Positive Romberg Test: Procedure, Causes & Next Steps

Receiving a positive Romberg test result can raise a lot of questions. You may be wondering what the result means, what happens next, and how worried you should be.

This guide explains what a positive Romberg test means and what to do next. We’ll cover:

• What the Romberg test measures (and what it doesn’t)
• How the test is performed (standard and modified versions)
• How clinicians interpret positive vs. negative results
• Common categories of conditions linked with a positive Romberg sign
• Typical follow-up evaluation (what might be checked next)
• Practical steps to improve balance and reduce fall risk

Important: This article is for education only. It can’t diagnose you or replace an exam with a qualified clinician.

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Quick Answer: What Is a Positive Romberg Test?

The Romberg test is a simple bedside balance test used in neurological exams. A clinician observes as you stand with your feet together, first with your eyes open, and then with your eyes closed.

A positive Romberg test means you can stand relatively steady with your feet together and eyes open, but when you close your eyes, your body sways a lot, you need to step to catch yourself, or you would fall if the examiner didn’t support you.

Neurology references like StatPearls and the Cleveland Clinic’s Romberg test overview describe a positive Romberg sign as a loss of balance with eyes closed in someone who can maintain balance with eyes open.

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Why Clinicians Do the Romberg Test

Staying upright requires your brain to continually integrate three kinds of input:

• Vision – what you see
• Proprioception – sensors in your muscles and joints that tell the brain where your body is in space
• Vestibular system – structures in the inner ear that detect head movement and position

Many clinical references explain balance as the combined output of these systems; the Romberg maneuver removes visual input to see how well the remaining systems compensate (Cleveland Clinic, StatPearls).

Common reasons to use the Romberg test include:

• Unsteady walking or standing (ataxia)
• Frequent falls or near-falls
• Numbness, tingling, or “dead feet” in the legs
• Trouble walking in the dark
• Dizziness or vertigo
• Suspected neurologic or inner ear disorders

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How the Romberg Test Is Performed (Step-by-Step)

The classic Romberg test is quick, low-tech, and usually takes less than a minute.

Standard Romberg test

1. Set-up and safety

   • You stand with feet together, arms at your sides or crossed.
   • Your clinician stands close enough to catch you if you start to fall.
   • The area around you is cleared to prevent injury.

2. Eyes open phase (baseline)

   • You keep your eyes open, focusing on a point ahead.
   • The clinician watches for sway, stepping, or arm movements.

3. Eyes closed phase (Romberg)

   • You then close your eyes while maintaining the same stance.
   • The clinician continues to guard you and observes for changes in sway or loss of balance.

Cleveland Clinic describes the test in this same eyes-open then eyes-closed sequence, typically held for 30 seconds to one minute (Cleveland Clinic).

Sharpened and single-leg Romberg variations

To make the test more sensitive, especially in mild cases, your clinician might also use:

• Sharpened Romberg test (tandem stance): one foot directly in front of the other, heel-to-toe
• Single-leg stance (single-leg Romberg): standing on one leg instead of two
• Foam surface or soft mat: to further challenge sensory input from the feet

These variations (especially tandem stance) are commonly discussed in clinical teaching resources and reviews (StatPearls, Healthline’s Romberg test explainer, Physiopedia’s Romberg test guide).

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Positive vs. Negative Romberg Test: How It’s Interpreted

Different textbooks and clinicians use slightly different wording, but most agree on the core ideas.

Negative Romberg test

A negative Romberg test generally means:

• You can stand with feet together with eyes open and closed
• Only mild, normal sway is present
• You don’t need to take a step or reach out to avoid falling

Positive Romberg test

A positive Romberg test generally means:

• You can stand reasonably well with eyes open, but
• When you close your eyes, you:
  • Sway much more, and/or
  • Take one or more steps to catch yourself, or
  • Would fall without support

This “stable with eyes open, unstable with eyes closed” pattern is classically associated with sensory ataxia (impaired proprioception pathways), not primarily cerebellar dysfunction (StatPearls).

Sensory vs. cerebellar ataxia

One of the most common clinical uses of the Romberg test is distinguishing sensory ataxia from cerebellar ataxia:

• Sensory ataxia (often positive Romberg):
  Clinicians often look for accompanying signs of impaired position/vibration sense (from peripheral nerves or dorsal columns), and a history of worse balance in low-light situations (StatPearls).

