Vestibular Rehab balance tests

During the initial assessment of a vestibular rehabilitation appointment, there are a lot of different balance tests to perform. This will be guided by what the patient tells us in the subjective or interview part of the assessment. There are 2 outcome measures that we use very frequently with patients. The Romberg test and the Functional Gait Assessment. Both are very simple tests to perform in the clinic and can tell us a lot about how each patient is functioning. They are also great at helping guide what exercises we give patients to do at home.

The Romberg test was named by 19th century neurologist Mortiz Romberg. To carry out this test, we ask the patient to take off their shoes and stand with their feet together and with their arms crossed. We ask them to hold this position for 30 seconds. We then ask them repeat this but this time ask the patient to close their eyes. A positive Romberg test is one where a patient is unable to maintain an upright stance with their eyes closed (1). People who have a positive Romberg test may have described difficulty moving around in the dark or maintaining their balance while washing their face or hair. We will sometimes modify this test to make it a bit tougher. For example, standing on a foam mat, or standing in step stance or on one foot depending on how good their standing balance is.  In PMC Physiotherapy Clinic Dunboyne, we have a force plate that we use for some patients to give an accurate measure of how much sway somebody exhibits when they stand with their eyes open versus with their eyes closed.

After a vestibular event such as a viral infection of the inner ear, standing balance has been shown to improve quite quickly. However, dynamic balance tasks such as walking with head movements continued to be abnormal at 3 months compared to controls in the same study (2). Patients with balance or vestibular disorders frequently demonstrate an unsteady walking pattern, poorer standing balance and fall more frequently than community-living adults without a balance or vestibular dysfunction (3-6).

Because of this, the other balance test we frequently use is the Functional Gait Assessment. This was developed to measure dysfunction while walking, as well as more complex tasks while walking. Like the Rhomberg test, this can easily be performed in the clinic.  There are 10 parts in the assessment. These include simply walking, walking with changes in speed, stepping over an obstacle, moving head while walking and using the stairs. While a patient is performing the assessment, the physio is looking for any deviations in their gait or walking pattern such as reducing speed, reducing step length, imbalance, staggering etc. Each item is given a score where 3 is Normal and 0 is a severe impairment.

We know that people with balance or vestibular disorders tend to have difficulty maintaining head or trunk stability and gaze stability while walking and moving their head (7), and this is probably the part of the Functional Gait Assessment that I see people have most difficulty with. This can manifest in day-to-day problems such as going for a walk and trying to have a conversation with someone beside them.  Or at a higher functional level, playing a football where the patient may be running and have difficulty scanning the pitch.

Both tests give us a clearer picture of where a patient is functionally and can give us a good idea of what aspects of their balance we need to target when designing their rehabilitation programme. These are also a vey useful tool to see how successful their programme is, as on subsequent visits the tests can easily be repeated.

If you have recently experienced a vestibular event such as a viral infection of the inner ear or your are concerned about poor balance, contact one of our physios at PMC Physiotherapy Dunboyne and get it checked out.

1.     Lanska DJ. The Romberg sign and early instruments for measuring postural sway. Semin Neurol. 2002 Dec;22(4):409-18.
2.     Whitney SL, Hudak MT, Marchetti GF. The Dynamic Gait Index relates to self-reported fall history in individuals with vestibular dysfunction. J Vestib Res. 2000;10:99–105.
3.     Herdman SJ, Blatt P, Schubert MC, Tusa RJ. Falls in patients with vestibular deficits. Am J Otol. 2000;21:847–851
4.     Murray KJ, Hill K, Phillips B, Waterston J. A pilot study of falls risk and vestibular dysfunction in older fallers presenting to hospital emergency departments. Disabil Rehabil. 2005;27:499–506
5.     Pothula VB, Chew F, Lesser TH, Sharma AK. Falls and vestibular impairment. Clin Otolaryngol Allied Sci. 2004;29:179–182.
6.     Allum JH, Adkin AL. Improvements in trunk sway observed for stance and gait tasks during recovery from an acute unilateral peripheral vestibular deficit. Audiol Neurootol. 2003;8:286–302.
7.     Patten C, Horak FB, Krebs DE. Head and body center of gravity control strategies: adaptations following vestibular rehabilitation. Acta Otolaryngol. 2003;123:32–40