Rombergs
- Fysiobasen
- Oct 4
- 3 min read
The Romberg Test is a neurological examination used to assess a person’s balance by testing the function of the dorsal columns of the spinal cord, which are responsible for proprioception (the body’s ability to sense its position in space)¹.
The test is primarily used to diagnose sensory ataxia, a gait disorder caused by abnormal proprioception. Conditions associated with a positive Romberg Test include:
Subacute combined degeneration of the spinal cord (vitamin B12 deficiency)
Posterior cord syndrome (posterior spinal artery infarction)
Brown-Séquard syndrome (hemisection of the spinal cord)²
Additionally, the test is sensitive for evaluating central and peripheral vertigo and balance impairments following head trauma³. The Romberg Test has been part of clinical examinations for over 150 years⁴.
Purpose
The Romberg Test evaluates the dorsal column–medial lemniscus pathway, which transmits sensory input from peripheral nerves to the brain.
With eyes open, balance is maintained using visual, proprioceptive, and vestibular signals.
With eyes closed, balance depends solely on proprioceptive and vestibular input².
Three sensory systems contribute to balance:
Vision
Proprioception
Vestibular system
At least two of these systems must function for balance to be maintained.
If a patient falls with eyes closed, this suggests proprioceptive or vestibular dysfunction.
If a patient cannot stand even with eyes open, this suggests cerebellar or central nervous system involvement⁵⁶.
Test Procedure
Original Romberg Test
Patient stands barefoot with feet together, arms by the side or crossed in front.
Test performed first with eyes open, then eyes closed.
Examiner observes if the patient maintains balance for at least 30 seconds.
Test is positive if the patient:
Shows excessive body sway
Steps to prevent a fall
Falls⁷⁸⁹¹⁰
Sharpened Romberg Test (Tandem Romberg)
A modified version with increased sensitivity for vestibular dysfunction.
Patient stands with one foot directly in front of the other (tandem stance).
Arms crossed over the chest.
Test performed with eyes open and closed.
Older or overweight patients may have difficulty performing this, influencing results⁷.
Interpretation of Results
Acute vestibular lesions → tendency to fall toward the affected side.
Chronic vestibular lesions → often normal in the standard Romberg test due to compensation.
Proprioceptive disorders (e.g., tabes dorsalis) → pronounced instability with eyes closed⁷.
Studies suggest that the Sharpened Romberg provides a more objective measure of postural stability and proprioception⁷.
Reliability and Validity
No consensus in the literature regarding intra- and inter-tester reliability, as the test is largely qualitative rather than quantitative.
The test is primarily a quick clinical screening tool for balance disorders.
Modern posturography and balance platforms provide more accurate quantitative measures of postural control.
Limitations
Not quantitative: measures balance qualitatively only.
Low sensitivity and specificity: limited ability to localize lesions or predict fall risk.
Limited predictive value: may not reflect real-world functional balance performance¹³¹⁴.
Conclusion
The Romberg Test is a classic, simple, and rapid clinical tool for assessing balance and proprioception. A positive test suggests impairment in proprioceptive or vestibular systems. However, due to limited sensitivity and specificity, it should be used in combination with other balance tests and diagnostic tools for a complete evaluation.
References
Healthline Romberg test Available:https://www.healthline.com/health/romberg-test#What-is-Rombergs-test? (accessed 6.11.2022)
Epomedicine Romberg test Available:https://epomedicine.com/clinical-medicine/romberg-test/ (accessed 6.11.2022)
Soochan Kim, Mijoo Kim, Nambom Kim, Sungmin Kim, Gyucheol Han.Quantification and Validity of Modified Romberg Tests Using Three-Axis Accelerometers.Green and Smart Technology with Sensor Applications. Communications in Computer and Information Science Volume 338, 2012, pp 254-261.
Reicke, N.: The Romberg head-shake test within the scope of equilibrium diagnosis. H.N.O 40, 195–201 (1992)
Blumenfeld, H. Neuroexam.com - Romberg test. www.neuroexam.com/neuroexam/content.php?p=37 (accessed 31 Dec 2013).
Zelczak TA. Neurologic examination. www.pacificu.edu/optometry/ce/courses/15840/neuroexampg3.cfm (accessed 31 Dec 2013).
Goebel JA. Practical management of the dizzy patient. Philadelphia: Lippincott Williams & Wilkins, 2008.
Johnson BG, et al. The sharpened Romberg test for assessing ataxia in mild acute mountain sickness. Wilderness Environ Med. 2005 Summer;16(2):62-6.
Black FO, et al. Normal subject postural sway during the Romberg test. Am J Otolaryngol. 1982 Sep-Oct;3(5):309-18.
Brinkman DMC, et al. Kwantificering en evaluatie van 5 neurologische evenwichtstests bij proefpersonen en patiënten. Ned Tijdschr Geneeskd. 1996;140:2176-80.
Longridge NS. Clinical Romberg testing does not detect vestibular disease. Otol Neurotol. 2010 Jul;31(5):803-6.
Agrawal Y. The modified Romberg balance test: normative data in US adults. Otol Neurotol, 2011 Oct,32(8):1309–1311.
McMichael,K.A., Vander, B.J., Lavery, L., Rodriguez, E., Ganguli, M.: Simple balance and mobility tests can assess falls risk when cognition is impaired. Geriatr. Nurs. 29, 311–323 (2008)
O’Neil, D.E., Gill-Body, K.M., Krebs, D.E.: Posturography changes do not predict functional performance changes. Am J. Otol. 19, 797–803 (1998)
