Multisensory balance training for unsteady elderly people: A scoping review

Abstract

BACKGROUND:

Posture control involves complex reactions of dynamic and static movements, and various sensory inputs. There is evidence that exercise using multisensory stimulation is moderately effective in improving the balance of the elderly.

OBJECTIVE:

The main purpose of this paper was to examine the existing literature to validate the effectiveness and applicability of multisensory stimulation training.

METHODS:

All relevant literature published as of June 1, 2020 in four prominent databases was searched (Embase, PubMed, PsycINFO, and Web of science) using the five-stage review framework proposed by Arksey and O’Malley.

RESULTS:

Multisensory stimulation training was more effective when vestibular and somatosensory were combined with visual stimuli, and differences in effectiveness compared to the effectiveness of existing treatments were confirmed. However, most of the reviewed papers are compared to simple strength training, and studies that compare the effects of multisensory stimulation training by setting a control group are still lacking.

CONCLUSION:

Further research is required to further elucidate the training conditions and treatment environment for multisensory training for the elderly at risk of falls and to provide strategies to improve treatment methods. In addition, a study that can evaluate user satisfaction in a way that best shows the treatment effect using qualitative research methods will be needed.

Keywords

Balance training multisensory older people scoping review

1. Introduction

Aging is associated with a decrease in postural control, which increases the risk of falling in the elderly. In particular, fractures of the hips caused by falls of the elderly can substantially affect their life and lead to death, and are costly to the community [1]. To maintain balance, the central nervous system must process and integrate sensory information from the visual, vestibular, and somatosensory systems to regulate essential movements. Problems with the vestibular and somatosensory systems due to aging lead to balance disorders, which increase the risk of falling. Exercise is a common technique to prevent falls. In particular, it has been emphasized that exercise related to posture control is crucial for overall health [2]. Various training methods have been used to improve posture stability and reduce the rate of falling. There is evidence that certain types of exercise are moderately effective in improving balance among the elderly. Interventions to improve gait function and prevent falls in the elderly are predominantly focused on increasing strength, and the knowledge of the effects of sensory training is limited [3, 4]. Posture control involves complex movement reactions of dynamic and static movements, and various sensory inputs such as afferent receptor systems, and vestibular, visual, and intrinsic sensations are required. Multi-sensory input is synchronized at various levels of the central nervous system. The control of posture requires a coordinated muscle response to control the alignment of various body parts on the basis of exercise and most functional activities. Muscle activity relies on sufficient and consistent machine acceptance, intrinsic acceptance, and vestibular and visual information. Multiple sensory inputs are synchronized at different levels of the central nervous system, and based on past experience, a motor pattern suitable for posture adjustment and movement is selected [5]. With increasing age, the ability of the sensory system to contribute to posture control decreases. Hence, studies have suggested combining multisensory exercises to existing balance exercises to improve balance ability. For example, the movement of walking on a bubble surface increases the difficulty of balance control by the vestibular system because visual and somatic sensory input is removed and reduced. The effectiveness of multiple sensory exercises to improve balance among older adults has been partially confirmed by previous studies. Although it was recognized that the existing multisensory exercise had a positive effect on the balance of the elderly, the explanation for the rational application method according to the difference in effect is still unknown [6, 7, 8].

Most reviews on the relationship between multisensory stimulation exercise and restorative balance ability have investigated the link between balance ability and the multisensory integration problem without focusing on applicability for therapeutic purposes. This literature review provides an overview and analysis of previous studies to determine the direction of available studies and to suggest further studies. Therefore, the main purpose of this paper was to examine the existing literature to confirm the effectiveness and applicability of multisensory stimulation training.

2. Methods

Scoping reviews provide answers to specific questions than does assessing an entire body of literature. This review survey the literature, synthesize quantitative data on previous studies, and then summarize and interpret the literature of a particular research field. To date, there have been no systematic reviews of this topic because the provision of multisensory balance training for unsteady elderly people is a new concept.

The research question was defined as the first step according to the method proposed by Arksey and O’Malley. Each database was searched for studies published as of June 1, 2020. In the first stage, relevant research was reviewed, and three initial exploratory research questions were selected: (1) How have the therapeutic effects of multisensory balance training for unsteady elderly people been explained over the past ten years? (2) What are the singularities of past methodologies and results? (3) What is the prevalent direction of the research, and what should be considered when proceeding in the field?

