The Romberg test is an essential diagnostic tool for assessing balance loss and ataxia. Let's examine its procedure and explore the appropriate steps to take based on positive or negative test results.
The Romberg test, also known as the Romberg manoeuver or Romberg's test, is a commonly used neurological test in otolaryngology and neurology. Its purpose is to diagnose conditions associated with balance and motor coordination problems, specifically ataxia. Symptoms such as dizziness, lightheadedness, and difficulty in coordinating movements and maintaining balance can indicate various diseases. These may include disorders affecting the vestibular apparatus (such as labyrinthitis, Ménière's disease, or benign paroxysmal positional vertigo) as well as conditions that impact the central nervous system, such as migraines, neuropathies, neoplasms, strokes, and cerebellar ataxias.
The Romberg test is a straightforward procedure that doesn't require any special preparation or equipment. It is typically conducted as part of a specialised neurological, ENT, or vestibular examination. During the test, the patient is instructed to stand with their feet together. They are asked to maintain this position for 30 seconds while keeping their eyes open. Following that, they are required to maintain the same posture for an additional 30 seconds, but this time with their eyes closed.
There are variations in how the test can be performed regarding the position of the arms. It can be done with the arms extended across the body, with the arms forming a right angle with the torso, or with the arms crossed over the chest, where the right hand rests on the left shoulder and the left hand on the right shoulder.
The ability to maintain balance, presence of oscillations, or any falls observed in both phases of the test (with eyes open and eyes closed) provide valuable information to the specialist conducting the examination. Oscillations while the eyes are open could indicate a cerebellar lesion, whereas oscillations with closed eyes could suggest a pathology related to the vestibular system.
It's important to note that slight oscillations observed during both phases of the test are normal and not indicative of pathology. However, false positives can occur, as instability during the test might be caused by anxiety-related disorders.
Cerebellar ataxia, characterised by an impaired ability to maintain balance and stability even with open eyes during the Romberg test, is attributed to a lesion in the cerebellum. This neurodegenerative condition can manifest in varying degrees of severity and not only affects stability and coordination of movements but also affect speech articulation, writing, and control of eye movements.
To further assess this condition, the index-nose test can be conducted. In this test, the patient extends their arm while standing and attempts to touch the tip of their nose with their index finger, where Ataxia will complicate this seemingly simple action. If there is suspicion of cerebellar ataxia, it is best to consult a neurological specialist to establish a definitive diagnosis and develop a comprehensive therapeutic and rehabilitation plan.
A positive result in the Romberg test indicates that the patient is unable to maintain balance when their eyes are closed. In such cases, the condition is commonly attributed to either a deficiency in proprioceptive sensitivity or dysfunction in the vestibular system.
However, in instances where the swings occur in all directions, the condition could suggest a deficit in proprioception. Conversely, if the patient consistently sways towards a particular direction, it indicates an imbalance related to the affected side in the vestibular system.
Based on the outcome, the otolaryngologist evaluates whether further investigations are necessary to determine the appropriate treatment.