Instrumented Test of Sensory Integration for Balance: A Validation Study

Lynn Freeman, Geetanjali Gera, Fay B. Horak, Mary T. Blackinton, Mark Besch, Laurie King

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Background and Purpose: Abnormal postural sway is associated with an increase in risk of falls but is difficult for clinicians to accurately quantify without access to laboratory equipment. Instrumenting clinical outcome measures using body-worn movement monitors is a low-cost alternative. This is the first study to compare the modified Clinical Test of Sensory Integration for Balance (i-mCTSIB) to the laboratory test of the Sensory Organization Test (SOT) with dynamic posturography in a group of participants with Parkinson's disease (PD) and subtle balance limitations. The purpose of this study was to (1) determine the concurrent validity of the i-mCTSIB with the SOT (6 and 4 conditions) and (2) compare the i-mCTSIB and the SOT to differentiate between individuals with and without recent falls within the previous 6 months. Methods: This cross-sectional study examined 26 participants with idiopathic PD who had a Motor Unified Parkinson's Disease Rating Scale score of 32.7 (13.5) out of 108. Results: The composite and conditions 1 and 4 of the i-mCTSIB and SOT scores were significantly correlated: composite scores r =-0.64 (P ≤.001), C1 r =-0.43 (P =.03), C3 r =-0.60 (P ≤.01), and C4 r =-0.54 (P ≤.001). A significant difference was observed in mean i-mCTSIB composite scores between fallers and nonfallers (P =.04). In contrast, the SOT composite was not significantly different between fallers and nonfallers (P = 0.31). Discussion: The results suggest that the i-mCTSIB may be a valid and clinically meaningful measure of sensory organization in persons with PD, even those with mild postural instability as measured by the median Hoehn and Yahr score (2.0). Future research should evaluate predictive validity of the i-mCTSIB for prospective falls. Conclusion: The instrumented mCTSIB with portable, body-worn movement allows clinicians to quantify abnormal postural sway without the ceiling effects of clinical balance testing or the expense and importability of force plate technology in the SOT. Instrumenting mCTSIB may also distinguish between fallers and nonfallers.

Original languageEnglish
Pages (from-to)77-84
Number of pages8
JournalJournal of Geriatric Physical Therapy
Issue number2
StatePublished - 2018

Bibliographical note

Funding Information:
1Aegis Therapies, Plano, Texas. 2Oregon Health & Science University, Portland. 3Nova Southeastern University, Fort Lauderdale, Florida. 4PATH Clinical Research Institute, USA. This research is partially supported by National Institute of Aging (R37AG006457), the Kinetics Foundation, and Oregon Clinical & Translational Institute (OCTRI) (ULIRR024140). Disclosure: Oregon Health and Science University (OHSU) and Dr Horak have a significant financial interest in APDM, a company that may have a commercial interest in the results of this research and technology. This potential institutional and individual conflict has been reviewed and managed by the OHSU, Integrity Oversight Council. Address correspondence to : Lynn Freeman, PT, PhD, DPT, GCS, CWS, Aegis Therapies, 7160 Dallas Parkway, Ste 400, Plano, TX 75024 ( Richard W Bohannon was the Decision Editor. Copyright © 2018 The Academy of Geriatric Physical Therapy, APTA.

Publisher Copyright:
© 2018 Lippincott Williams and Wilkins. All rights reserved.


  • accelerometers
  • balance
  • body-worn monitors
  • falls
  • measurement

ASJC Scopus subject areas

  • Rehabilitation
  • Geriatrics and Gerontology


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