When people deal with chronic symptoms that don’t match physical exams or diagnostic imaging or don’t respond to treatment that should work, searching for answers is a common activity. Often there can be ideas and answers to help manage symptoms but figuring out why those symptoms are there in the first place is more challenging and those answers are harder to find. We believe that there can often be an underlying neurologically patterned issue of posture or movement patterns that can have far ranging impacts on various body systems throughout the body. We feel we have found some answers to WHY these issues exist by looking at the various sensory and motor systems that you use every day with every activity you do. Our program is designed to help you relearn how to those systems in a better, more effective and efficient way to reduce symptoms related to this issue. Read below for more information on our theory and program.
What is PRIME?
Postural Restoration Integrative Multidisciplinary Engagement™ (PRIME) is a unique treatment option to assist with chronic, difficult to manage issues. Offered only through the Hruska Clinic™ in Lincoln, Nebraska, our PRIME team helps many people who have not been helped anywhere else. We seek to help people struggling with imbalance, instability, and confusing symptoms such as dizziness, that do not seem to be managed well by traditional means. Our PRIME team includes professionals from several different disciplines working together to assist in managing the whole person to more effectively manage the root of the problem rather than just to treat the symptoms.
Our team includes Clinical Integrative SpecialistsTM who assist in managing the engagement of our patients with experts in the specialties of Physical Therapy, Optometry, Dentistry, and Podiatry. The goal of this team approach is to utilize multidisciplinary coordination of care to establish and maintain balanced body position and movement patterns both during activity and at rest. When this position is attained and maintained with activity and at rest it allows the body to function at maximum efficiency and with the least amount of resistance or overuse of incorrect muscles or neurological (brain) activity. This is accomplished through a coordinated and customized plan of care, utilizing different sensory orthotics and novel activity prescription. This coordination of care will maximize each person’s ability to obtain and learn new postural and efficient movement strategies, regardless of the demands placed upon the individual. Ultimately this will reduce imbalance and strain on the body’s neurological (brain) and structural (muscular) systems.
PRIME Introduction video
How did I get here? Why do I have these symptoms? (video link)
Click HERE to listen and watch a video explaining this answer.
Our body is an amazing machine, when you reflect on the extent of all the things that it has to do, just to function. The amount of information that the body takes in and the number of things that are happening all at the same time is staggering. When it is functioning well it is a thing of beauty, and when it doesn’t it can be a very difficult machine to fix. Often when an injury is happens it is obvious. If a bone is broken we know what happened. If someone has a heart attack we know what happened. When you know what is broken, fixing it is a lot easier than when you don’t know what is broken.
For example if you walk into your house, go down stairs to the basement and the floor is wet you know something is wrong. If you don’t do anything to find where the water is coming from it probably won’t get better. If you just get out your wet-vac and start sucking up water you may make a little progress but you may be fighting a losing battle. The water may get higher and higher and eventually gets into the electrical socket and now the lights go out. If you then change your focus to figuring out why the lights went out and start changing lightbulbs or fixing the switch on the wall you won’t ever get the light to come on. Obviously you hopefully would have been looking at what was causing the water to get into the basement by finding the cause or source of the water. Once that is taken care of the lights may still be out, and the carpet will still be wet but you can start to get things back to normal. What if you could never find the source of the water coming into your basement? What a frustrating situation. Maybe you’ve got a sump pump going and the water level is down, the carpet is always wet but not underwater, you’ve got the wiring in the wall fixed or the fuse replaced and the lights work, but there is always water coming into your house. Would you be satisfied with that situation? Probably not. Unfortunately for some of us when our bodies stop working the way they should, things start to go wrong like the lights in our flooded house. It could be pain, it could be dizziness, it could be fatigue, it could be all of the above and more. At the root of all of them is they are just a sign that something is not right. If the light bulb burns out the fix is easy, if that doesn’t work, you’ve got to trace back to the cause of why that lightbulb won’t turn on.
