Rombergs

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

1. Healthline Romberg test Available:https://www.healthline.com/health/romberg-test#What-is-Rombergs-test? (accessed 6.11.2022)

2. Epomedicine Romberg test Available:https://epomedicine.com/clinical-medicine/romberg-test/ (accessed 6.11.2022)

3. 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.

4. Reicke, N.: The Romberg head-shake test within the scope of equilibrium diagnosis. H.N.O 40, 195–201 (1992)

5. Blumenfeld, H. Neuroexam.com - Romberg test. www.neuroexam.com/neuroexam/content.php?p=37 (accessed 31 Dec 2013).

6. Zelczak TA. Neurologic examination. www.pacificu.edu/optometry/ce/courses/15840/neuroexampg3.cfm (accessed 31 Dec 2013).

7. Goebel JA. Practical management of the dizzy patient. Philadelphia: Lippincott Williams & Wilkins, 2008.

8. 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.

9. Black FO, et al. Normal subject postural sway during the Romberg test. Am J Otolaryngol. 1982 Sep-Oct;3(5):309-18.

10. Brinkman DMC, et al. Kwantificering en evaluatie van 5 neurologische evenwichtstests bij proefpersonen en patiënten. Ned Tijdschr Geneeskd. 1996;140:2176-80.

11. Longridge NS. Clinical Romberg testing does not detect vestibular disease. Otol Neurotol. 2010 Jul;31(5):803-6.

12. Agrawal Y. The modified Romberg balance test: normative data in US adults. Otol Neurotol, 2011 Oct,32(8):1309–1311.

13. 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)

14. 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)