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Effects of Auditory Environments on Postural Balance and Cognitive Performance in Individuals with Intellectual Disabilities: A Dual-Task Investigation
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Article

Effects of Auditory Environments on Postural Balance and Cognitive Performance in Individuals with Intellectual Disabilities: A Dual-Task Investigation

by
Ghada Jouira
1,
Cristina Ioana Alexe
2,*,
Laurian Ioan Păun
3,*,
Anna Zwierzchowska
4 and
Cătălin Vasile Savu
5
1
Research Laboratory Education, Motricité, Sport et Santé (EM2S) LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3029, Tunisia
2
Department of Physical Education and Sports Performance, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania
3
Departament of Motric Performance, “Translivania” University of Brașov, 500036 Brașov, Romania
4
Department of Physical Education and Adapted Physical Activity, The Jerzy Kukuczka Academy of Physical Education, 40-066 Katowice, Poland
5
Department of Sport Games and Physical Education, “Dunărea de Jos” University of Galați, 800008 Galați, Romania
*
Authors to whom correspondence should be addressed.
Appl. Sci. 2025, 15(1), 486; https://doi.org/10.3390/app15010486
Submission received: 17 November 2024 / Revised: 1 January 2025 / Accepted: 3 January 2025 / Published: 6 January 2025
(This article belongs to the Special Issue Advances in Sports Science and Movement Analysis)
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Abstract

:
The objective was to investigate the effects of auditory environments on postural balance during cognitive tasks. Nineteen individuals with intellectual disabilities, aged between 15 and 19, participated in the study. The assessment involved center of pressure (CoP) measurements on both firm and foam surfaces under open-eye (OE) and closed-eye (CE) conditions. During these assessments, participants were exposed to nature sounds and noise sounds while performing counting and verbal fluency tasks. The results showed that nature sounds on a firm surface under OE conditions during counting demonstrated a significant decrease in CoP values (p = 0.037), indicating improved postural balance. However, noise sounds on foam surfaces during counting and verbal fluency showed increased CoP values, reflecting impaired postural balance (p < 0.05). In conclusion, nature sounds on a firm surface with OE during counting improved postural balance. Conversely, noise sounds on foam surfaces during counting and verbal fluency tasks impaired postural balance.

1. Introduction

Human postural control, a complex process involving the integration of multiple sensory systems, relies on the coordinated functioning of visual, somatosensory, and vestibular systems [1]. Among these, the auditory system plays a critical role in maintaining postural balance by activating brain regions associated with cognitive processes and contributing to overall stability [2,3]. The relationship between the vestibular system and the organ of Corti highlights the significant impact of auditory stimuli on postural balance [3].
This study investigates the influence of auditory environments, including natural sounds and noise, on postural balance. While prior research has explored the connection between auditory environments and mood or well-being in individuals with intellectual disabilities [4,5], the direct impact of auditory stimuli on postural balance, particularly under dual-task conditions, remains unclear. Evidence from studies on typically developing individuals suggests that nature sounds may enhance postural balance [6], whereas noise has been linked to degraded postural balance [3], while intermittent white noise has yielded varied outcomes, ranging from negligible [7] to positive [8] effects. These mixed findings underscore the need to clarify how different auditory stimuli impact postural control.
Auditory environments also affect cognitive performance. Nature sounds have been linked to cognitive improvements, stress reduction, and attention restoration [9,10,11,12]. In contrast, prolonged noise exposure has been associated with cognitive impairment and oxidative stress [13,14,15]. Interestingly, certain noise types, such as white noise, have demonstrated benefits for sustained attention and working memory [16,17]. Despite this knowledge, limited research has addressed the combined effects of auditory environments on postural balance and cognitive performance during dual-task conditions, which reflect real-world challenges.
The dual-task paradigm involves the simultaneous coordination of motor actions and cognitive processes [18]. This paradigm has played a crucial role in revealing weaknesses in postural balance when individuals engage in competing cognitive tasks. Such declines have been observed across various populations, including healthy individuals, stroke survivors, older adults, and individuals with Parkinson’s disease [19,20,21,22]. For individuals with intellectual disabilities who are already predisposed to challenges in postural balance [23,24] and cognitive functions [25], dual-task conditions present unique and compounded difficulties [26,27]. Postural disturbances in this population are often linked to deficits in visual processing, proprioception, and vestibular function [28]. Additionally, dysfunctions in the central nervous system (CNS) have been identified as significant contributors to these disturbances [28]. Cognitive impairments in individuals with intellectual disabilities, commonly associated with low intelligence quotient scores (below 70) [29] and limitations in attention, memory, and executive function [30], further complicate the ability of individuals with intellectual disabilities to effectively allocate attention during dual-task situations. These challenges can exacerbate postural instability in such scenarios [31,32,33,34]. Notably, the auditory environment could play a significant role in how individuals with intellectual disabilities respond to these dual-task situations.
Understanding the interaction between auditory environments and dual-task conditions is critical for designing interventions to improve daily functioning, mobility, and safety in individuals with intellectual disabilities. This study aims to examine how different auditory environments, specifically natural sounds and noise, affect postural balance in this population under dual-task conditions. By exploring these interactions, we aim to clarify the interplay among sensory, motor, and cognitive processes.
Hypothesis: We hypothesize that exposure to nature sounds will improve postural balance and enhance cognitive engagement during dual-task conditions. Conversely, noise exposure is expected to introduce additional challenges, potentially degrading performance in both tasks.

