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No matter what I pick up to read these days, it seems like this one message is clear: When it comes to the brain, it’s all connected. You can’t separate the visual process from any type of behavior, emotional, physiological, or physical. You also can’t separate the visual process from the rest of the senses. While there are some that are more heavily intertwined than others, the auditory system is so close it can’t be ignored.

We use the auditory process, including our sense of vibration, to help us determine our location in the spatial environment around us and to judge the location of objects producing sound and vibration. Vibration is also felt by our proprioceptive sense. Since the two main things we have to orient ourselves against gravity are the ground below us and the space around us, our ability to accurately perceive soundwaves is critical.

Besides being the geek that I am about vision and its pervasive role in human behavior, I also have a longstanding passion for music. I grew up playing the piano and added the flute and piccolo as I got older so I could be a part of marching and symphonic bands. I continued this through college, even picking a college largely because of the band programs there. My tastes vary widely, and there’s not really a genre that I don’t have a least a song or two from in my collection. What I listen to depends on my mood, as I’m sure it does for a lot of you reading this. Ever wonder why that is?

Kenny Chesney’s “I Go Back” echoes this sentiment. Music can transport you to a different place and time. For some, it even evokes other sensory experiences, such as smells or tastes. Many of us experience emotions when hearing certain songs, which may frequently be related to the lyrics. However, there are other qualities to music that often affect our brains, and therefore our behavior. It might be the beat of the song, including whether it’s fast or slow, subtle or strong. Can you feel the bass “thumping” your chest, or is there no identifiable drum? It may be the pitch of the vocalist or of the predominant instruments; are they singing high or low notes, female voice or male voice, is there a lot of lead electric guitar, horns, strings, piano, or bass guitar?

Some of our more challenging patients who have visual-integration dysfunction also have other sensory processing difficulties. This can range from the severe, as in the case of the patient who says “I tend to be sensitive to lots of things, including sound or the feel of materials in clothing,” to the more subtle case, who can’t identify a single symptom but yet can’t manage to use neutrality in a dynamic, functional sense. If we’ve given them the ability to be neutral through visual and physical intervention, and there are no orthopedic reasons why they shouldn’t be able to maintain it, we are forced to look at what other sensory processes might be obstacles.

This brings us to the Interdisciplinary Integration Symposium for 2016. It is such an exciting time to be in involved with PRI. For me, personally, it answers more of the “how did I get this way” question that I know many of you have as well. It also gives me a chance to bring two of my passions in this world together, vision and music. For our patients, it’s another tool we are researching and understanding more about every day. For a few of them, it’s already been the icing on the cake.

The thing I love about this most is that we know we will never have all the answers to why this amazing brain of ours does what it does; but it sure is exciting to keep trying to find out all we can.

Keep moving beyond sight!

Dr. Heidi

Posted September 17, 2015 at 9:17PM
Categories: Courses

My first trip ever to California for Postural-Visual Integration this last weekend did not disappoint!  Sensory awareness (aka Vision) and how it can impact physical performance is what our two days were all about.  Between the truly amazing visual scenes at the course location and the coast, the smells and sounds from the ocean and a ballpark, and the sight and sounds of a group of people having fun learning it was a weekend I’ll always remember.  Sensory experiences change lives; this was reinforced by a text I received the morning after the course from an attendee working with an 82-yr-old who has serious balance problems who was walking better during his visit using visual techniques learned the day before.  I couldn’t be more fulfilled!  

Thanks to Skip George and John Swain for hosting at this incredible venue!  It could not have been more perfect for a course all about “sensing” the space around you and the ground under you.   Thanks also to all the attendees, a great mixed group of PTs, OTs, trainers, strength coaches, massage therapists, and a  behavioral optometrist, for indulging Ron and I for two days while we played verbal ping-pong!  Here’s to Moving Beyond Sight!

Dr. Heidi

----Ron demonstrating a technique from Phase II:  Mimicking

----Caleb, Matt, and John finding “new floors”

Posted August 27, 2015 at 6:38PM
Categories: Courses

Read more on my latest blog #movingbeyondsight

Posted June 22, 2015 at 11:22PM

Our last Postural-Visual Integration Course was given a few weeks ago in Bethesda.  The therapists at Point Performance were great hosts and we are sincerely appreciative of their enthusiasm for bringing Ron and I there.  Despite the crazy weather, which included snow and some heavy ice that made travelling interesting (and gave this not-so-graceful speaker a huge bruise on her only “good” hip!), the group was excited and engaging, which made the weekend extremely enjoyable for the both of us.  Eating food I can’t get in Nebraska is always a bonus for me when I travel, and some amazing crab and oysters did not disappoint!  

