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What is NVPT?

Dr. Gietzen had the pleasure of working with the renowned Dr. Bill Padula who has helped pave the way of Neuro-Optometric Rehabilitation. He and Dr. Nichols have studied through the Neuro-Optometric Rehabilitation Association level 1 curriculum and Dr. Gietzen is currently pursuing his fellowship through the organization. 

Neuro-Visual Postural Therapy (NVPT) is a specific form of vision therapy utilizing movement and prism to help guide the patient through space. This form of therapy pays special attention to how posture, movement, and balance integrate with sensory information to create a stable postural base of support through which vision can effectively and efficiently guide motor movement of the individual.  NVPT is rooted in the understanding that the visual system consists of two processes that work in tandem to allow for us to visually interact and investigate our world while maintaining a stable posture and balance as we move through space.  The ambient process is pre-conscious, meaning that works behind the scenes without conscious thought.  It integrates spatial inputs from vision with information that comes from touch (i.e., proprioception) and movement from muscles and joints (i.e., kinesthesia) to create a relationship with gravity that allows us to move in space without losing balance, bumping into things, or feeling dizzy or disoriented.  The focal process is the conscious portion of vision that many people are familiar with.  This is the process that allows a person to read the acuity chart or look and interpret faces while in conversation.

Following a neurological event such as a stroke, traumatic brain injury, multiple sclerosis, cerebral palsy, etc., there may be a disruption in the fine coordination that occurs between these two visual processes.  This can result in a myriad of symptoms ranging from headaches, double vision, light sensitivity, dizziness or imbalance, and difficulty navigating busy, crowded environments (e.g., grocery stores), as well as many others.1,2 

NVPT is used in the rehabilitation process to integrate both motor and sensory inputs through vision to improve posture and dynamic movements of flexion and extension and to create a more favorable balance between the two visual processes which allows for a reduction in symptoms as well as an ability to build effective visual skills upon this foundation.2 NVPT originally found its therapeutic benefits in the neuroatypical and brain injured populations (acquired/traumatic) where obvious physical restrictions/limitations resulted in compensations from the visual system, but can be integrated into any vision therapy program for a variety of conditions including mTBI/concussion, Lyme disease, etc.3  A multidisciplinary approach integrating NVPT, traditional vision therapy, optometric phototherapy, as well as other therapeutic modalities (e.g., occupational therapy, physical therapy, etc.) has been clinically found to improve rehabilitation outcomes and is the preferred method of implementation at Excel Neuro-Optometric Institute. 

Use of specific lenses, prisms, and selective occlusion guided with vision rehabilitation can help improve the safety of the individual.  NVPT uses these tools to allow for effective matching of the ambient visual process with posture and dynamic movement which, in turn, can decrease the risk of fall for the individual.4 The proper prescribing of these lenses and prisms requires a careful gait analysis and prism assessment prior to therapy or in conjunction with a vision therapy program. 


1. Padula, W. V., Capo-Aponte, J. E., Padula, W. V., Singman, E. L., & Jenness, J. (2017). The consequence of spatial visual processing dysfunction caused by traumatic brain injury (TBI). Brain injury, 31(5), 589–600. 


2. Padula, W. V., Munitz, R., & Magrun, W. M. (2012). Chapter 7: Visual Midline Shift Syndrome. In Neuro-Visual Processing Rehabilitation: An interdisciplinary approach (pp. 78–89). essay, Optometric Extension Program Foundation.  


3. Padula W. V. (2016). Mild traumatic brain injury (mTBI): Symptoms without evidence. Journal of the neurological sciences, 370, 303–304.  


4.Padula, W. V., Subramanian, P., Spurling, A., & Jenness, J. (2015). Risk of fall (RoF) intervention by affecting visual egocenter through gait analysis and yoked prisms. NeuroRehabilitation, 37(2), 305–314. 

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