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Home› Physical Therapy› Free Self-Checks› FND Signs

FND & Functional Movement Disorder Signs

Positive bedside signs of functional neurological disorder, how to perform them, what the research says about their accuracy, and how to use them with care.

Reviewed by Dr. Richard Holsman, PT, DPT, NCS · Last reviewed November 14, 2026 · For clinician education

⚠️ For clinicians

For clinician education; positive signs support, but do not replace, a diagnosis made by a neurologist. This page is a reference for physical therapists, occupational therapists, students and other clinicians. Patients with new neurological symptoms should be examined by a physician. If you are a patient, read our guide to FND and physical therapy.

Bedside positive signs of functional neurological disorder (FND) and functional movement disorder (FMD): how to perform each test, what a positive looks like, its reported sensitivity and specificity, and the cautions that go with it.

On this page

Before you test: how to use positive signs

  • FND is a rule-in diagnosis. It rests on positive signs of inconsistency or incongruity, not on normal tests alone. Neurology reviews report specificities of 64–100% for clinical signs of functional motor disorder and functional seizures.[2]
  • The diagnosis belongs to a neurologist. Therapists who see these signs should document them and share them with the patient’s neurologist or physician, not label the patient.
  • Signs can coexist with other disease. A positive sign does not exclude MS, stroke, epilepsy or other conditions, and many patients have both.[3]
  • Positive signs are not evidence of feigning. DSM-5 dropped the requirement to show that symptoms are not intentionally produced and the requirement for a psychological stressor.[19] Never use these tests to accuse a patient of faking.
  • Use a pattern, not one sign. Studies are small, mostly unblinded, and lack a gold standard. A systematic review of 14 signs found low sensitivity (8–100%) but high specificity (92–100%), in class III studies.[1]

Accuracy at a glance

TestTarget conditionSnSp+LR−LRSource
Hoover’s signFunctional leg weakness in a suspected-stroke cohort (8 functional of 124 with leg weakness)63%100%——[4]
Hip abductor signUnilateral functional vs organic leg paresis (16 vs 17 patients)100%100%——[7]
Give-way (collapsing) weaknessAccuracy data not verified—
Drift without pronationUnilateral functional arm weakness vs organic (26 vs 28 patients)100%93%——[10]
Co-contraction signAccuracy data not verified—
Tremor entrainment testEntrainment to contralateral tapping (13 functional vs 25 organic tremor) (+ more below)39%100%——[11]
Distractibility and ballistic movement testClear pause of tremor with a ballistic movement (13 functional vs 25 organic) (+ more below)42%100%——[11]
Tremor co-activation, coherence and loadingTonic co-activation before tremor onset (13 functional vs 25 organic) (+ more below)46%96%——[11]
Functional gait featuresAccuracy data not verified—
Romberg and sway featuresAccuracy data not verified—
Functional (fixed) dystonia featuresAccuracy data not verified—
Functional sensory signsMidline split, hemifacial numbness (20 functional vs 80 organic) (+ more below)20%92.5%——[15]
Functional facial spasm (lip pulling)Accuracy data not verified—

Sn = sensitivity, Sp = specificity, LR = likelihood ratio. A dash means the source we checked did not report that value.

How to read the accuracy numbers

  • Sensitivity: of people who have the condition, the share with a positive test. A highly sensitive test that is negative helps rule the condition out.
  • Specificity: of people without the condition, the share with a negative test. A highly specific test that is positive helps rule it in.
  • Positive likelihood ratio (+LR): how much a positive result raises the odds. About 5–10 is a moderate shift; above 10 is large.
  • Negative likelihood ratio (−LR): how much a negative result lowers the odds. About 0.1–0.2 is a moderate-to-large shift; near 1 means little change.
  • Values depend on the study’s patients, examiners and reference standard. Many studies are small, so treat single-study numbers with caution.

FND and FMD signs, step by step

Each test is described in our own words. Explain what you are doing, and stop if a test causes significant pain.