This was the first time we gave the course after some heavy revision work.  The concept of what vision does for the postural system hasn’t changed.  What we really tried to convey is what components of the visual process impact posture during key phases of gait.  To accomplish this, there were some intense, heated discussions between Ron and myself!  Ironically, I wanted gait brought into it, and struggled taking more “PRI” words out of it, while Ron pushed us to “visualize” it more.  But since we are the geeks that we are, we can say it was a labor of love for both of us, and we have never felt better about what we are teaching and the clinical applications!  It seems the attendees agreed based on the feedback we’ve received, from both first-timers and repeaters, which assured us all the hours had been worth it! 

I have to pause and also say a HUGE THANK YOU to Stacy, our “everything” person in PRI Vision!  She spent hours upon hours at the computer formatting the manual as we wrote and re-wrote, then completed an entirely new power point to go with the finished product.  The word “formatting” is now on the list of dirty words in our office…..those of you who have ever made an extensive power point know what I am talking about!  But we could not have done it without her, so if you saw it and enjoyed it, make sure to thank her.   

With all of this recent work to “visualize” the gait cycle, all my initial thoughts I’d had months ago about my talk at Interdisciplinary Integration had been a bit scattered until this week.  A few discussions with Ron and about 12 hours in one day spent researching narrowed my focus.  I wanted to ensure this wasn’t just another talk about peripheral vision.  Don’t misunderstand me; using peripheral vision and flow is extremely powerful, as discussed in the P-V Integration course, and it will be an important part of my talk.  But if you are catching my references to the focused, narrowed, self-driven attention that is behaviorally tied to vision for many extension-powered patients, then you now know where I am headed for this symposium.  I will show how visual behavior is linked to, caused by, and perpetuates their self-efficacy through neurotransmitter activity in areas of the brain that control attention, which is largely visual in nature. 

And of course, we’ll discuss what to do, and what not to do, about it to help your patients maximize their potential without sacrificing their ability to rest and breathe.  You know, Postural Restoration 101. 

Looking forward to seeing you all there! 

Dr. Heidi

Posted March 23, 2015 at 4:16PM

I recently had the opportunity to take PRI’s Impingement & Instability (I&I)course for the first time.  The most important concept from this course, in my opinion, is that if patients can’t recognize, use, and integrate the sensory references need for upright, alternating, reciprocal function—the goal of any PRI program—then they will not be successful in their program.  And neither will you.  Definitely not something that excites most of us, regardless of whether you are a PT, strength and conditioning coach, trainer, or even an optometrist, dentist, podiatrist….the list could go on and include anyone working with this patient, whether  to improve performance, decrease/prevent pain, or treat their orthostatic or anxiety issues.   Impingement & Instability is the “bridge” course between the primary, “floor-up” PRI courses and the “top-down” secondary courses and the PRI Vision course.

I&I concepts are the type of thinking that, in some regards, are the only thing I really know how to do when it comes to PRI.  I am not a PT, nor do I have any formal educational background in human gait, movement, or physical performance.  The minute a term like “anterior pelvic inlet” or “late left stance” comes out of Ron’s mouth, I’m a little lost.  I’ve learned a lot over the past 5 years working with Ron and the other therapists here at the clinic, but this is why I keep taking and retaking courses!  Anyone who knows me knows how much I HATE that feeling!  But what I do clinically every day in PRI Vision with Ron is ALL about sensory awareness.  So for  the patients  that need me, I know if they can’t consciously “find & feel” the floor under their left foot—in  I&I the left calcaneus—nothing  I have done so far will help them and we have to keep going until they can.

There are, of course, other sensory references many patients need to increase or decrease.  Some of them are discussed in I&I, some are not, and these vary based on the patient.  Regardless of what these are, my job is to change the “top-down” brain’s sensory awareness so that the “bottom-up” activity from the primary courses can be effective.

The second concept for this course is the meaning of the words impingent and instability.  Impingement as a syndrome or diagnosis is usually associated with pain due to excessive or inappropriate contact between two points in the body.  Instability is usually associated with the lack of support or stability, often due to overstretched or lax ligaments or muscles.  But consider these definitions:

Impingement:  appropriate contact not only between two points in the body, but also between the body and a needed sensory reference, such as the floor.

Instability:  the freedom to “let go” of a contact point, sensory or physical, so movement can take place.  To obtain alternating, reciprocal function, you need proper impingement on one side paired with proper instability on the other, then the ability to reverse it—This is how “good gait” happens!

Every patient I see in PRI Vision needs less impingement and less instability in certain areas, and more of each in other areas.  Many have too much “impingement,” or reliance, on vision, and not enough on their left heel.  We also frequently have to change multiple reference areas for the patient to make use of the new “instability” I am giving them in Vision.   These changes can be the determining factor in the patient’s program success, and where I rely fully on Ron and the referring therapist to ensure this is accomplished when needed.

