From the Guidelines
The Romberg test should be performed in patients with chronic disequilibrium and signs of sensory or proprioceptive ataxia, as indicated by worsening symptoms with closed eyes. This is based on the most recent guidelines from the American College of Radiology, which suggest that the Romberg test is useful in evaluating patients with sensory or proprioceptive ataxia, characterized by loss of coordination due to loss of normal position sense 1.
Key Indications for the Romberg Test
- Chronic disequilibrium with signs of sensory or proprioceptive ataxia
- Symptoms of disequilibrium, such as unsteadiness, dizziness, or instability
- Worsening symptoms with closed eyes ### Performing the Romberg Test To perform the Romberg test, ask the patient to stand with feet together and arms at their sides, first with eyes open and then with eyes closed, for about 20-30 seconds in each position. Observe for increased swaying or falling when visual input is removed. A positive Romberg sign occurs when a patient can maintain balance with eyes open but becomes unstable or falls when eyes closed, indicating impaired proprioception in the lower extremities 1.
Interpretation of Results
The Romberg test can help differentiate between sensory or proprioceptive ataxia, cerebellar ataxia, and vestibular disorders. Patients with sensory or proprioceptive ataxia typically demonstrate instability only when eyes are closed, while those with cerebellar ataxia show instability even with eyes open, and those with vestibular disorders may exhibit directional falling toward the affected side 1.
From the Research
When to Perform the Romberg Test
The Romberg test is used to assess a patient's balance and proprioception. It can be performed in various situations, including:
- When a patient is experiencing dizziness or unsteadiness, as it can help identify vestibular or proprioceptive impairments 2
- To evaluate patients with suspected vestibular origin dizziness, as unsteadiness has been associated with higher age, heart disease, diabetes, hypertension, and cerebrovascular dizziness 3
- In patients with conspicuous postural instability, to evaluate for non-vestibular causes, as unsteadiness has been linked to increased long-term mortality 3
Key Considerations
When performing the Romberg test, it is essential to consider the following:
- The test should be performed with the patient standing with feet together and eyes closed, as this helps to assess vestibular function 2
- The surface on which the patient is standing can affect the results, with a compliant surface being more indicative of vestibular function than a firm surface 2
- The test can be used in conjunction with other assessments, such as static posturography, to evaluate unsteadiness and its relationship to cerebrovascular risk factors and mortality 3