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CTSIB TEST RESuLT INTERPRETaTION (Neurocom)
The CTSIB is the Clinical Test for Sensory Integration and Balance. The CTSIB is the standard
test for differentiating balance problems as a result of visual, vestibular or somatosensory
The CTSIB uses 4 conditions to test contribution of visual, vestibular and somatosensory inputs:
1. Eyes Open, firm surface: This is the baseline condition. Accurate information is available to all
three sensory systems: visual, vestibular and somatosensory. Normal individuals are very stable in
this condition.
2. Eyes Closed, Firm surface: No visual input is available. The Patient must rely on somatosen-
sory and vestibular inputs. Somatosensory is the primary sensory input. Vestibular inputs are sec-
ondary. High sway scores are indicative of problems with somatosensory. In normal individu-
als there is no significant difference in sway with eyes open or closed on a firm surface.
3. Eyes Open, Unstable (foam) surface. The unstable surface confounds the somatosensory
information as it imposes additional challenges to the musculoskeletal system. Primary inputs
are visual with vestibular as secondary. Normal individuals will sway more on the unstable sur-
face, but will not fall.
4. Eyes Closed, Unstable (foam) surface: This condition focuses on the vestibular sensory input as
visual is not available and somatosensory is challenged by the unstable surface. Again normal
individuals will sway more on the unstable surface, but will not fall.
To interpret or apply the test results consider under what condition was sway the greatest?
Normal balance includes the ability to hold still in various situations depending on the activity
or circumstance demands. The COG sway scores indicate how well the patient accomplished
this. Lower scores reflect little movement which are consider better than higher scores which
reflect more movement.
Firm Surface: Eyes Open vs. Eyes Closed
Normal individuals standing on a firm surface have similar amounts of sway with eyes open or
closed. On a firm surface, when significantly more sway is present with eyes closed then the
patient maybe having difficulty using somatosensory inputs (this is the input up from the feet).
An ankle strategy should be used for primary balance control on a firm surface.
unstable (Foam) Surface: Eyes Open vs Eyes Closed
With Eyes open on an unstable surface, normal individuals have significantly more sway then
when standing on a firm surface. And even more sway on the unstable surface with their eyes
closed. However – they do not become overly unstable or fall. Patients that do become unstable
or fall when standing on foam with eyes open may have difficultly using visual information for
balance control and/or may have lower extremity musculoskeletal problems. A hip strategy
should be used on unstable surfaces.
NOte: These tests are targeting sensory integration deficits. Standing on an unstable surface presents
biomechanical and musculoskeletal challenges. Patient with ankle or foot problems, joint weakness or pain
will have high scores. As such in these patients it can not be assumed that sensory abnormalities are the
underlying cause, as they can not be distinguished from motor (musculoskeletal) issues. Ideally patient
should be screen for motor problems prior to the CTSIB test. Only patients without motor problems
should be tested with the CTSIB. The LOS test is an effective test to tease out this question.
APPENDIX D
— D-6 —
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