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PRI Vision Website
The PRI Vision website is up and running!
Remember to Register! Postural-Visual Integration in Vermont!
PRI Vision’s second Postural-Visual Integration course is coming to Vermont March 24-25, 2012 in Essex Junction!
Remember to Register - Postural-Visual Integration February 25-26, 2012!
Postural-Visual Integration is coming to Minnesota!
PRI Vision Course Schedule
PRI Vision courses are set for 2012. To learn more about the courses offered click here! To join the PRI Vision mailing list . Postural-Visual Integration Course Description: This course is designed to educate Physical Therapists, PT Assistants, and Occupational Therapists on how a patient with persistent patterning that inhibits PRI neutral maintenance, can be objectively evaluated and managed through tri-planar visual integration and autonomic inhibition. It will allow the course attendee to better understand why a patient with cervical and cranial imbalanced neuromuscular tone and activity is unable to correct patterned asymmetries. Specific treatment approaches will be offered to improve head on body (HOB) activity and visual cortical influence of the anti-gravitational and accessory respiratory muscle of the head and neck. This course will utilize PRI concepts and theory and ocular functional integration to change vestibular postural autonomic and biomechanics of postural stability. The speakers have dedicated their careers to patients with postural and visual imbalance and have utilized scientific principles in their respective fields to treat, in this unique interdisciplinary manner, visual integrative dysfunction. No prior visual training or visual course prerequisites are required. However, information provided by attending Myokinematic Restoration or Postural Respiration would be helpful. Registration Form
Course Description : Have you ever considered what a patient’s subjective refraction or eye alignment has to do with their back pain? Or why a patient has constant neck pain while they are at the computer, even though they are pre-presbyopic and have good ergonomics? The answer lies in how they use their vision to direct their bodies to perform any given task, such as walking, sitting at their desk, or playing a sport. The relationship between vision, body posture and movement can be controlled through the use of lenses, then integrated and re-trained through physical activities designed to embed the new relationship. This frequently results in decreased pain, improved physical performance, and prevention of future symptoms for a myriad of complaints. We can influence the autonomic nervous system to turn the right muscles “on” and the wrong muscles “off” for any given physical task. This course is designed for both general eye care practitioners and behavioral/VT doctors to gain an appreciation for how vision controls the body and muscle tone, among other autonomic functions. The relationship of refractive findings, visuomotor skills, and visual processing to muscle tone and skeletal alignment will be outlined. The focus of this course will be on how to achieve a MORE symmetrical, relaxed, whole body musculoskeletal system through integration of the visual system. Considerations for prevention of musculoskeletal dysfunction and maximizing human performance will be discussed, including eyeglass and contact lens prescribing recommendations. Participants will be able to work as part of an integrated team to manage neuromuscular patterns that contribute to spatial disorientation, headaches, neck tension, and low back pain, as well as appreciate how these are related to visual system function. Registration Form
Updated PRI Vision Triage and New Self Assessment FormsWe have made a few updates to the PRI Vision Triage Forms! Please note that we’ve added instructions to follow when referring a patient to PRI Vision, as well as when other integrative disciplines are needed. We have also added a PRI Vision Self Assessment Form for those who are self-referring, as well as other disciplines (other than PTs/OTs) referring patients to PRI Vision.
Congratulations Dr. Heidi Wise!Dr. Heidi Wise has recently been certified as a Fellow in the College of Optometrists in Vision Development (FCOVD). Dr. Wise was one of only 27 optometrists to achieve this status within COVD at the association’s annual meeting last month. . It took years of hard work, hours and hours of qualification tests and case reports, and lots of sacrifice but all the work has paid off. Dr. Wise is one of only three optometrist in the state of Nebraska who has achieved this status and certification. As a fellow of COVD she is now certified to offer state-of-the-art clinical services in PRI Vision science, behavioral and developmental vision care, optometric vision therapy, sports vision and vision rehabilitation. All COVD Fellows are Board certified in vision development and therapy and offer functional and preventative vision care services to their patients. To maintain this honor and certification Dr. Wise must obtain a minimum of 15 hours of COVD courses per year. This assures all patients who see Dr. Wise at the Hruska clinic or PRI Vision are getting the latest care available in behavioral optometry and functional vision science. Congratulations Dr. Wise!!!!
PRI Vision Construction Update!
Check out our Facebook page for more updated construction pictures!
Construction Update!The construction is coming along very fast for PRI Vision! We now have walls!
Updated Construction News!
We’re making progress on our new PRI-Vision Clinic! The floor is coming along smoothly!
