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Digital Seminar

Prism and the Vestibular System – Vision, Balance, and Behavioral Dysfunction

Charles Boulet, BSc, BEd, OD
4 Hours 13 Minutes
Audio and Video
Jan 02, 2023
Product Code:
Media Type:
Digital Seminar


Vestibular function goes hand in hand with visual function. When you understand how these systems are intertwined, you can immediately resolve vision-related health and function concerns in many clinical populations: headache, diplopia (double-vision), blur, reading and learning deficits and discomfort, attention problems, photophobia (light sensitivity). Explore:

- How visual-vestibular dysfunction impacts brain injury treatment

- The role of oculomotor and vestibular dysfunction in reading disability and praxis

- Testing techniques that you can modify in your own practice: BPPV, Post-rotational nystagmus, peripheral vs. central visual fields, strabismus and other ocular restrictions.

- Opportunities for “coordinated firing” with multimodal experiences to promote the integration of visual and vestibular function.

- Use of prism in visual perceptual, visuomotor, and oculomotor therapies

- Training full body awareness, sensorimotor conditioning, visual-vestibular patterning with evidence-based tools

Accelerate and bolster outcomes in visuomotor, oculomotor, and perceptual training with simple tests and techniques you can implement right away.


Planning Committee Disclosure - No relevant relationships

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners.  For speaker disclosures, please see the faculty biography.

* Credit Note - **

NOTE: Tuition includes one free CE Certificate (participant will be able to print the certificate of completion after passing the online post-test (80% passing score) and completing the evaluation). Instructional methods will include PowerPoint, didactic lecture, and others.

Continuing Education Information:  Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Program content is reviewed periodically per accrediting board rules for currency and appropriateness for credit. Credit approvals are subject to change. Please note, your state licensing board dictates whether self-study is an acceptable form of continuing education. Please refer to your state rules and regulations. If your profession is not listed, please contact your licensing board to determine your continuing education requirements and check for reciprocal approval. 
For other credit inquiries not specified below, please contact or 800-844-8260 before purchase.

Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of your profession.  As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your profession's standards.  

For Planning Committee disclosures, please see below.  For speaker disclosures, please see the faculty biography.

Florida Occupational Therapists & Occupational Therapy Assistants

PESI, Inc. is an approved provider with the Florida Board of Occupational Therapy. Provider Number #50-399. This course qualifies for 4.0 self-study continuing education credits.

CE Broker

Occupational Therapists & Occupational Therapy Assistants

This course contains 4.0 hours of Distance Learning - Independent continuing education. It was not offered for AOTA CEUs. Please retain your certificate of completion. For state licensure or other credential renewal, contact those agencies for information about your reporting responsibilities and requirements.

California Physical Therapists & Physical Therapist Assistants

PESI, Inc. is recognized by the Physical Therapy Board of California as an approval agency to approve providers. This self-study lecture qualifies for 4.0 continuing competency hours.

Physical Therapists & Physical Therapist Assistants

This self-study course consists of 4.0 clock hours of instruction that is applicable for physical therapists. CE requirements for physical therapists vary by state/jurisdiction. Please retain the certificate of completion that you receive and use as proof of completion when required.

Illinois Physical Therapists & Physical Therapist Assistants

PESI, Inc. is a Registered Physical Therapy Continuing Education Sponsor through the State of Illinois Department of Financial and Professional Regulation, Division of Professional Regulation. License #: 216.000270. This self-study course qualifies for 4.0 CE credit hours.

Kentucky Physical Therapists & Physical Therapist Assistants

CE credit is available. This self-study course consists of 4.0 continuing education credit hours for Kentucky Physical Therapists. The rule under 201 KAR 22:045, Section 2, (2)(a) states that category 1 continued competency credits can be earned from providers approved by another physical therapy licensing agency. PESI, Inc. is a Registered Physical Therapy Continuing Education Sponsor through the State of Illinois Department of Financial and Professional Regulation, Division of Professional Regulation. License #: 216.000270.


New York Physical Therapists & Physical Therapist Assistants

PESI, Inc. is recognized by the New York State Education Department, State Board for Physical Therapy as an approved provider for physical therapy and physical therapy assistant continuing education. This self-study course qualifies for 5.0 contact hours.

North Carolina Physical Therapists & Physical Therapist Assistants

PESI, Inc. is an approved provider with the Illinois Division of Professional Regulation, Provider Number: 216-000071. This intermediate course is approved by the North Carolina Board of Physical Therapy Examiners by virtue of PESI Inc. approved provider status with the Illinois Division of Professional Regulation. This course qualifies for 4.0 continuing education hours.

Pennsylvania Physical Therapists and Assistants

The Pennsylvania State Board of Physical Therapy recognizes approval by all other state boards. This self-study activity consists of 4.0 clock hours of instruction that is applicable for physical therapists.

Texas Physical Therapists & Physical Therapist Assistants

This self-study activity is provided by the Texas Board of Physical Therapy Examiners Accredited Provider #2406032TX and meets continuing competence requirements for physical therapist and physical therapist assistant licensure renewal in Texas. Instructional Level: Advanced. This activity will provide 4.0 CCUs. The assignment of Texas PT CCUs does not imply endorsement of specific course content, products, or clinical procedures by TPTA or TBPTE. Full attendance is required; no partial credits will be offered for partial attendance.

