Skip to main content

Romberg's test - how to do and interpretation

 INTRODUCTION 
Romberg's test is done to assess the integrity of the dorsal columns of the spinal cord.

It is not a test to assess the cerebellar function.

The test was first described by Moritz Heinrich von Romberg who found that patients with tabes dorsalis (neurosyphilis) often complained of increased unsteadiness in the dark.

The test should be performed in all patients who complain of dizziness, imbalance or falls to rule out sensory ataxia.


 HOW TO DO THE TEST? 
The test is done by requesting the patient to keep his feet firmly together, arms by the side and the eyes open at first. The balance of the patient is noted.
Now the patient is asked to close both eyes and the balance is now noted for around 1 minute. The physician should stand in front of the patient with his arms extended on either side of the patient but not touching him. This is done as the latter may fall.

 INTERPRETATION 
1) If with the eyes open, the balance is not good then there may be a problem with the cerebellum. This condition is called as cerebellar ataxia.
2) If closing the eyes causes a much worse balance then the test is said to be positive (Romberg test positive). It indicates that the patient is excessively reliant on his vision to maintain balance. The problem may lie in the vestibular or proprioceptive systems.

The physiology behind this test is that to maintain balance we need at least 2 of the following 3 components:
1) vision,
2) proprioception and
3) vestibular function.
In simple words. . .If a patient has a vestibular problem then with his eyes open he can maintain balance because his proprioception as well as vision is helping him. But now if he closes his eyes, then there is only proprioception to maintain balance and that is not sufficient. So the patient will sway and may fall.

The same is true for someone with a problem of proprioception. With his eyes open, the patient can maintain balance because he is using his normal vision and vestibular apparatus. But when he closes his eyes, he is only relying on his vestibular function now and thus he will sway and may fall.

 COMMON CAUSES OF POSITIVE ROMBERG TEST: 
1) Vitamin B12 deficiency - Subacute combined degeneration of the cord,
2) Diabetic peripheral large fibre neuropathy,
3) Friedrich's ataxia,
4) Tabes dorsalis.

 N.B 
1) The test may be positive in some patients who are having some motor disorders.
2) If the unsteadiness is due to anxiety then we can divert the patient's attention, e.g. by having him touch the index finger of each hand alternately to his nose while standing with eyes closed.
3) Patients with authentic proprioceptive problems will sway when their gaze is diverted from the ground and the situation worsens when the eyes are closed.
4) Patients with factitious unsteadiness, usually will remain stable when their gaze is diverted from the ground e.g. if they are looking at the ceiling or a distant object and then become very unsteady when the eyes are closed.

Last reviewed on : 1 September 2015
Labels:

Comments

  1. Patrick Suckoo, DCSeptember 20, 2015 at 5:13 AM

    stenosis in the lumbar spine can cause a positive Romberg too....

    ReplyDelete
    Replies
    1. AnonymousAugust 1, 2017 at 7:22 AM

      Unlikely, posterior column is in the spinal cord, there is no spinal cord in most of the extent of lumbar spine . The cord usually ends between D12 and L1.

      Delete
  2. Public Health & PhysiotherapyJuly 29, 2019 at 8:53 AM

    Thank you for nice clarification with easy & simplify Languag.

    ReplyDelete

Post a Comment

Popular posts from this blog

Hypokalemia - Potassium replacement calculation

 DEFINITION  Hypokalemia is defined as a serum potassium level of less than 3.5 mmol/L. Normal level= 3.5-5.5 mmol/L. It is encountered in >20% of patients. Patients are usually asymptomatic but severe arrhythmias and rhabdomyolysis can occur. Non-specific complaints include easy fatiguability and skeletal muscle weakness. The preferred method of replacement is via the oral route but at times this is not possible. The article below will give you an idea about how to calculate the amount of KCl to be given I.V. 1) Potassium deficit in mmol is calculated as given below: K deficit  (mmol) = (K normal lower limit  - K measured ) x kg body weight x 0.4 2) Daily potassium requirement is around 1 mmol/Kg body weight. 3) 13.4 mmol of potassium found in 1 g KCl . ( molecular weight KCl = 39.1 + 35.5 = 74.6) Suppose we get an asymptomatic patient of  70 Kg with a serum potassium level of 3.0 mmol/L and he is on nil by mouth but having...
50 comments
Read more

