Modified Clinical Test for Sensory Interaction on Balance

Original Editor - Memoona Awan Top Contributors - Memoona Awan

Purpose[edit | edit source]

Physiotherapists ShumwayCook and Horak, invented this test in 1986 to devise fall risk assessments for older adults and 10 rehabilitation guidelines for balance deficits and lower extremity injuries. The test has changed over the years to include four conditions. It tests the static stability and dynamic stability utilizing foam pads[1].

It is used for balance analysis and to determine the dependence of the individual on all sensory systems ( vision, vestibular and somatosensory ) which maintain balance[2]. It can also be used as balance training/ rehabilitation as it provides multiple conditions which challenge the sensory feedback system needed to maintain balance[3]. Studies suggest that a decrease in sway can be achieved with a 1-week training program[3].

Population[edit | edit source]

Older adults, Vestibular disorders, Stroke, Pediatric disorder, Alzheimer's and Progressive dementia.

Technique[edit | edit source]

On Floor Complain surface ( Foam )
Condition 1 Condition 2 Condition 4 Condition 5
Feet together on the floor, Arms across the chest. Feet together on the floor, Arms across the chest. Feet together on the foam, Arms across the chest. Feet together on the foam, Arms across the chest.
30-second hold 30-second hold 30-second hold 30-second hold
Open eyes Closed eyes Open eyes Closed eyes
Interpretation[edit | edit source]
  • Equipment: Stopwatch
  • Each condition is tested 3 times and a value of 1 to 4 to characterize the sway. 1= minimal, 2-sway, 4 = a fall[1].
  • The timer stops when the patient opens their eyes, moves their arms, or loses balance[4][5].
  • The therapist adds up total times (30s max per condition) for a score out of 120s once all conditions are tested[4][5].
  • Composite sway is the mean sway speed averaged over the 4 conditions[6].
  • The Sway Index recorded over the 4 conditions. The higher the sway index, the more unsteady balance a person has during the test. [6]
  • Instrumenting m-CTSIB using body-worn inertial sensors improves the scale of measure from ordinal to ratio, thus test precision, which allows clinicians to quantify sway with accuracy in patients with mild impairments[7].

Evidence[edit | edit source]

The CTSIB and modified CTSIB have significant validity and reliability in adults with vestibular disorders[10].

The validity of the m-CTSIB test was significantly and positively correlated with the mini-BESTest-GR with r= -0.652 and p<0.001[11].

Resources[edit | edit source]

  2. M-CTSIB Calculator
  3. Test-Retest Reliability and Learning Effect of the Modified CTSIB Balance Protocol

References[edit | edit source]

  1. 1.0 1.1 Hathiram, Bachi. The Clinical Test for the Sensory Interaction of Balance. Otorhinolaryngology Clinics. 2012 Apr;4:41– 45.
  2. Boonsinsukh, Rumpa and Khumnonchai, Bodin and Saengsirisuwan, Vitoon and Chaikeeree, Nithinun. The effect of the type of foam pad used in the modified Clinical Test of Sensory Interaction and Balance (mCTSIB) on the accuracy in identifying older adults with fall history. Hong Kong Physiotherapy Journal. 2020 Jul;40(2):75–153.
  3. 3.0 3.1 Walter, E.; Brocht, E.; Carroll, A.; Johnson, P.; and Kieffer, S. Test-Retest Reliability and Learning Effect of the Modified CTSIB Balance Protocol in a Geriatric Population. International Journal of Exercise Science. 2019 Nov;9(7).
  4. 4.0 4.1 Peterka R. and Loughlin P.. Dynamic regulation of sensorimotor integration in human postural control. Journal of Neurophysiology 2004;91(1):410-423.
  5. 5.0 5.1 Brent Pritt. Modified Clinical Test of Sensory Interaction in Balance (CTSIB-M) [Internet]. Science of falling. 2010 [cited 2023 Dec 3]. Available from:,more%20trials%20of%20that%20condition.
  6. 6.0 6.1 Dawson, N, Dzurino, D, Karleskint, M, Tucker, J. Examining the reliability, correlation, and validity of commonly used assessment tools to measure balance. Health Sci Reports. 2018;1(12):e98.
  7. Freeman, L., Gera, G., Horak, F. B., Blackinton, M. T., Besch, M., & King, L. Instrumented Test of Sensory Integration for Balance: A Validation Study. Journal of geriatric physical therapy. 2019;41(2):77–84.
  8. PhysioSensing. Modified Clinical Test of Sensory Interaction on Balance - mCTSIB protocol . Available from: [Premiered Nov 26, 2018]
  9. Natus Newborn Care. Modified Clinical Test of Sensory Interaction on Balance mCTSIB. Available from: [Apr 23, 2018]
  10. Linda B. Horn, Teresa Rice, Jennifer L. Stoskus, Karen H. Lambert, Elizabeth Dannenbaum, Matthew R. Scherer. Measurement Characteristics and Clinical Utility of the Clinical Test of Sensory Interaction on Balance (CTSIB) and Modified CTSIB in Individuals With Vestibular Dysfunction. Archives of Physical Medicine and Rehabilitation. 2015 Sep;96(9):1747– 1748.
  11. Antoniadou, E., Kalivioti, X., Stolakis, K., Koloniari, A., Megas, P., Tyllianakis, M., & Panagiotopoulos, E. Reliability and validity of the mCTSIB dynamic platform test to assess balance in a population of older women living in the community. Journal of musculoskeletal & neuronal interactions. 2020;20(2):185– 193.