Romberg's test
Encyclopedia
Romberg's test or the Romberg maneuver is a test used by doctors in a neurological examination
, and also as a test for drunken driving. The exam is based on the premise that a person requires at least two of the three following senses to maintain balanced while standing:
Proprioception (the ability to know one's body in space); Vestibular function (the ability to know one's head position in space); and Vision (which can be used to monitor [and adjust for] changes in body position).
A patient who has a problem with proprioception can still maintain balance by using vestibular function 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.
The Romberg test is a test of the body's sense of positioning (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.
It is 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 his head. This is used to gauge the subject's internal clock and can be an indicator of stimulant or depressant use.
The essential features of the test are as follows:
Because the examiner is trying to elicit whether the patient falls when the eyes are closed, it is advisable to stand ready to catch the falling patient. For large subjects, a strong assistant is recommended.
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.
The main sensory inputs are:
Crucially, the brain
can obtain sufficient information to maintain balance if any two of the three systems are intact.
Sensorimotor integration is carried out by the cerebellum
and by the dorsal column-medial lemniscus
tract. The motor pathway is the corticospinal (pyramidal) tract
and the medial and lateral vestibular tracts
.
The first stage of the test (standing with the eyes open), demonstrates that at least two of the three sensory pathways is intact, and that sensorimotor integration and the motor pathway are functioning.
In the second stage, the visual pathway is removed by closing the eyes, known as a "sharpened Romberg". If the proprioceptive and vestibular pathways are intact, balance will be maintained. But if proprioception
is defective, two of the sensory inputs will be absent and the patient will sway then fall.
The sharpened Romberg does have an early learning effect
that will plateau between the third and fourth attempts.
such as:
function, as it is commonly misconstrued. Patients with cerebellar ataxia
will, generally, be unable to balance even with the eyes open; therefore, the test cannot proceed beyond the first step and no patient with cerebellar ataxia can correctly be described as Romberg's positive. Rather, Romberg's test is a test of the proprioception
receptor
s and pathways
function.
A positive Romberg's test has been shown to be 90% sensitive for lumbar spinal stenosis.
(1795-1873), who also gave his name to Parry-Romberg syndrome
and Howship-Romberg sign
.
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
, and also as a test for drunken driving. The exam is based on the premise that a person requires at least two of the three following senses to maintain balanced while standing:
Proprioception (the ability to know one's body in space); Vestibular function (the ability to know one's head position in space); and Vision (which can be used to monitor [and adjust for] changes in body position).
A patient who has a problem with proprioception can still maintain balance by using vestibular function 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.
The Romberg test is a test of the body's sense of positioning (proprioception
Proprioception
Proprioception , from Latin proprius, meaning "one's own" and perception, is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement...
), which requires healthy functioning of the dorsal columns of the spinal cord
Spinal cord
The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...
.
The Romberg test is used to investigate the cause of loss of motor coordination (ataxia
Ataxia
Ataxia is a neurological sign and symptom that consists of gross lack of coordination of muscle movements. Ataxia is a non-specific clinical manifestation implying dysfunction of the parts of the nervous system that coordinate movement, such as the cerebellum...
). 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.
It is used as an indicator for possible alcohol or drug impaired driving
DUI
DUI is a three letter acronym that may stand for:* Driving under the influence * Democratic Union for Integration — the largest ethnic Albanian party in the Republic of Macedonia* Data Use Identifier...
and neurological decompression sickness
Decompression sickness
Decompression sickness describes a condition arising from dissolved gases coming out of solution into bubbles inside the body on depressurization...
. When used to test impaired driving, the test is performed with the subject estimating 30 seconds in his head. This is used to gauge the subject's internal clock and can be an indicator of stimulant or depressant use.
Procedure
Ask the subject to stand erect with feet together and eyes closed. Stand close by as a precaution in order to stop the person from falling over and hurting himself or herself. Watch the movement of the body in relation to a perpendicular object behind the subject (corner of the room, door, window etc). A positive sign is noted when a swaying, sometimes irregular swaying and even toppling over occurs. The essential feature is that the patient becomes more unsteady with eyes closed.The essential features of the test are as follows:
- the subject stands with feet together, eyes open and hands by the sides.
- the subject closes the eyes while the examiner observes for a full minute.
Because the examiner is trying to elicit whether the patient falls when the eyes are closed, it is advisable to stand ready to catch the falling patient. For large subjects, a strong assistant is recommended.
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
Proprioception
Proprioception , from Latin proprius, meaning "one's own" and perception, is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement...
) the patient will become much more imbalanced.
Physiology
Maintaining balance while standing in the stationary position relies on intact sensory pathways, sensorimotor integration centers and motor pathways.The main sensory inputs are:
- Joint position sense (proprioceptionProprioceptionProprioception , from Latin proprius, meaning "one's own" and perception, is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement...
), carried in the dorsal columns of the spinal cord; - VisionVisual perceptionVisual perception is the ability to interpret information and surroundings from the effects of visible light reaching the eye. The resulting perception is also known as eyesight, sight, or vision...
- Vestibular apparatus
Crucially, the brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
can obtain sufficient information to maintain balance if any two of the three systems are intact.
