Romberg's Test for Myelopathy

Video Description

The Romberg test is a test of the body's sense of positioning (proprioception), which requires healthy functioning of the dorsal columns of the spinal cord. A positive Romberg test suggests that the ataxia is sensory in nature, that is, depending on loss of proprioception.

The exam is based on the premise that a person requires at least two of the three following senses to maintain balanced while standing: 1) Proprioception (the ability to know one's body in space); Vestibular function (the ability to know one's head position in space); and 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.

The essential features of the test are as follows:
1. The subject stands with feet together, eyes open and hands by the sides.
2. The subject closes the eyes while the examiner observes for a full minute.
3. Romberg's test is positive if the patient sways or falls while the patient's eyes are closed.

Romberg's test is positive in conditions causing sensory ataxia such as:
1. Conditions affecting the dorsal columns of the spinal cord, such as tabes dorsalis (neurosyphilis) and cervical myelopathy.
2. Conditions affecting the sensory nerves (sensory peripheral neuropathies), such as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).
3. Friedreich's AtaxiaKhasnis A, Gokula RM. Romberg's test. J Postgrad Med. 2003 Apr-Jun;49(2):169-72. Review. PubMed PMID: 12867698. Level of Evidence: 5 - Other.
PMID: 12867698 (Link to Abstract)