European Spine Journal

, Volume 18, Issue 10, pp 1528–1531

Does walking change the Romberg sign?

  • Gordon F. G. Findlay
  • Birender Balain
  • Jayesh M. Trivedi
  • David C. Jaffray
Original Article

Abstract

The Romberg sign helps demonstrate loss of postural control as a result of severely compromised proprioception. There is still no standard approach to applying the Romberg test in clinical neurology and the criteria for and interpretation of an abnormal result continue to be debated. The value of this sign and its adaptation when walking was evaluated. Detailed clinical examination of 50 consecutive patients of cervical myelopathy was performed prospectively. For the walking Romberg sign, patients were asked to walk 5 m with their eyes open. This was repeated with their eyes closed. Swaying, feeling of instability or inability to complete the walk with eyes closed was interpreted as a positive walking Romberg sign. This test was compared to common clinical signs to evaluate its relevance. Whilst the Hoffman’s reflex (79%) was the most prevalent sign seen, the walking Romberg sign was actually present in 74.5% of the cases. The traditional Romberg test was positive in 17 cases and 16 of these had the walking Romberg positive as well. Another 21 patients had a positive walking Romberg test. Though not statistically significant, the mean 30 m walking times were slower in patients with traditional Romberg test than in those with positive walking Romberg test and fastest in those with neither of these tests positive. The combination of either Hoffman’s reflex and/or walking Romberg was positive in 96% of patients. The walking Romberg sign is more useful than the traditional Romberg test as it shows evidence of a proprioceptive gait deficit in significantly more patients with cervical myelopathy than is found on conventional neurological examination. The combination of Hoffman’s reflex and walking Romberg sign has a potential as useful screening tests to detect clinically significant cervical myelopathy.

Keywords

Romberg Myelopathy Hoffman’s reflex 

References

  1. 1.
    Bemhardt M, Hynes RA, Blume HW, White AAIII (1993) Current concepts review. Cervical spondylotic myelopathy. J Bone Joint Surg Am 75(1):119–128Google Scholar
  2. 2.
    Glaser JA, Curé JK, Bailey KL, Morrow DL (2001) Cervical spinal cord compression and the Hoffmann sign. Iowa Orthop J 21:49–52PubMedGoogle Scholar
  3. 3.
    Heffez DS, Ross RE, Shade-Zeldow Y, Kostas K, Shah S, Gottschalk R, Elias DA, Shepard A, Leurgans SE, Moore CG (2004) Clinical evidence for cervical myelopathy due to chiari malformation and spinal stenosis in a non randomised group of patients with the diagnosis of fibromyalgia. Eur Spine J 13(6):516–523. doi:10.1007/s00586-004-0672-x PubMedCrossRefGoogle Scholar
  4. 4.
    Lanska DJ (2000) 19th century contributions to the clinical assessment and mechanical recording of postural sway. Arch Neurol 58:1147–1150. doi:10.1001/archneur.58.7.1147 CrossRefGoogle Scholar
  5. 5.
    Lanska DJ, Goetz CG (2000) Romberg’s sign-development, adoption and adaptation in the 19th century. Neurology 55:1201–1206PubMedGoogle Scholar
  6. 6.
    Lanska DJ (2002) The Romberg sign and early instruments for measuring postural sway. Semin Neurol 22(4):409–418. doi:10.1055/s-2002-36763 PubMedCrossRefGoogle Scholar
  7. 7.
    Muybridge E (1979) Abnormal movements, males and females (nude and semi-nude). In: Muybridge E (ed) Muybridge’s complete human and animal locomotion, vol 2. Dover publications Inc, New York, pp 1081–1139Google Scholar
  8. 8.
    Ono K, Ebara S, Fuji T, Yonenobu K, Fujiwara K, Yamashita K (1987) Myelopathy hand-new clinical signs of cervical cord damage. J Bone Joint Surg Br 69(2):215–219PubMedGoogle Scholar
  9. 9.
    Rao R (2002) Neck pain, cervical radiculopathy and cervical myelopathy: Pathophysiology, natural history and clinical evaluation. J Bone Joint Surg Am 84-A:1872–1881PubMedGoogle Scholar
  10. 10.
    Rogers JH (1980) Romberg and his test. J Laryngol Otol 94:1401–1404PubMedGoogle Scholar
  11. 11.
    Shumway-Cook A, Horak FB (1986) Assessing the influence of sensory interaction on balance: suggestion from the field. Phys Ther 66:1548–1550PubMedGoogle Scholar
  12. 12.
    Singh A, Crockard HA (1999) Quantitative assessment of cervical spondylotic myelopathy by a simple walking test. Lancet 354(9176):370–373. doi:10.1016/S0140-6736(98)10199-X PubMedCrossRefGoogle Scholar
  13. 13.
    Sung RD, Wang JC (2001) Correlation between a positive Hoffmann’s reflex and cervical pathology in asymptomatic individuals. Spine 26(1):67–70. doi:10.1097/00007632-200101010-00013 PubMedCrossRefGoogle Scholar
  14. 14.
    Weber PC, Cass SP (1993) Clinical assessment of postural stability. Am J Otol 14(6):566–569PubMedGoogle Scholar
  15. 15.
    Wong TM, Leung HB, Wong WC (2004) Correlation between magnetic resonance imaging and radiographic measurement of cervical spine in cervical myelopathic patients. J Orthop Surg (Hong Kong) 12(2):239–242Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Gordon F. G. Findlay
    • 1
  • Birender Balain
    • 2
  • Jayesh M. Trivedi
    • 2
  • David C. Jaffray
    • 2
  1. 1.Walton Centre for Neurology and Neurosurgery NHS TrustLiverpoolUK
  2. 2.RJAH Orthopaedic Hospital NHS TrustOswestryUK

Personalised recommendations