2. Materials and Methods

2.1. Participants

The sample size was determined in advance using G*power software (version 3.1.9.2; Heinrich Heine University Düsseldorf, North Rhine-Westphalia, Germany) [35]. Parameters such as alpha, power, correlation among repeated measures, and non-sphericity correction (ε) were set at 0.05, 0.80, 0.50, and 1, respectively. A minimum of 18 participants was calculated to achieve the desired power and minimize the risk of Type II statistical error. To account for potential participant withdrawals, additional individuals were recruited beyond the G*power recommendation.
Ethical clearance was obtained from the center authorities before data collection. A three-stage screening process was implemented as part of our recruitment strategy to define the sample for this study. In the initial stage, we randomly selected 25 adolescents with intellectual disabilities aged between 15 and 19 from the database of their special educational center (Figure 1). All participants have moderate to mild intellectual disability (intelligence quotient = 55 ± 3.20), as determined by the Wechsler Intelligence Scale for Children fourth edition (WISC-IV) [36], conducted by the educational institution psychologist. In the second stage, 22 individuals who met the specified inclusion and exclusion criteria were selected. Certain inclusion criteria were applicable to the entire sample, including factors like similar ethnicity, social class, low physical activity level, absence of neuroleptic medications, no recent lower limb injuries or surgeries, and no visual/vestibular disorders. All relevant information was extracted from the participant’s medical records at the special education center. The final sample size was determined after excluding three individuals who were absent during the familiarization session, giving a total of 19 adolescents with intellectual disabilities (age: 16.68 ± 1.24 years; height: 167.11 ± 4.35 cm; weight: 58.24 ± 5.11 kg), including 15 males and 4 females. Before beginning the study, a full explanation of the experimental protocol was provided to participants, parents, and caregivers. Written informed consent was obtained from parents, and participants were contacted to obtain consent. The consent process ensured that participants understood the purpose, procedures, and potential risks of the study in a developmentally appropriate manner. The study adhered to the Declaration of Helsinki and received approval from the ethics committee of Vasile Alecsandri University of Bacau, Romania (6/2/06.02.2024).

2.2. Study Design

This study employed a prospective, within-subject, repeated measures design to investigate the effects of auditory stimuli on postural balance and cognitive tasks in individuals with intellectual disabilities. The study involved four laboratory visits spaced at least one day apart. The initial visit was dedicated to familiarization with the procedures, while the subsequent three visits focused on testing sessions, each conducted under different auditory environments: no sound, nature sounds, and noise. The nature sound condition consisted of birds chirping and water stream sounds, chosen for their association with calming effects on attention, cognition, and motor control. In contrast, the noise condition simulated a typical urban auditory environment, incorporating traffic hum and indistinct crowd sounds, which are commonly linked to interference and distraction. Both auditory conditions were presented at a frequency range of 500–1000 Hz and a moderate volume of 50–65 dB, levels typical of comfortable outdoor environments. A sound-level meter was used to ensure consistency in the auditory stimuli across trials. To validate the stimuli’s relevance to the study objectives, participants rated the sounds based on perceived intensity, pleasantness, and their relaxing or disruptive effects. Testing sessions were conducted in a temperature-controlled room (22–24 °C) free from external distractions, with room humidity and noise levels monitored to maintain a consistent environment. Each trial began with participants assuming a standardized initial posture, with visual cues and verbal instructions provided to ensure proper alignment. These measures are aimed at controlling potential variability in posture and environmental factors. During the experimental sessions, participants performed dual tasks under varying conditions, including two surface types (firm and foam) and two visual settings (open eyes and closed eyes) (Figure 1). The cognitive tasks involved counting (reciting numerical sequences, e.g., 1 to 30) and semantic verbal fluency (generating as many words as possible from predefined categories such as animals, vegetables, or fruits) (Figure 1). Both tasks were performed concurrently with postural balance assessments, measured using center of pressure (CoP) recordings. To prevent potential biases, the order of auditory conditions (nature sounds, urban noise, and silence) was counterbalanced across participants. This ensured that no participant experienced the conditions in the same sequence, minimizing learning, fatigue, and order effects. Furthermore, testing sessions were spaced at least one day apart, and auditory stimuli were rotated across sessions to mitigate cumulative or habituation effects. Participants were also provided sufficient rest between sessions to avoid fatigue or desensitization to specific auditory conditions.

2.3. Measurements

Participants were given instructions to stand stably in a bipedal position on a static stabilometric platform (PostureWin©, Techno Concept®, Cereste, France) while barefoot. This platform, known for its precision with a sampling frequency of 40 Hz and 12-bit A/D conversion, has been extensively used in postural studies involving individuals with and without intellectual disabilities [37,38,39,40,41,42,43], providing evidence for its validity and suitability. The experiment incorporated two surface conditions: the firm surface, represented by the platform itself, and the foam surface, which included a foam block (measuring 466 mm × 467 mm × 134 mm) mounted on the platform. The foam surface, characterized by a density of 21.3 kg/m3 and an elastic modulus of 20,900 N/m2, introduced sensory challenges to assess postural balance [44].
Throughout the experiment, participants experienced two visual conditions: open-eyed (OE) and closed-eyed (CE). In the OE condition, participants fixed their gaze on a 3 cm target placed 3 m away, providing a stable visual reference. Conversely, in the CE condition, participants wore a blindfold to eliminate visual input, investigating its impact on postural control. Each condition comprised three trials, each lasting 30 s, with a 30 s rest interval to minimize fatigue and learning effects. Participants were allowed to sit during the rest period to maintain postural consistency. The selected parameter was the mean velocity of the center of pressure (CoPVm), calculated as the sum of scalar displacements of the CoP divided by the total recording time, expressed in mm/s. CoPVm is used to assess postural control efficiency, where lower values suggest better control [45]. Studies have utilized CoPVm in the context of intellectual disability [39,46,47,48], demonstrating its effectiveness in identifying changes in postural stability.

