Fukuda Test Research Articles

Symmetry of postural tone in right homogeneous functional laterality evaluated by Fukuda test.

Background:To study the symmetry of postural tone in subjects with right homogeneous functional laterality.Methods:It was an observational study; we looked for the right homogeneous functional laterality by clinical tests on the eyes, feet and hands. Postural tone was evaluated by the Fikuda test. We measured the mean value of the Fikuda angle and in cm walking forward or backward compared to the A axis and the deviation to the left or right compared to the B walking axis. These two axes were perpendicular.Results:There were 80 homogeneous right-hand adult subjects. There were 52 males (63, 52%) and 28 females (36, 47%). The median age was 34, 85 years (23, 42- 47, 57). For the studied population the deviation angle according to Fukuda test was 0° (-15°; 15°), the subjects stepped 81 cm (52; 110) forward without deviation from the B walking axis 0cm (-14; 20). Male subjects remained on the walking axis 0° (-17°, 19°) while stepping 81 cm (51, 119) forward without right-left deviation 0 cm (-17, 19). Female subjects stepped (83 cm (52; 110) forward, and away from the walking axis (3 cm (-23; 21)), without deviation 0° (-17°; 19°).Conclusion:The functional homogeneous laterality did not influence postural tone. The lateralization is a complex phenomenon. (www.actabiomedica.it)

Efficiency of a new complex rehabilitation method using mechano- and kinesiotherapy for balance disorders correction in patients with osteoporotic compression vertebral fractures

The aim of the study: Evaluate the impact of physical rehabilitation complex on balance function in patients with osteoporosis (OP) and vertebral compression fractures (VCFs). Materials and methods: A prospective controlled study of 40-80 years old men and women with OP and VCFs was conducted. Patients were divided into two groups by simple randomization. The intervention group (1) received an intensive rehabilitation course. The control group (2) received therapeutic exercise using the Gorinevska-Dreving method. Before rehabilitation all patients were tested: 1) stabilometry; 2) Tests: single leg stand, Fukuda test). Re-examination after rehabilitation and one month after the course. Results:The study enrolled 90 people (65.4±9.1 years). In group №1 after the course of rehabilitation there was a significant improvement in indicators: balance function coefficient (BFC) with open and closed eyes (84.1±8.6%, p=0.01 and 73.8±9.6%, p=0.01); frontal shifts (FS) (1.9 [0.7; 2,4], p=0,01), the area of statokinesiogram (ASKG) (131,9±210,4 mm2, p=0,04); center of pressure velocity (CPV) (12,2±10,1 mm/sec, p=0,001); in the Fukuda test the displacement in degrees has decreased (32.8±14.5, p=0.03), in the test «Single leg stand» the time for right and left leg with open eyes has improved (17.8±31.8 sec, p=0.001, 17.1±30.1 respectively). In group №2 there was an improvement in CPV (2.1 [1.9;5.2], p=0.001); FS movement rate (10.1±3.9 mm/sec, p=0.05). After a month in group №1 the positive dynamics by parameters was preserved: BFC with open and closed eyes, FS, CPV movement speed, SKG area, displacement in meters and degrees in the Fukuda test, standing time on the right and left legs with open and closed eyes. Conclusions: A physical rehabilitation complex aimed at training back muscles and coordination has improved balance function in patients who have experienced OP and VCFs. Pathological shift of CPV forward in frontal area was corrected and stability was improved. Stabilometry and coordination tests served as reliable methods to evaluate balance function in this group of patients.

