After a neurological impairment such as TBI or CVA, mismatches in neuro-motor and ambient vision processing can occur, causing shifts in concept of a person’s visual and neuro-motor midline. This shift in midline can cause a person to shift his body laterally or anteriorally/ posteriorally, affecting balance, posture, and gait. This shift in visual midline has been termed the Visual Midline Shift Syndrome (VMSS).

Due to the major impact of the visual system on cognitive and motor function, the visual rehabilitative needs of the head injured, stroke, or neurologically impaired patient must be addressed as early as possible. Neuro-optometric rehabilitation is an individualized treatment regimen for patients, with visual deficits as a result of such injuries. The treatment plan improves specific acquired vision dysfunctions determined by standardized diagnostic criteria. Treatment regimens encompass medically necessary noncompensatory lenses and prisms with and without occlusion and other appropriate rehabilitation strategies.

The Characteristics and Symptoms of VMSS include:
• Associated Neuromotor Difficulties with Balance, Coordination, and Posture
• Leaning Forward/Backward
• Leaning to One Side
• Seeing the Floor Tilted

Rehabilitation Professional’s Checklist (PTVS/VMSS)

Behavioral observations during therapy sessions or medical examinations, in-depth interviews and screenings will provide information to rehabilitation professionals about potential visual and neuro-motor dysfunctions. Following is a list of client symptoms and/or behaviors that may be reported or observed. If these symptoms are present, the client may be in the Post Trauma Syndrome and/or the Visual Midline Shift Syndrome and should be referred for neuro-optometric rehabilitation.

  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

For more information about Neuro-Optometric Rehabilitation, including where to find a Neuro-Optometric Rehabilitation Optometrist near you, visit

In Singapore, you can contact IGARD Vision Therapy Center for neuro-optometric rehabilitation services. The center in Singapore is headed by Dr Yap Tiong Peng who is US-board certified in vision therapy. He is a member of the Neuro-Optometric Rehabilitation Association, International, and he is also fully accredited in neuro-developmental and behavioral optometry.

Dr Yap Tiong Peng and the team at IGARD Vision Therapy (Singapore) provides vision therapy and neuro-optometric visual rehabilitation.