Romberg’s Sign

Definition: Romberg’s test/ Romberg’s sign/ Romberg maneuver is a test used in an exam of neurological function for balance.

The Romberg test is an appropriate tool to diagnose sensory ataxia, a gait disturbance caused by abnormal proprioception involving information about the location of the joints.

Basis Of Test: To maintain balance while standing a man needs at least 2(Two) of the 3(Three) following senses :

  •  proprioception – Ability to know body position.
  •  vestibular function – Ability to know head position.
  •  vision – Ability to monitor and adjust changes in body position.
How We Maintain Our Balance.

A person who has a problem with proprioception can maintain balance by vestibular function and vision.

The Romberg test is a test of proprioception, which requires intact functions of the dorsal columns of the spinal cord.

It also used as an indicator for alcohol or drug impaired driving and neurological decompression sickness.

Procedure:

ORIGINAL ROMBERG TEST:

  • The patient is asked to remove his shoes and stand with his two feet together. The arms are held next to the body or crossed in front of the body.
  • The Doctor asks the patient to first stand quietly with eyes open, and subsequently with eyes closed. The patient tries to maintain his balance.
  • For safety, it is essential that the observer stand close to the patient to prevent potential injury if the patient were to fall.
Romberg’s Test Procedure.

Observations:

  1. The Romberg test is scored by counting the seconds the patient is able to stand with eyes closed.
  2. Romberg’s test is positive if the patient falls while the eyes are closed. Swaying is not a positive sign as it shows proprioceptive correction.

THE SHARPENED OR TANDEM ROMBERG TEST :

  • The Sharpened or Tandem Romberg test is a variation of the original test. The implementation is mostly the same.
  • But Extra Process is – the patient has to place his feet in heel-to-toe position, with one foot directly in front of the other.
THE SHARPENED OR TANDEM ROMBERG TEST PROCEDURE

Observations:

  • The assessment is performed first with eyes open and then with eyes closed.
  • The patient crosses his arms over his chest, and the open palm of the hand lies on the opposite shoulder.
  • The patient also distributes his weight over both his feet and holds his chin parallel with the floor

Obese and older individuals may be unable to stand in this position for prolonged periods of time. For these populations, the Romberg test does not exclusively demonstrate proprioceptive impairments in comparison to other confounding factors

Key to Test:  The key to the test is that vision is taken away by asking the patient to close their eyes. This leaves only two of the three systems remaining and if there is a vestibular disorder (labyrinthine) or a sensory disorder (proprioceptive dysfunction) the patient will become much more unbalanced.

Why perform Romberg’s Test:

  1.  To investigate the cause of loss of motor coordination (ataxia)
    • A positive Romberg test suggests that the ataxia is sensory in nature, that is, depending on loss of proprioception. If a patient is ataxic and Romberg’s test is not positive, it suggests that ataxia is cerebellar in nature, that is, depending on localized cerebellar dysfunction instead.
  2.  Used as an indicator for possible alcohol or drug impaired driving and neurological decompression sickness.
    • When used to test impaired driving, the test is performed with the subject estimating 30 seconds in their head. This is used to gauge the subject’s internal clock and can be an indicator of stimulant or depressant use.

Causes Of Romberg’s Sign/Romberg’s Test Positive:

  • Multiple Sclerosis.
  • Subacute Combined degeneration of spinal cord.
  • Tabes dorsalis (Neurosyphilis) -in which it was first described.
  • Diabetic Neuropathy .
  • Other conditions causing sensory ataxia-
    • Vitamin deficiencies such as Vitamin B12.
    • sensory peripheral neuropathies.
    • chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).
    • Friedreich’s ataxia.
    • Ménière’s disease

Is Romberg’s Test is a test of cerebellar function?

No. Romberg’s test is not a test of cerebellar function, as it is commonly misconstrued.

Because , Patients with severe cerebellar ataxia will generally be unable to balance even with their eyes open. therefore, the test cannot possible.

Must Remember:

  • Romberg’s test is a test of the proprioception receptors and pathways function.
  • A positive Romberg’s test which will show wide base gait in patients with back pain has been shown to be 90 percent specific for lumbar spinal stenosis.

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