Modified Clinical Test of Sensory Interaction on Balance

Alzheimer’s Disease:

(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)

Alzheimer’s Disease:

(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

Alzheimer’s Disease:

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

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

Geldhof et al, 2006 determined normative scores with 99 children aged 9-10 years. Means and Standard deviations are presented in the table below.

(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)

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

Children:

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)

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)

(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

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)

Healthy adults:

Hageman et al, 1995, in a pilot study of 12 healthy subjects aged 24-68 years tested 1 week apart found high test-retest reliability for the first 2 conditions of the instrumented CTSIB-M (NeuroCom Balance Master).  ICC  = 0.91 for firm surface eyes open and ICC = 0.97 for firm surface eyes closed.

Healthy women:

Nitz et al, 2013 found that the inability to maintain standing on foam with eyes closed predicted future multiple falls (Odds Ratio 4.21 95% confidence interval 1.79-9.92) based on a 10 year prospective study involving 449 women aged 40-80.

Stroke:

Liston and Brouwer, 1996, found poor to moderate reliability for patients with stroke (n = 20, mean age 64 ± 8.5 years, time since stroke 6 months to 17 years, all ambulatory patients with hemiparesis) for the first 2 conditions of the instrumented CTSIB-M (NeuroCom Balance Master),  ICC = 0.56 for firm surface eyes open and ICC = 0.63 for firm surface eyes close

Adults with Imbalance:

In 81 patients with a complaint of imbalance, Loughran et al, 2005 found good agreement between 2 clinicians scoring the CTSIB-M and the scores on instrumented CTSIB-M (NeuroCom Balance Master) for conditions 2, firm surface eyes closed (kappa = 0.57); condition 3, foam surface eyes open (kappa = 0.72) and condition 4, foam surface eyes closed (kappa =0.72).  Agreement between the 2 clinicians ranged from kappa = 0.31 (condition 1 firm surface eyes open) to 0.81 (condition 3 foam surface eyes open).

Patients with complaints of dizziness or imbalance: 

Wrisley and Whitney, 2004 found significant but small correlations between CTSIB-M scores and SOT condition 2, firm surface with eyes closed (r = 0.48), condition 4, sway referenced surface, eyes open (r = 0.30), and condition 5, sway-referenced surface with eyes closed (r = 0.51)

Patients with complaints of dizziness or imbalance:

Weber and Cass, 1993, used the Sensory Organization Test (SOT) as the gold standard for the CTSIB-M with patients with complaints of dizziness or imbalance.  The CTSIB-M condition 4, standing on foam with the eyes closed had a sensitivity of 95%, and a specificity of 90% compared to SOT condition 5.

Vestibular dysfunction: 

Loughran et al, 2005 found weak correlations between scores on the instrumented CTSIB-M (NeuroCom Balance Master) firm surface conditions and the Dizziness Handicap Inventory (r = 0.262 and r = 0.370) in patients with vestibular dysfunction but no correlation between DHI Scores and the foam conditions of the CTSIB-M.  Weak correlations were also found between the Health Utilities Index and the scores on the CTSIB-M.

Unilateral Vestibulopathy:

Park et al 2013 explored the relationship between the Sensory Organization Test (SOT) and the instrumented CTSIB-M in subjects with uncompensated unilateral vestibulopathy.  Correlations between the 4 conditions of the CTSIB-M and the corresponding conditions of the SOT and the composite score ranged from -0.23 to -0.65 (all statistically significant).  The agreement between the SOT and CTSIB-M in classifying subjects who were normal or abnormal on the tests resulted in a sensitivity of 42% and a specificity of 68% (using SOT as the gold standard).

Vestibular dysfunction:

Whitney and Wrisley, 2004 found significant difference between patients with vestibular dysfunction with or without normal scores on CTSIB-M for self-perception (ABC, DHI) and functional balance scales (DGI, TUG, Gait Speed. Five times sit to stand and sensory organization test) (p < 0.05)

Giray et al, 2009 demonstrated significant differences on the instrumented CTSIB-M (NeuroCom Balance Master) between subjects with unilateral vestibular dysfunction who received vestibular rehabilitation and those who did not (p < 0.05 for all conditions and composite.

Community dwelling older adults:

Boulgarides et al, 2003, found that the instrumented CTSIB-M did not accurately predict falls in community dwelling older adults who were active and independent.