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

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

please see attached.

Comments for author File: Comments.pdf

Author Response

Dear Reviewer 1

Time is precious for everyone. We thank you for taking the time to review our manuscript and provide constructive feedback.
Attached we have responded to your observations and are confident that our article is now better structured, thanks to your observations.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

We appreciate the authors' attention to a significant research topic concerning the health of individuals with intellectual disabilities. This area of study is of great social importance. However, we have several points of concern that require further clarification and development:

1. Selection of Auditory Stimuli: The use of "natural sound" and "noise" as the two main auditory conditions in the study is problematic. These terms are quite broad and lack scientific specificity. Why were these two categories chosen instead of more clearly defined auditory stimuli, such as specific frequencies (e.g., 20Hz, 30Hz, 40Hz)? A more precise approach, including sounds of known frequency ranges or varying volumes (e.g., bird calls of different frequencies), would offer more scientific rigor. The current terminology does not provide sufficient clarity and could be interpreted in many ways, which limits the study’s reproducibility and scientific precision.

2. Need for Experimental Diagram: A schematic diagram illustrating the experimental process is essential. This would help readers better understand the methodology and provide a clearer representation of how the study was conducted. The lack of such a diagram makes it difficult to grasp the experimental design and process at a glance.

3. Subject Description: The manuscript lacks sufficient detail about the participants. A more comprehensive description of the participants' demographic characteristics (age, gender, specific intellectual disabilities, etc.) is needed. Including visual representations or summaries of their basic information would enhance the transparency and reliability of the study. Relying solely on data tables without context can raise concerns about the authenticity and rigor of the study. Additionally, photographs or more detailed participant profiles would help readers visualize the study and its participants more clearly.

4. Issues with Figure 1: Figure 1 requires significant improvement. The lack of labeled axes and the use of an incorrectly formatted coordinate axis detract from the clarity of the data presentation. Please revise the figure to include properly labeled axes, ensuring that it adheres to the scientific standards for data visualization.

5. Conclusion Section: A dedicated conclusion section should be added to the manuscript. This section would help summarize the key findings, discuss their implications, and provide a concise interpretation of the results. The absence of this section leaves the study feeling incomplete and lacking a clear, final takeaway.

6. Lack of Mechanistic Explanation: While the study identifies interesting effects of natural sounds and noise on postural balance, it does not address the underlying biological or molecular mechanisms. A deeper exploration of the mechanisms driving the observed effects would significantly strengthen the manuscript. For example, incorporating brain imaging techniques or biochemical markers could provide insights into the neural and physiological changes that underlie the phenomena observed. Without such an explanation, the study risks appearing more like an observational report rather than a scientifically rigorous investigation. Including a discussion on potential molecular pathways or neural activity related to these effects would enhance the scientific validity of the findings.

7. Surface Conditions and Postural Balance: The study observes significant differences in postural balance across different surface conditions (foam vs. firm surfaces). While natural sounds on firm surfaces were associated with improved postural balance, noise on foam surfaces led to increased postural sway. However, the reasons behind this surface-related discrepancy are not sufficiently explained. A more detailed discussion on the principles of surface stability and its impact on postural control would provide important context for understanding the observed results.

As reviewers, our primary concern is whether the study’s logic is scientifically sound and whether it offers new insights into the phenomena. Currently, the study seems to focus mainly on identifying and describing phenomena, without adequately explaining the underlying mechanisms. Additionally, the small sample size (19 subjects) raises concerns about the reliability and generalizability of the conclusions. We strongly recommend that the authors include additional experimental data, a clearer theoretical framework, and more detailed explanations of the observed effects to improve the manuscript’s scientific rigor.

Moreover, while we acknowledge that this journal is relatively new and may have less stringent requirements, we feel that more comprehensive experimental data and a robust theoretical explanation are necessary before the manuscript can be considered for publication. At this stage, the conclusions seem somewhat intuitive—particularly the finding that noise negatively impacts postural balance in individuals with intellectual disabilities. This is a finding that could be anticipated without the need for experiments. We would be more convinced by the addition of detailed explanations about how noise affects brain function, what specific changes occur in brain regions, and how these changes influence health and postural control.

We encourage the authors to address these points in order to strengthen the manuscript and increase its scientific contribution.

Author Response

Dear Reviewer 2

Time is precious for everyone. We thank you for taking the time to review our manuscript and provide constructive feedback.
Attached we have responded to your observations and are confident that our article is now better structured, thanks to your observations.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors,

I am grateful for the opportunity to review the manuscript entitled “Effects of Auditory Environments on Postural Balance and Cognitive Performance in Individuals with Intellectual Disabilities: A Dual-Task Investigation.” Your study addresses a critical issue of great relevance to the rehabilitation, health, and functional performance areas, exploring how different auditory stimuli affect postural balance and cognitive performance in a vulnerable population. The application of the dual-task paradigm in the context of intellectual disabilities is especially significant, as it reflects everyday scenarios and offers insights for practical and therapeutic interventions.