Update on new PRI Vision Facility!
Concrete has been poured for our new PRI Vision Facility, so progress is coming along!
Kelly Bridger
As I’ve mentioned in the recent blogs, we have our first PRI Vision employee! I asked her to take a moment and write a brief bio on herself to share. Kelly is our Administrative Services Manager, which right now, as the lone employee, means she gets to do everything that needs to get done! She will be the main contact point for both therapists and patients, which should speed up the response time from both Ron and I to any questions. She is also in charge of coordinating patient appointments and information needed for the visits. As someone with PRI background, she is going to be a very valuable asset to Ron and I as we grow! To contact Kelly, you can call the Hruska Clinic, until our new facility is done, at (402) 467-4545 or by email: . I am originally from Lincoln, NE, but spent 16 1/2 years out in Wyoming where I graduated in 1999 with an Associates of Applied Science as a Physical Therapist Assistant. In 2003, I also became a Certified Pilates Instructor. Since 1999, I have worked in many realms of physical therapy: long term care, acute hospital rehabilitation, handicapped adult facilities, pediatrics, home health, manual therapy, and outpatient orthopedic rehabilitation which has been the majority of my experience. I started taking PRI courses in 2004 when a PT friend of mine suggested the Myokinematic Restoration course. I then continued going to the PRI courses and have completed all of them. I was hooked from day one as I firmly believe this is the future of physical therapy and am very passionate about the PRI science. Unfortunately, I was never really able to use much of the PRI approach in Wyoming, which was professionally frustrating. I finally moved back home to Nebraska in June 2010, and just a year later was given the opportunity to make a slight change in my career path as the PRI Vision Administrative Services Manager. This was an opportunity I could not pass up! I am excited to watch this integrative approach grow and to be a part of it from the beginning. In my free time, I enjoy spending time with family and friends, traveling, hiking, biking, running, and many other seasonal outdoor activities. My fiancé, Chris, and I are making plans for a summer wedding in 2012.
Progress! The construction trailer arrived yesterday….
Excitement is building as we are about to break ground for our new PRI Vision facility! We will keep you posted on the progress of our new clinic as it is being constructed! While we are in our transition period, we will be working out of the Hruska Clinic. To contact Kelly or Dr. Wise, please call (402) 467-4545. If we are unavailable, you may leave us a voicemail. You can also email us at .
A New AdventureOnce again, it seems as though time has gotten away from me and it has been far too long since I blogged. Since my last writing, great things have been happening that I wanted to share with those of you we haven’t talked to or seen lately. First of all, I want to genuinely say thank you to so many of you who have asked about my own personal progress in my PRI Vision program. I am making some slow progress, as Ron “peels back” more layers of my adaptive pattern. I am able to be “unlocked” now, but not consistently. However, what is important to remember is that underneath this wonderful pattern I have a pathological scoliosis. That isn’t going to go away unfortunately. So I am thankful for small bits of progress and sometimes frustrated at the same time. Isn’t that our wonderful human nature? There has been a steady path of progress in our PRI Vision science, which has both Ron and I extremely excited! As of August 1st, I handed my primary care optometric practice over to a new owner! We are scheduled to break ground on our new PRI Vision Center in the lot adjacent to PRI and the Hruska Clinic in a few weeks, with completion estimated in late January 2012. So for now, I am seeing patients primarily at the Hruska Clinic. All of my former staff stayed with the practice, and we will have our first official full time PRI Vision employee joining us right after Labor Day. This will be a welcome relief to us, as it will streamline PRI Vision patient care, from scheduling to answering questions. Ron’s wife, Robin, is graciously helping us for now with as much as possible, so bear with us during this transition period. If you have questions for me, the easiest way for me to reply is by email: . Many times Ron and I like to confer on cases before an answer can be given about a patient we’ve seen, and in every case we need information from the referring therapist first. This allows the absolute best results and outcomes for our patients. In addition to my work in PRI Vision, I will continue to provide many of my current specialty vision services, such as vision training for eye muscle disorders or learning-related vision problems, and will also be expanding sports vision services for athletes of all ages. Of course, my old underlying tenets and principles are forever changed and now include the principles behind PRI Neutrality. I am proud to say that all of my patient care moving forward will reflect that. In our PRI Vision clinic I’ve been amazed by the many decreases (and even a few eliminations!) in needed nearsighted and astigmatic prescriptions. Other notable occurrences reported by patients include improvement in children’s classroom and gross motor performance, and even resolution of double vision. That’s not to mention the many examples of pain resolution, headache alleviation and athletic performance