Effects of Aging in Multisensory Integration: A Systematic Review

How spatial-cue reliability affects navigational performance in young and older adults

Navigational abilities decline with age, but the cognitive underpinnings of this cognitive decline remain partially understood. Navigation is guided by landmarks and self-motion cues, that we address when estimating our location. These sources of spatial information are often associated with noise and uncertainty, thus posing a challenge during navigation. To overcome this challenge, humans and other species rely on navigational cues according to their reliability: reliable cues are highly weighted and therefore strongly influence our spatial behavior, compared to less reliable ones. We hypothesize that older adults do not efficiently weigh spatial cues, and accordingly, the reliability levels of navigational cues may not modulate their spatial behavior, as with younger adults. To test this, younger and older adults performed a virtual navigational task, subject to modified reliability of landmarks and self-motion cues. The findings revealed that while increased reliability of spatial cues improved navigational performance across both age groups, older adults exhibited diminished sensitivity to changes in landmark reliability. The findings demonstrate a cognitive mechanism that could lead to impaired navigation abilities in older adults.

The role of different acoustic environmental stimuli on manual dexterity

Music has been reported to facilitate motor performance. However, there is no data on the effects of different acoustic environmental stimuli on manual dexterity. The present observational study aimed at investigating the effects of background music and noise on a manual dexterity task in young, middle-aged and elderly subjects. Sixty healthy, right-handed subjects aged between 18 and 80 years were enrolled. Twenty young (mean age: 22±2 years), 20 middle-aged (mean age: 55±8 years) and 20 elderly (mean age: 72±5 years) subjects performed the Nine Hole Peg Test (NHPT) in four different acoustic environments: silence (noise < 20dBA), classical music at 60dBA, rock music at 70 dBA, and a noise stimulus at 80dBA. Performance was recorded using an optical motion capture system and retro-reflective markers (SMART DX, 400, BTS). Outcome measures included the total test time and peg-grasp, peg-transfer, peg-in-hole, hand-return, and removing phases times. Normalized jerk, mean and peak of velocity during transfer and return phases were also computed. No differences were found for NHPT phases and total times, normalized jerk, peak of velocity and mean velocity between four acoustic conditions (p>0.05). Between-group differences were found for NHPT total time, where young subjects revealed better performance than elderly (p˂0.001) and middle-aged (p˂0.001) groups. Music and noise stimuli in the considered range of intensity had no influence on the execution of a manual dexterity task in young, middle-aged and elderly subjects. These findings may have implications for working, sportive and rehabilitative activities.

Longevity as a Responsibility: Constructing Healthy Aging by Enacting within Contexts over the Entire Lifespan

Studying aging now requires going beyond the bio-psycho-social model and incorporating a broader multidisciplinary view capable of capturing the ultimate complexity of being human that is expressed as individuals age. Current demographic trends and the lengthening of life expectancies allow the observation of long-lived individuals in full health. These super-agers are no longer an exception. Indeed, individuals can have a good quality of life even over age 70 and living with chronic or neurodegenerative diseases. This change is driven in part by the cohort effect observed in people who are about to age today (e.g., better schooling, more advanced health conditions, and technologization) but more so by the gradual overcoming of ageist views. An aged person is no longer seen as a quitter but rather as one empowered to direct their own trajectory of potentially healthy longevity. According to this vision, this article proposes a situated lifespan perspective for the study of aging that integrates pedagogical models of developmental ecology with psychological theories of optimal experience to understand the individual motivational perspective on aging. At the same time, it does not disregard analyzing the daily and cultural contexts in which everyone situates and that guide aging trajectories. Nor does it forget that aging people are body-mind (embodied) organisms that, with contexts and through motivations, seize opportunities for action (affordances) to evolve in an optimal way during their lifespan. This theoretical reflection sheds new light on the aging process and on future trends in healthy longevity research.

Individual factors and vection in younger and older adults: How sex, field dependence, personality, and visual attention do (or do not) affect illusory self-motion

An important aspect to an immersive experience in Virtual Reality is vection, defined as the illusion of self-motion. Much of the literature to date has explored strategies to maximize vection through manipulations of the visual stimulus (e.g., increasing speed) or the experimental context (e.g., framing of the study instructions). However, the role of individual differences (e.g., age, biological sex) in vection susceptibility has received little attention. The objective of the current study was to investigate the influence of individual-difference factors on vection perception in younger and older adults. Forty-six younger adults (M age = 25.1) and 39 older adults (M age = 72.4) completed assessments of personality traits, field dependence, and visual attention prior to observing a moving visual stimulus aimed at inducing circular vection. Vection was measured using self-reports of onset latency, duration, and intensity. Results indicated that, in both age groups, females experienced longer-lasting vection compared to males. Additionally, the level of field dependence was related to vection intensity and duration in males but not in females. Variability in vection intensity was best explained by a mixture of biological, perceptual, cognitive, and personality variables. Taken together, these findings suggest that individual factors are important for understanding differences in vection susceptibility.

The relationship between postural control and cognitive functioning following Zumba dancing in middle-aged women: A randomized clinical trial

This study aimed to investigate the effect of 12-week Zumba dancing on postural control and cognitive parameters and the correlations between these parameters in middle-aged women. Thirty-eight women, aged between 50 and 60 years, were randomly allocated to a Zumba group (ZG) or control group. Postural control and cognitive functions [working memory (WM) and reaction time (RT)] were assessed before and after 12 weeks of a Zumba dancing program using a stabilometric force platform, Corsi Block-Tapping Task and Simple RT tests, respectively. The results indicate that ZG showed significantly (p<.01) better balance performances when standing on a stable surface in both visual conditions [firm surface with eyes opened (EO) (20,9%) and eyes closed (EC) (12.3%)]. However, when standing on an unstable surface in both visual conditions (foam surface with EO/EC), the ZG showed no significant improvement in postural control. It seems that the benefits of Zumba on postural control depend on the sensory condition. Besides, 12-week Zumba dancing was not sufficient to significantly enhance cognitive performances (RT/WM) performances. These cognitive performances were related to postural control in challenging conditions and can be considered an effective tool for monitoring postural performances following an intervention program. Clinicians should, therefore, focus on interventions that boost cognitive functions in middle-aged women to achieve optimal postural control, mainly in challenging conditions, in order to prevent the risk and fear of falls as well as the incidence of falling.

Hazard warning modalities and timing thresholds for older drivers with impaired vision

PURPOSE

We examined collision warning systems with different modalities and timing thresholds, assessing their impact on responses to pedestrian hazards by drivers with impaired contrast sensitivity (ICS).

METHODS

Seventeen ICS (70-84 y, median CS 1.35 log units) and 17 normal vision (NV: 68-73 y, median CS 1.95) participants completed 6 city drives in a simulator with 3 bimodal warnings: visual-auditory, visual-directional-tactile, and visual-non-directional-tactile. Each modality had one drive with early and one with late warnings, triggered at 3.5 s and 2 s time-to-collision, respectively.

RESULTS

ICS participants triggered more early (43 vs 37 %) and late warnings (12 vs 6 %) than NV participants and had more collisions (3 vs 0 %). Early warnings reduced time to fixate hazards (late 1.9 vs early 1.2 s, p < 0.001), brake response times (2.8 vs 1.8 s, p < 0.001) and collision rates (1.2 vs 0.02 %). With late warnings, ICS participants took 0.7 s longer to brake than NV (p < 0.001) and had an 11 % collision rate (vs 0.7 % with early warnings). Non-directional-tactile warnings yielded the lowest collision rates for ICS participants (4 vs auditory 12 vs directional-tactile 15.2 %) in late warning scenarios. All ICS participants preferred early warnings.

CONCLUSIONS

While early warnings improved hazard responses and reduced collisions for ICS participants, late warnings did not, resulting in high collision rates. In contrast, both early and late warnings were helpful for NV drivers. Non-directional-tactile warnings were the most effective in reducing collisions. The findings provide insights relevant to the development of hazard warnings tailored for drivers with impaired vision.

Age Deficits in Associative Memory Are Not Alleviated by Multisensory Paradigms

OBJECTIVES

Age deficits in memory are widespread, this affects individuals at a personal level, and investigating memory has been a key focus in cognitive aging research. Age deficits occur in memory for an episode, where information from the environment is integrated through the senses into an episodic event via associative memory. Associating items in memory has been shown to be particularly difficult for older adults but can often be alleviated by providing support from the external environment. The current investigation explored the potential for increased sensory input (multimodal stimuli) to alleviate age deficits in associative memory. Here, we present compelling evidence, supported by Bayesian analysis, for a null age-by-modality interaction.

