When a motorist is stopped and questioned for suspected DUI or DWI, one of the “field sobriety tests” that is mistakenly administered is the “Finger to Nose” test. Most police officers are completely unaware of the origins and the stated purpose of the “Finger to Nose” test and why it is not a part of the Standardized Field Sobriety Tests (SFSTs).

The “finger-to-nose” test is a derivative of the Romberg sensory ataxia test^[1]. This procedure was initially developed by Doctor Moritz H. Romberg (1795-1873) while Dr. Romberg was studying tertiary syphilis at the University Hospital in Berlin, Germany. The exam is based on the premise that a person requires at least two of the three following senses to maintain balance while standing: proprioception (the ability to sense the relative position of neighboring parts in one’s body); vestibular function (the ability to know one's head position in space); and vision (which can be used to monitor, and adjust for, changes in body position).

As Dr. Romberg noted in his classic publication, Lehrbuch: “If he is ordered to close his eyes while in the erect posture, he at once commences to totter and swing from side to side; the insecurity of his gait also exhibits itself in the dark.” [Translated from the original German into English.] See, Romberg and His Sign by J.M.S. Pearce, European Neurology (2005) at pages 210-213. One of the key factors in the administration of the Romberg test is deprivation of visual senses by placing the person in a state of darkness, either actual darkness or shutting the eyelids to create a ‘sense’ of darkness. Once the individual affected with ataxia is placed in a darkened environment, the individual will fall over or sway significantly from side to side, due to impaired proprioception.

Neurosyphilis is an infection of the brain or spinal cord caused by the bacterium Treponema pallidum. It usually occurs in people who have had chronic, untreated syphilis, usually about ten to twenty years after first infection. However, not every person infected with syphilis will develop this complication. The classic signs of neurosyphilis are: difficulty walking, loss of coordination, loss of reflexes, muscle weakness, and wide-based gait (walking with legs spread apart to compensate for loss of balance). Once the disease has progressed to this point, the next and final stages are generally manifested by symptoms of dementia, blindness, confusion and insanity. As is well-known, American gangster Al Capone had advanced neurosyphilis prior to his death in 1947.

When Dr. Romberg completed studies to test for Stage III syphilis in the mid-1840’s, there was no microscopic examination process available. It was not until 1906 that bacteriologist August von Wassermann, coincidently also at the state hospital in Berlin, developed the now famous Wassermann test to determine syphilis antibodies present in the blood. Until the Wassermann test was developed, the only neurological testing available for advanced stage syphilis was the Romberg test. In fact, the Romberg test is still employed today in the study of proprioception disorders.

In a recent scientific publication, Romberg’s Test by Dr. Gokula of the Department of Internal Medicine of Michigan State University, the examination of the subject is done as follows: “The patient should be examined to rule out other causes of ataxia.  … The patient is then made to stand with his feet close together, arms by his side and eyes open. Any significant swaying or tendency to fall is noted. The patient is then asked to close his eyes. … Romberg’s test is considered positive if there is significant imbalance with the eyes closed or the imbalance significantly worsens on closing the eyes.” Dr. Gokula, Journal of Postgraduate Medicine, (2003) at pages 169-172. Thus, when the examination is undertaken by a medical doctor with specialized training in neurology, the Romberg test may prove a valuable indicator of existing neurological disease. However, the test itself has never been validated as a method to determine alcoholic sobriety. Romberg’s sign and the finger to nose test are only a simplified version of a variety of testing to evaluate coordination disturbances of the entire central nervous system. In no way can one assume that the Romberg sign and the finger to nose test are exclusive to the use and consumption of alcohol.

In the 1960’s and into the 1970’s, law enforcement agencies made a rough attempt to utilize the Romberg test as a measure of alcohol insobriety. As the forerunner to the National Highway Traffic Safety Administration’s “Standard Field Sobriety Battery” (1983), the National Safety Council developed the “Alcohol Influence Form” in 1939 for law enforcement officers to document insobriety and motor vehicle operation[2]. That form was then standardized by the Northwestern Traffic Institute and distributed widely to police agencies throughout the United States from the 1950s throughout the late 1970s as a combined note taking and field sobriety testing form. Romberg’s test was adapted by the NWTI as an improvised field sobriety test, wherein the subject was required to touch his or her nose with eyes closed. People with normal proprioception error in placement will not exceed 20 millimeters (the finger is placed within 20 millimeters of the tip of the nose), but not miss the entire nose. However, people suffering from impaired proprioception (a common symptom of moderate to severe alcohol intoxication) will fail this test due to difficulty locating their limbs in space relative to their noses. In actual practice, however, the “finger-to-nose” test is so varied in its administration and its objective evaluation as to have little relative use as a field sobriety test for determining alcohol sobriety.

Many other medical conditions produce impaired proprioception, and therefore a positive Romberg’s sign and the test result similar to that seen with alcohol intoxication. The most common of these conditions would be peripheral neuropathy, of which more than 100 types have been identified. Some of these types are commonly seen in the public at large, although the underlying cause of the condition may not be apparent. At least 8% of the general population is known to have some type of peripheral neuropathy: a history of trauma to the back or limbs, diabetes (up to 70% of all diabetics have peripheral neuropathy), thyroid disease, vitamin deficiency, infections (HIV, shingles, and others), and conditions less frequently encountered, such as multiple sclerosis.

The Romberg test as commonly used by law enforcement authorities requires the subject to stand with their feet together, hands at their side, the head tilted back, and their eyes closed.  Tilting the head disturbs the inner ear function which is necessary to maintain balance. The eyes depend upon the vestibular system to stabilize orientation. When one of the senses is ‘de-activated,’ such as closing the eyes, the Romberg test can detect dysfunction in the remaining pathways to and from the cerebellum. In a clinical setting, the test is always performed with the eyes open at first, in order to establish a performance baseline. The performance baseline evaluation is critical to using the Romberg test for neurological use.

The major issue with the law enforcement use of the Romberg test to determine alcoholic impairment is that balance requires the proper functioning of the vestibular system, the proprioception system, and the visual system simultaneously. See, Herdman, S.J., Vestibular Rehabilitation, (2002). Unless a clinical evaluation is undertaken by a trained medical doctor prior to use of the Romberg test, any purported results developed from the Romberg test are only speculative. In fact, the Romberg test was found to be so unreliable as an indicator of alcoholic sobriety that its use was specifically rejected by the National Highway Traffic Safety Administration for inclusion in the NHTSA standard test battery. ^[3] Thus, a police officer’s use of this discredited field sobriety test, originally conceived to study syphilitic patients, has only negligible use in determining alcoholic impairment and cannot in any manner form the basis for credible probable cause to support an arrest for DUI or DWI.