• Cerebellar ataxia (often not a “classic positive” Romberg):
  People may be unsteady even with eyes open, and closing the eyes may not change stability much—because the underlying problem is coordination and postural control rather than sensory input (StatPearls).

Because real patients are more complex than textbook patterns, clinicians interpret Romberg results alongside the rest of the neurologic exam, gait assessment, and symptom history.

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Conditions Associated With a Positive Romberg Test

A positive Romberg sign tells your clinician where in the balance system the problem might be. It does not identify a specific disease on its own (Cleveland Clinic).

Below are common categories of conditions linked with a positive Romberg sign in clinical reviews.

1. Dorsal column disorders (proprioception pathways)

Since the Romberg test assesses the dorsal column pathway, a positive result may be seen in conditions that impair it, such as (StatPearls):

• Vitamin B12 deficiency (subacute combined degeneration) — vitamin B12 deficiency can cause neurologic changes, and symptoms can occur even without anemia (NIH vitamin B12 fact sheet).
• Copper deficiency myelopathy (sometimes related to malabsorption or excess zinc) — copper deficiency is uncommon but can cause neurologic issues including ataxia (NIH copper fact sheet).
• Posterior cord syndrome (e.g., spinal cord infarction)
• Brown-Séquard syndrome (spinal cord hemisection)
• Neurosyphilis (tabes dorsalis) — historically the classic association with a positive Romberg sign

Clue from daily life: people with impaired proprioception often struggle more in dim light or darkness—because there’s less visual input available to “fill in the gaps” (StatPearls).

2. Peripheral sensory neuropathies

When the nerves carrying position and touch information from the feet and legs are damaged, people may have numbness/tingling plus worsening balance without visual cues, potentially causing a positive Romberg test.

Examples include:

• Diabetic peripheral neuropathy — severe cases with loss of proprioception may show a positive Romberg sign (Diabetes Care review).
• Other acquired neuropathies that can impair sensation and balance include alcohol-related neuropathy, toxin-related neuropathy, and chemotherapy-induced peripheral neuropathy (National Institute of Neurological Disorders and Stroke (NINDS) overview of peripheral neuropathy).

3. Vestibular (inner ear) disorders

Some vestibular disorders can also produce unsteadiness, especially when compensation is incomplete. StatPearls lists Ménière’s disease among conditions in which a Romberg sign can be seen (StatPearls).

• Ménière’s disease causes episodes of vertigo, tinnitus, hearing loss, and ear fullness (National Institute on Deafness and Other Communication Disorders (NIDCD)).

Guidance from the American Academy of Family Physicians (AAFP) notes that vertigo with unilateral hearing loss can suggest Ménière disease. The same guidance reviews other vestibular causes and bedside tests like the HINTS exam (Head-Impulse, Nystagmus, Test-of-Skew).

4. Broader neurologic conditions

A positive Romberg sign can also be part of a larger clinical picture in several neurologic conditions (StatPearls), including:

• Parkinson’s disease, which can cause postural instability (balance problems) and increase fall risk (National Institute of Neurological Disorders and Stroke (NINDS)).
• Normal pressure hydrocephalus (NPH), which can feature an early gait disturbance and unsteadiness along with urinary symptoms and cognitive changes (Merck Manual overview of NPH).
• Wernicke encephalopathy / Wernicke-Korsakoff syndrome, related to thiamine deficiency, which can include ataxia among symptoms (MedlinePlus).

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What a Positive Romberg Test Does Not Mean

A positive Romberg test does not automatically mean:

• That you have a specific disease like MS, Parkinson’s, or neurosyphilis
• That your condition is permanent or untreatable
• That you’re destined to fall or lose independence

Instead, think of the Romberg sign as a directional clue—it helps your clinician decide which parts of the balance system may need closer evaluation (Cleveland Clinic).

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What Happens After a Positive Romberg? Typical Next Steps

Follow-up after a positive Romberg test is individualized, but it often includes some combination of:

1. Detailed history and neurologic exam

Your clinician may ask about symptom timing, numbness/tingling, new medications, alcohol use, and other neurologic symptoms. In primary care, dizziness and imbalance are commonly approached by asking about Timing, Triggers, and a Targeted Exam (AAFP’s dizziness evaluation article).

