PRIME Week

Read below to see what happens during a typical week at PRIME

Click Through to See What Happens on a Typical Initial Week at PRIME

Lateral Cephalogram

Day One: Dr Hohl - Records and X-rays

Early the first day, if deemed necessary before you come to PRIME, you may be seen at Dr. Rebecca Hohls office.  At this appointment you will recieve imaging of your teeth and x-rays of your head and neck to assist our PRIME team in objectively seeing if there are any cervical spine, bite, or airway issues that may need to be addressed.  If any orthodontic consultation is needed, Dr. Hohl will be our lead  practitioner to assist with this.

Day One: Dental Impressions

Regardless of if you see Dr Hohl for records you will see our Dental team, usually Dr. Christine Campbell, to get impressions of your teeth.  A model of your teeth will be built that we will use to manufacture you oral splint with.  This process needs to be started as early as possible to ensure we get the splint back to you as soon as we possibly can.  This appointment should not take more than 15-20 minutes.

Day One - PRI Vision Assessemnt and Treatment

At your ~2-hour visit with Dr Heidi Wise, OD and Ron Hruska, PT at PRI Vision you will receive a comprehensive assessment of your body position and pattern. Through a consistent, progressive assessment, lenses will be prescribed to automatically change the way you recruit muscle to function in an upright stance.   This optimal position will allow the greatest freedom of movement with the greatest sense or awareness of this position (Neutrality).    Specific recommendations for footwear will be made at this visit.  Other information which may include recommendations on oral appliance use and physical activities will also be initiated at this stage.

Day One - Clinical Integration Specialist / PT Visit

On the first day following your PRI Vision assessment you will often meet for an hour with your Clinical Integration Specialist/Physical Therapist who will visit with you to answer any initial questions you may have and discuss how and when to utilize the orthotics you will be given.  If time permits some instruction in base-line activity recommendations will begin.  On occasion, particularly if you have not been seen by a Postural Restoration Institute® (PRI) trained therapist, this initial visit with the PT is before the PRI Vision assessment to assist us in gaining some more objective data about you and to answer any questions about the process you may have.  This visit will lay the roadmap for the activity recommendations for the rest of the week.

Day 2: Physical Therapy Treatment

Typically you will have up to 2 hours of time on Day 2 with the Physical Therapist.  At this time the majority of the activity and exercise recommendations will be given.  You will receive instruction in, and assistance with performance of each exercise recommended until you feel comfortable with them.  Handouts and/or videos of each exercise can be given to you to assist with remembering how to perform each activity. Continued education in use of glasses and other orthotics will be reinforced as well.  Your PT will also instruct you in progression ideas so you have exercises to progress to as you develop strength and endurance to perform the initial set of activities.  As always ask questions of your PT/Clinical Integration Specialist as needed.

Day 2 : Dental Bite Registration

At some point on the second day you will meet with our Dental team, either at the Hruska Clinic or at the Dentists office (check your itinerary to be sure) for a short visit for another tooth impression.  This impression (the bite registration) is different from the first in that it records how your teeth fit together.  The way your teeth fit affects and is affected by the way the rest of oyur body is positioned.  Now that we have an optimal position of your head and neck (from the PRI Vision glasses) we want to make sure the dental splint is made to match this position.  This is why this piece is not done on the first day.  We want to make the splint to match your new postural position not your old position.  One of the Clinical Integration Specialists will be present at this visit to ensure the bite registration is taken with your body in the correct position using your new glasses prescription and other tools as needed.

Day 3 : Podiatry / Foot Impressions taken

If it is deemed necessary through your triage information or at the initial assessment during the PRI Vision treatment, you will have impressions taken for foot orthotics.  As with the bite registration this impression will be taken with your body in the “new” position.  If needed you will meet with Dr Paul Coffin, a podiatrist, for consultation to assess foot biomechanics and to take foot impressions.  If a full podiatry consultation is not needed but orthotics are warranted, Dave Drummer, PT, will take proper impressions to send to Dr Coffin to manufacture the orthotics for each patient.  The foot orthotics will be shipped to you directly as the time it takes to manufacture prevents this from happening before you leave Lincoln.  Shoe wear recommendations will be made for each patient regardless of your need for custom orthotics.  On occasion this visit happens on the second day.

Day 3: Dental oral appliance seating appointment

On day three, one of the Clinical Integration Specialists will meet you at the dental office where you will receive the oral appliance manufactured based on the tooth models from day 1 and the bite registration taken on day 2.  As the Dentist ensures proper fit and function of the appliance, the Clinical Specialist will ensure it matches the position of neutrality that was established on day with with PRI Vision.  This co-treatment ensures that all of your orthotics will work as a team to give us the best ability to maximize our outcomes with these appliances.  This teamwork is what makes our program unique and successful.

