --> 00:22:40,530 +الإدراك وهنا طبعًا جايين على الفوفيا السليمة فال + +323 +00:22:40,530 --> 00:22:44,270 +result أنه المريض شايف فقط الثلاثة نقاط بتاعة + +324 +00:22:44,270 --> 00:22:48,590 +الفوفيا الشغالة وهيك أنا بعرف بهذا ال test أنه في + +325 +00:22:48,590 --> 00:22:51,390 +عندي central suppression scotoma طالما النقطتين + +326 +00:22:51,390 --> 00:22:54,690 +الحمر ما انشفوش طالما النقطتين الحمر ما انشفوش + +327 +00:22:54,690 --> 00:23:00,110 +فبالتالي هذا ال test من ضمن الفحوصات وطبعًا هم أربع + +328 +00:23:00,110 --> 00:23:04,850 +نقاط بس بيشوف في عين تلت نقاط من الأربع وبيشوف في + +329 +00:23:04,850 --> 00:23:08,970 +العين الثانية نقطتين من الأربع نقطتين من الأربع + +330 +00:23:08,970 --> 00:23:12,730 +طبعًا في نقطة مشتركة بتشوفها العين اليمنى والعين + +331 +00:23:12,730 --> 00:23:16,590 +اليسرى وهذا هنشرحه في حينه إن شاء الله تعالى فهذا + +332 +00:23:16,590 --> 00:23:20,750 +هو ال mono fixation syndrome أو ال micro atropia + +333 +00:23:20,750 --> 00:23:26,090 +أو ال microtropia بيظل أننا نقول ال .. بصورة عامة + +334 +00:23:26,090 --> 00:23:29,650 +حكينا عن ال sensations اللي بتصير ال sensations + +335 +00:23:29,650 --> 00:23:32,790 +اللي بتصير اللي هي ال confusion و الدبلوبيا و + +336 +00:23:32,790 --> 00:23:38,130 +حكينا عن ال adaptations اللي بتصير التأقلمات قلنا + +337 +00:23:38,130 --> 00:23:41,070 +في negative adaptation اللي هو ال suppression وفي + +338 +00:23:41,070 --> 00:23:43,570 +positive adaptation اللي هو ال abnormal retinal + +339 +00:23:43,570 --> 00:23:47,610 +correspondence وحكينا مثال على ال abnormal + +340 +00:23:47,610 --> 00:23:49,510 +retinal correspondence اليوم اللي هو ال + +341 +00:23:49,510 --> 00:23:54,360 +microtropias syndrome وكلها متوفرة في شروط ال .. ال + +342 +00:23:54,360 --> 00:23:57,460 +abnormal retinal correspondence تلخيص هذه + +343 +00:23:57,460 --> 00:24:01,360 +المحاضرات السابقة من suppression ومن abnormal + +344 +00:24:01,360 --> 00:24:04,500 +retinal correspondence ومن confusion ومن diplopia + +345 +00:24:04,500 --> 00:24:08,900 +بيسميه ال consequences of strabismus يعني إيش + +346 +00:24:08,900 --> 00:24:14,000 +ال .. الأشياء اللي بتنتج عن حدوث الحول إيش + +347 +00:24:14,000 --> 00:24:17,280 +الأشياء، يعني لو حبينا نحكي القصة، واحد صار عنده + +348 +00:24:17,280 --> 00:24:21,320 +حول، ترى إيش الأشياء والتتابعات اللي بتصير معه، + +349 +00:24:21,320 --> 00:24:24,700 +إيش ال consequences of strabismus؟ أول شيء لما + +350 +00:24:24,700 --> 00:24:27,980 +يصير عند الإنسان strabismus، أول شيء بيحدث أن ال + +351 +00:24:27,980 --> 00:24:32,160 +fovea of the squinting eye is suppressed to avoid + +352 +00:24:32,160 --> 00:24:35,610 +confusion يعني بيصير suppression في الفوفيا اللي + +353 +00:24:35,610 --> 00:24:39,490 +فيها .. اللي في العين اللي فيها اللي صار الحول، + +354 +00:24:39,490 --> 00:24:43,410 +الفوفيا suppressed .. suppressed عشان نتجنب + +355 +00:24:43,410 --> 00:24:48,930 +قضية ال confusion وهذا بيسموه central suppression + +356 +00:24:49,640 --> 00:24:54,160 +diplopia والـ okay الازدواجية ممكن تحدث عند بعض + +357 +00:24:54,160 --> 00:24:58,420 +الناس ليش؟ لأنه صار الحول فصار non-corresponding + +358 +00:24:58,420 --> 00:25:02,240 +retinal elements receive the same image إيش يعني + +359 +00:25:02,240 --> 00:25:04,500 +non-corresponding retinal elements receive the + +360 +00:25:04,500 --> 00:25:07,140 +same image؟ يعني ال .. ال image بعد ما صار عندي + +361 +00:25:07,140 --> 00:25:11,010 +حول بتسقط على الفوفيا في العين السليمة وبتسقط على + +362 +00:25:11,010 --> 00:25:14,450 +non-foveal area في العين اللي فيها الحول فهدول + +363 +00:25:14,450 --> 00:25:17,030 +الفوفيا مع ال non-foveal area مش corresponding + +364 +00:25:17,030 --> 00:25:21,770 +points إذا هيرسل الصور لمناطق مختلفة من ال visual + +365 +00:25:21,770 --> 00:25:26,130 +cortex ومش هيتم توحيدهم فهيصير عندي diplopia طيب + +366 +00:25:26,130 --> 00:25:30,090 +إيه بيتصرف ال brain عشان يتخلص من ال diplopia؟ to + +367 +00:25:30,090 --> 00:25:33,830 +avoid diplopia the patient will develop either + +368 +00:25:33,830 --> 00:25:37,100 +peripheral suppression ساعتها بيصير عندي central + +369 +00:25:37,100 --> 00:25:39,780 +suppression مع peripheral suppression وهذا بيصير + +370 +00:25:39,780 --> 00:25:43,990 +عندي total suppression أو إنه إذا كان زاوية الحول + +371 +00:25:43,990 --> 00:25:47,710 +صغيرة بدل ما يعمل peripheral suppression بيشغل + +372 +00:25:47,710 --> 00:25:51,010 +نقطة جديدة وبيعمل abnormal retinal correspondence + +373 +00:25:51,010 --> 00:25:55,050 +إذا توفرت الشروط abnormal retinal correspondence + +374 +00:25:55,050 --> 00:25:58,930 +معناه تفوفيا جديدة وترتيبة جديدة الشروط قلنا عنها + +375 +00:25:58,930 --> 00:26:03,130 +تلاتة small angle squint .. small angle squint .. + +376 +00:26:03,130 --> 00:26:06,970 +stable angle squint for long period .. for long + +377 +00:26:06,970 --> 00:26:12,020 +period طيب، if constant unilateral suppression، + +378 +00:26:12,020 --> 00:26:14,820 +إحنا قلنا central suppression عشان ما يصيرش + +379 +00:26:14,820 --> 00:26:18,060 +confusion، وأحيانًا peripheral suppression عشان + +380 +00:26:18,060 --> 00:26:20,960 +ما يصيرش diplopia، إذا صار عندي central مع + +381 +00:26:20,960 --> 00:26: + +401 +00:27:32,450 --> 00:27:35,610 +الدبلوبيا، الـ monocular هو فيه له تجسيمة ثانية، + +402 +00:27:35,610 --> 00:27:38,750 +monocular يعني بيحدث في عين واحدة دائماً و + +403 +00:27:38,750 --> 00:27:43,840 +alternating بتبادل بين العينين، الـ submission أيضًا + +404 +00:27:43,840 --> 00:27:47,640 +له تجسيمة ثالثة facultative يعني ممكن يصير وممكن + +405 +00:27:47,640 --> 00:27:51,020 +ما يصيرش إذا كان الـ حَوَل موجود في حَوَل بيسموه الـ + +406 +00:27:51,020 --> 00:27:53,920 +intermittent مثلًا Exotropia في حال وجود الـ + +407 +00:27:53,920 --> 00:27:57,720 +Exotropia بيكون في submission في حال راحت وصارت + +408 +00:27:57,720 --> 00:28:01,500 +straight eyes بترجع العينين وشَرْجَلَات مع بعض و + +409 +00:28:01,500 --> 00:28:04,460 +binocular single vision وفي عندي obligatory + +410 +00:28:04,460 --> 00:28:08,260 +submission سواء في حَوَل أو ما فيش حَوَل الـ + +411 +00:28:08,260 --> 00:28:12,590 +submission موجود في عين من العينين هذا الـ + +412 +00:28:12,590 --> 00:28:15,230 +separation عبارة عن negative adaptation بمعنى + +413 +00:28:15,230 --> 00:28:19,410 +إلغاء الرؤية من عين أثناء فتح العينين مع بعض في + +414 +00:28:19,410 --> 00:28:22,770 +عندي sensory adaptation positive إعادة تشغيل العين + +415 +00:28:22,770 --> 00:28:26,070 +اللي فيها الـ حَوَل بس بشروط عمل جديدة وفق الـ + +416 +00:28:26,070 --> 00:28:30,010 +abnormal retinal correspondence هنتوقف عند الـ + +417 +00:28:30,010 --> 00:28:33,670 +motor adaptation للـ strabismus ويعطيكم العافية + +418 +00:28:33,670 --> 00:28:36,330 +والسلام عليكم ورحمة الله وبركاته diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/j2qnQbTxwhM.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/j2qnQbTxwhM.srt new file mode 100644 index 0000000000000000000000000000000000000000..868dbc7b1ba651740051742333c731e546ea2cf3 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/j2qnQbTxwhM.srt @@ -0,0 +1,1454 @@ +1 +00:00:01,820 --> 00:00:06,140 +بسم الله الرحمن الرحيم بنواصل مع محاضرات حول واحد + +2 +00:00:06,140 --> 00:00:11,580 +ووصلنا عند ال interpretation أو التحليل بتاع ال + +3 +00:00:11,580 --> 00:00:15,340 +history chart و ال laser screen اللي هو نفس ال + +4 +00:00:15,340 --> 00:00:18,460 +history chart سيكون عندي فكيف أنا أحلله و كيف + +5 +00:00:18,460 --> 00:00:22,200 +أفهمه و كيف أستنتج من العضلة اللي فيها ضعف و من + +6 +00:00:22,200 --> 00:00:27,740 +العضلة اللي فيها over action و هل الفحص normal ولا +7 +00:00:27,740 --> 00:00:33,390 +abnormal يعني كيف أقرأ ال history chart results كيف + +8 +00:00:33,390 --> 00:00:39,950 +أقرأ ال history chart results؟ هذه مثلا history chart plot + +9 +00:00:39,950 --> 00:00:45,430 +أو رسمة لعين يعني هذه النتيجة بتاعة إحدى العينين + +10 +00:00:45,430 --> 00:00:49,410 +طبعا بيجيني ال history chart result بتاعة العين اليمين + +11 +00:00:49,410 --> 00:00:54,110 +و بتاعة العين الشمال مع بعضهم البعض عشان أقدر أحلل + +12 +00:00:54,110 --> 00:01:00,170 +بالضبط كيف ال results توفر .. كيف ال results توفر + +13 +00:01:00,190 --> 00:01:04,470 +أول نقطة the two charts are compared يعني بقارن + +14 +00:01:04,470 --> 00:01:07,930 +بين ال chart تاع العين اليمين وتاع العين الشمال + +15 +00:01:07,930 --> 00:01:12,370 +the smaller chart indicates the eye with the + +16 +00:01:12,370 --> 00:01:17,170 +paretic muscle لو في عندي في إحدى العينين شلل + +17 +00:01:17,170 --> 00:01:21,790 +في عضلة ما وعملت history chart يعني في شلل في عضلة + +18 +00:01:21,790 --> 00:01:26,170 +معينة من عين معينة نفرض من العين اليمين ال lateral + +19 +00:01:26,170 --> 00:01:29,810 +rectus من العين اليمين فيها شلل يعني في lateral + +20 +00:01:29,810 --> 00:01:34,190 +rectus palsy lateral rectus palsy عادة ال + +21 +00:01:34,190 --> 00:01:37,530 +smaller chart بيكون أو دائما ال smaller chart + +22 +00:01:37,530 --> 00:01:42,650 +بيكون أو بيشير إلى ال eye with the paretic muscle + +23 +00:01:42,650 --> 00:01:45,790 +اللي بيشير للعين أو بيكون ال chart بتاعة العين + +24 +00:01:45,790 --> 00:01:50,530 +اللي فيها ال paretic muscle نشوف هنا رسمة تمثيلية + +25 +00:01:50,530 --> 00:01:55,340 +سريعة بدون ما نرسم المربعات الصغيرة نقول هنا عندنا + +26 +00:01:55,340 --> 00:01:59,540 +ال chart اللي على اليمين للعين المريض اليمين و ال + +27 +00:01:59,540 --> 00:02:03,300 +chart اللي على الشمال بتاعة العين الشمال ال result + +28 +00:02:03,300 --> 00:02:06,500 +مرسومة باللون الأحمر معلمة باللون الأحمر و اللي + +29 +00:02:06,500 --> 00:02:09,140 +بالأسود هو ال template اللي هو الرسمة الأساسية + +30 +00:02:09,140 --> 00:02:13,720 +اللي على أساسها بأسي طيب من ال smaller chart على + +31 +00:02:13,720 --> 00:02:16,200 +ال right eye؟ إذاً ال right eye فيها ال paretic + +32 +00:02:16,200 --> 00:02:21,240 +muscle طيب ال larger chart indicates the eye with + +33 +00:02:21,240 --> 00:02:25,720 +the overacting yoke muscle هنا، من الـ Paretic + +34 +00:02:25,720 --> 00:02:28,760 +muscle أو الـ Paralytic muscle العضلة المشلولة الـ + +35 +00:02:28,760 --> 00:02:32,100 +Lateral Rectus؟ من العضلة الـ Yoke بتاعة الـ + +36 +00:02:32,100 --> 00:02:35,160 +Lateral Rectus في اليمين؟ الـ Medial Rectus في + +37 +00:02:35,160 --> 00:02:38,880 +الشمال، فنلاقيها Overacting The larger chart + +38 +00:02:38,880 --> 00:02:42,480 +indicates the eye with the overacting yoke muscle + +39 +00:02:42,480 --> 00:02:46,200 +هذه الـ Overacting بتكون الـ Yoke الـ Overacting + +40 +00:02:46,200 --> 00:02:51,240 +muscle اللي هي الـ Medial Rectus تعتبر ال yoke + +41 +00:02:51,240 --> 00:02:53,760 +بتاعة ال lateral rectus اللي هي under acting ال + +42 +00:02:53,760 --> 00:02:57,360 +lateral rectus المفروض توصل الخط الأحمر لهذا ال + +43 +00:02:57,360 --> 00:03:00,780 +line لهذا ال line طيب هنا ال medial rectus المفروض + +44 +00:03:00,780 --> 00:03:04,120 +توصل الخط الأحمر لهذا ال line هي تعدته و صارت أكثر + +45 +00:03:04,120 --> 00:03:07,880 +منه و صارت أكثر منه فبالتالي هي over acting مثلا + +46 +00:03:07,880 --> 00:03:10,620 +ممكن إنسان يقول طيب هنا ال inferior oblique over + +47 +00:03:10,620 --> 00:03:14,200 +acting لا ال inferior oblique مهمتها ترفع مش تعمل + +48 +00:03:14,200 --> 00:03:18,630 +adduction مهمتها ترفع و ال superior oblique مهمتها + +49 +00:03:18,630 --> 00:03:21,650 +تنزل، إذا ال inferior oblique هي معنية برفع الخط + +50 +00:03:21,650 --> 00:03:26,590 +عن هذا الخط الأفقي، برفعه أو أنه يكون زيه أو أنه + +51 +00:03:26,590 --> 00:03:30,880 +يكون أقل منه، حسب ال action دا و ال superior oblique + +52 +00:03:30,880 --> 00:03:35,140 +إما بتكون under acting أو acting normal أو over + +53 +00:03:35,140 --> 00:03:39,100 +acting إذا تعدت الخط بتاعها أما مش مهمتهم يعملوا + +54 +00:03:39,100 --> 00:03:42,720 +abduction مش مهمتهم يعملوا abduction فبالتالي + +55 +00:03:42,720 --> 00:03:45,920 +هدول مش over acting muscles أصلا ال .. ال oblique + +56 +00:03:45,920 --> 00:03:49,780 +muscles are abductors مش abductors طيب إذا هذا + +57 +00:03:49,780 --> 00:03:54,800 +الخط خط هنا عشان خاطر ال medial rectus over acting + +58 +00:03:54,800 --> 00:03:58,970 +إذا the larger chart indicates the eye with the + +59 +00:03:58,970 --> 00:04:03,550 +overacting yoke muscle نرجع ثانية نقول الـsmaller + +60 +00:04:03,550 --> 00:04:07,550 +the chart will show its greatest restriction in + +61 +00:04:07,550 --> 00:04:10,470 +the main direction of action of the paretic muscle + +62 +00:04:10,470 --> 00:04:14,170 +في المثل هذا ال right lateral rectus لو سألنا + +63 +00:04:14,170 --> 00:04:18,430 +نفسنا سؤال الـsmaller the chart عرفنا إنه في العين + +64 +00:04:18,430 --> 00:04:21,450 +اللي فيها paretic muscle، طب ما هو صار small من + +65 +00:04:21,450 --> 00:04:25,410 +أي ناحية، يعني من أي ناحية انكمش، تراجع، من + +66 +00:04:25,410 --> 00:04:29,770 +الناحية أو من منطقة عمل أو الانكماش أو التراجع أو + +67 +00:04:29,770 --> 00:04:34,070 +الصغر في الحجم، جاء من ناحية المنطقة اللي بتشتغل + +68 +00:04:34,070 --> 00:04:36,790 +فيها ال paretic muscle اللي هي ال right lateral + +69 +00:04:37,140 --> 00:04:41,820 +إذا التراجع و الانكماش in the main direction of + +70 +00:04:41,820 --> 00:04:44,320 +the action of the paretic muscle ال greatest + +71 +00:04:44,320 --> 00:04:48,420 +restriction، أكثر restriction، أكثر محدودية، + +72 +00:04:48,420 --> 00:04:54,940 +الانكماش، التراجع من الاتجاه اللي فيه بتعمل ال + +73 +00:04:54,940 --> 00:04:58,440 +paretic muscle the larger .. the larger chart + +74 +00:04:59,290 --> 00:05:02,730 +will show its greatest expansion هنا بنقول ال + +75 +00:05:02,730 --> 00:05:05,570 +larger ال chart هو ال chart اللي إيه تعالوا + +76 +00:05:05,570 --> 00:05:10,370 +للثانية طب large من وين؟ من وين تمدد؟ من اتجاه أو + +77 +00:05:10,370 --> 00:05:13,950 +أو تمدد في الاتجاه اللي بتعمل فيه ال over acting + +78 +00:05:13,950 --> 00:05:19,710 +muscle إذا the larger ال chart will show its + +79 +00:05:19,710 --> 00:05:24,090 +greatest expansion in the main direction of action + +80 +00:05:24,090 --> 00:05:27,750 +of the yoke muscle، في هذا المثال ال left medial + +81 +00:05:27,750 --> 00:05:30,710 +rectus، يعني هذا ال chart كبير من أي ناحية، من + +82 +00:05:30,710 --> 00:05:33,250 +ناحية ال medial rectus، ليش؟ لأن ال medial rectus + +83 +00:05:33,250 --> 00:05:36,830 +over acting، ليش over acting؟ لأنها اليوك بتاعة ال + +84 +00:05:36,830 --> 00:05:41,480 +lateral rectus اللي فيها بلس the degree of + +85 +00:05:41,480 --> 00:05:44,000 +disparity between the plotted point and the + +86 +00:05:44,000 --> 00:05:48,260 +template in any position of gaze gives an estimate + +87 +00:05:48,260 --> 00:05:52,280 +of the angle of deviation طبعا each square equals + +88 +00:05:52,280 --> 00:05:55,860 +five degrees وهذا الكلام احنا حكينا بنقول كالقاتي + +89 +00:05:55,860 --> 00:06:00,620 +هنا انكمشات ممكن أعرف انكمشات كم degree أو كم + +90 +00:06:00,620 --> 00:06:04,700 +prism و هنا تمددات ممكن أعرف تمددات كم degree أو + +91 +00:06:04,700 --> 00:06:09,820 +كم prism أيضا ممكن أعرف حسب ال central point حسب + +92 +00:06:09,820 --> 00:06:14,840 +ال central point لما + +93 +00:06:14,840 --> 00:06:17,960 +أنا بدوي للمريض ال laser الأحمر على ال central + +94 +00:06:17,960 --> 00:06:22,420 +point و هو بدوي هنا معناته عندي هنا exo عندي هنا + +95 +00:06:22,420 --> 00:06:28,000 +exo بمقدار .. ليش exo؟ أنا ببحث في العين اليمين و + +96 +00:06:28,000 --> 00:06:32,260 +هنا جاية out و هنا جاية in هنا ال media rectus + +97 +00:06:32,260 --> 00:06:36,840 +يعني هيطلع في العين اليمين لما يصير contraction في + +98 +00:06:36,840 --> 00:06:40,600 +ال media rectus العين هتيجي للناحية هذه فبالتالي + +99 +00:06:40,600 --> 00:06:44,080 +ضوء هنا معناته هنا باتجاه ال lateral rectus إذا + +100 +00:06:44,080 --> 00:06:48,570 +هنا exotropia عشر degrees يعني عشرين prism + +101 +00:06:48,570 --> 00:06:52,730 +و hypertropia خمس degrees يعني عشر prism يعني بقدر + +102 +00:06:52,730 --> 00:06:57,470 +أعرف كمية ال deviation بواسطة المربعات اللي أنا + +103 +00:06:57,470 --> 00:07:02,890 +شايفها طيب + +104 +00:07:02,890 --> 00:07:08,170 +..الآن قبل ما يعني نشوف إيش ال changes with time + +105 +00:07:09,470 --> 00:07:14,490 +بدنا ناخذ بعض الأمثلة نحللها و نشوف كيف بيصير معنا + +106 +00:07:14,490 --> 00:07:19,610 +بس مجرد تدريب على تحليل أو قراءة هذا ال test chart + +107 +00:07:19,610 --> 00:07:25,370 +طيب نفرض إن هذا ال chart للعين اليمين و في chart مش + +108 +00:07:25,370 --> 00:07:29,390 +معروض للعين اليسار نقول العين اليمين أول حاجة ال + +109 +00:07:29,390 --> 00:07:32,610 +chart بتاعها أصغر من ال template من الرسم الأساسي + +110 +00:07:33,600 --> 00:07:37,080 +الرسمة اللي بتيجي على الورق أصغر إذاً في عندي under + +111 +00:07:37,080 --> 00:07:41,620 +action في muscle أو أكثر نشوف ال superior rectus + +112 +00:07:41,620 --> 00:07:45,760 +under action superior rectus المفروض إلها نص الخط + +113 +00:07:45,760 --> 00:07:50,220 +الأعلى اللي هي up and out يعني إلها نص الخط الأعلى + +114 +00:07:50,220 --> 00:07:54,040 +المفروض الخط الأسود هذا يصل هنا إذاً في under + +115 +00:07:54,040 --> 00:07:58,620 +action في superior rectus muscle أيضا في under + +116 +00:07:58,620 --> 00:08:01,700 +action في ال inferior oblique النصف الثاني من الخط + +117 +00:08:01,700 --> 00:08:06,970 +اللي هو ال in الآن نص ال medial من الخط لازم يرتفع + +118 +00:08:06,970 --> 00:08:11,930 +لفوق يصل إلى هنا إذاً في under action في ال superior + +119 +00:08:11,930 --> 00:08:15,090 +rectus في العين اليمين وفي ال inferior oblique في + +120 +00:08:15,090 --> 00:08:18,330 +العين اليمين هل انتهى الموضوع؟ لا ال medial rectus + +121 +00:08:18,330 --> 00:08:23,030 +المفروض تجيب الخط بتاعها إلى عند الحدود هذه المنطقة + +122 +00:08:23,030 --> 00:08:27,310 +إذاً في severe under action أيضا في ال medial rectus + +123 +00:08:27,310 --> 00:08:32,840 +طيب ال inferior rectus المفروض تجيب نص الخط الأسود + +124 +00:08:32,840 --> 00:08:38,530 +هنا طيب إذاً في عندي superior rectus و inferior + +125 +00:08:38,530 --> 00:08:42,810 +oblique و medial rectus و inferior rectus لو سألت + +126 +00:08:42,810 --> 00:08:46,890 +نفسي سؤال هؤلاء الأربع عضلات superior و inferior + +127 +00:08:46,890 --> 00:08:50,230 +rectus و medial rectus و inferior oblique أي عصب + +128 +00:08:50,230 --> 00:08:53,910 +من الأعصاب الثلاثة بيغذيهم اللي هو ال third + +129 +00:08:53,910 --> 00:08:57,350 +cranial nerve ال oculomotor nerve إذاً في عندي + +130 +00:08:57,350 --> 00:09:00,730 +right احنا اتفقنا إنه هذا العين ال right right + +131 +00:09:00,730 --> 00:09:07,230 +third nerve palsy right third nerve palsy طيب من + +132 +00:09:07,230 --> 00:09:10,770 +اللي عندي ضال العضلات شغالة كويس لأنها ما بتتغذى من + +133 +00:09:10,770 --> 00:09:14,130 +ال third nerve ال lateral rectus زي ما احنا + +134 +00:09:14,130 --> 00:09:19,750 +شايفينه واصلة لحدودها طيب و ال superior oblique ال + +135 +00:09:19,750 --> 00:09:22,470 +action بتاعها normal ممكن إنسان يعترض يقول لا ال + +136 +00:09:22,470 --> 00:09:24,810 +action مش normal ال superior oblique المفروض توصل + +137 +00:09:24,810 --> 00:09:30,010 +للخط هذا بس ما ننساش إنه في ال primary position هذه + +138 +00:09:30,010 --> 00:09:33,910 +العين لما اختبرناها لما كانت العين اليسار fixating + +139 +00:09:33,910 --> 00:09:37,150 +العين اليسار لما كانت fixating عشان نختبر اليمين + +140 +00:09:37,150 --> 00:09:42,930 +اليمين كانت exo exo بمقدار قد إيش مربعين و شوية يعني + +141 +00:09:42,930 --> 00:09:47,790 +تقريبا exo عشرين تقريبا أربع و عشرين prism ديوبتر + +142 +00:09:47,790 --> 00:09:51,470 +وضعية ال out position مش مناسبة لل superior + +143 +00:09:51,470 --> 00:09:56,590 +oblique عشان تنزل العين و توصل الخط لهنا طبعا ال + +144 +00:09:56,590 --> 00:09:59,330 +superior oblique depressor في ال in position في ال + +145 +00:09:59,330 --> 00:10:02,170 +in position مش في ال out position طب كيف عرفت إنها + +146 +00:10:02,170 --> 00:10:05,490 +normal acting لأنها هي مش ال main depressor of the + +147 +00:10:05,490 --> 00:10:08,990 +eye و إنما هي بتعمل depression بس ال main action + +148 +00:10:08,990 --> 00:10:12,320 +بتاعها in torsion أما ال main depressor ال inferior + +149 +00:10:12,320 --> 00:10:16,540 +rectus فلما أنا بتطلع الخط هذا اللي نصه الداخلي + +150 +00:10:16,540 --> 00:10:19,100 +اللي هو ناحية ال medial rectus اللي نصه الداخلي + +151 +00:10:19,100 --> 00:10:22,720 +مسؤول عنه ال superior oblique و نصه الخارجي مسؤول + +152 +00:10:22,720 --> 00:10:25,680 +عنه ال inferior rectus بلاقي إنه ال superior + +153 +00:10:25,680 --> 00:10:28,840 +oblique عاملة depression أكثر من ال inferior + +154 +00:10:28,840 --> 00:10:33,540 +rectus طيب إذا عاملة depression أكثر من ال main + +155 +00:10:33,540 --> 00:10:36,300 +depressor of the eye إذاً هي normal .. هي normal بس + +156 +00:10:36,300 --> 00:10:40,120 +ال position بتاع العين مش مناسب لها عشان تعمل + +157 +00:10:40,120 --> 00:10:43,280 +depression .. مش مناسب لها عشان تعمل depression + +158 +00:10:43,280 --> 00:10:47,140 +هذه right third nerve palsy طبعا في ال third nerve + +159 +00:10:47,140 --> 00:10:50,200 +كل العضلات اللي بيغذيها ال third nerve بتتأثر تصير + +160 +00:10:50,200 --> 00:10:54,500 +under acting بينما العضلات اللي ما بيغذيها ال + +161 +00:10:54,500 --> 00:10:56,640 +third nerve اللي هي ال lateral rectus و ال + +162 +00:10:56,640 --> 00:10:59,950 +superior oblique بيكونوا normal acting في ال + +163 +00:10:59,950 --> 00:11:03,810 +primary position في ال straight ahead position لما + +164 +00:11:03,810 --> 00:11:05,570 +تكون ال other eye اللي هي ال left eye احنا + +165 +00:11:05,570 --> 00:11:09,530 +اتفقنا هي ال right لما بتكون left eye fixating + +166 +00:11:09,530 --> 00:11:15,160 +هذه بتكون exo بمقدار تقريبا عشر degrees و شوية نقول + +167 +00:11:15,160 --> 00:11:19,260 +اثنا عشر degrees تقريبا يعني أربع و عشرين بريم .. أربع + +168 +00:11:19,260 --> 00:11:24,020 +و عشرين بريم فهذا طريق التحليل اللي هي .. اللي هي + +169 +00:11:24,020 --> 00:11:27,300 +history chart طبعا التحليل لا يكتمل إلا بالتعليق + +170 +00:11:27,300 --> 00:11:32,820 +على ال chart العين الأخرى نيجي هنا نحاول .. يعني + +171 +00:11:32,820 --> 00:11:37,120 +نقرأ هنا هذا أيضا عندي chart هذه ال right eye و + +172 +00:11:37,120 --> 00:11:41,070 +هذه ال left eye الـ chart الأصغر هو ال left eye، + +173 +00:11:41,070 --> 00:11:46,070 +إذاً ال left eye فيها إحدى عضلاتها فيها شلل أو فيها + +174 +00:11:46,070 --> 00:11:49,450 +paralysis أو paralysis كيف عرفت إن هذا ال chart + +175 +00:11:49,450 --> 00:11:53,890 +الأصغر يعني منكمش من هذه الناحية بينما هذا متمدد + +176 +00:11:53,890 --> 00:11:57,830 +من هذه الناحية؟ المنكمش من أي ناحية؟ من ناحية ال + +177 +00:11:57,830 --> 00:12:05,060 +superior oblique الخط الأسفل هذا نصه .. نصه مسؤول + +178 +00:12:05,060 --> 00:12:09,840 +عنه ال inferior rectus النص البراني أساسا اتنزله + +179 +00:12:09,840 --> 00:12:15,810 +للأسفل و النص الآخر اللي هي ال superior oblique في + +180 +00:12:15,810 --> 00:12:18,110 +ال in position هي المسؤولة عن ال depression + +181 +00:12:18,110 --> 00:12:21,710 +فبالتالي أنا في عندي ضعف في superior oblique في + +182 +00:12:21,710 --> 00:12:26,130 +superior oblique left superior oblique palsy left + +183 +00:12:26,130 --> 00:12:29,430 +superior oblique palsy اللي عن العين هذه لما تحاول + +184 +00:12:29,430 --> 00:12:32,830 +تعمل fixation لازم تنزل لأن هذه العين في ال + +185 +00:12:32,830 --> 00:12:35,550 +primary position في ال primary position جاية + + +201 +00:13:27,530 --> 00:13:32,350 +لدرجة إن المريض ممكن يقشر إذا أناشرت هذه الإشارة + +202 +00:13:32,350 --> 00:13:35,510 +في منطقة عمل ال inferior rectus للعين اليمنى ممكن + +203 +00:13:35,510 --> 00:13:38,770 +هو يقشر بعيد على الجدار من كتر ما هي ال inferior + +204 +00:13:38,770 --> 00:13:43,460 +rectus over acting طبعا حسب كمية ال innovation اللي + +205 +00:13:43,460 --> 00:13:48,260 +بتجيه لما هذه نزلت لل primary position هذه نزلت عن + +206 +00:13:48,260 --> 00:13:51,580 +ال primary position للأسفل حسب herring law أيضا + +207 +00:13:51,580 --> 00:13:57,020 +بمقدار تقريبا خمسة degree يعني عشرة prism أصبحت + +208 +00:13:57,020 --> 00:14:00,460 +hypotropia when the other eye when the left eye is + +209 +00:14:00,460 --> 00:14:07,400 +fixed طيب، الآن في نقطة بنقول كالقادة، كل مكان + +210 +00:14:07,400 --> 00:14:14,120 +الفرق بين ال two charts واضح، كل ما كان الفرق في + +211 +00:14:14,120 --> 00:14:16,680 +الرسمة بين ال two charts واضح، زي ما أنا شايف هنا + +212 +00:14:16,680 --> 00:14:19,820 +فيه فرق واضح جدا، هذه under acting، هذه over + +213 +00:14:19,820 --> 00:14:24,720 +acting، بيكون ال policy جديدة، جديدة الحدوث، يعني + +214 +00:14:24,720 --> 00:14:29,220 +recent policy مع تقدم الوقت تبدأ ال superior + +215 +00:14:29,220 --> 00:14:33,700 +oblique تشفى، كثير من ال palsy يشفى لوحده تمام أو مع + +216 +00:14:33,700 --> 00:14:37,760 +العلاج كثير جدا، يعني نسبة عالية تقريبا تصل 90% أو + +217 +00:14:37,760 --> 00:14:43,880 +أكثر، بتبدأ تتحسن ال function فتبدأ ال under + +218 +00:14:43,880 --> 00:14:48,100 +action يتحسنوا ال over action بيبدأ يتراجع يعني + +219 +00:14:48,100 --> 00:14:52,500 +بيبدأ يتماثل الرسم أو ال chart بتاع العين اليمنى و + +220 +00:14:52,500 --> 00:14:56,320 +العين اليسرى بيصيروا competent بيصيروا competent + +221 +00:14:56,320 --> 00:15:00,180 +يعني متماثلات بيصيروا competent بيسموه spread of + +222 +00:15:00,180 --> 00:15:04,220 +competence انتشار التماثل .. انتشار التماثل هذا + +223 +00:15:04,220 --> 00:15:07,740 +الكلام بفيدنا في قضية فهم changes with time يعني + +224 +00:15:07,740 --> 00:15:13,140 +الإنسان اللي أنا عملتله الـ his chart أو ال easy screen + +225 +00:15:13,140 --> 00:15:18,120 +test المفروض أتابعه وأشوف التغيرات مع مضي الوقت + +226 +00:15:18,120 --> 00:15:21,940 +changes with time are very useful as a prognostic + +227 +00:15:21,940 --> 00:15:26,680 +guide يعني بستفيد من أني أعيد ال chart كل فترة + +228 +00:15:26,680 --> 00:15:30,320 +مثلا كل شهرين أو كل شهر إذا بالزم أو كل تلات شهور + +229 +00:15:30,320 --> 00:15:35,950 +حسب ال examiner ما هو شايف بيفيدني في أن أنا أعرف + +230 +00:15:35,950 --> 00:15:38,990 +ال prognosis، المصير، يعني هل هيتم تحسن، هل مش + +231 +00:15:38,990 --> 00:15:43,210 +هيتم تحسن، سرعة التحسن، هل بحتاج بعد ذلك تدخل + +232 +00:15:43,210 --> 00:15:49,470 +جراحي، بحتاجش، فبي .. بيفيد عمل أو تكرار عمل ال + +233 +00:15:49,470 --> 00:15:53,070 +his chart examination عشان أشوف بدت ال function + +234 +00:15:53,070 --> 00:15:57,270 +بتاعة المريض تتحسن ولا لساتها زي ما هي، ولا لساتها + +235 +00:15:57,270 --> 00:16:01,320 +زي ما هي for example in right superior rectus palsy + +236 +00:16:01,320 --> 00:16:04,420 +the hessy chart will show under action of the + +237 +00:16:04,420 --> 00:16:08,040 +affected muscle with an over action of its yoke + +238 +00:16:08,040 --> 00:16:12,240 +muscle اللي lift inferior oblique نشوف هنا هاي + +239 +00:16:12,240 --> 00:16:16,960 +احنا ال chart اللي على ال right على ال .. باتجاه + +240 +00:16:16,960 --> 00:16:19,220 +يدنا اليمنى و ال chart اللي على ال left لل left + +241 +00:16:19,220 --> 00:16:22,860 +eye باتجاه يدنا اليسرى إذا هذه لل right eye و هذه + +242 +00:16:22,860 --> 00:16:27,890 +لل left eye هنا طالما ال chart هو الأصغر معناه هنا + +243 +00:16:27,890 --> 00:16:31,510 +العضلة الضعيفة و هنا ال over acting muscle في + +244 +00:16:31,510 --> 00:16:34,750 +العين الثانية، ال .. ال .. مين ال under acting + +245 +00:16:34,750 --> 00:16:38,090 +muscle؟ ال superior rectus .. ال superior rectus + +246 +00:16:38,090 --> 00:16:42,010 +طالما ال superior rectus under acting معناته فيها + +247 +00:16:42,010 --> 00:16:44,870 +palsy، مين ال yoke بتاعتها في العين الثانية في ال + +248 +00:16:44,870 --> 00:16:48,350 +left eye؟ ال inferior oblique طبعا واضح الفرق في + +249 +00:16:48,350 --> 00:16:51,430 +الرسم بين اللي هدا، يعني لا يحتاج إلا جهد لنا .. + +250 +00:16:51,430 --> 00:16:55,730 +لنذكر إنه أو .. أو ل .. ل .. لنثبت إنه هذا الرسم + +251 +00:16:55,730 --> 00:16:59,730 +هي الأصغر بفارق واضح، فبالتالي هذه recent policy + +252 +00:17:00,820 --> 00:17:04,480 +because of the great incompetence عشان عدم التماثل + +253 +00:17:04,480 --> 00:17:07,980 +الكبير، هذا عدم تماثل كبير، يعني في فرق واضح + +254 +00:17:07,980 --> 00:17:11,580 +للغاية بين الرسمتين of the two charts, the + +255 +00:17:11,580 --> 00:17:14,600 +diagnosis is straightforward، يعني ما بيغلبش ال + +256 +00:17:14,600 --> 00:17:17,480 +diagnosis، يعني لما بتعرض علينا رسمة زي هيكها، + +257 +00:17:17,480 --> 00:17:21,980 +they write superior rectus palsy if the if the + +258 +00:17:21,980 --> 00:17:26,180 +العضلة الضعيفة recovers، إذا بدت تتماثل للشفاء + +259 +00:17:26,180 --> 00:17:30,670 +العضلة الضعيفة يعني هيتحسن ال function داها + +260 +00:17:30,670 --> 00:17:34,250 +طبعا مش هترجع مرة واحدة إلى الخط الطبيعي ولكن + +261 +00:17:34,250 --> 00:17:38,310 +هتبدأ يرتفع الخط مثلا عملنا بعد شهرين كان الخط هذا + +262 +00:17:38,310 --> 00:17:41,930 +استجابة المريض اللي بيمثل استجابة المريض أصبح + +263 +00:17:41,930 --> 00:17:45,910 +هنا أصبح هنا طالما بتزيد ال function بتاعة ال + +264 +00:17:45,910 --> 00:17:51,720 +superior rectus بتبدأ تتراجع ال over action بتاع ال + +265 +00:17:51,720 --> 00:17:56,100 +inferior oblique لأنه ما فيش حاجة إله ما هو من وين + +266 +00:17:56,100 --> 00:17:59,620 +إجا من ال under action بتاع ال superior rectus + +267 +00:17:59,620 --> 00:18:03,440 +عشان العين هيتعمل fixation بيجي لل superior rectus + +268 +00:18:03,440 --> 00:18:07,480 +increased innervation شحنات زيادة و هنا عشانها + +269 +00:18:07,480 --> 00:18:11,040 +الـ yoke تاخد شحنات زيادة طب بدت هذه العضلة تتمثل + +270 +00:18:11,040 --> 00:18:14,680 +للشفاء صار بدها شحنات زيادة بس أجل من أول فبرضه + +271 +00:18:14,680 --> 00:18:17,980 +هذه هيجيها أجل من أول فبالتالي بتبدأ إيش ده تراجع + +272 +00:18:19,250 --> 00:18:22,330 +if the paretic muscle recovers its function, both + +273 +00:18:22,330 --> 00:18:25,810 +charts will revert to normal both charts يعني ال + +274 +00:18:25,810 --> 00:18:28,410 +two charts بتاع اليمين و بتاع الشمال هيرجعوا + +275 +00:18:28,410 --> 00:18:32,030 +لل normal، هدا هيدمدد إلى باتجاه الطبيعي و هدا + +276 +00:18:32,030 --> 00:18:38,010 +هينكمش باتجاه الطبيعي however if the paresis + +277 +00:18:38,010 --> 00:18:41,970 +persists، إذا الشلل ضال، the shapes of both charts + +278 +00:18:41,970 --> 00:18:44,370 +will change as follows + +279 +00:18:47,840 --> 00:18:53,600 +عشان نفهم هذا .. هذه النقطة أنا بنصح حقًا إنّه + +280 +00:18:53,600 --> 00:18:59,300 +اللي طالب اللي ناسي ال muscle sequela يرجعها قبل + +281 +00:18:59,300 --> 00:19:02,840 +ما يتحرك عن هذه النقطة يعني .. يعني تم إيقاف هذا + +282 +00:19:02,840 --> 00:19:06,280 +ال .. الفيديو بتاع المحاضرة هاي عند النقطة هاي عند + +283 +00:19:06,280 --> 00:19:13,360 +الدقيقة هاي ثم يعود لتذكر ال muscle sequela و + +284 +00:19:13,360 --> 00:19:19,270 +بعدين يرجع عشان يكمل المحاضرة هاي التعامل التعامل + +285 +00:19:19,270 --> 00:19:21,510 +التعامل التعامل التعامل التعامل التعامل التعامل + +286 +00:19:21,510 --> 00:19:23,250 +التعامل التعامل التعامل التعامل التعامل التعامل + +287 +00:19:23,250 --> 00:19:27,410 +التعامل التعامل التعامل التعامل التعامل التعامل + +288 +00:19:27,410 --> 00:19:33,110 +التعامل التعامل التعامل التعامل التعامل التعامل + +289 +00:19:33,110 --> 00:19:39,180 +التعامل التعامل التعامل التعامل التعامل التعام احنا + +290 +00:19:39,180 --> 00:19:41,940 +في البداية ال right superior rectus كانت under + +291 +00:19:41,940 --> 00:19:45,940 +-acting لحالها و ال yoke بتاعها في العين الثانية + +292 +00:19:45,940 --> 00:19:48,020 +اللي هي ال inferior oblique over-acting لحالها، + +293 +00:19:48,020 --> 00:19:52,260 +إذا عضلة في كل عين، عضلة في كل عين، لو طولت ال palsy + +294 +00:19:52,260 --> 00:19:56,220 +و ما تم شفاءها، هذه العضلة فيها palsy اللي هي ال + +295 +00:19:56,220 --> 00:20:00,420 +superior rectus و ما شفيت، يعني دائما راخية، دائما + +296 +00:20:00,420 --> 00:20:03,940 +مشلولة، هيصير عندك contraction في ال antagonist + +297 +00:20:03,940 --> 00:20:06,720 +اللي هي ال inferior rectus فال inferior rectus + +298 +00:20:06,720 --> 00:20:11,980 +هتصير over acting هي تمددت برا الخط بتاعها over + +299 +00:20:11,980 --> 00:20:15,820 +acting بأقل innervation مش محتاجة innervation كثير + +300 +00:20:15,820 --> 00:20:19,680 +بس هي لأنها متقلصة contracted muscle هتكون + +301 +00:20:20,580 --> 00:20:24,880 +overacting طالما هيجيلها innervation قليل ال yoke + +302 +00:20:24,880 --> 00:20:26,920 +بتاعتها تاعت ال inferior rectus اللي هي ال + +303 +00:20:26,920 --> 00:20:29,820 +superior oblique في العين الثانية هيجيها أيضًا + +304 +00:20:29,820 --> 00:20:34,840 +innervation قليل وهي عضلة طبيعية غير متقلصة + +305 +00:20:34,840 --> 00:20:37,720 +innervation قليل لأنه إجا لل yoke اللي هي ال + +306 +00:20:37,720 --> 00:20:40,040 +inferior rectus innervation قليل ليش لأنها مش + +307 +00:20:40,040 --> 00:20:43,080 +محتاجة كثير ما فيش شيء يقاومها في عملها ال + +308 +00:20:43,080 --> 00:20:46,560 +antagonist بتاعتها واقفة و مشلولة من زمان فبالتالي + +309 +00:20:46,560 --> 00:20:51,110 +هذه عشان تؤدي عملها بدها innervation قليلة فبالتالي + +310 +00:20:51,110 --> 00:20:53,970 +ال superior oblique الـ yoke بتاعتها هيصلها أيضًا + +311 +00:20:53,970 --> 00:20:58,430 +innervation قليل وهي عضلة طبيعية فهتخش بما يسمى + +312 +00:20:58,430 --> 00:21:02,990 +Inhibitional Palsy Inhibitional Palsy مش حقيقية + +313 +00:21:02,990 --> 00:21:07,830 +وإنما ناتجة عن قلة ورود ال impulses العصبية لأن ال + +314 +00:21:07,830 --> 00:21:11,130 +brain بعت لل inferior rectus عجدها وهي مكتفية + +315 +00:21:11,130 --> 00:21:14,610 +بالقليل فهيبعت لل superior oblique نفس ما بعت لل + +316 +00:21:14,610 --> 00:21:20,770 +inferior rectus لأنهم yoke muscles هذه هي القضية طيب + +317 +00:21:20,770 --> 00:21:27,270 +.. الآن لو حابة العين اليمنى تعمل fixation هيجي + +318 +00:21:27,270 --> 00:21:31,850 +increased innervation للعضلة اللي بدت المشكلة عشان + +319 +00:21:31,850 --> 00:21:35,390 +ترفع العين لأن العين هتكون في ال down gaze لأنّه + +320 +00:21:35,390 --> 00:21:39,110 +superior rectus pulse هتكون hypotropia فهيجي + +321 +00:21:39,110 --> 00:21:43,920 +increased innervation لل superior rectus هنا إذا + +322 +00:21:43,920 --> 00:21:46,540 +إجا increased innervation للـ superior rectus هنا، + +323 +00:21:46,540 --> 00:21:50,060 +هيجي increased innervation لل inferior oblique + +324 +00:21:50,060 --> 00:21:53,300 +هنا، عشانها حسب hearing loss، فهتصير over acting + +325 +00:21:53,300 --> 00:21:57,260 +muscle صفة عندها two over acting muscle، هذه عشانها + +326 +00:21:57,260 --> 00:22:02,340 +contracted، وهذه عشان hearing loss و two under + +327 +00:22:02,340 --> 00:22:08,400 +acting muscles هدى palsy حقيقية و هدى palsy بسبب + +328 +00:22:08,400 --> 00:22:13,140 +ال inhibition أنه ما بعطلها ال brain ما يحفزها + +329 +00:22:13,140 --> 00:22:17,460 +لأنه بعطلها ال yoke بتاعتها قليلة فبالتالي هي بعطلها + +330 +00:22:17,460 --> 00:22:22,000 +قليلة الآن المشكلة تكمن أيه؟ هذا الكلام لما احنا + +331 +00:22:22,000 --> 00:22:26,300 +بنشرحه نظريًا و بنستنتج و احنا فرضنا إنّه هنا بدت + +332 +00:22:26,300 --> 00:22:31,610 +المشكلة المريض لما بيجي صار عنده superior rectus + +333 +00:22:31,610 --> 00:22:36,190 +palsy قديمًا، ما عنده أي ملف، ما عنده أي تقرير، ما عنده + +334 +00:22:36,190 --> 00:22:41,130 +أي إفادة، مش متذكر في أي عين بدأت المشكلة، حطناه + +335 +00:22:41,130 --> 00:22:46,170 +على ال hessy chart، طلع لنا المنظر هذا الآن عندي two + +336 +00:22:46,170 --> 00:22:49,290 +under acting muscle ما فيش واحدة منهم هتتكلم أو + +337 +00:22:49,290 --> 00:22:53,270 +تنطق وتقولي أنا بدت المشكلة عندي وانتهت هنا أو بدت + +338 +00:22:53,270 --> 00:22:56,290 +هنا وانتهت هنا هي على فكرة لو بدت في ال left + +339 +00:22:56,290 --> 00:23:00,230 +superior oblique palsy هتنتهي إنّه هذه العضلة اللي + +340 +00:23:00,230 --> 00:23:02,190 +هي superior rectus في العين اللي هي منها هتكون + +341 +00:23:02,190 --> 00:23:05,330 +inhibitional palsy يعني إذا بدت هنا هتنتهي هنا + +342 +00:23:05,330 --> 00:23:07,810 +و إذا بدت هنا هتنتهي هنا التنتين هيصيروا under + +343 +00:23:07,810 --> 00:23:12,910 +acting فبالتالي مش هقدر أعرف وين بدت المشكلة .. وين + +344 +00:23:12,910 --> 00:23:18,570 +بدت المشكلة لأنّه صار عندي أكثر من عضلة involved + +345 +00:23:18,570 --> 00:23:23,610 +المسألة ما بتوقفش عند هذه القضية ولكن أيضًا مع الوقت + +346 +00:23:23,610 --> 00:23:27,790 +بتتطور this could lead to incorrect impression + +347 +00:23:27,790 --> 00:23:30,410 +that the left superior oblique was the primary + +348 +00:23:30,410 --> 00:23:33,750 +muscle at fault هذا ال .. ال muscle sequelae اللي + +349 +00:23:33,750 --> 00:23:38,070 +حدث ممكن يعطي انطباع أنّ ال superior oblique هي + +350 +00:23:38,070 --> 00:23:43,510 +المشكلة اللي بدت من عندها، بدت من عندها، و بالتالي + +351 +00:23:43,510 --> 00:23:48,710 +هيكون هذا انطباع خاطئ، بس سببه إنّه ما فيش أي معلومات، + +352 +00:23:48,710 --> 00:23:52,130 +و ما فيش عندي إلا ال hessy chart، ما فيش عندي إلا ال hessy + +353 +00:23:52,130 --> 00:23:57,400 +chart لما بيمضي الزمن كمان، this with further + +354 +00:23:57,400 --> 00:24:01,020 +passage of time، the two charts become more and + +355 +00:24:01,020 --> 00:24:04,640 +more concomitant، يعني هدول ال two under acting + +356 +00:24:04,640 --> 00:24:10,100 +muscles، ها دي بتبدأ تستعيد يعني شوية من ال + +357 +00:24:10,100 --> 00:24:13,320 +function بتاعتها و هذه بتبدأ تتراجع هذه بتبدأ أيضًا + +358 +00:24:13,320 --> 00:24:17,140 +تتراجع هذه بتبدأ ال inhibitional palsy يروح عنها + +359 +00:24:17,140 --> 00:24:24,640 +ال inhibitional palsy فبالتالي ببدأ يرجع الرسمة + +360 +00:24:24,640 --> 00:24:27,740 +باتجاه الخطوط الطبيعية و الحدود الطبيعية لل + +361 +00:24:27,740 --> 00:24:30,780 +function بتاعة كل مثل With further passage of + +362 +00:24:30,780 --> 00:24:33,560 +time، the two charts become more and more + +363 +00:24:33,560 --> 00:24:38,040 +concomitant أكثر وأكثر تجانسًا until it may be + +364 +00:24:38,040 --> 00:24:41,300 +impossible to determine which was the primary + +365 +00:24:41,300 --> 00:24:44,580 +paretic muscle ممكن نصل لنقطة فعلًا احنا ما نقدرش + +366 +00:24:44,580 --> 00:24:48,580 +نحدد مين ال .. ال .. ال paretic muscle اللي بدأت + +367 +00:24:48,580 --> 00:24:52,220 +بس بدنا نقول كالقادة في عدة أشياء بدنا نحكيها في + +368 +00:24:52,220 --> 00:24:56,180 +النقطة هاي أول شيء لا .. لا نعتمد على ال hessy chart + +369 +00:24:56,180 --> 00:25:00,240 +كوسيلة و .. وحيدة و واحدة في ال diagnosis هذه نقطة + +370 +00:25:00,240 --> 00:25:05,920 +لازم إنّه ناخد ال history بشكل كويس لازم إنّه نطلب + +371 +00:25:05,920 --> 00:25:10,280 +تقارير من المريض يوفرها بقدر ما يستطيع لازم نطلب + +372 +00:25:10,280 --> 00:25:13,980 +old photos عشان أحيانًا ال abnormal head posture + +373 +00:25:13,980 --> 00:25:18,680 +ممكن يدلني نوعًا ما .. طبعًا برضه ما أعتمدش عليه + +374 +00:25:18,680 --> 00:25:24,120 +لوحده بس بجمع بجمع كل ما يمكن من معلومات بواسطة ال + +375 +00:25:24,120 --> 00:25:27,860 +old photos بواسطة ال history بواسطة التقارير الطبية + +376 +00:25:27,860 --> 00:25:31,480 +أيضًا بواسطة الفحوصات اللي أنا بأجريها للمريض عشان + +377 +00:25:31,480 --> 00:25:35,200 +أحاول أصل لل diagnosis الصحيح لل diagnosis + +378 +00:25:35,200 --> 00:25:39,330 +الصحيح فبالتالي هذه القضية ضرورة تكون واضحة طبعًا + +379 +00:25:39,330 --> \ No newline at end of file diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/j2qnQbTxwhM_raw.json b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/j2qnQbTxwhM_raw.json new file mode 100644 index 0000000000000000000000000000000000000000..3e8bed28bf02c919c371fbbb949259fabd572e93 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/j2qnQbTxwhM_raw.json @@ -0,0 +1 @@ +{"segments": [{"id": 1, "seek": 3064, "start": 1.82, "end": 30.64, "text": "بسم الله الرحمن الرحيم بنواصل مع محاضرات حوال واحد ووصلنا عند ال 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"word": " الخط", "probability": 0.941162109375}, {"start": 230.42, "end": 230.8, "word": " خط", "probability": 0.97998046875}, {"start": 230.8, "end": 231.1, "word": " هنا", "probability": 0.8896484375}, {"start": 231.1, "end": 231.86, "word": " عشان", "probability": 0.9827473958333334}, {"start": 231.86, "end": 232.42, "word": " خاطر", "probability": 0.9840494791666666}, {"start": 232.42, "end": 233.02, "word": " ال", "probability": 0.9599609375}, {"start": 233.02, "end": 233.5, "word": " medial", "probability": 0.63671875}, {"start": 233.5, "end": 234.04, "word": " rectus", "probability": 0.93212890625}, {"start": 234.04, "end": 234.36, "word": " over", "probability": 0.91455078125}, {"start": 234.36, "end": 234.8, "word": " acting", "probability": 0.69970703125}, {"start": 234.8, "end": 235.16, "word": " إذا", "probability": 0.939453125}, {"start": 235.16, "end": 235.34, "word": " the", "probability": 0.6494140625}, {"start": 235.34, "end": 235.72, "word": " larger", "probability": 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action of the bariatric muscle ال greatest restriction، أكتر restriction، أكتر محدودية، الانكماش، التراجع من الاتجاه اللي فيه بتعمل ال bariatric muscle the larger .. the larger chart", "tokens": [28814, 15730, 16712, 2288, 26108, 3615, 4032, 2423, 7649, 24793, 33599, 294, 264, 2135, 3513, 295, 264, 3069, 295, 264, 2159, 17252, 8679, 2423, 6636, 29529, 12399, 5551, 4117, 2655, 2288, 29529, 12399, 5551, 4117, 2655, 2288, 3714, 24401, 23328, 10632, 12399, 2423, 7649, 24793, 33599, 12399, 16712, 2288, 26108, 3615, 9154, 2423, 9307, 7435, 40294, 13672, 1829, 8978, 3224, 39894, 25957, 1211, 2423, 2159, 17252, 8679, 264, 4833, 4386, 264, 4833, 6927], "avg_logprob": -0.22740709439322754, "compression_ratio": 1.723756906077348, "no_speech_prob": 1.8477439880371094e-06, "words": [{"start": 277.14, "end": 278.06, "word": "إذا", "probability": 0.4070892333984375}, {"start": 278.06, "end": 278.74, "word": " التراجع", "probability": 0.9459228515625}, {"start": 278.74, "end": 278.86, "word": " و", 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greatest expansion هنا بنقول ال larger ال chart هو ال chart اللي إيه تعالين التانية طب large من وين؟ من وين تمدد؟ من اتجاه أو او تمدد في الاتجاه اللي بتعمل فيه ال over acting muscle إذا the larger ال chart", "tokens": [17044, 855, 1080, 6636, 11260, 34105, 44945, 39648, 2423, 4833, 2423, 6927, 31439, 2423, 6927, 13672, 1829, 11933, 1829, 3224, 37279, 6027, 9957, 16712, 7649, 10632, 23032, 3555, 2416, 9154, 4032, 9957, 22807, 9154, 4032, 9957, 46811, 3215, 3215, 22807, 9154, 1975, 2655, 7435, 40294, 34051, 1975, 2407, 46811, 3215, 3215, 8978, 2423, 9307, 7435, 40294, 13672, 1829, 39894, 25957, 1211, 8978, 3224, 2423, 670, 6577, 8679, 11933, 15730, 264, 4833, 2423, 6927], "avg_logprob": -0.19077281130326762, "compression_ratio": 1.6544502617801047, "no_speech_prob": 1.0371208190917969e-05, "words": [{"start": 299.29, "end": 299.59, "word": "will", "probability": 0.4091796875}, {"start": 299.59, "end": 300.03, "word": " show", "probability": 0.96240234375}, {"start": 300.03, "end": 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charts واضح، زي ما أنا شايف هنا فيه فرق واضح جدا، هذه under acting، هذه over acting، بيكون ال policy جديدة، جديدة الحدوث، يعني recent policy", "tokens": [3555, 9957, 2423, 732, 17767, 4032, 46958, 5016, 12399, 28242, 19446, 25961, 27188, 2288, 4587, 8978, 34892, 38251, 3660, 49374, 2423, 732, 17767, 4032, 46958, 5016, 12399, 30767, 1829, 19446, 41850, 13412, 995, 33911, 34105, 8978, 3224, 6156, 2288, 4587, 4032, 46958, 5016, 10874, 28259, 12399, 29538, 833, 6577, 12399, 29538, 670, 6577, 12399, 4724, 1829, 30544, 2423, 3897, 10874, 16254, 41891, 12399, 10874, 16254, 41891, 21542, 3215, 2407, 12984, 12399, 37495, 22653, 5162, 3897], "avg_logprob": -0.11194490484501186, "compression_ratio": 1.7094972067039107, "no_speech_prob": 4.76837158203125e-06, "words": [{"start": 849.52, "end": 849.9, "word": "بين", "probability": 0.896728515625}, {"start": 849.9, "end": 850.08, "word": " ال", "probability": 0.9814453125}, {"start": 850.08, "end": 850.3, "word": " two", "probability": 0.87890625}, 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1506.38, "end": 1506.54, "word": " من", "probability": 0.99462890625}, {"start": 1506.54, "end": 1507.0, "word": " المريض", "probability": 0.9894205729166666}, {"start": 1507.0, "end": 1507.78, "word": " يوفرها", "probability": 0.968505859375}, {"start": 1507.78, "end": 1508.3, "word": " بقدر", "probability": 0.9938151041666666}, {"start": 1508.3, "end": 1508.46, "word": " ما", "probability": 0.98583984375}, {"start": 1508.46, "end": 1509.06, "word": " يستطيع", "probability": 0.985107421875}, {"start": 1509.06, "end": 1509.9, "word": " لازم", "probability": 0.9488932291666666}, {"start": 1509.9, "end": 1510.28, "word": " نطلب", "probability": 0.9934895833333334}, {"start": 1510.28, "end": 1510.7, "word": " old", "probability": 0.93115234375}, {"start": 1510.7, "end": 1511.24, "word": " photos", "probability": 0.9208984375}, {"start": 1511.24, "end": 1511.62, "word": " عشان", "probability": 0.9822591145833334}, {"start": 1511.62, "end": 1512.26, "word": " أحيانا", "probability": 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"probability": 0.9862060546875}, {"start": 1534.46, "end": 1534.58, "word": " ل", "probability": 0.60107421875}, {"start": 1534.58, "end": 1534.68, "word": " ال", "probability": 0.98193359375}, {"start": 1534.68, "end": 1535.2, "word": " diagnosis", "probability": 0.8974609375}, {"start": 1535.2, "end": 1535.98, "word": " الصحيح", "probability": 0.994384765625}, {"start": 1535.98, "end": 1536.5, "word": " فبالتالي", "probability": 0.9810384114583334}, {"start": 1536.5, "end": 1536.7, "word": " هذه", "probability": 0.8525390625}, {"start": 1536.7, "end": 1537.26, "word": " القضية", "probability": 0.9939778645833334}, {"start": 1537.26, "end": 1537.98, "word": " ضرورة", "probability": 0.80853271484375}, {"start": 1537.98, "end": 1538.32, "word": " تكون", "probability": 0.993408203125}, {"start": 1538.32, "end": 1538.82, "word": " واضحة", "probability": 0.943115234375}], "temperature": 1.0}, {"id": 68, "seek": 155979, "start": 1538.91, "end": 1559.79, "text": "طبعاً بيلزم التدريب على الكثير من ال acid charts وتحليلها على أساس أن الإنسان يصير متمكن في هذه القضية في إجراء الفحص وفي تحليل النتائج بتاعة الفحص عند هنا بنتوقف ويعطيكم العافية والسلام عليكم ورحمة الله وبركاته", "tokens": [9566, 3555, 3615, 995, 14111, 4724, 26895, 11622, 2304, 16712, 3215, 16572, 3555, 15844, 33251, 12984, 13546, 9154, 2423, 8258, 17767, 34683, 5016, 20292, 1211, 11296, 15844, 5551, 3794, 32277, 14739, 33688, 1863, 3794, 7649, 7251, 9381, 13546, 44650, 43020, 8978, 29538, 25062, 11242, 10632, 8978, 11933, 7435, 2288, 16606, 27188, 5016, 9381, 4032, 41185, 6055, 5016, 20292, 1211, 28239, 2655, 16373, 7435, 39894, 995, 27884, 27188, 5016, 9381, 43242, 34105, 44945, 2655, 30543, 5172, 4032, 40228, 9566, 1829, 24793, 18863, 31845, 10632, 16070, 3794, 37440, 25894, 24793, 4032, 2288, 35571, 3660, 21984, 4032, 26890, 4117, 9307, 3224], "avg_logprob": -0.11253156731225024, "compression_ratio": 1.724770642201835, "no_speech_prob": 4.947185516357422e-06, "words": [{"start": 1538.91, "end": 1539.33, 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"end": 1553.19, "word": " النتائج", "probability": 0.9615478515625}, {"start": 1553.19, "end": 1554.19, "word": " بتاعة", "probability": 0.8543294270833334}, {"start": 1554.19, "end": 1554.83, "word": " الفحص", "probability": 0.9847005208333334}, {"start": 1554.83, "end": 1555.35, "word": " عند", "probability": 0.80322265625}, {"start": 1555.35, "end": 1555.51, "word": " هنا", "probability": 0.99267578125}, {"start": 1555.51, "end": 1556.19, "word": " بنتوقف", "probability": 0.891357421875}, {"start": 1556.19, "end": 1556.67, "word": " ويعطيكم", "probability": 0.93447265625}, {"start": 1556.67, "end": 1557.09, "word": " العافية", "probability": 0.974609375}, {"start": 1557.09, "end": 1557.51, "word": " والسلام", "probability": 0.9150390625}, {"start": 1557.51, "end": 1557.97, "word": " عليكم", "probability": 0.953125}, {"start": 1557.97, "end": 1558.41, "word": " ورحمة", "probability": 0.98486328125}, {"start": 1558.41, "end": 1558.77, "word": " الله", "probability": 0.9765625}, {"start": 1558.77, "end": 1559.79, "word": " وبركاته", "probability": 0.98076171875}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 1559.846875, "duration_after_vad": 1532.1012499999988} \ No newline at end of file diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/j2qnQbTxwhM_raw.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/j2qnQbTxwhM_raw.srt new file mode 100644 index 0000000000000000000000000000000000000000..dcef5834e0b21286197ca255c3e14441b16b83ae --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/j2qnQbTxwhM_raw.srt @@ -0,0 +1,1548 @@ +1 +00:00:01,820 --> 00:00:06,140 +بسم الله الرحمن الرحيم بنواصل مع محاضرات حوال واحد + +2 +00:00:06,140 --> 00:00:11,580 +ووصلنا عند ال interpretation أو التحليل بتاع ال + +3 +00:00:11,580 --> 00:00:15,340 +history chart و ال laser screen اللي هو نفس ال + +4 +00:00:15,340 --> 00:00:18,460 +history chart هيكون عندى فكيف أنا أحلله و كيف + +5 +00:00:18,460 --> 00:00:22,200 +أفهمه و كيف أستنتج مين العضلة اللي فيها ضعف و مين + +6 +00:00:22,200 --> 00:00:27,740 +العضلة اللي فيها over action و هل الفحص normal ولا + +7 +00:00:27,740 --> 00:00:33,390 +abnormal يعني كيف أقرأال his chart results كيف + +8 +00:00:33,390 --> 00:00:39,950 +أقرأ ال his chart results؟ هاي مثلا his chart plot + +9 +00:00:39,950 --> 00:00:45,430 +لأو رسمة لعين يعني هاي النتيجة بتاعة أحدى العينتين + +10 +00:00:45,430 --> 00:00:49,410 +طبعا بيجيني ال his chart result بتاعة العين اليمين + +11 +00:00:49,410 --> 00:00:54,110 +و بتاعة العين الشمال مع بعضهم البعض عشان أقدر أحلل + +12 +00:00:54,110 --> 00:01:00,170 +بالضبط كيف ال results توفر .. كيف ال results توفر + +13 +00:01:00,190 --> 00:01:04,470 +أول نقطة the two charts are compared يعني بقارن + +14 +00:01:04,470 --> 00:01:07,930 +بين ال chart تاع العين اليمين وتاع العين الشمال + +15 +00:01:07,930 --> 00:01:12,370 +the smaller chart indicates the eye with the + +16 +00:01:12,370 --> 00:01:17,170 +bariatric muscle لو في عندي في أحدى العين تاني شلل + +17 +00:01:17,170 --> 00:01:21,790 +في عضلة ماه وعملت his chart يعني في شلل في عضلة + +18 +00:01:21,790 --> 00:01:26,170 +معينة من عين معين نفرض من العين اليمين ال lateral + +19 +00:01:26,170 --> 00:01:29,810 +rectus من العين اليمينفيها شلال يعني في lateral + +20 +00:01:29,810 --> 00:01:34,190 +rectus pulsae lateral rectus pulsae عادة ال + +21 +00:01:34,190 --> 00:01:37,530 +smaller chart بيكون أو دائما ال smaller chart + +22 +00:01:37,530 --> 00:01:42,650 +بيكون أو بيشير إلى ال eye with the paretic muscle + +23 +00:01:42,650 --> 00:01:45,790 +اللي بيشير للعين أو بيكون ال chart بتاعة العين + +24 +00:01:45,790 --> 00:01:50,530 +اللي فيها ال paretic muscle نشوف هنا رسمة تمثيلية + +25 +00:01:50,530 --> 00:01:55,340 +سريعة بدون ما نرسم المربعات الصغيرةبنقول هنا عندنا + +26 +00:01:55,340 --> 00:01:59,540 +ال chart اللي على اليمين للعين المريض اليمين و ال + +27 +00:01:59,540 --> 00:02:03,300 +chart اللي على الشمال بتاعة العين الشمال ال result + +28 +00:02:03,300 --> 00:02:06,500 +مرسومة باللون الأحمر معلمة باللون الأحمر و اللي + +29 +00:02:06,500 --> 00:02:09,140 +بالأسود هو ال template اللي هو الرسمة الأساسية + +30 +00:02:09,140 --> 00:02:13,720 +اللي على أساسها بأسي طيب مين ال smaller chart على + +31 +00:02:13,720 --> 00:02:16,200 +ال right eye؟ إذا ان ال right eye فيها الbariatric + +32 +00:02:16,200 --> 00:02:21,240 +muscle طيب ال larger chart indicates the eye with + +33 +00:02:21,240 --> 00:02:25,720 +the overacting yoke muscleهنا، مين الـ Parietic + +34 +00:02:25,720 --> 00:02:28,760 +muscle أو الـ Paralytic muscle العضلة المشلولة الـ + +35 +00:02:28,760 --> 00:02:32,100 +Lateral Rectus؟ مين العضلة الـ Yoke بتاعة الـ + +36 +00:02:32,100 --> 00:02:35,160 +Lateral Rectus في اليمين؟ الـ Medial Rectus في + +37 +00:02:35,160 --> 00:02:38,880 +الشمال، فبنلاقيها Overacting The larger chart + +38 +00:02:38,880 --> 00:02:42,480 +indicates the eye with the overacting yoke muscle + +39 +00:02:42,480 --> 00:02:46,200 +هذه الـ Overacting بتكون الـ Yoke الـ Overacting + +40 +00:02:46,200 --> 00:02:51,240 +muscle اللي هي الـ Medial Rectusتعتبر ال yoke + +41 +00:02:51,240 --> 00:02:53,760 +بتاعة ال lateral rectus اللي هي under acting ال + +42 +00:02:53,760 --> 00:02:57,360 +lateral rectus المفروض توصل الخط الأحمر لهذا ال + +43 +00:02:57,360 --> 00:03:00,780 +line لهذا ال line طيب هنا ال medial rectus المفروض + +44 +00:03:00,780 --> 00:03:04,120 +توصل الخط الأحمر لهذا ال line هي اتعدته وصارت أكتر + +45 +00:03:04,120 --> 00:03:07,880 +منه وصارت أكتر منه فبالتالي هي over acting مثلا + +46 +00:03:07,880 --> 00:03:10,620 +ممكن إنسان يقول طيب هنا ال inferior oblique over + +47 +00:03:10,620 --> 00:03:14,200 +acting لأ ال inferior oblique مهمتها ترفع مش تعمل + +48 +00:03:14,200 --> 00:03:18,630 +adoptionمهمتها ترفع و ال superior oblique مهمتها + +49 +00:03:18,630 --> 00:03:21,650 +تنزل، إذا ال inferior oblique هي معنية برفع الخط + +50 +00:03:21,650 --> 00:03:26,590 +عن هذا الخط الأفقي، برفعه أو أنه يكون زيه أو أنه + +51 +00:03:26,590 --> 00:03:30,880 +يكون أقل منه، حسب ال action داوال superior oblique + +52 +00:03:30,880 --> 00:03:35,140 +إما بتكون under acting أو acting normal أو over + +53 +00:03:35,140 --> 00:03:39,100 +acting إذا اتعدت الخط بتاعها أما مش مهمتهم يعملوا + +54 +00:03:39,100 --> 00:03:42,720 +abduction مش مهمتهم يعملوا abduction فبالتالي + +55 +00:03:42,720 --> 00:03:45,920 +هدولة مش over acting muscles أصلا ال .. ال oblique + +56 +00:03:45,920 --> 00:03:49,780 +muscles are abductors مش abductors طيب إذا هذا + +57 +00:03:49,780 --> 00:03:54,800 +الخط خط هنا عشان خاطر ال medial rectus over acting + +58 +00:03:54,800 --> 00:03:58,970 +إذا the larger chartindicates the eye with the + +59 +00:03:58,970 --> 00:04:03,550 +overacting yoke muscle نرجع تاني نقول الـsmaller + +60 +00:04:03,550 --> 00:04:07,550 +the chart will show its greatest restriction in + +61 +00:04:07,550 --> 00:04:10,470 +the main direction of action of the peritec muscle + +62 +00:04:10,470 --> 00:04:14,170 +في المثل هذا ال right lateral rectus لو سألنا + +63 +00:04:14,170 --> 00:04:18,430 +نفسنا سؤال الـsmaller the chartعرفنا إنه في العين + +64 +00:04:18,430 --> 00:04:21,450 +اللي فيها parietic muscle، طب ما هو صار small من + +65 +00:04:21,450 --> 00:04:25,410 +أي ناحية، يعني من أي ناحية انكمش، تراجع، من + +66 +00:04:25,410 --> 00:04:29,770 +الناحية أو من منطقة عمل أو الانكماش أو التراجع أو + +67 +00:04:29,770 --> 00:04:34,070 +الصغر في الحجم، جاء من ناحية المنطقة اللي بتشتغل + +68 +00:04:34,070 --> 00:04:36,790 +فيها ال parietic muscle اللي هي ال right lateral + +69 +00:04:37,140 --> 00:04:41,820 +إذا التراجع و الانكماش in the main direction of + +70 +00:04:41,820 --> 00:04:44,320 +the action of the bariatric muscle ال greatest + +71 +00:04:44,320 --> 00:04:48,420 +restriction، أكتر restriction، أكتر محدودية، + +72 +00:04:48,420 --> 00:04:54,940 +الانكماش، التراجع من الاتجاه اللي فيه بتعمل ال + +73 +00:04:54,940 --> 00:04:58,440 +bariatric muscle the larger .. the larger chart + +74 +00:04:59,290 --> 00:05:02,730 +will show its greatest expansion هنا بنقول ال + +75 +00:05:02,730 --> 00:05:05,570 +larger ال chart هو ال chart اللي إيه تعالين + +76 +00:05:05,570 --> 00:05:10,370 +التانية طب large من وين؟ من وين تمدد؟ من اتجاه أو + +77 +00:05:10,370 --> 00:05:13,950 +او تمدد في الاتجاه اللي بتعمل فيه ال over acting + +78 +00:05:13,950 --> 00:05:19,710 +muscle إذا the larger ال chartwill show its + +79 +00:05:19,710 --> 00:05:24,090 +greatest expansion in the main direction of action + +80 +00:05:24,090 --> 00:05:27,750 +of the yoke muscle، في هذا المثال الـ left medial + +81 +00:05:27,750 --> 00:05:30,710 +rectus، يعني هذا ال chart كبير من أي ناحية، من + +82 +00:05:30,710 --> 00:05:33,250 +ناحية ال medial rectus، ليش؟ لأن ال medial rectus + +83 +00:05:33,250 --> 00:05:36,830 +over acting، ليش over acting؟ لأنها اليوك بتاعة ال + +84 +00:05:36,830 --> 00:05:41,480 +lateral rectus اللي فيها بلسthe degree of + +85 +00:05:41,480 --> 00:05:44,000 +disparity between the plotted point and the + +86 +00:05:44,000 --> 00:05:48,260 +template in any position of gaze gives an estimate + +87 +00:05:48,260 --> 00:05:52,280 +of the angle of deviation طبعا each square equals + +88 +00:05:52,280 --> 00:05:55,860 +five degrees وهذا الكلام احنا حكينا بنقول كالقاتي + +89 +00:05:55,860 --> 00:06:00,620 +هنا انكمشات ممكن اعرف انكمشات كام degree او كام + +90 +00:06:00,620 --> 00:06:04,700 +prism وهنا تمددات ممكن اعرف تمددات كام degree او + +91 +00:06:04,700 --> 00:06:09,820 +كام prism ايضا ممكن اعرف حسب ال central pointحسب + +92 +00:06:09,820 --> 00:06:14,840 +ال central point لما + +93 +00:06:14,840 --> 00:06:17,960 +أنا بدوي للمريض ال laser الأحمر على ال central + +94 +00:06:17,960 --> 00:06:22,420 +point و هو بدوي هنا معناته عندى هنا exoعندي هنا + +95 +00:06:22,420 --> 00:06:28,000 +exo مقدرة .. ليش exo؟ أنا ببحث في العين اليمين و + +96 +00:06:28,000 --> 00:06:32,260 +هنا جاية out و هنا جاية in هنا ال media rectus + +97 +00:06:32,260 --> 00:06:36,840 +يعني هيطلع في العين اليمين لما يصير contraction في + +98 +00:06:36,840 --> 00:06:40,600 +ال media rectus العين هتيجي للناحية هذه فبالتالي + +99 +00:06:40,600 --> 00:06:44,080 +ضوة هنا معناته هنا باتجاه ال lateral rectus إذا + +100 +00:06:44,080 --> 00:06:48,570 +هنا exotropiaعشرة degree يعني عشرين prism + +101 +00:06:48,570 --> 00:06:52,730 +وhypertropia خمسة degree يعني عشرة prism يعني بقدر + +102 +00:06:52,730 --> 00:06:57,470 +اعرف كمية ال deviation بواسطة المربعات اللي انا + +103 +00:06:57,470 --> 00:07:02,890 +شايف طيب + +104 +00:07:02,890 --> 00:07:08,170 +..الان جبل ما يعني نشوف ايش ال changes with time + +105 +00:07:09,470 --> 00:07:14,490 +بدنا ناخد بعض الأمثلة نحللها ونشوف كيف بيصير معانا + +106 +00:07:14,490 --> 00:07:19,610 +بس مجرد تدريب على تحليل أو قراءة هذا ال test chart + +107 +00:07:19,610 --> 00:07:25,370 +طيب نفرض إن هذا ال chart للعين اليمين وفي chart مش + +108 +00:07:25,370 --> 00:07:29,390 +معروض للعين الإشمال نقول العين اليمين أول حاجة ال + +109 +00:07:29,390 --> 00:07:32,610 +chart بتاعها أصغر من ال template من الرسم الأساسي + +110 +00:07:33,600 --> 00:07:37,080 +الرسمة اللي بتيجي على الورق أصغر إذا في عندي under + +111 +00:07:37,080 --> 00:07:41,620 +action في muscle أو أكتر نشوف ال superior rectus + +112 +00:07:41,620 --> 00:07:45,760 +under action superior rectus المفروض إلها نص الخط + +113 +00:07:45,760 --> 00:07:50,220 +الأعلى اللي هي up and out يعني إلها نص الخط الأعلى + +114 +00:07:50,220 --> 00:07:54,040 +المفروض الخط الأسود هذا يصل هنا إذا في under + +115 +00:07:54,040 --> 00:07:58,620 +action في superior rectus muscle أيضا في under + +116 +00:07:58,620 --> 00:08:01,700 +action في ال inferior oblique النُص التاني من الخط + +117 +00:08:01,700 --> 00:08:06,970 +اللي هو ال inالان نص ال media من الخط لازم يرتفع + +118 +00:08:06,970 --> 00:08:11,930 +لفوق يصل ل هنا إذا في under action في ال superior + +119 +00:08:11,930 --> 00:08:15,090 +rectus في العين اليمين وفي ال inferior oblique في + +120 +00:08:15,090 --> 00:08:18,330 +العين اليمين هل إنتهى الموضوع؟ لأ ال media rectus + +121 +00:08:18,330 --> 00:08:23,030 +المفروض تجيب الخط بتاعها لأ عند الحدود هذه المنقطة + +122 +00:08:23,030 --> 00:08:27,310 +إذا في severe under action أيضا في ال media rectus + +123 +00:08:27,310 --> 00:08:32,840 +طيب ال inferior rectusالمفروض تجيب نص الخط الأسود + +124 +00:08:32,840 --> 00:08:38,530 +هناطيب إذا في عندي superior rectus و inferior + +125 +00:08:38,530 --> 00:08:42,810 +oblique و medial rectus و inferior rectus لو سألت + +126 +00:08:42,810 --> 00:08:46,890 +نفسي سؤال هدولة الأربع عضلات superior و inferior + +127 +00:08:46,890 --> 00:08:50,230 +rectus و medial rectus و inferior oblique أي عصب + +128 +00:08:50,230 --> 00:08:53,910 +من الأعصاب التلاتة بيغذيهم اللي هو ال third + +129 +00:08:53,910 --> 00:08:57,350 +cranial nerve ال oculomotor nerve إذا في عندي + +130 +00:08:57,350 --> 00:09:00,730 +right احنا اتفقنا إنه هاد العين ل right right + +131 +00:09:00,730 --> 00:09:07,230 +third nerve palsyright third nerve palsy طيب مين + +132 +00:09:07,230 --> 00:09:10,770 +اللي عندى ضال العضلات شغالة كويس لأنه ما بتتغذى من + +133 +00:09:10,770 --> 00:09:14,130 +ال third nerve ال lateral rectus زى ما احنا + +134 +00:09:14,130 --> 00:09:19,750 +شايفينه واصلة لحدودها طيب و ال superior oblique ال + +135 +00:09:19,750 --> 00:09:22,470 +action بتاعها normal ممكن انسان يعترض يقول لأ ال + +136 +00:09:22,470 --> 00:09:24,810 +action مش normal ال superior oblique المفروض توصل + +137 +00:09:24,810 --> 00:09:30,010 +للخط هذا بس ما ننساشإنه في ال primary position هذه + +138 +00:09:30,010 --> 00:09:33,910 +العين لما اختبرناها لما كانت العين الشمال fixating + +139 +00:09:33,910 --> 00:09:37,150 +العين الشمال لما كانت fixating عشان نختبر اليمين + +140 +00:09:37,150 --> 00:09:42,930 +اليمين كانت exo exo بمقدار جديش مربعين وشوية يعني + +141 +00:09:42,930 --> 00:09:47,790 +تقريبًا exo عشرين تقريبًا أربع وعشرين prism ديوبتر + +142 +00:09:47,790 --> 00:09:51,470 +وضعيت ال out position مش مناسبة لل superior + +143 +00:09:51,470 --> 00:09:56,590 +oblique عشان تنزل العين وتوصل الخط لهناطبعا ال + +144 +00:09:56,590 --> 00:09:59,330 +superior oblique depressor في ال in position في ال + +145 +00:09:59,330 --> 00:10:02,170 +in position مش في ال out position طب كيف عرفت إنها + +146 +00:10:02,170 --> 00:10:05,490 +normal acting لأنه هي مش ال main depressor of the + +147 +00:10:05,490 --> 00:10:08,990 +eye و إنما هي بتعمل depression بس ال main action + +148 +00:10:08,990 --> 00:10:12,320 +بتاعها in torsionأما ال main depressor ال inferior + +149 +00:10:12,320 --> 00:10:16,540 +rectus فلما أنا بتطلع الخط هذا اللي نصه الداخلي + +150 +00:10:16,540 --> 00:10:19,100 +اللي هو ناحية ال media rectus اللي نصه الداخلي + +151 +00:10:19,100 --> 00:10:22,720 +مسئول عنه ال superior oblique و نصه الخارجي مسئول + +152 +00:10:22,720 --> 00:10:25,680 +عنه ال inferior rectus بلاقي أنه ال superior + +153 +00:10:25,680 --> 00:10:28,840 +oblique عاملة depression أكتر من ال inferior + +154 +00:10:28,840 --> 00:10:33,540 +rectusطيب إذا عاملة depression أكتر من ال main + +155 +00:10:33,540 --> 00:10:36,300 +depressor of the eye إذا هي normal .. هي normal بس + +156 +00:10:36,300 --> 00:10:40,120 +ال position بتاع العين مش مناسب لها عشان تعمل + +157 +00:10:40,120 --> 00:10:43,280 +depression .. مش مناسب لها عشان تعمل depression + +158 +00:10:43,280 --> 00:10:47,140 +هذه right third nerve palsy طبعا في ال third nerve + +159 +00:10:47,140 --> 00:10:50,200 +كل العضلات اللي بيغذيها ال third nerve بتتأثب تصير + +160 +00:10:50,200 --> 00:10:54,500 +under acting بينما العضلات اللي ما بيغذيها ال + +161 +00:10:54,500 --> 00:10:56,640 +third nerve اللي هي ال lateral rectus و ال + +162 +00:10:56,640 --> 00:10:59,950 +superior oblique بيكونوا normal actingفى ال + +163 +00:10:59,950 --> 00:11:03,810 +primary position فى ال straight ahead position لما + +164 +00:11:03,810 --> 00:11:05,570 +تكون ال other eye اللى هى ال left eye احنا + +165 +00:11:05,570 --> 00:11:09,530 +اتفاجنها هي ال right لما بتكون left eye fixating + +166 +00:11:09,530 --> 00:11:15,160 +هذه بتكون exo بمقدار تقريباعشرة ديجري وشوية نقول + +167 +00:11:15,160 --> 00:11:19,260 +اتناشر ديجري تقريبا يعني اربع وعشرين ابرز .. اربع + +168 +00:11:19,260 --> 00:11:24,020 +وعشرين ابرز فهذا طريق التحليل اللي هي .. اللي هي + +169 +00:11:24,020 --> 00:11:27,300 +search chart طبعا التحليل لا يكتمل الا بالتعليق + +170 +00:11:27,300 --> 00:11:32,820 +على ال chart العين الأخرى نيجي هنا نحاول .. يعني + +171 +00:11:32,820 --> 00:11:37,120 +نقرأ هنا هذا أيضا عندي chart هاي ال right eye و + +172 +00:11:37,120 --> 00:11:41,070 +هاي ال left eyeالـ chart الأصغر هو ال left eye، + +173 +00:11:41,070 --> 00:11:46,070 +إذا ال left eye فيها إحدى عضلاتها فيها شلل أو فيها + +174 +00:11:46,070 --> 00:11:49,450 +paralysis أو paralysis كيف عرفت إن هذا ال chart + +175 +00:11:49,450 --> 00:11:53,890 +الأصغر يعني منكمش من هذه الناحية بينما هذا متمدد + +176 +00:11:53,890 --> 00:11:57,830 +من هذه الناحية؟ المنكمش من أي ناحية؟ من ناحية ال + +177 +00:11:57,830 --> 00:12:05,060 +superior oblique الخط الأسفل هذا نصه .. نصهمسئول + +178 +00:12:05,060 --> 00:12:09,840 +عنه ال inferior rectus النص البراني عساس اتنزله + +179 +00:12:09,840 --> 00:12:15,810 +للأسفلوالنص الأخر اللي هي ال superior oblique في + +180 +00:12:15,810 --> 00:12:18,110 +ال in position هي المسؤولة عن ال depression + +181 +00:12:18,110 --> 00:12:21,710 +فبالتالي أنا في عندي ضعف في superior oblique في + +182 +00:12:21,710 --> 00:12:26,130 +superior oblique left superior oblique palsy left + +183 +00:12:26,130 --> 00:12:29,430 +superior oblique palsy اللي عن العين هذه لما تحاول + +184 +00:12:29,430 --> 00:12:32,830 +تعمل fixation لازم تنزل لأن هذه العين في ال + +185 +00:12:32,830 --> 00:12:35,550 +primary position في ال primary position جاية + +186 +00:12:35,550 --> 00:12:39,330 +hypertropiaهي محطوط دائرة على ال response بتاع + +187 +00:12:39,330 --> 00:12:42,110 +المريض، المفروض المريض يأشر بال laser الأخضر هنا + +188 +00:12:42,110 --> 00:12:45,430 +لما أنا أضويله ال laser الأحمر هنا، بس هو أشر أعلى + +189 +00:12:45,430 --> 00:12:49,110 +بمربع تقريبا، يعني هيك بنكون عندنا خمسة degree + +190 +00:12:49,110 --> 00:12:52,070 +right ال left hypertropia + +191 +00:12:53,350 --> 00:12:55,790 +الرسمة اللي على ال left لل left eye و اللي على ال + +192 +00:12:55,790 --> 00:12:59,510 +right لل right eye، اذا ال left hypertropia عشرة + +193 +00:12:59,510 --> 00:13:02,810 +prism اللي هي خمسة degree، لما بتحاول العين اللي + +194 +00:13:02,810 --> 00:13:06,830 +جالة الأعلى بمقدار عشرة prism، لما بتحاول تاخد + +195 +00:13:06,830 --> 00:13:12,190 +fixation، تصير هي العين القائدة، هتنزلللأسفل بفعل + +196 +00:13:12,190 --> 00:13:15,310 +إن ال superior oblique هيجيها كمية innervation + +197 +00:13:15,310 --> 00:13:18,990 +عالية حسب hearing law إذا وصل لل superior oblique + +198 +00:13:18,990 --> 00:13:22,170 +كمية innervation عالية اليوك muscle بتاعتها في + +199 +00:13:22,170 --> 00:13:24,790 +العين اليمين اللي هي ال inferior rectus أيضا + +200 +00:13:24,790 --> 00:13:27,530 +هيجيها كمية innervation عالية فهتصير over acting + +201 +00:13:27,530 --> 00:13:32,350 +لدرجة إن المريض ممكن يقشر إذا أناشرت هذا الإشارة + +202 +00:13:32,350 --> 00:13:35,510 +في منطقة عمل ال inferior rectus لل right eye ممكن + +203 +00:13:35,510 --> 00:13:38,770 +هو يقشر بعيد على الجدار من كتر ما هي ال inferior + +204 +00:13:38,770 --> 00:13:43,460 +rectus over actingطبعا حسب كمية ال innovation اللي + +205 +00:13:43,460 --> 00:13:48,260 +بتجيه لما هذه نزلت لل primary position هذه نزلت عن + +206 +00:13:48,260 --> 00:13:51,580 +ال primary position للأسفل حسب herring law أيضا + +207 +00:13:51,580 --> 00:13:57,020 +بمقدار تقريبا خمسة degree يعني عشرة prism أصبحت + +208 +00:13:57,020 --> 00:14:00,460 +hypotropia when the other eye when the left eye is + +209 +00:14:00,460 --> 00:14:07,400 +fixed طيب، الآن في نقطة بنقول كالقادة، كل مكان + +210 +00:14:07,400 --> 00:14:14,120 +الفرقبين ال two charts واضح، كل ما كان الفرق في + +211 +00:14:14,120 --> 00:14:16,680 +الرسمة بين ال two charts واضح، زي ما أنا شايف هنا + +212 +00:14:16,680 --> 00:14:19,820 +فيه فرق واضح جدا، هذه under acting، هذه over + +213 +00:14:19,820 --> 00:14:24,720 +acting، بيكون ال policy جديدة، جديدة الحدوث، يعني + +214 +00:14:24,720 --> 00:14:29,220 +recent policyمع تقدم الوقت تبدأ ال superior + +215 +00:14:29,220 --> 00:14:33,700 +oblique تشفى، كثير من البلس يشفى لوحده تمام أو مع + +216 +00:14:33,700 --> 00:14:37,760 +العلاج كثير جدا، يعني نسبة عالية تقريبا تصل 90% او + +217 +00:14:37,760 --> 00:14:43,880 +اكتر، بتبدأ تتحسن ال function فتبدأ ال under + +218 +00:14:43,880 --> 00:14:48,100 +action يتحسنو ال over action بيبدأ يتراجع يعني + +219 +00:14:48,100 --> 00:14:52,500 +بيبدأ يتماثل الرسم أو ال chart بتاع العين اليمين و + +220 +00:14:52,500 --> 00:14:56,320 +العين الشمال بيصيروا competent بيصيروا competent + +221 +00:14:56,320 --> 00:15:00,180 +يعني متماثلات بيصيروا competent بيسموه spread of + +222 +00:15:00,180 --> 00:15:04,220 +competence انتشار التماثل .. انتشار التماثلفهذا + +223 +00:15:04,220 --> 00:15:07,740 +الكلام بفيدنا في قضية فهم changes with time يعني + +224 +00:15:07,740 --> 00:15:13,140 +الإنسان اللي أنا عملتله his chart أو easy screen + +225 +00:15:13,140 --> 00:15:18,120 +test المفروض أتابعه و أشوف التغيرات مع مضي الوقت + +226 +00:15:18,120 --> 00:15:21,940 +changes with time are very useful as a prognostic + +227 +00:15:21,940 --> 00:15:26,680 +guide يعني بستفيد من أني أعيد ال chart كل فترة + +228 +00:15:26,680 --> 00:15:30,320 +مثلا كل شهرين أو كل شهر إذا بالزم أو كل تلات شهور + +229 +00:15:30,320 --> 00:15:35,950 +حسب ال examiner ما هو شايفبيفيدني في أن أنا أعرف + +230 +00:15:35,950 --> 00:15:38,990 +ال prognosis، المصير، يعني هل هيتم تحسن، هل مش + +231 +00:15:38,990 --> 00:15:43,210 +هيتم تحسن، سرعة التحسن، هل بحتاج بعد ذلك تدخل + +232 +00:15:43,210 --> 00:15:49,470 +جراحي، بحتاجش، فبي .. بيفيد عمل أو تكرار عمل ال + +233 +00:15:49,470 --> 00:15:53,070 +his chart examination عشان أشوف بدت ال function + +234 +00:15:53,070 --> 00:15:57,270 +بتاعة المصل تتحسن ولا لساتها زي ما هي، ولا لساتها + +235 +00:15:57,270 --> 00:16:01,320 +زي ما هيfor example in right superior rectus palsy + +236 +00:16:01,320 --> 00:16:04,420 +the hessy chart will show under action of the + +237 +00:16:04,420 --> 00:16:08,040 +affected muscle with an over action of its yoke + +238 +00:16:08,040 --> 00:16:12,240 +muscle اللي lift inferior oblique نشوف هنا هاي + +239 +00:16:12,240 --> 00:16:16,960 +احنا ال chart اللي على ال right على ال .. باتجاه + +240 +00:16:16,960 --> 00:16:19,220 +ايدنا اليمين و ال chart اللي على ال left لل left + +241 +00:16:19,220 --> 00:16:22,860 +eye باتجاه ايدنا الشمال إذا هذه لل right eye و هذه + +242 +00:16:22,860 --> 00:16:27,890 +لل left eye هنا طالما ال chart هو الأصغرمعناته هنا + +243 +00:16:27,890 --> 00:16:31,510 +الbariatric muscle و هنا ال over acting muscle في + +244 +00:16:31,510 --> 00:16:34,750 +العين التانية، ال .. ال .. مين ال under acting + +245 +00:16:34,750 --> 00:16:38,090 +muscle؟ ال superior rectus .. ال superior rectus + +246 +00:16:38,090 --> 00:16:42,010 +طالما ال superior rectus under acting معناته فيها + +247 +00:16:42,010 --> 00:16:44,870 +policy، مين ال yaw بتاعتها في العين التانية في ال + +248 +00:16:44,870 --> 00:16:48,350 +left eye؟ ال inferior obliqueطبعا واضح الفرق في + +249 +00:16:48,350 --> 00:16:51,430 +الرسم بين اللي هدا، يعني لا يحتاج إلا جهد لنا .. + +250 +00:16:51,430 --> 00:16:55,730 +لنذكر إنه أو .. أو ل .. ل .. لنثبت إنه هذا الرسم + +251 +00:16:55,730 --> 00:16:59,730 +هي الأصغر بفارق واضح، فبالتالي هذه recent policy + +252 +00:17:00,820 --> 00:17:04,480 +because of the great incompetence عشان عدم التماثل + +253 +00:17:04,480 --> 00:17:07,980 +الكبير، هذا عدم تماثل كبير، يعني في فرق واضح + +254 +00:17:07,980 --> 00:17:11,580 +للغاية بين الرسميتين of the two charts, the + +255 +00:17:11,580 --> 00:17:14,600 +diagnosis is straightforward، يعني ما بيغلبش ال + +256 +00:17:14,600 --> 00:17:17,480 +diagnosis، يعني لما بتعرض علينا رسمة زي هيكها، + +257 +00:17:17,480 --> 00:17:21,980 +they write superior rectus pulsae if the if the + +258 +00:17:21,980 --> 00:17:26,180 +bariatric muscle recovers، إذا بدت تتماثل للشفاء + +259 +00:17:26,180 --> 00:17:30,670 +ال bariatric muscleيعني هيتحسن ال function داها + +260 +00:17:30,670 --> 00:17:34,250 +طبعا مش هترجع مرة واحدة إلى الخط الطبيعي ولكن + +261 +00:17:34,250 --> 00:17:38,310 +هتبدأ يرتفع الخط مثلا عملنا بعد شهرين كان الخط هذا + +262 +00:17:38,310 --> 00:17:41,930 +الاستجابة المريض اللي بيمثل استجابة المريض أصبح + +263 +00:17:41,930 --> 00:17:45,910 +هنا أصبح هنا طالما بتزيد ال function بتاعة ال + +264 +00:17:45,910 --> 00:17:51,720 +super rectus بتبدأ تتراجعالـ over action بتاع ال + +265 +00:17:51,720 --> 00:17:56,100 +inferior oblique لأنه مافيش حاجة إله ماهو من وين + +266 +00:17:56,100 --> 00:17:59,620 +إجا من ال under action بتاع ال superior rectus + +267 +00:17:59,620 --> 00:18:03,440 +عشان العين هيتعمل fixation بيجي لل superior rectus + +268 +00:18:03,440 --> 00:18:07,480 +increased innervation شحنات زيادة و هنا عشانها + +269 +00:18:07,480 --> 00:18:11,040 +اليوت تاخد شحنات زيادة طب بدت هذه العضلة تتمثل + +270 +00:18:11,040 --> 00:18:14,680 +للشفاء صار بدها شحنات زيادة بس أجل من أول فبرضه + +271 +00:18:14,680 --> 00:18:17,980 +هذه هيجيها أجل من أول فبالتالي بتبدأ إيش ده تراجع + +272 +00:18:19,250 --> 00:18:22,330 +if the paretic muscle recovers its function, both + +273 +00:18:22,330 --> 00:18:25,810 +charts will revert to normal both charts يعني ال + +274 +00:18:25,810 --> 00:18:28,410 +two charts بتاع اليمين و بتاع الشمال هيرجعوا + +275 +00:18:28,410 --> 00:18:32,030 +للnormal، هدا هيدمدد إلى باتجاه الطبيعي و هدا + +276 +00:18:32,030 --> 00:18:38,010 +هينكمش باتجاه الطبيعي however if the paresis + +277 +00:18:38,010 --> 00:18:41,970 +persists, إذا الشلل ضال، the shapes of both charts + +278 +00:18:41,970 --> 00:18:44,370 +will change as follows + +279 +00:18:47,840 --> 00:18:53,600 +عشان نفهم هذا .. هذه النقطة أنا بنصح حقيقة انه + +280 +00:18:53,600 --> 00:18:59,300 +اللي طالب اللي ناسي ال muscle sequela يرجعها قبل + +281 +00:18:59,300 --> 00:19:02,840 +ما يتحرك عن هذا النقطة يعني .. يعني تم إيقاف هذا + +282 +00:19:02,840 --> 00:19:06,280 +ال .. الفيديو بتاع المحاضرة هاي عند النقطة هاي عند + +283 +00:19:06,280 --> 00:19:13,360 +الدقيقة هاي ثم يعود لتذكر ال muscle sequela و + +284 +00:19:13,360 --> 00:19:19,270 +بعدين يرجع عشان يكمل المحاضرة هايالتعامل التعامل + +285 +00:19:19,270 --> 00:19:21,510 +التعامل التعامل التعامل التعامل التعامل التعامل + +286 +00:19:21,510 --> 00:19:23,250 +التعامل التعامل التعامل التعامل التعامل التعامل + +287 +00:19:23,250 --> 00:19:27,410 +التعامل التعامل التعامل التعامل التعامل التعامل + +288 +00:19:27,410 --> 00:19:33,110 +التعامل التعامل التعامل التعامل التعامل التعامل + +289 +00:19:33,110 --> 00:19:33,110 +التعامل التعامل التعامل التعامل التعامل التعامل + +290 +00:19:33,110 --> 00:19:33,110 +التعامل التعامل التعامل التعامل التعامل التعامل + +291 +00:19:33,110 --> 00:19:33,110 +التعامل التعامل التعامل التعامل التعامل التعامل + +292 +00:19:33,110 --> 00:19:33,110 +التعامل التعامل التعامل التعامل التعامل التعامل + +293 +00:19:33,110 --> 00:19:39,180 +التعامل التعامل التعامل التعامل التعامل التعاماحنا + +294 +00:19:39,180 --> 00:19:41,940 +في البداية ال right superior rectus كانت under + +295 +00:19:41,940 --> 00:19:45,940 +-acting لحالها و ال yoke لأ تاعها في العين التانية + +296 +00:19:45,940 --> 00:19:48,020 +اللي هي ال inferior oblique over-acting لحالها، + +297 +00:19:48,020 --> 00:19:52,260 +اذا عضلة في كل عين، عضلة في كل عين، لو طولت البلسي + +298 +00:19:52,260 --> 00:19:56,220 +و ما تم الشفاءها، هذه العضلة فيها بلسي اللي هي ال + +299 +00:19:56,220 --> 00:20:00,420 +superior rectus و ما شفيت، يعني دايما راخية، دايما + +300 +00:20:00,420 --> 00:20:03,940 +مشلولة، هيصير عندك contraction في ال antagonist + +301 +00:20:03,940 --> 00:20:06,720 +اللي هي ال inferior rectusفال inferior rectus + +302 +00:20:06,720 --> 00:20:11,980 +هتصير over acting هي تمددت برا الخط بتاعها over + +303 +00:20:11,980 --> 00:20:15,820 +acting بأقل innervation مش محتاجة innervation كتير + +304 +00:20:15,820 --> 00:20:19,680 +بس هي لأنها متقلصة contracted muscle هتكون + +305 +00:20:20,580 --> 00:20:24,880 +overacting طالما هيجيلها innervation قليل ال yoke + +306 +00:20:24,880 --> 00:20:26,920 +بتاعتها تاعت ال inferior rectus اللي هي ال + +307 +00:20:26,920 --> 00:20:29,820 +subperior oblique في العين التانية هيجيها أيضا + +308 +00:20:29,820 --> 00:20:34,840 +innervation قليل وهي عضلة طبيعية غير متقلصة + +309 +00:20:34,840 --> 00:20:37,720 +innervation قليل لأنه إجا لل yoke اللي هي ال + +310 +00:20:37,720 --> 00:20:40,040 +inferior rectus innervation قليل ليش لأنها مش + +311 +00:20:40,040 --> 00:20:43,080 +محتاجة كتير مافيش إشي يقاومها في عملها ال + +312 +00:20:43,080 --> 00:20:46,560 +antagonist بتاعتها واجفة ومشلولة من زمان فبالتالي + +313 +00:20:46,560 --> 00:20:51,110 +هذه عشان تؤدي عملها بدها innervation قليلفبالتالي + +314 +00:20:51,110 --> 00:20:53,970 +ال superior oblique ال يوك بتاعتها هيصلها ايضا + +315 +00:20:53,970 --> 00:20:58,430 +innervation قليل وهي عضلة طبيعية فهتخش بما يسمى + +316 +00:20:58,430 --> 00:21:02,990 +Inhibitional Palsy Inhibitional Palsy مش حقيقية + +317 +00:21:02,990 --> 00:21:07,830 +وانما ناتجة عن قلة ورود ال impulses العصبية لأن ال + +318 +00:21:07,830 --> 00:21:11,130 +brain بعت لل inferior rectus عجدها وهي مكتفية + +319 +00:21:11,130 --> 00:21:14,610 +بالقليل فهيبعت لل superior oblique نفس ما بعت لل + +320 +00:21:14,610 --> 00:21:20,770 +inferior rectus لأنهم يوك musclesهذه هي القضية طيب + +321 +00:21:20,770 --> 00:21:27,270 +.. الآن لو حابة العين اليمين تعمل fixation هيجي + +322 +00:21:27,270 --> 00:21:31,850 +increased innervation للعضلة اللي بدت المشكلة عشان + +323 +00:21:31,850 --> 00:21:35,390 +ترفع العين لأن العين هتكون في ال down gaze لأنه + +324 +00:21:35,390 --> 00:21:39,110 +superior rectus pulse هتكون hypotropia فهيجي + +325 +00:21:39,110 --> 00:21:43,920 +increased innervation لل superior rectus هناإذا + +326 +00:21:43,920 --> 00:21:46,540 +إجا increased innervation للـ superior rectus هنا، + +327 +00:21:46,540 --> 00:21:50,060 +هيجي increased innervation لل inferior oblique + +328 +00:21:50,060 --> 00:21:53,300 +هنا، عشانها حسب hearing loss، فهتصير over acting + +329 +00:21:53,300 --> 00:21:57,260 +muscle صفة عنده two over acting muscle، هذه عشانها + +330 +00:21:57,260 --> 00:22:02,340 +contracted، وهذه عشان hearing lossو two under + +331 +00:22:02,340 --> 00:22:08,400 +acting muscles هدى pulse حقيقية و هدى pulse بسبب + +332 +00:22:08,400 --> 00:22:13,140 +ال inhibition انه ما بعطلها ال brain ما يحفزها + +333 +00:22:13,140 --> 00:22:17,460 +لأنه بعطلها اليكتاعتها جليل فبالتالي هي بعطلها + +334 +00:22:17,460 --> 00:22:22,000 +جليل الان المشكلة تكمن أيه؟ هذا الكلام لما احنا + +335 +00:22:22,000 --> 00:22:26,300 +بنشرحه نظري و بنستنتج و احنا فرضنا انه هنا بدت + +336 +00:22:26,300 --> 00:22:31,610 +المشكلة المريض لما بيجي صار عندهsuperior rectus + +337 +00:22:31,610 --> 00:22:36,190 +palsy قديما، ماعوش أي ملف، ماعوش أي تقرير، ماعوش + +338 +00:22:36,190 --> 00:22:41,130 +أي إفادة، مش متذكر في أي عين بدأت المشكلة، حطناه + +339 +00:22:41,130 --> 00:22:46,170 +على الهست شارد، طلعلنا المنظر هذاالان عندي two + +340 +00:22:46,170 --> 00:22:49,290 +under acting muscle مافيش واحدة منهم هتتكلم أو + +341 +00:22:49,290 --> 00:22:53,270 +تنطق وتقولي أنا بدت المشكلة عندي وانتهت هنا أو بدت + +342 +00:22:53,270 --> 00:22:56,290 +هنا وانتهت هنا هي على فكرة لو بدت في ال left + +343 +00:22:56,290 --> 00:23:00,230 +superior oblique pulse هتنتهي انه هذه العضلة اللي + +344 +00:23:00,230 --> 00:23:02,190 +هي superior rectus في العين اللي هي منها هتكون + +345 +00:23:02,190 --> 00:23:05,330 +inhibitional pulse يعني إذا بدت هنا هتنتهي هنا + +346 +00:23:05,330 --> 00:23:07,810 +وإذا بدت هنا هتنتهي هنا التنتين هيصيروا under + +347 +00:23:07,810 --> 00:23:12,910 +actingفبالتالي مش هقدر أعرف وين بدت المشكلة .. وين + +348 +00:23:12,910 --> 00:23:18,570 +بدت المشكلة لأنه صار عندي أكتر من عضلة involved + +349 +00:23:18,570 --> 00:23:23,610 +المسألة مابتوقفش عند هذا القضية ولكن أيضا مع الوقت + +350 +00:23:23,610 --> 00:23:27,790 +بتتطور this could lead to incorrect impression + +351 +00:23:27,790 --> 00:23:30,410 +that the left superior oblique was the primary + +352 +00:23:30,410 --> 00:23:33,750 +muscle at fault هذا ال .. ال muscle sequelae اللي + +353 +00:23:33,750 --> 00:23:38,070 +حدثتممكن تعطي انطباع أن ال superior rubric هي + +354 +00:23:38,070 --> 00:23:43,510 +المشكلة اللي بدت من عندها، بدت من عندها، و بالتالي + +355 +00:23:43,510 --> 00:23:48,710 +هيكون هذا انطباع خاطئ، بس سببه أنه فيش أي معلومات، + +356 +00:23:48,710 --> 00:23:52,130 +وفيش عندي إلا الهس إتش هارد، فيش عندي إلا الهس إتش + +357 +00:23:52,130 --> 00:23:57,400 +هاردلما بيمضي الزمن كمان، this with further + +358 +00:23:57,400 --> 00:24:01,020 +passage of time, the two charts become more and + +359 +00:24:01,020 --> 00:24:04,640 +more concomitant، يعني هدولة ال two under acting + +360 +00:24:04,640 --> 00:24:10,100 +muscles، ها دي بتبدأ تستعيديعني شوية من ال + +361 +00:24:10,100 --> 00:24:13,320 +function بتاعتها وهذه بتبدأ تتراجع هذه بتبدأ أيضا + +362 +00:24:13,320 --> 00:24:17,140 +تتراجع هذه بتبدأ ال inhibitional policy يروح عنها + +363 +00:24:17,140 --> 00:24:24,640 +ال inhibitional policy فبالتالي ببدأ يرجع الرسمة + +364 +00:24:24,640 --> 00:24:27,740 +باتجاه الخطوط الطبيعية و الحدود الطبيعية لل + +365 +00:24:27,740 --> 00:24:30,780 +function بتاعة كل مثل With further passage of + +366 +00:24:30,780 --> 00:24:33,560 +time, the two charts become more and more + +367 +00:24:33,560 --> 00:24:38,040 +concomitantأكثر وأكثر تجانسا until it may be + +368 +00:24:38,040 --> 00:24:41,300 +impossible to determine which was the primary + +369 +00:24:41,300 --> 00:24:44,580 +parietic muscle ممكن نصل لنقطة فعلا احنا مانقدرش + +370 +00:24:44,580 --> 00:24:48,580 +نحدد مين ال .. ال .. ال parietic muscle اللي بدأت + +371 +00:24:48,580 --> 00:24:52,220 +بس بدنا نقول كالقاتي في عدة أشياء بدنا نحكيها في + +372 +00:24:52,220 --> 00:24:56,180 +النقطة هاي أول إشي لن .. لا نعتمد على الحصة شرط + +373 +00:24:56,180 --> 00:25:00,240 +كوسيلة و .. وحيدة وواحدة في ال diagnosisهذه نقطة + +374 +00:25:00,240 --> 00:25:05,920 +لازم أنه ناخد ال history بشكل كويس لازم أنه نطلب + +375 +00:25:05,920 --> 00:25:10,280 +تقارير من المريض يوفرها بقدر ما يستطيع لازم نطلب + +376 +00:25:10,280 --> 00:25:13,980 +old photos عشان أحيانا ال abnormal head posture + +377 +00:25:13,980 --> 00:25:18,680 +ممكن يدلني نوعا ما .. طبعا برضه مابعتمدش عليه + +378 +00:25:18,680 --> 00:25:24,120 +لحاله بس بجمعبجمع كل ما يمكن من معلومات بواسطة ال + +379 +00:25:24,120 --> 00:25:27,860 +old photo بواسطة ال history بواسطة التقارير الطبية + +380 +00:25:27,860 --> 00:25:31,480 +أيضا بواسطة الفحوصات اللي أنا باجريها للمريض عشان + +381 +00:25:31,480 --> 00:25:35,200 +أحاول أصل ل ال diagnosis الصحيح ل ال diagnosis + +382 +00:25:35,200 --> 00:25:39,330 +الصحيح فبالتالي هذه القضية ضرورة تكون واضحةطبعاً + +383 +00:25:39,330 --> 00:25:42,850 +بيلزم التدريب على الكثير من ال acid charts + +384 +00:25:42,850 --> 00:25:47,190 +وتحليلها على أساس أن الإنسان يصير متمكن في هذه + +385 +00:25:47,190 --> 00:25:54,190 +القضية في إجراء الفحص وفي تحليل النتائج بتاعة + +386 +00:25:54,190 --> 00:25:57,970 +الفحص عند هنا بنتوقف ويعطيكم العافية والسلام عليكم + +387 +00:25:57,970 --> 00:25:59,790 +ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/lHQOmIXshYA.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/lHQOmIXshYA.srt new file mode 100644 index 0000000000000000000000000000000000000000..c7f413a2543252eaca717ef47b611204cbdb9fa1 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/lHQOmIXshYA.srt @@ -0,0 +1,2081 @@ +1 +00:00:01,480 --> 00:00:05,240 +بسم الله الرحمن الرحيم بنكمل محاضرات حول واحد + +2 +00:00:05,240 --> 00:00:10,740 +ووصلنا لـ subjective measurement of squint ال + +3 +00:00:10,740 --> 00:00:13,620 +subjective measurement of squint بتعتمد اعتمادًا + +4 +00:00:13,620 --> 00:00:19,220 +أساسي على المريض إنه يعني يخبرنا بالشيء اللي هو + +5 +00:00:19,220 --> 00:00:21,800 +بشايفه عشان إيه بيسموها subjective measurements + +6 +00:00:21,800 --> 00:00:28,440 +بعكس اللي هو سلسلة ال cover test و ال Hershberg و + +7 +00:00:28,440 --> 00:00:31,300 +ال Krimsky و ال prism reflection test اللي يعني + +8 +00:00:31,300 --> 00:00:35,180 +بتندرج تحت ال objective measurements of squint + +9 +00:00:35,180 --> 00:00:39,520 +تحت ال subjective measurement في عندي فحصين هناخد + +10 +00:00:39,520 --> 00:00:43,940 +اللي هو ال Maddox wing و Maddox rod subjective + +11 +00:00:43,940 --> 00:00:48,180 +tests are dissimilar image tests يعني dissimilar + +12 +00:00:48,180 --> 00:00:52,920 +image يعني بتقدم للعين اليمين صورة وللعين الشمال + +13 +00:00:52,920 --> 00:00:57,660 +بتقدم لها صورة مختلفة عنها، حقيقة they are of + +14 +00:00:57,660 --> 00:01:00,880 +limited value in the assessment of strabismus + +15 +00:01:00,880 --> 00:01:05,560 +لأنهم مش accurate كثير، مش accurate كثير، فأهميتهم + +16 +00:01:05,560 --> 00:01:09,660 +محدودة في تقييم الحول، بس أحيانا بنلجأ لهم في + +17 +00:01:09,660 --> 00:01:13,080 +ظروف معينة، they require simultaneous perception + +18 +00:01:14,040 --> 00:01:17,380 +cannot be used in manifest strabismus with + +19 +00:01:17,380 --> 00:01:19,680 +suppression يعني الإنسان اللي عنده suppression + +20 +00:01:19,680 --> 00:01:23,740 +هيشوف صورة من الصورتين وبالتالي العلاقة بين + +21 +00:01:23,740 --> 00:01:27,520 +الصورتين مش هيقدر يقيمها لأنه عنده suppression فأي + +22 +00:01:27,520 --> 00:01:30,980 +إنسان عنده suppression لا بنفع أستعمل مع ال Maddox + +23 +00:01:30,980 --> 00:01:35,780 +wing ولا ال Maddox rod and do not reveal the + +24 +00:01:35,780 --> 00:01:39,740 +full deviation يعني مابتقدرش .. يعني اتجيس لكل ال + +25 +00:01:39,740 --> 00:01:45,050 +deviation في بعض الأحيان في بعض الأحيان نبدأ مع ال + +26 +00:01:45,050 --> 00:01:48,490 +test الأول اللي هو Maddox's wing dissociates the + +27 +00:01:48,490 --> 00:01:52,590 +eyes for near fixation على بعد تلت متر and measures + +28 +00:01:52,590 --> 00:01:56,830 +heterophoria يعني بيجيسلي الفوريا على بعد تلت متر + +29 +00:01:56,830 --> 00:01:59,630 +the instrument is constructed in such a way that + +30 +00:01:59,630 --> 00:02:02,870 +the right eye sees only a white vertical arrow and + +31 +00:02:02,870 --> 00:02:06,480 +a red horizontal arrow. Whereas the left eye sees + +32 +00:02:06,480 --> 00:02:10,340 +only horizontal and vertical rows of numbers نشوف + +33 +00:02:10,340 --> 00:02:18,900 +جهاز ال Maddox Wing عبارة عن إيش؟ نطلع رسمة مكبرة، + +34 +00:02:18,900 --> 00:02:23,620 +هاي جهاز ال Maddox Wing عبارة عن لوحة سوداء من + +35 +00:02:23,620 --> 00:02:28,070 +المعدن فيها سطر من الأرقام عمودي مرسوم باللون + +36 +00:02:28,070 --> 00:02:31,450 +الأحمر، الأرقام مطبوعة على اللوحة السوداء باللون + +37 +00:02:31,450 --> 00:02:36,670 +الأحمر وجاية بشكل vertical وفي سطر آخر من الأرقام + +38 +00:02:36,670 --> 00:02:42,670 +جاية بشكل horizontal .. جاية بشكل horizontal طبعا + +39 +00:02:42,670 --> 00:02:48,080 +لونه أبيض، أيضا في عندي سهم أحمر مطبوع على اللوحة + +40 +00:02:48,080 --> 00:02:51,420 +اللي أنا بأشير عليه وفي سهم أبيض مختلف .. مخفي + +41 +00:02:51,420 --> 00:02:54,880 +طبعا خلف الحاجز، هنشوفه في صورة تانية، هاي السهم + +42 +00:02:54,880 --> 00:02:58,720 +الأحمر بيشير لرقم من الأرقام هاي، طبعا هو حقيقة + +43 +00:02:58,720 --> 00:03:03,460 +بيشير للرقم صفر، بس اللي عنده vertical phoria، + +44 +00:03:03,460 --> 00:03:06,720 +هيشوفه ما بيشيرش للرقم صفر، ممكن يشوفه أعلى من صفر + +45 +00:03:06,720 --> 00:03:13,940 +أو أدنى من صفر، وفي عندي سهم أبيض حقيقة الأمر هو + +46 +00:03:13,940 --> 00:03:19,360 +بيشير أو مطبوع بالضبط مقابل الرقم صفر ممكن اللي + +47 +00:03:19,360 --> 00:03:22,940 +عنده Exophoria أو Esophoria يشوفه على يمين صفر أو + +48 +00:03:22,940 --> 00:03:27,340 +على شمال صفر مقابل رقم من هذه الأرقام طبعا العين + +49 +00:03:27,340 --> 00:03:31,540 +اليمين اللي بتكون تتطلع من هذه الفتحة هتشوف الأسهم + +50 +00:03:31,540 --> 00:03:36,030 +فقط بدون ما تشوف الأرقام، والعين الشمال هتشوف + +51 +00:03:36,030 --> 00:03:40,470 +الأرقام فقط بدون ما تشوف الأسهم، كيف هذا بيتم + +52 +00:03:40,470 --> 00:03:45,770 +بواسطة حاجزين معدنين، الحاجز المعدني هذا و الحاجز + +53 +00:03:45,770 --> 00:03:50,150 +المعدني هذا بيخلوا العين اليمين فقط أمامها يعني .. + +54 +00:03:50,150 --> 00:03:54,350 +يعني بيحرموها أو بيشكلوا حاجز أمام رؤية الأرقام و + +55 +00:03:54,350 --> 00:03:57,790 +العين الشمال تقدرش تشوف الأسهم لأن الحاجز هذا + +56 +00:03:57,790 --> 00:04:02,110 +بيمنعها بالنسبة للعين الشمال .. بالنسبة للعين + +57 +00:04:02,110 --> 00:04:08,350 +الشمال طيب .. الآن في صورة يعني من أعلى .. هي عندي + +58 +00:04:08,350 --> 00:04:13,290 +أنا العين اليمين هتطلع الحاجز هذا هيمنعها أنها + +59 +00:04:13,290 --> 00:04:18,070 +تشوف الأرقام تماما أو العين الشمال الحاجز هذا + +60 +00:04:18,070 --> 00:04:24,410 +هيمنعها أن تشوف الأسهم تماما، الآن السهم الأحمر في + +61 +00:04:24,410 --> 00:04:33,050 +خط أبيض تحت الأرقام البيض موازي للسهم الأحمر السهم + +62 +00:04:33,050 --> 00:04:36,430 +الأحمر يمكن من طرفه من هنا أن نحركه للأعلى أو + +63 +00:04:36,430 --> 00:04:40,250 +للأسفل في حالة ما يكون فيه هندي Cyclophoria + +64 +00:04:40,250 --> 00:04:44,370 +والمريض شايف الخط هذا أو القطعة هذه من السهم + +65 +00:04:44,370 --> 00:04:47,610 +الأحمر، هذا قطعة بلاستيكية قطعة بلاستيكية بتبدأ من + +66 +00:04:47,610 --> 00:04:51,350 +هنا و بتنتهي هنا، المفروض أنها تكون موازية في حالة + +67 +00:04:51,350 --> 00:04:55,170 +ما كانش فيه Cyclophoria طيب، الآن هذا السهم الأحمر + +68 +00:04:55,170 --> 00:04:59,590 +الجزء هذا ثابت، ثابت الجزء هذا متحرك عشان يجيس للـ N + +69 +00:04:59,590 --> 00:05:03,210 +-cyclo و الـ X-cyclophoria الـ N-cyclo و الـ X + +70 +00:05:03,210 --> 00:05:09,710 +-cyclophoria هاي هنا عندي صورة من الأسفل طبعا هذا + +71 +00:05:09,710 --> 00:05:13,230 +الـ handle الإيد اللي بيمسكها المريض عشان يحط + +72 +00:05:13,230 --> 00:05:17,150 +الجهاز على عينه عشان يحط الجهاز على عينه هاي السهم + +73 +00:05:17,150 --> 00:05:21,910 +الأبيض في حقيقة الأمر بيشير للرقم صفر طبعا الأسهم + +74 +00:05:21,910 --> 00:05:25,290 +.. الأسهم .. ال .. الأسهم بتتشاف بالعين اليمين + +75 +00:05:25,700 --> 00:05:29,640 +الأرقام هاي بتتشاف بالعين الشمال .. بتتشاف بالعين + +76 +00:05:29,640 --> 00:05:35,540 +الشمال طبعا هنا المريض عنده Excyclophoria إذا كان + +77 +00:05:35,540 --> 00:05:38,780 +الفحص يعني انتهى بال .. بإنه المريض حرك هذه + +78 +00:05:38,780 --> 00:05:43,840 +الإدراع الحمرا للأعلى هي كلمة Excyclophoria و + +79 +00:05:43,840 --> 00:05:48,380 +للتحت للأسفل Excyclophoria .. Excyclophoria إذا + +80 +00:05:48,380 --> 00:05:51,980 +هذا dissociation test هنا نفس القضية هنا حرك + +81 +00:05:51,980 --> 00:05:58,570 +باتجاه ال Excyclophoria هو لو احنا عدلناله و حطناه + +82 +00:05:58,570 --> 00:06:02,210 +على صفر .. لو عدلناله و حطناه على صفر يعني خلناه + +83 +00:06:02,210 --> 00:06:06,690 +موازي للخط الأبيض هو هيشعر فيه .. لأنه عنده + +84 +00:06:06,690 --> 00:06:10,310 +Cyclophoria إما N-cyclo أو X-cyclophoria، هيشعر + +85 +00:06:10,310 --> 00:06:14,430 +فيه مائل، فهنقوله أو نطلب منه لما يحكي لنا أنا + +86 +00:06:14,430 --> 00:06:18,060 +شايف القطعة البلاستيكية الحمرة هايشايفها مائلة + +87 +00:06:18,060 --> 00:06:21,660 +بنقوله عدلها عشان تشوفها موازية، فهو لما يعدلها + +88 +00:06:21,660 --> 00:06:24,380 +باتجاه معين، هي بالنسبة إلنا مائلة، بس بالنسبة إله + +89 +00:06:24,380 --> 00:06:28,960 +عدلت بسبب إنه في عين من عينيتين عاملة إما N + +90 +00:06:28,960 --> 00:06:33,580 +-cyclophoria أو X-cyclophoria، حسب وين عدل، بينجيز + +91 +00:06:33,580 --> 00:06:38,340 +كم degree وبالتالي بنعرف جديش كمية الـcyclophoria + +92 +00:06:38,340 --> 00:06:44,170 +اللي عنده الآن في نقطة بدنا نوحلها هاي الرقم صفر + +93 +00:06:44,170 --> 00:06:46,910 +اللي ما عندهوش فوريا بالمرة horizontal فوريا، + +94 +00:06:46,910 --> 00:06:51,390 +هيلاقي السهم الأبيض بيأشر على النقطة صفر الأرقام + +95 +00:06:51,390 --> 00:06:55,570 +اللي على يمينه أرقام فردية، واحد، تلاتة، خمسة، + +96 +00:06:55,570 --> 00:06:59,750 +سبعة، تسعة، إحدى عشرة، تلاتة عشرة الأرقام الفردية + +97 +00:06:59,750 --> 00:07:05,210 +بتعني Esophoria من ناحية التانية، اتنين، اربع، ستة، + +98 +00:07:05,210 --> 00:07:08,790 +ثمانية، عشرة، اتناش، اربعتاش، ستاش، تمانتاش، + +99 +00:07:08,790 --> 00:07:12,510 +عشرين، اتنين وعشرين فبالتالي لما بي .. بنقوله يعني + +100 +00:07:12,510 --> 00:07:17,260 +السهم الأبيض على أي رقم بيأشرمثلا جالي على الرقم + +101 +00:07:17,260 --> 00:07:20,280 +أربعة، معناته عنده أربعة، رقم زوجي إذا هي + +102 +00:07:20,280 --> 00:07:25,160 +Exophoria .. Exophoria لو جالي مثلا بيقشر على + +103 +00:07:25,160 --> 00:07:30,480 +الرقم سبعة، الرقم يعني فردي، معناته Esophoria، + +104 +00:07:30,480 --> 00:07:35,540 +Esophoria، إذا الرقم المفرد أو المفرد بيعني + +105 +00:07:35,540 --> 00:07:38,400 +Esophoria، الرقم الزوجي بيعني + +106 +00:07:41,720 --> 00:07:45,900 +Exophoria في نقطة هنا بدنا نوّه إليها أيضا أنه + +107 +00:07:45,900 --> 00:07:50,620 +ضروري نسأل المريض مثلا جال على الرقم 6 ضروري نسأله + +108 +00:07:50,620 --> 00:07:56,120 +على الرقم 6 نفسه ولا جاي بين 5 و 7 و أنت استنتجت + +109 +00:07:56,120 --> 00:08:00,400 +أنه 6 لأن بعض المريض أو بعض المرضى بيكون يعني عنده + +110 +00:08:00,400 --> 00:08:04,220 +يعني ذكاء في الاستنتاج فبيقدر تقدير أنه والله + +111 +00:08:04,220 --> 00:08:08,660 +طالما جاي في النصف بين 5 و 7 إذا هو بين 5 و 7 إذا + +112 +00:08:08,660 --> 00:08:12,850 +أنا بستنتج أن هو 6 فضروري نتأكد من هذه الشغلة لأنه + +113 +00:08:12,850 --> 00:08:17,810 +إذا ما اتأكدناش ممكن يكون هو فعلا جاي هنا ع ال .. + +114 +00:08:17,810 --> 00:08:20,470 +على النقطة اللي بين خمسة و سبعة و تقديرا ان هي + +115 +00:08:20,470 --> 00:08:24,490 +فعلا ستة Prism Esophoria بس لما احنا بنسمع كلمة + +116 +00:08:24,490 --> 00:08:30,450 +ستة بنفكر انه Exo فبيكون احنا يعني جلبنا النتيجة و + +117 +00:08:30,450 --> 00:08:36,070 +خطأ مننا كفاحصين ك examiner انه بدل ما نعتبره + +118 +00:08:36,070 --> 00:08:40,830 +Esophoria اعتبرنا Exophoria فضالون نتأكد من الرقم + +119 +00:08:40,830 --> 00:08:46,500 +ممكن جالنا جاية بين تمانية او .. او تسعة تسعة + +120 +00:08:46,500 --> 00:08:49,380 +فيتبردر للذهن أنه هاي، بس إن أنا اتأكد تماما أقوله + +121 +00:08:49,380 --> 00:08:53,160 +هي تسعة فعلا على رقم تسعة بتأشر، ولا جاية بين + +122 +00:08:53,160 --> 00:08:56,520 +ثمانية و عشرة و أنت قدرت أنها تسعة، فإذا قال جاية + +123 +00:08:56,520 --> 00:09:00,140 +بين ثمانية و عشرة معناته هي جاية في خانة أو في + +124 +00:09:00,140 --> 00:09:04,940 +الجانب بتاع الأعداد الزوجية، إذا أن هي Exophoria + +125 +00:09:04,940 --> 00:09:10,120 +مش Esophoria، فضالون نتأكد من هذه القطية الآن + +126 +00:09:10,120 --> 00:09:17,380 +بالنسبة للأرقام الزوجية للأعلى Left hyperphoria و + +127 +00:09:17,380 --> 00:09:20,860 +للأسفل Right hyperphoria احنا لما بنقول Left + +128 +00:09:20,860 --> 00:09:24,400 +hyperphoria يعني Right hypo و لما بنقول Right + +129 +00:09:24,400 --> 00:09:28,820 +hyperphoria يعني Left hypo يعني خلاف بعضهم البعض + +130 +00:09:28,820 --> 00:09:31,780 +فهذا هو ال Maddox wing طبعا مسافته تلاتة و تلاتين + +131 +00:09:31,780 --> 00:09:38,870 +سنتمي فبالتالي بتكون الأمور بهكاء يعني واضحة بإذن + +132 +00:09:38,870 --> 00:09:43,910 +الله تعالى طبعا المريض الحواجز هاي .. الحاجز + +133 +00:09:43,910 --> 00:09:48,450 +والتاني بيشكلوا فاصل بين العين تانية يعني بيخلوا + +134 +00:09:48,450 --> 00:09:52,190 +dissociation between the two eyes الآن العين + +135 +00:09:52,190 --> 00:09:57,450 +اليمين لأنها فيها العين ال .. الشمال عفوا Left eye + +136 +00:09:57,450 --> 00:10:05,010 +هاي Left fovea ال Left eye لأن ال Left eye ع جبالي + +137 +00:10:05,010 --> 00:10:09,400 +ال fovea جاي بسبب وجود Exophoria أجى رقم أربعة + +138 +00:10:09,400 --> 00:10:15,040 +بالضبط ع جبال ال Left fovea و أجى السهم في ال + +139 +00:10:15,040 --> 00:10:19,360 +Right eye لأنها Straight أجى السهم ع جبال ال fovea + +140 +00:10:19,360 --> 00:10:23,320 +ال Right fovea فإذا طالما أن السهم صورته سقطت هنا + +141 +00:10:23,320 --> 00:10:28,340 +و ال fovea أو الرقم أربعة صورته سقطت على ال fovea + +142 +00:10:28,340 --> 00:10:31,080 +و ال fovea مع ال fovea corresponding areas فهيكون + +143 +00:10:31,080 --> 00:10:35,460 +المنظرهيك طبعا السهم هيكون أوطى شوية لإنه في + +144 +00:10:35,460 --> 00:10:39,200 +الرسمة الحقيقية أوطى في الفرار لإنه الأرقام أعلى + +145 +00:10:39,200 --> 00:10:43,660 +من رسمة السهم فهي .. فهيشوف السهم بيشير على الرقم + +146 +00:10:43,660 --> 00:10:47,100 +أربع هذه ال projected image هذه الصورة اللي هيشعر + +147 +00:10:47,100 --> 00:10:51,740 +فيها في حال ما عنده Exophoria 4 prism فبالتالي + +148 +00:10:51,740 --> 00:10:57,120 +هيقول أنا شايف السهم الأبيض بيأشر على رقم أربع + +149 +00:10:57,120 --> 00:11:02,840 +فبنعتبرها يعني أربع Prism Exophoria هذه الرسمة + +150 +00:11:02,840 --> 00:11:07,000 +بشكل واضح الأرقام الزوجية بتدل على ال Exophoria + +151 +00:11:07,000 --> 00:11:11,240 +الأرقام الفردية بتدل على ال Esophoria الأرقام + +152 +00:11:11,240 --> 00:11:16,160 +الزوجية اللي هي من صفر و أعلى Left hyperphoria يعني + +153 +00:11:16,160 --> 00:11:20,580 +هنا لو أشر السهم الأحمر على أو شافش السهم الأحمر + +154 +00:11:20,580 --> 00:11:23,800 +على جبال أربعة معناته عنده Left hyperphoria أربعة + +155 +00:11:23,800 --> 00:11:29,560 +prism الأرقام الفردية Right hyperphoria هنا ال + +156 +00:11:29,560 --> 00:11:32,300 +Left hyperphoria بقدر أقول بينجو سين Right + +157 +00:11:32,300 --> 00:11:35,880 +hypophoria و هنا ال Right hyperphoria بقدر أقول + +158 +00:11:35,880 --> 00:11:41,880 +Left hypophoria ضروري نوضح شغلة أن هدولة السطرية + +159 +00:11:41,880 --> 00:11:46,960 +من الأرقام مش cross مش cross وإنما هدول كأنهم فحسين + +160 +00:11:46,960 --> 00:11:50,860 +تمدمجهم في فحس واحد بس هم عملوا بالصورة هاي عشان + +161 +00:11:50,860 --> 00:11:55,660 +نقدر .. عشان نقدر ان العين اليمين تشوف إشي تشوف + +162 +00:11:55,660 --> 00:11:59,100 +الأسهم فقط و العين الشمال تشوف الأرقام فقط يعني + +163 +00:11:59,100 --> 00:12:02,460 +تشوف نقطة التقاطع عند ثمانية يعني هذا مش cross + +164 +00:12:02,460 --> 00:12:05,700 +مالهمش .. يعني السطر العمودي ليس له علاقة بالسطر + +165 +00:12:05,700 --> 00:12:11,260 +الأفقي من الأرقام وإنما هذه مسألة يعني أنا لما بفحص + +166 +00:12:11,260 --> 00:12:15,880 +المريض أول شي بقوله .. يعني امسك الجهاز احني + +167 +00:12:15,880 --> 00:12:19,580 +للأسفل قليلا تقريبا خمسة عشر degree ال reading + +168 +00:12:19,580 --> 00:12:25,680 +position وممكن أطلب منه أقوله غمض عينك لشمال إيه + +169 +00:12:25,680 --> 00:12:29,600 +شايف؟ هيقول لي شايف سهمين سهم أبيض جاي vertical + +170 +00:12:29,600 --> 00:12:33,960 +وسهم أحمر جاي horizontal طيب غمض عينك اليمين وافتح + +171 +00:12:33,960 --> 00:12:38,320 +عينك لشمال إيه شايف؟ شايف سطر من الأرقام عمودي + +172 +00:12:38,320 --> 00:12:42,600 +وشايف سطر من الأرقام أفقي، بعيني لشمال، الآن افتح + +173 +00:12:42,600 --> 00:12:47,820 +عينيك لشمال المسألة الأولى، أين يقع أو إلى أي رقم + +174 +00:12:47,820 --> 00:12:53,730 +يشير السهم الأبيض؟ وال + +201 +00:14:46,290 --> 00:14:48,850 +degree، هنا بالإبرزم و هنا بالبرزم، هنا يقاس بال + +202 +00:14:48,850 --> 00:14:53,010 +degree للأعلى encyclophoria، لو حركها للأسفل + +203 +00:14:53,010 --> 00:14:58,690 +encyclophoria هيك بيكون احنا فلسنا موضوع ال Maddox + +204 +00:14:58,690 --> 00:15:02,690 +Maddox rod ال Maddox wing as if و هو طبعا على النير، على + +205 +00:15:02,690 --> 00:15:07,210 +النير ضروري جداً نتأكد ان هو مش .. يعني مش كتير + +206 +00:15:07,210 --> 00:15:12,730 +له يعني أو أهميته لا تبلغ أهمية ال cover tests في + +207 +00:15:12,730 --> 00:15:16,750 +قياس الفوريا أو سلسلة ال cover tests في قياس + +208 +00:15:16,750 --> 00:15:20,210 +الفوريا و التروبيا و ال total deviation هذا + +209 +00:15:20,210 --> 00:15:26,810 +بالنسبة ل Maddox wing ال Maddox rod عبارة + +210 +00:15:26,810 --> 00:15:27,090 +عن + +211 +00:15:30,520 --> 00:15:33,220 +اللي هي قطعة ال Maddox rod اللي احنا اتعرفنا عليه + +212 +00:15:33,220 --> 00:15:36,900 +high power plus cylinders هنا ما أعطينها اللون + +213 +00:15:36,900 --> 00:15:40,500 +الأحمر، يعني في red Maddox وفي Maddox rod شفاف + +214 +00:15:40,500 --> 00:15:44,640 +ممكن نجري التجربة معه عشان نحدد الفوريا أو + +215 +00:15:44,640 --> 00:15:49,020 +التروبيا سواء استخدمنا ال Maddox rod ال red Maddox + +216 +00:15:49,500 --> 00:15:54,240 +أو ال white Maddox بس يفضل أن الإضاءة تكون في + +217 +00:15:54,240 --> 00:15:57,700 +حالة ما استخدمنا ال Maddox rod الشفاف أن تكون + +218 +00:15:57,700 --> 00:16:02,740 +إضاءة الغرفة مطفأة عشان يقدر يشعر بال line و يشعر + +219 +00:16:02,740 --> 00:16:08,060 +بال dot بتاعة العين الثانية كيف يجري ال Maddox + +220 +00:16:08,060 --> 00:16:11,420 +rod؟ consists of a series of fused cylindrical + +221 +00:16:11,420 --> 00:16:21,240 +red glass rods بمعنى هذه عبارة عن سلندر أو بيسموها + +222 +00:16:21,240 --> 00:16:25,980 +rod عمود من ال .. كأنه .. كأنه plus سلندر، هذا + +223 +00:16:25,980 --> 00:16:29,360 +rod آخر، هذا rod آخر، هذا rod آخر، fused مع + +224 +00:16:29,360 --> 00:16:32,400 +بعض، يعني ملزقين في بعضهم بالشكل .. بشكل كأنهم + +225 +00:16:32,400 --> 00:16:36,240 +عدسة، كأنهم عدسة، even consist of a series of + +226 +00:16:36,240 --> 00:16:40,280 +fused cylindrical red glass rods which convert + +227 +00:16:40,280 --> 00:16:43,100 +the appearance of white spot of light into red + +228 +00:16:43,100 --> 00:16:47,850 +streak، يعني لما أنا بقدّم spot of light، + +229 +00:16:47,850 --> 00:16:52,110 +نقطة ضيقة أمام العين هذه، هذه العين هتشوف النقطة + +230 +00:16:52,110 --> 00:16:57,570 +بشكل خط، streak وهذا الخط هيتجه عمودي على اتجاه + +231 +00:16:57,570 --> 00:17:01,730 +ال cylinders هذه، كل واحدة منها تعتبر cylinder + +232 +00:17:01,730 --> 00:17:05,110 +فبالتالي، العين اليمنى لما بضوي spot of light أو + +233 +00:17:05,110 --> 00:17:05,810 +pin torch + +234 +00:17:09,220 --> 00:17:14,560 +هيشوف بالعين اليمنى line عمودي اتجاه ال .. اللي هي + +235 +00:17:14,560 --> 00:17:18,100 +ال roads هذه هذه ال roads اللي جاية هوريزونتالي + +236 +00:17:18,100 --> 00:17:21,760 +هيشوف vertical red line طب و العين الثانية هتشوف + +237 +00:17:21,760 --> 00:17:27,700 +spot .. هتشوف spot الآن بدي عندي لما ب .. أجري هذا + +238 +00:17:27,700 --> 00:17:31,280 +ال test هذا ممكن أجريه على ال distance و أيضاً ممكن + +239 +00:17:31,280 --> 00:17:34,420 +أجريه على ال near بس و غالباً طالما ال Maddox wing + +240 +00:17:34,420 --> 00:17:37,620 +عندي ب .. بيكفي من ناحية ال near ممكن أنا أجري ال + +241 +00:17:37,620 --> 00:17:41,180 +Maddox rod على ال distance .. على ال distance طيب + +242 +00:17:41,180 --> 00:17:46,220 +.. الآن اللي بدي أعمله أنه بدي أضوي spot of light + +243 +00:17:46,220 --> 00:17:50,380 +أمام المريض و أحط مثلاً ال Maddox rod أمام إحدى + +244 +00:17:50,380 --> 00:17:53,720 +العينتين هنا في هذه الحالة أنا حاطها قدام العين + +245 +00:17:53,720 --> 00:17:57,600 +اليمنى و بدي أسأله بالضبط إيه اللي شايف هو هيشوف + +246 +00:17:57,600 --> 00:18:02,120 +بالعين اليسرى spot of light طبيعية زي ما هي بدون + +247 +00:18:02,120 --> 00:18:05,540 +أي تغيير بينما ال spot of light هتتحول ل red + +248 +00:18:05,540 --> 00:18:09,460 +streak بالنسبة للعين اليمنى و هيكون اتجاه ال + +249 +00:18:09,460 --> 00:18:15,210 +streak عمودي عمودي على اتجاه ال roads هذه على اتجاه + +250 +00:18:15,210 --> 00:18:18,610 +اللي بيسموه ال axis of Maddox ال axis of Maddox + +251 +00:18:18,610 --> 00:18:21,970 +rod هيك لأنه اتجاه ال cylinders فيه هيك + +252 +00:18:21,970 --> 00:18:26,450 +horizontal فهو هيشوف red streak vertical لما أنا + +253 +00:18:26,450 --> 00:18:29,210 +أبدأ أجيس ال horizontal phoria ال exophoria + +254 +00:18:29,210 --> 00:18:30,150 +وال esophoria + +255 +00:18:32,640 --> 00:18:36,280 +باستعمل ال .. ال Maddox Rod بالشكل اللي احنا + +256 +00:18:36,280 --> 00:18:39,960 +شايفينه يكون horizontal فهيعطيني vertical .. + +257 +00:18:39,960 --> 00:18:46,740 +vertical red light vertical red streak طبعاً ال .. + +258 +00:18:46,740 --> 00:18:50,420 +في حالة ما يكون orthophoria .. orthophoria المريض + +259 +00:18:50,420 --> 00:18:56,220 +هيقول شايف بالشكل هذا أن ال red streak و ال spot + +260 +00:18:56,220 --> 00:19:00,930 +of light جايين على بعضهم البعض طيب الآن في عندي + +261 +00:19:00,930 --> 00:19:05,590 +سيناريوهين آخرين لما يكون في عنده فوريا، سيناريو + +262 +00:19:05,590 --> 00:19:09,510 +مرة لل spot على اليمين و سيناريو مرة لل spot على + +263 +00:19:09,510 --> 00:19:14,950 +الشمال، الآن بدي أسأل نفسي سؤال، نفرض أنه حكى + +264 +00:19:14,950 --> 00:19:20,770 +السيناريو هذا، السيناريو هذا، بدنا نكبره شوي و + +265 +00:19:20,770 --> 00:19:22,710 +بعدين بنرجّع الصورة زي ما كان + +266 +00:19:26,430 --> 00:19:29,490 +ماذا يعني هذا ال scenario؟ ماذا يعني هذا ال + +267 +00:19:29,490 --> 00:19:37,030 +scenario؟ لو قال أنا شايف ال red streak وعلى يمينه + +268 +00:19:37,030 --> 00:19:41,850 +وعلى يمينه ال spot معناته العين اليسرى اللي شايفه + +269 +00:19:41,850 --> 00:19:45,070 +ال spot شايفة ال spot والعين اليمنى اللي شايفه ال + +270 +00:19:45,070 --> 00:19:47,850 +streak شايفة ال streak يعني في crossing لل images + +271 +00:19:48,570 --> 00:19:51,350 +الـ streak اللي هو بتشوفه العين اليمنى جاي ناحية + +272 +00:19:51,350 --> 00:19:54,710 +الشمال و ال spot اللي بتشوفه العين اليسرى جاي + +273 +00:19:54,710 --> 00:19:57,350 +ناحية اليمين إذا أنا بتسمّيه crossed image ال + +274 +00:19:57,350 --> 00:20:01,110 +crossed image يعني exophoria .. exophoria طيب + +275 +00:20:01,110 --> 00:20:05,850 +السيناريو الثاني لو جاء لي أنا شايف .. شايف طبعاً هنا + +276 +00:20:05,850 --> 00:20:12,500 +نفس السيناريو هنا ده خطأ هنعدّله على السريع لأن هنا + +277 +00:20:12,500 --> 00:20:14,960 +أيضاً ال spot على اليمين هي مرة ال spot على اليمين + +278 +00:20:14,960 --> 00:20:18,180 +و مرة ال spot على الشمال مرة ال spot على اليمين و + +279 +00:20:18,180 --> 00:20:27,880 +مرة ال spot على الشمال فبدنا احنا نعدّله بشكل ينهي + +280 +00:20:27,880 --> 00:20:32,400 +القضية في + +281 +00:20:32,400 --> 00:20:37,640 +الأول بدنا نعمل نسخ و + +282 +00:20:37,640 --> 00:20:47,680 +بعدين نعمل مرة ثانية نعمل اقتصاص أي + +283 +00:20:47,680 --> 00:20:49,200 +صورة + +284 +00:21:39,120 --> 00:21:45,180 +هكذا فصلناهم وهكذا بنقلبهم إذا هذا سيناريو وهذا + +285 +00:21:45,180 --> 00:21:54,540 +سيناريو آخر لما بيكون عندي صورة + +286 +00:21:54,540 --> 00:21:57,300 +العين اليسرى اللي هي ال spot جاية ناحية اليمين + +287 +00:21:57,300 --> 00:21:59,760 +وصورة العين اليمنى اللي هي ال streak جاية ناحية + +288 +00:21:59,760 --> 00:22:05,040 +الشمال إذا هذا crossed image إذا هذا exophoria لما + +289 +00:22:05,040 --> 00:22:08,160 +بيكون عندي السيناريو الثالث، السيناريو الأول أن ال + +290 +00:22:08,160 --> 00:22:12,300 +spot جاية على ال .. على ال streak is an + +291 +00:22:12,300 --> 00:22:15,300 +orthophoria هنا، ما فيش زوغان، يعني ما فيش صورة + +292 +00:22:15,300 --> 00:22:18,340 +زايفة بالنسبة لصورة، هنا a crossed image يعني + +293 +00:22:18,340 --> 00:22:22,240 +exophoria، هنا uncrossed image، كيف؟ + +294 +00:22:30,510 --> 00:22:33,590 +uncrossed مش كل عين صورتها على جبلها، كل عين + +295 +00:22:33,590 --> 00:22:36,750 +صورتها على جبلها، إذاً هذا esophoria، إذاً هذا + +296 +00:22:36,750 --> 00:22:43,070 +esophoria، طيب، في حالة ال exophoria، ممكن أستعمل + +297 +00:22:43,070 --> 00:22:46,550 +base in برزم، لأن ال exo لبرا، إذا ال apex لبرا، + +298 +00:22:46,550 --> 00:22:50,330 +ال base لجوهر، base in برزم لما أخلّي ال spot تيجي + +299 +00:22:50,330 --> 00:22:56,050 +على ال stream قيمة الـ Prism هذا بتكون تقييم لقيمة + +300 +00:22:56,050 --> 00:22:59,350 +الحوال subjectively لأن المريض هو اللي بيشعر + +301 +00:22:59,350 --> 00:23:02,850 +الصورة إيجاد على الصورة في حالة الـ Esophoria + +302 +00:23:02,850 --> 00:23:09,370 +بستعمل base out Prism لغاية ما ال spot تيجي على ال + +303 +00:23:09,370 --> 00:23:12,150 +streak وهيك بكون أنا عملت ال Maddox rod test + +304 +00:23:12,150 --> 00:23:17,010 +بالنسبة لل horizontal phoria لأن ال vertical + +305 +00:23:17,010 --> 00:23:24,210 +phoria نفس القضية بس بحط بدل ما أحط ال .. ال .. ال + +306 +00:23:24,210 --> 00:23:26,350 +.. ال .. ال .. ال axis بتاع ال Maddox rod horizontal + +307 +00:23:26,350 --> 00:23:30,750 +بحطه vertical، بحطه vertical، عندي أيضاً تلت + +308 +00:23:30,750 --> 00:23:35,690 +سيناريوهات، تلت سيناريوهات، السيناريو الأول ال + +309 +00:23:35,690 --> 00:23:39,440 +patient what the patient sees، بقول أنا شايف الـ + +310 +00:23:39,440 --> 00:23:42,440 +Spot جاية على الـ streak إذا ما فيش Vertical فوريه + +311 +00:23:42,440 --> 00:23:45,920 +طبعاً لما أنا بحط ال axis بتاع ال Maddox Road + +312 +00:23:45,920 --> 00:23:50,460 +Vertical هيشوف Horizontal Red Streak Horizontal + +313 +00:23:50,460 --> 00:23:53,800 +Red Streak و بالعين الثانية هيشوف Spot فبالتالي + +314 +00:23:53,800 --> 00:23:56,520 +إذا ال Spot جاية على ال streak معناته + +315 +00:23:58,790 --> 00:24:03,390 +ما فيش عندي vertical phoria الآن عندي سيناريوهين آخرين + +316 +00:24:03,390 --> 00:24:07,090 +في حالة وجود vertical phoria أما ال spot أسفل ال + +317 +00:24:07,090 --> 00:24:11,950 +streak أو ال spot أعلى ال streak كيف أميز بينهم؟ + +318 +00:24:11,950 --> 00:24:16,670 +اللي صورتها أسفل بيكون هو أعلى العين اللي صورتها + +319 +00:24:16,670 --> 00:24:21,690 +أسفل بتكون هي أعلى و العين اللي صورتها أعلى بتكون + +320 +00:24:21,690 --> 00:24:25,510 +هي أسفل طيب نيجي للسيناريو هذا عندي ال streak أعلى + +321 +00:24:25,510 --> 00:24:28,970 +من ال spot ال streak مين شايفها؟ العين اليمنى، إذا + +322 +00:24:28,970 --> 00:24:33,810 +العين اليمنى hypo لأن صورتها أعلى فهي hypo طيب، + +323 +00:24:33,810 --> 00:24:37,910 +العين اليسرى، ال spot، هي شايفة ال spot ال spot + +324 +00:24:37,910 --> 00:24:42,450 +أسفل، معناته هذه left hyper أو ممكن أقول بينج وسين + +325 +00:24:42,450 --> 00:24:48,190 +right hypo هنا السيناريو الثاني، الصورة تاعة العين + +326 +00:24:48,190 --> 00:24:51,830 +اليسرى أعلى، إذا العين اليسرى hypo، left hypo أو + +327 +00:24:52,240 --> 00:24:55,740 +بقدر أقول الصورة بتاعة العين اليمنى أسفل right + +328 +00:24:55,740 --> 00:25:02,600 +hyper باختصار القاعدة في هذا الموضوع أن اللي + +329 +00:25:02,600 --> 00:25:08,960 +صورته أسفل اللي صورته أسفل بيكون هذا العين مرتفع + +330 +00:25:08,960 --> 00:25:14,640 +يعني جاية hyper فبالتالي هذه القضية ضرورية نعرفها + +331 +00:25:14,640 --> 00:25:22,380 +هنا مثلاً قلنا left hyper لأ عفواً right hyper لأن + +332 +00:25:22,380 --> 00:25:26,580 +صورة العين اليمنى للأسفل right hyper بحط base down + +333 +00:25:26,580 --> 00:25:31,150 +أمام العين اليمنى لغاية ما ال spot تيجي على ال + +334 +00:25:31,150 --> 00:25:35,870 +streak أو بحط base up لأنها left hypo بحط base up + +335 +00:25:35,870 --> 00:25:41,270 +أمام العين اليسرى لغاية ما ال spot يجي على ال + +336 +00:25:41,270 --> 00:25:46,730 +streak هنا العكس .. هنا عندي left hyper .. left + +337 +00:25:46,730 --> 00:25:51,150 +hyper بحط base down هنا أو right hypo بحط base up + +338 +00:25:51,150 --> 00:25:55,230 +هنا لغاية ما ال spot يجي على ال streak و هيك بكون + +339 +00:25:55,230 --> 00:26:00,300 +أنا عرفت قيمة ال vertical phoria بواسطة ال Maddox + +340 +00:26:00,300 --> 00:26:04,520 +rod بواسطة ال Maddox rod فبالتالي هذه القضية ضرورية + +341 +00:26:04,520 --> 00:26:09,600 +تكون واضحة جداً نيجي ل ال motility tests ال ocular + +342 +00:26:09,600 --> 00:26:13,660 +motility examination of ocular movements involves + +343 +00:26:13,660 --> 00:26:17,420 +assessment of smooth pursuit movement followed by + +344 +00:26:17,420 --> 00:26:21,000 +that of saccadic movement ال pursuit movement هي + +345 +00:26:21,000 --> 00:26:26,890 +الحركة البطيئة للعين الحركة البطيئة للعين أو للعين + +346 +00:26:26,890 --> 00:26:32,710 +تان وهما يعني يتبعان target معين .. يتبعان target + +347 +00:26:32,710 --> 00:26:38,090 +معين لما العين تتحرك ببطء مع حركة ال target يعني + +348 +00:26:38,090 --> 00:26:42,110 +بسرعة بطيئة بيكون هذا .. احنا بنختبر ال pursuit movement + +349 +00:26:42,110 --> 00:26:48,660 +أيضاً بدي أختبر ال saccadic movements يعني + +350 +00:26:48,660 --> 00:26:53,300 +الحركة السريعة اللي الهدف منها أنها تعمل fixation + +351 +00:26:53,300 --> 00:26:58,160 +على target إذا حركات العين .. حركات العين في + +352 +00:26:58,160 --> 00:27:03,520 +حركات بطيئة بسموها حركات تتبعية وفي حركات سريعة + +353 +00:27:03,520 --> 00:27:07,560 +الهدف منها نقل ال .. ال object اللي سقطت صورته على + +354 +00:27:07,560 --> 00:27:10,500 +ال peripheral retina نقله فوراً .. فوراً إلى الفوفيا + +355 +00:27:10,500 --> 00:27:13,840 +للتركيز عليه إذا بدي أفحص هل ال pursuit movement + +356 +00:27:13,840 --> 00:27:18,120 +طبيعية لما قاعدي أفحص ال ocular motility و ال + +357 +00:27:18,120 --> 00:27:21,160 +saccadic movements هل هي طبيعية أو لا ممكن إنسان + +358 +00:27:21,160 --> 00:27:24,880 +يتساءل ليش أنا بفحص ال pursuit movement و أيضاً + +359 +00:27:24,880 --> 00:27:28,800 +برجع بفحص الـ saccadic movement لأن مراكز التحكم + +360 +00:27:28,800 --> 00:27:32,280 +فيها في الدماغ مختلفة أو مواقعها في الدماغ مختلفة + +361 +00:27:32,280 --> 00:27:35,720 +و ممكن تكون ال pursuit movement شغالة كويس بينما + +362 +00:27:35,720 --> 00:27:39,040 +ال saccadic movement مش شغالة أو العكس فبالتالي + +363 +00:27:39,040 --> 00:27:43,260 +ممكن هذا يدلني على خلل معين في ال central nervous + +364 +00:27:43,260 --> 00:27:49,800 +system في حال وجود يعني قصور في إحدى أنواع الحركات + +365 +00:27:49,800 --> 00:27:53,990 +الحركات البطيئة أو الحركات السريعة للعينين نيجي لل + +366 +00:27:53,990 --> 00:27:56,770 +versions احنا عارفين أن في عندنا reductions و في + +367 +00:27:56,770 --> 00:28:00,510 +عندنا versions و في عندنا vergence ال versions to + +368 +00:28:00,510 --> 00:28:03,170 +where the eight eccentric positions of gaze are + +369 +00:28:03,170 --> 00:28:06,570 +tested by asking the patient to follow a target + +370 +00:28:06,570 --> 00:28:10,230 +usually a pin or pin torch which offers the + +371 +00:28:10,230 --> 00:28:12,890 +advantage of corneal light reflection to aid + +372 +00:28:12,890 --> 00:28:18,400 +assessment يعني أنا بمسك القلم أو pen torch هو + +373 +00:28:18,400 --> 00:28:22,340 +الأفضل اللي هو عشان يوفر لي قضية ال light و أشوف ال + +374 +00:28:22,340 --> 00:28:25,680 +corneal light reflex و بخلي المريض يتطلع في ال + +375 +00:28:25,680 --> 00:28:28,280 +eighth eccentric position طبعاً ممكن الإنسان يقول + +376 +00:28:28,280 --> 00:28:31,400 +تسعة ال diagnostic position تسعة احنا هنبدأ أصلاً + +377 +00:28:31,400 --> 00:28:34,760 +من التاسع هنبدأ من ال primary position و بضل عندي + +378 +00:28:34,760 --> 00:28:38,260 +ثمانية الـ Eccentric positions of gaze اللي هي up و + +379 +00:28:38,260 --> 00:28:43,320 +down اثنين، up and out و down and out هي أربعة، up + +3 + +401 +00:30:43,910 --> 00:30:47,530 +هي leave a virgin وهي رجعت لل primary position هذه + +402 +00:30:47,530 --> 00:30:50,730 +القضية أنا جئت باختبار ال saccadic movements ال + +403 +00:30:50,730 --> 00:30:54,730 +saccadic movements طبعا ال saccadic movements بدي + +404 +00:30:54,730 --> 00:30:59,250 +أعملها بشكل سريع أو الأفضل أمسك two targets مثلا + +405 +00:30:59,250 --> 00:31:03,430 +هذا target على الشمال أمسكه بإيدي اليمين و target + +406 +00:31:03,430 --> 00:31:11,340 +آخر مثلا على ..على شمالي أنا أو على يمين المريض + +407 +00:31:11,340 --> 00:31:14,980 +امسكه بإيدي اليسرى لأن أنا مواجهة أنا عكس المريض + +408 +00:31:14,980 --> 00:31:20,260 +يعني بنقول له اتطلع على ال target الأول يفضل يكونوا + +409 +00:31:20,260 --> 00:31:24,380 +مختلفين في الألوان مثلا قرص أزرق أو قرص أحمر أو + +410 +00:31:24,380 --> 00:31:28,840 +two targets مثلا نجمة، سيارة، وأبدأ أنا بسرعة + +411 +00:31:29,760 --> 00:31:34,960 +يعني أطلب منه مرة على ال target هذا مثلا target + +412 +00:31:34,960 --> 00:31:39,380 +one بعدين target two أقول له one two أطلب منه .. لما + +413 +00:31:39,380 --> 00:31:42,640 +بقول له one تتطلع على one two تتطلع على two .. one two + +414 +00:31:42,640 --> 00:31:45,740 +.. one two .. one two فبالتالي أنا بتكلم بسرعة و + +415 +00:31:45,740 --> 00:31:49,400 +هو بده ينفذ بسرعة في هذه ال position بالنسبة لل + +416 +00:31:49,400 --> 00:31:55,220 +left و ال right gaze الآن ممكن أنا همسك ال target + +417 +00:31:55,220 --> 00:31:55,800 +الأول + +418 +00:31:59,650 --> 00:32:02,970 +في الأعلى و ال target الثاني في الأسفل نقول one + +419 +00:32:02,970 --> 00:32:06,810 +two one two فبالتالي هو بسرعة ينقل يعني بين ال + +420 +00:32:06,810 --> 00:32:12,670 +target أيضا هنا ممكن في ال saccadic movement لازم + +421 +00:32:12,670 --> 00:32:14,670 +هنا نسبتها ونتركها + +422 +00:32:17,200 --> 00:32:20,600 +هنا left and up right and down طبعا target one + +423 +00:32:20,600 --> 00:32:23,220 +target two target one target two وهكذا ضروري أنا + +424 +00:32:23,220 --> 00:32:27,480 +أتكلم بسرعة وتكون ال two targets سهلة مثلا القرص + +425 +00:32:27,480 --> 00:32:30,560 +الأحمر أو الأحمر الأزرق الأحمر الأزرق الأحمر + +426 +00:32:30,560 --> 00:32:34,320 +الأزرق ضروري ننقل عينيه بين الاثنين عشان أختبر ال + +427 +00:32:34,320 --> 00:32:35,660 +saccadic movement + +428 +00:32:38,950 --> 00:32:41,630 +طبعا لاحظين المريض في السيموليتر هو بيتبع ال + +429 +00:32:41,630 --> 00:32:43,970 +target الحقيقي لأن هذا ليس target هذا ال cover + +430 +00:32:43,970 --> 00:32:48,050 +فبالتالي ضروري جدا الآن down and left up and right + +431 +00:32:48,050 --> 00:32:51,450 +لما غايتي أختبر كل ال saccadic movements أما ال + +432 +00:32:51,450 --> 00:32:56,570 +pursuit movements بدي أمسك target واحد بدي أمسك + +433 +00:32:56,570 --> 00:32:59,510 +target واحد وأشوف ال .. أشوف ال full movement + +434 +00:32:59,510 --> 00:33:02,930 +أشوف ال full movement الآن في بعض الناس بيمد إيده + +435 +00:33:02,930 --> 00:33:07,270 +بمادة خفيفة هيك وبيوقف عند هنا وبيقول و الله إنه + +436 +00:33:07,270 --> 00:33:11,330 +في lift gaze and وفي مشكلة لأنه ما اجت للنهاية لأ + +437 +00:33:11,330 --> 00:33:15,050 +لازم أنا كفاحص أجيب إيدي للنهاية للنهاية يعني أمد + +438 +00:33:15,050 --> 00:33:18,570 +إيدي بأقصى ما أستطيع عشان أشوف ال full movement + +439 +00:33:18,570 --> 00:33:25,210 +بتاعة المريض وبالتالي يكون الأمر عندي واضح جدا في + +440 +00:33:25,210 --> 00:33:30,630 +هذه القضية إذا they + +441 +00:33:30,630 --> 00:33:34,570 +may also be elicited voluntarily in response to a + +442 +00:33:34,570 --> 00:33:37,420 +noise or by the doll's head maneuver in + +443 +00:33:37,420 --> 00:33:41,480 +uncooperative patient ممكن أنا ال virgin movements + +444 +00:33:41,480 --> 00:33:48,300 +يعني أستحثها عند المريض إما بالصوت أو ب doll's + +445 +00:33:48,300 --> 00:33:51,240 +head maneuver إن أنا أمسك رأس الطفل ال baby وأ + +446 +00:33:51,240 --> 00:33:54,280 +أحركه باتجاهه هلاحظ عينيه هتتحركوا بالاتجاه + +447 +00:33:54,280 --> 00:33:58,280 +العكسي ليش؟ أنا ب .. ب .. أتبّع عيني وباتبعش ال + +448 +00:33:58,280 --> 00:34:02,480 +target أحيانا لأنه بيكون الطفل إما صغير جدا أو مش + +449 +00:34:02,480 --> 00:34:05,380 +cooperative .. أو مش cooperative أحيانا لما بدنا + +450 +00:34:05,380 --> 00:34:09,420 +نناديه عليه أو بنصدر صوت معين أو فيه لعبة بتصدر صوت + +451 +00:34:09,420 --> 00:34:13,860 +ممكن ونحطلها على جانب .. من جوانب رأس المريض و + +452 +00:34:13,860 --> 00:34:18,060 +أصدرنا هذا الصوت ساعتها ممكن الطفل أو هذا المريض + +453 +00:34:18,060 --> 00:34:21,700 +الغير متعاون يطلع فجأة يعني بمعنى آخر يحرك عينه + +454 +00:34:21,700 --> 00:34:26,400 +باتجاه معين وهيك احنا بنختبر ال .. اللي هي ال + +455 +00:34:26,400 --> 00:34:29,020 +virgin movement بنيجي ل introductions + +456 +00:34:31,890 --> 00:34:35,450 +Reductions are assist if reduced ocular motility + +457 +00:34:35,450 --> 00:34:40,890 +is noted in either or both eyes طيب نيجي هنا لل + +458 +00:34:40,890 --> 00:34:43,210 +simulator نقول أنا مثلا + +459 +00:34:45,750 --> 00:34:49,030 +نفترض إنه ال target مش هنا، ال target مش هنا، ال + +460 +00:34:49,030 --> 00:34:52,110 +target هنا، على الآخر، ومع ذلك العين ما راحتش على + +461 +00:34:52,110 --> 00:34:56,330 +الآخر عين أو العينين، يعني في عندي reduction في ال + +462 +00:34:56,330 --> 00:34:59,550 +full movement بتاعة العينين، ساعتها أنا برجع + +463 +00:34:59,550 --> 00:35:03,940 +لاختبار reductions، لأ برجع لاختبار reductions قبل + +464 +00:35:03,940 --> 00:35:06,960 +ما نقول كيف اختبار الduction ممكن نسأل سؤال يعني + +465 +00:35:06,960 --> 00:35:11,440 +هل ال virgins إذا أنا اختبرتها بكفي ولا ضروري كل + +466 +00:35:11,440 --> 00:35:15,380 +أنواع الحركة أختبرها حقيقة ضروري كل أنواع الحركة + +467 +00:35:15,380 --> 00:35:18,300 +نختبرها لأن ممكن ال virgin يكون فيها مشكلة بينما + +468 +00:35:18,300 --> 00:35:21,900 +الduction ما يكونش فيها أي مشكلة .. مايكونش فيها أي + +469 +00:35:21,900 --> 00:35:27,820 +مشكلة فبالتالي ضروري جدا إن احنا نختبر كل أنواع + +470 +00:35:27,820 --> 00:35:33,970 +الحركة يجب أن تستخدم مصدر مصدر مصدر مصدر مصدر مصدر + +471 +00:35:33,970 --> 00:35:37,920 +مصدر مصدر مصدر الـ fellow eye is occluded، طبعا في + +472 +00:35:37,920 --> 00:35:40,460 +الدكشن لازم نسكرها يعني، الـ fellow eye للعين + +473 +00:35:40,460 --> 00:35:43,160 +الثانية is occluded and the patient asked to + +474 +00:35:43,160 --> 00:35:47,180 +follow a pin torch in various positions of gaze a + +475 +00:35:47,180 --> 00:35:51,760 +simple numeric system may be employed to using + +476 +00:35:51,760 --> 00:35:57,780 +zero to denote full movement and minus one to + +477 +00:35:57,780 --> 00:36:01,280 +minus four to denote increasing decrease of under + +478 +00:36:01,280 --> 00:36:04,990 +action ما معنى هذا الكلام؟ بنيجي احنا على ال simulator + +479 +00:36:04,990 --> 00:36:09,190 +نقول هذه بدنا نغطي عين ونجي نختبر الduction هل + +480 +00:36:09,190 --> 00:36:12,710 +نختبر .. نعتبر إن العين هنا مش موجودة إن العين هذه + +481 +00:36:12,710 --> 00:36:17,170 +مش موجودة وبدأ أختبر هذه العين في ال primary + +482 +00:36:17,170 --> 00:36:23,030 +position target بالضبط أمامه على بعد معين هذه + +483 +00:36:23,030 --> 00:36:24,870 +العين في ال primary position ال corneal light + +484 +00:36:24,870 --> 00:36:28,350 +reflex في النصر لأن بدأ أختبر ال abduction بتاعه + +485 +00:36:28,350 --> 00:36:29,050 +ال abduction + +486 +00:36:31,740 --> 00:36:35,100 +هذه العين راحت abduction كامل ماضاعش شيء من ال + +487 +00:36:35,100 --> 00:36:39,760 +sclera هنا نبين تمام فبالتالي هذه طالما ال + +488 +00:36:39,760 --> 00:36:43,200 +abduction full طالما ال abduction full بعطيه رقم + +489 +00:36:43,200 --> 00:36:48,220 +صفر يعني بكتب في file المريض left abduction 0 طيب + +490 +00:36:48,220 --> 00:36:56,060 +مثال آخر بنقول كالعادة هذه احنا ودينا ال + +491 +00:36:56,060 --> 00:37:01,490 +target نفترض ال target مش هنا نفترض ال target هنا و + +492 +00:37:01,490 --> 00:37:07,190 +مع ذلك أقصى حد وصلته العين الشكل هذا لسه ال + +493 +00:37:07,190 --> 00:37:10,810 +abduction مش full مع إنه ال target صار بعيد تماما + +494 +00:37:10,810 --> 00:37:14,970 +صار هنا ناحية ال prism نُفترض ال prism هو ال target + +495 +00:37:14,970 --> 00:37:21,750 +المفروض أن العين تكون هكذا ومع ذلك العين هيك يعني + +496 +00:37:21,750 --> 00:37:25,070 +ال abduction مش full هذا بعطيه minus one بقول + +497 +00:37:25,070 --> 00:37:29,610 +abduction in left eye minus one طيب لو أنا ال + +498 +00:37:29,610 --> 00:37:34,610 +target عندي هنا مكان ال prism ومع ذلك العين يعني + +499 +00:37:34,610 --> 00:37:38,410 +.. يعني في defect كثير في ال abduction أو أكثر من + +500 +00:37:38,410 --> 00:37:44,430 +ال minus one بعطيه minus two لو هيك بعطيه minus + +501 +00:37:44,430 --> 00:37:49,160 +three لو العين ظلت ثابتة في ال primary position فيش + +502 +00:37:49,160 --> 00:37:52,320 +أي نوع من ال abduction بيعطيه minus four، إذا لما + +503 +00:37:52,320 --> 00:37:55,460 +بنشوف في ملف المريض، احنا حكينا المثال على ال + +504 +00:37:55,460 --> 00:37:59,000 +abduction بس هو ينطبق على ال abduction وعلى ال + +505 +00:37:59,000 --> 00:38:01,080 +elevation وعلى ال depression وعلى أي نوع من + +506 +00:38:01,080 --> 00:38:05,220 +الduction movement، لما بنقول أو بنلاقي في ملف + +507 +00:38:05,220 --> 00:38:10,120 +المريض مثلا left abduction -4 ما عناه ما عناه ما عناه + +508 +00:38:10,120 --> 00:38:14,320 +ما عناه ما عناه ما عناه ما عناه ما عناه ما عناه ما عناه + +509 +00:38:14,320 --> 00:38:21,860 +ما عناه ما عناه ما عناه ما عناه ما عناه ما عناه ما عناه + +510 +00:38:21,860 --> 00:38:22,100 +ما عناه ما عناه ما عناه ما عناه ما عناه ما عناه ما عناه + +511 +00:38:22,100 --> 00:38:22,260 +ما عناه ما عناه ما عناه ما عناه ما عناه ما عناه ما عناه + +512 +00:38:22,260 --> 00:38:25,020 +ما عناه ما عناه ما عناه ما عناه ما عناه ما عناه ما عناه + +513 +00:38:25,020 --> 00:38:27,320 +ما عناه ما عناه ما عناه ما عناه ما عناه ما عناه ما عناه + +514 +00:38:27,320 --> 00:38:33,770 +ما عناه ما عناه ما عناه ما عوزميلي قيمها minus 2، + +515 +00:38:33,770 --> 00:38:37,810 +بنقول الاختلاف في التقييم إذا كان بسيط مقبول، + +516 +00:38:37,810 --> 00:38:41,830 +وبالنهاية في اتفاق إنه في defect في ال abduction + +517 +00:38:41,830 --> 00:38:45,350 +سواء من .. مني أو من زميلي، يعني ممكن أختلف أنا + +518 +00:38:45,350 --> 00:38:47,930 +وزميلي، أنا أقول minus 2 وزميلي يقول minus 3 + +519 +00:38:50,600 --> 00:38:54,040 +الاختلاف بسيط بينما أقول أنا minus واحد وزميل يقول + +520 +00:38:54,040 --> 00:38:57,820 +minus أربعة معناته أحدنا مخطئ .. أحدنا مخطئ في + +521 +00:38:57,820 --> 00:39:01,920 +التقييم ال minus أربعة يعني يعني العين ما تعملش أي + +522 +00:39:01,920 --> 00:39:04,720 +نوع من ال upduction يعني هنا .. هنا ال target .. + +523 +00:39:04,720 --> 00:39:06,800 +ما بنعش نختل .. احنا .. أنا جبت هذا ال target + +524 +00:39:06,800 --> 00:39:09,960 +الحقيقي هنا بس عشان العين تعدل نفترض إنه مش هذا ال + +525 +00:39:09,960 --> 00:39:12,040 +target الموجود ال target الموجود هو ال prism + +526 +00:39:12,040 --> 00:39:15,460 +وقلنا له يتطلع على ال prism وظلت عينه ثابتة .. هذه + +527 +00:39:15,460 --> 00:39:19,440 +العين راحت جوا على الآخر خلينا احنا عشان نعمل + +528 +00:39:19,440 --> 00:39:25,120 +simulation أكثر هذه العين راحت جوا على الآخر طبعا + +529 +00:39:25,120 --> 00:39:28,340 +هي مغطاة يعني مش لازم تكون مفتوحة بس بدنا نفترض إنه + +530 +00:39:28,340 --> 00:39:33,880 +بيحاول قاعد يطلع على ال target هذا العين هي مش + +531 +00:39:33,880 --> 00:39:37,460 +قادرة، بينما العين هي قدرت رغم أنها مغمضة، تمام؟ + +532 +00:39:37,460 --> 00:39:40,940 +طب قدرت ليش؟ لأنه عشان يحاول يطلع ال target هذا ال + +533 +00:39:40,940 --> 00:39:44,520 +lateral rectus بيجيها innervation كثير، تمام؟ و ال + +534 +00:39:44,520 --> 00:39:47,080 +medial rectus حسب hearing loss بيجيها innervation + +535 +00:39:47,080 --> 00:39:52,500 +كثير حتى وهي مغمضة، فبالتالي هنا ال abduction + +536 +00:39:52,500 --> 00:39:56,500 +بنقول عنه minus ما نفعش نقول عنه minus one حتى ولا + +537 +00:39:56,500 --> 00:40:00,100 +minus two لو أخطأنا قلنا minus ثلاثة يمكن نكون + +538 +00:40:00,100 --> 00:40:03,620 +مقبولة بس هنا طالما ما فيش أي نوع من ال abduction + +539 +00:40:03,620 --> 00:40:09,160 +معناته عندي -4 إذا يقيّم الduction movement سواء + +540 +00:40:09,160 --> 00:40:12,540 +abduction أو abduction أو subduction اللي هو + +541 +00:40:12,540 --> 00:40:14,840 +elevation أو infraduction اللي هو depression + +542 +00:40:14,840 --> 00:40:19,700 +بمقياس رقمين من minus one ل minus four اللي هو ال + +543 +00:40:19,700 --> 00:40:23,200 +under action ال under action zero معناته normal + +544 +00:40:23,200 --> 00:40:27,280 +action وفي أيضا من plus one ل plus four اللي هي + +545 +00:40:27,280 --> 00:40:32,830 +ال over action اللي هي ال over فبالتالي ضروري جدا + +546 +00:40:32,830 --> 00:40:37,730 +يعني تكون عندنا القضية واضحة .. تكون القضية + +547 +00:40:37,730 --> 00:40:41,510 +واضحة .. إذا في عندي over action للعضلة زيادة + +548 +00:40:41,510 --> 00:40:47,070 +في نشاط العضلة و under action للعضلة يعني نقص في + +549 +00:40:47,070 --> 00:40:51,230 +نشاط العضلة ال under action يقيم من minus one ل + +550 +00:40:51,230 --> 00:40:54,620 +minus four و ال over action من ال plus one ل plus + +551 +00:40:54,620 --> 00:40:58,420 +four طبعا plus four أكثر over action و zero معناته + +552 +00:40:58,420 --> 00:41:02,400 +normal action للعضلة لما بنشوف إن العضلة الدكشن مثلا + +553 +00:41:02,400 --> 00:41:07,560 +تاع ال right eye الدكشن zero معناته هذا الدكشن + +554 +00:41:07,560 --> 00:41:13,180 +طبيعي معناته هذا الدكشن طبيعي هنا بنقول طبعا + +555 +00:41:13,180 --> 00:41:17,740 +الدكشن هنا مش الفيرج المفروض هذه مش مرسومة هذه ليست + +556 +00:41:17,740 --> 00:41:20,940 +مرسومة بس رسمت عشان تبين لي إن العيون في الطبيعي + +557 +00:41:20,940 --> 00:41:25,540 +المفروض هنا ال target يكون للآخر رايح هذا ال + +558 +00:41:25,540 --> 00:41:29,260 +target to the left normal abduction of the left eye + +559 +00:41:29,260 --> 00:41:32,460 +minus one طبعا اللي بيساعدني عليه ال corneal light + +560 +00:41:32,460 --> 00:41:36,220 +reflex minus two بدأت ال sclera تظهر minus three و + +561 +00:41:36,220 --> 00:41:41,160 +minus four ما فيش أي نوع من ال abduction هنا العين + +562 +00:41:41,160 --> 00:41:44,800 +الثانية رسمت فقط عشان نبين إن وضعها واحد لأن ال + +563 +00:41:44,800 --> 00:41:48,400 +target مكانه واحد بس هذا مريض، هذا مريض ثاني، هذا + +564 +00:41:48,400 --> 00:41:51,280 +مريض ثالث، هذا مريض رابع، كل واحد منهم عنده degree + +565 +00:41:51,280 --> 00:41:56,560 +معينة من ال defect في ال abduction في ال left eye + +566 +00:41:56,720 --> 00:42:00,100 +هنا احنا بنتوقف عند هذه النقطة ويعطيكم العافية + +567 +00:42:00,100 --> 00:42:02,840 +والسلام عليكم ورحمة الله وبركاته diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/lHQOmIXshYA_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/lHQOmIXshYA_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..4f0690efbf194661be59da87c8ef696b731f1845 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/lHQOmIXshYA_postprocess.srt @@ -0,0 +1,2268 @@ +1 +00:00:01,480 --> 00:00:05,240 +بسم الله الرحمن الرحيم بنكمل محاضرات حوال واحد + +2 +00:00:05,240 --> 00:00:10,740 +ووصلنا لل subjective measurement of squint ال + +3 +00:00:10,740 --> 00:00:13,620 +subjective measurement of squint بتعتمد اعتماد + +4 +00:00:13,620 --> 00:00:19,220 +أساسي على المريضإنه يعني يخبرنا بالشيء اللي هو + +5 +00:00:19,220 --> 00:00:21,800 +بشايفه عشان إيه بيسموها subjective measurements + +6 +00:00:21,800 --> 00:00:28,440 +بعكس اللي هو سلسلة ال cover test و ال hersberg و + +7 +00:00:28,440 --> 00:00:31,300 +ال kremsky و ال prism reflection test اللي يعني + +8 +00:00:31,300 --> 00:00:35,180 +بتندرج تحت ال objective measurements of a school + +9 +00:00:35,180 --> 00:00:39,520 +تحت ال subjective measurement في عندي فحصين هناخد + +10 +00:00:39,520 --> 00:00:43,940 +اللي هو ال Maddox wing و Maddox roadsubjective + +11 +00:00:43,940 --> 00:00:48,180 +tests are dissimilar image tests يعني dissimilar + +12 +00:00:48,180 --> 00:00:52,920 +image يعني بتقدم للعين اليمين صورةوللعين الشمال + +13 +00:00:52,920 --> 00:00:57,660 +بتقدم لها صورة مختلفة عنها، حقيقة they are of + +14 +00:00:57,660 --> 00:01:00,880 +limited value in the assessment of strabismus + +15 +00:01:00,880 --> 00:01:05,560 +لأنهم مش accurate كتير، مش accurate كتير، فأهميتهم + +16 +00:01:05,560 --> 00:01:09,660 +محدودة في تقييم الحوال، بس أحيانا بنلجأ لهم في + +17 +00:01:09,660 --> 00:01:13,080 +ظروف معينة، they require simultaneous perception + +18 +00:01:14,040 --> 00:01:17,380 +cannot be used in manifest strabismus with + +19 +00:01:17,380 --> 00:01:19,680 +suppression يعني الإنسان اللي عنده suppression + +20 +00:01:19,680 --> 00:01:23,740 +هيشوف صورة من الصورتين وبالتالي العلاقة بين + +21 +00:01:23,740 --> 00:01:27,520 +الصورتين مش هيقدر يقيمها لأنه عنده suppression فأي + +22 +00:01:27,520 --> 00:01:30,980 +إنسان عنده suppression لا بنفع أستعمل مع ال Maddox + +23 +00:01:30,980 --> 00:01:35,780 +wing ولا ال Maddox throat and do not reveal the + +24 +00:01:35,780 --> 00:01:39,740 +full deviation يعني مابتقدرش .. يعني اتجيس لكل ال + +25 +00:01:39,740 --> 00:01:45,050 +deviation في بعضالأحيان في بعض الأحيان نبدأ مع ال + +26 +00:01:45,050 --> 00:01:48,490 +test الأول اللي هو Madog's wing dissociates the + +27 +00:01:48,490 --> 00:01:52,590 +eyes for near fixation على بعد تلت متر and majors + +28 +00:01:52,590 --> 00:01:56,830 +heterophore يعني بيجيسلي الفوريا على بعد تلت متر + +29 +00:01:56,830 --> 00:01:59,630 +the instrument is constructed in such a way that + +30 +00:01:59,630 --> 00:02:02,870 +the right eye sees only a white vertical arrow and + +31 +00:02:02,870 --> 00:02:06,480 +a red horizontal arrowWhereas the left eye sees + +32 +00:02:06,480 --> 00:02:10,340 +only horizontal and vertical rows of numbers نشوف + +33 +00:02:10,340 --> 00:02:18,900 +جهاز ال Maddox Wing عبارة عن إيش؟ نطلع رسمة مكبرة، + +34 +00:02:18,900 --> 00:02:23,620 +هاي جهاز ال Maddox Wing عبارة عن لوحة سوداء من + +35 +00:02:23,620 --> 00:02:28,070 +المعدنفيها سطر من الأرقام عمودي مرسوم باللون + +36 +00:02:28,070 --> 00:02:31,450 +الأحمر، الأرقام مطبوعة على اللوحة السوداء باللون + +37 +00:02:31,450 --> 00:02:36,670 +الأحمر وجاية بشكل vertical وفي سطر آخر من الأرقام + +38 +00:02:36,670 --> 00:02:42,670 +جاية بشكل horizontal .. جاية بشكل horizontal طبعا + +39 +00:02:42,670 --> 00:02:48,080 +لونه أبيض، أيضا في عندي سهم أحمرمطبوعة على اللوحة + +40 +00:02:48,080 --> 00:02:51,420 +اللي أنا بأشير عليه وفي سهم أبيض مختلف .. مختفي + +41 +00:02:51,420 --> 00:02:54,880 +طبعا خلف الحاجز، هنشوفه في صورة تانية، هاي السهم + +42 +00:02:54,880 --> 00:02:58,720 +الأحمر بيشير لرقم من الأرقام هاي، طبعا هو حقيقة + +43 +00:02:58,720 --> 00:03:03,460 +بيشير للرقم صفر، بس اللي عنده vertical phoria، + +44 +00:03:03,460 --> 00:03:06,720 +هيشوفه ما بيشيرش للرقم صفر، ممكن يشوفه أعلى من صفر + +45 +00:03:06,720 --> 00:03:13,940 +أو أدنى من صفر، وفي عندي سهم أبيضحقيقة الأمر هو + +46 +00:03:13,940 --> 00:03:19,360 +بيشير أو مطبوع بالضبط مقابل الرقم سفر ممكن اللي + +47 +00:03:19,360 --> 00:03:22,940 +عنده Exophoria أو Esophoria يشوفه على يمين صفر أو + +48 +00:03:22,940 --> 00:03:27,340 +على شمال صفر مقابل رقم من هذه الأرقام طبعا العين + +49 +00:03:27,340 --> 00:03:31,540 +اليمين اللي بتكون تتطلع من هذه الفتحة هتشوف الأسهم + +50 +00:03:31,540 --> 00:03:36,030 +فقطبدون ما تشوف الأرقام، والعين الشمال هتشوف + +51 +00:03:36,030 --> 00:03:40,470 +الأرقام فقط بدون ما تشوف الأسهم، كيف هذا بيتن + +52 +00:03:40,470 --> 00:03:45,770 +بواسطة حاجزين معدنين، الحاجز المعدني هذا و الحاجز + +53 +00:03:45,770 --> 00:03:50,150 +المعدني هذا بيخلوا العين اليمين فقط أمامهايعني .. + +54 +00:03:50,150 --> 00:03:54,350 +يعني بيحرموها أو بيشكلوا حاجز أمام رؤية الأرقام و + +55 +00:03:54,350 --> 00:03:57,790 +العين الشمال تقدرش تشوف الأسهم لأن الحاجز هذا + +56 +00:03:57,790 --> 00:04:02,110 +بيمنعها بالنسبة للعين الشمال .. بالنسبة للعين + +57 +00:04:02,110 --> 00:04:08,350 +الشمال طيب .. الآن في صورة يعني من أعلى .. هي عندي + +58 +00:04:08,350 --> 00:04:13,290 +أنا العين اليمين هتطلع الحاجز هذا هيمنعها أنها + +59 +00:04:13,290 --> 00:04:18,070 +تشوف الأرقام تماماو العين الشمال الحاجز هذا + +60 +00:04:18,070 --> 00:04:24,410 +هيمنعها أن تشوف الأسهم تماما، الآن السهم الأحمر في + +61 +00:04:24,410 --> 00:04:33,050 +خط أبيض تحت الأرقام البيض موازي للسهم الأحمرالسهم + +62 +00:04:33,050 --> 00:04:36,430 +الأحمر يمكن من طرفه من هنا أن نحركه للأعلى أو + +63 +00:04:36,430 --> 00:04:40,250 +للأسفل في حالة ما يكون فيه هندي Cyclophoria + +64 +00:04:40,250 --> 00:04:44,370 +والمريض شايف الخط هذا أو القطعة هذه من السهم + +65 +00:04:44,370 --> 00:04:47,610 +الأحمر، هذا قطعة بلاستيكية قطعة بلاستيكية بتبدأ من + +66 +00:04:47,610 --> 00:04:51,350 +هنا و بتنتهي هنا، المفروض أنها تكون موازية في حالة + +67 +00:04:51,350 --> 00:04:55,170 +ما كانش فيه Cyclophoria طيب، الآن هذا السهم الأحمر + +68 +00:04:55,170 --> 00:04:59,590 +الجزء هذا ثابت، ثابتالجزء هذا متحرك عشان يجيس لل N + +69 +00:04:59,590 --> 00:05:03,210 +-cyclo وال X-cyclophoria ال N-cyclo وال X + +70 +00:05:03,210 --> 00:05:09,710 +-cyclophoria هاي هنا عندي صورة من الأسفل طبعا هذا + +71 +00:05:09,710 --> 00:05:13,230 +ال handle الإيد اللي بيمسكها المريض عشان يحط + +72 +00:05:13,230 --> 00:05:17,150 +الجهاز على عينه عشان يحط الجهاز على عينه هاي السهم + +73 +00:05:17,150 --> 00:05:21,910 +الأبيض في حقيقة الأمر بيشير للرقم صفر طبعا الأسهم + +74 +00:05:21,910 --> 00:05:25,290 +.. الأسهم .. ال .. الأسهم بتنشف بالعين اليمين + +75 +00:05:25,700 --> 00:05:29,640 +الأرقام هاي بتتشاف بالعين الشمال .. بتتشاف بالعين + +76 +00:05:29,640 --> 00:05:35,540 +الشمال طبعا هنا المريض عنده encyclophoria إذا كان + +77 +00:05:35,540 --> 00:05:38,780 +الفحص يعني انتهى بال .. بإنه المريض حرك هذه + +78 +00:05:38,780 --> 00:05:43,840 +الإدراع الحمرا للأعلى هي كلمة encyclophoria و + +79 +00:05:43,840 --> 00:05:48,380 +للتحت للأسفل encyclophoria .. encyclophoria إذا + +80 +00:05:48,380 --> 00:05:51,980 +هذا dissociation test هنا نفس القضية هنا حرك + +81 +00:05:51,980 --> 00:05:58,570 +باتجاه ال encyclophoriaهو لو احنا عدلناله و حطناه + +82 +00:05:58,570 --> 00:06:02,210 +على صفر .. لو عدلناله و حطناه على صفر يعني خلناه + +83 +00:06:02,210 --> 00:06:06,690 +موازي للخط الأبيض هو هيشعر فيه .. لأنه عنده + +84 +00:06:06,690 --> 00:06:10,310 +cyclophoria إما N-cyclo أو X-cyclophoria، هيشعر + +85 +00:06:10,310 --> 00:06:14,430 +فيه مائل، فهنقوله أو نطلب منه لما يحكي لنا أنا + +86 +00:06:14,430 --> 00:06:18,060 +شايف القطعة البلاستيكية الحمرة هايشايفها مائلة + +87 +00:06:18,060 --> 00:06:21,660 +بنقوله عدلها عشان تشوفها موازية، فهو لما يعدلها + +88 +00:06:21,660 --> 00:06:24,380 +باتجاه معين، هي بالنسبة إلنا مائلة، بس بالنسبة إله + +89 +00:06:24,380 --> 00:06:28,960 +عدلت بسبب إنه في عين من عينيتين عاملة إما N + +90 +00:06:28,960 --> 00:06:33,580 +-cyclothoria أو X-cyclothoria، حسب وين عدل، بينجيز + +91 +00:06:33,580 --> 00:06:38,340 +كام degree وبالتالي بنعرف جديش كمية الـcyclothoria + +92 +00:06:38,340 --> 00:06:44,170 +اللي عندهالان في نقطة بدنا نوحلها هاي الرقم صفر + +93 +00:06:44,170 --> 00:06:46,910 +اللي ما عندهوش فوريا بالمرة horizontal فوريا، + +94 +00:06:46,910 --> 00:06:51,390 +هيلاقي السهم الأبيض بيأشر على النقطة صفر الأرقام + +95 +00:06:51,390 --> 00:06:55,570 +اللي على يمينه أرقام فردية، واحد، تلاتة، خمسة، + +96 +00:06:55,570 --> 00:06:59,750 +سبعة، تسعة، إحدى عشرة، تلاتة عشرة الأرقام الفردية + +97 +00:06:59,750 --> 00:07:05,210 +بتعني iso فورياعن ناحية التانية، اتنين، اربع، ستة، + +98 +00:07:05,210 --> 00:07:08,790 +تمانية، عشرة، اتناش، اربعتاش، ستاش، تمانتاش، + +99 +00:07:08,790 --> 00:07:12,510 +عشرين، اتنين وعشرين فبالتالي لما بي .. بنقوله يعني + +100 +00:07:12,510 --> 00:07:17,260 +السهم الأبيض على أي رقم بيأشرمثلا جالي على الرقم + +101 +00:07:17,260 --> 00:07:20,280 +أربعة، معناته عنده أربعة، رقم زوجي إذا هي + +102 +00:07:20,280 --> 00:07:25,160 +exophoria .. exophoria لو جالي مثلا بيقشر على + +103 +00:07:25,160 --> 00:07:30,480 +الرقم سبعة، الرقم يعني فردي، معناته هادية، + +104 +00:07:30,480 --> 00:07:35,540 +exophoria، إذا الرقم المفرد أو المفرد بيعني + +105 +00:07:35,540 --> 00:07:38,400 +exophoria، الرقم الزوجي بيعني + +106 +00:07:41,720 --> 00:07:45,900 +Exophoria في نقطة هنا بدنا نوّه إليها أيضا أنه + +107 +00:07:45,900 --> 00:07:50,620 +ضروري نسأل المريض مثلا جال على الرقم 6 ضروري نسأله + +108 +00:07:50,620 --> 00:07:56,120 +على الرقم 6 نفسه و لا جاي بين 5 و 7 و أنت استنتجت + +109 +00:07:56,120 --> 00:08:00,400 +أنه 6 لأن بعض المريض أو بعض المرضى بيكون يعني عنده + +110 +00:08:00,400 --> 00:08:04,220 +يعني ذكاء في الاستنتاج فبيقدر تقدير أنه والله + +111 +00:08:04,220 --> 00:08:08,660 +طالما جاي في النصف بين 5 و 7 إذا هو بين 5 و 7 إذا + +112 +00:08:08,660 --> 00:08:12,850 +أنا بستنتج أن هو 6فضروري نتأكد من هذه الشغلة لأنه + +113 +00:08:12,850 --> 00:08:17,810 +إذا ما اتأكدناش ممكن يكون هو فعلا جاي هناع ال .. + +114 +00:08:17,810 --> 00:08:20,470 +على النقطة اللي بين خمسة و سبعة و تقديرا ان هي + +115 +00:08:20,470 --> 00:08:24,490 +فعلا ستة prism esophoria بس لما احنا بنسمع كلمة + +116 +00:08:24,490 --> 00:08:30,450 +ستة بنفكر انه exo فبيكون احنا يعني جلبنا النتيجة و + +117 +00:08:30,450 --> 00:08:36,070 +خطأ مننا كفاحصين ك examiner انه بدل ما نعتبره + +118 +00:08:36,070 --> 00:08:40,830 +esophoria اعتبرنا exophoria فضالون نتأكد من الرقم + +119 +00:08:40,830 --> 00:08:46,500 +ممكن جالنا جاية بين تمانية او .. او تسعةتسعة + +120 +00:08:46,500 --> 00:08:49,380 +فيتبردر للذهن أنه هاي، بس إن أنا اتأكد تماما أقوله + +121 +00:08:49,380 --> 00:08:53,160 +هي تسعة فعلا على رقم تسعة بتأشر، ولا جاية بين + +122 +00:08:53,160 --> 00:08:56,520 +تمانية و عشرة و أنت قدرت أنها تسعة، فإذا قال جاية + +123 +00:08:56,520 --> 00:09:00,140 +بين تمانية و عشرة معناته هي جاية في خانة أو في + +124 +00:09:00,140 --> 00:09:04,940 +الجانب بتاع الأعداد الزوجية، إذا أن هي Exophoria + +125 +00:09:04,940 --> 00:09:10,120 +مش Esophoria، فضالون نتأكد من هذه القطيةالان + +126 +00:09:10,120 --> 00:09:17,380 +بالنسبة للأرقام الزوجية للأعلى left hyperphoria و + +127 +00:09:17,380 --> 00:09:20,860 +للأسفل right hyperphoria احنا لما بنقول left + +128 +00:09:20,860 --> 00:09:24,400 +hyperphoria يعني right hypo و لما بنقول right + +129 +00:09:24,400 --> 00:09:28,820 +hyperphoria يعني left hypo يعني خلاف بعضهم البعض + +130 +00:09:28,820 --> 00:09:31,780 +فهذا هو ال medics wing طبعا مسافته تلاتة و تلاتين + +131 +00:09:31,780 --> 00:09:38,870 +صنطي فبالتالي بتكون الأمور بهكاء يعني واضحةبإذن + +132 +00:09:38,870 --> 00:09:43,910 +الله تعالى طبعا المريض الحواجز هاي .. الحاجز + +133 +00:09:43,910 --> 00:09:48,450 +والتاني بيشكلوا فاصل بين العين تانية يعني بيخلوا + +134 +00:09:48,450 --> 00:09:52,190 +dissociation between the two eyes الآن العين + +135 +00:09:52,190 --> 00:09:57,450 +اليمين لأنها فيها العين ال .. الشمال عفوا left eye + +136 +00:09:57,450 --> 00:10:05,010 +هاي left fovea ال left eye لأن ال left eye ع جبالي + +137 +00:10:05,010 --> 00:10:09,400 +ال fovea جاي بسبب وجود exophoriaأجى رقم أربعة + +138 +00:10:09,400 --> 00:10:15,040 +بالضبط ع جبال ال left fovea و أجى السهم في ال + +139 +00:10:15,040 --> 00:10:19,360 +right eye لأنها straight أجى السهم ع جبال ال fovea + +140 +00:10:19,360 --> 00:10:23,320 +ال right fovea فإذا طالما أن السهم صورته سقطت هنا + +141 +00:10:23,320 --> 00:10:28,340 +و ال fovea أو الرقم أربعة صورته سقطت على ال fovea + +142 +00:10:28,340 --> 00:10:31,080 +و ال fovea مع ال fovea corresponding areas فهيكون + +143 +00:10:31,080 --> 00:10:35,460 +المنظرهيك طبعا السهم هيكون أوطى شوية لإنه في + +144 +00:10:35,460 --> 00:10:39,200 +الرسمة الحقيقية أوطى في الفرار لإنه الأرقام أعلى + +145 +00:10:39,200 --> 00:10:43,660 +من رسمة السهم فهي .. فهيشوف السهم بيشير على الرقم + +146 +00:10:43,660 --> 00:10:47,100 +أربع هذه ال projected image هذه الصورة اللي هيشعر + +147 +00:10:47,100 --> 00:10:51,740 +فيها في حال ما عنده exophoria 4 iparism فبالتالي + +148 +00:10:51,740 --> 00:10:57,120 +هيقول أنا شايف السهم الأبيض بيأشر علىرقم أربع + +149 +00:10:57,120 --> 00:11:02,840 +فبنعتبرها يعني أربع Prism Exophoria هذه الرسمة + +150 +00:11:02,840 --> 00:11:07,000 +بشكل واضح الأرقام الزوجية بتدل على ال Exophoria + +151 +00:11:07,000 --> 00:11:11,240 +الأرقام الفردية بتدل على ال Esophoria الأرقام + +152 +00:11:11,240 --> 00:11:16,160 +الزوجية اللي هي من صفر و أعلىleft hyperphoria يعني + +153 +00:11:16,160 --> 00:11:20,580 +هنا لو أشر السهم الأحمر على أو شافش السهم الأحمر + +154 +00:11:20,580 --> 00:11:23,800 +على جبال أربعة معناته عنده left hyperphoria أربعة + +155 +00:11:23,800 --> 00:11:29,560 +prison الأرقام الفردية right hyperphoria هنا ال + +156 +00:11:29,560 --> 00:11:32,300 +left hyperphoria بقدر أقول بينجو سين right + +157 +00:11:32,300 --> 00:11:35,880 +hypophoria و هنا ال right hyperphoria بقدر أقول + +158 +00:11:35,880 --> 00:11:41,880 +left hypophoria ضروري نوضح شغلة أن هدولة السطرية + +159 +00:11:41,880 --> 00:11:46,960 +من الأرقام مش crossمش cross وانما هدول كأنهم فحسين + +160 +00:11:46,960 --> 00:11:50,860 +تمدمجهم في فحس واحد بس هم عملوا بالصورة هاي عشان + +161 +00:11:50,860 --> 00:11:55,660 +نقدر .. عشان نقدر ان العين اليمين تشوف إشي تشوف + +162 +00:11:55,660 --> 00:11:59,100 +الأسهم فقط و العين الشمال تشوف الأرقام فقط يعني + +163 +00:11:59,100 --> 00:12:02,460 +تشوف نقطة التقاطع عند تمانية يعني هذا مش cross + +164 +00:12:02,460 --> 00:12:05,700 +مالهمش .. يعني السطر العمودي ليس له علاقة بالسطر + +165 +00:12:05,700 --> 00:12:11,260 +الأفقي من الأرقام وإنما هذه مسألةيعني أنا لما بفحص + +166 +00:12:11,260 --> 00:12:15,880 +المريض أول شي بقوله .. يعني امسك الجهاز احني + +167 +00:12:15,880 --> 00:12:19,580 +للأسفل قليلا تقريبا خمستاشر degree ال reading + +168 +00:12:19,580 --> 00:12:25,680 +position و ممكن أطلب منه أقوله غمض عينك لشمال إيه + +169 +00:12:25,680 --> 00:12:29,600 +شايف؟ هيقول لي شايف سهمين سهم أبيض جاي vertical + +170 +00:12:29,600 --> 00:12:33,960 +وسهم أحمر جاي horizontal طيب غمض عينك اليمين وافتح + +171 +00:12:33,960 --> 00:12:38,320 +عينك لشمال إيه شايف؟شايف سطر من الأرقام عمودي + +172 +00:12:38,320 --> 00:12:42,600 +وشايف سطر من الأرقام أفقي، بعيني لشمال، الآن افتح + +173 +00:12:42,600 --> 00:12:47,820 +عينيك لشمال المسألة الأولى، أين يقع أو إلى أي رقم + +174 +00:12:47,820 --> 00:12:53,730 +يشير السهم الأبيض؟ والله يجعل مثلا إلى الرقم خمسةو + +175 +00:12:53,730 --> 00:12:57,090 +في حقيقة الأمر يشير إلى صفر .. يشير إلى صفر هذه + +176 +00:12:57,090 --> 00:13:00,630 +الرسمة خطأ أنه يشير بين صفر و واحد هي .. هي يشير + +177 +00:13:00,630 --> 00:13:05,850 +إلى صفر في .. في حق واقع الأمر طيب .. إذا يشير إلى + +178 +00:13:05,850 --> 00:13:08,310 +صفر .. إذا جال يشير إلى صفر معناته مافيش عنده + +179 +00:13:08,310 --> 00:13:11,830 +horizontal phoria إذا يشير إلى الرقم تلاتة معناته + +180 +00:13:11,830 --> 00:13:16,130 +.. معناته عنده تلاتة prism esophoria إذا يشير إلى + +181 +00:13:16,130 --> 00:13:20,050 +الرقم مثلا إحداش .. بس جاء .. اللي جاية بين عشرة و + +182 +00:13:20,050 --> 00:13:24,240 +اتناش .. هناواتأكدت إن هو بيقصد بين عشر أو اتناش + +183 +00:13:24,240 --> 00:13:28,500 +معناته عنده حد عشر Prism Exophoria هذا بالنسبة + +184 +00:13:28,500 --> 00:13:32,920 +لسؤال الأول سؤال التاني أين يشير الرقم أو السهم + +185 +00:13:32,920 --> 00:13:37,380 +الأحمر لأي رقم من الأرقام العمودية مثل جان يشير + +186 +00:13:37,380 --> 00:13:41,420 +إلى الرقم واحد إلى الرقم واحد أنا شايفه ع جبال + +187 +00:13:41,420 --> 00:13:44,880 +الرقم واحد معناته عنده right hyperphoria right + +188 +00:13:44,880 --> 00:13:49,760 +hyperphoria فهي .. هي السؤال التاني السؤال التالت + +189 +00:13:50,540 --> 00:13:55,360 +هل السهم الأحمر أو قطعة ال plastic الحمرة موازية + +190 +00:13:55,360 --> 00:14:01,880 +لخط الأرقام الأفقي أو بالأصح موازية للسطر الأبيض + +191 +00:14:01,880 --> 00:14:06,320 +اللي تحت الخط الأفقي من الأرقام؟إذا جال موازية، + +192 +00:14:06,320 --> 00:14:09,640 +معناته مافيش عنده cyclophoric، إذا جال موازية، + +193 +00:14:09,640 --> 00:14:14,540 +معناته إن القطع الحمرا اللي plastic هي موازية لسطر + +194 +00:14:14,540 --> 00:14:19,600 +الأبيض اللي تحت الأرقام، معناته مافيش عنده .. إذا + +195 +00:14:19,600 --> 00:14:24,340 +جال tiltedبنقوله ما بنسأله تلتة لوين لأعلى لأسفل، + +196 +00:14:24,340 --> 00:14:29,380 +بنقوله امسك القطعة بانطرفها بإيدك اليمين و حركها + +197 +00:14:29,380 --> 00:14:33,640 +بأي اتجاه لغاية ما أنت تشوف أن القطعة ال plastic + +198 +00:14:33,640 --> 00:14:37,560 +موازية للخط الأبيض لتحت السطر الأفقي من الأرض + +199 +00:14:37,560 --> 00:14:42,770 +عامة، إذا حركت للأعلىإذا مسك طرف القطعة وحركها + +200 +00:14:42,770 --> 00:14:46,290 +للأعلى، معناته عنده encyclophoria هنا يقاس بال + +201 +00:14:46,290 --> 00:14:48,850 +degree، هنا بالإبرزم و هنا بالبرزم، هنا يقاس بال + +202 +00:14:48,850 --> 00:14:53,010 +degree للأعلى encyclophoria، لو حركها للأسفل + +203 +00:14:53,010 --> 00:14:58,690 +encyclophoria هيك بيكون احنا فلسنا موضوع ال Maddox + +204 +00:14:58,690 --> 00:15:02,690 +road ال Maddox wing as if و هو طبعا على النير، على + +205 +00:15:02,690 --> 00:15:07,210 +النير ضروري جداانه نتأكد ان هو مش .. يعني مش كتير + +206 +00:15:07,210 --> 00:15:12,730 +له يعني او اهميته لا تبلغ اهمية ال cover tests في + +207 +00:15:12,730 --> 00:15:16,750 +قياس الفوريا او سلسلة ال cover tests في قياس + +208 +00:15:16,750 --> 00:15:20,210 +الفوريا و التروبيا و ال total deviation هذا + +209 +00:15:20,210 --> 00:15:26,810 +بالنسبة ل Maddox wing ال Maddox road عبارة + +210 +00:15:26,810 --> 00:15:27,090 +عن + +211 +00:15:30,520 --> 00:15:33,220 +اللي هي قطعة ال Maddox rod اللي احنا اتعرفنا عليه + +212 +00:15:33,220 --> 00:15:36,900 +high power plus cylinders هنا ماعطينها اللون + +213 +00:15:36,900 --> 00:15:40,500 +الأحمر، يعني في red Maddox وفي Maddox rod شفاف + +214 +00:15:40,500 --> 00:15:44,640 +ممكن نجري التجربة معاه عشان نحدد الفوريا او + +215 +00:15:44,640 --> 00:15:49,020 +التروبيا سواء استخدمنا ال Maddox rod ال red Maddox + +216 +00:15:49,500 --> 00:15:54,240 +أو ال white Maddox بس يفضل انه الإضاءة تكون في + +217 +00:15:54,240 --> 00:15:57,700 +حالة ما استخدمنا ال Maddox road الشفاف انه تكون + +218 +00:15:57,700 --> 00:16:02,740 +إضاءة الغرفة مطفقة عشان يقدر يشعر بال line و يشعر + +219 +00:16:02,740 --> 00:16:08,060 +بال dot بتاعة العين التانية كيف يجرأ ال Maddox + +220 +00:16:08,060 --> 00:16:11,420 +road؟ consists of a series of fused cylindrical + +221 +00:16:11,420 --> 00:16:21,240 +red glass roads بمعنى هذه عبارة عنسلندر أو بيسموها + +222 +00:16:21,240 --> 00:16:25,980 +road عمود من ال .. كأنه .. كأنه plus سلندر، هذا + +223 +00:16:25,980 --> 00:16:29,360 +road آخر، هذا road آخر، هذا road آخر، fused مع + +224 +00:16:29,360 --> 00:16:32,400 +بعض، يعني ملزجين في بعضهم بالشكل .. بشكل كأنهم + +225 +00:16:32,400 --> 00:16:36,240 +عدسة، كأنهم عدسة، even consist of a series of + +226 +00:16:36,240 --> 00:16:40,280 +fused cylindrical red glass roads which convert + +227 +00:16:40,280 --> 00:16:43,100 +the appearance of white spot of light into red + +228 +00:16:43,100 --> 00:16:47,850 +streak، يعني لما أنا بقدويبأضوى spot of light، + +229 +00:16:47,850 --> 00:16:52,110 +نقطة مضيقة أمام العين هذه، هذه العين هتشوف النقطة + +230 +00:16:52,110 --> 00:16:57,570 +بشكل خط، streak وهذا الخط هيتجاهه عمودي على اتجاه + +231 +00:16:57,570 --> 00:17:01,730 +ال cylinders هذه، كل واحدة منها تعتبر cylinder + +232 +00:17:01,730 --> 00:17:05,110 +فبالتالي، العين اليمين لما بضوى spot of light أو + +233 +00:17:05,110 --> 00:17:05,810 +pin torch + +234 +00:17:09,220 --> 00:17:14,560 +هيشوف بالعين اليمين line عمودي اتجاه ال .. اللي هي + +235 +00:17:14,560 --> 00:17:18,100 +ال roads هذه هذه ال roads اللي جاية هوريزونتالي + +236 +00:17:18,100 --> 00:17:21,760 +هيشوف vertical red line طب و العين التانية هتشوف + +237 +00:17:21,760 --> 00:17:27,700 +spot .. هتشوف spotالان بدى عندي لما ب .. اجري هذا + +238 +00:17:27,700 --> 00:17:31,280 +ال test هذا ممكن اجريه على ال distance و ايضا ممكن + +239 +00:17:31,280 --> 00:17:34,420 +اجريه على ال near بس و غالبا طالما ال medics wing + +240 +00:17:34,420 --> 00:17:37,620 +عندي ب .. بيكفي من ناحية ال near ممكن انا اجري ال + +241 +00:17:37,620 --> 00:17:41,180 +medics road على ال distance .. على ال distance طيب + +242 +00:17:41,180 --> 00:17:46,220 +.. الاناللي بدي أعمله أنه بدي أضوي spot of light + +243 +00:17:46,220 --> 00:17:50,380 +أمام المريض و أحط مثلا ال Maddox road أمام إحدى + +244 +00:17:50,380 --> 00:17:53,720 +العينتين هنا في هذه الحالة أنا حاطها قدام العين + +245 +00:17:53,720 --> 00:17:57,600 +اليمين و بدي أسأله بالضبط إيه الشايف هو هيشوف + +246 +00:17:57,600 --> 00:18:02,120 +بالعين الشمال spot of light طبيعية زي ما هي بدون + +247 +00:18:02,120 --> 00:18:05,540 +أي تغيير بينما ال spot of light هتتحول ل red + +248 +00:18:05,540 --> 00:18:09,460 +streak بالنسبة للعين اليمين و هيكون اتجاه ال + +249 +00:18:09,460 --> 00:18:15,210 +streak عموديعمودي على اتجاه ال roads هذه على اتجاه + +250 +00:18:15,210 --> 00:18:18,610 +اللي بيسموه ال axis of Maddox ال axis of Maddox + +251 +00:18:18,610 --> 00:18:21,970 +road هيك لأنه اتجاه ال cylinders فيه هيك + +252 +00:18:21,970 --> 00:18:26,450 +horizontal فهو هيشوف red streak vertical لما انا + +253 +00:18:26,450 --> 00:18:29,210 +ابدا اجيس ال horizontal phoria ال exophoria + +254 +00:18:29,210 --> 00:18:30,150 +والisophoria + +255 +00:18:32,640 --> 00:18:36,280 +باستعمل ال .. ال Maddox Rod بالشكل اللي احنا + +256 +00:18:36,280 --> 00:18:39,960 +شايفينه يكون horizontal فهيعطيني vertical .. + +257 +00:18:39,960 --> 00:18:46,740 +vertical red light vertical red streak طبعا ال .. + +258 +00:18:46,740 --> 00:18:50,420 +في حالة ما يكون orthophoria .. orthophoria المريض + +259 +00:18:50,420 --> 00:18:56,220 +هيقول شايف بالشكل هذا ان ال red streak و ال spot + +260 +00:18:56,220 --> 00:19:00,930 +of light جايين ع بعضهم البعض طيبالآن في عندي + +261 +00:19:00,930 --> 00:19:05,590 +سيناريوين آخرين لما يكون في عنده فوريا، سيناريو + +262 +00:19:05,590 --> 00:19:09,510 +مرة لصبوت على اليمين و سيناريو مرة لصبوت على + +263 +00:19:09,510 --> 00:19:14,950 +الشمال، الآن بدي أسأل نفسي سؤال، نفرض أنه حكى + +264 +00:19:14,950 --> 00:19:20,770 +السيناريو هذا، السيناريو هذا، بدنا نكبره شوية و + +265 +00:19:20,770 --> 00:19:22,710 +بعدين بنرجح الصورة زي ما كان + +266 +00:19:26,430 --> 00:19:29,490 +ماذا يعني هذا ال scenario؟ ماذا يعني هذا ال + +267 +00:19:29,490 --> 00:19:37,030 +scenario؟ لو جال أنا شايف ال red streak وعلى يمينه + +268 +00:19:37,030 --> 00:19:41,850 +وعلى يمينه ال spot معناته العين الأشمال اللي شايفت + +269 +00:19:41,850 --> 00:19:45,070 +ال spot شايف ال spot والعين اليمين اللي شايف ال + +270 +00:19:45,070 --> 00:19:47,850 +streak شايف ال streak يعني في crossing لل images + +271 +00:19:48,570 --> 00:19:51,350 +الـ streak اللى هو بتشوفه العين اليمين جاى ناحية + +272 +00:19:51,350 --> 00:19:54,710 +الشمال و ال spot اللى بتشوفه العين الشمال جاى + +273 +00:19:54,710 --> 00:19:57,350 +ناحية اليمين اذا انا بتسموه crossed image ال + +274 +00:19:57,350 --> 00:20:01,110 +crossed image يعني exophoria .. exophoria طيب + +275 +00:20:01,110 --> 00:20:05,850 +السيناريو التانى لو جالى انا شايف .. شايف طبعا هنا + +276 +00:20:05,850 --> 00:20:12,500 +نفس السيناريو هنا ده خطأ هنعدله على السريعلأن هنا + +277 +00:20:12,500 --> 00:20:14,960 +ايضا ال spot على اليمين هي مرة ال spot على اليمين + +278 +00:20:14,960 --> 00:20:18,180 +و مرة ال spot على الشمال مرة ال spot على اليمين و + +279 +00:20:18,180 --> 00:20:27,880 +مرة ال spot على الشمال فبدنا احنا نعدله بشكل ينهي + +280 +00:20:27,880 --> 00:20:32,400 +القضية في + +281 +00:20:32,400 --> 00:20:37,640 +الأول بدنا نعمل نصر و + +282 +00:20:37,640 --> 00:20:47,680 +بعدين نعمل مرة تانيةنعمل اقتصاص أي + +283 +00:20:47,680 --> 00:20:49,200 +صورة + +284 +00:21:39,120 --> 00:21:45,180 +هك فصلناهم وهك بنقلبهم اذا هذا سيناريو وهذا + +285 +00:21:45,180 --> 00:21:54,540 +سيناريو اخر لما بيكون عندي صورة + +286 +00:21:54,540 --> 00:21:57,300 +العين الشمال اللي هي ال spot جاية ناحية اليمين + +287 +00:21:57,300 --> 00:21:59,760 +وصورة العين اليمين اللي هي ال street جاية ناحية + +288 +00:21:59,760 --> 00:22:05,040 +الشمال اذا هذا crossed image اذا هذا exophoriaلما + +289 +00:22:05,040 --> 00:22:08,160 +بيكون عندي السيناريو التالت، السيناريو الأول أن ال + +290 +00:22:08,160 --> 00:22:12,300 +spot جاية على ال .. على ال street is an + +291 +00:22:12,300 --> 00:22:15,300 +orthophoria هنا، مافيش زوغان، يعني مافيش صورة + +292 +00:22:15,300 --> 00:22:18,340 +زايغة بالنسبة لصورة، هنا a crossed image يعني + +293 +00:22:18,340 --> 00:22:22,240 +exophoria، هنا uncrossed image، كيف؟ + +294 +00:22:30,510 --> 00:22:33,590 +uncrossed مش كل عين صورتها على جبلها، كل عين + +295 +00:22:33,590 --> 00:22:36,750 +صورتها على جبلها، إذاً هذا isophoria، إذاً هذا + +296 +00:22:36,750 --> 00:22:43,070 +isophoria، طيب، في حالة ال exophoria، ممكن أستعمل + +297 +00:22:43,070 --> 00:22:46,550 +base in برزم، لأن ال exo لبرا، إذا ال apex لبرا، + +298 +00:22:46,550 --> 00:22:50,330 +ال base لجوهر، base in برزم لما أخل ال spot تيجي + +299 +00:22:50,330 --> 00:22:56,050 +على ال streamقيمة الـ Prism هذا بتكون تقييم لقيمة + +300 +00:22:56,050 --> 00:22:59,350 +الحوال subjectively لأن المريض هو اللي بيشعر + +301 +00:22:59,350 --> 00:23:02,850 +الصورة إيجاد على الصورة في حالة الـ Esophoria + +302 +00:23:02,850 --> 00:23:09,370 +بستعمل base out Prism لغاية ما ال spot تيجي على ال + +303 +00:23:09,370 --> 00:23:12,150 +streak وهيك بكون أنا عملت ال medox road test + +304 +00:23:12,150 --> 00:23:17,010 +بالنسبة لل horizontal phoria لأن ال vertical + +305 +00:23:17,010 --> 00:23:24,210 +phoriaنفس القضية بس بحط بدل ما أحط ال .. ال .. ال + +306 +00:23:24,210 --> 00:23:26,350 +.. ال .. ال access بتاع ال medics road horizontal + +307 +00:23:26,350 --> 00:23:30,750 +بحطه vertical، بحطه vertical، عندي أيضا تلت + +308 +00:23:30,750 --> 00:23:35,690 +سيناريوهات، تلت سيناريوهات، السيناريو الأول ال + +309 +00:23:35,690 --> 00:23:39,440 +patient what the patient sees، بقول أنا شايفالـ + +310 +00:23:39,440 --> 00:23:42,440 +Spot جاية على الـ streak إذا مافيش Vertical فوريه + +311 +00:23:42,440 --> 00:23:45,920 +طبعاً لما أنا بحط ال access بتاع ال Maddox Road + +312 +00:23:45,920 --> 00:23:50,460 +Vertical هيشوف Horizontal Red Streak Horizontal + +313 +00:23:50,460 --> 00:23:53,800 +Red Streak و بالعين التانية هيشوف Spot فبالتالي + +314 +00:23:53,800 --> 00:23:56,520 +إذا ال Spot جاية على ال streak معناته + +315 +00:23:58,790 --> 00:24:03,390 +فاش عندي vertical forum الان عندي سيناريوين اخرين + +316 +00:24:03,390 --> 00:24:07,090 +في حالة وجود vertical forum اما ال spot أسفل ال + +317 +00:24:07,090 --> 00:24:11,950 +streak او ال spot أعلى ال streak كيف اميز بينهم؟ + +318 +00:24:11,950 --> 00:24:16,670 +اللي صورته أسفل بيكون هو أعلى العين اللي صورتها + +319 +00:24:16,670 --> 00:24:21,690 +أسفل بتكون هي أعلى و العين اللي صورتها أعلى بتكون + +320 +00:24:21,690 --> 00:24:25,510 +هي أسفل طيب نيجي للسيناريو هذا عندي ال streak أعلى + +321 +00:24:25,510 --> 00:24:28,970 +من ال spotالستريك مين شايفها؟ العين اليمين، إذا + +322 +00:24:28,970 --> 00:24:33,810 +العين اليمين hypo لأن صورتها أعلى فهي hypo طيب، + +323 +00:24:33,810 --> 00:24:37,910 +العين الشمال، ال spot، هي شايفها ال spot ال spot + +324 +00:24:37,910 --> 00:24:42,450 +أسفل، معناته هذه left hyper أو ممكن أقول بينج وسين + +325 +00:24:42,450 --> 00:24:48,190 +right hypo هنا السيناريو التاني، الصورة تاعة العين + +326 +00:24:48,190 --> 00:24:51,830 +الشمال أعلى، إذا العين الشمال hypo، left hypo أو + +327 +00:24:52,240 --> 00:24:55,740 +بقدر أقول الصورة بتاعة العين اليمين أسفل right + +328 +00:24:55,740 --> 00:25:02,600 +hyper باختصار القاعدة في هذا الموضوع أنه اللي + +329 +00:25:02,600 --> 00:25:08,960 +صورته أسفل اللي صورته أسفل بيكون هذا العين مرتفع + +330 +00:25:08,960 --> 00:25:14,640 +يعني جاية hyper فبالتالي هذه القضية ضرورية نعرفها + +331 +00:25:14,640 --> 00:25:22,380 +هنا مثلا قلنا left hyperلأ عفوا right hyper لان + +332 +00:25:22,380 --> 00:25:26,580 +صورة العين اليمين للأسفل right hyper بحط base down + +333 +00:25:26,580 --> 00:25:31,150 +أمام العيناليمين لغاية ما ال spot تيجي على ال + +334 +00:25:31,150 --> 00:25:35,870 +street او بحط base up لانها left hypo بحط base up + +335 +00:25:35,870 --> 00:25:41,270 +أمام اليان الشمال لغاية ما ال spot ييجي على ال + +336 +00:25:41,270 --> 00:25:46,730 +street هنا العكس .. هنا عندي left hyper .. left + +337 +00:25:46,730 --> 00:25:51,150 +hyper بحط base down هنا او right hypo بحط base up + +338 +00:25:51,150 --> 00:25:55,230 +هنا لغاية ما ال spot ييجي على ال street و هيك بكون + +339 +00:25:55,230 --> 00:26:00,300 +انا عرفت قيمةال vertical phoria بواسطة ال medox + +340 +00:26:00,300 --> 00:26:04,520 +rod بواسطة ال medox rod فبالتالي هذه القضية ضرورية + +341 +00:26:04,520 --> 00:26:09,600 +تكون واضحة جدا نيجي ل ال motility tests ال ocular + +342 +00:26:09,600 --> 00:26:13,660 +motility examination of ocular movements involves + +343 +00:26:13,660 --> 00:26:17,420 +assessment of smooth pursuit movement followed by + +344 +00:26:17,420 --> 00:26:21,000 +that of saccadic movement ال pursuit movement هي + +345 +00:26:21,000 --> 00:26:26,890 +الحركة البطيئة للعين الحركة البطيئة للعينأو للعين + +346 +00:26:26,890 --> 00:26:32,710 +تان وهما يعني يتبعان target معين .. يتبعان target + +347 +00:26:32,710 --> 00:26:38,090 +معين لما العين تتحرك ببطء مع حركة ال target يعني + +348 +00:26:38,090 --> 00:26:42,110 +بسرعة بطيئة بيكون هذا .. احنا بنختبر ال pair-sot + +349 +00:26:42,110 --> 00:26:48,660 +movementأيضا بدي أختبر ال saccadic movements يعني + +350 +00:26:48,660 --> 00:26:53,300 +الحركة السريعة اللي الهدف منها أنها تعمل fixation + +351 +00:26:53,300 --> 00:26:58,160 +على target إذا حركات الأنتين .. حركات الأنتين في + +352 +00:26:58,160 --> 00:27:03,520 +حركات بطيقةبسموها حركات تتبعية وفي حركات سريعة + +353 +00:27:03,520 --> 00:27:07,560 +الهدف منها نقل ال .. ال object اللي سقطت صورته على + +354 +00:27:07,560 --> 00:27:10,500 +ال peripheral retina نقله فورا .. فورا إلى الفوفيا + +355 +00:27:10,500 --> 00:27:13,840 +للتركيز عليه إذا بدي أفحص هل ال pursuit movement + +356 +00:27:13,840 --> 00:27:18,120 +طبيعية لما قاعدي أفحص ال ocular motility و ال + +357 +00:27:18,120 --> 00:27:21,160 +saccadic movements هل هي طبيعية ولا لأ ممكن إنسان + +358 +00:27:21,160 --> 00:27:24,880 +يتساءل ليش أنا بفحصالـ pursuit movement و بأيضا + +359 +00:27:24,880 --> 00:27:28,800 +برجع بافحص الـ saccadic movement لأنه مراكز التحكم + +360 +00:27:28,800 --> 00:27:32,280 +فيها في الدماغ مختلفة أو مواقعها في الدماغ مختلفة + +361 +00:27:32,280 --> 00:27:35,720 +و ممكن تكون ال pursuit movement شغالة كويس بينما + +362 +00:27:35,720 --> 00:27:39,040 +ال saccadic movement مش شغالة أو العكس فبالتالي + +363 +00:27:39,040 --> 00:27:43,260 +ممكن هذا يدلني على خلل معين في ال central nervous + +364 +00:27:43,260 --> 00:27:49,800 +system في حال وجود يعني قصور في إحدى أنواع الحركات + +365 +00:27:49,800 --> 00:27:53,990 +الحركات البطيئة أو الحركات السريعة للعينيبنيجي لل + +366 +00:27:53,990 --> 00:27:56,770 +versions احنا عارفين ان في عندنا reductions و في + +367 +00:27:56,770 --> 00:28:00,510 +عندنا versions و في عندنا vergence ال versions to + +368 +00:28:00,510 --> 00:28:03,170 +where the eight eccentric positions of gaze are + +369 +00:28:03,170 --> 00:28:06,570 +tested by asking the patient to follow a target + +370 +00:28:06,570 --> 00:28:10,230 +usually a pin or pin torch which offers the + +371 +00:28:10,230 --> 00:28:12,890 +advantage of corneal light reflection to aid + +372 +00:28:12,890 --> 00:28:18,400 +assessmentيعني أنا بمسك القلم أو pen torch هو + +373 +00:28:18,400 --> 00:28:22,340 +الأفضل اللي هو عشان يوفرلي قضية ال light و أشوف ال + +374 +00:28:22,340 --> 00:28:25,680 +corneal light reflex و بخلي المريض يتطلع في ال + +375 +00:28:25,680 --> 00:28:28,280 +eighth eccentric position طبعا ممكن الإنسان يقول + +376 +00:28:28,280 --> 00:28:31,400 +تسعة ال diagnostic position تسعة احنا هنبدأ أصلا + +377 +00:28:31,400 --> 00:28:34,760 +من التاسع هنبدأ من ال primary position و بضل عندى + +378 +00:28:34,760 --> 00:28:38,260 +تمانيةالـ Eccentric positions of gaze اللي هي up و + +379 +00:28:38,260 --> 00:28:43,320 +down اتنين، up and out و down and out هي أربعة، up + +380 +00:28:43,320 --> 00:28:50,580 +and in and down and in هي ستةway out و in هاي + +381 +00:28:50,580 --> 00:28:54,340 +تمانية فبالتالي غير طبعا ال primary position + +382 +00:28:54,340 --> 00:28:57,920 +فبالتالي عندي eight eccentric position في كل + +383 +00:28:57,920 --> 00:29:01,720 +position من هذا ال positions بعمل quick cover test + +384 +00:29:01,720 --> 00:29:06,180 +is performed in each position of gaze to confirm + +385 +00:29:06,180 --> 00:29:10,370 +whether a phoria has become a tropiaorder angle + +386 +00:29:10,370 --> 00:29:13,970 +has increased and the patient is questioned + +387 +00:29:13,970 --> 00:29:18,250 +regarding diplopia أنا لازم أعمل cover test سريع + +388 +00:29:18,250 --> 00:29:21,630 +في ال 8th eccentric position عشان أشوف هل الفوريا + +389 +00:29:21,630 --> 00:29:24,970 +اللي عند المريض اتحولت لتروبيا أو الزاوية اللي + +390 +00:29:24,970 --> 00:29:28,590 +حولتها لتروبيا زادت هل المريض مثلا .. طبعا لازم + +391 +00:29:28,590 --> 00:29:31,250 +أسأله هل صار مثلا في position معين يشكي من + +392 +00:29:31,250 --> 00:29:35,530 +diplopia أو ما إلى ذلك الآن لو روحنا على ال squint + +393 +00:29:35,530 --> 00:29:38,170 +simulator نشوف هذا القضية كيف بتنفحص + +394 +00:30:01,100 --> 00:30:08,480 +resquent simulator بدنا + +395 +00:30:08,480 --> 00:30:15,580 +نشيل ال cover بدنا + +396 +00:30:15,580 --> 00:30:21,780 +نشيل ال prism هاي عندى ال target هاي ال primary + +397 +00:30:21,780 --> 00:30:29,140 +position هاي lift gazehigh left and up، level + +398 +00:30:29,140 --> 00:30:34,520 +elevation، high up elevation، high dextro + +399 +00:30:34,520 --> 00:30:39,040 +elevation، high dextroversion، high dextro + +400 +00:30:39,040 --> 00:30:42,960 +depression، high depression، high level depression + +401 +00:30:43,910 --> 00:30:47,530 +هي leave a virgin وهي رجعت لل primary position هذه + +402 +00:30:47,530 --> 00:30:50,730 +القضية أنا جاعت باختبار ال pairsot movements ال + +403 +00:30:50,730 --> 00:30:54,730 +pairsot movements طبعا ال saccadic movements بدي + +404 +00:30:54,730 --> 00:30:59,250 +أعملها بشكل سريع أو الأفضل أمسك two targets مثلا + +405 +00:30:59,250 --> 00:31:03,430 +هاي target على الشمال أمسكه بإيدي اليمين و target + +406 +00:31:03,430 --> 00:31:11,340 +أخر مثلا على ..على شمالي انا او على يمين المريض + +407 +00:31:11,340 --> 00:31:14,980 +امسكه بإيدي لشمال لأن انا مواجهة انا عكس المريض + +408 +00:31:14,980 --> 00:31:20,260 +يعني بنقوله اتطلع على ال target الأول يفضل جلمين + +409 +00:31:20,260 --> 00:31:24,380 +مختلفين في الألوان مثلا جلم أزرق أو جلم أحمر أو + +410 +00:31:24,380 --> 00:31:28,840 +two targets مثلا نجمة، سيارة وابد أبدأ انا بسرعة + +411 +00:31:29,760 --> 00:31:34,960 +يعني أطلب منه مرة على ال target هذا مثلا target + +412 +00:31:34,960 --> 00:31:39,380 +one بعدين target two أقوله one two أطلب منه .. لما + +413 +00:31:39,380 --> 00:31:42,640 +بقولك one تتطلع ع one two تتطلع ع two .. one two + +414 +00:31:42,640 --> 00:31:45,740 +.. one two .. one two فبالتالي أنا بتكلم بسرعة و + +415 +00:31:45,740 --> 00:31:49,400 +هو بده ينفذ بسرعة في هذه ال position بالنسبة لل + +416 +00:31:49,400 --> 00:31:55,220 +left و ال right gaze الآن ممكن أنا همسك ال target + +417 +00:31:55,220 --> 00:31:55,800 +الأول + +418 +00:31:59,650 --> 00:32:02,970 +في الأعلى و ال target التاني في الأسفل نقول one + +419 +00:32:02,970 --> 00:32:06,810 +two one two فبتالي هو بسرعة ينقل يعني بين ال + +420 +00:32:06,810 --> 00:32:12,670 +target ايضا هنا ممكن في ال saccadic movement لازم + +421 +00:32:12,670 --> 00:32:14,670 +هنا نسبتها و نتركها + +422 +00:32:17,200 --> 00:32:20,600 +هنا left and up right and down طبعا target one + +423 +00:32:20,600 --> 00:32:23,220 +target two target one target two و هكذا ضروري انا + +424 +00:32:23,220 --> 00:32:27,480 +اتكلم بسرعة و تكون ال two targets سهل مثلا الجلم + +425 +00:32:27,480 --> 00:32:30,560 +الأحمر أو الأحمر الأزرق الأحمر الأزرق الأحمر + +426 +00:32:30,560 --> 00:32:34,320 +الأزرق ضروري نجل عينيه بين التتين عشان اختبر ال + +427 +00:32:34,320 --> 00:32:35,660 +saccadic movement + +428 +00:32:38,950 --> 00:32:41,630 +طبعا لاحظين المريض في السيموليتر هو بتتبع ال + +429 +00:32:41,630 --> 00:32:43,970 +target الحقيقي لأن هذا مش target هذا ال cover + +430 +00:32:43,970 --> 00:32:48,050 +فبالتالي ضروري جدا الآن down and left up and right + +431 +00:32:48,050 --> 00:32:51,450 +لما غايت اختبر كل ال saccadic movements أما ال + +432 +00:32:51,450 --> 00:32:56,570 +pursuit movements بدي أمسك target واحد بدي أمسك + +433 +00:32:56,570 --> 00:32:59,510 +target واحد و أشوف ال .. أشوف ال full movement + +434 +00:32:59,510 --> 00:33:02,930 +أشوف ال full movement الآن في بعض الناس بمد إيده + +435 +00:33:02,930 --> 00:33:07,270 +مادة خفيفة هيكو بيوقف عند هنا و بيقول و الله انه + +436 +00:33:07,270 --> 00:33:11,330 +في lift gaesand و في مشكلة لأنه ما إجت للنهاية لأ + +437 +00:33:11,330 --> 00:33:15,050 +لازم أنا كفاحس أجيب إيدي للنهاية للنهاية يعني أمد + +438 +00:33:15,050 --> 00:33:18,570 +إيدي بأقصى ما أستطيع عشان أشوف ال full movement + +439 +00:33:18,570 --> 00:33:25,210 +بتاعة المريض وبالتالي يكون الأمر عندي واضح جدا في + +440 +00:33:25,210 --> 00:33:30,630 +هذه القضية اذا they + +441 +00:33:30,630 --> 00:33:34,570 +may also be elicited voluntarily in response to a + +442 +00:33:34,570 --> 00:33:37,420 +noiseor by the doll's head maneuver in + +443 +00:33:37,420 --> 00:33:41,480 +uncooperative patient ممكن انا ال virgin movements + +444 +00:33:41,480 --> 00:33:48,300 +يعني استحثها عند المريض اما بالصوت او ب doll's + +445 +00:33:48,300 --> 00:33:51,240 +head maneuver ان انا امسك رأس الطفل ال baby و + +446 +00:33:51,240 --> 00:33:54,280 +احركه باتجاهه هلاحظ عينيتي انت تتحركوا بالاتجاه + +447 +00:33:54,280 --> 00:33:58,280 +العكسي ليش؟ انا ب .. ب .. اتبعي عيني و باتبعش ال + +448 +00:33:58,280 --> 00:34:02,480 +target احيانا لانه بيكون الطفل اما صغير جداأو مش + +449 +00:34:02,480 --> 00:34:05,380 +cooperative .. او مش cooperative أحيانًا لما بدنا + +450 +00:34:05,380 --> 00:34:09,420 +نادى عليه أو بنصدر صوت معين أو فيه لعبة بتصدر صوت + +451 +00:34:09,420 --> 00:34:13,860 +ممكن ونحطلها ع جانب .. من جوانب رأس المريض و + +452 +00:34:13,860 --> 00:34:18,060 +أصدرنا هذا الصوت ساعتها ممكن الطفل أو هذا المريض + +453 +00:34:18,060 --> 00:34:21,700 +الغير متعاون يطلع فجأة يعني بمعنى أخر يحرك عنه + +454 +00:34:21,700 --> 00:34:26,400 +باتجاه معين و هيك احنا بنختبر ال .. اللي هي ال + +455 +00:34:26,400 --> 00:34:29,020 +virgin movement بنيجي ل introductions + +456 +00:34:31,890 --> 00:34:35,450 +reductions are assist if reduced ocular motility + +457 +00:34:35,450 --> 00:34:40,890 +is noted in either or both eyes طيب ليجي هنا لل + +458 +00:34:40,890 --> 00:34:43,210 +simulator نقول أنا مثلا + +459 +00:34:45,750 --> 00:34:49,030 +نفرض إنه ال target مش هنا، ال target مش هنا، ال + +460 +00:34:49,030 --> 00:34:52,110 +target هنا، على الآخر، و مع ذلك العين مارحتش على + +461 +00:34:52,110 --> 00:34:56,330 +الآخر عين أو العنتين، يعني في عندي reduction في ال + +462 +00:34:56,330 --> 00:34:59,550 +full movement بتاعة العنتين، ساعتها أنا برجع + +463 +00:34:59,550 --> 00:35:03,940 +لاختبار reductions، لأ برجع لاختبار reductionsقبل + +464 +00:35:03,940 --> 00:35:06,960 +ما نقول كيف اختبار الduction ممكن نسأل سؤال يعني + +465 +00:35:06,960 --> 00:35:11,440 +هل ال virgins اذا انا اختبرتها بكفي ولا ضروري كل + +466 +00:35:11,440 --> 00:35:15,380 +أنواع الحركة اختبرها حقيقة ضروري كل أنواع الحركة + +467 +00:35:15,380 --> 00:35:18,300 +نختبرها لأن ممكن ال virgin يكون فيها مشكلة بينما + +468 +00:35:18,300 --> 00:35:21,900 +الduction مايكونش فيها اي مشكلة .. مايكونش فيها اي + +469 +00:35:21,900 --> 00:35:27,820 +مشكلة فبالتالي ضروري جدا ان احنا نختبر كل أنواع + +470 +00:35:27,820 --> 00:35:33,970 +الحركةيجب أن تستخدم مصدر مصدر مصدر مصدر مصدر مصدر + +471 +00:35:33,970 --> 00:35:37,920 +مصدر مصدر مصدرالـ fellow eye is occluded، طبعا في + +472 +00:35:37,920 --> 00:35:40,460 +الدكشن لازم نسكرها يعني، الـ fellow eye لي العين + +473 +00:35:40,460 --> 00:35:43,160 +التانية is occluded and the patient asked to + +474 +00:35:43,160 --> 00:35:47,180 +follow a pin torch in various positions of gaze a + +475 +00:35:47,180 --> 00:35:51,760 +simple numeric system may be employed to using + +476 +00:35:51,760 --> 00:35:57,780 +zero to denote full movement and minus one to + +477 +00:35:57,780 --> 00:36:01,280 +minus four to denote increasing decrease of under + +478 +00:36:01,280 --> 00:36:04,990 +action مامعنى هذا الكلامبنجي احنا ع ال simulator + +479 +00:36:04,990 --> 00:36:09,190 +نقول هاي بدنا نغطي اين و نجي نختبر الduction هل + +480 +00:36:09,190 --> 00:36:12,710 +نختبر .. نعتبر ان العين هنا مش موجودة ان العين هذه + +481 +00:36:12,710 --> 00:36:17,170 +مش موجودة و بدأ اختبر هاي العين في ال primary + +482 +00:36:17,170 --> 00:36:23,030 +position target بالضبط أمامه على بعد معين هاي + +483 +00:36:23,030 --> 00:36:24,870 +العين في ال primary position ال corneal light + +484 +00:36:24,870 --> 00:36:28,350 +reflex في النصر لان بدأ اختبر ال abduction بتاعه + +485 +00:36:28,350 --> 00:36:29,050 +ال abduction + +486 +00:36:31,740 --> 00:36:35,100 +هذه العين راحت abduction كامل ماضالش اشي من ال + +487 +00:36:35,100 --> 00:36:39,760 +sclera هنا نبين تمام فبالتالي هذه طالما ال + +488 +00:36:39,760 --> 00:36:43,200 +abduction full طالما ال abduction full بعطيله رقم + +489 +00:36:43,200 --> 00:36:48,220 +صفر يعني بكتب في file المريض left abduction 0 طيب + +490 +00:36:48,220 --> 00:36:56,060 +مثال اخر بنقول كالعادى هاي احنا ودينا ال + +491 +00:36:56,060 --> 00:37:01,490 +target نفرض ال target مش هنانفرض ال target هنا و + +492 +00:37:01,490 --> 00:37:07,190 +مع ذلك أقصى حد وصلته العين الشكل هذا لسه ال + +493 +00:37:07,190 --> 00:37:10,810 +abduction مش full مع أنه ال target صار بعيد تماما + +494 +00:37:10,810 --> 00:37:14,970 +صار هنا ناحية ال prism نفرض ال prism هو ال target + +495 +00:37:14,970 --> 00:37:21,750 +المفروض أن العين تكون هكذا و مع ذلك العينهيك يعني + +496 +00:37:21,750 --> 00:37:25,070 +ال abduction مش full هذا بعطيله minus one بقول + +497 +00:37:25,070 --> 00:37:29,610 +abduction in left eye minus one طيب لو أنا ال + +498 +00:37:29,610 --> 00:37:34,610 +target عندى هنا مكان ال prism و مع ذلك العين يعني + +499 +00:37:34,610 --> 00:37:38,410 +.. يعني في defect كتير في ال abduction او اكتر من + +500 +00:37:38,410 --> 00:37:44,430 +ال minus one بعطيله minus two لو هيك بعطيله minus + +501 +00:37:44,430 --> 00:37:49,160 +three لو العين ضلت ثابتة في ال primary positionفيش + +502 +00:37:49,160 --> 00:37:52,320 +أي نوع من ال abduction بيعطيله minus four، إذا لما + +503 +00:37:52,320 --> 00:37:55,460 +بنشوف في ملف المريض، احنا حكينا المثال على ال + +504 +00:37:55,460 --> 00:37:59,000 +abduction بس هو ينطبق على ال abduction وعلى ال + +505 +00:37:59,000 --> 00:38:01,080 +elevation وعلى ال depression وعلى أي نوع من + +506 +00:38:01,080 --> 00:38:05,220 +الduction movement، لما بنقول أو بنلاقي في ملف + +507 +00:38:05,220 --> 00:38:10,120 +المريض مثلا left abduction-4 ماعنته ماعنته ماعنته + +508 +00:38:10,120 --> 00:38:14,320 +ماعنته ماعنته ماعنته ماعنته ماعنته ماعنته ماعنته + +509 +00:38:14,320 --> 00:38:21,860 +ماعنته ماعنته ماعنته ماعنته ماعنته ماعنته ماعنته + +510 +00:38:21,860 --> 00:38:22,100 +ماعنته ماعنته ماعنته ماعنته ماعنته ماعنته ماعنته + +511 +00:38:22,100 --> 00:38:22,260 +ماعنته ماعنته ماعنته ماعنته ماعنته ماعنته ماعنته + +512 +00:38:22,260 --> 00:38:25,020 +ماعنته ماعنته ماعنته ماعنته ماعنته ماعنته ماعنته + +513 +00:38:25,020 --> 00:38:27,320 +ماعنته ماعنته ماعنته ماعنته ماعنته ماعنته ماعنته + +514 +00:38:27,320 --> 00:38:33,770 +ماعنته ماعنته ماعنته ماعوزميلي قيمها minus 2، + +515 +00:38:33,770 --> 00:38:37,810 +بنقول الإختلاف في التقييم إذا كانه بسيط مقبول، + +516 +00:38:37,810 --> 00:38:41,830 +وبالنهاية في اتفاق أنه في defect في ال abduction + +517 +00:38:41,830 --> 00:38:45,350 +سواء من .. مني أو من زميلي، يعني ممكن أختلف أنا + +518 +00:38:45,350 --> 00:38:47,930 +وزميلي، أنا أقول minus 2 وزميلي يقول minus 3 + +519 +00:38:50,600 --> 00:38:54,040 +الاختلاف بسيط بينما اقول انا minus واحد وزميل يقول + +520 +00:38:54,040 --> 00:38:57,820 +minus أربع معناته أحدنا مخطئ .. أحدنا مخطئ في + +521 +00:38:57,820 --> 00:39:01,920 +التقييم ال minus أربع يعني يعني العين بتعملش أي + +522 +00:39:01,920 --> 00:39:04,720 +نوع من ال upduction يعني هنا .. هنا ال target .. + +523 +00:39:04,720 --> 00:39:06,800 +مابنعش نختل .. احنا .. انا جبت هذا ال target + +524 +00:39:06,800 --> 00:39:09,960 +الحقيقي هنا بس عشان العين تعدل نفرض انه مش هذا ال + +525 +00:39:09,960 --> 00:39:12,040 +target الموجود ال target الموجود هو ال prism + +526 +00:39:12,040 --> 00:39:15,460 +وقولنا له يتطلع على ال prism وضلت عينه ثابت .. هذه + +527 +00:39:15,460 --> 00:39:19,440 +العين راحت جوا على الآخرخلّينا احنا عشان نعمل + +528 +00:39:19,440 --> 00:39:25,120 +simulation أكتر هذه العين راحت جوا على الآخر طبعا + +529 +00:39:25,120 --> 00:39:28,340 +هي مغطى يعني مش لازم تكون مفتوحة بس بدنا نفرض انه + +530 +00:39:28,340 --> 00:39:33,880 +بيحاول قاعد يطلع على ال target هذاالعين هي مش + +531 +00:39:33,880 --> 00:39:37,460 +جادرة، بينما العين هي جدرت رغم أنها مغمضة، تمام؟ + +532 +00:39:37,460 --> 00:39:40,940 +طب جدرت ليش؟ لأنه عشان يحاول يطلع ال target هذا ال + +533 +00:39:40,940 --> 00:39:44,520 +lateral rectus بيجيها innervation كتير، تمام؟ و ال + +534 +00:39:44,520 --> 00:39:47,080 +medial rectus حسب hearing loss بيجيها innervation + +535 +00:39:47,080 --> 00:39:52,500 +كتير حتى و هي مغمضة، فبالتالي هنا ال abduction + +536 +00:39:52,500 --> 00:39:56,500 +بنقول عنه minusننفعش نقول عنه minus one حتى ولا + +537 +00:39:56,500 --> 00:40:00,100 +minus two لو أخطأنا قولنا minus تلاتة يمكن نكون + +538 +00:40:00,100 --> 00:40:03,620 +مقبولة بس هنا طالما مافيش أي نوع من ال abduction + +539 +00:40:03,620 --> 00:40:09,160 +معناته عندي-4 إذا يقيّم الduction movement سواء + +540 +00:40:09,160 --> 00:40:12,540 +abduction أو abduction أو subduction اللي هو + +541 +00:40:12,540 --> 00:40:14,840 +elevation أو infraduction اللي هو depression + +542 +00:40:14,840 --> 00:40:19,700 +بمقياس رقمين من minus one ل minus four اللي هو ال + +543 +00:40:19,700 --> 00:40:23,200 +under action ال under action zero معناته normal + +544 +00:40:23,200 --> 00:40:27,280 +action وفيه أيضا من plus one ل plus four اللي هي + +545 +00:40:27,280 --> 00:40:32,830 +ال over action اللي هي ال overفبالتالي ضروري جدا + +546 +00:40:32,830 --> 00:40:37,730 +يعني تكون عندنا القضية high واضحة .. تكون القضية + +547 +00:40:37,730 --> 00:40:41,510 +high واضحة .. اذا في عندي over action للمسل زيادة + +548 +00:40:41,510 --> 00:40:47,070 +في نشاط العضلة و under action للمسل يعني نقص في + +549 +00:40:47,070 --> 00:40:51,230 +نشاط العضلة ال under action يقيم من minus one ل + +550 +00:40:51,230 --> 00:40:54,620 +minus fourو ال over action من ال plus one ل plus + +551 +00:40:54,620 --> 00:40:58,420 +four طبعا plus four أكتر over action و zero معناته + +552 +00:40:58,420 --> 00:41:02,400 +normal action للمصل لما بنشوف أن المصل الدكشن مثلا + +553 +00:41:02,400 --> 00:41:07,560 +تاع ال right eye الدكشن zero معناته هذا الدكشن + +554 +00:41:07,560 --> 00:41:13,180 +طبيعي معناته هذا الدكشن طبيعي هنا بنقول طبعا + +555 +00:41:13,180 --> 00:41:17,740 +الدكشن هنا مش الفيرج المفروض هذه مش مرسومةهذه ليست + +556 +00:41:17,740 --> 00:41:20,940 +مرسومة بس رسمت عشان تبين لي أن العيون في الطبيعي + +557 +00:41:20,940 --> 00:41:25,540 +المفروض هنا ال target يكون للآخر رايح هذا ال + +558 +00:41:25,540 --> 00:41:29,260 +target to the leftnormal abduction of the left eye + +559 +00:41:29,260 --> 00:41:32,460 +minus one طبعا اللي بيساعدني عليه ال corneal light + +560 +00:41:32,460 --> 00:41:36,220 +reflex minus two بدت ال sclera تظهر minus three و + +561 +00:41:36,220 --> 00:41:41,160 +minus four مافيش أي نوع من ال abduction هنا العين + +562 +00:41:41,160 --> 00:41:44,800 +التانية رسمت فقط عشان نبين أن وضعها واحد لأن ال + +563 +00:41:44,800 --> 00:41:48,400 +target مكانه واحد بس هذا مريض، هذا مريض تاني، هذا + +564 +00:41:48,400 --> 00:41:51,280 +مريض تالت، هذا مريض رابع، كل واحد منهم عنده degree + +565 +00:41:51,280 --> 00:41:56,560 +معينة من ال defect في ال abduction في ال left eye + +566 +00:41:56,720 --> 00:42:00,100 +هنا احنا بنتوقف عند هذه النقطة ويعطيكم العافية + +567 +00:42:00,100 --> 00:42:02,840 +والسلام عليكم ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/lZMD6JQedTc_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/lZMD6JQedTc_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..108a8e08468df82a2874059873b80ab0e72daa3c --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/lZMD6JQedTc_postprocess.srt @@ -0,0 +1,1872 @@ +1 +00:00:01,530 --> 00:00:05,970 +بسم الله الرحمن الرحيم اتواصل محاضرات حوال واحد + +2 +00:00:05,970 --> 00:00:09,550 +واتوقفنا المرة الماضية عند ال virgences اللي هي + +3 +00:00:09,550 --> 00:00:13,970 +تالت نوع من أنواع حركة العين النوع الأول الدكشنز + +4 +00:00:13,970 --> 00:00:17,550 +اللي هي monocular movements بعدين ال virgins اللي + +5 +00:00:17,550 --> 00:00:20,150 +هي binocular movement in the same direction + +6 +00:00:20,150 --> 00:00:25,310 +وانتهينا أو توقفنا عند ال virgences اللي هي + +7 +00:00:25,310 --> 00:00:29,070 +binocular simultaneous disjugate or disjunctive + +8 +00:00:29,070 --> 00:00:34,540 +movementsطبعا تحت عنوان ال convergence's بنميز + +9 +00:00:34,540 --> 00:00:39,320 +نوعين من الحركات convergence يعني inward turning + +10 +00:00:39,320 --> 00:00:44,100 +of both eye التنتين او العنتين بتجهوا بتجاه ال + +11 +00:00:44,100 --> 00:00:46,640 +nose يعني اليمين بتروح على الشمال و الشمال بتروح + +12 +00:00:46,640 --> 00:00:49,900 +عكسها على اليمين فالتنتين بتجهوا بتجاه ال nose و + +13 +00:00:49,900 --> 00:00:53,900 +هذا بسميه convergence ال divergence طبعا بيتم من + +14 +00:00:53,900 --> 00:00:57,500 +convergent position is outward movement from a + +15 +00:00:57,500 --> 00:01:03,410 +convergent positionو لما حكينا عن ال convergence + +16 +00:01:03,410 --> 00:01:07,610 +اتوقفنا عند ان ال convergence ممكن يكون إيرادي أو + +17 +00:01:07,610 --> 00:01:12,410 +رد فعل reflex يعني voluntary or reflex convergence + +18 +00:01:12,410 --> 00:01:17,050 +ال voluntary يعني هو متعمد convergence متعمد حتى + +19 +00:01:17,050 --> 00:01:20,990 +ممكن يعمل الإنسان بدون وجود هدف يعني يحول عينيه + +20 +00:01:20,990 --> 00:01:27,170 +لجوا ال reflex convergence إله أسباب أو إله مكونات + +21 +00:01:30,200 --> 00:01:35,540 +convergence بتتم بشكل فاعل ال divergence بتتم بشكل + +22 +00:01:35,540 --> 00:01:38,940 +من ال convergent position يعني العين اليمين هتروح + +23 +00:01:38,940 --> 00:01:41,940 +على اليمين و العين الشمال هتروح على الشمال طبعا + +24 +00:01:41,940 --> 00:01:48,020 +هذا منظر من الأعلى و احنا بنتطلع على عينين المريض + +25 +00:01:48,020 --> 00:01:52,800 +زي ما حكينا ال reflex convergencehas four + +26 +00:01:52,800 --> 00:01:56,660 +components هنحكي عنهم اليوم أول نوع أو أول + +27 +00:01:56,660 --> 00:01:59,900 +component من ال reflex convergence هو ال tonic + +28 +00:01:59,900 --> 00:02:03,600 +convergence كلمة tone معناها انشدادية + +29 +00:02:05,910 --> 00:02:09,950 +يعني ان كل عضلة في إيها انشدادية معينة، يعني فيش + +30 +00:02:09,950 --> 00:02:15,230 +عضلة بتصير في حالة رخاوة تماما وحتى و هي في وضع ال + +31 +00:02:15,230 --> 00:02:19,070 +relaxation في إيها tone معين أو قوان معين أو + +32 +00:02:19,070 --> 00:02:23,230 +انشدادية معينة ال tonic convergence implies بيعني + +33 +00:02:23,230 --> 00:02:26,690 +inherent innervational tone to the medial recti + +34 +00:02:26,690 --> 00:02:35,160 +يعني بيعني ليه الانشدادية؟المتأصلة عصبيا في ال + +35 +00:02:35,160 --> 00:02:37,520 +media rectus muscle معروف أن ال media rectus + +36 +00:02:37,520 --> 00:02:43,960 +muscle هي أقوى عضلة في العضلات الستة و بتشتغل كتير + +37 +00:02:43,960 --> 00:02:47,940 +بالذات على ال near warp ال media rectus muscle في + +38 +00:02:47,940 --> 00:02:53,710 +عن ناحيتين بتكون أكثر عملا من باقي العضلاتفبتأصل + +39 +00:02:53,710 --> 00:02:59,110 +فيها ال innervational tone وبالتالي + +40 +00:02:59,110 --> 00:03:02,450 +بيصير عندي tonic convergence عشان نشرح بزيادة و + +41 +00:03:02,450 --> 00:03:06,030 +توضح الأمور بزيادة، في حاجة بيسموها ال anatomical + +42 +00:03:06,030 --> 00:03:09,070 +position of the eye وفي حاجة بيسموها ال + +43 +00:03:09,070 --> 00:03:13,410 +physiological position of the eyeالوضع التشريح + +44 +00:03:13,410 --> 00:03:17,130 +للعين تاني يعني بمعنى بدون أي تغذية عصبية والانسان + +45 +00:03:17,130 --> 00:03:21,470 +مخدر تماما تحت البنج العام أو هو نايم يا ترى كيف + +46 +00:03:21,470 --> 00:03:24,010 +بيكون وضع العين؟ بيكون وضع العين بيسموه وضع + +47 +00:03:24,010 --> 00:03:27,670 +التشريح للعين يعني العين مرتاحة في أي وضع وسط + +48 +00:03:27,670 --> 00:03:31,510 +العضلات ووسط الفات ووسط ال connective tissue اللي + +49 +00:03:31,510 --> 00:03:35,390 +موجود في ال orbit لو فتحنا عينين واحد مستغرق في + +50 +00:03:35,390 --> 00:03:39,660 +النومأو واحد يعني يخضع لعملية away أثناء ال binge + +51 +00:03:39,660 --> 00:03:43,280 +العام لو فتحنا عينيه هنلاقي العينين slightly + +52 +00:03:43,280 --> 00:03:47,660 +divergent slightly divergent هذا asleep يعني نايم + +53 +00:03:47,660 --> 00:03:52,200 +يعني العينين لبرا طالعينبوضع ال divergence هذا + +54 +00:03:52,200 --> 00:03:56,620 +بيسموه ال anatomical position of the eyes يعني + +55 +00:03:56,620 --> 00:04:00,740 +نتيجة انه العين مرتاحة هيك او .. او الانسج اللي + +56 +00:04:00,740 --> 00:04:05,680 +حواليها من عضلات و أوعية دموية و نسيج ضام و دهون و + +57 +00:04:05,680 --> 00:04:10,280 +الا اخرى بتساهم انه العين هذا هو الوضع التشريحي + +58 +00:04:10,280 --> 00:04:14,260 +المريح لها طب احنا لما بيصحى الإنسان بيصير awake + +59 +00:04:14,260 --> 00:04:19,160 +بلاحظ انه عينيه عدلينعينيه عدلين، طيب إيش اللي عدل + +60 +00:04:19,160 --> 00:04:23,000 +العينين؟ كانوا العينين شوية زيغين لبرا، هاي باتجاه + +61 +00:04:23,000 --> 00:04:26,540 +اليمين و هاي باتجاه الشمال، طبعا بدنا ننظر للأسهم، + +62 +00:04:26,540 --> 00:04:30,000 +أنا رسمت الأسهم عشان أوضح لما بيصحى الإنسان وين + +63 +00:04:30,000 --> 00:04:33,480 +العينين بتحركوا عشان يعدلوا، فبالتالي العينين + +64 +00:04:33,480 --> 00:04:35,840 +بيكونوا في وضع ال divergence لما يكون المريض + +65 +00:04:35,840 --> 00:04:42,050 +asleep or under general anesthesiaالأن لما بيصحى + +66 +00:04:42,050 --> 00:04:44,590 +الإنسان عينيا بيعدلوا، طب إيش اللي حصل؟ اللي حصل + +67 +00:04:44,590 --> 00:04:47,510 +convergence، إيش الدليل؟ إنه حصل في العين تانية، + +68 +00:04:47,510 --> 00:04:51,390 +إن العين ها يعني دخلت باتجاه الموز و العين ها دخلت + +69 +00:04:51,390 --> 00:04:54,110 +باتجاه الموز، إذا أنا هذا بسميه convergence، طبعا + +70 +00:04:54,110 --> 00:04:58,230 +بسيط، فبالتالي طب إيش معنى تتحركوا بهذا الاتجاه؟ + +71 +00:04:58,230 --> 00:05:02,490 +بسبب ال inherent toneto the media recti, التون + +72 +00:05:02,490 --> 00:05:05,450 +المتقصل في ال media rectus muscle ال innervational + +73 +00:05:05,450 --> 00:05:11,210 +tone بسبب أنها الأكثر يعني عملا و هي الأقوى من + +74 +00:05:11,210 --> 00:05:17,890 +ناحية كعضلة فهذا يسمى tonic convergence implies + +75 +00:05:17,890 --> 00:05:20,850 +inherent innervational tone to the media recti + +76 +00:05:20,850 --> 00:05:28,710 +when the patient is awakeالنوع التاني اللي هو ال + +77 +00:05:28,710 --> 00:05:32,570 +proximal convergence كلمة proximal convergence + +78 +00:05:32,570 --> 00:05:36,730 +تعني علوي يعني ال convergence اللي مصدره order + +79 +00:05:36,730 --> 00:05:41,890 +علوي من الدمار بسبب psychological awareness of + +80 +00:05:41,890 --> 00:05:48,340 +near object الإدراك النفسيالادراك النفسي لوجود + +81 +00:05:48,340 --> 00:05:52,240 +target جريم قبل ما نحكي او نفسر ايش معناته الجملة + +82 +00:05:52,240 --> 00:05:55,620 +هاي بدنا ناخد من الحياة العامة مثال و بنقول + +83 +00:05:55,620 --> 00:06:00,900 +كالقاتي لو طفل مريض تم استحابه للعيادة او المستشفى + +84 +00:06:00,900 --> 00:06:06,780 +و تم فحصه و قرر الطبيب اللي لابس مريول أبيض و + +85 +00:06:06,780 --> 00:06:10,860 +حوالي الطاقم الطبي لابسين كل واحد مريول أبيض قرر + +86 +00:06:10,860 --> 00:06:16,390 +الطبيب انه يعطيله حقن بالعضل يعني إبرةو الطفل يعني + +87 +00:06:16,390 --> 00:06:21,550 +تمحقنه و بكى و تألم و ما إلى ذلك بعد ذلك لو الطفل + +88 +00:06:21,550 --> 00:06:27,870 +ذهب مرافقمع أخوه أو أي حد تاني لعلاج هذا الشخص + +89 +00:06:27,870 --> 00:06:32,530 +الآخر فالطفل بمجرد ما يشوف المريول الأبيض ممكن + +90 +00:06:32,530 --> 00:06:36,850 +يبدأ بالبكاء أو يحاول الهرب أو ما إلى ذلك ليش؟ مع + +91 +00:06:36,850 --> 00:06:40,530 +أن القضية في الزيارة التانية مش إله، يعني مش هو + +92 +00:06:40,530 --> 00:06:45,330 +اللي معني بالإجراء الطبي السبب أنه صار عنده في + +93 +00:06:45,330 --> 00:06:49,510 +اللاوعي أن هذا اللي لبس و هذا المكان و هذا الناس + +94 +00:06:49,510 --> 00:06:54,790 +اللي لابس المريول البيضةيعني مرتبط فيها ذاكرة + +95 +00:06:54,790 --> 00:07:00,550 +الألم و الحقن في العضل و ما إلى ذلك و بنفس القياس + +96 +00:07:00,550 --> 00:07:02,910 +.. بنفس القياس بدنا نحكي عن ال proximal + +97 +00:07:02,910 --> 00:07:05,710 +convergence هو convergence هو نوع من أنواع ال + +98 +00:07:05,710 --> 00:07:10,510 +reflex convergence لا إرادي نتيجة الإدراك النفسي و + +99 +00:07:10,510 --> 00:07:16,280 +الذهني في اللاوعي أنه في عندي near targetعشان نوضح + +100 +00:07:16,280 --> 00:07:21,600 +بمثال آخر، بس هذا المثال من علم العيون والبصريات، + +101 +00:07:21,600 --> 00:07:27,780 +بنقول كالقاتل، عنا جهاز بنستخدمه في الفحص، + +102 +00:07:27,780 --> 00:07:32,840 +هنقل صورته، نطلع على التكبيرهذا الجهاز بيسمى + +103 +00:07:32,840 --> 00:07:38,480 +sinopto4 هي الجهاز صورته واضحة وهي الطفل اللي بيتم + +104 +00:07:38,480 --> 00:07:42,820 +فحصه حاطط يعني راسه على الجهاز و بتطلع في العدسات + +105 +00:07:42,820 --> 00:07:46,600 +هاي عينين الطفل هذا .. هذا رسمة تمثيلية بتطلع من + +106 +00:07:46,600 --> 00:07:51,120 +خلال هذه العدسات وين بتطلع؟ بتطلع باتجاه المرايا + +107 +00:07:51,120 --> 00:07:54,060 +هذه المرايا بتعكس الصورة هذه الصورة محتوطة .. + +108 +00:07:54,060 --> 00:07:57,640 +مناظر محتوطة في ال .. في ال visual unit display + +109 +00:07:57,640 --> 00:08:03,470 +هنامنظر بنحط و هنا بنحط منظر طبعا لما بنحط منظر + +110 +00:08:03,470 --> 00:08:08,230 +هنا و منظر هنا بتم إضاءة المنظر من خلفه و هنا بتم + +111 +00:08:08,230 --> 00:08:14,190 +إضاءة المنظر من خلفه هذه الإشعة الضوئية بتحمل صورة + +112 +00:08:14,190 --> 00:08:19,490 +المنظر للمرايا و المرايا بتعكس باتجاهه و هنا نفس + +113 +00:08:19,490 --> 00:08:24,810 +القضية باتجاه العين إذا المنظر بُعده .. بُعد + +114 +00:08:24,810 --> 00:08:29,970 +المنظر عن المراياوبعد العين عن المرايا نفس البعد + +115 +00:08:29,970 --> 00:08:34,250 +بسبب انه معروف انه الصورة اللي بتتكون في المرأة + +116 +00:08:34,250 --> 00:08:38,050 +المستوية ال plain mirror بعد الجسم عن الجسم اللي + +117 +00:08:38,050 --> 00:08:42,050 +هو المنظر .. الجسم اللي هو المنظر بعده عن المرايا + +118 +00:08:42,050 --> 00:08:45,290 +يساوي بعد الصورة عن المرايا وبالتالي المسافة من + +119 +00:08:45,290 --> 00:08:50,210 +العين هتكون مماثلةطيب، الآن مش هذا بيت القصيد + +120 +00:08:50,210 --> 00:08:53,650 +المناظر هانا احنا sample او عينة من المناظر اللي + +121 +00:08:53,650 --> 00:08:57,870 +ممكن احنا نوضعها و هيجي محاضرة نشرح فيها بشكل وافي + +122 +00:08:57,870 --> 00:09:01,050 +عن ال sin of two four بس احنا بدنا نوضح فكرة ال + +123 +00:09:01,050 --> 00:09:04,410 +proximal convergence واضح انه الجهاز حجمه صغير + +124 +00:09:04,410 --> 00:09:10,250 +واضح انه الجهاز حجمه صغير بمعنى الآخر لو انا حاولت + +125 +00:09:10,250 --> 00:09:18,590 +اشرح للطفل او المريض ان الصورة ابعيدةو استغرقت وقت + +126 +00:09:18,590 --> 00:09:22,870 +طويل في أني أشرحله الصورة بعيدة طيب هل يعني في + +127 +00:09:22,870 --> 00:09:27,010 +ذهنه هي .. هي .. هي تقصل أو هيكون مقتنع بأن الصورة + +128 +00:09:27,010 --> 00:09:31,750 +بعيدة؟ خلينا نشوف ليش أنا حاولت أشرح للطفل أنه أو + +129 +00:09:31,750 --> 00:09:35,770 +للمريض أنه الصورة بعيدة طبعا طول الأنبوبة هاي اللي + +130 +00:09:35,770 --> 00:09:39,470 +أنا بأشر عليه يعني من عند المنظر اللي بحطه أو ال + +131 +00:09:39,470 --> 00:09:42,690 +slide اللي أنا بحطه لغاية ال mirror طول طولها + +132 +00:09:42,690 --> 00:09:47,270 +خمستاشر سانتيوعن ناحية التانية ايضا طولها 15 cm + +133 +00:09:47,270 --> 00:09:52,830 +لما انسان بتطلع target بعده 15 cm لازم يبذل تقريبا + +134 +00:09:52,830 --> 00:09:56,970 +plus 6.5 diopter accommodation كيف عرفنا؟ بنجسم + +135 +00:09:56,970 --> 00:10:03,550 +100 على 15 تطلع تقريبا 16 او 6.5 diopter 100 على + +136 +00:10:03,550 --> 00:10:08,750 +15 cm تقريبا plus 6.5 diopter accommodation يعني + +137 +00:10:08,750 --> 00:10:14,330 +لازم يشد على عينه بمقدار plus 6.5 diopter لكل عين + +138 +00:10:14,550 --> 00:10:19,470 +طيب هذا الجهاز مصمم بحيث انه المفروض نلغي عملية ال + +139 +00:10:19,470 --> 00:10:22,910 +accommodation أثناء فحص الحوار على هذا الجهاز يعني + +140 +00:10:22,910 --> 00:10:28,630 +مابديش المريض أو الطفل اللي بافحص على الجهاز هذا + +141 +00:10:28,630 --> 00:10:34,210 +انه يبذل 6.5 ديوبتر ولا 4 ديوبتر ولا 5 ديوبتر ولا + +142 +00:10:34,210 --> 00:10:39,570 +بدي يبذل 0 ديوبتر محطوط في الجهاز عدسات كل عدسة + +143 +00:10:39,570 --> 00:10:48,090 +منهم plus 6.5 ديوبتر بحيثبحيث انه مايبذل اي نوع من + +144 +00:10:48,090 --> 00:10:49,790 +ال accommodation يعني ال accommodation اللي + +145 +00:10:49,790 --> 00:10:53,450 +المفروض يبذله اللي هو 6.5 ديوبتر انا بعودله بعدسة + +146 +00:10:53,450 --> 00:10:56,690 +plus بحيث تكون الصورة وكأنها على ال optical + +147 +00:10:56,690 --> 00:11:01,830 +infinity وكأنها على بعد 6 متر فا أكثر ممكن انسان + +148 +00:11:01,830 --> 00:11:07,550 +يعني يقول ليش انا بدي اخلي ال accommodation صفر + +149 +00:11:07,550 --> 00:11:12,070 +لأن الفحص على هذا الجهاز ضروري جدا مايكونش مصاحب ب + +150 +00:11:12,070 --> 00:11:15,840 +accommodationو طالما الجهاز صغير و المنظر قريب اذا + +151 +00:11:15,840 --> 00:11:18,940 +الطبيعي ان الانسان يعمل عليه accommodation فانا + +152 +00:11:18,940 --> 00:11:22,240 +بلغيله هذا ال accommodation بجداش بده يعمل + +153 +00:11:22,240 --> 00:11:26,260 +accommodation بحطله يعني عدسة اللي تلغيله ال + +154 +00:11:26,260 --> 00:11:29,240 +accommodation ممكن انسان اخر يسأل يقول طب انا شايف + +155 +00:11:29,240 --> 00:11:33,330 +هنا العدسة مكتوب عليها plus 4وهنا العدسة plus خمسة + +156 +00:11:33,330 --> 00:11:38,270 +و نص مظبوط هي plus ستة و نص بس هذا الشخص يكون عنده + +157 +00:11:38,270 --> 00:11:42,970 +refractive error يعني هنا عندي myopia درجتين و نص + +158 +00:11:42,970 --> 00:11:47,590 +يعني minus اتنين و نص لما بنضيفهم لل plus ستة و نص + +159 +00:11:47,590 --> 00:11:54,510 +يعني هو كأنه لابسminus 2.5 عدسة نضارة minus 2.5 + +160 +00:11:54,510 --> 00:12:00,290 +وعندي هنا plus 6.5 فبصف عندي plus 6.5 و minus 2.5 + +161 +00:12:00,290 --> 00:12:04,430 +بصف عندي plus 4 العين التانية طبعا انايزومتروبيا + +162 +00:12:04,430 --> 00:12:08,700 +عنده عندها minus 1 ديوبترمايوبيافبدل ما أحطه .. + +163 +00:12:08,700 --> 00:12:11,880 +أخليه يلبس نضارة و أخليه يحط العدسة اللي هي minus + +164 +00:12:11,880 --> 00:12:15,560 +واحد و في عندي plus 6 و نص ال plus 6 و نص و ال + +165 +00:12:15,560 --> 00:12:19,860 +minus واحد بيصف عندي plus 5 و نص هذا طبعا استطراد + +166 +00:12:19,860 --> 00:12:24,480 +بس عشان نوضح عشان ما .. مافي إنسان يستغرب من هذه + +167 +00:12:24,480 --> 00:12:28,800 +الرقم ليش بختلف عن هذه و ليش ما هما التانين plus 6 + +168 +00:12:28,800 --> 00:12:33,610 +و نصع العموم مفروض أي إنسان بينفحص على هذا الجهاز + +169 +00:12:33,610 --> 00:12:37,830 +يكون بنظر للمنظر طبعاً هينظر للمنظر من خلال العدسة + +170 +00:12:37,830 --> 00:12:41,510 +هي في المرايا لصورة المنظر هي sample أو عينة من + +171 +00:12:41,510 --> 00:12:45,270 +المناظر اللي ممكن أحطها مفروض مايبذلش أي نوع من ال + +172 +00:12:45,270 --> 00:12:49,730 +accommodation طيب طيب مدام ما بذلش أي نوع من ال + +173 +00:12:49,730 --> 00:12:54,970 +accommodation إذا مش مفروض يبذل أي نوع من ال + +174 +00:12:54,970 --> 00:12:58,290 +convergence لأنه معروف إن عملية ال accommodation + +175 +00:12:59,020 --> 00:13:02,740 +عملية ال accommodation أو ال near reflex عبارة عن + +176 +00:13:02,740 --> 00:13:08,080 +تلت أشياء accommodation و meiosis و convergenceأنا + +177 +00:13:08,080 --> 00:13:11,540 +بديش يعمل accommodation عشان مايعملش accommodative + +178 +00:13:11,540 --> 00:13:18,700 +convergence ومع ذلك لو فحصنا المريض على هذا الجهاز + +179 +00:13:18,700 --> 00:13:22,240 +هنلاقيه بيعمل شوية convergence إيش سبب هذا ال + +180 +00:13:22,240 --> 00:13:24,900 +convergence؟ هل هو ال accommodation؟ طبعاً لأ لأن + +181 +00:13:24,900 --> 00:13:28,740 +أنا لغي ال accommodation بواسطة العدسات ال plus 6 + +182 +00:13:28,740 --> 00:13:33,130 +.5 اللي حطيتها طيب إيش سبب ال convergence هذا؟سبب + +183 +00:13:33,130 --> 00:13:39,170 +ال convergence سبب نفسي .. سبب نفسي بسبب انه الطفل + +184 +00:13:39,170 --> 00:13:42,770 +او الانسان لما قاعد على الجهاز هذا رغم اني انا + +185 +00:13:42,770 --> 00:13:47,410 +شرحتله انه يعني ماتشدش على حالك و ارخي .. ماتشدش + +186 +00:13:47,410 --> 00:13:51,890 +على عينك و ارخي حالك تمام الا انه عنده ذهنيا في + +187 +00:13:51,890 --> 00:13:55,010 +عقله الباطن انه الجهاز حجمه صغير معناته الصورة + +188 +00:13:55,010 --> 00:13:58,870 +قريبة .. معناته الصورة قريبةطبعا هذا الكلام مش + +189 +00:13:58,870 --> 00:14:02,430 +هيناقش في نفسه بس هو قاعد على جهاز حجمه صغير إذا + +190 +00:14:02,430 --> 00:14:09,590 +فالصورة ذهنيا قريبة ف ال proximal convergenceهو أو + +191 +00:14:09,590 --> 00:14:13,050 +is induced by psychological awareness الإدراك + +192 +00:14:13,050 --> 00:14:17,030 +النفسي لإنهار object إذا إحنا اتكلمنا عن ال tone + +193 +00:14:17,030 --> 00:14:20,710 +convergence اللي هو ال inherent innervational tone + +194 +00:14:20,710 --> 00:14:24,070 +to the media recti و اتكلمنا عن ال proximal + +195 +00:14:24,070 --> 00:14:28,630 +convergence اللي هو الإدراك السيكولوجي و النفسي + +196 +00:14:28,630 --> 00:14:32,710 +لإنه ال target اللي أنا بتطلع عليهرغم إن أنا ملغي + +197 +00:14:32,710 --> 00:14:36,010 +ال accommodation بواسطة عدسات ورغم إنه المفروض إن + +198 +00:14:36,010 --> 00:14:41,470 +أعتبره target بعيد، إلا إنه بسبب صغر الجهاز، إني + +199 +00:14:41,470 --> 00:14:46,510 +مدرك إن الصورة قريبة في اللاوعي، قريبة في اللاوعي + +200 +00:14:46,510 --> 00:14:50,150 +طيب، تالت نوع من ال reflex convergence أو تالت + +201 +00:14:50,150 --> 00:14:53,530 +component هو ال fusional convergenceيعني ال + +202 +00:14:53,530 --> 00:14:58,490 +convergence المرتبط في قضية ال fusion .. المرتبط + +203 +00:14:58,490 --> 00:15:02,630 +بقضية ال fusion وعشان نحكي عن ال fusion ال + +204 +00:15:02,630 --> 00:15:05,890 +convergence بنقول هو ال convergence .. هو ال + +205 +00:15:05,890 --> 00:15:10,830 +convergence المرتبط بقضية ال fusion طيب ال fusion + +206 +00:15:10,830 --> 00:15:14,650 +.. ال fusion اللي هو دمج صورتين في صورة واحدة احنا + +207 +00:15:14,650 --> 00:15:20,790 +حكينا انه الدماغبيشترط .. بيشترط عدة شروط عشان + +208 +00:15:20,790 --> 00:15:25,050 +يدمج الصورتين صورة تاعة شبكية العين اليمين والصورة + +209 +00:15:25,050 --> 00:15:29,930 +تاعة شبكية العين الشمال بيشترط عدة شروط عشان يتم + +210 +00:15:29,930 --> 00:15:34,930 +دمجها في صورة واحدة ثلاثية الأبعاد من ضمن هذه + +211 +00:15:34,930 --> 00:15:40,830 +الشروط ومن أهمها ان الصورة تاعة شبكية العين اليمين + +212 +00:15:40,830 --> 00:15:47,110 +تسقط ع مكان في الشبكيةوتسقط ع مكان مماثل في شبكية + +213 +00:15:47,110 --> 00:15:54,470 +العين اليسار نيجي نشرح هذه القضية طيب، عندنا هنا + +214 +00:15:54,470 --> 00:16:02,390 +رسمة توضوحية هذه العين اليمين وهذه العين اليسار هي + +215 +00:16:02,390 --> 00:16:06,190 +عندي FFF يعني fovea right يعني ال fovea بتاعة + +216 +00:16:06,190 --> 00:16:11,680 +العين اليمين هنا temporal retina لل righttemporal + +217 +00:16:11,680 --> 00:16:17,660 +right و هنا nasal right هنا الفوفيا left ال nasal + +218 +00:16:17,660 --> 00:16:20,960 +left و ال temporal left طبعا ال نص هييجي بين + +219 +00:16:20,960 --> 00:16:25,420 +الانتين طبعا لما بنقول nasal left يعني ال nasal + +220 +00:16:25,420 --> 00:16:28,500 +retina تحت ال left eye يعني من عند الفوفيا من نص + +221 +00:16:28,500 --> 00:16:33,420 +الفوفيا من نص الفوفيا لل oracyrata يعني هذا الجزء + +222 +00:16:33,420 --> 00:16:37,180 +هذا نص العين هذا هو ال nasal retina تحت ال left + +223 +00:16:37,180 --> 00:16:39,140 +eye احنا بقولنا هاي left eye + +224 +00:16:42,150 --> 00:16:46,450 +و هنا ال nasal تاعة ال right eye من نص ال fovea + +225 +00:16:46,450 --> 00:16:49,370 +لعند ال oracleta هذا ال nasal retina تاعة ال right + +226 +00:16:49,370 --> 00:16:52,590 +eye و هنا اللي بعيد عن انواز ال temporal retina + +227 +00:16:52,590 --> 00:16:55,850 +تاعة ال right eye و هنا ال temporal retina تاعة ال + +228 +00:16:55,850 --> 00:17:01,710 +left eye اذا temporal right nasal right nasal left + +229 +00:17:01,710 --> 00:17:06,450 +temporal left و ال fovea و ال fovea بيقع في منتصف + +230 +00:17:06,450 --> 00:17:12,420 +الشبكية في منتصف الشبكية في ال posterior poolلو + +231 +00:17:12,420 --> 00:17:16,560 +اتخيلنا احنا في عندي تلاتة target ال target X و ال + +232 +00:17:16,560 --> 00:17:21,180 +target Z و ال target Y ال target X جايلة جدام + +233 +00:17:21,180 --> 00:17:25,120 +المريض او جدام الإنسان مباشرة و المريض بتطلع على + +234 +00:17:25,120 --> 00:17:29,300 +ال target X المريض او هذا الشخص بتطلع على ال + +235 +00:17:29,300 --> 00:17:33,400 +target X إذا الإنسان بتطلع على أي شيء بالفوفيا + +236 +00:17:33,400 --> 00:17:39,680 +بتاعته إذا بتسقط صورة Xصورة x بتسقط على الفوفيا + +237 +00:17:39,680 --> 00:17:42,400 +بتاعة ال right eye وفي نفس اللحظة بتسقط على + +238 +00:17:42,400 --> 00:17:47,220 +الفوفيا بتاعة ال left eye طيب الفوفيا و الفوفيا + +239 +00:17:48,000 --> 00:17:51,860 +مناطق متماثلة من الشبكية مش لأنه اسمها phobia و + +240 +00:17:51,860 --> 00:17:55,940 +اسمها phobia لأنهم نفس الاتجاه في الفرار ..الهم + +241 +00:17:55,940 --> 00:18:01,100 +نفس الاتجاه في الفرار ..الان و بينما هذا الشخص + +242 +00:18:01,100 --> 00:18:06,060 +بينظر على X ال target Y عنده ..ال target Y عنده + +243 +00:18:06,060 --> 00:18:10,650 +بيسقط على ال temporal retina هناوعلى ال nasal + +244 +00:18:10,650 --> 00:18:15,630 +retina في العين الشمال، إذا ال temporal retina هنا + +245 +00:18:15,630 --> 00:18:20,170 +وال nasal retina هنا بيسموهم corresponding retinal + +246 +00:18:20,170 --> 00:18:24,030 +area إيش يعني corresponding؟ مناطق متماثلة، + +247 +00:18:24,030 --> 00:18:28,740 +temporal في عين مع ال nasal في العين التانيةتمام؟ + +248 +00:18:28,740 --> 00:18:33,320 +إيش يعني متماثل؟ يعني بتبص على نفس الجهة من الفرق، + +249 +00:18:33,320 --> 00:18:36,920 +على نفس الجهة من الفرق، أيضًا ال temporal في ال + +250 +00:18:36,920 --> 00:18:40,560 +left eye و ال nasal في ال right eye بيبصوا على نفس + +251 +00:18:40,560 --> 00:18:45,220 +الجهة من الفرق، بمعنى بينما هذا الشخص بينظر لل + +252 +00:18:45,220 --> 00:18:50,170 +target Xالـ target z عنده .. ال target z عنده + +253 +00:18:50,170 --> 00:18:53,450 +بيسقط على ال temporal retina بتاعة ال left eye زي + +254 +00:18:53,450 --> 00:18:57,470 +ما انتوا شايفين الخط هذا صورة z بتسقط على المنطقة + +255 +00:18:57,470 --> 00:19:00,090 +high من ال retina من ال temporal retina بتاعة ال + +256 +00:19:00,090 --> 00:19:05,070 +left eye وفي نفس اللحظة بتسقط على ال nasal retina + +257 +00:19:05,070 --> 00:19:08,510 +بتاعة ال left .. بتاعة ال right eye إذا ال nasal + +258 +00:19:08,510 --> 00:19:13,280 +مع ال temporal متماثلو ال temporal مع ال nasal + +259 +00:19:13,280 --> 00:19:17,140 +متماثل، إيش يعني متماثل؟ يعني ببص على نفس الاتجاه + +260 +00:19:17,140 --> 00:19:24,470 +من الفرقإذن شرط أساسي عشان ال target الواحد ينشف + +261 +00:19:24,470 --> 00:19:29,550 +بشكل واحد ثلاث الأبعاد ومايصيرش ازدواجية ويصير + +262 +00:19:29,550 --> 00:19:35,530 +fusion دمج للصورتين لابد .. لابد من سقوط صور ال + +263 +00:19:35,530 --> 00:19:41,070 +target على نفس .. على نفس المناطق أو على مناطق + +264 +00:19:41,070 --> 00:19:48,890 +متماثلة من شبكيات العندىrefusion عشان يصير إله شرط + +265 +00:19:48,890 --> 00:19:54,490 +.. الشرط سقوط صورة ال target على مناطق متماثلة من + +266 +00:19:54,490 --> 00:20:01,450 +شبكية العنتين طيب .. الآن لو ما سقطش .. لو ما سقطش + +267 +00:20:01,450 --> 00:20:06,870 +ساعتها بلزم divergence movement .. divergence + +268 +00:20:06,870 --> 00:20:10,320 +movementبدناش نقول convergence نقول convergence + +269 +00:20:10,320 --> 00:20:15,240 +movement إما convergence أو divergence أو vertical + +270 +00:20:15,240 --> 00:20:18,480 +divergence يعني العين تين لازم يتحركوا إما لجوه + +271 +00:20:18,480 --> 00:20:22,480 +عكس بعض أو لبره عكس بعض أو واحدة تطلع بالنسبة + +272 +00:20:22,480 --> 00:20:28,080 +للتانية برضه عكس بعض عشان اتعدل موقع الصورة + +273 +00:20:28,080 --> 00:20:34,480 +الشبكية وإلا لن يتم ال fusionإذا لازم حركة + +274 +00:20:34,480 --> 00:20:40,560 +versions .. لازم حركة versions تتم الهدف منها .. + +275 +00:20:40,560 --> 00:20:45,120 +الهدف منها تعديل وضع الصورة على الشبكية حتى + +276 +00:20:45,120 --> 00:20:50,620 +الصورتين يسقطوا على مناطق متماثلةمن شبكية الانتين + +277 +00:20:50,620 --> 00:20:54,760 +وهذا شرط عشان يتم الفيوجين في البرين هذا الكلام + +278 +00:20:54,760 --> 00:20:59,540 +بنقوله في حالة ان الصور ما سقطتش على مناطق متماثلة + +279 +00:20:59,540 --> 00:21:04,120 +نضرب مثال عملي على ذلك بيوضحلي الفيوجين ال + +280 +00:21:04,120 --> 00:21:10,950 +convergence احنا قلنا وجود الصورتينصورة على شبكية + +281 +00:21:10,950 --> 00:21:15,190 +العين اليمين وصورة على شبكية العين الشمال و الدماغ + +282 +00:21:15,190 --> 00:21:20,490 +عايز يوحدهم الدماغ بشترت .. بشترت شرط مهم جدا انه + +283 +00:21:20,490 --> 00:21:24,590 +لازم تسقط الصورة في العين اليمين ع منطقة في + +284 +00:21:24,590 --> 00:21:28,930 +الشبكيةوتسقط على منطقة في شبكية العين الشمالة وإنه + +285 +00:21:28,930 --> 00:21:33,970 +يكونوا هدول المنطقتين متماثلات تماما بمعنى بيبصوا + +286 +00:21:33,970 --> 00:21:37,590 +على نفس اللي لهم نفس ال direction في الفرار إذا + +287 +00:21:37,590 --> 00:21:40,630 +ماصارش هذا الكلام مافيش fusion مافيش damage صورتين + +288 +00:21:40,630 --> 00:21:44,030 +في الصورة وبالتالي بيظل عند الصورتين صورتين بمعنى + +289 +00:21:44,030 --> 00:21:47,730 +بيصير المريض يشوف أو الإنسان يشوف diplopia طيب + +290 +00:21:47,730 --> 00:21:52,850 +نفرض جدلا إنه سقطوا الصورتين على مناطق غير متماثلة + +291 +00:21:54,040 --> 00:21:58,320 +من شبكية الانترن ساعتها لازم يتم convergence + +292 +00:21:58,320 --> 00:22:01,740 +movementاحنا بنحكي الآن عن ال convergence بس هذا + +293 +00:22:01,740 --> 00:22:04,920 +بنطبق على كل أنواع ال convergence movement يعني + +294 +00:22:04,920 --> 00:22:06,940 +إيش convergence movement يعني العين تانية لازم + +295 +00:22:06,940 --> 00:22:12,000 +يتحركوا حركة متعاكسة عشان يظبطوا وضعهم ويسقطوا + +296 +00:22:12,000 --> 00:22:15,880 +الصورة تحت شبكية العين اليامين ع منطقة تماثلها + +297 +00:22:15,880 --> 00:22:19,700 +سقوط الصورة على شبكية العين الشمال يعني لازم تسقط + +298 +00:22:19,700 --> 00:22:24,400 +الصورة على مناطق متماثلة من الشبكية بعد هيك بتم ال + +299 +00:22:24,400 --> 00:22:28,790 +fusion فساعتها بتسمى fusional convergenceممكن السن + +300 +00:22:28,790 --> 00:22:34,570 +يقول احنا الكلام صادق كتير و أصبح الواحد يعني + +301 +00:22:34,570 --> 00:22:38,170 +متلخبط شوية من هذه القضية، بنقول المثال التالي + +302 +00:22:38,170 --> 00:22:44,550 +بيوضح الأمر بشكل جدا واضح، بس بدنا نذكر باللي قبل + +303 +00:22:44,550 --> 00:22:49,900 +شوية حكيناها أنهالمناطق المتماثلة الفوفيا تماخلها + +304 +00:22:49,900 --> 00:22:53,300 +الفوفيا ليش؟ لأنهم لهم نفس ال direction من الفرار + +305 +00:22:53,300 --> 00:22:57,020 +يعني لو سقط صورة جسم على الفوفيا هنا وصورة جسم على + +306 +00:22:57,020 --> 00:23:00,160 +الفوفيا هنا بيتم توحيدهم في صورة واحدة ليش؟ لأن + +307 +00:23:00,160 --> 00:23:02,860 +هدولة corresponding retinal elements أو + +308 +00:23:02,860 --> 00:23:06,300 +corresponding retinal areas و ال temporal retina + +309 +00:23:06,300 --> 00:23:09,460 +في ال right eye و ال nasal retina في ال left eye + +310 +00:23:09,460 --> 00:23:14,180 +التنين بيبصوا على نفس الجهة من الفرارو ال temporal + +311 +00:23:14,180 --> 00:23:16,600 +retina في ال left eye و ال nasal retina في ال + +312 +00:23:16,600 --> 00:23:20,180 +right eye التانين بيبصوا على نفس الجهة من الفرق + +313 +00:23:20,180 --> 00:23:24,400 +فبالتالي ال temporal مع ال nasal و ال nasal مع ال + +314 +00:23:24,400 --> 00:23:29,720 +temporal هدولة مناطق متماثلة بس nasal مع nasal لأ + +315 +00:23:29,720 --> 00:23:32,940 +و temporal مع temporal لأ إيش يعني ال nasal مع + +316 +00:23:32,940 --> 00:23:36,060 +nasal لأ و temporal مع temporal لأ يعني لو صورة .. + +317 +00:23:36,060 --> 00:23:42,080 +لو صورة target ما target ما؟ أي target؟تسقطت على + +318 +00:23:42,080 --> 00:23:44,680 +ال nasal retina بتاعة ال right eye وعن nasal + +319 +00:23:44,680 --> 00:23:48,980 +retina بتاعة ال left eye بقولش بما أن هذه اسمها + +320 +00:23:48,980 --> 00:23:53,020 +nasal و هذه اسمها nasal معناته هدولة مناطق متمافلة + +321 +00:23:53,020 --> 00:23:56,060 +وبالتالي بيتم دمج الصورتين في صورة واحدة ثلاثية + +322 +00:23:56,060 --> 00:23:58,860 +لبعد، لأ ال nasal retina بتاعة ال right eye هي + +323 +00:23:58,860 --> 00:24:01,720 +اتجاهها في الفرارة، بهذا الاتجاه، هي ال nasal هي + +324 +00:24:01,720 --> 00:24:07,060 +موجهة باتجاهالحرف زد وما جاور الحرف زد والاتجاه + +325 +00:24:07,060 --> 00:24:10,280 +هذا هذه ال nasal retina طيب وال nasal retina بتاعة + +326 +00:24:10,280 --> 00:24:14,280 +ال left eye عكسها تماما موجهة عكسها فبالتالي ال + +327 +00:24:14,280 --> 00:24:17,640 +nasal retina ايش اللي بيمثلها ال temporal retina + +328 +00:24:17,640 --> 00:24:20,820 +في العين التاني طيب وال temporal retina في العين + +329 +00:24:20,820 --> 00:24:24,280 +high ال right ايش اللي بيمثلها ال nasal retina في + +330 +00:24:24,280 --> 00:24:28,600 +ال left eye فهذه ضروري ناخد بالنا منها من هذه + +331 +00:24:28,600 --> 00:24:32,760 +القضية في قضية تانيةفي الـ Geometric Optics + +332 +00:24:32,760 --> 00:24:41,080 +اتعلمنا مبدأ بسيط جدا ان الأشعة اللي + +333 +00:24:41,080 --> 00:24:44,560 +جاية من بعيد تقريبا بتكون parallel نفرض إنسان + +334 +00:24:44,560 --> 00:24:48,740 +بتطلع على target بعيد كتير يعني الأشعة جاية من هذا + +335 +00:24:48,740 --> 00:24:52,860 +ال target تقريبا parallel و بتسقط على الفوفيا الخط + +336 +00:24:52,860 --> 00:24:56,280 +المتقطع بيكمل عند الفوفيا يعني الفوفيا هنا و + +337 +00:24:56,280 --> 00:25:02,580 +الفوفيا هنا انا جمتأجريت التجربة بحيث بدي أثبت + +338 +00:25:02,580 --> 00:25:07,280 +وجود الفيوجينال convergence + +339 +00:25:07,760 --> 00:25:12,600 +فحطيت انا بريزم base out يعني ال base لبرا جاي و + +340 +00:25:12,600 --> 00:25:16,260 +بريزم اخر base out معروف انه ال بريزم في علم ال + +341 +00:25:16,260 --> 00:25:20,520 +geometric optics و كتير من علوم البصريات انه بيحرف + +342 +00:25:20,520 --> 00:25:23,900 +الأشعة باتجاه ال base بتاعته هي قمة ال بريزم وهي + +343 +00:25:23,900 --> 00:25:27,060 +ال base بتاعته فالاشعة اللي جاية من ال target + +344 +00:25:27,060 --> 00:25:33,250 +البعيد اللي بتطلع عليه هذا الإنسانجاية تسقط على + +345 +00:25:33,250 --> 00:25:36,550 +الفوفيا جاب الوجود لبريزم روحت انا حطيت لبريزم، + +346 +00:25:36,550 --> 00:25:39,810 +لبريزم هيحرف هذه الأشعة اللي دخلته باتجاه ال base + +347 +00:25:39,810 --> 00:25:44,910 +أصبحأصبح الصورة بدل ما تسقط على الفوفيا بتسقط على + +348 +00:25:44,910 --> 00:25:49,190 +ال temporal retina هنا طيب نفس الكلام أجريته للعين + +349 +00:25:49,190 --> 00:25:52,890 +التانية الأشعة اللي جاي من نفس ال target بتطلع + +350 +00:25:52,890 --> 00:25:56,530 +مثلا على شجرة بعيدة أو سيارة أو شخص بتسقط على + +351 +00:25:56,530 --> 00:26:00,490 +الفوفيا روحت أنا حطيت برزم البرزم بيحرف الأشعة + +352 +00:26:00,490 --> 00:26:03,570 +باتجاه ال base بتاعته يعني هتسقط على ال temporal + +353 +00:26:03,570 --> 00:26:07,650 +retina إذا صورة ال target البعيد اللي بتطلع عليه + +354 +00:26:07,650 --> 00:26:12,390 +هذا الإنسان اللي بتطلع عليه هذا الإنسانأصبحت بعد + +355 +00:26:12,390 --> 00:26:16,530 +إدخال برزمين أصبحت تسقط على ال temporal retina هنا + +356 +00:26:16,530 --> 00:26:20,230 +وعال temporal retina هنا طب يا ترى السؤال بيقول هل + +357 +00:26:20,230 --> 00:26:23,710 +ال temporal retina و ال temporal retina مناطق + +358 +00:26:23,710 --> 00:26:28,170 +متماثلة؟ طبعا مش مناطق متماثلة ال temporal retina + +359 +00:26:28,170 --> 00:26:34,490 +في العين هاي موجهة هيك اتجاه Y و مع حول Y و ال + +360 +00:26:34,490 --> 00:26:38,470 +temporal retina هنا موجهة باتجاه Z يعني كل واحدة + +361 +00:26:38,470 --> 00:26:45,650 +إلها اتجاه في الفرارةساعتها، الدماغ مش هيقدر يدمج + +362 +00:26:45,650 --> 00:26:53,250 +الصورتين وهيتحفظ ويتنشط وينتبه ويأمر بإجراء حركة + +363 +00:26:53,250 --> 00:26:59,690 +ما لإعادة إسقاط الصور على مناطق متمافلة من شبكية + +364 +00:26:59,690 --> 00:27:05,360 +العين اليمين وشبكية العين الإشمالأتخلص من وضعية أن + +365 +00:27:05,360 --> 00:27:09,580 +الصورة تسقط على temporal retina و temporal retina، + +366 +00:27:09,580 --> 00:27:13,860 +بد الصور تسقط على مناطق متماثلة، إيش المناطق + +367 +00:27:13,860 --> 00:27:18,760 +المتماثلة؟ الفوفيا، الفوفيا مع الفوفيا، فبالتالي + +368 +00:27:18,760 --> 00:27:23,580 +ال brain بيأمر الفوفيا اليمين تتحرك باتجاه الصورة، + +369 +00:27:23,580 --> 00:27:26,900 +يعني العين بدها تلف بالاتجاه تاع الأسهم، ليش بدها + +370 +00:27:26,900 --> 00:27:30,500 +تلف بالاتجاه تاع الأسهم؟ عشان الفوفيا، اللي هي + +371 +00:27:30,500 --> 00:27:35,360 +منطقتها هنا، تيجي على الصورةطبعا مابقدرش أنجل + +372 +00:27:35,360 --> 00:27:38,580 +الجسم اقوله والله اتحرك يا جسم اتحرك يا شجرة او + +373 +00:27:38,580 --> 00:27:43,120 +سيارة واسقطيلي على الفوفيا لأ العينين بيعملوا + +374 +00:27:43,120 --> 00:27:48,720 +دوران معين يعني العين اليمين هتتحرك بهذا الاتجاه + +375 +00:27:48,720 --> 00:27:50,840 +لو فرضنا هذه العين اليمين بهذا الاتجاه هي انها + +376 +00:27:50,840 --> 00:27:54,400 +هتتروح ناحية ال nose ساعتها ال back of the eye + +377 +00:27:54,400 --> 00:27:59,110 +هيتحرك يعني الفوفيا هتتحرك باتجاه الصورةنفس الكلام + +378 +00:27:59,110 --> 00:28:02,750 +.. نفس الكلام عشان الصورة صارت هنا الفوفيا بدأت + +379 +00:28:02,750 --> 00:28:07,530 +تتحرك باتجاهها، طب إذا الفوفيا راحت هيك لبرا و + +380 +00:28:07,530 --> 00:28:11,010 +الفوفيا هنا راحت لبرا، معناته ال anterior part of + +381 +00:28:11,010 --> 00:28:13,830 +the eye هيروح هنا لجوه و هنا لجوه، هذا convergence + +382 +00:28:13,830 --> 00:28:16,770 +.. هذا convergenceبس ايش الهدف من هذا ال + +383 +00:28:16,770 --> 00:28:20,150 +convergence انه يتم ال fusion عشان هيك بتسمى ال + +384 +00:28:20,150 --> 00:28:22,990 +fusion ال convergence ممكن الانسان يقول انا في + +385 +00:28:22,990 --> 00:28:26,090 +عندي اعتراض انه هذا accommodative convergence بسبب + +386 +00:28:26,090 --> 00:28:29,510 +فعل ال accommodation نقوله تنساش انه احنا مالناش + +387 +00:28:29,510 --> 00:28:32,250 +علاقة بتاعة بال accommodation لأنه ال target بعيد + +388 +00:28:32,250 --> 00:28:36,450 +عشرين تلاتين مائة متر فبالتالي مافي اي مشكلة يعني + +389 +00:28:36,450 --> 00:28:40,410 +بعد ستة متر يعتبر ال target بعيد وال accommodation + +390 +00:28:40,410 --> 00:28:44,250 +اللي بيلزمه يكاد لا يذكر يكاد لا يذكر اذا انا بفعل + +391 +00:28:44,250 --> 00:28:51,890 +برزمينبفعل لبريزمين خلّيت الصور تسقط على temporal + +392 +00:28:51,890 --> 00:28:55,390 +retina هنا و temporal retina هنا و ال temporal هنا + +393 +00:28:55,390 --> 00:28:59,770 +مش نقاط متجانسة أو corresponding مع ال temporal + +394 +00:28:59,770 --> 00:29:02,790 +لأن ال temporal هنا إله اتجاه و ال temporal هنا + +395 +00:29:02,790 --> 00:29:06,970 +إله اتجاه عكسه فهذه إسقاط الصور على temporal + +396 +00:29:06,970 --> 00:29:10,410 +retina و temporal retina بيسموه by temporal image + +397 +00:29:10,410 --> 00:29:14,530 +disparityby temporal image disparity image + +398 +00:29:14,530 --> 00:29:19,630 +disparity يعني خلل خلل في موقع الصورة disparity + +399 +00:29:19,630 --> 00:29:23,090 +خلل في موقع الصورة image disparity by temporal + +400 +00:29:23,090 --> 00:29:26,570 +يعني الخلل اش توصيفه انه سقطت على temporal و + +401 +00:29:26,570 --> 00:29:31,090 +temporal سقطت على temporal و temporal عشان اتخلص + +402 +00:29:31,090 --> 00:29:34,570 +من ال by temporal image disparity ال brain ع + +403 +00:29:34,570 --> 00:29:40,900 +السريع بحرك الفوفيا باتجاه ال outو بيحرك الفوفيا + +404 +00:29:40,900 --> 00:29:44,280 +باتجاه ال out عشان هي تروح تتلقى الصورة يعني العين + +405 +00:29:44,280 --> 00:29:49,100 +بتدور بحيث انه بدل الصورة ما تسقط هنا الفوفيا + +406 +00:29:49,100 --> 00:29:53,660 +بتيجي مكانها فالعين بتدور بالشكل .. باتجاه ال أسهم + +407 +00:29:53,660 --> 00:29:57,420 +ساعت ما العين بتروح لبرا من ناحية الفوفيا معناته + +408 +00:29:57,420 --> 00:30:01,480 +الكورنيا هتدخل لجوة هنا نفس القضية العين هتروح + +409 +00:30:01,480 --> 00:30:05,260 +لبرابحيث ان الفوفيا هي اللي هتروح لبرا ال back of + +410 +00:30:05,260 --> 00:30:09,060 +the eye هيتحرك باتجاه ال temporal side ساعتها ال + +411 +00:30:09,060 --> 00:30:12,100 +anterior part هيتحرك باتجاه ال nasal side النص + +412 +00:30:12,100 --> 00:30:15,680 +طبعا هنا بين العينتين جاهة فطالما العين هيتحركت + +413 +00:30:15,680 --> 00:30:18,800 +nasally وهد العين اتحركت nasally اذا هدا + +414 +00:30:18,800 --> 00:30:22,640 +convergence احنا ال convergence تعريفه binocular + +415 +00:30:22,640 --> 00:30:27,360 +العينتين هيتحركوا simultaneously في نفس اللحظة + +416 +00:30:28,070 --> 00:30:31,610 +inward او او او disjugate movement يعني حركة + +417 +00:30:31,610 --> 00:30:34,090 +خلفخلة في اليمين بتروح الشمال و الشمال بتروح + +418 +00:30:34,090 --> 00:30:37,810 +اليمين و هذا اللي عندي حصلت .. ليش سميته .. سميته + +419 +00:30:37,810 --> 00:30:41,290 +fusional convergence .. سميته fusional convergence + +420 +00:30:41,290 --> 00:30:46,830 +عشان بدونه بتمش ال fusion .. بدونه بتمش ال fusion + +421 +00:30:46,830 --> 00:30:50,400 +.. اذا هذا fusional convergenceفقط أنا عندي من + +422 +00:30:50,400 --> 00:30:53,480 +حركات ال .. ال .. ال fusion هي فقط ال fusional + +423 +00:30:53,480 --> 00:30:56,780 +convergence لأ بس احنا عشان موضوعنا ال convergence + +424 +00:30:56,780 --> 00:31:00,500 +عشان موضوعنا ال convergence فمن ضمن ال reflex + +425 +00:31:00,500 --> 00:31:03,220 +convergence اتكلمنا عن ال tonic convergence و + +426 +00:31:03,220 --> 00:31:07,140 +اتكلمنا عن ال proximal convergence و اتكلم .. + +427 +00:31:07,140 --> 00:31:10,540 +اتكلمنا هنا بنتكلم عن ال fusional convergence طيب + +428 +00:31:10,540 --> 00:31:13,920 +يعني في غير ال fusional convergence في fusional + +429 +00:31:13,920 --> 00:31:16,700 +divergence طبعا في fusional divergence .. في + +430 +00:31:16,700 --> 00:31:21,510 +fusional divergenceلو تخيلنا أنا عندى أنه ال base + +431 +00:31:21,510 --> 00:31:24,990 +بتاعة ال Prism هناو ال apex يعني ال prism جلبنا ال + +432 +00:31:24,990 --> 00:31:28,550 +base هنا و ال apex هنا ساعتها الصورة هتتنحرف + +433 +00:31:28,550 --> 00:31:31,370 +باتجاه ال base ال base صارت هنا إذا الصورة هتروح + +434 +00:31:31,370 --> 00:31:35,650 +نازل و هنا نفس الشيء خلنا قاعدة ال prism هنا هتروح + +435 +00:31:35,650 --> 00:31:41,050 +نازل إذا الصورة أصبحت نازل و نازل طيب هل النازل و + +436 +00:31:41,050 --> 00:31:43,930 +النازل corresponding لأ لأنه النازل هنا متجه في + +437 +00:31:43,930 --> 00:31:48,430 +الفرار بهذا الاتجاه و النازل هنا متجه بهذا الاتجاه + +438 +00:31:48,430 --> 00:31:52,620 +طيبإذا كان صارت الصورة هنا و صارت الصورة هنا + +439 +00:31:52,620 --> 00:31:56,300 +الفوفيا بتتحرك باتجاه الصورة و الفوفيا بتتحرك + +440 +00:31:56,300 --> 00:32:00,340 +باتجاه الصورة ساعتها هتكون الفوفيا بتتحرك نازلي و + +441 +00:32:00,340 --> 00:32:03,760 +الفوفيا بتتحرك نازلي إذا العنتين بتتحركوا ال + +442 +00:32:03,760 --> 00:32:07,920 +anterior بتتحرك لبرا و لبرا إيش الهدف؟ عشان تيجي + +443 +00:32:07,920 --> 00:32:12,010 +الفوفيا على منطقة الصورة و هذا بيسموهfusional + +444 +00:32:12,010 --> 00:32:17,430 +divergence وهذا مش موضوعنا اذا ايش ال stimulus هذا + +445 +00:32:17,430 --> 00:32:20,850 +سؤال ممكن ييجي في الامتحان ما هو المحفز ايش ال + +446 +00:32:20,850 --> 00:32:24,570 +stimulus لل fusional convergence ال fusional + +447 +00:32:24,570 --> 00:32:28,030 +convergence by temporal image disparity of the + +448 +00:32:28,030 --> 00:32:31,450 +image by temporal image disparity يعني لما الصورة + +449 +00:32:31,450 --> 00:32:35,330 +تقع temporal retina و temporal retinaع السريع + +450 +00:32:35,330 --> 00:32:40,490 +بيتحفز ال fusional convergence ع السريع بيتحفز ال + +451 +00:32:40,490 --> 00:32:44,670 +fusional convergence اذا ال fusional convergence + +452 +00:32:44,670 --> 00:32:50,330 +is an optomotor reflex optomotor reflex reflex + +453 +00:32:50,330 --> 00:32:57,030 +حركي عشان يتمدمج صورةحركي بصري عشان يتم دمش سورة + +454 +00:32:57,030 --> 00:33:02,210 +لازم العين تعدل من وضعها بعد تعديل وضعها بتم إسقاط + +455 +00:33:02,210 --> 00:33:05,830 +الصورتين على مناطق متماثلة من الشبكية يعني الفوفيا + +456 +00:33:05,830 --> 00:33:09,990 +و الفوفيا بعد هيك بتم ال fusion إذا هو optomotor + +457 +00:33:09,990 --> 00:33:14,170 +reflex which maintains the binocular single vision + +458 +00:33:14,170 --> 00:33:19,570 +كيف؟ by ensuring بإنه يأكدلي إن ال similar images + +459 +00:33:19,570 --> 00:33:22,670 +are projected موجودة + +460 +00:33:28,890 --> 00:33:35,000 +الصور التي تلعب بها الانتنجاية ومخصصة الانتجايةعلى + +461 +00:33:35,000 --> 00:33:38,760 +corresponding retinal areas لن يتم دمجها في صورة + +462 +00:33:38,760 --> 00:33:43,740 +واحدة لن يتم دمجها في صورة واحدة it is initiated + +463 +00:33:43,740 --> 00:33:48,000 +يعني المحفز لل fusion ال convergence هو ال by + +464 +00:33:48,000 --> 00:33:51,520 +temporal image disparity by temporal image + +465 +00:33:51,520 --> 00:33:56,390 +disparity هنتوقف عند هذه النقطة ان شاء الله تعالىو + +466 +00:33:56,390 --> 00:34:01,690 +هنستكمل المرة القادمة مع النوع الرابع من أنواع ال + +467 +00:34:01,690 --> 00:34:05,850 +reflex convergence و يعطيكم العافية والسلام عليكم + +468 +00:34:05,850 --> 00:34:07,690 +ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/lZMD6JQedTc_raw.json b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/lZMD6JQedTc_raw.json new file mode 100644 index 0000000000000000000000000000000000000000..2444245d856cd9dd29ba64e70503b17512fb786e --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/lZMD6JQedTc_raw.json @@ -0,0 +1 @@ +{"segments": [{"id": 1, "seek": 2965, "start": 1.53, 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accommodation", "probability": 0.8720703125}, {"start": 784.22, "end": 784.86, "word": " و", "probability": 0.982421875}, {"start": 784.86, "end": 785.44, "word": " meiosis", "probability": 0.777099609375}, {"start": 785.44, "end": 785.8, "word": " و", "probability": 0.9951171875}, {"start": 785.8, "end": 786.36, "word": " convergence", "probability": 0.97509765625}], "temperature": 1.0}, {"id": 35, "seek": 81252, "start": 787.22, "end": 812.52, "text": "أنا بديش يعمل accommodation عشان مايعملش accommodative convergence ومع ذلك لو فحصنا المريض على هذا الجهاز هنلاقيه بيعمل شوية convergence إيش سبب هذا ال convergence؟ هل هو ال accommodation؟ طبعاً لأ لأن أنا لغي ال accommodation بواسطة العدسات ال plus 6.5 اللي حطيتها طيب إيش سبب ال convergence هذا؟", "tokens": [10721, 8315, 4724, 16254, 8592, 7251, 25957, 1211, 27363, 6225, 8592, 7649, 19446, 1829, 25957, 1211, 8592, 11713, 1166, 32181, 4032, 2304, 3615, 29910, 23275, 45164, 6156, 5016, 9381, 8315, 9673, 16572, 11242, 15844, 23758, 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على عينك و ارخي حالك تمام الا انه عنده ذهنيا في عقله الباطن انه الجهاز حجمه صغير معناته الصورة قريبة .. معناته الصورة قريبة", "tokens": [35457, 3555, 2423, 32181, 8608, 3555, 3555, 8717, 36178, 1829, 4386, 8608, 3555, 3555, 8717, 36178, 1829, 4724, 35457, 3555, 16472, 3224, 41950, 5172, 1211, 1975, 2407, 2423, 7649, 3794, 7649, 5296, 15042, 12174, 995, 22488, 15844, 25724, 3224, 31377, 23758, 12602, 17082, 2304, 16472, 1829, 1975, 8315, 13412, 2288, 33753, 43761, 16472, 3224, 37495, 22653, 3714, 9307, 8592, 3215, 8592, 15844, 11331, 6027, 4117, 4032, 1975, 2288, 9778, 1829, 4386, 3714, 9307, 8592, 3215, 8592, 15844, 6225, 9957, 4117, 4032, 1975, 2288, 9778, 1829, 11331, 6027, 4117, 46811, 10943, 42963, 16472, 3224, 43242, 3224, 29910, 3224, 22653, 995, 8978, 6225, 4587, 43761, 29739, 41193, 1863, 16472, 3224, 25724, 3224, 31377, 11331, 7435, 2304, 3224, 20328, 17082, 13546, 20449, 8315, 47395, 31767, 13063, 3660, 12174, 16572, 49401, 4386, 20449, 8315, 47395, 31767, 13063, 3660, 12174, 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convergence بنقول هو ال convergence .. هو ال convergence المرتبط بقضية ال fusion طيب ال fusion .. ال fusion اللي هو دمج صورتين في صورة واحدة احنا حكينا انه الدماغ", "tokens": [40228, 22653, 2423, 32181, 9673, 43500, 3555, 9566, 8978, 12174, 11242, 10632, 2423, 23100, 4386, 9673, 43500, 3555, 9566, 4724, 4587, 11242, 10632, 2423, 23100, 4032, 3615, 8592, 7649, 8717, 5016, 4117, 1829, 18871, 2423, 23100, 2423, 32181, 44945, 39648, 31439, 2423, 32181, 4386, 31439, 2423, 32181, 9673, 43500, 3555, 9566, 4724, 4587, 11242, 10632, 2423, 23100, 23032, 1829, 3555, 2423, 23100, 4386, 2423, 23100, 13672, 1829, 31439, 11778, 2304, 7435, 20328, 13063, 2655, 9957, 8978, 20328, 13063, 3660, 36764, 24401, 3660, 1975, 5016, 8315, 11331, 4117, 1829, 8315, 16472, 3224, 32748, 2304, 5718, 118], "avg_logprob": -0.09423828450962901, "compression_ratio": 2.2285714285714286, "no_speech_prob": 1.9669532775878906e-06, "words": [{"start": 892.97, "end": 893.37, "word": "يعني", "probability": 0.959228515625}, 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0.9254150390625}, {"start": 1821.74, "end": 1822.64, "word": " binocular", "probability": 0.9358723958333334}, {"start": 1822.64, "end": 1823.32, "word": " العينتين", "probability": 0.901611328125}, {"start": 1823.32, "end": 1825.38, "word": " هيتحركوا", "probability": 0.87900390625}, {"start": 1825.38, "end": 1826.02, "word": " simultaneously", "probability": 0.1748046875}, {"start": 1826.02, "end": 1826.5, "word": " في", "probability": 0.9677734375}, {"start": 1826.5, "end": 1826.74, "word": " نفس", "probability": 0.996826171875}, {"start": 1826.74, "end": 1827.36, "word": " اللحظة", "probability": 0.995849609375}], "temperature": 1.0}, {"id": 81, "seek": 184867, "start": 1828.07, "end": 1848.67, "text": "inward او او او disjugate movement يعني حركة خلفخلة في اليمين بتروح الشمال و الشمال بتروح اليمين و هذا اللي عندي حصلت .. ليش سميته .. سميته fusional convergence .. سميته fusional convergence عشان بدونه بتمش ال fusion .. بدونه بتمش ال fusion .. اذا هذا fusional convergence", "tokens": [259, 1007, 1975, 2407, 1975, 2407, 1975, 2407, 717, 42068, 473, 3963, 37495, 22653, 11331, 31747, 3660, 16490, 46538, 9778, 37977, 8978, 2423, 32640, 9957, 39894, 32887, 5016, 25124, 2304, 6027, 4032, 25124, 2304, 6027, 39894, 32887, 5016, 2423, 32640, 9957, 4032, 23758, 13672, 1829, 18871, 16254, 11331, 36520, 2655, 4386, 32239, 8592, 8608, 2304, 36081, 3224, 4386, 8608, 2304, 36081, 3224, 23100, 304, 32181, 4386, 8608, 2304, 36081, 3224, 23100, 304, 32181, 6225, 8592, 7649, 47525, 11536, 3224, 39894, 2304, 8592, 2423, 23100, 4386, 47525, 11536, 3224, 39894, 2304, 8592, 2423, 23100, 4386, 1975, 15730, 23758, 23100, 304, 32181], "avg_logprob": -0.19245048855790997, "compression_ratio": 2.00507614213198, "no_speech_prob": 5.960464477539062e-07, "words": [{"start": 1828.07, "end": 1828.91, "word": "inward", "probability": 0.94482421875}, {"start": 1828.91, "end": 1829.23, "word": " او", "probability": 0.668212890625}, {"start": 1829.23, "end": 1829.47, "word": " او", 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fusion هي فقط ال fusional convergence لأ بس احنا عشان موضوعنا ال convergence عشان موضوعنا ال convergence فمن ضمن ال reflex convergence اتكلمنا عن ال tonic convergence و اتكلمنا عن ال proximal convergence و اتكلم .. اتكلمنا هنا بنتكلم عن ال fusional convergence طيب يعني في غير ال fusional convergence في fusional divergence طبعا في fusional divergence .. في fusional divergence", "tokens": [5172, 47432, 41850, 18871, 16254, 9154, 11331, 31747, 9307, 2423, 4386, 2423, 4386, 2423, 23100, 39896, 6156, 47432, 2423, 34326, 1966, 32181, 5296, 10721, 4724, 3794, 1975, 5016, 8315, 6225, 8592, 7649, 3714, 2407, 11242, 45367, 8315, 2423, 32181, 6225, 8592, 7649, 3714, 2407, 11242, 45367, 8315, 2423, 32181, 6156, 27842, 48812, 27842, 2423, 23802, 32181, 1975, 2655, 4117, 19528, 8315, 18871, 2423, 2952, 299, 32181, 4032, 1975, 2655, 4117, 19528, 8315, 18871, 2423, 21932, 304, 32181, 4032, 1975, 2655, 4117, 19528, 4386, 1975, 2655, 4117, 19528, 8315, 34105, 44945, 2655, 4117, 19528, 18871, 2423, 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a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/mH4L_ov9QU4.