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Romberg test: What it is and what to do when results are positive

Last update on Apr, 27, 2023

What is the Romberg test?

The Romberg test, also known as the Romberg sign or Romberg maneuver, is a common neurological test used in ENT and neurological fields to diagnose disorders related to loss of balance and motor coordination (ataxia). This test should only be performed and evaluated by a medical professional.

Vertigo, dizziness and difficulty in coordinating movements and maintaining balance can be symptoms of various pathologies, among these:

  • Disorders of the vestibular system, such as labyrinthitis, Ménière's disease, benign paroxysmal positional vertigo;
  • Pathologies affecting the central nervous system, migraines, neuropathies, neoplasms, strokes and cerebellar ataxias.

Why and when is the Romberg test performed?

Each person should be able to maintain balance thanks to two of the following senses:

  • Proprioception (perception of the position that one's body occupies in space)
  • Vestibular function (being able to recognize the position that one's head has in space)
  • Vision

If this does not happen, there is a problem, and the Romberg test is suggested. It is mainly performed in the case of:

  • Vertigo
  • Dizziness
  • Lightheadedness
  • Signs of intoxication
  • Imbalance
  • Uncoordinated movement
  • Head injury
  • Ataxia (impaired muscle control)

These can all be symptoms of potential neurological conditions assessed and confirmed with the Romberg Test, including, but not limited to:

  • Ménière’s disease
  • Cerebellar dysfunctions
  • Parkinson’s disease
  • Pathologies of the inner ear
  • Central nervous system disorders

The Romberg balance test is also as an assessment of the split attention effect by United States police officers during a DUI arrest. Split attention tests require subjects to pay attention to multiple stimuli at once, which can be difficult for someone under the influence of drugs and/or alcohol. Therefore, police officers use the Romberg balance test to assess a person's level of intoxication.

Police officers must have probable cause to arrest someone believed to be driving under the influence. In other words, they must have hard evidence confirming their drink-driving suspicions. To gather evidence, it is possible to subject drivers to Field Sobriety Testing (FST), or an officer can subject the driver to a non-standardized assessment, namely the Romberg balance test.

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How is a Romberg test performed?

The Romberg test is simple and requires no preparation or instruments. This test should only be performed and evaluated by a medical professional, and it is often performed as part of a specialist neurological examination, ENT examination or vestibular examination:

  • Patients must stand upright with their feet together and toes slightly apart (about 30 degrees). Their arms must stretch forward, and the test starts with their eyes open for 30 seconds;
  • If the patient has managed to maintain the position with eyes open, for 30 seconds, without losing balance, cerebellar ataxia can be excluded (loss of motor coordination linked to a problem involving the cerebellum); at this point, the test is repeated with the patient's eyes closed.

The Romberg test is positive when the patient cannot maintain balance with closed eyes. In these cases, information ataxia is diagnosed, which may be due to:

  • A deficit of proprioceptive sensitivity, in this case, the oscillations go in all directions,
  • Dysfunction of the vestibular system, where the patient tends to oscillate towards the same direction, ex: the side affected by the deficit.

A slight oscillation is not to be considered pathological. False positives, ex: loss of balance, can be found in healthy patients with balance problems caused by psychological disorders (anxiety, stress).

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Modified versions of Romberg Test

Modified versions of the Romberg test provide a wide range of clinical applications for balance assessment. 

Healthcare providers use this test when assessing ataxia (impaired coordination) in people recovering from decompression sickness, such as in divers. 

The difference compared to the classic Romberg Test lies in the position of the feet. In the Sharpened Romberg Test, the feet are aligned in a heel-to-toe position, not shoulder-width apart.

This variant of the Romberg Test assesses postural stability in the elderly and people with Parkinson's disease. Unlike the classic Romberg Test, this variant evaluated how well you can stand on one leg with your eyes open. The test repeats three times per leg. Specifically, the goal is to hold the position for one minute.
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Romberg test results and interpretation

The Romberg Test results are from your body movement during the test. Your healthcare provider will be able to determine if your Romberg test is positive or negative as soon as you complete the test. Let's see what these results mean.

A Romberg test is positive when you have a loss of balance when you close your eyes during the test. A healthcare specialist will evaluate factors like your stability, the direction of your deviations, and the presence of tremors. Postural instability and the inability to remain balanced during the Romberg test can trace back to potential neurological conditions.

One condition may be cerebellar ataxia, determined by a lesion to the cerebellum. This neurodegenerative disorder has varying degrees of severity, and can cause difficulties in articulating words, writing, and controlling eye movements. 

A further test can be conducted through the finger-nose test: the patient in an upright position must extend his arm and then touch the tip of his nose with his index finger. Ataxia makes this simple action complex. In case of suspected cerebellar ataxia, it is necessary to consult a neurologist specialist who will prescribe a series of tests to diagnose and prepare a therapeutic and rehabilitation plan.

The Romberg test will be negative if the patient remains standing (with eyes closed) without falling. A slight oscillation is not to be considered pathological. This means that the symptoms that led to the Romberg test are probably not attributable to balancing issues.

The Romberg test is positive if the patient cannot maintain balance with closed eyes.  If the patient suffers from ataxia, the patient likely sways in all directions during the test

If the patient suffers from a dysfunctional vestibular system, the patient tends to always sway in the same direction, most often to the side affected by the deficit. Based on the results, the ENT doctor assesses whether further examinations are necessary and the appropriate therapy.

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