PRI Vision Blog |
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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!!!!
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.
Introducing Dr. Heidi Wise
Let me take this opportunity to introduce myself, as I have already been impressed by the caring and passionate nature of the few of you I have met so far. My name is Heidi Wise, and I am an optometrist in Lincoln, Nebraska. I first met Ron Hruska a couple years ago. I have had the opportunity, since meeting him, to assist him and other PRI therapists to further progress their patients with visual modifications. But it wasn’t until earlier this year that I began to see the full impact that interdisciplinary integration, between optometry and PRI-based physical therapy, could really have on patients’ lives. My optometric background has been varied, but for quite some time has focused on vision as it relates to the entire person. This approach considers their behavior, their ability to perform at their maximum potential at school, work, and in athletics, as well as how they function in their every day life. This isn’t what I thought I’d be doing when I began practicing! I graduated in 1998 from Southern College of Optometry and began practicing what is known as primary care optometry. This includes the prescribing of glasses and contacts, as well as diagnosis and treatment of eye disease. I began to notice after a few years that there were many children who did not possess the visual skills really necessary to excel at school with the amount of effort commensurate with their intelligence level. To make matters worse, these are not typically problems that glasses or contacts can fix. In 2003, I went into private practice to address this issue. There was a regional shortage of optometrists providing this type of care, which usually includes vision training, and I was frustrated with the lack of treatment options for these children. After becoming experienced in this area of optometry, which is sometimes called “behavioral” optometry, I was asked to consider caring for patients who had experienced traumatic brain injuries or cerebral vascular incidents. I was fortunate enough to learn some of the basis of this type of care from another colleague, and soon realized this was not all that different from my work with children. The two categories were simply on opposite ends of a continuum, which included visual-motor skills as well as visual-perception skills. One group hadn’t had the fortune to develop the skills, and the other had possessed them to some degree, but those skills were compromised by an injury to the brain. In 2005, I began providing care onsite, as well as at my office, to inpatients and outpatients of Madonna Rehabilitation Hospital in Lincoln, Nebraska. Each of these type of patients, whether it was a child or an adult with poor vision skills, such as a lazy eye, focusing problems affecting behavior, double vision, or problems interpreting their world visually after an injury, has given me a broad base of understanding the eye’s influence on the brain and vice versa. Now, I am working with the Hruska Clinic therapists, seeing patients in tandem, to use vision and vision perception to change postural and movement patterns of patients who have not been successful in making or maintaining these PRI directed changes. I am learning a lot about PRI principles and techniques. The more patients we see, the more we are learning, together, the true potential of what can be accomplished through the visual system. It is a well-documented fact that 70-80% of all neural connections relate to vision. Central vision determines how far down we are able to read the letters on the eye test chart whether it’s with or without correction. Most of what relates to treatment of PRI vision, frontal plane astigmatism, cyclo-torsion, curvature of the spine, dizziness, visual push or visual pull, myopic myokinematics, visual midline shifts, or other associated neuro-visual postural influences will be shared with you in the future. In moving forward, we will share information with you, the PRI therapists, so that you may grow in your understanding just as we are. I gave the first in-service to the therapists at the Hruska Clinic last week and will continue to develop training materials with Ron for both PRI therapists and future optometric partners. I am looking forward with great anticipation to not only the Interdisciplinary Integration PRI course this spring but also to assisting PRI therapists in understanding the role vision can play in your treatment programs. Check back often, as this site will be used to post recommended references to help you establish your knowledge base about PRI Vision. Also, any information that I, in conjunction with the therapists at the Hruska Clinic, feel is beneficial to you along the way will be added. I look forward to working with you all as we embark on what will truly be an amazing journey! -Dr. Heidi Wise
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