gms | German Medical Science

Background: Traditionally the Romberg test is used to investigate the presence of a balance disorder. As this test is neither sensitive nor specific to balance disorders, the question arises whether carrying out stance tests on foam support might be more selective and more visible to the examiner. Here we review our evidence supporting use of foam.

Methods: All participants performed 4 two-legged stance tests as part of a battery of 14 stance and gait tasks. Subjects stood without shoes with the feet at shoulder width apart, eyes open and then eyes closed on a firm surface and then repeated on a foam surface (eof, ecf). Trunk sway angle and velocity in the pitch (AP) and roll (ML) directions were measured at L1-3 with a SwayStarTM system. Peak-to-peak values quantified population differences.

Results: Both chronic bilateral vestibular loss (BVL) and bilateral lower-leg proprioceptive (BPL) loss patients showed significantly larger sway for ecf conditions (Horlings et al 2008). The difficulty of BVL patients is easily noticed in their tendency to fall. Romberg quotients were equal to those of controls in BVL subjects, slight larger in BPL subjects. Acute unilateral vestibular loss patients first show improvement between 1 and 3 months for ecf stance conditions (Allum and Adkin 2003). On a normal surface, improvement is within the first month. Use of foam also provides indicators of non-organic-balance disorders (Vonk et al 2010).

Conclusions: This evidence supports the using a foam surface during stance trials being more sensitive to balance disorders than use of a firm surface as in the traditional Romberg test. Because the stance eyes closed on foam is not specific to one type of balance disorder, gait tests should also be used to aid functional diagnosis (Allum and Carpenter, 2005). However a patient’s instability is clearly observed on a foam surface.