Potential Risk of Benign Paroxysmal Positional Vertigo Due To Traumatic Effect of Osteotomy in Septorhinoplasty Patients

We investigated the effect of osteotomy on the vestibular system in septorhinoplasty patients and determined the potential risk of benign paroxysmal positional vertigo (BPPV) in these patients. In the present prospective study, 47 primary septorhinoplasty patients were evaluated as the study group and 50 septoplasty patients as the control group. Osteotomy was performed in all septorhinoplasty patients. No hammer and osteotomes were used in the control group. All patients underwent static balance tests (tandem stance test, 1-leg standing test, and Romberg test), dynamic balance tests (tandem walking test and Fukuda test), positional balance tests (Dix-Hallpike test and supine roll test), head impulse test, and the adult dizziness handicap inventory (ADHI) preoperatively and during the first postoperative week. No significant differences were found between the 2 groups in terms of the static balance tests, dynamic balance tests, positional balance tests, or head impulse test results. The postoperative ADHI scores were significantly worse in the septorhinoplasty patient group than in the control group. Posterior semicircular canal BPPV was observed in 2 patients in the septorhinoplasty group but none in the control group. BPPV is one of the possible early postoperative complications of rhinoplasty. In patients with vertigo after rhinoplasty, surgeons should evaluate the semicircular canals using the Dix-Hallpike and supine roll tests. To avoid the traumatic effect of osteotomy reflected on the inner ear, attention should be given to the applied force, and sharp osteotomes should be used.

Visual vestibular mismatch: is it a vestibular disorder?

BackgroundVisual vestibular mismatch (VVM) is a group of symptoms rather than a disease. All are exaggerated by introducing any visual conflict. For such reason, there is no adequate tools to investigate or to diagnose and limited research studies were done to explore such group of people.AimTo identify VVM disorder among dizzy patients and to study the vestibular function in them.Patients and methodsThis study was conducted on 30 patients suffering from VVM (out of 153 patients) who were selected by a questionnaire modified by the authors based on the original questionnaire. All patients were subjected to objective testing including: full neuro-otological history, office vestibular tests including dynamic visual test (DVA), modified clinical test of sensory integration of balance (MCTSIB), Fukuda stepping test, functional reach test, videonystagmography and vestibular evoked myogenic potentials (VEMPs).ResultsVVM symptomatology was found in 19 patients (subjectively by Mallison questionnaire) and reached 30 patients using a modified questionnaire. 23.33% patients had abnormal Fukuda test, 26.6% had abnormal functional reach test, while 97.6% of patients had abnormal MCTSIB test scores and 50% had abnormal DVA test scores. Abnormal cervical VEMP test results were present in 50% of cases, while only 10% suffered from videonystagmography abnormalities reflecting minor affection of semicircular canals as compared with the saccule.ConclusionThis study showed that VVM is a fairly common complain among the dizzy population and it can be easily picked up using a simple questionnaire. Office tests as DVA and MCTSIB were highly sensitive tests for VVM patients but more research is needed to find the correlations between these tests and VVM. The study pointed out to the importance of cervical VEMP test to be routinely enrolled in testing of patients with suggestive symptoms of VVM. Further researches should be conducted for knowing the underlying cause and the exact role of saccule in VVM.

Indicators of sarcopenia and their relation to intrinsic and extrinsic factors relating to falls among active elderly women

Abstract Introduction: Musculoskeletal aging can impair functional performance increasing the risk of falls. Objective: To analyze the correlation between sarcopenia and the intrinsic and extrinsic factors involved in falls among community-dwelling elderly women. Method: A cross-sectional study evaluated the number of falls of 85 active community-dwelling elderly women in the previous year and then divided them into two groups: non-fallers (n=61) and fallers (n=24). The sarcopenia indicators assessed were gait speed (GS, 10m); handgrip strength (HS); calf circumference; appendicular muscle mass index (DXA). Intrinsic factors: Mental State Examination (MSE); visual acuity; depression (GDS-30); hip , knee (Lequesne) and ankle/foot (FAOS) pain/function; vestibular function (Fukuda test); functional mobility and risk of falls (TUG); power (sitting and standing five times); gait (treadmill); fear of falling (FES-I-Brazil). Extrinsic factors: risk/security features in homes. The independent t test was applied for comparisons between groups and the Pearson and Spearman tests were used for correlations (p<0.05). Results: There was a moderate correlation between HS and GS in non-fallers (r=0.47; p=0.001) and fallers (r= 0.54; p=0.03). There was a moderate negative correlation (r= -0.52; p=0.03) between FES-I-Brazil and gait cadence in fallers. There was a greater presence of stairs (p=0.001) and throw rugs (p=0.03) in the homes of fallers than non-fallers. Conclusion: The elderly women were not sarcopenic. Elderly fallers presented inferior gait cadence and a greater fear of falling. Residential risks were determining factors for falls, and were more relevant than intrinsic factors in the evaluation of falls among active community-dwelling elders.