Utah Physical Therapists And Physical Therapist Assistants

This course is designed to meet the Utah DOPL Rule R156-24b-303b.2.c.iv - A commercial continuing education provider providing a course related to the practice of physical therapy. Please retain a copy of the advertising brochure and your certificate of completion to provide to your board should this be requested of you. This self-study activity consists of 4.0 clock hours of continuing education instruction.

Vermont Physical Therapists & Physical Therapist Assistants

CE credit is available. This course consists of 4.0 continuing education credit hours for Vermont Physical Therapists. The Board confirms acceptance of continuing education programs that are recognized by other state physical therapy licensing boards. PESI, Inc. is a Registered Physical Therapy Continuing Education Sponsor through the State of Illinois Department of Financial and Professional Regulation, Division of Professional Regulation. License #: 216.000270.

Virginia Physical Therapists & Physical Therapy Assistants

CE credit is available. This self-study course consists of 4.0 hours of type 2 continued competency credit for Virginia Physical Therapists and Physical Therapy Assistants. Regulation 18VAC112-20-131, Section B, (2) states that up to ten type 2 continued competency credits can be earned by completing independent study activities related to the clinical practice of physical therapy. 


PESI, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. PESI, Inc. designates this enduring material for a maximum of 4.0 AMA PRA Category 1 Credit(s)™. This activity was originally recorded on 1/2/2023. It was last reviewed on 3/6/2023 and is valid until 03/06/2026.


Physicians should only claim credit commensurate with the extent of their participation in the activity. You are required to successfully complete and submit a post-test prior to receiving a certificate of completion.

Other Professions

This self-study activity qualifies for 4.0 continuing education clock hours as required by many national, state and local licensing boards and professional organizations. Save your activity advertisement and certificate of completion, and contact your own board or organization for specific requirements.



Charles Boulet, BSc, BEd, OD's Profile

Charles Boulet, BSc, BEd, OD Related seminars and products

Charles Boulet, BSc, BEd, OD, has been a loud advocate for essential vision care for underserved populations and was instrumental in promoting Alberta’s Child Vision Assessment Act in 2014, which sought to achieve common vision exams for all children in the province. Along with his clinical work, Dr. Boulet is involved with ongoing research and advocacy with professionals from around the world, including a handful of publications and a growing library of online content.


Speaker Disclosures:
Financial: Charles Boulet maintains a private practice and has an employment relationship with Vision He receives a speaking honorarium from PESI, Inc. He has no relevant financial relationships with ineligible organizations.
Non-financial: Charles Boulet has no relevant non-financial relationships.

Additional Info

Access for Self-Study (Non-Interactive)

Access never expires for this product.


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  • Differentiate between sight and vision.
  • Evaluate functional elements of vision.
  • Investigate the complementary role of vision and vestibular function.
  • Categorize behavioral concerns as vision-related or vision un-related.
  • Distinguish differences between different motor and sensory systems affecting sight and vision.
  • Assess the role of cranial nerves in visual process
  • Test and quantify various aspects of oculomotor function and vestibular function
  • Integrate oculomotor testing into clinical practice
  • Construct a toolset to evaluate oculomotor skills in the context of clients with possible vestibular challenges.
  • Extrapolate costs for not properly assessing child vision.
  • Construct testing paradigms to suit different ages and populations.
  • Appraise how Visual Impediments to Learning and Development (VILD) can interfere with therapy, testing, and achievement.
  • Evaluate vision testing and its limitations.
  • Implement and create meaningful activities to integrate and accelerate visual and visuomotor functioning.