In this amazing machine we own the brain is the thing that is running our body. It controls everything we do consciously and unconsciously. It uses input that it receives from the body to make decisions on what to do next. If you see a ball flying towards you, your brain takes the information from your eyes about what is coming at you, how fast, and tells your arm muscles what to do to catch the ball. If your eyes were closed you wouldn’t be as good at catching the ball. This happens every millisecond of the day for thousands of pieces of information coming into the brain from multiple sites. If the input getting to the brain isn’t accurate or being processed well the output won’t be as good or accurate as we want it to be.
One of the most basic things we need to do for any body system to function is to hold ourselves up on the ground against gravity, as a start position for every other activity to occur. You won’t be able to eat your morning cereal if you can’t figure out how to sit in a chair and hold your head up and get your arms to get the spoon to your mouth. You couldn’t have gotten to that chair if you didn’t stand up with 2 feet on the ground, balance, and take steps to get there. You couldn’t have sat up in bed if you couldn’t figure out what up and down or lying flat is, and how to get from position one to the other. This most basic of things is a very complex process that takes input form lots of different areas of the body such as the eyes, ears, feet and hands. When the output to just be upright on the ground is not efficient our bodies, in their amazing design, will figure out a way to do it even if it is not done in an ideal way. Unfortunately, how you work at this point may create symptoms of muscular imbalance or tension, dizziness or postural imbalance, or any number of other issues.
The issues or symptoms that are manifested may not appear to be issues related to upright balance but often are related to this muscular or postural imbalance. For example, if the symptom is neck pain, it may be directly related to an old injury, or it could be that now the neck muscles are being told to work in a different way, by the brain, because the brain doesn’t have a normal understanding of what up and down is or where it is in relation to the ground or the world around it. This may be directly related to the neck injury or not but the cause of continued issues may be this perspective. The light bulb may be out because of the lightbulb or there may be other issues, such as the broken water pipe that no one fixed is now causing the electrical system to short out.
So if you find yourself standing in a house with wet carpet bailing water like crazy just to try and keep the lights on, or can’t get the lights on, or are fighting whatever problem you have, the issue is we haven’t yet identified what is wrong at the core. From our perspective, the leaky water pipe contributing to whatever problem we are dealing with is coming from the most basic issue of not accurately perceiving where you are at in space, on the ground, and against gravity appropriately.
Why hasn't anything else worked? (with video link)
To watch and listen to this answer click HERE.
Traditional programs typically don’t look as deeply for the reasons your body has to do what it is doing. They are looking for local causes for the issues you are having. If the main issue or problem was at the site where the symptoms are, traditional (orthopedic) treatments would work. If a burned out light bulb was the only problem keeping the light from coming on, changing the light bulb would work. Sometimes even treatment that does address the reasons why your body functions the way it does, can’t work because they did not modify the input your brain is receiving to re-position or re-orient you so better integrated activity can occur. For example, we may know that the lights are out because there is water in the outlet and the electrical system is shorted out but if you don’t have a way to stop the water you will not have success. Many programs, like a wet-vac, can get the water level down enough to possibly get the lights back on, but don’t work well enough to keep the lights on as the water level continues to rise. In our body what this may look like is someone who is working too hard just to keep the basic amount of activity happening (lights on) but can never truly addres or get to the cause. They are working hard to maintain a certain level of function, can’t move forward, and feel worse if they stop working so hard. They are managing symptoms and bailing water just to struggle to keep the lights on. Those types of programs that work to “maintain” or “manage” symptoms will be challenged for long term success because no matter what they do your body isn’t even in the correct position to start doing any activity without compensation. Therefore to have success you must further reduce the amount of extra work needed to just get to the start position. The only way to get this start position is to make sure the input the brain is getting is correct so that the output is efficient and long-lasting. Most programs, unlike our PRIME program, do not have the resources or approach necessary to keep the lights on by fixing the water problem.
How does this program (PRIME) work? (with video link)
To watch or listen a video with this answer click HERE.
