Review ArticleHearing, self-motion perception, mobility, and aging
Introduction
Hearing helps us to know where we are relative to important events and objects in our environment and it allows us to track our changing position dynamically over space and time. As such, auditory cues are used in combination with other sensory inputs (visual, vestibular, proprioceptive) to help us perceive our own movements through space, known as self-motion perception. Whether we are maintaining standing balance, walking, or driving, audition can provide unique and important information to help optimize self-motion perception, and consequently to support safe mobility. While other sensory systems have been well-studied in the context of self-motion perception and mobility, the auditory system has received far less attention. However, there is growing interest in pursuing empirical research directed towards understanding the role of hearing on mobility-related behaviors and the effects that hearing loss has on these critical abilities. Part of this interest has been prompted by recent epidemiological and experimental studies providing consistent and convincing evidence that hearing loss (notably in older adults) is associated with greater walking difficulties, poorer overall physical functioning, and a significantly increased risk of falling (Agmon et al., 2017; Chen et al., 2015; Jiam et al., 2016; Kamil et al., 2016; Lin and Ferrucci, 2012; Mikkola et al., 2015; Viljanen et al., 2009; Viljanen et al., 2009). Importantly, the mechanisms underlying the associations between hearing status and mobility are poorly understood. It is also critical to consider that age-related hearing loss is often concomitant with declines in other sensory, motor, and cognitive functions and that these declines may interact, particularly during realistic, everyday tasks. Indeed, hearing loss is associated with an increased risk of dementia and has recently been identified as one of the top potentially preventable risk factors for developing dementia (Albers et al., 2015; Lin et al., 2011, 2013; Livingston et al., 2017; Martini et al., 2014). Overall, exploring the role of auditory cues and the effects of hearing loss on self-motion perception specifically, and mobility more generally, is important to both building fundamental knowledge on the perceptual processes underlying the ability to perceive our movements through space, as well as to optimizing mobility-related interventions for those with hearing loss so that they can function better when confronted by everyday, real world, sensory-motor challenges.
The goal of this paper is to explore the role of hearing in self-motion perception across a range of mobility-related behaviors. First, we briefly review the ways in which auditory cues are used to perceive self-motion (alone and when combined with other sensory inputs) and how hearing affects behaviors such as standing balance, walking, and driving. Next, we consider how age-related changes in hearing can affect the ability to use relevant auditory cues to perceive self-motion and the potential consequences of age-related changes in auditory processing to the performance of mobility-related tasks. We then describe how hearing loss is associated with declines in mobility-related abilities and increased adverse outcomes such as falls. We describe age-related changes to other sensory and cognitive functions and how these may interact with hearing loss in ways that affect mobility. Finally, we briefly consider the implications of hearing-mobility associations with respect to applied domains such as screening for mobility problems and falls risk in those with hearing loss and developing interventions and training approaches targeting safe and independent mobility throughout the lifespan.
Section snippets
Auditory cues supporting self-motion perception
Of all the sensory systems that contribute the perception of self-motion, including visual, vestibular, tactile, and proprioceptive inputs, audition is by far the least studied. However, hearing clearly provides important information about the environment and about our own movement relative to the environment. This information can be useful for maintaining balance, remaining oriented in space, and directing targeted movement behaviors (e.g., moving towards a goal or avoiding an obstacle). To
Age-related changes to the use of auditory cues relevant for self-motion perception
Although there is a wealth of research examining the perceptual, behavioral and social effects of age-related hearing loss, there is a dearth of research specifically investigating age-related changes to auditory spatial motion perception. Age-related hearing loss can reduce older adults’ abilities to use auditory cues that are important for self-motion perception, including reduced audibility of high-frequency sounds and age-related declines in sensitivity to ITDs and ILDs (see Carlile and
Consequences of hearing loss to mobility-related outcomes
Everyday mobility-related activities like walking and driving are complex and involve multisensory and multitasking abilities that rely on temporally and spatially precise sensory and cognitive processing. As described above, age-related hearing loss can result in a reduced ability to perceive different properties of self-motion, but aging is also likely to change the way in which different sensory inputs are integrated or utilized. Furthermore, age-related hearing loss can affect the way that
Implications and future directions
In general, evidence points to a need to screen routinely for mobility problems and falls risk in older adults with hearing loss. Similarly, those attending falls clinics due to a history of, or increased risk of falls, should have their hearing assessed in addition to assessments of other sensory (visual, vestibular, tactile), motor, and cognitive functions. The design and implementation of hearing devices such as cochlear implants and hearing aids should consider how different types of signal
Funding
This work was supported by the Natural Sciences and Engineering Research Council of Canada Discovery Grant, RGPIN-2015-06619 (Campos).
We declare no competing or conflicts of interests.
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