Introduction
Deficits in sensory processing and body perception are among the most common impairments in older adults. Improper processing of sensory stimuli leads to deficits in body perception, motor and postural functions, the ability to perform activities of daily living, and social participation. Many older adults with perceptual-motor disorders have low awareness of their own bodies and their positions in the environment, and often complain about poor performance and decreased quality of life. This situation results in irregular movements, reduced coordination, and negative attitudes toward their bodies. Therefore, one of the effective treatments for these people is the use of perceptual-motor exercises and sensory integration, which can increase awareness and appropriate responses to the environment. Thus, this study aims to investigate the effects of perceptual-motor exercises based on multi-sensory therapy on body image and sensory processing in older adults with mild cognitive deficits.

Methods
This is a double-blinded randomized clinical trial with a pre-test/post-test design. The study population consists of all non-resident older adults visiting rehabilitation clinics in Semnan and Golestan. From this population, 30 were selected using a convenience sampling method and considering the inclusion criteria for the study. Then, they were randomly assigned to the experimental and control groups. The participants completed a demographic form, the multidimensional body-self relations questionnaire (MBSRQ) and the sensory profile questionnaires. The intervention for the experimental group was conducted individually at eight sessions (twice a week), each for 30-45 minutes, while the control group received conventional occupational therapy. All interventions were administered by two trained and blinded occupational therapists. After the completion of the therapy sessions, body image and sensory processing evaluations were conducted again for all participants. 
For data analysis, descriptive statistics, the Shapiro-Wilk test, and Levene’s test, paired t-test (to compare pre-test and post-test scores within groups), and analysis of covariance (to compare the effects of the exercises on each dependent variable between study groups) were used. The data had a normal distribution (P>0.05). Data were analyzed in SPSS software version 20.

Results
In this study, participants were 30 older adults (24 men and 6 women) with mild cognitive deficits and a mean age of 63.9±6.7 years. The mean score of mini-mental status examination was 22.46±8.09. There were significant differences between the two study groups in all domains of MBSRQ (P<0.05), except for body areas satisfaction and overweight preoccupation. For individuals aged 18-64 years, the mean scores of the sensory profile subscales ranged 24-35 for poor sensory registration, 43-56 for sensory seeking, 28-41 sensory sensitivity, and 27-41 sensory avoidance. The mean score of the experimental group in poor sensory registration was slightly higher (37.594) and in sensory seeking slightly lower (40.322) than the global average, while the score in the control group was slightly lower in sensory seeking (38.496) and slightly higher in sensory sensitivity (42.795) and sensory avoidance (42.700). Furthermore, the results of the analysis of covariance indicated that, after controlling for pre-test scores, there were significant differences in all variables except for body areas satisfaction and overweight preoccupation domains of MBSRQ and the sensory profile of older adults (P<0.05). 

Conclusion
The results of this study showed that the body image and its dimensions increased after the integrative exercise program in older adults with mild cognitive deficits. It seems that combining multi-sensory therapy with perceptual-motor exercises can integrate the senses, improve perception, and modify the behavior in older adults with mild cognitive deficits. Additionally, the movement of limbs in space, perceptual-motor planning, and the accurate processing of sensory information during the integrative exercises provide greater opportunities for understanding body image and making accurate mental judgments. In other words, the exercise program in this study was able to affect the modulation of sensory thresholds and the responsiveness of the elderly to external stimuli, placing them in the middle of the spectrum. This program can help therapists and older adults to achieve beneficial outcomes.

Ethical Considerations
Compliance with ethical guidelines
The present article is the result of a research project approved by the Student Research and Technology Committee (No.: A-10-322-14), and the Ethics Committee of Semnan University of Medical Sciences (Code: IR.SEMUMS.REC.1400.237, dated 2021/10/08). This study was also registered by Iranian Registry of Clinical Trials (IRCT) (Code: IRCT20171219037954N4 dated 2021/10/16). All participants read and signed the informed consent form. All their rights were reserved during and after the study

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

Authors' contributions
Conceptualization: All authors; Methodology: Jamil Eslami and Mina Sadat Mirshoja; Formal analysis: Hossein Alibakhshi, and Mina Sadat Mirshoja; Data curation: Jamil Eslami, Shima Shahrokhi, Hossein Mirzabeigi, and Ensieh Naimi; Writing the original draft: Hossein Alibakhshi, Jamil Eslami, and Mina Sadat Mirshoja; Review and editing: Hossein Alibakhshi, and Mina Sadat Mirshoja; Supervision, project administration and visualization: Mina Sadat Mirshoja.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to express their sincere gratitude and appreciation to the Neuromuscular Rehabilitation Research Center, the Student Research and Technology Committee of Semnan University of Medical Sciences, and all the esteemed participants.


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