Influência da realidade virtual nas atividades psicomotoras e percepção corporal de escolares: estudo piloto

Introduction : Psychomotricity can be defined as the science that works on the connection of body and mind. Virtual reality features can be playful tools to stimulate neuromotor abilities acquisition and improvement in growing children. Objective : To analyze Nintendo Wii® influence on psychomotor activities and body awareness in healthy children the public school system. Materials and Methods : We randomly involved in this sample three students of both genders, aged 7-10 years. Body perception was evaluated by the Askevold Protocol, balance was verified by the Fukuda test and psychomotor practices performance was analyzed by the Fonseca psychomotor test protocol . After evaluations, children have gone through a two-times-a-week virtual reality training for 30 minutes each, in a total of 10 sessions. Absolute and relative values were considered to analyze the results. Results: Regarding the COG Wii Fit® and stability could follow gains from prior to after the intervention. Score has increased in almost all games used in the intervention. Important improvements were also observed in students body perception, changing hiperesquematia condition for normoesquematia condition. Conclusion : It could be observed that virtual reality training has positively influenced performance on psychomotor activities and body perception in all children studied.

The Study of Correlationship of the Fukuda Stepping Test to Determine Type of Idiopathic Scoliosis Curve

PURPOSE: The Fukuda test can be used at home and in school to diagnose scoliosis at an early stage and prevent serious curvature of the spine. This study aimed to use the Fukuda test to detect scoliosis. An additional aim was to invoke the national interest in imbalanced postures and habits, which result in scoliosis, by providing data obtained in periodic assessments. METHODS: The study consisted of 35 idiopathic scoliosis patients (22 in right lumbar spinal region and 13 in the left lumbar spinal region). The distance of displacement and angle of displacement were measured following the Fukuda test. A correlation analysis was then used to examine the distance of displacement and angles of displacement and rotation with regard to the direction of the curve in scoliosis. RESULTS: There was a significant negative correlation (p

Impact of the Number of Steps on the Fukuda Stepping Test in Older Adults

ABSTRACTAims: This study aimed to compare performance, within-subject variability and test–retest reliability between the 50-step and 100-step Fukuda test in healthy older adults. Methods: Fifty participants aged between 65 and 75 years performed three trials of both the 50- and 100-step tests on two separate sessions seven days apart. Their final foot position was measured relative to the starting line. Results: Absolute values of body rotation and lateral and longitudinal displacements were significantly larger on the 100-step than on the 50-step test. The mean standard deviations of these measures on the three trials were significantly larger on the 100- compared to the 50-step test, indicating larger within-subject variability. Intraclass correlation coefficients were similar for both tests, suggesting comparable test–retest reliability. Conclusion: The 50-step test is recommended over the 100-step as it may have reduced measurement error.

A Pilot Study to Assess the Vestibular Apparatus Function with Videonystagmography During Chronic Otitis Media with Effusion.

