Exploring Romberg Test: Diagnosis Cerebellum, Posterior Columns, and Vestibular Apparatus lesions!
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- čas přidán 8. 06. 2014
- Discover the Key to Neurological Diagnosis with the Romberg Test! Join Dr. Conwell in this informative video as he guides you through the step-by-step process of performing the Modified Romberg test. Gain invaluable insights into differentiating between CNS lesions of the Cerebellum, Posterior Columns, and Vestibular Apparatus of CN VIII (Vestibular System). Unlock the secrets to accurately identifying and diagnosing neurological conditions affecting equilibrium and balance. Enhance your diagnostic skills and unravel the mysteries of the Romberg Test today! Don't miss this compelling instructional video by Dr. Conwell, your ultimate resource for understanding and mastering neurological assessments. Subscribe now and embark on a journey to becoming an expert in CNS lesion differentiation!
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Disclaimer:
This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute the provision of healthcare services. The content provided in this video is for informational and educational purposes only.
Please consult with a physician or healthcare professional regarding any medical or mental health-related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.
Check out Dr. Conwell's textbook, THE CLINICAL PICTURE, which compliments and adds to the knowledge gleaned from this video program:
Amazon purchase link - www.amazon.com/dp/B01JTA8U2G
Textbook description - www.theclinicalpicture.com/te...
Dr. Conwell’s Website - www.theclinicalpicture.com/
THE CLINICAL PICTURE is a 350-page textbook that covers the essentials of a comprehensive neuromusculoskeletal examination (medical history & physical examination) and the required documentation (daily office chart note & narrative report). This text is a valuable complementary addition to this teaching video.
Scroll down to learn more about Dr. Conwell’s 60-minute instructional video programs…..
Video Program I - CENTRAL NERVOUS SYSTEM SCREENING EXAM
This full hour-long instructional video demonstrates how to perform a neurological examination to evaluate for a CNS lesion which includes screening for mental status, cognition, cerebral cortex, cerebellar function tests (gait, coordination, equilibrium), DDx Cerebellum vs Posterior Columns vs Vestibular apparatus lesion (Modified Romberg), cranial nerves (CN) & spinal cord tracts. This video also demonstrates the 75 seconds in-office cranial nerve exam.
Video Program II - PERIPHERAL NERVOUS SYSTEM SCREENING EXAM
This full hour-long instructional video demonstrates how to screen for a PNS lesion. The video covers in detail how to evaluate deep tendon reflexes (DTR’s), perform an upper and lower extremity sensory exam (dermatomes), perform an upper and lower extremity motor exam (Kendall & Kendall muscle grading scale), evaluate the brachial and lumbosacral plexus, and how to perform a “three-minute” PNS exam.
Click on the card to view...
Video Program III - SPINE & PARASPINAL MUSCULOSKELETAL SCREENING EXAM
This full hour-long instructional video demonstrates how to screen for a musculoskeletal lesion of the axial skeleton. The video covers in detail how to perform the visual inspection exam, palpation of the Cervical and Lumbar spine and associated paraspinal tissues, Range of Motion of the Cervical and Lumbar spine (active, passive, resistive maneuvers to DDx sprain v. strain), orthopedic testing (provocative maneuvers), peripheral vascular exam, and evaluating for non-organic physical signs.
if a Meniere's disease patient fell down on second part of the Romberg Test cuz of Vestibular cause, would it be called Postive Romberg Test or Negative? or do we call it Positive only in the cases of Cerebeller cause?
This is an excellent question Han. When performing the Modified Rhomberg test the protocol is to document which part (anatomical position) of the test produced a positive finding. A positive finding would then indicate further testing to R/O a lesion of the suspected organ of tissue. Remember, this test is a screening test which requires further more sensitive testing with a positive finding. Unless, the physician knowns from the patient's HX or previous DX why a certain part of this test was postive. I hope this is helpful. This would be a great question to ask during the neurology class.
@@DrTimothyConwell Thank you Dr Conwell. It is just that I am now preparing for MRCP part 2 exam and all the questions I have encountered stated only "Romberg Test Positive/Negative" It didn't mention which phase exactly. That makes it really confusing to calculate an answer , even more so if the question has very limited data. But according to Oxford Handbook 10th edition, Positive Romberg generally means Sensory Ataxia. So I guess the question neglected the phase 1 and 2 of the test and directly jumped to the last part of the Romberg test. On the other hand, this video is tremendously helpful when it comes to actual bedside scenarios!! Thank you doctor!!
@@haydenwu1149 Hello Han, Thank you for your kind comment. I am pleased that my teaching videos have been helpful to enhance your medical training. I wish you great success with the MRCP II exam.
Now with regards to Rhomberg test - in an exam setting, a question regarding Rhomberg, may I suggest your primary clinical algorithm should focus on the body's sense of positioning (proprioception), which requires healthy functioning of the dorsal columns of the spinal cord. As you clearly stated the "classical" Romberg test is used to investigate the cause of sensory ataxia. My video describes a "modified" version of Rhomberg which allows the examiner to be more specific in the exam process. Hopes this helps. DrC
I start to fall on all three of these test.