In my opinion, the manuscript is a well-structured and consistent study, aligned with the journal's scope. The originality of the work focuses on the integrated approach of auditory and motor factors, with the potential to influence rehabilitation practices and the development of adapted therapeutic environments. On the other hand, I believe that revisions are necessary to enhance the impact of the study, increase clarity, and reinforce methodological rigor. Below I present my considerations in a structured manner, starting with the abstract and concluding with the references.

The abstract presents unnecessary details in some parts and could be refined for brevity and thus avoid redundancies. The methods section is robustly described, but the presentation of the results could be more balanced, highlighting the main findings. Finally, the positive effect of nature sounds on postural balance under specific visual conditions is a strong point, but it is not emphasized enough.

Your introduction section presents relevant information and contextualizes the topic. However, I recommend that it be rewritten to improve its flow and objectivity. I suggest summarizing the sections related to the literature review, prioritizing the most relevant studies, and reinforcing the connection between the problem investigated and the objectives of the study. In addition, reformulate the hypothesis more assertively and place it prominently at the end of the introduction.

The methodology adopted is well-planned and meets the objectives of the study. However, additional adjustments regarding the control of environmental variables, randomization, sound characteristics, and effects of repeated sessions are necessary. At first, although you mention nature sounds and urban noises, it is not clear whether they were previously validated or whether there was control over the decibel levels at different frequencies. I recommend adding details about the sounds used, such as duration, frequency, intensity (dB), and whether they were evaluated by experts or participants before the study. In addition, I also recommend indicating how environmental variables that may interfere with the results were controlled, as it is not specified whether the following external factors were controlled: room temperature, external distractions, or initial posture of the participants. Finally, two other issues need further elaboration: I. Although you mention a within-subject design with repeated measures, it is not clear whether the order of the conditions (nature, noise, silence) was randomized or balanced to avoid learning or fatigue effects; II. The four sessions are well explained, but you do not mention possible cumulative or habituation effects on the auditory stimuli. In this sense, I recommend including a brief discussion of this potential influence on the results.

Despite a clear and objective presentation of the results and a well-founded discussion, I recommend that you elaborate on the practical significance of some of your findings, such as the lack of a positive effect of natural sounds under challenging conditions. In addition, I recommend that you connect these results to more direct clinical implications. In this same context, I suggest reviewing passages that extrapolate your results, such as the interpretation that natural sounds can replace visual input. Finally, it would be interesting to expand the discussion on the lack of a control group and the possible cumulative or learning effects over the sessions.

The references used in the manuscript are relevant and well-selected, providing an adequate theoretical basis for the studied topic. However, I suggest the inclusion of three recent papers (published in 2024) that can further enrich the discussion and corroborate the results presented. The first addresses the interaction between supra-postural coordination and postural control in dual-task conditions, reinforcing the relevance of the auditory system in balance. The second explores how auditory tasks, even with low cognitive demand, can interact with postural control, contributing to the understanding of auditory and motor multitasking. The third, focused on patients with vestibular deficits, discusses the role of noise and the environment in postural stabilization, providing valuable insights into sensorimotor challenges in vulnerable populations. I recommend that the authors consider at least these references to enrich the discussion and strengthen the implications of the work.

1. Dotov, D., Motsenyat, A., & Trainor, L. (2024). Concurrent Supra-Postural Auditory–Hand Coordination Task Affects Postural Control: Using Sonification to Explore Environmental Unpredictability in Factors Affecting Fall Risk. Sensors (Basel, Switzerland), 24. https://doi.org/10.3390/s24061994.
2. Van Wilderode, M., Van Humbeeck, N., Krampe, R., & Van Wieringen, A. (2024). Speech-Identification During Standing as a Multitasking Challenge for Young, Middle-Aged and Older Adults. Trends in Hearing, 28. https://doi.org/10.1177/23312165241260621.

Comments on the Quality of English Language

The manuscript presents clear and coherent technical writing, using appropriate technical terms and formal structures. However, some points could be improved to increase textual fluency and accuracy:
1. Some subtle agreement errors deserve attention, such as "individual variations in response to auditory stimuli" that could be better contextualized with more details in the paragraph.
2. The use of commas is inconsistent in some passages of the manuscript, such as presented between lines 41-43, 92-94, 323-325, 369-371, and 416-417.
3. Some ideas are repeated, such as the impact of noise on cognition and postural balance, without adding new perspectives.
4. The sentence "Noise sounds may act as disruptive stimuli" could be more specific in describing the impact of noise on the vestibular and cognitive systems.
5. I checked for occasional use of terms that might seem colloquial, such as "it seems" instead of something more assertive like "evidence suggests."

In summary, careful proofreading is recommended.

Author Response

Dear Reviewer 3

Time is precious for everyone. We thank you for taking the time to review our manuscript and provide constructive feedback.
Attached we have responded to your observations and are confident that our article is now better structured, thanks to your observations.

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

Overall Feedback 

Your study provides valuable insights into the effects of auditory environments on postural balance in individuals with intellectual disabilities. While the findings on nature sounds enhancing balance under simple conditions (firm surface, open eyes, counting task) are promising, the scope is limited by the small sample size, lack of details regarding the specific intellectual disabilities and the narrow age range of participants, which may restrict the generalizability of the results, especially to school settings for students with special needs. Additionally, the study does emphasize task difficulty and sensory demands, however, does not fully explore underlying mechanisms or control for potential confounding variables. The strong focus on CoP measurements is a strength.  Overall, the research is a meaningful contribution.

