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

Learn how to perform and interpret the Modified Clinical Test of Sensory Interaction in Balance (mCTSIB). Discover its purpose, test conditions, and how it assesses sensory contributions to balance.

Sensory Interaction in Balance

Our ability to stay upright and understand where we are in space relies on three major sensory systems: visual, vestibular, and somatosensory. Under normal conditions, vision and somatosensation (information from muscles, joints, and skin) provide most of the input the brain uses for spatial orientation.

Although these systems overlap and provide redundant information, the vestibular system is unique, since it is the only one capable of detecting head acceleration, both angular (via the semicircular canals) and linear (via the otolith organs). Vision has its limitations because it also detects motion around us, not just our own movement, it can easily be “fooled.” For example, when a large object moves across our visual field, the brain may misinterpret it as our body moving. This illusion of self‑motion is called vection.

To make sense of conflicting signals, the Central Nervous System constantly compares information from all three systems and decides which one is most reliable at each moment. This process, known as sensory weighting, allows the brain to adjust the importance of each sensory input depending on the situation.

This dynamic interplay between our sensory systems is what keeps us stable, oriented, and able to move confidently through the world.

When Sensory Reweighting Becomes a Problem

This adaptive sensory‑weighting mechanism also comes into play when a sensory system is injured or not working properly. In these cases, the brain temporarily increases its reliance on the remaining systems to compensate for the poorer-quality input. This is helpful in the short term, but sometimes the brain keeps this strategy for too long.

When this happens, a maladaptive compensation can develop. The brain continues to over‑rely on the other sensory systems even in situations where it should not. This persistent imbalance often leads to ongoing symptoms such as dizziness and unsteadiness.

For example:

• Visual dependence: When a person becomes overly reliant on visual information, environments with lots of visual motion such as crowds, traffic, busy patterns, bright or repetitive lights can easily trigger dizziness and instability.

• Proprioceptive dependence: If the brain begins to depend too heavily on proprioceptive cues, walking on unstable or compliant surfaces (grass, sand, foam, slopes) may feel excessively difficult, increasing the risk of falls.

  
  

These maladaptive patterns highlight how crucial balanced sensory integration is for everyday stability and confidence in movement. It is essential to understand which sensory strategy a patient predominantly uses to maintain balance. This knowledge is crucial for two main reasons:

1. Identifying high‑risk environments: If a patient is visually dependent, busy environments full of motion and visual complexity may increase the risk of dizziness or falls. If the patient depends heavily on proprioception, soft or uneven surfaces may pose a greater challenge. Knowing the dominant strategy helps clinicians predict which situations are potentially hazardous.

   
   

2. Guiding effective rehabilitation: Rehabilitation should encourage the patient to make better use of the sensory inputs that are underused. By exposing the patient to controlled challenges and gradually retraining sensory integration, therapists can help restore a more balanced and adaptive weighting of visual, vestibular, and somatosensory cues.

   
   

Understanding these sensory preferences is a key step toward personalised and effective balance rehabilitation, helping each patient move more confidently and safely in their daily life.

mCTSIB: A Simple and Quick Way to Assess Sensory Integration

The mCTSIB is a simplified tool for assessing sensory integration in postural control. Through the analysis of balance control in the 4 test conditions we gain insight into which sensory systems may be impaired or overworking. 

1. eyes open on a stable surface;

2. eyes closed on a stable surface;

3. eyes open on an unstable surface (foam);

4. eyes closed on an unstable surface (foam).

   
   

Condition	1	2	3	4
Eyes	Open	Closed	Open	Closed
Surface	Stable	Stable	Unstable (Foam)	Unstable (Foam)
Vision	Present	Missing	Present	Missing
Available and accurate Inputs	VEST, SOM, VIS	VEST, SOM	VEST, VIS	VEST
Unavailable Inputs		VIS		VIS
Inaccurate Inputs			SOM	SOM

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.

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

Schedule a 15 minute talk with me!

Book now

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.

References

Assländer, L., & Peterka, R. J. (2014). Sensory reweighting dynamics in human postural control. Journal of Neurophysiology, 111(9), 1852–1864. https://doi.org/10.1152/jn.00669.2013

Boughen, J., Dunn, K., Nitz, J., Johnston, V., & Khan, A. (2013). A new method of interpreting the centre of gravity location using the modified Clinical Test of Sensory Interaction on Balance: A reliability study. Hong Kong Physiotherapy Journal, 31(2), 64–68. https://doi.org/10.1016/j.hkpj.2013.04.002

Bronstein, A. M. (2004). Vision and vertigo. Journal of Neurology, 251(4), 381–387. https://doi.org/10.1007/s00415-004-0410-7

Bronstein, A. M. (2016). Multisensory integration in balance control. In Handbook of Clinical Neurology (Vol. 137, pp. 57–66). Elsevier. https://doi.org/10.1016/B978-0-444-63437-5.00004-2

Carrick, F. R., Pagnacco, G., Hunfalvay, M., Azzolino, S., & Oggero, E. (2020). Head Position and Posturography: A Novel Biomarker to Identify Concussion Sufferers. Brain Sciences, 10(12), 1003. https://doi.org/10.3390/brainsci10121003

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. https://doi.org/10.1519/JPT.0000000000000110

Hupfeld, K., McGregor, H., Hass, C., Pasternak, O., & Seidler, R. (2022). Sensory system-specific associations between brain structure and balance [Preprint]. Neuroscience. https://doi.org/10.1101/2022.01.17.476654

Maire, R., Mallinson, A., Ceyte, H., Caudron, S., Van Nechel, C., Bisdorff, A., Magnusson, M., Petersen, H., Kingma, H., & Perrin, P. (2017). Discussion about Visual Dependence in Balance Control: European Society for Clinical Evaluation of Balance Disorders. The Journal of International Advanced Otology, 13(3), 404–406. https://doi.org/10.5152/iao.2017.4344

Martini, D. N., Gera, G., Brumbach, B. H., Campbell, K. R., Parrington, L., Chesnutt, J., & King, L. A. (2023). Symptoms and Central Sensory Integration in People With Chronic mTBI: Clinical Implications. Military Medicine, 188(11–12), 3553–3560. https://doi.org/10.1093/milmed/usac157

Nashner, L. M., & Peters, J. F. (1990). Dynamic Posturography in the Diagnosis and Management of Dizziness and Balance Disorders. Neurologic Clinics, 8(2), 331–349. https://doi.org/10.1016/S0733-8619(18)30359-1

Park, M. K., Kim, K.-M., Jung, J., Lee, N., Hwang, S. J., & Chae, S. W. (2013). Evaluation of Uncompensated Unilateral Vestibulopathy Using the Modified Clinical Test for Sensory Interaction and Balance. Otology & Neurotology, 34(2), 292–296. https://doi.org/10.1097/MAO.0b013e31827c9dae

Peterka, R. J. (2002). Sensorimotor Integration in Human Postural Control. Journal of Neurophysiology, 88(3), 1097–1118. https://doi.org/10.1152/jn.2002.88.3.1097

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

Wrisley, D. M., & Whitney, S. L. (2004). The effect of foot position on the modified clinical test of sensory interaction and balance. Archives of Physical Medicine and Rehabilitation, 85(2), 335–338. https://doi.org/10.1016/j.apmr.2003.03.005