METHODS

Across three preregistered studies, young and older adults (n = 860) completed associative memory tasks either in single modalities or in multimodal formats. Study 1 used either visual text (unimodal) or video introductions (multimodal) to test memory for name-face associations. Studies 2 and 3 tested memory for paired associates. Study 2 used unimodal visual presentation or cross-modal visual-auditory word pairs in a cued recall paradigm. Study 3 presented word pairs as visual only, auditory only, or audiovisual and tested memory separately for items (individual words) or associations (word pairings).

RESULTS

Typical age deficits in associative memory emerged, but these were not alleviated by multimodal presentation.

DISCUSSION

The lack of multimodal support for associative memory indicates that perceptual manipulations are less effective than other forms of environmental support at alleviating age deficits in associative memory.

A drift diffusion model analysis of age-related impact on multisensory decision-making processes

Older adults (OAs) are typically slower and/or less accurate in forming perceptual choices relative to younger adults. Despite perceptual deficits, OAs gain from integrating information across senses, yielding multisensory benefits. However, the cognitive processes underlying these seemingly discrepant ageing effects remain unclear. To address this knowledge gap, 212 participants (18-90 years old) performed an online object categorisation paradigm, whereby age-related differences in Reaction Times (RTs) and choice accuracy between audiovisual (AV), visual (V), and auditory (A) conditions could be assessed. Whereas OAs were slower and less accurate across sensory conditions, they exhibited greater RT decreases between AV and V conditions, showing a larger multisensory benefit towards decisional speed. Hierarchical Drift Diffusion Modelling (HDDM) was fitted to participants' behaviour to probe age-related impacts on the latent multisensory decision formation processes. For OAs, HDDM demonstrated slower evidence accumulation rates across sensory conditions coupled with increased response caution for AV trials of higher difficulty. Notably, for trials of lower difficulty we found multisensory benefits in evidence accumulation that increased with age, but not for trials of higher difficulty, in which increased response caution was instead evident. Together, our findings reconcile age-related impacts on multisensory decision-making, indicating greater multisensory evidence accumulation benefits with age underlying enhanced decisional speed.

Impacts of audiovisual simultaneity perception on single-task and dual-task gaits in middle-aged and older adults

BACKGROUND

While dual-task walking requires the ability to integrate sensory information from multiple ongoing sources, it remains unknown whether dual-task walking is more affected than single-task walking by the multisensory integration ability.

RESEARCH QUESTION

How does the audiovisual temporal integration ability affect single-task and dual-task gaits in the aging population?

METHODS

One hundred and thirty healthy middle-aged and older adults (age = 64.7 ± 6.4 years) completed an audiovisual simultaneity judgment (AVSJ) task and underwent single-task, motor dual-task, and cognitive dual-task gait assessments. In the AVSJ task, participants judged whether a flash and an auditory stimulus presented at different stimulus onset asynchronies were simultaneous. The accuracy and precision of the AVSJ performance were assessed using the point of subjective simultaneity (PSS) and the temporal binding window (δ), respectively. A lower absolute PSS and δ indicated better performance. Participants held a cup of water and performed serial-7 subtraction for motor and cognitive dual-task gait assessments, respectively. The spatiotemporal gait parameters and their variability were calculated. The influences of PSS and δ on the gait parameters of the three gaits were examined with multiple hierarchical regressions.

RESULTS

Only the cognitive dual-task gait was significantly affected by PSS and δ. Greater PSS predicted a longer single support time (β = 0.195, p = 0.024) and its variability (β = 0.224, p = 0.011). Greater δ predicted greater step time variability (β = 0.198, p = 0.022).

SIGNIFICANCE

Declined perception of audiovisual simultaneity particularly degrades temporal control of cognitive dual-task walking, highlighting the importance of assessing and training this ability after midlife.

Effects of older age on visual and self-motion sensory cue integration in navigation

Older adults demonstrate impairments in navigation that cannot be explained by general cognitive and motor declines. Previous work has shown that older adults may combine sensory cues during navigation differently than younger adults, though this work has largely been done in dark environments where sensory integration may differ from full-cue environments. Here, we test whether aging adults optimally combine cues from two sensory systems critical for navigation: vision (landmarks) and body-based self-motion cues. Participants completed a homing (triangle completion) task using immersive virtual reality to offer the ability to navigate in a well-lit environment including visibility of the ground plane. An optimal model, based on principles of maximum-likelihood estimation, predicts that precision in homing should increase with multisensory information in a manner consistent with each individual sensory cue's perceived reliability (measured by variability). We found that well-aging adults (with normal or corrected-to-normal sensory acuity and active lifestyles) were more variable and less accurate than younger adults during navigation. Both older and younger adults relied more on their visual systems than a maximum likelihood estimation model would suggest. Overall, younger adults' visual weighting matched the model's predictions whereas older adults showed sub-optimal sensory weighting. In addition, high inter-individual differences were seen in both younger and older adults. These results suggest that older adults do not optimally weight each sensory system when combined during navigation, and that older adults may benefit from interventions that help them recalibrate the combination of visual and self-motion cues for navigation.

Wrist proprioception-An update on scientific insights and clinical implications in rehabilitation of the wrist

The field of wrist proprioception, as it relates to rehabilitation and surgery, has gone through a period of intense growth in the past decade. From being primarily focused on the function of the joint and ligaments in patients with wrist trauma or after wrist surgery, the understanding is now that of a greater complexity in treating not just the wrist but the hand and arm as a whole. Proprioception is derived from the Latin words "proprius" - belonging to (oneself) and "-ception" to sense. In other words, how to sense ourselves. To have a complete sense of self, multiple sensory afferents originating from joints, ligaments, muscles, tendons, nerves, skin, vision, and hearing work together to orchestrate a balanced integration of sensorimotor functions, with the true goal to perceive and adapt to the physical world around us. In this update on wrist proprioception, we review current developments in the understanding of proprioception, with an implication for our everyday work as hand therapists and hand surgeons. Each contributing sense-joint, ligaments, muscles, skin, and brain-will be reviewed, and the clinical relevance will be discussed. An updated wrist rehabilitation protocol is proposed where the therapist is guided to rehabilitate a patient after wrist trauma and/or surgery in 4 stages: (1) basic hand and wrist rehabilitation with a focus on reducing edema, pain, and scar formation; (2) proprioception awareness to improve the sense of joint motion and position; (3) conscious neuromuscular rehabilitation where isometric exercises of muscles that are beneficial for a particular injury are promoted, whereas others that are potentially harmful are avoided; and (4) unconscious neuromuscular rehabilitation with training of the reflex and joint protective senses.

Visual Field Dependence Persists in Age-Related Central Visual Field Loss

Purpose

To examine whether the age-related increase in visual field dependence persists in older adults with central field loss (CFL).

Methods

Twenty individuals with CFL were grouped into participants with age-related binocular CFL (CFL, n = 9), age-related monocular CFL/relative scotomata (mCFL, n = 8), and CFL occurring at a young age (yCFL, n = 3). Seventeen controls were age-matched to the older CFL groups (OA) and three to the yCFL group (yOA). Participants judged the tilt direction of a rod presented at various orientations under conditions with and without a visual reference. Visual field dependence was determined as the difference in judgment bias between trials with and without the visual reference. Visual field dependence was examined between groups and relative to visual acuity and contrast sensitivity.

Results

All older groups performed similarly without the visual reference. The CFL group showed greater visual field dependence than the OA group (Mann-Whitney U test; U = 39, P = 0.045). However, there was no group difference when considering all three older groups (Kruskal-Wallis ANOVA; H(2, N = 34) = 4.31, P = 0.116). Poorer contrast sensitivity correlated with greater visual field dependence (P = 0.017; ρ = -0.43).

Conclusions

Visual field dependence persists in older adults with CFL and seems exacerbated in those with dense binocular scotomata. This could be attributed to the sensitivity of the spared peripheral retina to orientation and motion cues. The relationship with contrast sensitivity further suggests that a decline in visual function is associated with an increase in visual field dependence beyond the effects of normal aging. These observations can guide tailored care and rehabilitation in older adults with CFL.

