CTSIB (Clinical Test of Sensory Interaction in Balance)

Evaluates postural control under various sensory conditions.

Refer to the text below the calculator for more information about the CTSIB.


The CTSIB is a sensory test that is intended to quantify postural control under various sensory conditions, where the assessor observes the patient’s attempt to maintain balance.

This performance measure looks into both vestibular and non-vestibular balance and is addressed to patients with brain injury, stroke recovery, multiple sclerosis and during neurological rehabilitation.


Instructions:

  • Patient performance in maintaining balance during each of the 6 conditions is timed for 30 seconds.
  • If during the first attempt the patient is unable to maintain the position for 30 seconds, they are provided with 2 additional attempts and an average time of the 3 trials is calculated.
  • A trial is terminated when the patient’s arms or feet change position.

1Condition 1

Stand on the floor with arms across your chest and your hands touching your shoulders, feet together with ankle bones touching, and hold for 30 seconds.
Trial 1 (time in seconds out of 30 sec)
Trial 2 (time in seconds out of 30 sec)
Trial 3 (time in seconds out of 30 sec)

2Condition 2

Stand on the floor with arms across your chest and your hands touching your shoulders, feet together with ankle bones touching, with your eyes closed, and hold for 30 seconds.
Trial 1 (time in seconds out of 30 sec)
Trial 2 (time in seconds out of 30 sec)
Trial 3 (time in seconds out of 30 sec)

3Condition 3

Stand on the floor with arms across your chest with your hands touching your shoulders, feet together with ankle bones touching, the visual conflict dome on your head with your eyes open, and hold for 30 seconds.
Trial 1 (time in seconds out of 30 sec)
Trial 2 (time in seconds out of 30 sec)
Trial 3 (time in seconds out of 30 sec)

4Condition 4

Stand on a 3 inch high density foam cushion with your arms crossed and touching your shoulders, feet together with the ankle bones touching, and your eyes open, holding for 30 seconds.
Trial 1 (time in seconds out of 30 sec)
Trial 2 (time in seconds out of 30 sec)
Trial 3 (time in seconds out of 30 sec)

5Condition 5

Stand on a 3 inch high density foam cushion with your arms crossed and touching your shoulders, feet together with the ankle bones touching and your eyes closed, holding for 30 seconds.
Trial 1 (time in seconds out of 30 sec)
Trial 2 (time in seconds out of 30 sec)
Trial 3 (time in seconds out of 30 sec)

6Condition 6

Stand on a 3 inch high density foam cushion with your arms crossed and touching your shoulders, feet together wit ankle bone touching, and your eyes open looking into the dome, holding for 30 seconds.
Trial 1 (time in seconds out of 30 sec)
Trial 2 (time in seconds out of 30 sec)
Trial 3 (time in seconds out of 30 sec)
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About the CTSIB

The Clinical Test for Sensory Interaction in Balance (CTSIB) is a sensory strategy balance test. It is administered by manipulating the support surface from firm to soft (foam), by manipulating visual conditions (eyes open versus eyes closed) and by assessing vestibular system through sway with a dome or computerized sway platform).

The CTSIB test allows clinicians to determine which sensory system (visual, somatosensory, or vestibular) the patient relies on to maintain balance.

It is addressed to patients with a variety of conditions, from brain injury, multiple sclerosis, Parkinson’s disease, vestibular disorders to stroke recovery and neurological rehabilitation.

The CTSIB consists in 6 conditions (timed tests):

  • Conditions 1, 2, and 3 involve standing on the floor with eyes open, eyes closed, and wearing a visual-conflict dome*. Condition 2 examines how well the patient maintains balance in absence of vision whilst condition 3 examines balance performance when visual information conflict with vestibular information.
  • Conditions 4, 5, and 6 involve standing on foam and repeating the conditions 1 to 3, but this time the solid surface being replaced by a soft surface.

* The visual-conflict dome provides a sensory conflict by depriving the subject of peripheral vision and introducing a sway-referenced image.

Administration instructions:

  • Patient performance in maintaining balance during each of the 6 conditions is timed for 30 seconds.
  • If during the first attempt the patient is unable to maintain the position for 30 seconds, they are provided with 2 additional attempts and an average time of the 3 trials is calculated.
  • A trial is terminated when the patient’s arms or feet change position.
  • Equipment required: stopwatch, piece of medium density viscoelastic foam, visual conflict dome.
  • Initial notes on administering the conditions required the patients to remove their shoes, however, subsequent studies have shows that are is no significant impact on results from low-heeled shoes.

The below table examines the reliance on sensory systems during each of the 6 conditions:

Condition Sensory impact
1. Eyes open, foam surface All three sensory systems available – normal standing time is at least 30 seconds
2. Eyes closed, foam surface Only the somatosensory & vestibular systems are present. Patients who are dependent on vision for maintaining balance become unsteady.
3. Eyes open, visual conflict with dome, foam surface All three sensory systems available but with visual-vestibular conflict due to dome use. Patients who are dependent on vision are unsteady.
4. Eyes open, foam surface Visual & vestibular systems are present. Patients who are dependent on surface/somatosensory inputs are unsteady.
5. Eyes closed, foam surface Only vestibular system is present. Patients with vision dependency due to somatosensory or vestibular loss are unsteady.
6. Eyes open, visual conflict with dome, foam surface Visual conflict can create a problem for patients depending on their vision for balance, patients with somatosensory or vestibular loss are unsteady.

Patients who lose their balance on conditions 3 to 6 suffer from a sensory selection problem, they are unable to effectively adapt sensory information for postural control.

The shortened version, the modified Clinical Test of Sensory Interaction in Balance (MCTSIB) is more commonly used nowadays.

 

References

Original reference

Horak FB. Clinical measurement of postural control in adults. Phys Ther. 1987;67(12):1881-5.

Other references

Shumway-Cook A, Horak FB. Assessing the influence of sensory interaction of balance. Suggestion from the field. Phys Ther. 1986;66(10):1548-50.

Whitney SL, Wrisley DM. The influence of footwear on timed balance scores of the modified clinical test of sensory interaction and balance. Arch Phys Med Rehabil. 2004;85(3):439-43.


Specialty: Neurology

System: Nervous

No. Of Items: 6

Year Of Study: 1987

Abbreviation: CTSIB

Article By: Denise Nedea

Published On: May 6, 2020

Last Checked: May 6, 2020

Next Review: May 6, 2025