Quantitative Measurement of Hoover's Sign: Development of a Standardized Sensor, Interface Procedure, and Testing in Healthy Individuals
- 1Department of Neurology Teikyo University School of Medicine Itabashi‐ku Tokyo Japan
- 2School of Engineering The University of Edinburgh Edinburgh UK
- 3Centre for Clinical Brain Sciences University of Edinburgh Edinburgh UK
Abstract
Background Hoover's sign is a commonly used clinical sign for diagnosing functional leg weakness, a feature of functional neurological disorder (FND). However, it relies on clinicians’ qualitative assessment. Therefore, more reliable and objective assessment methods are needed. This study aims to develop a portable device and procedure for standardized quantitative measurement of Hoover's sign and validate its utility in healthy controls feigning leg weakness. Methods Healthy volunteers without medical backgrounds were recruited. A portable floor‐based device with a pressure sensor placed under the heel of one foot was developed to measure hip extension strength during voluntary and involuntary movements. Subjects performed the test under three conditions: healthy, feigning mild weakness, and feigning severe weakness. The involuntary/voluntary ratio (IV/V ratio) and the side ratio (the IV/V ratio of the feigning leg compared to the non‐feigning leg) were evaluated. Results Forty‐two subjects were recruited. In the healthy state, the mean IV/V ratio was 0.60 ± 0.23 on the right side and 0.62 ± 0.24 on the left. The IV/V ratio was significantly higher in the feigned leg during both mild (1.26 ± 0.49) and severe (1.83 ± 0.70) feigning compared to the healthy state (p < 0.001 for both), while it was significantly lower in the non‐feigned leg during mild (0.40 ± 0.22) and severe (0.32 ± 0.22) feigning (p < 0.001 for both). The side ratio also significantly increased during feigning. ROC analysis revealed optimal IV/V ratio cutoffs of 0.93 for distinguishing mild feigning (sensitivity: 77%, specificity: 93%), and 0.95 for severe feigning (sensitivity: 91%, specificity: 94%). Conclusions This portable device can provide a standardized quantitative measure of Hoover's sign and may be useful in future studies of functional leg weakness, particularly in patients with comorbid conditions.
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BibTeX
@article{kanbayashi2026quantitative,
title = {{Quantitative Measurement of Hoover's Sign: Development of a Standardized Sensor, Interface Procedure, and Testing in Healthy Individuals}},
author = {Takamichi Kanbayashi and Adarsh Nigam and Ciara Pletcher and Alexander White and Srinjoy Mitra and Jon Stone},
journal = {Brain and Behavior},
year = {2026},
month = nov,
doi = {10.1002/brb3.71893},
url = {https://doi.org/10.1002/brb3.71893},
note = {CC BY},
}
RIS
TY - JOUR
TI - Quantitative Measurement of Hoover's Sign: Development of a Standardized Sensor, Interface Procedure, and Testing in Healthy Individuals
AU - Takamichi Kanbayashi
AU - Adarsh Nigam
AU - Ciara Pletcher
AU - Alexander White
AU - Srinjoy Mitra
AU - Jon Stone
PY - 2026
DA - 2026/11/01
JO - Brain and Behavior
DO - 10.1002/brb3.71893
UR - https://doi.org/10.1002/brb3.71893
AB - Background Hoover's sign is a commonly used clinical sign for diagnosing functional leg weakness, a feature of functional neurological disorder (FND). However, it relies on clinicians’ qualitative assessment. Therefore, more reliable and objective assessment methods are needed. This study aims to develop a portable device and procedure for standardized quantitative measurement of Hoover's sign and validate its utility in healthy controls feigning leg weakness. Methods Healthy volunteers without medical backgrounds were recruited. A portable floor‐based device with a pressure sensor placed under the heel of one foot was developed to measure hip extension strength during voluntary and involuntary movements. Subjects performed the test under three conditions: healthy, feigning mild weakness, and feigning severe weakness. The involuntary/voluntary ratio (IV/V ratio) and the side ratio (the IV/V ratio of the feigning leg compared to the non‐feigning leg) were evaluated. Results Forty‐two subjects were recruited. In the healthy state, the mean IV/V ratio was 0.60 ± 0.23 on the right side and 0.62 ± 0.24 on the left. The IV/V ratio was significantly higher in the feigned leg during both mild (1.26 ± 0.49) and severe (1.83 ± 0.70) feigning compared to the healthy state (p < 0.001 for both), while it was significantly lower in the non‐feigned leg during mild (0.40 ± 0.22) and severe (0.32 ± 0.22) feigning (p < 0.001 for both). The side ratio also significantly increased during feigning. ROC analysis revealed optimal IV/V ratio cutoffs of 0.93 for distinguishing mild feigning (sensitivity: 77%, specificity: 93%), and 0.95 for severe feigning (sensitivity: 91%, specificity: 94%). Conclusions This portable device can provide a standardized quantitative measure of Hoover's sign and may be useful in future studies of functional leg weakness, particularly in patients with comorbid conditions.
SN - 2162-3279
ER -