Romberg Test

What is a Romberg test?

A Romberg test (also known as Romberg’s sign) is a simple physical test to see if you have balance problems that are related to proprioception — your body’s ability to sense your movements and position.

In particular, the test can determine if your dorsal column pathway of your brain and spinal cord, which controls proprioception, isn’t working properly.

The test involves standing with your feet together and your arms at your side or crossed in front of you. Part of the test is with your eyes open, and the second part is with your eyes closed. Your healthcare provider observes you during the test and notes any signs of imbalance, such as swaying.

The test is named after European neurologist, Mortiz Romberg, who came up with the tool in the 19th century to diagnose tertiary (late) syphilis.

How does balance work?

Balance is the ability to remain upright and move steadily by having even distribution of your body’s weight.

Your body normally maintains balance through a complex combination of sensorimotor control systems that include:

• Sensory input from vision (sight).
• Proprioception (your body’s ability to sense your movements and position).
• The vestibular system in your inner ear (motion, equilibrium and spatial orientation).
• Proper incorporation of that sensory input.
• Motor (motion) output to your eyes and muscles.

Injury, health conditions, vision issues, certain medications and the aging process can all affect one or more of these components and cause balance problems.

The Romberg test asses if a balance issue is due to a problem with your body’s proprioception.

What is proprioception?

Proprioception is your body’s ability to sense its movements and how it’s positioned in space (the area around your body).

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

With any movement of your body, sensory receptors in your skin, muscles and joints respond by sending impulses to your brain through your dorsal column. Along with other information from certain systems, such as vision input from your eyesight and equilibrium and motion input from your vestibular system in your inner ear, these cues help your brain determine where your body is in space.

The Romberg test determines if your balance issues are related to the function of your dorsal column by removing the visual and vestibular components that contribute to maintaining balance. It can identify a proprioception-related neurologic condition.

When would I need a Romberg test?

Healthcare providers typically perform a Romberg test on all people who are having issues with balance, dizziness and falls to help determine if their balance issues are related to issues with proprioception. They also often include the test during physical neurological exams.

The Romberg test is useful in assessing and confirming various neurological conditions, including, but not limited to:

• Parkinson’s disease.
• Friedreich’s ataxia.
• Vitamin B12 deficiency.
• Tertiary (late) syphilis.
• Normal pressure hydrocephalus (NPH) in older people who fall frequently.
• Wernicke’s syndrome.
• Ménière’s disease.
• Brown-Sequard syndrome.
• Posterior cord syndrome.

Several other conditions that are related to your vision and vestibular system can cause balance issues.

Who performs a Romberg test?

Any healthcare provider who knows how to safely perform a Romberg test can do so. Neurologists often perform the test, as it’s a neurological exam.

How is a Romberg test performed?

The Romberg test is a physical test. Your healthcare provider will give you instructions and observe you during the test. It involves the following steps:

• You’ll remove your shoes and stand with both feet together.
• You’ll hold your arms next to your body or cross them in front of your body.
• You’ll keep your eyes open and try to stand still for about 30 seconds while your healthcare provider assesses your body movements and balance.
• You’ll then close your eyes while still standing for 30 seconds or one minute, and then your healthcare provider will assess your body movements and balance.

There are many types, or modified versions, of the Romberg test, which provide a wide range of applications for balance assessment. Some types of Romberg tests include:

• Sharpened Romberg test (SRT): Healthcare providers use this test when assessing ataxia (impaired coordination) in people recovering from decompression sickness, such as in divers. It differs from the traditional Romberg test due to the positioning of your feet. Instead of standing with your feet shoulder-width apart, the Sharpened Romberg test requires that your feet are aligned in a heel-to-toe position.
• Single-legged Stance test (SLST): Healthcare providers use this test when assessing postural stability and control in older people and in people with Parkinson’s disease. The test involves assessing how long you can maintain standing on one leg with your eyes open. The test ends after one minute, and each leg is tested three times.

What should I expect during a Romberg test?

The Romberg test is a very quick and simple test. You’ll perform the test without any physical support. This means your healthcare provider won’t stabilize you or help you balance at the start of the test.

However, your healthcare provider will be nearby and watching you closely. If they notice you starting to fall, they’ll step in to prevent the fall and ensure your safety. They’ll also clear the space of objects to prevent any falling hazards.

How do I prepare for a Romberg test?

You don’t need to do anything special to prepare for a Romberg test.

What are the risks of a Romberg test?

If a trained healthcare provider performs a Romberg test in the correct setting, there aren’t any known risks or complications of the test.

When should I know the results of a Romberg test?

Your healthcare provider will be able to determine if your Romberg test is positive or negative as soon as you complete the test.

It’s important to know that a Romberg test can’t diagnose what specifically is causing your balance issue and the issue in your dorsal column. Your healthcare provider will order additional tests to confirm or rule out certain possible causes.

What does a positive Romberg test mean?

A Romberg test is positive when you have a loss of balance when you close your eyes during the test. Loss of balance is defined as increased swaying of your body, foot movement in the direction of a fall or falling.

If you have a positive Romberg test, your healthcare provider will order tests to determine what’s causing your dorsal column to not work properly. A positive Romberg test can result from several different conditions.

What does a negative Romberg test mean?

A Romberg test is negative if you’re able to stay stable during the test and have minimal swaying.

This means that your vestibular or proprioceptive symptoms may not be related to balancing issues.

When should I call my doctor about balance issues?

Balance issues can be dangerous and lead to falls. It’s important to see your healthcare provider if you’re experiencing any of the following symptoms or situations:

• Unsteadiness.
• Dizziness.
• Lightheadedness.
• Blurred vision.
• Losing your balance and falling.
• Feeling disoriented.
• Feeling as if the room is spinning around you, even for a very brief time.
• Feeling as if you’re moving when you know you’re sitting or standing still.
• Feeling as if you’re falling.

What is a modified Romberg balance test?

The modified Romberg balance test is a test law enforcement sometimes use to determine if a driver is under the influence. It’s not one of the field sobriety tests approved by the National Highway Traffic Safety Administration (NHTSA).

When administering this test, a law enforcement officer asks you to stand with your feet together with your head tilted slightly back and your eyes closed. They then ask you to estimate when 30 seconds have passed and to say “stop” when you think it’s been that long.

A note from Cleveland Clinic

It can be scary to have issues with balance or dizziness. If you’re feeling unstable and unbalanced, whether while you’re standing or walking, it’s important to see your healthcare provider. They can perform certain tests, such as the Romberg test, to determine what may be causing your balance issues.