What Is the Romberg Test & How the Romberg Test Is Performed

The Romberg test is a very common assessment of an individual’s balance and coordination. This test has been around for 150 years, proving its effectiveness as well as its ease of use. While the Romberg test can provide helpful clues for diagnosing various issues, it is not in itself a conclusive diagnosis. Results vary greatly with one’s individual strength and balance, so it’s best for a trained professional to assess the results. However, you can perform this test yourself for general information purposes.

How the Romberg Test Is Performed

two feet on brick walking

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The Romberg test is a very simple assessment that can be performed without any special equipment or training. To give an individual the Romberg test, follow these steps:

  1. Ask the subject to stand with their feet together and hands at their sides on level ground. Instruct them to keep their eyes open.
  2. Stand facing the subject with your arms out so you can catch them if they fall. Do not touch the individual unless they require support.
  3. Observe the subject for 20 seconds and note any swaying or falling.
  4. Instruct the subject to close their eyes for 30 seconds.
  5. Observe the patient and note whether they can remain in a stable, upright position with their eyes closed.

Anyone can perform a basic Romberg test, and doing so shouldn’t cause the subject any harm as long as you’re prepared and able to catch them should they fall. It’s important to be aware that swaying and falling are possible outcomes of the Romberg test. It’s best to do this test in a safe, open space where there are no sharp corners or other potential hazards should the subject struggle with their balance and potentially fall.

Understanding the Results of the Romberg Test

If the subject can remain standing with their eyes closed, they have passed the Romberg test, and no further assessments are needed in this area. However, the individual is considered to have a Romberg sign if they:

  • Sway with their eyes closed.
  • Move one of their feet to maintain balance while their eyes are closed.
  • Lose balance and fall when they close their eyes.

If an individual exhibits a Romberg sign, this indicates a problem with proprioception. Proprioception is the awareness or perception of one’s body. When the eyes are open, most people can compensate for proprioception issues with visual cues that help the brain understand where the body is and how it’s moving. Removing these visual cues reveals potential issues. Some of the common problems that are identified by the Romberg sign include the following:

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Cerebellar Ataxia

Ataxia is a lack of fine control over one’s voluntary movements. Cerebellar ataxia occurs when the cerebellum is damaged or inflamed. This part of the brain handles coordination, visual input, and the sense of body. Cerebellar ataxia is the most common type of ataxia. In some cases, it impacts the spinal cord as well as the cerebellum.

Other symptoms of cerebellar ataxia may include blurred vision, slurred speech, dizziness, muscle tremors, difficulty swallowing, headache, fatigue, and clumsiness. Patients experiencing ataxia may also have unusually poor handwriting, a wide gait, or difficulty with fine motor skills. These patients can also exhibit changes in their voice as a result of cerebellar ataxia.

Vestibular Ataxia

Also known as vertigo, vestibular ataxia involves the vestibular system. This system is made up of the ear canals and inner ear. These are filled with fluid and help you maintain balance and spacial orientation. Symptoms of vestibular ataxia include dizziness, staggering, nausea, vomiting, blurred vision, and difficulties sitting, standing, or walking in a straight line. Vestibular ataxia can be caused by head or neck trauma, motion sickness, and Meniere’s disease. Drug or alcohol use can also cause vestibular ataxia.

Proprioceptive Dysfunction

Proprioceptive dysfunction is any instance where the individual’s proprioception is impaired. This is caused by damage to the pathways connecting the cerebellum to the muscles and joints. When signals running along these pathways are disrupted, the body can’t properly understand its positioning or movements. Symptoms of proprioceptive dysfunction include uncoordinated movements, slouching, and clumsiness. Individuals with this type of dysfunction may not know their own strength and use too much force for common tasks like writing with a pen or pencil.

An individual may have one or more of these conditions, which point to other underlying problems that must be diagnosed and assessed by a medical professional.

When the Romberg Test Is Used?

The Romberg test is a very common tool for assessing a wide range of conditions. This test might be used:

  • As part of a routine neurological examination.
  • To assess the integrity of the dorsal column medial lemniscus.
  • To diagnose a cerebellar or vestibular disease.
  • As an assessment tool for a patient recovering from a cerebellar or vestibular disease.
  • As part of a field sobriety test.

Variations on the Romberg Test

The standard Romberg test described above is the most common choice for this type of assessment, but there are variations that may be employed as well. One common variation is known as the Tandem or Sharpened Romberg test. This begins with the assessment outlined above, but continues with this second part:

  1. Instruct the subject to cross their arms over their chest with open palms resting on opposite shoulders.
  2. Have the subject place their feet semi-tandem so one is slightly further forward than the other.
  3. Observe the subject’s balance in this position with eyes open for 10 seconds and eyes closed for 10 seconds.
  4. Have the subject place one foot directly in front of the other as their arms remain crossed over their chest.
  5. Observe the subject in this position with eyes open for 10 seconds and eyes closed for 10 seconds.
  6. These variations help one assess the severity of the individual’s condition in cases where a Romberg sign is present.

As a general assessment of balance and coordination, the Romberg test is a valuable tool for any type of medical professional, including our team members at Scheck & Siress. However, other tests, like the Oswestry Disability Index, may be necessary to get a full picture. As providers of custom orthotics and prosthetics, it’s our job to make sure every patient has the balance and coordination they need. Contact us for your orthotics needs.

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