To assess the effect of chronic middle ear effusion (CMEE) on balance and equilibrium. Prospective study controlling two groups of children. The active arm consisted of children having a unilateral or bilateral CMEE that persisted for at least 3 months. The control group consisted of children presenting with normal middle ear. Children and parents in both groups were questioned about any symptom of vertigo, dizziness, disequilibrium or child's tendency to fall. ENT exam included an assessment with pneumatic and microscopic otoscopy, evaluation of the vestibular system with the Romberg test, the Fukuda test, the head-shaking test and the Starwalk test. The study group consisted of 15 children (mean = 6.5 years, SD = 2; 10 females and 5 males). The control group consisted also of 15 children (mean = 7.2 years, SD = 1.8; 8 females and 7 males). The duration of MEE was between 3 and 12 months (mean = 8 months). Three children (20%) in the study group had a history of vertigo, imbalance, disequilibrium and/or tendency to fall. None of the children in the control group had such a history (p = 0.22); Five children in the study group had abnormal head-shaking test, Fukuda and/or Starwalk tests (33.33%). Two children in the control group had such a finding (13.33%) (p = 0.39). Romberg test was normal in all children in both groups. In the study group, one child showed positional and spontaneous nystagmus on VNG testing. Another one showed positional nystagmus. Hence, 2 children had abnormal findings on VNG (13.33%). In the control group, VNG was normal in all children (p = 0.46). Tympanometry showed a type B curve in 26 ears, a type C curve in 3 ears and type A in one ear. In the control group all patients presented a type A curve. This paper describes the first study using VNG in a population of children with CMEE. The presence of balance disturbances associated or not with hearing loss is of paramount importance to the clinician as to the indications of myringotomy with a tube intervention.

Utility of Stepping, Walking, and Head Impulses for Screening Patients for Vestibular Impairments

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.

Usefulness of ultrasound-computer-craniocorpography in different vestibular disorders.

Vertigo is one of the most unpleasant symptoms. Two of the main points of the examinations are the vestibulospinal tests (Romberg test and Unterberger- Fukuda test) can be measured objectively by the ultrasound-computer-craniocorpography. Using ultrasound-markers on head and shoulders, the ultrasound-computer-craniocorpography can measure and analyze the numerical data of statokinetic tests. The study is comparing the parameters of the vestibulospinal tests in different vestibular disorders. 84 patients were examined. The main parameters in the standing test are the longitudinal and sway, the torticollis angle, and the forehead covering. In the stepping test the main parameters were the longitudinal deviation, the lateral sway, the angular deviation, and the self-spin degree. The patients were divided on normal, unilateral and bilateral peripheral lesion and central lesion groups. The data of the longitudinal and lateral sway and the forehead covering in Romberg test are quite different in the normal and dizzy patients. Ultrasound-computer-craniocorpography is a useful method in the examination of the balance system disorders. The differential diagnostic value is not sufficient alone, we needs other investigations for the topical diagnosis of the vestibular system.

Fukuda and Babinski-Weil tests: within-subject variability and test-retest reliability in nondisabled adults.

The Fukuda Stepping Test and the Babinski-Weil test are clinical assessments that presumably reveal unilateral vestibular hypofunction. However, abnormal performances on both of these two tests have been found in nondisabled individuals. This study compared measures of lateral and longitudinal displacements and body rotation for both tests, as well as the within-subject variability and test-retest reliability of the measures. In addition, correlations between hand and foot dominance and these measures were studied. Fifty young, nondisabled participants performed three trials of the 100-step Fukuda test and three trials of the Babinski-Weil test. The testing session was repeated 7 d later (retest). Lateral displacement, body rotation, and within-subject variability of these two measures were larger on the Fukuda than the Babinski-Weil test. No difference in test-retest reliability was found between the two tests, and a significant correlation was found between body rotation on the Fukuda test and score on the Waterloo Footedness Questionnaire. There may have been smaller variability in results of the Babinski-Weil test because it contains fewer steps (36) than the 100-step Fukuda test. Future research should compare tests with an equal number of steps; but, in the meantime, the Babinski-Weil test seems to have better psychometric properties than the Fukuda test, at least in nondisabled individuals.