Ability to Process Multisensory Information Is Impaired in Open Angle Glaucoma

PRCIS

Patients with glaucoma demonstrated deficiencies in their ability to process multisensory information when compared with controls, with those deficiencies being related to glaucoma severity. Impaired multisensory integration (MSI) may affect the quality of life in individuals with glaucoma and may contribute to the increased prevalence of falls and driving safety concerns. Therapeutic possibilities to influence cognition in glaucoma should be explored.

PURPOSE

Glaucoma is a neurodegenerative disease of the optic nerve that has also been linked to cognitive health decline. This study explored MSI as a function of glaucoma status and severity.

METHODS

MSI was assessed in 37 participants with open angle glaucoma relative to 18 age-matched healthy controls. The sound-induced flash illusion was used to assess MSI efficiency. Participants were presented with various combinations of simultaneous visual and/or auditory stimuli and were required to indicate the number of visual stimuli observed for each of the 96 total presentations. Central retinal sensitivity was assessed as an indicator of glaucoma severity (MAIA; CenterVue).

RESULTS

Participants with glaucoma performed with equivalent capacity to healthy controls on unisensory trials ( F1,53 =2.222, P =0.142). Both groups performed equivalently on congruent multisensory trials involving equal numbers of auditory and visual stimuli F1,53 =1.032, P =0.314). For incongruent presentations, that is, 2 beeps and 1 flash stimulus, individuals with glaucoma demonstrated a greater influence of the incongruent beeps when judging the number of flashes, indicating less efficient MSI relative to age-matched controls ( F1,53 =11.45, P <0.002). In addition, MSI performance was positively correlated with retinal sensitivity ( F3,49 =4.042, P <0.025), adjusted R ²=0.15).

CONCLUSIONS

Individuals with open angle glaucoma exhibited MSI deficiencies that relate to disease severity. The type of deficiencies observed were similar to those observed among older individuals with cognitive impairment and balance issues. Impaired MSI may, therefore, be relevant to the increased prevalence of falls observed among individuals with glaucoma, a concept that merits further investigation.

Alterations of Audiovisual Integration in Alzheimer's Disease

Audiovisual integration is a vital information process involved in cognition and is closely correlated with aging and Alzheimer's disease (AD). In this review, we evaluated the altered audiovisual integrative behavioral symptoms in AD. We further analyzed the relationships between AD pathologies and audiovisual integration alterations bidirectionally and suggested the possible mechanisms of audiovisual integration alterations underlying AD, including the imbalance between energy demand and supply, activity-dependent degeneration, disrupted brain networks, and cognitive resource overloading. Then, based on the clinical characteristics including electrophysiological and imaging data related to audiovisual integration, we emphasized the value of audiovisual integration alterations as potential biomarkers for the early diagnosis and progression of AD. We also highlighted that treatments targeted audiovisual integration contributed to widespread pathological improvements in AD animal models and cognitive improvements in AD patients. Moreover, investigation into audiovisual integration alterations in AD also provided new insights and comprehension about sensory information processes.

Does the Sensory Experience of Words Boost Recollection in Aging?

OBJECTIVES

We examine age-related differences in recollection and test the impact of words with high vs low sensory experience ratings (SER) in older and younger adults. We expected that the recollection of words with high SER would be similar in older and young adults, as they depend on knowledge, unlike recollection of words with a low SER, which would depend on executive functions.

METHODS

We manipulated the sensory experience of words (high vs. low) in encoding in young and older adults. The participants then took a word-recognition test using the Remember/Know paradigm (Gardiner, 1988). We also evaluated executive functions using several measures.

RESULTS

Results show that the age-related difference in recollective experience was eliminated under the high SER encoding condition. Moreover, Remember (R) responses in the low SER condition seem to be related to executive functioning, unlike R responses in the high SER condition and Know (K) responses in both low and high SER conditions.

DISCUSSION

Our study shows that the memory benefit of high-SER words is greater for older than younger adults. The study also supports the observation that older adults can compensate for their deficits by using sensory experience to consciously recollect information.

Age-Related Changes in the Utilization of Visual Information for Collision Prediction: A Study Using an Affordance-Based Model

The ability to predict collisions with moving objects deteriorates with aging. We followed the affordance-based model to identify optical variables that older adults had difficulty using for collision prediction. We reproduced a modified version of the interception task used in Steinmetz (Steinmetz, Layton, Powell, & Fajen, 2020, "Affordance-based versus current - future accounts of choosing whether to pursue or abandon the chase of a moving target," Journal of Vision, 20(3), 8) in a virtual reality (VR) environment and newly introduced perturbation for each of three optical variables (vertical and horizontal expansions of a moving object and the bearing angle produced between participants and a moving object). We expected that perturbation would negatively affect the performance only for those who rely on the optical variable to perform the interception task effectively. We tested 18 older and 15 younger adults and showed that older participants were not negatively affected by the perturbation for the vertical and horizontal expansion of a moving object, while they showed decreased performance when the perturbation was introduced with a bearing angle. These findings suggest that predicting collisions with moving objects deteriorates with aging because the perception of object expansion is impaired with aging.

The effect of unisensory and multisensory information on lexical decision and free recall in young and older adults

Studies using simple low-level stimuli show that multisensory stimuli lead to greater improvements in processing speed for older adults than young adults. However, there is insufficient evidence to explain how these benefits influence performance for more complex processes such as judgement and memory tasks. This study examined how presenting stimuli in multiple sensory modalities (audio-visual) instead of one (audio-only or visual-only) may help older adults to improve their memory and cognitive processing compared to young adults. Young and older adults completed lexical decision (real word vs. pseudoword judgement) and word recall tasks, either independently, or in combination (dual-task), with and without perceptual noise. Older adults were better able to remember words when encoding independently. In contrast, young adults were better able to remember words when encoding in combination with lexical decisions. Both young and older adults had better word recall in the audio-visual condition compared with the audio-only condition. The findings indicate significant age differences when dealing with multiple tasks during encoding. Crucially, there is no greater multisensory benefit for older adults compared to young adults in more complex processes, rather multisensory stimuli can be useful in enhancing cognitive performance for both young and older adults.

Multisensory perception constrains the formation of object categories: a review of evidence from sensory-driven and predictive processes on categorical decisions

Although object categorization is a fundamental cognitive ability, it is also a complex process going beyond the perception and organization of sensory stimulation. Here we review existing evidence about how the human brain acquires and organizes multisensory inputs into object representations that may lead to conceptual knowledge in memory. We first focus on evidence for two processes on object perception, multisensory integration of redundant information (e.g. seeing and feeling a shape) and crossmodal, statistical learning of complementary information (e.g. the 'moo' sound of a cow and its visual shape). For both processes, the importance attributed to each sensory input in constructing a multisensory representation of an object depends on the working range of the specific sensory modality, the relative reliability or distinctiveness of the encoded information and top-down predictions. Moreover, apart from sensory-driven influences on perception, the acquisition of featural information across modalities can affect semantic memory and, in turn, influence category decisions. In sum, we argue that both multisensory processes independently constrain the formation of object categories across the lifespan, possibly through early and late integration mechanisms, respectively, to allow us to efficiently achieve the everyday, but remarkable, ability of recognizing objects. This article is part of the theme issue 'Decision and control processes in multisensory perception'.

Comparative Effectiveness of eConsent: Systematic Review

BACKGROUND

Providing informed consent means agreeing to participate in a clinical trial and having understood what is involved. Flawed informed consent processes, including missing dates and signatures, are common regulatory audit findings. Electronic consent (eConsent) uses digital technologies to enable the consenting process. It aims to improve participant comprehension and engagement with study information and to address data quality concerns.

OBJECTIVE

This systematic literature review aimed to assess the effectiveness of eConsent in terms of patient comprehension, acceptability, usability, and study enrollment and retention rates, as well as the effects of eConsent on the time patients took to perform the consenting process ("cycle time") and on-site workload in comparison with traditional paper-based consenting.

METHODS

The systematic review was conducted and reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Ovid Embase and Ovid MEDLINE were systematically searched for publications reporting original, comparative data on the effectiveness of eConsent in terms of patient comprehension, acceptability, usability, enrollment and retention rates, cycle time, and site workload. The methodological validity of the studies that compared outcomes for comprehension, acceptability, and usability across paper consent and eConsent was assessed. Study methodologies were categorized as having "high" validity if comprehensive assessments were performed using established instruments.

