Clinical Test Of Sensory Interaction And Balance Research Articles

Zinc Deficiency: A Harbinger of Vestibular Dysfunction?

Background: Role of zinc in the maintenance of redox homeostasis have been explored & is established to have antioxidant effects in the body. Presence of zinc in auditory system & its role in deafness & tinnitus is well established. Zinc supplementation has shown to not only improve tinnitus but also dizziness associated with it which marks the presence of zinc in vestibular system 4. The possible role of zinc in modulating neurotransmission across the glutaminergic synapses in vestibulo cerebellar, vestibulo-occular pathways are established. So, this study aims to assess serum zinc levels in vestibular disorder patients & correlate with severity of the vestibular dysfunction Methodology: This was Cross sectional comparative study, 40 patients with vestibular disorders & 40 subjects without vestibular dysfunction were included in the study. After thorough history taking, these patients were subjected to Dix Hallpike test, Head Impulse test Romberg test on foam with eyes closed /The Clinical Test of Sensory Interaction and Balance (CTSIB) to confirm vestibular dysfunction. After that, Dizziness handicap inventory (DHI) to assess the severity of the vestibular dysfunction. Serum zinc levels along with other, micronutrients like magnesium, calcium & Serum vitamin B12 & vitamin D were also assessed. Serum zinc levels were compared with age matched controls. Results: Out of 40 patients, 24 had mild & 16 had moderate scores according to DHI. Serum zinc levels in study group was 60.63±10.10 which was significantly (p<0.005) lower than compared control group 70.50±19.1. Also, Serum zinc levels were corelated with the severity of the vestibular dysfunction, (r=0.89, p<0.00) which shows that more severe the dysfunction lesser the serum zinc levels. Conclusion: Role of zinc as an antioxidant is well established and deficiency of zinc is linked with the pathogenesis of various diseases. Since evidences suggest involvement of zinc in vestibular system, zinc supplementation in vestibular disorder patients can be considered as add on therapy, which might have a beneficial role with respect to cognitive function as well.

Functional Mobility and postural balance in older adults with Alzheimer's disease: comparative study between mild and moderate stages

Objective: This study aimed to compare the functional mobility and postural balance of older adults among smild and moderate stages of Alzheimer's disease using the Timed Up and Go test (TUGT) and the Clinical Test of Sensory Interaction and Balance (CTSIB). Methodology: Forty elderly people were divided into two groups according to the mild (CDR1; n = 26) and moderate (CDR2; n = 14) stages of the disease. The Clinical Dementia Rating Scale (CDR) was used for staging the disease, which allows classifying the different degrees of dementia, assessing cognition and behavior. The scale allows classification into CDR 0 (normal or no alteration); 0.5 (questionable or mild cognitive impairment); 1 (mild dementia); 2 (moderate dementia) and 3 (severe dementia). In this study, only subjects classified as CDR 1 or CDR 2 were included. For the assessment of functional mobility, the Timed Up and Go Test (TUGT) was used in the conditions of single task, dual cognitive task and dual motor task, and the Clinical Test of Sensory (CTSIB) to assess postural balance. Data were compared between groups. Results: Performance on the TUGT single task, cognitive dual task, and motor dual task was significantly worse in the CDR2 group compared to the CDR1 group (p < 0.05). The CTSIB was not significantly different between the groups in the four conditions. Conclusion: Functional mobility during tasks involving cognition differs between older adults with mild and moderate dementia, and this commitment is more accentuated in dual-task situations. Postural balance did not differ between the stages of the disease.

Is Ankle Kinesio Taping Effective to Immediately Change Balance, Range of Motion, and Muscle Strength in Healthy Individuals? A Randomized, Sham-Controlled Trial.

