Bertec COBALT: An Ideal Balance Test for Athletes


Bertec COBALT is the ideal balance test for athletes. It is best used as part of a concussion screening and management program. This is because it provides an objective measure of balance control when relying on visual, somatosensory, and vestibular demands.The COBALT protocol includes a unique set of testing conditions that put high demands on the visual and vestibular systems. A traditional static balance test cannot provide this.

Functional Significance

Athletesrequire a high-functioning balance system. Any dysfunction in the VOR can result in movement-related issuesthat drastically affect athletic performance.In extreme cases, it can increase risk of injury.

COBALT can help significantly reduce post-injury balance dysfunction. It also decreases thenumber of errors during the test. Be that as it may, COBALT cannot be used to diagnose a concussion.Unlike standard static balance assessments, COBALT adds the headshake test with eyes closed (which places a higher demand on the vestibular system) and the VOR Cancellation (Motion Sensitivity Test), which places increased demand on the visual system.

Measures of COBALT:

Trials are 20 seconds long and are scored by counting errors or loss of balance. Quantifiable errors/loss of balance include:

  • Lifting hands off iliac crest 
  • Opening eyes during eyes closed trials
  • Stepping off force plate or moving feet from placement markers while on plate/foam
  • Inability to keep beat with the metronome for 2 beats in a row or more

Note: If subject commits multiple errors simultaneously, only one error is recorded

After an error is recorded, the clinician should resume the test and continue to count errors until the entire assessment is complete.

Conditions of COBALT:

There are eight conditions of COBALT. 4 of which are taken from the Modified CTSIB. The reason for this is CTSIB conditions are stable and are used as a method of comparison with additional dynamic measures. 

Each condition is performed twice. A metronome is used to maintain the rhythm of the patient's head movement during dynamic conditions.The metronome pace is set at 120 bpm when the head is moving with eyes closed, and 40 bpm for the motion sensitivity test.

  • Condition 1*: Eyes open firm surface
  • Condition 2*: Eyes closed firm surface
  • Condition 3: Eyes closed firm surface head shake
  • Condition 4: VOR cancellation firm surface
  • Condition 5*: Eyes open foam surface
  • Condition 6*: Eyes closed foam surface
  • Condition 7: Eyes closed foam surface head shake
  • Condition 8: VOR cancellation foam surface

*C1, C2, C5, C6 = Conditions of the mCTSIB assessment

Which Patients are Right for COBALT?

COBALT is not only great for post-injury assessment and rehabilitation over time for athletes, but it’s also a valuable injury prevention screening tool. The 8 conditions of COBALT can be boiled down into justtwo (7 & 8 of COBALT), making it easy and efficient to perform on an entire sports teams, and other active patients.

Learn More About COBALT Today!

Interested in Bertec COBALT? Get in touch with your local e3 office today! We’d love to provide you with more information and even schedule a live demonstration.