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Romberg Balance Test

The Romberg Balance Test was named after the German neurologist Moritz Heinrich Romberg (1795-1873).  The Romberg test used by members of the California Highway Patrol, San Francisco Police Officers and other law enforcement officers as a Field Sobriety Test (FST) for drivers suspected of driving under the influence (DUI). However, the Romberg Test is not a Standardized Field Sobriety Test (SFST) It is also used by physicians in a neurological examination.

As a Field Sobriety Test, the Romberg Balance Test 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 in space), sensation (the ability to feel touch, pressure, or vibration -- e.g., to feel one's feet against the ground), and vision (which can be used to monitor changes in balance). A person who has a problem with proprioception can still maintain balance by using sensation and vision. In the Romberg test, the subject is asked to close their eyes while standing in a fixed position with their hands at their sides.

The subject performing the Romberg Balance Test is also instructed to estimate thirty (30) seconds in their mind.   This is used to gauge the subject's internal clock and can be an indicator of stimulant or depressant use.  Alcohol is generally considered to be depressant.

Performance on the Romberg Balance Test is evaluated on the individual components of balance and the internal clock segment of the test.  As such, it is a two part Field Sobriety Test and used as an indicator for possible alcohol or drug impaired driving. To some degree,  the Romberg Test is a divided attention test.

A loss of balance is interpreted as a positive Romberg sign and as an indication that the driver may be under the influence. Estimating the passage of thirty (30) seconds between twenty (20) and forty (40) seconds is within the passing range for the internal clock portion of the Field Sobriety Test according to the California Highway Patrol DUI Enforcement Manual.

The Romberg Balance Test is a test of the body's sense of positioning (proprioception), which requires healthy and unimpaired functioning of the dorsal columns of the spinal cord. The Romberg test is also used to investigate the cause of loss of motor coordination (ataxia). A positive Romberg test suggests that the ataxia is sensory in nature, that is, depending on loss of proprioception. If a subject is ataxic and Romberg's test is not positive, it suggests that ataxia is cerebellar in nature, that is, depending on localized cerebellar dysfunction instead. 

Romberg Balance Test Administration

The subject is asked to stand erect with feet together and eyes closed. The examiner watches for movement of the body in relation to a perpendicular object behind the subject (corner of building, light post, sign post, door, window or some other stationary vertical object). 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 than when opened.

The subject is also instructed to estimate the passage of thirty (30) seconds in their head.  Although not indicated on the police reports, passing the internal clock portion of the test requires the subject to be within ten (10) seconds of thirty (30) seconds.

Romberg Balance Test Subject Position

   1. the subject stands with feet together, eyes open and hands by the sides.
   2. the subject closes the eyes while the examiner observes the subject for a minimum of thirty (30) seconds and records performance when the subject closes their eyes.

The examiner is trying to determine whether the DUI suspect sways when the eyes are closed.

Romberg's Field Sobriety Test is positive if the subject sways while the eyes are closed.

Subjects with a positive result are said to demonstrate Romberg's sign or Rombergism. They can also be described as Romberg 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 unless illness, disease, impairment or some other disorder is present. 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 lose balance and sway.

Romberg Test Physiology

Maintaining balance while standing in the stationary position relies on intact sensory pathways, sensorimotor integration centers and motor pathways.

The main sensory inputs are:

   1. Joint position sense (proprioception), carried in the dorsal columns of the spinal cord;
   2. Vision
   3. Vestibular apparatus

Crucially, a healthy and unimpaired brain can obtain sufficient information to maintain balance if any two of the three systems are intact.

Sensorimotor integration is carried out by the cerebellum and by the dorsal column-medial lemniscus tract. The motor pathway is the corticospinal (pyramidal) tract and the medial and lateral vestibular tracts.

The first stage of the test (standing with the eyes open), demonstrates that at least two of the three sensory pathways is intact, and that sensorimotor integration and the motor pathway are functioning.

In the second stage, the visual pathway is removed by closing the eyes, known as a "sharpened Romberg". If the proprioceptive and vestibular pathways are intact, balance will be maintained. But if proprioception is defective, two of the sensory inputs will be absent and the patient will sway.

The sharpened Romberg does have an early learning effect that will plateau between the third and fourth attempts.

Positive Romberg

Romberg's test is positive in conditions causing sensory ataxia such as:

Conditions affecting the dorsal columns of the spinal cord, such as tabes dorsalis (neurosyphilis), in which it was first described.
Conditions affecting the sensory nerves (sensory peripheral neuropathies), such as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).
Friedreich's Ataxia

Romberg and Cerebellar function

Romberg's test is not a test of cerebellar function, as it is commonly misconstrued. Patients with cerebellar ataxia will, generally, be unable to balance even with the eyes open; therefore, the test cannot proceed beyond the first step and no patient with cerebellar ataxia can correctly be described as Romberg's positive. Rather, Romberg's test is a test of the proprioception receptors and pathways function. A positive Romberg's test has been shown to be 90% sensitive for lumbar spinal stenosis.