Hoover’s sign

Also called: Hoover test (hip extension)

Purpose
Shows that weak hip extension on one side recovers automatically when the other hip flexes against resistance (functional leg weakness).
Patient position
Lying on the back, legs straight; examiner’s hands cupped under both heels.
How to perform[22]
  1. Ask the patient to push the weak leg straight down into your hand; note the force.
  2. Ask the patient to lift the strong leg up against your resistance, while you keep a hand under the weak heel.
  3. Feel whether the weak heel now presses down firmly. Reverse version: ask the patient to lift the weak leg and feel for any downward push from the strong heel.
Positive finding
Hip extension is weak when tested directly but becomes strong, without the patient trying, during resisted flexion of the other hip. In the reverse version, no downward pressure comes from the strong heel.
Caution
Valid only for weakness in one leg (the other leg is the control). Pain, hemi-neglect and apraxia can give false positives, and a positive sign does not exclude other disease, such as MS.[5][6]

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Functional leg weakness in a suspected-stroke cohort (8 functional of 124 with leg weakness)[4]63%100%——
95% CI 24–91% (sensitivity) and 97–100% (specificity). Very small functional group; unblinded.

Hip abductor sign

Also called: Sonoo abductor sign

Purpose
Compares automatic bracing of each leg during resisted hip abduction of the other (functional leg weakness).
Patient position
Lying on the back, legs straight; examiner’s hands on the outside of both legs.
How to perform[22]
  1. Ask the patient to push the weak leg out sideways against your hand; feel whether the strong leg braces.
  2. Then ask the patient to push the strong leg out sideways; feel the weak leg.
Positive finding
When the weak leg is tested, the strong leg barely holds still; when the strong leg is tested, the “weak” leg pushes strongly outward to brace. In organic paresis the strong leg stays braced while the weak leg is tested.
Caution
Pain and trouble following instructions can confound it. Useful when Hoover’s sign is non-diagnostic because hip extension is strong.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Unilateral functional vs organic leg paresis (16 vs 17 patients)[7]100%100%——
All 33 patients classified correctly. Single study, examiner not blinded.

Give-way (collapsing) weakness

Also called: Break weakness; ratchety weakness

Purpose
Looks for weakness that suddenly lets go rather than fading steadily.
Patient position
Sitting or lying, limb ideally held against gravity.
How to perform[22]
  1. Ask the patient to hold the limb in position.
  2. Apply steadily increasing resistance with clear encouragement.
Positive finding
The limb holds normal strength briefly, then suddenly collapses or gives way in an on-off, ratchety pattern.
Caution
Weak supportive sign only. In 30 patients with acute structural brain damage, every one showed at least one so-called “hysterical” sign, giveaway weakness among them.[8] Pain, fatigue and poor understanding all cause give-way. On a dynamometer, more than 20% greater force with the break than the make technique has been proposed as a marker.[9]

Diagnostic accuracy

Accuracy data not verified. We did not find a diagnostic accuracy study for this test that we could check, so we show no numbers.

Drift without pronation

Also called: Pronator drift test, functional pattern

Purpose
Distinguishes functional arm weakness (downward drift without pronation) from pyramidal weakness (drift with pronation).
Patient position
Sitting, both arms straight out in front, palms fully up, fingers together.
How to perform[22]
  1. Ask the patient to hold the position with eyes closed for 10 seconds.
  2. Watch whether the arm drifts down and whether the forearm turns palm-down.
Positive finding
The affected arm drifts down without pronating. Pyramidal (corticospinal) weakness drifts with pronation.
Caution
Best suited to mild weakness; a completely paralyzed arm cannot drift.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Unilateral functional arm weakness vs organic (26 vs 28 patients)[10]100%93%——
95% CI 84–100% (sensitivity) and 76–98% (specificity). Unblinded; patients with complete paralysis excluded.

Co-contraction sign

Purpose
Looks for simultaneous contraction of agonist and antagonist muscles when the patient attempts a movement that appears weak.
Patient position
Sitting or lying; palpate the agonist and antagonist (for example, biceps and triceps).
How to perform[22]
  1. Ask the patient to move the “weak” joint (for example, extend the elbow).
  2. Palpate both the prime mover and its antagonist during the attempt.
Positive finding
The antagonist tightens at the same time as the agonist, so the joint does not move despite visible effort.
Caution
Described in neurological texts, but we could not find a diagnostic accuracy study for it that we could check. Do not rely on it alone.

Diagnostic accuracy

Accuracy data not verified. We did not find a diagnostic accuracy study for this test that we could check, so we show no numbers.

