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Rehab Measures: Clinical Test of Sensory Interaction on Balance (VEDGE)

Link to instrument

 

Title of Assessment

Clinical Test of Sensory Interaction on Balance (VEDGE) 

Acronym

CTSIB

Instrument Reviewer(s)

Diane Wrisley, PT, PhD, NCS and Elizabeth Dannenbaum, MScPT for the Vestibular EDGEtask force of the Neurology section of the APTA

Summary Date

11/14/2013 

Purpose

The CTSIB provides the clinician with a means to quantify postural control under various sensory conditions

Description

  • The CTSIB was developed as a clinical version of the Sensory Organization Test and was developed to assess sensory contributions to postural control
  • Patients stand with their hands at their sides, feet together and perform the following 6 sensory conditions:
    1. Stand on firm surface, eyes open
    2. Stand on firm surface, eyes closed
    3. Stand on firm surface, visual conflict dome
    4. Stand on foam surface, eyes open
    5. Stand on foam surface, eyes closed
    6. Stand on foam surface, visual conflict dome
  • Patient performance is timed for 30 seconds.  If a patient is unable to maintain the position for 30 seconds they are provided with 2 additional attempts.  The scores of the 3 trials are averaged.  Shumway-Cook and Horak 1986
  • A pediatric version has been developed

Area of Assessment

Balance Vestibular; Balance Non-Vestibular 

Body Part

Not Applicable 

ICF Domain

Body Function; Activity 

Domain

Motor; Sensory 

Assessment Type

Performance Measure 

Length of Test

06 to 30 Minutes 

Time to Administer

  • 5-15 minutes

Number of Items

Equipment Required

  • stopwatch
  • 40.64 x 40.64 x 7.62cm piece of medium density viscoelastic (Temper) foam, visual conflict dome: a modified 16” Japanese lantern with horizontal ribs, holes are cut for the patient’s neck and head leaving about 270° circumference (for instructions see Shumway-Cook and Horak 1986)

Training Required

None

Type of training required

No Training; Reading an Article/Manual 

Cost

Free 

Actual Cost

Free

Age Range

Child: 6-12 years; Adolescent: 13-17 years; Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

Acquired Brain Injury; Geriatrics; Knee Dysfunction; Movement Disorders; Multiple Sclerosis; Parkinson’s Disease; Peripheral Neuropathy; Stroke; Traumatic Brain Injury; Vestibular Disorders 

Populations Tested

  • Fall risk in older adults (Geriatric)
  • Stroke
  • Vestibular Disorders

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Not Established

Normative Data

Healthy Adults:

Normative data for the CTSIB were determined by El-Kashlan et al, 1998, using 69 healthy adults aged 20-79 years.  Normative scores are listed below, maximum score is 180, 30 seconds for each condition.  Scores of < 180 are recommended for ages 20-49 even though the 5% is 176.5.

Age 20-49
Age 50-59
Age 60-69
Age 70-79
Mean
179.7
180
179.9
177.4
SD
1.6
0
0.5
8.7
5%
176.5 (180)
180
178
151.3

Test-retest Reliability

Healthy young adults:

Test-retest reliability was reported as high by Cohen et al, 1993 based on their pilot study (r = 0.99).  Healthy young adults were tested twice by the same investigator.

 

Community dwelling adults:
Anacker and DiFabio, 1992, explored test-retest reliability of the CTSIB in 10 community dwelling older adults tested 7 days apart, Correlation of the CTSIB total scores (r = 0.75) was significant.  A 95% agreement was found between sessions.

Interrater/Intrarater Reliability

Healthy young adults:

Inter-rater reliability was reported as high by Cohen et al based on their pilot study of healthy young adults.  5 subjects were tested by 2 investigators simultaneously.

 

Hemiplegia:
DiFabio and Badke, 1990 determined inter-rater reliability with 5 subjects with hemiplegia who were not part of their full study. Each subject was scored simultaneously by 2 raters on the CTSIB.  The percentage of perfect agreement between raters ranged from 68-100%, with kappa value of 0.77 for the CTSIB.

