Romberg Test: Romberg test used in an exam of neurological function for balance, and also is done to assess the integrity of the dorsal columns of the spinal cord. The exam is based on the premise that a person requires at least two of the following 3 components:
- Vestibular function
The Romberg test is a test of the body’s understanding of positioning, which demands healthy functioning of the dorsal columns of the spinal cord.
A patient who has a problem with proprioception can still maintain balance by using vestibular function and vision. In the Romberg test, the standing patient is required to close his or her eyes. A developing loss of balance is interpreted as a positive Romberg’s test. The Romberg test is used to examine the cause of loss of motor coordination (ataxia). If a patient is ataxic and Romberg’s test is not positive, it recommends that ataxia is cerebellar in nature, that is, depending on localized cerebellar dysfunction preferably. The test should be conducted in all patients who complain of dizziness, imbalance or falls to rule out sensory ataxia.
Cerebellar Ataxia – this is dysfunction caused by damage to a brain region called the cerebellum or too nervous pathways connecting to it. The cerebellum is responsible for understanding sensory data, for instance, limb position and visual data, and co-ordinating movements resulting from that.
Proprioceptive sensors are positioned in the muscles and joints and feedback positional data to the cerebellum. The injury anywhere along the pathway from the proprioceptive sensors to the cerebellum can give rise to cerebellar ataxia and it will be. Proprioceptive
The Romberg Test is a non-specific test of inner ear dysfunction and is not suggestive of a specific condition. It is normally consolidated with other tests including finger-to-nose tests. Vertigo, vestibular and cerebellar ataxia, and proprioceptive dysfunction are all almost usually seen in multiple sclerosis.
Romberg Test is not a test to assess the cerebellar function.
The Technique of the Romberg Test
The patient should stand with feet together on the level ground, arms at their sides, and eyes open. The doctor should stand to face the patient with their arms out, without touching them, to catch the patient if they fall. Examine the patient for about 20 seconds, Record any swaying or falling.
Ask the patient to close both eyes for 30 seconds. The Romberg test is positive when the patient is unable to maintain balance with their eyes closed. Losing balance can be defined as increased body sway, placing one foot in the direction of the fall, or even falling. Note the patient’s ability to maintain an upright posture.
Examine the patient to stand with eyes closed and is required to hold the head in various positions, flexed or extended, with head/neck rotated in one direction or the other. Variations in the direction of swaying of the trunk can be described to be the result of labyrinth imbalance.
Results of the Romberg Test
Negative: Minimal swaying occurs
Positive: Failure to keep the eyes closed, able to stand upright with eyes open and minimal swaying.
Romberg sign is said to be positive in patients with sensory ataxia and negative in cerebellar ataxia.
Diagnostic Accuracy of Romberg test
Sensitivity: 63% (for detecting vestibular impairment)
Low power to determine lesions, predict the risk of falling and reflect the discomfort and ability to perform daily activities.
Possible Causes Positive Romberg Sign
Romberg test is positive in conditions causing sensory ataxia such as:
- Vitamin B12 deficiency – Subacute combined degeneration of the cord.
- Conditions concerning the dorsal columns of the spinal cord, such as tabes dorsalis.
- Conditions affecting the sensory peripheral neuropathies, such as chronic inflammatory demyelinating polyradiculoneuropathy.
- Ménière’s disease
- Friedreich’s ataxia