In the second stage, we established the following eligibility criteria: (1) journal article type, (2) articles published from 2010-present, (3) articles written in English, and (4) studies aimed at confirming the effects of multisensory balance training for unsteady elderly people. We combined the following search terms: (multisensory room OR snoezelen OR multisensory environment OR multisensory therapy OR sensory adapted environment) AND (elder people OR frail person OR aging OR older adult). Four electronic databases were included: Embase, PubMed, PsycINFO, and Web of science. The pertinent articles were exported and managed using the RefWorks referencing software program.

In the third stage, initial selection was performed by reviewing the titles and abstracts. The entire studies were then read and evaluated, subject to the eligibility criteria. As the intention was to achieve maximum specificity, this review did not include studies in which the participants had other underlying pathological problems.

In the final stage of the survey, data was systematically categorized and organized using a data charting form developed using Microsoft Excel. The suggestion regarding availability was to treat persons with brain injuries through emotion-based stimuli treatment.

Table 1
Summary of multisensory intervention characteristics from 10 studies

Article citation	Stimuli protocol	Sessions
Alfieri et al. 2010 [9]	Visual stimuli: eye close and open Proprioceptive stimuli: differently speeds, distances, ground density, and obstacles	12 weeks, 2 times/week (1 session: 60 min)
Alfieri et al. 2010 [10]	Visual stimuli: eye close and open Proprioceptive stimuli: differently direction, ground density, and obstacles/exercises using elastic bed, gel disc	12 weeks, 3 times/week (1 session: 30 min)
Bhat and Walia, 2010 [11]	Visual stimuli: eye close and open Proprioceptive stimuli: ground surface condition (ex. soft surface, foam mat)	3 weeks, 5 times/week (1 session: 2–3 sets of 8–10 repetitions)
Klages et al. 2011 [17]	Visual stimuli: eye-tracking and head-moving activities Proprioceptive stimuli: swinging/throwing or kicking differently shaped balls/playing percussion musical instruments Somatosensory stimuli: vibratory/listening music/smelling	12 weeks, 2 times/week (1 session: 30 min)
Alfieri et al. 2012 [12]	Visual stimuli: eye close and open Proprioceptive stimuli: differently speeds, distances, ground density, and obstacles	12 weeks, 2 times/week (1 session: 60 min)
Kutty and Majida, 2013 [13]	Visual stimuli: eye close and open Proprioceptive stimuli: differently speeds, distances, ground surface condition (mattresses, foam rubber), and obstacles (ropes, cones, and sticks)/tandem walking, and rising from a chair without using arms	6 weeks, 3 times/week (1 session: 30 min)
Kristinsdottir et al. 2014 [14]	Proprioceptive stimuli: differently direction and ground density Vestibular stimuli: head movement, body turning	18 weeks, 3 times/week (1 session: 45 min)
Liston et al. 2014 [15]	Visual and somatosensory: re-train sensory strategies (i.e. reduce somatosensory/visual dependency), learn to adapt strategies to changing contexts (reduced support base, upper limb activities) Vestibular: head movement	8 weeks, 2 times/week (1 session: 60 min)
Nematollahi et al. 2016 [16]	Visual stimuli: eye close and open Vestibular stimuli: single-leg standing with diagonal head movements Somatosensory stimuli: under foot or walking on a foam surface	4 weeks, 3 times/week (1 session: 60 min)
Lee and Magee, 2017 [18]	Visual stimuli: eye close and open Somatosensory stimuli: standing on a single leg or by keeping the platform moving	3 weeks, 3 times/week (1 session: 60 min)

Figure 1.

Flowchart of illustrating inclusion process.

3. Results

3.1 Descriptive summary of the articles

Four databases were searched for articles published between 2010 and 2020. From the final ten articles, data were extracted in six categories that were used to analyze the full reviews: the study design, participants, the stimuli protocol, combined sensory, the outcome measure, and the main finding of the analyses. A flow diagram illustrated the process of the study selection, and the findings were presented with a narrative description in table form (Fig. 1) (Tables 1 and 2). Eight papers included a randomized controlled trial, and two were conducted as single group studies. For multisensory training, six studies using visual and proprioception [9, 10, 11, 12, 13, 14], two studies using visual, vestibular and somatosensory [15, 16], one study using visual, proprioception and somatosensory [17], and one study using only visual and somatosensory has been confirmed [18].