improvement. Every day it’s exciting to start it thinking to myself, “What incredible change will I get to witness today?” Ron and I are hard at work on the Postural-Visual Integration Dysfunction Course for September. The hardest part is deciding what not to include in the interest of time allotted and immediate clinical relevancy! I am ensuring that we include pertinent information for any optometrist that you, the PRI community, may have talked with about PRI Vision. There will be a huge amount of useful, scientific information in the manual. If you haven’t registered yet, please do so soon! You don’t want to miss out on the latest clinically relevant, and quickly evolving, information on PRI Vision! Finally, for those of you who remember my quest for Fellowship certification, I took the written examination last week and was notified that I passed this week! The step will be an oral interview with a panel of examiners at the annual COVD meeting in October. It’s been a lot of work, but also immensely helpful to me both as a behavioral optometric practitioner and in developing some of our PRI Vision theories. I know I promised tips about computer use in my last blog. But to be honest, the more patients we’ve seen that can’t maintain neutrality while looking at a computer or sitting at their desk, the more I’ve decided there are no universal truths regarding computer use. I will say this: If you have a patient that is coming in to see you that is consistently neutral, but spends more than 30 minutes at a time sitting at a desk or looking at a computer, you should simulate that computer work environment and recheck their neutrality. You can do this by having them look at a magazine, positioned at the same distance away as the computer is, for a minute or so. Then keep them visually engaged on that target as they move to your mat and you check for neutrality in the brachial and cervical chains. Chances are if they are not neutral in this scenario, then it will be difficult for them to experience an elimination of symptoms with the relatively small amount of time they are physically active in the upright position each day. This has led us to have some patients schedule a two-hour appointment for their PRI Vision consultation, rather than just one hour, so that upright, functional activity and the seated position required by their occupation can both be addressed at that visit. We’ve had many successes in the 13 months since we began seeing patients together at the Hruska Clinic, and we are looking forward to many more! Hope to see you all at the upcoming course! Dr. Heidi
Locked Up In LincolnAs many of you know, it’s been a busy first part of the year for me. I am working towards a Fellowship certification this year in the College of Optometrists in Vision Development. So far, this has meant writing five-page answers to six questions on different aspects of vision and three case reports, the last of which I submitted late last night. For those of you who were here in Lincoln a few weeks ago, you saw a glimpse of my obsession with our PRI Vision Program. Putting together that first course was truly one of the most exciting, challenging, rewarding, and growth-stimulating processes I’ve ever been through. And I am happy to say, that part isn’t over. So while I have been busy with activities that have kept my blogging activity limited, I have also had the opportunity to become more secure in my understanding of vision and its role in many PRI treatment programs. During these last few months, I also embarked on a PRI treatment program for myself. If you haven’t heard me talk, here’s a quick summary of my physical background. I have a pathologic scoliotic curve, tend to be in a Left AIC pattern but can be bilateral above the hips, have had problems with muscle spasms primarily in my traps since high school, started getting severe pain in my right hip a year ago and would have it “give out” randomly while walking, and developed increased headaches which progressed into migraines a year ago after having my two back left molars crowned. The fact that my right eye has a tendency to turn outward under certain conditions is a contributor to all of the above as well as to me needing vision intervention to make any progress in PRI. So I traded in dress shoes for Asics, got a mouth splint that I wear almost continuously despite the slight lisp it creates, and changed my glasses prescription to a PRI Vision Program one. Truthfully, once I got these things in place, I couldn’t remember the last time I felt that good. Relaxed. No tension. It was absolutely amazing. The same feeling many of your patients will get when they become fully neutral during a PRI Vision evaluation. Ahhhhhhhhhhh……… We’ve been told by patients that this feeling rivals many things—a glass of good scotch, valium, and morphine, among others. I did go through a rough period about a week and a half into wearing my new glasses. It only lasted a few days, but I felt like I was getting the flu. I know I wasn’t, because all the symptoms went away with some manual work, at least temporarily. After that about eight weeks passed, along with a ton of time sitting at a desk in front of books, notebooks, and a computer screen to accomplish all those things I talked about for my Fellowship and the April course. I wasn’t neutral with my glasses on while sitting at the computer. It was a little better with them off, but I would feel tension in my neck after a couple hours. I’d put on my PRI Vision glasses and get up and move. This worked well for a while. But by the time the course got here, I was not feeling so relaxed. I began to feel more overall