BackgroundThe ankle–foot complex plays a key role in maintaining balance because it collects proprioceptive data. Kinesio taping (KT) is a rehabilitative method performed by the cutaneous application of a special elastic tape. The mechanical correction technique of KT was suggested to reposition the joints and alter balance parameters. The aim was to reveal the pure effects of ankle KT on balance, range of motion (ROM), and muscle strength in healthy individuals.MethodsForty healthy students were recruited for this randomized, sham-controlled study at a local university. Participants were divided into two groups—experimental and sham application groups. The primary outcome measures were balance parameters. Athlete Single Leg (ASL), Limits of Stability (LoS), and Clinical Test of Sensory Interaction and Balance (CTSIB) were used to measure single-leg dynamic balance, dynamic postural control, and sensory interaction of balance, respectively. Dorsiflexion ROM and dorsiflexor muscle strength were the secondary outcomes.ResultsThe ASL score showed significant improvement only in the experimental KT group (P=0.02); however, the LoS score increased significantly in both groups (P<0.05). CTSIB scores, dorsiflexion ROM, and dorsiflexor muscle strength for both ankles did not change in any of the groups after intervention (P>0.05). Moreover, there was no superiority of one intervention over the other in improving any of the variables (P>0.05).ConclusionThe mechanical correction technique of KT can be useful in providing immediate improvement in single-leg dynamic balance in healthy individuals. However, it may not be effective to significantly change the sensory interaction of balance, dorsiflexion ROM, and muscle strength.

Vestibular Assessments in Children With Global Developmental Delay: An Exploratory Study.

To compare results of 3 clinical vestibular tests between children with global developmental delay (GDD) and children with typical development (TD) and investigate the test-retest reliability. Twenty children with GDD (aged 4.1-12.1 years) and 11 age-matched controls with TD participated. Participants with GDD underwent 2 sessions of testing. Each session consisted of the Clinical Test of Sensory Interaction and Balance (CTSIB), Dynamic Visual Acuity (DVA) test, and the modified Emory Clinical Vestibular Chair Test (m-ECVCT). Up to 33% of the children with GDD had abnormal DVA scores. m-ECVCT results of children with GDD demonstrated larger variance than children with TD. The CTSIB score was significantly reduced in the group with GDD. The test-retest reliability varied, with good reliability for the m-ECVCT and CTSIB, and fair reliability for the DVA. Findings suggest vestibular involvement in children in GDD. The clinical tests demonstrated moderate test-retest reliability.

Correlation between accelerometry and clinical balance testing in stroke.

[Purpose] The purpose of this study was to determine the correlation between the Berg Balance Scale (BBS) and acceleration of postural sway in the Clinical Test of Sensory Interaction and Balance (CTSIB) by using a triaxial accelerometer for quantitative assessment. [Subjects and Methods] Twenty-seven stroke patients participated in this study. Balance ability was evaluated with the BBS, and postural sway was evaluated with a triaxial accelerometer. The data were then analyzed for frequency and correlation by using statistical software (SPSS 18.0). [Result] Acceleration in left-right and forward-backward directions in all conditions of the CTSIB assessment showed a significant correlation with BBS assessment. Acceleration in Signal Vector Magnitude values in condition 3 of the CTSIB assessment showed a significant correlation with BBS assessment. [Conclusion] This study revealed that postural sway represented balance ability as acceleration in the quantitative measurement of kinematic analysis. This finding suggests that the triaxial accelerometer could be used as a measurement tool in clinical conditions.

Clinical and functional aspects of body balance in elderly subjects with benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) may compromise the balance of elderly subjects. ObjectiveTo observe the effects of the Epley maneuver in elderly subjects with BPPV and assess clinical and functional aspects of body balance. MethodThis is a prospective clinical study. Patients diagnosed with BPPV (Dix-Hallpike test) were submitted to the Timed Up & Go (TUG) test, the Clinical Test of Sensory Interaction and Balance (CTSIB), and lower limb testing before and after they were repositioned using the modified Epley maneuver. Resultsmost subjects were females, and the group's mean age was 70.10 years (SD = 7.00). All patients had canalithiasis of the posterior canal. The following symptoms improved after the maneuver: postural instability (p = 0.006), nausea and vomiting (p = 0.021), and tinnitus (p = 0.003). Subjects improved their times significantly in the TUG and lower limb tests after the Epley maneuver (p < 0.001). Patients performed better on the CTSIB after the Epley maneuver on condition 2 (p < 0.003), condition 3 (p < 0.001), condition 4 (p < 0.001), condition 5 (p < 0.001), and condition 6 (p < 0.001). ConclusionClinical and functional aspects of body balance in elderly with BPPV improved after treatment with the modified Epley maneuver.

