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Rehab Measures: Clinical Test of Sensory Interaction and Balance; Modified Clinical Test of Sensory Interaction and Balance

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Link to Instrument 

Title of Assessment

Clinical Test of Sensory Interaction and Balance; Modified Clinical Test of Sensory Interaction and Balance 

Acronym

CTSIB; mCTSIB; SOT

Instrument Reviewer(s)

Initially reviewed by Theresa Sukal Moulton, PT, DPT, PhD and Rachel Tappan, PT, NCS in 2010; Updated with vestibular, Alzheimers, and elderly populations by Sofia Anastasopoulos, SPT and Ned Zerwic, SPT in 2011; Updated by Heidi Roth, PT, DHS, NCS, Katie Hays, PT, DPT, and the TBI EDGE task force of the Neurology Section of the ATPA in 2012; Updated with references for Pediatric, Alzheimer's, and Stroke populations by Megan O'Connell, SPT and Jeff Beyrau, SPT in 11/2012. Updated by Deb Kegelmeyer DPT, MS, GCS and the PD EDGE task force 2013. Updated by 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

Assesses patient’s balance under a variety of conditions to infer the source of instability
 
The mCTSIB provides the clinician with a means to quantify postural control under various sensory conditions. 

Description

  1. The CTSIB was developed as a clinical version of the Sensory Organization Test to assess sensoy contributions to postural control
  2. The CTSIB involves the observation of a patient's attempt to maintain balance in
  3. 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 (not included in mCTSIB)
    4. Stand on foam surface, eyes open
    5. Stand on foam surface, eyes closed
    6. Stand on foam surface, visual conflict dome (not included in mCTSIB)
  • The patient performance is timed for 30 seconds.
  • Test is terminated when a subject's arms or feet change position.
  • If a patient in unable to maintain the position for 30 seconds they are provided with 2 additional attempts.
  • The scores of the 3 trials are averages (Shumway-Cook and Horak, 1986)
  • Patients dependent on vision become unstable in conditions 2,3, 5 & 6 with either eyes closed or a conflict between vision and the vestibular system
  • Patients dependent on surface/somatosensory inputs become unstable in conditions 4,5 & 6 because they stand on a soft surface (foam)
  • Patients with vestibular loss become unstable in conditions 5 &6 because they can’t rely on vision or surface / somatosensory function
  • Patients with sensory selection problems become unstable in conditions 3-6
    • If one or both knees flex condition 1 is a baseline, and changes in sway direction and amount are noted in conditions 2-6 (if unable to maintain 30 seconds on first trial, given second trial, and 3rd if needed > then trials are averaged
  • Conditions 1 thru 4:
    • Record the time (in seconds) the patient was able to maintain the starting position (maximum of 30 seconds)
  • Total score (Modified CTSIB) =
    • Average Time Cond 1 (if > 1 trial required) +
    • Average Time Cond 2 (if > 1 trial required) +
    • Average Time Cond 3 (if > 1 trial required) +
    • Average Time Cond 4 (if > 1 trial required)
  • Sensory Organization Test (SOT) utilizes dynamic posturography (standing on a force plate) to objectively measure postural sway and center of pressure (COP) under the same testing conditions as the CTSIB , but with 20 (versus 30) second trials and with feet shoulder width apart
    • Equilibrium Score: quantifies the center of gravity (COG) sway or postural stability under each of the three trials of each of six sensory conditions (higher scores indicative of better balance)
    • Composite equilibrium scores and the weighted averages of the scores are computed for each of six conditions
    • Ratios are also computed to identify impairments of individual sensory systems
    • Center of Gravity (COG) Alignment computed for individual’s COG position relative to center of base of support at the start of the trial
  • A pediatric version has been developed.