tension in my neck and my headaches began again, although not severe. Sitting was definitely not comfortable, but neither was standing. The days at my office were OK, most of which I spent in the exam rooms with the lights low. The days at the Hruska Clinic in full light and more standing still were harder. I found myself wanting to shut off the room lights by lunch time. My head hurt more, and my neck was tight, especially at the base of my skull. I was now “locking up” into a bilateral pattern above the hips most of the time. I had more problems with fluorescent lighting. I was exhausted, but not sleeping well. This all escalated in the past couple of weeks, with last Tuesday ending pretty rough. Ron manually put my cranium back into flexion at the end of the work day, and I felt better for about an hour. Then I crashed. After driving home and getting dinner for my kids, I lay down on my couch and the hypersensitivity set in. The skin on my entire face, my ears, my hands, and even my arms was on fire. I was asleep shortly, but it wasn’t gone when I woke up a half hour later. I went to bed and had to change my pillow case because it was making the skin on my face and neck hurt wherever it touched. The sound of the sheets moving as I tried unsuccessfully to get comfortable was so loud that I tried to be still so the popping in my ears would stop. I was a mess. And all my husband could do was to take over getting the kids taken care of and to bed and keep walking into the bedroom to see if I was still coherent. I got new lenses in my glasses on Wednesday to try and force myself into flexion a little easier. These helped a little, but as I discovered on Thursday, there is NO quick, easy fix. I can consciously work at it, and be neutral, in my neck at least, with either pair of lenses. As I sit and type this, I have to keep forcing myself to “let go” of my neck and get rid of the tension. Riding in my vehicle the last two days, with my husband driving, has been interesting as we’ve traveled to my son’s baseball games. If I am not careful, it doesn’t matter what pair of glasses I have on, I “lock up” my neck. If I think about it, and “let go”, the tension is better overall, but concentrates at the base of my skull on both sides. I feel like my head is being pulled backward from the top and that if I let it go too much it would break my neck. So I fight feeling like a “bobblehead doll” and tense up again. I tell you all this not to bore you with my personal details. But the past couple weeks’ experience, along with some patient encounters as recently as two days ago, have made one thing blindingly clear. If you have a patient who needs vision intervention to progress, you likely have a patient who has cervical issues/cervical instability. Think about it. If you have a patient who can’t get neutral, and you determine there is a vision problem, they are a body on a head. The head, and therefore the neck, are controlling their body. If you take that away, and they aren’t equipped with the ability to integrate this loss of control, what do you think they will do in response? We saw a patient two days ago who is a PT herself, but has been unable to get neutral for more than a day. She is a PEC-type patient, often bilateral above the hips, although she may be only locked in her left hip at times. She is very strong and her complaint is overall feeling “tight”. She has some right-sided facial pain, but no dizziness or hypersensitivity symptoms. Once we put her in lenses to inhibit extension and facilitate flexion, essentially taking away all that tension, she began to feel “off”. She didn’t feel very good, almost as if she were going to be sick. But she was completely neutral. This is what can happen to patients when they have a lot of tension and we help them suddenly inhibit it. All the tension gets compressed into the neck because they can’t control their neck any other way. Not all patients will experience this, as we’ve had several who didn’t. But the ones who do can be the toughest patients you will ever have, and also the ones you will learn from the most. The PRI Vision Program Eyewear assists them in getting neutral; it does not give them the ability to use this new position. You, as the PRI-trained therapist, must be aware of what can happen and why so that you can help the patient manage their capabilities. Imagine a patient out there going through what I did this week. Would they want to continue in their treatment program? Would they believe that it can work? As their therapist, you must find what helps them to deal with acute episodes as well as direct them in their Vision Program and other needed PRI activities to facilitate integration. I have some basic activities from the Myokinematics’ course that I do to help strengthen my weak right Iliacus muscle and facilitate integration, combined with my Vision Program activities. It is still a process, not a quick fix, and I have to be active in my own program or decide I don’t want to go through the bad time to get to a better one. Your patients must understand this, as well as their loved ones, or you will have some disappointments. In the next blog, I will give some tips and techniques to help patients stay loose at their desks. There is not one “cookbook” answer for every patient. Understanding who your patient is at the core of their pattern, frequent dialog as they begin their PRI Vision Treatment Program, frank honesty with them regarding expectations and restrictions, involvement and understanding from the patient’s significant others, and remembering your PRI basic principles are all essential to your patient’s success.
