It is the inability to stand with the feet together when the subject closes his eyes.
Romberg’s sign compares balance with eyes open and closed, exploring the imbalance due to proprioceptive sensory loss.
When proprioception is impaired, the patient may stand with his eyes open but sway or fall with his eyes closed.
The patient stands with the feet as close as possible, which will allow the eyes to be kept open. Typically, closing the eyes causes a temporary and minor loss of balance.
In patients with impaired proprioception, closing the eye produces increased sway or a sincere loss of balance, with the need to take a step to regain it and, rarely, a near fall.
The Romberg is a sensitive sign of the posterior column; it is not a cerebellar sign.
What is the Romberg test?
The Romberg test is a suitable tool for diagnosing sensory ataxia, a gait disturbance caused by abnormal proprioception involving information about the joints’ location.
It has also been shown to be a sensitive and accurate means of measuring the degree of imbalance caused by central vertigo, peripheral vertigo, and head trauma. It has been used in the clinic for 150 years.
The Romberg test demonstrates the effects of posterior column disease on human vertical postural control.
Posterior column disease involves selective damage to the posterior column, known as tabes dorsalis neurosyphilis.
The Romberg test is used for clinically evaluating patients with imbalance or ataxia due to sensory and motor disorders.
Equilibrium is any condition where all the acting forces cancel each other, resulting in a stable, balanced system. It is maintained through sensory information from the vestibular, somatosensory, and visual systems.
A patient with a problem with proprioception (somatosensory) can maintain balance by compensating for vestibular function and vision.
In the Romberg test, the patient stands up and asks you to close your eyes. A loss of equilibrium is interpreted as a positive Romberg sign.
The Romberg test was first described in 1846 and was initially described for the condition of tabes dorsalis.
Before performing the Romberg test, it is necessary to test other aspects of the patient’s balance when there are potential problems with ataxia or imbalance.
Often proprioceptive challenges are not the first problems faced by this population. Sometimes it is more straightforward. First, evaluating other aspects of impaired balance is essential to rule out confounding factors that could lead to a false-positive test.
Clinically relevant anatomy
Three sensory systems provide information to the cerebellum to maintain trunk stability when the eyes are open:
- Entrance exam.
Only two of the three systems are necessary to maintain balance. When visual information is removed, instability due to lack of vision can be separated from other sensory impairments.
If there is a more severe proprioceptive or vestibular injury, or if there is a midline cerebellar injury-causing trunk instability, the patient will not be able to maintain a standing position, even when the eyes are open.
Instability can also be seen with lesions in other parts of the nervous system, such as the upper or lower motor neurons or the basal ganglia.
Romberg’s original test
The test is carried out as follows:
The patient is asked to remove his shoes and stand with both feet together. The arms are held to the side of the body or crossed in front of the body.
The doctor asks the patient to stand silently with his eyes open and subsequently with his eyes closed. The patient tries to maintain balance. For safety reasons, the observer must stand close to the patient to avoid possible injury if the patient falls.
When patients close their eyes, you should not orient yourself with light, sense, or sound, as this could influence the test result and cause a false-positive result.
The Romberg test is scored by counting the seconds the patient can stand with their eyes closed.
The literature does not report on alternative methods for scoring a Romberg test.
To make the Romberg test more complex, the doctor may try to disturb the patient’s balance with a disturbance. The clinician mustn’t exaggerate the disorder.
A Romberg test can also be used as a follow-up assessment for patients with balance and proprioception problems by comparing several different estimates against each other.
If the physician observes that the patient can stand longer with his eyes closed, it is clear that the patient’s balance and proprioceptive deficits have decreased.