Modified Clinical Test of Sensory Integration in Balance (mCTSIB)
Sometimes colloquially referred to as the ‘Foam and Dome’ Test. It was created by Shunway-Cook and Horak in 1986 and consisted of 6 tests with the patient standing with feet together and arms across chest. The tests included standing with eyes open, eyes closed, eyes open with a dome that provided visual stimulation. Then the tests were performed again on perturbational foam. The clinician scored postural sway over 30 seconds. This tests visual, vestibular and proprioceptive challenge. The dome tests were later dropped hence the modified version with four tests.
Using posturography this test can be performed objectively and provide data on postural sway, area and location of sway, velocity of change in centre of pressure, whether or not the patient’s stability improves over the duration of the test (motor learning). The patient’s scores can then be compared to an age, height and sex matched normative database to provide a percentage of stability score and hence the likelihood of a fall.
In addition once objective tests have been done the patient can then be tested with a functional challenge, such as specific reflex stimulation , head or gaze positional change or a mental task and results compared to their normal. Thus this test can be useful in determining the likelihood of a fall, the likely direction and dynamics of a fall, under what specific condition this is likely to occur, and how best to create a rehabilitation program to improve postural stability.
Limit of Stability Test (LoS)
Measures the area that the patient can move their trunk (shift their Centre of Gravity) without falling over in static stance. Useful for measuring bias to one side and documenting outcomes. The smaller the LoS the shorter the gait cycle and the higher the likelihood of a fall.
Sit to Stand Test (StS)
Patient stands from sitting on a visual cue. Measures reaction time, bias to one side, and how quickly the patient stabilises on standing. A particularly useful assessment of pelvic and hip biomechanics as well as how well a patient can generate forward momentum. Also useful in early stage movement disorders, to see how quickly the patient stabilises following a ballistic movement.
Weight – Shift Targeting
Measures a whole body response to a visual target. Analogous to the cerebellar finger- nose test in different visual fields. Measures reaction time, efficiency to the target (motor planning and execution) accuracy to the target (undershoot or overshoot, right or left)
Power, Velocity & Acceleration
Measure changes in force of centre of pressure and position of centre of pressure to provide power, velocity, acceleration and displacement of a particular movement. Particularly useful for athletes, or for measuring lower limb strength in balance rehabilitation.
I run my own Falls Risk Assessment protocol. The assessment includes a focussed balance history and specialised posturographic assessment which measures:
- Static stability using a modified Clinical Test of Sensory Integration in Balance (mCTSIB). Using normative data comparison, we are able to measure stability and quantify the risk of a fall;
- Limit of stability (LoS);
- Efficiency and speed in standing using a Sit to Stand Test; and
- Lower Extremity strength using a Sit to Stand Test.
Our assessment provides us with an objective and accurate risk of a fall, functional limitations, ‘postural character’ as well as likely direction of a fall and statistical documentation of movement characteristics for outcome measurement of therapy progress. The Assessment takes 30 minutes and is non invasive. Should a patient fail the assessment and be appropriate for rehabilitation we recommend our Postural Rehabilitation Program.
The Postural Rehabilitation 6 week exercise and physical therapy program is suitable for patients with musculoskeletal conditions with a weight bearing component as well as patients with deteriorating stability.
The core of this program revolves around:
- Developing an individually tailored program prescribed following a Falls Risk Assessment;
- Improving the patient’s centre of pressure (CoP) in static stance and limit of stability (LoS); and
- Using posturography for regular feedback on therapy progress and for rehabilitation.
The first session of the program, I perform a ‘Functional Postural Assessment’ where I evaluate stability in response to head movement, eye movement, various proprioceptive stimulations, vestibular stimulations and mental tasks. From this information I design the specific rehabilitation. This Postural Assessment takes 30 minutes, and in non invasive.
Physical Therapy is applied by Dr Tranfield and rehabilitation in 1:1 with a specially trained exercise physiologist.
Once stability has been established and limit of stability increased we work on stability during the gait cycle. Rehabilitation includes step timing, coordination, stimulation of central pattern generators and dual tasking.
I am currently writing a Posturography training program for Physical Therapists. If you would like to learn how to incorporate Posturographic testing and rehabilitation in your practice register your interest by contacting me here.