Relationship between the medial longitudinal arch and the thoracic and lumbar curvatures with the static and dynamic stability in obese females

Background and Aim: Materials and Methods: Twenty eight obese females (age= 25±8 years old, BMI=37±4) and twenty nine non-obese females (age= 23±4 years old, BMI=23±3) were recruited in this case-control study with the cross-sectional technique. The MLA, spinal curve angles and the static or dynamic balance index of the subjects were measured using the navicular drop, flexible ruler and Biodex balance system tools, respectively. The static balance test was carried out using a modified Clinical Test of Sensory Interaction and Balance (CTSIB) test in both the open and closed eyes while the subjects stood on their dominant legs. The order of the dynamic and static tests was selected randomly. Results: The findings of this study showed that in closed eye condition, most changes happened between the global Stability Index (SI) and BMI; while in open eye condition, most changes occurred between the lateral-medial stability index and BMI (r=0.5). Also during an open eye condition, a moderate correlation was found between the navicular drop and lateral-medial stability index (r=0.05). In closed eyes condition, no significant changes were found between the SI and lumbar lordosis (r=0.0004); while a weak correlation was found between the thoracic curve angle and lateral-medial stability index (r=0.04). Conclusion: The dynamic stability is not only correlated to their BMI, but is highly dependent on their foot curvature types and slightly on their thoracic curve angle. Abdominal obesity always played a significant role in antero-posterior stability index. Lumbar curvature showed a minor effect on static index value. Key words: Dynamic stability, static stability, obesity, thoracic kyphosis, lumbar lordosis. Reviewing the literature reveals a possible correlation between the obesity and the potential foot, spine and stability problems. Investigating the important parameters affecting the balance of obese people and prevention from falling are of high importance to reduce the resulting expenditures. This study aimed to assess the acts and the counter acts between the medial longitudinal arch (MLA) and the thoracic and lumbar curvatures with the static and dynamic stability in obese females.

치매환자의 균형반응과 신체활동에 관한 연구

본 연구는 30명의 치매환자를 대상으로 균형반응 특성을 알아보고자 다음과 같이 실시하였다. 인지기능이 중등도와 중도인 환자로 나누어 인지 기능에 따른 균형과 감각상호작용(CTSIB), 균형수행력(BBS), 일상생활동작(BI)의 상관관계를 각각 측정하였다. 그 결과 치매환자의 균형과 감각상호작용(CTSIB)은 두 그룹 간에 유의한 차이가 없었다. 중등도와 중도의 치매환자에서 균형수행력(BBS)은 중등도 <TEX>$47.32{\pm}4.80$</TEX>점, 중도 <TEX>$43.09{\pm}4.18$</TEX>점으로 통계학적으로 유의한 차이가 있었으며(p<0.05), 일상생활동작에서도 중등도 <TEX>$92.89{\pm}9.33$</TEX>점, 중도 <TEX>$76.82{\pm}6.81$</TEX>점으로 통계학적으로 유의한 차이가 있었다(p<0.05). 치매환자의 인지기능, 균형수행력, 일상생활동작도 통계학적으로 유의한 상관관계가 있었다(p<0.05, p<0.01). 따라서 향후 치매환자를 위한 재활프로그램 개발이나 치매환자의 보호관리 시 기초자료로 이용 될 수 있을 것으로 생각된다. The purpose of this study was to investigate the balance reaction characteristics of dementia patients. Under the object of 30 dementia patients, they were divided into moderate group and severe group and examined the correlation among Clinical test of sensory interaction and balance(CTSIB), Berg balance scale(BBS) and Bathel index(BI) according to perceptional function. As a result, CTSIB was no significant difference between severe group and very severe group and BBS was significant difference between severe group (<TEX>$47.32{\pm}4.80$</TEX>) and very severe group (<TEX>$43.09{\pm}4.18$</TEX>)(p<0.05) and BI was significant difference between severe group (<TEX>$92.89{\pm}9.33$</TEX>) and very severe group (<TEX>$76.82{\pm}6.81$</TEX>)(p<0.05) and significant correlation among perceptional function, BBS and BI(p<0.05, p<0.01). Therefore, these results should be used the base data of developing rehabilitation program or protection management for dementia patients.

