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The term proprioceptive system was first proposed by Sherrington more than 100 years ago (1). Sherrington also proposed that for movement to take place, there needs to be the excitation of one or more agonist muscle(s) with a simultaneous inhibition of the antagonist muscle(s) acting at the same joint (2). For these processes to occur smoothly, the brain must recognise the correct state of tonicity of each of the muscles involved. 


In the 1960’s, following on from the work of Dr Carpinteiro on patients with rachialgia at the Department of Rehabilitation Medicine, University Hospital St Maria in Lisbon, Dr Martins da Cunha identified a wide range of symptoms in patients with aetiologies which could not be attributed to organic factors. After examining thousands of cases, Dr Martins da Cunha proposed a new clinical entity – the Postural Deficiency Syndrome (PDS), which he presented internationally in 1977 (3) in Spain and published in France in 1979 (4). He also developed Dr Carpinteiro’s treatment further, to allow patients to rely less on frequent visits to the hospital.  Dr Martins da Cunha named this treatment Postural Reprogramming.


As soon as I become Head of Strabismus and Orthoptics at the University Hospital

St Maria in 1977, Dr Martins da Cunha sought my advice, bringing one of his patients with him. He wanted me to explain why his patients with PDS had a particular way of looking at others “as if they were suspicious”, for no apparent reason. After observing how the patient looked differently in the lateral positions, I modified the use of a Clement Clarke Synoptophore to investigate what might be happening at the level of the gaze of both patients in the lateral positions.


This led me to pioneer a diagnostic and classification protocol, Directional Scotometry, and to embark on the joint observation of hundreds of patients with Dr Martins da Cunha. By the end of 1977 I had developed an inexpensive, non-invasive, fast and accurate ophthalmological diagnostic protocol that allowed to identify and classify all types of Postural Deficiency Syndrome by means of Directional Scotometry. I also pioneered Active Prisms, for the treatment of each type of Postural Deficiency Syndrome which I had identified.


Together with the treatment developed by Dr Martins da Cunha, my contribution allowed for:

  • Inexpensive, non-invasive, fast and accurate diagnostics of patients with Postural Deficiency Syndrome

  • Inexpensive, more effective treatments enabling patients to better manage their conditions, without relying on frequent visits to the hospital

  • The treatment of functional types of oculomotor discoordination, monocular diplopia, paracentral scotomas in the visual fields, convergence insufficiency, near exotropia, asthenopia and metatopsia

  • The understanding of the importance of the visual system in the Postural Deficiency Syndrome led us to identify a major, new and exciting chapter in Ophthalmology (5)

  • The treatment of a wider number of clinical cases that had previously not been possible, including that of certain types of cognitive dysfunctions and functional ataxia, dyspraxia, and various types of lack of balance and pain

  • The understanding of the extensive influence of the Proprioceptive System in the maintenance of human health

  • The understanding of the extensive and diverse impact of a dysfunction of the Proprioception System

  • The understanding that the Postural Deficiency Syndrome is the result of a dysfunction of the Proprioception System

  • The understanding that many symptoms of the Proprioception Dysfunction Syndrome are misdiagnosed as having an organic aetiology even when there is no evidence to that effect

  • A better understanding of the aetiology of the Proprioception Dysfunction Syndrome

  • The understanding that, when the Proprioceptive System is dysfunctional, the brain does not recognise the correct state of tonicity of the muscles at rest 9low dynamic) or in movement (high dynamic), and therefore Sherrington’s agonist/antagonist model is not applicable

  • The understanding that vaso-motricity is also affected as in PDS, the brain does not recognise the correct state of tonicity of vascular smooth muscle that is fundamental to regulate the caliber of the blood vessels

  • The understanding of why other treatments may also be effective


Our understandings would not have been possible without extensive multidisciplinary research, and the exchange of ideas and clinical practices, in particular during the late 1970’s and throughout the 1980’s and the 1990's, with leading researchers and clinicians from a variety of countries, including Portugal, France, Romania and Japan. We have presented our work at many international conferences and published various papers (see publications).

Note: the terms Proprioceptive System and Proprioception are frequently used interchangeably, even though this is a simplification. The term Proprioception Dysfunctions is used to mean Dysfunctions of the Proprioceptive System.


  1. Sherrington CS. On the proprioceptive system, especially in its reflex aspect. Brain, 1907; 29:467-85

  2. See for example Burke RE. Sir Charles Sherrington's The integrative action of the nervous system: a centenary appreciation, Brain, 2007; 130, 4:887–894

  3. Martins da Cunha, H. The vertebral Column and the Postural Deficiency Syndrome - Conf. VI Reunion sobre Patologia de la Columna Vertebral, Murcia, Espana

  4. Martins da Cunha H. Le syndrome de déficience posturale – S.D.P. Actualités en rééducation fonctionnelle et réadaptation, 4 série, L Simone Ed. Paris: Mallon, 1979.

  5. Martins da Cunha H., Alves da Silva O. Syndrome de Déficience Posturale. Un Nouveau et Grand Chapitre de L’Olphtalmologie, J Fr Ophtalmol (Paris), 1986, 9:747-755

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