BLOG: Proprioceptive dysfunction syndrome a common but challenging diagnosis
The proprioceptive system helps you sense limb and body position and movement.
It relies on sensory receptors in the nervous system, muscles and joints and is closely integrated with the visual and vestibular systems for healthy balance and motor function. Unfortunately, more than a century after the proprioceptive system was first characterized, this system and its disorders are still poorly understood.
Head trauma and body positions that frequently conflict with the neurological wiring can disrupt the proprioceptive system, resulting in a syndrome called postural deficiency or proprioceptive dysfunction syndrome (PDS). Patients with PDS experience a wide range of symptoms, including abnormal eye movements, headache, problems with gait and coordination, neck and muscle pain, vertigo, dyslexia, burning mouth syndrome and others. Although PDS is quite common, the sheer variety of symptoms makes it difficult to diagnose, and patients often go from one doctor to the next without a correct diagnosis or relief of symptoms. This is a great shame because treatment is available and very effective.
PDS was first described in the late 1970s by my mentor, Dr. Martins da Cunha. I worked closely with him to better characterize the syndrome and later developed a diagnostic protocol to identify and classify different types of PDS, as well as the prisms that are indicated to best treat each type. [Protocol is available here: https://www.orlandoalvesdasilva.org/protocols-diagnostic-active-prisms]
In my clinic, we use a team approach. As an ophthalmologist, I make the diagnosis and prescribe the prism lenses, while other rehabilitation specialists provide postural reprogramming and ongoing therapy. The results are rapid. In fact, we can see patients improve immediately, before our eyes, during the very first session when prisms are applied.
I recently treated a 12-year-old girl who had been having increasing trouble with mobility and balance over the past 2 years. She had gotten to the point of needing to use a cane and was experiencing frequent vomiting episodes, causing her to miss 52 days of school. Her parents had taken her to many specialists, including those in the orthopedic and digestive fields, but all the diagnostic tests were negative. Her symptoms continued to worsen, dramatically affecting her quality of life.
Three days after treatment for PDS, her parents sent me a video of her smiling and dancing.
It is because of stories like this that I continue to advocate for more widespread knowledge of PDS and its treatment.
For more information:
Orlando Alves da Silva, MD, is a consultant ophthalmologist, surgeon and professor of ocular motricity and proprioception based in Lisbon, Portugal, where he directs a busy multidisciplinary clinic. He has published papers on the topic of postural deficiency/PDS and has treated nearly 50,000 patients with PDS over his career. He pioneered the use of active prisms for the management of PDS and for dissociated vertical deviation, avoiding the need for surgery. He has also developed a treatment for certain types of functional amblyopia in adults.
Da Silva will be teaching a course on the diagnosis and treatment of proprioceptive dysfunction syndrome at the 2021 NORA virtual conference. For more information and to register, visit www.nora2021.com.
Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.
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