Benign Paroxysmal Positional Vertigo and Clinical Test of Sensory Interaction and Balance in Ankylosing Spondylitis

To assess the frequency and characteristics of benign paroxysmal positional vertigo (BPPV) and clinical test of sensory interaction and balance (CTSIB) abnormalities in patients with ankylosing spondylitis (AS). A series of consecutive patients that fulfilled the modified New York diagnostic criteria for AS and matched controls were studied. The study was performed at the Otolaryngology Division of a tertiary reference center. Fifty-nine patients with AS (47 men [79.6%]) attending hospital outpatient rheumatology clinics between March and October 2008, and 46 controls (34 men [73.9%]) were studied. Dix-Hallpike and cephalic rotational tests and CTSIB were performed in AS patients and age-, sex-, and ethnically frequency-matched controls. Type and frequency of BPPV and CTSIB conditions were assessed. BPPV was diagnosed in 6 patients (10.1%) with AS and in 2 (4.3%) of the controls (p = 0.24). Abnormal caloric test was more commonly observed in patients with AS (n = 15 [25.4%]) than the controls (n = 0) (p < 0.001). Increased frequency of abnormal CTSIB also was observed in patients (19/59 [32%]) compared with the controls (3 [6.5%]) (odds ratio, 6.81 [95% confidence interval, 1.77-38.0]; p = 0.001). Among the abnormal CTSIB patterns, the vestibular loss was the most commonly observed in patients with AS (15/59 [25.4%]). The present study shows an increased frequency of abnormal postural control in CTSIB test of vestibular origin in patients with AS.

Benign Paroxysmal Positional Vertigo and Clinical Test of Sensory Interaction and Balance in Systemic Sclerosis

To assess the frequency and characteristics of benign paroxysmal positional vertigo (BPPV) and clinical test of sensory interaction and balance (CTSIB) abnormalities in patients with systemic sclerosis (SSc). A series of consecutive patients diagnosed with SSc according to well-established classification criteria and matched controls were studied. The study was performed at the otolaryngology division of a tertiary reference center. Forty-two patients (35 with limited SSc [lSSc] and 7 with diffuse SSc [dSSc]) and 74 controls were studied between January and May 2007. Dix-Hallpike and cephalic rotational tests and CTSIB were performed in SSc patients and age-, sex-, and ethnically frequency-matched controls. Type and frequency of BPPV and CTSIB conditions were assessed. Seven patients (17%) fulfilled the diagnostic criteria for BPPV compared with none of the controls (p < 0.001). It was related to the involvement of the posterior semicircular canal in two lSSc patients and the horizontal semicircular canal in another three patients with lSSc and two with dSSc. A significantly increased frequency of abnormal CTSIB was also observed in SSc patients (20 [48%]) compared to controls (7 [10%]; p < 0.0001; odds ratio, 8.70; 95% confidence interval, 2.97-27.2). It was caused by a vestibular pattern in most patients (p < 0.0001). The present study shows an increased frequency of BPPV and a vestibular pattern in CTSIB in SSc patients.

The influence of footwear on timed balance scores of the modified clinical test of sensory interaction and balance

Whitney SL, Wrisley DM. The influence of footwear on timed balance scores of the modified Clinical Test of Sensory Interaction and Balance. Arch Phys Med Rehabil 2004;85:439–43. Objectives To determine if timed balance scores on the modified Clinical Test of Sensory Interaction and Balance (CTSIB) were affected by shoe wear in patients with balance and vestibular disorders and to determine if there is a difference in correlation with the Sensory Organization Test (SOT) or in the sensitivity or specificity based on footwear. Design Prospective correlational trial. Setting Outpatient clinic. Participants Thirty persons (mean age, 63±17y) currently undergoing vestibular physical therapy (PT). Intervention All subjects completed the modified CTSIB with their shoes on and off at the end of a PT session; 16 of them (53%) also completed the SOT on the same day. Main outcome measures Scores on the modified CTSIB and SOT. Results No difference existed between scores on the modified CTSIB with shoes on versus off. Similar correlation was found between the modified CTSIB performed with the shoes on and off and SOT scores. The sensitivity and specificity of the modified CTSIB was similar with shoes on and off. Conclusions The modified CTSIB can be performed with or without shoes, with no difference expected in patient score or test sensitivity or specificity.

