Impact of visual impairment on postural balance and fall risk: Contributions of physical therapy to functional rehabilitation

Abstract

Introduction: Vision plays a fundamental role in postural control, spatial orientation, and safe gait execution. Retinal diseases can compromise visual acuity, contrast sensitivity, and environmental perception, contributing to impairments in balance and functional mobility, as well as an increased risk of falls. In this context, physical therapy can contribute to rehabilitation through strategies targeting balance, muscle strength, proprioception, gait, and sensory adaptation. Objective: To synthesize the available evidence regarding the impact of visual impairment on postural balance, mobility, and fall risk, and to analyze the contributions of physical therapy strategies to the functional rehabilitation of these individuals, considering their effects on balance, functional capacity, independence, and safety during the performance of daily activities. Methods: This is an integrative literature review of a qualitative and descriptive nature. The search was conducted in the PubMed/MEDLINE, SciELO, and Virtual Health Library databases, using descriptors related to visual impairment, retinal diseases, postural balance, gait, falls, physical therapy, and rehabilitation. Initially, 217 records were identified, 17 of which were duplicates. At the end of the selection process, 17 studies met the inclusion criteria and comprised the final sample, covering individuals with visual impairments of various etiologies and degrees of severity; this included specific studies on age-related macular degeneration and glaucoma, as well as investigations involving blindness or visual impairment not limited to retinal diseases. This diversity was taken into account during the synthesis and interpretation of findings regarding postural balance, mobility, fall risk, and interventions aimed at functional rehabilitation. The data were organized into a summary table and analyzed descriptively and qualitatively. Results: The included studies featured various designs, including observational, comparative, and experimental studies, as well as systematic reviews and meta-analyses. The main outcomes analyzed were static and dynamic balance, postural sway, gait speed and characteristics, functional mobility, muscle strength, proprioception, functional capacity, and fall risk. Overall, the findings demonstrated that visual impairment is associated with greater postural instability and gait adaptations, such as reduced speed, changes in step length, and the adoption of more cautious strategies during locomotion. Exercise programs—including balance training, muscle strengthening, core stability, proprioceptive training, sensorimotor activities, and visual rehabilitation—have shown potential to improve balance, mobility, and functional performance. However, their effects on directly reducing the incidence of falls have remained less consistent. The heterogeneity of the causes of visual impairment and the protocols employed also limits the generalizability of the results specifically to retinal diseases. Conclusion: Visual impairment resulting from retinal diseases can compromise postural control, gait, and mobility, thereby increasing functional vulnerability and the risk of falls. Physiotherapy holds significant potential for rehabilitation through interventions targeting balance, muscle strength, proprioception, gait, and sensory integration. However, the approach must be individualized and, when necessary, combined with visual rehabilitation and environmental adaptations. Further studies using standardized protocols and populations specifically affected by retinal diseases are needed to determine more precisely the effects of these interventions on fall prevention and functional independence.