Department of Neurology, University of Athens, Eginition Hospital, Athens, Greece.
Department of Neurology, University of Athens, Eginition Hospital, Athens, Greece.
Neurophysiol Clin. 2024 Sep;54(5):102999. doi: 10.1016/j.neucli.2024.102999. Epub 2024 Jul 23.
The Romberg test, undoubtedly a classical and well-established method in physical neurological assessment of patients with sensory ataxia, has long been suspected to be prone to several limitations. Here, we quantified upright stance before and after visual deprivation in a selected cohort of patients with pure sensory neuropathy.
Static balance was assessed in sensory neuropathy patients during quiet stance on a force platform under different visual and proprioceptive feedback conditions. Sural nerve neurography was employed to evaluate the severity of peripheral neuropathy. Conventional and advanced postural sway metrics were investigated to draw a quantitative analogy to the clinical Romberg test.
Posturographic analyses showed that patients displayed Romberg and vestibular Romberg quotient values around 2, indicating an approximately twofold increase in body sway in the absence of vision. However, the diagnostic discrimination ability between patients and controls was only modest. Even less impactful were the diagnostic contributions of frequency domain and non-linear sway analyses. This was primarily attributed to the heightened body sway exhibited by patients with sensory neuropathy under 'eyes open' conditions, diminishing the contrast with the 'eyes closed' condition as assessed in the classical Romberg test.
We conclude that the Romberg test, even in its quantitative form with the aid of an apparatus, had an unsatisfactory classification value in terms of distinguishing patients from healthy controls. Instead, it should be interpreted within the comprehensive context of the broader neurological examination and the electrodiagnosis of peripheral nerve function.
Romberg 测试无疑是一种经典且成熟的感觉性共济失调患者物理神经评估方法，但长期以来一直被怀疑存在多种局限性。在这里，我们对一组单纯感觉性神经病患者进行了视觉剥夺前后的直立姿势测试。
在感觉神经病患者静息站立于力台上时，采用不同的视觉和本体感觉反馈条件，评估其静态平衡。通过对腓肠神经神经传导速度测定来评估周围神经病的严重程度。研究了常规和先进的姿势摆动指标，以对临床 Romberg 测试进行定量类比。
动态姿势分析显示，患者在无视觉时的 Romberg 和前庭 Romberg 商值约为 2，表明身体摆动增加了近两倍。但是，患者与对照组之间的诊断区分能力仅适中。频域和非线性摆动分析的诊断贡献更小。这主要是由于感觉性神经病患者在“睁眼”条件下表现出更高的身体摆动，从而降低了与经典 Romberg 测试中“闭眼”条件的对比度。
我们得出结论，即使 Romberg 测试采用仪器进行定量形式，在区分患者与健康对照组方面的分类价值也不尽如人意。相反，它应该在更广泛的神经系统检查和周围神经功能的电诊断的综合背景下进行解释。