Area of Assessment

Balance Vestibular; Balance Non-Vestibular; Functional Mobility 

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

  • CTSIB: 9 minutes for testing all conditions (6 conditions * 3 trials * 30 seconds), with additional time for setup and explanation; 3 trials of full test in 20 min (Cohen, Blatchly et al, 1993)
  • mCTSIB: <= 10 minutes (Whitney & Wrisley, 2004)
  • SOT: 15 min (Broglio, 2007)

Number of Items

Not applicable 

Equipment Required

  • Stopwatch (CTSIB / mCTSIB)
  • 40.64 x 40.64 x 7.62 cm piece of medium density foam (upholstery foam, or high density foam) (CTSIB / mCTSIB)
  • Visual / Vestibular conflict dome (for CTSIB, not modified)
  • Computerized Dynamic Posturography (SOT)

Training Required

  • Training required for SOT
  • No training required for CTSIB or mCTSIB

Type of training required

Reading an Article/Manual; Training Course 

Cost

Free 

Actual Cost

Free

Age Range

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

Administration Mode

Computer 

Diagnosis

Geriatrics; Peripheral Neuropathy; Spinal Cord Injury; Stroke; Traumatic Brain Injury; Vestibular Disorders 

Populations Tested

  • Alzheimer's Disease
  • Athletes s/p concussion
  • Chronic Whiplash Injury
  • Fall risk in older adults (Geriatric)
  • Parkinson's disease 
  • Pediatrics
  • Peripheral Neuropathy
  • Spinal Cord Injury
  • Stroke
  • Traumatic Brain Injury
  • Vestibular disorders

Standard Error of Measurement (SEM)

Alzheimer’s Disease (mCTSIB):

(Suttanon et al, 2011; n = 14 patients with mild to moderate Alzheimer’s Disease; mean age = 79.57(6.19) years, Alzheimer's Disease)

  • SEM = 0.17 (deg/sec)

Minimal Detectable Change (MDC)

Alzheimer’s Disease (mCTSIB):

(Suttanon et al, 2011, Alzheimer's Disease)

  • Relatively high MDC₅ (MDC = 0.34)
  • Large changes are needed in order to ensure a significant clinical change in people with Alzheimer’s disease

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Community-Dwelling Elderly:

(Di Fabio and Anacker, 1996; n = 47 adults with falls n = 16 vs. no falls n = 31; mean age = 80.5(9.0); fall group had > 2 falls in past 6 months, Community-Dwelling Elderly)

  • A composite score < 260 seconds (summing all 3, 30sec trials for each of 6 conditions) has specificity of 90% and sensitivity of 44% for identifying fallers
  • If average score below 81s in compliant surface conditions, relative risk of falling is 8.67 (age adjusted odds ratio)

Normative Data

CTSIB

Elderly Adults:

(Ricci et al, 2009; n = 96 independent elderly; mean age = 74.81 (7.25), 75.19 (7.32) and 74.47 (6.39) years for groups 1 (no falls),2 (one fall), and 3 (recurrent falls), respectively, Elderly Adults)

Mean Scores for Elderly Adults Depending on Individual Fall History:
CTSIB Domain
Groups
Time (s)
 
 
anova p-value
Firm; eyes open
Group 1 (no falls)
30 (0)
 
0.5
Group 2 (one fall) 29.9 (0.56)
0.5
 
Group 3 (recurrent falls)
29.7 (1.68)
0.5
Firm; eyes closed
Group 1 (no falls)
29.74 (1.05)
0.079
Group 2 (one fall) 29.57 (2.38)
0.079
Group 3 (recurrent falls)
27.93 (5.44)
0.079
Firm; dome
Group 1 (no falls)
29.21 (4.36)
0.177
Group 2 (one fall)
28.76 (5)
0.177
Group 3 (recurrent falls)
26.53 (8.25)
0.177
Foam; eyes open
Group 1 (no falls)
30 (0)
0.043
Group 2 (one fall)
29.27 (4.08)
0.043
Group 3 (recurrent falls)
26.85 (4.95)
0.043
Foam; eyes closed
Group 1 (no falls)
26.22 (8.38)
0.042
Group 2 (one fall)
25.96 (7.45)
0.042
Group 3 (recurrent falls)
20.97 (11.38)
0.042
Foam; dome
Group 1 (no falls)
26.86 (7.65)
0.052
Group 2 (one fall)
25.15 (8.86)
0.052
Group 3 (recurrent falls)
21.09 (11.8)
0.052