Sensorimotor integration is carried out by the cerebellum
Cerebellum
The cerebellum is a region of the brain that plays an important role in motor control. It may also be involved in some cognitive functions such as attention and language, and in regulating fear and pleasure responses, but its movement-related functions are the most solidly established...
and by the dorsal column-medial lemniscus
Medial lemniscus
The medial lemniscus, also known as Reil's band or Reil's ribbon, is a pathway in the brainstem that carries sensory information from the gracile and cuneate nuclei to the thalamus.-Path:...
tract. The motor pathway is the corticospinal (pyramidal) tract
Corticospinal tract
The corticospinal or pyramidal tract is a collection of axons that travel between the cerebral cortex of the brain and the spinal cord....
and the medial and lateral vestibular tracts
Vestibulospinal tract
The vestibulospinal tract is a component of the extrapyramidal system and also can be classified as a component of the medial pathway. The vestibulospinal fibers relay information from nuclei to motor neurons, like other descending motor pathways. Specifically, the vestibular nuclei receive...
.
The first stage of the test (standing with the eyes open), demonstrates that at least two of the three sensory pathways is intact, and that sensorimotor integration and the motor pathway are functioning.
In the second stage, the visual pathway is removed by closing the eyes, known as a "sharpened Romberg". If the proprioceptive and vestibular pathways are intact, balance will be maintained. But if proprioception
Proprioception
Proprioception , from Latin proprius, meaning "one's own" and perception, is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement...
is defective, two of the sensory inputs will be absent and the patient will sway then fall.
The sharpened Romberg does have an early learning effect
Habituation
Habituation can be defined as a process or as a procedure. As a process it is defined as a decrease in an elicited behavior resulting from the repeated presentation of an eliciting stimulus...
that will plateau between the third and fourth attempts.
Positive Romberg
Romberg's test is positive in conditions causing sensory ataxiaSensory ataxia
Sensory ataxia is both a symptom and a sign in neurology. It is a form of ataxia caused not by cerebellar dysfunction but by loss of sensory input into the control of movement....
such as:
- Conditions affecting the dorsal columns of the spinal cord, such as tabes dorsalisTabes dorsalisTabes dorsalis is a slow degeneration of the sensory neurons that carry afferent information. The degenerating nerves are in the dorsal columns of the spinal cord and carry information that help maintain a person's sense of position , vibration, and discriminative touch.-Cause:Tabes dorsalis is...
(neurosyphilisNeurosyphilisNeurosyphilis is an infection of the brain or spinal cord caused by the bacterium Treponema pallidum. It usually occurs in people who have had untreated syphilis for many years, usually about 10 - 20 years after first infection.-Symptoms and signs:...
), in which it was first described. - Conditions affecting the sensory nerves (sensory peripheral neuropathies), such as chronic inflammatory demyelinatingDemyelinating diseaseA demyelinating disease is any disease of the nervous system in which the myelin sheath of neurons is damaged. This impairs the conduction of signals in the affected nerves, causing impairment in sensation, movement, cognition, or other functions depending on which nerves are involved.The term...
polyradiculoneuropathy (CIDP). - Friedreich's AtaxiaFriedreich's ataxiaFriedreich's ataxia is an inherited disease that causes progressive damage to the nervous system, resulting in symptoms ranging from gait disturbance to speech problems; it can also lead to heart disease and diabetes....
Romberg and cerebellar function
Romberg's test is not a test of cerebellarCerebellum
The cerebellum is a region of the brain that plays an important role in motor control. It may also be involved in some cognitive functions such as attention and language, and in regulating fear and pleasure responses, but its movement-related functions are the most solidly established...
function, as it is commonly misconstrued. Patients with cerebellar ataxia
Ataxia
Ataxia is a neurological sign and symptom that consists of gross lack of coordination of muscle movements. Ataxia is a non-specific clinical manifestation implying dysfunction of the parts of the nervous system that coordinate movement, such as the cerebellum...
will, generally, be unable to balance even with the eyes open; therefore, the test cannot proceed beyond the first step and no patient with cerebellar ataxia can correctly be described as Romberg's positive. Rather, Romberg's test is a test of the proprioception
Proprioception
Proprioception , from Latin proprius, meaning "one's own" and perception, is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement...
receptor
Sensory receptor
In a sensory system, a sensory receptor is a sensory nerve ending that responds to a stimulus in the internal or external environment of an organism...
s and pathways
Metabolic pathway
In biochemistry, metabolic pathways are series of chemical reactions occurring within a cell. In each pathway, a principal chemical is modified by a series of chemical reactions. Enzymes catalyze these reactions, and often require dietary minerals, vitamins, and other cofactors in order to function...
function.
A positive Romberg's test has been shown to be 90% sensitive for lumbar spinal stenosis.
History
The test was named after the German neurologist Moritz Heinrich RombergMoritz Heinrich Romberg
Moritz Heinrich Romberg was a Jewish physician from Berlin who published his classic textbook in sections between 1840 and 1846; Edward Henry Sieveking translated it into English in 1853....
(1795-1873), who also gave his name to Parry-Romberg syndrome
Parry-Romberg syndrome
Parry–Romberg syndrome is a rare neurocutaneous syndrome characterized by progressive shrinkage and degeneration of the tissues beneath the skin, usually on only one side of the face but occasionally extending to other parts of the body...
and Howship-Romberg sign
Howship-Romberg sign
Howship–Romberg sign is a sign used to identify obturator hernia.It can be caused by a granuloma.It is named for John Howship and Moritz Heinrich Romberg.It should not be confused with Romberg sign.-References:...
.