Endomysium, Perimysium and epimysium - definition, histology

Each muscle fibre is closely surrounded by connective tissue. This acts as a support for the muscle fibres and unites them to each other. 1) Each muscle fibres is surrounded by delicate connective tissue that is called the endomysium . 2) Individual fasciculi are enclosed by a stronger sheath of connective tissue called the perimysium . 3) The entire muscle is surrounded by connective tissue called the epimysium . This is illustrated by the schematic diagram below. 1= perimysium, 2= endomysium, 3= fasciculus. At the junction of a muscle with a tendon, the fibres of the endomysium, the perimysium and the epimysium become continuous with the fibres of the tendon. First published on: 27 December 2016
Post a Comment
Read more

The plantar reflex - Babinski's sign

The plantar response is an important test to identify an upper motor neuron lesion.  PROCEDURE  To elicit it, the muscles of the lower limbs must be relaxed. The outer edge of the sole of the foot is stimulated by firmly scratching a blunt object like a key or a stick along it from the heel towards the little toe. This is what  Joseph Babinski did in the year 1896. He described the 'great toe sign' that year and then in 1903 the 'toe abduction or fan sign'. Nowadays, a final medial movement across the sole of the metatarsus is also done. i.e. we start at the heel to the little toe and finally arcing to the big toe. The final arcing movement is absent in the original Babinski plantar response test. Babinski sign refers to a combination of 'the great toe sign' and the 'fan sign'.  SIGNIFICANCE  The normal response is plantar flexion of the toes (down going) and they are drawn together. More precisely, there is flexion of the big toe and addu...
4 comments
Read more

Edema - Definition, pathophysiology, causes, clinical features

 DEFINITION  Edema is an abnormal presence of excessive fluid in the interstitial space.  PATHOPHYSIOLOGY  The movement of water and low molecular weight solutes such as salts between the intravascular and interstitial spaces is controlled primarily by the opposing effect of vascular hydrostatic pressure and plasma colloid osmotic pressure. Normally the outflow of fluid from the arteriolar end of the microcirculation into the interstitium is nearly balanced by inflow at the venular end. A small residual amount of fluid may be left in the interstitium and is drained by the lymphatic vessels, ultimately returning to the bloodstream via the thoracic duct. Either increased capillary pressure, diminished colloid osmotic pressure or inadequate lymphatic drainage can result in an abnormally increased interstitial fluid i.e. edema. An abnormal increase in interstitial fluid within tissues is called edema, while fluid collections in the different body cavi...
5 comments
Read more

Gram staining - Procedure, mechanism, explanation

 INTRODUCTION  The Gram stain was developed in 1884 by the Danish bacteriologist Hans Christian Gram. It is one of the most useful staining procedures because it classifies bacteria into two large groups:  1) gram-positive and  2) gram-negative.  PROCEDURE  1) A heat-fixed smear is flooded with a basic purple dye, usually crystal violet. Because the purple stain imparts its color to all cells, it is referred to as a primary stain . 2) After 1 minute, the crystal violet is drained off and washed with distilled water. The smear is then covered with Gram's iodine, a mordant or helper . When the iodine is washed off, both gram-positive and gram-negative bacteria appear dark violet or purple. 3) Next, the slide is washed with alcohol (95% ethanol) or an alcohol-acetone solution. This solution is a decolorizing agent which removes the purple from the cells of some species but not from others. When the procedure is carried out, the slide is held ...
3 comments
Read more