Our program uses professionals with knowledge in a variety of areas, such as optometry, podiatry, dentistry, and physical therapy. Each professional’s job is to influence the sensory input your brain is receiving, to allow you to sense something different. As soon as your brain starts to receive different input (including the way your teeth hit, your spatial awareness or orientation, the way your foot feels on the ground, and the way you orient yourself with movement) it will automatically have you hold your body in space, against gravity, on the ground differently. Using objective tests and measures and Postural Restoration(R) science (as taught by the Postural Restoration Institute(R)) the most optimal position that allows you to obtain upright posture will be attained in a manner with the least amount of work necessary. Then with every activity you will be automatically learning new movement and posture strategies subconsciously. The primary inputs that your body uses for attaining this start position include the sensation from your feet, and the input from your balance or vestibular centers which are housed in your inner ear and influenced strongly by your visual system, and your tooth or bite (occlusal) position. This optimal start position, or position of most efficient upright control, is the position that shuts the water off to truly get to the root of the problem. Now you can really get to fixing the problems that were associated with the flooding in the first place. The carpet may still be wet and the lights are still off but we can finally start to make progress because your body is in the right position.
Gradually as you learn how to do activities from this new start point, the amount of guidance we need to give your brain, through different sensory input, will go down. As this happens you will regain control of your body in a more automatic fashion, for whatever functional output you demand from it.
How do we (PRIME) measure success? (with video link)
Click HERE to watch/listen to the answer to this question.
In our PRIME program we don’t measure success by just making sure that your symptoms are gone. In our house example above if our only goal was to make sure the lightbulb worked upstairs but never really got to the root of the problem, our success in keeping the light on would be minimal at best if the basement was still flooding. This program allows our patients to regain control of their upright body position on the ground with the least amount of input needed. The new input and your ability to learn how to manage it will allow that start position to happen in an easy, efficient manner. Our goals, therefore, are to enable you to achieve this positon, to make sure you know that you are there, and to make sure you have the control to make it happen over and over again. Once this can happen in an automatic way, functional activities such as walking, exercising, squatting down to put your socks on or touching your toes, or any other movement activity will be possible and performed in a different and more appropriate, efficient way. Only then will we be able to make sure that the light will stay on because our feet will stay dry.
What next? How do I get started to see if I am a candidate for PRIME?
If you have questions whether or not you are a candidate feel free to contact Megan, our PRIME Patient Care Coordinator at 402-975-8533 or send her an e-mail at email@example.com and she will get back to you.
If you feel we may be able to help you and you are a candidate for PRIME you can fill out our application packet found on our Forms section here.
Once we receive this we will be in touch with you to assist in collecting any additional information we may need as well as answer any questions you may have.
Once we have all the information we need our team will look at your paperwork and determine the best options for you to engage with our program and start the scheduling process.
The PRIME team recognizes that the patient’s recovery also affects and is affected by the patient’s family and/or significant others. Support is an integral part of the recovery process and we encourage both the patient to include a spouse, family member and/or close friend to be engaged with us you throughout the entire process. For more information for your support engager please see our information page here.
What does a typical PRIME week (initial and return) look like?
We utilize an extensive triage process to ensure that we provide all needed aspects of care that our program provides when you come to Lincoln for PRIME. Once we have all of the information from you that we request from our application form we can move forward with setting a schedule for coming to see us. We anticipate 3-4 days for an initial PRIME week to ensure adequate time to provide you with the necessary information and tools. If you would need to return to PRIME for a follow-up visit we anticipate being able to accomplish that in 2 days.
For information on what a typical PRIME week for initial and follow-up looks like click HERE.
How much does the program cost? Does insurance cover the treatment?
PRIME is a unique program in that it integrates the expertise and services of different disciplines, based in different offices, working together for the good of the patient. Unfortunately this can lead to some confusion in regards to cost and who gets paid what. In order to ensure each discipline gets reimbursed for their services we have left it up to each business/office to collect and/or submit to insurance for their services. There are some central services that are outside the realm of each discipline that will be billed through PRIME.
Once we have recieved your application paperwork we will make recommendations for which services in our PRIME program will probably be utilized. At that point we can, and will, give you a better estimated breakdown for costs associated with the program and what may be covered with your insurance.
If you have questions on a general estimate please contact us and we’d be glad to give you a general idea but each individual is unique.