Tremor entrainment test

Also called: Entrainment and tapping test

Purpose
Tests whether a tremor takes on an external rhythm (functional tremor).
Patient position
Sitting, tremor visible (rest or posture).
How to perform[22]
  1. Ask the patient to tap the thumb and index finger of the other hand to a rhythm you set (slow, medium, fast), copying you.
  2. Watch the tremulous hand while the other hand taps.
Positive finding
The tremor adopts the tapping rhythm (entrains), changes its frequency, stops, or the patient cannot copy the rhythm with the other hand.
Caution
Bedside observation is probably less sensitive than these laboratory figures. Some organic tremors, such as dystonic tremor, can show similar features.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Entrainment to contralateral tapping (13 functional vs 25 organic tremor)[11]39%100%——
Measured with accelerometry and EMG, not bedside observation alone.
Abnormal frequency shift with tapping[11]77%88%——
Incorrect tapping performance[11]46%84%——

Distractibility and ballistic movement test

Also called: Ballistic movement test; distraction with mental tasks

Purpose
Tests whether a tremor pauses or lessens when attention shifts or the other arm makes a quick movement.
Patient position
Sitting, tremor visible.
How to perform[22]
  1. Ask for one quick, ballistic pointing movement of the other arm (for example, touch your hand fast) and watch the tremor.
  2. Repeat several times.
  3. Add a mental task, such as counting backward by 7s, and watch for change.
Positive finding
The tremor pauses or clearly lessens during the ballistic movement or the mental task, and its frequency or amplitude varies.
Caution
Variability on its own is weak; look for a consistent pattern across trials.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Clear pause of tremor with a ballistic movement (13 functional vs 25 organic)[11]42%100%——
Laboratory measurement.
≥50% tremor reduction after ballistic movement (in ≥7 of 10 trials)[11]67%84%——

Tremor co-activation, coherence and loading

Purpose
Other tremor features that favor a functional cause.
Patient position
Sitting, arms outstretched or resting; a small weight can be used for loading.
How to perform[22]
  1. Feel for stiffening of the limb just before the tremor starts.
  2. Compare the rhythm of both arms when both shake.
  3. Add a light weight to the wrist and watch the amplitude.
Positive finding
Tonic co-activation before tremor onset; both arms shaking at the same frequency; tremor amplitude increasing with loading.
Caution
No single tremor test has adequate accuracy alone; see the validated battery under clusters.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Tonic co-activation before tremor onset (13 functional vs 25 organic)[11]46%96%——
Laboratory measurement.
Coherence of tremor between both arms[11]56%96%——
Amplitude increase with loading[11]33%92%——

Functional gait features

Also called: Astasia-abasia; functional gait disorder

Purpose
Recognizes walking patterns typical of functional gait disorder.
Patient position
Walking in a hallway, including turns, a dual task, and standing with feet together.
How to perform[22]
  1. Watch straight walking, turning, and walking while counting or talking.
  2. Note changes with suggestion and distraction.
Positive finding
Six features described in 37 patients: fluctuations from moment to moment (often with suggestion); excessive slowness or hesitation; a “psychogenic” Romberg; uneconomic, effortful postures; “walking on ice” (small cautious steps, fixed ankles); and sudden knee buckling, usually without falls. Other features: astasia-abasia, dragging the leg with the forefoot on the floor, and visible effort such as huffing and puffing.
Caution
Lempert’s features occurred in 97% of 37 patients but have no published sensitivity or specificity.[12] The “huffing and puffing” effort sign raised the odds of a functional diagnosis about 13-fold (95% CI 4.2–43.8) in 131 functional vs 37 organic gait disorders.[13] Dystonia, chorea and frontal gait disorders can also look unusual.

Diagnostic accuracy

Accuracy data not verified. We did not find a diagnostic accuracy study for this test that we could check, so we show no numbers.

Romberg and sway features

Also called: Psychogenic Romberg; sway with distraction

Purpose
Looks for sway that behaves unlike sensory or cerebellar ataxia.
Patient position
Standing, feet together, eyes open then closed.
How to perform[22]
  1. Watch sway with eyes open and closed.
  2. Repeat while the patient does a distracting task, such as writing numbers you trace on the hand or counting backward.
Positive finding
Sway builds up after a silent delay, often large but without falls, and lessens with distraction or a dual task.
Caution
Described in case series; we found no accuracy numbers we could verify.

