In 2014, the Hruska Clinic recognized that we were challenged in how we were treating patients with a multidisciplinary approach especially patients that came to see us from out of the area. Out of this need to improve our level of care we started our PRIME program.  The primary reason we were seeing these patients from out of state was to be seen in an established Visual Integration program called PRI-Vision.   Most of the patients that were seen in the PRI-Vision clinic were given recommendations by that staff for additional multi-disciplinary integrated care such as foot orthotics or a dental splint for occlusal guidance.  Often these patients received this care when they returned home by practitioners that may or may not have understood a PRI approach to integrated care.  After a few years we found that the other tools that these patients often needed such as shoes or oral appliances worked most effectively if they were calibrated with each other and built to “match” each other.  People who got foot orthotics from one practitioner and a dental appliance at another location and PRI-Vision training glasses here were struggling to make progress the way they should have.  The slight mismatch in the calibration of these tools and orthotics were potentially limiting the patient’s ability to maintain appropriate body positions and move forward in their rehabilitation programs.  However, if we made sure that the foot orthotic impression and/or the dental impressions and splints were calibrated after setting a neutral position with the PRI-Vision piece we had better success.   This was the model of PRIME that we have utilized for the last several years.  First, utilize the visual system to assist with upright orientation, and then “match” the rest of the tools to that individual’s training glasses prescription.  This was the start position needed to begin a movement based rehabilitation program.

Over the years, we improved our integration of these different systems and tools, and therefore have been able to become more efficient with their implementation.  The more patients we have seen the more we realized that the most important aspect of the program was the integration of the pieces more-so than any one piece by itself. Over time we have been able to de-emphasize the importance of any one “expert” provider to direct the program and re-emphasize the patient’s needs as the driver of the program.  This has allowed us to make improvements in how we manage our patients.  We know that as long as we can integrate sense of pressure through the feet on the ground with appropriate footwear or orthotics, with appropriate occlusal (tooth contact) sense, and balanced visual system input in an upright position (especially on the left leg) our need to over-treat or push the system with any one tool is decreased.  This progression of our program has allowed us to streamline our program into a more patient-oriented program rather than a clinician-oriented program.

What this means is that the program is more about the needs of each patient and the integration of the pieces to give the minimal input they need to maintain a neutral orientation and less about the need to see any one practitioner.  We no longer consider patients “dental patients” or “vision patients”, or “foot patients”. Any patient that has integration needs in any one area, needs all 3 to integrate or work well together and are considered “PRIME patients”.  Some people may have very specific needs in one area and we have the ability to utilize “experts” in different fields as needed. However, the power of our PRIME program is the coordination of care with integration-minded foot people, integration minded dentists, and integration minded optometrists willing to work with each patient and our PRIME Case Managers to come up with a much more patient centered plan of care.

This progression of our PRIME program is natural and good.  This has been gradually coming and we now feel we are in an even better position to give our patients the level of care they need to move forward in a more consistently integrated manner that is easier for the patient, the referring practitioner and us as PRIME team members to fully Engage in.    Thank you all for continuing to engage with us and if you have any questions do not hesitate to contact us at or call us at 402-975-8533.

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