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A positive Romberg test suggests that ataxia is sensory in nature, i.e. depending on loss of proprioception. A negative Romberg test suggests that ataxia is cerebellar in nature, i.e. depending on localised cerebellar dysfunction instead.
It is sometimes used as an indicator for a possible drunk driving.
Additional recommended knowledge
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 themselves. 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 is unsteadier than with open eyes.
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, and only if, the following two conditions are both met:
The test is not positive if either:
Patients with a positive result are said to demonstrate Romberg's sign or Rombergism. They can also be described as Romberg's positive.
Maintaining balance while standing in the stationary position relies on intact sensory pathways, sensorimotor integration centres and motor pathways.
The main sensory inputs are:
Crucially, the brain can obtain sufficient information to maintain balance if either the visual or the proprioceptive inputs are intact.
The first stage of the test (standing with the eyes open), demonstrates that at least one of the two sensory pathways is intact, and that sensorimotor integration and the motor pathway are intact.
In the second stage, the visual pathway is removed by closing the eyes. If the proprioceptive pathway is intact, balance will be maintained. But if proprioception is defective, both of the sensory inputs will be absent and the patient will sway then fall.
Romberg's test is positive in conditions causing sensory ataxia such as:
Romberg and cerebellar function
Romberg's test is not a test of cerebellar 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 receptors and pathways function.
The test was named after the German neurologist Moritz Heinrich Romberg (1795-1873), who also gave his name to Parry-Romberg syndrome.
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Romberg's_test". A list of authors is available in Wikipedia.|