Performance of Fukuda Stepping Test as a Function of the Severity of Caloric Weakness in Chronic Dizzy Patients

Background: The purpose of the Fukuda Stepping Test (FST) is to measure asymmetrical vestibulospinal reflex tone resulting from labyrinthine dysfunction. The FST is a low cost evaluation for dizzy patients; however, when compared with gold standard caloric irrigation unilateral weakness (UW) value ≥25%, the FST has not been shown to be a sensitive tool for identifying unilateral vestibular hypofunction.

Purpose: The purpose of this technical report is to further evaluate the clinical utility of FST with and without headshake as a function of increased caloric asymmetry for individuals with unilateral peripheral vestibular pathology.

Research Design: Retrospective review of FST results with and without head shaking component as compared to gold standard, caloric irrigation UW outcome values at four severity levels: 0–24% UW (normal caloric value); 25–50% UW (mild caloric UW); 51–75% UW (moderate caloric UW); 76–100% UW (severe caloric UW).

Study Sample: 736 chronic (≥8 wk symptom complaints) dizzy patients.

Results: Standard FST and FST following a head shake task are insensitive to detecting mild to moderate peripheral vestibular paresis. Increased test performance was observed for patients with severe canal paresis (>76% UW); however, continued inconsistencies were found in turn direction toward the severe unilateral vestibular dysfunction.

Conclusions: Overall, the FST provides little benefit to clinicians when used in the vestibular bedside examination.

Key Words

Caloric irrigations - Fukuda Stepping Test - head shake - unilateral weakness