How we wish to be cited:
Ekstedt J. Cerebellar and proprioceptive function. [debate]. Rondel 2001; 12. URL: http://www.rondellen.net

The Romberg test should be combined with another co-ordination test, the finger-nose test.

1. In the erect position, the patient stands with feet fitted together, heel beside heel and big toe beside big toe.
2. The patient points at his nose with his right index finger, then with his left index finger.
3. The patient repeats the procedure with eyes closed.

The finger-nose test, patient erect with closed eyes, evaluates the ability of the cerebellum to maintain balance and perform precise movements simultaneously.

A correct performance of the finger-nose test suggests that cerebellum is able to co-ordinate information from the semi-circular canals of the labyrinth with information from the proprioceptive receptors of muscles, tendons and joints. The ability to correct deviations from the erect position are also intact. The patient does not suffer from ataxia.

The patient who passes the finger-nose test with open eyes but not with closed eyes probably has problems with his proprioceptive signals to his cerebellum, not with cerebellum itself. The classical example of such an sensory ataxia is provided by tabes dorsalis, a late stage of syphilis. Sensory ataxia may be seen in multiple sclerosis and other myelopathias, e.g. due to cobalamin deficiency; the sign usually reflects a dysfunction of the dorsal tracts of the spinal cord.

It is possible to improve the Romberg test – erect position, feet together, closed eyes, finger-nose test, and turning the head to right and to left, repeatedly. The performance forces the cerebellum to co-ordinate changing information from the semi-circular canals and the muscle spindles.

Those who manage to perform the improved Romberg test have no fault in proprioceptive signal flow and cerebellar function. However, some healthy persons are not able to perform the improved test absolutely correct.

It is reasonable to assume that the proprioceptive flow from foot and ankle are essential for balance; a disturbance of the longest neurons is apt to be revealed by the Romberg test.

A common form of "improved Romberg test" is to set the feet in file, big toe to heel; the value of this maneuver is obscure.

It should be emphasized that testing of the vibratory sense in the distal joint of the big toe is valuable; the longer the nerve tracts, the earlier the signs of a polyneuropathy, e.g. in vitamin B12 deficiency(1).

Reference