 
Healthy Adults:
(Cohen et al, 1993; pilot study with n = 22 healthy adults; mean age = 21.3 (0.85); experiment compares neurologically asymptomatic adults to adults diagnosed with vestibular disorders, Healthy Adults)
 

Mean Balance Scores

Age
Time
Conditions
25-44 yrs
30 secs
4,5 & 6
45-64 yrs
30 secs
4 & 5
45-64 yrs
28-30 secs
6
65-84 yrs

26-28 secs

4
65-84 yrs
13-19 secs
5
65-84 yrs
14-24secs
6

Parkinson Disease SOT: Landers MR et al, 2008; n = 49 ambulatory individuals with PD; mean age = 70.9(8.9) years old; 20 females, 29 males; 25 of the participants were classified as fallers; mean age = 71.8(7.4) years old, 11 females, 14 males and 24 were non-fallers, mean age = 70.1 (6.9) years old, 9 females, 15 males.

SOT score: fallers = 61.6(15.6); non-fallers = 68.9(11.7); no difference in scores between the two groups (p = .072).

Pediatrics:

(Kluenter et al, 2008; n = 65; mean age = 7 years for children born full-term and children born pre-term with low birth weight, Pediatrics)

Modified CTSIB domain

Healthy full-term (sway: degrees/s)

Pre-term (sway: degrees/s)

Firm: eyes open

0.70 (0.32)

0.86 (0.47)

Firm: eyes closed

0.91 (0.39)

1.05 (0.50)

Foam: eyes open

1.25 (0.47)

1.30 (0.42)

Foam: eyes closed

2.01 (0.66)

1.98 (0.61)

(Gagnon et al, 2006; n = 16; mean age = 9.8 (3.5) years, Healthy Pediatrics)

Tandem (s)

Single leg (s)

Eyes open

29.4 (2.4)

26.5 (7.6)

Eyes closed

23.0 (9.3)

9.4 (6.9)

Altered vision

18.6 (11.0)

7.4 (6.9)

Eyes open with altered support

28.6 (4.5)

23.5 (8.9)

Eyes closed with altered support

14.9 (11.3)

6.0 (4.4)

Altered vision with altered support

9.6 (9.3)

3.9 (2.5)

 
Stroke:
(Bernhardt et al, 1998; n = 29; mean age = 71.8 (10.5) years; < 4 weeks post onset, Acute Stroke)
 
CTSIB domain
Week 4: mean (SD)
Week 8: mean (SD)
Firm; eyes open
25.2 (10.7)
28.5 (6.1)
Firm; eyes closed
24.0 (11.3)
28.1 (6.4)
Firm; dome
23.2 (11.9)
26.7 (8.8)
Foam; eyes open
23.5 (11.9)
27.0 (7.7)
Foam; eyes closed
19.8 (13.3)
24.3 (10.7)
Foam; dome
18.5 (13.6)
23.2 (11.9)
 

Vestibular Impairment:

(Cohen et al, 1993, n = 17, mean age 59.8 (18.9), Vestibular Impairment):

  • Condition 1: 30 seconds
  • Condition 2: 30 seconds
  • Condition 3: 30 seconds
  • Condition 4: 25.7 (8.8), 27.6 (7.3), 26.6 (8.4) seconds across trials
  • Condition 5: 11.4 (12.6), 14.0 (13.0), 16.1 (13.3) seconds across trials
  • Condition 6: 8.0 (11.1), 12.9 (13.5), 12.5 (13.7) seconds across trials

Test-retest Reliability

Alzheimer’s Disease:

(Suttanon et al, 2011, Alzheimer’s Disease)

  • Excellent test-retest reliability in mCTSIB (ICC = 0.91)

Community-Dwelling Elderly:

