Timed single leg stance (SLS) has been correlated with amplitude and speed of sway in people without disease (Billek, 1990). The ability to maintain SLS generally decreases with increasing age (Bohannon et. al, 1985; Ekdahl . al, 1989). Single leg stance has been shown to improve over the course of 6 months of rehabilitation (Judge et. al, 1993) and during the multi-site FIXCIT trials. Initial foot position affects the ability to stand in single leg stance (Kirby, Price and MacLeod, 1987). Rossiter and Wolf et. Al (1995) found that older adults in the community could maintain SLS for 10 sec about 89% of the time and nursing home residents for 45% of the time.
Instructions for the Patient (Eyes Open, SLS):
Stand on one leg, place your arms across your chest with your hands touching your shoulders and do not let your legs touch each other. Look straight ahead with your eyes open and focus on an object about 3 feet in front of you. Ideally do this with the shoes off.
Criteria to stop timing the test:
The legs touched each other, the feet moved on the floor, their foot touches down, or the arms moved from their start position.
Instructions for the Patient (Eyes Closed, SLS):
Stand on one leg, place your arms across your chest with your hands touching your shoulders and do not let your legs touch each other. Close your eyes once you have gotten in position. Ideally do this with the shoes off and be about 3 feet from any wall.
Criteria to stop timing the test:
The legs touched each other, the feet moved on the floor, their foot touches down, the eyes open during the eyes closed test, or the arms moved from their start position.
Romberg
Instructions for the Patient (Eyes Open, Romberg):
Stand with both ankle bones touching each other with your hands crossed and touching the opposite shoulders. Stand without shoes on, if possible, and look straight ahead at a target about 3 feet in front of you. Try to stay in this position for 30 sec.
Criteria to stop the test (Eyes Open, Romberg):
The test is stopped if the subject moves their feet on the floor or changes their arm starting position. The test is timed and could be rated for the amount of sway (see CTSIB criteria (Horak, 1987))
Instructions for the Patient (Eyes Closed, Romberg):
Stand with both ankle bones touching each other with your hands crossed and touching the opposite shoulders. Stand without shoes on, if possible, and look straight ahead with your eyes closed. Try to stay in this position for 30 sec.
Criteria to stop the test (Eyes Open, Romberg):
The test is stopped if the subject moves their feet on the floor, opens their eyes, or changes their arm starting position. The test is timed and could be rated for the amount of sway (see CTSIB criteria (Horak, 1987))
Sharpened Romberg (Tandem)
Instructions for the Patient (Eyes Open, Sharpened Romberg):
Stand with one foot directly in front of the other with your eyes open. Place your arms on your chest crossed with your hands touching your opposite shoulder. Do this test 3 feet from the wall and focus on a visual target. Stand with your eyes open for 30 sec.
Instructions for the Patient (Eyes Closed, Sharpened Romberg):
Stand with one foot directly in front of the other with your eyes closed. Place your arms on your chest crossed with your hands touching your shoulders. Stand with your eyes open for 30 sec.
Criteria to stop timing the test:
The feet moved on the floor, the eyes open during the eyes closed test, or the arms moved from their start position.
Romberg References:
Black FO, Wall C, Rockette H, Kitch R. Normal subject postural sway during the Romberg test. Am J Otolaryngol. 3:309-318, 1982
Newton R. Review of tests of standing balance abilities. Br Injury 3(4):335-343, 1989
Single Leg Stance References:
O'Loughllin J. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol. 137:342-354, 1993
Vellas BJ, Wayne S, Romero L, et al. One-leg balance is an important predictor of injurious falls in older persons. J Amer Geriatr Sco. 45:735-738, 1997
Bohannon R, Larkin P, Cook A, Gear J, Singer J. Decrease in timed balance test scores with aging. Phys Ther 64(7):1067-70, 1984
Susan L. Whitney, PhD, PT, ATC
University of Pittsburgh
CORE Network, Eye and Ear Institute