RESULTS

Overall, 37 publications describing 35 studies (13,281 participants) were included. All studies comparing eConsenting and paper-based consenting for comprehension (20/35, 57% of the studies; 10 with "high" validity), acceptability (8/35, 23% of the studies; 1 with "high" validity), and usability (5/35, 14% of the studies; 1 with "high" validity) reported significantly better results with eConsent, better results but without significance testing, or no significant differences in overall results. None of the studies reported better results with paper than with eConsent. Among the "high" validity studies, 6 studies on comprehension reported significantly better understanding of at least some concepts, the study on acceptability reported statistically significant higher satisfaction scores, and the study on usability reported statistically significant higher usability scores with eConsent than with paper (P<.05 for all). Cycle times were increased with eConsent, potentially reflecting greater patient engagement with the content. Data on enrollment and retention were limited. Comparative data from site staff and other study researchers indicated the potential for reduced workload and lower administrative burden with eConsent.

CONCLUSIONS

This systematic review showed that compared with patients using paper-based consenting, patients using eConsent had a better understanding of the clinical trial information, showed greater engagement with content, and rated the consenting process as more acceptable and usable. eConsent solutions thus have the potential to enhance understanding, acceptability, and usability of the consenting process while inherently being able to address data quality concerns, including those related to flawed consenting processes.

Keep your finger on the pulse: Better rate perception and gap detection with vibrotactile compared to visual stimuli

Important characteristics of the environment can be represented in the temporal pattern of sensory stimulation. In two experiments, we compared accuracy of temporal processing by different modalities. Experiment 1 examined binary categorization of rate for visual (V) or vibrotactile (T) stimulus pulses presented at either 4 or 6 Hz. Inter-pulse intervals were either constant or variable, perturbed by random Gaussian variates. Subjects categorized the rate of T pulse sequences more accurately than V sequences. In V conditions only, subjects disproportionately tended to mis-categorize 4-Hz pulse rates, for all but the most variable sequences. In Experiment 2, we compared gap detection thresholds across modalities, using the same V and T pulses from Experiment 1, as well as with bimodal (VT) pulses. Visual gap detection thresholds were larger (3[Formula: see text]) than tactile thresholds. Additionally, performance with VT stimuli seemed to be nearly completely dominated by their T components. Together, these results suggest (i) that vibrotactile temporal acuity surpasses visual temporal acuity, and (ii) that vibrotactile stimulation has considerable, untapped potential to convey temporal information like that needed for eyes-free alerting signals.

Age-related changes to the attentional modulation of temporal binding

During multisensory integration, the time range within which visual and auditory information can be perceived as synchronous and bound together is known as the temporal binding window (TBW). With increasing age, the TBW becomes wider, such that older adults erroneously, and often dangerously, integrate sensory inputs that are asynchronous. Recent research suggests that attentional cues can narrow the width of the TBW in younger adults, sharpening temporal perception and increasing the accuracy of integration. However, due to their age-related declines in attentional control, it is not yet known whether older adults can deploy attentional resources to narrow the TBW in the same way as younger adults. This study investigated the age-related changes to the attentional modulation of the TBW. Thirty younger and 30 older adults completed a cued-spatial-attention version of the stream-bounce illusion, assessing the extent to which the visual and auditory stimuli were integrated when presented at three different stimulus-onset asynchronies, and when attending to a validly cued or invalidly cued location. A 2 × 2 × 3 mixed ANOVA revealed that when participants attended to the validly cued location (i.e., when attention was present), susceptibility to the stream-bounce illusion decreased. However, crucially, this attentional manipulation significantly affected audiovisual integration in younger adults, but not in older adults. These findings suggest that older adults have multisensory integration-related attentional deficits. Directions for future research and practical applications surrounding treatments to improve the safety of older adults' perception and navigation through the environment are discussed.

Longitudinal grip strength is associated with susceptibility to the Sound Induced Flash Illusion in older adults

The precision of temporal multisensory integration is associated with specific aspects of physical functioning in ageing, including gait speed and incidents of falling. However, it is unknown if such an association exists between multisensory integration and grip strength, an important index of frailty and brain health and predictor of disease and mortality in older adults. Here, we investigated whether temporal multisensory integration is associated with longitudinal (eight-year) grip strength trajectories in a large sample of 2,061 older adults (mean age = 64.42 years, SD = 7.20; 52% female) drawn from The Irish Longitudinal Study on Ageing (TILDA). Grip strength (kg) for the dominant hand was assessed with a hand-held dynamometer across four testing waves. Longitudinal k-means clustering was applied to these data separately for sex (male, female) and age group (50-64, 65-74, 75+ years). At wave 3, older adults participated in the Sound Induced Flash Illusion (SIFI), a measure of the precision of temporal audio-visual integration, which included three audio-visual stimulus onset asynchronies (SOAs): 70, 150 and 230 ms. Results showed that older adults with a relatively lower (i.e., weaker) grip strength were more susceptible to the SIFI at the longer SOAs compared to those with a relatively higher (i.e., stronger) grip strength (p <.001). These novel findings suggest that older adults with relatively weaker grip strength exhibit an expanded temporal binding window for audio-visual events, possibly reflecting a reduction in the integrity of the central nervous system.

The temporal precision of audiovisual integration is associated with longitudinal fall incidents but not sensorimotor fall risk in older adults

Sustained multisensory integration over long inter-stimulus time delays is typically found in older adults, particularly those with a history of falls. However, the extent to which the temporal precision of audio-visual integration is associated with longitudinal fall or fall risk trajectories is unknown. A large sample of older adults (N = 2319) were grouped into longitudinal trajectories of self-reported fall incidents (i.e., decrease, stable, or increase in number) and, separately, their performance on a standard, objective measure of fall risk, Timed Up and Go (TUG; stable, moderate decline, severe decline). Multisensory integration was measured once as susceptibility to the Sound-Induced Flash Illusion (SIFI) across three stimulus onset asynchronies (SOAs): 70 ms, 150 ms and 230 ms. Older adults with an increasing fall number showed a significantly different pattern of performance on the SIFI than non-fallers, depending on age: For adults with increasing incidents of falls, those aged 53-59 years showed a much smaller difference in illusion susceptibility at 70 ms versus 150 ms than those aged 70 + years. In contrast, non-fallers showed a more comparable difference between these SOA conditions across age groups. There was no association between TUG performance trajectories and SIFI susceptibility. These findings suggests that a fall event is associated with distinct temporal patterns of multisensory integration in ageing and have implications for our understanding of the mechanisms underpinning brain health in older age.

Successful aging of musicians: Preservation of sensorimotor regions aids audiovisual speech-in-noise perception

Musicianship can mitigate age-related declines in audiovisual speech-in-noise perception. We tested whether this benefit originates from functional preservation or functional compensation by comparing fMRI responses of older musicians, older nonmusicians, and young nonmusicians identifying noise-masked audiovisual syllables. Older musicians outperformed older nonmusicians and showed comparable performance to young nonmusicians. Notably, older musicians retained similar neural specificity of speech representations in sensorimotor areas to young nonmusicians, while older nonmusicians showed degraded neural representations. In the same region, older musicians showed higher neural alignment to young nonmusicians than older nonmusicians, which was associated with their training intensity. In older nonmusicians, the degree of neural alignment predicted better performance. In addition, older musicians showed greater activation in frontal-parietal, speech motor, and visual motion regions and greater deactivation in the angular gyrus than older nonmusicians, which predicted higher neural alignment in sensorimotor areas. Together, these findings suggest that musicianship-related benefit in audiovisual speech-in-noise processing is rooted in preserving youth-like representations in sensorimotor regions.

Increases in sensory noise predict attentional disruptions to audiovisual speech perception

We receive information about the world around us from multiple senses which combine in a process known as multisensory integration. Multisensory integration has been shown to be dependent on attention; however, the neural mechanisms underlying this effect are poorly understood. The current study investigates whether changes in sensory noise explain the effect of attention on multisensory integration and whether attentional modulations to multisensory integration occur via modality-specific mechanisms. A task based on the McGurk Illusion was used to measure multisensory integration while attention was manipulated via a concurrent auditory or visual task. Sensory noise was measured within modality based on variability in unisensory performance and was used to predict attentional changes to McGurk perception. Consistent with previous studies, reports of the McGurk illusion decreased when accompanied with a secondary task; however, this effect was stronger for the secondary visual (as opposed to auditory) task. While auditory noise was not influenced by either secondary task, visual noise increased with the addition of the secondary visual task specifically. Interestingly, visual noise accounted for significant variability in attentional disruptions to the McGurk illusion. Overall, these results strongly suggest that sensory noise may underlie attentional alterations to multisensory integration in a modality-specific manner. Future studies are needed to determine whether this finding generalizes to other types of multisensory integration and attentional manipulations. This line of research may inform future studies of attentional alterations to sensory processing in neurological disorders, such as Schizophrenia, Autism, and ADHD.

