Exercise Clinical Trial
Official title:
Visual Dependence and Multisensory Balance Exercise for Elderly
The study aimed to investigate the effectiveness of multisensory balance training on the levels of visual dependence and sensory organization capacity in community-dwelling older adults. Participants in the experimental group received multisensory balance training while those in the control group received conventional balance training without sensory manipulation.
Older people often find it difficult to maintain balance with their eyes closed, which
emphasizes the importance of vision. The greater influence of vision on orientation and
balance has been observed by manipulating static and dynamic visual cues—for instance,
tilting the frame of reference or moving visual scenes. Older people—particularly those prone
to falls—have been reported to make significantly greater errors in subjective visual
verticality and exhibit greater sway and continued center of gravity oscillation during and
following visual disturbances. They also adopted hip strategies to restore balance in
response to visual perturbation, indicating that they were unstable in the event of visual
disturbance. These results indicate that older people may have higher levels of visual
dependence than younger adults.
The underlying mechanism of visual dependence remains unclear. Visual dependence is
considered a form of sensory reweighting deficit. In a situation of sensory conflict, the
central nervous system must first recognize the discrepancy and reduce the weighting
(suppress) of the inaccurate input while increasing the weighting of the input from the
sensory systems that are deemed to provide more reliable information. This complex process of
sensory organization is termed multiple-sensory reweighting and is vital in maintaining
balance and orientation in a continuously changing and complex environment.
Studies have suggested that visual dependence could benefit from promoting desensitization
and increased visual motion tolerance through visual adaptation and habituation exercises in
vestibular rehabilitation. This may be because the majority of visually dependent adults have
the comorbid symptom of visual vertigo. However, according to the National Audit Survey in
the United States, one-third of patients with vestibular disorders and visual dependence lack
signs and symptoms of dizziness or vertigo. Recent evidence has demonstrated that healthy
older adults with greater levels of visual dependence did not have dizziness; therefore, it
is unclear whether visual adaptation exercises can effectively reduce the degree of visual
dependence in such people. However, visual dependence can be considered as a sensory
reweighting deficit; therefore, multisensory balance training with manipulation of the
visual, vestibular, and proprioceptive inputs could be an alternative for decreasing visual
dependence through improving the integration and reweighting of sensory systems. In fact,
multiple studies have documented that multisensory balance training improves mobility and
balance in older adults with instability or a history of falls; however, few have
investigated its effectiveness on visual dependence and in healthy elderly people. Therefore,
the aim of the study was to investigate the effectiveness of multisensory balance training on
the levels of visual dependence and sensory organization capacity in older adults.
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