Table 1.

Summary of screening tests mentioned

Type of Test (Name)	Description
Tests of VOR
Dix-Hallpike maneuver	Test of individual posterior semicircular canals; for diagnosis of posterior canal BPPV; best performed with infrared video-oculography for accuracy.
Supine roll test	Test of individual horizontal semicircular canal; for diagnosis of horizontal canal BPPV; best performed with infrared video oculography for accuracy.
Head impulse tests	Tests of high-velocity VOR; most useful for subjects over age 60 with >60% unilateral vestibular weakness and no cervical limitations; not useful for younger adults or older adults with reduced cervical spine ranges; may be useful for screening for bilateral vestibular impairment, but statistical data are not available; a negative response does not necessarily indicate normal vestibular function; uninstrumented test of little value; minimal research currently available on suppression head impulse tests, so clinical value remains unknown; interpret all results with caution, as results are not definitive.
Head shaking	Test for nystagmus elicited by head rotation; not a useful test.
Tests of balance
Romberg on foam with eyes closed (a.k.a. CTSIB)	Tests of standing balance; best on medium density, compliant foam, performed with arms crossed; if head still condition is normal for age, test conditions with head moving in pitch or yaw at 0.3 Hz; moderately high sensitivity and good specificity; not useful for patients with lower-extremity peripheral neuropathy, however; interpret with care if patient has >1 joint replacement; no studies have tested joint replacement patients.
Tandem walking	Test of walking balance; eyes open condition not useful; best tested with 10 steps eyes closed after a few steps of practice, best with arms crossed; total no. of tandem steps is a more sensitive measure than number of consecutive tandem steps; problematic with patients with lower-extremity peripheral neuropathy; interpret with care if patient has >1 joint replacement; no studies have tested joint replacement patients.
Tests of spatial orientation
Fukuda Stepping Test	Might indicate the impaired side; not useful for diagnostic or rehabilitation screening; Cohen and colleagues (Cohen et al. 2017; Dai et al. 2014, 2017) have used it successfully for pretesting patients with mal de debarquement for treatment planning.
Vertical and Torsional Alignment Nulling	May indicate impairments of otolith function; New test paradigm with promising data, using minimal table technology and colored lenses, but too little data so far for clinical use.
Bucket test	Designed as a test of subjective visual vertical; data do not support it.

BPPV, benign paroxysmal positional vertigo of the posterior semicircular canal; CTSIB, Clinical Test of Sensory Interaction and Balance; VOR, vestibulo-ocular reflex. The order within each category indicates this author’s opinion about relative value of the test.