The Romberg Test is a neurological test to detect poor balance. Specifically, it detects the inability to maintain a steady standing posture with the eyes closed. The test is named after the 19th century German Ear Specialist, Moritz Heinrich Romberg (1795-1873).

The test consists of standing with your feet together and your eyes closed. The neurologist will often push you slightly to check whether you are able to compensate and regain your posture. He or she should also stand close by to catch you if you sway excessively or fall. A positive Romberg is excessive swaying or even falling over and is sometimes called Romberg's Sign. There are several variants of Romberg's Test - some involve different positions of the feet, for example, standing heel-to-toe - others use mechanical devices to quantify the dysfunction.

Some people without neurological or balance problems have some problems maintaining a steady posture.

A positive Romberg's sign indicates one or more of these problems:

• Vertigo or Vestibular Ataxia - problems with the balance organs in the inner ear or sensory feedback. These can be caused by
• problems in the inner ear itself
• problems in the cranial nerve supplying the ear (CN VIII)
• lesions in the Pons region of the brainstem where CN VIII arises
• damage to other central nervous system pathways which connect to the Pons
• Cerebellar Ataxia - this is dysfunction caused by damage to a brain region called the cerebellum or to nervous pathways connecting to it. The cerebellum is responsible for assimilating sensory data, for example limb position and visual data, and co-ordinating movements resulting from that.
• Proprioceptive Dysfunction. Proprioceptive sensors are located in the muscles and joints and feedback positional data to the cerebellum. Damage anywhere along the pathway from the proprioceptive sensors to the cerebellum can give rise to cerebellar ataxia.

The Romberg Test is a non-specific test of neurological or inner ear dysfunction and is not indicative of a specific condition. It is usually combined with other tests including finger-to-nose tests. Vertigo, vestibular and cerebellar ataxia and proprioceptive dysfunction are all relatively commonly seen in multiple sclerosis.

Failure to compensate in a particular direction is indicative of damage on a particular side of the central nervous system.

Romberg Test links:
Romberg Test (with video demonstration)
Balance Assessment: a modified Romberg test
Cerebellar and proprioceptive function

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