Audiovisual integration of the dynamic hand-held tool at different stimulus intensities in aging

Introduction: In comparison to the audiovisual integration of younger adults, the same process appears more complex and unstable in older adults. Previous research has found that stimulus intensity is one of the most important factors influencing audiovisual integration. Methods: The present study compared differences in audiovisual integration between older and younger adults using dynamic hand-held tool stimuli, such as holding a hammer hitting the floor. Meanwhile, the effects of stimulus intensity on audiovisual integration were compared. The intensity of the visual and auditory stimuli was regulated by modulating the contrast level and sound pressure level. Results: Behavioral results showed that both older and younger adults responded faster and with higher hit rates to audiovisual stimuli than to visual and auditory stimuli. Further results of event-related potentials (ERPs) revealed that during the early stage of 60-100 ms, in the low-intensity condition, audiovisual integration of the anterior brain region was greater in older adults than in younger adults; however, in the high-intensity condition, audiovisual integration of the right hemisphere region was greater in younger adults than in older adults. Moreover, audiovisual integration was greater in the low-intensity condition than in the high-intensity condition in older adults during the 60-100 ms, 120-160 ms, and 220-260 ms periods, showing inverse effectiveness. However, there was no difference in the audiovisual integration of younger adults across different intensity conditions. Discussion: The results suggested that there was an age-related dissociation between high- and low-intensity conditions with audiovisual integration of the dynamic hand-held tool stimulus. Older adults showed greater audiovisual integration in the lower intensity condition, which may be due to the activation of compensatory mechanisms.

Effect of aging on audiovisual integration: Comparison of high- and low-intensity conditions in a speech discrimination task

Audiovisual integration is an essential process that influences speech perception in conversation. However, it is still debated whether older individuals benefit more from audiovisual integration than younger individuals. This ambiguity is likely due to stimulus features, such as stimulus intensity. The purpose of the current study was to explore the effect of aging on audiovisual integration, using event-related potentials (ERPs) at different stimulus intensities. The results showed greater audiovisual integration in older adults at 320–360 ms. Conversely, at 460–500 ms, older adults displayed attenuated audiovisual integration in the frontal, fronto-central, central, and centro-parietal regions compared to younger adults. In addition, we found older adults had greater audiovisual integration at 200–230 ms under the low-intensity condition compared to the high-intensity condition, suggesting inverse effectiveness occurred. However, inverse effectiveness was not found in younger adults. Taken together, the results suggested that there was age-related dissociation in audiovisual integration and inverse effectiveness, indicating that the neural mechanisms underlying audiovisual integration differed between older adults and younger adults.

Can the balance evaluation systems test be used to identify system-specific postural control impairments in older adults with chronic neck pain?

BACKGROUND

Older adults with chronic neck pain (CNP) demonstrate impaired postural control. The Balance Evaluation Systems Test (BESTest) is used to assess systems underlying postural control impairments, but its use in CNP has not been reported. This study assessed whether the BESTest can identify postural control impairments in CNP as well as the level of BESTest item difficulty by Rasch analysis.

MATERIALS AND METHODS

This cross-sectional study recruited thirty young adults (YOUNG) aged 20-40 years and eighty older adults aged 60 years or older [without neck pain (OLD) = 60, with chronic neck pain (CNP) = 20]. Questionnaires were administered to collect demographic data, intensity of neck pain (VAS), patient's self-rated neck pain and disability (NDI), and balance confidence in daily activities (ABC). The BESTest was used to assess postural control.

RESULTS

The CNP group showed the lowest ABC scores. Compared to the YOUNG group, the BESTest score was significantly lower in the OLD group, while the CNP group showed the lowest score, suggesting that balance control deteriorated from the normal aging process and further declined in the CNP group, especially in biomechanical constraints, transitions-anticipatory postural adjustment, and reactive postural response (p < 0.05). Using scores from these three sections, the BESTest was accurate at the cutoff score of 48.5 out of 51 for differentiating the older adults whose daily life are affected by neck problems (using the NDI as a reference) with a high AUC (0.79), sensitivity (72%), and specificity (69%). The Rasch analysis revealed that the Timed Up and Go with dual task test was the most difficult BESTest item for all groups, whereas 14 items showed more difficulty for the CNP group.

CONCLUSION

The BESTest can be used to identify postural control impairments in CNP patients, even those with moderate pain and mild disability with a high level of physical functioning. The combined score of biomechanical constraints, transitions-anticipatory postural adjustment, and reactive postural response domains was suggested for the detection of older adults whose daily lives are affected by neck problems. This will also help clinicians consider the management of neck pain to prevent falls in CNP.

Multisensory Integration in Caenorhabditis elegans in Comparison to Mammals

Multisensory integration refers to sensory inputs from different sensory modalities being processed simultaneously to produce a unitary output. Surrounded by stimuli from multiple modalities, animals utilize multisensory integration to form a coherent and robust representation of the complex environment. Even though multisensory integration is fundamentally essential for animal life, our understanding of the underlying mechanisms, especially at the molecular, synaptic and circuit levels, remains poorly understood. The study of sensory perception in Caenorhabditis elegans has begun to fill this gap. We have gained a considerable amount of insight into the general principles of sensory neurobiology owing to C. elegans’ highly sensitive perceptions, relatively simple nervous system, ample genetic tools and completely mapped neural connectome. Many interesting paradigms of multisensory integration have been characterized in C. elegans, for which input convergence occurs at the sensory neuron or the interneuron level. In this narrative review, we describe some representative cases of multisensory integration in C. elegans, summarize the underlying mechanisms and compare them with those in mammalian systems. Despite the differences, we believe C. elegans is able to provide unique insights into how processing and integrating multisensory inputs can generate flexible and adaptive behaviors. With the emergence of whole brain imaging, the ability of C. elegans to monitor nearly the entire nervous system may be crucial for understanding the function of the brain as a whole.

Multisensory visual-vestibular training improves visual heading estimation in younger and older adults

Self-motion perception (e.g., when walking/driving) relies on the integration of multiple sensory cues including visual, vestibular, and proprioceptive signals. Changes in the efficacy of multisensory integration have been observed in older adults (OA), which can sometimes lead to errors in perceptual judgments and have been associated with functional declines such as increased falls risk. The objectives of this study were to determine whether passive, visual-vestibular self-motion heading perception could be improved by providing feedback during multisensory training, and whether training-related effects might be more apparent in OAs vs. younger adults (YA). We also investigated the extent to which training might transfer to improved standing-balance. OAs and YAs were passively translated and asked to judge their direction of heading relative to straight-ahead (left/right). Each participant completed three conditions: (1) vestibular-only (passive physical motion in the dark), (2) visual-only (cloud-of-dots display), and (3) bimodal (congruent vestibular and visual stimulation). Measures of heading precision and bias were obtained for each condition. Over the course of 3 days, participants were asked to make bimodal heading judgments and were provided with feedback (“correct”/“incorrect”) on 900 training trials. Post-training, participants’ biases, and precision in all three sensory conditions (vestibular, visual, bimodal), and their standing-balance performance, were assessed. Results demonstrated improved overall precision (i.e., reduced JNDs) in heading perception after training. Pre- vs. post-training difference scores showed that improvements in JNDs were only found in the visual-only condition. Particularly notable is that 27% of OAs initially could not discriminate their heading at all in the visual-only condition pre-training, but subsequently obtained thresholds in the visual-only condition post-training that were similar to those of the other participants. While OAs seemed to show optimal integration pre- and post-training (i.e., did not show significant differences between predicted and observed JNDs), YAs only showed optimal integration post-training. There were no significant effects of training for bimodal or vestibular-only heading estimates, nor standing-balance performance. These results indicate that it may be possible to improve unimodal (visual) heading perception using a multisensory (visual-vestibular) training paradigm. The results may also help to inform interventions targeting tasks for which effective self-motion perception is important.

