BLOG: How functional neurology and optometry can work together
by David Rosenthal, DC, FICPA, FIBFN-CND
Functional neurology practitioners use clinical rehabilitation techniques and physical manipulation to improve human efficiency in a variety of areas, including: vision, balance, coordination, strength, gait and cognition.
We evaluate the sensory, processing and motor systems to assess the efficiency of the taste, touch, sight, sound and smell networks, and then provide rehabilitation, often working with an interdisciplinary team.
We typically focus on identifying and making improvements to three qualities of sensorimotor processing problems:
Latency – Does the patient have a delay in doing what they want to do, when they want to do it? For example, if a child doesn’t raise his hand as soon as he knows the answer, is it due to slowed cognition or due to movement dysfunctional?
Velocity – Can the patient move at the appropriate speed — fast when they want to go fast and slow when they want to go slowly?
Accuracy – Can the patient go exactly where he or she wants to go? After a head injury, we often see patients who want to walk straight but instead turn and run into walls. These types of problems have both neurological and visual system components that can and usually should be more effectively addressed by multiple practitioners.
In fact, the functional neurosciences specialty has evolved over the past 20 years out of frustration that traditional, “siloed” disciplines often could not fully address and resolve patient symptoms in complex cases. We believe that the best way to help patients is to do what you do well, know what you don’t do well and find collaborative partners so that, together, you can improve the patient’s quality of life — physically, intellectually, emotionally, socially and spiritually.
For example, in treating a patient with a movement disorder such as Parkinson’s disease, a medical neurologist primarily treats the underlying neuropathology with medication and may recommend ongoing physical therapy. Both of those aspects of care are important. But we need to remember that eye movements, in concert with the vestibular system, are often significantly compromised in these disorders.
It is important to remember that the vestibular system, with input from the basal nuclei and cerebellum, coordinates head, body and eye movements. A functional neurology practitioner may be able to better integrate therapies for the neurological, vestibular and visual systems just by evaluating how the presynaptic and postsynaptic networks function. In addition, we may be able to teach the patient some useful techniques for increasing sensory feedback to brainstem nuclei (such as the trigeminal nucleus) to improve overall balance and coordination.
If a patient is having an oculogyric crisis or needs yoked prisms, or if the neurological examination reveals problems with the second, third, fourth or sixth cranial nerves, then we know that the patient also would benefit from a referral for a comprehensive optometric evaluation.
There are so many ways to work together for the patient’s benefit. I encourage readers of this blog to build a network of people you like and trust, whose expertise complements your own. You can find a directory of functional neurology providers on the Interdisciplinary Association of Functional Neurosciences and Rehabilitation website (IAFNR.org). What other types of practitioners have you found to be good collaborative resources in your community?
For more information:
David Rosenthal, DC, FICPA, FIBFN-CND, is a doctor of chiropractic, board certified in functional neurology and in private practice in North Dallas. He is fellowship trained in functional neurology, childhood developmental disorders, pediatrics and vestibular rehabilitation and serves as president of the Interdisciplinary Association of Functional Neurosciences and Rehabilitation. He works with several companies to develop new products that address neurological and visual issues.
Disclosure: Rosenthal reports a financial interest in Glia LLC.
Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.