Effects of physiotherapy on balance and unilateral vestibular hypofunction in vertiginous elderly.

BackgroundWe aimed to analyze the effect of a physical therapy protocol on unilateral vestibular hypofunction and overall balance in elderly with vertigo.MethodsThe study included nine subjects, four male subjects (68.5 ± 11.09 years old) and five females (72.4 ± 7.09 years old). It was used the performance-oriented Mobility Assessment (POMA), to evaluate the balance and the Unterberger – Fukuda test for analysis of unilateral vestibular dysfunction through rotations and displacements of the body. We developed and applied a structured physical therapy protocol, consisting of group exercises.ResultsIt was observed that after the protocol, all participants improved balance (33.9 ± 5.1 vs. 47.3 ± 7.6, p < 0.0001) and displacement (111.1 ± 38.0 vs. 53.3 ± 34.6, p = 0.0001). However, it was not found significant differences for rotation.ConclusionThe proposed protocol has contributed to an improvement in balance and vestibular dysfunction of the aged.

The Role of Cervical and Ocular Vestibular-Evoked Myogenic Potentials in the Follow-Up of Vestibular Neuritis

This study evaluates the recovery of vestibular nerve function after vestibular neuritis (VN) by vestibular-evoked myogenic potentials (VEMPs). Twenty-six patients with the diagnosis of VN were included. All patients underwent ocular VEMP (oVEMP) and cervical VEMP (cVEMP) recordings, at 6 days and 6 months from the onset of the symptoms. Of the 26 patients, 14 showed improvement on oVEMP at month 6 (group 1), and 12 showed no change or worsening on oVEMP at 6 months (group 2). At the same time, there was no change in the amplitudes of the cVEMP on either healthy or affected sides in both groups. Inability to perform the Fukuda test, and chronic white matter supratentorial lesions present on brain magnetic resonance imaging (MRI) were more frequent in patients with worse outcome on oVEMP (P = 0.044 and 0.045, respectively). Although involvement of the inferior branch of the vestibular nerve was not associated with oVEMP outcome, oVEMP latencies (N10 and P13) were associated with improvement or worsening in oVEMP amplitudes, showing that prolonged latencies correlate with 6-month improvement in oVEMP amplitudes (Pearson correlation -0.472, P = 0.041 and -0.580, P = 0.009, respectively). This study identified clinical, MRI and neurophysiological predictors of recovery in patients with superior VN, and offers additional insight into, and better understanding of, the role of VEMP in diagnosis and prognosis of patients with VN. Further studies are needed to validate this diagnostic procedure and to assess its clinical usefulness in VN management.

Ergonomic and individual risk evaluation

The ergonomic risks constitute a vital aspect of study and prevention for the worker's health, especially for people with different capacities. Very job has and implies certain type of risk for the worker's health, depending on the conditions it is done with the use of tools or without them. Aplicated techniques: posturogram, baropodometry, Schober test, biocinemátic chain test, Fukuda test, propioceptiva plataform in personnel with special capabilities.

The Stepping Test: A Step Back In History

The stepping test is a valuable part of the neurological examination that is used to localize labyrinthine pathology. The test is known by two eponyms: the “Fukuda Test” in the United States and Asia and the “Unterberger Test” in Europe. Some controversy exists as to which name is correct. Siegfried Unterberger was an Austrian otolaryngologist who initially described the test in 1939. It was modified in 1959 by Tadashi Fukuda, a Japanese otolaryngologist, who introduced a method to better quantify the test results. Thus, the test should be called the “Unterberger Test,” unless Fukuda's methods for measurement are used.

What are the factors responsible for the deviation in stepping on the spot?

