Overview of Romberg Test
The Romberg’s sign, also known as the Romberg’s test, is a procedure used by doctors to evaluate a patient’s nerve function. It was first recorded by Marshall Hall, Moritz Romberg, and Bernardus Brach, and it’s named after Mortiz Romberg, a European neurologist.
Initially, this test was used specifically for patients with a severe form of syphilis, a sexually transmitted infection. In these patients, the disease had progressed to its last stage, characterized by a disorder known as locomotor ataxia, or tabes dorsalis, in which the patient suffers from loss of coordination.
The Romberg’s sign test is a useful way to check out how well the nerves in the brain and spinal cord that control our sense of body position, a sense called proprioception, are functioning. Romberg noted that patients with severe damage to these nerves exhibited significant difficulty in maintaining their posture when asked to stand in the dark or with their eyes closed.
It’s important to note that the Romberg’s test isn’t a way to identify disorders related to the cerebellum (the part of the brain responsible for coordination and balance) but rather disorders linked to the posterior column (nerves in the spinal cord relating to proprioception). The ability to stand upright is normally governed by three things: vision, proprioception (our sense of body position), and vestibular function (our balance system). The Romberg’s test asks the patient to remove the visual and balance systems from the equation to better determine if a neurological disease is affecting the patient’s sense of body position.
A patient has a positive Romberg’s sign if they can stand with their feet together and eyes open, but when they close their eyes (and hence don’t have visual cues to help with balance), they start to sway or fall.
Anatomy and Physiology of Romberg Test
The dorsal column, a part of your spinal cord, is responsible for transmitting signals to the brain. It lets us feel vibrations, complete touch, tell the difference between two close points we touch, and helps us understand our body’s movement and position, known as proprioception. If the protective coating of the nerves in the dorsal column gets damaged, as seen in some diseases, it may lead to severe sensory deficits, including proprioception.
The cerebellum, a part of our brain situated below the base of the brain, also plays a key role in helping us maintain balance and coordination. Remarkably, it’s associated with our body’s voluntary and synchronized movements.
An exam known as the Romberg’s test is used by doctors to gauge the function of the dorsal column and proprioception. If the results show some deficiency, it could point to damage in the dorsal column or the cerebellum, potentially causing coordination problems. However, it’s important to remember that a negative result does not always mean there is damage to the cerebellum.
Our body maintains balance using data from our vision, balance mechanisms in our ears, and proprioception. This physiologic harmony can get disturbed in conditions such as neurosyphilis, vitamin B12 deficiency, or issues with the blood vessels of the spinal cord, resulting in difficulties in balance and awareness of body movement. Of these, advanced stages of vitamin B12 deficiency can cause the protective coating of nerve fibers to break down, disrupting the transmission of nerve impulses, particularly those related to proprioception.
Similarly, an issue that affects the blood supply to the spinal cord can also disturb balance and proprioception. Moreover, a condition where the spinal cord gets partially damaged, usually due to injury (known as Brown-Sequard syndrome), can result in a weakened or paralyzed side of the body, loss of vibration and proprioception, and opposite side loss of pain and temperature sensation.
These conditions can lead to balance issues and other symptoms. Diagnosis of these conditions requires a comprehensive medical history record. This is why it’s important to provide all necessary past health-related information to your healthcare provider to ensure proper treatment planning.
Why do People Need Romberg Test
The Romberg test is a standard method used during an examination of the nervous system. It plays an important role in checking the health of the part of the spinal cord that helps manage your sense of body position and movement, especially useful for patients struggling with balance.
This test is generally necessary when someone finds it difficult to navigate in dim light or keep their balance while doing something as simple as washing their face. In more serious conditions, where the patient has a significant loss of body sense, the patient might display visible difficulty in standing with their feet together. There might be clear signs of poor body balance or difficulty in staying steady with eyes open or closed, in which case the Romberg test becomes very important.
The Romberg test is quite valuable in diagnosing a wide range of neurological conditions. These include Parkinson’s disease (which causes balance problems and a shuffling walk), Friedreich ataxia (which leads to a staggering walk and frequent falls), Vitamin B12 deficiency (leading to a shaky gait), Tertiary syphilis (causing impaired body sense), Normal pressure hydrocephalus in the elderly (balance issues with falls), Wernicke’s syndrome (related to chronic alcoholism, causing limb shakiness), and Ménière’s disease.
