A positive Romberg’s sign refers to a patient’s inability to maintain balance when standing erect with his feet together and his eyes closed. Normally (a negative Romberg’s sign) the patient should be able to stand with his feet together and his eyes closed with minimal swaying for about 20 seconds.
If positive, Romberg’s sign indicates a vestibular or proprioceptive disorder, or a disorder of the spinal tracts (the posterior columns) that carry proprioceptive information—the perception of one’s position in space, of joint movements, and of pressure sensations—to the brain. Insufficient vestibular or proprioceptive information causes an inability to execute precise movements and maintain balance without visual cues. Difficulty performing this maneuver with eyes open or closed may indicate a cerebellar disorder.
Once you’ve detected a positive Romberg’s sign, perform other neurologic screening tests. A positive Romberg’s sign only indicates the presence of a defect; it doesn’t pinpoint its cause or location. First, test proprioception. If the patient can’t maintain his balance with his eyes open, ask him to hop on one foot and then on the other. Next, ask him to do a knee bend and to walk a straight line, placing heel to toe. Lastly, ask him to walk a short distance so you can evaluate his gait.
Test the patient’s awareness of body part position by changing the position of one of his fingers, or any other joint, while his eyes are closed. Ask him to describe the change you’ve made.
Next, test the patient’s direction of movement. Ask him to close his eyes and to touch his nose with the index finger of one hand and then with the other. Ask him to repeat this movement several times, gradually increasing his speed. Then test the accuracy of his movement by having him rapidly touch each finger of one hand to the thumb. Next, test sensation in all dermatomes, using a pin to assess sharp/dull differentiation. Also test two-point discrimination by touching two pins (one in each hand) to his skin simultaneously. Does he feel one or two pinpricks? Finally, test and characterize the patient’s deep tendon reflexes (DTRs).
To test the patient’s vibratory sense, ask him to close his eyes; then apply a mildly vibrating tuning fork to a bony prominence such as the medial malleolus. If the patient doesn’t feel the stimulus initially, increase the vibration, and then test the knee or hip. This procedure can also be done to test the fingers, the elbow, and the shoulder.
Record and compare all test results. Ask the patient if he has noticed sensory changes, such as numbness and tingling in his limbs. If so, when did these changes begin?
Early features may include vision changes, diplopia, and paresthesia. Other findings include a positive Romberg’s sign, nystagmus, constipation, muscle weakness and spasticity, and hyperreflexia. The patient may also have dysphagia, dysarthria, incontinence, urinary frequency and urgency, impotence, and emotional instability.
Besides a positive Romberg’s sign, advanced disease may produce impotence, fatigue, and paresthesia, hyperesthesia, or anesthesia in the hands and feet. Related findings include incoordination, ataxia, burning pain in the affected area, progressive muscle weakness and atrophy, and loss of vibration sense. DTRs may be hypoactive.
A positive Romberg’s sign and loss of proprioception in the lower limbs reflect peripheral nerve and spinal cord damage. Gait changes (usually ataxia), muscle weakness, impaired coordination, paresthesia, and sensory loss may be present. DTRs may be hypoactive or hyperactive. Other findings include a sore tongue, a positive Babinski’s reflex, fatigue, blurred vision, diplopia, and light-headedness.
With this disorder, a positive Romberg’s sign accompanies decreased visual acuity, fatigue, paresthesia, loss of vibration sense, incoordination, ataxic gait, and muscle weakness and atrophy. DTRs may be hypoactive.
A positive Romberg’s sign may accompany pain, fasciculations, muscle weakness and atrophy, loss of sphincter tone, and loss of proprioception, vibration, and other senses. DTRs may be hypoactive at the level of the lesion and hyperactive above it.
A positive Romberg’s sign may occur, but burning extremity pain is this disorder’s classic symptom. Other findings include a wide-based ataxic gait, loss of proprioception in the lower limbs (common), and loss of pain and temperature sensation. As the disease progresses, DTRs in the legs become hypoactive or absent, muscle tone decreases, and muscles atrophy. The patient may also develop Charcot’s joints and Argyll Robertson pupils.
Besides a positive Romberg’s sign, these disorders commonly cause vertigo. Nystagmus, nausea, and vomiting may also occur.
Help the patient with ambulation, especially in poorly lit areas. Also, keep a night-light on in his room, and raise the side rails of the bed. Encourage him to ask for assistance and to use visual cues to maintain his balance. Instruct him in the use of assistive devices if necessary.
Romberg’s sign can’t be tested in children until they can stand without support and follow commands. However, a positive sign in children commonly results from spinal cord disease.
Review other book chapters online related to Parry Romberg Syndrome:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
|
More About This Book:
Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9 
|
|
What do you think about the features of this website? Take our user survey and have your say:
Next articles:
Tools & Services:
Medical Articles:
Search Specialists by State and City
By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.
Copyright © 2009 Health Grades Inc. All rights reserved.