Enhanced vection in older adults: Evidence for age-related effects in multisensory vection experiences

The illusion of self-motion (vection) is a multisensory phenomenon elicited by visual, auditory, tactile, or other sensory cues. Aging is often associated with changes in sensory acuity, visual motion perception, and multisensory integration, processes which may influence vection perception. However, age-related differences in vection have received little study to date. Thus, the objective of the present study was to investigate age-related differences in vection during multisensory stimulation. Nineteen younger adults and 19 older adults were exposed to rotating visual, auditory, and tactile stimuli (separately or in combination) at a speed of 45°/s inside a VR laboratory inducing circular vection. The size of the field-of-view (FOV) was large (240°), medium (75°), small (30°), or contained no visuals. Vection intensity and duration were reported verbally after each trial. Overall, older adults experienced significantly stronger and longer vection compared to younger adults. Additionally, there were main effects of FOV and sensory cues, such that larger FOVs and the presence of auditory and tactile stimulation increased vection ratings for both age groups. These findings support the idea that vection is a multisensory experience that can be elicited by visual, auditory, and tactile stimuli and demonstrates these effects for the first time in older adults.

Object Handling for People With Dementia: A Scoping Review and the Development of Intervention Guidance

Background and Objectives

Among the various psychosocial interventions aiming at improving behavior, quality of life, and the well-being of people with dementia, one that has attracted recent attention has been object handling. This scoping review synthesizes available studies on object handling for people with dementia, their effects, and methodological characteristics and describes its components and likely domains.

Research Design and Methods

The search was conducted using CINAHL, PsycINFO, MEDLINE, PsycARTICLES, Academic Search Elite, and Art Full Text, plus review of reference lists and hand search. Data from the studies included were chattered and reported in narrative form.

Results

Eleven studies were included; of which, 9 described a group intervention and 10 investigated the distinctive value of heritage items. Studies used a mixed-methods or qualitative design and varied in their procedures, including number of sessions and length of intervention. Most studies reported positive effects on well-being, mood, and emotion in those with dementia. Qualitative investigations revealed that the co-construction of an object’s meaning facilitated new learning, social inclusion, and change in attitudes toward dementia. From the review and stakeholder consultations, a definition of object handling is proposed, which includes three components: presenting, receiving, and responding.

Discussion and Implications

The findings suggest that people with dementia may benefit from object handling interventions as a means of improving well-being, mood, and social inclusion. The review highlighted a variety of approaches used and a small number of studies were identified under the term of “object handling.” Further studies are needed to examine the complexity of object handling, its impact within dementia care settings, and that explicitly use the term “object handling.” Given the focus to date on heritage, archive, and museum objects, more studies involving the handling of everyday material objects are needed because these are by definition highly accessible.

Age-related changes in visuo-proprioceptive processing in perceived body position

This study investigated age-related change in visuo-proprioceptive processing in the perceived body position using mirror hand/foot illusions, focusing on its temporal characteristics, its dependency on body parts, and its association with older adults’ fall risk. Either immediately or 15 s after the exposure to the mirror-induced inconsistency of visuo-proprioceptive signals regarding the right hand or foot position, participants performed a reaching task using the unseen, illusion-affected hand or foot. Results showed clear age group differences. Specifically, older adults exhibited larger reaching errors than younger adults in the hand condition, and after the 15 s delay in the foot condition. Further, the reaching errors were constant across time for older adults but decreased after the delay in young adults, regardless of the tested body part. Particularly, older adults’ risk of falling, which was assessed by the timed up-and-go test, was negatively correlated with the reduction of reaching error across time. This suggests that older adults, especially those with a high risk of falling, face difficulties in appropriately processing visual and proprioceptive information for body perception in accordance with their external environment.

Does audio-visual information result in improved health-related decision-making compared with audio-only or visual-only information? Protocol for a systematic review and meta-analysis

INTRODUCTION

Making health-related decisions can be difficult due to the amount and complexity of information available. Audio-visual information may improve memory for health information but whether audio-visual information can enhance health-related decisions has not been explored using quantitative methods. The objective of this systematic review is to understand how effective audio-visual information is for informing health-related decision-making compared with audio-only or visual-only information.

METHODS AND ANALYSIS

Randomised controlled trials (RCTs) will be included if they include audio-visual and either audio-only or visual-only information provision and decision-making in a health setting. Studies will be excluded if they are not reported in English. Twelve databases will be searched including: Ovid MEDLINE, PubMed and PsychINFO. The Cochrane Risk of Bias tool (V.7) will be used to assess risk of bias in included RCTs. Results will be synthesised primarily using a meta-analysis; where quantitative data are not reported, a narrative synthesis will be used.

ETHICS AND DISSEMINATION

No ethical issues are foreseen. Data will be disseminated via academic publication and conference presentations. Findings may also be published in scientific newsletters and magazines. This review is funded by the Economic and Social Research Council.

PROSPERO REGISTRATION NUMBER

CRD42021255725.

Age-related changes to vestibular heave and pitch perception and associations with postural control

Falls are a common cause of injury in older adults (OAs), and age-related declines across the sensory systems are associated with increased falls risk. The vestibular system is particularly important for maintaining balance and supporting safe mobility, and aging has been associated with declines in vestibular end-organ functioning. However, few studies have examined potential age-related differences in vestibular perceptual sensitivities or their association with postural stability. Here we used an adaptive-staircase procedure to measure detection and discrimination thresholds in 19 healthy OAs and 18 healthy younger adults (YAs), by presenting participants with passive heave (linear up-and-down translations) and pitch (forward-backward tilt rotations) movements on a motion-platform in the dark. We also examined participants' postural stability under various standing-balance conditions. Associations among these postural measures and vestibular perceptual thresholds were further examined. Ultimately, OAs showed larger heave and pitch detection thresholds compared to YAs, and larger perceptual thresholds were associated with greater postural sway, but only in OAs. Overall, these results suggest that vestibular perceptual sensitivity declines with older age and that such declines are associated with poorer postural stability. Future studies could consider the potential applicability of these results in the development of screening tools for falls prevention in OAs.

A Lifespan Approach to Balance in Static and Dynamic Conditions: The Effect of Age on Balance Abilities

Postural control is a complex sensorimotor skill that is fundamental to our daily life. The abilities to maintain and recover balance degrade with age. However, the time decay of balance performance with age is not well understood. In this study, we aim at quantifying the age-dependent changes in standing balance under static and dynamic conditions. We tested 272 healthy subjects with ages ranging from 20 to 90. Subjects maintained the upright posture while standing on the robotic platform hunova®. In the evaluation of static balance, subjects stood on the fixed platform both with eyes open (EO) and eyes closed (EC). In the dynamic condition, subjects stood with eyes open on the moving foot platform that provided three different perturbations: (i) an inclination proportional to the center of pressure displacements, (ii) a pre-defined predictable motion, and (iii) an unpredictable and unexpected tilt. During all these tests, hunova® measured the inclination of the platform and the displacement of the center of pressure, while the trunk movements were recorded with an accelerometer placed on the sternum. To quantify balance performance, we computed spatio-temporal parameters typically used in clinical environments from the acceleration measures: mean velocity, variability of trunk motion, and trunk sway area. All subjects successfully completed all the proposed exercises. Their motor performance in the dynamic balance tasks quadratically changed with age. Also, we found that the reliance on visual feedback is not age-dependent in static conditions. All subjects well-tolerated the proposed protocol independently of their age without experiencing fatigue as we chose the timing of the evaluations based on clinical needs and routines. Thus, this study is a starting point for the definition of robot-based assessment protocols aiming at detecting the onset of age-related standing balance deficits and allowing the planning of tailored rehabilitation protocols to prevent falls in older adults.

Less is more: Removing a modality of an expected olfactory-visual stimulation enhances brain activation

In recent years, multisensory integration of visual and olfactory stimuli has extensively been explored resulting in the identification of responsible brain areas. As the experimental designs of previous research often include alternating presentations of unimodal and bimodal stimuli, the conditions cannot be regarded as completely independent. This could lead to effects of an expected but surprisingly missing sensory modality. In our experiment, we used a common functional magnetic resonance imaging (fMRI) study design with alternating strong unimodal and bimodal olfactory-visual food stimuli, in addition to a slight overhang of the bimodal stimuli in an effort to examine the effects of removing a visual or olfactory congruent stimulus for older people (41-83 years). Our results suggest that the processing of olfactory and visual stimuli stays intact over a wide age-range and that the utilization of strong stimuli does not lead to superadditive multisensory integration in accordance with the principle of inverse effectiveness. However, our results demonstrate that the removal of a stimulus modality leads to an activation of additional brain areas. For example, when the visual stimulus modality is missing, the right posterior superior temporal gyrus shows higher activation, whereas the removal of the olfactory stimulus modality leads to higher activation in the amygdala/hippocampus and the postcentral gyrus. These brain areas are related to attention, memory, and the search of the missing stimulus. Consequently, careful attention must be paid to the design of a valid, multimodal sensory experiment while also controlling for cognitive expectancy effects that might confound multimodal results.

