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The CTSIB provides the clinician with a means to quantify postural control under various sensory conditions.
6
20 minutes
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)
Child
6 - 12
yearsAdolescent
13 - 17
yearsAdult
18 - 64
yearsElderly Adult
65 +
yearsDiane Wrisley, PT, PhD, NCS and Elizabeth Dannenbaum, MScPT for the Vestibular EDGEtask force of the Neurology section of the APTA.
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 (Vestibular EDGE) 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: ANPT Outcome Measures Recommendations (EDGE)
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)
Vestibular EDGE
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
Vestibular EDGE
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
Vestibular EDGE
Yes
Yes
Yes
Yes
Do you see an error or have a suggestion for this instrument summary? Please e-mail us!
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)
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
Community dwelling adults:
(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)
Community-Dwelling Elderly:
(Di Fabio and Anacker, 1996, Community-Dwelling Elderly)
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
Community-Dwelling Elderly:
(Di Fabio and Anacker, 1996, Community-Dwelling Elderly)
(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)
Hemiplegia:
(DiFabio & Badke, 1990; tested on subset of subjects: n = 5, mean age = 58 (12) years, hemiparesis, Chronic Stroke)
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.
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
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
(Cohen et al, 1993, n = 17, mean age 59.8 (18.9), Vestibular Impairment):
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)
Vestibular Disorders:
(Cohen et al, 1993, n = 17, mean age 59.8 (18.9), Vestibular Impairment):
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.
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
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
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.
Healthy Young Adults:
(Cohen et at, 1993, Healthy Young Adults)
Healthy Young Adults:
(Cohen et al, 1993, Healthy Young Adults)
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.
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.