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Sensory-Challenge Balance Exercises Improve Multisensory Reweighting in Fall-Prone Older Adults

Allison, Leslie, K., PT, PhD; Kiemel, Tim, PhD; Jeka, John, J., PhD

Journal of Neurologic Physical Therapy: April 2018 - Volume 42 - Issue 2 - p 84–93
doi: 10.1097/NPT.0000000000000214
Research Articles

Background and Purpose: Multisensory reweighting (MSR) deficits in older adults contribute to fall risk. Sensory-challenge balance exercises may have value for addressing the MSR deficits in fall-prone older adults. The purpose of this study was to examine the effect of sensory-challenge balance exercises on MSR and clinical balance measures in fall-prone older adults.

Methods: We used a quasi-experimental, repeated-measures, within-subjects design. Older adults with a history of falls underwent an 8-week baseline (control) period. This was followed by an 8-week intervention period that included 16 sensory-challenge balance exercise sessions performed with computerized balance training equipment. Measurements, taken twice before and once after intervention, included laboratory measures of MSR (center of mass gain and phase, position, and velocity variability) and clinical tests (Activities-specific Balance Confidence Scale, Berg Balance Scale, Sensory Organization Test, Limits of Stability test, and lower extremity strength and range of motion).

Results: Twenty adults 70 years of age and older with a history of falls completed all 16 sessions. Significant improvements were observed in laboratory-based MSR measures of touch gain (P = 0.006) and phase (P = 0.05), Berg Balance Scale (P = 0.002), Sensory Organization Test (P = 0.002), Limits of Stability Test (P = 0.001), and lower extremity strength scores (P = 0.005). Mean values of vision gain increased more than those for touch gain, but did not reach significance.

Discussion and Conclusions: A balance exercise program specifically targeting multisensory integration mechanisms improved MSR, balance, and lower extremity strength in this mechanistic study. These valuable findings provide the scientific rationale for sensory-challenge balance exercise to improve perception of body position and motion in space and potential reduction in fall risk.

Department of Physical Therapy, Winston-Salem State University, Winston-Salem, North Carolina (L.K.A.); Department of Kinesiology, University of Maryland, College Park (T.K.); and Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware (J.J.J.).

Correspondence: Leslie K. Allison, PT, PhD, Department of Physical Therapy, School of Health Sciences, Winston-Salem State University, 342 FL Atkins Bldg, 601 S. Martin Luther King Jr Dr, Winston-Salem, NC 27110 (

Preliminary findings were presented at the Combined Sections Meeting of the American Physical Therapy Association in Tampa, Florida, February 2003.

This research was supported by a grant from The Erickson Foundation.

The authors declare no conflict of interest.

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© 2018 Academy of Neurologic Physical Therapy, APTA