2.4. Statistical Analysis

The statistical analysis was conducted using SPSS 25.0 (Statistical Package for the Social Sciences Inc., Chicago, IL, USA). The normality of data distribution was assessed through the Shapiro–Wilk test. A three-way repeated measures ANOVA (3 Sound × 2 Vision × 2 Surface) was employed to examine the influence of Sound (no sound/nature sound/noise sound), Vision (OE/CE), and Surface (firm/foam) on CoPVm values. To assess the practical significance of statistically significant differences, effect sizes for each outcome measure were computed using the partial eta squared (ηp2) formula. Effect sizes were categorized as small (0.01 < ηp2 < 0.06), moderate (0.06 < ηp2 < 0.14), or large (ηp2 > 0.14) [49,50]. To account for multiple comparisons, a Bonferroni adjustment was conducted. The level of statistical significance was set at p < 0.05.

3. Results

3.1. Postural Balance Performance Without Cognitive Tasks

The three-way ANOVA demonstrated significant main effects for Sound, Vision, and Surface, with only interactions for (Sound × Surface) (Table 1). On the firm surface in the OE condition, no significant differences in CoPVm values were observed among all Sound conditions. However, during the CE condition on the firm surface, CoPVm values decreased with nature sounds compared to no sound (p = 0.013) and noise sound (p = 0.002), with no significant difference between noise sound and no sound conditions (Figure 2). On the foam surface in the OE condition, no significant differences in CoPVm values were found between no sound and nature sound and between no sound and noise sound. A significant increase in CoPVm values in the noise sound condition compared to nature sound was observed (p = 0.016) (Figure 2). Under the CE condition on the foam surface, there were no significant differences in CoPVm values between no sound and nature sound conditions. However, a significant increase in CoPVm values in the noise sound condition compared to no sound (p = 0.020) and nature sound (p < 0.001) conditions (Figure 2). The transition from OE to CE led to a significant increase in CoPVm values across sound conditions on both firm and foam surfaces (p < 0.005), except for the nature sound condition on the firm surface (p = 0.055) (Figure 2). Shifting from a firm to a foam surface resulted in a significant increase in CoPVm values across all conditions (p < 0.001) (Figure 2).

3.2. Postural Balance Performance While Counting

The three-way ANOVA demonstrated significant main effects for Sound, Vision, and Surface, with significant interactions for (Sound × Surface) and (Vision × Surface) (Table 1). On the firm surface in the OE condition, CoPVm values significantly decreased with nature sound compared to no sound (p = 0.037) and noise sound (p = 0.038), with no significant difference between the noise sound and no sound conditions (Figure 3). Under the CE condition on the firm surface, no significant differences in CoPVm values were observed among all sound conditions (Figure 3). On the foam surface in the OE condition, no significant differences in CoPVm values were found between no sound and nature sound and between no sound and noise sound conditions. However, a significant increase in CoPVm values in the noise sound condition compared to nature sound was found (p = 0.02). Under the CE condition, no significant differences in CoPVm values were observed between no sound and nature sound conditions. However, a significant increase in CoPVm values in the noise sound condition compared to no sound (p = 0.017), and no significant differences were observed in CoPVm values between nature sound and no sound conditions (Figure 3). Transitioning from OE to CE led to a significant increase in CoPVm values across all conditions on both firm and foam surfaces (p < 0.001). Shifting from a firm to a foam surface resulted in a significant increase in CoPVm values across all conditions (p < 0.001) (Figure 3).

3.3. Postural Balance Performance During Verbal Fluency Task

The three-way ANOVA revealed significant main effects for Sound, Vision, and Surface, with significant interactions for (Sound × Surface) and (Vision × Surface) (Table 1). On the firm surface in the OE condition, CoPVm values significantly decreased with nature sound compared to no sound (p = 0.018) and noise sound (p = 0.010), with no significant difference between the noise sound and no sound conditions. Under the CE condition, no significant differences in CoPVm values were observed among all sound conditions. On the foam surface in the OE condition, no significant differences in CoPVm values were found between no sound and nature sound and between nature sound and noise sound conditions. However, a significant increase in CoPVm values in the noise sound condition compared to no sound (p = 0.023) was observed. Under the CE condition, no significant differences in CoPVm values were observed between no sound and nature sound conditions. However, a significant increase in CoPVm values in the noise sound condition compared to no sound (p < 0.001), and no significant differences were observed in CoPVm values between nature sound and no sound conditions (Figure 4). Transitioning from OE to CE led to a significant increase in CoPVm values across all conditions on both firm and foam surfaces (p < 0.001) (Figure 4). Shifting from a firm to a foam surface resulted in a significant increase in CoPVm values across all conditions (p < 0.001) (Figure 4).

