05/25/2018
Shumway-Cook, Horak (1986) gave us the CTSIB Clinical test of sensory organization and balance. This test helps the clinician decide how vision, vestibular, and somatosensory input interact to help to maintain balance. This is a profound test with great insight into the balance system. To help quantify results, the authors also graded the test from 1-4 encapsulating minimal sway (1) to falling (4). I am grateful and have used this test hundreds if not thousands of times at my clinic. Now with 21st century technology, even more precise objective results can be obtained. The use of accelerometers and gyroscopes can now objectify sway to a millisecond of accuracy.
A full explanation of the CTSIB test can be found at CTSIB - Clinical Test of Sensor
geriatrictoolkit.missouri.edu/vest/CTSIB.pdf
Over thirty years of clinical experience has shown that this test is an excellent gauge on the components and interactions of balance. Especially in the geriatric population, for whom the test was originally designed. With simple modification, this test can also be an excellent gauge on the interactions of balance in the athletic population. In this population, due to ability, compensation for deficit can be easily performed. Remember, before trainings and movements are given to the athlete, compensations should be identified and removed. We want to train the TRUE athlete, not the compensatory process.
The standing single leg balance test has been performed millions of times. Every possible way to perform this test has been employed. Eyes open and closed, firm and soft surfaces. Why not organize these tests into the original protocol of CTSIB? By doing so, the interpretations of CTSIB can be used, while greater demand to override compensation can be tried. Once an area of deficit is identified, interventions to improve can be made.
1) Vision: make sure your athlete gets a complete Opthamologic exam. Visual spatial field test, useful field of view (UFOV), prism analysis, should all be included
2) Vestibular: must get a thorough exam. In many instances the test becomes the treatment. Eye movement, tracking, fluidity, accomodation, etc
3) Somatosensory: the standards pinwheel, pinprick, lateral shear, etc. What I would like to bring everyones attention to is a product out of Toronto Canada called Barefoot Science. Barefoot Science is a non orthotic, mid arch proprioceptive stimulator. This product worn in the shoe comes with a program that takes approximately one year to complete. In my 39 years of clinical experience I have never found a product to help a somatosensory deficit work so well. Checkout Barefootscience.com
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To conclude..... before we train and recommend to our athletes, lets first take a step back to understand WHO they really are. No sense in trying to create speed and strength, on an unstable foundation. This would only lead to compensation by the athlete. Vision, vestibular, somatosensory have a direct effect on the balance system. By employing a simple approach CTSIB and increasing the demand (stand on one leg) I feel that pertinent information can be obtained both with and without technology. Remember .... Athletes do not allow athletes to perform D.R.U.N.K. Dramatically Reduced Utilization of Normal Kinematics. Lets sober the athlete by fixing the imbalances first, then train the TRUE ATHLETE
