Clinical Test of Sensory Interaction on Balance

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)

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)

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)

• Excellent test-retest reliability (r = 0.75)

Community-Dwelling Elderly:

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

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

Community-Dwelling Elderly: 

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

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

(Bernhardt et al, 1998; n = 29; mean age = 71.8 (10.5) years; < 4 weeks post onset, Acute Stroke)

Hemiplegia:

(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

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:

Stroke:

(Bernhardt et al, 1998, Acute Stroke)

Standard Responsiveness Measures (SRM)

(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

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.

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)

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)

• Excellent interrater reliability (r = 0.99)

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