The effect of foot position on the modified clinical test of sensory interaction and balance

Wrisley DM, Whitney SL. The effect of foot position on the modified Clinical Test of Sensory Interaction and Balance. Arch Phys Med Rehabil 2004;85:335–8. Objectives To determine whether there was a difference in the timed scores on a modified version of the Clinical Test of Sensory Interaction and Balance (CTSIB) with the feet apart versus feet together and to correlate modified CTSIB scores with Sensory Organization Test (SOT) scores. Design Prospective correlational study. Setting Outpatient clinic. Participants Thirty patients (mean age, 58±17y) with vestibular dysfunction who were undergoing vestibular therapy. Interventions Subjects completed the modified CTSIB with their feet together and feet apart at the end of a vestibular therapy session. Subjects also completed the SOT on the same day. Main outcome measures Modified CTSIB scores (feet together, feet apart) and SOT scores. Results Modified CTSIB scores were slightly lower when performed with feet together as compared with feet apart. However, no statistically significant difference existed between scores on the modified CTSIB with feet together versus feet apart using the Wilcoxon signed-rank test ( P<.05). The modified CTSIB correlated more strongly with SOT scores when performed with feet together than with feet apart using the Spearman ρ. Conclusions Scores on the modified CTSIB performed with the feet together did not differ from scores on the modified CTSIB performed with the feet apart. In persons with vestibular disorders, the CTSIB done with the feet together correlated more closely with the SOT.

Vestibulo-ocular, optokinetic and postural function in diabetes mellitus.

We compared vestibulo-ocular reflex, optokinetic reflex and postural function in subjects with insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM), as well as non-diabetic controls. Both IDDM and NIDDM subjects exhibited significant deficits in gaze-holding in darkness (p < 0.05), small changes in vestibulo-ocular reflex (VOR) phase re velocity (p < 0.005) without a change in VOR gain, and a decrease in optokinetic reflex (OKR) slow phase velocity (p < 0.001). In addition, a smaller decrease was found in OKR quick phase amplitude (p < 0.02); postural sway was increased in both diabetic groups (p < 0.05), although this was not specific to the conditions of the Clinical Test of Sensory Interaction and Balance (CTSIB) that test vestibular contributions to postural stability. No differences were found in optokinetic afternystagmus or latency to circularvection. These results suggest that both IDDM and NIDDM are associated with deficits in gaze-holding, VOR and OKR function.

A review of balance instruments for older adults.

The purpose of this article is to review balance instruments developed within the past 10 years that can be used in the clinic or home environment. The use of such instruments may assist in identifying older adults who are at risk for falling, a major problem that can result in impaired function and loss of independence. Six instruments were reviewed: the Berg Balance Scale (Berg), the Clinical Test of Sensory Interaction and Balance (CTSIB), the Functional Reach Test, the Tinetti Balance Test of the Performance-Oriented Assessment of Mobility Problems (Tinetti), the Timed "Up and Go" Test (TU&GT), and the Physical Performance Test (PPT). Considered were what aspects of balance are assessed, time needed to administer the instrument, tools or equipment needed, evidence of reliability and validity, advantages and disadvantages, and the target population. The Berg, Tinetti, and PPT measure a variety of aspects of balance, whereas the Functional Reach, TU&GT, and CTSIB measure more narrow aspects of balance. All six instruments have been used with older adults and do not require much equipment. The instruments differ in their reliability and validity. Familiarity with balance instruments can be helpful in selecting the one most appropriate for clinical setting and clients in order to institute appropriate prevention programs, such as environmental modifications and lifestyle adaptations.