Fukuda stepping test: sensitivity and specificity.

Division of Audiology, Mayo Clinic, Rochester, MN 55905, USA.
Journal of the American Academy of Audiology (Impact Factor: 1.63). 06/2009; 20(5):311-4; quiz 335. DOI: 10.3766/jaaa.20.5.4
Source: PubMed

ABSTRACT A vestibulospinal test known as the Fukuda stepping test (FST) has been suggested to be a measure of asymmetrical labyrinthine function. However, an extensive review of the performance of this test to identify a peripheral vestibular lesion has not been reported.
The purpose of this study was to evaluate the sensitivity and specificity of the standard FST and a head shaking variation for identification of a peripheral vestibular system lesion.
In this retrospective review, we compared performance on the FST with and without a head shaking component to electronystagmography (ENG) caloric irrigation unilateral weakness results.
We studied these factors in 736 chronic dizzy patients.
Receiving operating characteristics (ROC) analysis and area under the curve (AUC) indicated no significant benefit to performance from the head shaking variation compared to the standard FST in identifying labyrinthine weakness as classified by caloric unilateral weakness results.
These findings suggest that the FST with and without head shake component is not a reliable screening tool for peripheral vestibular asymmetry in chronic dizzy patients; however, future research may hold promise for the FST as a tool for patients with acute unilateral disorders.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine if some common screening tests predict scores on detailed, objective diagnostic tests of the vestibular system. Sixty patients with vestibular disorders were compared with 60 asymptomatic controls. Vestibular diagnostic laboratory, tertiary care center. Subjects were screened with head impulse tests, Fukuda stepping tests while walking and marching in place, and tandem walking tests with eyes open and closed. All subjects underwent bithermal caloric tests and Dix-Hallpike maneuvers; patients underwent low-frequency sinusoidal tests of the vestibulo-ocular reflex in darkness and cervical vestibular evoked myogenic potentials. On tandem walking tests, patients differed significantly from controls, but receiver operating characteristic scores were < 0.80. On Fukuda tests, patients turned significantly more than controls for walking but not marching, but receiver operating characteristic values were considerably less than 0.80. On head impulse tests, patients with bithermal caloric weakness (≥20% and <60%) did not differ from controls, but patients with severe bithermal caloric weakness (≥60%) differed significantly from controls. Receiver operating characteristic values were >0.80 only for subjects with severe bithermal caloric weakness and were highest, at 0.88, for subjects with severe weakness and age ≥ 60 years. The Fukuda test is a poor screening test because it does not correlate well with objective test findings. Tandem walking is best used for screening older patients for vestibular disorders. Positive findings on a head impulse test are probably consistent with severe peripheral vestibular impairment and may be most useful in older patients. In younger patients with vertigo, negative results on head impulse tests may not be informative.
    Otolaryngology Head and Neck Surgery 03/2014; · 1.73 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Falls are a prevalent issue in the geriatric population and can result in damaging physical and psychological consequences. Fall risk assessment can provide information to enable appropriate interventions for those at risk of falling. Wearable inertial-sensor-based systems can provide quantitative measures indicative of fall risk in the geriatric population. Forty studies that used inertial sensors to evaluate geriatric fall risk were reviewed and pertinent methodological features were extracted; including, sensor placement, derived parameters used to assess fall risk, fall risk classification method, and fall risk classification model outcomes. Inertial sensors were placed only on the lower back in the majority of papers (65%). One hundred and thirty distinct variables were assessed, which were categorized as position and angle (7.7%), angular velocity (11.5%), linear acceleration (20%), spatial (3.8%), temporal (23.1%), energy (3.8%), frequency (15.4%), and other (14.6%). Fallers were classified using retrospective fall history (30%), prospective fall occurrence (15%), and clinical assessment (32.5%), with 22.5% using a combination of retrospective fall occurrence and clinical assessments. Half of the studies derived models for fall risk prediction, which reached high levels of accuracy (62-100%), specificity (35-100%), and sensitivity (55-99%). Inertial sensors are promising sensors for fall risk assessment. Future studies should identify fallers using prospective techniques and focus on determining the most promising sensor sites, in conjunction with determination of optimally predictive variables. Further research should also attempt to link predictive variables to specific fall risk factors and investigate disease populations that are at high risk of falls.
    Journal of NeuroEngineering and Rehabilitation 08/2013; 10(1):91. · 2.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Laboratory vestibular tests are relatively expensive and may be not available in every clinic. On the other hand, office vestibular tests can be easily performed and are low-cost. Objectives: To measure the sensitivity of a proposed battery approach to be conducted as an office procedure to diagnose side and site of vestibular lesions. Methods: This study was conducted on 36 patients suffering from vertigo with a confirmed diagnosis of vestibular disorder by laboratory vestibular tests. These included a standard video nystagmography (VNG) test that entails recording of eye examination including gaze testing, saccadic eye movements and smooth pursuit together with positional and positioning examinations as well as bithermal calorics and Vestibular Evoked Myogenic Potential (VEMP) tests. Patients were evaluated independently by history, examination of eye movements and a battery of office vestibular tests that included the Head Shake nystagmus Test (HST), Head Thrust Test (HTT) and Fukuda Stepping Test as well as the Dix-Hallpike test. Audiological, radiological and laboratory tests were applied to establish aetiological diagnosis whenever indicated. Results and conclusions: One patient showed abnormal eye movements that were confirmed by full diagnostic work-up for vestibular disorders in keeping with a diagnosis of multiple sclerosis, and was excluded from forthcoming analysis. Sensitivity of the HST test with respect to results of the laboratory vestibular tests (VNG and VEMP) was 51.5% while that of HTT was 43%. Moreover, the Fukuda Stepping Test showed a sensitivity of 48.5% with non-significant correlation to the side of caloric weakness and a significant correlation to the side of abnormal VEMP response. The proposed battery of office vestibular tests proved to be a quick screening approach that was successful in helping to identify site and side of peripheral vestibular lesions in 77% of patients. On the other hand, normal office vestibular tests were obtained in patients with laboratory findings showing mild caloric weakness or with only an abnormal VEMP.
    05/2011; 9(2):79-84.

Full-text (2 Sources)

Available from
Jun 1, 2014