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Special Test

Romberg Test | Balance Testing

Romberg Test is a neurological examination that is used to test for balance and coordination. It assesses the patient’s ability to stand with the feet parallel and together with the eyes open and then closed for 30s.

Romberg sign is one of the earliest signs of spinal posterior column disease.

This test was first described in the 19th-century by Mortiz Romberg, an European neurologist.

See Also: Gait Cycle

How do you perform the Romberg Test?

The patient is asked to stand on both feet together without shoes, The examiner asks the patient to hold the arms next to or crossed in front of the body.

First: the examiner asks the patient to keep his eyes open while the examiner assesses the patient’s body movement relative to balance.

Second: The patient closes his eyes while the examiner notes any balance impairment for a duration of one minute.

Romberg Test procedure

What does a positive Romberg test mean?

With the eyes open, the vision, proprioception, and vestibular systems provide input to the cerebellum to maintain truncal stability. If there is a mild lesion in the vestibular or proprioception systems, the patient is usually able to compensate with the eyes open. When the patient closes their eyes, however, visual input is removed, and instability can be provoked (Positive Romberg sign).

Loss of balance can be defined as the increased swaying of the body, foot movement in the direction of the fall, or falling.

Patients with a vestibular lesion tend to fall in the direction of the lesion. If there is a more severe proprioceptive or vestibular lesion, or if there is a midline cerebellar lesion causing truncal instability, the patient will be unable to maintain this position even with their eyes open.

Note that instability can also be seen with lesions in other parts of the nervous system such as the upper motor neuron or upper motor neuron or the basal ganglia, so these should be tested for separately in other parts of the exam.

positive Romberg sign
A: The patient can stand with feet together and eyes open.
B: falls with eyes closed.
C: in contrast, the patient with a cerebellar lesion cannot stand with feet together and eyes open.

Accuracy

The Romberg test has predictive validity with regard to recurrent falls over a 6-month period in patients with Parkinson’s disease:

  • Sensitivity: 65%
  • Specificity: 90%

Tandem Romberg Test

Tandem Romberg Test or Sharpened test is a variation of the original Romberg test.

Tandem Romberg Test assesses the patient’s ability to stand with the feet in the heel-to-toe position with the arms folded across the chest and eyes closed for 1 min. The rationale for this test is the same as for the Romberg test. The ataxic patient will prefer to stand with a wider BOS and will show reluctance when asked to stand with the feet close together.

Tandem Romberg Test
Tandem Romberg Test

Notes

Romberg described this sign in patients with tabes dorsalis and thought it was pathognomonic. He said, “If he is ordered to close his eyes while in the erect posture, he at once commences to totter or swing from side to side; the insecurity of his gait also exhibits itself more in the dark.”

Romberg did not state that the feet should be placed together; that was a later addition. Nor did he comment on where the arms were to be positioned.

Some histrionic patients will sway with eyes closed in the absence of any organic neurologic impairment (false Romberg sign). The toes of the patient with histrionic sway are often extended; the patient with organic imbalance flexes the toes strongly and tries to grip the floor.

The swaying is usually from the hips and may be exaggerated.

References

  1. Forbes J, Cronovich H. Romberg Test. [Updated 2021 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563187/
  2. Newton R: Review of tests of standing balance abilities. Brain Injury: [BI] 3: 335–43, 1989.
  3. Simon RP, Aminoff MJ, Greenberg DA: Clinical Neurology, 4th ed.). Stanford, CT, Appleton and Lange, 1999.
  4. Bloem BR, Grimbergen YA, Cramer M, et al.: Prospective assessment of falls in Parkinson , s disease. J Neurol. 248:950–8, 2001
  5. Netter’s Orthopaedic Clinical Examination An Evidence-Based Approach 3rd Edition Book.
  6. William W.Campbell, Richard J.Barohn. DeJong’s The Neurologic Examination, 8th Edition.

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Last Reviewed
January 23, 2023
Contributed by
OrthoFixar

Orthofixar does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice.

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