During each visit with the neurologist, I get to go through the steps of testing balance and gait. The term gait refers to how you walk. It’s fun getting to show off my abilities on any given day. However, there is one particular neurological test which always gives me a chuckle. It is the Romberg Test.
"What is the Romberg Test?"
The Romberg Test is a neurological test which detects poor balance because of deficits in proprioception. The test involves standing with your feet together and closing your eyes. The doctor will observe how you are able to maintain your balance and an upright posture. The doctor may even push you slightly to see whether you are able to compensate and maintain an upright posture.
The very first time I underwent this testing, I thought that my neurologist had shoved me in the middle of the back. He quickly told me to open my eyes. My mother, who had come with me to the visit, told me later that he had caught me as I was quickly falling backwards. I had no idea. I had demonstrated a positive Romberg sign.
During the past couple of years, I don’t even need to close my eyes when I’m standing with my feet together before I begin to sway and wobble. I can’t feel my feet which makes feeling their positioning more difficult. As a result, I hardly ever stand with my feet together and I definitely don’t close my eyes in the shower. My physical therapist even has a nifty testing device which can map the amount of swaying I do under different circumstances.
"What is proprioception?"
Proprioception is the sense of knowing where your body and joints are positioned in space. Proprioception sensory receptors are located in the muscle, joints, and skin. Lesions along the dorsal columns of the spinal cord leading to the cerebellum, especially through the cervical area, can impair proprioception giving rise to sensory ataxia and a positive Romberg sign. Sensory ataxia (loss of proprioception from the feet) can cause the “sink sign” which is when the patient begins to fall forward immediately upon closing his/her eyes.
"What does a positive Romberg sign indicate?"
It should be noted that some people without any neurological or balance problems may have some problems maintaining a steady posture. In their case, the swaying is normal and means nothing in particular.
In addition to sensory ataxia and proprioception dysfunction, a positive Romberg sign can indicate problems with the balance organs in the inner ear or sensory feedback. These may include vertigo or vestibular ataxia which can be caused by problems in the inner ear itself, problems in the 8th cranial nerve, or lesions in the Pons region of the brainstem where the 8th cranial nerve connects.
I found contradictory information as to whether a positive Romberg test can indicate cerebellar ataxia. According to the Multiple Sclerosis Encyclopedia online, the cerebellum is responsible for assimilating sensory data, such as limb position and visual cues, and coordinating movements based on sensory input.
"Does a positive Romberg Test mean that I have MS?"
No. The Romberg Test is a non-specific test of neurological dysfunction or inner ear dysfunction which does not indicate a specific condition. However, problems including vertigo, vestibular and cerebellar ataxia, and proprioceptive dysfunction are commonly seen in patients with multiple sclerosis.
"Can the Romberg sign change over time?"
Yes. Your response to the test may vary depending upon what’s going on with your MS at the time. When I’m having a relapse or having a ‘bad day’, I have more difficulty controlling the swaying especially since I can’t feel my feet.
View a video of a patient who is able to successfully pass the Romberg Test.
"What is the dynamic Romberg Test?"
Tandem walking, or heel-toe walking, is known as the dynamic Romberg Test. Tandem walking involves walking along a straight line placing one foot directly in front of the other, heel to toe. Some might call this the “drunken walk” test. In both cerebellar and sensory ataxic disorders, the ability to tandem walk is impaired. A patient may not realize that they compensate for this impairment by walking with their legs farther apart.
Romberg Test on mult-sclerosis.org
Romberg Test on neuroexam.com
AJ.Larner. A Dictionary of Neurological Signs. Second Edition. Springer 2006
© 2006, 2001 Springer Science+Business Media, Inc.