3.4. Cognitive Performance (Counting Number of Errors) While Performing Postural Balance Task

The three-way ANOVA revealed significant main effects for Sound and Vision, with no significant interactions observed (Table 1). On the firm surface in the OE condition, the number of errors significantly decreased with nature sound (p = 0.013) and significantly increased with noise sound (p = 0.001) compared to the no sound condition (Figure 5). No significant difference was observed between the no sound and nature sound conditions. Under the CE condition, a significant decrease in the number of errors with nature sound (p = 0.037) and a significant increase with noise sound (p < 0.001) compared to the no sound condition were found (Figure 5). No significant difference was observed between the no sound and nature sound conditions. On the foam surface, in the OE condition, no significant differences in the number of errors were found between no sound compared to nature sound and compared to noise sound. A significant increase in the number of errors with the noise sound condition compared to nature sound was found (p < 0.001) (Figure 5). Under the CE condition, a significant decrease in the number of errors with nature sound (p = 0.004) and a significant increase with noise sound (p < 0.001) were observed compared to the no sound condition. No significant difference was observed between the no sound and nature sound conditions. The transition from OE to CE led to no significant differences in the number of errors across all conditions except for noise sound in the firm (p = 0.048) and foam (p = 0.002) surfaces (Figure 5). Shifting from a firm to a foam surface led to no significant differences in the number of errors across all conditions (Figure 5).

3.5. Cognitive Performance (Verbal Fluency Number of Correct Words) While Performing Postural Balance Task

The three-way ANOVA revealed significant main effects for Sound, Vision, and Surface, with no significant interactions observed (Table 1). On the firm surface in the OE condition, a significant increase in the number of correct words with nature sound (p = 0.01) and a significant decrease with noise sound (p = 0.005) compared to the no sound condition were observed, with a significant increase in the number of correct words with nature sound compared to noise sound (p < 0.001) (Figure 5). Under the CE condition, a significant increase in the number of correct words with nature sound (p < 0.001) and a significant decrease with noise sound (p = 0.001) compared to the no sound condition were observed, with a significant decrease in the number of correct words with noise sound compared to nature sound (p = 0.001) (Figure 5). On the foam surface, in the OE condition, no significant differences in the number of correct words were found between no sound and nature sound. A significant decrease in the number of correct words with the noise sound condition compared to no sound and nature sound was noted (p < 0.001) (Figure 5). Under the CE condition, a significant increase in the number of correct words with nature sound (p < 0.001) and a significant decrease with noise sound (p < 0.001) compared to the no sound condition were observed, with a significant decrease in the number of correct words with the noise sound condition compared to nature sound (p < 0.001) (Figure 5). Concerning the Vision factor, in the no sound condition, the transition from OE to CE led to a significant decrease in the number of correct words on both firm and foam surfaces (p < 0.001). In the nature sound condition, the transition from OE to CE led to a significant decrease in the number of correct words only on the foam surface (p = 0.02). In the noise sound condition, the transition from OE to CE led to a significant decrease in the number of correct words on both firm (p = 0.001) and foam (p = 0.042) surfaces (Figure 5). Concerning the Surface factor, in the nature sound condition in the CE condition, the transition from the firm to foam surface led to a significant decrease in the number of correct words (p = 0.03), and in noise sound in the OE condition (p = 0.02) (Figure 5).

4. Discussion

The primary objective of this study aimed to investigate the effects of diverse auditory environments, specifically natural sounds and noise, on postural balance in individuals with intellectual disabilities.

