{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T10:05:49Z","timestamp":1784801149265,"version":"3.55.0"},"reference-count":29,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sci.","Brain Sciences"],"abstract":"<jats:p>Background\/Objectives: Postural control depends on the integration and reweighting of visual, somatosensory, vestibular, and contextual sensory information. Stable auditory cues may support balance, whereas complex musical stimulation may impose additional sensory-cognitive demand during multisensory conflict. This study examined the acute effects of relative device-output music intensity on virtual-reality-based postural control in trained athletes and explored whether responses differed by sport background. Methods: Forty-eight athletes from tennis, combat sports, swimming, football, and volleyball completed the Clinical Test of Sensory Interaction in Balance delivered through virtual reality (CTSIB-VR) and Limits of Stability (LOS) assessments under four auditory conditions: routine\/no sound and low (+10 dB), moderate (+20 dB), and high (+30 dB) relative device-output increments. Linear mixed-effects models included sport, auditory condition, and their interaction as fixed effects and participant-specific random intercepts and random linear condition slopes. Model-based estimated marginal means, Bonferroni-adjusted contrasts, 1.5\u00d7IQR sensitivity analyses, and robust generalized estimating equations were calculated. Results: Auditory condition affected all five CTSIB-VR outcomes (Wald \u03c72(3) = 16.773\u201394.404, all p &lt; 0.001). The routine condition exceeded the high-intensity condition for composite score (adjusted mean difference = 6.05, 95% CI 3.99\u20138.10; Bonferroni-adjusted p &lt; 0.001) and somatosensory score (8.62, 95% CI 6.78\u201310.46; adjusted p &lt; 0.001). Sport \u00d7 condition interactions were significant for all CTSIB-VR outcomes (\u03c72(12) = 54.869\u201398.953, all p &lt; 0.001), but sport-stratified findings were exploratory. For LOS, auditory-condition effects were detected for endpoint excursion (p = 0.004), maximum excursion (p &lt; 0.001), and directional control (p = 0.002), whereas reaction time (p = 0.648) and movement velocity (p = 0.056) did not show clear main effects. Sensitivity analyses supported the endpoint-excursion, maximum-excursion, and directional-control findings; movement-velocity inference was method-sensitive. Conclusions: Relative device-output music intensity was associated with consistent changes in CTSIB-VR sensory-organization measures and outcome-specific changes in LOS performance. Sport-related patterns require confirmation in adequately powered, balanced samples.<\/jats:p>","DOI":"10.3390\/brainsci16080772","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T09:11:26Z","timestamp":1784797886000},"page":"772","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Relative Device-Output Music Intensity and Virtual-Reality-Based Postural Control in Trained Athletes"],"prefix":"10.3390","volume":"16","author":[{"given":"Hanifi","family":"Korkmaz","sequence":"first","affiliation":[{"name":"Battalgazi Vocational School, Malatya Turgut Ozal University, Battalgazi, Malatya 44280, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3805-9214","authenticated-orcid":false,"given":"\u0130pek Bal\u0131k\u00e7\u0131","family":"\u00c7i\u00e7ek","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Battalgazi, Malatya 44280, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5488-3158","authenticated-orcid":false,"given":"\u00d6zg\u00fcr","family":"Eken","sequence":"additional","affiliation":[{"name":"Department of Physical Education and Sport Teaching, Faculty of Sport Sciences, Inonu University, Battalgazi, Malatya 44280, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5255-4860","authenticated-orcid":false,"given":"Monira I.","family":"Aldhahi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1152\/jn.1998.80.3.1211","article-title":"Stiffness control of balance in quiet standing","volume":"80","author":"Winter","year":"1998","journal-title":"J. Neurophysiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/B978-0-444-63916-5.00002-1","article-title":"Sensory integration for human balance control","volume":"159","author":"Peterka","year":"2018","journal-title":"Handb. Clin. Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1152\/jn.01145.2015","article-title":"Sensory reweighting dynamics following removal and addition of visual and proprioceptive cues","volume":"116","author":"Peterka","year":"2016","journal-title":"J. Neurophysiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.apmr.2003.08.089","article-title":"Intrasession reliability of center of pressure measures of postural steadiness in healthy elderly people","volume":"85","author":"Lafond","year":"2004","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s00221-006-0709-y","article-title":"Auditory biofeedback substitutes for loss of sensory information in maintaining stance","volume":"178","author":"Dozza","year":"2007","journal-title":"Exp. Brain Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2357","DOI":"10.1007\/s00221-015-4304-y","article-title":"Auditory white noise reduces postural fluctuations even in the absence of vision","volume":"233","author":"Ross","year":"2015","journal-title":"Exp. Brain Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.neulet.2016.07.060","article-title":"Auditory white noise reduces age-related fluctuations in balance","volume":"630","author":"Ross","year":"2016","journal-title":"Neurosci. Lett."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Gandemer, L., Parseihian, G., Kronland-Martinet, R., and Bourdin, C. (2017). Spatial cues provided by sound improve postural stabilization: Evidence of a spatial auditory map?. Front. Neurosci., 11.","DOI":"10.3389\/fnins.2017.00357"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"433","DOI":"10.3233\/VES-160599","article-title":"Auditory contributions to maintaining balance","volume":"26","author":"Stevens","year":"2016","journal-title":"J. Vestib. