Stroke case study question

[afriedm5]

Hi Chrissy,

For the question below, I am having trouble understanding the difference between choices C and D. Could you explain this to me?

You assess standing balance with the modified Clinical Test of Sensory Interaction and Balance (mCTSIB) and note the patient loses his balance on conditions 2 and 4. He stands for 30 seconds without imbalance on conditions 1 and 3. What does this suggest?

a. Impaired use of somatosensory cues for balance
b. Impaired use of vestibular cues for balance
c. Impaired use of visual cues for balance
d. Visual dependence

Thank you!

[Chrissy Durrough Lugge]

Hi there!

Impaired use of visual cues for balance indicates difficulty utilizing visual information whereas visual dependence indicates difficulty using anything except visual information.

This patient maintains his balance whenever his eyes are open (suggesting he does not have difficulty using visual cues) and loses his balance whenever his eyes are closed.

Taken together, this points to the patient being overly dependent on visual cues to the point that he loses his balance whenever he is forced to rely on somatosensory and/or vestibular cues.

Chrissy

[Aushem]

Chrissy,
Can you give examples using the mCTSIB for where someone would have impaired use of somatosensory and visual cues? Thanks.

[Chrissy Durrough Lugge]

Hi there!

Here are the sensory systems that are available for each mCTSIB condition in a perfect world:
-Condition 1: visual, vestibular, somatosensory all available
-Condition 2: vestibular and somatosensory available
-Condition 3: visual and vestibular available
-Condition 4: vestibular available

In real life, standing on a cushion in conditions 3 and 4 won’t totally eliminate somatosensory cues, so interpret with a grain of salt.

Someone with impaired use of somatosensory cues would have a noticeable decline in performance from condition 1 to 2. They would likely have more postural sway than normal in all conditions. We might see this in someone with peripheral neuropathy or a posterior cord-type SCI presentation.

Someone with impaired use of visual cues would likely not have much change in their balance from conditions 1 to 2 or 3 to 4 (the use of visual cues in conditions 1 and 3 wouldn’t be beneficial). We might see this in someone who is visually impaired or blind.

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