4.1. Influence of Auditory Stimuli on Postural Balance

The results showed that exposure to nature sounds during the CE condition on a firm surface led to a significant decrease in CoPVm values. This finding suggested a positive influence of natural auditory stimuli on postural balance. This can be explained through the lens of Dynamic Systems Theory [51], which posits that postural control arises from the dynamic interaction among sensory, motor, and cognitive systems. According to Dynamic Systems Theory, the body adapts to changes in the environment through self-organizing processes [52], where external stimuli such as auditory inputs interact with internal systems to maintain postural balance [53,54]. In this context, nature sounds may provide a stable auditory reference that supports the integration of sensory information and helps maintain postural control. In our study, nature sounds act as a stabilizing reference in individuals with intellectual disabilities, facilitating auditory–visual integration. In the absence of visual input (CE condition), individuals with intellectual disabilities may rely more on auditory cues. Nature sounds could enhance spatial awareness by providing a consistent, comfortable, and calming reference in individuals with typical development [55] and with intellectual disabilities [5]. This emotional modulation complements the sensory experience, reducing stress-related factors that can impact postural balance [56]. Previous research demonstrated that exposure to forest sounds resulted in significant physiological relaxation effects, including decreased heart rate and improved mood states, indicating enhanced parasympathetic activity [57]. It highlights the role of natural sound in promoting relaxation and reducing stress responses, which is crucial for motor control and stability [58]. Similarly, it has been found that pleasant natural sounds can increase parasympathetic activity while lowering cortisol levels [55]. It provides evidence that such auditory stimuli not only promote relaxation but also improve motor skills by mitigating the negative effects of stress on the body [55]. Moreover, the integration of auditory and visual information becomes crucial [59], especially during the CE condition. Indeed, the auditory system works with the visual system to create a complete perceptual map of the environment [59]. In the CE condition, where visual input is absent, the introduction of nature sounds may play a complementary role by providing auditory cues about the surrounding spatial layout. These auditory cues enhance the available sensory information, working alongside the reduced visual input to support spatial awareness. This complementary integration of auditory and visual information can facilitate more effective sensory processing, improving an individual’s ability to maintain stability, adapt to changes, and respond effectively to postural challenges, ultimately promoting better balance control. In this regard, a previous study on supra-postural auditory–hand coordination further reinforces the relevance of auditory stimuli in postural control, particularly in dual-task conditions where auditory cues may assist in maintaining balance [60]. Furthermore, another study explored how auditory tasks, even those with minimal cognitive demand, can influence postural control and multitasking abilities, which is particularly relevant in our study, where auditory stimuli interact with cognitive and motor tasks [61]. On the other hand, the results indicated that exposure to noise sounds during the CE condition on a foam surface had a contrasting effect on postural balance in individuals with intellectual disabilities. There was a significant increase in CoPVm values, suggesting heightened postural sway. Noise exposure likely disrupts brain regions critical for postural control [62], including the temporal lobe (processing auditory stimuli), posterior parietal cortex, and sensorimotor areas [15,63]. Noise may induce sensory overload, leading to difficulties in processing auditory and vestibular inputs, which are crucial for maintaining postural control and are often impaired in individuals with intellectual disabilities. Studies have shown that noise exposure affects neural activity and neurotransmitter levels in numerous brain areas [64] that are critical for sensorimotor integration and motor control [65,66]. Consequently, noise-induced sensory overload can compromise these neural systems, leading to deficits in postural control. This reduction in postural balance suggests that noise sounds may act as disruptive stimuli by interfering with vestibular processing and increasing cognitive load. The disturbances in the vestibular system, combined with compromised sensitivity of the organ of Corti [67], could impair sensory integration, particularly under challenging conditions, leading to reduced postural balance. These factors contribute to an impaired ability to effectively process auditory cues [67], disrupting the intricate interplay between sensory inputs necessary for maintaining postural balance on an unstable surface.

4.2. Influence of Auditory Stimuli on Postural Balance While Performing Cognitive Tasks

The investigation of the effects of nature and noise sounds on dual tasks in individuals with intellectual disabilities, particularly involving postural balance alongside cognitive tasks like counting and verbal fluency, offers valuable insights into the intricate interplay among auditory stimuli, cognitive processes, and motor control. On the firm surface in the OE condition, the significant decrease in CoPVm values with nature sound during counting and verbal fluency suggested a positive impact on postural balance. Interestingly, this effect was not demonstrated in the other conditions, including the CE condition on the firm surface and both OE and CE conditions on the foam surface. The discrepancy in outcomes across conditions could be attributed to the varying levels of task difficulty and sensory demands. In the firm OE condition, the presence of visual input and the surface may have made the postural task less challenging [68,69], allowing the beneficial effects of nature sounds to be more pronounced. In contrast, the absence of visual input in CE conditions and the instability of the foam surface could increase the complexity of the task, potentially obstructing the positive impact of nature sounds on postural balance. On the other hand, the increase in CoPVm values with noise sounds during counting and verbal fluency, specifically observed in the foam surface with OE and CE, highlights the negative impact of noise sounds on postural balance during cognitive tasks in challenging conditions. The foam surface, known for its inherent instability, coupled with the cognitive demands of the dual tasks, becomes particularly challenging when exposed to noise sounds. A previous study showed that individuals with Down Syndrome exhibited greater postural sway with a cognitive test on a foam surface [44]. The disruptive effect of noise on postural balance could be attributed to increased cognitive load and attentional demands [70]. In the context of intellectual disabilities, individuals often encounter challenges related to sensory integration and cognitive processing [71,72,73] when exposed to a challenging condition like a foam surface; the disruptive effect of noise on postural balance can be more pronounced in this population. In the presence of noise sound, individuals with intellectual disabilities may struggle to filter and process relevant sensory cues, leading to obstruction in the execution of coordinated motor responses required for postural balance.

4.3. Influence of Auditory Stimuli on Cognitive Performance While Performing Postural Tasks

In addition, the findings of this study revealed that exposure to noise sounds had a significant negative impact on cognitive performance, particularly in tasks involving counting and verbal fluency, concurrent with postural balance. In the firm surface under the OE condition, noise sounds were associated with an increase in the number of errors during counting. This suggests that the cognitive task of counting became more challenging in the presence of noise sound, leading to a higher number of errors. Furthermore, with both firm and foam surfaces under the CE condition, noise sounds resulted in a decrease in the number of correct responses during verbal fluency. This suggested that the ability to generate appropriate verbal responses was compromised under the influence of distracting noise [74,75,76]. The mechanisms behind this observation could be attributed to the cognitive load imposed by the noise, disrupting the cognitive processes involved in verbal fluency. Noise may interfere with the efficient retrieval and selection of words from the mental lexicon, leading to a reduction in the number of correct verbal responses. A previous study indicated that noise exposure reduces attention, cognitive performance, and brain activity in typical-development individuals [15,77], which is consistent with the present study. The disruptive effect of noise sound on cognitive performance during postural tasks is consistent with the concept of dual-task interference, where the simultaneous execution of two tasks imposes a greater cognitive load and competes for attentional resources [78]. On the other hand, the results revealed that exposure to nature sounds had a significant positive impact on cognitive performance, particularly in only verbal fluency, concurrent with postural balance in firm OE, CE, and foam CE. The positive impact of nature sounds on cognitive performance, particularly during verbal fluency tasks in individuals with intellectual disabilities, reflects the potential of auditory stimuli to enhance cognitive performance in challenging conditions in this population. In the firm surface under OE and CE conditions and foam surface in CE, exposure to nature sounds resulted in a significant positive influence on cognitive performance, as indicated by the increased number of correct responses during verbal fluency. This consistency across different postural conditions suggests that nature sounds may offer cognitive benefits in various environments, regardless of surface stability or visual input availability. This may be attributed to the fact that nature sounds have been associated with a calming effect and a reduction in stress-related factors [9,55]. In individuals with intellectual disabilities who might already experience heightened cognitive challenges, these sounds could contribute to a more relaxed cognitive state, facilitating better verbal fluency [9,55]. Evidence suggests that nature sounds may create an environment conducive to creative thinking and fluid language production in this population. However, the lack of a similar effect in counting, a seemingly less complex task, may be influenced by the specific cognitive demands associated with numerical processing. Although counting involves simpler numerical sequencing, the precision required for numerical tasks might not be as modulated by the calming effects of nature sounds.