Table 2
Summary of study characteristics and key results from 10 studies

Article citation	Study design	Participants	Combined sensory	Outcome measures	Main findings
Alfieri et al. 2010 [9]	RCT	Strength training group ( $N=$ 23, 70.2 (4.8) years) Multisensory training ( $N=$ 23, 68.8 (5.9) years)	Visual $+$ Proprioception	TUG, Guralnik test battery CoP	Multisensory group (pre-post): TUG ( $p=$ 0.002), Guralnik ( $p=$ 0.009), A/P displ ( $p=$ 0.03), L/M displ ( $p=$ 0.02) Compared group: TUG ( $p=$ 0.03)
Alfieri et al. 2010 [10]	Pre-post study	$N=$ 29, 68.06 (2.84) years	Visual $+$ Proprioception	EMG, CoP	Cop (UO, $p=$ 0.01/UC, $p=$ 0.075) Envoltory: Gastrocnemius (UO, $p=$ 0.002/UC, $p=$ 0.002)/Tibialis anterior (UO, $p=$ 0.492/UC, $p=$ 0.037) Median frequency: Gastrocnemius (UO, $p=$ 0.0004/UC, $p=$ 0.0001)/ Tibialis anterior (UO, $p=$ 0.0004/UC, $p=$ 0.0001)
Bhat and Walia, 2010 [11]	RCT	Multisensory group ( $N=$ 24, 71.95 (3.91) years) Control group ( $N=$ 24, 71.79 (4.0) years)	Visual $+$ Proprioception	BBS, mCTSIB, 10MWT	BBS, mCTSIB, and 10MWT ( $p=$ 0.000) Compared group difference: BBS ( $p=$ 0.94), mCTSIB ( $p=$ 0.887), 10 MWT ( $p=$ 912)
Klages et al. 2011 [17]	RCT	Intervention group ( $N=$ 9, 84.0 (6.6) years) Control group ( $N=$ 10, 89.0 (3.2) years)	Visual $+$ Proprioception $+$ Somatosensory	FRT, SR, TUG, TUGc	All groups showed trends toward small balance improvements over time on all tests (n.s.)
Alfieri et al. 2012 [12]	RCT	Strength training group ( $N=$ 23, 70.2 (4.8) years) Multisensory training group ( $N=$ 23, 68.8 (5.9) years)	Visual $+$ Proprioception	CoP	Peak torque: plantar flexion ( $p=$ 0.007) and dorsiflexion ( $p=$ 0.01) bilaterally and in inversion ( $p=$ 0.008) and eversion ( $p=$ 0.007) on the right side Total work: plantar flexion ( $p=$ 0.031) and dorsiflexion ( $p=$ 0.007) bilaterally
Kutty and Majida, 2013 [13]	RCT	Multisensory group ( $N=$ 16, 65.0 (2.12) years) Control group ( $N=$ 16, 68.0 (2.17) years)	Visual $+$ Proprioception	TUG, 6MWT	TUG ( $p<$ 0.0001), 6MWT ( $p=$ 0.072) Compared group difference: TUG and 6MWT (n.s.)
Kristinsdottir et al. 2014 [14]	Pre-post study	$N=$ 37, 80.8 years	Visual $+$ Vestibular $+$ Proprioception	SOT, FTSTS, Normal and fast 30 m walk, AD 11 steps, ABC scale	Significantly better in all the test ( $p<$ 0.001)
Liston et al. 2014 [15]	RCT	OTAGO $+$ multisensory group ( $N=$ 10, 77.8 years) OTAGO $+$ stretching group ( $N=$ 11, 76.7 years)	Visual $+$ Vestibular $+$ Somatosensory	FGA, PPA, SVV, ABC, VVS-V, VVS-A, HAD-A, HAD-D, SCQ	FCA (week 4/week 8): $p<$ 0.05 PPA (week 8): $p<$ 0.05 VVS-V (week 8): $p<$ 0.05 Between group difference: FGA (week 4/week 8, $p<$ 0.05), PPA (week 8): $p<$ 0.05
Nematollahi et al. 2016 [16]	RCT	Conventional training group ( $N=$ 14, 67.7 (4.98) years) Multisensory training ( $N=$ 15, 64.7 (5.0) years) Dual-task training ( $N=$ 15, 63.8 (3.82) years)	Visual $+$ Vestibular $+$ Somatosensory	FAB, GSR, Gait speed	Multisensory group (pre-post): FAB ( $p<$ 0.001) Compared group: FAB ( $p=$ 0.23)
Lee and Magee, 2017 [18]	RCT	$N=$ 24, elderly training group/elderly control group, 60 to 80 years	Visual $+$ Somatosensory	CDBS, BBT	Overall sway, medial-lateral sway, and anterior-posterior sway (eye closed, $p=$ 0.000/eye open, $p=$ 0.000) Bilateral stance ( $p=$ 0.000)/unilateral stance ( $p=$ 0.000) Dominant leg ( $p=$ 0.000)/non-dominant leg ( $p=$ 0.000) BBT ( $p=$ 0.001)

