What Is the Romberg Test for MS?

Around 75% of people with multiple sclerosis experience issues with their balance, due to direct damage to nerves or because other symptoms (like spasticity, vision problems, or muscle weakness) interfere with the signals that help you stay upright.

That’s why your doctor may ask you to perform what’s known as the Romberg test—a simple neurological exam that can be used to evaluate the impact of the disease. We went to the experts to find out when and how the test is used, what it means, and what you can expect if you are asked to try it.

The Romberg Test, which has been in use since the 19th century and is named after European neurologist Mortiz Romberg, was not developed specifically for MS, although it is a common assessment that neurologists use to assess levels of disability. It’s also used to help identify balance problems caused by numerous other conditions, according to the Cleveland Clinic, including Parkinson’s disease, vitamin B12 deficiency, and Ménière’s disease (an inner ear problem that causes vertigo).

Here’s how the Romberg test works:

• You’ll be asked to remove your shoes and stand with both feet together, with your arms at your sides for 30 seconds.

• Next, you’ll be asked to close your eyes as you remain standing still for another 30 to 60 seconds.

It’s during this second part of the exam that any balance problems will likely show themselves. “A positive test, called a Romberg sign, is seen when the patient loses their balance, stumbles, or has to take a step when their eyes are closed [during the test],” says Tirisham Gyang, M.D., a neurologist who specializes in MS at The Ohio State University Wexner Medical Center in Columbus, OH.

The Romberg test is an assessment of your balance, which can be used as an indicator of MS and to evaluate how the disease has progressed. The test measures one of the three different systems that work together to help your body achieve balance.

These are the systems in your body that coordinate your balance, per the Cleveland Clinic:

• Vision, which allows you to see where you are.

• The vestibular system, located in your inner ear, which helps you to maintain your balance as you move your head or body.

• Proprioception, which is your body’s ability to sense its position in space through the use of sensory signals that travel from your skin, muscles, and joints to your central nervous system.

With your eyes open, visual signals sent to your brain help you establish your position and allow you to maintain your balance. Closing your eyes cuts off those visual signals. The Romberg test also cancels out the ability of your vestibular system to help you maintain balance. That leaves your proprioception to do the work of keeping you standing still—and it’s proprioception that gets distorted by MS.

In multiple sclerosis, the areas of the central nervous system that control proprioception— located in the dorsal column in the back of your spinal cord—can come under attack, explains Dr. Gyang. The subsequent formation of lesions, or scars, can interfere with the nerve fibers that carry sensory signals involved in balance.

“If you have a lot of those lesions on the tracks where those nerve fibers travel, then the proprioception in an MS patient can be significantly affected,” says Dr. Gyang. “If you lose that proprioception, your brain isn’t aware of exactly where all your body parts are, and so that manifests as a loss of balance.”

Having balance difficulties can impact you in a few different ways, adds neurologist Tyler Smith, M.D., a clinical assistant professor in NYU Langone Health’s Multiple Sclerosis Comprehensive Care Center in New York City. “Commonly, impaired proprioception will lead to difficulty ambulating and coordinating limb movements,” says Dr. Smith.

Troubles with balance becomes even more pronounced in the dark, adds Dr. Gyang, because you can’t see well enough to compensate for your problems with proprioception. “[When there’s light], you know your left arm is here and the right leg is here. But in the dark, when you lose those visual cues, people tend to stumble and become more impaired in terms of losing balance or having trouble maintaining their balance,” she notes.

Balance problems increase the risk of dangerous falls as well as the fear of falling. Those fears, say the authors of a study published in the journal Frontiers in Neurology, “dramatically limit MS patients’ quality of life and can often lead to reduced activity levels, decreased productivity and social withdrawal.”

You should expect to undergo a Romberg test as part of your MS diagnosis as well as at every appointment with your neurologist.

“The Romberg test should be the part of each neurological exam done each time the patient is seen, if the patient can stand,” says neurologist Irena Dujmovic Basuroski, M.D., Ph.D., the multiple sclerosis/neuroimmunology division chief at UNC School of Medicine’s Department of Neurology in Chapel Hill, NC.

That’s because the test helps doctors keep tabs on the disease’s progression, says Dr. Dujmovic Basuroski. It’s one tool they use to determine whether your MS is in remission or whether you’re having a flare-up (also called a relapse or an exacerbation) in which your MS symptoms intensify. The results of several Romberg tests over time also can indicate whether your symptoms are slowly getting worse, says Dr. Dujmovic Basuroski.

Mobility problems, which include difficulties with balance, are among the most common symptoms of MS, according to the National Multiple Sclerosis Society. But they are far from the only issue. Since MS affects the central nervous system, damage can occur in the brain, spinal cord, and optic nerves. Just where those attacks occur and the subsequent symptoms that develop will differ from person to person with MS. And these symptoms can change over time. Other frequent symptoms of MS include:

• Fatigue

• Memory difficulties

• Mood changes

• Numbness

• Pain

• Tingling

• Vision impairment

Treating your balance issues from multiple sclerosis depends on what may be causing them—whether it’s due to a flare or ongoing progression of the disease.

Balance Issues Due to Flares

During a relapse, MS-related inflammation may cause new or worsening symptoms, which can include proprioception problems. That’s because your flare may trigger a new lesion or cause an older lesion to activate in the part of your spine where the nerve fibers that help control proprioception are found. “If it was related to an acute multiple sclerosis relapse, then treating with steroids may help,” says Dr. Smith. For severe relapses, doctors typically use high doses of corticosteroids—either in pill form or intravenously—to reduce that inflammation over the course of three to five days.

Dr. Gyang says that your neurologist also may recommend physical therapy during a flare-up in addition to steroid medications.

Balance Issues Due to Progression

People whose difficulties with proprioception have developed over time as their MS progressed require a different approach. That’s because the damage that’s causing the problem is permanent.

“We do not expect any medications to help with this problem, and this is where long term balance exercises are beneficial,” says Dr. Dujmovic Basuroski. “This is especially important in the aging population in which proprioception sensitivity will likely also decline due to the aging process.”

Dr. Gyang recommends neurologic physical therapists (PTs) for such patients. Neurologic PTs have specialized training that qualifies them to work with people who have neurological diseases such as MS. They design individualized programs that help to restore balance, improve the ability to walk, reduce the risk of falls, and more. Depending on your needs, your PT may recommend using mobility aids, like a cane or a walker, says Dr. Gyang.

The Romberg test is frequently used by neurologists to help evaluate whether multiple sclerosis has progressed and potential levels of disability. It’s a standard part of every exam and will help identify problems with proprioception. If your test is positive, treatment will depend on the cause. Medications, physical therapy, or both can help. Talk to your doctor about what the best plan of action might be best for you.