تأثیر تمرینات تعادلی چندحسی بر عملکرد تعادل و کاهش خطر افتادن در سالمندان: یک مطالعه کنترل‌شده تصادفی

Introduction

Falls constitute a major global health concern among older adults, significantly impacting morbidity, mortality, and healthcare systems. Age-related declines in visual, vestibular, and proprioceptive systems - all critical for postural stability - coupled with reduced muscle strength and neuromuscular function, markedly elevate fall risk. Epidemiological data show that 30% of adults aged 65+ and 50% of those over 80 experiences at least one fall annually.

Current evidence suggests that conventional balance training, often targeting isolated systems, yields limited benefits. In contrast, multisensory training offers a more effective approach by simultaneously engaging multiple sensory modalities (visual, vestibular, and somatosensory), thereby enhancing sensory integration and adaptive balance control. This method leverages the neurophysiological principle of sensory reweighting - the CNS's ability to prioritize different sensory inputs based on environmental demands - promoting neuroplasticity through varied challenges.

This study examined the effects of a 6-week multisensory training program in community-dwelling elderly women, with four primary objectives:

1. Assess fall risk reduction using the Biodex Balance System
2. Measure static balance improvements via the Berg Balance Scale
3. Evaluate dynamic balance function through the Timed Up and Go test
4. Compare intervention outcomes with a control group

Methods

This quasi-experimental study employed a pre-test post-test design with a control group to examine the effects of multisensory balance training on balance performance and fall risk in elderly women.

Participants: Twenty elderly women (mean age: 67.2± 4.8 years) were recruited and randomly allocated to either the training group (n=10) or control group (n=10). Inclusion criteria included: age between 60-75 years, ability to walk independently without assistive devices, absence of severe cognitive impairment (Mini-Mental State Examination score ≥24), no history of falls in the previous six months, and absence of neurological or musculoskeletal disorders that could affect balance performance. Exclusion criteria included participation in structured exercise programs within the previous three months, use of medications affecting balance or cognitive function, and presence of severe visual or hearing impairments.

Intervention Protocol: The training group participated in a comprehensive six-week multisensory balance training program, consisting of three sessions per week, with each session lasting 60 minutes. The training protocol was designed to progressively challenge multiple sensory systems through various balance exercises performed on different surfaces and under varying sensory conditions. The program included: (1) static balance exercises on stable and unstable surfaces with eyes open and closed; (2) dynamic balance activities involving weight shifting and reaching tasks; (3) perturbation-based training using balance pads and wobble boards; (4) dual-task exercises combining cognitive tasks with balance challenges; and (5) functional movement patterns relevant to activities of daily living.

Outcome Measures: Three primary outcome measures were assessed at baseline and following the six-week intervention period:

Fall Risk Assessment: The Biodex Balance System was used to evaluate overall fall risk through a composite stability index. This computerized platform provides objective measurements of postural sway and stability under various testing conditions.

Static Balance Performance: The Berg Balance Scale (BBS) was employed to assess functional balance performance through 14 standardized tasks of varying difficulty. Scores range from 0-56, with higher scores indicating better balance performance.

Dynamic Balance Function: The Timed Up and Go (TUG) test was used to evaluate functional mobility and dynamic balance. Participants were instructed to rise from a chair, walk three meters, turn around, return to the chair, and sit down, with the total time recorded.

Results

The intervention group demonstrated significant improvements compared to the control group across all measured parameters. Fall risk index (Biodex) showed substantial improvement with the training group decreasing from 3.98 ± 2.50 to 2.31 ± 1.70, while the control group remained relatively unchanged (4.46 ± 2.48 to 5.39 ± 2.42). Statistical analysis revealed significant main effect of time (F _{(1,18) =}14.62, P<0.001), group effect (F _(1,18) = 6.78, P= 0.013), and time × group interaction (F _{(1,18) =}12.95, P<0.001). Berg Balance Scale scores increased significantly in the training group from 44.6±5.30 to 49.2±5.58, while the control group showed minimal change (45.2 ± 5.85 to 45 ± 6.25). Analysis revealed significant time effect (F _(1,18) =35.27, P< 0.001), group effect (F_(1,18)=8.41, P= 0.006), and time × group interaction (F_(1,18)=27.13, P<0.001). Timed Up and Go test performance improved markedly in the training group, with execution time decreasing from 13.8±3.20 to 11.2 ± 0.70 seconds, while the control group remained stable (13.1 ± 3.05 to 13 ± 2.85 seconds). Statistical analysis showed significant time effect (F_(1,18)=28.56, P<0.001), group effect (F_(1,18)= 5.92, P=0.02), and time × group interaction (F_(1,18)= 22.41, P<0.001). In contrast, the control group showed no significant changes in any of the measured outcomes over the same time period, with fall risk index, Berg Balance Scale scores, and TUG times remaining essentially unchanged from baseline values.

Conclusion

The findings of this study provide compelling evidence for the effectiveness of multisensory balance training in improving balance performance and reducing fall risk among elderly women. The significant improvements observed in static balance, dynamic balance, and fall risk measures demonstrate the potential of this intervention approach to address the multifactorial nature of balance impairment in aging populations.

The multisensory training approach used in this study appears to be particularly effective due to its comprehensive nature, addressing multiple aspects of balance control simultaneously. By challenging various sensory systems and promoting sensory integration, this training method may enhance the capacity for adaptive postural responses and improve overall balance confidence. The large effect sizes observed across all outcome measures suggest that these improvements are not only statistically significant but also clinically meaningful.

These findings have important implications for fall prevention programs in elderly populations. Multisensory balance training can be implemented as a safe and effective intervention strategy in community-based settings, potentially reducing the substantial healthcare burden associated with fall-related injuries in older adults. The relatively short duration of the training program (six weeks) makes it a practical and feasible intervention that could be easily integrated into existing healthcare and wellness programs for elderly individuals.

Future research should focus on investigating the long-term retention of training benefits, optimal training parameters, and the effectiveness of multisensory balance training in diverse elderly populations with varying levels of functional capacity and fall risk.

Footnotes

Conflict of interest: The author declares no conflict of interest.

Ethical approval: This study was approved by the Motor Behavior Ethics Committee of Shahid Beheshti University, and the exercise protocol was officially endorsed by this committee. Additionally, the trial is registered with the Iranian Registry of Clinical Trials under code IRCT2013061513672N1.

Funding: The author received no financial support for conducting this article, authorship, and/or publication.

Acknowledgments: We thank the participants who took part in the present study.