ROMBERG (R) & SHARPENED ROMBERG (SR)

1 ROMBERG (R) & SHARPENED ROMBERG (SR) Test and Measures: Adult 2012 ROM Page 1 Do not copy without permission of Teresa Steffen ROMBERG (R) & SHARPENED ROMBERG (SR) [Note: SR is sometimes called AUGMENTED (MODIFIED) ROMBERG or TANDEM ROMBERG ] Type of test: The test is a measure of balance maintenance or equilibrium with a narrowed base of support Time to administer: A maximum of 3 trials per each test position (60 seconds per trial) Clinical Comments: The client should be closely supervised while doing the test to avoid falls. This test is nice to use because neurologists are familiar with it.

2 If a client reaches the ceiling on the Berg, the ROMBERG may help to distinguish balance problems. Purpose/population for which tool was developed: The original ROMBERG test was developed around 1851-3 and had subjects stand with feet close together. The examiner observed body sway with eyes open and closed. The SR came to be used clinically around 1944. 1 It is considered a more progressive posture requiring a higher skill level than the ROMBERG . 2 This test was introduced in 1853 by ROMBERG to demonstrate the effect of luetic posterior column disease upon human upright posture control.

3 The test has been used with some minor modification for the clinical assessment of patients with dysequilibrium or ataxia from both sensory and motor disorders. When appropriate to use: when individual has loss of vestibular function, cerebral ataxia, sensory ataxia and sensory neuropathy as in the case of unilateral or bilateral motor weakness, diseases of peripheral nerves, cerebellar disease and vertebrobasilar disease. The test has been used in aircrew, patients with disequilibrium and in divers with dysbaric illness and Scaling: When timed, these four tests use ratio scaling.

4 Equipment needed: Level surface Digital stop watch or watch with a second-hand Directions: Four maneuvers comprise these tests ROMBERG o 1) Feet together, eyes open, 60 sec (R-EO) o 2) Feet together, eyes closed, 60 sec. (R-EC) SHARPENED ROMBERG o 1) Feet heel-to-toe (dominant foot behind non-dominant foot), eyes open, 60 sec. (SR-EO) o 2) Feet heel-to-toe (dominant foot behind non-dominant foot), eyes closed, 60 sec. (SR-EC) Some studies have shortened the time to 30 seconds for testing, but this increases the ceiling effects. Three large studies used a limit of 10 seconds, rather than 60 seconds, on the Other studies allow participants to continue as long as they are It is best to use 60 The SR is performed in a heel-to-toe standing position with the dominant foot behind the non-dominant foot.

5 The dominant foot is determined by asking the person to kick an object. Timing is started after the person assumes the proper position. Timing is stopped if subjects move their feet from the proper position, if they open their eyes on eyes closed trials, or if they reach their maximum balance times of 60 seconds. Three trials are performed if the maximum balance time is not reached in either of the first two trials. The longest balance time should be recorded (NOT THE AVERAGE OF THE TRIALS)! Sometimes subjects are told to cross their arms so that the open palm falls across the opposite Other times subjects are able to move their , 8, 9 It is unclear whether subjects who need help to assume the position should be given it.

6 In our study we did not give assist. A study of 71 non-institutionalized women (60-86 years) found no difference with shoes-on and shoes-off Learning Effect: Diamantopoulos, (2003) 10 found no short-term learning effects in 24 subjects who practiced the tandem ROMBERG for a period of 10 days, 1 minute per day. There appears to be no learning effect past the second In people who were tested on 15 consecutive walking days (29 healthy subjects, mean age=33), there was a decrease in postural sway when holding the SR ROMBERG (R) & SHARPENED ROMBERG (SR) Test and Measures: Adult 2012 ROM Page 2 Do not copy without permission of Teresa Steffen Reliability: Reference N = Sample description Reliability statistic Intrarater reliability: same rater within one session (or one day) Black, 198213 132 Normal subjects.

7 There was no significant difference between two trials for standard ROMBERG test with eyes open but with eyes closed and both SHARPENED ROMBERG tests (eyes open and closed) there was significant second-trial improvement. Mean squared displacement data given. Franchignoni, 199814 45 Females, SR ICC(2,1) = .99 (EO & EC) Kammerlind, 200515 30 Unilateral Vestibular loss, SR ICC(2, 2) Eyes open = .63 Eyes closed = .76 20 Central neurological dysfunction, SR Eyes open = .75 Eyes closed = .97 Interrater Reliability Franchignoni, 199814 45 Females, 2 raters, SR Eyes open =.

8 90 Eyes closed = .76 Test-retest reliability: same rater over time ( , 1 week) Black, 198213 12 Normal subjects; The coefficient of variation (CV) of 12 subjects over 5 consecutive days, suggests a high degree of variability for all 4 tests. CV = 39 45% Hamilton, 198916 19 Volunteers aged 24-39; SR reliability for eyes open for Day 9 and Day 10 practice sessions comparisons r=.72 Kammerlind, 200515 30 Unilateral vestibular loss SR Eyes Closed ICC = .63 SR Eyes Open ICC = .76 20 Central neurological dysfunction SR Eyes Closed ICC = .75 SR Eyes Opened ICC =.

9 97 Construct / Concurrent Validity: It is difficult to always differentiate between these 2 types of validity. Evaluating this property requires a gold standard measure with which to compare the tests results. Such a gold standard is often not available. Population N = Support for Validity Volunteers with Simulator Sickness 19 The SR eyes open was related to subjective reports of balance Healthy Women 45 SR eyes open is correlated to SR eyes closed (.55), one-legged stance eyes open (.56), eyes closed (.45), functional reach (.45) and sit to stand time ( ).

10 Correlations of SR eyes closed: one-legged stance eyes open (.45), one leg stance eyes closed (.65), functional reach (.45) and sit to stand time ( ).14 110 SR eyes closed is significantly correlated to step width (rho= )8 Men 54 Men, age 60-90 years, who considered themselves active had significantly higher SR eyes-closed scores compared to those who rated themselves less active. SR scores are positively correlated with normalized torques of hip extensors and right hip abductors (.28 to .31)9 ROMBERG (R) & SHARPENED ROMBERG (SR) Test and Measures: Adult 2012 ROM Page 3 Do not copy without permission of Teresa Steffen People with vestibular & Nonvestibular dizziness & unsteadiness 214 Age 23-87 yrs (mean 54), 110 males, DHI correlated with SR EO ( ), SR EC ( ) & Rom w/Jendrassik Manuever(UEs clasped & abducted)( ) [Vereeck 2006].