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