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/mH4L_ov9QU4.srt new file mode 100644 index 0000000000000000000000000000000000000000..26a865a5b795ba25ea939e414889fa3950364389 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/mH4L_ov9QU4.srt @@ -0,0 +1,1214 @@ +1 +00:00:05,110 --> 00:00:09,890 +بسم الله الرحمن الرحيم نستكمل + +2 +00:00:09,890 --> 00:00:14,350 +محاضرات حول واحد ووصلنا عند تعريف ال visual + +3 +00:00:14,350 --> 00:00:19,030 +direction أو الاتجاه البصري is the projection of a + +4 +00:00:19,030 --> 00:00:22,030 +given retinal element in a specific direction in + +5 +00:00:22,030 --> 00:00:25,750 +the subjective space الـ subjective space أو الـ + +6 +00:00:25,750 --> 00:00:32,080 +space بتاع الشخص بتاع شخص ما يعني الفراغ المحيط بشخص + +7 +00:00:32,080 --> 00:00:35,980 +ما بيسمّوه الـ subjective space لهذا الشخص الفراغ + +8 +00:00:35,980 --> 00:00:45,000 +أو الحقل الإبصاري المحيط بـ .. أو الذي أمام شخص ما + +9 +00:00:45,000 --> 00:00:49,200 +بيسمّوه الـ subjective space بتاع هذا الشخص يعني الـ + +10 +00:00:49,200 --> 00:00:54,710 +.. الـ .. الشيء اللي بيتطلّع عليه من هذه الدنيا + +11 +00:00:54,710 --> 00:00:59,030 +بنقصد بـ visual direction معناته الاتجاه البصري، + +12 +00:00:59,030 --> 00:01:04,190 +اتجاه نقطة ما من الشبكية في الفراغ، في عندي نقطة + +13 +00:01:04,190 --> 00:01:06,930 +سين، في عندي الفوفيا، في عندي نقطة سات، في نقطة + +14 +00:01:06,930 --> 00:01:10,830 +عين إلى أخرى، نقاط الشبكية، كل نقطة في الشبكية + +15 +00:01:10,830 --> 00:01:15,650 +إلها اتجاه ما في الفراغ، هذا الاتجاه في الفراغ + +16 +00:01:15,650 --> 00:01:19,670 +بيسمّوه الـ visual direction لهذه النقطة .. لهذه + +17 +00:01:19,670 --> 00:01:23,890 +النقطة أو الاتجاه البصري لهذه النقطة بمعنى أنّه لو + +18 +00:01:23,890 --> 00:01:29,600 +اعترض هذا الاتجاه object ما في الفراغ جاي على الخط + +19 +00:01:29,600 --> 00:01:32,500 +أو جاي على الـ visual direction هتسقط صورته على هذه + +20 +00:01:32,500 --> 00:01:36,900 +النقطة أو هذه المنطقة في عند العلماء بيميزوا بين + +21 +00:01:36,900 --> 00:01:40,500 +شغلتين في principal visual direction وفي secondary + +22 +00:01:40,500 --> 00:01:43,760 +visual direction يعني في عندي principal visual + +23 +00:01:43,760 --> 00:01:48,060 +direction وفي عندي secondary visual direction طبعًا + +24 +00:01:48,060 --> 00:01:51,560 +الـ principle visual direction is the direction in + +25 +00:01:51,560 --> 00:01:56,540 +external space interpreted as the line of sight + +26 +00:01:56,540 --> 00:02:02,680 +يعني هذا الـ principle visual direction هو الاتجاه + +27 +00:02:02,680 --> 00:02:07,920 +.. اتجاه معيّن في الفراغ اللي بيعبر عنه الشخص أو .. + +28 +00:02:07,920 --> 00:02:12,080 +أو بنعبر عنه بإنّه هو خط الإبصار بمعنى الإنسان بيتطلّع + +29 +00:02:12,080 --> 00:02:16,920 +بالـ principle visual direction أو الـ visual axis + +30 +00:02:16,920 --> 00:02:22,250 +اللي عرفناه في أوّل محاضرة هو جاي على نفس خط الـ line + +31 +00:02:22,250 --> 00:02:25,310 +of sight أو على نفس خط الـ principle visual + +32 +00:02:25,310 --> 00:02:29,470 +direction وهذا طبعًا في الطبيعي this is normally + +33 +00:02:29,470 --> 00:02:33,470 +the visual direction of the fovea لما بنقول this + +34 +00:02:33,470 --> 00:02:36,310 +is normally the visual direction of the fovea + +35 +00:02:36,310 --> 00:02:39,750 +معناته هذا في الأمور أو في الوضع الطبيعي لما يكون + +36 +00:02:39,750 --> 00:02:44,370 +الإنسان ما عنده مرض الـ principle visual direction + +37 +00:02:44,370 --> 00:02:49,080 +هو نفسه الـ visual direction بتاع الفوفيا لأنّ + +38 +00:02:49,080 --> 00:02:52,480 +الفوفيا حتكون إلها الـ principle visual direction + +39 +00:02:52,480 --> 00:02:57,300 +and is associated with a sense of direct viewing + +40 +00:02:57,300 --> 00:03:01,680 +يعني الـ principle visual direction لو إجا object + +41 +00:03:01,680 --> 00:03:05,740 +على خط الـ principle visual direction على الاتجاه + +42 +00:03:05,740 --> 00:03:09,480 +الأساسي للنظر اللي هو منطلق من الفوفيا لو إجا + +43 +00:03:09,480 --> 00:03:13,600 +object في الطريق هتسقط صورته على الفوفيا لو طلبنا + +44 +00:03:13,600 --> 00:03:18,530 +من هذا الإنسان وقلنا له اتطلّع على هذا الـ object أو + +45 +00:03:18,530 --> 00:03:22,410 +هذا الـ target مباشرة، هيكون الجواب فورًا مما أنا + +46 +00:03:22,410 --> 00:03:26,490 +بتطلّع عليه مباشرة، بمعنى بيعطيني إحساس بأنّ أنا + +47 +00:03:26,490 --> 00:03:32,490 +قاعد بتطلّع على الشيء المعيّن بشكل مباشر، مش بزاوية + +48 +00:03:32,490 --> 00:03:36,830 +أو مش بجانب، مش بجانب، يعني بتطلّع عليه بشكل مباشر + +49 +00:03:37,010 --> 00:03:40,270 +إذا الـ principle visual direction في الطبيعي هو الـ + +50 +00:03:40,270 --> 00:03:44,010 +visual direction بتاع الفوفيا ويبقى the sense of + +51 +00:03:44,010 --> 00:03:47,390 +direct viewing .. of direct viewing لما بنقول + +52 +00:03:47,390 --> 00:03:51,770 +normally .. لما بنقول normally معناته في abnormal + +53 +00:03:51,770 --> 00:03:57,030 +situation .. abnormal situation بتكون الفوفيا فقدت + +54 +00:03:57,030 --> 00:04:01,890 +مكانها و بطل الـ principle visual direction هو الـ + +55 +00:04:01,890 --> 00:04:05,150 +visual direction في الفراغ تاع الفوفيا وإنّما + +56 +00:04:05,150 --> 00:04:10,610 +بتكون نقطة أخرى من الشبكية أصبح لها الـ principle + +57 +00:04:10,610 --> 00:04:16,110 +visual direction لأنّها من قبل الدماغ أصبحت الفوفيا + +58 +00:04:16,110 --> 00:04:22,080 +خاملة لا تعمل sub rest وأصبح في عندي extrafovial + +59 +00:04:22,080 --> 00:04:26,040 +area بيسمّوها الـ pseudophobia أصبح إلها هي الـ + +60 +00:04:26,040 --> 00:04:30,000 +principle visual direction ولو سقط target في + +61 +00:04:30,000 --> 00:04:34,560 +الفراغ على هذه الـ pseudophobia ساعتها الإنسان بيحس + +62 +00:04:34,560 --> 00:04:37,740 +بالـ .. بالرؤية المباشرة أو أنّه بيتطلّع في الشغل + +63 +00:04:37,740 --> 00:04:43,430 +مباشر حتّى لو كان فعلًا هو مش الاتجاه بتاع الفوفيا، + +64 +00:04:43,430 --> 00:04:47,050 +إذا هذا طبعًا الكلام في الوضع الغير طبيعي أو الوضع + +65 +00:04:47,050 --> 00:04:50,290 +المرضي، أما في الوضع الطبيعي الـ principle visual + +66 +00:04:50,290 --> 00:04:53,570 +direction is the direction in external space + +67 +00:04:53,570 --> 00:04:59,110 +interpreted as the line of sight هو نفسه الاتجاه + +68 +00:04:59,110 --> 00:05:02,970 +اللي إحنا بنعبر عنه وبنقول عنه أنّه خط الإبصار + +69 +00:05:02,970 --> 00:05:07,840 +يعني الإنسان وين بيتطلّع بشكل مباشر This is normally + +70 +00:05:07,840 --> 00:05:11,180 +the visual direction of the fovea and is + +71 +00:05:11,180 --> 00:05:15,000 +associated with a sense of direct viewing وهذا + +72 +00:05:15,000 --> 00:05:18,400 +الكلام هنوضّحه في الرسمة التالية بس بدنا نحكي في + +73 +00:05:18,400 --> 00:05:21,400 +الأوّل عن الـ secondary visual direction الـ + +74 +00:05:21,400 --> 00:05:24,160 +secondary visual directions are the projecting + +75 +00:05:24,160 --> 00:05:28,100 +directions of extra foveal points with respect to + +76 +00:05:28,100 --> 00:05:31,120 +the principal visual direction of the fovea + +77 +00:05:31,120 --> 00:05:36,480 +associated with indirect or eccentric view يعني أيّ + +78 +00:05:36,480 --> 00:05:40,420 +اتجاه آخر .. أيّ اتجاه آخر غير الـ principle visual + +79 +00:05:40,420 --> 00:05:44,240 +direction يُعتبر secondary visual direction طيّب إيش + +80 +00:05:44,240 --> 00:05:47,860 +همّ الاتجاهات الأخرى؟ هي اتجاهات باقي نقاط الشبكية + +81 +00:05:47,860 --> 00:05:53,360 +باقي نقاط الشبكية اتجاهاتها طبعًا تختلف .. + +82 +00:05:53,360 --> 00:05:57,340 +اتجاهاتها في الفراغ تختلف عن اتجاه الفوفيا + +83 +00:05:57,340 --> 00:06:02,860 +وبالتالي تُعتبر secondary visual directions وبتعطي + +84 +00:06:02,860 --> 00:06:07,090 +شعور بالرؤية غير المباشرة ممكن انسان يقول طب + +85 +00:06:07,090 --> 00:06:10,850 +الموضوع اللي أنا اختلطت عليه، بنقول له لأ ما اختلط، + +86 +00:06:10,850 --> 00:06:15,390 +الإنسان هو بيتطلّع بالفوفيا، وهو بيتطلّع بالفوفيا على + +87 +00:06:15,390 --> 00:06:19,910 +target ما نفرض شمعة، وفي جنب هذا الـ target أو + +88 +00:06:19,910 --> 00:06:25,460 +بعيد عنه قليلًا، target آخر يعني مثلًا صندوق الشمعة + +89 +00:06:25,460 --> 00:06:29,080 +حيطلّع عليها معناته بيتطلّع عليها بالـ line of sight + +90 +00:06:29,080 --> 00:06:33,200 +أو بيتطلّع عليها بالـ principle visual direction ولو + +91 +00:06:33,200 --> 00:06:36,600 +سألناه أنت بتطلّع على الشمعة حيقول أنا بتطلّع على + +92 +00:06:36,600 --> 00:06:42,650 +الشمعة بشكل مباشر، الآن في نفس الوقت في نفس الوقت + +93 +00:06:42,650 --> 00:06:47,130 +لو قلنا له أنت بتطلّع على الشمعة وأنت بتطلّع على + +94 +00:06:47,130 --> 00:06:50,270 +الشمعة ومركز في الشمعة شايف حاجة ثانية غير + +95 +00:06:50,270 --> 00:06:54,030 +الشمعة، حيقول طبعًا أنا وأنا بتطلّع على الشمعة، + +96 +00:06:54,030 --> 00:06:57,250 +شايف الصندوق، بس شايفه بشكل غير مباشر، إيش يعني + +97 +00:06:57,250 --> 00:07:02,150 +شايفه بشكل غير مباشر؟ شايفه بشكل أنّ أنا مش مركز + +98 +00:07:02,150 --> 00:07:06,090 +فيه، هو أنا مركز في الشمعة وهو جاي يعني في نفس + +99 +00:07:06,090 --> 00:07:10,430 +الصورة أو في نفس حقل الإبصار بس يعني جاي بشكل جانب + +100 +00:07:10,430 --> 00:07:13,990 +من الشمعة، جانب لليمين، للشمال، لفوق، لتحت، إذا + +101 +00:07:13,990 --> 00:07:17,990 +هو مش جاي .. أنا .. أنا مش موجه نظري له، أنا موجه + +102 +00:07:17,990 --> 00:07:23,810 +نظري للشمعة وهو ظاهر بشكل غير مباشر في حقل + +103 +00:07:23,810 --> 00:07:27,660 +الإبصار بتاعي إيش يعني بشكل غير مباشر؟ يعني النظر + +104 +00:07:27,660 --> 00:07:31,980 +مش مركز عليه وإنّما هو جاي لجانب من الشيء أو .. أو + +105 +00:07:31,980 --> 00:07:36,420 +لـ .. بعيد قليلًا أو كثيرًا عن الشيء اللي أنا بمركز + +106 +00:07:36,420 --> 00:07:43,520 +فيه الرسم التالي حتوضّح الأمر بشكل أفضل، بنقول هي + +107 +00:07:43,520 --> 00:07:48,220 +عندنا الفوفيا، هي اتجاه الفوفيا في الفراغ إحنا + +108 +00:07:48,220 --> 00:07:52,700 +بنحكي عن عين طبيعي، هذا اتجاه الفوفيا في الفراغ، + +109 +00:07:52,700 --> 00:07:56,720 +بيسمّوه principal visual direction، إله اسم ثاني + +110 +00:07:56,720 --> 00:08:02,920 +line of sight صورة الشجرة هنا حتقع على الـ phobia + +111 +00:08:02,920 --> 00:08:07,260 +لأنّها جاية على طريق أو على خط الـ principle visual + +112 +00:08:07,260 --> 00:08:11,640 +direction لو سألنا الإنسان صاحب هذه العين قلنا له + +113 +00:08:11,640 --> 00:08:17,240 +أنت يعني كيف شايف الشجرة؟ بجانب أنت شايفها يعني؟ + +114 +00:08:17,240 --> 00:08:20,580 +ولا أنت بتطلّع فيها مباشر؟ الجواب الطبيعي هيكون أنا + +115 +00:08:20,580 --> 00:08:25,200 +بتطلّع فيها مباشر وجاي عاجب بالي مباشرة في نفس + +116 +00:08:25,200 --> 00:08:29,610 +اللحظة اللي هذا الشخص أو هذه العين بتطلّع على الشجرة + +117 +00:08:29,610 --> 00:08:39,350 +في عندي two targets مثلث فوق وجسم بيضاوي أو شكل + +118 +00:08:39,350 --> 00:08:45,890 +بيضاوي في الأسفل اتجاه هذا الشكل البيضاوي هو صحيح + +119 +00:08:45,890 --> 00:08:50,350 +في الأسفل بس مقارنة مع العين صورته حتسقط .. باتجاه + +120 +00:08:50,350 --> 00:08:54,930 +العين حتسقط على superior retina الآن إحنا مش هذا + +121 +00:08:54,930 --> 00:08:58,190 +اللي بدّنا إياه، بدّنا العكس، بنقول المنطقة high من + +122 +00:08:58,190 --> 00:09:01,950 +الشبكية أو النقطة scene أو الـ area scene، المساحة + +123 +00:09:01,950 --> 00:09:04,890 +من الشبكية اللي جاية في الـ superior retina الـ + +124 +00:09:04,890 --> 00:09:10,660 +visual direction بتاعها إيش؟ جاية للأسفل وعندي مثلث + +125 +00:09:10,660 --> 00:09:15,760 +فوق في الفراغ حقيقة هو موجود في .. في العالم + +126 +00:09:15,760 --> 00:09:19,280 +الخارجي موجود فوق .. فوق الشجرة وفوق الجسم + +127 +00:09:19,280 --> 00:09:23,940 +البيضاوي بس صورته حتسقط على inferior retina إحنا + +128 +00:09:23,940 --> 00:09:28,240 +بدّنا عكس ذلك يعني بمعنى آخر لو سألنا أين تتجه نقاط + +129 +00:09:28,240 --> 00:09:31,580 +الشبكية اللي جاية في الـ inferior retina حتتجه + +130 +00:09:31,580 --> 00:09:35,620 +superiorly الـ visual direction بتاعها superiorly + +131 +00:09:35,620 --> 00:09:39,160 +إذا الـ inferior retina موجهة superiorly الـ + +132 +00:09:39,160 --> 00:09:43,060 +visual direction بتاع نقاطها superiorly والـ .. + +133 +00:09:43,060 --> 00:09:46,000 +الـ visual direction بتاع الـ superior retina + +134 +00:09:46,000 --> 00:09:49,960 +inferiorly على كده الحالين أنّ الـ superior retina + +135 +00:09:49,960 --> 00:09:53,940 +بتبص للأسفل والـ inferior retina بتبص للأعلى على + +136 +00:09:53,940 --> 00:09:59,550 +كده الحالين وهذه العين مركّزة في الشجرة لو سألنا + +137 +00:09:59,550 --> 00:10:03,530 +صاحب هذه العين كيف شايف المثلث، بشكل مباشر ولا غير + +138 +00:10:03,530 --> 00:10:07,830 +مباشر، هيكون الجواب وأنا بطلّع .. وأنا بطلّع + +139 +00:10:07,830 --> 00:10:13,010 +الشجرة، المثلث ظاهر عندي، بس بشكل غير مباشر، و .. + +140 +00:10:13,010 --> 00:10:18,010 +وأنا بطلّع .. على الشجرة أيضًا الجسم البيضاوي أو + +141 +00:10:18,010 --> 00:10:22,710 +الشكل البيضاوي ظاهر عندي بس بشكل غير مباشر يعني إيش + +142 +00:10:22,710 --> 00:10:26,710 +يعني بشكل غير مباشر يعني ما بطلّعش فيه بشكل يعني + +143 +00:10:26,710 --> 00:10:31,790 +مباشر وما بركّزش النظر فيه وإنّما أنا مركز في الشجرة + +144 +00:10:31,790 --> 00:10:35,850 +اتجاه نقاط الشبكية في الفراغ سواء الفوفيا أو غيرها + +145 +00:10:35,850 --> 00:10:40,190 +اتجاه نقاط الشبكية في الفراغ يُسمّى الـ visual + +146 +00:10:40,190 --> 00:10:45,200 +direction وجسم الـ principal visual direction + +147 +00:10:45,200 --> 00:10:47,540 +اللي هو الـ visual direction بتاع الفوفيا فيه في + +148 +00:10:47,540 --> 00:10:52,340 +الوضع الطبيعي وبيعطي sense of direct viewing بينما + +149 +00:10:52,340 --> 00:10:55,660 +الـ secondary visual direction هو اتجاه باقي نقاط + +150 +00:10:55,660 --> 00:10:59,640 +الشبكية كلّها، ما عدا الفوفيا، يعني هذا يُعتبر + +151 +00:10:59,640 --> 00:11:02,220 +secondary visual direction، هذا يُعتبر secondary + +152 +00:11:02,220 --> 00:11:05,340 +visual direction، هذا اللي في الـ temporal retina واللي + +153 +00:11:05,340 --> 00:11:08,200 +في الـ nasal retina، كلّها تُعتبر secondary + +154 +00:11:08,200 --> 00:11:11,910 +visual directions ما عدا direction واحد في الفراغ + +155 +00:11:11,910 --> 00:11:15,130 +اللي هو direction الفوفيا في الوضع الطبيعي .. في + +156 +00:11:15,130 --> 00:11:19,930 +الوضع الطبيعي وهذا + +157 +00:11:19,930 --> 00:11:23,570 +هو طبعًا الـ principle والـ secondary visual + +158 +00:11:23,570 --> 00:11:30,390 +direction نيجي للتعريف الثاني متعلّق جدًّا بموضوع الـ + +159 +00:11:30,390 --> 00:11:35,050 +visual direction واسمه الـ projection إيش الفرق بين + +160 +00:11:35,050 --> 00:11:43,110 +الـ visual direction وبين الـ projection طبعًا الـ + +161 +00:11:43,110 --> 00:11:46,870 +visual direction زي ما حكينا اتجاه نقاط الشبكية + +162 +00:11:46,870 --> 00:11:53,550 +اتجاه نقاط الشبكية في الفراغ اتجاه نقاط الشبكية في + +163 +00:11:53,550 --> 00:11:57,750 +الفراغ الفوفيا في الوضع الطبيعي اتجاهها مباشرة على + +164 +00:11:57,750 --> 00:12:01,930 +الـ target اللي بتطلّع عليه superior retina أسفل الـ + +165 +00:12:01,930 --> 00:12:05,270 +target متجهة في الفراغ أسفل الـ target اللي الإنسان + +166 +00:12:05,270 --> 00:12:11,320 +بتطلّع عليه superior retina نقاطها كلّها متجهة للأسفل + +167 +00:12:11,320 --> 00:12:15,680 +الـ inferior retina نقاطها كلّها متجهة للأعلى الـ + +168 +00:12:15,680 --> 00:12:19,420 +temporal retina متجهة nasally والـ nasal retina + +169 +00:12:19,420 --> 00:12:22,920 +متجهة temporally كلّها اتجاهات في الفراغ لنقاط + +170 +00:12:22,920 --> 00:12:29,100 +الشبكية لنقاط الشبكية الـ only projection تعبير + +171 +00:12:29,100 --> 00:12:35,700 +الشخص صاحب الرؤية أو صاحب العين عن موقع الشيء في + +172 +00:12:35,700 --> 00:12:43,840 +الفراغ استنادًا .. استنادًا لسقوط صورة هذا الشيء على + +173 +00:12:43,840 --> 00:12:50,030 +منطقة من الشبكية إلها اتجاه معيّن في الفراغ نُعيد + +174 +00:12:50,030 --> 00:12:55,750 +بنقول الـ projection عبارة عن التعبير الشخصي للشخص + +175 +00:12:55,750 --> 00:13:00,410 +صاحب العين أو صاحب الرؤية تعبيره الشخصي عن موقع + +176 +00:13:00,410 --> 00:13:05,010 +الشيء في الفراغ استنادًا لاتجاه النقطة اللي سقط + +177 +00:13:05,010 --> 00:13:08,310 +عليها صورة الشيء في الشبكية اتجاه هذه النقطة في + +178 +00:13:08,310 --> 00:13:14,390 +الفراغ نيجي إحنا هذا التعريف نفسرّه بنقول هذا شخص + +179 +00:13:14,390 --> 00:13:20,570 +ما، هذه عين شخص ما وإحنا قلنا لو أنت بتطلّع على + +180 +00:13:20,570 + +201 +00:14:54,500 --> 00:14:59,400 +في الفرق للأسفل هو صحيح superior retina بس بيبص على + +202 +00:14:59,400 --> 00:15:02,920 +الجزء الأسفل من ال visual field فال subjective + +203 +00:15:02,920 --> 00:15:07,760 +interpretation of the position of an object in + +204 +00:15:07,760 --> 00:15:12,980 +space معتمدا عليه on the basis of the stimulated + +205 +00:15:12,980 --> 00:15:17,760 +retinal elements أي جسم موجود في الفراغ، لو قلنا + +206 +00:15:17,760 --> 00:15:24,280 +لشخص عبّر عنه وين موقعه في الفراغ، هيعبّر عنه بناء + +207 +00:15:24,280 --> 00:15:29,480 +على إن صورته سقطت على مكان ما من ال retina و هذا + +208 +00:15:29,480 --> 00:15:33,080 +المكان ما من ال retina، إله اتجاه معين في الفراغ + +209 +00:15:33,080 --> 00:15:39,180 +إذا المكان ما من ال retina اتجاهه + +210 +00:15:39,180 --> 00:15:43,230 +في الفراغ للأسفل هذا الشخص هيعبّر يقول أنا شايف هذا + +211 +00:15:43,230 --> 00:15:47,950 +ال target للأسفل، إذا المكان ما من ال retina متجه + +212 +00:15:47,950 --> 00:15:53,210 +للأعلى، هيقول أنا شايفه للأعلى، إذا المكان ما من + +213 +00:15:53,210 --> 00:15:58,130 +ال retina اللي سقطت عليه صورة ال target جاي في ال + +214 +00:15:58,130 --> 00:16:02,010 +nasal retina واتجاهه temporal، هيقول والله أنا + +215 +00:16:02,010 --> 00:16:06,750 +شايفه جاي temporal، جاي temporal، يعني بتوضح الآن + +216 +00:16:06,750 --> 00:16:10,810 +بالنسبة لل superior و ال inferior projection + +217 +00:16:10,810 --> 00:16:15,650 +الصورة هذه بتوضحه .. طب ال nasal و ال temporal في + +218 +00:16:15,650 --> 00:16:20,670 +مثال آخر .. احنا بنقول هذه العين بتطلع straight + +219 +00:16:20,670 --> 00:16:23,930 +ahead على ال target الأحمر .. على ال target الأحمر + +220 +00:16:23,930 --> 00:16:30,020 +.. لو طلعنا عرض مكبر .. بنقول هذه العين يعني .. + +221 +00:16:30,020 --> 00:16:34,220 +يعني معتادلة .. يعني بتبتطلع للأمام صورة ال target + +222 +00:16:34,220 --> 00:16:40,000 +الأحمر .. صورة ال target الأحمر بتسقط على الفوفيا + +223 +00:16:40,000 --> 00:16:44,180 +.. صورة ال target الأحمر بتسقط على الفوفيا صاحب + +224 +00:16:44,180 --> 00:16:47,000 +هذه العين .. بنقوله عبر عن ال target الأحمر وين + +225 +00:16:47,000 --> 00:16:49,820 +جاي بالنسبة لك .. هيقول أنا جاي بالنسبة لي مباشر + +226 +00:16:49,820 --> 00:16:54,640 +عيني .. مباشر مقابلي في نفس اللحظة .. هو بتطلع + +227 +00:16:56,190 --> 00:17:01,050 +على ال target الأحمر يوجد target آخر أسود هذا ال + +228 +00:17:01,050 --> 00:17:05,710 +target موجود في مكان ما من الفرارة صورة ال target + +229 +00:17:05,710 --> 00:17:09,110 +هذا تسقط على ال temporal retina طالما هي ال + +230 +00:17:09,110 --> 00:17:13,530 +temporal retina رمز لها بحرف ال T معناته هي ال + +231 +00:17:13,530 --> 00:17:16,890 +nasal retina ال temporal retina معروف إنها بتبص في + +232 +00:17:16,890 --> 00:17:19,630 +الفرارة أو ال visual direction تعني قطعها nasal + +233 +00:17:19,630 --> 00:17:25,340 +عكسها بتبص بالفراغ نازلي، لو قلنا لهذا الشخص عبّر + +234 +00:17:25,340 --> 00:17:30,240 +على ال target الأسودي، أين يقع بالنسبة له، هيحكي + +235 +00:17:30,240 --> 00:17:34,020 +نازلي أو هيقشر باتجاه ال nasal side، هذا بالنسبة + +236 +00:17:34,020 --> 00:17:37,300 +لعين واحدة، هذا بالنسبة لعين واحدة، و هو مغمض + +237 +00:17:37,300 --> 00:17:40,620 +العين الثانية، و هو مغمض العين الثانية، طيب لو + +238 +00:17:40,620 --> 00:17:45,550 +قلنا له يفتح عينيتين الثانية لو قلنا له يفتح عينيه + +239 +00:17:45,550 --> 00:17:48,530 +التنتين هي عينيه التنتين هو بتطلع في ال target + +240 +00:17:48,530 --> 00:17:53,230 +الأحمر صورة ال target الأحمر تسقط على الفوفيا في + +241 +00:17:53,230 --> 00:17:56,190 +ال right eye أفرض أنه هي ال right eye وتسقط على + +242 +00:17:56,190 --> 00:18:00,410 +الفوفيا في ال left eye لو قلنا له بعينيك التنتين + +243 +00:18:00,410 --> 00:18:03,470 +عبّر لنا عن ال target الأحمر وين شايفه؟ هيقول شايفه + +244 +00:18:03,470 --> 00:18:08,610 +مقابلي مباشر مقابلي مباشر يعني ال projection بتاعه + +245 +00:18:08,610 --> 00:18:13,670 +أنه straight ahead في نفس اللحظة اللي هذا الشخص + +246 +00:18:13,670 --> 00:18:17,750 +بيركز بعينيه التنتين في ال target الأحمر في target + +247 +00:18:17,750 --> 00:18:22,330 +آخر أسود في مكان ما من الفرار صورة هذا ال target + +248 +00:18:22,330 --> 00:18:27,050 +بتسقط على temporal retina في ال right eye وعلى + +249 +00:18:27,050 --> 00:18:31,770 +nasal retina في ال left eye لو قلنا له بالنسبة لل + +250 +00:18:31,770 --> 00:18:35,450 +right eye وين هذا ال target بيسقط؟ أو أولا شايفه في + +251 +00:18:35,450 --> 00:18:39,410 +الفرق هو طالما شخص سقط على temporal retina هيشعر + +252 +00:18:39,410 --> 00:18:43,810 +فيه بالنسبة للعين هذه جاي نازلي جاي نازلي وهنا + +253 +00:18:43,810 --> 00:18:47,010 +طالما سقط على nasal retina هيشعر فيه جاي + +254 +00:18:47,010 --> 00:18:50,050 +temporally بالنسبة للعين هذه يعني صورة ال target + +255 +00:18:50,050 --> 00:18:55,950 +هذه هيشعر فيها في العين اليمين أنها جاية نازلي وفي + +256 +00:18:55,950 --> 00:18:59,910 +العين الشمال جاية temporally في الفرق ما هو ال + +257 +00:18:59,910 --> 00:19:04,920 +nasal space بالنسبة للعين high ال nasal space للعين + +258 +00:19:04,920 --> 00:19:08,880 +high جاي هيك على الشمال و ال temporal space بالنسبة + +259 +00:19:08,880 --> 00:19:11,640 +للعين high ال temporal space جاي أيضا على نفس + +260 +00:19:11,640 --> 00:19:15,140 +الاتجاه هم نفس ال space إذا ال temporal field بتاع + +261 +00:19:15,140 --> 00:19:18,040 +ال left eye .. عفوا ال nasal field بتاع ال right + +262 +00:19:18,040 --> 00:19:20,760 +eye و ال temporal field بتاع ال left eye هم نفس ال + +263 +00:19:20,760 --> 00:19:24,080 +field نفس الجزء من ال field فلو احنا قلنا له مفت + +264 +00:19:24,080 --> 00:19:29,200 +عيني تنتين هيطلع على ال target الأحمر ال target + +265 +00:19:29,200 --> 00:19:32,460 +الأسود بالنسبة لي جاي وين؟ هيقول جاي على الشمال + +266 +00:19:32,460 --> 00:19:37,440 +ما هي كلمة جاي على الشمال تعني عن nasal side عن + +267 +00:19:37,440 --> 00:19:41,640 +nasal direction بتاع ال right eye يعني هذه المنطقة + +268 +00:19:41,640 --> 00:19:45,960 +هذه جاية نازلي بالنسبة لل right eye لأن هي النزلو + +269 +00:19:45,960 --> 00:19:49,280 +جاية temporally .. temporally بالنسبة لل left eye + +270 +00:19:49,280 --> 00:19:52,040 +لأنه هي النزل أيضا فبالتالي هي جاية temporal + +271 +00:19:52,040 --> 00:19:55,420 +بالنسبة لل left eye وجاية nasal بالنسبة لل right + +272 +00:19:55,420 --> 00:19:58,980 +eye في المجموع بنقولش temporal و nasal بنقول جاية + +273 +00:19:58,980 --> 00:20:02,100 +على ال left side لأنها جاية على شمال العين اليمين + +274 +00:20:02,100 --> 00:20:06,180 +وعلى شمال العين الشمال فبالتالي هيكون تعبيره ال + +275 +00:20:06,180 --> 00:20:09,000 +subjective interpretation بتاعه أو ال projection + +276 +00:20:09,000 --> 00:20:13,220 +أن ال target الأسود جاية على شمال ال target الأحمر + +277 +00:20:13,220 --> 00:20:19,080 +اللي أنا بركز فيه نقرأ المثال هذا بنقول if a red + +278 +00:20:19,080 --> 00:20:25,130 +object stimulates the right fovea اللي هي ال F and + +279 +00:20:25,130 --> 00:20:28,050 +the black object which lies in the nasal field + +280 +00:20:28,050 --> 00:20:32,230 +stimulates temporal retinal element the red object + +281 +00:20:32,230 --> 00:20:35,110 +will be interpreted by the brain as having + +282 +00:20:35,110 --> 00:20:39,270 +originated from a straight ahead position and the + +283 +00:20:39,270 --> 00:20:42,810 +black object will be interpreted as having + +284 +00:20:42,810 --> 00:20:48,870 +originated in the nasal field زي ما الرسمة بتوضح + +285 +00:20:48,870 --> 00:20:54,540 +أن دماغ هيفسر .. هيفسر .. هيعبّر دماغ الشخص أن ال + +286 +00:20:54,540 --> 00:20:58,180 +red target جاي from straight ahead position بينما + +287 +00:20:58,180 --> 00:21:04,640 +ال black target جاي from a nasal field ليش حسينا + +288 +00:21:04,640 --> 00:21:08,160 +أو هذا الشخص حس أن ال black target جاي from nasal + +289 +00:21:08,160 --> 00:21:11,720 +field لأنه صورة ال target سقطت على temporal + +290 +00:21:11,720 --> 00:21:15,500 +retinal element طيب وإيش يعني؟ أو temporal area + +291 +00:21:15,500 --> 00:21:18,940 +أو temporal retina أو temporal retinal elements أو + +292 +00:21:18,940 --> 00:21:23,020 +temporal points أي تعبير استخدمناها مش مشكلة الـ + +293 +00:21:23,020 --> 00:21:26,180 +temporal retinal elements اتجاهها في الفراغ .. + +294 +00:21:26,180 --> 00:21:30,020 +اتجاهها في الفراغ نازلي جاي .. جاي نازلي باتجاه ال + +295 +00:21:30,020 --> 00:21:36,690 +nasal side بتاع هذه الآن similarly nasal retinal + +296 +00:21:36,690 --> 00:21:40,030 +element project into the temporal field upper + +297 +00:21:40,030 --> 00:21:44,070 +retinal element into the lower field و العكس + +298 +00:21:44,070 --> 00:21:48,270 +بالعكس vice versa يعني lower retina متجهة في ال + +299 +00:21:48,270 --> 00:21:51,850 +upper field زي ما الصورة هنا بتبين هذا superior + +300 +00:21:51,850 --> 00:21:55,150 +retina متجهة في ال lower field inferior retina + +301 +00:21:55,150 --> 00:21:58,910 +متجهة في ال upper field temporal retina لل nasal + +302 +00:21:58,910 --> 00:22:02,970 +field و nasal retina لل temporal field + +303 +00:22:07,770 --> 00:22:11,510 +بما يفتحان عيون كلاهما، فإن موضوع الـ Red Fixation + +304 +00:22:11,510 --> 00:22:19,110 +يدفع الآن كلّ فوفيا التي تتجاوز نقطة رتينية الوضع + +305 +00:22:19,110 --> 00:22:23,070 +الأمريكي الآن ليس فقط يدفع الوضع الوضع الوضع الوضع + +306 +00:22:23,070 --> 00:22:24,830 +الوضع الوضع الوضع الوضع الوضع الوضع الوضع الوضع + +307 +00:22:24,830 --> 00:22:29,030 +الوضع الوضع الوضع الوضع الوضع الوضع الوضع الوضع + +308 +00:22:29,030 --> 00:22:36,690 +الوضع الوضع الوضع الوضع الوضع الوضع + +309 +00:22:36,690 --> 00:22:40,550 +الوضع + +310 +00:22:44,540 --> 00:22:58,520 +بما أنه بما + +311 +00:22:58,520 --> 00:23:03,640 +أنه ال temporal elements في ال right eye و ال + +312 +00:23:03,640 --> 00:23:07,300 +nasal elements في ال left eye اللي سقط عليهم صورة + +313 +00:23:07,300 --> 00:23:09,960 +ال target الأسود بما أنهم corresponding يعني + +314 +00:23:09,960 --> 00:23:14,560 +متجهين نفس الاتجاه في الفرق إذا هيتم توحيد صورة ال + +315 +00:23:14,560 --> 00:23:17,720 +black object اللي هنا مع صورة ال black object اللي + +316 +00:23:17,720 --> 00:23:22,280 +هنا في صورة واحدة و هيفسرها الشخص أنه ال black + +317 +00:23:22,280 --> 00:23:25,880 +object جاي على الشمال بالنسبة لل red Straight + +318 +00:23:25,880 --> 00:23:31,760 +object ليش لأنه بناء على أي أجزاء من الشبكية تم ال + +319 +00:23:31,760 --> 00:23:34,380 +stimulation بتاعتها ال temporal retina هنا موجهة + +320 +00:23:34,380 --> 00:23:38,160 +للشمال و ال nasal retina هنا أيضا موجهة للشمال + +321 +00:23:38,160 --> 00:23:42,960 +فبالتالي هيشعر بال target أنه جاي على الشمال على + +322 +00:23:42,960 --> 00:23:50,200 +الشمال نتوقف عند ال retinomotor value و بيتم شرح إن + +323 +00:23:50,200 --> 00:23:53,540 +شاء الله المرة القادمة و يعطيكم العافية والسلام + +324 +00:23:53,540 --> 00:23:55,760 +عليكم ورحمة الله وبركاته diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/mH4L_ov9QU4_raw.json b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/mH4L_ov9QU4_raw.json new file mode 100644 index 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المرضي، اما في الوضع الطبيعي ال principle visual direction is the direction in external space interpreted as the line of sight هو نفسه الاتجاه اللي احنا بنعبر عنه و بنقول عنه انه خط الإبصال يعني الإنسان وين بتطلع بشكل مباشر", "tokens": [5172, 3615, 15040, 31439, 37893, 2423, 9307, 7435, 40294, 39894, 45761, 27188, 38688, 25528, 12399, 1975, 15730, 23758, 23032, 3555, 3615, 995, 2423, 28820, 10943, 8978, 2423, 2407, 11242, 3615, 6024, 118, 13546, 23032, 21292, 3615, 1829, 34051, 2423, 2407, 11242, 3615, 9673, 43042, 1829, 12399, 1975, 15042, 8978, 2423, 2407, 11242, 3615, 41950, 21292, 3615, 1829, 2423, 8665, 5056, 3513, 307, 264, 3513, 294, 8320, 1901, 26749, 382, 264, 1622, 295, 7860, 31439, 8717, 36178, 3224, 2423, 9307, 7435, 40294, 13672, 1829, 1975, 5016, 8315, 44945, 3615, 26890, 18871, 3224, 4032, 44945, 39648, 18871, 3224, 16472, 3224, 16490, 9566, 33688, 3555, 9381, 6027, 37495, 22653, 33688, 1863, 3794, 7649, 4032, 9957, 39894, 9566, 1211, 3615, 4724, 8592, 28820, 3714, 3555, 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مكان آخر غير الفوغيا", "tokens": [6027, 39184, 23100, 11843, 294, 264, 6814, 295, 257, 1359, 5802, 10067, 8889, 5296, 15042, 4724, 1829, 30544, 43242, 7578, 30767, 995, 2407, 10632, 11331, 2407, 6027, 20328, 17082, 48923, 37893, 9122, 3555, 48923, 9122, 2304, 10632, 21542, 2407, 6027, 2423, 3567, 4724, 1829, 34268, 2304, 3215, 29538, 6024, 110, 995, 2407, 10632, 31767, 17082, 48923, 4032, 4724, 1829, 34268, 2304, 3215, 3714, 41361, 19753, 34740, 32771, 13546, 27188, 2407, 17082, 25528], "avg_logprob": -0.19178082518381614, "compression_ratio": 1.5271739130434783, "no_speech_prob": 2.384185791015625e-07, "words": [{"start": 202.73, "end": 203.01, "word": "الـ", "probability": 0.49432373046875}, {"start": 203.01, "end": 203.39, "word": " fusion", "probability": 0.615234375}, {"start": 203.39, "end": 204.01, "word": " occurs", "probability": 0.84228515625}, {"start": 204.01, "end": 204.27, "word": " in", "probability": 0.96728515625}, {"start": 204.27, "end": 204.43, "word": " the", 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233.3, "word": " of", "probability": 0.9775390625}, {"start": 233.3, "end": 233.46, "word": " the", "probability": 0.90966796875}, {"start": 233.46, "end": 233.98, "word": " deviated", "probability": 0.992431640625}, {"start": 233.98, "end": 234.28, "word": " eye", "probability": 0.9384765625}, {"start": 234.28, "end": 234.5, "word": " وهذا", "probability": 0.6954752604166666}, {"start": 234.5, "end": 236.22, "word": " هنشوفه", "probability": 0.848828125}, {"start": 236.22, "end": 236.82, "word": " بطريقة", "probability": 0.95654296875}, {"start": 236.82, "end": 237.36, "word": " الرسم", "probability": 0.988037109375}, {"start": 237.36, "end": 238.26, "word": " بمعنى", "probability": 0.95625}, {"start": 238.26, "end": 238.46, "word": " أن", "probability": 0.5478515625}, {"start": 238.46, "end": 239.04, "word": " الفوفيا", "probability": 0.8308919270833334}, {"start": 239.04, "end": 239.34, "word": " للـ", "probability": 0.5001220703125}, {"start": 239.34, "end": 239.9, "word": " 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اقوله يعني غمض عينك اللي هي اليمين احنا بالاساس اغلقنا العين الشمال التجربة هتجرى على العين اليمين عرضنا العين اليمين لضوء قوي أفقي بشكل slit هي كزي ما احنا شايفين", "tokens": [3555, 6027, 21366, 39182, 29910, 3224, 3555, 2423, 21366, 39182, 29910, 3224, 3555, 2423, 21366, 3714, 43020, 1975, 8315, 11331, 49975, 19446, 1975, 9778, 20292, 3224, 2407, 8592, 45030, 25708, 12602, 32277, 3224, 3714, 43020, 1975, 39648, 3224, 37495, 22653, 32771, 2304, 11242, 6225, 9957, 4117, 13672, 1829, 39896, 2423, 32640, 9957, 1975, 5016, 8315, 20666, 32277, 32277, 1975, 17082, 1211, 4587, 8315, 18863, 9957, 25124, 2304, 6027, 16712, 7435, 25513, 3660, 8032, 2655, 7435, 2288, 7578, 15844, 18863, 9957, 2423, 32640, 9957, 6225, 43042, 8315, 18863, 9957, 2423, 32640, 9957, 5296, 11242, 2407, 38207, 12174, 45865, 5551, 5172, 38436, 4724, 8592, 28820, 43182, 39896, 9122, 11622, 1829, 19446, 1975, 5016, 8315, 13412, 995, 33911, 9957], "avg_logprob": -0.1391559813776587, "compression_ratio": 2.0422535211267605, 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2072.6, "end": 2073.48, "word": " ننهي", "probability": 0.9744873046875}, {"start": 2073.48, "end": 2074.02, "word": " المحاضرة", "probability": 0.9891357421875}, {"start": 2074.02, "end": 2074.2, "word": " أن", "probability": 0.580078125}, {"start": 2074.2, "end": 2074.38, "word": " ال", "probability": 0.75244140625}, {"start": 2074.38, "end": 2074.9, "word": " abnormal", "probability": 0.9267578125}, {"start": 2074.9, "end": 2075.38, "word": " retinal", "probability": 0.970703125}, {"start": 2075.38, "end": 2076.04, "word": " correspondence", "probability": 0.93408203125}, {"start": 2076.04, "end": 2076.42, "word": " هو", "probability": 0.9501953125}, {"start": 2076.42, "end": 2077.2, "word": " adaptation", "probability": 0.95703125}, {"start": 2077.2, "end": 2077.94, "word": " وال", "probability": 0.72021484375}, {"start": 2077.94, "end": 2078.42, "word": " suppression", "probability": 0.1820068359375}, {"start": 2078.42, "end": 2079.16, "word": " أيضا", "probability": 0.8567708333333334}, {"start": 2079.16, "end": 2080.0, "word": " adaptation", "probability": 0.94384765625}, {"start": 2080.0, "end": 2081.28, "word": " وبالتالي", "probability": 0.909765625}, {"start": 2081.28, "end": 2082.44, "word": " يعني", "probability": 0.975341796875}], "temperature": 1.0}, {"id": 94, "seek": 209983, "start": 2082.83, "end": 2099.83, "text": "بيكون عندى ال two adaptations suppression و abnormal retinal correspondence هذا negative ال brain بده يريح نفسه بيقول خلاص اللي هو صورة من الصور و بيصير هذا ال patient monocular و خلصناه أما ال abnormal retinal correspondence توافرت شروط لل brain", "tokens": [21292, 30544, 43242, 7578, 2423, 732, 44465, 36807, 4032, 32847, 1533, 2071, 38135, 23758, 3671, 2423, 3567, 47525, 3224, 7251, 16572, 5016, 8717, 36178, 3224, 4724, 1829, 39648, 16490, 1211, 33546, 13672, 1829, 31439, 20328, 13063, 3660, 9154, 31767, 13063, 4032, 4724, 1829, 9381, 13546, 23758, 2423, 4537, 1108, 905, 1040, 4032, 16490, 1211, 9381, 8315, 3224, 5551, 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التانية هيشغلها ال brain بس وفق شروط جديدة و وفق ترتيبة جديدة وهذا يعتبر positive adaptation ليش؟ لأن العين اشتغلت", "tokens": [3615, 8592, 7649, 7251, 8592, 17082, 1211, 18863, 9957, 9154, 10874, 16254, 3215, 9122, 8592, 16572, 4117, 3660, 20449, 18863, 9957, 16712, 7649, 10632, 25124, 32887, 9566, 39896, 6055, 1211, 9307, 3660, 1359, 5802, 2339, 686, 5754, 2339, 686, 37495, 22653, 37893, 44650, 17082, 13546, 938, 2896, 39182, 19446, 47525, 10721, 21542, 2407, 6027, 37495, 22653, 3714, 41891, 30767, 2304, 7649, 10632, 3714, 33753, 2288, 46007, 39182, 19446, 47525, 10721, 21542, 2407, 6027, 6156, 3794, 995, 34268, 11296, 18863, 9957, 16712, 7649, 10632, 39896, 8592, 17082, 1211, 11296, 2423, 3567, 4724, 3794, 4032, 5172, 4587, 13412, 32887, 9566, 10874, 16254, 41891, 4032, 4032, 5172, 4587, 6055, 2288, 31371, 49401, 10874, 16254, 41891, 37037, 15730, 7251, 34268, 26890, 3353, 21549, 32239, 8592, 22807, 5296, 33456, 18863, 9957, 1975, 8592, 2655, 17082, 1211, 2655], "avg_logprob": 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of file diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/nhuuX600TDc_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/nhuuX600TDc_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..1199efbb8a55525bd5f9093058eaf065f2e0118f --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/nhuuX600TDc_postprocess.srt @@ -0,0 +1,1548 @@ +1 +00:00:02,040 --> 00:00:07,180 +بسم الله الرحمن الرحيم بنتواصل و بنكمل محاضرات + +2 +00:00:07,180 --> 00:00:14,000 +حوال واحد و وصلنا لعنوان spiral of telox the + +3 +00:00:14,000 --> 00:00:17,340 +spiral is an imaginary line joining the insertions + +4 +00:00:17,340 --> 00:00:20,440 +of the four rectus muscles أو of the four recti + +5 +00:00:20,440 --> 00:00:24,460 +and is an important anatomical landmark when + +6 +00:00:24,460 --> 00:00:28,640 +performing surgerythe insertions gets farther away + +7 +00:00:28,640 --> 00:00:34,560 +from the medial rectus toward the superior rectus + +8 +00:00:35,250 --> 00:00:40,450 +from the limbus and make spiral pattern يعني ال + +9 +00:00:40,450 --> 00:00:43,090 +media rectus بقولنا بيصير لها insertion بعيدا عن + +10 +00:00:43,090 --> 00:00:46,850 +ال limbus خمسة و نص ملي متر ال inferior rectus ستة + +11 +00:00:46,850 --> 00:00:51,210 +و نص ملي متر ال lateral rectus ستة و تسعة من عشرة + +12 +00:00:51,210 --> 00:00:56,310 +ملي متر و superior rectus سبعة و سبعة من عشرة ملي + +13 +00:00:56,310 --> 00:01:02,050 +متر يعني أقرب عضلة بتتثبت قريبا من ال limbus هي ال + +14 +00:01:02,050 --> 00:01:06,650 +media rectusو أبعد عضلة هي ال superior rectus و + +15 +00:01:06,650 --> 00:01:12,570 +كأنه مكان ال insertion لو حاولت أنا يعني .. يعني + +16 +00:01:12,570 --> 00:01:16,970 +أمثله بخط وهمي بنقول تبدأ من عند ال media rectus + +17 +00:01:16,970 --> 00:01:20,490 +أقرب إشي و بعدين هذا الخط أو ال spiral اللي هو ال + +18 +00:01:20,490 --> 00:01:24,950 +.. ال .. ال .. ال ..الدائرة أو الحلزون تمام أو + +19 +00:01:24,950 --> 00:01:28,430 +الزنبراج تمام اللي هو الخط اللي بيمثل ال insertion + +20 +00:01:28,430 --> 00:01:31,990 +تمام لو مديته لهنا بيبدأ يبعد عن ال limbus بيبدأ + +21 +00:01:31,990 --> 00:01:36,930 +يبعد أكتر يبعد أكتر فهذا بيسموه ال spiral of telox + +22 +00:01:36,930 --> 00:01:42,770 +وهو له أهمية جراحية أثناء عمل عمليات على ال four + +23 +00:01:42,770 --> 00:01:48,550 +rectus muscles يعني عمليات الحول عمليات الحول نيجي + +24 +00:01:48,550 --> 00:01:49,750 +اليوم نحكي عن + +25 +00:02:04,180 --> 00:02:09,590 +السهم الأحمر بيمثل ال superior oblique muscleهي ال + +26 +00:02:09,590 --> 00:02:13,150 +visual axis بتاع ال eye في الوضع الطبيعي ال axis + +27 +00:02:13,150 --> 00:02:16,890 +بتاع ال superior oblique tendon بيعمل زاوية واحد و + +28 +00:02:16,890 --> 00:02:22,090 +خمسين degree مع ال visual axis مع ال visual axis + +29 +00:02:22,090 --> 00:02:26,490 +يعني بيعمل مع ال axis العمودي العمودي على العين + +30 +00:02:26,490 --> 00:02:30,850 +بيعمل زاوية تسعة و تلاتين degree اللي هي تسعة و + +31 +00:02:30,850 --> 00:02:34,590 +تلاتين و واحد و خمسين يعني هي تسعين degreeإذا في + +32 +00:02:34,590 --> 00:02:38,010 +عندي ال visual axis و ال axis العمودي على ال + +33 +00:02:38,010 --> 00:02:41,890 +visual axis بتكون ال superior oblique تندن أقرب لل + +34 +00:02:41,890 --> 00:02:46,230 +axis العمودي منها لل visual axis منها لل visual + +35 +00:02:46,230 --> 00:02:50,630 +axis إذا the obliques are inserted behind the + +36 +00:02:50,630 --> 00:02:55,710 +equator andform an angle of 51 degree with the + +37 +00:02:55,710 --> 00:03:00,910 +visual axis الان في يعني بعض الناس ممكن يقرأ كلمة + +38 +00:03:00,910 --> 00:03:04,630 +behind the equator ويمر عليها مرور الكيرام يعني + +39 +00:03:04,630 --> 00:03:08,670 +مكان التثبيت تاع ال superior oblique و أيضا تاع ال + +40 +00:03:08,670 --> 00:03:12,510 +inferior oblique خلف ال equator خلف خط الاستواق + +41 +00:03:12,510 --> 00:03:16,470 +بتاع العين احنا قولنا خط الاستواق تاع العينهو الخط + +42 +00:03:16,470 --> 00:03:20,170 +المنصف اللي بيقسم العين طبعا خط وهمي بيقسم العين + +43 +00:03:20,170 --> 00:03:24,510 +أو مستوى وهمي بيقسم العين لأنه جزء أمامي أو نصف + +44 +00:03:24,510 --> 00:03:29,390 +أمامي و نصف خلفي الآن ما أهمية أن نقول أن ال + +45 +00:03:29,390 --> 00:03:32,090 +oblique muscles superior oblique و ال inferior + +46 +00:03:32,090 --> 00:03:36,940 +obliqueinserted مكان تثبيتهم behind the equator .. + +47 +00:03:36,940 --> 00:03:40,280 +behind the equator عادي طب .. يعني هذا شي .. يعني + +48 +00:03:40,280 --> 00:03:45,700 +ما .. إيش أهميته؟ لأ أهميته كبيرة جدا جدا جدا إيش؟ + +49 +00:03:45,700 --> 00:03:51,920 +السبب أنه الأثر تعيس ال oblique muscles هيكون ع ال + +50 +00:03:51,920 --> 00:03:56,190 +back of the eyeالأثر .. الأثر تاع ال .. ال oblique + +51 +00:03:56,190 --> 00:03:58,970 +muscles ال superior oblique وال inferior oblique + +52 +00:03:58,970 --> 00:04:02,590 +لما بيبدوا يشدوا يصيروا فيهم contraction أول شيء + +53 +00:04:02,590 --> 00:04:06,950 +بيتأثر المنطقة الخلفية من العين أو النصف الخلفي من + +54 +00:04:06,950 --> 00:04:10,690 +العين لما بنقول superior oblique muscle .. + +55 +00:04:10,690 --> 00:04:14,520 +superior oblique muscleيعني جاية من فوق جاية من + +56 +00:04:14,520 --> 00:04:17,700 +فوق العين طيب جاية من فوق العين معروف ان العضلات + +57 +00:04:17,700 --> 00:04:20,880 +اللي جاية من فوق العين بترفع زي ال superior rectus + +58 +00:04:20,880 --> 00:04:24,980 +muscle مطبوط هي بترفع بس هنا ال superior oblique + +59 +00:04:24,980 --> 00:04:30,000 +muscle بما انه مكان تثبيته خلف ال equator هي بترفع + +60 +00:04:30,000 --> 00:04:34,940 +حقيقة بس بترفع أي جزء بترفع الجزء الخلفي من العين + +61 +00:04:34,940 --> 00:04:39,380 +فلما الجزء الخلفي من العين يرتفع الجزء الأمامي + +62 +00:04:39,380 --> 00:04:44,260 +بينزل فأصبحت ال superior obliqueبسبب إنها مثبتة أو + +63 +00:04:44,260 --> 00:04:49,160 +inserted behind the equator عملها مش elevation + +64 +00:04:49,160 --> 00:04:53,360 +عملها depression ليش؟ لأن هي حقيقة بترفع الجزء + +65 +00:04:53,360 --> 00:04:57,200 +الخلفي من العين الجزء الخلفي من العين فالجزء + +66 +00:04:57,200 --> 00:05:01,440 +الأمامي بينزل طبعا والعبرة بالجزء الأمامي اللي أنا + +67 +00:05:01,440 --> 00:05:05,100 +شايفه إذا بيصير من ال action بتاع superior oblique + +68 +00:05:05,100 --> 00:05:08,680 +muscle اللي هو قضية ال depression قضية ال + +69 +00:05:08,680 --> 00:05:12,480 +depressionوهذا الكلام أيضًا بينطبق على ال inferior + +70 +00:05:12,480 --> 00:05:15,840 +oblique muscle ال inferior oblique muscle مثبتة + +71 +00:05:15,840 --> 00:05:19,140 +خلف ال equator بس من أسفل العين، من أسفل العين + +72 +00:05:19,140 --> 00:05:22,600 +معروف لما نقول inferior معناته المفروض إنها بتنزل + +73 +00:05:22,600 --> 00:05:27,380 +حقيقة نعم هي بتنزل الجزء الخلفي من العين فبالتالي + +74 +00:05:27,380 --> 00:05:33,580 +الجزء الأمامي من العين بيصعد للأعلى وهذا يعني بسبب + +75 +00:05:33,580 --> 00:05:38,040 +إنها مثبتة خلف ال equator بسبب إنها مثبتة خلف ال + +76 +00:05:38,040 --> 00:05:42,790 +equatorنيجي نحكي عن ال superior oblique muscle + +77 +00:05:42,790 --> 00:06:02,830 +نيجي + +78 +00:06:02,830 --> 00:06:07,370 +احنا نحاول نشوف رسومات كتيرة توضحلي هذه القضية هاي + +79 +00:06:07,370 --> 00:06:11,430 +أول رسمةهي ال orbit .. هاي حدود ال orbit انا + +80 +00:06:11,430 --> 00:06:20,130 +هضللها او ممكن احنا حتى يعني انحدد + +81 +00:06:20,130 --> 00:06:26,810 +حدود ال orbit بواسطة الأشكال هاي + +82 +00:06:26,810 --> 00:06:31,130 +ال media wall بتاعة ال orbit + +83 +00:06:44,260 --> 00:06:51,840 +والـ lateral wall الآن هاي + +84 +00:06:51,840 --> 00:06:53,320 +ال lateral wall بتاعة ال orbit + +85 +00:07:00,510 --> 00:07:03,690 +هي ال medial wall هذه اللي أنا بأشير عليها هي + +86 +00:07:03,690 --> 00:07:08,010 +superior oblique muscle بتنشأ subpyromedial يعني + +87 +00:07:08,010 --> 00:07:11,350 +أعلى و لجوة من ال optic canal هاي ال optic nerve + +88 +00:07:11,350 --> 00:07:14,530 +طالع من ال optic canal و داخل على ال brain احنا + +89 +00:07:14,530 --> 00:07:18,810 +بنتطلع قاعدين من جهة ال brain هاي الأين هاي كرة + +90 +00:07:18,810 --> 00:07:24,360 +الأين البيضة هاي ال superior rectus muscleمن تحت + +91 +00:07:24,360 --> 00:07:27,320 +ال superior rectus muscle بيدخل ال optic nerve + +92 +00:07:27,320 --> 00:07:31,940 +بيخرج من العين و بيدخل على ال optic canal و بيسير + +93 +00:07:31,940 --> 00:07:35,300 +في داخل ال brain في داخل ال brain عشان يتحد مع ال + +94 +00:07:35,300 --> 00:07:38,440 +optic nerve التاني و يعملولي ال optic chiasm طبعا + +95 +00:07:38,440 --> 00:07:41,580 +ال optic chiasm مشيولة من هنا مشيولة من هنا ال + +96 +00:07:41,580 --> 00:07:46,260 +superior oblique muscle بتنشأ subpyromedial لل + +97 +00:07:46,260 --> 00:07:50,480 +optic canalبتمشي في الزاوية في الجورنة بين ال + +98 +00:07:50,480 --> 00:07:53,180 +media wall اللي انا حطيت عليها خط و ال superior + +99 +00:07:53,180 --> 00:07:57,400 +wall اللي هي مشيولة الآن عشان نقدر نشوف و بتتحول ل + +100 +00:07:57,400 --> 00:08:00,220 +tendon هذا اللون الأبيض هنا خلصت ال muscle و أصبح + +101 +00:08:00,220 --> 00:08:03,720 +الرباط بتاعها تتحول ل tendon قبل ما تصل لتروكليا + +102 +00:08:03,720 --> 00:08:07,970 +هذه التروكليا اللي هي عبارة عن بكرةطبعا التندن هذا + +103 +00:08:07,970 --> 00:08:11,430 +بيدخل في الاتروكليا و بيرجع شايفين كيف بيرجع + +104 +00:08:11,430 --> 00:08:15,390 +backward and laterally بروح باتجاه lateral و للخلف + +105 +00:08:15,390 --> 00:08:19,190 +و للخلف هنا النقطة أمامية لأنه بيرجع للخلف و + +106 +00:08:19,190 --> 00:08:24,530 +بيتثبت في المربع العلوي الخالفي ال temporal لكرة + +107 +00:08:24,530 --> 00:08:30,710 +العين إذا بيتثبت في هذه المنطقة طبعا لو احنا شوفنا + +108 +00:08:30,710 --> 00:08:35,700 +رسمة تانيةهي ال superior oblique muscle هي ال + +109 +00:08:35,700 --> 00:08:39,340 +superior oblique muscle بتبدأ subpyromedial أو + +110 +00:08:39,340 --> 00:08:42,400 +subpyronesia للoptic canal هي ال optic canal ماشي + +111 +00:08:42,400 --> 00:08:46,060 +ال optic nerve فيها و بتتحول لتندون طبعا هنا + +112 +00:08:46,060 --> 00:08:49,580 +رسمينها كلها ك muscle و هذا خطأ بتتحول لتندون قبل + +113 +00:08:49,580 --> 00:08:53,980 +وصولها للاتروكليا اللي أنا بأشر عليها و هذا + +114 +00:08:53,980 --> 00:08:57,620 +التندون بيعدي عبر الاتروكليا and is reflected + +115 +00:08:57,620 --> 00:09:03,320 +بينعكس backward للوراء .. للوراءو temporal عشان + +116 +00:09:03,320 --> 00:09:09,180 +يتثبت في الربع الخلفي لو جسمنا الهين .. لو جسمنا + +117 +00:09:09,180 --> 00:09:13,880 +الهين لتمن أرباع .. تمن أرباع .. أربع أرباع علوية + +118 +00:09:14,600 --> 00:09:18,200 +anterior nasal, anterior temporal, posterior + +119 +00:09:18,200 --> 00:09:22,180 +temporal, posterior nasal وتحت نفس الأشياء بنقول + +120 +00:09:22,180 --> 00:09:27,880 +بتثبت ال superior oblique في ال superior temporal + +121 +00:09:27,880 --> 00:09:34,160 +posterior quadrant في الجزء الخلفي ال temporal + +122 +00:09:34,160 --> 00:09:38,300 +العلوي الخلفي ال temporal العلوي الخلفي ال + +123 +00:09:38,300 --> 00:09:43,930 +temporal العلوي وهذا الكلامواضح تمام inserts in + +124 +00:09:43,930 --> 00:09:48,030 +the posterior upper temporal quadrant of the globe + +125 +00:09:48,030 --> 00:09:52,190 +of the globe the primary action of the superior + +126 +00:09:52,190 --> 00:09:56,390 +oblique is in torsion secondary actions are + +127 +00:09:56,390 --> 00:10:00,570 +depression and abduction نجي نفهم كل action من ال + +128 +00:10:00,570 --> 00:10:03,610 +three actions بتاعة ال superior oblique muscle + +129 +00:10:03,610 --> 00:10:09,430 +عشان تتضح الأمور بالنسبة لنا بشكل واضح هنا أيضا + +130 +00:10:10,280 --> 00:10:13,760 +simulation أو رسمة بتوضح لإن هاي ال optic nerve + +131 +00:10:13,760 --> 00:10:16,820 +هيروح يطلع من ال optic canal في عمق ال orbit ويدخل + +132 +00:10:16,820 --> 00:10:20,040 +على ال brain طبعا ال superior oblique muscle بتبدأ + +133 +00:10:20,040 --> 00:10:23,680 +above the optic canal superior medial to the optic + +134 +00:10:23,680 --> 00:10:27,980 +canal تتحول لتندون هذا التندون بيصل الاتروكليا، + +135 +00:10:27,980 --> 00:10:31,560 +بيعد من الاتروكليا و بيرجع عشان يتثبت في ال + +136 +00:10:31,560 --> 00:10:34,120 +posterior upper temporal equadrant + +137 +00:10:38,570 --> 00:10:41,510 +هي منظر جانبي لل superior oblique اللي في العمق + +138 +00:10:41,510 --> 00:10:45,570 +جاية هيك و معدية من خلال التركليا وهي مكان تثبيتها + +139 +00:10:45,570 --> 00:10:48,830 +مع أنه في الرسمة المفروض يكون شوية لورا خلف ال + +140 +00:10:48,830 --> 00:10:52,930 +equator خلف ال equator هاي أيضا منظر آخر لل + +141 +00:10:52,930 --> 00:10:59,330 +superior oblique muscle وهنا أيضا منظر تالت لل + +142 +00:10:59,330 --> 00:11:03,330 +superior oblique muscleالان بدنا نيجي نحكي عن ال + +143 +00:11:03,330 --> 00:11:07,210 +superior oblique muscle و كيف انه استنتجنا او كيف + +144 +00:11:07,210 --> 00:11:10,630 +هي بتعمل ال three actions بتاعتها بنقول ال + +145 +00:11:10,630 --> 00:11:13,450 +superior oblique muscle لما يصير فيها contraction + +146 +00:11:13,450 --> 00:11:18,550 +.. لما يصير فيها contraction هيصير لها شد بهذا + +147 +00:11:18,550 --> 00:11:22,870 +الاتجاه .. باتجاه السهم البرتقالي .. باتجاه السهم + +148 +00:11:22,870 --> 00:11:27,720 +البرتقالي طبعاعشان نستنتج ال action بتاعها لازم + +149 +00:11:27,720 --> 00:11:31,800 +نعمل تحليل للقوة تحليل للقوة نفرض ان ال superior + +150 +00:11:31,800 --> 00:11:37,480 +oblique تندن بشد بمقدار قوة نيوتن هذه ال 100 نيوتن + +151 +00:11:37,480 --> 00:11:42,760 +بدنا نحللها لقوتين متعامدات قوة .. قوة بتشد بهذا + +152 +00:11:42,760 --> 00:11:43,440 +الاتجاه + +153 +00:11:47,080 --> 00:11:51,680 +قوة بتشد بهذا الاتجاه اللي متفق مع محور العين وقوة + +154 +00:11:51,680 --> 00:11:56,720 +بتشد بالاتجاه العمودي الرسمة مش هذه هي الرسمة اللي + +155 +00:11:56,720 --> 00:12:01,200 +بدنا ياها قوة بتشد بهذا الاتجاه وقوة بتشد بالاتجاه + +156 +00:12:01,200 --> 00:12:04,720 +العمودي عليه إذا هنشيل هذه القوة اللي كانت بتشد + +157 +00:12:04,720 --> 00:12:08,140 +باتجاه ال superior oblique tendon ونستعيد عنها + +158 +00:12:08,140 --> 00:12:12,280 +بقوتين محيطات فيها قوة متفقة مع ال visual axis + +159 +00:12:12,280 --> 00:12:18,250 +وقوةمتفق عمودية على ال visual axis يا ترى مين من + +160 +00:12:18,250 --> 00:12:22,350 +القوتين مين من القوتين بيكون له نصيب الأسد حقيقة + +161 +00:12:22,350 --> 00:12:25,890 +القوة الأقرب اللي هي العمودية على ال visual axis + +162 +00:12:25,890 --> 00:12:29,530 +طبعا هذه القوة هنشيلها هنشيلها و هنستبدلها بقوتين + +163 +00:12:29,530 --> 00:12:33,360 +قوة بتشد بهذا الاتجاهمتفق مع ال visual axis و قوة + +164 +00:12:33,360 --> 00:12:36,660 +بتشد في هذا الاتجاه عمودي على ال visual axis هذه + +165 +00:12:36,660 --> 00:12:39,720 +القوة هيكون لها نصيب الأسد لأن ال superior oblique + +166 +00:12:39,720 --> 00:12:43,480 +تندن أقرب لها من القوة التانية و احنا قلنا في + +167 +00:12:43,480 --> 00:12:47,250 +تحليل القوة ان هدول القوتين بيسدوا عن هذه القوةأو + +168 +00:12:47,250 --> 00:12:51,510 +هذه القوة بتصد عن هذه القواتين يعني هذه مكافئة لهم + +169 +00:12:51,510 --> 00:12:55,410 +التنتين أو هدولة العناصر بتاعتها أو التحليل بتاع + +170 +00:12:55,410 --> 00:12:58,790 +هذه القوة احنا محتاجين انه نلغي هذه القوة و + +171 +00:12:58,790 --> 00:13:03,390 +نستبدلها بالقواتين اللي هي مكافئة لهم عشان نستنتج + +172 +00:13:03,390 --> 00:13:08,420 +ال ..الـ Action بتاعة الـ Superior Oblique Tendon + +173 +00:13:08,420 --> 00:13:13,200 +إذا شيلنا هذه القوة واستبدلناها بقوتين هيكون نصيب + +174 +00:13:13,200 --> 00:13:16,460 +الأسد للقوة العمودية ليش؟ لأنها أقرب للقوة + +175 +00:13:16,460 --> 00:13:20,100 +الأساسية .. أقرب للقوة الأساسية طيب قوة عمودية + +176 +00:13:20,100 --> 00:13:24,780 +بتشد من فوق العين بهذا الإتجاهعمودية على جسم كراوي + +177 +00:13:24,780 --> 00:13:28,520 +او على العين اذا هيكون المفعول الاول لل superior + +178 +00:13:28,520 --> 00:13:32,360 +oblique muscle هو ال in torsion ال in torsion لانه + +179 +00:13:32,360 --> 00:13:35,860 +ساعتما تشد هذه القوة العمودية بهذا الاتجاه ال + +180 +00:13:35,860 --> 00:13:38,960 +superior limbus هيتحرك نيزا ليهنا النزل ..هنا + +181 +00:13:38,960 --> 00:13:43,200 +النزل اذا اول action و ال action الاهم هو ال in + +182 +00:13:43,200 --> 00:13:47,360 +torsion طيب الان ال action التاني هي قوة متفقة مع + +183 +00:13:47,360 --> 00:13:51,920 +محور العين و بتشد في هذا الاتجاه هترفع ال back of + +184 +00:13:51,920 --> 00:13:55,550 +the eyeطالما رفعت ال back of the eye معناته ال + +185 +00:13:55,550 --> 00:13:59,150 +anterior part اللي انا بشاهده هيكون يصير في وضع + +186 +00:13:59,150 --> 00:14:02,610 +depression اذا بنقولش احنا ال superior oblique + +187 +00:14:02,610 --> 00:14:05,730 +بتعمل intortion و بتعمل elevation لل back of the + +188 +00:14:05,730 --> 00:14:08,990 +eye احنا إلنا بالظاهر هي بتعمل intortion كفعل + +189 +00:14:08,990 --> 00:14:11,970 +أساسي ال secondary action depression، depression + +190 +00:14:11,970 --> 00:14:15,470 +ليه؟ لأنه هي بترفع ال back of the eye بالسبب إنها + +191 +00:14:15,470 --> 00:14:18,910 +مثبتة خلفال equator، اذا هدولا القواتين، واحدة + +192 +00:14:18,910 --> 00:14:22,370 +هتعمل intortion وهي الفعل الأساسي لل superior + +193 +00:14:22,370 --> 00:14:25,270 +oblique muscle وواحدة هتعمل depression اللي هو + +194 +00:14:25,270 --> 00:14:30,010 +الفعل الثانوي لل superior oblique muscle، اذا + +195 +00:14:30,010 --> 00:14:33,790 +intortion و depression، الآن تالت action هو ال + +196 +00:14:33,790 --> 00:14:34,610 +abduction + +197 +00:14:36,840 --> 00:14:40,400 +في ال abduction ليش بيصير abduction؟ طبعا احنا + +198 +00:14:40,400 --> 00:14:44,460 +قولنا during contraction ال superior oblique + +199 +00:14:44,460 --> 00:14:49,300 +muscle بتقصر فلما بتقصر بتشد التندن معاها بتشد + +200 +00:14:49,300 --> 00:14:53,360 +التندن معاها لما التندن ينشد بهذا الاتجاه ال back + +201 +00:14:53,360 --> 00:14:57,320 +of the eye بتحرك بهذا الاتجاه يعني بيروح باتجاه ال + +202 +00:14:57,320 --> 00:15:00,360 +abduction ال back of the eye بيروح باتجاه ال + +203 +00:15:00,360 --> 00:15:04,960 +abduction بسبب انه التندن قاعدبشد لما ال back of + +204 +00:15:04,960 --> 00:15:08,060 +the eye يروح في اتجاه ال abduction ساعتها ال + +205 +00:15:08,060 --> 00:15:12,120 +anterior part of the eye هيروح باتجاه ال abduction + +206 +00:15:12,120 --> 00:15:16,360 +ال abduction وهيك احنا بنكون استنتجنا three + +207 +00:15:16,360 --> 00:15:20,000 +actions of the superior oblique muscle of the + +208 +00:15:20,000 --> 00:15:23,260 +superior oblique muscle اذا ال three action هي + +209 +00:15:23,630 --> 00:15:28,250 +entortion و depression و abduction entortion و + +210 +00:15:28,250 --> 00:15:31,830 +depression و abduction وبالتالي هذه القضية بدها + +211 +00:15:31,830 --> 00:15:36,830 +تكون واضحة تماما الان كيف اختبر ال actions بتاعة + +212 +00:15:36,830 --> 00:15:40,790 +superior oblique muscle كيف اختبر ال actions بتاعة + +213 +00:15:40,790 --> 00:15:45,050 +superior oblique muscle عشان نختبر ال actions بدنا + +214 +00:15:45,050 --> 00:15:50,780 +احنا يعني ننظرأي action من ال three actions أنا + +215 +00:15:50,780 --> 00:15:54,300 +بدي أختبرها هل بدي أختبر ال intortion اللي هو + +216 +00:15:54,300 --> 00:15:58,020 +الفعل الأساسي؟ طب ال intortion هي عملية غير مرئية + +217 +00:15:58,020 --> 00:16:01,120 +بالنسبة لنا في الوضع الطبيعي هل بدي أختبر ال + +218 +00:16:01,120 --> 00:16:04,740 +abduction؟ أنا فيه عندي ال main abductor of the + +219 +00:16:04,740 --> 00:16:07,520 +eye و اللي بقدرش أحيده هو ال lateral rectus muscle + +220 +00:16:07,520 --> 00:16:11,950 +اللي هي هنا مرسومة بشكل خيال بشكل ضل أوخيار، إذا + +221 +00:16:11,950 --> 00:16:16,310 +ال intortion بقدرش أشوفه و ال abduction بقدرش أحيد + +222 +00:16:16,310 --> 00:16:20,030 +ال lateral rectus muscle عن إنها تتوقف عن العمل، + +223 +00:16:20,030 --> 00:16:24,770 +إذا بضل عندي أني أختبر الفعل التاني اللي هو ال + +224 +00:16:24,770 --> 00:16:29,090 +depressionإذا بتعمل depression كويس معناته هذه + +225 +00:16:29,090 --> 00:16:32,550 +العضلة اللي هي superior oblique muscle عضلة سليمة + +226 +00:16:32,550 --> 00:16:38,650 +لو احنا اتطلعنا هنا على الرسمة رقم تلاتة على + +227 +00:16:38,650 --> 00:16:42,690 +الرسمة رقم تلاتة والرسمة رقم تلتاش بنقول في الرسمة + +228 +00:16:42,690 --> 00:16:46,650 +رقم تلاتة العين راحت في وضع ال adduction في وضع ال + +229 +00:16:46,650 --> 00:16:50,350 +adduction وأيضا في تلتاش راحت في وضع ال adduction + +230 +00:16:50,350 --> 00:16:55,440 +يعني باتجاه ال noseالـ nose لما بتروح العين باتجاه + +231 +00:16:55,440 --> 00:16:58,820 +الـ nose في ال adoption ساعتها محور ال superior + +232 +00:16:58,820 --> 00:17:01,900 +oblique tendon محور ال superior oblique tendon + +233 +00:17:01,900 --> 00:17:06,120 +بيتفق مع محور العين وساعتها بيصير action واحد لل + +234 +00:17:06,120 --> 00:17:09,080 +superior oblique tendon أو superior oblique muscle + +235 +00:17:09,080 --> 00:17:12,060 +هي ال depression ساعتها هي فقط هترفع ال back of + +236 +00:17:12,060 --> 00:17:16,080 +the eye فال anterior part هينزل لتحت وفي نفس + +237 +00:17:16,080 --> 00:17:19,570 +اللحظة ال other depressorالـ Other Depressor تاع + +238 +00:17:19,570 --> 00:17:22,150 +العين اللي هو الـ Inferior Rectus محور الـ + +239 +00:17:22,150 --> 00:17:25,530 +Inferior Rectus بيتعامد على محور العين هذه محور + +240 +00:17:25,530 --> 00:17:28,550 +العين اللي أنا يعني بأشر عليه ومحور السبيق الـ + +241 +00:17:28,550 --> 00:17:31,390 +Inferior Rectus اللي هي الـ Other Depressor of the + +242 +00:17:31,390 --> 00:17:35,370 +eye بيصير متعامدين فبالتالي الـ Inferior Rectus لا + +243 +00:17:35,370 --> 00:17:39,130 +تستطيع أن تساهم بالـ Depression وإنما هتصير فقط + +244 +00:17:39,130 --> 00:17:44,790 +Extorter إذا في وضع الـ In position باختبرفي ال in + +245 +00:17:44,790 --> 00:17:47,990 +and down .. في ال in and down بختبر ال function + +246 +00:17:47,990 --> 00:17:51,750 +بتاعة ال superior oblique muscle لأنه لن يشاركها + +247 +00:17:51,750 --> 00:17:55,730 +في ال in and down بمجرد ما تيجي العين .. العين in + +248 +00:17:55,730 --> 00:17:58,130 +ممكن الإنسان يقولي طب كيف هتيجي in بفعل ال media + +249 +00:17:58,130 --> 00:18:01,410 +rectus هتيجي in بفعل ال media rectus هتعمل + +250 +00:18:01,410 --> 00:18:05,010 +adoption طب صار عند ال adoption موجود .. صار عند + +251 +00:18:05,010 --> 00:18:09,930 +ال adoption موجودساعتها من ال two depressors أنا + +252 +00:18:09,930 --> 00:18:12,590 +فيه عندي two depressors في ال eye في ال inferior + +253 +00:18:12,590 --> 00:18:15,590 +rectus و في ال superior oblique طبعا ال inferior + +254 +00:18:15,590 --> 00:18:20,150 +rectus هتكون تعامدة على محور العين هتبطل تشتغل ك + +255 +00:18:20,150 --> 00:18:24,050 +depressor هتشتغل ك extorter لأنه متعامدة وجاية من + +256 +00:18:24,050 --> 00:18:29,250 +أسفل بينما ال superior oblique هتشتغل ك pure + +257 +00:18:29,250 --> 00:18:32,530 +depressor إذا أنا باختبر ال superior oblique + +258 +00:18:32,530 --> 00:18:37,120 +muscleفي وضع ال in and down position ال in and + +259 +00:18:37,120 --> 00:18:41,500 +down position دل نحكي عن نقطة واحدة ممكن إنسان + +260 +00:18:41,500 --> 00:18:45,560 +يتساءل يقول طب احنا عندنا هاي ال superior oblique + +261 +00:18:45,560 --> 00:18:52,590 +muscle بتبدأ يعني من .. من قمة ال orbitمن قمة ال + +262 +00:18:52,590 --> 00:18:56,270 +orbit و بتمشي تتحول لتندون و تدخل في الاتروكليا و + +263 +00:18:56,270 --> 00:18:59,410 +بعدين هذا يعني ليش الغلبة هذه كلها؟ ليش يعني مثلا + +264 +00:18:59,410 --> 00:19:02,930 +ال superior oblique ما تبدأ من هنا الاتروكليا و + +265 +00:19:02,930 --> 00:19:07,030 +تكون مثبتة في العظم و خلصنا هتأدي نفس القضية؟ ليش + +266 +00:19:07,030 --> 00:19:11,670 +هالطول هذا لزيادة عن اللزوم؟ فبنقول هذا له حكمة في + +267 +00:19:11,670 --> 00:19:16,740 +حاجة بيسموها عزم القوةعزم القوة يعني قدرة العضلة + +268 +00:19:16,740 --> 00:19:21,120 +على أداء شغل قدرة العضلة على تنفيذ شغل وتنفيذ عمل + +269 +00:19:21,120 --> 00:19:26,260 +عزم القوة يساوي القوة ضرب ذراع القوة ذراع القوة + +270 +00:19:26,260 --> 00:19:30,880 +يعني هو طول الذراع طول الذراع كل ما كان الطول أطول + +271 +00:19:30,880 --> 00:19:36,040 +بيكون العزم أعلى وبالتالي بتقدر أكتر على أنها تؤدي + +272 +00:19:36,040 --> 00:19:40,300 +شغل وبالتالي هذه القضية بدها تكون إيش واضحة إن شاء + +273 +00:19:40,300 --> 00:19:44,550 +الله تعالى إذا ال superior oblique muscleال + +274 +00:19:44,550 --> 00:19:48,930 +superior oblique muscle هي يعني ال main action + +275 +00:19:48,930 --> 00:19:55,050 +اللي لها ال intortion و ال secondary action اللي + +276 +00:19:55,050 --> 00:19:58,810 +لها ال depression و ال tertiary action اللي لها ال + +277 +00:19:58,810 --> 00:20:03,170 +abduction ال abduction .. ال abduction و بنتوقف + +278 +00:20:03,170 --> 00:20:07,110 +عند هذه النقطة بس خلينا نقرأ يعني اللي هو ما كتب + +279 +00:20:07,110 --> 00:20:11,030 +عنها .. ما كتب عنها اذا ال primary action of the + +280 +00:20:11,030 --> 00:20:15,200 +superior oblique is intortionsecondary actions are + +281 +00:20:15,200 --> 00:20:20,480 +depression and abduction طبعا ممكن إنسان يسأل عن + +282 +00:20:20,480 --> 00:20:30,500 +شغلة يقول في نقطة بدها توضيح في + +283 +00:20:30,500 --> 00:20:34,620 +نقطة بدها توضيح هنا هاي الاتروكليا .. هاي + +284 +00:20:34,620 --> 00:20:38,700 +الاتروكليا .. هاي الجزء من التندن اللي لف عبر + +285 +00:20:38,700 --> 00:20:45,630 +الاتروكليااللي لف عبر الاتروكليا وفرد واتسبت في + +286 +00:20:45,630 --> 00:20:48,510 +العين زي ما احنا .. او على سطح العين زي ما احنا + +287 +00:20:48,510 --> 00:20:51,610 +يعني شايفين .. شايفين هنا مضموم ملموم على بعض و + +288 +00:20:51,610 --> 00:20:55,950 +هنا أصبح فارد كتير هذه المنطقة .. خليني نطلع لعرض + +289 +00:20:55,950 --> 00:20:59,750 +أكبر .. خليني نطلع لعرض أكبر + +290 +00:21:02,810 --> 00:21:05,990 +في العرض الأكبر واضح إنه أنا فيها عندي fibers + +291 +00:21:05,990 --> 00:21:11,090 +ألياف هذه المنطقة بيسموها anterior fibers وهذه + +292 +00:21:11,090 --> 00:21:16,090 +المنطقة بيسموها posterior fibers اللي هي الألياف + +293 +00:21:16,090 --> 00:21:18,710 +اللي .. اللي جاية لقدام بيسموها ال anterior fibers + +294 +00:21:18,710 --> 00:21:21,790 +والألياف اللي جاية لورق بيسموها ال posterior + +295 +00:21:21,790 --> 00:21:24,710 +fibers ممكن إنسان يقول طب وإحنا إيش استفدنا من + +296 +00:21:24,710 --> 00:21:27,230 +موضوع ال fibers ده أو .. أو إيش بيفيدنا من الناحية + +297 +00:21:27,230 --> 00:21:32,290 +العمليةهنشرح هذه القضية بالرسمة اللي احنا رسمينها + +298 +00:21:32,290 --> 00:21:37,950 +هى ان احنا أخدنا ليفة واحدة من ال posterior و ليفة + +299 +00:21:37,950 --> 00:21:41,090 +واحدة من ال anterior عشان بس نوضح الفكرة هى + +300 +00:21:41,090 --> 00:21:44,890 +الاتروكليا هى مقدمة العين هنا هى مقدمة العين هذا + +301 +00:21:44,890 --> 00:21:48,130 +الجزء الأمامي من العين وهذا الجزء الخلفي لو أجينا + +302 +00:21:48,130 --> 00:21:53,060 +احنا جسنا هذه الزاويةو جثنا هذه الزاوية بنلاقي ان + +303 +00:21:53,060 --> 00:21:56,540 +ال anterior fibers عاملة زاوية اكثر تعامدا يعني + +304 +00:21:56,540 --> 00:22:02,360 +اقرب لل 90 يعني اقرب لل 90 مع ال visual axis من ال + +305 +00:22:02,360 --> 00:22:06,160 +posterior fibers ال posterior fibers الزاوية بينها + +306 +00:22:06,590 --> 00:22:10,810 +الـ posterior fibers الذاوية بينها وبين الـ visual + +307 +00:22:10,810 --> 00:22:14,870 +axis أقل من الذاوية بين الـ anterior fibers و الـ + +308 +00:22:14,870 --> 00:22:18,170 +visual axis يعني هذه الـ anterior fibers أكتر + +309 +00:22:18,170 --> 00:22:22,430 +تعامداً و الـ posterior fibers أقل تعامداً + +310 +00:22:22,430 --> 00:22:25,530 +فبالتالي هذه الـ anterior fibers هي أكتر fibers + +311 +00:22:25,530 --> 00:22:29,410 +أكتر fibers مسئولة عن الـ intorsion عن الـ + +312 +00:22:29,410 --> 00:22:33,610 +intorsion هذه الرسمة هرجعلها بنقول هي الـ anterior + +313 +00:22:33,610 --> 00:22:37,670 +fibersأكتر تعامدا على ال visual axis فبسموها + +314 +00:22:37,670 --> 00:22:42,190 +torsional fibers و ال posterior fibers أقل تعامدا + +315 +00:22:42,190 --> 00:22:46,490 +فبسموها ال depression fibers أو depressor fibers + +316 +00:22:46,490 --> 00:22:50,250 +على العموم كل ال fibers بتشارك في ال intorsion و + +317 +00:22:50,250 --> 00:22:53,570 +الدبريشن بس ال anterior fibers mainly are + +318 +00:22:53,570 --> 00:23:00,540 +intorsionalفبنقول كالأيات احنا حكينا قولنا أي قوة + +319 +00:23:00,540 --> 00:23:04,460 +.. أي قوة .. أي قوة الإيد عمودية على جسم كروي أو + +320 +00:23:04,460 --> 00:23:08,980 +إستواني أو بيضاوي أو شبه بيضاوي بيكون الفعل دوراني + +321 +00:23:08,980 --> 00:23:12,720 +البرغي فهذه الإيد لما بتسحب باتجاه الإنسان اللي + +322 +00:23:12,720 --> 00:23:16,620 +بيخبز أو عكس اتجاهه بيكون على الحالتين دوراني + +323 +00:23:16,620 --> 00:23:21,520 +البرغي إما باتجاهنا، باتجاه الأمام أو باتجاه الخلف + +324 +00:23:22,230 --> 00:23:25,330 +الرجل اللي .. اللي بيشتغل .. بيشتغل اه و اللي + +325 +00:23:25,330 --> 00:23:30,310 +بيعمل .. اذا هذه بتمثلي يعني واضح ان هو القوة هنا + +326 +00:23:30,310 --> 00:23:33,790 +بتتحرك بهذا الاتجاه و الجسم اللي بتتم تحريكه و + +327 +00:23:33,790 --> 00:23:37,930 +موجود ال axis بتاعه بهذا الاتجاه قوة عمودية على + +328 +00:23:37,930 --> 00:23:43,090 +جسم استواني على جسم استواني و هذه القضية يعني بدها + +329 +00:23:43,090 --> 00:23:46,850 +تكون ان شاء الله تعالى واضحة بدها تكون واضحة بإذن + +330 +00:23:46,850 --> 00:23:48,290 +الله تعالى + +331 +00:23:50,460 --> 00:23:53,520 +إذن the anterior fibers of the superior oblique + +332 +00:23:53,520 --> 00:23:58,540 +tendon are primarily responsible for in torsion + +333 +00:23:58,540 --> 00:24:01,960 +primarily يعني غالبا هي المسؤولة عن ال in torsion + +334 +00:24:01,960 --> 00:24:05,520 +and the posterior fibers for depression طب هذا + +335 +00:24:05,520 --> 00:24:08,820 +الكلام يعني إيش نستفيد منه هذا الكلام بيسمح لنا + +336 +00:24:08,820 --> 00:24:12,380 +separate surgical manipulation of these two + +337 +00:24:12,380 --> 00:24:16,190 +actions يعني ممكن أنا أشتغل على جزءجراحيا على جزء + +338 +00:24:16,190 --> 00:24:20,610 +من التندن دون الجزء الآخر حسب المشكلة بتاعة المريض + +339 +00:24:20,610 --> 00:24:24,730 +هل هو بشكي من torsional diplopia ولا من vertical + +340 +00:24:24,730 --> 00:24:29,010 +diplopia وهذا هييجي في حوال اتنين في موعده ان شاء + +341 +00:24:29,010 --> 00:24:34,490 +الله تعالىطيب لما بيصير عندى adoption للجلوب واحد + +342 +00:24:34,490 --> 00:24:39,270 +وخمسين degree the visual axis coincide with the + +343 +00:24:39,270 --> 00:24:42,670 +line of pull .. with the line of pull of the + +344 +00:24:42,670 --> 00:24:45,950 +muscle in this position it can only act as + +345 +00:24:45,950 --> 00:24:51,380 +depressor وهذا الكلام بده يكون واضح عندىفي الرسمة + +346 +00:24:51,380 --> 00:24:54,920 +هاي لما بيصير العين abducted واحد وخمسين degree + +347 +00:24:54,920 --> 00:24:59,160 +تقريبا بيصير ال muscle أو ال tendon بتاع ال muscle + +348 +00:24:59,160 --> 00:25:04,160 +منطبق coincident with the axis of the eye وساعتها + +349 +00:25:04,160 --> 00:25:07,880 +العين أو ساعتها ال superior oblique هتشتغل ك + +350 +00:25:07,880 --> 00:25:13,360 +depressor ك puredepressor this is therefore the + +351 +00:25:13,360 --> 00:25:16,240 +best position of the globe for testing the action + +352 +00:25:16,240 --> 00:25:19,400 +of the superior oblique muscle thus although the + +353 +00:25:19,400 --> 00:25:22,620 +superior oblique has an abducting action in a + +354 +00:25:22,620 --> 00:25:26,420 +primary position the main effect of the superior + +355 +00:25:26,420 --> 00:25:29,560 +oblique weakness is seen as failure of depression + +356 +00:25:29,560 --> 00:25:36,620 +in abduction يعني عشان أعرف عشان أعرفال superior + +357 +00:25:36,620 --> 00:25:41,000 +oblique ضعيفة ولا مش ضعيفة بخلي المريض يتطلع لجوة + +358 +00:25:41,000 --> 00:25:45,140 +و للأسفل in and down position لما بيصير failure of + +359 +00:25:45,140 --> 00:25:48,540 +depression in adduction يعني مش قادر العين تنزل في + +360 +00:25:48,540 --> 00:25:51,920 +وضع ال adoption يعني أجت العين لجوة بس مش قادرة + +361 +00:25:51,920 --> 00:25:55,900 +تنزل لتحت يعني in and down ساعتها بعرف أن في عندي + +362 +00:25:55,900 --> 00:25:58,960 +superior oblique weakness superior oblique + +363 +00:25:58,960 --> 00:26:04,950 +weakness لما العين بيصير الهاءabduction abduction + +364 +00:26:04,950 --> 00:26:09,970 +تسعة و تلاتين degree زي الرسمة الآن هناخدها لما + +365 +00:26:09,970 --> 00:26:13,190 +العين بيصير لها abduction تسعة و تلاتين degree + +366 +00:26:13,190 --> 00:26:17,050 +نروح على الرسمة رقم ستة بنقول هنا العين في وضع ال + +367 +00:26:17,050 --> 00:26:21,090 +abduction ساعتها بيتعامد ال superior oblique + +368 +00:26:21,090 --> 00:26:25,290 +tendon مع محور العين إذا تعامد ساعتها ال superior + +369 +00:26:25,290 --> 00:26:29,710 +oblique هتشتغل كentorter فقط كentorter فقط يعني هي + +370 +00:26:29,710 --> 00:26:34,730 +هتجيب الساعة اتناش في ال limbusهتلفها nasally .. + +371 +00:26:34,730 --> 00:26:41,550 +هتلفها nasally اذا when the eye is abducted .. + +372 +00:26:41,550 --> 00:26:46,510 +abducted تسعة وتلاتين degree the visual axis and + +373 +00:26:46,510 --> 00:26:49,990 +the superior oblique make an angle of تسعين degree + +374 +00:26:49,990 --> 00:26:53,410 +with each other in this position the superior .. + +375 +00:26:53,410 --> 00:26:56,810 +superior oblique can only cause intorsion .. + +376 +00:26:56,810 --> 00:26:59,920 +intorsionالان هاي اللي عين في ال primary position + +377 +00:26:59,920 --> 00:27:03,360 +ال superior oblique عاملة معاها واحد وخمسين degree + +378 +00:27:03,760 --> 00:27:08,860 +في ال adoption في ال adoption بيتفق محور ال + +379 +00:27:08,860 --> 00:27:11,920 +superior oblique ومحور العين في ال abduction + +380 +00:27:11,920 --> 00:27:15,780 +بيتعامد محور العين مع محور ال superior oblique إذا + +381 +00:27:15,780 --> 00:27:20,120 +أنا باختبر ال superior oblique بإني أخلي المريض + +382 +00:27:20,120 --> 00:27:23,740 +يتطلع لجوه ولمّا يتطلع لجوه طبعا بفعل ال media + +383 +00:27:23,740 --> 00:27:27,680 +rectus بقوله يتطلع لتحت in and down position هو ال + +384 +00:27:27,680 --> 00:27:31,500 +best position لاختبار ال superior obliquemuscle + +385 +00:27:31,500 --> 00:27:35,220 +إذا ال in and down position هو ال best position + +386 +00:27:35,220 --> 00:27:39,640 +لاختبار ال superior oblique muscle و بنتوقف هنا و + +387 +00:27:39,640 --> 00:27:40,280 +يعطيكم + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/nhuuX600TDc_raw.json b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/nhuuX600TDc_raw.json new file mode 100644 index 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اقرب", "probability": 0.97705078125}, {"start": 1318.86, "end": 1319.02, "word": " لل", "probability": 0.7705078125}, {"start": 1319.02, "end": 1319.58, "word": " 90", "probability": 0.9501953125}, {"start": 1319.58, "end": 1320.52, "word": " مع", "probability": 0.98974609375}, {"start": 1320.52, "end": 1320.68, "word": " ال", "probability": 0.98486328125}, {"start": 1320.68, "end": 1320.98, "word": " visual", "probability": 0.958984375}, {"start": 1320.98, "end": 1321.58, "word": " axis", "probability": 0.84912109375}, {"start": 1321.58, "end": 1322.2, "word": " من", "probability": 0.9873046875}, {"start": 1322.2, "end": 1322.36, "word": " ال", "probability": 0.9375}, {"start": 1322.36, "end": 1322.74, "word": " posterior", "probability": 0.970703125}, {"start": 1322.74, "end": 1323.28, "word": " fibers", "probability": 0.9208984375}, {"start": 1323.28, "end": 1323.5, "word": " ال", "probability": 0.60107421875}, {"start": 1323.5, "end": 1324.04, "word": " posterior", "probability": 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{"start": 1345.53, "end": 1346.19, "word": " أكتر", "probability": 0.931396484375}, {"start": 1346.19, "end": 1346.77, "word": " fibers", "probability": 0.9580078125}, {"start": 1346.77, "end": 1347.71, "word": " مسئولة", "probability": 0.9373779296875}, {"start": 1347.71, "end": 1347.95, "word": " عن", "probability": 0.99609375}, {"start": 1347.95, "end": 1348.23, "word": " الـ", "probability": 0.7061767578125}, {"start": 1348.23, "end": 1348.91, "word": " intorsion", "probability": 0.7381184895833334}, {"start": 1348.91, "end": 1349.19, "word": " عن", "probability": 0.97021484375}, {"start": 1349.19, "end": 1349.41, "word": " الـ", "probability": 0.95703125}, {"start": 1349.41, "end": 1350.09, "word": " intorsion", "probability": 0.8943684895833334}, {"start": 1350.09, "end": 1350.83, "word": " هذه", "probability": 0.9189453125}, {"start": 1350.83, "end": 1351.19, "word": " الرسمة", "probability": 0.9720052083333334}, {"start": 1351.19, "end": 1351.81, "word": " هرجعلها", "probability": 0.8201904296875}, {"start": 1351.81, "end": 1352.21, "word": " بنقول", "probability": 0.6658935546875}, {"start": 1352.21, "end": 1352.53, "word": " هي", "probability": 0.84521484375}, {"start": 1352.53, "end": 1353.23, "word": " الـ", "probability": 0.941162109375}, {"start": 1353.23, "end": 1353.61, "word": " anterior", "probability": 0.93212890625}, {"start": 1353.61, "end": 1354.37, "word": " fibers", "probability": 0.93212890625}], "temperature": 1.0}, {"id": 59, "seek": 137453, "start": 1355.11, "end": 1374.53, "text": "أكتر تعامدا على ال visual axis فبسموها torsional fibers و ال posterior fibers أقل تعامدا فبسموها ال depression fibers أو depressor fibers على العموم كل ال fibers بتشارك في ال intorsion و الدبريشن بس ال anterior fibers mainly are intorsional", "tokens": [10721, 4117, 2655, 2288, 37279, 10943, 28259, 15844, 2423, 5056, 10298, 6156, 3555, 38251, 2407, 11296, 3930, 82, 1966, 25252, 4032, 2423, 33529, 25252, 5551, 4587, 1211, 37279, 10943, 28259, 6156, 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0000000000000000000000000000000000000000..2dcea77617890a819834f453fad88eb6d4bf171d --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/npmA7i6RT9s.srt @@ -0,0 +1,1631 @@ +1 +00:00:01,650 --> 00:00:07,470 +بسم الله الرحمن الرحيم بنستكمل محاضرات حول واحد + +2 +00:00:07,470 --> 00:00:10,930 +واتوقفنا المرة الماضية عند ال sensory adaptation + +3 +00:00:10,930 --> 00:00:14,370 +to strabismus وقلنا لما بيصير الـ حول فجأة عند + +4 +00:00:14,370 --> 00:00:20,390 +الإنسان ممكن يشعر بالـ confusion أو الـ diplopia وإن + +5 +00:00:20,390 --> 00:00:25,450 +الـ confusion بينشأ من سقوط صورة الـ target على الـ fovea + +6 +00:00:25,450 --> 00:00:29,550 +وصورة الـ target الآخر على الـ fovea الثانية نتيجة أنه + +7 +00:00:29,550 --> 00:00:33,250 +في الفرق أصبح الـ visual direction لـ الـ two foveas + +8 +00:00:33,250 --> 00:00:40,810 +مش موحد فكل fovea إذا وجد عندها target هتسقط + +9 +00:00:40,810 --> 00:00:44,190 +صورة هذا الـ target على هذه الـ fovea وبالتالي ممكن + +10 +00:00:44,190 --> 00:00:49,470 +يصير عندي confusion اختلاط الصور في بعضها البعض زي + +11 +00:00:49,470 --> 00:00:54,400 +ما المنظر اللي عرضناه المرة الماضية بيوضح هذا هو الـ + +12 +00:00:54,400 --> 00:00:58,080 +confusion .. هذا هو الـ confusion اختلاط صورة + +13 +00:00:58,080 --> 00:01:03,240 +الشجرة بصورة البيت لأنه البيت إجا على الـ fovea + +14 +00:01:03,240 --> 00:01:08,040 +الشمال و الشجرة إجت على الـ fovea اليمين أرسله لنفس + +15 +00:01:08,040 --> 00:01:11,660 +المنطقة من الدماغ للتحليل لأن الـ fovea و الـ fovea + +16 +00:01:11,660 --> 00:01:15,060 +are corresponding retinal areas أيضا زي ما المنظر + +17 +00:01:15,060 --> 00:01:20,950 +هنا بيوضح الشجرة إجت على الـ fovea الشمال والبيت إجت + +18 +00:01:20,950 --> 00:01:24,870 +على الـ fovea اليمين فاختلطت الصورتين ببعضهم مش إجوا + +19 +00:01:24,870 --> 00:01:28,210 +قدام بعضهم، إذا هذا الـ sensation الأول اللي بيشعر + +20 +00:01:28,210 --> 00:01:33,390 +فيه الإنسان وبالتالي بيكون الأمر مزعج بالنسبة + +21 +00:01:33,390 --> 00:01:37,310 +للمريض الـ sensation الثاني اللي هو قضية الـ + +22 +00:01:37,310 --> 00:01:41,670 +diplopia هو سقوط صورة الـ target واحد على non + +23 +00:01:41,670 --> 00:01:44,490 +-corresponding retinal areas، يعني هذا الـ target + +24 +00:01:44,490 --> 00:01:45,130 +الأحمر + +25 +00:01:47,790 --> 00:01:52,610 +سقط على الـ fovea في العين الشمال و سقط بعيد عن الـ + +26 +00:01:52,610 --> 00:01:55,850 +fovea في العين اليمين، طبعا الـ fovea و الـ nasal + +27 +00:01:55,850 --> 00:02:01,430 +retina في العين اليمين معناته في عندي diplopia، في + +28 +00:02:01,430 --> 00:02:04,050 +عندي diplopia لأن هذه مش corresponding retinal + +29 +00:02:04,050 --> 00:02:09,010 +areas وبالتالي مش هترسل لنفس النقطة من المنطقة + +30 +00:02:09,010 --> 00:02:12,530 +التحليل في الدماغ وبالتالي هيضلوا الصورتين صورتين + +31 +00:02:12,530 --> 00:02:16,310 +طبعا هيصير عندي أنا diplopia فحكينا أيضا الـ + +32 +00:02:16,310 --> 00:02:19,310 +diplopia تقسم لـ cross diplopia في حالة الـ + +33 +00:02:19,310 --> 00:02:24,590 +Exotropia exotropia crossed و exotropia uncrossed + +34 +00:02:24,590 --> 00:02:29,130 +diplopia و أيضا تقسم لأنواع اللي هي الـ horizontal + +35 +00:02:29,130 --> 00:02:33,050 +diplopia الـ vertical diplopia و الـ torsional + +36 +00:02:33,050 --> 00:02:37,070 +diplopia زي ما الصورة هنا بتوضح زي ما الصورة بتوضح + +37 +00:02:37,070 --> 00:02:41,220 +في قضية الـ torsional diplopia أيضا الأمر مزعج جدا، + +38 +00:02:41,220 --> 00:02:44,980 +تخيل إنسان بتفرج أو بيقود سيارته و عنده torsional + +39 +00:02:44,980 --> 00:02:48,800 +dyplopia و كل شيء أمامه، من السيارات و المباني و + +40 +00:02:48,800 --> 00:02:52,180 +ده ده، يعني في إيحاء خيال مائل، في إيحاء خيال مائل، + +41 +00:02:52,180 --> 00:02:56,300 +الصورة هيك هتكون يعني مزعجة أو إنسان بيقرأ و عنده + +42 +00:02:56,300 --> 00:02:59,040 +dyplopia بغض النظر عن نوعها torsional أو + +43 +00:02:59,040 --> 00:03:01,920 +horizontal أو ما شابه، هي أنا عندي horizontal + +44 +00:03:01,920 --> 00:03:06,940 +dyplopia، طبعا هذه برضه شيء يعني مزعج للإنسان، + +45 +00:03:06,940 --> 00:03:11,060 +مزعج للإنسان، كيف؟ الـ .. الـ .. الدماغ بيساعد + +46 +00:03:11,060 --> 00:03:15,000 +الإنسان اللي عنده حول أنه يتخلص من هذه الـ + +47 +00:03:15,000 --> 00:03:19,260 +sensations، لما بيصير الـ حول بيصير عندي sensations، + +48 +00:03:19,260 --> 00:03:22,900 +الـ pathological diplopia عبارة عن إحساس، إحساس .. + +49 +00:03:24,840 --> 00:03:29,980 +أنه بيرى الشغلة أو الشيء .. شيء .. شيئين الـ .. الـ .. + +50 +00:03:29,980 --> 00:03:34,920 +الـ confusion أنه بيحس إنه الأشياء ملخبطة مع بعضها + +51 +00:03:34,920 --> 00:03:38,260 +و .. و صورها متداخلة مع بعضها البعض إذا الـ + +52 +00:03:38,260 --> 00:03:40,880 +confusion و الـ diplopia الـ pathological diplopia + +53 +00:03:40,880 --> 00:03:45,160 +عبارة عن sensations إحساسات كيف هذه الإحساسات + +54 +00:03:45,160 --> 00:03:50,620 +الدماغ بيتخلص منها في طلب ما في sensation معناته + +55 +00:03:50,620 --> 00:03:55,370 +لازم الدماغ يتخذ الـ نوع من الـ adaptation التأقلم + +56 +00:03:55,370 --> 00:04:00,890 +بحيث أنه يجري عمليات معينة تخلصوا من هذه القضايا + +57 +00:04:00,890 --> 00:04:03,690 +المزعجة اللي هي الـ confusion و الدبلوبيا the + +58 +00:04:03,690 --> 00:04:07,590 +ocular sensory system in children has the ability + +59 +00:04:07,590 --> 00:04:11,130 +to adapt to anomalous states الـ confusion و + +60 +00:04:11,130 --> 00:04:14,590 +الدبلوبيا by two mechanisms إحنا عارفين أن الـ حول + +61 +00:04:14,590 --> 00:04:19,110 +أغلب مرضى الـ حول هم عبارة عن أطفال عبارة عن أطفال + +62 +00:04:19,920 --> 00:04:23,800 +النظام البصري تاع الطفل أو بالـ .. بالـ .. بالصورة + +63 +00:04:23,800 --> 00:04:28,680 +المبسطة الدماغ تاع الطفل عنده القدرة to adapt أنه + +64 +00:04:28,680 --> 00:04:32,680 +يتأقلم على الأوضاع الغير طبيعية، إيش هي الأوضاع + +65 +00:04:32,680 --> 00:04:35,360 +الغير طبيعية؟ اللي هي الـ confusion و الدبلوبيا + +66 +00:04:35,360 --> 00:04:40,620 +بواسطة two mechanisms، بواسطة آليتين، الآلية + +67 +00:04:40,620 --> 00:04:44,180 +الأولى اللي هي الـ suppression الآلية الأولى هي الـ + +68 +00:04:44,180 --> 00:04:47,160 +suppression والآلية الثانية هي الـ abnormal + +69 +00:04:47,160 --> 00:04:51,000 +retinal correspondence الـ abnormal retinal + +70 +00:04:51,000 --> 00:04:53,980 +correspondence هي الآلية الثانية إذا كان .. إذا + +71 +00:04:53,980 --> 00:04:57,100 +عندي أنا في .. زي ما في عندي two sensations في + +72 +00:04:57,100 --> 00:05:01,020 +عندي two types of adaptation two types of + +73 +00:05:01,020 --> 00:05:05,460 +adaptations الـ adaptation الأول أو التأقلم الأول + +74 +00:05:05,460 --> 00:05:09,350 +اللي هو الـ suppression والتأقلم الثاني هو الـ + +75 +00:05:09,350 --> 00:05:12,510 +abnormal retinal correspondence الـ abnormal + +76 +00:05:12,510 --> 00:05:16,150 +retinal correspondence إيش يعني suppression؟ + +77 +00:05:16,150 --> 00:05:21,550 +suppression يعني إلغاء صورة من الصورتين إلغاء صورة + +78 +00:05:21,550 --> 00:05:26,010 +من الصورتين اللي واصلين من العينين حتى ما يشعر + +79 +00:05:26,010 --> 00:05:30,310 +الإنسان ما يشعر الإنسان بأنه في عنده لا confusion + +80 +00:05:30,310 --> 00:05:36,230 +ولا diplopia لا confusion ولا diplopia الـ .. الـ + +81 +00:05:36,230 --> 00:05:39,410 +abnormal retinal correspondence هذه طريقة ثانية للـ + +82 +00:05:39,410 --> 00:05:44,950 +adaptation يعني هنحكي عنها في موعدها، these + +83 +00:05:44,950 --> 00:05:49,410 +adaptations occur because of the plasticity of + +84 +00:05:49,410 --> 00:05:53,210 +developing visual system in children under the age + +85 +00:05:53,210 --> 00:05:57,570 +of seven to eight years هذه الآليات للتخلص من الـ + +86 +00:05:57,570 --> 00:06:02,110 +confusion و الـ diplopia يعني بتحدث بسبب أنه في + +87 +00:06:02,110 --> 00:06:05,790 +عندي مرونة في الـ visual system plasticity مرونة في + +88 +00:06:05,790 --> 00:06:09,270 +الـ visual system بتاع الأطفال اللي أعمارهم بتتراوح + +89 +00:06:09,270 --> 00:06:13,810 +من سبعة لثمان سنين فأقل اللي أعمارهم من أعمار + +90 +00:06:13,810 --> 00:06:17,790 +سبعة لثمان سنين فأقل بعد ثمان سنوات من العمر + +91 +00:06:17,790 --> 00:06:21,510 +بيصير صعب هذه الـ adaptation مش مستحيل ولكن في + +92 +00:06:21,510 --> 00:06:26,730 +صعوبة ما يعني كثير من الأطفال فوق السبع سنين أو + +93 +00:06:26,730 --> 00:06:30,730 +ثمان سنوات عمر عشر سنوات اثنا عشر سنة أو الـ adults + +94 +00:06:30,730 --> 00:06:35,210 +صعب يعمل suppression و صعب يعمل abnormal retinal + +95 +00:06:35,210 --> 00:06:38,870 +correspondence فعلى هذا الأساس هيضلي يعاني من الـ + +96 +00:06:38,870 --> 00:06:42,370 +sensations اللي قولنا عنهم اللي هم الـ confusion و + +97 +00:06:42,370 --> 00:06:47,170 +الـ diplopia و الـ diplopia occasional adults قليل جدا + +98 +00:06:47,170 --> 00:06:51,130 +من البالغين who develop sudden onset strabismus + +99 +00:06:51,130 --> 00:06:55,490 +are able to ignore the second image قليل جدا من + +100 +00:06:55,490 --> 00:07:00,170 +الكبار البالغين اللي صار عنده مفاجأة حول بيستطيع + +101 +00:07:00,170 --> 00:07:04,210 +أنه يهمل الصورة الثانية لما يصير عنده ازدواجية + +102 +00:07:04,210 --> 00:07:07,630 +after a time and therefore do not complain of + +103 +00:07:07,630 --> 00:07:12,530 +diplopia أي إنسان دماغه بيستطيع ينسى الصورة الثانية + +104 +00:07:12,530 --> 00:07:16,650 +ويعمل suppression إلغاء للصورة الثانية، ساعتها مش + +105 +00:07:16,650 --> 00:07:20,130 +هيصير عنده dyplopia لأنه اللي هيصل للدماغ صورة + +106 +00:07:20,130 --> 00:07:23,390 +واحدة من عين واحدة، وساعتها بسميهوش binocular + +107 +00:07:23,390 --> 00:07:26,970 +single vision وإنما بسميه monocular single vision + +108 +00:07:26,970 --> 00:07:30,930 +عينيتين مفتوحتين ولكن عين واحدة هي اللي بترسل + +109 +00:07:30,930 --> 00:07:34,990 +للدماغ الثانية في وضع استراحة بتطبع الصورة على + +110 +00:07:34,990 --> 00:07:39,470 +الشبكية في هذه العين ولكن يرفض الدماغ استقبالها + +111 +00:07:39,740 --> 00:07:44,840 +وكأنها تم إلغاءها وموجودة فقط للشكل الجمالي مش + +112 +00:07:44,840 --> 00:07:49,540 +للعمل كتيما مع الثانية وهذا اللي بيسموه الـ + +113 +00:07:49,540 --> 00:07:52,440 +suppression نيجي نعرف الـ suppression الـ + +114 +00:07:52,440 --> 00:07:55,660 +suppression involves active inhibition in the + +115 +00:07:55,660 --> 00:08:00,340 +visual cortex of an image from one eye when both + +116 +00:08:00,340 --> 00:08:05,420 +eyes are open ضروري جدا هذا التعريف يعني نتطلع فيه + +117 +00:08:05,420 --> 00:08:09,680 +و نفهم كل كلماته active inhibition .. active + +118 +00:08:09,680 --> 00:08:13,420 +inhibition يعني الدماغ هو اللي بيأتي بالعملية و + +119 +00:08:13,420 --> 00:08:16,980 +معنى يأتي بالعملية عشان يتخلص الإنسان من الـ + +120 +00:08:16,980 --> 00:08:19,660 +sensations المزعجة اللي هي الـ confusion و + +121 +00:08:19,660 --> 00:08:23,680 +الدبلوبية، إذا active inhibition مين اللي بيعمل الـ + +122 +00:08:23,680 --> 00:08:26,900 +inhibition؟ الـ visual cortex، الدماغ in the visual + +123 +00:08:26,900 --> 00:08:32,880 +cortex of an image لصورة من الصور from one eye when + +124 +00:08:32,880 --> 00:08:37,160 +both eyes are open ضروري جدا نقول when both eyes + +125 +00:08:37,160 --> 00:08:40,320 +are open ليش؟ لأنه لو الإنسان غطى عين من عينيه + +126 +00:08:40,320 --> 00:08:45,740 +اثنتين معناته هذا الدماغ ما له علاقة فيه الشخص نفسه + +127 +00:08:45,740 --> 00:08:49,200 +وضع يده منع استقبال الصورة منع الصورة أنها تسقط + +128 +00:08:49,200 --> 00:08:53,020 +على الشبكية إذا من البداية هو عين واحدة عنده + +129 +00:08:53,020 --> 00:08:56,870 +مفتوحة وعين واحدة بتستقبل الصورة، إذا الدماغ ما عمل + +130 +00:08:56,870 --> 00:09:01,330 +inhibition ولكن اليد هي اللي منعت الصورة من أن تُصل + +131 +00:09:01,330 --> 00:09:05,490 +للشبكية أما لما بيصير عندي أن العينين both + +132 +00:09:05,490 --> 00:09:11,530 +eyes are open both eyes are open معناته في عندي + +133 +00:09:11,530 --> 00:09:15,900 +صورتين الصورتين انطبعتا على الشبكية في العين اليمين + +134 +00:09:15,900 --> 00:09:19,820 +وعلى الشبكية في العين الشمال وأرسلهما إلى الدماغ، + +135 +00:09:19,820 --> 00:09:24,180 +الدماغ اختار صورة من الصور واعتمدها واستقبلها + +136 +00:09:24,180 --> 00:09:27,800 +وفهمها، و الصورة الثانية عمل لها active inhibition + +137 +00:09:27,800 --> 00:09:32,700 +يعني رفض استقبالها رفض استقبالها، فهذا يسمى الـ + +138 +00:09:32,700 --> 00:09:36,820 +suppression، هذا يسمى الـ suppression و هنا بدنا نبه + +139 +00:09:36,820 --> 00:09:42,060 +في التعريف لنقطة غاية في الأهمية، إيش هذه النقطة؟ + +140 +00:09:42,060 --> 00:09:46,420 +active inhibition مفهومة in the visual cortex يعني + +141 +00:09:46,420 --> 00:09:48,300 +الـ brain اللي بيكون بالـ .. بيكون بالـ active + +142 +00:09:48,300 --> 00:09:53,520 +inhibition برضه مفهومة of an image from one eye ليش + +143 +00:09:53,520 --> 00:09:56,260 +ذكر في التعريف from one eye؟ ليش ما قلنا from the + +144 +00:09:56,260 --> 00:09:59,880 +squinting eye؟ ليش حددناها؟ ليش حددناها؟ أنا مثلا + +145 +00:09:59,880 --> 00:10:06,080 +إنسان عنده exotropia sudden onset of exotropia في + +146 +00:10:06,080 --> 00:10:09,080 +العين اليمين المفروض أن الـ suppression يصير في + +147 +00:10:09,080 --> 00:10:14,000 +العين اليمين بنقول هنا التعريف دقيق جدا واحدة من + +148 +00:10:14,000 --> 00:10:16,990 +الـ image لازم يصير لها suppression لازم يصير لها + +149 +00:10:16,990 --> 00:10:20,130 +suppression عشان ما يشكيش هذا الطفل أو هذا المريض + +150 +00:10:20,130 --> 00:10:23,490 +من diplopia، بس ليش إحنا حددنا .. قلنا من العين + +151 +00:10:23,490 --> 00:10:27,090 +اللي فيها الـ squint، بنقول مش دائما .. مش دائما + +152 +00:10:27,090 --> 00:10:30,790 +العين اللي فيها الـ squint، الدماغ بيرفض الصورة + +153 +00:10:30,790 --> 00:10:35,000 +بتاعتها ممكن الـ squint يكون في الـ right eye ممكن الـ + +154 +00:10:35,000 --> 00:10:37,800 +squint يكون في الـ right eye مثلا esotropia أو + +155 +00:10:37,800 --> 00:10:41,860 +exotropia أو ما شابه و الـ .. الـ .. الـ suppression + +156 +00:10:41,860 --> 00:10:45,420 +يصير في العين الشمال مش في العين اليمين يعني الـ + +157 +00:10:45,420 --> 00:10:47,900 +squint في العين اليمين و الـ suppression في العين + +158 +00:10:47,900 --> 00:10:51,200 +الشمال إيش الـ .. يعني .. يعني كيف نفهم هذه القضية؟ + +159 +00:10:51,200 --> 00:10:56,820 +بنقول الدماغ دائما بيقبل الصورة الأكثر وضوحا بغض + +160 +00:10:56,820 --> 00:11:00,600 +النظر الصورة الأكثر وضوحا جاءت من العين اللي فيها + +161 +00:11:00,600 --> 00:11:04,020 +squint ولا من العين الـ straight يعني نفرض أنه عنده + +162 +00:11:04,020 --> 00:11:07,980 +right exotropia right exotropia و الـ vision في + +163 +00:11:07,980 --> 00:11:12,380 +الـ right eye ستة على ستة وفيها حوالي الخارج exotropia + +164 +00:11:12,380 --> 00:11:16,860 +والعين الشمال اللي هي straight فيها amblyopia لسبب + +165 +00:11:16,860 --> 00:11:20,260 +سابق amblyopia لسبب سابق ممكن يكون عندها high + +166 +00:11:20,260 --> 00:11:23,320 +refractive error أو ما شابه والـ best corrected + +167 +00:11:23,320 --> 00:11:27,740 +visual acuity في الشمال مثلا ستة على أربع وعشرين + +168 +00:11:27,740 --> 00:11:31,840 +إذا اليمين ستة على ستة والشمال ستة على أربع وعشرين + +169 +00:11:31,840 --> 00:11:35,440 +إذا الصورة في العين اليمين الصورة في العين اليمين + +170 +00:11:35,440 --> 00:11:39,840 +أوضح من الصورة في العين الشمال، الدماغ هيعتمد صورة + +171 +00:11:39,840 --> 00:11:43,200 +العين اليمين و هيُلغي صورة الشمال عشان ما يصيرش عنده + +172 +00:11:43,200 --> 00:11:47,580 +الـ sensations اللي قلنا عنها، اللي هي الـ confusion + +173 +00:11:47,580 --> 00:11:51,600 +و الدبلوبيا، رغم أنه الـ squint في اليمين، إلا أنه + +174 +00:11:51,600 --> 00:11:55,070 +الـ suppression في الشمال فبالتالي هيك هتُلغى الـ + +175 +00:11:55,070 --> 00:11:58,050 +diplopia و الـ confusion نعم هيك هتُلغى الـ diplopia + +176 +00:11:58,050 --> 00:12:01,510 +و الـ confusion لأن صورة واحدة هي اللي اعتمدت و + +177 +00:12:01,510 --> 00:12:04,610 +الدماغ دائما بيعتمد الصورة الأوضح عشان هيك في + +178 +00:12:04,610 --> 00:12:08,810 +تعريف الـ suppression أن واحدة من الـ images واحدة + +179 +00:12:08,810 --> 00:12:12,950 +من الـ images بيتلغى أو لا + +201 +00:13:24,240 --> 00:13:28,060 +.. عن موضوع الحول والرؤية الموحدة اللي هو ال + +202 +00:13:28,060 --> 00:13:32,140 +blurred image، إنسان عنده straight eyes بس عنده في + +203 +00:13:32,140 --> 00:13:35,720 +في عين الصورة واضحة والصورة في العين الثانية فيها + +204 +00:13:35,720 --> 00:13:39,300 +blurred image فهذا الـ blurred image ناتج عن إيش؟ + +205 +00:13:39,300 --> 00:13:42,460 +عما يكون عنده astigmatism أو anisometropia أو + +206 +00:13:42,460 --> 00:13:46,940 +الإثنين مع بعض، الدماغ لا يقبل الصور أن واحدة تكون + +207 +00:13:46,940 --> 00:13:52,100 +واضحة والثانية تكون مش واضحة blurred وإنما عشان + +208 +00:13:52,100 --> 00:13:54,760 +يعمل fusion لـ two images into one three + +209 +00:13:54,760 --> 00:13:57,980 +dimensional image عشان يتم هذا الأمر لازم يكون + +210 +00:13:57,980 --> 00:14:02,630 +الصورتين يعني تقريبا متساويات في الوضوح، إذا ممكن + +211 +00:14:02,630 --> 00:14:06,030 +ما يكونش عند طفل حول ويكون عنده just blurred + +212 +00:14:06,030 --> 00:14:09,570 +image ليش؟ لأنه عنده astigmatism أو anisometropia + +213 +00:14:09,570 --> 00:14:12,770 +أو الإثنين مع بعض، طيب هذه الـ blurred image الصورة + +214 +00:14:12,770 --> 00:14:18,550 +المغبشة، الدماغ هيعملها صبرش، الدماغ هيعملها صبرش + +215 +00:14:18,800 --> 00:14:22,480 +الآن هذا هو الـ suppression الآن العلماء جسموا الـ + +216 +00:14:22,480 --> 00:14:27,700 +suppression إلى أنواع كثيرة، أول تجسيمة من تجسيمات + +217 +00:14:27,700 --> 00:14:30,600 +الـ suppression في عندي central suppression وفي + +218 +00:14:30,600 --> 00:14:35,260 +عندي peripheral suppression ليش العلماء جسموا الـ + +219 +00:14:35,260 --> 00:14:38,740 +suppression لـ central ولـ peripheral؟ هنشوف الصورة + +220 +00:14:38,740 --> 00:14:44,820 +بتاعة الـ sensations بنقول + +221 +00:14:44,820 --> 00:14:51,110 +الـ confusion بينشأ نتيجة سقوط target على فوفيا على الـ + +222 +00:14:51,110 --> 00:14:54,710 +central retina، الفوفيا هي الـ central retina في + +223 +00:14:54,710 --> 00:14:58,350 +العين اليمنى وtarget آخر على الفوفيا اللي هي الـ + +224 +00:14:58,350 --> 00:15:01,530 +central retina في العين الشمالية، إذا الـ confusion + +225 +00:15:01,530 --> 00:15:04,870 +ناتج عن تحفيز الـ center تحت الـ retina هنا والـ + +226 +00:15:04,870 --> 00:15:08,170 +center تحت الـ retina هنا، الدماغ ممكن يخلي العين + +227 +00:15:08,170 --> 00:15:12,210 +كلها شغالة ويروح بس منطقة الفوفيا يعملها + +228 +00:15:12,210 --> 00:15:16,820 +suppression يعني يرفض استقبال الصور اللي فقط ابتقى + +229 +00:15:16,820 --> 00:15:20,400 +على one phobia، إذا عمل central suppression عشان + +230 +00:15:20,400 --> 00:15:25,200 +يتخلص من إيه؟ من موضوع الـ confusion، طيب حاجة ثانية + +231 +00:15:28,650 --> 00:15:32,150 +الآن صورة target واحدة بتسقط على الفوفيا هنا و + +232 +00:15:32,150 --> 00:15:35,550 +بتسقط على peripheral retina، كلمة peripheral retina + +233 +00:15:35,550 --> 00:15:39,730 +كل الـ retina ماعدا الفوفيا، كل ما هو برة الفوفيا + +234 +00:15:39,730 --> 00:15:42,870 +منطقة التقاطع الخاتين هدول بسميه peripheral + +235 +00:15:42,870 --> 00:15:48,460 +retina، إذا سقط target على الفوفيا في عين وعلى non + +236 +00:15:48,460 --> 00:15:50,700 +-foveal أو على الـ peripheral retina في العين + +237 +00:15:50,700 --> 00:15:53,660 +الثانية حيصير double vision، حيصير عندي diplopia، + +238 +00:15:53,660 --> 00:15:56,720 +ليش diplopia؟ لأن هدول non-corresponding retinal + +239 +00:15:56,720 --> 00:16:01,340 +areas، وبالتالي مش هيتم توحيد الصورة، طيب، كيف أنا + +240 +00:16:01,340 --> 00:16:04,980 +الدماغ بيتخلص من الـ diplopia، الصورة سقطت على الـ + +241 +00:16:04,980 --> 00:16:07,280 +peripheral retina، إذا لازم يصير عندي peripheral + +242 +00:16:07,280 --> 00:16:11,760 +suppression، إذا الـ central suppression بيخلصني من + +243 +00:16:11,760 --> 00:16:15,480 +الـ confusion والـ peripheral suppression بيخلصني + +244 +00:16:15,480 --> 00:16:19,660 +من الدبلوبيا.. بيخلصني من الدبلوبيا، طيب لو صار + +245 +00:16:19,660 --> 00:16:22,710 +عندي في نفس الواجهة الـ central suppression والـ + +246 +00:16:22,710 --> 00:16:24,990 +peripheral suppression يعني total suppression + +247 +00:16:24,990 --> 00:16:29,010 +للعين ولا جزء من الصورة يستقبل، لا الجزء اللي ييجي + +248 +00:16:29,010 --> 00:16:31,630 +على الفوفيا ولا الجزء اللي ييجي على الـ peripheral + +249 +00:16:31,630 --> 00:16:34,390 +retina، يعني صار عندي total suppression، هذا + +250 +00:16:34,390 --> 00:16:37,310 +المريض اللي عنده total suppression لا حيشكي من + +251 +00:16:37,310 --> 00:16:41,010 +diplopia ولا حيشكي من confusion، لا حيشكي من + +252 +00:16:41,010 --> 00:16:45,250 +diplopia ولا حيشكي من confusion، وعلى هيك بنقول أول + +253 +00:16:45,250 --> 00:16:48,910 +تجسيمة للـ subversion في عندي central subversion or + +254 +00:16:48,910 --> 00:16:52,050 +peripheral subversion، in the central subversion + +255 +00:16:52,050 --> 00:16:55,410 +the image from the fovea of the deviating eye is + +256 +00:16:55,410 --> 00:17:00,070 +inhibited، ليش؟ to avoid confusion، عشان نتخلص من الـ + +257 +00:17:00,070 --> 00:17:04,270 +confusion بواسطة الـ central subversion، الـ diplopia + +258 +00:17:04,270 --> 00:17:07,770 +on the other hand يعني على النقيض من ذلك، كيف + +259 +00:17:07,770 --> 00:17:11,930 +بنتخلص من الـ diplopia الدبلوبيا is eradicated يتم + +260 +00:17:11,930 --> 00:17:14,750 +التخلص منها by the process of peripheral + +261 +00:17:14,750 --> 00:17:18,010 +suppression in which the image from the peripheral + +262 +00:17:18,010 --> 00:17:21,830 +retina of the deviating eye is inhibited، إذا الـ + +263 +00:17:21,830 --> 00:17:25,570 +central suppression بيخلصني من الـ confusion والـ + +264 +00:17:25,570 --> 00:17:29,810 +peripheral suppression بيخلصني من الدبلوبيا، الـ + +265 +00:17:29,810 --> 00:17:33,850 +total suppression central and peripheral بيخلصني من + +266 +00:17:33,850 --> 00:17:36,590 +الإثنين، بيخلصني من الإثنين، لما بقول total + +267 +00:17:36,590 --> 00:17:40,850 +suppression يعني العين واقفة تماما عن العمل، بمعنى + +268 +00:17:40,850 --> 00:17:44,390 +الصورة كلها، الجزء منها اللي وجه على الـ fovea والـ + +269 +00:17:44,390 --> 00:17:47,370 +الجزء اللي وجه على الـ periphery، تنا كله، لا يستقبل + +270 +00:17:47,370 --> 00:17:50,750 +من الدماغ، العين مفتوحة والناس بتتطلع على ده، طفل + +271 +00:17:50,750 --> 00:17:54,630 +مفتح عينيه الاثنتين لكن إحدى العينين فيها central.. + +272 +00:17:54,630 --> 00:17:56,810 +يعني فيها central and peripheral suppression، + +273 +00:17:56,950 --> 00:17:59,870 +total suppression يعني كأنها مغمضة هذه العين، هي + +274 +00:17:59,870 --> 00:18:03,670 +مفتوحة والناس شايفينه مفتحة عينه الاثنتين بس في هذه الـ + +275 +00:18:03,670 --> 00:18:07,350 +.. في.. في نفس الوقت هو بيستقبل أو دماغه بيستقبل + +276 +00:18:07,350 --> 00:18:10,510 +من عين واحدة والثانية كأنها مغلقة رغم أنها + +277 +00:18:10,510 --> 00:18:13,270 +مفتوحة، طبعا الـ central والـ peripheral + +278 +00:18:13,270 --> 00:18:14,450 +suppression + +279 +00:18:17,550 --> 00:18:21,670 +أيضا في تجسيمة ثانية للـ.. ال.. الـ suppression + +280 +00:18:21,670 --> 00:18:26,030 +monocular or alternating، إيش يعني monocular أو + +281 +00:18:26,030 --> 00:18:29,530 +alternating؟ إحنا بنقول كالاتي، إنسان عنده + +282 +00:18:29,530 --> 00:18:35,330 +diplopia أو عنده confusion وبده يصير عنده + +283 +00:18:35,330 --> 00:18:38,430 +suppression، أحيانا الـ suppression بيصير في عين + +284 +00:18:38,430 --> 00:18:42,210 +واحدة بي.. بي.. بيغادرهاش، إيش يعني في عين واحدة + +285 +00:18:42,210 --> 00:18:45,710 +بيغادر؟ عشان الدماغ كل ما بترسل صورتين دائما بحبط + +286 +00:18:45,710 --> 00:18:49,650 +صورة مثلا من العين اليمنى فقط، سواء اليوم أو بكرة + +287 +00:18:49,650 --> 00:18:52,710 +أو بعد ساعة أو بعد شهر، دائما العين اليمنى ما تستقبلش + +288 +00:18:52,710 --> 00:18:56,540 +منها على سبيل المثال، ودائما بيستقبل من الشمال، هذا + +289 +00:18:56,540 --> 00:18:59,820 +بيسموه monocular suppression يعني.. يعني دائما + +290 +00:18:59,820 --> 00:19:03,240 +عين واحدة اللي إيش بيتم تثبيت الصورة أو عمل + +291 +00:19:03,240 --> 00:19:06,240 +suppression للصورة اللي جاية منها، هذا الـ monocular + +292 +00:19:06,240 --> 00:19:09,580 +suppression.. هذا الـ monocular suppression بيختلف + +293 +00:19:09,580 --> 00:19:12,240 +عن الـ alternating suppression، alternating + +294 +00:19:12,240 --> 00:19:15,280 +suppression مرة الدماغ بيستقبل من العين اليمنى و + +295 +00:19:15,280 --> 00:19:18,580 +بيعمل suppression للصورة ما بيستقبلش الصورة اللي من + +296 +00:19:18,580 --> 00:19:23,120 +العين اليسرى، بعد لحظات بيلاقي بيستقبل الصورة من + +297 +00:19:23,120 --> 00:19:26,120 +العين اليسرى و بيرفض الصورة من العين اليمنى، بعد + +298 +00:19:26,120 --> 00:19:30,380 +لحظات أخرى برجع بشغل العين اليمنى وبيوقف العين + +299 +00:19:30,380 --> 00:19:36,160 +اليسرى، فبالتالي هذا بيسموه alternating submission + +300 +00:19:36,160 --> 00:19:42,540 +alternating submission، مين بيخوف أكثر أو مين يعني + +301 +00:19:42,540 --> 00:19:46,440 +مزعج أكثر طبعا الـ monocular submission.. الـ + +302 +00:19:46,440 --> 00:19:50,760 +monocular submission مؤذي أكثر، ليش مؤذي أكثر؟ احنا + +303 +00:19:50,760 --> 00:19:53,440 +بنقول عملية الـ submission بتتم عند الأطفال اللي + +304 +00:19:53,440 --> 00:19:58,480 +تحت سن سبع أو ثمان سنوات فأصغر، بنقول كالاتي أن + +305 +00:20:00,080 --> 00:20:04,700 +لما دائما الدماغ بيرفض صورة من العين نفرض من العين + +306 +00:20:04,700 --> 00:20:08,080 +اليمنى، مش راضي يستقبل منها أي صورة، لما العين الثانية + +307 +00:20:08,080 --> 00:20:12,740 +مفتوحتين يعني هو الطفل بيعتمد في الرؤية ومفتحة عينيه + +308 +00:20:12,740 --> 00:20:16,040 +الاثنتين على العين اليسرى، يوم ويومين وثلاثة + +309 +00:20:16,040 --> 00:20:19,220 +وأربعة وهادي مش شغالة مفتوحة صحيح بس الصورة منها + +310 +00:20:19,220 --> 00:20:25,600 +مش شغالة، هذا هيقدر بعد هيك إلى amblyopia، إيش الفرق + +311 +00:20:25,600 --> 00:20:30,490 +بين suppression وamblyopia؟ عنده عينيتين، عنده + +312 +00:20:30,490 --> 00:20:35,670 +suppression هنا وبعد فترة سنوات من الـ suppression + +313 +00:20:35,670 --> 00:20:39,230 +صار عنده amblyopia، إحنا بنقول كالاتي كيف أش.. + +314 +00:20:39,230 --> 00:20:43,910 +كيف أفرق بين الـ suppression وبين الـ amblyopia، بين + +315 +00:20:43,910 --> 00:20:46,870 +الـ amblyopia اللي هي الكسل البصري ضروري جدا + +316 +00:20:46,870 --> 00:20:50,110 +التفريق بينهم، إحنا بنقول الـ suppression يعني العين + +317 +00:20:50,110 --> 00:20:54,670 +مش شغالة بس بشرط أن العينين تكونوا مفتوحتين مع بعض + +318 +00:20:55,230 --> 00:20:59,170 +لو أغلقنا العين الثانية، النظر هنا طبيعي جدا، ستة + +319 +00:20:59,170 --> 00:21:02,370 +على ستة، ما في أي مشكلة، بس هو مفتحة عينيه الاثنتين، + +320 +00:21:02,370 --> 00:21:04,870 +هذه اللي شغالة فقط، وهذه فيها suppression يعني + +321 +00:21:04,870 --> 00:21:08,590 +الدماغ بيقولها ارتاحي، مش هستقبل منك صورة، طب + +322 +00:21:08,590 --> 00:21:12,170 +أغلقنا العين الـ high، بيصير الدماغ يستقبل من العين + +323 +00:21:12,170 --> 00:21:15,710 +الـ high، لأنه ما في عنده مجال آخر، هذه مغلقة تمام، + +324 +00:21:15,710 --> 00:21:20,300 +سكرناها، غطناها، والنظر بيكون فيها طبيعي، أما الـ + +325 +00:21:20,300 --> 00:21:23,160 +amblyopia لما بنغلق العين الثانية وهذه فيها + +326 +00:21:23,160 --> 00:21:27,620 +amblyopia النظر فيها ضعيف ما بيوصلش لـ 6 على 6 مثلا 6 على + +327 +00:21:27,620 --> 00:21:33,120 +24، 6 على 60، 3 على 60 حسب شدة الـ amblyopia، إذا الـ + +328 +00:21:33,120 --> 00:21:36,580 +suppression هي حالة إيقاف استقبال الصورة من العين + +329 +00:21:36,580 --> 00:21:42,010 +أثناء فتح العين الثانية، أن الاثنتين مفتوحتين، هذه لا + +330 +00:21:42,010 --> 00:21:44,690 +يستقبل منها، سكرنا العين اللي ما فيش فيها + +331 +00:21:44,690 --> 00:21:48,390 +suppression، معناته هاي بنبدأ نستقبل منها وبشكل + +332 +00:21:48,390 --> 00:21:53,470 +طبيعي، يعني النظر فيها طبيعي، فهيك بدنا نفرق بين الـ + +333 +00:21:53,470 --> 00:21:57,030 +.. الـ suppression والـ amblyopia، طبعا لما بنقول + +334 +00:21:57,030 --> 00:22:01,330 +alternating suppression يعني مرة هاي بتشتغل وهاي + +335 +00:22:01,330 --> 00:22:04,530 +بيصير فيها suppression للصورة ومرة هاي بيصير فيها + +336 +00:22:04,530 --> 00:22:07,820 +suppression وهاي بتشتغل، بتبادل، وساعتها أنا + +337 +00:22:07,820 --> 00:22:11,020 +ما بخافش يصير عندي amblyopia، ما بخاف في الـ + +338 +00:22:11,020 --> 00:22:15,180 +alternating suppression أنه يصير عندي amblyopia، + +339 +00:22:15,180 --> 00:22:19,200 +ليش؟ لأنه كل عين بيجيها دور تشتغل، الآن.. الساعة + +340 +00:22:19,200 --> 00:22:22,480 +الآن في الوقت الحالي، العين اليمنى شغالة والعين + +341 +00:22:22,480 --> 00:22:26,400 +اليسرى suppressed، بعد دقيقة تبادلوا، صارت اليسرى + +342 +00:22:26,400 --> 00:22:29,580 +شغالة واليمنى suppressed، إذا الـ alternating + +343 +00:22:29,580 --> 00:22:32,680 +suppression.. الـ alternating suppression ما + +344 +00:22:32,680 --> 00:22:36,540 +بيخوفش بقدر ما بيخوف الـ monocular suppression، إذا + +345 +00:22:36,540 --> 00:22:39,120 +الـ monocular suppression التجسيمة الثانية، إحنا + +346 +00:22:39,120 --> 00:22:41,420 +جسمنا التجسيمة الأولى، قلنا central وperipheral + +347 +00:22:43,110 --> 00:22:46,290 +central وperipheral هذه التجسيمة الأولى للـ + +348 +00:22:46,290 --> 00:22:48,830 +subversion، التجسيمة الثانية للـ subversion + +349 +00:22:48,830 --> 00:22:53,010 +monocular وalternating subversion، is monocular + +350 +00:22:53,010 --> 00:22:56,110 +when the image from the dominant eye always + +351 +00:22:56,110 --> 00:22:59,590 +predominate over the image of the deviating eye or + +352 +00:22:59,590 --> 00:23:03,910 +more ametropic eye، لما دائما الصورة من العين + +353 +00:23:03,910 --> 00:23:07,990 +السليمة بتسود على الصورة من العين اللي فيها squint + +354 +00:23:07,990 --> 00:23:13,000 +أو الصورة من العين اللي فيها ametropia بتسود على + +355 +00:23:13,000 --> 00:23:15,960 +الصورة اللي في العين الـ more ametropic اللي فيها + +356 +00:23:15,960 --> 00:23:20,280 +refractive error، دائمة، إيش يعني بتسود؟ يعني هي + +357 +00:23:20,280 --> 00:23:23,840 +اللي تستقبل من الدماغ والثانية الـ squinting أو + +358 +00:23:23,840 --> 00:23:27,560 +الأضعف في النظر بترفض صورتها، so that the image + +359 +00:23:27,560 --> 00:23:30,100 +from the later اللي هي الـ more ametropic أو الـ + +360 +00:23:30,100 --> 00:23:33,790 +deviating is constantly suppressed يعني دائما في + +361 +00:23:33,790 --> 00:23:36,550 +عندي suppression في عين واحدة، this type of + +362 +00:23:36,550 --> 00:23:40,190 +suppression leads to amblyopia، إذا دائما ال.. الـ + +363 +00:23:40,190 --> 00:23:43,870 +suppression مركز عندي في عين دون العين الأخرى، يعني + +364 +00:23:43,870 --> 00:23:46,790 +ما فيش تبادل في موضوع الـ suppression، ما فيش تبادل في + +365 +00:23:46,790 --> 00:23:49,350 +موضوع الشغل بين العينين، يعني العين تشتغل + +366 +00:23:49,350 --> 00:23:53,150 +والثانية ترتاح وبعدين يتبادلوا، اللي كانت مرتاحة أو + +367 +00:23:53,150 --> 00:23:56,270 +suppressed تشتغل يصير استجبل من الدماغ ويرتاح + +368 +00:23:56,270 --> 00:24:00,630 +الثانية، إذا ما فيش تبادل ساعتها أنا بخاف من الـ + +369 +00:24:00,630 --> 00:24:04,670 +amblyopia اللي constant suppression في one eye + +370 +00:24:04,670 --> 00:24:08,590 +leads to amblyopia والـ amblyopia معروف أنه حيصير + +371 +00:24:08,590 --> 00:24:12,250 +النظر ضعيف حتى لو أغلقنا العين الثانية حيضل عندي + +372 +00:24:12,250 --> 00:24:15,930 +الـ best correction ما بتوصل لـ ستة على ستة، على ستة when + +373 +00:24:15,930 --> 00:24:19,190 +suppression alternates لما الـ suppression بيصير + +374 +00:24:19,190 --> 00:24:22,970 +فيه تبادلية بين العينين، switches from one eye to + +375 +00:24:22,970 --> 00:24:26,830 +other amblyopia does not develop، عشان هات لما + +376 +00:24:26,830 --> 00:24:31,130 +بيصير عندي suppression أو بكتشف أن العين فيها + +377 +00:24:31,130 --> 00:24:33,810 +altern.. أو العينين فيهم alternating suppression + +378 +00:24:33,810 --> 00:24:37,870 +بكون أنا مطمن أكثر مما لو يكون عندي + +401 +00:26:06,430 --> 00:26:10,600 +straight eyes مرة ثانية ساعتها هيستعيد ال binocular + +402 +00:26:10,600 --> 00:26:13,540 +single vision والعينتين هيكونوا بيشتغلوا مع بعض + +403 +00:26:13,540 --> 00:26:15,980 +وال suppression هيروح، إذا هذا الـ الـ + +404 +00:26:15,980 --> 00:26:19,620 +suppression بيسموه facultative يعني فقط بيحدث في + +405 +00:26:19,620 --> 00:26:23,720 +أوقات معينة وليس إكراهي أو إجباري أو طول الوقت + +406 +00:26:23,720 --> 00:26:27,610 +موجود في أنواع تانية من الحوار، سواء العين straight + +407 +00:26:27,610 --> 00:26:32,810 +أو سواء العين مش straight، ممكن يكون عندي الـ الـ + +408 +00:26:32,810 --> 00:26:35,850 +الـ الـ ال suppression إجباري، إجباري يعني سواء + +409 +00:26:35,850 --> 00:26:38,150 +العين straight أو مش straight، العين اللي فيها + +410 +00:26:38,150 --> 00:26:42,370 +المشكلة فيها suppression، مثال على ذلك Duane + +411 +00:26:42,370 --> 00:26:46,480 +Syndromeممكن هو Duane Syndrome و هو بينظر للأمام + +412 +00:26:46,480 --> 00:26:50,280 +العين عنده تكون straight لما بننظر للجانب يصير في + +413 +00:26:50,280 --> 00:26:53,960 +عنده ال squint تظهر و هنحكي عن Duane Syndrome صفاته + +414 +00:26:53,960 --> 00:26:57,120 +و أعراضه في حوالي اتنين إن شاء الله تعالى بس Duane + +415 +00:26:57,120 --> 00:26:59,900 +Syndrome بعد مرضى لـ Duane بيكون عنده و هو بتطلع + +416 +00:26:59,900 --> 00:27:03,280 +للأمام straight ahead عينيه straight لما بتطلع + +417 +00:27:03,280 --> 00:27:07,180 +للجانب لنحيط العين أو نحيط العين باتجاه العين اللي + +418 +00:27:07,180 --> 00:27:10,240 +فيها الـ Duane Syndrome نفرض في الـ left eye و تطلع + +419 +00:27:10,240 --> 00:27:14,010 +نحيط الـ leftيعني هيظهر ال squint بشكل واضح جدا + +420 +00:27:14,010 --> 00:27:17,810 +فهذا المريض ممكن لو كانت عينيه straight في الـ + +421 +00:27:17,810 --> 00:27:20,530 +في وضع الـ primary position أو لو كانت عينيه + +422 +00:27:20,530 --> 00:27:24,910 +squinting في الـ side gaze أو في على الـ في + +423 +00:27:24,910 --> 00:27:28,250 +النظر إلى الجانب في الحالتين هيضل عنده إيش + +424 +00:27:28,250 --> 00:27:32,510 +suppression في الـ eye اللي فيها Duane syndrome وهذا + +425 +00:27:32,510 --> 00:27:36,240 +يسمى obligatory لأنه بغض النظر irrespective of + +426 +00:27:36,240 --> 00:27:39,420 +whether the eyes are deviated يعني فيهم حوال أو + +427 +00:27:39,420 --> 00:27:42,380 +straight الـ الـ ال suppression موجود موجود + +428 +00:27:42,380 --> 00:27:46,000 +فهذا بيسموه obligatory يعني في facultative اختياري + +429 +00:27:46,000 --> 00:27:49,700 +يعني مش دائما موجود بيوجد في حالة وجود ال squint + +430 +00:27:49,700 --> 00:27:53,260 +بيروح لما العينين تعدل وفي obligatory إجباري سواء + +431 +00:27:53,260 --> 00:27:56,540 +العينين عدلة أو مش عدلة بيكون في عندي suppression + +432 +00:27:56,540 --> 00:27:59,860 +هدول الثلاث أنواع أو الثلاث تصنيفات three + +433 +00:27:59,860 --> 00:28:02,940 +classification لل suppression اللي هو إلغاء صورة + +434 +00:28:02,940 --> 00:28:07,050 +من الصورة وقلنا مش شرط إنها تكون الصورة اللي جاية + +435 +00:28:07,050 --> 00:28:10,650 +من ال deviated eye فتُصَنّف ثلاث: central عشان + +436 +00:28:10,650 --> 00:28:13,710 +يخلصني من الـ من ال confusion و peripheral عشان + +437 +00:28:13,710 --> 00:28:19,430 +يخلصني من ال diplopia monocular و alternating + +438 +00:28:19,430 --> 00:28:23,610 +monocular suppression و alternating suppression الـ + +439 +00:28:23,610 --> 00:28:27,230 +monocular بخوف إنه ممكن يصير عندي amblyopia ثالث + +440 +00:28:27,230 --> 00:28:30,790 +شيء facultative و obligatoryأيضا ال obligatory + +441 +00:28:30,790 --> 00:28:37,030 +suppression ممكن يخوفني من موضوع موضوع اللي هي + +442 +00:28:37,030 --> 00:28:39,910 +ال amblyopia، الموضوع ال amblyopia، ليش؟ لأن ال + +443 +00:28:39,910 --> 00:28:43,450 +obligatory suppression بيحصل في في في عين + +444 +00:28:43,450 --> 00:28:46,310 +اللي فيها المشكلة سواء العينين straight أو + +445 +00:28:46,310 --> 00:28:52,900 +deviated، سواء straight أو deviated، الآن كيف نفحص + +446 +00:28:52,900 --> 00:28:55,900 +ال suppression؟ كيف نفحص ال suppression؟ هنأتي إليه + +447 +00:28:55,900 --> 00:28:58,800 +إن شاء الله المرة القادمة بالفحوصات اللي احنا + +448 +00:28:58,800 --> 00:29:03,320 +شايفين الصور بتاعتها واللي بتحتاج يعني شرح شوية + +449 +00:29:03,320 --> 00:29:07,940 +مستفيد حتى تفهم فكرتها و هنتوقف عند فحوصات الـ + +450 +00:29:07,940 --> 00:29:10,920 +suppression ويعطيكم العافية والسلام عليكم ورحمة + +451 +00:29:10,920 --> 00:29:12,240 +الله وبركاته diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/npmA7i6RT9s_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/npmA7i6RT9s_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..20b91051b07798449a2002d8e4f2a862f3f1b35f --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/npmA7i6RT9s_postprocess.srt @@ -0,0 +1,1804 @@ +1 +00:00:01,650 --> 00:00:07,470 +بسم الله الرحمن الرحيم بنستكمل محاضرات حوال واحد + +2 +00:00:07,470 --> 00:00:10,930 +واتوقفنا المرة الماضية عند ال sensory adaptation + +3 +00:00:10,930 --> 00:00:14,370 +to strabismus وقلنا لما بيصير الحوال فجأة عند + +4 +00:00:14,370 --> 00:00:20,390 +الإنسان ممكن يشعر بال confusion أو ال diplopia وإن + +5 +00:00:20,390 --> 00:00:25,450 +ال confusion بينشأ من سقوطصورة target على phobia + +6 +00:00:25,450 --> 00:00:29,550 +وصورة target آخر على ال phobia التانية نتيجة انه + +7 +00:00:29,550 --> 00:00:33,250 +في الفرق أصبح ال visual direction ل ال two phobias + +8 +00:00:33,250 --> 00:00:40,810 +مش موحد فكل phobia إذا وجد عند بالها target هتسقط + +9 +00:00:40,810 --> 00:00:44,190 +صورة هذا ال target على هذه ال phobia وبالتالي ممكن + +10 +00:00:44,190 --> 00:00:49,470 +يصير عندي confusion اختلاط الصور في بعضها البعض زي + +11 +00:00:49,470 --> 00:00:54,400 +ما المنظر اللي عرضناه المرة الماضيةبيوضح هذا هو ال + +12 +00:00:54,400 --> 00:00:58,080 +confusion .. هذا هو ال confusion اختلاط صورة + +13 +00:00:58,080 --> 00:01:03,240 +الشجرة بصورة البيت لأنه البيت إجا على ال fovea + +14 +00:01:03,240 --> 00:01:08,040 +الشمال و الشجرة إجت على ال fovea اليمين أرسله لنفس + +15 +00:01:08,040 --> 00:01:11,660 +المنطقة من الدماغ للتحليل لأن ال fovea و ال fovea + +16 +00:01:11,660 --> 00:01:15,060 +are corresponding retinal areas أيضا زي ما المنظر + +17 +00:01:15,060 --> 00:01:20,950 +هنابيوضح الشجرة إجت على الفوفيا الشمال والبيت إجت + +18 +00:01:20,950 --> 00:01:24,870 +على الفوفيا اليمين فاختلطت الصورتين ببعضهم مش إجوا + +19 +00:01:24,870 --> 00:01:28,210 +قدام بعضهم، إذا هذا ال sensation الأول اللي بشعر + +20 +00:01:28,210 --> 00:01:33,390 +فيه الإنسان وبالتالي بيكون الأمر مزعج بالنسبة + +21 +00:01:33,390 --> 00:01:37,310 +للمريض ال sensation التاني اللي هو قضية ال + +22 +00:01:37,310 --> 00:01:41,670 +diplopia هو سقوط صورة target واحد على non + +23 +00:01:41,670 --> 00:01:44,490 +-corresponding retinal areas، يعني هذا ال target + +24 +00:01:44,490 --> 00:01:45,130 +الأحمر + +25 +00:01:47,790 --> 00:01:52,610 +سقط على ال fovea في العين الشمال و سقط بعيد عن ال + +26 +00:01:52,610 --> 00:01:55,850 +fovea في العين اليمين، طبعا ال fovea و ال nasal + +27 +00:01:55,850 --> 00:02:01,430 +retina في العين اليمين معناته في عندي diplopia، في + +28 +00:02:01,430 --> 00:02:04,050 +عندي diplopia لأن هذه مش corresponding retinal + +29 +00:02:04,050 --> 00:02:09,010 +areasبالتالي مش هترسل لنفس النقطة من المنطقة + +30 +00:02:09,010 --> 00:02:12,530 +التحليل في الدماغ وبالتالي هيضلوا الصورتين صورتين + +31 +00:02:12,530 --> 00:02:16,310 +طبعا هيصير عندي انا diplopia فحكينا ايضا ال + +32 +00:02:16,310 --> 00:02:19,310 +diplopia تقسم ل cross diplopia في حالة ال + +33 +00:02:19,310 --> 00:02:24,590 +Exotropiaexotropia crossed و exotropia uncrossed + +34 +00:02:24,590 --> 00:02:29,130 +diplopia و أيضا تقسم لأنواع اللي هي ال horizontal + +35 +00:02:29,130 --> 00:02:33,050 +diplopia ال vertical diplopia و ال torsional + +36 +00:02:33,050 --> 00:02:37,070 +diplopia زي ما الصورة هنا بتوضح زي ما الصورة بتوضح + +37 +00:02:37,070 --> 00:02:41,220 +في قضية ال torsional diplopiaأيضا الأمر مزعج جدا، + +38 +00:02:41,220 --> 00:02:44,980 +تخيل إنسان بتفرج أو بيقود سيارته و عنده torsional + +39 +00:02:44,980 --> 00:02:48,800 +dyplopia و كل إشي أمامه، من السيارات و المباني و + +40 +00:02:48,800 --> 00:02:52,180 +ده ده، يعني في إله خيال مائل، في إله خيال مائل، + +41 +00:02:52,180 --> 00:02:56,300 +الصورة هيك هتكون يعني مزعجة أو إنسان بيقرأ و عنده + +42 +00:02:56,300 --> 00:02:59,040 +dyplopia بغض النظر عن نوعها torsional أو + +43 +00:02:59,040 --> 00:03:01,920 +horizontal أو ما شابه، هي أنا عندي horizontal + +44 +00:03:01,920 --> 00:03:06,940 +dyplopia، طبعا هذه برضه إشي يعني مزعج للإنسان، + +45 +00:03:06,940 --> 00:03:11,060 +مزعج للإنسان، كيف؟ال .. ال .. الدماغ بيساعد + +46 +00:03:11,060 --> 00:03:15,000 +الإنسان اللي عنده حول أنه يتخلص من هذه ال + +47 +00:03:15,000 --> 00:03:19,260 +sensations، لما بيصير الحول بيصير عندي sensations، + +48 +00:03:19,260 --> 00:03:22,900 +ال pathological diplopia عبارة عن إحساس، إحساس .. + +49 +00:03:24,840 --> 00:03:29,980 +إنه بيرى الشغلة أو الشي .. شي .. شيئين ال .. ال .. + +50 +00:03:29,980 --> 00:03:34,920 +ال confusion إنه بيحس إنه الأشياء ملخبطة مع بعضها + +51 +00:03:34,920 --> 00:03:38,260 +و .. و صورها متداخلة مع بعضها البعض إذا ال + +52 +00:03:38,260 --> 00:03:40,880 +confusion و ال diplopia ال pathological diplopia + +53 +00:03:40,880 --> 00:03:45,160 +عبارة عن sensations إحساسات كيف هذه الإحساسات + +54 +00:03:45,160 --> 00:03:50,620 +الدماغ بيتخلص منها في طلب ما في sensation معناته + +55 +00:03:50,620 --> 00:03:55,370 +لازم الدماغ يتخذالنوع من ال adaptation التأقلم + +56 +00:03:55,370 --> 00:04:00,890 +بحيث انه يجري عمليات معينة تخلصوا من هذه القضايا + +57 +00:04:00,890 --> 00:04:03,690 +المزعجة اللي هي ال confusion و الدبلوبيا the + +58 +00:04:03,690 --> 00:04:07,590 +ocular sensory system in children has the ability + +59 +00:04:07,590 --> 00:04:11,130 +to adapt to anomalous states ال confusion و + +60 +00:04:11,130 --> 00:04:14,590 +الدبلوبيا by two mechanisms احنا عارفين ان الحوال + +61 +00:04:14,590 --> 00:04:19,110 +اغلب مرضى الحوال هم عبارة عن اطفال عبارة عن اطفال + +62 +00:04:19,920 --> 00:04:23,800 +النظام البصري تاع الطفل أو بال .. بال .. بالصورة + +63 +00:04:23,800 --> 00:04:28,680 +المبسطة الدماغ تاع الطفل عنده القدرة to adapt أنه + +64 +00:04:28,680 --> 00:04:32,680 +يتأقلم على الأوضاع الغير طبيعية، إيش هي الأوضاع + +65 +00:04:32,680 --> 00:04:35,360 +الغير طبيعية؟ اللي هي ال confusion و الدبلوبيا + +66 +00:04:35,360 --> 00:04:40,620 +بواسطة two mechanisms، بواسطة آليتين، الآلية + +67 +00:04:40,620 --> 00:04:44,180 +الأولى اللي هي ال suppressionالقالية الأولى هي ال + +68 +00:04:44,180 --> 00:04:47,160 +suppression والقالية التانية هي ال abnormal + +69 +00:04:47,160 --> 00:04:51,000 +retinal correspondence ال abnormal retinal + +70 +00:04:51,000 --> 00:04:53,980 +correspondence هي القالية التانية اذا كان .. اذا + +71 +00:04:53,980 --> 00:04:57,100 +عندي انا في .. زي ما في عندي two sensations في + +72 +00:04:57,100 --> 00:05:01,020 +عندي two types of adaptation two types of + +73 +00:05:01,020 --> 00:05:05,460 +adaptations ال adaptation الأول أو التأقلم الأول + +74 +00:05:05,460 --> 00:05:09,350 +اللي هو ال suppression والتأقلم التانيهو ال + +75 +00:05:09,350 --> 00:05:12,510 +abnormal retinal correspondence ال abnormal + +76 +00:05:12,510 --> 00:05:16,150 +retinal correspondence إيش يعني suppression؟ + +77 +00:05:16,150 --> 00:05:21,550 +suppression يعني ألغاء صورة من الصورتين ألغاء صورة + +78 +00:05:21,550 --> 00:05:26,010 +من الصورتين اللي واصلين من العنتين حتى ما يشعر + +79 +00:05:26,010 --> 00:05:30,310 +الإنسان ما يشعر الإنسان بإنه في عنده لا confusion + +80 +00:05:30,310 --> 00:05:36,230 +ولا diplopia لا confusion ولا diplopiaال .. ال + +81 +00:05:36,230 --> 00:05:39,410 +abnormal retinal correspondence هذه طريقة تانية لل + +82 +00:05:39,410 --> 00:05:44,950 +adaptation يعني هنحكي عنها في موعدها، these + +83 +00:05:44,950 --> 00:05:49,410 +adaptations occur because of the plasticity of + +84 +00:05:49,410 --> 00:05:53,210 +developing visual system in children under the age + +85 +00:05:53,210 --> 00:05:57,570 +of seven to eight yearsهذه القاليات للتخلص من ال + +86 +00:05:57,570 --> 00:06:02,110 +confusion و ال diplopia يعني بتحدث بسبب أنه في + +87 +00:06:02,110 --> 00:06:05,790 +عندي مرونة في ال visual system plasticity مرونة في + +88 +00:06:05,790 --> 00:06:09,270 +ال visual system بتاع الأطفال اللي أعمارهم بتتراوح + +89 +00:06:09,270 --> 00:06:13,810 +من سبعة ل تمان سنين فأقل اللي أعمارهم من أعمار + +90 +00:06:13,810 --> 00:06:17,790 +سبعة ل تمان سنين فأقل بعد تمان سنوات من العمر + +91 +00:06:17,790 --> 00:06:21,510 +بيصير صعب هذه ال adaptation مش مستحيل ولكن في + +92 +00:06:21,510 --> 00:06:26,730 +صعوبة مايعني كتير من الأطفال فوق السبع سنين أو + +93 +00:06:26,730 --> 00:06:30,730 +تمان سنوات عمر عشر سنوات اتن عشر سنة أو ال adults + +94 +00:06:30,730 --> 00:06:35,210 +صعب يعمل suppression و صعب يعمل abnormal retinal + +95 +00:06:35,210 --> 00:06:38,870 +correspondence فعلى هذا الأساس هيضلي يعاني من ال + +96 +00:06:38,870 --> 00:06:42,370 +sensations اللي قولنا عنهم اللي هم ال confusion و + +97 +00:06:42,370 --> 00:06:47,170 +الdiplopia و الdiplopiaoccasional adults قليل جدا + +98 +00:06:47,170 --> 00:06:51,130 +من البالغين who develop sudden onset strabismus + +99 +00:06:51,130 --> 00:06:55,490 +are able to ignore the second image قليل جدا من + +100 +00:06:55,490 --> 00:07:00,170 +الكبار البالغين اللي صار عنده مفاجأة حول بيستطيع + +101 +00:07:00,170 --> 00:07:04,210 +أنه يهمل الصورة التانية لما يصير عنده ازدواجية + +102 +00:07:04,210 --> 00:07:07,630 +after a time and therefore do not complain of + +103 +00:07:07,630 --> 00:07:12,530 +diplopia أي إنساندماغه بيستطيع ينسى الصورة التانية + +104 +00:07:12,530 --> 00:07:16,650 +ويعمل suppression إلغاء للصورة التانية، ساعتها مش + +105 +00:07:16,650 --> 00:07:20,130 +هيصير عنده dyplopia لأنه اللي هيصل للدماغ صورة + +106 +00:07:20,130 --> 00:07:23,390 +واحدة من عين واحدة، وساعتها بسميهوش binocular + +107 +00:07:23,390 --> 00:07:26,970 +single vision وإنما بسميه monocular single vision + +108 +00:07:26,970 --> 00:07:30,930 +عينيتينتين مفتوحات ولكن عين واحدة هي اللي بترسل + +109 +00:07:30,930 --> 00:07:34,990 +للدماغ التانية في وضع استراحة بتطبع الصورة على + +110 +00:07:34,990 --> 00:07:39,470 +الشبكية في هذه العين ولكن يرفض الدماغ استقبالها + +111 +00:07:39,740 --> 00:07:44,840 +وكأنها تم إلغاءها وموجودة فقط للشكل الجمالي مش + +112 +00:07:44,840 --> 00:07:49,540 +للعمل كتيم مع الهين التاني وهذا اللي بيسموه ال + +113 +00:07:49,540 --> 00:07:52,440 +suppression نيجي نعرف ال suppression ال + +114 +00:07:52,440 --> 00:07:55,660 +suppression involves active inhibition in the + +115 +00:07:55,660 --> 00:08:00,340 +visual cortex of an image from one eye when both + +116 +00:08:00,340 --> 00:08:05,420 +eyes are openضروري جدا هذا التعريف يعني نتطلع فيه + +117 +00:08:05,420 --> 00:08:09,680 +و نفهم كل كلماته active inhibition .. active + +118 +00:08:09,680 --> 00:08:13,420 +inhibition يعني الدماغ هو اللي بيجيه بالعملية و + +119 +00:08:13,420 --> 00:08:16,980 +معنى يجيه بالعملية عشان يتخلص الإنسان من ال + +120 +00:08:16,980 --> 00:08:19,660 +sensations المزعجة اللي هي ال confusion و + +121 +00:08:19,660 --> 00:08:23,680 +الدبلوبية، اذا active inhibition مين اللي بيعمل ال + +122 +00:08:23,680 --> 00:08:26,900 +inhibition؟ ال visual cortex، الدماغ in the visual + +123 +00:08:26,900 --> 00:08:32,880 +cortexof an image لصورة من الصور from one eye when + +124 +00:08:32,880 --> 00:08:37,160 +both eyes are open ضروري جدا نقول when both eyes + +125 +00:08:37,160 --> 00:08:40,320 +are open ليش؟ لأنه لو الإنسان غط عين من عينته + +126 +00:08:40,320 --> 00:08:45,740 +تنتين معناته هذا الدماغ مايله علاقة فيه الشخص نفسه + +127 +00:08:45,740 --> 00:08:49,200 +وضع يده منع استقبال الصورة منع الصورة أنها تسقط + +128 +00:08:49,200 --> 00:08:53,020 +على الشبكية إذا من البداية هو عين واحدة عنده + +129 +00:08:53,020 --> 00:08:56,870 +مفتوحة وعين واحدة بتستقبلصورة، اذا الدماغ ماعمل + +130 +00:08:56,870 --> 00:09:01,330 +inhibition ولكن اليد هي اللي منعت الصورة من انها + +131 +00:09:01,330 --> 00:09:05,490 +تصل للشبكية أما لما بيصير عندي ان الانتين both + +132 +00:09:05,490 --> 00:09:11,530 +eyes are open both eyes are open معناته في عندي + +133 +00:09:11,530 --> 00:09:15,900 +صورتينالصورتين انطبعوا على الشبكية في العين اليمين + +134 +00:09:15,900 --> 00:09:19,820 +وعلى الشبكية في العين الشمال وأرسله إلى الدماغ، + +135 +00:09:19,820 --> 00:09:24,180 +الدماغ اختار صورة من الصور واعتمدها واستقبلها + +136 +00:09:24,180 --> 00:09:27,800 +وفهمها، و الصورة التانية عملها active inhibition + +137 +00:09:27,800 --> 00:09:32,700 +يعني رفض استقبالهارفض استقباله، فهذا يسمى ال + +138 +00:09:32,700 --> 00:09:36,820 +submission، هذا يسمى ال submission و هنا بدنا نبه + +139 +00:09:36,820 --> 00:09:42,060 +في التعريف لنقطة غاية في الأهمية، إيش هذه النقطة؟ + +140 +00:09:42,060 --> 00:09:46,420 +active inhibition مفهومة in the visual cortex يعني + +141 +00:09:46,420 --> 00:09:48,300 +ال brain اللي بيكون بال .. بيكون بال active + +142 +00:09:48,300 --> 00:09:53,520 +inhibition برضه مفهومة of an imagefrom one eye ليش + +143 +00:09:53,520 --> 00:09:56,260 +ذكر في التعريف from one eye؟ ليش مقولنا from the + +144 +00:09:56,260 --> 00:09:59,880 +squinting eye؟ ليش محددنا؟ ليش محددنا؟ انا مثلا + +145 +00:09:59,880 --> 00:10:06,080 +انسان عنده exotropia sudden onset of exotropia في + +146 +00:10:06,080 --> 00:10:09,080 +العين اليمين المفروض ان ال suppression يصير في + +147 +00:10:09,080 --> 00:10:14,000 +العين اليمين بنقول هنا التعريف دقيق جدا واحدة من + +148 +00:10:14,000 --> 00:10:16,990 +ال image لازم يصير لها suppressionلازم يصير لها + +149 +00:10:16,990 --> 00:10:20,130 +suppression عشان ما يشكيش هذا الطفل او هذا المريض + +150 +00:10:20,130 --> 00:10:23,490 +من دبلوبيا، بس ليش احنا محددنا .. قولنا من العين + +151 +00:10:23,490 --> 00:10:27,090 +اللي فيها ال squint، بنقول مش دائما .. مش دائما + +152 +00:10:27,090 --> 00:10:30,790 +العين اللي فيها ال squint، الدماغ بيرفض الصورة + +153 +00:10:30,790 --> 00:10:35,000 +بتاعتهاممكن ال squint يكون في ال right eye ممكن ال + +154 +00:10:35,000 --> 00:10:37,800 +squint يكون في ال right eye مثلا esotropia أو + +155 +00:10:37,800 --> 00:10:41,860 +exotropia أو ما شابه و ال .. ال .. ال suppression + +156 +00:10:41,860 --> 00:10:45,420 +يصير في العين الشمال مش في العين اليمين يعني ال + +157 +00:10:45,420 --> 00:10:47,900 +squint في العين اليمين و ال suppression في العين + +158 +00:10:47,900 --> 00:10:51,200 +الشمال إيش ال .. يعني .. يعني كيف نفهم هذه القضية؟ + +159 +00:10:51,200 --> 00:10:56,820 +بنقول الدماغ دائما بيقبل الصورة الأكثر وضوحابغض + +160 +00:10:56,820 --> 00:11:00,600 +النظر الصورة الأكتر وضوحا جاءت من العين اللي فيها + +161 +00:11:00,600 --> 00:11:04,020 +squint ولا من العين ال straight يعني نفرض أنه عنده + +162 +00:11:04,020 --> 00:11:07,980 +right اكزوتروبيا right اكزوتروبيا و ال vision في + +163 +00:11:07,980 --> 00:11:12,380 +ال right eye ستة ع ستةوفيها حوالي الخارج Exotropia + +164 +00:11:12,380 --> 00:11:16,860 +والعين الشمال اللي هي straight فيها Amblyopia لسبب + +165 +00:11:16,860 --> 00:11:20,260 +سابق Amblyopia لسبب سابق ممكن يكون عندها high + +166 +00:11:20,260 --> 00:11:23,320 +refractive error او ما شابه وال best corrected + +167 +00:11:23,320 --> 00:11:27,740 +visual acuity في الشمال مثلا ستة على اربع وعشرين + +168 +00:11:27,740 --> 00:11:31,840 +اذا اليمين ستة على ستة والشمال ستة على اربع وعشرين + +169 +00:11:31,840 --> 00:11:35,440 +اذا الصورة في العين اليمينالصورة في العين اليمين + +170 +00:11:35,440 --> 00:11:39,840 +أوضح من الصورة في العين الشمال، الدماغ هيعتمد صورة + +171 +00:11:39,840 --> 00:11:43,200 +العين اليمين و هيلغي صورة الشمال عشان مايصيرش عنده + +172 +00:11:43,200 --> 00:11:47,580 +ال sensations اللي قلنا عنها، اللي هي ال confusion + +173 +00:11:47,580 --> 00:11:51,600 +و الدبلوبيا، رغم أنه ال squint في اليمين، إلا أنه + +174 +00:11:51,600 --> 00:11:55,070 +ال suppression في الشمالفبالتالي هيك هتلتغى ال + +175 +00:11:55,070 --> 00:11:58,050 +diplopia و ال confusion نعم هيك هتلتغى ال diplopia + +176 +00:11:58,050 --> 00:12:01,510 +و ال confusion لأن صورة واحدة هي اللي اعتمدت و + +177 +00:12:01,510 --> 00:12:04,610 +الدماغ دائما بيعتمد الصورة الأوضح عشان هيك في + +178 +00:12:04,610 --> 00:12:08,810 +تعريف ال suppression ان واحدة من ال images واحدة + +179 +00:12:08,810 --> 00:12:12,950 +من ال images بيتلغى او لا يستقبلها الدماغ بس مش + +180 +00:12:12,950 --> 00:12:15,970 +شرط انها تكون ال image اللي جاية من ال squinting + +181 +00:12:15,970 --> 00:12:19,650 +eye من ال squinting eye اذا نعيد ال suppression + +182 +00:12:19,650 --> 00:12:24,730 +نقرأ تعريفه involves activeالإنهيبشية المشهورة في + +183 +00:12:24,730 --> 00:12:31,810 +كورتكس مصورة من عين واحدة عندما يفتح عيون كما يفتح + +184 +00:12:31,810 --> 00:12:33,890 +عيون كما يفتح عيون كما يفتح عيون كما يفتح عيون كما + +185 +00:12:33,890 --> 00:12:35,090 +يفتح عيون كما يفتح عيون كما يفتح عيون كما يفتح + +186 +00:12:35,090 --> 00:12:35,370 +عيون كما يفتح عيون كما يفتح عيون كما يفتح عيون كما + +187 +00:12:35,370 --> 00:12:35,410 +عيون كما يفتح عيون كما يفتح عيون كما يفتح عيون كما + +188 +00:12:35,410 --> 00:12:39,980 +يفتح عيون كما يفتح عيون كما يفتحblurred image from + +189 +00:12:39,980 --> 00:12:43,020 +one eye resulting from astigmatism او + +190 +00:12:43,020 --> 00:12:48,120 +anisometropia طيب ايش الحافظ للدماغ اللي بيخليه + +191 +00:12:48,120 --> 00:12:51,740 +يعمل موضوع ال suppression و انه يرفض استقبال صورة + +192 +00:12:51,740 --> 00:12:55,040 +اول حافظ ال diplomacy عشان مايصيرش ازدواجية اول ما + +193 +00:12:55,040 --> 00:12:59,140 +بتصير ازدواجية بروح الدماغ بيوقف صورة من الصورتين + +194 +00:12:59,140 --> 00:13:03,740 +بيرفض استقبالها من عين من العينتين طبعا بيوقف + +195 +00:13:03,740 --> 00:13:07,380 +استقبال الصورة الأقل وضوحااو انه يكون اندي + +196 +00:13:07,380 --> 00:13:10,520 +confusion، خربطت صور عشان مايصيرش ال confusion، + +197 +00:13:10,520 --> 00:13:14,020 +ايضا .. ايضا هذا يعتبر حافظ للدماغ انه يعمل + +198 +00:13:14,020 --> 00:13:16,940 +suppression، stimulus .. stimulus عشان هذا، اذا + +199 +00:13:16,940 --> 00:13:20,740 +اول حافظ الدبلوبيا، تاني حافظ ل .. لموضوع ال + +200 +00:13:20,740 --> 00:13:24,240 +suppression، ال confusion، تالت حافظ وهو بعيد عن + +201 +00:13:24,240 --> 00:13:28,060 +.. عن موضوع الحول والرؤية الموحدة اللي هو ال + +202 +00:13:28,060 --> 00:13:32,140 +blurred image، انسان عنده straight eyesبس عنده في + +203 +00:13:32,140 --> 00:13:35,720 +في عين الصورة واضحة والصورة في العين التانية فيها + +204 +00:13:35,720 --> 00:13:39,300 +blurred image فهذا ال blurred image ناتج عن إيش؟ + +205 +00:13:39,300 --> 00:13:42,460 +عمّا يكون عنده astigmatism أو anisometropia أو + +206 +00:13:42,460 --> 00:13:46,940 +الإتنين مع بعض إدماغ لا يقبل الصور أن واحدة تكون + +207 +00:13:46,940 --> 00:13:52,100 +واضحة والتانية تكون مش واضحة blurred وإنما عشان + +208 +00:13:52,100 --> 00:13:54,760 +يعمل fusion ل two images into one three + +209 +00:13:54,760 --> 00:13:57,980 +dimensional image عشان يتم هذا الأمر لازم يكون + +210 +00:13:57,980 --> 00:14:02,630 +الصورتينيعني تقريبا متساويات في الوضوح، إذا ممكن + +211 +00:14:02,630 --> 00:14:06,030 +ما يكونش عند طفل حوال و يكون عنده just blurred + +212 +00:14:06,030 --> 00:14:09,570 +image ليش؟ لأنه عنده astigmatism أو anisometropia + +213 +00:14:09,570 --> 00:14:12,770 +أو التنين مع بعض، طيب هذه ال blurred image الصورة + +214 +00:14:12,770 --> 00:14:18,550 +المغبشة، الدماغ هيعملها صبرش، الدماغ هيعملها صبرش + +215 +00:14:18,800 --> 00:14:22,480 +الان هذا هو ال suppression الان العلماء جسموا ال + +216 +00:14:22,480 --> 00:14:27,700 +suppression إلى أنواع كثيرة أول تجسيمة من تجسيمات + +217 +00:14:27,700 --> 00:14:30,600 +ال suppression في عندي central suppression وفي + +218 +00:14:30,600 --> 00:14:35,260 +عندي peripheral suppression ليش العلماء جسموا ال + +219 +00:14:35,260 --> 00:14:38,740 +suppression ل central و ل peripheral؟ هنشوف الصورة + +220 +00:14:38,740 --> 00:14:44,820 +بتاعة ال sensations بنقول + +221 +00:14:44,820 --> 00:14:51,110 +ال confusionبينشأ نتيجة سقوط target ع فوفيا ع ال + +222 +00:14:51,110 --> 00:14:54,710 +central retina الفوفيا هي ال central retina في + +223 +00:14:54,710 --> 00:14:58,350 +العين اليمين و target آخر على الفوفيا اللي هي ال + +224 +00:14:58,350 --> 00:15:01,530 +central retina في العين الشمالية إذا ال confusion + +225 +00:15:01,530 --> 00:15:04,870 +ناتج عن تحفيز ال center تحت ال retina هنا و ال + +226 +00:15:04,870 --> 00:15:08,170 +center تحت ال retina هنا الدماغ ممكن يخلي العين + +227 +00:15:08,170 --> 00:15:12,210 +كلها شغالة و يروح بس منطقة الفوفيا يعملها + +228 +00:15:12,210 --> 00:15:16,820 +suppression يعني يرفض استقبالالصور اللى فقط ابتقى + +229 +00:15:16,820 --> 00:15:20,400 +على one phobia اذا عمل central suppression عشان + +230 +00:15:20,400 --> 00:15:25,200 +يتخلص من ايه؟ من موضوع ال confusion طيب حاجة تانية + +231 +00:15:28,650 --> 00:15:32,150 +الان صورة target واحد بتسقط على الفوفيا هنا و + +232 +00:15:32,150 --> 00:15:35,550 +بتسقط على peripheral retina كلمة peripheral retina + +233 +00:15:35,550 --> 00:15:39,730 +كل ال retina معدى الفوفيا كل ما هو براة الفوفيا + +234 +00:15:39,730 --> 00:15:42,870 +منطقة التقاطع الخاتين هدولة بسميه peripheral + +235 +00:15:42,870 --> 00:15:48,460 +retina إذا سقط target على الفوفيا في عينيوعلى non + +236 +00:15:48,460 --> 00:15:50,700 +-foveal أو على الـ peripheral retina في العين + +237 +00:15:50,700 --> 00:15:53,660 +التاني حيصير double vision، حيصير عندى diplopia، + +238 +00:15:53,660 --> 00:15:56,720 +ليش diplopia؟ لأن هدولة non-corresponding retinal + +239 +00:15:56,720 --> 00:16:01,340 +areas، وبالتالي مش هيتم توحيد الصورة طيب، كيف أنا + +240 +00:16:01,340 --> 00:16:04,980 +ادماغ بيتخلص من ال diplopia، الصورة سقطت على ال + +241 +00:16:04,980 --> 00:16:07,280 +peripheral retina، إذا لازم يصير عندى peripheral + +242 +00:16:07,280 --> 00:16:11,760 +suppression، إذا ال central suppressionبيخلصني من + +243 +00:16:11,760 --> 00:16:15,480 +ال confusion و ال peripheral suppression بيخلصني + +244 +00:16:15,480 --> 00:16:19,660 +من الدبلوبيا .. بيخلصني من الدبلوبيا طيب لو صار + +245 +00:16:19,660 --> 00:16:22,710 +عندي في نفس الواجهة ال central suppressionو + +246 +00:16:22,710 --> 00:16:24,990 +peripheral suppression يعني total suppression + +247 +00:16:24,990 --> 00:16:29,010 +للعين ولا جزء من الصورة استقبل، لا الجزء اللي إيجي + +248 +00:16:29,010 --> 00:16:31,630 +على الفوفيا ولا الجزء اللي إيجي على ال peripheral + +249 +00:16:31,630 --> 00:16:34,390 +retina، يعني صار عندي total suppression، هذا + +250 +00:16:34,390 --> 00:16:37,310 +المريض اللي عنده total suppression لا حيشكي من + +251 +00:16:37,310 --> 00:16:41,010 +diplopia ولا حيشكي من confusion، لا حيشكي من + +252 +00:16:41,010 --> 00:16:45,250 +diplopia ولا حيشكي منconfusion وعلى هيك بنقول أول + +253 +00:16:45,250 --> 00:16:48,910 +تجسيمة لل subversion في عندي central subversion or + +254 +00:16:48,910 --> 00:16:52,050 +peripheral subversion in the central subversion + +255 +00:16:52,050 --> 00:16:55,410 +the image from the fovea of the deviating eye is + +256 +00:16:55,410 --> 00:17:00,070 +inhibited ليش؟ to avoid confusion عشان نتخلص من ال + +257 +00:17:00,070 --> 00:17:04,270 +confusion بواسطة ال central subversion ال diplopia + +258 +00:17:04,270 --> 00:17:07,770 +on the other hand يعني على النقيد من ذلك كيف + +259 +00:17:07,770 --> 00:17:11,930 +بنتخلص من ال diplopiaالدبلوبيا is eradicated يتم + +260 +00:17:11,930 --> 00:17:14,750 +التخلص منها by the process of peripheral + +261 +00:17:14,750 --> 00:17:18,010 +suppression in which the image from the peripheral + +262 +00:17:18,010 --> 00:17:21,830 +retina of the deviating eye is inhibited إذا ال + +263 +00:17:21,830 --> 00:17:25,570 +central suppression بيخلصني من ال confusion وال + +264 +00:17:25,570 --> 00:17:29,810 +peripheral suppression بيخلصني من الدبلوبيا ال + +265 +00:17:29,810 --> 00:17:33,850 +total suppression central and peripheralبيخلصني من + +266 +00:17:33,850 --> 00:17:36,590 +الأتنين، بيخلصني من الأتنين، لما بقول total + +267 +00:17:36,590 --> 00:17:40,850 +suppression يعني العين واقفة تماما عن العمل، بمعنى + +268 +00:17:40,850 --> 00:17:44,390 +الصورة كلها، الجزء منها اللي وجه على ال fovea و + +269 +00:17:44,390 --> 00:17:47,370 +الجزء اللي وجه على ال periphery تنا كله، لا يستقبل + +270 +00:17:47,370 --> 00:17:50,750 +من الدماغ، العين مفتوحة و الناس بتتطلع ع ده طفل + +271 +00:17:50,750 --> 00:17:54,630 +مفتح عينيه تنتينلكن إحدى العينين فيها central .. + +272 +00:17:54,630 --> 00:17:56,810 +يعني فيها central and peripheral suppression, + +273 +00:17:56,950 --> 00:17:59,870 +total suppression يعني كأنها مغمضة هذه العين، هي + +274 +00:17:59,870 --> 00:18:03,670 +مفتحة و الناس شايفينه مفتة عينه تنتين بس في هذه ال + +275 +00:18:03,670 --> 00:18:07,350 +.. في .. في نفس الوقت هو بيستقبل أو دماغه بيستقبل + +276 +00:18:07,350 --> 00:18:10,510 +من عين واحدة و التانية كأنها مغلقة رغم أنها + +277 +00:18:10,510 --> 00:18:13,270 +مفتوحة، طبعا ال central و ال peripheral + +278 +00:18:13,270 --> 00:18:14,450 +suppression + +279 +00:18:17,550 --> 00:18:21,670 +أيضا في تجسيمة تانية لال .. ال .. ال suppression + +280 +00:18:21,670 --> 00:18:26,030 +monocular or alternating إيش يعني monocular أو + +281 +00:18:26,030 --> 00:18:29,530 +alternating؟ إحنا بنقول كالقاتل، إنسان عنده + +282 +00:18:29,530 --> 00:18:35,330 +diplopia أو عنده confusion و بده يصير عنده + +283 +00:18:35,330 --> 00:18:38,430 +suppression أحيانا ال suppression بيصير في عين + +284 +00:18:38,430 --> 00:18:42,210 +واحدة بي .. بي .. بيغادرهاشإيش يعني في عين واحدة + +285 +00:18:42,210 --> 00:18:45,710 +بيغادر؟ عشان الدماغ كل ما بترسل صورتين دائما بحبط + +286 +00:18:45,710 --> 00:18:49,650 +صورة مثلا من العين اليمين فقط، سواء اليوم أو بكرة + +287 +00:18:49,650 --> 00:18:52,710 +أو بعد ساعة أو بعد شهر، دائما العين اليمين مستقبلش + +288 +00:18:52,710 --> 00:18:56,540 +منها على سبيل المثالودائما بيستقبل من الشمال هذا + +289 +00:18:56,540 --> 00:18:59,820 +بيسموه monocular suppression يعني .. يعني دائما + +290 +00:18:59,820 --> 00:19:03,240 +عين واحدة اللي ايش بيتم تثبيت الصورة أو عمل + +291 +00:19:03,240 --> 00:19:06,240 +suppression للصورة اللي جاية منها هذا ال monocular + +292 +00:19:06,240 --> 00:19:09,580 +suppression .. هذا ال monocular suppression بيختلف + +293 +00:19:09,580 --> 00:19:12,240 +عن ال alternating suppression alternating + +294 +00:19:12,240 --> 00:19:15,280 +suppression مرة دماغ بيستقبل من العين اليمين و + +295 +00:19:15,280 --> 00:19:18,580 +بيعمل suppression للصورة بيستقبلش الصورة اللي من + +296 +00:19:18,580 --> 00:19:23,120 +العين الشمال بعد لحظات بيلاقي بيستقبل الصورة من + +297 +00:19:23,120 --> 00:19:26,120 +العين الشمالو بيرفض الصورة من العين اليمين بعد + +298 +00:19:26,120 --> 00:19:30,380 +لحظات أخرى برجع بشغل العين اليمين و بيوقف العين + +299 +00:19:30,380 --> 00:19:36,160 +الشمال فبالتالي هذا بيسموه alternatingsubmission + +300 +00:19:36,160 --> 00:19:42,540 +alternating submission مين بيخوف أكتر أو مين يعني + +301 +00:19:42,540 --> 00:19:46,440 +مزعج أكتر طبعا ال monocular submission .. ال + +302 +00:19:46,440 --> 00:19:50,760 +monocular submission مؤذي أكتر ليش مؤذي أكتر؟ احنا + +303 +00:19:50,760 --> 00:19:53,440 +بنقول عملية ال submission بتتم عند الأطفال اللي + +304 +00:19:53,440 --> 00:19:58,480 +تحت سن سبع أو تمان سنوات فأصغر بنقول كالقاتل انه + +305 +00:20:00,080 --> 00:20:04,700 +لما دائما الدماغ بيرفض صورة من العين نفرض من العين + +306 +00:20:04,700 --> 00:20:08,080 +اليمين مش راضي يستقبل منها أي صورة لما العين تاني + +307 +00:20:08,080 --> 00:20:12,740 +مفتوحات يعني هو الطفل بيعتمد في الرؤية ومفتة عيني + +308 +00:20:12,740 --> 00:20:16,040 +التنتين على العين الشمال مار يوم ويومين وتلاتة + +309 +00:20:16,040 --> 00:20:19,220 +واربعة وهادي مش شغالة مفتوحة صحيح بس الصورة منها + +310 +00:20:19,220 --> 00:20:25,600 +مش شغالة هذا هيقدر بعد هيك إلى amblyopia إيش الفرق + +311 +00:20:25,600 --> 00:20:30,490 +بين suppression وamblyopia؟عنده عينيتين تان عنده + +312 +00:20:30,490 --> 00:20:35,670 +suppression هنا و بعد فترة سنوات من ال suppression + +313 +00:20:35,670 --> 00:20:39,230 +صار عنده amblyopia احنا بنقول كالقاتي كيف اش .. + +314 +00:20:39,230 --> 00:20:43,910 +كيف افرج بين ال suppression و بين ال amblyopia بين + +315 +00:20:43,910 --> 00:20:46,870 +ال amblyopia اللي هي الكسل البصري ضروري جدا + +316 +00:20:46,870 --> 00:20:50,110 +التفريك بينهم احنا بنقول ال suppression يعني العين + +317 +00:20:50,110 --> 00:20:54,670 +مش شغالة بس بشرط ان العينتين تكونوا مفتوحات مع بعض + +318 +00:20:55,230 --> 00:20:59,170 +لو أغلقنا العين التانية، النظر هنا طبيعي جدا، ستة + +319 +00:20:59,170 --> 00:21:02,370 +على ستة، مافي أي مشكلة، بس هو مفتة عين التنتين، + +320 +00:21:02,370 --> 00:21:04,870 +هذه اللي شغالة فقط، و هذه فيها suppression يعني + +321 +00:21:04,870 --> 00:21:08,590 +الدماغ بيقولها ارتاحي، مش هستقبل منك صورة، طب + +322 +00:21:08,590 --> 00:21:12,170 +أغلقنا العين high، بيصير الدماغ يستقبل من العين + +323 +00:21:12,170 --> 00:21:15,710 +high، لأنه مافيش عنده مجال آخر، هذه مغلقة تمام، + +324 +00:21:15,710 --> 00:21:20,300 +سكرناها، غطناها، و النظر بيكون فيها طبيعيأما ال + +325 +00:21:20,300 --> 00:21:23,160 +amblyopia لما بنغلق العين التانية و هذه فيها + +326 +00:21:23,160 --> 00:21:27,620 +amblyopia النظر فيها ضعيف مابوصلش ل 6 ع 6 مثلا 6 ع + +327 +00:21:27,620 --> 00:21:33,120 +24، 6 ع 60، 3 ع 60 حسب شدة ال amblyopia إذا ال + +328 +00:21:33,120 --> 00:21:36,580 +suppression هي حالة إيقاف استقبال الصورة من العين + +329 +00:21:36,580 --> 00:21:42,010 +أثناء فتح العين التانية إنه التنتين مفتوحاتهذه لا + +330 +00:21:42,010 --> 00:21:44,690 +يستقبل منها سكرنا العين اللي مافيش فيها + +331 +00:21:44,690 --> 00:21:48,390 +suppression معناته هاي بنبدأ نستقبل منها وبشكل + +332 +00:21:48,390 --> 00:21:53,470 +طبيعي يعني النظر فيها طبيعي فهيكا بدنا نفرج بين ال + +333 +00:21:53,470 --> 00:21:57,030 +.. ال suppression و ال amblyopia طبعا لما بنقول + +334 +00:21:57,030 --> 00:22:01,330 +alternating suppression يعني مرة هاي بتشتغل و هاي + +335 +00:22:01,330 --> 00:22:04,530 +بيصير فيها suppression للصورة و مرة هاي بيصير فيها + +336 +00:22:04,530 --> 00:22:07,820 +suppression و هاي بتشتغل بتبادلواساعتها أنا + +337 +00:22:07,820 --> 00:22:11,020 +مابخافش يصير عندي amblyopia، مابخاف في ال + +338 +00:22:11,020 --> 00:22:15,180 +alternating suppression أنه يصير عندي amblyopia، + +339 +00:22:15,180 --> 00:22:19,200 +ليش؟ لأنه كل عين بيجيها دور تشتغل، الآن .. الساعة + +340 +00:22:19,200 --> 00:22:22,480 +الآن في الوقت الحالي، العين اليمين شغالة و العين + +341 +00:22:22,480 --> 00:22:26,400 +الشمال suppressedبعد دقيقة تبادلوا، صارت الشمال + +342 +00:22:26,400 --> 00:22:29,580 +شغالة واليمين sub rest، إذا ال alternating + +343 +00:22:29,580 --> 00:22:32,680 +suppression .. ال alternating suppression ما + +344 +00:22:32,680 --> 00:22:36,540 +بيخوفش بقدر ما بيخوف ال monocular suppression، إذا + +345 +00:22:36,540 --> 00:22:39,120 +ال monocular suppression التجسيمة التانية، احنا + +346 +00:22:39,120 --> 00:22:41,420 +جسمنا التجسيمة الأولى، قولنا central و peripheral + +347 +00:22:43,110 --> 00:22:46,290 +central و peripheral هذه التجسيمة الأولى لل + +348 +00:22:46,290 --> 00:22:48,830 +subversion التجسيمة التانية لل subversion + +349 +00:22:48,830 --> 00:22:53,010 +monocular و alternating subversion is monocular + +350 +00:22:53,010 --> 00:22:56,110 +when the image from the dominant eye always + +351 +00:22:56,110 --> 00:22:59,590 +predominate over the image of the deviating eye or + +352 +00:22:59,590 --> 00:23:03,910 +more ametropic eye لما دائما الصورة من العين + +353 +00:23:03,910 --> 00:23:07,990 +السليمة بتسود على الصورة من العين اللي فيها squint + +354 +00:23:07,990 --> 00:23:13,000 +أوالصورة من العين اللي فيها ametropia بتسود على + +355 +00:23:13,000 --> 00:23:15,960 +الصورة اللي في العين ال more ametropic اللي فيها + +356 +00:23:15,960 --> 00:23:20,280 +refractive error دائمة، إيش يعني بتسود؟ يعني هي + +357 +00:23:20,280 --> 00:23:23,840 +اللي تستقبل من الدماغ والتانية ال squinting أو + +358 +00:23:23,840 --> 00:23:27,560 +الأضعف في النظر بترفض صورتها، so that the image + +359 +00:23:27,560 --> 00:23:30,100 +from the later اللي هي ال more ametropic أو ال + +360 +00:23:30,100 --> 00:23:33,790 +deviatingis constantly suppressed يعني دائما في + +361 +00:23:33,790 --> 00:23:36,550 +عندي suppression في عين واحدة this type of + +362 +00:23:36,550 --> 00:23:40,190 +suppression leads to amblyopia إذا دائما ال .. ال + +363 +00:23:40,190 --> 00:23:43,870 +suppression مركز عندي في عين دون العين الأخرى يعني + +364 +00:23:43,870 --> 00:23:46,790 +مافيش تبادل في موضوع ال suppression مافيش تبادل في + +365 +00:23:46,790 --> 00:23:49,350 +موضوع الشغل بين العين تانية يعني العين تشتغل + +366 +00:23:49,350 --> 00:23:53,150 +والتانية تريح وبعدين يتبادلوا اللي كانت مريحة أو + +367 +00:23:53,150 --> 00:23:56,270 +suppressed تشتغل يصير استجبل من الدماغ ويريح + +368 +00:23:56,270 --> 00:24:00,630 +التانية إذا مافيش تبادل ساعتها أنا بخاف منالـ + +369 +00:24:00,630 --> 00:24:04,670 +Amblyopiaاللي constant suppression في one eye + +370 +00:24:04,670 --> 00:24:08,590 +leads to amblyopia والamblyopia معروف انه هيصير + +371 +00:24:08,590 --> 00:24:12,250 +النظر ضعيف حتى لو أغلقنا العين التانية هيضل عندي + +372 +00:24:12,250 --> 00:24:15,930 +ال best correction ماب توصل لست ع ستة ع ستة when + +373 +00:24:15,930 --> 00:24:19,190 +suppression alternates لما ال suppression بيصير + +374 +00:24:19,190 --> 00:24:22,970 +فيه تبادلية بين العينتين switches from one eye to + +375 +00:24:22,970 --> 00:24:26,830 +other amblyopia does not develop عشان هات لما + +376 +00:24:26,830 --> 00:24:31,130 +بيصير عندي suppression او بكتشف انه العينفيها + +377 +00:24:31,130 --> 00:24:33,810 +altern .. او العينين فيهم alternating suppression + +378 +00:24:33,810 --> 00:24:37,870 +بكون انا مطمن اكتر مما لو يكون عندي monocular + +379 +00:24:37,870 --> 00:24:41,170 +suppression كيف نفحص انه في عند الطفل alternating + +380 +00:24:41,170 --> 00:24:44,650 +suppression او monocular suppression؟ هذه فيه + +381 +00:24:44,650 --> 00:24:49,560 +الفحوصاتحنجيلها في وقتها ان شاء الله تعالى تالت + +382 +00:24:49,560 --> 00:24:53,420 +تالت تجسيمة واخر تجسيمة لل suppression اللي هي + +383 +00:24:53,420 --> 00:24:57,380 +facultative or obligatory facultative suppression + +384 +00:24:57,380 --> 00:25:00,440 +occurs only when the eyes are misaligned + +385 +00:25:00,440 --> 00:25:04,660 +obligatory suppression is present at all times + +386 +00:25:04,660 --> 00:25:07,920 +irrespective of whether the eyes are deviated or + +387 +00:25:07,920 --> 00:25:11,100 +straight examples are seen in the intermittent + +388 +00:25:11,100 --> 00:25:15,860 +exotropia and duane syndrome بمعنى أخراش يعني + +389 +00:25:15,860 --> 00:25:19,520 +facultative؟ يعني facultative اختياريو obligatory + +390 +00:25:19,520 --> 00:25:24,300 +إجباري ال facultative suppression أحيانا بعض أنواع + +391 +00:25:24,300 --> 00:25:28,720 +الحوال بتكون أنواع بيسموها intermittent squint + +392 +00:25:28,720 --> 00:25:33,200 +مثال على ذلك intermittent exotropia حوال وحشي + +393 +00:25:33,200 --> 00:25:36,280 +للخارج بس intermittentish and intermittent متقطع + +394 +00:25:36,280 --> 00:25:40,120 +يعني طول النهار أو الغالبية العظمة من وقت النهار + +395 +00:25:40,120 --> 00:25:43,920 +عينين الطفل straight مافيش حوال أحيانا لما بيصرح + +396 +00:25:43,920 --> 00:25:47,580 +أو بينعس أو بيصفن في إشي معين بيركز في إشي معين + +397 +00:25:47,870 --> 00:25:54,130 +أحدى العين تانى بتحرف في هذه اللحظات اللى حرفت عين + +398 +00:25:54,130 --> 00:25:58,150 +من العين تانى لما صرح أو نعس العين اللى حرفت بيصير + +399 +00:25:58,150 --> 00:26:01,910 +فيها suppression طيب واحد نبه او انتبه لحاله بعد + +400 +00:26:01,910 --> 00:26:06,430 +عشر ثوانى او عشرين ثانية واعتدلت العين تانى وصاروا + +401 +00:26:06,430 --> 00:26:10,600 +straight eyes مرة تانيةساعتها هيستعيد ال binocular + +402 +00:26:10,600 --> 00:26:13,540 +single vision والعينتين هيكونوا بيشتغلوا مع بعض + +403 +00:26:13,540 --> 00:26:15,980 +وال suppression هيروح، اذا هذا ال .. ال + +404 +00:26:15,980 --> 00:26:19,620 +suppression بيسموه facultative يعني فقط بيحدث في + +405 +00:26:19,620 --> 00:26:23,720 +أوقات معينة وليس إكراهي أو إجباري أو طول الوقت + +406 +00:26:23,720 --> 00:26:27,610 +موجودفي أنواع تانية من الحوار، سواء العين straight + +407 +00:26:27,610 --> 00:26:32,810 +أو سواء العين مش straight، ممكن يكون عندي ال .. ال + +408 +00:26:32,810 --> 00:26:35,850 +.. ال .. ال suppression إجباري، إجباري يعني سواء + +409 +00:26:35,850 --> 00:26:38,150 +العين straight أو مش straight، العين اللي فيها + +410 +00:26:38,150 --> 00:26:42,370 +المشكلة فيها suppression، مثال على ذلك Dwan + +411 +00:26:42,370 --> 00:26:46,480 +Syndromeممكن هو Dwayne Syndrome و هو بينظر للأمام + +412 +00:26:46,480 --> 00:26:50,280 +العين عنده تكون straight لما بنظر للجانب يصير في + +413 +00:26:50,280 --> 00:26:53,960 +عنده ال skin تظهر و هنحكي عن Dwayne Syndrome صفاته + +414 +00:26:53,960 --> 00:26:57,120 +و أعراضه في حوال اتنين ان شاء الله تعالى بس Dwayne + +415 +00:26:57,120 --> 00:26:59,900 +Syndrome بعد مرضى ل Dwayne بيكون عنده و هو بتطلع + +416 +00:26:59,900 --> 00:27:03,280 +للأمام straight a head عينيه straight لما بتطلع + +417 +00:27:03,280 --> 00:27:07,180 +للجانب لنحيط العين او نحيط العين باتجاه العين اللي + +418 +00:27:07,180 --> 00:27:10,240 +فيها ل Dwayne Syndrome نفرض في ال left eye و تطلع + +419 +00:27:10,240 --> 00:27:14,010 +نحيط ال leftيعني هيظهر ال squint بشكل واضح جدا + +420 +00:27:14,010 --> 00:27:17,810 +فهذا المريض ممكن لو كانت عينيه straight في ال .. + +421 +00:27:17,810 --> 00:27:20,530 +في وضع ال primary position أو لو كانت عينيه + +422 +00:27:20,530 --> 00:27:24,910 +squinting في ال side gaze او في .. على ال .. في + +423 +00:27:24,910 --> 00:27:28,250 +النظر إلى الجانب في الحالتين هيضل عنده إيش + +424 +00:27:28,250 --> 00:27:32,510 +suppression في ال eye اللي فيها Dwan syndrome وهذا + +425 +00:27:32,510 --> 00:27:36,240 +يسمى obligatory لأنهبغض النظر irrespective of + +426 +00:27:36,240 --> 00:27:39,420 +whether the eyes are deviated يعني فيهم حوال أو + +427 +00:27:39,420 --> 00:27:42,380 +straight ال .. ال .. ال suppression موجود موجود + +428 +00:27:42,380 --> 00:27:46,000 +فهذا بيسموه obligatory يعني في facultative اختياري + +429 +00:27:46,000 --> 00:27:49,700 +يعني مش دايما موجود بيوجد في حالة وجود ال squint + +430 +00:27:49,700 --> 00:27:53,260 +بيروح لما العينين تعدل وفي obligatory إجباري سواء + +431 +00:27:53,260 --> 00:27:56,540 +العينين عدلة أو مش عدلة بيكون في عندي suppression + +432 +00:27:56,540 --> 00:27:59,860 +هدولة التلت أنواع أو التلت تجسيمات three + +433 +00:27:59,860 --> 00:28:02,940 +classification لل suppression اللي هو ألغاء صورة + +434 +00:28:02,940 --> 00:28:07,050 +من الصورةوقولنا مش شرط إنها تكون الصورة اللي جاية + +435 +00:28:07,050 --> 00:28:10,650 +من ال deviated eye فتجسمات تلاتة central عشان + +436 +00:28:10,650 --> 00:28:13,710 +يخلصني من ال .. من ال confusion و peripheral عشان + +437 +00:28:13,710 --> 00:28:19,430 +يخلصني من ال diplopia monocular و alternating .. + +438 +00:28:19,430 --> 00:28:23,610 +monocular suppression و alternating suppression ال + +439 +00:28:23,610 --> 00:28:27,230 +monocular بخوف إنه ممكن يصير عندي amblyopia تالت + +440 +00:28:27,230 --> 00:28:30,790 +إشي facultative و obligatoryأيضا ال obligatory + +441 +00:28:30,790 --> 00:28:37,030 +suppression ممكن يخوفني من موضوع .. موضوع اللي هي + +442 +00:28:37,030 --> 00:28:39,910 +ال amblyopia، الموضوع ال amblyopia، ليش؟ لأن ال + +443 +00:28:39,910 --> 00:28:43,450 +obligatory suppression بيحصل في .. في .. في عين + +444 +00:28:43,450 --> 00:28:46,310 +اللي فيها المشكلة سواء العين تين straight أو + +445 +00:28:46,310 --> 00:28:52,900 +deviated، سواء straight أو deviated، الآنكيف نفحص + +446 +00:28:52,900 --> 00:28:55,900 +ال suppression؟ كيف نفحص ال suppression؟ هنيجييله + +447 +00:28:55,900 --> 00:28:58,800 +ان شاء الله المرة القادمة بالفحوصات اللي احنا + +448 +00:28:58,800 --> 00:29:03,320 +شايفين الصور بتاعتها و اللي بتحتاج يعني شرح شوية + +449 +00:29:03,320 --> 00:29:07,940 +مستفيد حتى تفهم فكرتها و هنتوقف عند فحوصات ال + +450 +00:29:07,940 --> 00:29:10,920 +suppression و يعطيكم العافية والسلام عليكم ورحمة + +451 +00:29:10,920 --> 00:29:12,240 +الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/onFDnOI6W6I_raw.json b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/onFDnOI6W6I_raw.json new file mode 100644 index 0000000000000000000000000000000000000000..b789282e3a21bf1517f906e8f98d8c63de3d7838 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/onFDnOI6W6I_raw.json @@ -0,0 +1 @@ +{"segments": [{"id": 1, "seek": 721, "start": 5.75, "end": 7.21, "text": "بسم الله الرحمن الرحيم", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640], "avg_logprob": -0.023779296688735484, "compression_ratio": 1.0789473684210527, "no_speech_prob": 0.0, "words": [{"start": 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file mode 100644 index 0000000000000000000000000000000000000000..e15e5f1dc484196ce713cbda13af08227edc9b59 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/opuV4XCX5uM_raw.srt @@ -0,0 +1,2380 @@ +1 +00:00:01,520 --> 00:00:05,300 +بسم الله الرحمن الرحيم بنكمل مع محاضرات حوال واحد + +2 +00:00:05,300 --> 00:00:10,300 +ووصلنا لموضوع غير في الأهمية لازم يتقنه كل إنسان + +3 +00:00:10,300 --> 00:00:14,860 +بيعمل أو بيفحث مرض الحوال اللي هو ال measurement + +4 +00:00:14,860 --> 00:00:19,340 +of deviation يعني كيف أجيس الحوال أو ما هي الطرق + +5 +00:00:19,340 --> 00:00:23,740 +التي يقاس بها الحوال هنبدأ بالطرق البسيطة أول + +6 +00:00:23,740 --> 00:00:27,420 +طريقة اللي هي ال hersberg test اختبار hersberg أو + +7 +00:00:27,420 --> 00:00:31,220 +ال hersberg test gives a rough objective estimate + +8 +00:00:31,600 --> 00:00:36,000 +rough يعني مش دقيق كتير، objective يعني المريض مش + +9 +00:00:36,000 --> 00:00:39,700 +شرط أنه يتعاون، هو المطلوب من المريض فقط أنه يطلع + +10 +00:00:39,700 --> 00:00:44,480 +على ال light اللي أنا ماسكه بإيدي عشان أنا بنفسي ك + +11 +00:00:44,480 --> 00:00:51,740 +examiner أقيم مقدار الحول واتجاههالهيرشبرك تست + +12 +00:00:51,740 --> 00:00:55,480 +عبارة عن rough objective estimate of the angle of + +13 +00:00:55,480 --> 00:00:59,460 +manifest strabismus لما بيكون عندي ال latent + +14 +00:00:59,460 --> 00:01:03,100 +strabismus لعينين straight الهيرشبرك تست مش + +15 +00:01:03,100 --> 00:01:07,160 +هيفيدني بشيء، اذا a manifest strabismus يعني بقيم + +16 +00:01:07,160 --> 00:01:11,880 +للتروبيا بس بشكل غير دقيق، امتى باستعمله؟ لما يكون + +17 +00:01:11,880 --> 00:01:16,170 +في عندي youngor uncooperative patients young يعني + +18 +00:01:16,170 --> 00:01:19,990 +طفل صغير مش .. مش متوقع أنه يتعاون عمره مثلا ست + +19 +00:01:19,990 --> 00:01:23,830 +شهور، تسعة شهور، سنة، سنة و نصف أو uncooperative + +20 +00:01:23,830 --> 00:01:28,110 +patients يعني مرضى، أطفال أو كبار غير متعاونين + +21 +00:01:28,110 --> 00:01:35,210 +لسبب أو لآخر مثلا الإنسان يعني عنده يعني مرض عقلي + +22 +00:01:35,210 --> 00:01:38,290 +أو شيء من هذا القبيل مش .. مش .. لا يستطيع أنه + +23 +00:01:38,290 --> 00:01:43,040 +يتعاون .. لا يستطيع أنه يتعاونor when fixation in + +24 +00:01:43,040 --> 00:01:46,380 +the deviating eye is poor لما بيكون عندي ال + +25 +00:01:46,380 --> 00:01:50,100 +deviating eye أو العين اللي فيها ال squint ال + +26 +00:01:50,100 --> 00:01:53,900 +vision فيها يعني سيء للغاية مش هيقدر يشوف ال + +27 +00:01:53,900 --> 00:01:58,620 +target لو أنا بدأ أستعمله يعني فحوصات أدق زي ال + +28 +00:01:58,620 --> 00:02:01,720 +cover test اللي هنحكي عنها بعد ذلك فبالتالي بقى + +29 +00:02:01,720 --> 00:02:06,820 +ألجأ إلى أنه أستعمل ال hersberg test في القياصة + +30 +00:02:06,820 --> 00:02:10,080 +عبارة عن إيش ال hersberg ال hersberg عبارة عن pin + +31 +00:02:10,080 --> 00:02:14,790 +torchis shown into the eyes from arms length بعض + +32 +00:02:14,790 --> 00:02:20,250 +الكتب بتكتب أنه من بعد متر أو من طول دراع الفاحس + +33 +00:02:20,250 --> 00:02:24,810 +يعني بابعد مقدار سبعين تمانين صنطي بقدر ما تسمح في + +34 +00:02:24,810 --> 00:02:30,950 +طول إيديا تمام عن المريض و بأضوي على وجه المريض ب + +35 +00:02:30,950 --> 00:02:35,530 +pin torch قلم مضيقand the patient ask to fixate + +36 +00:02:35,530 --> 00:02:39,330 +the light بس المطلوب من الطفل أو من المريض أنه + +37 +00:02:39,330 --> 00:02:43,310 +يتطلع على الضوء على العموم الطفل أول ما بأضوئ + +38 +00:02:43,310 --> 00:02:47,330 +باتجاه عينه غالبا ببدأ يتطلع على الضوء اللي أنا + +39 +00:02:47,330 --> 00:02:53,350 +يعني ضويته باتجاهه the corneal reflection of light + +40 +00:02:53,350 --> 00:02:57,970 +will be more or less centered يعني أنا بتطلع ال + +41 +00:02:57,970 --> 00:03:03,560 +corneal reflexالـ corneal reflex للـ light اللي هو + +42 +00:03:03,560 --> 00:03:06,600 +سموه الـ corneal light reflex و بقى شوفوا هل جاي + +43 +00:03:06,600 --> 00:03:11,100 +في ال center ولا مش م center في نص البقبو بتاع + +44 +00:03:11,100 --> 00:03:14,580 +المريض فبالتالي the corneal reflection of light + +45 +00:03:14,580 --> 00:03:18,440 +will be more or less centered in the pupil of the + +46 +00:03:18,440 --> 00:03:23,260 +fixating eye but will be decentered in squinting + +47 +00:03:23,260 --> 00:03:26,800 +eye حيكون في العين ال fixating تقريبا في ال center + +48 +00:03:28,350 --> 00:03:32,030 +بينما في العين الـ deviating هيكون decentral light + +49 +00:03:32,030 --> 00:03:35,380 +reflex زي ما هنشوف بعد قليلin the direction + +50 +00:03:35,380 --> 00:03:38,620 +opposite to that of deviation ايش يعني in the + +51 +00:03:38,620 --> 00:03:40,780 +direction opposite to that of deviation يعني لما + +52 +00:03:40,780 --> 00:03:44,040 +تكون العين داخلة لجوة بيكون ال light reflex مبين + +53 +00:03:44,040 --> 00:03:47,120 +انه طالع لبرا بالنسبة لهذه العين بالنسبة لهذه + +54 +00:03:47,120 --> 00:03:51,460 +العين لما العين بتكون يعني صعدة للأعلى hypertropia + +55 +00:03:51,460 --> 00:03:54,780 +ال light reflex هيكون منخفض بالنسبة لها زي ما + +56 +00:03:54,780 --> 00:04:00,870 +هنشوف الآن بإذن الله تعالى نشوف هناهي الصورة + +57 +00:04:00,870 --> 00:04:04,390 +الأولى أو الحالة الأولى ضوّينا على وجه المريض + +58 +00:04:04,390 --> 00:04:07,090 +النقطة البيضه هي اللي احنا شايفينها اللي انا + +59 +00:04:07,090 --> 00:04:10,410 +غطيتها بال .. بال mouse هذه النقطة البيضه لو + +60 +00:04:10,410 --> 00:04:14,390 +اطلعنا على عرض مكبر هيبين أفضل هذه النقطة البيضه + +61 +00:04:14,390 --> 00:04:18,570 +هي ال corneal light reflex يعني الكمية اللي انعكست + +62 +00:04:18,570 --> 00:04:22,830 +من ال cornea من ال cornea .. هذه ال corneal light + +63 +00:04:22,830 --> 00:04:28,590 +reflex هنا جاية تقريبا في ال centerبينما هنا العين + +64 +00:04:28,590 --> 00:04:32,510 +عشانها داخلة لجوا النقطة البيضا أو ال corneal + +65 +00:04:32,510 --> 00:04:36,310 +light reflex جاي لبرا تقريبا عند الحفة تقريبا عند + +66 +00:04:36,310 --> 00:04:40,550 +الحفة الخارجية لل pupil هذه لما بتكون ال corneal + +67 +00:04:40,550 --> 00:04:43,090 +light reflex طالع لبرا بالنسبة للعين بنقول + +68 +00:04:43,090 --> 00:04:48,420 +esotropia هنا على العكس هنا طبعاالـ corneal light + +69 +00:04:48,420 --> 00:04:51,840 +reflex تقريباً سنتد، تقريباً سنتد وجاي للأعلى + +70 +00:04:51,840 --> 00:04:55,480 +شوية، بس هو لأن المريضة بتبطل على الأسفل شوية، + +71 +00:04:55,480 --> 00:04:58,540 +بينما هنا جاي عقبال ال center بالضبط، هنا هي ال + +72 +00:04:58,540 --> 00:05:01,640 +fixating eye، هنا ال corneal light reflex تقريباً + +73 +00:05:01,640 --> 00:05:04,680 +جاي عند الليمبس، وين الإشارة اللي أنا بقشت عليها، + +74 +00:05:04,680 --> 00:05:08,860 +فبالتالي طالما ال corneal light reflex داخل لجوة، + +75 +00:05:08,860 --> 00:05:12,900 +العين واضح أنها طالعة لبرا، دائما ال corneal light + +76 +00:05:12,900 --> 00:05:16,560 +reflex اتجاهه عكس اتجاه الحوال، لما الحوال بيكون + +77 +00:05:16,560 --> 00:05:21,130 +لبرا،لما الحوال بيكون لبرا ال corneal light reflex + +78 +00:05:21,130 --> 00:05:27,410 +بيكون لجوه هنا أيضا درجات مختلفة من الisotropia + +79 +00:05:27,410 --> 00:05:31,470 +أولا الرسم الأعلى ال corneal light reflex centered + +80 +00:05:31,470 --> 00:05:34,710 +في الانتين هنا Ortho يعني مافيش عنده حوال طبعا لما + +81 +00:05:34,710 --> 00:05:38,670 +بكتب Ortho في الملفمع ان مافيش حوار مدي اكتب بين + +82 +00:05:38,670 --> 00:05:43,410 +جثين by ht by herzberg test by herzberg test عشان + +83 +00:05:43,410 --> 00:05:48,630 +يتأكد زميلي اللي هييجي من بعدي ويقرأ الملف انه هذا + +84 +00:05:48,630 --> 00:05:53,030 +الفحص ربما مايكونش دقيق 100% واحنا قولنا مابنلجأ + +85 +00:05:53,030 --> 00:05:58,370 +لل herzberg test إذا بنستطيع نستعمل فحوصات أدق منه + +86 +00:05:58,370 --> 00:06:04,070 +زي سلسلة cover test زي سلسلة cover test هنا الدرجة + +87 +00:06:04,070 --> 00:06:08,940 +الأولى من الisotropiaهنا زيغله شوية طبعا + +88 +00:06:08,940 --> 00:06:13,040 +herschberg اللي اول مانفكر في هذا ال test افترض + +89 +00:06:13,040 --> 00:06:17,240 +انه مساحة او القطر تاع ال pupil القطر تاع ال pupil + +90 +00:06:17,240 --> 00:06:21,780 +في الطبيعي عنده متوسطه اربعة ملي يعني من الحافة + +91 +00:06:21,780 --> 00:06:25,220 +هاي للحافة هاي اربعة ملي من الحافة العليه للحافة + +92 +00:06:25,220 --> 00:06:28,620 +السفله اربعة ملي المفروض ال corner light reflex + +93 +00:06:28,620 --> 00:06:32,180 +يكون على جبال منتصف البقبق يعني المسافة من النصف + +94 +00:06:32,180 --> 00:06:39,340 +من المنتصفلأي من الحواف تساوي 2 ملي، طيب هنا ال + +95 +00:06:39,340 --> 00:06:44,160 +corner light reflex زاغ تقريبا واحد ملي او اتنين + +96 +00:06:44,160 --> 00:06:48,620 +مليلو فرضناه على حفة البؤبؤ بالضبط، على الحافة + +97 +00:06:48,620 --> 00:06:52,320 +بالضبط، هو أقرب شويه من الحافة، بدنا نفترضوا أنه + +98 +00:06:52,320 --> 00:06:55,080 +على الحافة بالضبط، بيكون ال Cornial light reflex + +99 +00:06:55,080 --> 00:06:58,900 +هنا اتحرك لبرا اتنين ملي، معناته اللي عين دخلت + +100 +00:06:58,900 --> 00:07:03,180 +لجوه اتنين ملي، Herschberg قال كل واحد منيه يساوي + +101 +00:07:03,180 --> 00:07:10,020 +سبعة degreeوكل degree تقريبا تقريبا تقريبا تقريبا + +102 +00:07:10,020 --> 00:07:11,060 +تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا + +103 +00:07:11,060 --> 00:07:12,560 +تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا + +104 +00:07:12,560 --> 00:07:16,960 +تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا + +105 +00:07:16,960 --> 00:07:18,680 +تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا + +106 +00:07:18,680 --> 00:07:19,300 +تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا + +107 +00:07:19,300 --> 00:07:27,270 +تقريبا تقريبا تقريبا تقريبا تقريبا ت14 degree او + +108 +00:07:27,270 --> 00:07:30,850 +بقول تلاتين Prism ديوبتر احنا بنقول تقريبا مش مائة + +109 +00:07:30,850 --> 00:07:35,430 +بالمائة كل one degree تساوي اتنين Prism طيب هنا + +110 +00:07:35,430 --> 00:07:40,190 +بقول lift ايزو تروبيا تقريبا هنا اتنين ملي وكمان + +111 +00:07:40,190 --> 00:07:44,270 +ملي تقريبا بنقول تلاتة ملي يعني عندي واحد وعشرين + +112 +00:07:44,270 --> 00:07:46,770 +degree يعني تقريبا احنا بنحكي عن + +113 +00:07:50,340 --> 00:07:54,780 +خمسة واربعين IPRISM خمسة واربعين IPRISM لأنه + +114 +00:07:54,780 --> 00:07:58,060 +التلاتة degree يعني واحد .. التلاتة ملي واحد + +115 +00:07:58,060 --> 00:08:02,240 +وعشرين degree ت .. بنضربهم في اتنين تقريبا يعني + +116 +00:08:02,240 --> 00:08:04,840 +واحد وعشرين بتطلع اتنين واربعين IPRISM مع اني + +117 +00:08:04,840 --> 00:08:09,840 +تقريبا تقريبا احنا جولنا كل one ملي خمستاشر IPRISM + +118 +00:08:09,840 --> 00:08:16,050 +اذا التلاتة ملي خمسة واربعين IPRISM هناالـ Corneal + +119 +00:08:16,050 --> 00:08:19,350 +Light Reflex جاي برا ال Limbus، طبعا عند ال Limbus + +120 +00:08:19,350 --> 00:08:24,330 +تقريبا تسعين Prism، تسعين Prism، حسب تقديرات + +121 +00:08:24,330 --> 00:08:28,010 +هيرشبرج، حسب تقديرات هيرشبرج، فبالتالي هذه القضية + +122 +00:08:28,010 --> 00:08:33,050 +بدأت تكون واضحة بالنسبة لنا، طبعانشوف هنا مثلًا + +123 +00:08:33,050 --> 00:08:37,690 +مثال، بنقول هذا الطفل Ortho، هذا الطفل Ortho by + +124 +00:08:37,690 --> 00:08:41,750 +Hirschberg test هذا الطفل هنا Center، بالظبط في نص + +125 +00:08:41,750 --> 00:08:46,050 +البؤبو، هنا جاي على الحافة الخارجية للبؤبو، معناته + +126 +00:08:46,050 --> 00:08:50,590 +العين داخلة لجوة، is an left esotropia-13 abrism + +127 +00:08:50,590 --> 00:08:55,990 +left esotropia-13 abrism فضروري جدًا، the distance + +128 +00:08:55,990 --> 00:08:59,150 +of corneal light reflection from the center of the + +129 +00:08:59,150 --> 00:09:03,150 +pupil is notedeach millimeter of deviation is + +130 +00:09:03,150 --> 00:09:06,950 +approximately equal to 7 degree وكل one degree + +131 +00:09:06,950 --> 00:09:10,850 +تقريبا اتنين prism ديوبتر for example if the + +132 +00:09:10,850 --> 00:09:14,450 +reflex is situated at the temporal border of the + +133 +00:09:14,450 --> 00:09:18,810 +pupil assuming the pupillary diameter of 4 + +134 +00:09:18,810 --> 00:09:22,870 +millimeter هاي عندي على ال temporal border of the + +135 +00:09:22,870 --> 00:09:26,070 +pupil هاي ال light reflex جاي بالظبط على ال + +136 +00:09:26,070 --> 00:09:30,340 +temporal border of the pupilوفرضنا إن الـ + +137 +00:09:30,340 --> 00:09:35,840 +pupillary diameter كله، القطر كله، من هنا لهنا، + +138 +00:09:35,840 --> 00:09:40,880 +أربع ملي، the angle is about خمستاشر degree، ليش؟ + +139 +00:09:40,880 --> 00:09:44,300 +لأنها اتحركت اتنين ملي، اتحركت اتنين ملي، بمعنى + +140 +00:09:44,300 --> 00:09:48,300 +إنه مش هيتحرك من هنا لهنا، هو هيتحرك من النص لهنا، + +141 +00:09:48,300 --> 00:09:50,840 +إذا هذا أربع ملي، معناته من النص اللي هي ال + +142 +00:09:50,840 --> 00:09:56,410 +radius، نصف قطر ال pupil، اتنين ملي،الـ light + +143 +00:09:56,410 --> 00:09:59,890 +reflex كان المفروض يكون هنا، أصبح هنا، معناته + +144 +00:09:59,890 --> 00:10:02,930 +العين داخلة لجوا بمقدار اتنين ميلي، اتنين ميلي + +145 +00:10:02,930 --> 00:10:08,670 +يعني تقريبا خمستاشر degree، يعني تساوي تقريبا .. + +146 +00:10:08,670 --> 00:10:16,200 +بنضربها في اتنين تلاتين بريزم ده يبدوإذا كانت + +147 +00:10:16,200 --> 00:10:19,300 +الـ corneal light reflex عند الليمباص، يعني بدل ما + +148 +00:10:19,300 --> 00:10:23,980 +هو هنا، هو على الحفة الخارجية للليمباص، معناته أنا + +149 +00:10:23,980 --> 00:10:29,060 +عندي تسعين prism لخمسة واربعين ديجري، this test is + +150 +00:10:29,060 --> 00:10:33,120 +also useful in detecting pseudostrabismuswhich may + +151 +00:10:33,120 --> 00:10:36,020 +be caused by the following condition قبل ما نحكي + +152 +00:10:36,020 --> 00:10:40,320 +عن الحوار الكاذب قبل ما نحكي عن الحوار الكاذب هبنا + +153 +00:10:40,320 --> 00:10:43,800 +نطلع على simulation يوضحلي قضية الherzberg test + +154 +00:10:43,800 --> 00:10:47,840 +ونشوف كيف هذا ال simulation ابنعمله هذا ال + +155 +00:10:47,840 --> 00:10:53,880 +simulation تابع لل American Academy هنبدأ + +156 +00:10:53,880 --> 00:10:58,790 +من وضعية الصفرهي عندي انا العينين straight ال + +157 +00:10:58,790 --> 00:11:04,090 +corneal light reflex هو النقاط البيضة طيب احنا + +158 +00:11:04,090 --> 00:11:10,090 +الآن بدنا نفرض عنده اكزوتروبيا مثلا تلاتين prison + +159 +00:11:13,990 --> 00:11:18,770 +تلاتين Prism اكزوتروبيا في ال right eye اكزوتروبيا + +160 +00:11:18,770 --> 00:11:22,190 +تلاتين Prism تقريبا ال pupil light reflex جاية على + +161 +00:11:22,190 --> 00:11:28,150 +حافة البؤبؤ الداخلية nasal border + +162 +00:11:28,150 --> 00:11:29,190 +of the pupil + +163 +00:11:32,230 --> 00:11:36,210 +هك أفضل للرؤية طبعا ال simulation مش دقيق 100% + +164 +00:11:36,210 --> 00:11:39,290 +لأنه المفروض تكون النقطة البيضة على الحافة بس لو + +165 +00:11:39,290 --> 00:11:44,950 +حطيناها على الحافة هكا بتبين اقل من 30 بريسم اقل + +166 +00:11:44,950 --> 00:11:50,030 +من 30 بريسم اذا هذا Exotropia 30 بريسم طب لو انا + +167 +00:11:50,030 --> 00:11:57,170 +بدعمل simulation هنا left Exotropia 30 بريسم by + +168 +00:11:57,170 --> 00:12:02,400 +Hersberg test بدنا Exotropia مثلاالإيزو تروبيا + +169 +00:12:02,400 --> 00:12:06,500 +هتبين عندى بال minus لإن هنا محتوط حرف ال X بال + +170 +00:12:06,500 --> 00:12:13,700 +minus هنا إيزو تروبيا تلاتين ابرزم تلاتين ابرزم + +171 +00:12:13,700 --> 00:12:22,100 +طيب لو أنا بدي hyper تروبيا مثلا left + +172 +00:12:22,100 --> 00:12:22,580 +hyper + +173 +00:12:27,530 --> 00:12:30,550 +خمسة و تلاتين بريزم هيبين الكورنيا ال light reflex + +174 +00:12:30,550 --> 00:12:41,010 +نازل بالنسبة للعين طيب لو بدي hypotropia هيك + +175 +00:12:41,010 --> 00:12:44,770 +right hyper بس بدي right hypo مثلا + +176 +00:12:53,010 --> 00:12:57,850 +فبيبين الـ corneal light reflex طالع بالنسبة للعين + +177 +00:12:57,850 --> 00:13:01,650 +يعني العين نازلة اذا هذا بالنسبة للهيرشبرج test + +178 +00:13:01,650 --> 00:13:07,010 +منعمل من مسافة ال arms length او من مسافة واحد + +179 +00:13:07,010 --> 00:13:11,450 +هامتر هي اورثو باي هيرشبرج test اورثو باي هيرشبرج + +180 +00:13:11,450 --> 00:13:25,040 +test بنشوف الآنما هي أسباب الـ pseudostrabismus ما + +181 +00:13:25,040 --> 00:13:32,020 +هي الأشياء اللي ممكن تخلي الإنسان يكون عنده انطباع + +182 +00:13:32,020 --> 00:13:35,920 +إنه في حوال في نفس الوقت مافيش حوال في نفس الوقت + +183 +00:13:35,920 --> 00:13:39,870 +مافيش حوال هو الحاجة Epicanthic Faultsالـ + +184 +00:13:39,870 --> 00:13:44,070 +Epicanthic folds may simulate anisotropia. What is + +185 +00:13:44,070 --> 00:13:46,930 +epicanthic folds؟ هي الثنيات الجلدية اللي احنا + +186 +00:13:46,930 --> 00:13:50,890 +شايفينها، الثنيات الجلدية هي اللي بيكون عند + +187 +00:13:50,890 --> 00:13:58,690 +الأطفالبتخفي جزء من بياض العين ال nasal part of + +188 +00:13:58,690 --> 00:14:03,390 +sclera .. of sclera ال nasal part أو ال inner part + +189 +00:14:03,390 --> 00:14:08,230 +of sclera بيكون مخفي فبالتالي .. فبالتالي بتبين + +190 +00:14:08,230 --> 00:14:12,030 +العين و كأنها داخلة جوا .. و كأنها داخلة جوا + +191 +00:14:12,030 --> 00:14:14,490 +فبالتالي هذه القضية ممكن يقولوا لأ هذا عنده + +192 +00:14:14,490 --> 00:14:18,630 +esotropia لأ هذا الطفل بتطلع لليمينيعني شوية عيني + +193 +00:14:18,630 --> 00:14:22,570 +التنتين رايحين لليمين فلو احنا قارننا بين ال .. ال + +194 +00:14:22,570 --> 00:14:24,690 +.. ال .. ال cornial light reflex هنا و ال cornial + +195 +00:14:24,690 --> 00:14:27,550 +light reflex هنا صحيح هذا جاي على ال temporal + +196 +00:14:27,550 --> 00:14:30,470 +border of the pupil تقريبا بس هذا جاي على ال nasal + +197 +00:14:30,470 --> 00:14:33,970 +border اذا يعني هو ortho .. هو ortho يعني لو عدلنا + +198 +00:14:33,970 --> 00:14:38,050 +وضع ال light هنلاقي ان ال light بيجي في النص + +199 +00:14:38,050 --> 00:14:41,590 +بالضبط .. في النص بالضبط فبالتالي السبب في انه + +200 +00:14:41,590 --> 00:14:45,970 +بظهر كأنه العين داخلة هو ال apicanic fold فبيبين + +201 +00:14:45,970 --> 00:14:52,130 +كأنه عندى ..Epicantric folds هي ثنيات الجلدية + +202 +00:14:52,130 --> 00:14:55,670 +الموجودة بتكون عندى هذا + +203 +00:15:00,250 --> 00:15:04,930 +عبارة عن ثنيات جلدية بتغطي .. طبعا من جلد الأنف + +204 +00:15:04,930 --> 00:15:09,790 +بتغطي جزء من الـ sclera بتخليه مش مبين فبالتالي + +205 +00:15:09,790 --> 00:15:15,510 +simulate esotropia simulate esotropia .. اول سبب + +206 +00:15:15,510 --> 00:15:19,030 +من أسباب الـ pseudostrabismus اللي حاول الكاذب هي + +207 +00:15:19,030 --> 00:15:21,970 +الـ apicantic fold و بتعمل simulation كأنه عندي + +208 +00:15:21,970 --> 00:15:26,380 +esotropia طيب كيف انا ..في حاجتين لازم أعملها لما + +209 +00:15:26,380 --> 00:15:29,080 +أشوف ال baby can't take fold إذا الأهل كانوا + +210 +00:15:29,080 --> 00:15:34,320 +جالجانين إن الطفل عنده esotropia أول شاملة بتخصني + +211 +00:15:34,320 --> 00:15:38,880 +أنا كفاحس أو ك examiner القاعدة بتقول look at the + +212 +00:15:38,880 --> 00:15:43,440 +light not at the white القاعدة بتقول look at the + +213 +00:15:43,440 --> 00:15:47,800 +light not + +214 +00:15:47,800 --> 00:15:48,560 +at the white + +215 +00:15:52,320 --> 00:15:55,540 +هيش يعني look at the light not at the wire؟ احنا + +216 +00:15:55,540 --> 00:15:58,460 +قلنا في ال corneal light reflex جاي في نص ال pupil + +217 +00:15:58,460 --> 00:16:02,040 +ولا لا؟ مالناش في ال sclera، مقلنا في ال sclera و + +218 +00:16:02,040 --> 00:16:05,940 +احنا بنقيم الحوار، اذا انا اتطلعت حتى لو كان ال + +219 +00:16:05,940 --> 00:16:09,940 +apicantic fold مغطي جزء حتى من ال iris، مش من ال + +220 +00:16:09,940 --> 00:16:13,220 +sclera بس، يعني لو كان أعرض من هيك، طالما ال + +221 +00:16:13,220 --> 00:16:15,780 +corneal light reflex جاي في النص، اذا هذا ماعندوش + +222 +00:16:15,780 --> 00:16:20,550 +اسكونةإذا هذا ماعندهوش squint، إذا أول حاجة بتخصني + +223 +00:16:20,550 --> 00:16:25,770 +أنا ك examiner إني أطمن إنه مافيش عندي squint بإني + +224 +00:16:25,770 --> 00:16:28,990 +أنظر لل corn .. لل cornial light reflex مش لل + +225 +00:16:28,990 --> 00:16:34,580 +scleraهذه نقطة النقطة التانية كيف أقنع الأهل بإنه + +226 +00:16:34,580 --> 00:16:38,480 +العينان straight يعني بدي أنا أعمل الهيرشبيرج test + +227 +00:16:38,480 --> 00:16:43,660 +أمامهم و أمسك المنطقة high و أشدها للأعلى بحيث أنه + +228 +00:16:43,660 --> 00:16:48,280 +هذه الثانية الجلدية تختفي يعني لما بمسك جلد الأنف + +229 +00:16:48,280 --> 00:16:52,840 +و برفعه للأعلى قليلابثنيات الجلد هيبتنشد معاه + +230 +00:16:52,840 --> 00:16:56,340 +فبالتالي بتبين ال sclera و بقولهم هاي ال corneal + +231 +00:16:56,340 --> 00:16:59,560 +light reflex يعني جاي في منتصف العين فبالتالي هذا + +232 +00:16:59,560 --> 00:17:04,840 +حوالي كاذب غالبا الطفل لما بيكبر المنطقة العظمية + +233 +00:17:04,840 --> 00:17:08,970 +تحت الجلد هيبتتشكل و ترتفع قليلافبتشد معاها الجلد + +234 +00:17:08,970 --> 00:17:14,170 +غالبا و مش دائما طبعا غالبا ولكن بتتحسن الأمور + +235 +00:17:14,170 --> 00:17:18,210 +كتير تصير هذا المنظر مش مبين أحيانا بالذات عند + +236 +00:17:18,210 --> 00:17:21,910 +الشعوب شرق أسيا ممكن إذا كان الإنسان حابب يتخلص + +237 +00:17:21,910 --> 00:17:26,000 +منها ممكن يرجع لهاعملية جراحية للتخلص من هذه + +238 +00:17:26,000 --> 00:17:29,880 +المشكلة .. من هذه المشكلة طبعا عملياتها هتكون في + +239 +00:17:29,880 --> 00:17:33,920 +الجلد بتاع الجفن .. في الجلد بتاع الجفن فهذا أول + +240 +00:17:33,920 --> 00:17:37,100 +سبب من أسباب الـ pseudo squint أو الـ pseudo + +241 +00:17:37,100 --> 00:17:41,360 +strabismus تاني حاجة .. في عندي حاجة بسمها ال IPD + +242 +00:17:41,360 --> 00:17:45,560 +الـ interpupillary distance ممكن تكون واسعة .. + +243 +00:17:45,560 --> 00:17:49,880 +ممكن تكون واسعةبتعملي simulation كأنه فيه + +244 +00:17:49,880 --> 00:17:55,800 +Exotropia أو تكون دقيقة ال IPD صغيرة فبتعملي + +245 +00:17:55,800 --> 00:17:59,200 +simulation Exotropia لما بيكون ال IPD المسافة بين + +246 +00:17:59,200 --> 00:18:03,820 +العينين صغيرة نتيجة أن محجر العين صغير والمسافة + +247 +00:18:03,820 --> 00:18:08,240 +بين المحجرين صغيرة بتخيل الإنسان للواهلة اللي قول + +248 +00:18:08,240 --> 00:18:11,940 +أن الطفل عنده Exotropia ولو كانت واسعة زي المنظر + +249 +00:18:11,940 --> 00:18:18,400 +هذا اللي أماميبيبين كأنه العينين فيهم إكزوتروبيا + +250 +00:18:18,400 --> 00:18:21,100 +برضه بنرجع للقاعدة نفسها بيقول + +251 +00:18:27,610 --> 00:18:30,750 +look at the light not at the white look at the + +252 +00:18:30,750 --> 00:18:34,030 +light not at the white فبالتالي هذه القضية ضرورية + +253 +00:18:34,030 --> 00:18:37,650 +جدا إذا ال light reflex جاي في نص ال pupil ساعتها + +254 +00:18:37,650 --> 00:18:43,770 +بيكون عندي انا مافي اي مشكلة و هذه بالسبب ال wide + +255 +00:18:43,770 --> 00:18:47,870 +أو ال narrow inter pupillary distance ال wide أو + +256 +00:18:47,870 --> 00:18:49,990 +ال narrow inter pupillary distance يعني ال + +257 +00:18:49,990 --> 00:18:54,890 +abnormal IPD ممكن إذا كانه ضيق أكتر من اللازم ي + +258 +00:18:55,700 --> 00:18:59,660 +يشتبه علينا إنه في إيزو تروبيا وممكن لو إنه واسع + +259 +00:18:59,660 --> 00:19:03,120 +أكتر من اللازم يشتبه علينا إنه إكزو تروبيا، بلجأ + +260 +00:19:03,120 --> 00:19:06,280 +لهذه القاعدة عشان أشوف هل فعلا أنا في عندي squint + +261 +00:19:06,280 --> 00:19:14,680 +ولا مافيش عندي squint تالت شيء من أسباب ال pseudo + +262 +00:19:14,680 --> 00:19:19,630 +-strapismus اللي هي angle cupالجزء الكبير هو الجزء + +263 +00:19:19,630 --> 00:19:22,150 +بين الجزء الواضح والجزء الاناطميكالي اللي هو الجزء + +264 +00:19:22,150 --> 00:19:22,190 +الواضح والجزء الاناطميكالي اللي هو الجزء + +265 +00:19:22,190 --> 00:19:23,970 +الاناطميكالي اللي هو الجزء الاناطميكالي اللي هو + +266 +00:19:23,970 --> 00:19:27,610 +الجزء الانطميكالي اللي هو الجزء الانطميكالي اللي + +267 +00:19:27,610 --> 00:19:28,310 +هو الجزء الانطميكالي اللي هو الجزء الانطميكالي + +268 +00:19:28,310 --> 00:19:29,350 +اللي هو الجزء الانطميكالي اللي هو الجزء + +269 +00:19:29,350 --> 00:19:32,290 +الانطميكالي اللي هو الجزء الانطميكالي اللي هو + +270 +00:19:32,290 --> 00:19:35,150 +الجزء الانطميكالي اللي هو الجزء الانطميكالي اللي + +271 +00:19:35,150 --> 00:19:44,810 +هو الجزء الانطميكالي + +272 +00:19:44,810 --> 00:19:50,770 +الليthis is term positive angle kappa هذه القضية + +273 +00:19:50,770 --> 00:19:55,270 +حقيقة لازم نرسمها عساس انه يعني تكون الأمور واضحة + +274 +00:19:55,270 --> 00:20:02,330 +جدا هنا و نتخيلها بشكل سليم .. نتخيلها بشكل سليم + +275 +00:20:02,330 --> 00:20:03,370 +بنقول كالقاتل + +276 +00:20:31,400 --> 00:20:34,600 +نشوف المنظر الأول كيف هيكون عندى و المنظر التانى + +277 +00:20:34,600 --> 00:20:42,120 +كيف هيكون عندى + +278 +00:20:42,120 --> 00:20:58,220 +إذا + +279 +00:20:58,220 --> 00:21:04,140 +بالنسبة لالانجل كبه هي الانجل بين ال anatomical + +280 +00:21:04,140 --> 00:21:08,980 +axis اللي هو مرسوم باللون الأزرق و ال visual axis + +281 +00:21:08,980 --> 00:21:12,980 +اللي هو مرسوم باللون الأحمر، الآن الفوفيا، هنا ال + +282 +00:21:12,980 --> 00:21:16,000 +right eye عنده، الفوفيا جاي عادة temporarily + +283 +00:21:16,000 --> 00:21:20,680 +بالنسبة لل posterior poolو بما انه temporally + +284 +00:21:20,680 --> 00:21:25,040 +هتخرج ال visual axis هيخرج slightly nasal بالنسبة + +285 +00:21:25,040 --> 00:21:28,320 +لل anatomical او ال pupillary axis هذه ال angle + +286 +00:21:28,320 --> 00:21:31,780 +المحصورة angle بيسموها angle كابة بين ال visual + +287 +00:21:31,780 --> 00:21:35,680 +axis الأحمر و ال anatomical axis الأزرق طبعا ال + +288 +00:21:35,680 --> 00:21:38,460 +corneal light reflex اللي احنا اشرناه هنا ال + +289 +00:21:38,460 --> 00:21:42,440 +corneal light reflex اشرناه بالنجمة الصفراء مرافق + +290 +00:21:42,920 --> 00:21:46,240 +مرافق لل visual axis ممكن إنسان يسأل ليش مرافق لل + +291 +00:21:46,240 --> 00:21:49,640 +visual axis لأنه الإنسان لما بنضوي على عينه ضوء + +292 +00:21:49,640 --> 00:21:53,040 +بتطلع على الضوء بال visual axis بال line of sight + +293 +00:21:53,040 --> 00:21:56,560 +ما بتطلع بال anatomical axis هو بتطلع بال fovea + +294 +00:21:56,560 --> 00:22:00,080 +وال fovea جاية على طول خط ال visual axis إذا ال + +295 +00:22:00,080 --> 00:22:04,350 +corneal light reflex مرافق لل visual axisماذا يحدث + +296 +00:22:04,350 --> 00:22:09,230 +لو ان الفوفيا عندى جاية خلقا temporal كتير، هنا + +297 +00:22:09,230 --> 00:22:13,310 +يعني موقعها temporal كتير، هيكون كمية angle كبيرة + +298 +00:22:13,310 --> 00:22:17,550 +و هيكون ال visual axis خروجه كتير نازل بالنسبة لل + +299 +00:22:17,550 --> 00:22:21,630 +anatomical axis زى ما المنظر هذا بيوضع، فلما بتكون + +300 +00:22:21,630 --> 00:22:26,170 +الفوفيا كتير temporalهيخرج ال visual axis كتير + +301 +00:22:26,170 --> 00:22:29,230 +nasal فهيبين ال corneal light reflex جاى لجوا + +302 +00:22:29,230 --> 00:22:32,970 +مقارنة مع العين فالعين هتكون كإنها exo احنا قلنا + +303 +00:22:32,970 --> 00:22:36,230 +اذا انحرف ال corneal light reflex لجوا معناته + +304 +00:22:36,230 --> 00:22:40,490 +العين هتبين انها كإنها exo ممكن تكون exo فعلا او + +305 +00:22:40,490 --> 00:22:44,390 +ممكن تكون بسبب angle kappa اذا angle kappa سبب من + +306 +00:22:44,390 --> 00:22:47,510 +اسباب ال pseudo strabismus لو انا عندي العكس ان + +307 +00:22:47,510 --> 00:22:52,430 +الفوفيا جاية هنانزل للـ anatomical axis ساعتها + +308 +00:22:52,430 --> 00:22:57,210 +خروج الـ visual axis هيكون temporal فهيكون الـ + +309 +00:22:57,210 --> 00:23:00,590 +corneal light reflex هنا فهيبين العين كأنها داخلة + +310 +00:23:00,590 --> 00:23:04,170 +لجوا، اذا negative angle كبّا هذه بيسموها بالاتجاه + +311 +00:23:04,170 --> 00:23:07,250 +هذا positive و بالاتجاه هذا negative negative + +312 +00:23:07,250 --> 00:23:12,470 +angle كبّا بتعمل simulation لإيزوتروبيا و positive + +313 +00:23:12,470 --> 00:23:16,870 +angle كبّا بتعمل simulation للإكزواتروبيا + +314 +00:23:16,870 --> 00:23:22,260 +للإكزواتروبياألا يتم إظهاره إلى الكورنيا، فسيسبب + +315 +00:23:22,260 --> 00:23:27,460 +فيها رفلكس صحيح إلى المركز في حالة عادية الكورنيا + +316 +00:23:27,460 --> 00:23:33,480 +في كلا العين، هذا هو كلمة positive angle kappaa + +317 +00:23:33,480 --> 00:23:36,660 +large positive angle kappa may simulate an + +318 +00:23:36,660 --> 00:23:39,360 +exotropia زي المنظر اللي عدينا عليه و هنيجي نقول + +319 +00:23:39,360 --> 00:23:43,040 +كيف نكتشف إن هي positive angle kappa ولا حاجة + +320 +00:23:43,040 --> 00:23:48,480 +تانية a large positive angle kappa may simulate an + +321 +00:23:48,480 --> 00:23:52,100 +exotropia negative angle kappa occurs when the + +322 +00:23:52,100 --> 00:23:55,880 +fovea is situated nasal to the posterior pole + +323 +00:23:55,880 --> 00:23:59,160 +nasal to the posterior pole لما الفوفيا الفوفيا + +324 +00:24:09,000 --> 00:24:14,700 +العين ستظهر كإنها إيزواتروبيا + +325 +00:24:16,330 --> 00:24:19,690 +large positive angle kappa may simulate exotropia، + +326 +00:24:19,690 --> 00:24:22,670 +negative angle kappa occurs when the fovea is + +327 +00:24:22,670 --> 00:24:27,190 +situated nasal to the posterior pool أمتى بتكون + +328 +00:24:27,190 --> 00:24:29,330 +nasal to the posterior pool؟ في حالات الـhigh + +329 +00:24:29,330 --> 00:24:32,510 +myopia أو الـectopic fovea في الحالات الـhigh + +330 +00:24:32,510 --> 00:24:35,350 +myopia أو الـectopic fovea،ectopic fovea يعني + +331 +00:24:35,350 --> 00:24:40,230 +فوفيا مش في مكانها المتوقع خلقا، خلقا يعني جاية + +332 +00:24:40,230 --> 00:24:44,570 +nasal بدل ما هي temporal من الـposterior poolالعين + +333 +00:24:44,570 --> 00:24:50,680 +تتكبر و تتمدد فتصبح الفوفيا عينالفوفيا جاية نزل + +334 +00:24:50,680 --> 00:24:55,700 +بالنسبة للبوستيريور البول بالنسبة للبوستيريور + +335 +00:24:55,700 --> 00:24:58,820 +البول in this situation the corneal light reflex + +336 +00:24:58,820 --> 00:25:01,880 +is situated temporal ليش temporal؟ لأنه لاحقا + +337 +00:25:01,880 --> 00:25:05,720 +الفوفيا جاية نزل فال visual axis هيكون خروجه + +338 +00:25:05,720 --> 00:25:10,760 +باتجاه ال target temporal من مقارنة مع + +339 +00:25:10,760 --> 00:25:14,780 +الbiopillary axis مقارنة مع الbiopillary axis and + +340 +00:25:14,780 --> 00:25:19,400 +may simulate an isotropicكيف انا اتذكر هذا في + +341 +00:25:19,400 --> 00:25:22,980 +الامتحان بدون ما ارجع للشريح positive across + +342 +00:25:23,930 --> 00:25:27,990 +positive إشارة cross و هنا في عندي X ال positive + +343 +00:25:27,990 --> 00:25:32,430 +مع ال X بتاعة ال Exotopia إذا ال positive إجزو يظل + +344 +00:25:32,430 --> 00:25:36,370 +ال negative إيزو طبعا simulation مش أكيد يعني + +345 +00:25:36,370 --> 00:25:40,110 +بمعنى إنه هذا حوال كاذب هذا حوال كاذب هاي عندي أنا + +346 +00:25:40,110 --> 00:25:45,090 +مريض عنده left positive angle كبر left positive + +347 +00:25:45,090 --> 00:25:48,750 +angle كبر المريض اللي عنده left positive angle كبر + +348 +00:25:48,750 --> 00:25:53,490 +هنتخيل إنه عندهexotropia زي ما هي هنا كأنها + +349 +00:25:53,490 --> 00:25:57,530 +exotropia كيف أعرف إنها exotropia ولا مش exotropia + +350 +00:25:57,530 --> 00:26:01,290 +ولا positive angle كبّا بغطي العين التانية إذا + +351 +00:26:01,290 --> 00:26:05,370 +العين اتحركت من هذا ال position وعدلت معناته هذه + +352 +00:26:05,370 --> 00:26:09,410 +exotropia إذا ضلت زي ما هي معناته هذه positive + +353 +00:26:09,410 --> 00:26:14,870 +angle كبّاأو بعض الأشياء التانية اللي مش في المجال + +354 +00:26:14,870 --> 00:26:18,210 +اللي احنا نحكي عليها الآن و اللي ممكن تبين مع ال + +355 +00:26:18,210 --> 00:26:21,730 +fundus examination المهم في حالة ال positive angle + +356 +00:26:21,730 --> 00:26:26,410 +كبّا انا رديت العين اليمين زي ما هو واضح هناضال + +357 +00:26:26,410 --> 00:26:29,310 +المريض يتطلع بنفس الشكل اللي كان عليه و هو مفتة + +358 +00:26:29,310 --> 00:26:33,290 +عينيه تنتين إذا هو طبيعة عينه هيك لأن هيك الفوفيا + +359 +00:26:33,290 --> 00:26:36,670 +بتكون ع جبال ال target هيك الفوفيا بتكون ع جبال ال + +360 +00:26:36,670 --> 00:26:40,050 +target شايفين ال coneal light reflex داخل لجوه + +361 +00:26:40,050 --> 00:26:45,010 +معناته العين طالع لبرا بس هذا positive angle كبه و + +362 +00:26:45,010 --> 00:26:48,670 +ليس squint حقيقي بدليل إنه لما غطيت عملت cover ل + +363 +00:26:48,670 --> 00:26:52,870 +right eye و left eye ما اتحركت ما عدلت إذا هذه مش + +364 +00:26:52,870 --> 00:26:56,580 +exo لو إنها exo المفروض إنها تعدلللـ straight head + +365 +00:26:56,580 --> 00:26:59,580 +position هذا بالنسبة لهذا الوضع اللي احنا شايفينه + +366 +00:26:59,580 --> 00:27:02,980 +هو ال straight هو ال straight بالنسبة لهذه العين + +367 +00:27:02,980 --> 00:27:09,510 +اذا هذا بالنسبة ل angle كبّة نيجي الآنللفحص التاني + +368 +00:27:09,510 --> 00:27:15,050 +من فحصات الحوال هو Kremsky والفحص التالت لـ Prism + +369 +00:27:15,050 --> 00:27:18,790 +Reflection Test Corneal reflexes are used for the + +370 +00:27:18,790 --> 00:27:22,690 +same indication as for the Hirschberg test but + +371 +00:27:22,690 --> 00:27:25,410 +combined with the prisms to give more accurate + +372 +00:27:25,410 --> 00:27:29,170 +approximation of the angle in a manifest deviation + +373 +00:27:29,780 --> 00:27:36,340 +هذه الفحوصات .. هذه الفحوصات بتستخدم نفس فكرة ال + +374 +00:27:36,340 --> 00:27:40,060 +herzberg test light وبدأ أضوي من بعد طول الغراع أو + +375 +00:27:40,060 --> 00:27:43,860 +من بعد متر على عين .. عينيان المريض أو على وجه + +376 +00:27:43,860 --> 00:27:47,290 +المريض عشان أشوف ال corneal light reflexهيدا ان هي + +377 +00:27:47,290 --> 00:27:50,330 +بتعتمد على الـ corneal reflexes هذه الفحوصات بس + +378 +00:27:50,330 --> 00:27:53,290 +إيش بتختلف عن الهيرشبيرج test ان بتختلف انه + +379 +00:27:53,290 --> 00:27:59,270 +يضافلها .. يضافلها برزم لرفع مستوى الدقة لرفع + +380 +00:27:59,270 --> 00:28:04,450 +مستوى الدقة لانساش انه الهيرشبيرج test هو فحص مش + +381 +00:28:04,450 --> 00:28:08,940 +دقيق 100%هذه الفحوصات أكتر دقة بس برضه مابتصلش في + +382 +00:28:08,940 --> 00:28:14,440 +دقتها لقضية انها تصير مائة بالمائة ايضا في .. قبل + +383 +00:28:14,440 --> 00:28:17,180 +ما .. يعني نبدأ في هذه الفحوصات في شيء بدنا نفكر + +384 +00:28:17,180 --> 00:28:20,980 +فيه انه هرشبرج لما عمل الفحص تاعه افترض .. افترض + +385 +00:28:20,980 --> 00:28:24,780 +.. افتراض ان الـ pupillary diameter مقدره أربعة + +386 +00:28:24,780 --> 00:28:29,900 +مليم و هذا افتراض حقيقة خاطئ السبب انه بختلف ال + +387 +00:28:29,900 --> 00:28:35,680 +pupil من جيل لجيل من منطقة لمنطقة من شعب لشعبفبعض + +388 +00:28:35,680 --> 00:28:39,960 +الشعوق بتكون ال pupilary diameter واسع كتير وبعضها + +389 +00:28:39,960 --> 00:28:45,080 +بتكون ضيق كتير بعتمد أيضا على لون ال iris ال color + +390 +00:28:45,080 --> 00:28:48,840 +of the iris بعتمد على حاجات كتيرة بعض العلماء + +391 +00:28:48,840 --> 00:28:52,340 +قالوا انه one millimeter إزاحة في ال .. في ال + +392 +00:28:52,340 --> 00:28:55,880 +corneal light reflex مش خمسة عشر prism ديوبتر + +393 +00:28:55,880 --> 00:29:01,040 +وإنما اتنين وعشرين prism ديوبتر فزي في يونا روي في + +394 +00:29:01,040 --> 00:29:06,920 +.. في ..بريطانيا يعني ال .. ال .. ال professor في + +395 +00:29:06,920 --> 00:29:11,980 +Una Roy هي professor في البصريات و .. في ال + +396 +00:29:11,980 --> 00:29:16,000 +orthoptics في قياسات الحوال وما إلى ذلك فالها كتاب + +397 +00:29:16,000 --> 00:29:20,180 +بتقول انه كل one millimeter تقريبا يساوي اتنين + +398 +00:29:20,180 --> 00:29:24,540 +وعشرين prison مش خمستاشر prison طبعا كل one .. one + +399 +00:29:24,540 --> 00:29:26,960 +millimeter ازاحة في ال corneal light reflex ب .. + +400 +00:29:26,960 --> 00:29:31,400 +بأي اتجاهين كان فبالتالي من ضمن الافتراضات الخاطئة + +401 +00:29:31,400 --> 00:29:35,340 +بتاعة Hirschbergأنه افترض انه الـ pupillary + +402 +00:29:35,340 --> 00:29:41,120 +diameter هي يعني average أربعة ملي بس هي بتختلف من + +403 +00:29:41,120 --> 00:29:46,340 +شخص إلى شخص الأن بالنسبة لـ Kremsky test و ال + +404 +00:29:46,340 --> 00:29:49,780 +prism reflection test مذكورين مع بعضهم بس في فرق + +405 +00:29:49,780 --> 00:29:54,520 +بينهم هنوضحه الآن بال simulation بنقول كالقادي + +406 +00:29:54,520 --> 00:29:56,720 +إنسان عنده مثلا + +407 +00:30:03,570 --> 00:30:09,070 +exotropia exotropia خمسة و تلاتين prism واضح ان + +408 +00:30:09,070 --> 00:30:13,070 +هذا بالهيرشبرج test في عندي exotropia right + +409 +00:30:13,070 --> 00:30:18,250 +exotropia خمسة و تلاتين prism الان انا بدى احط + +410 +00:30:18,250 --> 00:30:23,530 +prism عشان اعدل ال exotropia في ال crimsky test ال + +411 +00:30:23,530 --> 00:30:28,780 +prism بدى حط قدام امام امامالـ straight eyes في + +412 +00:30:28,780 --> 00:30:32,280 +الكريمسكي بده ينحط أمام الـ straight eyes في ال + +413 +00:30:32,280 --> 00:30:35,700 +Prism Reflection Test أمام الـ deviating eye طبعا + +414 +00:30:35,700 --> 00:30:41,240 +في ال Exo .. ال Exo حول اتجاهه للخارج بيعالج ب + +415 +00:30:41,240 --> 00:30:46,280 +Prism اتجاهه أيضا للخارج ال apex بتاعته للخارج + +416 +00:30:46,280 --> 00:30:52,940 +معناته ال base ده تكون Nنشوف كيف لما بنحط هاي عندى + +417 +00:30:52,940 --> 00:30:56,540 +prism مقداره خمسة prism ضيوبة خمسة prism ضيوبة + +418 +00:30:56,540 --> 00:31:00,400 +هحطه أمام ال fixating eye بدى يعدل نشوف مرة تانية + +419 +00:31:00,400 --> 00:31:04,740 +بدى يعدل الحوالي ليش بدى يعدل الحوالي؟ إيش السر؟ + +420 +00:31:04,740 --> 00:31:09,220 +طبعا لما بحط أمام ال fixating eye الصورة بالنسبة + +421 +00:31:09,220 --> 00:31:12,800 +لل left eye هتنتقل باتجاه ال apex فهيتبعها .. + +422 +00:31:12,800 --> 00:31:15,700 +هتتبعها ال left eye هتروح باتجاه ال apex بمقدار + +423 +00:31:15,700 --> 00:31:19,280 +خمسة prism حسب hearing level هاي هتتحرك لجوه شوية + +424 +00:31:19,700 --> 00:31:24,240 +لو كترنا هذه بدأت تحرك حسب hearing law طبعا هنا مش + +425 +00:31:24,240 --> 00:31:27,840 +مرسومة انها بتتحرك بس هي المفروض انها تتحرك حسب + +426 +00:31:27,840 --> 00:31:32,120 +hearing حسب اتجاه الصورة لل apex وهذه حسب hearing + +427 +00:31:32,120 --> 00:31:36,460 +law طيب زودنا قيمة ال prison بدأ يعدل اكتر زودنا + +428 +00:31:36,460 --> 00:31:39,240 +قيمة ال prison بدأ ال corneal light reflex يعدل + +429 +00:31:39,240 --> 00:31:45,610 +بدأ يعدل اكتر بدأ يعدل اكترصار بالسنتة قيمة البرزم + +430 +00:31:45,610 --> 00:31:50,550 +35 اللي هي تكافئ قيمة الحوال اذا بقول buy kremski + +431 +00:31:50,550 --> 00:31:56,030 +test write exotropia write exotropia buy kremski + +432 +00:31:56,030 --> 00:32:04,490 +test 35 برزم دا يمكن نشوف مثلا مثال تاني استعمل + +433 +00:32:04,490 --> 00:32:09,290 +فيه البرزم طيب + +434 +00:32:09,290 --> 00:32:17,000 +بنقول كالاتي هي عندي مثلاالعين الشمال فيها إيزو + +435 +00:32:17,000 --> 00:32:23,980 +تروبيا خمسين + +436 +00:32:23,980 --> 00:32:28,080 +بريزم ديوبتر خمسين بريزم ديوبتر أول حاجة في ال + +437 +00:32:28,080 --> 00:32:31,180 +crimsky test بده أحط أمام ال fixating eye ماننساش + +438 +00:32:31,180 --> 00:32:35,620 +أنه ال crimsky test أمام ال fixating eye بده أحط + +439 +00:32:35,620 --> 00:32:40,960 +طبعا العين اللي حول اتجاهه للداخل إذا بده أستعمل + +440 +00:32:40,960 --> 00:32:46,210 +based out بريزم بده نشوف كيفهذا خمسة و تلاتين بدنا + +441 +00:32:46,210 --> 00:32:50,250 +نخليه أقل عشان نمشي بالتدريج هاي استعملت عشرة + +442 +00:32:50,250 --> 00:32:55,520 +prison base out عشانهذا بدأ يعدل كورنيا ال light + +443 +00:32:55,520 --> 00:32:59,020 +reflex الآن بدأ ازود قيمة ال Prism طبعا ليش بدأ + +444 +00:32:59,020 --> 00:33:02,400 +يعدل؟ هذه العين الصورة بالنسبة إليها ال light + +445 +00:33:02,400 --> 00:33:05,480 +reflex ال light اللي أنا حامله ال light reflex + +446 +00:33:05,480 --> 00:33:09,080 +هيتجه باتجاه ال apex دائما الصورة بنشوفها باتجاه + +447 +00:33:09,080 --> 00:33:13,700 +ال apex و الأشعة بتنحرف باتجاه ال base طيب بدأ + +448 +00:33:13,700 --> 00:33:20,220 +ازود قيمة ال Prism بدأ يعدل أكتر زودنا أكتر زودنا + +449 +00:33:20,220 --> 00:33:26,540 +أكتر زودنا أكترزودنا اكتر الان لما وصلنا ل برزم + +450 +00:33:26,540 --> 00:33:30,380 +قوته خمسين برزم اصبح ال corneal light reflex في ال + +451 +00:33:30,380 --> 00:33:35,780 +deviating eye في النص فبالتالي قيمة الحوال بقول + +452 +00:33:35,780 --> 00:33:40,040 +left esotropia نقول لأ هنا right لأ احنا حطينا + +453 +00:33:40,040 --> 00:33:43,500 +امام العين السليمة لبرزم هيك لكريمسكي لكريمسكي ان + +454 +00:33:43,500 --> 00:33:49,160 +انا بحط برزموببدأ أزوده أمام العين السليمة لغاية + +455 +00:33:49,160 --> 00:33:52,680 +ما يعدل الـ corneal light reflex في العين اللي + +456 +00:33:52,680 --> 00:33:56,860 +فيها الحوار في العين اللي فيها الحوار فبالتالي هذه + +457 +00:33:56,860 --> 00:34:12,160 +القضية بدها تكون واضحة ناخد مثال تالت نقول + +458 +00:34:12,160 --> 00:34:12,380 +أن + +459 +00:34:19,710 --> 00:34:25,150 +lift hybrid lift hybrid مقدارها تلاتين iparism + +460 +00:34:25,150 --> 00:34:29,850 +lift hybrid مقدارها تلاتين iparism طيب، الآن بدنا + +461 +00:34:29,850 --> 00:34:33,890 +نستعمل vertical iparism vertical iparism الآن في + +462 +00:34:33,890 --> 00:34:39,050 +الحول في ال vertical squint ضروري أنتبه لشغله، + +463 +00:34:39,050 --> 00:34:46,530 +ضروري أنتبه لشغله هنا العين طال على فوقعشان + +464 +00:34:46,530 --> 00:34:51,470 +انازلها لتحت لازم هذه تنزل لتحت عشان انازلها لتحت + +465 +00:34:51,470 --> 00:34:56,690 +العين السليمة لازم تنزل لتحت عشان هذه تنزل حسب + +466 +00:34:56,690 --> 00:35:00,190 +hearing loss هذه نزلت هذه هتنزل طيب كيف بده انازل + +467 +00:35:00,190 --> 00:35:04,830 +هذه لتحت؟ بده اخلي صورة ال light reflex لتحت يعني + +468 +00:35:04,830 --> 00:35:07,310 +ال apex بتاعت ال prism لتحت فبالتالي انا بده + +469 +00:35:07,310 --> 00:35:14,840 +استعمل base of prism يعني عكسأحنا قلنا في ال + +470 +00:35:14,840 --> 00:35:18,380 +horizontal point وين اتجاه الحوال بحط طب هنا اتجاه + +471 +00:35:18,380 --> 00:35:21,780 +الحوال أعلى بس انا هحط ال apex بتاعة ال prism + +472 +00:35:21,780 --> 00:35:26,740 +لأسفل يعني هو المفروض هنا احط base down في ال + +473 +00:35:26,740 --> 00:35:29,960 +prism بس هنا هحط انا base up ليش؟ عشان العين + +474 +00:35:29,960 --> 00:35:33,880 +هيتنزل فبالتالي هادي تنزل حسب hearing low ويتعدى + +475 +00:35:33,880 --> 00:35:36,540 +لل corneal light reflex نشوف كيف بده يصير هذا + +476 +00:35:36,540 --> 00:35:40,620 +الكلام طبعا دائما و أبدا كريمسكي test بحط أمام + +477 +00:35:40,620 --> 00:35:43,930 +العين السليم نشوف كيفبدأ ينزل الـ corneal light + +478 +00:35:43,930 --> 00:35:48,870 +reflex زودنا بدأ ينزل أكتر .. زودنا بدأ ينزل أكتر + +479 +00:35:48,870 --> 00:35:53,610 +.. أكتر .. أكتر .. أكتر .. أكتر .. أكتر .. أكتر .. + +480 +00:35:53,610 --> 00:35:55,310 +أكتر .. أكتر .. أكتر .. أكتر .. أكتر .. أكتر .. + +481 +00:35:55,310 --> 00:35:55,470 +أكتر .. أكتر .. أكتر .. أكتر .. أكتر .. أكتر .. + +482 +00:35:55,470 --> 00:35:55,490 +أكتر .. أكتر .. أكتر .. أكتر .. أكتر .. أكتر .. + +483 +00:35:55,490 --> 00:35:55,490 +أكتر .. أكتر .. أكتر .. أكتر .. أكتر .. أكتر .. + +484 +00:35:55,490 --> 00:35:59,670 +أكتر .. أكتر .. أكتر .. أكتر .. أكتر + +485 +00:35:59,670 --> 00:36:03,910 +.. أكتر .. + +486 +00:36:03,910 --> 00:36:06,170 +أكت + +487 +00:36:17,730 --> 00:36:21,690 +هي 40 Prism Right Hypo بدنا بال .. بال .. Kremski + +488 +00:36:21,690 --> 00:36:25,410 +Test طبعا + +489 +00:36:25,410 --> 00:36:29,210 +بدي أرفع العين هاي اللي هي Hypo جاية عشان يصير + +490 +00:36:29,210 --> 00:36:34,450 +Central Corneal Light Reflex بدي أستخدم انا Prism + +491 +00:36:34,450 --> 00:36:38,030 +آخر أمام العين الشمال لازم أرفع العين الشمال عشان + +492 +00:36:38,030 --> 00:36:42,500 +العين اليمين ترتفع حسب hearing loadالان بدأ اتصلح + +493 +00:36:42,500 --> 00:36:45,200 +و اضع كورنيا light reflex بضل ازود في قيمة ال + +494 +00:36:45,200 --> 00:36:48,820 +Prism امام العين السليمة لغاية ما يصير عندي ال + +495 +00:36:48,820 --> 00:36:53,160 +central كورنيا light reflex اربعين Prism لانه عنده + +496 +00:36:53,160 --> 00:36:57,620 +ال hypo اربعين Prism بقول write hypotropia اربعين + +497 +00:36:57,620 --> 00:37:02,640 +Prism by Kremskyby kremsky test أخر شئ لبريزم + +498 +00:37:02,640 --> 00:37:06,540 +reflection test لبريزم reflection test لا يختلف + +499 +00:37:06,540 --> 00:37:11,360 +أبدا عن لكريمسكي test هو عبارة عن هرشبرج مضاف إليه + +500 +00:37:11,360 --> 00:37:15,780 +بريزم بس المرة هذه في لبريزم reflection test سمينا + +501 +00:37:15,780 --> 00:37:21,120 +بريزم reflection test عشان أنا بحط ال لبريزم أمام + +502 +00:37:21,120 --> 00:37:25,610 +ال deviating eye لأن عندي rightهيبوتروبيا بدأ + +503 +00:37:25,610 --> 00:37:29,590 +استعمل ال Prism أمام الهيبوتروبيك I بدنا نقول + +504 +00:37:29,590 --> 00:37:34,270 +كالآيات خلّين أول إش نخلي قيمته قليلة هاي خمسة + +505 +00:37:34,270 --> 00:37:39,370 +بدنا نشوف كيف بده يعدل عنده بده يعدل بده أزود بده + +506 +00:37:39,370 --> 00:37:42,130 +يعدل بده يعدل بده يعدل + +507 +00:37:45,650 --> 00:37:48,610 +طبعا هنا بدنا ننطبه لنقطة عشان احنا نفرج بين + +508 +00:37:48,610 --> 00:37:53,270 +الحياة العملية وال simulation هنا .. هنا طبعا انه + +509 +00:37:53,270 --> 00:37:58,280 +يعدي لإن ان انت تتحرك لفوق خطأهو لما انا ب .. احط + +510 +00:37:58,280 --> 00:38:01,800 +لبريزم ال .. ال cornial light reflex بنزل زي ما ال + +511 +00:38:01,800 --> 00:38:04,920 +pupil نازل هنا ال cornial light reflex جاي فوق ال + +512 +00:38:04,920 --> 00:38:08,260 +pupil لما انا بحط هنا .. طبعا هنا بال simulation + +513 +00:38:08,260 --> 00:38:11,360 +ان العين طلعت لأ بالعكس العين هتضلها متجهة باتجاه + +514 +00:38:11,360 --> 00:38:14,660 +ال apex لأنه دائما الصورة بتاعة لبريزم صورة ال + +515 +00:38:14,660 --> 00:38:17,500 +light اللي انا ماسمها هتكون باتجاه ال apex فهذا + +516 +00:38:17,500 --> 00:38:20,840 +خطأ في ال simulation نفسه هو ال cornial light + +517 +00:38:20,840 --> 00:38:23,960 +reflex بنزل .. بنزل .. بنزل لما يصير centralهذه + +518 +00:38:23,960 --> 00:38:28,200 +العين بيبقى عالية المهم هيك انا عندى عدل كورنيا + +519 +00:38:28,200 --> 00:38:31,620 +light reflex فهذا ساعتها بسميه برزم reflection + +520 +00:38:31,620 --> 00:38:35,580 +test برزم reflection test لو انا حطيت البرزم هنا + +521 +00:38:35,580 --> 00:38:40,020 +بوضعية معينة و عدلت هتسميه kremsky test الان نيجي + +522 +00:38:40,020 --> 00:38:47,860 +مثال اخر نقول ايزوتروبيا مثلا خمسة + +523 +00:38:47,860 --> 00:38:50,120 +و ستين برزم بحط + +524 +00:38:54,270 --> 00:38:59,610 +Base Out Prism و ببدأ اش برضه نفس القضية هنا بيبين + +525 +00:38:59,610 --> 00:39:02,530 +لي ان العين هي اللي بتعدل هي لأ هو ال Cornial + +526 +00:39:02,530 --> 00:39:05,910 +Light Reflex بتدخل لغاية ما يسير ع جبال ال Pupil + +527 +00:39:05,910 --> 00:39:11,110 +نشوف كيف بنزود قيمة ال Prism لغاية ما يصير Center + +528 +00:39:11,110 --> 00:39:15,390 +فبالتالي هاي عندي خمسة و ستين Prism Right + +529 +00:39:15,390 --> 00:39:22,270 +Esotropia Right Esotropia نشوف هنا اخر + +530 +00:39:22,270 --> 00:39:22,810 +مثال + +531 +00:39:26,090 --> 00:39:30,930 +مثلا اربعين بريزم اكزو تروبيا اربعين بريزم اكزو + +532 +00:39:30,930 --> 00:39:34,770 +تروبيا نشوف كيف بدنا نصلحها بواسطة ال بريزم + +533 +00:39:34,770 --> 00:39:38,110 +reflection test فال بريزم reflection test بيفرج عن + +534 +00:39:38,110 --> 00:39:40,790 +ال cream scheme انه انا بحط امام ال deviating eye + +535 +00:39:40,790 --> 00:39:45,830 +ايضا مش العين هي اللي بتعد ال reflex بروح باتجاه + +536 +00:39:45,830 --> 00:39:49,350 +ال apex بس هنا هذا خطأ فيه ال simulation خطأ فيه + +537 +00:39:49,680 --> 00:39:53,360 +السيموليشن بتضلنا نزود لغاية ما يصير عندي central + +538 +00:39:53,360 --> 00:39:58,400 +corneal light reflex بقول انا حكى انه left + +539 +00:39:58,400 --> 00:40:02,740 +exotropia by prism reflection test تساوي اربعين + +540 +00:40:02,740 --> 00:40:08,580 +ابرزمهذا يكون أكتر دقة ال crimsky test و ال prism + +541 +00:40:08,580 --> 00:40:12,340 +reflection test أكتر شوية دقة من ال hersberg test + +542 +00:40:12,340 --> 00:40:15,520 +بس في عندي أيضا نفس المشاكل اللي بتواجه ال + +543 +00:40:15,520 --> 00:40:22,600 +hersberg test ممكن تواجه ال .. اللي هي ..اللي + +544 +00:40:22,600 --> 00:40:26,380 +كريمسكي واللي بريزم ريفليكشن زي أسباب ال pseudo + +545 +00:40:26,380 --> 00:40:31,480 +squint هذه ما بتغلبوش عليها بالنسبة لهذه الوضع + +546 +00:40:31,480 --> 00:40:37,840 +بمعنى أخر أنه في نقطة .. في نقطة أنه مثلا هالجيت + +547 +00:40:37,840 --> 00:40:44,060 +أنا حطيت هاي أصبحأصبح عندي central .. central .. + +548 +00:40:44,060 --> 00:40:47,380 +طيب ماشي ما أدراني أن طبيعة العين هذه لازم يكون + +549 +00:40:47,380 --> 00:40:50,560 +central .. ما أدراني أن طبيعة العين هذه لازم يكون + +550 +00:40:50,560 --> 00:40:56,180 +central .. يعني ممكن أنا يكون عنديالوضعية الطبيعية + +551 +00:40:56,180 --> 00:40:59,580 +لأنها عندها positive angle كبّا بالإضافة لل-squint + +552 +00:40:59,580 --> 00:41:04,820 +يعني ممكن سبب من أسباب الـ pseudosquint يكون موجود + +553 +00:41:04,820 --> 00:41:08,680 +وفي نفس الوقت يكون فيه squint وفي نفس الوقت يكون + +554 +00:41:08,680 --> 00:41:13,290 +فيه squint يعني هنا مثلاهذا الطفل عنده left + +555 +00:41:13,290 --> 00:41:16,870 +esotropia by hershberg test واضح جدا تقريبا تلاتين + +556 +00:41:16,870 --> 00:41:20,270 +prism وفي نفس الوقت عنده pseudosquint ناتج عن + +557 +00:41:20,270 --> 00:41:23,690 +الابيكانتك fold يعني أنا صحيح بده أطلع ال light و + +558 +00:41:23,690 --> 00:41:27,470 +بديش أطلع ال white هو عنده حشتين عنده pseudosquint + +559 +00:41:27,470 --> 00:41:32,980 +بسبب الابيكانتك foldsهو في نفس الوقت عنده squint + +560 +00:41:32,980 --> 00:41:35,460 +يعني مش معناته أنه أول ما أشوف ال ابي can take + +561 +00:41:35,460 --> 00:41:39,020 +fold أقول لأهل المريض أو لأهل الطفل أنه ابنكم عنده + +562 +00:41:39,020 --> 00:41:41,760 +حوال كاذب طبعا ممكن يكون عنده حوال كاذب في نفس + +563 +00:41:41,760 --> 00:41:46,340 +الوقت عنده حوال حقيقي فضلوري أطلع ال light reflex + +564 +00:41:46,340 --> 00:41:48,940 +أيضا هنا لما بنقول احنا عدلنا + +565 +00:41:51,440 --> 00:41:54,380 +هك عدّى، طب ممكن يكون هذه العين فيها positive أو + +566 +00:41:54,380 --> 00:41:57,260 +negative angle كبرة، يعني المفروض أن ال reflex + +567 +00:41:57,260 --> 00:42:00,820 +يكون زي هيك، عشان اعتبره طبيعي، مثلا فبالتالي هذه + +568 +00:42:00,820 --> 00:42:04,440 +القضايا مابتغلبش عليها لا ال Prism Reflection Test + +569 +00:42:04,440 --> 00:42:08,540 +ولا الكريمسكي test طيب، الآن بدنا .. آخر نقطة في + +570 +00:42:08,540 --> 00:42:12,660 +المحاضرة، أيه ماء ده؟ ال Prism Reflection Test ولا + +571 +00:42:12,660 --> 00:42:15,380 +الكريمسكي test ولا الكريمسكي test؟ + +572 +00:42:19,990 --> 00:42:24,670 +أيه ما أضأ لبريزم reflection test ولا لكريمسكي + +573 +00:42:24,670 --> 00:42:29,410 +test حقيقة بيقولوا لكريمسكي test أفضل من لبريزم + +574 +00:42:29,410 --> 00:42:32,730 +reflection لأن أنا بحط أمام العين السليمة لبريزم و + +575 +00:42:32,730 --> 00:42:35,490 +العين اللي فيها الحوار اللي بتطلع عليها مباشرة مش + +576 +00:42:35,490 --> 00:42:39,790 +من خلال لبريزم هنا لو بدأ أستعمل لبريزم reflection + +577 +00:42:39,790 --> 00:42:46,550 +test أنا مضطر بدي أشوفالعين و كيف عدّل ال reflex + +578 +00:42:46,550 --> 00:42:49,230 +فيها من خلال ال prism، لو انا حط ال prism أمام + +579 +00:42:49,230 --> 00:42:54,810 +العين فهذا ممكن يصير فيه يعني parallax في .. في .. + +580 +00:43:02,210 --> 00:43:06,870 +البرزم رفليكشن تاست تتعلق على وضع برزم أمام العين + +581 +00:43:06,870 --> 00:43:11,230 +المتحركة حتى تتعلق كورنيا الليت رفليكشن ر متساومة + +582 +00:43:11,230 --> 00:43:16,090 +ر متساومة بينما الكريمسكي تاست تتعلق على وضع برزم + +583 +00:43:16,090 --> 00:43:20,490 +أمام العين المتحركةuntil corneal light reflections + +584 +00:43:20,490 --> 00:43:25,590 +are symmetrical هذا ال test لكريمسكي بيخفف ال + +585 +00:43:25,590 --> 00:43:29,850 +problem of parallax يعني الحركة الظاهرية بتاعة ال + +586 +00:43:29,850 --> 00:43:32,890 +pupil من و خلال ال prism and is more commonly used + +587 +00:43:32,890 --> 00:43:37,010 +than prism reflection testإذا لو جينا إحنا نقيم + +588 +00:43:37,010 --> 00:43:40,450 +التلاتة من ناحية الأفضلية الـKremski أفضل من + +589 +00:43:40,450 --> 00:43:43,190 +الـPrism Reflection Test و الـPrism Reflection + +590 +00:43:43,190 --> 00:43:46,850 +Test أفضل من الـHershberg Test فهيكا ترتيبهم + +591 +00:43:46,850 --> 00:43:50,570 +الـKremski أفضلهم أقل منه الـPrism Reflection أقل + +592 +00:43:50,570 --> 00:43:53,990 +منه الـHershberg Test بس التلاتة ما بيصلوا لدقة + +593 +00:43:53,990 --> 00:43:58,410 +100% هنتوقف عند هذه النقطة و المرة القادمة هناخد + +594 +00:43:58,410 --> 00:44:01,030 +الفحوصات الدقيقة للحوالي اللي هي الـCover Test + +595 +00:44:01,030 --> 00:44:04,770 +ويعطيكم العافية والسلام عليكم ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/v6c8RPLn33E_raw.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/v6c8RPLn33E_raw.srt new file mode 100644 index 0000000000000000000000000000000000000000..c9bb058d9291e9c8376ea554ab35ba641ce2db7d --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/v6c8RPLn33E_raw.srt @@ -0,0 +1,124 @@ +1 +00:00:02,300 --> 00:00:06,620 +Primary Action Elevation وSecondary Action + +2 +00:00:06,620 --> 00:00:10,520 +Intortion الان ال tertiary action هاي ال Intortion + +3 +00:00:10,520 --> 00:00:16,000 +بده اول جه مرة تالتة Intortion طبعا واضح جدا ان ال + +4 +00:00:16,000 --> 00:00:19,300 +Superior Limbus بتحرك باتجاه النوت الان ال + +5 +00:00:19,300 --> 00:00:23,060 +tertiary action عشان نفهمه بنقول اي عضلة في جسمنا + +6 +00:00:23,060 --> 00:00:26,080 +بما فيها عضلات العين لما يصير فيها contraction + +7 +00:00:26,080 --> 00:00:30,350 +ابتقصربتقصر طب احنا بنعرف ان العضلة منتدة بين + +8 +00:00:30,350 --> 00:00:34,910 +المبدأ تاعها او ال origin و بين المنتهى تاعها اللي + +9 +00:00:34,910 --> 00:00:38,970 +هو ال insertion طيب مين بنشد باتجاه مين هل ال + +10 +00:00:38,970 --> 00:00:42,810 +insertion باتجاه ال origin ولا ال origin باتجاه ال + +11 +00:00:42,810 --> 00:00:47,190 +insertion طبعا لازم حد فيهم ينشد باتجاه الآخر لأن + +12 +00:00:47,190 --> 00:00:51,650 +العضلة قصرت وتداخلت الألياف العضلية مع بعضها البعض + +13 +00:00:51,650 --> 00:00:55,070 +فبالتالي احنا بنقول ال insertion دائما هو اللي + +14 +00:00:55,070 --> 00:00:59,390 +بنشد او بيجرب منالـ origin لأن الـ origin ثابت + +15 +00:00:59,390 --> 00:01:02,670 +ومثبت في العظم الـ annulus of zinc عبارة عن + +16 +00:01:02,670 --> 00:01:06,170 +fiberous tissue adherent to the bone يعني ملتصق + +17 +00:01:06,170 --> 00:01:09,230 +بالعظم ولا يمكن انه يتحرك من مكانه اللي هيتحرك + +18 +00:01:09,230 --> 00:01:12,630 +ويشد معاه العين هو ال insertion طب إذا ملاحظين + +19 +00:01:12,630 --> 00:01:16,550 +احنا حسب التصوير ان ال origin جاي medial او nasal + +20 +00:01:16,550 --> 00:01:20,170 +مقارنة مع ال insertion فبالتالي لما بتقصر العضلة + +21 +00:01:20,170 --> 00:01:23,930 +بتشد العين كلها بتشد العين كلها غير قضية ال + +22 +00:01:23,930 --> 00:01:26,470 +insertion وهذا مش ال insertion اللي انا بحكي عليه + +23 +00:01:26,570 --> 00:01:28,690 +الـ Intortion حكينا عنه اللي هو الـ secondary + +24 +00:01:28,690 --> 00:01:33,490 +action بينما لما بتقصر العضلة بتتحرك كل العين طبعا + +25 +00:01:33,490 --> 00:01:37,530 +حركة بسيطة جدا لا تكتسكر زي ما أنا برجي باتجاه ال + +26 +00:01:37,530 --> 00:01:41,510 +adduction بصفي عندي ال superior rectus muscle اللي + +27 +00:01:41,510 --> 00:01:45,350 +بتعمل elevation زي ما أنا هعمل ال simulation هنا و + +28 +00:01:45,350 --> 00:01:50,730 +Intortion و Adduction elevation و Intortion و + +29 +00:01:50,730 --> 00:01:54,580 +Adductionفبالتالي هذه القضية جدا مفروض احنا نكون + +30 +00:01:54,580 --> 00:01:59,580 +واضحين فيها ويعطيكم العافية والسلام عليكم ورحمة + +31 +00:01:59,580 --> 00:02:00,820 +الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/yPsD1s_bTI8.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/yPsD1s_bTI8.srt new file mode 100644 index 0000000000000000000000000000000000000000..106509fcf97549d51a46ffec08357067788dfd07 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/yPsD1s_bTI8.srt @@ -0,0 +1,1665 @@ +1 +00:00:02,060 --> 00:00:06,740 +بسم الله الرحمن الرحيم بنستكمل محاضرات حول واحد و + +2 +00:00:06,740 --> 00:00:10,180 +توقفنا عند ال sensory perceptions يعني الإحساسات + +3 +00:00:10,180 --> 00:00:13,660 +اللي بتصير عند الإنسان لما يصير عنده sudden onset + +4 +00:00:13,660 --> 00:00:17,300 +of squint لما يصير عنده أو يبدأ الحول كان عنده + +5 +00:00:17,300 --> 00:00:20,360 +binocular single vision وطبيعي وبعدين فجأة بدأ + +6 +00:00:20,360 --> 00:00:25,400 +عنده الحول ممكن تحدث إحدى الظاهراتين معه أو + +7 +00:00:25,400 --> 00:00:29,270 +الظاهراتين في نفس الوقت، إيش اللي ممكن يحدث؟ ممكن + +8 +00:00:29,270 --> 00:00:33,910 +يحدث عندي confusion أو pathological diplopia أو + +9 +00:00:33,910 --> 00:00:37,390 +الاثنين مع بعض، at the onset of squint two sensory + +10 +00:00:37,390 --> 00:00:42,290 +perceptions إحساسين arise بينشأ based on the + +11 +00:00:42,290 --> 00:00:45,090 +normal projection of the retinal areas stimulated + +12 +00:00:45,090 --> 00:00:50,510 +طبعًا ال projection هو التعبير الشخصي لرؤية شيء ما + +13 +00:00:50,510 --> 00:00:54,550 +في الفراغ واتجاهه بناءً على سقوط هذا الشيء على + +14 +00:00:54,550 --> 00:01:00,030 +مناطق متماثلة من شبكية العينين يعني مناطق لها نفس + +15 +00:01:00,030 --> 00:01:06,020 +الاتجاه طبعًا الحول هيقلب المعادلة كلها ويقلب + +16 +00:01:06,020 --> 00:01:10,500 +الطاولة رأسًا على عقب .. ليش؟ لأن النقطة سين في + +17 +00:01:10,500 --> 00:01:13,020 +العين اليمين .. في شبكية العين اليمين والنقطة سين + +18 +00:01:13,020 --> 00:01:17,120 +شرطة المثيلة بتاعتها أو المماثلة إليها في شبكية + +19 +00:01:17,120 --> 00:01:20,740 +العين اليسرى كان لهم قبل الحول نفس الاتجاه في + +20 +00:01:20,740 --> 00:01:25,000 +الفرار طبعًا بعد نشوء الحول في إحدى العينين أصبح + +21 +00:01:25,000 --> 00:01:28,820 +لسين لها اتجاه ولسين شرطة لها اتجاه الفوفيا في + +22 +00:01:28,820 --> 00:01:31,700 +العين اليمين لها اتجاه في الفراغ والفوفيا في + +23 +00:01:31,700 --> 00:01:35,280 +العين اليسرى لها اتجاه آخر بناءً على اختلاف + +24 +00:01:35,280 --> 00:01:39,300 +الاتجاهات أيضًا هيصير ال projection مختلف التعبير + +25 +00:01:39,300 --> 00:01:45,420 +الشخصي مختلف فبالتالي هذه القضية هتأدي لإحساس من + +26 +00:01:45,420 --> 00:01:48,560 +إحساسين اللي هو ال confusion أو ال pathological + +27 +00:01:48,560 --> 00:01:54,380 +diplopia أو الاثنين مع بعضهم البعض طبعًا عشان يحدث + +28 +00:01:54,380 --> 00:01:57,900 +ال confusion أو تحدث ال pathological diplopia اللي + +29 +00:01:57,900 --> 00:02:01,930 +هي الإزدواجية طبعًا ال confusion معناها خربطت الصور + +30 +00:02:01,930 --> 00:02:06,050 +في بعضها ودمج صور لا تدمج في بعضها أنه يشوفها + +31 +00:02:06,050 --> 00:02:09,390 +مع بعض في نفس ال .. وجدت في نفس المكان من الفرق ال + +32 +00:02:09,390 --> 00:02:13,050 +confusion اللي هي خربطت ال .. ال .. الصور مع بعضها + +33 +00:02:13,050 --> 00:02:16,650 +و هنشرحه بعد شوية و ال pathological diplopia اللي + +34 +00:02:16,650 --> 00:02:20,770 +هي الإزدواجية بتطلبوا عشان يصيروا لازم يكون في عين + +35 +00:02:20,770 --> 00:02:25,250 +دي حاجة اسمها simultaneous perception القدرة على + +36 +00:02:25,250 --> 00:02:28,530 +الالتقاط المتزامن بين العين الثانية يعني ما فيش عين + +37 +00:02:28,530 --> 00:02:31,930 +واقفة عن العمل أو ال brain عاملها suppression + +38 +00:02:31,930 --> 00:02:35,350 +عاملها تثبيت يعني مستقبلش منها صورة لأنه لو في + +39 +00:02:35,350 --> 00:02:38,830 +عندي suppression يعني تثبيت من قبل ال brain لصورة + +40 +00:02:38,830 --> 00:02:42,290 +من الصورتين تمام؟ فبالتالي في الصين عندي بساط في + +41 +00:02:42,290 --> 00:02:45,090 +صورة واحدة فبالتالي هذه الإحساسات .. الإحساسات + +42 +00:02:45,090 --> 00:02:49,490 +اللي هي الازدواجية أو ال confusion ما بتنشأ ليش؟ + +43 +00:02:49,490 --> 00:02:52,890 +لأن عين واحدة بتستقبل ضروري جدًا عشان المريض يشعر + +44 +00:02:52,890 --> 00:02:56,270 +بالإحساسين هدول واللي هم عبارة عن pathological + +45 +00:02:56,270 --> 00:02:59,250 +sensations يعني مش .. مش في الطبيعي أن الإنسان بيه + +46 +00:02:59,250 --> 00:03:04,590 +هذا وسببهم الحول عشان يحس فيهم الإنسان لازم يكون + +47 +00:03:04,590 --> 00:03:07,450 +في عندي simultaneous .. simultaneous visual + +48 +00:03:07,450 --> 00:03:12,760 +perception هذا يعني ضروري جدًا عشان أنه لما تسقط + +49 +00:03:12,760 --> 00:03:17,260 +صورتين والدماغ مواقع الصورتين ع الشبكيات ع مناطق + +50 +00:03:17,260 --> 00:03:20,900 +غير متماثلة فبالتالي مش قادر يدمج الصورتين في بعض + +51 +00:03:20,900 --> 00:03:24,780 +فممكن إحساسات مختلفة تصير زي ال confusion وال + +52 +00:03:24,780 --> 00:03:27,600 +pathological diplopia واللي هنشرحهم بعد شوية إذا + +53 +00:03:27,600 --> 00:03:31,460 +these sensations require simultaneous visual + +54 +00:03:31,460 --> 00:03:35,180 +perception بمعنى the ability to perceive images + +55 +00:03:35,180 --> 00:03:39,780 +from both eyes simultaneously في نفس اللحظة نيجي + +56 +00:03:39,780 --> 00:03:49,380 +نحكي عن ال confusion نحكي عن ال confusion ال + +57 +00:03:49,380 --> 00:03:54,040 +confusion is the simultaneous appreciation of two + +58 +00:03:54,040 --> 00:03:58,020 +superimposed but dissimilar images caused by + +59 +00:03:58,020 --> 00:04:01,000 +stimulation of corresponding retinal points + +60 +00:04:01,000 --> 00:04:04,520 +usually the fovea by images of different objects + +61 +00:04:04,520 --> 00:04:09,040 +إيش اللي بيحصل في ال confusion نشرحه بنقول هي عندنا + +62 +00:04:09,040 --> 00:04:13,620 +احنا ال right eye وهي عندي أنا ال left eye الفوفيا + +63 +00:04:13,620 --> 00:04:17,560 +بتاعة ال right eye موجهة حسب الخط الأسود والفوفيا + +64 +00:04:17,560 --> 00:04:20,600 +بتاعة ال left eye بسبب الحول ما لهاش نفس الاتجاه + +65 +00:04:20,600 --> 00:04:25,690 +هو معروف ان ال two fovias لهم نفس الاتجاه في + +66 +00:04:25,690 --> 00:04:29,190 +الفرار في ال .. في الوضع الطبيعي يعني .. يعني لهم + +67 +00:04:29,190 --> 00:04:31,930 +نفس الاتجاه يعني إذا كان الفوفيا اليمين متجهة + +68 +00:04:31,930 --> 00:04:35,950 +باتجاه المثلث مفروض في الطبيعي الفوفيا اليسرى أيضًا + +69 +00:04:35,950 --> 00:04:40,070 +تكون متجهة باتجاه المثلث يعني لهم نفس الاتجاه نفس + +70 +00:04:40,070 --> 00:04:44,590 +ال visual direction حقيقة هذا المريض اللي عاملينه + +71 +00:04:44,590 --> 00:04:48,410 +احنا رسمنا simulation أو .. أو نقلنا له صورة تعمل + +72 +00:04:48,410 --> 00:04:52,490 +simulation أو محاكاة الحول .. هذا عنده حول + +73 +00:04:52,490 --> 00:04:56,850 +بالعين فبالتالي أصبح اتجاه الفوفيا في الفراغ .. + +74 +00:04:56,850 --> 00:05:01,070 +اتجاه الفوفيا في الفراغ مختلف بين ال two fovias .. + +75 +00:05:01,070 --> 00:05:05,050 +between the two fovias طيب .. الآن صدف أنه في + +76 +00:05:05,050 --> 00:05:08,650 +الفراغ في عندي target اللي هو المثلث الأسود جاي في + +77 +00:05:08,650 --> 00:05:12,520 +طريق الفوفيا في ال visual direction بتاع الفوفيا + +78 +00:05:12,520 --> 00:05:16,340 +فصورة هذا ال target الأسود هتسقط على الفوفيا في + +79 +00:05:16,340 --> 00:05:20,360 +العين اليمين وصدف في نفس اللحظة أنه على جبل + +80 +00:05:20,360 --> 00:05:23,740 +الفوفيا في الفراغ طبعًا على جبل الفوفيا في target + +81 +00:05:23,740 --> 00:05:28,420 +أحمر فصورته هتسقط على الفوفيا طيب معروف أن الفوفيا + +82 +00:05:28,420 --> 00:05:31,780 +والفوفيا جبل ما يصير الحول corresponding retinal + +83 +00:05:31,780 --> 00:05:35,090 +areas يعني المعلومات اللي وصلت للفوفيا هنا + +84 +00:05:35,090 --> 00:05:38,910 +والمعلومات اللي وصلت للفوفيا هنا هيرسلوا لنفس + +85 +00:05:38,910 --> 00:05:43,210 +منطقة التحليل من الدماغ وهيدمجوا مع بعضهم البعض + +86 +00:05:43,210 --> 00:05:47,190 +فهيصف إنه الإنسان شايف المنظر اللي إحنا شايفينه + +87 +00:05:47,190 --> 00:05:50,890 +هذا مثلث ومعاه دائرة مخربطين مع بعض جايين على بعض + +88 +00:05:50,890 --> 00:05:54,950 +الصورتين هذا بيسمى ال confusion .. هذا بيسمى ال + +89 +00:05:54,950 --> 00:05:58,150 +confusion ممكن إنسان يقول طب هذا يعني إحساس يعني + +90 +00:05:58,150 --> 00:06:02,690 +بسيط أو ما فيش فيه إزعاج أو ما فيش فيه أي شيء من هذا + +91 +00:06:02,690 --> 00:06:05,790 +القبيل طبعًا هذا في ال simulation ما في إزعاج بالمرة + +92 +00:06:05,790 --> 00:06:09,950 +بس إحنا لو أجينا ناخد أمثلة عملية بنقول هاي إنسان + +93 +00:06:10,790 --> 00:06:13,410 +عنده ال .. ال .. ال .. ال right eye .. الفوفيا + +94 +00:06:13,410 --> 00:06:17,070 +بتاعة ال right eye موجهة باتجاه معين في الفراغ و + +95 +00:06:17,070 --> 00:06:19,970 +صار عنده حول بالعين اليسرى إيزوتروبيا، العين دخلت + +96 +00:06:19,970 --> 00:06:24,270 +لجوا فأصبحت مش موجهة بنفس .. بنفس الاتجاه، هذا + +97 +00:06:24,270 --> 00:06:28,900 +الخط المنقط .. هذا الخط المنقط كان المفروض أن + +98 +00:06:28,900 --> 00:06:31,700 +الفوفيا يكون اتجاهها يعني المفروض كانت العين عدلة + +99 +00:06:31,700 --> 00:06:36,460 +والفوفيا جاية هنا وبتنظر بنفس الاتجاه اللي بتنظر + +100 +00:06:36,460 --> 00:06:39,600 +فيه الفوفيا بتاعة العين اليمين بس مع وجود الحول + +101 +00:06:39,600 --> 00:06:42,740 +أصبح ال visual direction للفوفيا بتاعة ال left eye + +102 +00:06:42,740 --> 00:06:47,940 +بهذا الاتجاه الآن صدف عندي أنه مقابل الفوفيا بتاعة + +103 +00:06:47,940 --> 00:06:51,480 +ال right eye في مبنى اللي هو البيت هذا ذو الطابقين + +104 +00:06:52,350 --> 00:06:56,630 +ومقابل .. ومقابل الفوفيا في العين اليسرى صدف في + +105 +00:06:56,630 --> 00:06:58,690 +الفراغ .. طبعًا الفوفيا في العين اليسرى هي اتجاه + +106 +00:06:58,690 --> 00:07:03,530 +آخر .. صدف شجرة، هاي المنظر اللي بيشوفه المريض، + +107 +00:07:03,530 --> 00:07:08,130 +الشجرة مختلطة .. مختلطة، مش جاية أمام البيت، مش + +108 +00:07:08,130 --> 00:07:10,610 +جاية أمام البيت، لأنها لو جاية أمام البيت، المفروض + +109 +00:07:10,610 --> 00:07:15,760 +إحنا ما نشوفش الشباك هذا لو جاية أمام البيت، يعني + +110 +00:07:15,760 --> 00:07:19,980 +الشباك هذا يعني .. يعني كأنه متداخل مع ورق الشجرة + +111 +00:07:19,980 --> 00:07:23,720 +وهذه يعني شغلة بتبين قد إيش الإنسان ممكن ينزعج من + +112 +00:07:23,720 --> 00:07:27,820 +موضوع ال confusion منظر آخر، هذا الإنسان عنده + +113 +00:07:27,820 --> 00:07:34,580 +الحاجتين عنده confusion وعنده diplopia عنده + +114 +00:07:34,580 --> 00:07:37,740 +confusion وعنده diplopia طبعًا، عندنا الفوفيا تحت + +115 +00:07:37,740 --> 00:07:43,260 +العين اليمين موجهة باتجاه الشجرة موجهة باتجاه + +116 +00:07:43,260 --> 00:07:46,900 +الشجرة طبعًا ال isotropy عنده في العين اليمين عنده + +117 +00:07:46,900 --> 00:07:50,520 +العين اليمين داخلة بزيادة عن اللزوم العين اليسرى + +118 +00:07:50,520 --> 00:07:56,420 +تتطلع على البيت هذا البيت بيسقط على الفوفيا وفي + +119 +00:07:56,420 --> 00:08:00,600 +عندي مقابل العين اليمين .. مقابل الفوفيا بتاعة + +120 +00:08:00,600 --> 00:08:05,040 +العين اليمين في شجرة فحيصير عندي مشكلة ال confusion + +121 +00:08:05,040 --> 00:08:08,560 +يعني برضه نفس الشيء إذا ملاحظين أنه إحنا شايفين + +122 +00:08:08,560 --> 00:08:14,180 +الشباك مختلط مع هذا أو حتى أكثر من شباك الشباكين + +123 +00:08:14,180 --> 00:08:18,300 +تمام اندماج صور وهذه الألوان هذه ألوان البيت وهذه + +124 +00:08:18,300 --> 00:08:22,220 +الألوان السوداء والغامجة ألوان الشجرة فبالتالي هذه + +125 +00:08:22,220 --> 00:08:25,460 +خربطة الأشياء مع بعضها البعض هذا يتسمى confusion + +126 +00:08:25,460 --> 00:08:30,390 +الموضوع ما .. ما وقف عند هذه الحد صورة البيت هنا .. + +127 +00:08:30,390 --> 00:08:35,950 +صورة البيت هنا بتسقط على الفوفيا وأيضًا بتسقط على + +128 +00:08:35,950 --> 00:08:38,970 +منطقة خارج الفوفيا، إحنا بنحكي عن البيت لحاله، + +129 +00:08:38,970 --> 00:08:43,310 +منطقة على الفوفيا في العين اليسرى وعلى non-fovial + +130 +00:08:43,310 --> 00:08:46,110 +area في العين اليمين، على nasal retina، على nasal + +131 +00:08:46,110 --> 00:08:49,050 +retina، طبعًا ال nasal retina هنا والفوفيا مش + +132 +00:08:49,050 --> 00:08:53,060 +corresponding retinal areas فبالتالي هيرسله لمناطق + +133 +00:08:53,060 --> 00:08:56,880 +مختلفة من الدماغ وهيصير البيت عندي أنا بيتين يعني + +134 +00:08:56,880 --> 00:09:00,560 +عندي ازدواجية البيت صار بيتين وعندي confusion + +135 +00:09:00,560 --> 00:09:06,600 +اللي هو تخربطت صورة البيت مع صورة الشجرة فبالتالي + +136 +00:09:06,600 --> 00:09:11,080 +هذا ال .. الخيال بتاع البيت مصنوع بصورة أقل وضوحًا .. + +137 +00:09:11,080 --> 00:09:15,100 +أقل يعني غامج أقل يعني ال .. ال .. الصورة الأصلية + +138 +00:09:15,100 --> 00:09:20,440 +اللي هي خربطة مع الشجرة أكثر يعني contrast من + +139 +00:09:20,440 --> 00:09:24,500 +الصورة الثانية فعنده diplopia .. عنده diplopia وفي + +140 +00:09:24,500 --> 00:09:28,440 +نفس الوقت عنده confusion الآن كيف أفرق بين ال + +141 +00:09:28,440 --> 00:09:32,140 +diplopia وال confusion ال diplopia .. ال diplopia + +142 +00:09:32,140 --> 00:09:36,440 +صورتين لنفس ال target صورتين لنفس ال target هاي + +143 +00:09:36,440 --> 00:09:39,760 +target هيله صورة اللي مخربطة من الشجرة وهي الصورة + +144 +00:09:39,760 --> 00:09:44,720 +الثانية هذه diplopia إيش سبب ال diplopia سقوط سقوط + +145 +00:09:44,720 --> 00:09:48,300 +صورة ال target على non-corresponding retinal areas + +146 +00:09:48,300 --> 00:09:51,520 +سقطت هنا على الفوفيا وسقطت هنا على ال nasal + +147 +00:09:51,520 --> 00:09:55,280 +retina اللي هي non-corresponding مع الفوفيا مش + +148 +00:09:55,280 --> 00:09:59,460 +مماثلة للفوفيا يعني سقوط صورة target واحد عندي + +149 +00:09:59,460 --> 00:10:02,440 +target واحد بس المريض بيشوفه اثنين ليش شافه اثنين + +150 +00:10:02,440 --> 00:10:07,200 +لأنه بيسقط على مناطق غير متماثلة من شبكية العينين + +151 +00:10:07,200 --> 00:10:12,000 +الآن ال confusion .. ال confusion عكس ال diplopia + +152 +00:10:12,000 --> 00:10:15,020 +عكس ال diplopia في الميكانزم أن في عندي two + +153 +00:10:15,020 --> 00:10:19,210 +targets مختلفين two targets هنا الشجرة target و + +154 +00:10:19,210 --> 00:10:23,330 +البيت target البيت سقط على الفوفيا هنا والشجرة + +155 +00:10:23,330 --> 00:10:27,070 +سقطت على الفوفيا هنا طيب طالما الفوفيا والفوفيا + +156 +00:10:27,070 --> 00:10:30,130 +بالأساس قبل ما يصير المرض قبل ما يصير الحول + +157 +00:10:30,130 --> 00:10:33,970 +corresponding retinal areas يعني مكان التحليل + +158 +00:10:33,970 --> 00:10:37,770 +عندهم في الدماغ موحد يعني بصبو معلوماتهم في نفس + +159 +00:10:37,770 --> 00:10:40,970 +المكان فساعتها هذه الفوفيا هتصب معلوماتها وهي + +160 +00:10:40,970 --> 00:10:45,030 +صورة الشجرة وهذه الفوفيا هتصب معلوماتها وهي صورة + +161 +00:10:45,030 --> 00:10:49,480 +البيت في نفس المكان والدماغ هيقوم بدمج دمج + +162 +00:10:49,480 --> 00:10:52,700 +الصورتين في صورة واحدة طبعًا صورتين غير قابلتين + +163 +00:10:52,700 --> 00:10:57,560 +للدمج صورتين مختلفتين يعني different images سقطوا + +164 +00:10:57,560 --> 00:11:00,000 +يعني عندي two targets سقطوا على corresponding + +165 +00:11:00,000 --> 00:11:05,320 +retinal areas بيعطيني confusion two targets سقطوا + +166 +00:11:05,320 --> 00:11:08,720 +على corresponding retinal areas Target الأول سقط + +167 +00:11:08,720 --> 00:11:12,880 +على الفوفيا وال target الثاني سقط على الفوفيا هاي + +168 +00:11:12,880 --> 00:11:16,500 +الشجرة سقطت على الفوفيا نتبع الضوء اللي جاي من + +169 +00:11:16,500 --> 00:11:19,800 +الشجرة سقط على الفوفيا والضوء اللي جاي من المنزل + +170 +00:11:19,800 --> 00:11:22,640 +سقط على الفوفيا طب الفوفيا والفوفيا corresponding + +171 +00:11:22,640 --> 00:11:26,040 +retinal areas إذن two targets بيسقطوا على + +172 +00:11:26,040 --> 00:11:29,380 +corresponding retinal areas هيوحدوا في target واحد + +173 +00:11:29,380 --> 00:11:32,760 +وهذا اللي بنسميه ال confusion اللي هو اللخبطة + +174 +00:11:32,760 --> 00:11:37,820 +اللخبطة اللخبط أو الخربطة لل two images مختلفات عن + +175 +00:11:37,820 --> 00:11:41,540 +بعضهم البعض ال diplopia target واحد ننسى الشجرة + +176 +00:11:41,540 --> 00:11:46,100 +تمامًا target واحد بيسقط على الفوفيا في عين وبسبب + +177 +00:11:46,100 --> 00:11:49,62 + +201 +00:13:22,130 --> 00:13:25,270 +الأحمر تسقط على الفوفيا هنا و صورة ال-target + +202 +00:13:25,270 --> 00:13:29,050 +الأحمر تسقط على الفوفيا هنا الوضع طبيعي فيش سكوينت + +203 +00:13:29,050 --> 00:13:34,020 +الفوفيا مع الـ fovea في بينهم correspondence تناسق .. + +204 +00:13:34,020 --> 00:13:37,280 +تناسق يعني لهم نفس الـ .. الـ visual direction هذه + +205 +00:13:37,280 --> 00:13:39,380 +العين طبعا هي straight ahead و العين straight + +206 +00:13:39,380 --> 00:13:44,020 +ahead يعني معتدلات الـ image النهائية الـ two .. one + +207 +00:13:44,020 --> 00:13:48,040 +image صح التقتت صورة و صورة بس تم الـ fusion و + +208 +00:13:48,040 --> 00:13:51,780 +حصلنا على واحد .. على صورة واحدة ثلاثية الأبعاد + +209 +00:13:51,780 --> 00:13:55,920 +اللي هي binocular single vision في حالة الحوال .. + +210 +00:13:55,920 --> 00:13:58,960 +هذه العين straight ahead هذه في العين .. في حالة + +211 +00:13:58,960 --> 00:14:02,860 +العين straight ahead هذه العين فيها exo فيها exotropia + +212 +00:14:02,860 --> 00:14:06,660 +فصدف .. صدف أن هذه العين تتطلع الـ target الأحمر + +213 +00:14:06,660 --> 00:14:11,020 +هيجي على الـ fovea و هنا صدف أنه لأنها exo .. لأنها + +214 +00:14:11,020 --> 00:14:14,900 +exotropia صدف أن عجبالها في الفرار المربع الأخضر هيسقط + +215 +00:14:14,900 --> 00:14:17,580 +على الـ fovea إذن المربع الأخضر هيسقط على الـ fovea + +216 +00:14:17,580 --> 00:14:20,510 +اللي فيها exotropia في العين اللي فيها إكسوتروفيا + +217 +00:14:20,510 --> 00:14:23,510 +هيسقط على الـ fovea و الـ target الأحمر هيسقط على + +218 +00:14:23,510 --> 00:14:27,130 +الـ fovea في العين الـ straight فـ fovea مع fovea هذه + +219 +00:14:27,130 --> 00:14:30,650 +استقبلت الدائرة الحمرا وهذه استقبلت المربع الأخضر + +220 +00:14:30,650 --> 00:14:35,570 +بما أنهم corresponding retinal areas إذن هيرسلوا + +221 +00:14:35,570 --> 00:14:38,730 +لنفس المنطقة من الدماغ و هيدمجهم الدماغ في صورة + +222 +00:14:38,730 --> 00:14:42,130 +واحدة وهذا المنظر اللي ممكن أو الاحتمال يشوفه + +223 +00:14:42,130 --> 00:14:45,630 +المريض اللي هو confusion لخبطة .. لخبطة اللي هو + +224 +00:14:45,630 --> 00:14:49,070 +الأمور مع بعضها البعض طبعا هذه كلمة straight ahead + +225 +00:14:49,070 --> 00:14:52,050 +هي خطأ مطبعي هنا لأ في exotropia عندي مش straight + +226 +00:14:52,050 --> 00:14:55,750 +ahead العين وإنما هذه العين هي straight ahead + +227 +00:14:55,750 --> 00:14:59,030 +فبالتالي هذا الـ confusion .. هذا الـ confusion الآن + +228 +00:14:59,030 --> 00:15:02,630 +نحكي عن الشعور الثاني اللي بيصير و اللي حكينا .. + +229 +00:15:03,920 --> 00:15:08,420 +عنه في الصور أنه بينتج عن أنه نفس الـ target .. نفس + +230 +00:15:08,420 --> 00:15:12,040 +الـ target بيسقط صورته على الـ fovea في عين وعلى non + +231 +00:15:12,040 --> 00:15:15,200 +foveal area في العين الثانية هو target واحد بس + +232 +00:15:15,200 --> 00:15:18,520 +بنشاف double زي المنزل منشاف منزلين طبعا بيكون + +233 +00:15:18,520 --> 00:15:22,200 +الصورة الثانية أقل وضوحا من الصورة الأولى ليش + +234 +00:15:22,200 --> 00:15:24,780 +سميناها pathological diplopia؟ pathological + +235 +00:15:24,780 --> 00:15:29,320 +diplopia عشان نفرجها عن الـ physiological diplopia + +236 +00:15:29,320 --> 00:15:33,500 +لكل الـ targets الموجودة خارج الـ pan-infusional + +237 +00:15:33,500 --> 00:15:37,460 +space أبعد من الـ pan-infusional space أو أقرب من + +238 +00:15:37,460 --> 00:15:39,940 +الـ pan-infusional space وهذه الـ physiological + +239 +00:15:39,940 --> 00:15:44,700 +diplopia احنا أجريناها بتجربة أننا نمسك جلمين و + +240 +00:15:44,700 --> 00:15:49,040 +واحد نمده أبعد ما يكون و واحد نجربه من وجهنا و لما + +241 +00:15:49,040 --> 00:15:52,300 +نركز بالجلم القريب هيصير الثاني double اللي هو + +242 +00:15:52,300 --> 00:15:55,920 +الجلم الأبعد double لما بنركز بالجلم الأبعد هيصير + +243 +00:15:55,920 --> 00:16:00,240 +الجلم الأقرب يعني نشعر فيه أنه مزدوج أو فيه + +244 +00:16:00,240 --> 00:16:04,180 +diplopia وقلنا هذه physiological diplopia لأنه + +245 +00:16:04,180 --> 00:16:09,470 +الجلم الأول لما بركز فيه الجلم الثاني بيكون خارج الـ + +246 +00:16:09,470 --> 00:16:12,670 +pan-infusional space إذا لازم ينشاف double ولما + +247 +00:16:12,670 --> 00:16:16,010 +بركز في الجلم الثاني الجلم الأول بنشاف double لأنه + +248 +00:16:16,010 --> 00:16:20,130 +خارج الـ pan-infusional space فبالتالي لازم ينشاف + +249 +00:16:20,130 --> 00:16:23,470 +double مابيصيرلهوش fusion وقلنا إن الغالبية + +250 +00:16:23,470 --> 00:16:25,890 +العظمى من البشر مابشعروش بالـ physiological + +251 +00:16:25,890 --> 00:16:29,270 +diplopia لأنها مصاحبة من قبل الـ brain بـ + +252 +00:16:29,270 --> 00:16:33,060 +physiological suppression تثبيتللرؤية المزدوجة + +253 +00:16:33,060 --> 00:16:35,640 +يعني الـ brain بيكون مركز في الـ target اللي هو مركز + +254 +00:16:35,640 --> 00:16:38,560 +فيه ومالوش علاقة في الـ target الـ .. أو الـ target + +255 +00:16:38,560 --> 00:16:41,240 +اللي بعيدة اللي هي برّات اللي فيها الـ panem في + +256 +00:16:41,240 --> 00:16:44,260 +genal space طبعا هذهك الـ physiological diplopia طب + +257 +00:16:44,260 --> 00:16:47,380 +إيش الـ physiological diplopia هي ازدواجية مرضية؟ + +258 +00:16:47,380 --> 00:16:50,860 +يعني ناتجة عن موجود حول، ناتجة عن موجود حول في + +259 +00:16:50,860 --> 00:16:54,580 +موضوع الـ binocular single في جنة إذا pathological + +260 +00:16:54,580 --> 00:16:58,100 +diplopia is the simultaneous appreciation الشعور + +261 +00:16:58,100 --> 00:17:02,920 +في نفس اللحظة of two images of the same object in + +262 +00:17:02,920 --> 00:17:06,880 +different positions in space and results ليش؟ ليش + +263 +00:17:06,880 --> 00:17:10,850 +بيصير؟ ليش أنا بشعر أن الشغل شايفها تنتين؟ المنزل + +264 +00:17:10,850 --> 00:17:13,510 +شايفه اتنين، الجلم شايفه اتنين، السيارة شايفها + +265 +00:17:13,510 --> 00:17:16,670 +اتنين، الشخص شايفه اتنين، الأصبع .. أصبع إيدي أنا + +266 +00:17:16,670 --> 00:17:19,970 +شايفه اتنين أو الخمس أصابع شايفهم كأنهم عشر أصابع، + +267 +00:17:19,970 --> 00:17:23,430 +ليش هذه الكلام؟ لأن أنا بشعر بالشغلة أنه في + +268 +00:17:23,430 --> 00:17:28,350 +إزدواجية في الرؤية بسبب سقوط صور هذه الأشياء على + +269 +00:17:28,350 --> 00:17:33,830 +مناطق غير متماثلة من شبكية الـ retina سقوطها على + +270 +00:17:33,830 --> 00:17:38,030 +مناطق غير متماثلة لـ brain بيرفض يعملها fusion لأن + +271 +00:17:38,030 --> 00:17:42,750 +الـ brain عنده شرط أنه تسقط الصور على مناطق متماثلة + +272 +00:17:42,750 --> 00:17:48,330 +حتى يستطيع أنه يعملها fusion .. fusion عفوا و يدمج + +273 +00:17:48,330 --> 00:17:52,870 +الصورتين في صورة واحدة إذا الـ .. الـ pathological + +274 +00:17:52,870 --> 00:17:57,750 +diplopia results from images of the same object هو + +275 +00:17:57,750 --> 00:18:01,150 +object واحد بس هدول الـ two images واحدة للعين + +276 +00:18:01,150 --> 00:18:03,830 +اليمين واحدة للعين الشمال falling on non + +277 +00:18:03,830 --> 00:18:06,910 +-corresponding retinal points falling on non + +278 +00:18:06,910 --> 00:18:12,330 +-corresponding retinal points الآن + +279 +00:18:12,330 --> 00:18:18,210 +لا يكفي .. لا يكفي أن أقول أن والله Diplopia و خلاص + +280 +00:18:18,210 --> 00:18:22,550 +يعني المريض مش من ازدواجية و فقط الازدواجية فيه + +281 +00:18:22,550 --> 00:18:26,630 +لها تجسيمات كثيرة أول تجسيمة بدنا نشوف هل هي + +282 +00:18:26,630 --> 00:18:31,410 +crossed diplopia ولا uncrossed diplopia إيش يعني + +283 +00:18:31,410 --> 00:18:34,010 +crossed diplopia ولا uncrossed diplopia وامتى + +284 +00:18:34,010 --> 00:18:37,350 +بنلاحظ هاي وامتى بنلاحظ الثانية احنا بنقول + +285 +00:18:37,350 --> 00:18:43,050 +كالعادة ننسى موضوع الشجرة الآن، نتخيل أن الشجرة مش + +286 +00:18:43,050 --> 00:18:46,630 +موجودة، هاي أنا عندي منزل أمام العين الثانية، العين + +287 +00:18:46,630 --> 00:18:50,610 +الشمال straight، العين اليمين جاية لجوا، كيف بعرف + +288 +00:18:50,610 --> 00:18:53,070 +أن العين اليمين هي exotropia؟ لأن الفوفيا جاية + +289 +00:18:53,070 --> 00:18:55,850 +لبرا، الفوفيا إذا ما قرنا أن موقع الفوفيا هي + +290 +00:18:55,850 --> 00:18:58,840 +الفوفيا اللي عليها حرف الـ F وهي الفوفيا اللي عليها + +291 +00:18:58,840 --> 00:19:02,080 +حرف الـ F هذه جاية لبرا شوية جاية temporal طالما + +292 +00:19:02,080 --> 00:19:04,960 +الفوفيا جاية temporal معناته العين جاية نزّل الـ + +293 +00:19:04,960 --> 00:19:07,900 +anterior part الكون يعني داخل إلى جوا باتجاه النزل + +294 +00:19:07,900 --> 00:19:13,940 +إذا هذه فيها exotropia exotropia طيب الآن سقط + +295 +00:19:13,940 --> 00:19:19,760 +سقطت صورة البيت على الفوفيا هنا هذه العين هتشوف الـ + +296 +00:19:19,760 --> 00:19:24,280 +target أمامها مباشرة لأن الفوفيا بتعطي شعور بالـ + +297 +00:19:24,280 --> 00:19:29,200 +straight ahead direction أو بالـ direct vision أي + +298 +00:19:29,200 --> 00:19:32,340 +صورة target .. أي صورة target بتسقط عندي على + +299 +00:19:32,340 --> 00:19:36,400 +الفوفيا أو عند أي إنسان على الفوفيا بتعطي شعور إن + +300 +00:19:36,400 --> 00:19:38,920 +هذا الـ target موجود أمامه تماما .. أمام العين + +301 +00:19:38,920 --> 00:19:43,790 +تمامًا .. طيب الآن أي شيء بيسقط على الـ nasal retina + +302 +00:19:43,790 --> 00:19:47,150 +زي الصورة هنا طالما العين جاية exotropia إذن صورة + +303 +00:19:47,150 --> 00:19:51,250 +المنزل هتسقط على الـ nasal retina الـ nasal retina + +304 +00:19:51,250 --> 00:19:55,810 +مواجهة للـ temporal field مواجهة للـ temporal field + +305 +00:19:55,810 --> 00:19:59,950 +يعني بمعنى آخر هتكون الصورة طالما سقطت الصورة على + +306 +00:19:59,950 --> 00:20:03,970 +nasal retina الـ projection تاع الـ nasal retina + +307 +00:20:03,970 --> 00:20:06,630 +temporal temporal بالنسبة لهذه العين يعني هيكون + +308 +00:20:06,630 --> 00:20:11,330 +الصورة الثانية جاية هنا جاية هنا زي ما المنظر هذا + +309 +00:20:11,330 --> 00:20:15,230 +بيوضع هي العين اليمين وهي العين الشمال هي العين + +310 +00:20:15,230 --> 00:20:18,790 +اليمين وهي العين الشمال كل واحدة العين اليمين شافت + +311 +00:20:18,790 --> 00:20:23,230 +الصورة هنا باتجاهها والعين الشمال شافت الصورة + +312 +00:20:23,230 --> 00:20:27,050 +باتجاهها يعني كل صورة على ناحية العين بتاعتها هذه + +313 +00:20:27,050 --> 00:20:29,990 +الصورة ناحية العين بتاعتها وهذه الصورة ناحية العين + +314 +00:20:29,990 --> 00:20:33,470 +بتاعتها يعني نتخيل احنا الآن واقفين أمام الشاشة + +315 +00:20:33,470 --> 00:20:37,890 +نتخيل الشجرة هاي مش موجودة وكل إنسان من عينه اليمين + +316 +00:20:37,890 --> 00:20:41,170 +الآن على جبال المنزل هذا وعينه الشمال على جبال المنزل + +317 +00:20:41,170 --> 00:20:44,450 +هذا يعني العين اليمين على جبال هذه الصورة بتاعتها + +318 +00:20:44,450 --> 00:20:48,970 +اللي شفتها و .. كيف يعرفنا أنه بتاعتها؟ طبعا لما + +319 +00:20:48,970 --> 00:20:52,900 +الصورة بتسقط على .. non-foveal area الوضوح بيكون + +320 +00:20:52,900 --> 00:20:57,160 +أقل لأن أكثر منطقة أحد إبصارا في كل من العين الثانية + +321 +00:20:57,160 --> 00:21:00,440 +الفوفيا إذا بعدنا عن الفوفيا بتبدأ حدث الإبصار و + +322 +00:21:00,440 --> 00:21:03,860 +وضوح الصورة يقل فهنا الصورة واضحة احنا نقول ننسى + +323 +00:21:03,860 --> 00:21:07,800 +الشجرة تمامًا هذه الصورة بتاعة العين الشمال وهذه + +324 +00:21:07,800 --> 00:21:10,660 +الصورة بتاعة العين اليمين لو وقفنا أمام الصورة هاي + +325 +00:21:10,660 --> 00:21:16,870 +وجربنا وجهنا من شاشة الكمبيوتر أو شاشة الـ laptop + +326 +00:21:16,870 --> 00:21:20,690 +هنلاحظ أن الصورة .. عفوا أن الصورة بتاعة العين + +327 +00:21:20,690 --> 00:21:25,430 +اليمين جاية ناحية العين اليمين و الصورة بتاعة + +328 +00:21:25,430 --> 00:21:28,630 +العين الشمال جاية ناحية العين الشمال هذه بسمها + +329 +00:21:28,630 --> 00:21:32,970 +uncrossed diplopia uncrossed diplopia يعني .. + +330 +00:21:32,970 --> 00:21:35,950 +diplopia كل عين بتشوف صورتها ناحيتها في الفراغ + +331 +00:21:35,950 --> 00:21:38,830 +ناحيتها في الفراغ ناحيتها فبتسمى uncrossed + +332 +00:21:38,830 --> 00:21:42,690 +diplopia الـ uncrossed diplopia الـ uncrossed + +333 +00:21:42,690 --> 00:21:47,470 +diplopia بتنشاف في الـ exotropia .. في الـ exotropia + +334 +00:21:47,470 --> 00:21:50,650 +the diplopia is homonymous متجانسة .. إيش يعني + +335 +00:21:50,650 --> 00:21:53,670 +متجانسة؟ يعني uncrossed .. إيش يعني uncrossed؟ + +336 +00:21:53,670 --> 00:21:57,730 +يعني كل عين بتشوف الصورة بتاعتها ناحيتها على جهتها + +337 +00:21:58,040 --> 00:22:01,520 +على جهتها بينما في الـ exotropia الصورة بتكون + +338 +00:22:01,520 --> 00:22:05,380 +across .. بالصورة بتكون across هذه exotropia .. + +339 +00:22:05,380 --> 00:22:08,880 +هذه exotropia الصورة اللي هي أقل وضوحا باتجاه + +340 +00:22:08,880 --> 00:22:11,880 +العين اللي فيها الحول طبعا منطقة التقاطع دول + +341 +00:22:11,880 --> 00:22:15,720 +الخاطئة بيقول لي هنا موقع الفوفيا هنا سقطت صورة الـ + +342 +00:22:15,720 --> 00:22:18,680 +target الأحمر على nasal retina طالما على nasal + +343 +00:22:18,680 --> 00:22:22,330 +retina الـ projection بتاعها temporal أي إشي بسقط + +344 +00:22:22,330 --> 00:22:25,470 +عندي عنه ذريتنا أنا بشعر فيه temporal طالما + +345 +00:22:25,470 --> 00:22:28,330 +temporal إذا .. إذا على نفس جهة عيني إذا هذه + +346 +00:22:28,330 --> 00:22:30,910 +الصورة شفتها العين اليمين و هذه الصورة شفتها العين + +347 +00:22:30,910 --> 00:22:35,050 +الشمال كل .. كل صورة من الصور جاية ناحية العين + +348 +00:22:35,050 --> 00:22:38,430 +اللي شفتها فبالتالي هذا يتسمى uncrossed diplopia + +349 +00:22:38,430 --> 00:22:42,410 +.. uncrossed diplopia الآن بنشوف كيف الـ diplopia + +350 +00:22:42,410 --> 00:22:45,190 +طبعا في الـ exotropia العكس .. في الـ exotropia + +351 +00:22:45,190 --> 00:22:49,460 +العكس هي أنا عندي exotropia .. هي أنا عندي + +352 +00:22:49,460 --> 00:22:53,240 +exotropia بدنا ننسى المربع الأخضر .. بدنا ننسى + +353 +00:22:53,240 --> 00:22:56,740 +المربع الأخضر و بدنا ننسى قضية الـ confusion الصورة + +354 +00:22:56,740 --> 00:23:00,780 +هنا هتسقط على الـ fovea .. هذه العين هتشوف الصورة + +355 +00:23:00,780 --> 00:23:04,000 +الـ target الأحمر straight ahead طيب .. هنا هتسقط + +356 +00:23:04,000 --> 00:23:07,780 +على temporal retina لما بتسقط صورة الـ target + +357 +00:23:07,780 --> 00:23:11,360 +الأحمر على temporal retina الـ projection بتاع الـ + +358 +00:23:11,360 --> 00:23:15,190 +temporal retina نازلي يعني هذه العين هتشوف الصورة + +359 +00:23:15,190 --> 00:23:18,650 +هنا فهذا بتسمى crossed diplopia الـ crossed + +360 +00:23:18,650 --> 00:23:21,370 +diplopia في الـ exotropia في عندي أنا crossed + +361 +00:23:21,370 --> 00:23:26,060 +diplopia in exotropia the diplopia is heteronymous + +362 +00:23:26,060 --> 00:23:30,080 +غير متجانسة الازدواجية غير متجانسة يعني إيش غير + +363 +00:23:30,080 --> 00:23:33,480 +متجانسة يعني crossed يعني كل .. كل صورة العين + +364 +00:23:33,480 --> 00:23:36,920 +بتكون عن ناحية الثانية باتجاه العين الثانية يعني + +365 +00:23:36,920 --> 00:23:41,240 +صورة الـ target الأول العين هاي بتشوف الـ target + +366 +00:23:41,240 --> 00:23:45,910 +صحيح هيك بس العين هاي بتشوف الـ target هناك إذا الـ + +367 +00:23:45,910 --> 00:23:48,870 +target هذا اللي هو صورة العين هاي جاي عن ناحية + +368 +00:23:48,870 --> 00:23:52,150 +الثانية يعني أقرب للعين الثانية و هذا هيكون أقرب + +369 +00:23:52,150 --> 00:23:55,810 +للعين الأولى فبالتالي هذه cross diplopia إذا إنسان + +370 +00:23:55,810 --> 00:24:00,910 +يعني في الامتحان مطلخبط كلمة exotropia بتحتوي على + +371 +00:24:00,910 --> 00:24:06,270 +كلمة X أو على حرف X X يعني cross diplopia بيضل .. + +372 +00:24:06,270 --> 00:24:09,910 +بيضل عندي خيار آخر اللي هو الـ esotropia uncrossed + +373 +00:24:09,910 --> 00:24:15,120 +إذا الـ exotropia crossed لأن في حرف الـ X طبعا احنا + +374 +00:24:15,120 --> 00:24:18,660 +هذا الكلام اللي سبقنا فيه هو الشرح ليش؟ بينما + +375 +00:24:18,660 --> 00:24:22,520 +الـ esotropia uncrossed .. uncrossed ممكن زي يقول + +376 +00:24:22,520 --> 00:24:25,540 +طب يعني و هذه يعني جدية كبيرة للـ diplopia بيقول + +377 +00:24:25,540 --> 00:24:3 + +401 +00:25:59,730 --> 00:26:04,070 +torsional diplopia كيف torsional diplopia هاي + +402 +00:26:04,070 --> 00:26:08,360 +السيارة ناخذ السيارة هذه معتادة على الأسفل + +403 +00:26:08,360 --> 00:26:11,540 +صورتها وخيالها مائل يعني لو شوفنا ساق في السيارة + +404 +00:26:11,540 --> 00:26:15,850 +هنا عامل خط أفقي بينما هنا ساق السيارة نفسها الصورة + +405 +00:26:15,850 --> 00:26:19,190 +التانية مائلان يعني بينهم لو مدناهم كخطوط + +406 +00:26:19,190 --> 00:26:23,330 +هتكون بينهم زاوية إذا هذه مش vertical فقط ولا + +407 +00:26:23,330 --> 00:26:27,590 +horizontal فقط هذه torsional diplopia يعني في + +408 +00:26:27,590 --> 00:26:31,430 +مشكلة عندي في الـ encyclotorsion أو الـ excyclotorsion + +409 +00:26:31,430 --> 00:26:34,370 +يعني الـ oblique muscle ممكن يكون في + +410 +00:26:34,370 --> 00:26:38,390 +لها علاقة في هذا الموضوع torsional diplopia أيضا + +411 +00:26:38,390 --> 00:26:44,720 +السيارة التانية هنا هذه السيارة زي لون الـ beige + +412 +00:26:44,720 --> 00:26:49,680 +أو الـ .. اه الـ beige تقريبا أو بين beige و أخضر + +413 +00:26:49,680 --> 00:26:54,640 +هاي أحد الصورتين ساق في السيارة هيو معتدل الصورة + +414 +00:26:54,640 --> 00:26:58,940 +التانية يعني مائل هذه torsional diplopia .. هذه + +415 +00:26:58,940 --> 00:27:02,520 +torsional diplopia أيضا هذه نموذج للـ torsional + +416 +00:27:02,520 --> 00:27:06,000 +diplopia هاي الصورة الأساسية للعين السليمة الـ + +417 +00:27:06,000 --> 00:27:09,640 +fixating eye my child has blue eyes and brown hair + +418 +00:27:10,340 --> 00:27:13,940 +العين التانية اللي فيها مشكلة في الـ encyclotortion + +419 +00:27:13,940 --> 00:27:19,100 +أو excyclotortion my child has blue eyes and brown + +420 +00:27:19,100 --> 00:27:23,320 +hair واضح إنه فيه ميلان في الخط مائل يعني .. يعني + +421 +00:27:23,320 --> 00:27:28,080 +مش مجرد إنه نازل مثلا بشكل موازي للخط الأول ولكن + +422 +00:27:28,080 --> 00:27:33,000 +أيضا فيه طبعا ميلان فيه وهو أقل وضوحا لأنه جاي من + +423 +00:27:33,000 --> 00:27:36,080 +الـ squinting eye غالبا جاي من الـ squinting eye + +424 +00:27:36,080 --> 00:27:39,640 +فهذه مثال على الـ torsional diplopia إذا الدبلوبيا + +425 +00:27:39,640 --> 00:27:43,260 +ضروري جدا ما أنساش في منها crossed وفي uncrossed + +426 +00:27:43,260 --> 00:27:46,640 +الـ crossed في الـ Exotropia بنجيبها والـ uncrossed + +427 +00:27:46,640 --> 00:27:52,270 +في .. في الـ Esotropia هذه التجسيمة الأولى للـ + +428 +00:27:52,270 --> 00:27:55,550 +Diplopia في تجسيمة تانية بس قبل ما نحكي التجسيمة + +429 +00:27:55,550 --> 00:27:57,790 +التانية اللي قبل شوية حكيتها ممكن نقول إنسان إيش + +430 +00:27:57,790 --> 00:28:00,330 +الفايدة؟ طب ما أنا خلاص الـ Esotropia معروفة والـ + +431 +00:28:00,330 --> 00:28:03,950 +Exotropia معروفة أحيانا بيكون كمية الحول خفيفة + +432 +00:28:03,950 --> 00:28:07,290 +جدا لدرجة إنه على الفعص ممكن ما تبينش وما أقدرش + +433 +00:28:07,290 --> 00:28:10,610 +أعرفها إلا بفحوصات الـ Diplopia أو بسؤال المريض + +434 +00:28:10,610 --> 00:28:14,530 +الصورة الأقل وضوحا جاية عيمينك ولا عشمالك جاية + +435 +00:28:14,530 --> 00:28:20,880 +عيمينك ولا عشمالك أنا مثلا مش شايف يعني إلا أسكنت + +436 +00:28:20,880 --> 00:28:23,920 +بسيط أو مش شايف يعني بالفحص مش مبين معاه ممكن من + +437 +00:28:23,920 --> 00:28:27,680 +ضمن الـ history أني أخمن وين المشكلة أو هل هي + +438 +00:28:27,680 --> 00:28:31,480 +crossed diplopia يعني أنا بحكي عن exo ولا non + +439 +00:28:31,480 --> 00:28:35,720 +-crossed أو uncrossed بحكي عن esotropia إذا في + +440 +00:28:35,720 --> 00:28:39,510 +عندي vertical diplopia زي ما إحنا شايفين في عندي + +441 +00:28:39,510 --> 00:28:42,430 +horizontal diplopia في عندي هنا horizontal + +442 +00:28:42,430 --> 00:28:45,730 +diplopia المريض شايف اتنين عندي هنا vertical + +443 +00:28:45,730 --> 00:28:48,790 +diplopia اتنين بس فوق بعض هنا torsional diplopia + +444 +00:28:48,790 --> 00:28:53,150 +بس الرسمة مش كتير موفقة .. مش كتير موفقة هنا يعني + +445 +00:28:53,150 --> 00:28:57,410 +صورة بتوضح الـ torsional diplopia بشكل واضح جدا .. + +446 +00:28:57,410 --> 00:29:02,190 +بشكل واضح جدا يمكن إحنا كمان لو يعني نظرنا في + +447 +00:29:02,190 --> 00:29:07,320 +العمق على الآخر هنلاقي الجسرهنلاقي الجسر وهنلاقي + +448 +00:29:07,320 --> 00:29:11,120 +الجسر المائل .. الجسر المائل هي اللي هي الأعمدة + +449 +00:29:11,120 --> 00:29:13,220 +اللي على الجسر وهي الأعمدة اللي على الجسر مائلة + +450 +00:29:13,220 --> 00:29:16,680 +كأنه الجسر مائل كأنه .. كأنه بينهم زاوية .. كأنه + +451 +00:29:16,680 --> 00:29:19,620 +بينهم زاوية torsional diplopia بنسبة مائة + +452 +00:29:19,620 --> 00:29:22,940 +بالمائة الآن لو طلبنا من المريض يغطي أي عين من + +453 +00:29:22,940 --> 00:29:27,410 +العين التانية هتلاقي أحد الجسور راحيعني العين اليمين + +454 +00:29:27,410 --> 00:29:30,990 +لو هي شايفة هذا الخط المائل أو الجسر المائل مجرد + +455 +00:29:30,990 --> 00:29:34,450 +ما نغطي اليمين هيروح هذا الخط طب لو فتحنا اليمين + +456 +00:29:34,450 --> 00:29:38,970 +وغطينا الشمال هيروح الخط المعتدل وكل الإزدواجية الـ + +457 +00:29:38,970 --> 00:29:42,390 +binocular diplopia يعني الدبلوبيا اللي بتكون وإنا + +458 +00:29:42,390 --> 00:29:46,690 +مفتح عينيا التنتين لو غطيت أي عين من العنتين بتروح + +459 +00:29:46,690 --> 00:29:49,030 +الإزدواجية .. بتروح الإزدواجية + +460 +00:29:51,520 --> 00:29:57,700 +هنتوقف عند هنا عشان نعرف إيش الدماغ بيتاخذ خطوات + +461 +00:29:57,700 --> 00:30:00,660 +للتأقلم على هذه الـ sensation اللي إحنا حكينا عنها + +462 +00:30:00,660 --> 00:30:04,920 +اللي هي الـ confusion والـ pathological dyplopia و + +463 +00:30:04,920 --> 00:30:09,180 +يعطيكم العافية والسلام 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بعض في نفس ال .. وجدت في نفس المكان من الفرق ال confusion اللي هي خربطت ال .. ال .. الصور مع بعضها و هنشرحه بعد شوية و ال pathological dyplopia اللي هي الإزدواجية", "tokens": [9778, 25513, 9566, 2655, 31767, 13063, 8978, 45030, 11242, 11296, 4032, 40448, 7435, 20328, 13063, 20193, 6055, 40448, 7435, 8978, 45030, 11242, 29739, 3615, 11242, 14739, 3224, 7251, 8592, 38688, 11296, 20449, 45030, 11242, 8978, 8717, 36178, 2423, 4386, 49610, 3215, 2655, 8978, 8717, 36178, 9673, 41361, 9154, 27188, 2288, 4587, 2423, 15075, 13672, 1829, 39896, 16490, 25513, 9566, 2655, 2423, 4386, 2423, 4386, 31767, 13063, 20449, 45030, 11242, 11296, 4032, 8032, 1863, 46309, 5016, 3224, 39182, 13412, 2407, 10632, 4032, 2423, 3100, 4383, 14584, 564, 22376, 13672, 1829, 39896, 33688, 11622, 3215, 2407, 26108, 10632], "avg_logprob": -0.15616945384703962, "compression_ratio": 1.832512315270936, "no_speech_prob": 7.152557373046875e-07, "words": [{"start": 120.99, "end": 121.55, "word": "خربطت", "probability": 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"text": "بنقول confusion is the simultaneous appreciation هو الالتقاط المتزامن أو الشعور المتزامن بصورتين جايين فوق بعض ملخبطين مع بعض صورتين ل dissimilar images أو dissimilar objects caused ليش .. ليش .. ليش انا اتخربطوا الصور عندى مع بعض؟", "tokens": [3555, 1863, 39648, 15075, 307, 264, 46218, 18909, 31439, 2423, 6027, 2655, 4587, 41193, 9673, 2655, 11622, 10943, 1863, 34051, 25124, 3615, 13063, 9673, 2655, 11622, 10943, 1863, 4724, 9381, 13063, 2655, 9957, 10874, 47302, 9957, 6156, 30543, 45030, 11242, 3714, 1211, 9778, 3555, 9566, 9957, 20449, 45030, 11242, 20328, 13063, 2655, 9957, 5296, 7802, 332, 2202, 5267, 34051, 7802, 332, 2202, 6565, 7008, 32239, 8592, 4386, 32239, 8592, 4386, 32239, 8592, 1975, 8315, 1975, 2655, 34740, 3555, 9566, 14407, 31767, 13063, 43242, 7578, 20449, 45030, 11242, 22807], "avg_logprob": -0.1334269716498557, "compression_ratio": 1.638095238095238, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 752.24, "end": 752.6, "word": "بنقول", 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"start": 921.88, "end": 940.86, "text": "ليش سمناها pathological diplopia؟ pathological diplopia عشان نفرجها عن ال physiological diplopia لكل ال targets الموجودة خارج ال pan-infusional space أبعد من ال pan-infusional space أو أقرب من ال pan-infusional space وهذه ال physiological diplopia", "tokens": [20292, 8592, 8608, 2304, 8315, 11296, 3100, 4383, 11432, 22376, 22807, 3100, 4383, 11432, 22376, 6225, 8592, 7649, 8717, 5172, 47341, 11296, 18871, 2423, 41234, 11432, 22376, 5296, 28820, 2423, 12911, 9673, 29245, 23328, 3660, 16490, 9640, 7435, 2423, 2462, 12, 19920, 5704, 304, 1901, 5551, 3555, 22488, 9154, 2423, 2462, 12, 19920, 5704, 304, 1901, 34051, 5551, 4587, 25513, 9154, 2423, 2462, 12, 19920, 5704, 304, 1901, 37037, 24192, 2423, 41234, 11432, 22376], "avg_logprob": -0.15645832737286886, "compression_ratio": 1.869047619047619, "no_speech_prob": 1.1920928955078125e-07, "words": [{"start": 921.88, "end": 922.2, "word": "ليش", "probability": 0.802490234375}, {"start": 922.2, "end": 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diplopia", "probability": 0.955078125}], "temperature": 1.0}, {"id": 43, "seek": 96794, "start": 941.22, "end": 967.94, "text": "احنا أجريناها بتجربة أننا نمسك جلمين و واحد نمده أبعد ما يكون و واحد نجربه من وجهنا و لما نركز بالجلم الجريب هيصير التاني double اللي هو الجلم الأبعد double لما بنركز بالجلم الأبعد هيصير الجلم الأقرب يعني نشعر فيه أنه مزدوج أو فيه diplopia وقولنا هذه physiological diplopia لأنه الجلم الأول لما بركز فيه الجلم التاني", "tokens": [39319, 8315, 5551, 7435, 16572, 8315, 11296, 39894, 7435, 25513, 3660, 14739, 8315, 8717, 2304, 3794, 4117, 10874, 19528, 9957, 4032, 36764, 24401, 8717, 2304, 3215, 3224, 5551, 3555, 22488, 19446, 7251, 30544, 4032, 36764, 24401, 8717, 7435, 25513, 3224, 9154, 49610, 3224, 8315, 4032, 5296, 15042, 8717, 31747, 11622, 20666, 7435, 19528, 25724, 16572, 3555, 39896, 9381, 13546, 16712, 7649, 1829, 3834, 13672, 1829, 31439, 25724, 19528, 16247, 3555, 22488, 3834, 5296, 15042, 44945, 31747, 11622, 20666, 7435, 19528, 16247, 3555, 22488, 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"temperature": 1.0}, {"id": 59, "seek": 131773, "start": 1301.77, "end": 1317.73, "text": "ال uncrossed diplopia بتنشاف في الاسوتروبيا .. في الاسوتروبيا the diplopia is homonymous متجانسة .. إيش يعني متجانسة؟ يعني uncrossed .. إيش يعني uncrossed؟ يعني كل عين بتشوف الصورة بتاعتها ناحيتها على جهتها", "tokens": [6027, 6219, 1887, 292, 11432, 22376, 39894, 1863, 8592, 31845, 8978, 2423, 32277, 35473, 2288, 2407, 21292, 995, 4386, 8978, 2423, 32277, 35473, 2288, 2407, 21292, 995, 264, 11432, 22376, 307, 3655, 18092, 44650, 7435, 7649, 3794, 3660, 4386, 11933, 1829, 8592, 37495, 22653, 44650, 7435, 7649, 3794, 3660, 22807, 37495, 22653, 6219, 1887, 292, 4386, 11933, 1829, 8592, 37495, 22653, 6219, 1887, 292, 22807, 37495, 22653, 28242, 6225, 9957, 39894, 8592, 38688, 31767, 13063, 3660, 39894, 995, 34268, 11296, 8717, 39319, 36081, 11296, 15844, 10874, 3224, 2655, 11296], "avg_logprob": -0.186458340452777, "compression_ratio": 1.76536312849162, "no_speech_prob": 0.0, "words": [{"start": 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0.95263671875}, {"start": 1308.35, "end": 1308.99, "word": " homonymous", "probability": 0.957275390625}, {"start": 1308.99, "end": 1309.95, "word": " متجانسة", "probability": 0.92158203125}, {"start": 1309.95, "end": 1310.33, "word": " ..", "probability": 0.404541015625}, {"start": 1310.33, "end": 1310.49, "word": " إيش", "probability": 0.8426106770833334}, {"start": 1310.49, "end": 1310.65, "word": " يعني", "probability": 0.943359375}, {"start": 1310.65, "end": 1311.45, "word": " متجانسة؟", "probability": 0.90087890625}, {"start": 1311.45, "end": 1311.55, "word": " يعني", "probability": 0.966552734375}, {"start": 1311.55, "end": 1312.33, "word": " uncrossed", "probability": 0.9488932291666666}, {"start": 1312.33, "end": 1312.45, "word": " ..", "probability": 0.578125}, {"start": 1312.45, "end": 1312.63, "word": " إيش", "probability": 0.9695638020833334}, {"start": 1312.63, "end": 1312.81, "word": " يعني", "probability": 0.973876953125}, {"start": 1312.81, "end": 1313.67, "word": " uncrossed؟", "probability": 0.9530029296875}, {"start": 1313.67, "end": 1313.95, "word": " يعني", "probability": 0.954345703125}, {"start": 1313.95, "end": 1314.33, "word": " كل", "probability": 0.9755859375}, {"start": 1314.33, "end": 1314.63, "word": " عين", "probability": 0.992431640625}, {"start": 1314.63, "end": 1315.13, "word": " بتشوف", "probability": 0.9921875}, {"start": 1315.13, "end": 1315.67, "word": " الصورة", "probability": 0.98291015625}, {"start": 1315.67, "end": 1316.17, "word": " بتاعتها", "probability": 0.9808349609375}, {"start": 1316.17, "end": 1316.73, "word": " ناحيتها", "probability": 0.949951171875}, {"start": 1316.73, "end": 1317.19, "word": " على", "probability": 0.54833984375}, {"start": 1317.19, "end": 1317.73, "word": " جهتها", "probability": 0.9810791015625}], "temperature": 1.0}, {"id": 60, "seek": 134034, "start": 1318.04, "end": 1340.34, "text": "على جهتها بينما في ال Exotropia الصورة بتكون across .. بالصورة بتكون across هذه Exotropia .. هذه Exotropia الصورة اللي هي أقل وضوحا باتجاه العين اللي فيها الحوالي طبعا منطقة التقاطع دول الخاطين بيقول لي هنا موقع الفوفيا هنا سقطت صورة ال target الأحمر على nasal retina طالما على nasal retina ال projection بتاعها", "tokens": [3615, 23942, 10874, 3224, 2655, 11296, 49374, 15042, 8978, 2423, 2111, 310, 1513, 654, 31767, 13063, 3660, 39894, 30544, 2108, 4386, 20666, 9381, 13063, 3660, 39894, 30544, 2108, 29538, 2111, 310, 1513, 654, 4386, 29538, 2111, 310, 1513, 654, 31767, 13063, 3660, 13672, 1829, 39896, 5551, 4587, 1211, 4032, 11242, 2407, 5016, 995, 4724, 9307, 7435, 40294, 18863, 9957, 13672, 1829, 8978, 11296, 21542, 2407, 6027, 1829, 23032, 3555, 3615, 995, 9154, 9566, 28671, 16712, 4587, 41193, 3615, 11778, 12610, 33962, 41193, 9957, 4724, 1829, 39648, 32239, 34105, 3714, 30543, 3615, 27188, 38688, 25528, 34105, 8608, 47432, 2655, 20328, 13063, 3660, 2423, 3779, 16247, 5016, 29973, 15844, 41575, 1533, 1426, 23032, 6027, 15042, 15844, 41575, 1533, 1426, 2423, 22743, 39894, 45761, 11296], 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1322.98, "word": " بالصورة", "probability": 0.8197021484375}, {"start": 1322.98, "end": 1323.36, "word": " بتكون", "probability": 0.9599609375}, {"start": 1323.36, "end": 1323.8, "word": " across", "probability": 0.5595703125}, {"start": 1323.8, "end": 1324.24, "word": " هذه", "probability": 0.609375}, {"start": 1324.24, "end": 1325.08, "word": " Exotropia", "probability": 0.81011962890625}, {"start": 1325.08, "end": 1325.38, "word": " ..", "probability": 0.626953125}, {"start": 1325.38, "end": 1325.6, "word": " هذه", "probability": 0.900390625}, {"start": 1325.6, "end": 1326.38, "word": " Exotropia", "probability": 0.9676513671875}, {"start": 1326.38, "end": 1327.32, "word": " الصورة", "probability": 0.9783528645833334}, {"start": 1327.32, "end": 1327.42, "word": " اللي", "probability": 0.88134765625}, {"start": 1327.42, "end": 1327.52, "word": " هي", "probability": 0.86865234375}, {"start": 1327.52, "end": 1327.84, "word": " أقل", "probability": 0.93701171875}, {"start": 1327.84, "end": 1328.36, "word": " وضوحا", "probability": 0.939453125}, {"start": 1328.36, "end": 1328.88, "word": " باتجاه", "probability": 0.87255859375}, {"start": 1328.88, "end": 1329.2, "word": " العين", "probability": 0.98291015625}, {"start": 1329.2, "end": 1329.34, "word": " اللي", "probability": 0.96337890625}, {"start": 1329.34, "end": 1329.56, "word": " فيها", "probability": 0.988037109375}, {"start": 1329.56, "end": 1330.06, "word": " الحوالي", "probability": 0.7099609375}, {"start": 1330.06, "end": 1330.62, "word": " طبعا", "probability": 0.96435546875}, {"start": 1330.62, "end": 1331.08, "word": " منطقة", "probability": 0.8341471354166666}, {"start": 1331.08, "end": 1331.62, "word": " التقاطع", "probability": 0.947998046875}, {"start": 1331.62, "end": 1331.88, "word": " دول", "probability": 0.961669921875}, {"start": 1331.88, "end": 1332.36, "word": " الخاطين", "probability": 0.7533365885416666}, {"start": 1332.36, "end": 1332.64, "word": " بيقول", "probability": 0.95849609375}, {"start": 1332.64, "end": 1332.72, "word": " لي", "probability": 0.265625}, {"start": 1332.72, "end": 1332.9, "word": " هنا", "probability": 0.81494140625}, {"start": 1332.9, "end": 1333.28, "word": " موقع", "probability": 0.9783528645833334}, {"start": 1333.28, "end": 1333.8, "word": " الفوفيا", "probability": 0.7548014322916666}, {"start": 1333.8, "end": 1334.44, "word": " هنا", "probability": 0.716796875}, {"start": 1334.44, "end": 1335.24, "word": " سقطت", "probability": 0.9788411458333334}, {"start": 1335.24, "end": 1335.56, "word": " صورة", "probability": 0.9951171875}, {"start": 1335.56, "end": 1335.72, "word": " ال", "probability": 0.8583984375}, {"start": 1335.72, "end": 1335.98, "word": " target", "probability": 0.9775390625}, {"start": 1335.98, "end": 1336.48, "word": " الأحمر", "probability": 0.9671223958333334}, {"start": 1336.48, "end": 1336.7, "word": " على", "probability": 0.91650390625}, {"start": 1336.7, "end": 1337.04, "word": " nasal", "probability": 0.58203125}, {"start": 1337.04, "end": 1337.5, "word": " retina", "probability": 0.98486328125}, {"start": 1337.5, "end": 1338.14, "word": " طالما", "probability": 0.9537760416666666}, {"start": 1338.14, "end": 1338.36, "word": " على", "probability": 0.6708984375}, {"start": 1338.36, "end": 1338.68, "word": " nasal", "probability": 0.97509765625}, {"start": 1338.68, "end": 1339.06, "word": " retina", "probability": 0.985595703125}, {"start": 1339.06, "end": 1339.16, "word": " ال", "probability": 0.9189453125}, {"start": 1339.16, "end": 1339.62, "word": " projection", "probability": 0.88525390625}, {"start": 1339.62, "end": 1340.34, "word": " بتاعها", "probability": 0.745361328125}], "temperature": 1.0}, {"id": 61, "seek": 136609, "start": 1340.97, "end": 1366.09, "text": "temporal أي إشي بسقط عندى عنه ذريتنا أنا بشعر فيه temporal طالما temporal إذا .. إذا على نفس جهة عينى إذا هذه الصورة شفتها العين اليمين و هذه الصورة شفتها العين الشمال كل .. كل صورة من الصور جاية ناحية العين اللى شفتها فبالتالي هذا يتسمى uncrossed diplopia .. uncrossed diplopia الآن بنشوف كيف ال diplopia طبعا في ال Exotropia العكس .. في ال Exotropia العكس", "tokens": [83, 11840, 304, 36632, 11933, 8592, 1829, 4724, 3794, 47432, 43242, 7578, 18871, 3224, 29910, 16572, 2655, 8315, 41850, 4724, 8592, 3615, 2288, 8978, 3224, 30881, 23032, 6027, 15042, 30881, 11933, 15730, 4386, 11933, 15730, 15844, 8717, 36178, 10874, 3224, 3660, 6225, 9957, 7578, 11933, 15730, 29538, 31767, 13063, 3660, 13412, 5172, 2655, 11296, 18863, 9957, 2423, 32640, 9957, 4032, 29538, 31767, 13063, 3660, 13412, 5172, 2655, 11296, 18863, 9957, 25124, 2304, 6027, 28242, 4386, 28242, 20328, 13063, 3660, 9154, 31767, 13063, 10874, 995, 10632, 8717, 39319, 10632, 18863, 9957, 13672, 7578, 13412, 5172, 2655, 11296, 6156, 3555, 6027, 2655, 6027, 1829, 23758, 7251, 2655, 38251, 7578, 6219, 1887, 292, 11432, 22376, 4386, 6219, 1887, 292, 11432, 22376, 6024, 48506, 4724, 1863, 8592, 38688, 9122, 33911, 2423, 11432, 22376, 23032, 3555, 3615, 995, 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"probability": 0.48974609375}, {"start": 1356.39, "end": 1356.97, "word": " يتسمى", "probability": 0.819580078125}, {"start": 1356.97, "end": 1358.03, "word": " uncrossed", "probability": 0.80810546875}, {"start": 1358.03, "end": 1358.43, "word": " diplopia", "probability": 0.8955078125}, {"start": 1358.43, "end": 1358.55, "word": " ..", "probability": 0.28857421875}, {"start": 1358.55, "end": 1359.15, "word": " uncrossed", "probability": 0.9451497395833334}, {"start": 1359.15, "end": 1359.59, "word": " diplopia", "probability": 0.96044921875}, {"start": 1359.59, "end": 1360.39, "word": " الآن", "probability": 0.752685546875}, {"start": 1360.39, "end": 1361.65, "word": " بنشوف", "probability": 0.712646484375}, {"start": 1361.65, "end": 1361.87, "word": " كيف", "probability": 0.983154296875}, {"start": 1361.87, "end": 1361.99, "word": " ال", "probability": 0.51611328125}, {"start": 1361.99, "end": 1362.41, "word": " diplopia", "probability": 0.734130859375}, {"start": 1362.41, "end": 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المربع الأخضر و بدنا ننسى قضية ال confusion الصورة هنا هتسقط على ال phobia .. هذه العين هتشوف الصورة ال target الأحمر straight ahead طيب .. هنا هتسقط على temporal retina لما بتسقط صورة ال target الأحمر على temporal retina ال projection بتاع ال temporal retina نازلي", "tokens": [3224, 1829, 1975, 8315, 43242, 7578, 2111, 310, 1513, 654, 4386, 8032, 7578, 1975, 8315, 43242, 7578, 2111, 310, 1513, 654, 47525, 8315, 8717, 1863, 3794, 7578, 9673, 25513, 3615, 16247, 9778, 11242, 2288, 4386, 47525, 8315, 8717, 1863, 3794, 7578, 9673, 25513, 3615, 16247, 9778, 11242, 2288, 4032, 47525, 8315, 8717, 1863, 3794, 7578, 12174, 11242, 10632, 2423, 15075, 31767, 13063, 3660, 34105, 8032, 2655, 3794, 47432, 15844, 2423, 903, 24613, 4386, 29538, 18863, 9957, 8032, 2655, 8592, 38688, 31767, 13063, 3660, 2423, 3779, 16247, 5016, 29973, 2997, 2286, 23032, 1829, 3555, 4386, 34105, 8032, 2655, 3794, 47432, 15844, 30881, 1533, 1426, 5296, 15042, 39894, 3794, 47432, 20328, 13063, 3660, 2423, 3779, 16247, 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1567.18, "end": 1567.7, "word": " معتادة", "probability": 0.693328857421875}, {"start": 1567.7, "end": 1567.82, "word": " على", "probability": 0.6845703125}, {"start": 1567.82, "end": 1568.36, "word": " الأسفل", "probability": 0.893310546875}, {"start": 1568.36, "end": 1569.36, "word": " صورتها", "probability": 0.953857421875}, {"start": 1569.36, "end": 1569.84, "word": " وخيالها", "probability": 0.92978515625}, {"start": 1569.84, "end": 1570.2, "word": " مائل", "probability": 0.8671875}, {"start": 1570.2, "end": 1570.4, "word": " يعني", "probability": 0.6851806640625}, {"start": 1570.4, "end": 1570.54, "word": " لو", "probability": 0.888671875}, {"start": 1570.54, "end": 1570.76, "word": " شوف", "probability": 0.82470703125}, {"start": 1570.76, "end": 1571.06, "word": " نساق", "probability": 0.7347412109375}, {"start": 1571.06, "end": 1571.14, "word": " في", "probability": 0.94384765625}, {"start": 1571.14, "end": 1571.54, "word": " السيارة", "probability": 0.9501953125}, {"start": 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او بين beige و أخضر هاي أحد الصورتين ساكت في السيارة هيو معتدل الصورة التانية يعني مائل هذه torsional diplopia .. هذه torsional diplopia أيضا هذه نموذج لل torsional diplopia هاي الصورة الأساسية للعين السليمة ال fixating eye my child has blue eyes and brown hair", "tokens": [11622, 1829, 13672, 11536, 2423, 40274, 1975, 2407, 2423, 4386, 1975, 3224, 2423, 40274, 6055, 4587, 16572, 3555, 995, 1975, 2407, 49374, 40274, 4032, 5551, 9778, 11242, 2288, 8032, 47302, 5551, 24401, 31767, 13063, 2655, 9957, 8608, 995, 4117, 2655, 8978, 21136, 1829, 9640, 3660, 39896, 2407, 20449, 2655, 3215, 1211, 31767, 13063, 3660, 16712, 7649, 10632, 37495, 22653, 3714, 16373, 1211, 29538, 3930, 82, 1966, 11432, 22376, 4386, 29538, 3930, 82, 1966, 11432, 22376, 36632, 11242, 995, 29538, 8717, 2304, 2407, 8848, 7435, 24976, 3930, 82, 1966, 11432, 22376, 8032, 47302, 31767, 13063, 3660, 16247, 3794, 32277, 10632, 24976, 3615, 9957, 21136, 20292, 46007, 2423, 3191, 990, 3313, 452, 1440, 575, 3344, 2575, 293, 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المثيلة بتاعتها أو المماثلة إليها في شبكية + +19 +00:01:17,120 --> 00:01:20,740 +العين الإشمالكان لهم قبل الحول نفس الاتجاه في + +20 +00:01:20,740 --> 00:01:25,000 +الفرار طبعا بعد نشوء الحول في إحدى العنتين أصبح + +21 +00:01:25,000 --> 00:01:28,820 +سين إلها اتجاه و سين شرطه إلها اتجاه الفوفيا في + +22 +00:01:28,820 --> 00:01:31,700 +العين اليمين إلها اتجاه في الفرار و الفوفيا في + +23 +00:01:31,700 --> 00:01:35,280 +العين الشمال إلها اتجاه آخربناءً على اختلاف + +24 +00:01:35,280 --> 00:01:39,300 +الاتجاهات أيضًا هيصير ال projection مختلف التعبير + +25 +00:01:39,300 --> 00:01:45,420 +الشخصي مختلف فبالتالي هذه القضية هتأد لإحساس من + +26 +00:01:45,420 --> 00:01:48,560 +إحساسين اللي هو ال confusion أو ال pathological + +27 +00:01:48,560 --> 00:01:54,380 +diplopia أو الإتنين مع بعضهم البعض طبعًا عشان يحدث + +28 +00:01:54,380 --> 00:01:57,900 +ال confusion أو تحدث ال pathological diplopia اللي + +29 +00:01:57,900 --> 00:02:01,930 +هي الإزدواجية طبعًا ال confusion معناهاخربطت الصور + +30 +00:02:01,930 --> 00:02:06,050 +في بعضها ودمج صور لا تدمج في بعض البعض أنه يشوفها + +31 +00:02:06,050 --> 00:02:09,390 +مع بعض في نفس ال .. وجدت في نفس المكان من الفرق ال + +32 +00:02:09,390 --> 00:02:13,050 +confusion اللي هي خربطت ال .. ال .. الصور مع بعضها + +33 +00:02:13,050 --> 00:02:16,650 +و هنشرحه بعد شوية و ال pathological dyplopia اللي + +34 +00:02:16,650 --> 00:02:20,770 +هي الإزدواجيةبيتطلبوا عشان يصيروا لازم يكون في عين + +35 +00:02:20,770 --> 00:02:25,250 +دي حاجة اسمها semioletaneous perception القدرة على + +36 +00:02:25,250 --> 00:02:28,530 +الالتقاط المتزامن بين العين تانية يعني مافيش عين + +37 +00:02:28,530 --> 00:02:31,930 +واقفة عن العمل أو ال brain عاملها suppression + +38 +00:02:31,930 --> 00:02:35,350 +عاملها تثبيت يعني مستقبلش منها صورة لأنه لو في + +39 +00:02:35,350 --> 00:02:38,830 +عندي suppression يعني تثبيت من قبل ال brain لصورة + +40 +00:02:38,830 --> 00:02:42,290 +من الصورتينتمام؟ فبالتالي في الصين عندي بساط في + +41 +00:02:42,290 --> 00:02:45,090 +صورة واحدة فبالتالي هذه الإحساءات .. الإحساسات + +42 +00:02:45,090 --> 00:02:49,490 +اللي هي الازدواجية أو ال confusion ما بتنشأ ليش؟ + +43 +00:02:49,490 --> 00:02:52,890 +لأن عين واحدة بتستقبل فضروري جدا عشان المريض يشعر + +44 +00:02:52,890 --> 00:02:56,270 +بالإحساسين هدولة و اللي هم عبارة عن pathological + +45 +00:02:56,270 --> 00:02:59,250 +sensations يعني مش .. مش في الطبيعي أن الإنسان بيه + +46 +00:02:59,250 --> 00:03:04,590 +هذا وسببهم الحوال عشان يحس فيهم الإنسان لازم يكون + +47 +00:03:04,590 --> 00:03:07,450 +في عندي simultaneous .. simultaneous visual + +48 +00:03:07,450 --> 00:03:12,760 +perceptionهذا يعني ضروري جدا عشان انه لما تسقط + +49 +00:03:12,760 --> 00:03:17,260 +صورتين و الدماغ مواقع الصورتين ع الشبكيات ع مناطق + +50 +00:03:17,260 --> 00:03:20,900 +غير متماثلة فبالتالي مش قادر يدمج الصورتين في بعض + +51 +00:03:20,900 --> 00:03:24,780 +فممكن إحساسات مختلفة تصير زي ال confusion و ال + +52 +00:03:24,780 --> 00:03:27,600 +pathological dyplopia و اللي هنشرحهم بعد شوية اذا + +53 +00:03:27,600 --> 00:03:31,460 +these sensations require simultaneous visual + +54 +00:03:31,460 --> 00:03:35,180 +perception بمعنى the ability to perceive images + +55 +00:03:35,180 --> 00:03:39,780 +from both eyes simultaneously في نفسكاللحظة نيجي + +56 +00:03:39,780 --> 00:03:49,380 +نحكي عن ال confusion نحكي عن ال confusion ال + +57 +00:03:49,380 --> 00:03:54,040 +confusion is the simultaneous appreciation of two + +58 +00:03:54,040 --> 00:03:58,020 +superimposed but dissimilar images caused by + +59 +00:03:58,020 --> 00:04:01,000 +stimulation of corresponding retinal points + +60 +00:04:01,000 --> 00:04:04,520 +usually the fovea by images of different objects + +61 +00:04:04,520 --> 00:04:09,040 +إيش اللي بيحصل في ال confusion نشرحهبنقول هي عندنا + +62 +00:04:09,040 --> 00:04:13,620 +احنا ال right eye وهي عندي انا ال left eye الفوفيا + +63 +00:04:13,620 --> 00:04:17,560 +بتاعة ال right eye موجهة حسب الخط الأسود والفوفيا + +64 +00:04:17,560 --> 00:04:20,600 +بتاعة ال left eye بسبب الحوال مالهاش نفس الاتجاه + +65 +00:04:20,600 --> 00:04:25,690 +هو معروف ان ال two foviasالهم نفس الاتجاه في + +66 +00:04:25,690 --> 00:04:29,190 +الفرار في ال .. في الوضع الطبيعي يعني .. يعني الهم + +67 +00:04:29,190 --> 00:04:31,930 +نفس الاتجاه يعني إذا كان الفوفيا اليمين متجهة + +68 +00:04:31,930 --> 00:04:35,950 +باتجاه المثلث مفروض في الطبيعي الفوفيا الشمال أيضا + +69 +00:04:35,950 --> 00:04:40,070 +تكون متجهة باتجاه المثلث يعني الهم نفس الاتجاه نفس + +70 +00:04:40,070 --> 00:04:44,590 +ال visual direction حقيقة هذا المريض اللي عاملينه + +71 +00:04:44,590 --> 00:04:48,410 +احنا رسمت simulation أو .. أو نقلينله صورةتعمل + +72 +00:04:48,410 --> 00:04:52,490 +simulation أو محاكالة الحوال .. هذا عنده حوال + +73 +00:04:52,490 --> 00:04:56,850 +بالعين فبالتالي أصبح اتجاه الفوفيا في الفراغ .. + +74 +00:04:56,850 --> 00:05:01,070 +اتجاه الفوفيا في الفراغ مختلف بين ال two fovias .. + +75 +00:05:01,070 --> 00:05:05,050 +between the two fovias طيب .. الآن صدف أنه في + +76 +00:05:05,050 --> 00:05:08,650 +الفراغ في عندي target اللي هو المثلث الأسود جاي في + +77 +00:05:08,650 --> 00:05:12,520 +طريقالفوفيا في ال visual direction بتاع الفوفيا + +78 +00:05:12,520 --> 00:05:16,340 +فصورة هذا ال target الأسود هتسقط على الفوفيا في + +79 +00:05:16,340 --> 00:05:20,360 +العين اليمين وصدف في نفس اللحظة أنه على جبال + +80 +00:05:20,360 --> 00:05:23,740 +الفوفيا في الفراغ طبعا على جبال الفوفيا في target + +81 +00:05:23,740 --> 00:05:28,420 +أحمر فصورته هتسقط على الفوفيا طيب معروف أن الفوفيا + +82 +00:05:28,420 --> 00:05:31,780 +والفوفيا جبل ما يصير الحوال corresponding retinal + +83 +00:05:31,780 --> 00:05:35,090 +areas يعنيالمعلومات اللى وصلت ل الفوفيا هنا + +84 +00:05:35,090 --> 00:05:38,910 +والمعلومات اللى وصلت ل الفوفيا هنا هيرسلوا لنفس + +85 +00:05:38,910 --> 00:05:43,210 +منطقة التحليل من الدماغ و هيدمجوا مع بعضهم البعض + +86 +00:05:43,210 --> 00:05:47,190 +فهيصف إنه الإنسان شايف المنظر اللى إحنا شايفينه + +87 +00:05:47,190 --> 00:05:50,890 +هذا مثلث و معاه دائرة مخربطين مع بعض جايين على بعض + +88 +00:05:50,890 --> 00:05:54,950 +الصورتينهذا بيسمى ال confusion .. هذا بيسمى ال + +89 +00:05:54,950 --> 00:05:58,150 +confusion ممكن إنسان يقول طب هذا يعني إحساس يعني + +90 +00:05:58,150 --> 00:06:02,690 +بسيط أو مافيش فيه إزعاج أو مافيش فيه أي شيء من هذا + +91 +00:06:02,690 --> 00:06:05,790 +القبيل طبعا هذا في ال simulation مافي إزعاج بالمرة + +92 +00:06:05,790 --> 00:06:09,950 +بس احنا لو أجينا نخد أمثلة عملية بنقول هاي إنسان + +93 +00:06:10,790 --> 00:06:13,410 +عنده ال .. ال .. ال .. ال right eye .. الفوفيا + +94 +00:06:13,410 --> 00:06:17,070 +بتاعة ال right eye موجهة باتجاه معين في الفراغ و + +95 +00:06:17,070 --> 00:06:19,970 +صار عنده حول بالعين الشمال إيزوتروبيا، العين دخلت + +96 +00:06:19,970 --> 00:06:24,270 +لجوا فأصبحت مش موجهة بنفس .. بنفس الاتجاه، هذا + +97 +00:06:24,270 --> 00:06:28,900 +الخط المنقط .. هذا الخط المنقطكان المفروض ان + +98 +00:06:28,900 --> 00:06:31,700 +الفوفيا يكون اتجاهها يعني المفروض كانت العين عدلة + +99 +00:06:31,700 --> 00:06:36,460 +و الفوفيا جاية هنا و بتنظر بنفس الاتجاه اللى بتنظر + +100 +00:06:36,460 --> 00:06:39,600 +فيه الفوفيا بتاعة العين اليمين بس مع وجود الحوال + +101 +00:06:39,600 --> 00:06:42,740 +أصبح ال visual direction للفوفيا تاعة ال left eye + +102 +00:06:42,740 --> 00:06:47,940 +بهذا الاتجاه الان صدف عندى انه مقابل الفوفيا تاعة + +103 +00:06:47,940 --> 00:06:51,480 +ال right eye في مبنى اللي هو البيت هذا ذو الطابقين + +104 +00:06:52,350 --> 00:06:56,630 +ومقابل .. ومقابل الفوفيا في العين الشمال صدف في + +105 +00:06:56,630 --> 00:06:58,690 +الفراخ .. طبعا الفوفيا في العين الشمال هي اتجاه + +106 +00:06:58,690 --> 00:07:03,530 +آخر .. صدف شجرة، هاي المنظر اللي بيشوفه المريض، + +107 +00:07:03,530 --> 00:07:08,130 +الشجرة مختلطة .. مختلطة، مش جاية أمام البيت، مش + +108 +00:07:08,130 --> 00:07:10,610 +جاية أمام البيت، لأنها لو جاية أمام البيت، المفروض + +109 +00:07:10,610 --> 00:07:15,760 +إحنا مانشوفش الشباك هذالو جاية أمام البيت، يعني + +110 +00:07:15,760 --> 00:07:19,980 +الشباك هذا يعني .. يعني كأنه متداخل مع ورق الشجرة + +111 +00:07:19,980 --> 00:07:23,720 +وهذه يعني شغلة بتبين قداش الإنسان ممكن ينزعج من + +112 +00:07:23,720 --> 00:07:27,820 +موضوع ال confusion منظر آخر، هذا الإنسان عنده + +113 +00:07:27,820 --> 00:07:34,580 +الحاجتين عنده confusion و عنده diplopia عنده + +114 +00:07:34,580 --> 00:07:37,740 +confusion و عنده diplopia طبعا، عندنا الفوفيا تحت + +115 +00:07:37,740 --> 00:07:43,260 +العين اليمين موجهة باتجاه الشجرةموجهة باتجاه + +116 +00:07:43,260 --> 00:07:46,900 +الشجرة طبعا الـisotropy عنده في العين اليمين عنده + +117 +00:07:46,900 --> 00:07:50,520 +العين اليمين داخلة بزيادة عن اللزوم العين الشمال + +118 +00:07:50,520 --> 00:07:56,420 +تتطلع على البيت هذا البيت بيسقط على الفوفيا وفي + +119 +00:07:56,420 --> 00:08:00,600 +عندي مقابل العين اليمين .. مقابل الفوفيا بتاعة + +120 +00:08:00,600 --> 00:08:05,040 +العين اليمين في شجرة فحيصير عنديمشكلة ال confusion + +121 +00:08:05,040 --> 00:08:08,560 +يعني برضه نفس الاشي اذا ملاحظين انه احنا شايفين + +122 +00:08:08,560 --> 00:08:14,180 +الشباك مختلط مع هذا او حتى اكتر من شباك الشباكين + +123 +00:08:14,180 --> 00:08:18,300 +تمام اندماج صور وهذه الألوان هذه ألوان البيت وهذه + +124 +00:08:18,300 --> 00:08:22,220 +الألوان السودة والغامجة ألوان الشجرة فبالتالي هذه + +125 +00:08:22,220 --> 00:08:25,460 +خربطت الأشياء مع بعضها البعض هذا يتسمى confusion + +126 +00:08:25,460 --> 00:08:30,390 +الموضوع ما .. ماوقفش عند هذه الحدصورة البيت هنا .. + +127 +00:08:30,390 --> 00:08:35,950 +صورة البيت هنا بتسقط على الفوفيا وأيضا بتسقط على + +128 +00:08:35,950 --> 00:08:38,970 +منطقة خارج الفوفيا، احنا بنحكي عن البيت لحاله، + +129 +00:08:38,970 --> 00:08:43,310 +منطقة على الفوفيا في العين الشمال وعلى non-fovial + +130 +00:08:43,310 --> 00:08:46,110 +area في العين اليمين، على nasal retina، على nasal + +131 +00:08:46,110 --> 00:08:49,050 +retina، طبعا ال nasal retina هنا والفوفيا مش + +132 +00:08:49,050 --> 00:08:53,060 +corresponding retinal areasفبالتالي هيرسله لمناطق + +133 +00:08:53,060 --> 00:08:56,880 +مختلفة من الدماغ و هيصير البيت عندي أنا بيتين يعني + +134 +00:08:56,880 --> 00:09:00,560 +عندي ازدواجية البيت صار بيتين و عندي confusion + +135 +00:09:00,560 --> 00:09:06,600 +اللي هو تخربطت صورة البيت مع صورة الشجرة فبالتالي + +136 +00:09:06,600 --> 00:09:11,080 +هذا ال ..الخيال بتاع البيت مصوم بصورة أقل وضوحا .. + +137 +00:09:11,080 --> 00:09:15,100 +أقل يعني غامج أقل يعني ال .. ال .. الصورة الأصلية + +138 +00:09:15,100 --> 00:09:20,440 +اللي هي خربطة مع الشجرة أكثر يعني contrast من + +139 +00:09:20,440 --> 00:09:24,500 +الصورة التانية فعنده dyplopia .. عنده dyplopia وفي + +140 +00:09:24,500 --> 00:09:28,440 +نفس الوجد عنده confusion الآن كيف أفرج بين ال + +141 +00:09:28,440 --> 00:09:32,140 +dyplopia و ال confusion ال dyplopia .. ال dyplopia + +142 +00:09:32,140 --> 00:09:36,440 +صورتين لنفس ال targetصورتين لنفس ال target هاي + +143 +00:09:36,440 --> 00:09:39,760 +target هيله صورة اللي مخربطة من الشجرة وهي الصورة + +144 +00:09:39,760 --> 00:09:44,720 +التانية هذه diplopia ايش سبب ال diplopia سقوط سقوط + +145 +00:09:44,720 --> 00:09:48,300 +صورة ال target على non-corresponding retinal areas + +146 +00:09:48,300 --> 00:09:51,520 +سقطت هنا على الفوفيا و سقطت هنا على ال nasal + +147 +00:09:51,520 --> 00:09:55,280 +retina اللي هي non-corresponding مع الفوفيا مش + +148 +00:09:55,280 --> 00:09:59,460 +مماثلة للفوفيايعني سقوط صورة target واحد عندى + +149 +00:09:59,460 --> 00:10:02,440 +target واحد بس المريض بيشوفه اتنين ليش شافه اتنين + +150 +00:10:02,440 --> 00:10:07,200 +لأنه بسقط على مناطق غير متماثلة من شبكية الانتن + +151 +00:10:07,200 --> 00:10:12,000 +الان ال confusion .. ال confusion عكس ال diplopia + +152 +00:10:12,000 --> 00:10:15,020 +عكس ال diplopia في الميكانزم ان في عندي two + +153 +00:10:15,020 --> 00:10:19,210 +targets مختلفين two targets هنا الشجرة targetو + +154 +00:10:19,210 --> 00:10:23,330 +البيت target البيت سقط على الفوفيا هنا و الشجرة + +155 +00:10:23,330 --> 00:10:27,070 +سقطت على الفوفيا هنا طيب طالما الفوفيا و الفوفيا + +156 +00:10:27,070 --> 00:10:30,130 +بالأساس قبل ما يصير المرض قبل ما يصير الحوال + +157 +00:10:30,130 --> 00:10:33,970 +corresponding retinal areas يعني مكان التحليل + +158 +00:10:33,970 --> 00:10:37,770 +عندهم في الدماغ موحد يعني بصبوا معلوماتهم في نفس + +159 +00:10:37,770 --> 00:10:40,970 +المكان فساعتها هذه الفوفيا هتصب معلوماتها و هي + +160 +00:10:40,970 --> 00:10:45,030 +صورة الشجرة و هذه الفوفيا هتصب معلوماتها و هي صورة + +161 +00:10:45,030 --> 00:10:49,480 +البيت في نفس المكان و الدماغ هيقوم بدمجبدمج + +162 +00:10:49,480 --> 00:10:52,700 +الصورتين في صورة واحدة طبعا صورتين غير قابلات + +163 +00:10:52,700 --> 00:10:57,560 +للدمج صورتين مختلفات يعني different images سقطوا + +164 +00:10:57,560 --> 00:11:00,000 +يعني عندي two targets سقطوا على corresponding + +165 +00:11:00,000 --> 00:11:05,320 +retinal areas بيعطيني confusion two targetsسقطوا + +166 +00:11:05,320 --> 00:11:08,720 +على corresponding retinal areas Target الأول سقط + +167 +00:11:08,720 --> 00:11:12,880 +على الفوفيا و ال target التاني سقط على الفوفيا هاي + +168 +00:11:12,880 --> 00:11:16,500 +الشجرة سقطت على الفوفيا نتبع الضوء اللي جاي من + +169 +00:11:16,500 --> 00:11:19,800 +الشجرة سقط على الفوفيا و الضوء اللي جاي من المنزل + +170 +00:11:19,800 --> 00:11:22,640 +سقط على الفوفيا طب الفوفيا و الفوفيا corresponding + +171 +00:11:22,640 --> 00:11:26,040 +retinal areas إذن two targets بيسقطوا على + +172 +00:11:26,040 --> 00:11:29,380 +corresponding retinal areas هيوحدوا في target واحد + +173 +00:11:29,380 --> 00:11:32,760 +و هذا اللي بنسميه ال confusion اللي هو اللخبطة + +174 +00:11:32,760 --> 00:11:37,820 +اللخبطةاللخبط أو الخربطة لل two images مختلفات عن + +175 +00:11:37,820 --> 00:11:41,540 +بعضهم البعض ال diplopia target واحد ننسى الشجرة + +176 +00:11:41,540 --> 00:11:46,100 +تماما target واحد بيسقط على الفوفيا في عين وبسبب + +177 +00:11:46,100 --> 00:11:49,620 +الحوال بيسقط على non-foveal area سواء nasal أو + +178 +00:11:49,620 --> 00:11:52,500 +temporal أو superior أو inferior بس المهم مابسقطش + +179 +00:11:52,500 --> 00:11:55,640 +على الفوفيا بسقط على الفوفيا في ال left eye مثلا + +180 +00:11:55,640 --> 00:11:59,380 +هنا حسب الرسمة و بسقط على non-foveal area هنا حسب + +181 +00:11:59,380 --> 00:12:03,290 +الرسمة في ال nasal retinaو طبعا ال nasal retina مع + +182 +00:12:03,290 --> 00:12:06,610 +الفوفيا مش corresponding retinal area هيرسلوا + +183 +00:12:06,610 --> 00:12:11,290 +لمناطق مختلفة من الدماغ لتحليلهم وبالتالي هيظل .. + +184 +00:12:11,290 --> 00:12:15,150 +مافيش إمكانية لدمجهم في صورة واحدة و هيظلوا صورتين + +185 +00:12:15,150 --> 00:12:17,930 +وهذا اللي بتسمى diplopia .. وهذا اللي بتسمى + +186 +00:12:17,930 --> 00:12:24,970 +diplopia إذا .. + +187 +00:12:24,970 --> 00:12:28,690 +بنرجع + +188 +00:12:32,240 --> 00:12:36,360 +بنقول confusion is the simultaneous appreciation + +189 +00:12:36,360 --> 00:12:42,940 +هو الالتقاط المتزامن أو الشعور المتزامن بصورتين + +190 +00:12:42,940 --> 00:12:47,000 +جايين فوق بعض ملخبطين مع بعض صورتين ل dissimilar + +191 +00:12:47,000 --> 00:12:50,900 +images أو dissimilar objects caused ليش .. ليش .. + +192 +00:12:50,900 --> 00:12:54,980 +ليش انا اتخربطوا الصور عندى مع بعض؟بالسبب + +193 +00:12:54,980 --> 00:12:58,720 +stimulation of corresponding retinal points، + +194 +00:12:58,720 --> 00:13:02,440 +غالباً الفوفيا، كل فوفيا بيصير لها stimulation ب + +195 +00:13:02,440 --> 00:13:05,720 +target معين، ب image مختلفة عن ال image التانية، + +196 +00:13:05,720 --> 00:13:09,040 +زي ما هي الرسمة هنا بتوضح، by images of different + +197 +00:13:09,040 --> 00:13:12,790 +objects، هذا ال confusionال confusion طبعا احنا + +198 +00:13:12,790 --> 00:13:15,870 +بنقول كالاتي هاي رسمة تانية بتوضح ال confusion هذا + +199 +00:13:15,870 --> 00:13:19,350 +عندي normal .. normal situation binocular single + +200 +00:13:19,350 --> 00:13:22,130 +vision .. binocular single vision صورة ال target + +201 +00:13:22,130 --> 00:13:25,270 +الأحمر تسقط على الفوفيا هنا و صورة ال target + +202 +00:13:25,270 --> 00:13:29,050 +الأحمر تسقط على الفوفيا هنا الوضع طبيعي فيش سكوينت + +203 +00:13:29,050 --> 00:13:34,020 +الفوفيا مع الفوفيافي بينهم correspondence تناسق .. + +204 +00:13:34,020 --> 00:13:37,280 +تناسق يعني لهم نفس ال .. ال visual direction هذه + +205 +00:13:37,280 --> 00:13:39,380 +العين طبعا هي straight ahead و العين straight + +206 +00:13:39,380 --> 00:13:44,020 +ahead يعني معتدلات ال image النهائية ال two .. one + +207 +00:13:44,020 --> 00:13:48,040 +image صح التقتت صورة و صورة بس تم ال fusion و + +208 +00:13:48,040 --> 00:13:51,780 +حصلنا على واحد .. على صورة واحدة ثلاثية الأبعاد + +209 +00:13:51,780 --> 00:13:55,920 +اللي هي binocular single visionفي حالة الحوال .. + +210 +00:13:55,920 --> 00:13:58,960 +هذه العين straight ahead هذه في العين .. في حالة + +211 +00:13:58,960 --> 00:14:02,860 +العين straight ahead هذه العين فيها exo فيها exo + +212 +00:14:02,860 --> 00:14:06,660 +فصدف .. صدف أن هذه العين تتطلع ال target الأحمر + +213 +00:14:06,660 --> 00:14:11,020 +هيجي على ال fovea و هنا صدف أنه لأنها exo .. لأنها + +214 +00:14:11,020 --> 00:14:14,900 +exo صدف أن عجبالها في الفرار المربع الأخضر هيسقط + +215 +00:14:14,900 --> 00:14:17,580 +على ال fovea إذن المربع الأخضر هيسقط على ال fovea + +216 +00:14:17,580 --> 00:14:20,510 +اللي فيها exotropiaفي العين اللي فيها إكسوتروفيا + +217 +00:14:20,510 --> 00:14:23,510 +هيسقط على الـ fovea و ال target الأحمر هيسقط على + +218 +00:14:23,510 --> 00:14:27,130 +ال fovea في العين ال straight ف fovea مع fovea هذه + +219 +00:14:27,130 --> 00:14:30,650 +استقبلت الدائرة الحمرا وهذه استقبلت المربع الأخضر + +220 +00:14:30,650 --> 00:14:35,570 +بما أنهم corresponding retinal areasإذن هيرسلوا + +221 +00:14:35,570 --> 00:14:38,730 +لنفس المنطقة من الدماغ و هيدمجهم الدماغ في صورة + +222 +00:14:38,730 --> 00:14:42,130 +واحدة وهذا المنظر اللي ممكن أو الاحتمال يشوفه + +223 +00:14:42,130 --> 00:14:45,630 +المريض اللي هو confusion لخبطة .. لخبطة اللي هو + +224 +00:14:45,630 --> 00:14:49,070 +الأمور مع بعضها البعض طبعا هذه كلمة straight ahead + +225 +00:14:49,070 --> 00:14:52,050 +هي خطأ مطبعي هنا لأ في Exotopia عندي مش straight + +226 +00:14:52,050 --> 00:14:55,750 +ahead العين وانما هذه العين هي straight ahead + +227 +00:14:55,750 --> 00:14:59,030 +فبالتالي هذا ال confusion .. هذا ال confusion الآن + +228 +00:14:59,030 --> 00:15:02,630 +نحكي عن الشعور التاني اللي بيصير و اللي حكينا .. + +229 +00:15:03,920 --> 00:15:08,420 +عنه في الصور انه بينتج عن انه نفس ال target .. نفس + +230 +00:15:08,420 --> 00:15:12,040 +ال target بيسقط صورته على ال fovea في عين وعلى non + +231 +00:15:12,040 --> 00:15:15,200 +foveal area في العين التانية هو target واحد بس + +232 +00:15:15,200 --> 00:15:18,520 +بنشاف double زي المنزل منشاف منزلين طبعا بيكون + +233 +00:15:18,520 --> 00:15:22,200 +الصورة التانية أقل وضوحا من الصورة الأولىليش + +234 +00:15:22,200 --> 00:15:24,780 +سمناها pathological diplopia؟ pathological + +235 +00:15:24,780 --> 00:15:29,320 +diplopia عشان نفرجها عن ال physiological diplopia + +236 +00:15:29,320 --> 00:15:33,500 +لكل ال targets الموجودة خارج ال pan-infusional + +237 +00:15:33,500 --> 00:15:37,460 +space أبعد من ال pan-infusional space أو أقرب من + +238 +00:15:37,460 --> 00:15:39,940 +ال pan-infusional space وهذه ال physiological + +239 +00:15:39,940 --> 00:15:44,700 +diplopiaاحنا أجريناها بتجربة أننا نمسك جلمين و + +240 +00:15:44,700 --> 00:15:49,040 +واحد نمده أبعد ما يكون و واحد نجربه من وجهنا و لما + +241 +00:15:49,040 --> 00:15:52,300 +نركز بالجلم الجريب هيصير التاني double اللي هو + +242 +00:15:52,300 --> 00:15:55,920 +الجلم الأبعد double لما بنركز بالجلم الأبعد هيصير + +243 +00:15:55,920 --> 00:16:00,240 +الجلم الأقرب يعني نشعر فيه أنه مزدوج أو فيه + +244 +00:16:00,240 --> 00:16:04,180 +diplopia وقولنا هذه physiological diplopia لأنه + +245 +00:16:04,180 --> 00:16:09,470 +الجلم الأول لما بركز فيه الجلم التانيبيكون خارج ال + +246 +00:16:09,470 --> 00:16:12,670 +pan-infusional space إذا لازم ينشاف double ولمّا + +247 +00:16:12,670 --> 00:16:16,010 +بركز في الجلم التاني الجلم الأول بنشاف double لأنه + +248 +00:16:16,010 --> 00:16:20,130 +خارج ال pan-infusional space فبالتالي لازم ينشاف + +249 +00:16:20,130 --> 00:16:23,470 +double مابيصيرلهوش infusion وقلنا إن الغالبية + +250 +00:16:23,470 --> 00:16:25,890 +العظمة من البشر مابشعروش بال physiological + +251 +00:16:25,890 --> 00:16:29,270 +dyplopia لأنها مصاحبة من قبل ال brain ب + +252 +00:16:29,270 --> 00:16:33,060 +physiological suppression تثبيتللرؤية المزدوجة + +253 +00:16:33,060 --> 00:16:35,640 +يعني ال brain بيكون مركز في ال target اللي هو مركز + +254 +00:16:35,640 --> 00:16:38,560 +فيه ومالوش علاقة في ال target ال .. او ال target + +255 +00:16:38,560 --> 00:16:41,240 +اللي بعيدة اللي هي برّات اللي فيها ال panem في + +256 +00:16:41,240 --> 00:16:44,260 +genal space طبعا هذهك ال physiological diplopia طب + +257 +00:16:44,260 --> 00:16:47,380 +إيش ال physiological diplopia هي ازدواجية مرضية؟ + +258 +00:16:47,380 --> 00:16:50,860 +يعني ناتجة عن موجود حول، ناتجة عن موجود حول في + +259 +00:16:50,860 --> 00:16:54,580 +موضوع ال binocular single في جنةإذا pathological + +260 +00:16:54,580 --> 00:16:58,100 +diplopia is the simultaneous appreciation الشعور + +261 +00:16:58,100 --> 00:17:02,920 +في نفس اللحظة of two images of the same object in + +262 +00:17:02,920 --> 00:17:06,880 +different positions in space and results ليش؟ ليش + +263 +00:17:06,880 --> 00:17:10,850 +بيصير؟ ليش أنا بشعر أن الشغل شايفها تنتين؟المنزل + +264 +00:17:10,850 --> 00:17:13,510 +شايفه اتنين، الجلم شايفه اتنين، السيارة شايفها + +265 +00:17:13,510 --> 00:17:16,670 +اتنين، الشخص شايفه اتنين، الأصبع .. أصبع إيدي أنا + +266 +00:17:16,670 --> 00:17:19,970 +شايفه اتنين أو الخمس أصابع شايفهم كأنهم عشر أصابع، + +267 +00:17:19,970 --> 00:17:23,430 +ليش هذه الكلام؟ لأن أنا بشعر بالشغلة أنه في + +268 +00:17:23,430 --> 00:17:28,350 +إزدواجية في الرؤية بسبب سقوط صور هذه الأشياء على + +269 +00:17:28,350 --> 00:17:33,830 +مناطق غير متماثلة من شبكية الـ Antennaeسقوطها على + +270 +00:17:33,830 --> 00:17:38,030 +مناطق غير متماثلة ل brain بيرفض يعملها fusion لأن + +271 +00:17:38,030 --> 00:17:42,750 +ال brain عنده شرط أنه تسقط الصور على مناطق متماثلة + +272 +00:17:42,750 --> 00:17:48,330 +حتى يستطيع أنه يعملها fusion .. fusion عفوا و يدمج + +273 +00:17:48,330 --> 00:17:52,870 +الصورتين في صورة واحدة إذا ال .. ال pathological + +274 +00:17:52,870 --> 00:17:57,750 +diplopia resultsfrom images of the same object هو + +275 +00:17:57,750 --> 00:18:01,150 +object واحد بس هدول ال two images واحدة للعين + +276 +00:18:01,150 --> 00:18:03,830 +اليمين واحدة للعين الشمال falling on non + +277 +00:18:03,830 --> 00:18:06,910 +-corresponding retinal points falling on non + +278 +00:18:06,910 --> 00:18:12,330 +-corresponding retinal points الان + +279 +00:18:12,330 --> 00:18:18,210 +لا يكفي .. لا يكفي ان اقول ان واللهDiplopia و خلاص + +280 +00:18:18,210 --> 00:18:22,550 +يعني المريض مش من ازدواجية و فقط الازدواجية فيه + +281 +00:18:22,550 --> 00:18:26,630 +لها تجسيمات كتيرة اول تجسيمة بدنا نشوف هل هي + +282 +00:18:26,630 --> 00:18:31,410 +crossed diplopia ولا uncrossed diplopia ايش يعني + +283 +00:18:31,410 --> 00:18:34,010 +crossed diplopia ولا uncrossed diplopia و امتى + +284 +00:18:34,010 --> 00:18:37,350 +بنلاحظ هاي و امتى بنلاحظ التانية احنا بنقول + +285 +00:18:37,350 --> 00:18:43,050 +كالعاتيننسى موضوع الشجرة الآن، نتخيل أن الشجرة مش + +286 +00:18:43,050 --> 00:18:46,630 +موجودة، هاي أنا عندي منزل أمام العين تان، العين + +287 +00:18:46,630 --> 00:18:50,610 +الشمال straight، العين اليمين جاية لجوا، كيف بعرف + +288 +00:18:50,610 --> 00:18:53,070 +أن العين اليمين هي الاسوتروبيا؟ لأن الفوفيا جاية + +289 +00:18:53,070 --> 00:18:55,850 +لبرا، الفوفيا إذا ما قرنا أن موقع الفوفيا هي + +290 +00:18:55,850 --> 00:18:58,840 +الفوفيا اللي عليها حرف ال Fوهي الفوفيا اللي عليها + +291 +00:18:58,840 --> 00:19:02,080 +حرف ال F هذه جاية لبرا شوية جاية temporal طالما + +292 +00:19:02,080 --> 00:19:04,960 +الفوفيا جاية temporal معناته العين جاية نزل ال + +293 +00:19:04,960 --> 00:19:07,900 +anterior part الكون يعني داخل إلى جوا باتجاه النزل + +294 +00:19:07,900 --> 00:19:13,940 +إذا هذه فيها إيزوتروبيا إيزوتروبيا طيب الآن سقط + +295 +00:19:13,940 --> 00:19:19,760 +سقطصورة البيت على الفوفيا هنا هذه العين هتشوف ال + +296 +00:19:19,760 --> 00:19:24,280 +target أمامها مباشرة لإن الفوفيا بتعطي شعور بال + +297 +00:19:24,280 --> 00:19:29,200 +straight ahead direction أو بال direct vision أي + +298 +00:19:29,200 --> 00:19:32,340 +صورة target .. أي صورة target بتسقط عندي على + +299 +00:19:32,340 --> 00:19:36,400 +الفوفيا أو عند أي إنسان على الفوفيا بتعطي شعور إن + +300 +00:19:36,400 --> 00:19:38,920 +هذا ال target موجود أمامه تماما .. أمام العين + +301 +00:19:38,920 --> 00:19:43,790 +تماما .. طيبالآن أي شيء بيسقط على ال nasal retina + +302 +00:19:43,790 --> 00:19:47,150 +زي الصورة هنا طالما العين جاية إيزوتروبيا إذن صورة + +303 +00:19:47,150 --> 00:19:51,250 +المنزل هتسقط على ال nasal retina ال nasal retina + +304 +00:19:51,250 --> 00:19:55,810 +مواجهة لل temporal field مواجهة لل temporal field + +305 +00:19:55,810 --> 00:19:59,950 +يعني بمعنى آخر هتكون الصورة طالما سقطت الصورة على + +306 +00:19:59,950 --> 00:20:03,970 +nasal retina ال projection تاع ال nasal retina + +307 +00:20:03,970 --> 00:20:06,630 +temporal temporal بالنسبة لهذه العين يعني هيكون + +308 +00:20:06,630 --> 00:20:11,330 +الصورة التانية جاية هناجاية هنا زي ما المنظر هذا + +309 +00:20:11,330 --> 00:20:15,230 +بيوضع هي العين اليمين وهي العين الشمال هي العين + +310 +00:20:15,230 --> 00:20:18,790 +اليمين وهي العين الشمال كل واحدة العين اليمين شافت + +311 +00:20:18,790 --> 00:20:23,230 +الصورة هنا باتجاهها والعين الشمال شافت الصورة + +312 +00:20:23,230 --> 00:20:27,050 +باتجاهها يعني كل صورة على ناحية العين بتاعتها هذه + +313 +00:20:27,050 --> 00:20:29,990 +الصورة ناحية العين بتاعتها وهذه الصورة ناحية العين + +314 +00:20:29,990 --> 00:20:33,470 +بتاعتها يعني نتخيل احنا الان واقفين أمام الشاشة + +315 +00:20:33,470 --> 00:20:37,890 +نتخيل الشجرة هاي مش موجودةوكل إنسان من عينه اليمين + +316 +00:20:37,890 --> 00:20:41,170 +الآن ع جبال المنزل هذا وعينه الشمال ع جبال المنزل + +317 +00:20:41,170 --> 00:20:44,450 +هذا يعني العين اليمين على جبال هذه الصورة بتاعتها + +318 +00:20:44,450 --> 00:20:48,970 +اللي شفتها و .. كيف يعرفنا انه بتاعتها؟ طبعا لما + +319 +00:20:48,970 --> 00:20:52,900 +الصورة بتسقط على ..non-foveal area الوضوح بيكون + +320 +00:20:52,900 --> 00:20:57,160 +أقل لأن أكثر منطقة أحد إبصارا في كل من العين تانية + +321 +00:20:57,160 --> 00:21:00,440 +الفوفيا إذا بعدنا عن الفوفيا بتبدأ حدث الإبصار و + +322 +00:21:00,440 --> 00:21:03,860 +وضوح الصورة يقل فهنا الصورة واضحة احنا نقول ننسى + +323 +00:21:03,860 --> 00:21:07,800 +الشجرة تمام هذه الصورة بتاعة العين الشمال وهذه + +324 +00:21:07,800 --> 00:21:10,660 +الصورة بتاعة العين اليمين لو وقفنا أمام الصورة هاي + +325 +00:21:10,660 --> 00:21:16,870 +وجربناوجهنا من شاشة الكمبيوتر او شاشة ال laptop + +326 +00:21:16,870 --> 00:21:20,690 +هنلاحظ ان الصورة .. عفوا ان الصورة بتاعة العين + +327 +00:21:20,690 --> 00:21:25,430 +اليمين جاية ناحيت العين اليمين و الصورة بتاعة + +328 +00:21:25,430 --> 00:21:28,630 +العين الشمال جاية ناحيت العين الشمال هذه بسمها + +329 +00:21:28,630 --> 00:21:32,970 +uncrossed diplopia uncrossed diplopia يعني .. + +330 +00:21:32,970 --> 00:21:35,950 +diplopia كل عين بتشوف صورتها ناحيتها في الفراغ + +331 +00:21:35,950 --> 00:21:38,830 +ناحيتها في الفراغ ناحيتها فبتسمى uncrossed + +332 +00:21:38,830 --> 00:21:42,690 +diplopia ال uncrossed diplopiaال uncrossed + +333 +00:21:42,690 --> 00:21:47,470 +diplopia بتنشاف في الاسوتروبيا .. في الاسوتروبيا + +334 +00:21:47,470 --> 00:21:50,650 +the diplopia is homonymous متجانسة .. إيش يعني + +335 +00:21:50,650 --> 00:21:53,670 +متجانسة؟ يعني uncrossed .. إيش يعني uncrossed؟ + +336 +00:21:53,670 --> 00:21:57,730 +يعني كل عين بتشوف الصورة بتاعتها ناحيتها على جهتها + +337 +00:21:58,040 --> 00:22:01,520 +على جهتها بينما في ال Exotropia الصورة بتكون + +338 +00:22:01,520 --> 00:22:05,380 +across .. بالصورة بتكون across هذه Exotropia .. + +339 +00:22:05,380 --> 00:22:08,880 +هذه Exotropia الصورة اللي هي أقل وضوحا باتجاه + +340 +00:22:08,880 --> 00:22:11,880 +العين اللي فيها الحوالي طبعا منطقة التقاطع دول + +341 +00:22:11,880 --> 00:22:15,720 +الخاطين بيقول لي هنا موقع الفوفيا هنا سقطت صورة ال + +342 +00:22:15,720 --> 00:22:18,680 +target الأحمر على nasal retina طالما على nasal + +343 +00:22:18,680 --> 00:22:22,330 +retina ال projection بتاعهاtemporal أي إشي بسقط + +344 +00:22:22,330 --> 00:22:25,470 +عندى عنه ذريتنا أنا بشعر فيه temporal طالما + +345 +00:22:25,470 --> 00:22:28,330 +temporal إذا .. إذا على نفس جهة عينى إذا هذه + +346 +00:22:28,330 --> 00:22:30,910 +الصورة شفتها العين اليمين و هذه الصورة شفتها العين + +347 +00:22:30,910 --> 00:22:35,050 +الشمال كل .. كل صورة من الصور جاية ناحية العين + +348 +00:22:35,050 --> 00:22:38,430 +اللى شفتها فبالتالي هذا يتسمى uncrossed diplopia + +349 +00:22:38,430 --> 00:22:42,410 +.. uncrossed diplopia الآن بنشوف كيف ال diplopia + +350 +00:22:42,410 --> 00:22:45,190 +طبعا في ال Exotropia العكس .. في ال Exotropia + +351 +00:22:45,190 --> 00:22:49,460 +العكسهي انا عندى Exotropia .. هى انا عندى + +352 +00:22:49,460 --> 00:22:53,240 +Exotropia بدنا ننسى المربع الأخضر .. بدنا ننسى + +353 +00:22:53,240 --> 00:22:56,740 +المربع الأخضر و بدنا ننسى قضية ال confusion الصورة + +354 +00:22:56,740 --> 00:23:00,780 +هنا هتسقط على ال phobia .. هذه العين هتشوف الصورة + +355 +00:23:00,780 --> 00:23:04,000 +ال target الأحمر straight ahead طيب .. هنا هتسقط + +356 +00:23:04,000 --> 00:23:07,780 +على temporal retina لما بتسقط صورة ال target + +357 +00:23:07,780 --> 00:23:11,360 +الأحمر على temporal retina ال projection بتاع ال + +358 +00:23:11,360 --> 00:23:15,190 +temporal retina نازلييعني هذه العين هتشوف الصورة + +359 +00:23:15,190 --> 00:23:18,650 +هنا فهذا بتسمى crossed diplopia ال crossed + +360 +00:23:18,650 --> 00:23:21,370 +diplopia في ال Exotropia في عندي أنا crossed + +361 +00:23:21,370 --> 00:23:26,060 +diplopiain Exotropia the diplopia is heteronymous + +362 +00:23:26,060 --> 00:23:30,080 +غير متجانسة الازدواجية غير متجانسة يعني ايش غير + +363 +00:23:30,080 --> 00:23:33,480 +متجانسة يعني crossed يعني كل .. كل صورة العين + +364 +00:23:33,480 --> 00:23:36,920 +بتكون عن ناحية التانية باتجاه العين التاني يعني + +365 +00:23:36,920 --> 00:23:41,240 +صورة ال target الأول العين هاي بتشوف ال target + +366 +00:23:41,240 --> 00:23:45,910 +صحيح هيك بس العين هاي بتشوف ال target هناكإذا ال + +367 +00:23:45,910 --> 00:23:48,870 +target هذا اللي هو صورة العين high جاي عن ناحية + +368 +00:23:48,870 --> 00:23:52,150 +التانية يعني أقرب للعين التانية و هذا هيكون أقرب + +369 +00:23:52,150 --> 00:23:55,810 +للعين الأولى فبالتالي هذه cross diplopia إذا إنسان + +370 +00:23:55,810 --> 00:24:00,910 +يعني في الامتحان مطلخبط كلمة exotropia بتحتوي على + +371 +00:24:00,910 --> 00:24:06,270 +كلمة X أو على حرف X X يعني cross diplopia بيضل .. + +372 +00:24:06,270 --> 00:24:09,910 +بيضل عندي خيار آخر اللي هو ال esotropia uncrossed + +373 +00:24:09,910 --> 00:24:15,120 +إذا ال exotropia crossedلأن في حرف ال X طبعا احنا + +374 +00:24:15,120 --> 00:24:18,660 +هذا الكلام اللي سبجنا فيه هو الشرح ليش؟ بينما + +375 +00:24:18,660 --> 00:24:22,520 +الisotropia unacrossed .. unacrossed ممكن زي يقول + +376 +00:24:22,520 --> 00:24:25,540 +طب يعني و هذي يعني جدية كبيرة للdiplomia بيقول + +377 +00:24:25,540 --> 00:24:30,360 +اتفرجنتفرج مع بعض، هاي إنسان ممكن يشعر بال double + +378 +00:24:30,360 --> 00:24:34,380 +vision بالشكل هذا، طبعا ب .. ب .. بصعوبة بنقرأ، + +379 +00:24:34,380 --> 00:24:38,020 +بنقول how text appears if you have double vision، + +380 +00:24:38,020 --> 00:24:41,240 +يعني كيف النص أو كيف الكتابة بتبين لما أنت يكون + +381 +00:24:41,240 --> 00:24:45,220 +عندك ازدواجية في الرؤية، فبالتالي هذه القضية ضروري + +382 +00:24:45,220 --> 00:24:49,280 +احنا نتذكرها، ضروري نتذكرها، ايضا نفس القضية، هذه + +383 +00:24:49,280 --> 00:24:53,620 +dyplopia، طبعا ايضا غير قضية crossed و uncrossed + +384 +00:24:54,890 --> 00:24:58,770 +غير قضية crossed و uncrossed في أنواع من ال + +385 +00:24:58,770 --> 00:25:01,650 +diplopia تجسيمات تانية هذه horizontal diplopia ان + +386 +00:25:01,650 --> 00:25:04,930 +ال two targets ال two images بيبينوا جنب بعضهم + +387 +00:25:04,930 --> 00:25:08,470 +البعض مش فوق بعضهم البعض هذه horizontal diplopia + +388 +00:25:08,470 --> 00:25:12,490 +إيش ممكن يفيدني هذا الكلام؟ معناته في خلل عندي في + +389 +00:25:12,490 --> 00:25:16,230 +واحدة من ال horizontal muscles بمعنى آخر يعني في + +390 +00:25:16,230 --> 00:25:21,120 +عندي ..في كل العين في عضلتين horizontal muscles ال + +391 +00:25:21,120 --> 00:25:24,400 +media rectus و ال lateral rectus في ال right eye و + +392 +00:25:24,400 --> 00:25:26,960 +ال media rectus و ال lateral rectus في ال left eye + +393 +00:25:26,960 --> 00:25:30,740 +ممكن واحدة فيهم تكون فيها مشكلة ما .. مشكلة ما .. + +394 +00:25:30,740 --> 00:25:33,460 +اذا هذه horizontal diplopia لازم اعرف الدبلوبيا هل + +395 +00:25:33,460 --> 00:25:37,640 +هي horizontal ولا vertical هنا أنواع من الدبلوبيا + +396 +00:25:37,640 --> 00:25:43,410 +.. horizontal diplopiaهنا vertical diplopia هنا في + +397 +00:25:43,410 --> 00:25:46,970 +عندى حاجة بيسموها oblique او torsional diplopia مع + +398 +00:25:46,970 --> 00:25:51,010 +انه في رسم اوضح من هذه القضية و من نوع ال diplopia + +399 +00:25:51,010 --> 00:25:55,270 +ممكن انا ابدأ احصر ايش العضلات اللى ممكن يكون فيها + +400 +00:25:55,270 --> 00:25:59,730 +اشكالية هنا عندى يعني منظر رائع جدا لانسان عنده + +401 +00:25:59,730 --> 00:26:04,070 +torsional diplopia كيف torsional diplopia هاي + +402 +00:26:04,070 --> 00:26:08,360 +السيارة ناخد السيارة هايهذه معتادة على الأسفل + +403 +00:26:08,360 --> 00:26:11,540 +صورتها وخيالها مائل يعني لو شوف نساق في السيارة + +404 +00:26:11,540 --> 00:26:15,850 +هنا عامل خط أفقيبينما هنا سجف السيارة نفسها الصورة + +405 +00:26:15,850 --> 00:26:19,190 +التانية مائي الميالان يعني بينهم لو مدناهم كخطوط + +406 +00:26:19,190 --> 00:26:23,330 +هتكون بينهم زاوية اذا هذه مش vertical فقط ولا + +407 +00:26:23,330 --> 00:26:27,590 +horizontal فقط هذه torsional diplopia يعني في + +408 +00:26:27,590 --> 00:26:31,430 +مشكلة عندى في ال N cyclotorsion او ال X + +409 +00:26:31,430 --> 00:26:34,370 +cyclotorsion يعني ال oblique muscle ممكن يكون في + +410 +00:26:34,370 --> 00:26:38,390 +لها علاقة في هذا الموضوع torsional diplopia ايضا + +411 +00:26:38,390 --> 00:26:44,720 +السيارة التانية هنا هذه السيارةزي اللون ال beige + +412 +00:26:44,720 --> 00:26:49,680 +او ال .. اه ال beige تقريبا او بين beige و أخضر + +413 +00:26:49,680 --> 00:26:54,640 +هاي أحد الصورتين ساكت في السيارة هيو معتدل الصورة + +414 +00:26:54,640 --> 00:26:58,940 +التانية يعني مائل هذه torsional diplopia .. هذه + +415 +00:26:58,940 --> 00:27:02,520 +torsional diplopia أيضا هذه نموذج لل torsional + +416 +00:27:02,520 --> 00:27:06,000 +diplopia هاي الصورة الأساسية للعين السليمة ال + +417 +00:27:06,000 --> 00:27:09,640 +fixating eye my child has blue eyes and brown hair + +418 +00:27:10,340 --> 00:27:13,940 +العين التانية اللي فيها مشكلة في ال encyclotortion + +419 +00:27:13,940 --> 00:27:19,100 +او excyclotortion my child has blue eyes and brown + +420 +00:27:19,100 --> 00:27:23,320 +hair واضح انه فيه ميلان في الخط مائليعني .. يعني + +421 +00:27:23,320 --> 00:27:28,080 +مش مجرد أنه نازل مثلا بشكل موازي للخط الأول ولكن + +422 +00:27:28,080 --> 00:27:33,000 +أيضا فيه طبعا ميلان فيه و هو أقل وضوحا لأنه جاي من + +423 +00:27:33,000 --> 00:27:36,080 +ال squinting eye غالبا جاي من ال squinting eye + +424 +00:27:36,080 --> 00:27:39,640 +فهذه مثال على ال torsional diplopia إذا الدبلوبيا + +425 +00:27:39,640 --> 00:27:43,260 +ضروري جدا ما أنساش في منها crossed و في uncrossed + +426 +00:27:43,260 --> 00:27:46,640 +ال crossed في ال Exotropia بلجيها و ال uncrossed + +427 +00:27:46,640 --> 00:27:52,270 +في ..في الـ Esotropia هذه التجسيمة الأولى لـ + +428 +00:27:52,270 --> 00:27:55,550 +Diplopia في تجسيمة تانية بس قبل ما نحكي التجسيمة + +429 +00:27:55,550 --> 00:27:57,790 +التانية اللي قبل شوية حكيتها ممكن نقول إنسان إيش + +430 +00:27:57,790 --> 00:28:00,330 +الفايدة؟ طب ما أنا خلاص ال Esotropia معروفة و ال + +431 +00:28:00,330 --> 00:28:03,950 +Exotropia معروفة أحيانا بيكون كمية الحوال خفيفة + +432 +00:28:03,950 --> 00:28:07,290 +جدا لدرجة إنه على الفعص ممكن ما تبينش وماقدرش + +433 +00:28:07,290 --> 00:28:10,610 +أعرفها إلا بفحوصات ال Diplopia أو بسؤال المريض + +434 +00:28:10,610 --> 00:28:14,530 +الصورة الأقل واضحا جاية عيمينك و لا عشمالك جاية + +435 +00:28:14,530 --> 00:28:20,880 +عيمينك و لا عشمالكأنا مثلا مش شايف يعني إلا أسكنت + +436 +00:28:20,880 --> 00:28:23,920 +بسيط أو مش شايف يعني بالفحص مش مبين معاه ممكن من + +437 +00:28:23,920 --> 00:28:27,680 +ضمن ال history أني أخمن وين المشكلة أو هل هي + +438 +00:28:27,680 --> 00:28:31,480 +crossed diplopia يعني أنا بحكي عن exo ولا non + +439 +00:28:31,480 --> 00:28:35,720 +-crossed أو uncrossed بحكي عن isoitropia إذا في + +440 +00:28:35,720 --> 00:28:39,510 +عندي vertical diplopia زي ما أحنا شايفينفى عندى + +441 +00:28:39,510 --> 00:28:42,430 +horizontal diplopia فى عندى هنا horizontal + +442 +00:28:42,430 --> 00:28:45,730 +diplopia الجلم مشيوف اتنين عندى هنا vertical + +443 +00:28:45,730 --> 00:28:48,790 +diplopia اتنين بس فوق بعض هنا torsional diplopia + +444 +00:28:48,790 --> 00:28:53,150 +بس الرسمة مش كتير موفقة .. مش كتير موفقة هنا يعني + +445 +00:28:53,150 --> 00:28:57,410 +صورة بتوضح ال torsional diplopia بشكل واضح جدا .. + +446 +00:28:57,410 --> 00:29:02,190 +بشكل واضح جدا يمكن احنا كمان لو يعني نظرنا في + +447 +00:29:02,190 --> 00:29:07,320 +العمق على الآخر هنلاقي الجسرهنلاقي الجسر و هنلاقي + +448 +00:29:07,320 --> 00:29:11,120 +الجسر المائل .. الجسر المائل هي اللي هي الأعمدة + +449 +00:29:11,120 --> 00:29:13,220 +اللي على الجسر وهي الأعمدة اللي على الجسر مائلة + +450 +00:29:13,220 --> 00:29:16,680 +كأنه الجسر مائل كأنه .. كأنه بينهم زاوية .. كأنه + +451 +00:29:16,680 --> 00:29:19,620 +بينهم زاوية retortional diplopia بنسبة مائة + +452 +00:29:19,620 --> 00:29:22,940 +بالمائة الآن لو طلبنا من المريض يغطي أي عين من + +453 +00:29:22,940 --> 00:29:27,410 +العين تانية هتلاقي أحد الجسور راحيعني العين اليمين + +454 +00:29:27,410 --> 00:29:30,990 +لو هي شايفة هذا الخط المائل أو الجسر المائل مجرد + +455 +00:29:30,990 --> 00:29:34,450 +ما نغطي اليمين هيروح هذا الخط طب لو فتحنا اليمين + +456 +00:29:34,450 --> 00:29:38,970 +وغطينا الشمال هيروح الخط المعتدل وكل الإزدواجية ال + +457 +00:29:38,970 --> 00:29:42,390 +binocular diplopia يعني الدبلوبيا اللي بتكون وانا + +458 +00:29:42,390 --> 00:29:46,690 +مفتح عينيا التنتين لو غطيت أي عين من العنتين بتروح + +459 +00:29:46,690 --> 00:29:49,030 +الإزدواجية .. بتروح الإزدواجية + +460 +00:29:51,520 --> 00:29:57,700 +هنتوقف عند هنا عشان نعرف إيش الدماغ بيتاخذ خطوات + +461 +00:29:57,700 --> 00:30:00,660 +للتأقلم على هذه ال sensation اللي احنا حكينا عنها + +462 +00:30:00,660 --> 00:30:04,920 +اللي هي ال confusion و ال pathological dyplopia و + +463 +00:30:04,920 --> 00:30:09,180 +يعطيكم العافية و السلام عليكم و رحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/zmdPbqFsHCw_postprocess.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/zmdPbqFsHCw_postprocess.srt new file mode 100644 index 0000000000000000000000000000000000000000..abc1b9496638a71ba1c7eaa4e23ffdc0be6b00f7 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/zmdPbqFsHCw_postprocess.srt @@ -0,0 +1,1832 @@ +1 +00:00:00,790 --> 00:00:04,610 +بسم الله الرحمن الرحيم بنواصل مع محاضرات حوال واحد + +2 +00:00:04,610 --> 00:00:09,730 +والموضوع اللي كنا بصدده المحاضرة الماضية كان هو + +3 +00:00:09,730 --> 00:00:13,510 +testing visual acuity أو assessment of visual + +4 +00:00:13,510 --> 00:00:16,630 +behavior in preverbal children وعدينا على عدة + +5 +00:00:16,630 --> 00:00:22,010 +فحوصات منها ال fixation and following وعدينا أيضا + +6 +00:00:22,010 --> 00:00:24,850 +على ال comparison between the behavior of the two + +7 +00:00:24,850 --> 00:00:32,020 +eyes وعدينا أيضا على ال fixation behaviorلما بغطي + +8 +00:00:32,020 --> 00:00:34,600 +العين اللي مافيش فيها squint بشوف تصرف العين اللي + +9 +00:00:34,600 --> 00:00:37,500 +فيها ال squint هل اللي في عندها central fixation و + +10 +00:00:37,500 --> 00:00:40,940 +لا مش central هل هو steady و لا مش steady و لما + +11 +00:00:40,940 --> 00:00:44,900 +برفع الغطاء ايش السيناريوهات المحتملة و ايضا حكينا + +12 +00:00:44,900 --> 00:00:48,580 +اخر شيء عن ال 10-prism vertical test عشان احداث + +13 +00:00:48,580 --> 00:00:52,660 +دبلوبيا في ال target اللي بتطلع عليه ال infant دال + +14 +00:00:52,660 --> 00:00:56,880 +بس شيء بسيط جدا في ال 10-prism test هنشوفه بال + +15 +00:00:56,880 --> 00:00:57,540 +simulation + +16 +00:01:00,210 --> 00:01:03,630 +هي أنا عندي تن برزم لنفرض هذا infant pre verbal + +17 +00:01:03,630 --> 00:01:08,310 +يعني ما اتكلمش لسه و حطينا أمامه ال target هذا هو + +18 +00:01:08,310 --> 00:01:11,950 +بتطلع straight على ال target هذا روحت أنا حطيت + +19 +00:01:11,950 --> 00:01:16,210 +vertical برزم سواء base up أو base down زي ما هي + +20 +00:01:16,210 --> 00:01:20,130 +الصورة عندي هنا base down لمجرد ما حطينا عيني + +21 +00:01:20,130 --> 00:01:23,310 +التنتين اتجهوا للأعلى طبعا معناته العين الشمال هي + +22 +00:01:23,310 --> 00:01:27,550 +اللي بتركزليش؟ لأنه لما حطيت ال Prism الصورة ال + +23 +00:01:27,550 --> 00:01:30,790 +Prism بنجل الصورة باتجاه ال apex بتاعه فطالما + +24 +00:01:30,790 --> 00:01:34,770 +الطفل اتطلع على فوق معناته هو ال target بالنسبة له + +25 +00:01:34,770 --> 00:01:38,110 +أصبح لفوق معناته العين الشمال هي اللي بتركز لو أنا + +26 +00:01:38,110 --> 00:01:41,330 +حطيت ال Prism وضلوا العينين straight زي ما هم + +27 +00:01:41,330 --> 00:01:44,570 +معناته عينه اليمين هي اللي بتركز طيب لو أنا حطيت + +28 +00:01:44,570 --> 00:01:47,430 +ال Prism و مرة بتطلع لفوق و مرة بتطلع straight + +29 +00:01:47,430 --> 00:01:51,670 +معناته both eyesيعني في بينهم alternate fixation + +30 +00:01:51,670 --> 00:01:55,530 +between the global targets وبالتالي في عندي تقريبا + +31 +00:01:55,530 --> 00:01:59,730 +equal vision في العينتين في العينتين هذا بالنسبة + +32 +00:01:59,730 --> 00:02:04,210 +لل test رقم أربعة نيجي لل test رقم خمسة واللي هو + +33 +00:02:04,210 --> 00:02:09,790 +بيحكي عن ال rotation test ال rotation testis a + +34 +00:02:09,790 --> 00:02:12,970 +gross qualitative test طبعا qualitative test كل ال + +35 +00:02:12,970 --> 00:02:15,190 +testات اللي احنا عدينا عليها هي عبارة عن + +36 +00:02:15,190 --> 00:02:21,890 +qualitative tests يعني بتعطيني فكرة عن جودة النظر + +37 +00:02:21,890 --> 00:02:26,610 +هل هو جيد ولا متوسط ولا سيء بس ما بتعطيش رقم يعني + +38 +00:02:26,610 --> 00:02:30,090 +مش quantitative مش quantitative ال rotation test + +39 +00:02:30,090 --> 00:02:33,510 +ايضا احد ال qualitative tests اللي بستعملهم مع ال + +40 +00:02:33,510 --> 00:02:38,320 +preverbal children بيمكنني ال rotation testطبعا هو + +41 +00:02:38,320 --> 00:02:41,700 +عبارة عن ال gross test يعني مش دقيق للغاية ولكن + +42 +00:02:41,700 --> 00:02:46,100 +بيمكنني ان اعرف هل الطفل قادر انه يعمل fixation + +43 +00:02:46,100 --> 00:02:51,120 +with both eyes open ومفتح عينيتين تين يعني هل في + +44 +00:02:51,120 --> 00:02:54,980 +عنده قدرة انه يعمل fixation with both eyes open + +45 +00:02:54,980 --> 00:02:58,800 +اذا كان القدرة هاي موجودة معناته النظر عنده لا بأس + +46 +00:02:58,800 --> 00:03:03,440 +به اذا كان القدرة هاي مش موجودة معناته ال .. ال .. + +47 +00:03:05,020 --> 00:03:09,240 +النظر فيه مشكلة ما ال test is performed as follows + +48 +00:03:09,240 --> 00:03:12,720 +كيف بنعمل ال rotation test هو الحاجة ال examiner + +49 +00:03:12,720 --> 00:03:16,960 +بيحمل الطفل facing him يعني وجهه لوجهه فبالتالي + +50 +00:03:16,960 --> 00:03:21,060 +أنا بحمل .. بحمل الطفل الرضيع و بقى واجهه بطلع + +51 +00:03:21,060 --> 00:03:26,380 +عينيا في عينيه و بعدين بدور فيه دورة بسرعة دورة + +52 +00:03:26,380 --> 00:03:30,080 +واحدة تلت مية و ستيندرجة يعني مابضل أدور فيه ولكن + +53 +00:03:30,080 --> 00:03:34,460 +دورة واحدة ثم بتوقف إذا كان ال vision normal إيش + +54 +00:03:34,460 --> 00:03:37,220 +اللي بيحدث وإذا كان ال vision abnormal إيش اللي + +55 +00:03:37,220 --> 00:03:41,640 +بيحدث إذا كان عندي ال vision normal بنلاقي العينين + +56 +00:03:41,640 --> 00:03:45,700 +بتتحركوا باتجاه الدورانو بعدين بيعودوا ل ال + +57 +00:03:45,700 --> 00:03:48,220 +primary position يعني بيصير عنده nestagmas + +58 +00:03:48,220 --> 00:03:51,780 +nestagmas هذا ال nestagmas بيشوف بيسموه rotation + +59 +00:03:51,780 --> 00:03:56,400 +nestagmas العينين إذا أنا بتحرك الدورة بتاعتي أو + +60 +00:03:56,400 --> 00:03:59,640 +اللفة بتاعتي من اليمين للشمال عينيه بيصيروا + +61 +00:03:59,640 --> 00:04:04,940 +يتحركوا من اليمين للشمال باتجاه الدوران بتاعي و + +62 +00:04:04,940 --> 00:04:08,200 +بعد هيك بيرجعوا ل ال primary position ل ال central + +63 +00:04:08,200 --> 00:04:11,960 +position عشان يلاحظوا ال field المتحركيعني ال + +64 +00:04:11,960 --> 00:04:14,820 +field بتحرك لما أنا بدور، ال field أمام الطفل + +65 +00:04:14,820 --> 00:04:17,720 +بتحرك، فبالتالي عينيه بيحاولوا يلاحجوا، فبيصير + +66 +00:04:17,720 --> 00:04:23,750 +عنده rotation stigmaهذا تحت تأثير ما يسمى بالـ + +67 +00:04:23,750 --> 00:04:27,410 +vestibulo-ocular response أو الـ vestibulo-ocular + +68 +00:04:27,410 --> 00:04:31,570 +reflex إذن بيصير عندي rotational nystagmus under + +69 +00:04:31,570 --> 00:04:34,850 +the influence تحت تأثير ال vestibulo-ocular + +70 +00:04:34,850 --> 00:04:40,150 +response بتجه العينتين باتجاه الدوران بعد هيك + +71 +00:04:40,150 --> 00:04:42,850 +بيعودوا the eyes flick back to the primary + +72 +00:04:42,850 --> 00:04:46,610 +position to produce rotational nystagmusروحت + +73 +00:04:46,610 --> 00:04:50,990 +العينين، ذهاب العينين في اتجاه الدوران، ثم عودتهم + +74 +00:04:50,990 --> 00:04:54,630 +لل primary position، لل primary position هذا بتسمى + +75 +00:04:54,630 --> 00:04:58,510 +rotational nystagmus، هذا ال rotational nystagmus + +76 +00:04:58,510 --> 00:05:03,270 +تحت تأثير ال vestibulo-ocular response، مش هذا هو + +77 +00:05:03,270 --> 00:05:07,000 +اللي هيقيملي موضوع ال visionلما أنا اتوقفت، إيش + +78 +00:05:07,000 --> 00:05:10,480 +اللي بده يصير؟ هنا إحنا بناخد بالنا و إحنا بنطلع + +79 +00:05:10,480 --> 00:05:14,120 +على الطفل When rotation stops, nystagmus is + +80 +00:05:14,120 --> 00:05:17,800 +briefly observed in opposite direction يعني إذا ال + +81 +00:05:17,800 --> 00:05:21,580 +nystagmus اتجاهه لليمين، بس أتوقف عن الدوران، + +82 +00:05:21,580 --> 00:05:25,460 +بيصير اتجاه ال nystagmus للشمال يعني بعكس اتجاهه + +83 +00:05:25,460 --> 00:05:31,660 +لمدة ثانية أو ثانيتين، بعدين بيصيرله اختفاق، بيصير + +84 +00:05:31,660 --> 00:05:35,240 +then ceaseddue to separation of post-rotary + +85 +00:05:35,240 --> 00:05:37,060 +nystagmus by fixation + +86 +00:05:41,040 --> 00:05:46,300 +عن الدوران بعد ما لفيت لفة كاملة ال نستجمص بيظل + +87 +00:05:46,300 --> 00:05:50,280 +مستمر بس باتجاه عكس الاتجاه الأول احنا قولنا اتجاه + +88 +00:05:50,280 --> 00:05:54,320 +ال نستجمص الأول مع اتجاه الدوران الدوران بتاعنا + +89 +00:05:54,320 --> 00:06:00,180 +وبالتالي لما بتوقف بيصير نستجمص باتجاه عكسي هذا ال + +90 +00:06:00,180 --> 00:06:03,640 +نستجمص اللي بالاتجاه العكسي بيسموه post rotary أو + +91 +00:06:03,640 --> 00:06:08,150 +post rotationنستجمس هو هذا اللي انا بدي الاحظه انه + +92 +00:06:08,150 --> 00:06:12,130 +مايضلش ال post rotation نستجمس لمدة اكتر من ثانية + +93 +00:06:12,130 --> 00:06:17,250 +لثانيتين طبعا بعد هيك بيهدأ ليش بيهدأ لأنه بتسير + +94 +00:06:17,250 --> 00:06:21,390 +الآن البيئة اللي حواليها هادية مافيش حركة فيها + +95 +00:06:21,780 --> 00:06:25,880 +فبترسل الصورة ل ال brain و ال brain بيعرف أنه مافي + +96 +00:06:25,880 --> 00:06:30,240 +روتيشن في ال environment حوالين هذا الطفل فبالتالي + +97 +00:06:30,240 --> 00:06:34,620 +بتهدأ عينيه طب لو ال vision bad معناته مش هترسل + +98 +00:06:34,620 --> 00:06:38,980 +الصورة أو هترسل بشكل ready فبظل ال post rotation + +99 +00:06:38,980 --> 00:06:43,260 +استجمس مستمر لعدد ثوانيممكن يستمر لعشر ثواني، + +100 +00:06:43,260 --> 00:06:46,840 +عشرين ثانية، خمسين ثانية، دقيقة، دقيقة و نص، ع بال + +101 +00:06:46,840 --> 00:06:50,220 +ما يتوجب، فبالتالي ضروري جدا أن ال post-rotation + +102 +00:06:50,220 --> 00:06:57,620 +stigma ألاحظه بعد ما أتوقف وأنا بأنظر طبعا لعين + +103 +00:06:57,620 --> 00:07:00,880 +الطفل if vision is severely impaired, the post + +104 +00:07:00,880 --> 00:07:04,480 +-rotation stigma does not stop as quicklywhen + +105 +00:07:04,480 --> 00:07:07,920 +rotation ceases لما بال rotation بيوقف ال post + +106 +00:07:07,920 --> 00:07:11,860 +rotation stigma بيظل شغال بسبب ان ال vision سيء + +107 +00:07:11,860 --> 00:07:17,120 +فال feedback من العين ل ال brain بيكون سيء + +108 +00:07:17,120 --> 00:07:19,980 +وبالتالي ال vestibular و ال ocular response + +109 +00:07:19,980 --> 00:07:24,360 +بيصيرلوش block يعني بتوقفش فبتظهر العين تهتز + +110 +00:07:24,360 --> 00:07:31,390 +فبتظهر العين تهتز نشوف فيديو بيوضح حد القضيةهي + +111 +00:07:31,390 --> 00:07:35,010 +طبعا الفيديو هيجرى على شخص كبير بس نفس الفكرة و + +112 +00:07:35,010 --> 00:07:41,370 +هيتم على الكرسي المتحرك بتم دورانه إذا ملاحظين هنا + +113 +00:07:41,370 --> 00:07:47,130 +في نقطة بدناش تفوت علينا الآن العين بتهتز باتجاه + +114 +00:07:47,130 --> 00:07:53,270 +شمال الشاشة، لأن عكست مرة تانية، انت لاحظ هي العين + +115 +00:07:53,270 --> 00:07:57,230 +تهتز باتجاه يمين المريض، لأن عكست مرة تالتة، انت + +116 +00:07:57,230 --> 00:08:01,790 +لاحظالعين تهتز باتجاه يمين المريض، الآن عكسة + +117 +00:08:01,790 --> 00:08:06,310 +الاتجاه، هذا هو الـ Post Rotation Stagmas لما عكست + +118 +00:08:06,310 --> 00:08:10,010 +الاتجاه، المفروض الـ Post Rotation Stagmas يعني + +119 +00:08:10,010 --> 00:08:15,630 +يتوقف بعد ثانية أو ثانيتين، واضح أن هنا في عندي + +120 +00:08:15,630 --> 00:08:19,810 +لازل الاهتزاز موجود، مرة أخيرة على أساس، هاي + +121 +00:08:19,810 --> 00:08:23,110 +بتتحرك باتجاه يمين المريض، الآن بتتحرك باتجاه + +122 +00:08:23,110 --> 00:08:27,710 +الشمالكما نلاحظ، اتجاه اليمين العين تتحرك، الآن + +123 +00:08:27,710 --> 00:08:32,950 +تهتز باتجاه الشمال، باتجاه الشمال، وبالتالي هذه + +124 +00:08:32,950 --> 00:08:36,310 +القضية بدها تكون واضحة، هذا هو ال post rotation + +125 +00:08:36,310 --> 00:08:44,010 +stagmas اللي انا ب .. بلاحظه وانا .. يعني منتبه + +126 +00:08:44,010 --> 00:08:45,950 +للطفل، وانا منتبه للطفل + +127 +00:08:49,720 --> 00:08:52,340 +ب .. نيجي لل test اللي بعده اللي هو ال + +128 +00:08:52,340 --> 00:08:55,480 +preferential looking test ايش يعني preferential + +129 +00:08:55,480 --> 00:09:00,080 +تفضيلي؟ preferential looking يعني الرؤية التفضيلية + +130 +00:09:00,080 --> 00:09:04,120 +ايش المقصود بالرؤية التفضيلية؟ وجدوا العلماء عند + +131 +00:09:04,120 --> 00:09:07,980 +الأطفال و عند الناس عموما النظام البصري او ال + +132 +00:09:07,980 --> 00:09:12,920 +visual system مبني بحيث انه بينجذب باتجاه ال + +133 +00:09:12,920 --> 00:09:17,080 +bottomإيش يعني بنجذب باتجاه البطغان؟ يعني لو في + +134 +00:09:17,080 --> 00:09:23,800 +عندي مثلا على سبيل المثال سبورة نظيفة تماما و في + +135 +00:09:23,800 --> 00:09:27,560 +أطراف من أطرافها في رسمة صغيرة، الإنسان على السريع + +136 +00:09:27,560 --> 00:09:32,850 +بتجذب ..بتجذب الرسمة الصغيرة بتجذبه لإنه يتطلع + +137 +00:09:32,850 --> 00:09:37,390 +عليها بينما الصبورة الكبيرة اللي هي نظيفة مافيش + +138 +00:09:37,390 --> 00:09:41,830 +عليها أي كلام ما بتجذبه هذا رغم إنه ال stimulus أو + +139 +00:09:41,830 --> 00:09:45,510 +ال light stimulus الصادر من الصبورة ككل أكبر بكتير + +140 +00:09:45,510 --> 00:09:50,070 +من ال light stimulus اللي صادر من هذه الرسمة + +141 +00:09:50,070 --> 00:09:53,850 +الصغيرة إذا ال preferential looking test can be + +142 +00:09:53,850 --> 00:09:58,090 +used from early infancy نقدر نستعملهم منمن المرحلة + +143 +00:09:58,090 --> 00:10:02,890 +الأولى للعمر، الأشهر الأولى للعمر بيعتمدوا على + +144 +00:10:02,890 --> 00:10:06,670 +المعلومة أو على القاعدة اللي بتقول they are based + +145 +00:10:06,670 --> 00:10:10,970 +on the factالحقيقة اللي بتقول إن infants وحقيقة مش + +146 +00:10:10,970 --> 00:10:14,730 +ال infants لحالهم كل الناس prefer to look at a + +147 +00:10:14,730 --> 00:10:17,830 +pattern rather than a homogeneous stimulus + +148 +00:10:17,830 --> 00:10:20,910 +homogeneous stimulus يعني stimulus مافيش فيه أي + +149 +00:10:20,910 --> 00:10:26,090 +أشكال يعني plain stimulus أو stimulus يعني مافيش + +150 +00:10:26,090 --> 00:10:31,110 +فيه أي أشكال أيضا مثلا مثال على ذلك نقول لو إنسان + +151 +00:10:31,110 --> 00:10:37,120 +واقف على شط البحر و البحر كبير جدا جداوالموج هادق + +152 +00:10:37,120 --> 00:10:42,880 +مافيش اي يعني تحرك للموج وفي يعني قارب صغير جدا في + +153 +00:10:42,880 --> 00:10:47,440 +عمق البحر هنلاقي انه الإنسان اللي بيجذبه للنظر هو + +154 +00:10:47,440 --> 00:10:51,960 +بي .. بي .. بيجذب للنظر باتجاه القارب وبنسى البحر + +155 +00:10:51,960 --> 00:10:56,780 +ككل فبالتالي هذه القضية انه فيه a defect انه ال + +156 +00:10:56,780 --> 00:11:01,040 +infants prefer to look at a pattern rather than a + +157 +00:11:01,040 --> 00:11:03,720 +homogeneous stimulusاستفادوا العلماء من هذه + +158 +00:11:03,720 --> 00:11:07,060 +القاعدة أو هذه الحقيقة العلمية في عمل الـ + +159 +00:11:07,060 --> 00:11:10,580 +preferential looking test the infant is exposed to + +160 +00:11:10,580 --> 00:11:15,400 +a stimulus بنعرض ال infant عين ال infant ل pattern + +161 +00:11:15,400 --> 00:11:19,440 +معين and the examiner observes بلاحظ ال examiner + +162 +00:11:19,440 --> 00:11:23,160 +the eyes for fixation movement طبعا هذا ال target + +163 +00:11:23,160 --> 00:11:27,660 +اللي بده أعرضه إليه عبارة عن رسمة في لوحات مختلفة + +164 +00:11:27,660 --> 00:11:31,300 +و مكان الرسمة بتغير من لوحة لل لوحة اللتي تليها زي + +165 +00:11:31,300 --> 00:11:35,680 +ما هنعرضبعد شوية طبعا ال examiner observes the + +166 +00:11:35,680 --> 00:11:38,520 +eyes for fixation movements without themselves + +167 +00:11:38,520 --> 00:11:42,180 +knowing the stimulus position انا حامل اللوحة + +168 +00:11:42,180 --> 00:11:47,220 +موجهها باتجاه الطفل على بعد معين بيكون الرسم فيها + +169 +00:11:47,220 --> 00:11:50,920 +على جانب من الجوانب اما اليمين او الشمال او فوق او + +170 +00:11:50,920 --> 00:11:54,880 +تحت مش شرط انه انا ك examiner اعرف مكان الرسمة بس + +171 +00:11:54,880 --> 00:11:58,870 +انا بيبقى عينيا مركزة على عينين الطفلوكل لوحة + +172 +00:11:58,870 --> 00:12:02,770 +واللوحة اللتي تليها إذا الطفل بنجّل عينيه من لوحة + +173 +00:12:02,770 --> 00:12:06,090 +للتانية بمعنى آخر بيغير اتجاه البصر معناته هو قاعد + +174 +00:12:06,090 --> 00:12:09,250 +بتطلع على هذا ال butter أو هذا ال stimulus + +175 +00:12:09,250 --> 00:12:13,070 +وبالتالي بعرف أن هو شايفه هذا الكلام هنعرضه بعد + +176 +00:12:13,070 --> 00:12:16,990 +شوية طيب إيش ال testات اللي .. اللي تستعمل في ال + +177 +00:12:16,990 --> 00:12:20,710 +preferential looking test في كتير من ال testات في + +178 +00:12:20,710 --> 00:12:21,410 +عندى teller + +179 +00:12:25,150 --> 00:12:30,270 +في عندي ال keyler test و ال keyler و أيضا في عندي + +180 +00:12:30,270 --> 00:12:34,430 +ال cardiff ال cardiff طبعا فكرته بتختلف عن ال + +181 +00:12:34,430 --> 00:12:34,830 +tiller + +182 +00:12:41,820 --> 00:12:44,220 +في عند ال tiller و في عند ال killer و في عند ال + +183 +00:12:44,220 --> 00:12:48,040 +cardiff ال tiller و ال killer عبارة عن خطوط سوداء + +184 +00:12:48,040 --> 00:12:52,200 +بينها خطوط بيضاء و كل لوحة و لوحة التالية بتبدأ + +185 +00:12:52,200 --> 00:12:55,920 +ترفع هذه الخطوط ال cardiff عبارة عن رسمات حقيقية + +186 +00:12:55,920 --> 00:13:02,700 +سمكة سيارة بيت إلى اخرىفبالتالي tests in common + +187 +00:13:02,700 --> 00:13:06,340 +use include teller or killer acuity cards which + +188 +00:13:06,340 --> 00:13:10,560 +consist of black stripes يعني grating يعني تخطيطات + +189 +00:13:10,560 --> 00:13:15,060 +سودة of varying with عرضها بيختلف من لوحة لتانية + +190 +00:13:15,060 --> 00:13:19,740 +زي ما هنعرف بعد شويةand card if acuity cards which + +191 +00:13:19,740 --> 00:13:23,700 +consist of familiar pictures سيارة سمكة كرة إلى + +192 +00:13:23,700 --> 00:13:29,580 +آخره with variable outline width بمعنى أن الرسمة + +193 +00:13:29,580 --> 00:13:33,060 +بتبدأ في اللوحة الأولى بخط عريض و بعدين اللوحة + +194 +00:13:33,060 --> 00:13:38,090 +التانية خط أقل عرضا ثم بيبدأ يرفع الخط بتاعالرسمة + +195 +00:13:38,090 --> 00:13:41,930 +زي ما هنشوف بعد شوية هاي الكاردف هاي بعض اللوحات + +196 +00:13:41,930 --> 00:13:46,970 +من الكاردف هاي سمكة مرسومة بخط عريض هنا بيت هنا + +197 +00:13:46,970 --> 00:13:50,930 +قطار إلى آخرين طبعا مكان الرسمة هنا في التلات + +198 +00:13:50,930 --> 00:13:55,070 +لوحات اللي تم افتيارها في الأعلى طبعا بدنا نعرف + +199 +00:13:55,070 --> 00:13:58,670 +ونكون على يقين انه عندي في تقريبا ستة و تلاتين + +200 +00:13:58,670 --> 00:14:04,490 +لوحة كل لوحةكل لوحة بيكون مكان الرسم إلها معين، + +201 +00:14:04,490 --> 00:14:08,070 +ممكن فوق أو تحت، يعني ممكن فوق أو تحت، بختلفوا + +202 +00:14:08,070 --> 00:14:12,150 +بشكل عشوائي، بحيث بيكونوا مرتبين من الأخمل للأرفع، + +203 +00:14:12,150 --> 00:14:15,950 +و مرة الصورة بتكون فوق، مرة تحت، مرة تحت، مرة فوق، + +204 +00:14:15,950 --> 00:14:19,590 +إلى آخر، بشكل عشوائي، بحيث إنه أعرف، لأن لو كل + +205 +00:14:19,590 --> 00:14:23,980 +الصور في مكان واحدالطفل مش هينجل عينيه مش هقدر + +206 +00:14:23,980 --> 00:14:29,260 +استطيع ان اعرف اللي هو فعلا شايف و لا مجرد انه + +207 +00:14:29,260 --> 00:14:33,320 +بينظر باتجاه مبهر .. باتجاه مبهر هذا بالنسبة لل + +208 +00:14:33,320 --> 00:14:38,880 +cardiff هذه ال test بيسموه cardiff acuity test + +209 +00:14:45,240 --> 00:14:49,040 +طيب، بالنسبة لـ Taylor، الـ Taylor هي واضح عبارة + +210 +00:14:49,040 --> 00:14:53,880 +عن لوحات جاية بال .. بشكل مستطيل، فيها رسمة عبارة + +211 +00:14:53,880 --> 00:14:57,700 +عن خطوط Stripes أو Grating، خطوط سودة وبينها خطوط + +212 +00:14:57,700 --> 00:15:01,640 +بيضا، طبعا هنا أخمل، هنا أرفع، أرفع، كل ما بنروح + +213 +00:15:01,640 --> 00:15:08,070 +طبعا بتحمل بشكل مستعرض وبالتالي ..أحياناً بتكون + +214 +00:15:08,070 --> 00:15:10,670 +على اليمين أحياناً بتكون على الشمال فبدي ألاحظ + +215 +00:15:10,670 --> 00:15:14,750 +الطفل هل هو بيتطلع على اليمين ولا على الشمال يعني + +216 +00:15:14,750 --> 00:15:18,550 +بنجّل بصر ومعناته شايف هاد ال tiller وهي ال killer + +217 +00:15:18,550 --> 00:15:21,370 +ال killer زي ال tiller بس واضح أنه ال target في ال + +218 +00:15:21,370 --> 00:15:25,490 +tiller مربع بينما في ال killer مستدير وفي عندي + +219 +00:15:25,490 --> 00:15:29,690 +target آخر مبهم فبالتالي ال visual system عند ال + +220 +00:15:29,690 --> 00:15:33,990 +infantبيجذب انه يطلع على ال pattern مش على ال + +221 +00:15:33,990 --> 00:15:36,990 +plane stimulus مرة بتكون على اليمين و مرة بتكون + +222 +00:15:36,990 --> 00:15:41,290 +على الشمال طبعا هذه أخمل أرفع أرفع هذا بيسموها low + +223 +00:15:41,290 --> 00:15:44,430 +frequency و هذه بيسموها high frequency يعني كل ما + +224 +00:15:44,430 --> 00:15:47,010 +اتحركنا هيك باتجاه ال high frequency ايش يعني low + +225 +00:15:47,010 --> 00:15:50,210 +frequency grating تخطيطات low frequency يعني + +226 +00:15:50,210 --> 00:15:53,710 +ترددهافي الدائرة high أو في المساحة المرسومة فيها + +227 +00:15:53,710 --> 00:15:57,810 +قليل، هنا عندنا تلت خطوط سودة، هنا مثلا فوق العشرة + +228 +00:15:57,810 --> 00:16:02,010 +أو الخمستاشر خط أسود، فبالتالي ترددها أعلى، ال low + +229 +00:16:02,010 --> 00:16:04,690 +frequency تعني low visual acuity و ال high + +230 +00:16:04,690 --> 00:16:08,590 +frequency إذا اتعرف عليها الطفل معناته better + +231 +00:16:08,590 --> 00:16:14,490 +visual acuity، مابنقدرش نقول جدإذا low frequency + +232 +00:16:14,490 --> 00:16:18,270 +cursive writing or picture with a wider outline + +233 +00:16:18,270 --> 00:16:21,410 +لما بنحكي عن ال card بنحكي عن picture لما بيكون + +234 +00:16:21,410 --> 00:16:27,310 +الرسمة .. خمي الحد بتاعها أو الرسم بتاعها أو لما + +235 +00:16:27,310 --> 00:16:30,150 +بستعمل ال tiller و ال killer لما يكون في عندي low + +236 +00:16:30,150 --> 00:16:34,330 +frequency writing are more easily seen are seen + +237 +00:16:34,330 --> 00:16:37,570 +more easily than high frequency writing or thin + +238 +00:16:37,570 --> 00:16:40,850 +outlines طبعا أصعب يكونوا في .. لما يكون ال thin + +239 +00:16:40,850 --> 00:16:46,080 +..خط الرسم thin أو ال grating رفيعة كتير بيكون + +240 +00:16:46,080 --> 00:16:51,340 +عنده صعب التعرف عليها اللي بيصير .. بيصير + +241 +00:16:51,340 --> 00:16:54,580 +assessment لل resolution not recognition إيش يعني + +242 +00:16:54,580 --> 00:16:57,640 +assessment لل resolution not recognition؟ يعني + +243 +00:16:57,640 --> 00:17:03,140 +اللي بنختبره فقط الطفل شايف أو مش شايفيعني شايف + +244 +00:17:03,140 --> 00:17:06,380 +رسمة ولا .. مش شايف بس مش شرط انه اتعرف على طبيعة + +245 +00:17:06,380 --> 00:17:10,240 +هذه الرسمة مجرد انه حرك عينيه باتجاه هذا ال + +246 +00:17:10,240 --> 00:17:13,260 +pattern او باتجاه هذا الرسمة معناته شايفها + +247 +00:17:13,260 --> 00:17:19,410 +فبالتالي هيكا بيتم التقييم طيببالتالي بنعمل visual + +248 +00:17:19,410 --> 00:17:22,450 +acuity is met accordingly يعني بنقدر نقيم هل ال + +249 +00:17:22,450 --> 00:17:26,870 +vision good ولا moderate ولا bad since grating + +250 +00:17:26,870 --> 00:17:30,670 +acuity often exceeds snilling acuity in amblyopia + +251 +00:17:30,670 --> 00:17:35,070 +teller cards may overestimate visual acuity مامعنى + +252 +00:17:35,070 --> 00:17:38,890 +هذا القضية لو إنسان عنده مثلا على سبيل المثال خمس + +253 +00:17:38,890 --> 00:17:45,790 +سنوات وسألته .. سألتهعنده أمبيوبيا وسألته على + +254 +00:17:45,790 --> 00:17:51,350 +listening chart وكان ال best correction عنده 66 + +255 +00:17:51,350 --> 00:17:56,790 +أمبيوبيك 66 هو نفس الشخص لو جيت أفحصه بال killer + +256 +00:17:56,790 --> 00:18:01,570 +أو بال tiller أو بال cardiff هيكون عنده أفضل من 66 + +257 +00:18:01,570 --> 00:18:05,970 +ليش؟ لأن هذه ال test بتعمل over estimation بتعطي + +258 +00:18:06,460 --> 00:18:10,680 +درجة أو بتعطي نتيجة أفضل من الـ Snellen كرقم بس هي + +259 +00:18:10,680 --> 00:18:13,640 +على حقيقة الأمر أقل دقة من الـ Snellen لأنه الـ + +260 +00:18:13,640 --> 00:18:17,220 +crowding فنوميلون مش موجودة منهم فيها بمعنى أنه + +261 +00:18:17,220 --> 00:18:20,580 +هتلاقوا target واحد في كل لوحة يعني مافيش crowding + +262 +00:18:20,580 --> 00:18:23,880 +مافيش crowding واحنا قلنا ضروري تكون بالذات عند ال + +263 +00:18:23,880 --> 00:18:27,220 +amblyobic patients أنه أستعمل ظاهرة ال crowding + +264 +00:18:27,220 --> 00:18:32,260 +لأنها بتعكس النظر بصورة صحيحة بشكل أكبر إذا ال + +265 +00:18:32,260 --> 00:18:37,210 +tillerأو الـ Grating Acuity عادة بتفوق الـ + +266 +00:18:37,210 --> 00:18:40,370 +Snilling Acuity في الامبيوبيا، عشان هيك الـ Tiller + +267 +00:18:40,370 --> 00:18:45,110 +و الـ Cardiff و ال .. Tiller و ال .. و ال killer و + +268 +00:18:45,110 --> 00:18:49,620 +ال Cardiff may over estimate visual acuityالان في + +269 +00:18:49,620 --> 00:18:52,340 +ضال اخر شغلتين نحكي عن ال preferential looking + +270 +00:18:52,340 --> 00:18:56,340 +test اول شغلة لازم لما افحص بال .. بال .. + +271 +00:18:56,340 --> 00:19:00,720 +بالفحوصات هاي بهذه ال testات لازم استمع .. اتبع + +272 +00:19:00,720 --> 00:19:05,020 +protocol معين وضروري يكون ال protocol صارم these + +273 +00:19:05,020 --> 00:19:08,100 +methods may not be reliable ممكن لا يعتمد على + +274 +00:19:08,100 --> 00:19:11,540 +نتائجهم اذا انا ما اتبعت his first choice + +275 +00:19:11,540 --> 00:19:15,220 +staircase protocol يعني ضروري يكون المسافة محددة + +276 +00:19:15,220 --> 00:19:20,380 +ضروري جدا ا ..أعمل أداء لل test بشكل صحيح عشان + +277 +00:19:20,380 --> 00:19:25,160 +أقدر أخد نتيجة وبتطلها النتيجة رغم ذلك أقل دقة من + +278 +00:19:25,160 --> 00:19:29,020 +listening acuity فبالتالي هذا القضية تاني شيء + +279 +00:19:29,020 --> 00:19:34,700 +ضروري جدا انه أعرف ان هذه ال testات التلاتةneither + +280 +00:19:34,700 --> 00:19:39,740 +sensitive nor specific أو + +281 +00:19:39,740 --> 00:19:41,620 +.. أو neither sensitive يعني ال sensitivity + +282 +00:19:41,620 --> 00:19:45,900 +بتاعتها لل .. لل presence of ampliobia قليلة، يعني + +283 +00:19:45,900 --> 00:19:48,580 +ممكن الإنسان يكون عنده ampliobia و يعطيني على هذه + +284 +00:19:48,580 --> 00:19:53,310 +التستات التلاتة يعطيني ستة ع ستة، فضروري أناما + +285 +00:19:53,310 --> 00:19:58,150 +أكتفي بكلمة 6 ع 6 وإنما ضروري أسأل نفسي هل الطفل + +286 +00:19:58,150 --> 00:20:01,610 +في عنده risk factors for amblyopia ال risk factors + +287 +00:20:01,610 --> 00:20:06,410 +الخامسة اللي هي ال squint ال anisometropia ال high + +288 +00:20:06,410 --> 00:20:10,530 +bilateral ametropia الastigmatism و ال form vision + +289 +00:20:10,530 --> 00:20:13,930 +deprivation اللي هي أنواع ال amblyopia الخامسة هي + +290 +00:20:13,930 --> 00:20:17,350 +نفسها ال risk factors for amblyopia فإذا كان في + +291 +00:20:17,350 --> 00:20:20,970 +موجود واحد أو أكتر من هذه الأنواعيعني من هذه ال + +292 +00:20:20,970 --> 00:20:25,310 +risk factors for Ampliobia وعلى هذه ال testات أداء + +293 +00:20:25,310 --> 00:20:29,690 +المريض 6 ع 6 وأداء الطفل 6 ع 6 برضه أنا لازم أخبر + +294 +00:20:29,690 --> 00:20:33,350 +الأهل أن هذه لا تعني بالضرورة 6 ع 6 وإنما طالما في + +295 +00:20:33,350 --> 00:20:37,840 +وجود risk factor for Ampliobiaفغالبا ال amblyopia + +296 +00:20:37,840 --> 00:20:42,700 +موجودة ساعتها أنا بقول أنه بدنا .. بدنا نبدأ نعالج + +297 +00:20:42,700 --> 00:20:46,220 +حتى لو النظر على هذه ال testات أعطاني 6 ع 6 لأن + +298 +00:20:46,220 --> 00:20:50,400 +هذه الفحوصات ليست دقيقة وهذه بتقيم ال equality مش + +299 +00:20:50,400 --> 00:20:55,200 +ال quantity نيجي لأخر شيء اللي هو ال pattern + +300 +00:20:55,200 --> 00:21:00,080 +visually evoked potential هذه ال VEP اختصار ل + +301 +00:21:00,080 --> 00:21:04,520 +visually evoked + +302 +00:21:06,080 --> 00:21:10,540 +potential بس قبل ما نبدأ فيها في فيديو كنت حابب + +303 +00:21:10,540 --> 00:21:15,800 +أرضه ل preferential looking desk اللي هي ال tiller + +304 +00:21:15,800 --> 00:21:22,420 +و ال killer نروح + +305 +00:21:22,420 --> 00:21:31,420 +للفيديو هاي ال tiller acuity cards هاي + +306 +00:21:31,420 --> 00:21:33,360 +بيعرض للطفل انكبر + +307 +00:21:37,370 --> 00:21:42,710 +طبعا الطفل ممكن يشير بأداة مثلا معينة هذه أداة ال + +308 +00:21:42,710 --> 00:21:47,070 +cover test وين ما كان الرسمة مش شرط يعرف إيش هي + +309 +00:21:47,070 --> 00:21:55,630 +الرسمة هاي الطفل بيشير بالاتجاه مرة بتكون على + +310 +00:21:55,630 --> 00:21:58,030 +اليمين و مرة على الشمال و مرة بيخربطله إياها و مره + +311 +00:21:58,030 --> 00:22:03,430 +و مرة بيخربطله + +312 +00:22:03,430 --> 00:22:05,210 +إياها و مرة و مرة و مرة و مرة و مرة و مرة و مرة و + +313 +00:22:05,210 --> 00:22:11,540 +مرةإذا ملاحظين ال examiner غالبا بتطلع في اتجاه في + +314 +00:22:11,540 --> 00:22:12,960 +اتجاه عين الطفل + +315 +00:22:17,970 --> 00:22:22,410 +هيو جلبله إياها الطفل بي shower عليها بشكل صحيح طب + +316 +00:22:22,410 --> 00:22:26,210 +لو الطفل بيقدرش ي shower مجرد أنا أطلع في عينيه + +317 +00:22:26,210 --> 00:22:32,070 +أشوف طبعا هل هو بيحرك عينيه باتجاه ال target ولا + +318 +00:22:32,070 --> 00:22:36,010 +لأ باتجاه ال target ولا لأ طبعا كل لوحة و لوحة + +319 +00:22:36,010 --> 00:22:41,290 +التي تليها الخطوط بتبدأ تعرض الآن في نقطة بدأ أحكي + +320 +00:22:41,290 --> 00:22:46,840 +عنهااحيانا الطفل بيكون أخطأ لمرة واحدة أنه بدل ما + +321 +00:22:46,840 --> 00:22:51,340 +يأشر على المكان أشر جنبه أو كده ماباعتبرهوش خطأ و + +322 +00:22:51,340 --> 00:22:56,120 +بكمل لغاية .. يعني هيكون التأشير على اللوحات بتالي + +323 +00:22:56,120 --> 00:22:59,660 +.. يعني ب .. ب .. بتصحح طبعا الطفل برضه بدنا ناخد + +324 +00:22:59,660 --> 00:23:04,040 +بالنا أنه ممكن يكون تحكمه في عضلات أيدي لسه مش .. + +325 +00:23:04,040 --> 00:23:09,080 +مش مائة بالمائة فبالتالي بتأخذ هذه بعين الاعتبار + +326 +00:23:13,400 --> 00:23:18,900 +هي الطفل أشر هى جلبله عشان تكون ع شماله هيؤشر طبعا + +327 +00:23:18,900 --> 00:23:26,020 +أشر مش عليها 100% ولكن باتجاهها باتجاهها هى + +328 +00:23:26,020 --> 00:23:33,660 +بده يستعمل أيده لشمال هذا هو أحد ال preferential + +329 +00:23:33,660 --> 00:23:38,960 +looking tests زى ما احنا شايفين زى ما احنا شايفين + +330 +00:23:38,960 --> 00:23:40,160 +الآن + +331 +00:23:44,540 --> 00:23:49,120 +بنيجي لل test رقم سبعة من ال testات اللي + +332 +00:23:49,120 --> 00:23:56,540 +استعرضناهم ل .. اللي هي assessment of vision in + +333 +00:23:56,540 --> 00:24:01,180 +preverbal children ما معنى visually evoked + +334 +00:24:01,180 --> 00:24:05,290 +potential؟potential يعني فرق الجهد evoked المستحث + +335 +00:24:05,290 --> 00:24:10,230 +بصريا يعني إيش فرق الجهد المستحث بصريا الفرق الجهد + +336 +00:24:10,230 --> 00:24:14,750 +يعني الكهربا يعني النشاط الكهربائي المستحث بصريا + +337 +00:24:14,750 --> 00:24:18,590 +نشاط الكهربائي تعمين تعاد دماغ يعني لو أنا حطيت + +338 +00:24:18,590 --> 00:24:22,570 +أقطاب على رأس الطفل أو على رأس الإنسان اللي بدأ + +339 +00:24:22,570 --> 00:24:28,030 +أفحصه عشان يتجيس لنشاط الكهربا إلى الدماغبس أستحث + +340 +00:24:28,030 --> 00:24:31,390 +العين بصريًا يعني بدأ أعرض العين ل pattern أو شكل + +341 +00:24:31,390 --> 00:24:37,550 +معين و أشوف نتيجة الصورة اللي سقطت على الشبكية و + +342 +00:24:37,550 --> 00:24:41,670 +أرسلت للدماغ كيف الدماغ تنشط كهربائيًا و منها بقدر + +343 +00:24:41,670 --> 00:24:45,790 +أعرف ال vision طبعًا pattern VEP give + +344 +00:24:45,790 --> 00:24:49,730 +representation of spatial acuity but is more + +345 +00:24:49,730 --> 00:24:52,470 +regularly used in the diagnosis of optic + +346 +00:24:52,470 --> 00:24:56,180 +neuropathyغالبا هذا ال test لا يستعمل لتقييم النظر + +347 +00:24:56,180 --> 00:25:00,760 +عند الأطفال غالبا يستعمل في اعتلالات العصب البصري + +348 +00:25:00,760 --> 00:25:04,840 +عند الكبار غالبا ولكن ممكن في حالات معينة أني + +349 +00:25:04,840 --> 00:25:09,020 +أستعمله عند الطفل عشان أقدر أشوف الإبصار عنده كيف + +350 +00:25:09,020 --> 00:25:13,600 +و أضعه إذا بوسائل تانية ماقدرتش أحدد يعني بدنا + +351 +00:25:13,600 --> 00:25:17,820 +انعرض العين ل pattern معين عشان هيك بيسموه pattern + +352 +00:25:17,820 --> 00:25:22,060 +VEP ال VEP في منها نوعين في .. هي عندي flash VEP + +353 +00:25:25,180 --> 00:25:29,080 +يعني نشاط كهربائي في الدماغ بستحسه بواسطة flash of + +354 +00:25:29,080 --> 00:25:32,960 +light، هذا ال flash of light بخليه مرة يضوي و مرة + +355 +00:25:32,960 --> 00:25:38,560 +يضفي، و بعد ذلك بقى أبدأ أصغر ال flash كل ما كانت + +356 +00:25:38,560 --> 00:25:41,880 +استجابة الدماغ، و أنه في نشاط كهربائي في الدماغ + +357 +00:25:42,220 --> 00:25:45,660 +نتيجة تصغير ال flash معناته ال vision أفضل كل ما + +358 +00:25:45,660 --> 00:25:49,720 +صغرت أكتر وجدر الدماغ يعمل نشاط كهربائي معناته هذا + +359 +00:25:49,720 --> 00:25:53,900 +الضوء الصغير أو تصغير الضوء برضه وصلت صورة هذا + +360 +00:25:53,900 --> 00:25:58,460 +الضوء للدماغ وجدر يتنشط كهربائيا في عندي flash VAB + +361 +00:25:58,460 --> 00:26:03,440 +وفي عندي patternVEB اللي بجالي ينفيه حدة الإبصار + +362 +00:26:03,440 --> 00:26:06,880 +اللي هي ال pattern VEB نشاط الكهرباء المستحاف + +363 +00:26:06,880 --> 00:26:11,800 +بصريا بواسطة pattern معين أو شكل معين هو عبارة عن + +364 +00:26:11,800 --> 00:26:16,420 +شاشة بتعرض مربعات سودة وبيضة بالضبط زي رقعة + +365 +00:26:16,420 --> 00:26:20,650 +الشطرانجالشاشة بتجلب يعني الأبيض بيصير أسود + +366 +00:26:20,650 --> 00:26:25,410 +والأسود بيصير أبيض بسرعة معينة هذا تغيير في الشكل + +367 +00:26:25,410 --> 00:26:28,590 +لما الأبيض يصير أسود والأسود يصير أبيض معناته + +368 +00:26:28,590 --> 00:26:34,770 +الشكل اتغير الدماغ بيستحث بتغيير الشكل فبيصير عنده + +369 +00:26:34,770 --> 00:26:39,170 +نشاط كهربائي مربعات قطعة الشطرانج هذه اللي بتعرضها + +370 +00:26:39,170 --> 00:26:45,890 +الشاشة بيتم تصغيرها وكل مكان فيه نشاط للدماغموجود + +371 +00:26:45,890 --> 00:26:48,970 +معناته هو اتعرف على المربعات الأصغر فما بالتالي + +372 +00:26:48,970 --> 00:26:52,990 +حدة الإبصار بيكون أفضل إذا .. إذا سألني حدا + +373 +00:26:52,990 --> 00:26:56,590 +بالنسبة للـ visually evoked potential أي نوع منها + +374 +00:26:56,590 --> 00:27:00,290 +اللي يستخدم للتقييم حدة الإبصار بنقوله النوع اللي + +375 +00:27:00,290 --> 00:27:04,590 +يستخدم هو ال pattern VAB وليس ال flash VAB + +376 +00:27:04,590 --> 00:27:09,050 +فبالتالي هذه القضية ضرورة تكون واضحة وجالية نشوف + +377 +00:27:09,050 --> 00:27:16,430 +احنا أول حاجة بدناهي الطفل على رأسه الأقطاب، بتعرض + +378 +00:27:16,430 --> 00:27:23,010 +أمامه شاشة، الشاشة ممكن تعرضلي مربعاتمربعات أو + +379 +00:27:23,010 --> 00:27:30,050 +ممكن تعرض ل flash ال flash VEP ال flash VEP on off + +380 +00:27:30,050 --> 00:27:35,370 +يعني مرة بيصير ضاوي و مرة بيصير مطفي و مرة بيصير + +381 +00:27:35,370 --> 00:27:39,310 +ضاوي و بتردد هذه القضية الان هنشوف ال test هذا على + +382 +00:27:39,310 --> 00:27:45,830 +شخص كبير بس هو نفسه اللي يجرى على شخص يعني طفل + +383 +00:27:45,830 --> 00:27:50,500 +صغير هاي المربعاتاللي بتعرضه الشاشة طبعا و إيه هذه + +384 +00:27:50,500 --> 00:27:55,700 +الأقطاب موصولة عشان تعملي مخطط لكهربائي دماغ + +385 +00:27:55,700 --> 00:28:00,320 +المريض بتغلق عين و العين التانية بتكون مركزة في + +386 +00:28:00,320 --> 00:28:04,340 +النقطة الحمرا هاي على المسافة هاي ليه سبعة و خمسين + +387 +00:28:04,340 --> 00:28:08,360 +صنطة شايفين الأبيض بيقلب أسود و الأسود بيقلب أبيض + +388 +00:28:08,360 --> 00:28:12,540 +كل مربع بيعمل one degree مع العين one degree مع + +389 +00:28:12,540 --> 00:28:14,380 +العين يعني إله حجم معين + +390 +00:28:17,610 --> 00:28:22,410 +الـ test له ست مراحل تلت مراحل بتخص العين اليمين + +391 +00:28:22,410 --> 00:28:27,170 +وتلت مراحل بتخص العين الشمال المرحلة الأولى نختبر + +392 +00:28:27,170 --> 00:28:34,510 +العين اليمين المرحلة التانية .. المرحلة واحد نختبر + +393 +00:28:34,510 --> 00:28:37,490 +فيها العين اليمين بالمربعات اللي بتعمل one degree + +394 +00:28:37,490 --> 00:28:43,770 +المرحلة تلاتةالمرحلة تلاتة بنختبر العين الشمال + +395 +00:28:43,770 --> 00:28:47,110 +برضه بنفس حجم المربعات اللي بتعمل one degree + +396 +00:28:47,110 --> 00:28:53,610 +المرحلة خمسة يعني واحد step one step one هيكم زي + +397 +00:28:53,610 --> 00:28:58,010 +ما كنتوا شايفين مغطي عينه الشمال وفاتح عينه اليمين + +398 +00:28:58,010 --> 00:29:01,790 +بتطلع في ال fixation target وهذا ال pattern sort + +399 +00:29:01,790 --> 00:29:06,010 +of تسقط على الفوفيا وما حول الفوفياطيب، ليش حجم + +400 +00:29:06,010 --> 00:29:09,430 +الشاشة هيك؟ وليش المريض بعيد سبعة وخمسين صنطي؟ + +401 +00:29:09,430 --> 00:29:13,730 +عشان كل مربع يعمل زاوية مع العين مقدارها واحد + +402 +00:29:13,730 --> 00:29:17,510 +degree طيب، step one، بنختبر العين اليمين step + +403 +00:29:17,510 --> 00:29:20,190 +تلاتة، ممكن السان يقول طب step اتنين، لا step + +404 +00:29:20,190 --> 00:29:24,390 +اتنين جايين، لا، بس في حجم مربعات أخر step واحد، + +405 +00:29:24,390 --> 00:29:28,070 +بنختبر العين اليمين step تلاتة، بنختبر العين + +406 +00:29:28,070 --> 00:29:33,770 +الشمال، بنفس المربعاتstep 5 بنختبر العينين مع بعض + +407 +00:29:33,770 --> 00:29:38,410 +مفتوحات عشان نشوف ال response أفضل ولا لأ فبالتالي + +408 +00:29:38,410 --> 00:29:42,270 +في عندي step 1 للعين اليمين step 3 للعين الشمال و + +409 +00:29:42,270 --> 00:29:47,690 +step 5 للعينين مع بعض بحيث ان الحجم المربعات ان كل + +410 +00:29:47,690 --> 00:29:51,710 +مربع بعمل one degree مع العين نشوف هذه القضية + +411 +00:29:51,710 --> 00:29:54,990 +طبعاً لما بنختبر العين اليمين و لما بنختبر العين + +412 +00:29:54,990 --> 00:29:59,490 +الشمالو لما بنختبر العين تان مع بعض الشاشة بتغير + +413 +00:29:59,490 --> 00:30:05,230 +الأبيض أسود والأسود أبيض زي ما احنا شايفين بالصورة + +414 +00:30:05,230 --> 00:30:11,770 +اللي واضحة جدا في هذه القضية الآن بدنا نروح ل + +415 +00:30:12,860 --> 00:30:18,380 +المربعات أصغر .. المربعات أصغر .. كل مربع بيعمل + +416 +00:30:18,380 --> 00:30:21,920 +ربع degree إذا نزلنا بحجم المربع من one degree + +417 +00:30:21,920 --> 00:30:25,720 +بيعملوا مع العين لربع degree بيعملوا مع العين step + +418 +00:30:25,720 --> 00:30:31,210 +2 .. step 2في هذا الحجم من المربعات بنستخدم .. + +419 +00:30:31,210 --> 00:30:34,110 +بنفحص فيه العين اليمين ال response تاع العين + +420 +00:30:34,110 --> 00:30:38,810 +اليمين step 4 بنفحص العين الشمال step 6 بنفحص + +421 +00:30:38,810 --> 00:30:44,390 +العينتين مع بعض زي ما احنا شايفين الشاشة بتغير + +422 +00:30:44,390 --> 00:30:48,610 +الأسود أبيض و الأبيض أسود عشان الصورة تتغير على + +423 +00:30:48,610 --> 00:30:53,110 +سطح الشبكية فبالتالي الدماغ يستجيب .. الدماغ + +424 +00:30:53,110 --> 00:30:56,730 +يستجيب في هذه اللحظة بيكون الجهاز بتخطيط زي ما + +425 +00:30:56,730 --> 00:31:03,150 +انتوا شايفينإيه هذا؟ الآن في ال VEP في شغلتين + +426 +00:31:03,150 --> 00:31:08,330 +ضروريات إنه ناخد بالنا منهم اللي تنسي، إيش يعني + +427 +00:31:08,330 --> 00:31:13,590 +اللي تنسي؟ الفترة بين إن أعرض العين لهذه قطعة + +428 +00:31:13,590 --> 00:31:17,150 +الشطرانج وبين إنه تبدأ الاستجابة، هنا لسه مافيش + +429 +00:31:17,150 --> 00:31:22,310 +استجابةهذا أول استجابة عند خمسة وسبعين ثانية + +430 +00:31:22,310 --> 00:31:26,530 +بيسموها negative خمسة وسبعين and خمسة وسبعين بعدين + +431 +00:31:26,530 --> 00:31:30,690 +استجابة أخرى positive مية عند ميت ثانية بعدين + +432 +00:31:30,690 --> 00:31:33,570 +negative مية وخمسة وتلاتين اذا في عندي two + +433 +00:31:33,570 --> 00:31:38,280 +deflections انحضارينواحد على خمسة وسبعين ثانية + +434 +00:31:38,280 --> 00:31:42,200 +وواحد على مية وخمسة وتلاتين ثانية وفي ارتفاع في + +435 +00:31:42,200 --> 00:31:46,900 +المخطط الكهربائي للدماغ هذا المخطط ناتج عن تعريض + +436 +00:31:46,900 --> 00:31:50,340 +العين ل stimulus ناتج عن تعريض العين ل stimulus + +437 +00:31:50,340 --> 00:31:53,800 +وهذا الرسم هي في ال normal احنا بنشوفهطبعا لو + +438 +00:31:53,800 --> 00:31:57,780 +اختلف شكل الرسمة بيكون في عندي abnormality وهذه + +439 +00:31:57,780 --> 00:32:01,520 +بيحددوها الناس المتخصصة في هذه القضية الناس + +440 +00:32:01,520 --> 00:32:05,460 +المتخصصة في هذه القضية فهذه هي ال visually evoked + +441 +00:32:05,460 --> 00:32:08,040 +potential ال visually evoked potential واللي + +442 +00:32:08,040 --> 00:32:13,940 +بتستخدم لإنها تعيين لل vision بس هي أكثر استخداما + +443 +00:32:13,940 --> 00:32:17,680 +في ال optic neuropathy في ال optic neuropathy هيك + +444 +00:32:17,680 --> 00:32:22,180 +بنكون خلصناالـ assessment أو الـ qualitative + +445 +00:32:22,180 --> 00:32:25,600 +assessment of visual behavior طبعاً هنا عندي + +446 +00:32:25,600 --> 00:32:30,240 +اللاتنسي اللي من بداية ما أعرض العين لل stimulus + +447 +00:32:30,240 --> 00:32:36,180 +لغاية بداية الاستجابة سموها اللاتنسيكمية الـ + +448 +00:32:36,180 --> 00:32:39,320 +deflection أو ارتفاعه بيسموه الـ amplitude هدولة + +449 +00:32:39,320 --> 00:32:43,820 +التنين هم يعني مؤشرين بقدر استخدم عشان اعرف ال + +450 +00:32:43,820 --> 00:32:47,920 +normal من ال abnormal طبعا ال pattern بيتغير + +451 +00:32:47,920 --> 00:32:52,120 +الأسود أبيض و الأبيض أسود أمام العين و الأقطاب + +452 +00:32:52,120 --> 00:32:56,900 +الموجودة على الرأس من الخارج بتوصل بكمبيوتر و + +453 +00:32:56,900 --> 00:33:00,020 +الكمبيوتر بيعطيني الرسمة في ال normal و ال + +454 +00:33:00,020 --> 00:33:06,300 +abnormalفي ال normal و ال abnormal يعني بتتضح عندى + +455 +00:33:06,300 --> 00:33:10,160 +الأمور بتتضح عندى الأمور نتوقف عند هذه النقطة و + +456 +00:33:10,160 --> 00:33:13,060 +المرة القادمة ان شاء الله تعالى هنعمل testing لل + +457 +00:33:13,060 --> 00:33:16,800 +verbal children يعني الأطفال اللي بدأوا يتكلموا و + +458 +00:33:16,800 --> 00:33:20,280 +يعطيكم العافية والسلام عليكم ورحمة الله وبركاته + diff --git a/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/zmdPbqFsHCw_raw.srt b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/zmdPbqFsHCw_raw.srt new file mode 100644 index 0000000000000000000000000000000000000000..245c45c2c8e86dd84819f0d15767bedb13af37b1 --- /dev/null +++ b/PL9fwy3NUQKwbXnyKPmq0kXeJC3LJADqhC/zmdPbqFsHCw_raw.srt @@ -0,0 +1,1848 @@ +1 +00:00:00,790 --> 00:00:04,610 +بسم الله الرحمن الرحيم بنواصل مع محاضرات حوال واحد + +2 +00:00:04,610 --> 00:00:09,730 +والموضوع اللي كنا بصدده المحاضرة الماضية كان هو + +3 +00:00:09,730 --> 00:00:13,510 +testing visual acuity أو assessment of visual + +4 +00:00:13,510 --> 00:00:16,630 +behavior in preverbal children وعدينا على عدة + +5 +00:00:16,630 --> 00:00:22,010 +فحوصات منها ال fixation and following وعدينا أيضا + +6 +00:00:22,010 --> 00:00:24,850 +على ال comparison between the behavior of the two + +7 +00:00:24,850 --> 00:00:32,020 +eyes وعدينا أيضا على ال fixation behaviorلما بغطي + +8 +00:00:32,020 --> 00:00:34,600 +العين اللي مافيش فيها squint بشوف تصرف العين اللي + +9 +00:00:34,600 --> 00:00:37,500 +فيها ال squint هل اللي في عندها central fixation و + +10 +00:00:37,500 --> 00:00:40,940 +لا مش central هل هو steady و لا مش steady و لما + +11 +00:00:40,940 --> 00:00:44,900 +برفع الغطاء ايش السيناريوهات المحتملة و ايضا حكينا + +12 +00:00:44,900 --> 00:00:48,580 +اخر شيء عن ال 10-prism vertical test عشان احداث + +13 +00:00:48,580 --> 00:00:52,660 +دبلوبيا في ال target اللي بتطلع عليه ال infant دال + +14 +00:00:52,660 --> 00:00:56,880 +بس شيء بسيط جدا في ال 10-prism test هنشوفه بال + +15 +00:00:56,880 --> 00:00:57,540 +simulation + +16 +00:01:00,210 --> 00:01:03,630 +هي أنا عندي تن برزم لنفرض هذا infant pre verbal + +17 +00:01:03,630 --> 00:01:08,310 +يعني ما اتكلمش لسه و حطينا أمامه ال target هذا هو + +18 +00:01:08,310 --> 00:01:11,950 +بتطلع straight على ال target هذا روحت أنا حطيت + +19 +00:01:11,950 --> 00:01:16,210 +vertical برزم سواء base up أو base down زي ما هي + +20 +00:01:16,210 --> 00:01:20,130 +الصورة عندي هنا base down لمجرد ما حطينا عيني + +21 +00:01:20,130 --> 00:01:23,310 +التنتين اتجهوا للأعلى طبعا معناته العين الشمال هي + +22 +00:01:23,310 --> 00:01:27,550 +اللي بتركزليش؟ لأنه لما حطيت ال Prism الصورة ال + +23 +00:01:27,550 --> 00:01:30,790 +Prism بنجل الصورة باتجاه ال apex بتاعه فطالما + +24 +00:01:30,790 --> 00:01:34,770 +الطفل اتطلع على فوق معناته هو ال target بالنسبة له + +25 +00:01:34,770 --> 00:01:38,110 +أصبح لفوق معناته العين الشمال هي اللي بتركز لو أنا + +26 +00:01:38,110 --> 00:01:41,330 +حطيت ال Prism وضلوا العينين straight زي ما هم + +27 +00:01:41,330 --> 00:01:44,570 +معناته عينه اليمين هي اللي بتركز طيب لو أنا حطيت + +28 +00:01:44,570 --> 00:01:47,430 +ال Prism و مرة بتطلع لفوق و مرة بتطلع straight + +29 +00:01:47,430 --> 00:01:51,670 +معناته both eyesيعني في بينهم alternate fixation + +30 +00:01:51,670 --> 00:01:55,530 +between the global targets وبالتالي في عندي تقريبا + +31 +00:01:55,530 --> 00:01:59,730 +equal vision في العينتين في العينتين هذا بالنسبة + +32 +00:01:59,730 --> 00:02:04,210 +لل test رقم أربعة نيجي لل test رقم خمسة واللي هو + +33 +00:02:04,210 --> 00:02:09,790 +بيحكي عن ال rotation test ال rotation testis a + +34 +00:02:09,790 --> 00:02:12,970 +gross qualitative test طبعا qualitative test كل ال + +35 +00:02:12,970 --> 00:02:15,190 +testات اللي احنا عدينا عليها هي عبارة عن + +36 +00:02:15,190 --> 00:02:21,890 +qualitative tests يعني بتعطيني فكرة عن جودة النظر + +37 +00:02:21,890 --> 00:02:26,610 +هل هو جيد ولا متوسط ولا سيء بس ما بتعطيش رقم يعني + +38 +00:02:26,610 --> 00:02:30,090 +مش quantitative مش quantitative ال rotation test + +39 +00:02:30,090 --> 00:02:33,510 +ايضا احد ال qualitative tests اللي بستعملهم مع ال + +40 +00:02:33,510 --> 00:02:38,320 +preverbal children بيمكنني ال rotation testطبعا هو + +41 +00:02:38,320 --> 00:02:41,700 +عبارة عن ال gross test يعني مش دقيق للغاية ولكن + +42 +00:02:41,700 --> 00:02:46,100 +بيمكنني ان اعرف هل الطفل قادر انه يعمل fixation + +43 +00:02:46,100 --> 00:02:51,120 +with both eyes open ومفتح عينيتين تين يعني هل في + +44 +00:02:51,120 --> 00:02:54,980 +عنده قدرة انه يعمل fixation with both eyes open + +45 +00:02:54,980 --> 00:02:58,800 +اذا كان القدرة هاي موجودة معناته النظر عنده لا بأس + +46 +00:02:58,800 --> 00:03:03,440 +به اذا كان القدرة هاي مش موجودة معناته ال .. ال .. + +47 +00:03:05,020 --> 00:03:09,240 +النظر فيه مشكلة ما ال test is performed as follows + +48 +00:03:09,240 --> 00:03:12,720 +كيف بنعمل ال rotation test هو الحاجة ال examiner + +49 +00:03:12,720 --> 00:03:16,960 +بيحمل الطفل facing him يعني وجهه لوجهه فبالتالي + +50 +00:03:16,960 --> 00:03:21,060 +أنا بحمل .. بحمل الطفل الرضيع و بقى واجهه بطلع + +51 +00:03:21,060 --> 00:03:26,380 +عينيا في عينيه و بعدين بدور فيه دورة بسرعة دورة + +52 +00:03:26,380 --> 00:03:30,080 +واحدة تلت مية و ستيندرجة يعني مابضل أدور فيه ولكن + +53 +00:03:30,080 --> 00:03:34,460 +دورة واحدة ثم بتوقف إذا كان ال vision normal إيش + +54 +00:03:34,460 --> 00:03:37,220 +اللي بيحدث وإذا كان ال vision abnormal إيش اللي + +55 +00:03:37,220 --> 00:03:41,640 +بيحدث إذا كان عندي ال vision normal بنلاقي العينين + +56 +00:03:41,640 --> 00:03:45,700 +بتتحركوا باتجاه الدورانو بعدين بيعودوا ل ال + +57 +00:03:45,700 --> 00:03:48,220 +primary position يعني بيصير عنده nestagmas + +58 +00:03:48,220 --> 00:03:51,780 +nestagmas هذا ال nestagmas بيشوف بيسموه rotation + +59 +00:03:51,780 --> 00:03:56,400 +nestagmas العينين إذا أنا بتحرك الدورة بتاعتي أو + +60 +00:03:56,400 --> 00:03:59,640 +اللفة بتاعتي من اليمين للشمال عينيه بيصيروا + +61 +00:03:59,640 --> 00:04:04,940 +يتحركوا من اليمين للشمال باتجاه الدوران بتاعي و + +62 +00:04:04,940 --> 00:04:08,200 +بعد هيك بيرجعوا ل ال primary position ل ال central + +63 +00:04:08,200 --> 00:04:11,960 +position عشان يلاحظوا ال field المتحركيعني ال + +64 +00:04:11,960 --> 00:04:14,820 +field بتحرك لما أنا بدور، ال field أمام الطفل + +65 +00:04:14,820 --> 00:04:17,720 +بتحرك، فبالتالي عينيه بيحاولوا يلاحجوا، فبيصير + +66 +00:04:17,720 --> 00:04:23,750 +عنده rotation stigmaهذا تحت تأثير ما يسمى بالـ + +67 +00:04:23,750 --> 00:04:27,410 +vestibulo-ocular response أو الـ vestibulo-ocular + +68 +00:04:27,410 --> 00:04:31,570 +reflex إذن بيصير عندي rotational nystagmus under + +69 +00:04:31,570 --> 00:04:34,850 +the influence تحت تأثير ال vestibulo-ocular + +70 +00:04:34,850 --> 00:04:40,150 +response بتجه العينتين باتجاه الدوران بعد هيك + +71 +00:04:40,150 --> 00:04:42,850 +بيعودوا the eyes flick back to the primary + +72 +00:04:42,850 --> 00:04:46,610 +position to produce rotational nystagmusروحت + +73 +00:04:46,610 --> 00:04:50,990 +العينين، ذهاب العينين في اتجاه الدوران، ثم عودتهم + +74 +00:04:50,990 --> 00:04:54,630 +لل primary position، لل primary position هذا بتسمى + +75 +00:04:54,630 --> 00:04:58,510 +rotational nystagmus، هذا ال rotational nystagmus + +76 +00:04:58,510 --> 00:05:03,270 +تحت تأثير ال vestibulo-ocular response، مش هذا هو + +77 +00:05:03,270 --> 00:05:07,000 +اللي هيقيملي موضوع ال visionلما أنا اتوقفت، إيش + +78 +00:05:07,000 --> 00:05:10,480 +اللي بده يصير؟ هنا إحنا بناخد بالنا و إحنا بنطلع + +79 +00:05:10,480 --> 00:05:14,120 +على الطفل When rotation stops, nystagmus is + +80 +00:05:14,120 --> 00:05:17,800 +briefly observed in opposite direction يعني إذا ال + +81 +00:05:17,800 --> 00:05:21,580 +nystagmus اتجاهه لليمين، بس أتوقف عن الدوران، + +82 +00:05:21,580 --> 00:05:25,460 +بيصير اتجاه ال nystagmus للشمال يعني بعكس اتجاهه + +83 +00:05:25,460 --> 00:05:31,660 +لمدة ثانية أو ثانيتين، بعدين بيصيرله اختفاق، بيصير + +84 +00:05:31,660 --> 00:05:35,240 +then ceaseddue to separation of post-rotary + +85 +00:05:35,240 --> 00:05:37,060 +nystagmus by fixation + +86 +00:05:41,040 --> 00:05:46,300 +عن الدوران بعد ما لفيت لفة كاملة ال نستجمص بيظل + +87 +00:05:46,300 --> 00:05:50,280 +مستمر بس باتجاه عكس الاتجاه الأول احنا قولنا اتجاه + +88 +00:05:50,280 --> 00:05:54,320 +ال نستجمص الأول مع اتجاه الدوران الدوران بتاعنا + +89 +00:05:54,320 --> 00:06:00,180 +وبالتالي لما بتوقف بيصير نستجمص باتجاه عكسي هذا ال + +90 +00:06:00,180 --> 00:06:03,640 +نستجمص اللي بالاتجاه العكسي بيسموه post rotary أو + +91 +00:06:03,640 --> 00:06:08,150 +post rotationنستجمس هو هذا اللي انا بدي الاحظه انه + +92 +00:06:08,150 --> 00:06:12,130 +مايضلش ال post rotation نستجمس لمدة اكتر من ثانية + +93 +00:06:12,130 --> 00:06:17,250 +لثانيتين طبعا بعد هيك بيهدأ ليش بيهدأ لأنه بتسير + +94 +00:06:17,250 --> 00:06:21,390 +الآن البيئة اللي حواليها هادية مافيش حركة فيها + +95 +00:06:21,780 --> 00:06:25,880 +فبترسل الصورة ل ال brain و ال brain بيعرف أنه مافي + +96 +00:06:25,880 --> 00:06:30,240 +روتيشن في ال environment حوالين هذا الطفل فبالتالي + +97 +00:06:30,240 --> 00:06:34,620 +بتهدأ عينيه طب لو ال vision bad معناته مش هترسل + +98 +00:06:34,620 --> 00:06:38,980 +الصورة أو هترسل بشكل ready فبظل ال post rotation + +99 +00:06:38,980 --> 00:06:43,260 +استجمس مستمر لعدد ثوانيممكن يستمر لعشر ثواني، + +100 +00:06:43,260 --> 00:06:46,840 +عشرين ثانية، خمسين ثانية، دقيقة، دقيقة و نص، ع بال + +101 +00:06:46,840 --> 00:06:50,220 +ما يتوجب، فبالتالي ضروري جدا أن ال post-rotation + +102 +00:06:50,220 --> 00:06:57,620 +stigma ألاحظه بعد ما أتوقف وأنا بأنظر طبعا لعين + +103 +00:06:57,620 --> 00:07:00,880 +الطفل if vision is severely impaired, the post + +104 +00:07:00,880 --> 00:07:04,480 +-rotation stigma does not stop as quicklywhen + +105 +00:07:04,480 --> 00:07:07,920 +rotation ceases لما بال rotation بيوقف ال post + +106 +00:07:07,920 --> 00:07:11,860 +rotation stigma بيظل شغال بسبب ان ال vision سيء + +107 +00:07:11,860 --> 00:07:17,120 +فال feedback من العين ل ال brain بيكون سيء + +108 +00:07:17,120 --> 00:07:19,980 +وبالتالي ال vestibular و ال ocular response + +109 +00:07:19,980 --> 00:07:24,360 +بيصيرلوش block يعني بتوقفش فبتظهر العين تهتز + +110 +00:07:24,360 --> 00:07:31,390 +فبتظهر العين تهتز نشوف فيديو بيوضح حد القضيةهي + +111 +00:07:31,390 --> 00:07:35,010 +طبعا الفيديو هيجرى على شخص كبير بس نفس الفكرة و + +112 +00:07:35,010 --> 00:07:41,370 +هيتم على الكرسي المتحرك بتم دورانه إذا ملاحظين هنا + +113 +00:07:41,370 --> 00:07:47,130 +في نقطة بدناش تفوت علينا الآن العين بتهتز باتجاه + +114 +00:07:47,130 --> 00:07:53,270 +شمال الشاشة، لأن عكست مرة تانية، انت لاحظ هي العين + +115 +00:07:53,270 --> 00:07:57,230 +تهتز باتجاه يمين المريض، لأن عكست مرة تالتة، انت + +116 +00:07:57,230 --> 00:08:01,790 +لاحظالعين تهتز باتجاه يمين المريض، الآن عكسة + +117 +00:08:01,790 --> 00:08:06,310 +الاتجاه، هذا هو الـ Post Rotation Stagmas لما عكست + +118 +00:08:06,310 --> 00:08:10,010 +الاتجاه، المفروض الـ Post Rotation Stagmas يعني + +119 +00:08:10,010 --> 00:08:15,630 +يتوقف بعد ثانية أو ثانيتين، واضح أن هنا في عندي + +120 +00:08:15,630 --> 00:08:19,810 +لازل الاهتزاز موجود، مرة أخيرة على أساس، هاي + +121 +00:08:19,810 --> 00:08:23,110 +بتتحرك باتجاه يمين المريض، الآن بتتحرك باتجاه + +122 +00:08:23,110 --> 00:08:27,710 +الشمالكما نلاحظ، اتجاه اليمين العين تتحرك، الآن + +123 +00:08:27,710 --> 00:08:32,950 +تهتز باتجاه الشمال، باتجاه الشمال، وبالتالي هذه + +124 +00:08:32,950 --> 00:08:36,310 +القضية بدها تكون واضحة، هذا هو ال post rotation + +125 +00:08:36,310 --> 00:08:44,010 +stagmas اللي انا ب .. بلاحظه وانا .. يعني منتبه + +126 +00:08:44,010 --> 00:08:45,950 +للطفل، وانا منتبه للطفل + +127 +00:08:49,720 --> 00:08:52,340 +ب .. نيجي لل test اللي بعده اللي هو ال + +128 +00:08:52,340 --> 00:08:55,480 +preferential looking test ايش يعني preferential + +129 +00:08:55,480 --> 00:09:00,080 +تفضيلي؟ preferential looking يعني الرؤية التفضيلية + +130 +00:09:00,080 --> 00:09:04,120 +ايش المقصود بالرؤية التفضيلية؟ وجدوا العلماء عند + +131 +00:09:04,120 --> 00:09:07,980 +الأطفال و عند الناس عموما النظام البصري او ال + +132 +00:09:07,980 --> 00:09:12,920 +visual system مبني بحيث انه بينجذب باتجاه ال + +133 +00:09:12,920 --> 00:09:17,080 +bottomإيش يعني بنجذب باتجاه البطغان؟ يعني لو في + +134 +00:09:17,080 --> 00:09:23,800 +عندي مثلا على سبيل المثال سبورة نظيفة تماما و في + +135 +00:09:23,800 --> 00:09:27,560 +أطراف من أطرافها في رسمة صغيرة، الإنسان على السريع + +136 +00:09:27,560 --> 00:09:32,850 +بتجذب ..بتجذب الرسمة الصغيرة بتجذبه لإنه يتطلع + +137 +00:09:32,850 --> 00:09:37,390 +عليها بينما الصبورة الكبيرة اللي هي نظيفة مافيش + +138 +00:09:37,390 --> 00:09:41,830 +عليها أي كلام ما بتجذبه هذا رغم إنه ال stimulus أو + +139 +00:09:41,830 --> 00:09:45,510 +ال light stimulus الصادر من الصبورة ككل أكبر بكتير + +140 +00:09:45,510 --> 00:09:50,070 +من ال light stimulus اللي صادر من هذه الرسمة + +141 +00:09:50,070 --> 00:09:53,850 +الصغيرة إذا ال preferential looking test can be + +142 +00:09:53,850 --> 00:09:58,090 +used from early infancy نقدر نستعملهم منمن المرحلة + +143 +00:09:58,090 --> 00:10:02,890 +الأولى للعمر، الأشهر الأولى للعمر بيعتمدوا على + +144 +00:10:02,890 --> 00:10:06,670 +المعلومة أو على القاعدة اللي بتقول they are based + +145 +00:10:06,670 --> 00:10:10,970 +on the factالحقيقة اللي بتقول إن infants وحقيقة مش + +146 +00:10:10,970 --> 00:10:14,730 +ال infants لحالهم كل الناس prefer to look at a + +147 +00:10:14,730 --> 00:10:17,830 +pattern rather than a homogeneous stimulus + +148 +00:10:17,830 --> 00:10:20,910 +homogeneous stimulus يعني stimulus مافيش فيه أي + +149 +00:10:20,910 --> 00:10:26,090 +أشكال يعني plain stimulus أو stimulus يعني مافيش + +150 +00:10:26,090 --> 00:10:31,110 +فيه أي أشكال أيضا مثلا مثال على ذلك نقول لو إنسان + +151 +00:10:31,110 --> 00:10:37,120 +واقف على شط البحر و البحر كبير جدا جداوالموج هادق + +152 +00:10:37,120 --> 00:10:42,880 +مافيش اي يعني تحرك للموج وفي يعني قارب صغير جدا في + +153 +00:10:42,880 --> 00:10:47,440 +عمق البحر هنلاقي انه الإنسان اللي بيجذبه للنظر هو + +154 +00:10:47,440 --> 00:10:51,960 +بي .. بي .. بيجذب للنظر باتجاه القارب وبنسى البحر + +155 +00:10:51,960 --> 00:10:56,780 +ككل فبالتالي هذه القضية انه فيه a defect انه ال + +156 +00:10:56,780 --> 00:11:01,040 +infants prefer to look at a pattern rather than a + +157 +00:11:01,040 --> 00:11:03,720 +homogeneous stimulusاستفادوا العلماء من هذه + +158 +00:11:03,720 --> 00:11:07,060 +القاعدة أو هذه الحقيقة العلمية في عمل الـ + +159 +00:11:07,060 --> 00:11:10,580 +preferential looking test the infant is exposed to + +160 +00:11:10,580 --> 00:11:15,400 +a stimulus بنعرض ال infant عين ال infant ل pattern + +161 +00:11:15,400 --> 00:11:19,440 +معين and the examiner observes بلاحظ ال examiner + +162 +00:11:19,440 --> 00:11:23,160 +the eyes for fixation movement طبعا هذا ال target + +163 +00:11:23,160 --> 00:11:27,660 +اللي بده أعرضه إليه عبارة عن رسمة في لوحات مختلفة + +164 +00:11:27,660 --> 00:11:31,300 +و مكان الرسمة بتغير من لوحة لل لوحة اللتي تليها زي + +165 +00:11:31,300 --> 00:11:35,680 +ما هنعرضبعد شوية طبعا ال examiner observes the + +166 +00:11:35,680 --> 00:11:38,520 +eyes for fixation movements without themselves + +167 +00:11:38,520 --> 00:11:42,180 +knowing the stimulus position انا حامل اللوحة + +168 +00:11:42,180 --> 00:11:47,220 +موجهها باتجاه الطفل على بعد معين بيكون الرسم فيها + +169 +00:11:47,220 --> 00:11:50,920 +على جانب من الجوانب اما اليمين او الشمال او فوق او + +170 +00:11:50,920 --> 00:11:54,880 +تحت مش شرط انه انا ك examiner اعرف مكان الرسمة بس + +171 +00:11:54,880 --> 00:11:58,870 +انا بيبقى عينيا مركزة على عينين الطفلوكل لوحة + +172 +00:11:58,870 --> 00:12:02,770 +واللوحة اللتي تليها إذا الطفل بنجّل عينيه من لوحة + +173 +00:12:02,770 --> 00:12:06,090 +للتانية بمعنى آخر بيغير اتجاه البصر معناته هو قاعد + +174 +00:12:06,090 --> 00:12:09,250 +بتطلع على هذا ال butter أو هذا ال stimulus + +175 +00:12:09,250 --> 00:12:13,070 +وبالتالي بعرف أن هو شايفه هذا الكلام هنعرضه بعد + +176 +00:12:13,070 --> 00:12:16,990 +شوية طيب إيش ال testات اللي .. اللي تستعمل في ال + +177 +00:12:16,990 --> 00:12:20,710 +preferential looking test في كتير من ال testات في + +178 +00:12:20,710 --> 00:12:21,410 +عندى teller + +179 +00:12:25,150 --> 00:12:30,270 +في عندي ال keyler test و ال keyler و أيضا في عندي + +180 +00:12:30,270 --> 00:12:34,430 +ال cardiff ال cardiff طبعا فكرته بتختلف عن ال + +181 +00:12:34,430 --> 00:12:34,830 +tiller + +182 +00:12:41,820 --> 00:12:44,220 +في عند ال tiller و في عند ال killer و في عند ال + +183 +00:12:44,220 --> 00:12:48,040 +cardiff ال tiller و ال killer عبارة عن خطوط سوداء + +184 +00:12:48,040 --> 00:12:52,200 +بينها خطوط بيضاء و كل لوحة و لوحة التالية بتبدأ + +185 +00:12:52,200 --> 00:12:55,920 +ترفع هذه الخطوط ال cardiff عبارة عن رسمات حقيقية + +186 +00:12:55,920 --> 00:13:02,700 +سمكة سيارة بيت إلى اخرىفبالتالي tests in common + +187 +00:13:02,700 --> 00:13:06,340 +use include teller or killer acuity cards which + +188 +00:13:06,340 --> 00:13:10,560 +consist of black stripes يعني grating يعني تخطيطات + +189 +00:13:10,560 --> 00:13:15,060 +سودة of varying with عرضها بيختلف من لوحة لتانية + +190 +00:13:15,060 --> 00:13:19,740 +زي ما هنعرف بعد شويةand card if acuity cards which + +191 +00:13:19,740 --> 00:13:23,700 +consist of familiar pictures سيارة سمكة كرة إلى + +192 +00:13:23,700 --> 00:13:29,580 +آخره with variable outline width بمعنى أن الرسمة + +193 +00:13:29,580 --> 00:13:33,060 +بتبدأ في اللوحة الأولى بخط عريض و بعدين اللوحة + +194 +00:13:33,060 --> 00:13:38,090 +التانية خط أقل عرضا ثم بيبدأ يرفع الخط بتاعالرسمة + +195 +00:13:38,090 --> 00:13:41,930 +زي ما هنشوف بعد شوية هاي الكاردف هاي بعض اللوحات + +196 +00:13:41,930 --> 00:13:46,970 +من الكاردف هاي سمكة مرسومة بخط عريض هنا بيت هنا + +197 +00:13:46,970 --> 00:13:50,930 +قطار إلى آخرين طبعا مكان الرسمة هنا في التلات + +198 +00:13:50,930 --> 00:13:55,070 +لوحات اللي تم افتيارها في الأعلى طبعا بدنا نعرف + +199 +00:13:55,070 --> 00:13:58,670 +ونكون على يقين انه عندي في تقريبا ستة و تلاتين + +200 +00:13:58,670 --> 00:14:04,490 +لوحة كل لوحةكل لوحة بيكون مكان الرسم إلها معين، + +201 +00:14:04,490 --> 00:14:08,070 +ممكن فوق أو تحت، يعني ممكن فوق أو تحت، بختلفوا + +202 +00:14:08,070 --> 00:14:12,150 +بشكل عشوائي، بحيث بيكونوا مرتبين من الأخمل للأرفع، + +203 +00:14:12,150 --> 00:14:15,950 +و مرة الصورة بتكون فوق، مرة تحت، مرة تحت، مرة فوق، + +204 +00:14:15,950 --> 00:14:19,590 +إلى آخر، بشكل عشوائي، بحيث إنه أعرف، لأن لو كل + +205 +00:14:19,590 --> 00:14:23,980 +الصور في مكان واحدالطفل مش هينجل عينيه مش هقدر + +206 +00:14:23,980 --> 00:14:29,260 +استطيع ان اعرف اللي هو فعلا شايف و لا مجرد انه + +207 +00:14:29,260 --> 00:14:33,320 +بينظر باتجاه مبهر .. باتجاه مبهر هذا بالنسبة لل + +208 +00:14:33,320 --> 00:14:38,880 +cardiff هذه ال test بيسموه cardiff acuity test + +209 +00:14:45,240 --> 00:14:49,040 +طيب، بالنسبة لـ Taylor، الـ Taylor هي واضح عبارة + +210 +00:14:49,040 --> 00:14:53,880 +عن لوحات جاية بال .. بشكل مستطيل، فيها رسمة عبارة + +211 +00:14:53,880 --> 00:14:57,700 +عن خطوط Stripes أو Grating، خطوط سودة وبينها خطوط + +212 +00:14:57,700 --> 00:15:01,640 +بيضا، طبعا هنا أخمل، هنا أرفع، أرفع، كل ما بنروح + +213 +00:15:01,640 --> 00:15:08,070 +طبعا بتحمل بشكل مستعرض وبالتالي ..أحياناً بتكون + +214 +00:15:08,070 --> 00:15:10,670 +على اليمين أحياناً بتكون على الشمال فبدي ألاحظ + +215 +00:15:10,670 --> 00:15:14,750 +الطفل هل هو بيتطلع على اليمين ولا على الشمال يعني + +216 +00:15:14,750 --> 00:15:18,550 +بنجّل بصر ومعناته شايف هاد ال tiller وهي ال killer + +217 +00:15:18,550 --> 00:15:21,370 +ال killer زي ال tiller بس واضح أنه ال target في ال + +218 +00:15:21,370 --> 00:15:25,490 +tiller مربع بينما في ال killer مستدير وفي عندي + +219 +00:15:25,490 --> 00:15:29,690 +target آخر مبهم فبالتالي ال visual system عند ال + +220 +00:15:29,690 --> 00:15:33,990 +infantبيجذب انه يطلع على ال pattern مش على ال + +221 +00:15:33,990 --> 00:15:36,990 +plane stimulus مرة بتكون على اليمين و مرة بتكون + +222 +00:15:36,990 --> 00:15:41,290 +على الشمال طبعا هذه أخمل أرفع أرفع هذا بيسموها low + +223 +00:15:41,290 --> 00:15:44,430 +frequency و هذه بيسموها high frequency يعني كل ما + +224 +00:15:44,430 --> 00:15:47,010 +اتحركنا هيك باتجاه ال high frequency ايش يعني low + +225 +00:15:47,010 --> 00:15:50,210 +frequency grating تخطيطات low frequency يعني + +226 +00:15:50,210 --> 00:15:53,710 +ترددهافي الدائرة high أو في المساحة المرسومة فيها + +227 +00:15:53,710 --> 00:15:57,810 +قليل، هنا عندنا تلت خطوط سودة، هنا مثلا فوق العشرة + +228 +00:15:57,810 --> 00:16:02,010 +أو الخمستاشر خط أسود، فبالتالي ترددها أعلى، ال low + +229 +00:16:02,010 --> 00:16:04,690 +frequency تعني low visual acuity و ال high + +230 +00:16:04,690 --> 00:16:08,590 +frequency إذا اتعرف عليها الطفل معناته better + +231 +00:16:08,590 --> 00:16:14,490 +visual acuity، مابنقدرش نقول جدإذا low frequency + +232 +00:16:14,490 --> 00:16:18,270 +cursive writing or picture with a wider outline + +233 +00:16:18,270 --> 00:16:21,410 +لما بنحكي عن ال card بنحكي عن picture لما بيكون + +234 +00:16:21,410 --> 00:16:27,310 +الرسمة .. خمي الحد بتاعها أو الرسم بتاعها أو لما + +235 +00:16:27,310 --> 00:16:30,150 +بستعمل ال tiller و ال killer لما يكون في عندي low + +236 +00:16:30,150 --> 00:16:34,330 +frequency writing are more easily seen are seen + +237 +00:16:34,330 --> 00:16:37,570 +more easily than high frequency writing or thin + +238 +00:16:37,570 --> 00:16:40,850 +outlines طبعا أصعب يكونوا في .. لما يكون ال thin + +239 +00:16:40,850 --> 00:16:46,080 +..خط الرسم thin أو ال grating رفيعة كتير بيكون + +240 +00:16:46,080 --> 00:16:51,340 +عنده صعب التعرف عليها اللي بيصير .. بيصير + +241 +00:16:51,340 --> 00:16:54,580 +assessment لل resolution not recognition إيش يعني + +242 +00:16:54,580 --> 00:16:57,640 +assessment لل resolution not recognition؟ يعني + +243 +00:16:57,640 --> 00:17:03,140 +اللي بنختبره فقط الطفل شايف أو مش شايفيعني شايف + +244 +00:17:03,140 --> 00:17:06,380 +رسمة ولا .. مش شايف بس مش شرط انه اتعرف على طبيعة + +245 +00:17:06,380 --> 00:17:10,240 +هذه الرسمة مجرد انه حرك عينيه باتجاه هذا ال + +246 +00:17:10,240 --> 00:17:13,260 +pattern او باتجاه هذا الرسمة معناته شايفها + +247 +00:17:13,260 --> 00:17:19,410 +فبالتالي هيكا بيتم التقييم طيببالتالي بنعمل visual + +248 +00:17:19,410 --> 00:17:22,450 +acuity is met accordingly يعني بنقدر نقيم هل ال + +249 +00:17:22,450 --> 00:17:26,870 +vision good ولا moderate ولا bad since grating + +250 +00:17:26,870 --> 00:17:30,670 +acuity often exceeds snilling acuity in amblyopia + +251 +00:17:30,670 --> 00:17:35,070 +teller cards may overestimate visual acuity مامعنى + +252 +00:17:35,070 --> 00:17:38,890 +هذا القضية لو إنسان عنده مثلا على سبيل المثال خمس + +253 +00:17:38,890 --> 00:17:45,790 +سنوات وسألته .. سألتهعنده أمبيوبيا وسألته على + +254 +00:17:45,790 --> 00:17:51,350 +listening chart وكان ال best correction عنده 66 + +255 +00:17:51,350 --> 00:17:56,790 +أمبيوبيك 66 هو نفس الشخص لو جيت أفحصه بال killer + +256 +00:17:56,790 --> 00:18:01,570 +أو بال tiller أو بال cardiff هيكون عنده أفضل من 66 + +257 +00:18:01,570 --> 00:18:05,970 +ليش؟ لأن هذه ال test بتعمل over estimation بتعطي + +258 +00:18:06,460 --> 00:18:10,680 +درجة أو بتعطي نتيجة أفضل من الـ Snellen كرقم بس هي + +259 +00:18:10,680 --> 00:18:13,640 +على حقيقة الأمر أقل دقة من الـ Snellen لأنه الـ + +260 +00:18:13,640 --> 00:18:17,220 +crowding فنوميلون مش موجودة منهم فيها بمعنى أنه + +261 +00:18:17,220 --> 00:18:20,580 +هتلاقوا target واحد في كل لوحة يعني مافيش crowding + +262 +00:18:20,580 --> 00:18:23,880 +مافيش crowding واحنا قلنا ضروري تكون بالذات عند ال + +263 +00:18:23,880 --> 00:18:27,220 +amblyobic patients أنه أستعمل ظاهرة ال crowding + +264 +00:18:27,220 --> 00:18:32,260 +لأنها بتعكس النظر بصورة صحيحة بشكل أكبر إذا ال + +265 +00:18:32,260 --> 00:18:37,210 +tillerأو الـ Grating Acuity عادة بتفوق الـ + +266 +00:18:37,210 --> 00:18:40,370 +Snilling Acuity في الامبيوبيا، عشان هيك الـ Tiller + +267 +00:18:40,370 --> 00:18:45,110 +و الـ Cardiff و ال .. Tiller و ال .. و ال killer و + +268 +00:18:45,110 --> 00:18:49,620 +ال Cardiff may over estimate visual acuityالان في + +269 +00:18:49,620 --> 00:18:52,340 +ضال اخر شغلتين نحكي عن ال preferential looking + +270 +00:18:52,340 --> 00:18:56,340 +test اول شغلة لازم لما افحص بال .. بال .. + +271 +00:18:56,340 --> 00:19:00,720 +بالفحوصات هاي بهذه ال testات لازم استمع .. اتبع + +272 +00:19:00,720 --> 00:19:05,020 +protocol معين وضروري يكون ال protocol صارم these + +273 +00:19:05,020 --> 00:19:08,100 +methods may not be reliable ممكن لا يعتمد على + +274 +00:19:08,100 --> 00:19:11,540 +نتائجهم اذا انا ما اتبعت his first choice + +275 +00:19:11,540 --> 00:19:15,220 +staircase protocol يعني ضروري يكون المسافة محددة + +276 +00:19:15,220 --> 00:19:20,380 +ضروري جدا ا ..أعمل أداء لل test بشكل صحيح عشان + +277 +00:19:20,380 --> 00:19:25,160 +أقدر أخد نتيجة وبتطلها النتيجة رغم ذلك أقل دقة من + +278 +00:19:25,160 --> 00:19:29,020 +listening acuity فبالتالي هذا القضية تاني شيء + +279 +00:19:29,020 --> 00:19:34,700 +ضروري جدا انه أعرف ان هذه ال testات التلاتةneither + +280 +00:19:34,700 --> 00:19:39,740 +sensitive nor specific أو + +281 +00:19:39,740 --> 00:19:41,620 +.. أو neither sensitive يعني ال sensitivity + +282 +00:19:41,620 --> 00:19:45,900 +بتاعتها لل .. لل presence of ampliobia قليلة، يعني + +283 +00:19:45,900 --> 00:19:48,580 +ممكن الإنسان يكون عنده ampliobia و يعطيني على هذه + +284 +00:19:48,580 --> 00:19:53,310 +التستات التلاتة يعطيني ستة ع ستة، فضروري أناما + +285 +00:19:53,310 --> 00:19:58,150 +أكتفي بكلمة 6 ع 6 وإنما ضروري أسأل نفسي هل الطفل + +286 +00:19:58,150 --> 00:20:01,610 +في عنده risk factors for amblyopia ال risk factors + +287 +00:20:01,610 --> 00:20:06,410 +الخامسة اللي هي ال squint ال anisometropia ال high + +288 +00:20:06,410 --> 00:20:10,530 +bilateral ametropia الastigmatism و ال form vision + +289 +00:20:10,530 --> 00:20:13,930 +deprivation اللي هي أنواع ال amblyopia الخامسة هي + +290 +00:20:13,930 --> 00:20:17,350 +نفسها ال risk factors for amblyopia فإذا كان في + +291 +00:20:17,350 --> 00:20:20,970 +موجود واحد أو أكتر من هذه الأنواعيعني من هذه ال + +292 +00:20:20,970 --> 00:20:25,310 +risk factors for Ampliobia وعلى هذه ال testات أداء + +293 +00:20:25,310 --> 00:20:29,690 +المريض 6 ع 6 وأداء الطفل 6 ع 6 برضه أنا لازم أخبر + +294 +00:20:29,690 --> 00:20:33,350 +الأهل أن هذه لا تعني بالضرورة 6 ع 6 وإنما طالما في + +295 +00:20:33,350 --> 00:20:37,840 +وجود risk factor for Ampliobiaفغالبا ال amblyopia + +296 +00:20:37,840 --> 00:20:42,700 +موجودة ساعتها أنا بقول أنه بدنا .. بدنا نبدأ نعالج + +297 +00:20:42,700 --> 00:20:46,220 +حتى لو النظر على هذه ال testات أعطاني 6 ع 6 لأن + +298 +00:20:46,220 --> 00:20:50,400 +هذه الفحوصات ليست دقيقة وهذه بتقيم ال equality مش + +299 +00:20:50,400 --> 00:20:55,200 +ال quantity نيجي لأخر شيء اللي هو ال pattern + +300 +00:20:55,200 --> 00:21:00,080 +visually evoked potential هذه ال VEP اختصار ل + +301 +00:21:00,080 --> 00:21:04,520 +visually evoked + +302 +00:21:06,080 --> 00:21:10,540 +potential بس قبل ما نبدأ فيها في فيديو كنت حابب + +303 +00:21:10,540 --> 00:21:15,800 +أرضه ل preferential looking desk اللي هي ال tiller + +304 +00:21:15,800 --> 00:21:22,420 +و ال killer نروح + +305 +00:21:22,420 --> 00:21:31,420 +للفيديو هاي ال tiller acuity cards هاي + +306 +00:21:31,420 --> 00:21:33,360 +بيعرض للطفل انكبر + +307 +00:21:37,370 --> 00:21:42,710 +طبعا الطفل ممكن يشير بأداة مثلا معينة هذه أداة ال + +308 +00:21:42,710 --> 00:21:47,070 +cover test وين ما كان الرسمة مش شرط يعرف إيش هي + +309 +00:21:47,070 --> 00:21:55,630 +الرسمة هاي الطفل بيشير بالاتجاه مرة بتكون على + +310 +00:21:55,630 --> 00:21:58,030 +اليمين و مرة على الشمال و مرة بيخربطله إياها و مره + +311 +00:21:58,030 --> 00:22:03,430 +و مرة بيخربطله + +312 +00:22:03,430 --> 00:22:05,210 +إياها و مرة و مرة و مرة و مرة و مرة و مرة و مرة و + +313 +00:22:05,210 --> 00:22:05,210 +مرة و مرة و مرة و مرة و مرة و مرة و مرة و مرة و + +314 +00:22:05,210 --> 00:22:05,210 +مرة و مرة و مرة و مرة و مرة و مرة و مرة و مرة و + +315 +00:22:05,210 --> 00:22:05,210 +مرة و مرة و مرة و مرة و مرة و مرة و مرة و مرة و + +316 +00:22:05,210 --> 00:22:05,210 +مرة و مرة و مرة و مرة و مرة و مرة و مرة و مرة و + +317 +00:22:05,210 --> 00:22:11,540 +مرةإذا ملاحظين ال examiner غالبا بتطلع في اتجاه في + +318 +00:22:11,540 --> 00:22:12,960 +اتجاه عين الطفل + +319 +00:22:17,970 --> 00:22:22,410 +هيو جلبله إياها الطفل بي shower عليها بشكل صحيح طب + +320 +00:22:22,410 --> 00:22:26,210 +لو الطفل بيقدرش ي shower مجرد أنا أطلع في عينيه + +321 +00:22:26,210 --> 00:22:32,070 +أشوف طبعا هل هو بيحرك عينيه باتجاه ال target ولا + +322 +00:22:32,070 --> 00:22:36,010 +لأ باتجاه ال target ولا لأ طبعا كل لوحة و لوحة + +323 +00:22:36,010 --> 00:22:41,290 +التي تليها الخطوط بتبدأ تعرض الآن في نقطة بدأ أحكي + +324 +00:22:41,290 --> 00:22:46,840 +عنهااحيانا الطفل بيكون أخطأ لمرة واحدة أنه بدل ما + +325 +00:22:46,840 --> 00:22:51,340 +يأشر على المكان أشر جنبه أو كده ماباعتبرهوش خطأ و + +326 +00:22:51,340 --> 00:22:56,120 +بكمل لغاية .. يعني هيكون التأشير على اللوحات بتالي + +327 +00:22:56,120 --> 00:22:59,660 +.. يعني ب .. ب .. بتصحح طبعا الطفل برضه بدنا ناخد + +328 +00:22:59,660 --> 00:23:04,040 +بالنا أنه ممكن يكون تحكمه في عضلات أيدي لسه مش .. + +329 +00:23:04,040 --> 00:23:09,080 +مش مائة بالمائة فبالتالي بتأخذ هذه بعين الاعتبار + +330 +00:23:13,400 --> 00:23:18,900 +هي الطفل أشر هى جلبله عشان تكون ع شماله هيؤشر طبعا + +331 +00:23:18,900 --> 00:23:26,020 +أشر مش عليها 100% ولكن باتجاهها باتجاهها هى + +332 +00:23:26,020 --> 00:23:33,660 +بده يستعمل أيده لشمال هذا هو أحد ال preferential + +333 +00:23:33,660 --> 00:23:38,960 +looking tests زى ما احنا شايفين زى ما احنا شايفين + +334 +00:23:38,960 --> 00:23:40,160 +الآن + +335 +00:23:44,540 --> 00:23:49,120 +بنيجي لل test رقم سبعة من ال testات اللي + +336 +00:23:49,120 --> 00:23:56,540 +استعرضناهم ل .. اللي هي assessment of vision in + +337 +00:23:56,540 --> 00:24:01,180 +preverbal children ما معنى visually evoked + +338 +00:24:01,180 --> 00:24:05,290 +potential؟potential يعني فرق الجهد evoked المستحث + +339 +00:24:05,290 --> 00:24:10,230 +بصريا يعني إيش فرق الجهد المستحث بصريا الفرق الجهد + +340 +00:24:10,230 --> 00:24:14,750 +يعني الكهربا يعني النشاط الكهربائي المستحث بصريا + +341 +00:24:14,750 --> 00:24:18,590 +نشاط الكهربائي تعمين تعاد دماغ يعني لو أنا حطيت + +342 +00:24:18,590 --> 00:24:22,570 +أقطاب على رأس الطفل أو على رأس الإنسان اللي بدأ + +343 +00:24:22,570 --> 00:24:28,030 +أفحصه عشان يتجيس لنشاط الكهربا إلى الدماغبس أستحث + +344 +00:24:28,030 --> 00:24:31,390 +العين بصريًا يعني بدأ أعرض العين ل pattern أو شكل + +345 +00:24:31,390 --> 00:24:37,550 +معين و أشوف نتيجة الصورة اللي سقطت على الشبكية و + +346 +00:24:37,550 --> 00:24:41,670 +أرسلت للدماغ كيف الدماغ تنشط كهربائيًا و منها بقدر + +347 +00:24:41,670 --> 00:24:45,790 +أعرف ال vision طبعًا pattern VEP give + +348 +00:24:45,790 --> 00:24:49,730 +representation of spatial acuity but is more + +349 +00:24:49,730 --> 00:24:52,470 +regularly used in the diagnosis of optic + +350 +00:24:52,470 --> 00:24:56,180 +neuropathyغالبا هذا ال test لا يستعمل لتقييم النظر + +351 +00:24:56,180 --> 00:25:00,760 +عند الأطفال غالبا يستعمل في اعتلالات العصب البصري + +352 +00:25:00,760 --> 00:25:04,840 +عند الكبار غالبا ولكن ممكن في حالات معينة أني + +353 +00:25:04,840 --> 00:25:09,020 +أستعمله عند الطفل عشان أقدر أشوف الإبصار عنده كيف + +354 +00:25:09,020 --> 00:25:13,600 +و أضعه إذا بوسائل تانية ماقدرتش أحدد يعني بدنا + +355 +00:25:13,600 --> 00:25:17,820 +انعرض العين ل pattern معين عشان هيك بيسموه pattern + +356 +00:25:17,820 --> 00:25:22,060 +VEP ال VEP في منها نوعين في .. هي عندي flash VEP + +357 +00:25:25,180 --> 00:25:29,080 +يعني نشاط كهربائي في الدماغ بستحسه بواسطة flash of + +358 +00:25:29,080 --> 00:25:32,960 +light، هذا ال flash of light بخليه مرة يضوي و مرة + +359 +00:25:32,960 --> 00:25:38,560 +يضفي، و بعد ذلك بقى أبدأ أصغر ال flash كل ما كانت + +360 +00:25:38,560 --> 00:25:41,880 +استجابة الدماغ، و أنه في نشاط كهربائي في الدماغ + +361 +00:25:42,220 --> 00:25:45,660 +نتيجة تصغير ال flash معناته ال vision أفضل كل ما + +362 +00:25:45,660 --> 00:25:49,720 +صغرت أكتر وجدر الدماغ يعمل نشاط كهربائي معناته هذا + +363 +00:25:49,720 --> 00:25:53,900 +الضوء الصغير أو تصغير الضوء برضه وصلت صورة هذا + +364 +00:25:53,900 --> 00:25:58,460 +الضوء للدماغ وجدر يتنشط كهربائيا في عندي flash VAB + +365 +00:25:58,460 --> 00:26:03,440 +وفي عندي patternVEB اللي بجالي ينفيه حدة الإبصار + +366 +00:26:03,440 --> 00:26:06,880 +اللي هي ال pattern VEB نشاط الكهرباء المستحاف + +367 +00:26:06,880 --> 00:26:11,800 +بصريا بواسطة pattern معين أو شكل معين هو عبارة عن + +368 +00:26:11,800 --> 00:26:16,420 +شاشة بتعرض مربعات سودة وبيضة بالضبط زي رقعة + +369 +00:26:16,420 --> 00:26:20,650 +الشطرانجالشاشة بتجلب يعني الأبيض بيصير أسود + +370 +00:26:20,650 --> 00:26:25,410 +والأسود بيصير أبيض بسرعة معينة هذا تغيير في الشكل + +371 +00:26:25,410 --> 00:26:28,590 +لما الأبيض يصير أسود والأسود يصير أبيض معناته + +372 +00:26:28,590 --> 00:26:34,770 +الشكل اتغير الدماغ بيستحث بتغيير الشكل فبيصير عنده + +373 +00:26:34,770 --> 00:26:39,170 +نشاط كهربائي مربعات قطعة الشطرانج هذه اللي بتعرضها + +374 +00:26:39,170 --> 00:26:45,890 +الشاشة بيتم تصغيرها وكل مكان فيه نشاط للدماغموجود + +375 +00:26:45,890 --> 00:26:48,970 +معناته هو اتعرف على المربعات الأصغر فما بالتالي + +376 +00:26:48,970 --> 00:26:52,990 +حدة الإبصار بيكون أفضل إذا .. إذا سألني حدا + +377 +00:26:52,990 --> 00:26:56,590 +بالنسبة للـ visually evoked potential أي نوع منها + +378 +00:26:56,590 --> 00:27:00,290 +اللي يستخدم للتقييم حدة الإبصار بنقوله النوع اللي + +379 +00:27:00,290 --> 00:27:04,590 +يستخدم هو ال pattern VAB وليس ال flash VAB + +380 +00:27:04,590 --> 00:27:09,050 +فبالتالي هذه القضية ضرورة تكون واضحة وجالية نشوف + +381 +00:27:09,050 --> 00:27:16,430 +احنا أول حاجة بدناهي الطفل على رأسه الأقطاب، بتعرض + +382 +00:27:16,430 --> 00:27:23,010 +أمامه شاشة، الشاشة ممكن تعرضلي مربعاتمربعات أو + +383 +00:27:23,010 --> 00:27:30,050 +ممكن تعرض ل flash ال flash VEP ال flash VEP on off + +384 +00:27:30,050 --> 00:27:35,370 +يعني مرة بيصير ضاوي و مرة بيصير مطفي و مرة بيصير + +385 +00:27:35,370 --> 00:27:39,310 +ضاوي و بتردد هذه القضية الان هنشوف ال test هذا على + +386 +00:27:39,310 --> 00:27:45,830 +شخص كبير بس هو نفسه اللي يجرى على شخص يعني طفل + +387 +00:27:45,830 --> 00:27:50,500 +صغير هاي المربعاتاللي بتعرضه الشاشة طبعا و إيه هذه + +388 +00:27:50,500 --> 00:27:55,700 +الأقطاب موصولة عشان تعملي مخطط لكهربائي دماغ + +389 +00:27:55,700 --> 00:28:00,320 +المريض بتغلق عين و العين التانية بتكون مركزة في + +390 +00:28:00,320 --> 00:28:04,340 +النقطة الحمرا هاي على المسافة هاي ليه سبعة و خمسين + +391 +00:28:04,340 --> 00:28:08,360 +صنطة شايفين الأبيض بيقلب أسود و الأسود بيقلب أبيض + +392 +00:28:08,360 --> 00:28:12,540 +كل مربع بيعمل one degree مع العين one degree مع + +393 +00:28:12,540 --> 00:28:14,380 +العين يعني إله حجم معين + +394 +00:28:17,610 --> 00:28:22,410 +الـ test له ست مراحل تلت مراحل بتخص العين اليمين + +395 +00:28:22,410 --> 00:28:27,170 +وتلت مراحل بتخص العين الشمال المرحلة الأولى نختبر + +396 +00:28:27,170 --> 00:28:34,510 +العين اليمين المرحلة التانية .. المرحلة واحد نختبر + +397 +00:28:34,510 --> 00:28:37,490 +فيها العين اليمين بالمربعات اللي بتعمل one degree + +398 +00:28:37,490 --> 00:28:43,770 +المرحلة تلاتةالمرحلة تلاتة بنختبر العين الشمال + +399 +00:28:43,770 --> 00:28:47,110 +برضه بنفس حجم المربعات اللي بتعمل one degree + +400 +00:28:47,110 --> 00:28:53,610 +المرحلة خمسة يعني واحد step one step one هيكم زي + +401 +00:28:53,610 --> 00:28:58,010 +ما كنتوا شايفين مغطي عينه الشمال وفاتح عينه اليمين + +402 +00:28:58,010 --> 00:29:01,790 +بتطلع في ال fixation target وهذا ال pattern sort + +403 +00:29:01,790 --> 00:29:06,010 +of تسقط على الفوفيا وما حول الفوفياطيب، ليش حجم + +404 +00:29:06,010 --> 00:29:09,430 +الشاشة هيك؟ وليش المريض بعيد سبعة وخمسين صنطي؟ + +405 +00:29:09,430 --> 00:29:13,730 +عشان كل مربع يعمل زاوية مع العين مقدارها واحد + +406 +00:29:13,730 --> 00:29:17,510 +degree طيب، step one، بنختبر العين اليمين step + +407 +00:29:17,510 --> 00:29:20,190 +تلاتة، ممكن السان يقول طب step اتنين، لا step + +408 +00:29:20,190 --> 00:29:24,390 +اتنين جايين، لا، بس في حجم مربعات أخر step واحد، + +409 +00:29:24,390 --> 00:29:28,070 +بنختبر العين اليمين step تلاتة، بنختبر العين + +410 +00:29:28,070 --> 00:29:33,770 +الشمال، بنفس المربعاتstep 5 بنختبر العينين مع بعض + +411 +00:29:33,770 --> 00:29:38,410 +مفتوحات عشان نشوف ال response أفضل ولا لأ فبالتالي + +412 +00:29:38,410 --> 00:29:42,270 +في عندي step 1 للعين اليمين step 3 للعين الشمال و + +413 +00:29:42,270 --> 00:29:47,690 +step 5 للعينين مع بعض بحيث ان الحجم المربعات ان كل + +414 +00:29:47,690 --> 00:29:51,710 +مربع بعمل one degree مع العين نشوف هذه القضية + +415 +00:29:51,710 --> 00:29:54,990 +طبعاً لما بنختبر العين اليمين و لما بنختبر العين + +416 +00:29:54,990 --> 00:29:59,490 +الشمالو لما بنختبر العين تان مع بعض الشاشة بتغير + +417 +00:29:59,490 --> 00:30:05,230 +الأبيض أسود والأسود أبيض زي ما احنا شايفين بالصورة + +418 +00:30:05,230 --> 00:30:11,770 +اللي واضحة جدا في هذه القضية الآن بدنا نروح ل + +419 +00:30:12,860 --> 00:30:18,380 +المربعات أصغر .. المربعات أصغر .. كل مربع بيعمل + +420 +00:30:18,380 --> 00:30:21,920 +ربع degree إذا نزلنا بحجم المربع من one degree + +421 +00:30:21,920 --> 00:30:25,720 +بيعملوا مع العين لربع degree بيعملوا مع العين step + +422 +00:30:25,720 --> 00:30:31,210 +2 .. step 2في هذا الحجم من المربعات بنستخدم .. + +423 +00:30:31,210 --> 00:30:34,110 +بنفحص فيه العين اليمين ال response تاع العين + +424 +00:30:34,110 --> 00:30:38,810 +اليمين step 4 بنفحص العين الشمال step 6 بنفحص + +425 +00:30:38,810 --> 00:30:44,390 +العينتين مع بعض زي ما احنا شايفين الشاشة بتغير + +426 +00:30:44,390 --> 00:30:48,610 +الأسود أبيض و الأبيض أسود عشان الصورة تتغير على + +427 +00:30:48,610 --> 00:30:53,110 +سطح الشبكية فبالتالي الدماغ يستجيب .. الدماغ + +428 +00:30:53,110 --> 00:30:56,730 +يستجيب في هذه اللحظة بيكون الجهاز بتخطيط زي ما + +429 +00:30:56,730 --> 00:31:03,150 +انتوا شايفينإيه هذا؟ الآن في ال VEP في شغلتين + +430 +00:31:03,150 --> 00:31:08,330 +ضروريات إنه ناخد بالنا منهم اللي تنسي، إيش يعني + +431 +00:31:08,330 --> 00:31:13,590 +اللي تنسي؟ الفترة بين إن أعرض العين لهذه قطعة + +432 +00:31:13,590 --> 00:31:17,150 +الشطرانج وبين إنه تبدأ الاستجابة، هنا لسه مافيش + +433 +00:31:17,150 --> 00:31:22,310 +استجابةهذا أول استجابة عند خمسة وسبعين ثانية + +434 +00:31:22,310 --> 00:31:26,530 +بيسموها negative خمسة وسبعين and خمسة وسبعين بعدين + +435 +00:31:26,530 --> 00:31:30,690 +استجابة أخرى positive مية عند ميت ثانية بعدين + +436 +00:31:30,690 --> 00:31:33,570 +negative مية وخمسة وتلاتين اذا في عندي two + +437 +00:31:33,570 --> 00:31:38,280 +deflections انحضارينواحد على خمسة وسبعين ثانية + +438 +00:31:38,280 --> 00:31:42,200 +وواحد على مية وخمسة وتلاتين ثانية وفي ارتفاع في + +439 +00:31:42,200 --> 00:31:46,900 +المخطط الكهربائي للدماغ هذا المخطط ناتج عن تعريض + +440 +00:31:46,900 --> 00:31:50,340 +العين ل stimulus ناتج عن تعريض العين ل stimulus + +441 +00:31:50,340 --> 00:31:53,800 +وهذا الرسم هي في ال normal احنا بنشوفهطبعا لو + +442 +00:31:53,800 --> 00:31:57,780 +اختلف شكل الرسمة بيكون في عندي abnormality وهذه + +443 +00:31:57,780 --> 00:32:01,520 +بيحددوها الناس المتخصصة في هذه القضية الناس + +444 +00:32:01,520 --> 00:32:05,460 +المتخصصة في هذه القضية فهذه هي ال visually evoked + +445 +00:32:05,460 --> 00:32:08,040 +potential ال visually evoked potential واللي + +446 +00:32:08,040 --> 00:32:13,940 +بتستخدم لإنها تعيين لل vision بس هي أكثر استخداما + +447 +00:32:13,940 --> 00:32:17,680 +في ال optic neuropathy في ال optic neuropathy هيك + +448 +00:32:17,680 --> 00:32:22,180 +بنكون خلصناالـ assessment أو الـ qualitative + +449 +00:32:22,180 --> 00:32:25,600 +assessment of visual behavior طبعاً هنا عندي + +450 +00:32:25,600 --> 00:32:30,240 +اللاتنسي اللي من بداية ما أعرض العين لل stimulus + +451 +00:32:30,240 --> 00:32:36,180 +لغاية بداية الاستجابة سموها اللاتنسيكمية الـ + +452 +00:32:36,180 --> 00:32:39,320 +deflection أو ارتفاعه بيسموه الـ amplitude هدولة + +453 +00:32:39,320 --> 00:32:43,820 +التنين هم يعني مؤشرين بقدر استخدم عشان اعرف ال + +454 +00:32:43,820 --> 00:32:47,920 +normal من ال abnormal طبعا ال pattern بيتغير + +455 +00:32:47,920 --> 00:32:52,120 +الأسود أبيض و الأبيض أسود أمام العين و الأقطاب + +456 +00:32:52,120 --> 00:32:56,900 +الموجودة على الرأس من الخارج بتوصل بكمبيوتر و + +457 +00:32:56,900 --> 00:33:00,020 +الكمبيوتر بيعطيني الرسمة في ال normal و ال + +458 +00:33:00,020 --> 00:33:06,300 +abnormalفي ال normal و ال abnormal يعني بتتضح عندى + +459 +00:33:06,300 --> 00:33:10,160 +الأمور بتتضح عندى الأمور نتوقف عند هذه النقطة و + +460 +00:33:10,160 --> 00:33:13,060 +المرة القادمة ان شاء الله تعالى هنعمل testing لل + +461 +00:33:13,060 --> 00:33:16,800 +verbal children يعني الأطفال اللي بدأوا يتكلموا و + +462 +00:33:16,800 --> 00:33:20,280 +يعطيكم العافية والسلام عليكم ورحمة الله وبركاته +