Abstract
As a retired neurologist, I read with great interest Michael O’Brien’s paper on the use and abuse of physical signs in neurology. 1 I agree entirely with his emphasis on the history as the most important part of a neurological assessment; however, I felt I must write a short note in defence of an old stalwart, Romberg’s test.
I have always emphasised over the years, particularly to students, the need to accumulate information about the patient before the formal examination. This includes such things as their behaviour in the waiting room and office, whether they were accompanied on their visit or not, their general appearance and their mobility around the office, including a good walk up and down the hall fully clothed, with modifications as needed such as heel-toe walking, standing on one or other leg, walking backwards and Romberg’s test. It is my experience that many patients with a disorder of proprioception are unaware that their balance is worse with the eyes closed. They take a bath not a shower, they do not go out at night and they sleep with some form of night light.
This component of the overall evaluation I think helps in our ability to hopefully have a fairly firm diagnosis, or at worst, a small list of alternative diagnoses, before proceeding to the formal neurological examination, which can include, as needed, more sophisticated testing of the sensory nervous system.
I would urge that we keep Romberg’s test as part of our clinical repertoire.