The Romberg Test: Measuring Balance Impairment in MS

Nerve impairment can affect your proprioception

One of the neurological tests doctors use to diagnose multiple sclerosis (MS) is the Romberg test, in which you place your feet together, extend your arms in front of you, and close your eyes. As simple as this may sound, people with MS will often find themselves nearly toppling over the moment their eyes are shut. What they've experienced is not clumsiness or a sudden bout of dizziness. It is a sensory effect known as Romberg's sign, or the loss of proprioception.

Understanding Proprioception

Proprioception is your ability to determine where you are in space without being able to see your surroundings. It is based on sensory input from the joints and muscles, affecting your awareness of your posture, weight, movement, and position of your limbs, both in relation to your environment and to other parts of your body.

Proprioception is an ability many often take for granted. They may fail to realize how important it is to their mobility and spatial awareness—arguably as much as sight, touch, or hearing.

Many people refer to proprioception as the "sixth sense."

How Proprioception Is Affected in MS

MS disrupts communications between the central nervous system (involving the brain and spinal cord) and the peripheral nervous system (covering the rest of the body) through a process known as demyelination. This happens when the protective covering of nerve cells is gradually stripped away, leading to the development of scar tissue, or lesions.

Because proprioception requires instant and coordinated communication between these systems, MS can leave you a little less "in touch" with your sensory responses. Oftentimes, the loss of balance is due to the disruption of nerve impulses from the ankles—the primary source of sensory feedback for balance—to the brain.

In addition to balance, you use proprioception to walk, eat, and pick up objects. When impaired, you can lose the ability to navigate spaces, play sports, or even drive.

Sensation and movement are inextricably linked. While the complete loss of proprioception is virtually impossible (given that you receive sensory information from all of your muscles and nerves), impairment of any sort can be unnerving and sometimes even debilitating.

What Is the Romberg Test?

The Romberg test is the gold standard for measuring proprioception. Here's how it's done:

  • You're asked to remove your footwear and stand upright with your feet together and your arms next to your body or crossed in front of your body.
  • You'll then be asked to close your eyes. The doctor will observe how well you are able to maintain your balance and an upright posture. The doctor may even push you slightly to see whether you are able to compensate and maintain an upright posture.

The Romberg test is considered to be positive if you are unable to stand for long with your eyes closed without losing your balance. You may sway and try to place one foot in front of the other to break your fall or fall completely.

A related test, sometimes called the dynamic Romberg test or Tandem walking, is the same as the classic test given to determine whether someone is intoxicated. You are asked to walk on a straight line and place one foot in front of the other. If your proprioception is compromised, you will have a hard time maintaining your balance and keeping your feet on the line.

Treating the Loss of Proprioception

Balance training is often used for people with MS to enhance the three sensory systems responsible for balance: proprioceptive, visual, and vestibular (inner ear). Since MS can affect one or more of these systems individually, therapists need to identify what role, if any, each part plays.

One of the frustrating aspects of the intervention is that some people improve their balance while others do not, often because the causes of a loss of proprioception can be so far-ranging and diverse. Your response to the Romberg test may also change from time to time depending on if you're having a relapse or your MS is worsening.

The location of MS lesions is usually key to understanding the problem. For example, the loss of proprioception is usually caused by a lesion on a single tract of the spinal cord. Any impairment of vision, meanwhile, is usually related to the development of lesions on the optic nerves or white matter areas in the posterior regions of the brain where the visual center is located. Similarly, problems with postural control (the ability to maintain an upright posture) are usually related to lesions on the brain stem affecting the vestibular system.

By addressing and integrating all of these sensory factors into balance training, therapists are more likely to achieve positive results in people with MS.

A Word From Verywell

Keep in mind that a positive result on either or both types of Romberg tests does not mean you have MS. There are various reasons someone may lose their balance during the test, including inner ear problems or vertigo. Many factors go into making a diagnosis of multiple sclerosis.

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