What is a Romberg test?

A Romberg test, also known as Romberg's sign, is a simple physical examination intended to determine whether you suffer from balance problems due to an impairment of your body's ability to determine movement and position.

The test may specifically assess whether the dorsal column pathway in the brain and spinal cord, which is in charge of proprioception, is impaired.

In the Romberg test, you stand with your feet shoulder-width apart and your arms at your side or crossed in front of your body. You do one part of the test with your eyes open and the second part closed. Your healthcare provider watches you while performing the test and writes down any signs of imbalance, such as swaying.

It was developed and named after European neurologist Mortiz Romberg, who created this diagnostic tool for tertiary (late) syphilis in the 19th century.

How is the balance achieved?

Balance is a state of remaining upright and moving steadily while maintaining an even distribution of your body's weight.

Your body, under normal circumstances, balances through a complex combination of sensorimotor control systems that consist of:

• Sensory input from vision (sight).
• Proprioception- or your body's sense of its movements and position).
• The vestibular system in your inner ear is the sense of motion, equilibrium, and spatial orientation.
• Proper interpretation of that sensory input.
• Motor-movement-output to your eyes and muscles.
• Injury, medical conditions, vision disorders, some medications and the ageing process can all impact one or more of these components and lead to balance disorders.
• The Romberg test determines if a balance problem is due to a problem with your proprioception.

What is proprioception?

It is a sense of how your body moves and its position in space (the space around your body).

Your dorsal column-medial lemniscus pathway is a sensory pathway of your central nervous system and spinal cord that interprets fine touch, vibration, and positioning sensations from nerves in your skin, muscles, and joints.

Whenever your body is in motion, sensory receptors in your skin, muscles, and joints detect this movement and send nerve impulses up your spinal column to your brain. In combination with other input from some of your body's other systems, such as input from your eyesight and vestibular input from your inner ear, which indicate your body's equilibrium and motion, these cues allow your brain to know where your body is in space.

The Romberg test evaluates whether balance problems are related to the function of the dorsal column by eliminating the visual and vestibular components that contribute to balance. It may diagnose a neurologic condition related to proprioception.

When would I need a Romberg test?

Healthcare providers commonly perform the Romberg test for patients who complain about imbalance, dizziness and falls in order to help establish whether their problem with balance might have something to do with proprioception. The test is also commonly used in conjunction with the physical neurological examination.

The Romberg test helps diagnose and confirm several neurologic conditions, among which, but not inclusive, are:

• Parkinson's disease.
• Friedreich's ataxia.
• Vitamin B12 deficiency.
• Tertiary (late) syphilis.
• Normal pressure hydrocephalus (NPH) in the elderly patient with recurrent falls.
• Wernicke's syndrome.
• Ménière's disease.
• Brown-Sequard syndrome.
• Posterior cord syndrome.

A number of other causes involving your eyes and your balance system.

Who performs a Romberg test?

Any medical professional who is qualified to conduct a Romberg test can do so. Since the test involves a neurological examination, neurologists frequently administer it.

How is a Romberg test performed?

The Romberg test is a physical examination. Your healthcare provider will instruct and observe you during the test. It requires:

• You get rid of your shoes and stand with both feet together.
• Then you put your arms next to your body or cross them in front of your body.
• You will be asked to keep your eyes open and keep still for 30 seconds while your health provider checks your moving body and balance.
• You will then close your eyes while standing for 30 seconds or one minute, after which he/she will check your moving body and balance.

Various types or modified versions of the Romberg test are used, and applications for balance have been found in various assessments. There are several types, including:

• Sharpened Romberg test (SRT): This test is used by medical professionals to evaluate ataxia, or poor coordination, in patients recovering from decompression sickness, such as divers. The way your feet are placed makes it different from a traditional Romberg test. The Sharp Romberg test determines that your feet should be in a heel-to-toe alignment rather than shoulder-width apart.
• Single-legged Stance test (SLST): Health care professionals administer this test when they examine the postural stability and control in older adults and individuals with Parkinson's disease. The test involves determining how long you can stand on one leg, keeping your eyes open. It lasts for one minute, and each leg is tested thrice.

What can I expect for a Romberg test?

The Romberg test is short and simple. You will be tested without the need for any form of support. This simply means your physician will not balance you or help you maintain balance at the beginning of the test.

However, your healthcare provider will be watching you and standing nearby. If they see that you are starting to fall, they will reach out to help prevent the fall and keep you safe. They will also clear the area of objects that could fall.

How do I prepare for a Romberg test?

You do not have to prepare for a Romberg test. No special preparation is needed.

What are the risks of a Romberg test?

If a trained healthcare provider performs a Romberg test in the appropriate setting, there are no known risks or complications of the test.

When will I find out the results of a Romberg test?

You should know right after you finish the test whether your Romberg test is positive or negative.

It is worth noting that it cannot determine what could be causing your problem in terms of balance and the issue in your dorsal column. Your doctor would require further tests to confirm or to rule out various possible causes.

What does a positive Romberg test mean?

A loss of balance during a Romberg test is a positive test if you lose your balance when your eyes are closed. Loss of balance is defined as increased body swaying or foot movement in the direction of a fall.

If you have a positive Romberg test, your doctor will send orders to perform tests to determine why your dorsal column isn't working correctly. A positive Romberg test can be due to many different conditions.

What does a negative Romberg test mean?

A negative Romberg test occurs when you remain still during the test and move very little.

This means your vestibular or proprioceptive symptoms may have nothing to do with balance problems.

When to call my doctor about balance problems?

Balance disorders can be difficult, and you may have fallen. See your healthcare professional if you feel some or all the following signs or symptoms:

• You feel that you're off-balance.
• You feel dizzy.
• Lightheadedness.
• Blurred vision.
• You lose your balance, and you fall.
• You feel dizzy.
• It feels like the room around you is turning, even for a second.
• Feeling that you are moving when you know you are sitting or standing still.
• Feeling as if you're falling.

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