Ocular Physical Therapy, Rapid Rehab, and Slappin’ the Sockets

Though our tripartite title smacks of an Ed McMahon setup for Carnac the Magnificent, it’s actually based on a serious subject that our field has danced around for years.  I introduced the subject in a blog post last week about the lack of synergy between ophthalmology and optometry in strabismus surgery, prompted by an insightful post in MainosMemos.  The absence of any interest in on the part of ophthalmology in pre- or post-surgical therapy stands in stark contrast with the synergy that exists in orthopedics and physical therapy.

The point was brought home last weekend with an up close and personal look at the concept of Rapid Rehab.  Seems almost too quick that  physical therapists would push patients to sit up, yet alone stand on the same day as surgery for total hip replacement.  The term “minimally invasive” to describe the surgical procedure seems like a bit of a soft pedal, and clearly the amount of pain experienced by the patient after the anesthesia wears off  attests to the fact that the term is relative.  Yet there they are, the PT enforcers, pushing like clockwork to proceed from the standing phase to shuffling side-to-side, to walking a few steps and then down the hallway before one’s scheduled hospital departure to extended rehab.  The surgeons essentially defer the rehab protocol to the PTs, who are the experts in getting function to support structure in guiding performance.

I have in my prized collection of  books a copy of Jack Kurtz’s 1931 classic, The Principles and Practice of Ocular Physical Therapy for Optometrists.  The book is wide-ranging and in a sense futuristic.  A portion of it anticipates what would ensue 75 years later in terms of transcranial magnetic stimulation of vision.  What the book mostly reminds us of, however, is that part of optometric vision therapy really is physical therapy for the eyes.  In a recent blog, Dr. Rochelle Mozlin commented on the astute lecture given by Dr. W.C. Maples at this year’s annual meeting of the College of Optometrists in Vision Development.  One of WC’s favorite sayings is the importance of “slappin’ the sockets”, an expression used to describe ocular calisthenics aimed at increasing the range of motion and balance between abduction and adduction.

The idea of slappin’ the sockets reminds us that while behavioral and cognitive aspects of vision therapy are important, we shouldn’t lose sight of the fact that the kinematics of the eye are constrained by the fact that they are specialized joints adapted for seeing.  The eye works as a ball-in-socket.  Thought it isn’t a weight-bearing joint, slappin’ the sockets is a principle that is used in rapid rehab.  Rapid rehab helps the patient re-align range of motion in the hip region.  The secret to its success resides in the active engagement of the patient in guided, repetitive action in motor fields of restriction.  Isn’t it time that eye surgeons follow the lead of orthopedic surgeons in acknowledging the synergy to be had in an allied therapeutic field?

– Leonard J. Press, O.D., FCOVD, FAAO

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