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Multisensory Training

Multisensory 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

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Multisensory Training

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  1. Multisensory Training Laura Morris, P.T. University of Pittsburgh Medical Center

  2. 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)

  3. Sensory Systems Respond to ENVIRONMENTALManipulations

  4. Seated Standing Moving Task Demands Multiple Single Surface Type Cognition Environment Strength Individual Capabilities ROM Lighting Visual Flow Sensory Loss

  5. Multisensory Training • Successful sensory input depends on: • Amount and quality of peripheral sensory receptors • Integration and organization of info by the central nervous system

  6. Peripheral Sensation • Visual • Vestibular • Somatosensory • ALL degrade with the aging process...

  7. 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

  8. Sensory Hierarchy: Vision • Gives information about head/eye position relative to surrounding environment • Sensitive but slower than somatosensation • Favored under stable surround but unstable surfaces

  9. Sensory Hierarchy: Somatosensation • Measures leg/foot position relative to the surface • Fastest and most sensitive to balance disturbance • Favored under fixed surface conditions with limited vision

  10. Sensory 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

  11. Training Rationale and Goal: Optimize function of sensory systems whilecompensating for permanent damage

  12. Training Principles: • Optimize function by Stimulating or Forcing the use of sensory systems that are intact or when impairment is temporary • Compensatefor sensory impairments that are permanent or progressive • Macular degeneration • Diabetic Neuropathy

  13. Training Principles: • Sensory Systems respond to changes in theENVIRONMENT • By limiting/removing environmental input to system, challenge remaining systems to work harder

  14. Assessment through MCTSIB • Allows for identification of sensory impairments • Medical history will help determine permanence of impairment

  15. Stimulate Somatosensory:Disadvantage Vision on Stable Surface • Destabilize vision: • Eye/Head movement • (ball tracking, reading) • Complex visual • environment • (grocery store, crowds)

  16. Stimulate Somatosensory:Disadvantage Vision on Stable Surface • Remove vision: • Eyes closed activities • Can progress via sunglasses, low light in room

  17. Assessmentthrough MCTSIB • Which condition assesses somatosensory input?

  18. Stimulate Vision:Disadvantage Somatosensory while emphasizing stable visual focus • Moving surface for gait (treadmill, uneven surfaces)

  19. Stimulate Vision:Disadvantage Somatosensory while emphasizing stable visual focus • Destabilize standing surface (compliant surfaces)

  20. Assessment through MCTSIB • Which condition assesses visual input?

  21. Stimulate Vestibular:Remove/disadvantage both Somatosensation and Vision • Destabilized vision with compliant surface • Also head turning, reading, catching/tossing ball

  22. Stimulate Vestibular:Remove/disadvantage both Somatosensory and Vision • Absent vision on compliant/moving surfaces • Can progress via sunglasses, low light in room

  23. Assessmentthrough MCTSIB • Which condition assesses vestibular input?

  24. 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

  25. 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

  26. 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

  27. 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)

  28. Eye-Head Coordination • Necessary for everyday life! • Mall • Grocery Store • Crowds

  29. 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

  30. 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

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