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Evaluation of Balance
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
The Romberg test, originally described for patients with tabes dorsalis, is positive in patients with dorsal column or severe afferent polyneuropathy. A positive Romberg means that the patient shows a tendency to actually fall, unlike normal subjects and almost all patients with balance problems who show a small to moderate increase in body sway on eye closure. Only in the acute phase of a peripheral vestibular disorder will the Romberg test be positive, usually with an ipsilesional fall. In a patient with either cerebellar degeneration or polyneuropathy, a high level of unsteadiness on eye closure may indicate the presence of additional bilateral vestibular failure.9 This syndrome has been named CANVAS (cerebellar atrophy, neuropathy, vestibular arreflexia syndrome).66 Patients with anterior lobe cerebellar degeneration may show the characteristic trunk oscillation or titubation only on eye closure; when mild, this may just be visible as a tremor of the ankle extensors (‘dancing tendons’). On a practical note, anyone who can stand on either foot unaided, with eyes closed, is unlikely to have any objective and organic postural balance problem.
Discussions (D)
Published in Terence R. Anthoney, Neuroanatomy and the Neurologic Exam, 2017
Most authors of recent textbooks in clinical neuroscience describe the Romberg test as follows. The patient is asked to stand with feet together (and eyes open); then, after her/his balance has been noted by the examiner, s/he is asked to close her/his eyes and balance is again noted (e.g., Barr, p. 54; G&M, p. 11; S&M, p. 71; VanA&R, p. 8–9; Bann, p. 123). Usually, the position of the arms is not described, nor is the presence or absence of footwear. I assume that the arms are usually hanging down freely at the sides; and the one relevant figure noted shows them in that position (VanA&R, p. 9 [Fig. 3]). Thornas and Dale note, however, that “Some examiners prefer to have the patient extend the arms” (1981, p. 120). I assume that they mean extend forward horizontally, but that is not specified.
Neurological Examination
Published in Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner, The Integrated Nervous System, 2017
Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner
The accepted test for balance is called the Romberg Test. The patient is asked to stand with feet together and told to look at a distant point. If able to accomplish this without beginning to lose his or her balance, the patient is then asked to close his or her eyes and balance is reassessed. The examiner should stand nearby and be prepared to assist should the person begin to fall.
Vestibulospinal system findings caused by ageing between 40 and 55 years
Published in Hearing, Balance and Communication, 2022
Ozlem Konukseven, Sema Satici, Inci Adali, Yagmur Yildiz, Lena Dogru, Sencan Duruoglu
The mCTSIB test is a simplified derivative of SOT, a sensory organization test performed with a Computed Dynamic Posturography device. It provides objective evidence for a sensory balance problem. In the mCTSIB test, no difference was observed between the groups on the firm and foam surface with the eyes open, while significant weakness was obtained in both conditions with the eyes closed in 40–55 ages. It was observed that the swingings of the study group increased when the eyes were closed compared to the control group. Similar to the Tandem Romberg test, in this test, when the surface is changed and the eyes are open/closed, the vestibular system is more active while maintaining balance. Therefore, it is inevitable that we will see age-related effects in this test battery. In the study of Garcia using SOT and LOS on 70 individuals with an average age of 45, it was observed that the average in SOT decreased as the age increased [19]. In the evaluation made by Choy using mCTSIB on women in the 20–80 age group, it was shown that the increase in oscillation on foam ground with eyes closed started from the age of 50 s [16].
Sex differences and normative data for the m-CTSIB and sensory integration on baseline concussion assessment in collegiate athletes
Published in Brain Injury, 2020
Ryan N. Moran, Jeff Meek, Jeff Allen, James Robinson
Another test that has received attention regarding balance assessment is the Romberg Test, which measures balance when individuals experience reduced visual sensory input (1). Test administration consists of having a subject maintain balance in a feet together or heel-to-toe position with eyes open and closed, with a positive test being scored if the individual begins to sway involuntarily during the reduced vision condition (1). While the BESS and Romberg tests are commonly cited in the literature, limitations exist with the scoring of the tests, as they are completely reliant on subjective interpretations of each position that is tested, rather than objective data that can be compared to an established baseline (1).
Symptom profiles and postural control after concussion in female artistic athletes
Published in Brain Injury, 2020
Emily A. Sweeney, Julie C. Wilson, Morgan N. Potter, Katherine S. Dahab, Keri L. Denay, David R. Howell
All athletes also completed a clinical postural control protocol consisting of the BESS, tandem gait, and Romberg tests (31–34). The BESS test consists of the athlete standing for 20 seconds in three different stances (double leg, single leg, tandem) on two different surfaces (firm ground and foam) with their eyes closed and hands on hips. They were instructed by the clinician to remain in each position, and the primary outcome variable was the number of errors committed in each condition. During the tandem gait test, athletes walked along a straight line in an alternating heel-to-toe manner in a forward direction down and back along the pathway, as quickly and accurately as possible. The primary outcome variable from the tandem gait test was dichotomous: normal or abnormal. A normal test was identified by being able to walk without significant loss of balance and to maintain heel/toe contact throughout the test. In addition, excessive upper body movement was identified as an abnormal test, as this may indicate exaggeration and symptom feigning. Finally, the Romberg test consisted of asking the athletes to stand with their hands at their sides or across their chests, eyes closed, and feet together so that their malleoli touched. The primary outcome variable was dichotomous (normal vs. abnormal). A normal Romberg test was defined as the athlete being able to hold still without significant loss of balance (opening eyes, lifting foot, falling out of position). An abnormal test was defined as a loss of balance or increased body movement during the test. As with the tandem gait, increased upper body movement while the feet remained still was classified as an abnormal test. The BESS was administered by a certified athletic trainer in clinic, while the tandem gait and Romberg were administered by the diagnosing physician.