A Scoping Review of Audiovisual Integration Methodology: Screening for Auditory and Visual Impairment in Younger and Older Adults

With the rise of the aging population, many scientists studying multisensory integration have turned toward understanding how this process may change with age. This scoping review was conducted to understand and describe the scope and rigor with which researchers studying audiovisual sensory integration screen for hearing and vision impairment. A structured search in three licensed databases (Scopus, PubMed, and PsychInfo) using the key concepts of multisensory integration, audiovisual modality, and aging revealed 2,462 articles, which were screened for inclusion by two reviewers. Articles were included if they (1) tested healthy older adults (minimum mean or median age of 60) with younger adults as a comparison (mean or median age between 18 and 35), (2) measured auditory and visual integration, (3) were written in English, and (4) reported behavioral outcomes. Articles that included the following were excluded: (1) tested taste exclusively, (2) tested olfaction exclusively, (3) tested somatosensation exclusively, (4) tested emotion perception, (5) were not written in English, (6) were clinical commentaries, editorials, interviews, letters, newspaper articles, abstracts only, or non-peer reviewed literature (e.g., theses), and (7) focused on neuroimaging without a behavioral component. Data pertaining to the details of the study (e.g., country of publication, year of publication, etc.) were extracted, however, of higher importance to our research question, data pertaining to screening measures used for hearing and vision impairment (e.g., type of test used, whether hearing- and visual-aids were worn, thresholds used, etc.) were extracted, collated, and summarized. Our search revealed that only 64% of studies screened for age-abnormal hearing impairment, 51% screened for age-abnormal vision impairment, and that consistent definitions of normal or abnormal vision and hearing were not used among the studies that screened for sensory abilities. A total of 1,624 younger adults and 4,778 older participants were included in the scoping review with males composing approximately 44% and females composing 56% of the total sample and most of the data was obtained from only four countries. We recommend that studies investigating the effects of aging on multisensory integration should screen for normal vision and hearing by using the World Health Organization's (WHO) hearing loss and visual impairment cut-off scores in order to maintain consistency among other aging researchers. As mild cognitive impairment (MCI) has been defined as a “transitional” or a “transitory” stage between normal aging and dementia and because approximately 3–5% of the aging population will develop MCI each year, it is therefore important that when researchers aim to study a healthy aging population, that they appropriately screen for MCI. One of our secondary aims was to determine how often researchers were screening for cognitive impairment and the types of tests that were used to do so. Our results revealed that only 55 out of 72 studies tested for neurological and cognitive function, and only a subset used standardized tests. Additionally, among the studies that used standardized tests, the cut-off scores used were not always adequate for screening out mild cognitive impairment. An additional secondary aim of this scoping review was to determine the feasibility of whether a meta-analysis could be conducted in the future to further quantitatively evaluate the results (i.e., are the findings obtained from studies using self-reported vision and hearing impairment screening methods significantly different from those measuring vision and hearing impairment in the lab) and to assess the scope of this problem. We found that it may not be feasible to conduct a meta-analysis with the entire dataset of this scoping review. However, a meta-analysis can be conducted if stricter parameters are used (e.g., focusing on accuracy or response time data only).

Systematic Review Registration:https://doi.org/10.17605/OSF.IO/GTUHD.

The Role of Altered Sensory Processing and Its Association with Participation in Daily Activities and Quality of Life among Older Adults in the Community

To identify variables that contribute to fall risk in older adults, this study examined the relationship between fall risk, sensory processing, participation in daily activities, and quality of life (QoL). Of the 123 participants, those at high-risk were significantly less able to register sensory input and had increased sensory sensitivity, restricted participation and overall lower QoL. Altered sensory processing was related with risk of falling. Additionally, both sensory process and fall risk were subsequently related with lower daily participation and, together, were related with lower QoL. Thus, sensory processing, participation and QoL assessments need to be included in occupational therapy evaluations and interventions for fall risk among older adults.

Influence of age on postural control during dual task: a centre of pressure motion and electromyographic analysis

BACKGROUND

Dual task influences postural control. A cognitive task seems to reduce muscle excitation during a postural balance, especially in older adults (OA).

AIM

The aim of this study is to evaluate the effect of three cognitive tasks on muscle excitation and static postural control in OA and young adults (YA) in an upright posture maintenance task.

METHODS

31 YA and 30 OA were evaluated while performing a modified Romberg Test in five different conditions over a force plate: open eyes, closed eyes, spatial-memory brooks' test, counting backwards aloud test and mental arithmetic task. The surface electromyographic signals of Tibialis anterior (TA), Lateral Gastrocnemius (GL), Peroneus Longus (PL), and Erector Spinae (ES) was acquired with an 8-channel surface electromyographic system. The following variables were computed for both the electromyographic analysis and the posturographic assessment: Root mean square (RMS), centre of pressure (CoP) excursion (Path) and velocity, sway area, RMS of the CoP Path and 50%, 95% of the power frequency. Mixed ANOVA was used to detect differences with group membership as factor between and type of task as within. The analysis was performed on the differences between each condition from OE.

RESULTS

An interaction effect was found for Log (logarithmic) Sway Area. A main effect for task emerged on all posturographic variables except Log 95% frequencies and for Log PL and ES RMS. A main effect for group was never detected.

DISCUSSION AND CONCLUSION

This study indicates a facilitating effect of mental secondary task on posturographic variables. Non-silent secondary task causes increase in ES and TA muscle activation and a worsening in static postural control performance.

Virtual Hand Illusion in younger and older adults

Introduction

Embodiment involves experiencing ownership over our body and localizing it in space and is informed by multiple senses (visual, proprioceptive and tactile). Evidence suggests that embodiment and multisensory integration may change with older age. The Virtual Hand Illusion (VHI) has been used to investigate multisensory contributions to embodiment, but has never been evaluated in older adults. Spatio-temporal factors unique to virtual environments may differentially affect the embodied perceptions of older and younger adults.

Methods

Twenty-one younger (18–35 years) and 19 older (65+ years) adults completed the VHI paradigm. Body localization was measured at baseline and again, with subjective ownership ratings, following synchronous and asynchronous visual-tactile interactions.

Results

Higher ownership ratings were observed in the synchronous relative to the asynchronous condition, but no effects on localization/drift were found. No age differences were observed. Localization accuracy was biased in both age groups when the virtual hand was aligned with the real hand, indicating a visual mislocalization of the virtual hand.

Conclusions

No age-related differences in the VHI were observed. Mislocalization of the hand in VR occurred for both groups, even when congruent and aligned; however, tactile feedback reduced localization biases. Our results expand the current understanding of age-related changes in multisensory embodiment within virtual environments.

Postural Control under Cognitive Load: Evidence of Increased Automaticity Revealed by Center-of-Pressure and Head Kinematics

How postural responses change with sensory perturbations while also performing a cognitive task is still debatable. This study investigated this question via comprehensive assessment of postural sway, head kinematics and their coupling. Twenty-three healthy young adults stood in tandem with eyes open or wearing the HTC Vive Head-Mounted Display (HMD) with a static or dynamic (i.e., movement in the anterior-posterior direction at 5 mm or 32 mm at 0.2 Hz) 3-wall stars display. On half of the trials, participants performed a cognitive serial subtraction task. Medio-lateral center-of-pressure (COP) path significantly increased with the cognitive task, particularly with dynamic visuals whereas medio-lateral variance decreased with the cognitive task. Head path and velocity significantly increased with the cognitive task in both directions while variance decreased. Head-COP cross-correlations ranged between 0.78 and 0.66. These findings, accompanied by frequency analysis, suggest that postural control switched to primarily relying on somatosensory input under challenging cognitive load conditions. Several differences between head and COP suggest that head kinematics contribute an important additional facet of postural control and the relationship between head and COP may depend on task and stance position. The potential of HMDs for clinical assessments of balance needs to be further explored.

Predicting Audiovisual Word Recognition in Noisy Situations: Toward Precision Audiology

OBJECTIVE

Spoken communication is better when one can see as well as hear the talker. Although age-related deficits in speech perception were observed, Tye-Murray and colleagues found that even when age-related deficits in audiovisual (AV) speech perception were observed, AV performance could be accurately predicted from auditory-only (A-only) and visual-only (V-only) performance, and that knowing individuals' ages did not increase the accuracy of prediction. This finding contradicts conventional wisdom, according to which age-related differences in AV speech perception are due to deficits in the integration of auditory and visual information, and our primary goal was to determine whether Tye-Murray et al.'s finding with a closed-set test generalizes to situations more like those in everyday life. A second goal was to test a new predictive model that has important implications for audiological assessment.