(Anacker and Di Fabio, 1992; n = 47 adults with falls n = 16 vs no falls n = 31; mean age = 80.5 (9.0); fall group had > 2 falls in past 6 months, Community Dwelling Elderly)

  • Excellent test-retest reliability (r = 0.75)

Healthy Young Adults:

(Cohen et at, 1993, Healthy Young Adults)

  • Excellent pilot study test-retest reliability (r = 0.99) for young adults

Pediatric (Mild TBI):

(Gagnon et al, 1993; n = 38; mean age = 12.2 (2.8) years; mean Glasgow Coma Scale score = 14.8, used Pediatric-CTSIB-tandem standing added for total of 12 conditions, Pediatric Mild TBI)

  • Excellent test-retest reliability in P-CTSIB (ICC = 0.79 - 0.82, across 12 sensory conditions)

Pediatric:

(Geldhof et al, 2006; n = 20, 9 to 10 year old children; mean age = 10.1 (0.7) years, Pediatric)

  • Poor to adequate intersession test-retest reliability in mCTSIB (ICC = 0.37-0.77 for four sensory conditions)

Interrater/Intrarater Reliability

Healthy Young Adults:

(Cohen et at, 1993, Healthy Young Adults)

  • Excellent interrater reliability (r = 0.99)

Pediatrics with Cerebral Palsy:

(Lowes et al, 2004; n = 14; age not given, Pediatrics with CP)

  • Excellent overall interrater reliability (r = 0.88, range 0.60-1.00)

Stroke:

(DiFabio & Badke, 1990; tested on subset of subjects: n = 5, mean age = 58 (12) years, hemiparesis, Chronic Stroke)

  • Excellent interrater reliability: kappa = 0.77 (tested on a different sample of individuals with hemiparesis

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

CTSIB

Community-Dwelling Elderly:

(Di Fabio and Anacker, 1996, Community-Dwelling Elderly)

  • Cross validation analyses predicted 75% fallers and 60% of non-fallers

Healthy Young Adults:

(Cohen et al, 1993, Healthy Young Adults)

  • CTSIB scores for healthy adults compared to those with vestibular impairments were found to be significantly different

Healthy Pediatrics:

(Gagnon et al, 2006, Healthy Pediatric)

  • P-CTSIB scores and SOT scores on domains measuring proprioceptive alteration differ
  • On domains measuring visual integration, they are related
  • These two tests are not interchangeable

Parkinson Disease:

(Landers MR et al, 2008)

  • SOT was not found to be a sensitive means of differentiating fallers from non-fallers; AUC – 62.6 with cut off score of 68.5; sensitivity = .60, specificity = .625, +LR = 1.60, -LR = .64, odds ratio = 2.5 (0.80 -7.9)

(Rossi et al, 2009; n = 45 with PD (26 men, 19 women); mean age = 70.4 years (range = 46-82 years); Average time since diagnosis = 4.53 (2.9) years; H&Y I = 0; H&Y II = 17; H&Y III = 20; H&Y IV = 8. Controls were 20 healthy volunteers mean age 68.7 (range 60-84) years; 10 men, 10 women)

  • Individuals with PD performed significantly worse on the SOT than controls; condition 3 (p = 0.022), condition 4 (p = 0.014), condition 5 (p = 0.002), condition 6 (p = 0.002). Sensory Analysis individuals with PD had significantly worse performance on average balance (p = 0.001), visual input (p = 0.014), and vestibular input (p = 0.002).
  • Pathological balance scores (<68) were found in 24 of 45 individuals (6 in H&Y II, 12 in H&Y III, 6 in H&Y IV).

(Franklach et al, 2009; 102 subjects with PD (25 women, 77 men), mean age 60.2 (9.3) years; There was a subgroup of 18 individuals who had UPDRS III score < 20 and never had medication and 25 control subjects (18 women, 7 men) mean age 56.9 (8.4) years.

  • No statistical difference between PD patients with UPDRS < 20 and controls on any SOT condition
  • PD patients with UPDRS III scores > 20 and controls differed significantly (p < 0.01) in all 6 SOT conditions
  • The equilibrium score for each SOT condition correlated with the UPDRS III score; Spearman rank correlation, SOT 1, 4, 5 (p < 0.0001); SOT 2 (p < 0.02); SOT 3, 6 (p < 0.001).

