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Multisensory TrainingMultisensory Training
Laura Morris, P.T.
University of Pittsburgh Medical Center
Session Objectives Be able to describe how each sensory system contributes
to postural control in different sensory environments Be able to understand how the type of sensory system
impairment will affect exercise selection and progression
Be able to identify the rationale behind the selection of exercises for stimulating each of the three sensory systems (visual, somatosensory, vestibular)
Sensory Systems
Respond to ENVIRONMENTALENVIRONMENTAL
Manipulations
Task Demands
Environment IndividualCapabilities
SurfaceType
Visual Flow
SeatedStandingMoving
Single Multiple
Strength
ROM
Sensory Loss
Cognition
Lighting
Multisensory TrainingMultisensory Training
Successful sensory input depends on: Amount and quality of peripheral sensory receptors
Integration and organization of info by the central nervous system
Peripheral SensationPeripheral Sensation
Visual VestibularSomatosensory ALL degrade with the aging process...
How do we survive with such degrading sensory systems??!
Compensate for gradual changes as we age
Usually don’t develop problems until a disease process is added to the mix
Sensory Hierarchy: VisionSensory Hierarchy: Vision
Gives information about head/eye position relative to surrounding environment
Sensitive but slower than somatosensation Favored under stable surround but unstable
surfaces
Sensory Hierarchy: Sensory Hierarchy: SomatosensationSomatosensation
Measures leg/foot position relative to the surface
Fastest and most sensitive to balance disturbance
Favored under fixed surface conditions with limited vision
Sensory Hierarchy: VestibularSensory Hierarchy: Vestibular
Gives information about head position relative to gravity and inertial space
Fast but less sensitive to balance disturbances
Essential when vision is absent and surface is unstable
Optimize functionOptimize function of sensory systems while compensatingcompensating for permanent damage
Training Rationale and Goal:
Training Principles:Training Principles: Optimize function by Stimulating or Forcing
the use of sensory systems that are intact or when impairment is temporary
Compensate for sensory impairments that are permanent or progressive
Macular degeneration Diabetic Neuropathy
Training Principles:Training Principles:
Sensory Systems respond to changes in the ENVIRONMENTENVIRONMENT
By limiting/removing environmental input to system, challenge remaining systems to work harder
Assessment Assessment throughthrough MCTSIB MCTSIB
Allows for identification of sensory impairments
Medical history will help determine permanence of impairment
Stimulate Somatosensory:Stimulate Somatosensory:Disadvantage Vision on Stable SurfaceDisadvantage Vision on Stable Surface
• Destabilize vision: Eye/Head movement (ball tracking, reading)Complex visual environment (grocery store, crowds)
Stimulate Somatosensory:Stimulate Somatosensory: Disadvantage Vision on Stable SurfaceDisadvantage Vision on Stable Surface
• Remove vision:Eyes closed activitiesCan progress via sunglasses, low light in room
AssessmentAssessmentthroughthrough MCTSIB MCTSIB
Which condition assesses somatosensory input?
Stimulate Vision:Stimulate Vision: Disadvantage Somatosensory while
emphasizing stable visual focus
• Moving surface for gait (treadmill, uneven surfaces)
Stimulate Vision:Stimulate Vision: Disadvantage Somatosensory while
emphasizing stable visual focus
• Destabilize standing surface (compliant surfaces)
Assessment Assessment throughthrough MCTSIB MCTSIB
Which condition assesses visual input?
Stimulate Vestibular:Remove/disadvantage both Somatosensation and Vision
Destabilized vision with compliant surface• Also head turning, reading,
catching/tossing ball
Stimulate Vestibular:Remove/disadvantage both
Somatosensory and Vision
Absent vision on compliant/moving surfaces• Can progress via sunglasses, low light
in room
AssessmentAssessmentthroughthrough MCTSIB MCTSIB
Which condition assesses vestibular input?
Reminders...
It is important to know the health history of each participant• avoid contraindicated activities
If a multisensory activity causes significant, unexpected dizziness:• stop the activity and encourage the individual
to contact their PCP
Reminders…
SAFETY FIRST Participants may be able to perform
advanced activities in one area but not another due to different capabilities of each sensory system
Eye-Head Coordination
Designed to improve the ability for:• Eyes alone to focus
on moving object
• Eyes and head together to focus on moving object
Eye-Head Coordination
Designed to improve the ability for:
• Eyes to move quickly from one object to another without losing focus
• Eyes to focus on an object while the head is moving (gaze stabilization)
Eye-Head CoordinationEye-Head Coordination
Necessary for everyday life!• Mall• Grocery Store• Crowds
Eye-Head Coordination
Be aware that these exercises can activate the vestibular system
If participant has an identified vestibular impairment or scores low on condition 4 of M-CTSIB, Level Two activities may be very challenging
Sensory Retraining Works! (Hu & Woollacott 1994)
Healthy older adults in controlled study Group setting for sensory training
program Addressed all sensory conditions Improved in postural stability during
perturbations