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.

  1. Padula, W.V, OD. A Behavioral Vision Approach for Persons with Physical Disabilities. ISBN # 0-943599-04-0.
  2. Padula, W.V., Capo-Aponte, J.E., Padula, W.V., Singman, E.L. and Jenness, J. (2017) The consequence of spatial visual processing dysfunction caused by traumatic brain injury (TBI), Brain Injury, 31(5), 589-600, DOI: 10.1080/02699052.2017.1291991
  3. Thomas, J.A., OD. "Post Trauma Vision Syndrome." Colorado Head Injury Newsletter. Fall 1995.
  4. Padula, W.V. & Argyris, S.. "Post Trauma Vision Syndrome and Visual Midline Shift Syndrome." Neuro Rehabilitation Journal. June 1996. pp. 165-171.
  5. Padula, W.V., OD. "Head Injury Causing Post Trauma Vision Syndrome." New England Journal of Optometry. December 1988. pp. 16-21.

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