Which bedside tests assess balance and proprioception in vestibular assessment?

• A. Romberg test, tandem gait, Fukuda stepping test
• B. Dix-Hallpike, caloric testing, ENG
• C. Audiometry, tympanometry, otoacoustic emissions
• D. Vasalva maneuver, sniff test, head thrust test

Answer: (A)

Balance and proprioception at the bedside are best assessed with simple maneuvers that challenge posture without relying on vision. The Romberg test checks static balance by comparing stability with eyes open versus eyes closed; increased sway or loss of balance with the eyes closed points to a reliance on vestibular and proprioceptive inputs and possible sensory integration issues. Tandem gait tests dynamic balance and precise proprioceptive control by having you walk heel-to-toe in a straight line; trouble staying in line or stepping oddly suggests impaired integration of vestibular and proprioceptive cues. The Fukuda stepping test looks at vestibulospinal function by having you march in place with eyes closed; a notable rotation or veering to one side indicates an asymmetric vestibular input, often from a unilateral vestibular deficit.

The other options involve tests that focus more on specific vestibular pathways or non-balance functions. Dix-Hallpike and caloric testing probe semicircular canal function and nystagmus in structured settings, not bedside balance, while audiometry, tympanometry, and otoacoustic emissions assess hearing and middle/inner-ear function rather than balance. The remaining items include a bedside vestibulo-ocular reflex test (head thrust) and functions like Valsalva or sniff tests that aren’t direct measures of balance or proprioception.