Neural Regeneration Research ›› 2025, Vol. 20 ›› Issue (1): 82-92.doi: 10.4103/NRR.NRR-D-23-01484

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Multisensory mechanisms of gait and balance in Parkinson’s disease: an integrative review

Stiven Roytman1, *, Rebecca Paalanen2, Giulia Carli2, 3, Uros Marusic4, 5, Prabesh Kanel1, 3, 6, Teus van Laar7, Nico I. Bohnen1, 2, 3, 6, 8   

  1. 1Department of Radiology, University of Michigan, Ann Arbor, MI, USA; 2Department of Neurology, University of Michigan, Ann Arbor, MI, USA; 3Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI, USA; 4Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia; 5Department of Health Sciences, Alma Mater Europaea – ECM, Maribor, Slovenia; 6Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, USA; 7Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 8Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
  • Online:2025-01-15 Published:1900-01-01

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Abstract: Understanding the neural underpinning of human gait and balance is one of the most pertinent challenges for 21st-century translational neuroscience due to the profound impact that falls and mobility disturbances have on our aging population. Posture and gait control does not happen automatically, as previously believed, but rather requires continuous involvement of central nervous mechanisms. To effectively exert control over the body, the brain must integrate multiple streams of sensory information, including visual, vestibular, and somatosensory signals. The mechanisms which underpin the integration of these multisensory signals are the principal topic of the present work. Existing multisensory integration theories focus on how failure of cognitive processes thought to be involved in multisensory integration leads to falls in older adults. Insufficient emphasis, however, has been placed on specific contributions of individual sensory modalities to multisensory integration processes and cross-modal interactions that occur between the sensory modalities in relation to gait and balance. In the present work, we review the contributions of somatosensory, visual, and vestibular modalities, along with their multisensory intersections to gait and balance in older adults and patients with Parkinson’s disease. We also review evidence of vestibular contributions to multisensory temporal binding windows, previously shown to be highly pertinent to fall risk in older adults. Lastly, we relate multisensory vestibular mechanisms to potential neural substrates, both at the level of neurobiology (concerning positron emission tomography imaging) and at the level of electrophysiology (concerning electroencephalography). We hope that this integrative review, drawing influence across multiple subdisciplines of neuroscience, paves the way for novel research directions and therapeutic neuromodulatory approaches, to improve the lives of older adults and patients with neurodegenerative diseases.

Key words: aging, balance, encephalography, functional magnetic resonance imaging, gait, multisensory integration, Parkinson’s disease, positron emission tomography, somatosensory, vestibular, visual