Abstract

Lines 25-27 . My question here is, did nature sounds and firm surface have a positive effect or did it reduce the negative effect of being blind folded?

Introduction

The introduction is succinct and provides a detailed background to research in the area this study has been conducted. Well done!

Method Section

Lines 146-165, please cite references to show that the tests conducted are valid and also reliable measures. This is essential.

Results

Provided in a manner that is easy to make sense and well supported by accompanying figures. 

Discussion

I do have some concerns with the limitations of the study. As noted in your method section, the control condition was performed first, followed by subsequent conditions over 3 following days without a sufficient gap in time to prevent a learning effect. It is very possible that in this study, learning effect may influence results considering that different conditions were provided day after day without a break. I do understand for this particular study, that conducting the testing on consecutive days made the study feasible and increased participation rate. 

Final Comment

A well designed study whereby there are not many issues with the methodology. I also congratulate you on being able to secure participants for this study which seeks to benefit many young people and hopefully children in the future. 

Author Response

Dear Reviewer 4

Time is precious for everyone. We thank you for taking the time to review our manuscript and provide constructive feedback.
Attached we have responded to your observations and are confident that our article is now better structured, thanks to your observations.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

It seems that the authors have addressed the concerns.

Author Response

Responses to the Reviewer 1 comments

Thank you for your insightful comments and suggestions. Appended is my point-by-point response to these comments. I have submitted an updated version of my manuscript, incorporating your feedback. The changes made in this version are highlighted in red. I hope you will agree that this new version is much stronger as a result.

Reviewer 1 Comment

It seems that the authors have addressed the concerns.

Author response

Thank you very much for your comment.

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you very much for the author's response and revisions. The article is now more logical and suitable for publication. However, reference No. 46 is an informally published email. It is recommended to replace it with https://doi.org/10.3389/fnut.2024.1335950 or another appropriate source.

Author Response

Responses to the Reviewer 2 comments

Thank you for your positive feedback. I have submitted an updated version of my manuscript, incorporating your suggestion.

 

Reviewer 2 Comment

Thank you very much for the author's response and revisions. The article is now more logical and suitable for publication. However, reference No. 46 is an informally published email. It is recommended to replace it with https://doi.org/10.3389/fnut.2024.1335950 or another appropriate source.

Author response

We sincerely appreciate your positive feedback and your observation. While we acknowledge the importance of using up-to-date and appropriate references, Cohen’s Statistical Power Analysis for the Behavioral Sciences remains a cornerstone in effect size interpretation and statistical power discussions, with extensive citation (271289) and enduring relevance in research. Given its historical and foundational value, we believe it is appropriate in this context. However, we have considered your suggestion and we have added another reference:

Richardson, J.T., Eta squared and partial eta squared as measures of effect size in educational research. Educational research review, 2011. 6(2): p. 135-147.

Please see the new version of the revised manuscript.

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you for the opportunity to review the second version of your manuscript entitled "Effects of Auditory Environments on Postural Balance and Cognitive Performance in Individuals with Intellectual Disabilities: A Dual-Task Investigation." I appreciate the substantial effort you have put into addressing the comments from the initial review and acknowledge the significant improvements in the manuscript.

The revisions have effectively addressed my feedback, resulting in notable enhancements to the clarity, methodological rigor, and practical relevance of the study. Upon reviewing the updated version, I did not identify any major concerns. However, I would like to suggest the following minor refinements for the final version: 1. provide more detailed explanations of the symbols used in the figures (e.g., asterisks and other markings); 2. although the discussion of clinical implications is well-developed, a stronger connection between the findings and specific rehabilitation scenarios could further enhance the manuscript’s impact.

I commend your dedication to strengthening this study and thank you for your attention to these suggestions.

Author Response

Reviewer 3 Comment

Thank you for the opportunity to review the second version of your manuscript entitled "Effects of Auditory Environments on Postural Balance and Cognitive Performance in Individuals with Intellectual Disabilities: A Dual-Task Investigation." I appreciate the substantial effort you have put into addressing the comments from the initial review and acknowledge the significant improvements in the manuscript.

The revisions have effectively addressed my feedback, resulting in notable enhancements to the clarity, methodological rigor, and practical relevance of the study. Upon reviewing the updated version, I did not identify any major concerns.

However, I would like to suggest the following minor refinements for the final version: 1. provide more detailed explanations of the symbols used in the figures (e.g., asterisks and other markings); 2. although the discussion of clinical implications is well-developed, a stronger connection between the findings and specific rehabilitation scenarios could further enhance the manuscript’s impact.

I commend your dedication to strengthening this study and thank you for your attention to these suggestions.

Author response

Thank you for your valuable and positive feedback. We greatly appreciate your time and effort in reviewing the revised version. In response to your suggestions, we have revised the figure legends as well, we have further strengthened the connection between our findings and specific rehabilitation scenarios in the discussion of clinical implications.  

Please see the new version of the revised manuscript.