CTSIB for Vestibular Dysfunction
What is the CTSIB (Clinical Test of Sensory Interaction in Balance)? Why is the CTSIB so important for Balance and Vestibular Rehabilitation?
What do FYZICAL and NASA have in common? Both use state-of-the-art equipment called computerized dynamic posturography, or CDP, to objectively assess sensory deficits in your balance system.
Originally developed by NASA to assess imbalance and dizziness symptoms in astronauts after their return to Earth, the sensory organization test, or SOT, measures a patient's ability to stand still and their subsequent sway velocity. What we know from the research is the greater your sway velocity, the higher risk you are of falling or feeling dizzy. FYZICAL uses this cutting-edge technology with our patients, especially those with dizziness or imbalance.
The SOT is made up of six conditions, or tests, that measure the sensory parts of your balance system. The sensory components of your balance system are your vision, your vestibular system, and your somatosensory system. Vision, which is the most used sensory system, is responsible for processing what you see and the movement around you. The vestibular system, which is the judge for balance and it senses gravity, processes velocity and acceleration of your eyes, head and body in six planes of motion:
- Yaw - Turning right and left
- Pitch - Bending forward and backwards
- Roll - Bending side to side
- Bob - Moving linearly up and down
- Heave - Moving linearly side to side
- Surge - Moving linearly forwards and backwards
Your somatosensory system, which is the largest sensory system, processes how your body feels itself in space and how your feet feel the ground.
We are going to briefly go over each condition of the SOT. Starting at:
- Condition One (C1): In condition one, we conduct a baseline assessment that allows us to see how you do when all three systems are functioning together. This is a good test of how you would do without an assistive device like a cane or walker, but it can also pick up whether you are using compensation strategies like holding onto furniture or touching walls to stabilize yourself.
- Condition 2 (C2): In condition two, we remove your vision by asking you to close your eyes. This is meant to mimic a situation with low light or darkness. For example, when you get up in the middle of the night to use the restroom or when walking at dusk or at night. Some people find this really difficult, while balance for others actually improves, especially patients with high visual sensitivity. The importance of all these tests is to individually assess your balance and dizziness to get to the root of the problem.
- Condition 3 (C3): In condition three, we disrupt your visual system with what we call visual conflict. The sensation will feel similar to what you might feel when watching a 3D movie at the theater. The lights moving on the walls of the CDP during the test are meant to mimic situations where you are sitting or standing and people or objects for example cars are moving around you. Think about walking into a grocery store and all the items on the shelves - it can create a visual conflict. This test is described as a responsive test, meaning if you move, the lights on the walls of the CDP move with you. It would be like people moving around at church or in a store, which might cause dizziness and imbalance.
- Condition 4 (C4): In conditions one to three, we kept the floor or surface steady. In condition four, we start to impair your surface or somatosensory system and require you to use the joints of your ankles, knees, and hips. We do this by creating what we call a compliant surface, this means the surface under your feet is going to move. This is meant to mimic a situation such as transitioning from hardwood to carpet, walking over gravel, or stepping on ice or wet grass. As we age we become more reliant on our somatosensory system, which is why we need to assess how well our other two systems are working. Unfortunately things like peripheral neuropathy or pain in your feet can actually leave you reliant on a weakened somatosensory system.
- Condition 5 (C5): In condition five, we challenge both your somatosensory and visual systems forcing you to rely more heavily on your vestibular system. Much like in condition two where we asked you to close your eyes, condition five is meant to mimic a situation with low light and when you may not have sure footing, such as walking to your car after dinner or walking to take the trash cans out in the evening.
- Condition 6 (C6): Last is condition six, which is often the most challenging condition. During this test, we impair both your somatosensory and visual systems by using visual and surface conflict/challenges to mimic a situation in which you are actively moving. This forces you to again actively rely on your vestibular system. Condition six closely mirrors situations where you are walking in environments like the store or mall or driving in your car.
Due to the precision and accuracy of the sensory organization test, we can identify objectively patterns that you use to maintain balance and understand why you are feeling dizziness symptoms and possibly imbalance.
Fact: Every 11 seconds a senior is admitted to the Emergency Room in the U.S. due to unintentional falls.
Interestingly, some people rely more on their eyes for balance and develop visual dependency. Others rely on their feet too much leading to surface or somatosensory dependencies. When you rely on these strategies inappropriately, this leads to dizziness or imbalance, and ultimately the likely cause of your falling and ultimate falls.
Fact: Every 19 minutes, a senior dies in the U.S. due to the complications of an unintentional fall.
The great news about FYZICAL Therapy & Balance Centers is that we can objectively identify your imbalance and dizziness using the SOT and CDP technology and treat your dizziness and imbalance. The FYZICAL Balance Paradigm allows us to focus specifically on your deficits and waste no time on needless guesses and delayed results.
If you are suffering from dizziness or vertigo, imbalance or a history of falls, FYZICAL provides free fall risk screening daily at any of our centers, which only take 10 minutes. If you want more information about SOT and CDP, please visit our website at www.FYZICAL.com/location. If you would like for us to speak to your doctor(s) about balance or provide his/her/them office a lunch and learn about our technology, please let your doctor know or call us and we will be happy to provide a free inservice.