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

Vestibular Disorders:
El-Kashlan et al 1998 compared scores on CTSIB with scores on the Sensory Organization Test (SOT) in adults with vestibular disorders.  They found significant correlations between total scores on both tests r-values ranged from 0.41 to 0.89 depending on the time period during rehabilitation the tests were performed.  When the SOT is used as the gold standard, the CTSIB demonstrates a Cohen’s k (measure of agreement) of 0.80; specificity of 87% and sensitivity of 60%, positive predictive value was 89% and negative predictive value was 55%.  When comparing response patterns elicited by the SOT and CTSIB in 21 patients who demonstrated abnormalities in both tests, the CTSIB was significantly less sensitive in identifying more subtle patterns of balance dysfunction (p < 0.05)

Construct Validity (Convergent/Discriminant)

Vestibular Disorders:

Cohen et al found that 17 people with vestibular disorders scored significantly lower than 45 healthy adults aged 25-84 years on conditions 5,and 6. Subjects with vestibular disorders had greater variability than the healthy adults.

 

Stroke:

Significant positive correlations were found by DiFabio and Badke, 1990 between the CTSIB and Fugl-Meyer Sensorimotor Assessment (FMSA) sensory subscore (r = 0.55), the FMSA balance subscores (r = 0.77), and the FMSA lower extremity recovery score (r = 0.69) in 10 subjects post stroke.

Anacker and DiFabio, 1992, found a significant group by surface interaction (p = 0.048) when comparing CTSIB scores between 16 older adults with a history of falling and 31 older adults without a history of falling.  Older adults with a history of falling demonstrated a reduction in stance duration on a compliant surface compared to non-fallers.

 

Older adult fallers:
Ricci et al 2009 found significant differences between older adults who fell 2 or more times in the past year, 1 time in the past year and did not fall in the past year on conditions 4-6 of the CTSIB p < 0.05

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Stroke:
Bernhardt et al reported that for each condition 10-24% of subjects with stroke were unable to complete the test at week 4 whereas 72-93% achieved the maximum score for each condition at week 8.

Responsiveness

Stroke:
Bernhardt et al explored the responsiveness of the CTSIB in 29 subjects less than 4 weeks post stroke.  Subjects were assessed at 4, 6, and 8 weeks post-stroke. Subjects received their usual treatments.  Standardized Response Measure (SRM)was calculated for each condition of the CTSIB.  Moderate levels of responsiveness were found with SRM ranging from 0.34 to 0.46.

Professional Association Recommendations

Measure: Clinical Test of Sensory Interaction in Balance

 

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 months post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

VEDGE

LS

LS

LS

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

UR

UR

UR

UR

UR

TBI EDGE

LS

LS

LS

LS

LS

 

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

LS

LS

LS

NR

 

 

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

UR

UR

UR

NR

 

 

Recommendations based on vestibular diagnosis

 

Peripheral

Central

Benign Paroxysmal Positional Vertigo (BPPV)

Other

VEDGE

LS

LS

LS

LS

 

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

MS EDGE

No

No

No

Yes

TBI EDGE

Yes

Yes

No

Not reported

VEDGE

Yes

Yes

Yes

Yes

Considerations

The modified Clinical Test of Sensory Interaction on Balance is more commonly used currently

Bibliography

Anacker, S. L. and Di Fabio, R. P. (1992). "Influence of sensory inputs on standing balance in community-dwelling elders with a recent history of falling." Phys Ther 72(8): 575-581; discussion 581-574. Find it on PubMed

Bernhardt, J., Ellis, P., et al. (1998). "Changes in balance and locomotion measures during rehabilitation following stroke." Physiother Res Int 3(2): 109-122. Find it on PubMed

Cohen, H., Blatchly, C. A., et al. (1993). "A study of the clinical test of sensory interaction and balance." Phys Ther 73(6): 346-351; discussion 351-344. Find it on PubMed

Di Fabio, R. P. and Badke, M. B. (1990). "Relationship of sensory organization to balance function in patients with hemiplegia." Phys Ther 70(9): 542-548. Find it on PubMed

El-Kashlan, H. K., Shepard, N. T., et al. (1998). "Evaluation of clinical measures of equilibrium." Laryngoscope 108(3): 311-319. Find it on PubMed

Horak, F. B. (1987). "Clinical measurement of postural control in adults." Physical Therapy 67(12): 1881-1885.

Ricci, N. A., de Faria Figueiredo Goncalves, D., et al. (2009). "Sensory interaction on static balance: a comparison concerning the history of falls of community-dwelling elderly." Geriatr Gerontol Int 9(2): 165-171. Find it on PubMed

Shumway-Cook, A. and Horak, F. B. (1986). "Assessing the influence of sensory integration on balance. Suggestions from the field." Physical Therapy 66: 1548-1549.

Year published

1986 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 1/30/2014 11:58 AM  by Jason Raad 
Last modified at 9/3/2014 9:57 AM  by Jason Raad