Romberg's Test

[apocalypse]

I am sorry to ask such a stupid question but this always seems to get me.

Right, I know how to do a positive romberg.

If they sway excessively or fall with eyes closed then its a proprioception problem because you take away the visual input you rely on the proprioception - what about vestibular input?

What if they fall, sway excessively on eyes open.

Again, sorry for a dumb question

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[physiobob]

Good revision questions and much of this below comes from other websites and a summary of that information. The test is named after the 19th century German Ear Specialist, Moritz Heinrich Romberg (1795-1873).

The Rhomberg's test is based on the premise that a person requires at least two of the three following senses to maintain balance while standing: proprioception (the ability to know one's body in space), sensation (the ability to feel touch, pressure, or vibration -- e.g., to feel one's feet against the ground), and vision (which can be used to monitor changes in balance).

What if they fall, sway excessively on eyes open.

A patient who has a problem with proprioception can still maintain balance by using sensation and vision. In the Romberg test, the patient is stood up and asked to close his eyes. A loss of balance is interpreted as a positive Romberg sign. This could be linked to things like Tabes dorsalis, the result of untreated syphillis.

I would suggest then that if they sway excessively with their eyes open (and they are not drunk) then the issue is more than a proproceptive one. This could be vestibular but could also be something from higher centers e.g. cerebellar ataxia.

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

The Romberg test is used 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.

The essential features of the test are as follows:

1. the subject stands with feet together, eyes open and hands by the sides.
2. the subject closes the eyes while the examiner observes for a full minute.

Romberg's test is positive if the patient sways or falls while the patient's eyes are closed.

Patients with a positive result are said to demonstrate Romberg's sign or Rombergism. They can also be described as Romberg's positive. The basis of this test is that balance comes from the combination of several neurological systems, namely proprioception, vestibular input, and vision. If any two of these systems are working the person should be able to demonstrate a fair degree of balance. 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 imbalanced.

A positive Romberg's sign indicates one or more of these problems:

Vertigo or Vestibular Ataxia - problems with the balance organs in the inner ear or sensory feedback. These can be caused by:

• problems in the inner ear itself
• problems in the cranial nerve supplying the ear (CN VIII)
• lesions in the Pons region of the brainstem where CN VIII arises
• damage to other central nervous system pathways which connect to the Pons

Cerebellar Ataxia - this is dysfunction caused by damage to a brain region called the cerebellum or to nervous pathways connecting to it. The cerebellum is responsible for assimilating sensory data, for example limb position and visual data, and co-ordinating movements resulting from that.

Proprioceptive Dysfunction. Proprioceptive sensors are located in the muscles and joints and feedback positional data to the cerebellum. Damage anywhere along the pathway from the proprioceptive sensors to the cerebellum can give rise to cerebellar ataxia.

By eliminating visual feedback, the Romberg Test can detect dysfunction in other pathways to and from the cerebellum.

The Romberg Test is a non-specific test of neurological or inner ear dysfunction and is not indicative of a specific condition. It is usually combined with other tests including finger-to-nose tests. Vertigo, vestibular and cerebellar ataxia and proprioceptive dysfunction are all relatively commonly seen in multiple sclerosis.

Failure to compensate in a particular direction is indicative of damage on a particular side of the central nervous system.

[Fyzzio]

Hi,
I agree with physiobob.

Neurologically, balance depends on three systems. On even ground, the relation is 80% eye sight, 10% sensory, 10% vestibular. Apparently (and I cannot find the reference for this), on uneven ground this changes to 50% eye sight, 10% sensory and 40% vestibular.

So, if Romberg is positive, either the sensory or the vestibular system is affected (or a combination :-)). You can then go to Sharpened Romberg or use other outcome measures to test sensation and vestibular functions.

However -as above- swaying in unsupported standing has not neccessarily a neurological origin.
I like the BEST Test, which differentiates between all possible systems (e.g. posture, musculoskeletal system, strength).

Regards,
Fyzzio

[apocalypse]

Thanks guys. I appreciate your help