As co-creator of Concussion Health’s Visual Vestibular Functional Integration Training (V2FIT) certification program, one of the most common questions I receive is in regards to central-peripheral integration. What I have come to realize is that this term appears to have various meanings, so I thought a good place to start is to hear from you on how you interpret/define central-peripheral integration. First, let's take a look at central-peripheral integration from different angles:
1. Central-peripheral integration as related to functional anatomy and physiology by discussing eye movements: For instance, saccadic eye movements are the quick jumps we make to move our eyes from target to target. Saccades is controlled by 2 important systems that we discussed in the V2FIT certification program: (1) our central vision which is the “What is it?” (ventral stream) system that allows to fixate on a target to provide a clear image; and (2) our peripheral or side vision which is the “Where is it?” (dorsal stream) system that locates the next target to tell our eyes where to move. These 2 systems must work seamlessly together for us to read. Central-peripheral integration appears to be disrupted with head trauma, resulting in several symptoms and decreased performance in the following areas: visual attention, processing speed, reaction time, simultaneous processing, multi-tasking, organization, efficient reading skills, balance integration and good performance.
2. Central-peripheral integration as related to motion sensitivity: This term is also used to describe focusing on something centrally while processing information in your periphery – imagine riding in a car. You are looking forwards but your brain is receiving a lot of information from the periphery. Following head trauma, this often becomes difficult and leads to motion sensitivity while riding in a car, being in busy places, etc. Thus, there appears to be a reference to central-peripheral integration as more of a sensitivity to processing busy and/or incorrect visual stimulation.
3. Central-peripheral integration as a theoretical foundation for rehabilitation to promote neuroplasticity: Think of it this way…as therapists, we are taught that you start in the most supported position to optimize function then begin to increase the demand of the task by decreasing the support base. For instance, you may start a patient in sitting then progress to standing then eventually on more uneven and/or dynamic surfaces. More sensory (or periphery) information can also be done by adding proprioceptive input with weighted vests, grounding techniques, and/or resisted movements (e.g., proprioceptive neuromuscular facilitation techniques). In other words, we are increasing proprioceptive input (in the periphery…our bodies) for central compensation. Thus, central-peripheral integration from a therapy reference appears to be synonymous with sensory integration.
So, why did I choose to bring up this topic? Because I realized in recent conversations with other clinicians that there are completely different references to the meaning of central-peripheral integration. This reminds me of how we hear each other from our own experiences, so it’s important we continue to have ongoing conversations which other…for feedback. That is the reason I would like to invite you to join me for a free training call on April 27th at 12:00pm CST. Click here to save your spot! I look forward to hearing from you — whether it is on this topic or your own area of interest.
Bridgett Wallace, PT, DPT
Co-Founder, Concussion Health
Director of Clincial Education
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