Without vision, keeping a straight-ahead direction while stepping on the spot is almost impossible, everybody deviates more or less. Several explanations for this, such as laterality, vestibulo-spinal influence, dopamine system, have been proposed. The aims of the experiment presented here were (1) to quantify the lateral deviation when stepping using a modified Fukuda test apparatus, and (2) to determine the factors potentially underlying such deviation. Twenty-five young adults, blindfolded, performed the experiment which consisted in stepping while holding a rotating vertical roll bar fixed on the wall. Four experimental conditions (i.e., normal, with an imposed pace, dual-task, or with the neck bent) were tested. All participants deviated towards one side or the other in all conditions. Adding an attentional load or imposing a particular pace did not change the amount of deviation. For three conditions (normal, with an imposed pace and dual-task), the deviation towards one side was not significantly larger than towards the other side at the group level. In the bent-neck condition, the deviation was significantly larger than in the other conditions. Furthermore, in this condition the deviation towards the left was significantly larger than the deviation towards the right at the group level. We discussed the results regarding the role of vestibular information and proprioceptive feedback from neck muscles in correcting a spontaneous deviation. Our results, however, go against the idea that sensorimotor lateral preferences are among the factors underlying such deviations, since we found no relationship between lateral preferences (hand, foot, and eye) and the side of deviation.

Evaluation of head-to-trunk control in whiplash patients using digital CranioCorpoGraphy during a stepping test

We used digital-CranioCorpoGraphy (dCCG) to document whiplash effects on head-on-trunk stabilization while subjects walked on the spot (Fukuda test). Twenty-five healthy subjects were compared with 33 whiplash patients. Whiplash patients were classified as chronic (more than 6 months after injury) and recent (less than 6 months after injury). Clear differences between healthy subjects and patients were seen and three different strategies were detected. Pattern A appeared similar to normals but quantitative analysis showed significant differences with paradoxical head over-stabilization (collar-effect); pattern B decreased head stability; pattern C decreased head stabilization with reduced displacements of the body. Due to the complexity of the data analyzed for each marker, a coefficient of performance (CP) was calculated to simplify the cut-off between normal and pathological tests. CP clearly identified an abnormal stepping pattern. Our findings indicate that firstly dCCG identified a specific vestibular task in whiplash patients, secondly whiplash did not always provoke vestibular involvement and thirdly dCCG could be a tool to discriminate patients with and without vestibular involvement after whiplash.

Supratentorial arachnoid cyst mimicking a Ménière’s disease attack

Arachnoid cysts (AC) often present with symptoms depending on their anatomical location within the skull; while supratentorial cysts grow causing relatively few symptoms, infratentorial ones may impair liquor circulation at the level of the fourth ventricle, giving rise to intracranial hypertension, or may stretch the complex nerve network in the cerebello-pontine angle. We report the singular clinical history of a 54-year-old male, who suddenly began to feel dizzy while sitting at his workplace, complaining of left tinnitus and aural fullness, in a classic clinical picture of Ménière's disease. The anomalous findings at otoneurological examination (markedly the left deviation at the Fukuda test) made a magnetic resonance image (MRI) scan mandatory and a huge AC was found in the left fronto-parietal lobe. The mass provoked an evident clockwise rotation of the brainstem that we suppose to be the cause of acoustico-facial bundle stretching explaining the vestibular symptomatology.

Relationship between Changes of Shoulder Angulation and Angle of Deviation while Stepping

The changes in angulation of the shoulders while stepping in patients with unilateral peripheral vestibular disorders were mesured by POLGON and relationship between them and deviations in the Fukuda's stepping test were analyzed.The ratio of average angular change of the shoulder on the affected side to that of the contralateral shoulder was increased in patients with marked deviations in Fukuda's test. There were a significant correlation between the abovementioned ratio and the angle of rotation in Fukuda's stepping test.The coefficient of variation (C.V.) of the changes of shoulder angulation tended to be increased on the affected side, while no correlation was obtained between the ratio of the C.V. on the affected side to that on the intact side one and the angle of deviation.These results suggest that the differences bet-ween the angulation of the shoulders while stepping are closely related to the results of Fukuda's test.