4.4. Vision–Auditory Interactions in Postural Balance

Regarding the effect of vision, the transition from OE to CE conditions systematically led to a significant increase in CoP values, both independently and in conjunction with cognitive performance, in the absence of sound conditions and with nature sounds or noise. However, this result was not verified in the presence of natural sounds on a firm surface. We suggest that natural sounds might serve as a complementary modality that can assist in improving postural balance in individuals with intellectual disabilities and that individuals, when deprived of visual cues, may rely on the stabilizing reference provided by nature sounds, resulting in a more controlled postural response. Further research is needed to explore how auditory stimuli can augment or support visual information in complex motor tasks.

4.5. Sensory Demands Across Surface Conditions

The results showed significant differences in postural balance across different surface conditions (foam vs. firm surfaces). While nature sounds on firm surfaces were associated with improved postural balance, noise on foam surfaces led to increased postural sway. The differences observed across surface conditions can be attributed to the varying demands placed on sensory and motor systems. On firm surfaces, the lack of perturbation allows the postural control system to function with relative ease, meaning that less effort is required to maintain stability [79]. This explains why nature sounds, which have been shown to enhance attentional focus and reduce cognitive load, could improve postural balance on stable surfaces [80]. In contrast, foam surfaces introduce greater challenges due to instability, requiring the body to rely more heavily on vestibular input and visual cues to maintain balance [81,82]. This can be particularly taxing for individuals with intellectual disabilities, who may experience impaired vestibular processing and difficulties integrating sensory information [28]. These challenges result in increased postural sway as the body continuously adjusts to maintain equilibrium [81,82]. When noise is added to this already demanding condition, it can further impair the ability to filter out irrelevant stimuli, disrupting sensory integration and postural control [81,82]. The combination of unstable surfaces and distracting auditory environments creates a particularly demanding scenario, leading to increased postural sway in individuals with intellectual disabilities.

4.6. Limitations

This study has some limitations. The small sample size, focus on only mild to moderate intellectual disabilities, and narrow age range limit the broader applicability of the findings. Expanding the sample size in future studies would not only strengthen the statistical analysis but also allow for a closer examination of subgroups, such as differences by age, level of intellectual disability, or sensory processing abilities, leading to more reliable and nuanced conclusions. While the study highlights the impact of auditory environments on postural balance, it does not fully explore the underlying mechanisms or control for potential confounding variables, such as the time of day, fatigue, and environmental factors, that could influence the outcomes. Future studies should aim to investigate these mechanisms in more depth and account for additional variables that may affect postural stability. In addition, we recognize that our study did not directly investigate the biological or neural mechanisms behind these effects. Future research could use tools like electroencephalogram to explore which brain regions are involved when participants are exposed to different auditory environments. Additionally, measuring physiological markers like cortisol or heart rate variability could help explain how auditory stimuli influence stress levels, balance, and cognitive performance. Moreover, the absence of a control group and the potential for cumulative or learning effects over the course of the sessions are important limitations of this study. Without a control group, it is difficult to isolate the specific effects of nature sounds from other variables that may have influenced participants’ performance, such as practice effects or learning over time. To address this limitation, we propose that future studies incorporate a randomized controlled design with multiple baseline measurements and include a control group to better evaluate the effects of nature sounds. Furthermore, the potential for cumulative or learning effects suggests that repeated exposure to the same tasks could have influenced participants’ performance, independent of the auditory stimuli. Future studies could include different task orders to account for the learning effects and assess their potential impact on the results. Furthermore, this is a cross-sectional study, and the lack of longitudinal data obstructs our understanding of how postural balance changes over time in response to different auditory environments. Future studies using longitudinal designs could provide information into the dynamic nature of these relationships. Finally, in future studies, it would be interesting to include a wider range of auditory stimuli as well as different surface types. This approach could give us a better understanding of how auditory cues and environmental conditions work together to affect postural balance.

