What is sensory mismatch, and are you relying too much on your eyes instead of your feet and inner ear?

What are the four conditions of the mCTSIB?

1. Eyes open, firm surface: all three inputs available
2. Eyes closed, firm surface: removes vision, testing the feet and inner ear
3. Eyes open, foam surface: reduces reliable foot input, testing vision and the inner ear
4. Eyes closed, foam surface: leaves mainly the inner ear

On our BioSway computerized system, each condition is measured as sway, giving numbers we can compare over time¹.

What does visual dependence mean?

Visually dependent people sway much more when vision is unreliable, for example in busy stores, and feel worse with visual motion. It is common after vestibular injury and concussion, and in PPPD². People with weak inner ear function struggle most in the eyes closed, foam condition, and people with reduced foot sensation, such as from neuropathy, struggle when vision is removed.

How does therapy correct sensory mismatch?

Training targets whichever input is under-used: standing and walking on foam with eyes closed to build inner ear reliance, visual motion habituation to reduce visual dependence, and foot and ankle work to sharpen sensation³. We retest on BioSway to confirm the change.

Where can I get computerized balance testing in Alpharetta or Cumming?

BioSway testing is part of balance and dizziness evaluations at our Cumming and Alpharetta clinics, serving Johns Creek, Milton, Roswell, Suwanee and Forsyth County. Results can be sent to your physician.

Where can I get help in Alpharetta, Cumming and nearby?

Dr. Manan Patel, PT, DPT, TPS and our team of physical therapists see patients from Alpharetta, Johns Creek, Milton, Roswell, Cumming, Suwanee, Sugar Hill, Buford, Duluth and Forsyth County at two North Atlanta clinics. Every visit is 60 minutes, one-on-one, and urgent appointments are available within 48 hours. We are in-network with Traditional Medicare, BCBS / Anthem and Tricare, and offer a $129 rate per visit for self-pay and out-of-network plans. Not sure where to start? Take the free symptom self-check, or visit our Alpharetta clinic or Cumming clinic page.

Related care

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References

1. Shumway-Cook A, Horak FB. Assessing the influence of sensory interaction on balance: suggestion from the field. Physical Therapy. 1986.
2. Staab JP, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD). Journal of Vestibular Research. 2017.
3. Hall CD, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline. Journal of Neurologic Physical Therapy. 2022.

Answered by Dr. Manan Patel, PT, DPT, TPSDoctor of Physical Therapy, Certified Vestibular Specialist and one of the few certified Therapeutic Pain Specialists in North Atlanta, with 15+ years of outpatient care. About Dr. Patel

This answer is general education, not a diagnosis or a substitute for an examination. If you have new or worsening symptoms, contact your doctor. Call 911 for sudden severe dizziness with trouble speaking, weakness, numbness, double vision or a severe headache.