A Refined Vestibular Romberg Test to Differentiate Somatosensory from Vestibular-Induced Disequilibrium

Abstract

Background: The vestibular Romberg test, which assesses the deterioration of balance while standing on rubber foam with closed eyes, is a well-established method in the physical neurological assessment of patients with peripheral vestibulopathy. This study aims to determine whether it can differentiate peripheral vestibulopathy from its main differential diagnosis, namely sensory ataxia, as both conditions typically present with a positive classical Romberg test. Methods: Static balance was assessed in three groups: patients with peripheral vestibulopathy, patients with pure sensory neuropathy, and healthy age-matched controls. Participants stood quietly on a force platform under varying visual and proprioceptive feedback conditions. Conventional and advanced postural sway metrics were investigated to establish a quantitative analogy to both the clinical Romberg and vestibular Romberg tests. Results: Posturographic analysis revealed that, in contrast to healthy controls, patients with vestibular disorders exhibited higher vestibular Romberg quotient values. However, the classical vestibular Romberg quotient did not show diagnostic discrimination between vestibulopathy and sensory neuropathy patients. This lack of discrimination was mainly due to the increased body sway observed in all patient groups under the "eyes open" condition. Nevertheless, a refined vestibular Romberg quotient-comparing standing on foam versus standing on firm support with eyes closed-was able to reliably distinguish vestibulopathy from sensory ataxia. This distinction was evident in both conventional linear sway and spectral postural sway metrics. Conclusions: We conclude that a refined Romberg test, performed solely under conditions of visual deprivation, offers valuable classification potential in differentiating peripheral vestibulopathy not only from healthy controls but also from patients with disequilibrium due to sensory loss.

Keywords: Romberg’s test; ataxia; posturography; sensory neuropathy; vestibulopathy.

Figure 1

Recordings from a healthy participant (2nd column from left, blue) alongside those from a patient with pure sensory neuropathy (3rd column from left, green) and a patient with peripheral vestibulopathy (4th column from left, red). Comparison of antero-posterior (AP), medio-lateral (ML), and joint (AP vs. ML) postural sway. Each recording spans 40 s and is presented under four distinct sensory feedback conditions.

Figure 2

Distribution densities of linear domain vestibular RQs (A) and refined vestibular RQs (B). Significant differences between sensory neuropathy and vestibulopathy patients are observed only for refined vestibular RQs.