Targeting Balance in Vestibular Rehabilitation - The Limits of Stability and Motor-Cognitive Training
- Ana Souto
- 4 days ago
- 3 min read
Balance Assessment in Vestibular Rehabilitation - Limits of Stability
Assessing the Limits of Stability (LOS) allows us to evaluate stability under dynamic conditions. This is especially important because many daily activities challenge these limits, such as leaning forward to reach an object. LOS provides valuable information about voluntary motor control required for safe and independent performance of activities of daily living. Remember that most falls occur during dynamic tasks, which highlights the importance of assessing proactive balance in Vestibular Rehabilitation.
If you want to learn more about the Limits of Stability Assessment Protocol, consult our blog article.
Functional Implications
A reduction in the limits of stability or a decline in movement quality can:
Significantly increase the difficulty of performing daily activities.
Increase the risk of falls and loss of balance.
Reduce overall safety and independence in daily function.
Balance and Cognition: A Close Interaction
It is important to keep in mind the strong association between balance control and cognitive function. This interaction becomes even more evident in tasks where posture approaches its stability limits. What is to be expected?
• Sedentary older adults tend to allocate increasing cognitive resources to process critical sensory information.
• Fear of falling itself may reduce the amount of cognitive resources available for postural control, leading to a situation in which fall risk increases (Uemura et al., 2012).
Motor-Cognitive Training: Evidence and Impact
Motor cognitive training is an intervention that integrates cognitive and motor tasks to improve cognitive function and motor skills. This approach has been shown to induce significant improvements in balance.
Evidence From Literature
1. Meta-analysis in Chronic Stroke (Zhou et al., 2021)
A meta-analysis of randomised controlled trials demonstrated that Cognitive Motor Dual-Task Training significantly improves:
• Balance ability
• Gait performance
• Upper limb function
In individuals with chronic stroke, these findings confirm that Cognitive Motor Dual-Task Training is a valuable rehabilitation strategy for enhancing multiple domains of motor recovery.
2. Improvements in Balance for Older Adults (Zhang et al., 2023)
This second study showed that cognitive-motor training significantly improved balance in older adults. The intervention was shown to be effective in:
• Static balance tasks
• Dynamic balance tasks
Highlighting its potential for autonomy preservation and reducing fall risk in ageing populations.
3. Reduced Fall Risk Through Dual-Task Training (Pang et al., 2018)
The third study found that dual-task training may successfully reduce fall risk in situations that demand high levels of attention. This suggests that training under cognitively demanding conditions helps individuals manage real-life environments where motor and cognitive challenges occur simultaneously.
PhysioSensing - Memory Game
The PhysioSensing Memory Game was designed as a motor-cognitive challenge to train balance, memory, and coordination. Based on the classic Simon Says, it features three distinct modes:
• Follow the Arrow – the player reacts to the direction and colour of a rotating arrow.
• Memory – an expanded version of the original game, with progressive challenges such as color rotation and a second phase where buttons lose their colours during gameplay.
• Numbers – the player memorizes the position of temporarily visible numbers on the buttons and must press them in the correct order.
The game is controlled by shifting the center of pressure on the platform
Go check the Otoneuro System Product Sheet
Ana Souto
Meet Ana, a physiotherapist with a master's degree in human physiology and certified by the American Institute of Balance.
Ana currently serves as the clinical specialist at PhysioSensing, a cutting-edge Balance Assessment and training device. Her approach is firmly rooted in the latest scientific findings, ensuring that PhysioSensing users receive the most effective and up-to-date care. In addition to her role in designing tailored programs, Ana plays a pivotal role in guiding new clients through the learning process of using PhysioSensing. She also provides advanced training and support to existing customers seeking to further deepen their clinical practice knowledge and stay on top of the latest scientific advancements.
Pang, M. Y. C., Yang, L., Ouyang, H., Lam, F. M. H., Huang, M., & Jehu, D. A. (2018). Dual-Task Exercise Reduces Cognitive-Motor Interference in Walking and Falls After Stroke: A Randomized Controlled Study. Stroke, 49(12), 2990–2998. https://doi.org/10.1161/STROKEAHA.118.022157
Uemura, K., Yamada, M., Nagai, K., Tanaka, B., Mori, S., & Ichihashi, N. (2012). Fear of falling is associated with prolonged anticipatory postural adjustment during gait initiation under dual-task conditions in older adults. Gait & Posture, 35(2), 282–286. https://doi.org/10.1016/j.gaitpost.2011.09.100
Zhang, Longhai, Guo, J., Zhang, J., Zhang, Ling, Li, Y., Yang, S., Zhu, W., & Guo, F. (2023). Interactive Cognitive Motor Training: A Promising Approach for Sustainable Improvement of Balance in Older Adults. Sustainability, 15(18), 13407. https://doi.org/10.3390/su151813407
Zhou, Qiang, Yang, H., Zhou, Quanfu, & Pan, H. (2021). Effects of cognitive motor dual-task training on stroke patients: A RCT-based meta-analysis. Journal of Clinical Neuroscience, 92, 175–182. https://doi.org/10.1016/j.jocn.2021.08.009
