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The Romberg test

A neurological standing test to check balance

About the meaning, use, evaluation & interpretation of the balance test

Learn all about the Romberg standing test: What exactly does this test entail? What is its purpose? How is it carried out? What do its results mean? If you suspect that you might be suffering from hearing loss, take our free online hearing test before booking an appointment with a hearing care professional. This online test takes only 3 minutes and will give you an initial indication of your hearing health.

What is the Romberg test?

The Romberg test, also known as the Romberg test or Romberg standing test, is a neurological test that examines your body's ability to sense your movements and position.

What is the use of the Romberg test?

Seeing as dizziness, lightheadedness, difficulty coordinating movements and maintaining balance can be symptoms of various diseases  (like labyrinthitis or Ménière's disease), the Romberg test is a neurological test that can diagnose conditions that may affect a person's balance and coordination of movement (ataxia).

This test is based on the premise that balance comes from the combination of several neurological systems, namely proprioception, vestibular input, and vision. A person with a fair degree of balance requires at least two of the three to maintain balance while standing.

Below you will learn more about how to perform the test and what should be done in case of a positive or negative result.

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How to perform the Romberg test?

The Romberg test is simple and requires no preparation or instruments and it is often performed as part of a specialist neurological examination, ENT examination or vestibular examination. In order to perform the test, the patient must stand upright with their feet close together. The patient must maintain this position for 30 seconds with their eyes open, then for another 30 seconds with their eyes closed.

During the test, the arms can be held next to the body, crossed in front of the body or held at a right angle to the torso. In both phases of the test (with eyes open and with eyes closed), the goal is  to maintain balance. Any signs of imbalance or the tendency to sway may indicate the presence of a possible condition.

Romberg evaluation & interpretation

While swaying with the eyes open could indicate a cerebellar lesion, swaying with the eyes closed could be symptomatic of a disease related to the vestibular system. It is important to take into that slight swaying during either test phase is physiological and has no pathological relevance. Not to mention that anxiety can affect a person's sense of balance, so a false positive results is also possible with this test.

Possible cause: cerebellar ataxia

If you are unable to maintain your balance during the Romberg test, it could be due to ta cerebellar ataxia caused by a lesion on the cerebellum. This neurodegenerative disorder, which  varies in severity, could trigger unsteadiness and movement coordination problems and make it increasingly difficult to articulate words, write, and control eye movements.

Further evidence by finger-nose test

The finger-nose test assesses coordinated, target-driven movement of the upper limbs. In order to perform the test, the patient must stand upright and extend their arm to touch the tip of their nose with their index finger, This test can help determine if a patient is suffering from cerebellar ataxia. For a more definitive diagnosis, a neurologist should be consulted so they can prescibe a series of follow-up examination and devise the proper treatment and rehabilitation plan.

What to do when you fail the test?

The Romberg test is positive if the patient is unable to maintain balance with closed eyes.  If the patient is suffering from ataxia, it likely that the patient sways in all directions during the test. However, if the patient is suffering from a dysfunction of the vestibular system, the patient tends to always sway in the same direction, most often to the side affected by the deficit. Contrarily, the Romberg test is negative if the patient is able to stay stable during the test and have minimal swaying. This means that any vestibular or proprioceptive symptoms may not be related to balancing issues. Based on the results, the ENT doctor assesses whether further examinations are necessary and the appropriate therapy.

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