A positive Romberg sign is associated with:
- Loss of body sense due to diseases of the spinal cord and nerves
- Dysfunction of the parts of the ears that help with balance, and
- Damage to specific parts of the cerebellum, an region of the brain that plays a crucial role in movement control.
In conditions affecting the cerebellum, patients are often unsteady even with their eyes open. During the test, these patients tend to fall towards the side of the damaged balance organ.
The Romberg test, along with the Timed Get Up and Go Test, has also been used to measure frailty—the decrease in body strength, energy, and function—in older patients. The modified version of the Romberg Test of Standing Balance is also utilized for assessing the risk of falling.
When a Person Should Avoid Romberg Test
Recent medical studies show that doing the test is safe when it’s properly supervised by a healthcare professional and the right steps are followed.
Equipment used for Romberg Test
This test doesn’t need any special medical tools. The Romberg test is a simple test that can help doctors see if you have a problem with your sense of body position (proprioception) or a certain pathway in your nervous system (dorsal column medial lemniscus pathway) with no need for any equipment. However, this test can sometimes make mistakes. Its success depends entirely on how well you can follow the doctor’s instructions during the test.
Only a trained healthcare provider should carry out this test, and it should be done in a safe place. This makes sure that the results are as accurate as possible, and it ensures your safety during the test.
Who is needed to perform Romberg Test?
A doctor or another trained medical expert might carry out this procedure. Whether done alone or with help, it’s important to know that these individuals are well-educated in performing these types of medical tasks.
Preparing for Romberg Test
The healthcare professional conducting the test should stand near the patient. This is a safety step to prevent the patient from losing balance or falling during the test.
How is Romberg Test performed
For this balance test, you have to take off your shoes and stand with both feet together. The doctor will then ask you to place your arms by your sides or crossed in front of you. Then, they’ll watch you as you stand still with your eyes open, to see how your body moves when trying to keep balanced.
Next, you’ll be asked to stand straight with your eyes closed, while the doctor evaluates your balance for one minute. It is normal to sway a little – this is just your body adjusting its position to keep stable without the help of sight. However, if you lose your balance when your eyes are closed, this can be seen as excessive swaying, stepping to stop a fall, or actually falling. This would mean you’ve tested positive on the Romberg test.
This test can be made more challenging in the following ways, to give the doctor more information:
- By asking you to stand with your feet in a heel-to-toe line, this narrows your base of support;
- Or by asking you to stand on a piece of foam rubber with your eyes closed. This will make it harder for you to feel your own body’s position, which would show how good your balance is without relying on your sense of touch.
Possible Complications of Romberg Test
When this procedure is done properly by a qualified healthcare expert, it isn’t known to have any issues or side effects.
What Else Should I Know About Romberg Test?
The Romberg test is a straightforward test that doctors use for people who experience problems with balance, dizziness, or unexplained falls. This test can help identify whether an issue with the body’s sense of its own position and motion (known as sensory ataxia) is causing imbalance. Being able to stay balanced when standing still relies on certain pathways in the brain that both sense and control movement. If there’s a problem with your body’s sense of position (known as proprioception), a positive Romberg test may signal that further investigation is needed into potential underlying conditions affecting the spinal cord.
In some cases, issues with balance may be treatable if detected early. There are many causes of sensory ataxia, including certain inherited disorders, nutritional deficiencies, toxins, immune system disorders, and more. One traditional cause is a condition known as tabes dorsalis. Also, the doctors look to rule out causes like tertiary syphilis or vitamin B12 deficiency that can also lead to balance issues.
Doctors have developed several versions of the Romberg test to assess balance in a wide range of scenarios. For example, the Sharpened Romberg Test is used for patients recovering from decompression sickness (like divers) – in this test, the patient stands with their feet in a straight line, one foot right in front of the other. The Single-legged Stance Test is primarily used for older people and those with Parkinson’s disease. And the Sitting-rising Test and Get-Up and Go Test help assess balance and strength in the elderly and those who’ve had a stroke.
The specific test selected usually depends on the doctor’s judgement and the patient’s symptoms. While other tests are not necessarily better or worse than the original Romberg test, certain variations may be better suited for specific patients or conditions.