The Vision and Vestibular Link - Part 1: Foundations

  1. The Mind and the Mindness State – The Role of Motricity in Cognition
  2. The Human Case: Centering in Space
  3. A core function of mammalian neurology, human neurology, is to ‘find and maintain centre’.
  4. Our sense of being as well as our anchor for motricity rely on this ability to self-orient.
    1. This is the foundation for our learning, our personalities, our sense of personal security.
  5. When this spatial grounding is in disorder or disrupted, critical voluntary/reflex muscle responses and mental processes fail.
  6. Personal Spatial Stability – What it Provides
  7. Vestibular/Auditory Anatomy
  8. The sense of security in positioning and stability in space is predicated on three primary senses being healthy and well-integrated.
  9. Impact of Discordance Between Visual, Vestibular, and Somatic Signalling
  10. Our intuitive sense of space arises from our natural neurological predisposition
  11. Review of 8 cranial nerves involved in visual function.
  12. Visual Anatomy: Ambient (Peripheral) vs Central (Focal) Visual Pathways
  13. We view the world through two eyes but also through two distinct visual systems:
    1. Central Visual Pathway vs Peripheral Visual Pathway.
    2. This is volitional as well as reflexive.
  14. Bi-foveation, suppression, diplopia. Visual Fusion Drives Ocular Function.
    1. Ambient (Peripheral) vs Central (Focal) Visual Pathways
  15. The Role of Neural Sensory Afferents – The Chair of Vision
    1. Visual input stabilizes vestibular function
    2. Vestibular input stabilizes visual function
  16. The Role of Auditory Input In Visual Function
  17. Elements of Strong/Robust Visual Process
  18. Overview of Human Visuo-Vestibular Function
  19. Vestibular Function (The Role of the Vestibulum)
  20. Somatosensation
    1. Types of somatic receptors.
    2. Role of somatosensation in oculomotor targeting.
    3. Teaching somatic awareness.
    4. Skin/body hypersensitivity can be modulated.
  21. The Role of Motor Afferents/Input
  22. The Importance of EOM Proprioception
  23. Neurological Representation of Peripersonal (Near) vs. Extrapersonal (Tele-personal or ‘Far’) Space
  24. Vestibular Function is Neurologically Tightly Intertwined with Visual Function
  25. How to tell if dizziness is related to vestibular dysfunction
  26. The role of visual impediments on vestibular function.
  27. Ametropias / Anisometropias
  28. The role of optics.
  29. Strabismus
  30. Amblyopia/suppression
  31. Nystagmus.
  32. Ruling out medical / anatomical / physiological causes
  33. Behavioural / Developmental Optometry is a good place to start.
  34. When to refer, and to whom.
  35. Notes on vision-based psychological/cognitive probes.
  36. Receptor-based Dizziness/Vertigo
    1. BPPV and why Dix-Hallpike / Epley have a narrow clinical application.
  37. What is left is conditioning, therefore trainable.
  38. References & Resources
  39. Additional Notes on the Neurological Representation of Peripersonal and Far Space

The Vision and Vestibular Link - Part 2: Practice

  1. Introduction to the program.
  2. Vision, then, is at the root of cognition and goes beyond simple eyesight. 
  3. Introduction to Vestibular Tools of the Trade

 Prism Goggles / Yoked Prism, weighted blankets, bare feet, sit/bouncing balls, ‘Bosu’ or standing balls, cardboard tubes, ‘plus’ and ‘minus’ lens flippers/trial frames up to +/- 2D, large mirrors, laser pointers, anaglyphic filters, penlight, pens.

  1. BPPV – Benign Paroxysmal Positional Vertigo
  2. Which side is affected in benign paroxysmal positional vertigo (BPPV)?
  3. General notes on repositioning techniques
    1. Dix-Hallpike Test
    2. Epley Maneuver
  4. Ambient/Peripheral Fields vs. Central Fields and Depth Perception
    1. Central acuity
    2. Perimetry (measurement of peripheral fields)
    3. Static’ vs ‘dynamic’ Acuity Testing
    4. Visual acuity charts vs Amsler Grid testing, Confrontational Fields, Automated perimetry
    5. Demo of Confrontation Fields
  5. Next Steps – Oculomotor Testing
    1. Demo of Simple EOM testing – looking for misalignment and difficult vergence at near.
    2. Saccades/pursuits and the NSUCO Oculomotor Test
  6. Additional examples of EOM Testing
    1. Nielsen Fixations: Spatial-Motor Training
    2. OKR (Optokinetic Response) Response – What it tells us.
    3. OKN Drum demo.
  7. Post-Rotary (rotational) Nystagmus (PRN) Testing
    1. OKN v VOR stimulus
    2. Basic Methods of Testing
    3. Validity of PRN Testing
    4. Modification of the post-rotary nystagmus test for evaluating young children
    5. Normative PRN groups and reasons for differences.
    6. Discussion re: Cortical vs developmental PRN
    7. Limits of PRN testing in Children
  8. Prism
    1. Introduction to Prism Optical Basics
    2. Real Life Example of Prism in Strabismus
    3. ‘Yoked’ prism. 
    4. Prism adaptation
    5. Alignment of Prism: the importance of orientation.
    6. Exercising Caution When Using Prism
  9. Using prism with motor skills training – Introduction.
    1. Defining Posture: Phoria vs Strabismus
    2. General Vestibular Training
    3. General Practice – Easy At-Home Practice
    4. Low Tolerance / ‘Medical’ Training:
  10. Notes on Binasal Occlusion
  11. Use of compliant surfaces/Sit Balls
  12. Team Walking
  13. Chair Spinning
  14. Core Four: Swimming, Climbing, Martial Arts, Yoga
  15. The Great Outdoors
    1. Swinging: 15 min of free swinging can have lasting effects on attention deficits and motor overflow.
    2. Walking: Flat vs. uneven surfaces.
    3. Walk-Spin / Spin-Targeting
    4. Playgrounds
  16. Vestibular Training and Nausea - Commentary
  17. Things I Couldn’t Get In This Class
    1. Near Range
    2. EOM Testing – Restrictions in movement can cause vestibular effects.
    3. Distance Range
  18. Notes and Comments
    1. Read/Buy these (Amazon)
    2. Investigate / Explore – Easy cost-effective resources.
    3. Commercial solutions.

Target Audience

  • Physical Therapists
  • Occupational Therapists
  • Osteopathic Doctors
  • Medical Doctors


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