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Modified Clinical Test of Sensory Interaction in Balance - mCTSIB. How to perform and interpret the results!

The modified clinical test of sensory interaction in balance is a modified version of the Clinical Test of Sensory Interaction (CTSIB) that was first developed by Shumway-Cook and Horak whit the purpose of evaluating how different sensory conditions affect balance(Shumway-Cook & Horak, 1986). This initial test, CTSIB, was composed by 6 test conditions:

1)    standing on a firm surface with open eyes;

2)    standing on a firm surface with closed eyes;

3)    standing on a firm surface while an error input is given to the individual's visual system;

4)    standing on a foam with open eyes;

5)    standing on a foam with eyes closed;

6)    standing on a foam while an error input is given to the individual's visual system.

After research shown that there was no significant difference between the results from the closed eyes condition versus condition with visual challenge, on both surface types, condition 3 and 6 were eliminated, and the mCTSIB protocol was established (Lotfi et al., 2018).

Like CTSIB, mCTSIB allows the understanding of sensory interaction on postural stability. Through the analysis of balance control in the 4 test conditions we gain insight into which sensory systems may be impaired or overworking. 

The integration of instrumented testing counteracts the limitations of clinical assessment, such as the subjective analysis from the clinical and the lack of sensitivity for detecting subtle changes or deficiencies. Performing the mCTSIB using a posturography plate enables a rigorous measurement in body sway while sensory information for balance is altered between each condition, delivering an objective assessment of balance control with gold-standard laboratory measures (Freeman et al., 2018).

Check the table below to see how to interpret the results from each test condition.

mCTSIB interpretation table


Freeman, L., Gera, G., Horak, F. B., Blackinton, M. T., Besch, M., & King, L. (2018). Instrumented Test of Sensory Integration for Balance: A Validation Study. Journal of Geriatric Physical Therapy, 41(2), 77–84.

Lotfi, Y., Javanbakht, M., Sayaf, M., & Bakhshi, E. (2018). Modified clinical test of sensory interaction on balance test use for assessing effectiveness of Epley maneuver in benign paroxysmal positional vertigo patients rehabilitation. Aud Vest Res (2018);27(1):12-18.

Shumway-Cook, A., & Horak, F. B. (1986). Assessing the Influence of Sensory Interaction on Balance. 1545–1550.

Do you have questions about this topic? Or want to know more about balance system?

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Ana Souto

Meet Ana, a physiotherapist with a master's degree in human physiology, currently

specializing in neurobiology. Her professional journey has led her to gain extensive expertise in both neurology and sports physiotherapy.

Ana currently serves as the clinical specialist at PhysioSensing, a cutting-edge Balance Assessment and training device. Leveraging her strong foundation in scientific research and evidence-based practices, Ana creates customized assessment and training plans. Her approach is firmly rooted in the latest scientific findings, ensuring that PhysioSensing users receive the most effective and up-to-date care.

In addition to her role in designing tailored programs, Ana plays a pivotal role in guiding new clients through the learning process of using PhysioSensing. She also provides advanced training and support to existing customers seeking to further deepen their clinical practice knowledge and stay on top of the latest scientific advancements.

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