Diagnostic accuracy

Accuracy data not verified. We did not find a diagnostic accuracy study for this test that we could check, so we show no numbers.

Functional (fixed) dystonia features

Also called: Fixed dystonia

Purpose
Recognizes fixed postures typical of functional dystonia.
Patient position
Observe at rest and during passive movement.
How to perform[22]
  1. Look at the posture at rest and during walking.
  2. Gently test passive range of motion.
  3. Ask about onset, pain and any previous casting or immobilization.
Positive finding
A fixed posture from onset, such as a plantar-flexed and inverted ankle or a clenched hand, often painful, resisting passive movement, and without the sensory trick or overflow typical of organic dystonia.
Caution
Described in a series of 103 patients (84% women; a peripheral injury before onset in 63%; 20% also met criteria for complex regional pain syndrome); no sensitivity or specificity.[14] Avoid casting and splinting, which can worsen it.

Diagnostic accuracy

Accuracy data not verified. We did not find a diagnostic accuracy study for this test that we could check, so we show no numbers.

Functional sensory signs

Also called: Midline splitting; splitting of vibration sense

Purpose
Looks for sensory loss that does not follow anatomy.
Patient position
Sitting or lying.
How to perform[22]
  1. Map the border of the sensory loss.
  2. Test vibration on each side of the forehead or sternum.
Positive finding
Loss that stops exactly at the midline, vibration felt less on one side of the forehead or sternum, or a sharp, non-anatomical border.
Caution
Weak signs. They occur often in organic disease too, so do not base a diagnosis on them.

Diagnostic accuracy

Target condition (source)SensitivitySpecificity+LR−LR
Midline split, hemifacial numbness (20 functional vs 80 organic)[15]20%92.5%——
Our calculation from the reported rates (20% functional vs 7.5% organic). The difference was not significant.
Reduced vibration on one side of the forehead[15]95%14%——
Our calculation from the reported rates (95% vs 86%). Not significant.

Functional facial spasm (lip pulling)

Also called: Functional hemifacial spasm

Purpose
Recognizes the typical functional facial movement pattern.
Patient position
Sitting, face relaxed and during speech.
How to perform[22]
  1. Watch the lower lip, jaw and neck (platysma) at rest and while talking.
Positive finding
Sustained pulling of one side of the lower lip down or out, often with the jaw deviating the same way and the platysma contracting on that side.
Caution
Described in 61 patients (most common pattern in 84.3%); no sensitivity or specificity.[16]

Diagnostic accuracy

Accuracy data not verified. We did not find a diagnostic accuracy study for this test that we could check, so we show no numbers.

Combined scores

Combinations of findings usually perform better than any single sign.

Laboratory-supported functional tremor battery

Items: Ten-point electrophysiological score (tapping tests, ballistic movement, co-activation, coherence and loading), cut-off 3 or more.

Accuracy: Sensitivity 89.5%, specificity 95.9% in 38 functional vs 73 organic tremor, blinded raters.[17]

Bedside sensory-motor sign score (Daum 2015)

Items: Ten-sign bedside scale for weakness and sensory signs, scored from video-recorded examinations.

Accuracy: A score of 4 or more gave sensitivity 95% and specificity 100% in 20 functional vs 20 organic patients (pilot study).[18]

Sharing the diagnosis and starting rehab

Consensus recommendations for physiotherapy in functional motor disorder suggest using positive signs therapeutically: show the patient that normal movement can occur (for example, demonstrating their own Hoover’s sign) as part of education, then retrain movement with attention diverted, focus on function and automatic movement, avoid unnecessary aids, splints and casts, and build a self-management plan.[20] Explain the sign as evidence that the nervous system can work and recovery is possible, never as a catch.

Our patient guide covers FND, functional movement disorder and how physical therapy helps. For gait and balance baselines, see the 10-meter walk test, Functional Gait Assessment and Berg Balance Scale.

Outcome scales

The Simplified Functional Movement Disorders Rating Scale (S-FMDRS) rates the severity of functional movement symptoms by body region.[21] It is copyrighted by the International Parkinson and Movement Disorder Society and is not openly licensed, so we do not reproduce it here. See the original publication. The Psychogenic Movement Disorders Rating Scale (PMDRS) also requires permission from the MDS for each use; see the MDS rating scales page.