Blurry Vision and Leashes?I’ll have to admit when I first started seeing patients with Ron in the clinic I was having a little trouble mentally with the concept of blurry vision. As optometrists, we are taught to make people see clearly. Let’s face it. The number one reason why a patient comes into our office is that they want to see more clearly than they currently do. If you are the doc who gives them 20/15 vision, which means they are able to discriminate details smaller than the “20/20” standard you hear about, they are happy. Think back to experiences you have had when you picked up your new glasses or contacts and put them on. Many of us, myself included, have probably even said “Wow, I didn’t realize what I couldn’t see” to ourselves. Coming from a background in behavioral optometry, I was already comfortable with prescribing lenses for function. My own two children use lenses for reading that don’t change the clarity of the words, but allow their visual systems to do near work more effortlessly. However, for the patient who has headaches at the computer, but can see clearly, it is hard to make them understand why a different prescription for computer use can help their headaches. The vast majority of us believe if our vision is clear, then there isn’t anything that warrants change. As an optometrist, you must ultimately satisfy the patient’s desire for clear vision. So when I first started seeing patients with Ron, and the lenses the patient needed to achieve PRI-defined neutrality made their vision blurry in the distance, I was very nervous. Not that I didn’t know we were doing the right thing for that patient, because I did believe it. Whole-heartedly. The problem was that the traditional eyeglass and contact prescriber in me was concerned about how the patients would react to their new way of seeing. Would they keep wearing their new lenses, allowing them to progress through their PRI program? Now, after five full months of seeing patients a couple days each week with the Hruska clinicians, I am almost more nervous when the lenses that allow the patient to be neutral also allow them to see relatively the same as with their current lenses. Why? Because we know more now than we did five months ago. We’ve had the opportunity to see patients do what humans are so good at doing: adapt! What adaptation means, in terms of what we are doing, is that they stay neutral for a period of time with the new lenses, but then they either go back to their old pattern or perhaps a less severe version of that pattern. For some, that period might be two months; for others, it might be two weeks. These patients are generally compliant with program activities, exactly as they were instructed. The point is, something allows them to get a hold of the old neural pathway and old muscle memory associated with the old pattern. That something might be as innocuous as picking up their violin for a few practices. This is what has led us to develop some variation on when we tell the patients to wear their “training” glasses. Your patient’s wearing schedule will reflect a few things. If we had to make a dramatic change to their prescription to get them neutral, likely we will have them wearing the glasses only for physical activities. We may even tell them we don’t want them to wear them if they are going to look at things farther than 15 feet away. This is where the concept of blurry vision is most critical. Some patients are so strong in their old pattern, that any time they engage far away vision, they lose neutrality. So, we start with them trying to maintain neutral in a smaller area, so distant vision doesn’t engage. As they improve and are able to hold that neutrality given those limited conditions, we will continue to extend their range of clear vision out further, slowly progressing them towards more clear distance vision. We affectionately refer to this slow increase in visual space as a “leash.” There will be patients that are using their new prescription full time. They may habitually not wear any correction, or maybe the new correction blurs their vision a little, but not enough to have them reject it. There are others that require that full-time reinforcement at all distances of visual space to be able to make a change. How do we know which ones can handle which option? Again, we are learning an immense amount, and there will certainly be times that our best-educated predictions are wrong. We are, after all, humans trying to predict the neurologic behavior of other humans. Not exactly what we’d call an “Exact Science”. Yet you can rest assured that we are constantly re-evaluating our approach and taking advantage of every learning opportunity a patient’s experience gives us to provide improved, more predictable patient outcomes. What I have come to realize is this: How can I expect someone to do something different if I allow them to have relatively the same visual reaction? There are always exceptions to these “rules”. Lazy eyes, high amounts of astigmatism, and strong Functional Cortical Dominance, which we will talk more about in the spring Integration Course, are all variables that make the need for visual change that much stronger. As we peel away the layers of some of these patterns, we are finding other sometimes undiagnosed strong visual patterns that will have to be addressed through more vision-specific training. We do our best to make sure patients leaving the clinic understand we are trying to provide vision that forces them to develop different neurological and muscular patterns, not make them see more clearly. We have them identify a pain or tightness that is present on the day of their visit before we start changing lenses. That pain or tension is either gone or diminished when we have on our “final” prescription. We absolutely LOVE when a significant other accompanies the patient to their visit, so there is a second pair of eyes and ears to remember what changed for them in that treatment room. Reinforcement of those concepts from their PRI physical therapist is crucial. The ultimate goal is to have the patient maintain neutrality regardless of what prescription they do or do not have on their eyes. To achieve that goal, it takes motivation, consistent repetition of program activities, patience, relatively blurry vision, and sometimes, even a “leash”. Here’s to progress through integration!
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