Document Type : Research Paper
Authors
Department of Sport Science, Faculty of Motor learning, Ferdowsi University of Mashhad, Mashhad, Iran
Abstract
Extended Abstract
Background and Purpose
Balance is a critical component of physical fitness closely linked to health, defined as the ability to maintain the body’s position in space. As aging populations increase globally, falls have become a common and serious problem among the elderly, often leading to injury and disability. Therefore, investigating effective methods to prevent falls and enhance balance is of paramount importance. These methods aim to improve balance performance by targeting the underlying somatosensory and neuromuscular systems that support postural control. The present study examined the effects of three non-invasive intervention methods—active somatosensory training, passive somatosensory training (foot massage), and neurofeedback training—on static and dynamic balance in healthy elderly adults. The research sought to answer two primary questions: (a) Do active, passive, and neurofeedback somatosensory training differentially affect the acquisition of static and dynamic balance? (b) Do these interventions influence the transfer of static and dynamic balance abilities?
Methods
Sixty healthy male adults from Mashhad, Iran, with a mean age of 67.66 years (SD = 3.1), participated in the study. None had prior experience with balance training. Participants completed the General Health Questionnaire (GHQ-28) and underwent neurobehavioral cognitive status evaluation (NCSE) to ensure mental and physical health and absence of cognitive impairment. They were randomly assigned to one of four groups: active somatosensory training (SST-1), passive somatosensory training (SST-2), neurofeedback training (NFT), or a control group. Two participants (one from the NFT group and one from the control group) did not complete the delayed transfer tests.
Static balance was assessed using the Biodex SD balance system’s fall risk test during the acquisition phase (pre- and post-test) and the limit of stability test during the transfer phase, both set at level 8 difficulty. Dynamic balance was evaluated using the Berg Balance Scale (BBS) during acquisition and the Timed Up and Go (TUG) test during transfer.
Neurofeedback training was conducted using the Biograph Infiniti software system (version 5). Active somatosensory training involved exercises on a 5-meter patterned surface with small round bumps designed to stimulate plantar mechanoreceptors under weight-bearing conditions. Passive somatosensory training consisted of foot massage using a grooved foam roller (7 cm diameter, 20 cm length) to provide non-weight-bearing tactile stimulation.
Each experimental group completed 15 sessions of 30 minutes each over the study period. The control group underwent only pre- and post-testing without intervention.
Data were analyzed using SPSS version 19. Independent t-tests compared demographic variables, and a one-way mixed ANOVA (group × time) was conducted to analyze static and dynamic balance outcomes. Tukey’s HSD test was applied for post hoc comparisons. Mauchly’s test assessed sphericity assumptions. Statistical significance was set at α = 0.05 with a 95% confidence interval.
Results
Baseline comparisons showed no significant differences among groups in age, weight, height, mental health (GHQ-28), or cognitive status (NCSE), confirming group homogeneity (Table 1).
All three intervention groups demonstrated significant improvements in balance measures post-intervention (Table 2). Specifically, the interaction effects among NFT, SST-1, and SST-2 groups indicated a reduced fall risk (Figure A-2). The TUG test revealed significant reductions in completion time for SST-1, NFT, and SST-2 groups, respectively (Figure A-2).
Transfer test results suggested differential effects of interventions on balance transfer abilities. SST-1 showed superior performance in dynamic balance transfer, while NFT excelled in static balance transfer. Although SST-2 outperformed the control group, it lagged behind SST-1 and NFT in transfer test performance (Figure 3).
Conclusion
The findings indicate that both static and dynamic balance improved significantly following neurofeedback (NFT), active somatosensory training (SST-1), and passive somatosensory training (SST-2). These interventions enhance balance through distinct mechanisms. Active somatosensory training, involving weight-bearing stimulation of a broad plantar surface, likely engages multiple somatosensory receptors and the vestibular system, thereby improving dynamic balance performance and maintenance in healthy elderly individuals. Passive stimulation, even without weight bearing, still exerts a meaningful effect on balance preservation.
Neurofeedback training enhances balance by promoting self-regulation at the cerebral cortex level, improving information processing, directing attention toward environmental perception, and augmenting visual recognition and observation processes. This mechanism particularly benefits static balance stability.
Overall, the study supports the use of these non-invasive interventions to improve balance and reduce fall risk in the elderly. Practitioners may consider substituting one method with another when necessary, as all showed beneficial effects.
Keywords: Static Balance, Dynamic Balance, Somatosensory Training, Neurofeedback Training, Foot Massage
ArticleMessage
If any of the three methods—active somatosensory training, passive somatosensory training, or neurofeedback—are unavailable, substituting with one of the others can still yield positive and meaningful improvements in balance among elderly individuals.
Ethical Considerations
All experimental procedures were conducted under the supervision of the Motor Behavior Group at Ferdowsi University, adhering strictly to ethical guidelines. Ethical approval was granted by the relevant committee, with documentation submitted to the journal.
Authors’ Contributions
Conceptualization: Azarpaikan and Taheri
Data Collection: Azarpaikan and Galkhani
Data Analysis: Azarpaikan and Galkhani
Manuscript Writing: Azarpaikan and Galkhani
Review and Editing: Azarpaikan and Taheri
Project Management: Taheri
Literature Review: Azarpaikan
Funding Responsibility: None
Confli t of Interest
The authors declare no conflicts of interest.
Acknowledgments
The authors gratefully acknowledge the support of the Faculty of Sport Sciences laboratory at Ferdowsi University and express sincere thanks to all participants, especially the elderly individuals who contributed to this research
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