Neuropsychology and Rehabilitation Psychology Division Department of Physical Medicine and Rehabilitation.


Could my balance problems be connected to impairments in vision and hearing? I seem to have problems in all these areas since my head trauma.

Balance or equilibrium difficulties are common sequela to head injury. They are associated with vision and hearing (the oculovestibulo mechanism). Post-trauma vision syndrome, a common sequela to head injury, frequently includes a subclassification referred to as midline shift syndrome. The midline shift syndrome results in a patient experiencing a constant sense of disequilibrium, difficulty with maintenance of balance, an inappropriate posture and weight distribution on the balls of the feet, and inappropriate gait, combined with a directional drift. Such patients also often express that they perceive their world in a strange way, in that the horizon may be tilted, walls may be tilted or compressing in upon them.

These symptoms of midline shift syndrome are effectively addressed in most cases with a concept referred to as yoked prism reorientation. It must not be concluded that this is a cure for this problem. It is an immediate amelioration of the symptoms in most cases that are correctly diagnosed as midline shift damage. This requires a differential diagnosis eliminating damage to the vestibular mechanism. The most common imbalance experience following head injury is oculo motor decompensation and binocular visual-motor-perceptual imbalance decompensation resulting in midline shift syndrome. This case is symptomatically treated with yoked prism reorientation therapy.

  • Padula, William V., OD. A Behavioral Vision Approach for Persons with Physical Disabilities. ISBN # 0-943599-04-0.
  • Thomas, John A., OD. "Post Trauma Vision Syndrome." Colorado Head Injury Newsletter. Fall 1995.
  • Padula, William V., OD, Argyris, Stephanie. "Post Trauma Vision Syndrome and Visual Midline Shift Syndrome." Neuro Rehabilitation Journal. June 1996. pp. 165-171.
  • Padula, William V., OD. "Head Injury Causing Post Trauma Vision Syndrome." New England Journal of Optometry. December 1988. pp. 16-21.
  • 3 comments (Add your own)

    1. Lisa J. Cookson wrote:
    Are the prism glasses the only source of rehabilitation recommended? Aren't there other resources to help recover, get physically strong, and feel safe on your own two feet again from this mid-line shift syndrome? I'm thinking O.T., balance therapy, yoga, and strength training would be a great treatment plan. When I searched for rehabilitation providers in my area there weren't any to be found. Can you help me?

    Wed, October 22, 2014 @ 8:35 AM

    2. Clo Overcast wrote:
    It had been shown that even a partial degree of a shift over time causes a stress to the brain. The glasses are only worn for a short period of time. Until the brain feels less stressed. People can be born with a shift, it does not have to be from trauma, but additional brain trauma makes symptoms long term. A baby that does not crawl can gave the condition. Rehabilitation alone, cross brain training helps but the prism glasses are needed to sync the brain with the eyes. An eye reabilitation specialist is needed to treat the condition. Look untill you find one, this field is newer and the medical field is just now looking at how important it is to correct the condition. Migraines, ringing in the ears and mental conditions can come from a one degree or less shift.

    Wed, December 17, 2014 @ 1:36 AM

    3. Lynn Dalton wrote:
    Is there a medical code for VMS, vision therapy, or Yoked Prisms?

    Tue, September 29, 2015 @ 2:19 PM

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