Clinical Romberg Testing Does Not Detect Vestibular Disease

Longridge, N S; Mallinson, Arthur I.

doi:10.1097/mao.0b013e3181e3deb2

Cited by 29 publications

(26 citation statements)

References 8 publications

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“…Therefore the clinician should use this test with caution, and perhaps only as an adjunct to other tests. Thus we agree with Longridge and Mallinson [15] that tandem walking with eyes closed is not useful in screening patients for vestibular disease, when the dependent measure is the number of steps taken. Despite it’s long history, high reliability, and widespread use this test is so challenging for some normals or so easy for some known patients that it does not differentiate normals from patient groups.…”

Section: Discussionsupporting

confidence: 91%

“…Although TW is widely used, Longridge and Mallinson recently reported that less than 30% of patients or normals could perform 5 steps of tandem walking with eyes closed [15]. Kammerlind et al [13] tested TW for 15 steps with eyes open and showed that patients as well as normals could perform a mean of 13 consecutive steps, but they did not test the eyes closed condition.…”

Section: Introductionmentioning

confidence: 99%

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Tests of walking balance for screening vestibular disorders1

Cohen

Mulavara

Peters

et al. 2012

VES

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Few reliable tests are available for screening people rapidly for vestibular disorders although such tests would be useful for a variety of testing situations. Balance testing is widely performed but of unknown value for screening. The goal of this study was to determine the value of tests of walking balance for screening people with vestibular impairments. We tested three groups of patients with known vestibular impairments: benign paroxysmal positional vertigo, unilateral vestibular weakness, and post-acoustic neuroma resection. We compared them to normal subjects. All subjects were independently ambulatory without gait aids. Subjects were tested on tandem walking (TW) with eyes open and eyes closed for 10 steps, walking with no additional head motions and with augmented head rotations in yaw for 7 m (WwHT), and an obstacle avoidance task, the Functional Mobility Test (FMT). Subjects wore a 3-D motion sensor centered at mid-torso to capture kinematic measures. Patients and normals differed significantly on some behavioral measures, such as the number of steps to perform TW, and on some but not all kinematic measures. ROC analyses, however, were at best only moderate, and failed to find strong differences and cut-points that would differentiate the groups. These findings suggest that although patients and normals differ in performance of these tests in some interesting ways the groups are not sufficiently different on these tests for easy use as screening tests to differentiate the populations.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Tests of walking balance for screening vestibular disorders1

Cohen

Mulavara

Peters

et al. 2012

VES

View full text Add to dashboard Cite

show abstract

“…(11) Longridge and Mallinson recently reported that less than 30% of patients with vestibular disorders or normals could perform 5 steps of tandem walking with eyes closed. (13) Patients with vestibular impairments have impaired performance compared to normals. (14) Performance on several variations of TW declines slightly with age.…”

Section: Introductionmentioning

confidence: 99%

Sharpening the Tandem Walking Test for Screening Peripheral Neuropathy

Cohen¹,

Mulavara²,

Peters³

et al. 2013

Southern Medical Journal

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Objective Few tests of functional motor behavior are useful for rapidly screening people for lower extremity peripheral neuropathy. The goal of this study was to improve the widely used Tandem Walking test (TW). Methods We tested adult normals and ambulatory peripheral neuropathy patients (PN) with eyes open and eyes closed, while they performed TW on industrial carpeting, in sock-covered feet. Each subject wore a torso-mounted inertial motion unit to measure kinematic data. PN subjects’ data were also compared to historical data on patients with vestibular impairments (VI). Results The normal and PN groups differed significantly on TW on the number of steps completed. PN and VI data also differed significantly on both visual conditions. Kinematic data showed that PN patients were more unstable than normals. For the number of steps taken during the eyes open condition receiver operating characteristic (ROC) values were only 0.81. For the number of steps taken during the eyes closed condition, however, ROC=0.88. Although not optimal, this ROC value is better. Sensitivity and specificity at a cut-off of 2 steps were 0.81 and 0.92, respectively, and at a cut-off of 3 steps was 0.86 and 0.75, respectively. ROC values for kinematic data were all < 0.8 and, when combined with the ROC value for the number of steps, the total ROC value did not improve appreciably. Conclusions Although not ideal for screening patients who may have peripheral neuropathy, counting the number of steps during TW is a quick and useful clinical test. TW is most sensitive to peripheral neuropathy patients when they are tested with eyes closed.

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“…Previously, postural stability in healthy young subjects was assessed by using only eyes open, eyes closed, or sway-referenced vision. Such conditions have been too easy, so the upper limit of stability was never reached (6). With the visual perturbation, we have a full range of perturbation from absolute stability to fall in perfectly healthy young subjects.…”

Section: Introductionmentioning

confidence: 99%

Balance in Virtual Reality: Effect of Age and Bilateral Vestibular Loss

et al. 2017

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BackgroundQuantitative balance measurement is used in clinical practice to prevent falls. The conditions of the test were limited to eyes open, eyes closed, and sway-referenced vision. We developed a new visual perturbation to challenge balance using virtual reality (VR), measuring postural stability by a Wii Balance Board (WBB).MethodsIn this study, we recorded balance performance of 116 healthy subjects and of 10 bilateral vestibular loss patients using VR to assess the effect of age and the effect of total loss of vestibular function. We used several conditions: eyes open (normal visual inputs), eyes closed (no visual inputs), stable visual world (vision referenced), and perturbed visual world (visual perturbation) at different amplitudes of perturbation. Balance under these visual conditions was assessed on the WBB (stable support surface) and on the WBB plus foam rubber (unstable support surface).ResultsIn healthy subjects, we found that the percentage of falls increased with age and with the amplitude of perturbation for both conditions: WBB or WBB + foam. Moreover, we can define a threshold for falls in each age group as the amplitude of perturbation which induced falls. For bilateral vestibular loss patients, on the WBB + foam, all of them failed with eyes closed and with perturbed visual world even at the minimal amplitude of perturbation. Finally, we observed that stable visual world induced fewer falls than eyes closed whatever the subject’s group (healthy or bilateral vestibular loss) and whatever the age decade.ConclusionVR allowed us to develop a useful new tool with a wide range of visual perturbations. Rather than only two levels of visual condition (eyes open and eyes closed), the VR stimulus can be continuously adjusted to produce a visual perturbation powerful enough to induce falls even in young healthy subjects and which has allowed us to determine a threshold for falls.

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Clinical Romberg Testing Does Not Detect Vestibular Disease

Abstract: The tandem Romberg and tandem walking tests, despite being in widespread clinical use as office screening tests, may not be effective at determining the presence of newly developed vestibular disease.

Cited by 29 publications

References 8 publications

Tests of walking balance for screening vestibular disorders1

Tests of walking balance for screening vestibular disorders1

Sharpening the Tandem Walking Test for Screening Peripheral Neuropathy

Balance in Virtual Reality: Effect of Age and Bilateral Vestibular Loss

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