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Romberg/Sharpened Romberg test

Author(s) of measurement tool: German neurologist Moritz Heinrich Romberg was thechief author of the Romberg test, however, Bernardus Brach, a German physician,

contributed greatly to the development of the Romberg test, but is highly under

recognized.

Purpose of tool: The purpose of the Romberg test is to examine whether a patient is

displaying symptoms of sensory ataxia. The test was designed to determine if the patienthad a proprioception deficit. The Romberg test was initially developed in the 19

thcentury

to test for the occurrence of tabes dorsalis, which was caused by the bacteria Treponemapallidum. Today, the test is used to detect myelopathies and sensory neuropathies

associated with sensory ataxia.1

Target population: The target population when the Romberg test was first developedand implemented was people with tabes dorsalis. People with tabes dorsalis displayed a

great loss of proprioception, but it was usually only detected when the lights were off orwhen they washed their face and covered their eyes.1Moritz Romberg designed a test

that would measure whether people displayed a positive sign in which they only lostproprioception when they could not see. This helped eliminate the diagnosis of muscle

weakness and correlated it directly to proprioception deficit. Today, the test is used todetermine whether the ataxia is related to cerebellar dysfunction or sensory dysfunction

typically in the elderly.

What it tests: The Romberg test tests for myelopathies and neuropathies associated withsensory dysfunction. If a patient displays a positive Romberg sign then the physician can

conclude that the ataxia is sensory related and not cerebellar related.

Psychometric characteristics: There was limited evidence available that detailed thereliability and validity of the Romberg test and the Sharpened Romberg test. However, in

a test-retest reliability study, consisting of 37 subjects, they were able to derive that theRomberg test performed with the eyes open had an Intraclass Correlation Coefficient

(ICC) of .86, and an ICC of .84 when eyes were closed. In addition the results showedand ICC of .70 when eyes were open during the Sharpened Romberg test, and an ICC of

.91 when the eyes were closed during the same test.2Resources were exhausted in

searching for measures of validity related to the Romberg and Sharpened Romberg tests.

Administration: The Romberg test is performed with the patient standing with their feet

together, with their eyes open and while looking at a fixed point straight ahead. Theymust try and maintain balance without swaying or falling over. If they pass this portion of

the test, they then close their eyes and perform the same test. If they do sway or fall thenthey have a positive Romberg test. In addition, there is now a Sharpened Romberg test

that is performed in a similar fashion as the Romberg test, but the patient is now standingheel-to-toe typically with the non-dominant foot in front. A positive Sharpened Romberg

test is displayed if the patient sways or falls while they have their eyes closed. There aresome variations to the test, but this is generally how it is administered.

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Time Required: The test can be performed in as little as one minute, but other trials may

be performed to confirm the initial findings, which can lengthen the duration of the timerequired.

Advantages: The main advantage of the Romberg test is that it is free to the physicianand provides a baseline for determining the cause of the dysfunction.

Limitations: The main limitation to the Romberg test is the limited studies available thatdefine its reliability and validity. The test has been used for many years, but the data

statistically showing its effectiveness is not readily available. Also, patients who performthe test during several trials may begin to adapt and perform better on each successive

trial. This could skew the results and provide an inconclusive result.

References:

1. Lanska DJ, Goetz CG. Romberg's sign: development, adoption, and adaptation in the

19th century.Neurology. 2000;55:1201-1206.2. Steffen T, Seney M. Test-retest reliability and minimal detectable change on balance

and ambulation tests, the 36-item short-form health survey, and the unified Parkinsondisease rating scale in people with Parkinsonism.Phys Ther. 2008;88:733-746.

Ordering/acquisition information: The Romberg test is free. The physician just needs

to be accurate when observing the feedback displayed by the patient.

Appraised by:Dario Callegari Date appraised: August 3, 2009