Your Audiology Tutorial: CTSIB

The Clinical Test of Sensory Integration and Balance (CTSIB), a test of postural stability, was developed by physical therapists in the mid-1980s to assess how the three modalities of balance: vestibular, visual, and somatosensory allow equilibrium to be maintained against gravity.   When a patient has their standing surface and visual capability adjusted, deficits with the peripheral system (ear) can be discerned by their performance.   In my clinic I utilize a modified version of the CTSIB as a supplement to the videonystagmography (VNG) test, which assesses inner ear function as related to balance.

A large, dense square of foam is used as the "dynamic" surface.  The patient will remove their shoes and stand first on the floor ("static") and then the foam with eyes open and closed.  The clinician will observe for any sway in any direction during all conditions.  Patients with a central (brain) dysfunction may even begin to fall when attempting to navigate the dynamic surface.   For the unmodified version of the CTSIB, the patient will also perform all of the above with what is known as a visual conflict dome on their head ("foam and dome test").

The CTSIB is especially sensitive for those with an uncompensated peripheral vestibulopathy - one ear that has weaker output for balance information that is causing dizziness.  Interpretation should allow for consideration of co-morbidities, history of falls, as well as visual and orthopedic problems.