PRIME Case study Part 3: “The Return of the Jedi”
To review Episode I of this case study click here.
After a few months of continued work (Epidode II) with the local PRC (and others) Chris, our hero, had plateaued in progression. According to information sent to the PRIME team by the PRC therapist, at this point Chris was able to maintain neutrality at the pelvis consistently between PT visits and could clear the BC (thorax) tests easily with the program and glasses and splint use. Unfortunately, Chris again showed a strong R TMCC (neck) pattern (as described by the Postural Restoration Institute), and was having continued dizziness and left tempro-mandibular joint clicking (this had been an off and on issue for some time.) The symptoms down the arms were gone but right neck and chest wall tightness had returned with any upper body activity. This is the symptom that Chris felt had been the “lifelong” symptom as if we had gotten now to the root of the problem. So we recommended that Chris return to Lincoln (For Episode III) for a shorter follow-up to be seen in PRI-Vision to adjust the visual prescription, see the Hruska Clinic PT for one session to modify and adjust the PT home program, and see the dentist to adjust the splint, if needed.
[PT note: Chris had been told at the initial visit to expect that this would happen, as it often does, and a return visit would be probable. We estimated that we would need to see Chris back in about 4 months after the initial visit, as that is approximately the time frame we’ve seen plateaus happen. Had Chris not been engaged with the local therapist and with us, the need to come back and pursue the next layer may have not happened and Chris would have not continued on the path to improvement. I unfortunately see that this may be where some people who do not have an engaged home PT may stop on their path to getting better due to not seeing full resolution with the first session.]
When Chris returned to the clinic, improvements in ability to sense floor-up activity were dramatic and Chris could center well on right and left leg (in fact the left was now the go-to, comfortable, preferred side). Chris had mastered some early PRI-vision exercises and continued to progress with PRI integrated standing activities as prescribed by the PRC therapist. At this point however, it was found that the left temporal bone position led to a position that pulled the left Tempro-Mandibular (T-M) disc out of place. The current vision glasses and splint, which initially were designed and needed to inhibit the PEC pattern were now not the best tool to allow appropriate shifting from side to side through the head and neck and inhibit the overactive R TMCC pattern. When that script was adjusted and the occlusal reference was taken away, neutrality was attained everywhere and Chris was able to stay on the left T-M disc more easily (yes, her jaw clicking and pain was improved by a change in her glasses prescription). This resulted in feeling all the habitual right sided tension to go away. The current splint was recalibrated and Chris was given a recommendation to get an ALF with a local dentist to help provide more stability through the temporal/cranial region.
The Hruska Clinic PT also saw Chris for one session to give progression recommendations for the home program for further R BC/R TMCC inhibition and management. These recommendations were also provided to the PRC therapist who is assisting in follow-through and helping with further dental integration. We feel Chris will likely be able to wean out of the current PRI Vision eye wear and into a more habitual pair of glasses for activity and continue to move forward with the help of the local PRC PT. PRIME will still be able to assist and make recommendations, and we don’t know what the future will hold or what layers will be uncovered, but we feel good about the direction that Chris is moving in.
While this is a long duration case, this case represents a typical case of someone who didn’t respond as would be expected to a good PRI program. Fortunately this patient has now had success utilizing the services of PRIME to take the next step forward. This case had a great engaged patient, who was willing to do the work and listen to recommendations, a great referring PRC PT who took the time to refer to PRIME and continued to work with the patient, and a team of professionals willing to assist and unpeel the layers that undoubtedly exist with chronic patients like Chris. We have also had success with people who have no PRI background or PTs with minimal PRI background as they are not as “patterned” in their thinking and open to whatever recommendations are given; however, the value of a good home-team PT is never underestimated!
If you have questions about how PRIME could benefit you as a patient or as a PRI or non-PRI trained practitioner, please do not hesitate to contact us at PRIMEngagement@gmail.com or look for more information at www.primengagement.com.