Clinical use
Clinical applications
CDP earns its keep across vestibular, neurological, geriatric, sports and occupational medicine. Each use-case has a characteristic CDP signature, a specific management decision the test informs, and a level of evidence.
The eight cards below cover the use-cases where CDP changes management. They span peripheral vestibular diagnosis, central nervous system disease, rehabilitation, fall-risk, sports concussion, functional disorders and aerospace fitness.
The strongest evidence base is in vestibular differential — Di Fabio's meta-analysis put CDP sensitivity for vestibular dysfunction at around 50–70% and specificity at 90–95%, making it useful as a confirmatory functional test when site-of-lesion tests (caloric, vHIT) are borderline.1,2 The rehabilitation-planning evidence is equally strong: baseline CDP profiles direct rehab focus, and CDP-tracked outcomes correlate with patient-reported dizziness-handicap.3,4
The fall-risk literature consistently identifies three predictors that independently associate with subsequent falls — composite score below age norm, hip-dominant strategy, and prolonged MCT latency. Combined, they identify older adults for targeted intervention.5,6
In central disease — Parkinson's, multiple sclerosis, post-stroke — CDP detects mild deficits the routine clinical exam misses, and tracks progression. Direction-specific instability is a Parkinson's fingerprint; cerebellar-dominant disease shows on the ADT before falls.8,9
In concussion management, the test's value is functional baseline-to-recovery comparison: athletes can return to symptom-free without returning to their pre-injury postural-control baseline.7Aerospace and occupational fitness-to-fly assessments use the same baseline-to-deviation pattern after vestibulotoxic exposure or long-duration spaceflight.10
Application cards
Filter by domain to focus on a single area. Each card pairs the clinical question, the typical CDP pattern, the action it supports, and the evidence tier.
Peripheral vestibular
Peripheral vestibular hypofunction
established- Question
- Is this patient's chronic imbalance attributable to a vestibular deficit when caloric or vHIT data are equivocal?
- Pattern
- Disproportionately reduced equilibrium scores on SOT conditions 5 and 6 (vestibular-only), preserved performance on 1–4.
- Action
- Supports the vestibular diagnosis when other tests are borderline; biases towards a targeted gaze-stabilisation and substitution VRT programme.
Peripheral vestibular
Bilateral vestibulopathy
established- Question
- Does this patient with progressive imbalance and oscillopsia have bilateral vestibular loss?
- Pattern
- Severe drop in SOT 5/6 with falls; CDP composite score in the impaired range; surface and vision dependency together.
- Action
- Confirms functional impact; underpins the case for substitution training and prosthetic balance research enrolment.
Central nervous system
Central CNS disease (Parkinson, MS, cerebellar)
established- Question
- Is the postural dyscontrol consistent with a central, rather than peripheral, lesion?
- Pattern
- Hip-strategy bias, abnormal MCT latencies, poor ADT adaptation, and direction-specific instability.
- Action
- Justifies neurology referral and targeted rehabilitation; longitudinal CDP tracks disease progression.
Rehabilitation
Vestibular rehabilitation planning
established- Question
- Which sensory modality is this patient over-relying on, and what should the rehab focus on?
- Pattern
- Visual-dependency profile: poor on conditions 3 and 6 with relatively preserved 5 → optokinetic and visual-desensitisation work.
- Action
- Individualises VRT; baseline scores serve as the comparator at re-test.
Fall risk
Fall-risk prediction in the elderly
established- Question
- Is this older adult at elevated risk of falling in the next 12 months?
- Pattern
- Composite SOT < age-norm, hip-dominant strategy, prolonged MCT latency.
- Action
- Triggers community-balance programme, home-modification review, deprescribing of sedatives.
Sports / concussion
Sport-related concussion
established- Question
- Has this athlete's postural control returned to baseline before return-to-play?
- Pattern
- Persisting reduction in SOT composite vs pre-season baseline; abnormal MCT latencies after symptom resolution.
- Action
- Defers return-to-play; complements neurocognitive testing.
Functional / non-organic
Functional / non-organic balance disorder
emerging- Question
- Are the sway patterns physiologically plausible, or do they suggest a functional component?
- Pattern
- Inconsistent patterns: better on harder conditions; excessive sway with eyes open and reduced sway with eyes closed.
- Action
- Supports a multidisciplinary referral including psychiatric / psychological assessment; never the sole basis for diagnosis.
Aerospace / occupational
Aerospace and occupational medicine
established- Question
- Is the pilot, astronaut or soldier fit to return to duty after vestibular insult, fatigue or microgravity exposure?
- Pattern
- Quantified deviation from pre-deployment baseline; impaired adaptation on ADT post-spaceflight.
- Action
- Informs fitness-to-fly decisions, reconditioning timelines, and mission-design considerations.
What CDP does NOT do
- Localises the lesion. CDP identifies the dysfunctional sensory system, not the anatomical site. Caloric, vHIT, VEMP and imaging do the localisation.
- Replaces clinical examination. The history, the bedside exam, and audiogram remain the foundation. CDP is functional adjunct.
- Diagnoses a functional disorder. Physiologically implausible patterns raise suspicion, but functional balance disorder needs multidisciplinary evaluation.
- Replicates real-world settings. A booth is not a kitchen or a building site — for ecological validity, wearable IMUs are starting to fill the gap.