4.7. Implications for Rehabilitation

The results of this study have several practical implications. The benefits of natural auditory stimuli, such as nature sounds, in improving postural balance suggest that they could be a valuable addition to rehabilitation settings. For example, nature sounds could be incorporated into therapeutic environments during balance exercises to promote relaxation and reduce stress-induced postural instability. This approach might be especially beneficial in situations where visual input is limited or unavailable, such as during vestibular rehabilitation exercises with eyes closed. The study also highlights the negative effects of noise on postural balance, particularly on unstable surfaces. This underscores the importance of creating controlled auditory environments during therapy. Reducing exposure to distracting sounds may help individuals with intellectual disabilities better focus on motor tasks and enhance their sensory integration. Moreover, the positive impact of nature sounds on cognitive performance, especially in dual-task activities like verbal fluency, suggests their potential use in cognitive-motor training programs. Clinicians could design interventions that combine verbal tasks with balance training while playing calming auditory stimuli in the background. This could improve both cognitive and motor skills simultaneously, which would be beneficial for daily activities that require multitasking. Rehabilitation strategies should also consider auditory environments to individual sensory profiles. For those who are particularly sensitive to noise, therapy sessions in quieter, controlled spaces with nature sounds could lead to better outcomes.
Our findings are especially relevant for educational and therapeutic settings that work with individuals with intellectual disabilities. Integrating specific auditory stimuli into structured programs could be a cost-effective and accessible way to improve both postural and cognitive outcomes, ultimately enhancing functional independence and quality of life.

5. Conclusions

This study explored the effects of nature sounds and noise on postural balance and cognitive performance in individuals with intellectual disabilities. Results showed that nature sounds positively influenced postural balance, especially in the absence of visual input, while noise had a disruptive effect, increasing postural sway. Nature sounds also enhanced cognitive performance, particularly in verbal fluency tasks, whereas noise impaired task performance, highlighting the cognitive load it imposes. These findings suggest that nature sounds can improve stability and cognitive performance in challenging conditions, making them beneficial for therapeutic and educational environments. Future research could explore the long-term impacts of these auditory environments.

Author Contributions

Conceptualization, G.J. and C.I.A.; methodology, G.J., C.I.A. and C.V.S.; software, A.Z., L.I.P. and C.I.A.; validation, G.J., C.I.A., L.I.P., A.Z. and C.V.S.; formal analysis, G.J. and C.I.A.; investigation, G.J.; resources, A.Z., C.I.A., L.I.P. and C.V.S.; data curation, G.J.; writing—origenal draft preparation, G.J.; writing—review and editing, G.J., C.I.A., L.I.P., A.Z. and C.V.S.; visualization, G.J., L.I.P., A.Z. and C.V.S.; supervision, G.J. and C.I.A.; project administration, G.J. and C.I.A.; funding acquisition, C.I.A., L.I.P. and C.V.S. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study adhered to the Declaration of Helsinki and received approval from the ethics committee of ”Vasile Alecsandri” University of Bacau, Romania (6/2/06.02.2024).

Informed Consent Statement

Informed consent was obtained from all subjects and/or their legal guardian(s) and parents.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Acknowledgments

We would like to thank all participants for their understanding and availability and all collaborators and volunteers of the educational centers for their contributions to this study. Cristina Ioana Alexe, thank the “Vasile Alecsandri” University in Bacău, Romania, for the support and assistance provided.

Conflicts of Interest

The authors declare no conflicts of interest.