(This picture is a sample splint and not a representative of all splints used)

Day 3: Physical Therapy /Clinical Integration visit

2 more hours are usually scheduled with your Physical Therapist to ensure all questions are answered and you feel confident with performance and progression of therapeutic activities prescribed.  The opportunite to fine tune your technique and ask any questions in regards to the activities is encouraged.  Time is taken at this visit to ensure orthotic wear and use is understood and the patient is comfortable integrating this program into their daily life including adjunct PT and non-PT related activities and treatments.  By the end of this session you should feel confident with when and why to use each of your orthotics, what activities to begin doing as well as what activities to progress toward as you get stronger.  We will also try to give you ideas of what your progress whould look like in terms of improved function, return to prior activities, and when/if you may need to return for follow-up treatment.  Summaries can be given or sent to you at anytime.  We encourage each patient to feel confident and ready to engage your program before leaving Lincoln.

Day 3: Wrap up with Patient Care Coordinator

On the last day, an optional wrap up session with one of our Patient Care Coordinators may be set up.  This is a great time for both sides to make sure that all questions and concerns have been addressed and gives you a chance to decompress your experience with someone who has been on both sides of the table.  Our coordinators will be able to answer questions and facilitate any communication needed.  If you would like to provide some advice or testimonials to future patients we would love to get your feedback so we can continue to make our program better.  Thank you for any and all information you may have for us.

Day 4: (If needed) Discharge appointment with PT

Occasionally a 4th day is warranted if it is felt additional time is needed with any of the above specialists.  Most often this is with the Physical Therapist to make sure all of the pieces are in place and you as the patient feel confident with returning home.  This visit is decided prior to coming to PRIME and will be utilized only if needed or requested by you the patient.

See What Happens on a Typical RETURN Week to PRIME

If your progress plateaus or halts, which is typical, or you have met certain goals spelled out at your initial PRIME week, you may need to return for a follow up visit.  Typically, the second visit is much less intense and for a shorter duration than the first. Since you have all the pieces needed, they may just need to be adjusted to assist you in moving forward in your program.  New recommendations to address continued issues will be given as needed.  Some people underestimate the need to return and often feel as if they just got the most out of the first session that they could.  We anticipate needing to update and progress your program to gain optimal results, and strive to give you anticipated progression and return time tables at your initial PRIME week.  A shorter return trip to Lincoln will help you continue to improve if your progress plateaus.

Prior to returning to Lincoln

Prior to coming back to PRIME we will collect information from you, and therapists or practitioners you are working with to ensure we make the most of your return trip.  Contact our PRIME Patient Coordinator to allow us to assist you in getting to needed information to us.

Day 1: PRI Vision

As you progress through your fist set of activities as directed at your initial week of PRIME and learn different movement and postural strategies with your first pair of training glasses the time will come that that lens is no longer what you need and may actually be a problem for you.  When you return to PRIME we will make sure that you have a prescription that matches the “new you” to help continue to make progress.  Often this includes less power or correction, or a different power to address a new movement pattern you need to learn.  Additional recommendations for near vision/computer work or other sensory inputs that need to be managed may also be addressed at this visit.

Day 1: Physical Therapy visit

Following your visit with the PRI Vision team a session with your PT will occur to help instruct you in new movements or activities that you will be able to progress to or emphasize.  There will be less focus on the wear schedule as you will be used to that and you can focus on activity reccommendations.

Day 2: Splint adjustment

If a significant change has been made to your visual script your splint may need to be re-equilibrated or adjusted to match the new glasses prescription.  One of our Clinical Integration Staff members will be present to ensure proper body position is maintained.  In some cases a new appliance may need to be made.  If that is the case a longer trip will be needed to get new molds and bite registrations done.

Day 2: Physical Therapy visit (if needed)

If needed, a second visit may be scheduled to again review and progress activities and exercises, however often this is done in one session to save time.  Depending on your situation, progress and comfort with your activities this will be scheduled and known prior to coming to Lincoln.

Other potential issues

Occationally other practitioners may need to be consulted if specific situations arise.  If orthodontia (braces) is a recommendation another consultation with Dr. Hohl, the orthodontist, may be warranted.  If foot orthotics need to be adjusted or now you are ready for foot orthotics as your stability grows, you may see Dr Coffin the podiatrist.  Consultation with a specialist in regards to auditory processing, oral-motor function, or integrating your program with a return to working out with a PRI-certified personal trainer are also possibilities.  These will be discussed and scheduled on an as needed basis and prior to coming to Lincoln.  If you have questions about any of these things please do not hesitate to contact PRIME to ask.