What condition is indicated by a positive stepping test?

Fukuda Stepping Test and Vestibular Dysfunction

A positive Fukuda Stepping Test indicates peripheral vestibular dysfunction, specifically unilateral vestibular deficits. However, the test has significant limitations in reliability and should not be used as a standalone diagnostic tool.

What the Test Indicates

• The Fukuda Stepping Test is primarily used to detect unilateral peripheral vestibular disturbances 1
• A positive test manifests as rotation and displacement from the starting position when stepping in place with eyes closed 2
• The test is considered one of the vestibulo-spinal reactions used to assess balance and vestibular function 1

Critical Limitations and Caveats

The test has poor reliability and should be interpreted with extreme caution:

• In patients with nearly compensated peripheral vestibular defects (such as after vestibular neuronitis), the test was positive in only 10 of 22 patients, incorrect in 5 patients, and equivocal in 7 patients 1
• The test could not be performed at all in 6 of 7 patients after acoustic neuroma removal 1
• Test-retest reliability is only moderate for the 50-step protocol and even lower for the 100-step protocol 2
• A reliable spontaneous vestibulo-spinal reaction could not be determined in patients with nearly compensated peripheral vestibular defects 1

Clinical Recommendations

If you choose to use this test, follow these specific guidelines:

• Use the 50-step protocol rather than the 100-step protocol for better reliability 2
• Never use the Fukuda Stepping Test as a screening tool in isolation 2
• Always combine it with other vestibular function tests and clinical assessments 2
• Measure angle of rotation, angle of displacement, and distance of displacement 2
• The test should be performed with the patient blindfolded, stepping in place with outstretched arms 2

Alternative Assessment Approaches

For more reliable fall risk and balance assessment in patients with vestibular disorders:

• The Four Square Step Test has good reliability (ICC 0.93) and validity for people with vestibular balance deficits, with a cutoff of >12 seconds showing 80% sensitivity and 92% specificity for fall risk 3
• Consider comprehensive vestibular testing when the clinical presentation is atypical or diagnosis unclear 4