Romberg Test – Physical Exam

Romberg test, Romberg’s sign, or the Romberg maneuver is a test used in an exam of neurological function for balance, and also as a test for drunken driving. The exam is based on the premise that a person requires at least two of the three following senses to maintain balance while standing: proprioception (the ability to know one’s body position in space); vestibular function (the ability to know one’s head position in space); and vision (which can be used to monitor and adjust for changes in body position).

A patient who has a problem with proprioception can still maintain balance by using vestibular function and vision. In the Romberg test, the standing patient is asked to close his or her eyes. A loss of balance is interpreted as a positive Romberg test.

How to Perform Romberg Test:

Ask the patient to stand erect with feet together and eyes closed. Stand close by as a precaution in order to stop the person from falling over and hurting himself or herself. Watch the movement of the body in relation to a perpendicular object behind the subject (corner of the room, door, window etc.). A positive sign is noted when a swaying, sometimes irregular swaying and even toppling over occurs. The essential feature is that the patient becomes more unsteady with eyes closed.

The essential features of the test are as follows:

1) the subject stands with feet together, eyes open and hands by the sides.
2) the subject closes the eyes while the examiner observes for a full minute.

Because the examiner is trying to elicit whether the patient falls when the eyes are closed, it is advisable to stand ready to catch the falling patient. For large subjects, a strong assistant is recommended.

Romberg test is positive if the patient sways or falls while the patient’s eyes are closed.

Patients with a positive result are said to demonstrate Romberg’s sign or Rombergism. They can also be described as Romberg’s positive. The basis of this test is that balance comes from the combination of several neurological systems, namely proprioception, vestibular input, and vision. If any two of these systems are working the person should be able to demonstrate a fair degree of balance. The key to the test is that vision is taken away by asking the patient to close their eyes. This leaves only two of the three systems remaining and if there is a vestibular disorder (labyrinthine) or a sensory disorder (proprioceptive dysfunction) the patient will become much more imbalanced.

References for text:
– Link 1

Romberg Test by Dr. Timothy Conwell is an instructional video clip that demonstrates how to perform the modified Romberg Test which screens for equilibrium dysfunction (balance) and differentiates between lesions of the vestibular apparatus (inner ear) and posterior column-medial lemniscus tract (body’s sense of positioning -proprioception).

This free YouTube clip is part of an hour-long instructional medical video program by Dr. Conwell that covers in detail how to perform a screening evaluation of the CENTRAL NERVOUS SYSTEM (Program I of a three-program video trilogy) in the clinical setting. The full hour long instructional video is a valuable aid in assisting students and young clinicians who are looking for a clear and concise vehicle to expand their exam procedures to enhance overall clinical skills. This teaching video may also be very helpful when reviewing for board examinations.

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Video Program I – CENTRAL NERVOUS SYSTEM SCREENING EXAM
This full hour long instructional video demonstrates how to perform a neurological examination to evaluate for a CNS lesion which includes screening for mental status, cognition, cerebral cortex, cerebellar function tests (gait, coordination, equilibrium), cranial nerves (CN) & spinal cord tracts. This video also demonstrates the 75 second in office cranial nerve exam.
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Video Program II – PERIPHERAL NERVOUS SYSTEM SCREENING EXAM
This full hour long instructional video demonstrates how to screen for a PNS lesion. The video covers in detail how to evaluate deep tendon reflexes (DTR’s), perform an upper and lower extremity sensory exam (dermatomes), perform an upper and lower extremity motor exam (Kendall & Kendall muscle grading scale), evaluate the brachial and lumbosacral plexus, and how to perform a “three minute” PNS exam.
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Video Program III – SPINE & PARASPINAL MUSCULOSKELETAL SCREENING EXAM
This full hour long instructional video demonstrates how to screen for a musculoskeletal lesion of the axial skeleton. The video covers in detail how to perform the visual inspection exam, palpation of the Cervical and Lumbar spine and associated paraspinal tissues, Range of Motion of the Cervical and Lumbar spine (active, passive, resistive maneuvers to DDx sprain v. strain), orthopedic testing (provocative maneuvers), peripheral vascular exam, and evaluating for non-organic physical signs.
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