What test should be performed next for a patient presenting with unsteady gait?

In evaluating a patient with an unsteady gait, the Romberg test is particularly useful because it assesses balance and proprioception, specifically the ability to maintain posture while standing with the eyes closed. This test can help differentiate between vestibular and proprioceptive causes of imbalance. It provides crucial information about one’s sensory integration and balance control mechanisms.

The Romberg test involves having the patient stand with feet together and eyes closed. If the patient sways significantly or falls, it can indicate issues with the vestibular system, sensory systems, or even central nervous system pathology. Therefore, it serves as a vital initial step in determining the underlying cause of the unsteadiness.

While gait assessment is also relevant, it primarily observes the movement pattern rather than pinpointing balance issues directly, making it less specific for determining the nature of the unsteady gait. The Mini-Mental State Exam focuses on cognitive abilities and is not designed for assessing balance. The Finger-to-nose test evaluates coordination but does not directly assess balance in a standing position, which is often crucial for understanding gait disturbances. Thus, selecting the Romberg test as the next step aligns perfectly with the need to assess the patient’s balance and determine the potential cause of the unsteady gait.