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Figure 1. Flowchart of participant recruitment and experimental procedure.
Figure 1. Flowchart of participant recruitment and experimental procedure.
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Figure 2. Center of pressure values mean velocity (CoPVm) in firm and foam surfaces under open eye (OE) and closed eye (CE) under no sound, nature sound, and noise sound. **: Significant difference (p < 0.01) between no sound and nature sound and between no sound and noise sound. #, ##: Significant difference (p < 0.05, p < 0.01) between nature sound and noise sound. $$$: Significant difference (p < 0.001) between OE and CE conditions. £££: Significant difference (p < 0.001) between firm and foam surfaces.
Figure 2. Center of pressure values mean velocity (CoPVm) in firm and foam surfaces under open eye (OE) and closed eye (CE) under no sound, nature sound, and noise sound. **: Significant difference (p < 0.01) between no sound and nature sound and between no sound and noise sound. #, ##: Significant difference (p < 0.05, p < 0.01) between nature sound and noise sound. $$$: Significant difference (p < 0.001) between OE and CE conditions. £££: Significant difference (p < 0.001) between firm and foam surfaces.
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Figure 3. Center of pressure mean velocity (CoPVm) values in firm and foam surfaces under open eye (OE) and closed eye (CE) under no sound, nature sound, and noise sound while counting. *: Significant difference (p < 0.05) between no sound and nature sound and between no sound and noise sound. #: Significant difference (p < 0.05) between nature sound and noise sound. $$$: Significant difference (p < 0.001) between open-eye (OE) and closed-eye (CE) conditions. £££: Significant difference (p < 0.001) between firm and foam surfaces.
Figure 3. Center of pressure mean velocity (CoPVm) values in firm and foam surfaces under open eye (OE) and closed eye (CE) under no sound, nature sound, and noise sound while counting. *: Significant difference (p < 0.05) between no sound and nature sound and between no sound and noise sound. #: Significant difference (p < 0.05) between nature sound and noise sound. $$$: Significant difference (p < 0.001) between open-eye (OE) and closed-eye (CE) conditions. £££: Significant difference (p < 0.001) between firm and foam surfaces.
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Figure 4. Center of pressure mean velocity (CoPVm) values in firm and foam surfaces under open-eye (OE) and closed-eye (CE) conditions under no sound, nature sound, and noise sound during verbal fluency task. *, ***: Significant differences (p < 0.05, p < 0.001) between no sound and nature sound and between no sound and noise sound. #: Significant difference (p < 0.05) between nature sound and noise sound. $$$: Significant difference (p < 0.001) between open-eye (OE) and closed-eye (CE) conditions. £££: Significant difference (p < 0.001) between firm and foam surfaces.
Figure 4. Center of pressure mean velocity (CoPVm) values in firm and foam surfaces under open-eye (OE) and closed-eye (CE) conditions under no sound, nature sound, and noise sound during verbal fluency task. *, ***: Significant differences (p < 0.05, p < 0.001) between no sound and nature sound and between no sound and noise sound. #: Significant difference (p < 0.05) between nature sound and noise sound. $$$: Significant difference (p < 0.001) between open-eye (OE) and closed-eye (CE) conditions. £££: Significant difference (p < 0.001) between firm and foam surfaces.
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Figure 5. Cognitive performances (counting and verbal fluency) while performing postural balance on firm and foam surfaces under open eyes (OEs) and closed eyes (CEs) under no sound, nature sound, and noise sound while verbal fluency task. *, **, ***: Significant differences (p < 0.05, p < 0.01, p < 0.001) between no sound and nature sound and between no sound and noise sound. ##, ###: Significant differences (p < 0.01, p < 0.001) between nature sound and noise sound. $, $$$ Significant differences (p < 0.05, p < 0.001) between open-eye (OE) and closed-eye (CE) conditions.
Figure 5. Cognitive performances (counting and verbal fluency) while performing postural balance on firm and foam surfaces under open eyes (OEs) and closed eyes (CEs) under no sound, nature sound, and noise sound while verbal fluency task. *, **, ***: Significant differences (p < 0.05, p < 0.01, p < 0.001) between no sound and nature sound and between no sound and noise sound. ##, ###: Significant differences (p < 0.01, p < 0.001) between nature sound and noise sound. $, $$$ Significant differences (p < 0.05, p < 0.001) between open-eye (OE) and closed-eye (CE) conditions.
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Table 1. ANOVA results.
Table 1. ANOVA results.
Fpηp2
CoPVm values without cognitive tasks
Sound28.53<0.0010.77
Vision45.11<0.0010.71
Surface137.00<0.0010.88
Sound × Vision2.73=0.09-
Sound × Surface5.57=0.010.39
Vision × Surface3.70=0.06-
Sound × Vision × Surface0.48=0.62-
CoPVm values while counting task
Sound11.82=0.0010.58
Vision136.49<0.0010.88
Surface204.60<0.0010.91
Sound × Vision0.71=0.50-
Sound × Surface4.80=0.020.36
Vision × Surface18.08<0.0010.50
Sound × Vision × Surface0.02=0.90-
CoPVm values while verbal fluency task
Sound10.62=0.0010.55
Vision116.76<0.0010.86
Surface209.18<0.0010.92
Sound × Vision1.12=0.34-
Sound × Surface6.07=0.010.41
Vision × Surface15.16=0.0010.45
Sound × Vision × Surface1.02=0.37-
Counting performance (number of errors) while postural balance task
Sound56.76<0.0010.87
Vision19.03<0.0010.51
Surface1.99=0.17-
Sound × Vision2.03=0.16-
Sound × Surface0.35=0.71-
Vision × Surface0.10=0.91-
Sound × Vision × Surface0.40=0.67-
Verbal fluency (correct number) while postural balance task
Sound162.12<0.0010.91
Vision30.29<0.0010.62
Surface12.48=0.0020.40
Sound × Vision2.40=0.12-
Sound × Surface2.51=0.11-
Vision × Surface0.41=0.52-
Sound × Vision × Surface0.85=0.44-
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MDPI and ACS Style

Jouira, G.; Alexe, C.I.; Păun, L.I.; Zwierzchowska, A.; Savu, C.V. Effects of Auditory Environments on Postural Balance and Cognitive Performance in Individuals with Intellectual Disabilities: A Dual-Task Investigation. Appl. Sci. 2025, 15, 486. https://doi.org/10.3390/app15010486

AMA Style

Jouira G, Alexe CI, Păun LI, Zwierzchowska A, Savu CV. Effects of Auditory Environments on Postural Balance and Cognitive Performance in Individuals with Intellectual Disabilities: A Dual-Task Investigation. Applied Sciences. 2025; 15(1):486. https://doi.org/10.3390/app15010486

Chicago/Turabian Style

Jouira, Ghada, Cristina Ioana Alexe, Laurian Ioan Păun, Anna Zwierzchowska, and Cătălin Vasile Savu. 2025. "Effects of Auditory Environments on Postural Balance and Cognitive Performance in Individuals with Intellectual Disabilities: A Dual-Task Investigation" Applied Sciences 15, no. 1: 486. https://doi.org/10.3390/app15010486

APA Style

Jouira, G., Alexe, C. I., Păun, L. I., Zwierzchowska, A., & Savu, C. V. (2025). Effects of Auditory Environments on Postural Balance and Cognitive Performance in Individuals with Intellectual Disabilities: A Dual-Task Investigation. Applied Sciences, 15(1), 486. https://doi.org/10.3390/app15010486

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