Romberg test

Clinic

• Romberg's Test/ Sign/ Maneuver is a test for neurological function of balance.
• Normally a person requires at least two of the three following senses to maintain balance while standing:
  1. Proprioception (the ability to know one's body position in space);
  2. Vestibular function (the ability to know one's head position in space);
  3. 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 standing patient is asked to close their eyes. An increased loss of balance is interpreted as a positive Romberg's test.
• Proprioception requires healthy functioning of the dorsal columns of the spinal cord.
• 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.

Cerebellar ataxia

• Romberg's test is positive in conditions causing sensory ataxia
• Romberg's test is not a test of cerebellar function, as it is commonly misconstrued. Patients with severe cerebellar ataxia will generally be unable to balance even with their 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 receptors and pathways function.