What we left out

We left out the arm-drop and face-hand tests, because we found no accuracy data we could check. We also left out the per-sign values in the Daum 2014 systematic review table, because we could only verify its abstract; each number on this page comes from an original study we checked. We do not reproduce copyrighted rating scales.

Sources, review and disclosures

Graded citations

How we grade sources. A = systematic review or meta-analysis. B = single prospective diagnostic accuracy study. C = small, retrospective, case-control or descriptive case series. R = narrative review or expert consensus statement. D = expert clinical opinion (our test descriptions). Every accuracy number on this page was checked against the cited abstract or full text on November 14, 2026. If we could not check a number, we left it out and say “accuracy data not verified.”

  1. Grade A Daum C, Hubschmid M, Aybek S. The value of ‘positive’ clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review. J Neurol Neurosurg Psychiatry. 2014;85(2):180-190. doi:10.1136/jnnp-2012-304607 (abstract). PubMed 23467417
  2. Grade R Aybek S, Perez DL. Diagnosis and management of functional neurological disorder. BMJ. 2022;376:o64. doi:10.1136/bmj.o64 (abstract). PubMed 35074803
  3. Grade R Espay AJ, Aybek S, Carson A, et al. Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurol. 2018;75(9):1132-1141 (full text). PMC7293766
  4. Grade B McWhirter L, Stone J, Sandercock P, Whiteley W. Hoover’s sign for the diagnosis of functional weakness: a prospective unblinded cohort study in patients with suspected stroke. J Psychosom Res. 2011;71(6):384-386. doi:10.1016/j.jpsychores.2011.09.003 (abstract). PubMed 22118379
  5. Grade R Stone J, Sharpe M. Hoover’s sign. Pract Neurol. 2001;1:50-53 (full text).
  6. Grade R Dolbow J, El-Azzouni S, Zhang Y, Geiger C. A practical guide to assessing functional motor weakness: a review of validated techniques. J Neurol. 2025;272(6):427. doi:10.1007/s00415-025-13139-4 (full text). PMC12116663
  7. Grade B Sonoo M. Abductor sign: a reliable new sign to detect unilateral non-organic paresis of the lower limb. J Neurol Neurosurg Psychiatry. 2004;75(1):121-125 (abstract). PubMed 14707320
  8. Grade C Gould R, Miller BL, Goldberg MA, Benson DF. The validity of hysterical signs and symptoms. J Nerv Ment Dis. 1986;174(10):593-597 (abstract). PubMed 3760849
  9. Grade C van der Ploeg RJ, Oosterhuis HJ. The “make/break test” as a diagnostic tool in functional weakness. J Neurol Neurosurg Psychiatry. 1991;54(3):248-251 (abstract). PubMed 2030354
  10. Grade B Daum C, Aybek S. Validity of the “Drift without pronation” sign in conversion disorder. BMC Neurol. 2013;13:31. doi:10.1186/1471-2377-13-31 (abstract, open access). PMC3617996
  11. Grade B Schwingenschuh P, Katschnig P, Seiler S, et al. Moving toward “laboratory-supported” criteria for psychogenic tremor. Mov Disord. 2011;26(14):2509-2515 (full text). PMC3664413
  12. Grade C Lempert T, Brandt T, Dieterich M, Huppert D. How to identify psychogenic disorders of stance and gait. A video study in 37 patients. J Neurol. 1991;238(3):140-146 (abstract). PubMed 1869889
  13. Grade B Laub HN, Dwivedi AK, Revilla FJ, et al. Diagnostic performance of the “Huffing and Puffing” sign in psychogenic (functional) movement disorders. Mov Disord Clin Pract. 2015;2(1):29-32 (abstract). PubMed 25961068
  14. Grade C Schrag A, Trimble M, Quinn N, Bhatia K. The syndrome of fixed dystonia: an evaluation of 103 patients. Brain. 2004;127(10):2360-2372. doi:10.1093/brain/awh262 (abstract). PubMed 15342362
  15. Grade C Rolak LA. Psychogenic sensory loss. J Nerv Ment Dis. 1988;176(11):686-687 (abstract). PubMed 3183653
  16. Grade C Fasano A, Valadas A, Bhatia KP, et al. Psychogenic facial movement disorders: clinical features and associated conditions. Mov Disord. 2012;27(12):1544-1551 (abstract). PMC3633239
  17. Grade B Schwingenschuh P, Saifee TA, Katschnig-Winter P, et al. Validation of “laboratory-supported” criteria for functional (psychogenic) tremor. Mov Disord. 2016;31(4):555-562. doi:10.1002/mds.26525 (abstract). PubMed 26879346
  18. Grade B Daum C, Gheorghita F, Spatola M, et al. Interobserver agreement and validity of bedside ‘positive signs’ for functional weakness, sensory and gait disorders in conversion disorder: a pilot study. J Neurol Neurosurg Psychiatry. 2015;86(4):425-430. doi:10.1136/jnnp-2013-307381 (abstract). PubMed 24994927
  19. Grade R Stone J, LaFrance WC Jr, Brown R, Spiegel D, Levenson JL, Sharpe M. Conversion disorder: current problems and potential solutions for DSM-5. J Psychosom Res. 2011;71(6):369-376 (abstract). PubMed 22118377
  20. Grade R Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry. 2015;86(10):1113-1119. doi:10.1136/jnnp-2014-309255 (full text). PMC4602268
  21. Grade R Nielsen G, Ricciardi L, Meppelink AM, Holt K, Teodoro T, Edwards M. A simplified version of the Psychogenic Movement Disorders Rating Scale: the Simplified Functional Movement Disorders Rating Scale (S-FMDRS). Mov Disord Clin Pract. 2017;4(5):710-716. doi:10.1002/mdc3.12475. doi:10.1002/mdc3.12475
  22. Grade D Holsman Physical Therapy clinical guidance. Patient position, test steps and positive findings written in our own words by Holsman physical therapists and reviewed by Dr. Richard Holsman, PT, DPT, NCS. Expert opinion, not a research source.