(Colnat-Coulbois et al 2011, 24 subjects in late stage PD (10 women, 14 men), mean age 60.0 (14) years. 48 control subjects (20 women, 28 men), mean age 62.0 (11.0) years. Median disease duration for the PD group was 11 years, all were in H&Y stage IV)

  • Individuals in late stage PD had significantly lower scores on SOT indicating poorer equilibrium (z = -5.93, p < 0.001) and lower strategy scores (z = -3.67, p < 0.001) than healthy controls
  • The PD group had more difficulty controlling balance sways in more complex sensory conflict situations: in which visual information is the main reliable cue (z = -2.98, p = 0.003); vestibular information was the main reliable cue (z = -4.80, p < 0.001); proprioceptive information is disrupted (z = -4.77, p < 0.001).

(Chong R et al. 1999, 15 individuals with PD (8 females, 7 males), mean age 60 (9) years. 11 subjects with Alzheimers disease (5 females, 6 males), mean age 73 (10) years. 17 healthy controls (8 females, 9 males), mean age 65 (6) years.)

  • Individuals with PD had more falls during the SOT than the control group x2(1) = 6.4, p < 0.05) but were equivalent to those with Alzheimers.
  • In condition 6 in which both visual and proprioceptive information is incongruent 53% of the PD subjects fell in the first trial, 100% of AD subjects lost their balance and 59% of the healthy controls. Both healthy controls and PD subjects improved performance in trials 2 and 3 while subjects with AD did not improve.

(Lee JM et al. 2012, 31 individuals with early stage PD (H&Y 1 to 2.5), (16 women, 15 men) mean age 68.1 (7.28) years; 20 healthy control subjects (10 women, 10 men) mean age 66.6 (7.8) years.

  • No difference in equilibrium control between early stage PD and control subjects.

SOT condition (%)a
Group I H-Y 1 (n = 10)
Group II H-Y 2 and 2.5 (n = 21)
Controls (n = 20)
p-value
SOT 1
91.48(1.77)
93.21(2.78)
93.29(3.02)
0.196
SOT 2
88.53 (2.38)
88.85(5.46)
89.82(5.74)
0.758
SOT 3
85.88(7.57)
87.85(5.89)
88.38(6.92)
0.621
SOT 4
73.53(7.23)
73.36(9.78)
76.03(7.30)
0.559
SOT 5
58.08(8.01)
47.26(23.74)
58.54(10.52)
0.082
SOT 6

53.78(14.23)

43.95(30.05)

54.60(14.95)

0.275

a, Kruskal-Wallis test

Construct Validity (Convergent/Discriminant)

Balance and Vestibular Disorders:

(Whitney and Wrisley, 2004; n = 30; mean age = 63 (17); patients with balance and vestibular disorders, Balance and Vestibular Disorders)

  • Modified CTSIB and SOT (Sensory Organization Test) scores were slightly more correlated when participants completed the assessment with their feet together than when completed with feet apart.

Community-Dwelling Elderly:

(Di Fabio and Anacker, 1996, Community-Dwelling Elderly)

  • Discriminant functions classified 63% of fallers and 77% of non-fallers

Pediatric (Hearing Impairments):

(De Kegel et al, 2010; n = 76; mean age = 9 (3.0 years); children with bilateral hearing impairment vs typically developing children, Pediatric - Hearing Impairments)

  • Modified CTSIB (mCTSIB) scores were able to illustrate a strong, significant amount of postural sway when two types of sensory information were disturbed in children with hearing impairments when compared to typical children

Pediatric (SMD):

(Su et al, 2010; n = 31; mean age = 6.75 (2.25 years); n = 17 children with SMD vs. n = 14 typically developing children, Pediatric (SMD))

