Dizziness In Orthopaedic Physical Therapy Practice: History And Physical Examination Page 16
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30leg stance test (especially with eyes closed) precludes
as compared to the Romberg test. The ataxic patient
further vestibulospinal testing.
will prefer to stand with a wider base of support and
will show reluctance when asked to stand with the feet
Romberg and Sharpened Romberg
close together. Patients with sensory ataxia are usually
The Romberg test (Figure 1A) challenges balance
able to stand with the feet close together, as are some
by decreasing the base of support. Patients with sen-
patients with vestibular lesions. These patients will
sory or vestibular dysfunction may be able to stand in
compensate for the loss of somatosensory and labyrin-
a Romberg stance, but closing the eyes takes away the
thine input, respectively, with an increased reliance on
visual cues used to maintain balance, causing them to
visual input. The Romberg test has predictive validity
fall, i.e., have a positive Romberg sign
. Patients with
with regards to recurrent falls over a 6-month period in
10
a vestibular lesion tend to fall in the direction of the
patients with Parkinson’s disease: sensitivity was 65%
lesion
. Patients with cerebellar ataxia are unable to use
and specificity >90%
.
10
65
visual cues to compensate and are unable to maintain
Modifi ed Clinical Test of Sensory Integration of
their balance in a Romberg stance whether their eyes
Balance
are open or closed
. A sharpened Romberg (Figure 1B)
10
test involves standing with a decreased base of support
The modified Clinical Test of Sensory Integration of
Balance (CTSIB) assesses the contribution of the visual,
vestibular, and somatosensory systems to postural control.
The test has four components with the patient standing
on a level surface with the eyes open (Figure 2A), on a
level surface with eyes closed (Figure 2B), on foam with
the eyes open (Figure 2C), and on foam with eyes closed
(Figure 2D). Initially, a patient will have available all
sensory systems to maintain balance. The eyes-closed
condition will eliminate visual contribution, putting
increased demand on the somatosensory and vestibular
systems. Standing on a foam surface with eyes closed
alters the somatosensory input and eliminates visual
input; thus, the patient has to rely mostly on vestibular
input. Patients with vestibulopathy will have difficulty
maintaining an upright posture
. Platform posturography
64
is a computerized version of this test with >90% specific-
ity but very low sensitivity for the diagnosis of patients
with peripheral vestibular deficits
. Posturography in
66
combination with other vestibular function tests has
Fig. 1a-b:
Fig. 1a-b:
F
Romberg test-Sharpened Romberg test
been shown to increase sensitivity to 61-89%
.
66
Fig. 2a-d: Modified Clinical Test of Sensory Integration of Balance (CTSIB)
Dizziness in Orthopaedic Physical Therapy Practice:
History and Physical Examination / 237
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