ABC scale: Activities-specific balance confidence scale, AD: Ascending-descending, AP: Anterior-posterior, BBS: Berg balance scale, CDBS: Chattecx dynamic balance system, COM: Center of mass, CoP: Center of pressure, displ: displacement of center of pressure, EG: Experimental group, FAB: Fullerton advanced balance, FGA: Functional gait assessment, FRT: Functional reach test, FTSTS: Five times sit to stand test, GSR: Gait stability ratio, HAD: Hospital anxiety and depression scale anxiety score, HAD-D: Hospital anxiety and depression scale depression score, L/M: Lateromedial, LOS: Limits of stability test, mCTSIB: Modified clinical test of sensory interaction for balance, ML: Mediolateral, MSR: Multisensory reweighting, n.s.: not significant difference, PPA: Short-form physiological profile assessment, RCT: Randomized control trial, ROM: Range of motion, SBP: Systolic blood pressure SCQ: Situational characteristics questionnaire, SOT: Sensory organized test, SR: Sharpened Romberg, SVV: Dynamic subjective visual vertical test, TUG test: Time up and go test, TUGc: Timed up and go with dual task, MWT: Minute walk test, VVS: Vertigo symptom scale.

Most of the subjects were aged 65 years or older, and in order to compare the effects of multisensory stimulation training on treatment activities, four papers were comparative studies with simple strength training [9, 12, 15, 16], and four studies were compared with control groups [11, 13, 17, 18]. The multisensory stimulation training excluded the virtual reality-based intervention method, and considered only the multisensory stimulation training intervention protocol that can be applied to the existing balance training.

3.2 Thematic summary of the articles

This scoping review demonstrated the functional properties and effects of multisensory stimuli used for the purpose of therapeutic training in unsteady elderly people. Each stimulus was further described by classifying the application strategy (Table 1). The results are summarized by topic, and the order of the factors does not indicate any specific relevance or priority.

3.3 Combined with visual and proprioception stimulations

In a multisensory stimulation training study of unsteady elderly people, it was confirmed that the complex application of visual and proprioception stimulus was effective for the balance ability of the participants. Vision and proprioception were combined in six studies [9, 10, 11, 12, 13, 14], and vestibular perception was applied in one of them [14]. In the case of visual and proprioception stimulus, there were no differences in the application method in different studies. In the case of visual stimuli, they kept my eyes open or closed. For the proprioception stimuli, environmental conditions such as direction, speed, distances, ground density, and obstacles were used when walking. In the case of the vestibular stimuli applied in one study, the movement of the head and body was conditioned.

A study that investigated the effectiveness of improving the balance ability of the elderly, Alfieri et al. demonstrated that training based on the combination of visual and proprioception stimulus had improved the participant’s pressure-centered movement and the calf muscle power to maintain the posture [10]. In two studies, the strength training group was compared to a control group, and the TUG (Time up and go test) score revealed a significant difference between the groups [9, 12]. In the studies of Bhat and Walia and Kutty and Majida, the effects of balance and gait ability in the experimental group were confirmed by similarly applying the multisensory training method, but no significant difference was found when compared to the control group [11, 13].

Kristinsdottir et al. have evaluated postural control ability and various functional gait abilities in the application of multisensory stimulation training combined with visual, proprioception, and vestibular stimulus [14]. As the study was conducted in a single group, the difference from the control group could not be validated, but the effectiveness was observed in all evaluations.

3.4 Combined with visual and somatosensory stimulations

Somatosensory is often applied to improve patients sensations with neurological disorders function. In this review, we applied multisensory stimulation training that combined visual and somatosensory in three studies [15, 16, 18]. In two of these studies, vestibular sensation was additionally applied [15, 16]. In the case of the integrated application of visual and somatosensory, there were differences in application. In the case of vision, some studies applied the method of closing or opening the eyes, but the method of controlling the degree of stimulation by adjusting the level of visual dependence (increased somatic reliance). In the case of somatosensory, attempts were made to activate the somatic sensation of the subject through various stimuli, and the vestibular sensation applied in the two studies triggered an unstable posture and activated the vestibular sensation of the participants.