  • CTSIB scores showed that children with Sensory Modulation Disorder (SMD) had poorer stance control than typically developing children for all visual input types (p < 0.05), except for the condition of reliable somatosensory input with sway-referenced vision. Results revealed that body sway of the child with SMD was greater than that of the typically developing child for all visual input types under the condition of unreliable somatosensory input (p < 0.05)

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Parkinson Disease:

(Colnat-Coulbois et al. 2011)

  • 24 individuals in H&Y stage IV were able to successfully complete the test indicating no floor effect for ambulatory individuals with PD.
Stroke:
(Bernhardt et al, 1998, Acute Stroke)
Floor effects at 4 weeks & ceiling effects at 8 weeks:
 
CTSIB domain
Week 4: mean (SD)

% Floor

Week 8: mean (SD)

%Ceiling

Firm; eyes open
25.2 (10.7)

10

28.5 (6.1)

93

Firm; eyes closed
4.0 (11.3)

14

28.1 (6.4)

90

Firm; dome
23.2 (11.9)

17

26.7 (8.8)

86

Foam; eyes open
23.5 (11.9)

14

27.0 (7.7)

83

Foam; eyes closed
19.8 (13.3)

21

24.3 (10.7)

72

Foam; dome
18.5 (13.6)

24

23.2 (11.9)

72

Responsiveness

Stroke:
(Bernhardt et al, 1998, Acute Stroke)
 
Standard Responsiveness Measures (SRM)
 
CTSIB domain
SRM
Firm; eyes open
0.38
Firm; eyes closed
0.48
Firm; dome
0.45
Foam; eyes open
0.34
Foam; eyes closed
0.46
Foam; dome
0.44

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

*We are currently in the process of creating individual summaries for the CTSIB, mCTSIB and the SOT.  These individual summaries can be viewed in their working-state under their respective instrument titles.

  • CTSIB was developed to evaluate the relative contributions of sensory systems involved in the maintenance of balance, not to evaluate change over time.
  • For test batteries, Bernhardt et al, 1998 recommend one component of the CTSIB
    • The Repetitive Reach (RR, step stance)
    • Step Test (ST) and
    • Gait velocity assessments
  • The CTSIB initially required participants to remove their shoes prior to administration. However, research suggests that CTSIB scores with low-heeled shoes are not significantly different from no-shoe administrations (Whitney & Wrisley, 2004).
  • Stance (feet together versus feet apart) did not result in significantly different mCTSIB scores. (Wrisley and Whitney, 2004)
  • There is likely a maturation effect on the P-CTSIB, as older children perform better than younger children (Richardson et al, 1992; n = 40 preschool and kindergarten children) and adults perform better than children (Kluenter et al, 2008)
  • Some research evaluates performance on the scale in terms of sway (e.g., degrees/second) instead of the time the subject maintains the starting position.
Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

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

Basta, D., Clarke, A., et al. (2007). "Stance performance under different sensorimotor conditions in patients with post-traumatic otolith disorders." Journal of Vestibular Research 17(1): 25-31.

Basta, D., Todt, I., et al. (2005). "Postural control in otolith disorders." Human movement science 24(2): 268-279.

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

Boulgarides, L. K., McGinty, S. M., et al. (2003). "Use of clinical and impairment-based tests to predict falls by community-dwelling older adults." Phys Ther 83(4): 328-339. Find it on PubMed

Broglio, S. P., Sosnoff, J. J., et al. (2009). "The relationship of athlete-reported concussion symptoms and objective measures of neurocognitive function and postural control." Clin J Sport Med 19(5): 377-382. Find it on PubMed

Chong, R. K., Horak, F. B., et al. (1999). "Sensory organization for balance: specific deficits in Alzheimer's but not in Parkinson's disease." The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 54(3): M122-M128.

Clendaniel, R. A. (2000). "Outcome measures for assessment of treatment of the dizzy and balance disorder patient." Otolaryngologic Clinics of North America 33(3): 519-533.

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Year published

1986 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 10/30/2010 11:36 AM  by Dawood Ali 
Last modified at 9/21/2016 8:47 AM  by Jason Raad