DESIGN

Participants (N = 109; ages 22-93 years), previously studied by Tye-Murray et al., were administered our new, open-set Lex-List test to assess their auditory, visual, and audiovisual perception of individual words. All testing was conducted in six-talker babble (three males and three females) presented at approximately 62 dB SPL. The level of the audio for the Lex-List items, when presented, was approximately 59 dB SPL because pilot testing suggested that this signal-to-noise ratio would avoid ceiling performance under the AV condition.

RESULTS

Multiple linear regression analyses revealed that A-only and V-only performance accounted for 87.9% of the variance in AV speech perception, and that the contribution of age failed to reach significance. Our new parabolic model accounted for even more (92.8%) of the variance in AV performance, and again, the contribution of age was not significant. Bayesian analyses revealed that for both linear and parabolic models, the present data were almost 10 times as likely to occur with a reduced model (without age) than with a full model (with age as a predictor). Furthermore, comparison of the two reduced models revealed that the data were more than 100 times as likely to occur with the parabolic model than with the linear regression model.

CONCLUSIONS

The present results strongly support Tye-Murray et al.'s hypothesis that AV performance can be accurately predicted from unimodal performance and that knowing individuals' ages does not increase the accuracy of that prediction. Our results represent an important initial step in extending Tye-Murray et al.'s findings to situations more like those encountered in everyday communication. The accuracy with which speech perception was predicted in this study foreshadows a form of precision audiology in which determining individual strengths and weaknesses in unimodal and multimodal speech perception facilitates identification of targets for rehabilitative efforts aimed at recovering and maintaining speech perception abilities critical to the quality of an older adult's life.

A systematic review of the neural correlates of multisensory integration in schizophrenia

Multisensory integration (MSI), in which sensory signals from different modalities are unified, is necessary for our comprehensive perception of and effective adaptation to the objects and events around us. However, individuals with schizophrenia suffer from impairments in MSI, which could explain typical symptoms like hallucination and reality distortion. Because the neural correlates of aberrant MSI in schizophrenia help us understand the physiognomy of this psychiatric disorder, we performed a systematic review of the current research on this subject. The literature search concerned investigated MSI in diagnosed schizophrenia patients compared to healthy controls using brain imaging. Seventeen of 317 identified studies were finally included. To assess risk of bias, the Newcastle-Ottawa quality assessment was used, and the review was written according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The results indicated that multisensory processes in schizophrenia are associated with aberrant, mainly reduced, neural activity in several brain regions, as measured by event-related potentials, oscillations, activity and connectivity. The conclusion is that a fronto-temporal region, comprising the frontal inferior gyrus, middle temporal gyrus and superior temporal gyrus/sulcus, along with the fusiform gyrus and dorsal visual stream in the occipital-parietal lobe are possible key regions of deficient MSI in schizophrenia.

High Sensory Responsiveness in Older Adults is Associated with Walking Outside but Not Inside: Proof of Concept Study

Background and Purpose

Reduced mobility and a higher risk of falls among older adults are related to aging-associated sensory alteration. Sensory responsiveness (SR) has been found to be strongly correlated with postural control in studies on young adults in stimulating environments; however, SR has not been studied in the context of mobility among older adults, despite its potential to enhance fall risks. The aim of the current study is to characterize the associations between SR and gait under single and dual-task (ST, DT) conditions inside and outside the laboratory.

Methods

Twenty-six community-dwelling older adults (age 70.3 ± 4.6 years, 65.4% women) participated in this cross-sectional study. Gait variables were measured using the APDM system under single and dual task conditions, in a quiet corridor inside and in an ecological (outside) environment. SR was evaluated using the SR questionnaire and cognition was assessed with the Trail-Making Test and the Montreal Cognitive Assessment.

Results

SR was negatively associated with gait speed during ST (r_s = −0.491, p < 0.05) and DT (r_s = −0.528, p < 0.01) outside and with ST gait speed inside (r_s = −0.528, p < 0.01). SR was positively associated with gait variability under DT (r_s = 0.41, p < 0.05) and with DT cost (r_s = 0.44, p < 0.05) only outside.

Conclusion

SR may play an important role in understanding mobility deterioration throughout the aging process, especially outside, illuminating the importance of SR evaluation among older adults during mobility assessment. Therefore, accounting for SR in gait research may contribute to a better understanding of mobility decline throughout the aging process.

Can Haptic Stimulation Enhance Music Perception in Hearing-Impaired Listeners?

Cochlear implants (CIs) have been remarkably successful at restoring hearing in severely-to-profoundly hearing-impaired individuals. However, users often struggle to deconstruct complex auditory scenes with multiple simultaneous sounds, which can result in reduced music enjoyment and impaired speech understanding in background noise. Hearing aid users often have similar issues, though these are typically less acute. Several recent studies have shown that haptic stimulation can enhance CI listening by giving access to sound features that are poorly transmitted through the electrical CI signal. This “electro-haptic stimulation” improves melody recognition and pitch discrimination, as well as speech-in-noise performance and sound localization. The success of this approach suggests it could also enhance auditory perception in hearing-aid users and other hearing-impaired listeners. This review focuses on the use of haptic stimulation to enhance music perception in hearing-impaired listeners. Music is prevalent throughout everyday life, being critical to media such as film and video games, and often being central to events such as weddings and funerals. It represents the biggest challenge for signal processing, as it is typically an extremely complex acoustic signal, containing multiple simultaneous harmonic and inharmonic sounds. Signal-processing approaches developed for enhancing music perception could therefore have significant utility for other key issues faced by hearing-impaired listeners, such as understanding speech in noisy environments. This review first discusses the limits of music perception in hearing-impaired listeners and the limits of the tactile system. It then discusses the evidence around integration of audio and haptic stimulation in the brain. Next, the features, suitability, and success of current haptic devices for enhancing music perception are reviewed, as well as the signal-processing approaches that could be deployed in future haptic devices. Finally, the cutting-edge technologies that could be exploited for enhancing music perception with haptics are discussed. These include the latest micro motor and driver technology, low-power wireless technology, machine learning, big data, and cloud computing. New approaches for enhancing music perception in hearing-impaired listeners could substantially improve quality of life. Furthermore, effective haptic techniques for providing complex sound information could offer a non-invasive, affordable means for enhancing listening more broadly in hearing-impaired individuals.

Gait Speed Modulations Are Proportional to Grades of Virtual Visual Slopes-A Virtual Reality Study

Gait is a complex mechanism relying on integration of several sensory inputs such as vestibular, proprioceptive, and visual cues to maintain stability while walking. Often humans adapt their gait to changes in surface inclinations, and this is typically achieved by modulating walking speed according to the inclination in order to counteract the gravitational forces, either uphill (exertion effect) or downhill (braking effect). The contribution of vision to these speed modulations is not fully understood. Here we assessed gait speed effects by parametrically manipulating the discrepancy between virtual visual inclination and the actual surface inclination (aka visual incongruence). Fifteen healthy participants walked in a large-scale virtual reality (VR) system on a self-paced treadmill synchronized with projected visual scenes. During walking they were randomly exposed to varying degrees of physical-visual incongruence inclinations (e.g., treadmill leveled & visual scene uphill) in a wide range of inclinations (−15° to +15°). We observed an approximately linear relation between the relative change in gait speed and the anticipated gravitational forces associated with the virtual inclinations. Mean relative gait speed increase of ~7%, ~11%, and ~17% were measured for virtual inclinations of +5°, +10°, and +15°, respectively (anticipated decelerating forces were proportional to sin[5°], sin[10°], sin[15°]). The same pattern was seen for downhill virtual inclinations with relative gait speed modulations of ~-10%, ~-16%, and ~-24% for inclinations of −5°, −10°, and −15°, respectively (in anticipation of accelerating forces). Furthermore, we observed that the magnitude of speed modulation following virtual inclination at ±10° was associated with subjective visual verticality misperception. In conclusion, visual cues modulate gait speed when surface inclinations change proportional to the anticipated effect of the gravitational force associated the inclinations. Our results emphasize the contribution of vision to locomotion in a dynamic environment and may enhance personalized rehabilitation strategies for gait speed modulations in neurological patients with gait impairments.