In a study confirming the effect of improving balance among older adults, Nematollahi et al. explained that training based on a combination of visual acuity, vestibular and somatosensory showed a difference in functional gait improvement when compared to the control group, before and after comparing the results of each intervention group. (Traditional balance training and dual task training) [16]. Liston et al. trained using stimulation methods that regulate the dependence level of each stimulus rather than integrating each stimulus (visual, vestibular, somatosensory), and were able to see improvement in walking ability and a reduced risk of falls. It has also been shown to be more effective in reducing walking ability and risk of falls when compared to controls [15].

4. Discussion

This scoping review is intended to provide an overview of the effectiveness of multisensory stimulation training, which contributes to treatment options that can reduce the risk of falls through improving balance in older adults. We reviewed a total of 10 publications, which focused on the study of therapeutic effects, with the main study subjects being unsteady elderly patients. This review had revealed two types of multisensory stimulation methods that can be applied to unsteady elderly people. However, no study has compared the differences between the advantages and disadvantages, and the effects of multisensory stimulation training for each study type.

For example, Nematollah et al. attempted to compare the effectiveness of traditional therapy and dual-task training and multisensory training [16]. Alfieri et al. also attempted to compare to the strength training group [12]. The comparison of the training methods of the previous studies were mostly comparative studies on the effectiveness of the exercise method, and there was a lack of additional research to how and why the effects of the multisensory integration factors were different. Moreover, it was surprising that most of the studies focused on balance and gait ability, and no assessments related to basic sensory integration were performed. This study is not intended to investigate the overall quality of the reviewed study, so readers should not perceive the results as proof of decisive effect. Instead, they should be interpreted as suggestions to carefully consider the application of multisensory stimulation training to improve balance and prevent falls among unstable elderly people.

Several synonyms and approximations have been combined in the review filter to fully include relevant publications related to multisensory stimulation training. Publications related to other types of multisensory stimulation treatment were included in the selection phase. Despite the rigorous search process, some studies may have been missed. Multisensory stimulation is often associated with multimedia interventions and requires other specific adjustments. Therefore, the current scope of evaluation excluded studies focusing on virtual reality training. In general, as treatment is applied in a way that provides an environment in which balance training threatens the patient’s balance level, our review confirms a more effective therapeutic protocol for balance training method and improves balance ability and prevents falls in elderly patients. As a therapeutic intervention for patients, we found more information about multisensory stimulation training applied during training.

Current research on multisensory stimulation training often focused on proprioception and somatosensory along with visual stimuli. The results show that both proprioception and somatosensory combined with visual stimuli can increase the level of recovery of balance. However, the combination of the two senses did not show the effectiveness to show a difference between the groups from the control group. However, when vestibular sensation was added, it showed a different pattern. In the case of visual and proprioception sensations, a single group of studies was reported, and the differences between the groups could not be compared. However, it has been confirmed that in the case of somatosensory, when vestibular sensation is combined with visual and somatosensory, it can show a greater effect on the functional balance ability in the participants. Also, unconditional sensory coupling did not prove effective. For example, in the study of Klages et al., training combined with proprioception and somatosensory was applied with visual stimuli, but no improved effect was confirmed [17]. As a result, it suggests that the type of senses that are combined can be a factor that can affect the subject’s ability to balance. In general, multisensory stimulation has been shown to be crucial on human kinematic function recovery in various research fields [19, 20, 21]. Additionally, it has been demonstrated that the multiple sensory stimuli provided by the rich environment can modulate various biological mechanisms that enhance functional recovery over standard rehabilitation environments through cognitive, sensory and motor stimuli [22, 23, 24]. Multisensory stimulation training greatly contributes to the recovery of motor function after long-term training in terms of peripheral effects and subjective aspects. However, it does not provide objective measurement data for this and little is known about the short-term effects on cortical activation during training. Therefore, the most important challenge will be to evaluate the effect of multiple sensory stimuli on the activation response of the cerebral cortex [25, 26]. This will contribute to providing basic data on the design of training protocols and related products for balance training for the unstable elderly. In addition, multiple sensory integration occurs when information from more than one sensory modality is recognized and synthesized. Past studies have shown that destination-oriented motor sensation can be enhanced by multisensory stimulation training. It has also been reported that in terms of age, elderly experience more improvement in multisensory processing compared to young adults. Zuo et al. explained that the improved ability to perform work through multisensory stimulation training has a stronger impact on older subjects compared to younger groups [27]. These results suggest that multisensory integration can have a particularly increased effect on the elderly, but few studies have addressed this.

