What is a Romberg Test & What Can Cause a Positive Romberg Test?

What is Romberg’s Test?

The Romberg’s test is a chair side tool for clinical diagnosis of sensory ataxia, and gait and balance disorders most commonly caused by abnormal proprioception involving location of the joints. It is also used in causes of disequilibrium associated with head trauma and vertigo (central and peripheral).

Romberg’s test is a commonly used diagnostic test that is carried out to quantify balance. It is a simple test, the difficulty of which can be modified based on each person’s condition and capacity. Romberg’s test is very commonly used by police officers to assess instability and imbalance due to alcohol intoxication and other substance abuse. The use of this test can be traced back to about 150 years from now. This test was brought into use by Romberg in 1846 and was further developed by Rogers in the year 1980. It is used in determining cases associated with cerebellar disturbances.

Romberg’s test is often misspelt as Rhomberg’s test and should be avoided to create any confusion. It can be carried out without using any equipment and thus it can be used for large scale deployment.

Other variants of this test are often used for measuring sobriety. These variants include the “one leg stand” test (part of standard field sobriety test); oculomotor testing (pursuit, gaze nystagmus) and walk and turn test, eyes open regular (EORR), eyes closed regular (ECRR), eyes open tandem (EOTR), eyes closed tandem (ECTR). However, Romberg’s test is not used in cases of concussion such as in sports injury.

How is a Romberg’s Test Done?

The Romberg’s test can be carried out as follows:

  • Step 1: The patient is asked to remove his footwear and stand upright with feet together. He or she is asked to keep his arms next to his body or hold them crossed in front of his body.
  • Step 2: The patient is then asked to keep his eyes open and subsequently asked to close his eyes and observed if he or she is able to maintain his balance. It advised that the physician or the observer should stand close to the patient as a safety measure and prevent any physical injury to the patient in case he falls. Once the patient closes his eye, he or she should not get distracted by light, sound or other senses as this can give false positive outcome.
  • Step 3: The scoring is done based on the number of seconds the patients is able to stand with his or her eyes closed without losing balance.

In some cases, the physician may use perturbation to distract the patient; however, this should be done with caution and without exaggeration.

The Romberg test is considered to be positive when the subject is unable to stand for long with eyes closed as demonstrated by losing of balance leading to swaying of the body and placement of one foot in direction of fall or complete fall of the patient.

What Does It Mean If You Have A Positive Or Negative Romberg Test?

  • Positive Romberg’s Test: It is characterised by failure to keep eyes shut with loss of balance leading to moving feet apart and patient fall. It may be characterized by ability to stand upright with eyes open and minimal swaying. When Romberg test is positive, it indicates ataxia due to dorsal column disease and impaired proprioception.
  • Negative Romberg’s Test result: It is characterised by minimal swaying. A negative Romberg’s test indicates that the person does not have ataxia and the proprioception is normal.

What Can Cause Positive Romberg’s Test Results?

The Romberg’s test can be positive under 2 circumstances: genuinely positive i.e., when the person has ataxia and false positive report. The reason for the occurrence of positive report under both situations is described below:

Causes of Positive Romberg’s Test Result

  • Inherited Causes for Positive Romberg Test:
    • Autosomal dominant sensory neuropathy with scoliosis and deafness
    • Autosomal dominant sensory ataxic neuropathy
    • Posterior column ataxia and retinitis pigmentosa
    • Friedrich’s ataxia
    • Autosomal dominant posterior column ataxia
    • Cerebellar atrophy of late onset
    • Ataxia associated with progressive external ophthalmoplegia
    • Biemond syndrome (posterior column ataxia)
  • Metabolic and Toxic Causes for Positive Romberg Test:
    • Vitamin E deficiency
    • Thiamine deficiency
    • Pyridoxine excess
    • Vitamin B12 deficiency – subacute combined degeneration of the cord (SACD)
    • Drugs – Taxol, Cisplatin, semi synthetic penicillin
  • Immunological and Other Causes of Positive Romberg Test:
  • Causes of False Positive Romberg’s Test:
    • Hysteria
    • Labyrinthine disease

Conclusion

Romberg’s test is a simple diagnostic test which is sensitive in nature and used to pinpoint to sensory ataxia in a patient with balance and postural issues. It is indicated in patients with imbalance, dizziness, and falls.

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