If you haven’t taken I&I, you absolutely should!  Ask some of the attendees that experienced the “right” PRI function for the first time during those two days.  If you’ve taken I&I, then the next step is to take the Cervical Rotation and Postural-Visual Integration courses.  These two courses will show you what to do when you have patients (or yourself!) that just can’t find and keep those sensory references from the I&I course.  The head, neck, and ultimately the BRAIN are the “top-down” drivers that can negate, or reinforce, all of your and your patients’ “floor-up” hard work.

Moving Beyond Sight!

Dr. Heidi

Posted January 30, 2015 at 3:21PM
Categories: Courses

After teaching the first two PRI Vision Integration for the Baseball Player courses in back-to-back weekends before Thanksgiving, I don’t know where the month of November went!  But I wouldn’t have had it any other way.  Ron and I really enjoyed writing and presenting this course for many reasons. 

First, I LOVE baseball, and Ron gained a new appreciation for the sport as well.  Having the Royals in the World Series during some of our heavy prep time was a bonus, giving us some exciting games to watch as we fine-tuned our day of material.  Second, because it’s only a one-day course and it’s geared for the not-so-seasoned PRI practitioner, we got down to the plain and simple approach to a complex subject and just had some fun with it.  No time for all the neurological discussions (which you ALL know we are geeky enough to enjoy way too much!); demonstrations and step-by-step guides dominated.  Third, it gave us a chance to tie our information into another course, which took place the two days preceding ours.  It was great to learn so much about the proper mechanics of the sport from Allen and James in their PRI Integration for Baseball material as we were preparing the course.  Hearing them present some of it was a gift; they truly love teaching and they make a great team!

Our courses were a nice mixture of practitioners from the baseball arena and those in more general modes of practice.  Having that mix gave us the opportunity to not only learn more about applications to the sport of baseball, but it allowed us to hear from those thinking outside the sport as well.

We want to again thank our hosts, the Arizona Diamondbacks and the Philadelphia Phillies, for all they did to make these courses go so smoothly.  The team at the Diamondbacks of Ken Crenshaw, Neil Rampe, Andrew Hauser, Ryan DiPanfilo, and Nate Shaw has been an instrumental part in helping us over the past year to develop this course.  Andrew was invaluable as the one trialing these concepts, communicating with me regarding outcomes, and helping me “see” what they do in players’ performances.  Many in the sport benefit from their “big picture” integrated approach.  James Ready, our host from the Phillies, is another great thinker who has a passion for integration, as I got the privilege of learning over the course of our day with him.     

As a Florida-born girl, I enjoyed the relative warmth of Phoenix and Clearwater while it was really cold back here in Nebraska.  Since my favorite things include beaches, baseball, and being around the #PRInation, these were weekends that couldn’t have been better!  Already looking forward to the next one, which is right after the New Year! 

To go with the great people pictures James posted in his course reviews, here are a couple of my must-see places: 

  Part of the Dbacks’ Complex at Salt River Fields

 Phillies’ Spring Training Stadium

Course Testimonials:

“Great course!  This course was an excellent introduction to the role that vision plays, not just in sports or rehab, but how it’s integrated with and influences the performance of the entire human system.  Ron and Heidi presented the course in such a clear way that I was able to begin applying many of these visual techniques in my rehab programs the next day.  This definitely changed the way I look at rehab programming for all of my athletes, but especially in baseball, where visual skill is so directly related to their success.  Thanks for a great experience.”

Josh Ogden, MS, LAT, ATC, CSCS, CES

“Fantastic course!  I have been involved in baseball for 25 years and have utilized PRI concepts, with much success,  in treating my collegiate baseball players for almost 15 years and the PRI vision course was unbelievable.  It changed how I look at treating my athletes, as well as how I look at baseball and baseball players in general when it comes to treating their complaints both on and off the field.  Thanks Heidi and Ron for an eye opening experience!”

Jeff Wood, MS, ATC, LAT

"I just participated in the PRI Vision Integration for the Baseball player, held in Clearwater Florida. I consider myself a connoisseur of PRI courses. I learn so much from every seminar--even if I have taken it before. As such, I was blown away with the concepts that I was able to grasp during this one day course. 

This seminar was an amazing starting point for understanding the role of vision in the PRI evaluation and treatment model. I work with a very varied clientele, and all principles/skills taught apply to all populations, not only my athletes. Heidi and Ron presented very complex material in such a systematic and logical manner that I was able to apply the techniques with patients the very next day (literally). I also believe that practicing and integrating the materials from this one-day program will enable me to learn at a deeper level, when I am able to take the 2-day vision course next year."

Donna Behr PT, MS, DPT, PRC

Posted December 10, 2014 at 8:00PM
Categories: Courses


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