Interestingly, no paper has compared differences in single and multisensory sensory stimulation training or differences in stimulus application methodology. Future research should carefully examine the differences between the effects of multisensory stimulation training and the effects of single stimulation. Furthermore, it seems necessary to fully investigate the effects of binding between stimuli. In addition, there have been few studies on multisensory stimulation training in which somatosensory stimulation is relatively combined. The use of somatosensory combined with vibration, smell, and hearing can induce a powerful neurophysiological movement mechanism when performing a desired movement [28, 29, 30]. As a result, somatosensory stimulation, which leads to positive emotions applied to the trainee, can be understood as a form of stimulation that can produce a strong synergistic effect with vestibular stimulation. Moreover, further consideration of factors based on the memory of the subject in the form of stimuli may have a more potent synergistic effect on emotion-based stimuli for the trainee. These factors can also influence the treatment environment developed for the customer during treatment. While sensory stimulation may lead to a sense of risk during training to control difficulty, we generally describe the treatment environment in terms of access to space and comfort, and keep in mind that emotion-based stimulation environments can act as treatments [31, 32]. It is recommended to improve the overall awareness of rehabilitation professionals about the potential effects of non-verbal and verbal signals as well as other therapeutic environmental factors for the treatment situation.

To determine clinical significance and future research, rehabilitation professionals must have a deep understanding of the types of multisensory stimulation training that can be applied during treatment activities to improve balance among older adults and the requirements related to protocols [33, 34]. However, experts often have to work in an improper environment, which cannot be modified or are difficult to modify. Obviously, in order to change the treatment methods and conditions, it will be necessary to support the health management system. As can be seen from the results of this review, training with multisensory stimulation may ultimately contribute to an improvement in the therapeutic effect that may benefit the elderly who are at risk of falling. In particular, in the case of multisensory stimulation training, it was confirmed that the desired effect was strong when the vestibular and somatosensory combined with the visual stimuli. The results of this review show that therapists for training need more experience and awareness of certain factors during training. Multisensory stimulation training should take care when adjusting the therapeutic methods and therapeutic conditions based on the two types of multisensory combinations shown in this review. Most of the reviewed papers are compared to simple strength training, and studies that compare the effects of multisensory stimulation training by setting a control group are still lacking. Further research is required to further elucidate the training conditions and treatment environment for multisensory training for the elderly at risk of falls and to provide strategies to improve treatment methods. In addition, qualitative research methods could be used to assess user satisfaction in the way that best shows the effectiveness of treatment. Also, the effectiveness of treatment according to the type of stimulus could be identified, and quantitative methods could have be used to study differences in the method of application.

5. Conclusions

This review found that strategies for the application of multisensory training for elderly people at risk of falling could have a positive impact on the function recovery of training participants. Interventional application to multisensory stimulation training was more effective when vestibular and somatosensory were combined with vision, and differences in effectiveness from existing treatments were also confirmed. Experts in this field will need to consider the effectiveness that multisensory stimulation training can provide in treatment situations and apply it extensively to treatment. As shown in this review, careful interpretation is necessary as there is insufficient evidence for the advantages and disadvantages, and effects of different types of multisensory stimulation.

Author contributions

All authors contributed equally.

Ethical considerations

Not applicable.

Funding

None.

Footnotes

Acknowledgments

The authors have no acknowledgements.

Conflict of interest

The authors declare that they have no competing interests.

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Multisensory balance training for unsteady elderly people: A scoping review

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1. Introduction

2. Methods

Table 1 Summary of multisensory intervention characteristics from 10 studies

3.1 Descriptive summary of the articles

Table 2 Summary of study characteristics and key results from 10 studies

3.3 Combined with visual and proprioception stimulations

3.4 Combined with visual and somatosensory stimulations

4. Discussion

5. Conclusions

Author contributions

Ethical considerations

Funding

Footnotes

Acknowledgments

Conflict of interest

References

Table 1
Summary of multisensory intervention characteristics from 10 studies

Table 2
Summary of study characteristics and key results from 10 studies