2. Lab tests

Blood work may be used to look for reversible or treatable contributors, such as:

• Vitamin B12 status (and sometimes methylmalonic acid/homocysteine, depending on context) (NIH vitamin B12 fact sheet)
• Copper status in selected cases (especially if malabsorption or excess zinc intake is suspected) (NIH copper fact sheet)
• Diabetes-related tests when neuropathy is suspected (Diabetes Care review)

3. Imaging and specialized studies

Depending on your symptoms and examination findings, your clinician might consider:

• MRI of the brain and/or spine
• Nerve conduction studies / EMG for suspected neuropathy
• Vestibular testing when dizziness/vertigo is prominent

4. Referral

Common referrals include neurology, ENT/otology, and physical therapy (especially vestibular or neuro PT).

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Living With Balance Problems: Reducing Fall Risk Right Now

A positive Romberg test suggests your margin for error is smaller, especially in low-light environments where vision can’t compensate.

1. Simple home safety upgrades

The CDC’s home fall-prevention checklist recommends steps like removing or securing throw rugs, keeping walkways clear, improving lighting (including the path from bed to bathroom), and adding grab bars and non-slip surfaces in bathrooms (CDC STEADI home checklist PDF).

2. Targeted strength and balance training

A large Cochrane systematic review found that exercise reduces the rate of falls in older adults living in the community, with balance/functional exercise being particularly effective (Cochrane review abstract on PubMed).

If you want a structured starting point, see:

• Fall prevention exercises to improve balance and strength
• How to improve balance: exercises for every level

3. Bone health matters when balance is impaired

If balance is impaired, bone strength becomes even more important—because fractures are often the most serious consequence of a fall.

• If you have risk factors for low bone density, ask your clinician whether you need a diagnostic hip/spine DXA (DEXA) bone density test. Our guide explains what it measures and who typically needs it: DEXA bone density test: a complete guide.

4. Tracking muscle and bone health to support stability

Regular whole-body DEXA (DXA) wellness scans can help you track key metrics that support stability—especially muscle mass and whole-body bone mineral density trends.

Two important clarifications:

• BodySpec’s scans are whole-body wellness scans, designed for tracking body composition and trend data over time.
• They are not the same as a clinician-ordered diagnostic bone density DXA (which focuses on the hip and spine and is used to diagnose osteoporosis/osteopenia). If you’re deciding which scan you need, this comparison can help: DEXA body composition vs. bone density: which scan is right for you?.

If you’re using balance training, strength training, weight loss, or a metabolic health plan as part of your strategy to improve stability and strength, having a repeatable DEXA baseline can make progress easier to see. If you’d like to establish that baseline, you can book a BodySpec DEXA scan appointment.

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For Students and Clinicians: Quick Interpretation Table

Always interpret in context of the full neurologic exam and history. The table above is simplified for teaching purposes and does not replace clinical judgment.

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FAQs About a Positive Romberg Test

Is a positive Romberg test dangerous?

The test itself is safe when done correctly because the clinician guards you to prevent a fall. A positive result is a warning sign that your balance system is compromised, especially without visual input (Cleveland Clinic).

Can a Romberg test be positive in healthy people?

A clearly positive Romberg (needing to step or falling with eyes closed after standing steadily with eyes open) is unusual in healthy adults. Mild extra sway with eyes closed is common and doesn’t necessarily mean the test is “positive” (StatPearls; Healthline).

Will my Romberg test always stay positive?

Not necessarily. If the underlying cause is treatable—such as vitamin deficiency or certain vestibular disorders—balance can improve with treatment and rehabilitation (StatPearls).

What should I ask my clinician if my Romberg test is positive?

• What do you think is the most likely cause of my balance problems?
• Do I need blood tests (like vitamin B12) or other labs?
• Do I need imaging or nerve/vestibular testing?
• Should I see neurology, ENT, or physical therapy?
• What can I do at home this week to lower my fall risk?

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Key Takeaways

• A positive Romberg test means balance worsens significantly when your eyes are closed, suggesting an issue with proprioception pathways and/or vestibular function, not primarily the cerebellum (StatPearls).
• It’s a screening clue, not a diagnosis; clinicians interpret it with the rest of the neurologic exam and your history (Cleveland Clinic).
• Common associated categories include dorsal column disorders (e.g., B12 deficiency), peripheral neuropathies (including diabetic neuropathy), vestibular disorders (e.g., Ménière’s disease), and broader neurologic syndromes.
• While evaluation is underway, you can often lower fall risk with home safety steps and strength/balance training—and use measurement tools (including, when appropriate, DEXA scans) to track progress.