Reviewer

Reviewed by Dr. Richard Holsman, PT, DPT, NCS (Board-Certified Clinical Specialist in Neurologic Physical Therapy), founder of Holsman Physical Therapy. Last reviewed: November 14, 2026.

Change log

  • November 14, 2026: Page published. Test descriptions written in our own words; accuracy values checked against the cited sources.

Review policy

We re-check every number on this page against its source at least once a year, and sooner if a source is updated, a better study is published or a reader reports a problem. Changes are listed in the change log with the date. To report an error, contact us.

Licensing

Test descriptions, steps and the accuracy summaries are original text by Holsman Physical Therapy. Accuracy values are individual numbers cited with credit to the original studies; no tables, figures or text from journals, textbooks or other websites are reproduced. Linking to a source does not imply its endorsement. Demonstration videos, when added, will be filmed by Holsman physical therapists with consenting adult models.

Conflict of interest and advertising

This page is published by Holsman Physical Therapy and Wellness, P.C., which runs outpatient and in-home therapy practices; that is our only commercial interest. The page carries no advertising, no sponsorship and no affiliate links, and we received no payment from any source for it. Holsman Physical Therapy is not affiliated with the authors or publishers cited, and they do not endorse this website.

For clinician education; positive signs support, but do not replace, a diagnosis made by a neurologist. A positive or negative test changes the probability of a condition; it does not make a diagnosis. Interpret every result with the history, the rest of the examination, imaging when indicated, and clinical judgment. Stop any test that provokes severe pain or neurological symptoms.

Common Questions

What are positive signs of functional neurological disorder?

Examination findings that show inconsistency or incongruity with recognized neurological disease, such as Hoover’s sign, the hip abductor sign, drift without pronation and tremor entrainment. They allow FND to be diagnosed on positive grounds rather than only because tests are normal.

Does a positive Hoover’s sign mean the patient is faking?

No. Positive signs show that the nervous system can produce normal movement automatically; they say nothing about intent. Current diagnostic criteria do not require proof that symptoms are not feigned, and these tests must never be used to accuse a patient.

Can a physical therapist diagnose FND?

The diagnosis is made by a neurologist or physician. Physical therapists can recognize and document positive signs, share them with the patient’s physician, and treat functional motor symptoms using the published consensus approach.

How accurate are FND bedside signs?

Most signs are highly specific but have variable sensitivity. Studies are small and mostly unblinded, so clinicians should look for a pattern of several signs and remember that FND can coexist with other neurological disease.

Referring a Patient?

Holsman physical therapists see patients at clinics across North Jersey, the Bronx and Brooklyn, plus in-home visits.

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