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.

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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.

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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.

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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.

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