Good explaination and good reply to everyone....
i agree with both the below persons
Yes, it does check cerebellar functioning also it evaluates balance and coordination.
+Lesslee Habon Performing a careful neurological exam incorporating the modified Romberg exam will help the examiner in ruling out a lesion of the Posterior Columns, Vestibular Apparatus and provide incites into the function of the Cerebellum. Thank you for your erudite comment! Dr Conwell
I have a positive Romberg Test and i always Fall on the left side also i had a MRT of my Brain just some Medullary Lesions but my Doctor said its not because of them i think its the Vestibular System or can it be of Disc Prolaps with Myleopathie on the BWS because i have this also and Scoliosis also if i hear a Loud Sound my Arms getting Spasms first i had Spasms in my one eye on my neck and left arm and i was always falling on the left side at night its more worse i cant hold my Balance at night rly good but now i only have it on my left arm when i hear a loud sound or when i try to sleep right or left i feel Dizzy i dont understand whats the cause ? The said its not the ear or spinal cord ? For me it can be the Vestibular System but why does my left arm get spasm when i hear a loud Machine Sound ? It can be only a ear problem or spinal ?
Why checking the vest apparatus in head extension , why not to check vestibullar apparatus in straight looking of patient....
If we extend patient head we only check one semicircular canal and not all the three ....
Hello Dr Atif, your suggestion and comment is most interesting and triggers those erudite observers cause for a deeper dive into the neurophysiology. I look forward to reading the responces to your valid suggestion. Thank you for your addition to this video. DrC
how sensitive/specific is this? i tried the foam romberg test and the dynamic visual and the fast head movement visual ocular test and this (modified) romberg test. doesn't that rule out almost ALL kinds of vestibular/cerebellar balance issues? i have some weird light-headed feelings and feel slightly off balance (i usually have phenomenal balance, i was a wrestler thru highschool and i'm a trail/ultra runner). how can this be? how can i feel off balance and stlightly stumbly but pass all these tests? i woke up one morning a few weeks ago with pretty bad balance and experienced one significant instance of vertigo while brushing my teeth, but my balance slowly got better over the following few days and has continued to improve but slowly at this point.
that doesn't make sense to me since the hair cells in the inner ear do not regenerate AT ALL (at least type II ones, which have the most sensors in them, and type I cells seem to have limited regeneration capacity) in mammals.
is it possible i had significant hair cell damage, but they were able to repair/recover?
i sometimes feel pain/pressure in my left ear ONLY, so could it be maybe that only one side is dysfunctional and the other side is perfect and my body has already adapted to only use the right side vestibular system to balance? (also i may have a good deal of balance-related reserve because of my history as an athlete.)
I also have no hearing loss and little to no tinnitus (i have had problems with small bits of tinnitus here and there for many years, it's really not even a big deal and seems to be associated with stress/anxiety)
how is this possible? wouldn't i fail some of these tests? i mean i don't fall or anything but i don't feel very sure-footed like i used to. none of this makes sense. i expected to fail a bunch of these tests but i passed just fine. i even saw a website that showed some examples of ppl that failed the tests (vestibular loss due to gentamicin ototoxicity) and i didnt even fail like the moderate ppl did. i don't feel all that steady on the foam block with my eyes shut but i don't really sway too much or fall over either, but... it's not easy for sure. i have to concentrate. i would assume standing perfectly straight on a thick pad with ur feet together isn't exactly supposed to be easy, even if u have perfect balance.
this is so confusing i have been reading peer reviewed data for days and i can't figure it out. i took aspirin and amoxicillin (which can cause BVH) so it would make sense for that to be the cause. but why can i pass these tests? i'm so lost. I was thinking viral neuritis from a cold? i woke up one day feeling way "off" and had severe conjunctivitis, but not many other signs.
Hello, there is a lot to unpack here. My response unfortunately will not be satisfactory I am afraid. I read your comment numerous times to see if I would be able to assist you with this complex case presentation. However, my channel is not able to provide medical advice or render a diagnostic opinion, or recommend treatment. My channel solely provides health care students and young health care providers with instructional videos designed to enhance their clinical acumen and patient exam skills. I applaud your investigative approach to better understanding your clinical presentation. I understand how frustrating it is with not being able to identify the etiology of your symptoms. During my 30 plus years in practice, I also experienced such frustration when working up patients with a complex neurological presentation. My approach was to refer this complex patient population who presented with CNS symptoms to a neurologist. A neurologist is the medical specialist best able to address such unusual and complex symptoms. I apologize for not being able to assist you further. I hope you find the answers you are looking for. DrC
Can used this when a person is intoxicated. Please tell how do perform it and any article or reference for further understanding. Thanks in advance.
Hello Pratik, interesting question. Certainly a person who is intoxicated will render this testing inaccurate or in the very least inconclusive. I am unaware of any literature that addresses your inquiry. Thanks for the comment. DrC
you don't poke like that lol, if she had a real problem she would have KOd herself
IKR
Point well taken :)