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1159\/000525951","article-title":"The effect of auditory cues on static postural control: A systematic review and meta-analysis","volume":"27","author":"Zarei","year":"2022","journal-title":"Audiol. Neurotol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1007\/s00221-023-06598-6","article-title":"Auditory, tactile, and multimodal noise reduce balance variability","volume":"241","author":"Carey","year":"2023","journal-title":"Exp. Brain Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"10518","DOI":"10.1038\/s41598-024-61186-0","article-title":"Effects of auditory noise intensity and color on the dynamics of upright stance","volume":"14","author":"Carey","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"351","DOI":"10.3233\/VES-2010-0361","article-title":"The influence of music on static posturography","volume":"20","author":"Forti","year":"2010","journal-title":"J. Vestib. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1007\/s10439-023-03136-x","article-title":"The effects of vibratory and acoustic stimulations on postural control in healthy people: A systematic review","volume":"51","author":"Minino","year":"2023","journal-title":"Ann. Biomed. Eng."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"22","DOI":"10.5152\/iao.2023.22671","article-title":"Influence of auditory information on postural control during different gait tasks in the elderly","volume":"19","author":"Basta","year":"2023","journal-title":"J. Int. Adv. Otol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2844","DOI":"10.1093\/cercor\/bhn042","article-title":"Listening to musical rhythms recruits motor regions of the brain","volume":"18","author":"Chen","year":"2008","journal-title":"Cereb. Cortex"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"112328","DOI":"10.1016\/j.ijpsycho.2024.112328","article-title":"The effects of music and auditory stimulation on autonomic arousal, cognition and attention: A systematic review","volume":"199","author":"Chee","year":"2024","journal-title":"Int. J. Psychophysiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"103181","DOI":"10.1016\/j.humov.2024.103181","article-title":"Sensory conflicts through short, discrete visual input manipulations: Identification of balance responses to varied input characteristics","volume":"93","author":"Ketterer","year":"2024","journal-title":"Hum. Mov. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Christofoletti, G., Silva B\u00e9\u00e9, G.M., Reginato, O., Rodrigues, N.O., Franco, S.S.P.C., and de Souza Pegorare, A.B.G. (2026). Effects of 3D virtual reality on postural control in young adults: Clinical and practical implications. Clin. Pract., 16.","DOI":"10.3390\/clinpract16020040"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1080\/14763141.2022.2162434","article-title":"Effects of virtual reality immersion on postural stability during a dynamic transition task","volume":"24","author":"Bendixen","year":"2025","journal-title":"Sports Biomech."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e15067","DOI":"10.14814\/phy2.15067","article-title":"A review of center of pressure (COP) variables to quantify standing balance in elderly people: Algorithms and open-access code","volume":"9","author":"Quijoux","year":"2021","journal-title":"Physiol. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"800","DOI":"10.26603\/ijspt20180800","article-title":"Test-retest reliability of the Limits of Stability test performed by young adults using NeuroCom VSR Sport","volume":"13","author":"Lininger","year":"2018","journal-title":"Int. J. Sports Phys. Ther."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Viseu, J.P., Yiou, E., Morin, P.O., and Olivier, A. (2023). Sport-dependent effects on the sensory control of balance during upright posture: A comparison between professional horseback riders, judokas and non-athletes. Front. Hum. Neurosci., 17.","DOI":"10.3389\/fnhum.2023.1213385"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"H\u00fclsd\u00fcnker, T., Riedel, D., K\u00e4sbauer, H., Ruhnow, D., and Mierau, A. (2021). Auditory information accelerates the visuomotor reaction speed of elite badminton players in multisensory environments. Front. Hum. Neurosci., 15.","DOI":"10.3389\/fnhum.2021.779343"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Zemkov\u00e1, E., and Kov\u00e1\u010dikov\u00e1, Z. (2023). Sport-specific training induced adaptations in postural control and their relationship with athletic performance. Front. Hum. Neurosci., 16.","DOI":"10.3389\/fnhum.2022.1007804"},{"key":"ref_26","first-page":"311","article-title":"Clinical Test of Sensory Interaction in Balance (CTSIB): Concurrent validity study in healthy Indian children","volume":"9","author":"Pandian","year":"2011","journal-title":"J. Pediatr. Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1037\/0021-9010.63.4.458","article-title":"Individual differences in reactions to noise: A longitudinal study in a college dormitory","volume":"63","author":"Weinstein","year":"1978","journal-title":"J. Appl. Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"894","DOI":"10.3906\/sag-1908-44","article-title":"Validating the Turkish version of the Weinstein Noise Sensitivity Scale: Effects of age, sex, and education level","volume":"50","author":"Yildiz","year":"2020","journal-title":"Turk. J. Med. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.tics.2025.10.007","article-title":"Sensory processing sensitivity: Theory, evidence, and directions","volume":"30","author":"Greven","year":"2026","journal-title":"Trends Cogn. Sci."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/8\/772\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T09:42:56Z","timestamp":1784799776000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/8\/772"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":29,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["brainsci16080772"],"URL":"https:\/\/doi.org\/10.3390\/brainsci16080772","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]}}}